Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Authors:
Claudia L Reardon,  Brian Hainline,  Cindy Miller Aron, David Baron, Antonia L Baum, Abhinav Bindra, Richard Budgett, Niccolo Campriani, João Mauricio Castaldelli-Maia, Alan Currie, Jeffrey Lee Derevensky, Ira D Glick, Paul Gorczynski, Vincent Gouttebarge, Michael A Grandner, Doug Hyun Han, David McDuff, Margo Mountjoy, Aslihan Polat, Rosemary Purcell, Margot Putukian, Simon Rice, Allen Sills,Todd Stull, Leslie Swartz, Li Jing Zhu, Lars Engebretsen
Reference: Claudia L Reardon et al. Br J Sports Med 2019;53:667-699

Abstract

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

This is a very thorough and in depth study of Mental Health, a few things that stand out for me

The reported prevalence of mental health symptoms and disorders among male elite athletes from team sports (cricket, football, handball, ice hockey and rugby) varies from 5% for burnout and adverse alcohol use to nearly 45% for anxiety and depression.

Men’s:

The reported prevalence of mental health symptoms and disorders among male elite athletes from team sports (cricket, football, handball, ice hockey and rugby) varies from 5% for burnout and adverse alcohol use to nearly 45% for anxiety and depression.

Prospective studies have reported that mental health disorders occur in 5% to 35% of elite athletes over a follow-up period of up to 12 months.

The sports with the highest general substance use/misuse rates across all substances for men’s elite sports are lacrosse, ice hockey, football, rugby, baseball, soccer, wrestling, weightlifting, skiing, biathlon, bobsleigh and swimming, and lowest for track, tennis and basketball.

Women’s

For women’s elite sports, the highest rates occur in ice hockey, gymnastics, lacrosse, softball, swimming, and rowing, and lowest in track, tennis, basketball and golf.

As women continue to engage in elite sport opportunities, their participation has led to varying degrees of cultural acceptance.

Women competing in sports traditionally considered ‘male’ may face being marginalised and stereotyped and may experience unequal training opportunities and resources.

Sexualisation, traditional gender roles, religion and ethnic beliefs all influence opportunities for women.

Tension may also exist between what is functionally optimal for women elite athletes to be wearing and what is culturally deemed acceptable. Gender stereotyping in the media may influence how women athletes view themselves.

Women athletes may be stereotyped as ‘lesbian’ to keep them from playing certain sports, or from playing for certain coaches or with certain teams. Some professional women athletes must train outside their native countries and may struggle to find a support network and cultural understanding from teammates in their new location

Summary on Male and Female

In general, those who participate in team sports are more likely to use or misuse substances than athletes in individual sports.

Common risk factors for use include: sport context and culture (eg, normative beliefs about heavy peer drinking or illicit drug use); situational temptation (eg, drinking games); permissive on attitudes among athletes, coaches and parents; male sex; use of performance enhancing substances or tobacco; identification as lesbian, gay, bisexual, transgender or queer; party lifestyle or drinking game participation; sensation seeking; overestimating peer use; achievement orientation; lower use of protective measures (eg, avoiding serious intoxication, using a designated driver); leadership position; fraternity/sorority membership; problem gambling; and injury.

Summary

The IOC has committed to improve the mental health of elite athletes, recognising that doing so will reduce suffering and improve quality of life in elite athletes and serve as a model for society at large. The IOC hopes that all involved in sport will increasingly recognise that mental health symptoms and disorders should be viewed in a similar light as other medical illnesses and musculoskeletal injuries; all can be severe and disabling, and nearly all can be managed properly by well informed medical providers, coaches and other stakeholders. Mental health is an integral dimension of elite athlete wellbeing and performance and cannot be separated from physical health.

Mental health assessment and management in elite athletes should be as commonplace and accessible as their other medical care; ideally elite athletes should have access to the best interdisciplinary care. To advance a more unified, evidence informed approach to mental health assessment and management in elite athletes, the IOC Consensus Group has critically evaluated the current state of the science and practice of mental health in elite athletes.

Click on the link for the full report: Report

Methods

Sleep and the Athlete: Narrative Review and 2021 expert consensus recommendations

AUTHORS: Neil P Walsh1, Shona L Halson2, Charli Sargent3, Gregory D Roach3, Mathieu Nédélec4, Luke Gupta5, Jonathan Leeder6, Hugh H Fullagar7, Aaron J Coutts7, Ben J Edwards1, Samuel A Pullinger1,8, Colin M Robertson9, Jatin G Burniston1, Michele Lastella3, Yann Le Meur4, Christophe Hausswirth10, Amy M Bender11, Michael A Grandner12, Charles H Samuels13

Abstract

Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1–3 nights, a more real-world scenario, remains unclear.

Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health.

For example, athlete sleep is influenced by sport-specific factors (relating to training, travel, and competition) and non-sport factors (eg, female gender, stress and anxiety).

The study recommends an individualised approach that should consider the athlete’s perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).

For the full article and understanding of Sleep and elite athletes click on the link bjsports-2020-102025.full

Mental health management of elite athletes during COVID-19: a narrative review and recommendations

Reardon CL, et al. Br J Sports Med 2020;0:1–10. doi:10.1136/bjsports-2020-102884

Authors:
Claudia L Reardon, Abhinav Bindra, Cheri Blauwet,
Richard Budgett, Niccolo Campriani,Alan Currie, Vincent Gouttebarge, David McDuff,
Margo Mountjoy, Rosemary Purcell, Margot Putukian, Simon Rice, Brian Hainline

Article Abstract:

ABSTRACT: Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy, and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/ family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants, and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

The study states :

What is already known:

► Elite athletes suffer from many mental health symptoms and disorders at rates equivalent to or exceeding those in the general population.

► The COVID-19 pandemic has created several new stressors for elite athletes.

► Management for athletes during the COVID-19 pandemic has focused on cardiac complications, screening for asymptomatic disease and return to sport, incorporating hygiene measures

What are the new findings:

► The COVID-19 pandemic has created changes in the way in which management of mental health symptoms and disorders in elite athletes—inclusive of community-based or outpatient psychotherapy, outpatient pharmacotherapy and higher levels of care—should be delivered.

► Within the realm of psychotherapy, crisis counselling and other forms of individual psychotherapy, couple/family and group psychotherapy all may be helpful during the COVID-19 pandemic, with novel content and means of delivery.

► Some important aspects of pharmacotherapy for management of mental health symptoms and disorders in elite athletes have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders.

► It is important for providers to consider when in-person management or higher levels of care for mental health symptoms and disorders are necessary for elite athletes, despite potential risk of viral exposure during the COVID-19 pandemic.

Full Article Click here bjsports-2020-102884.full

Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians

Published on the 5/9/2020 from the BJSM : Scans and cardiological tests for return to play, in athletes who have suffered covid 19.

Wilson MG, et al. Br J Sports Med 2020;54:1157–1161. doi:10.1136/bjsports-2020-102710

Authors:

1.Mathew G Wilson1,2,  2. James H Hull1,3,4, 3. John Rogers5,6,7, 4. Noel Pollock1,8, 5. Miranda Dodd2, 6. Jemma Haines5,6,9, 7. Sally Harris5,7, 8. Mike Loosemore1,4,
9. Aneil Malhotra5,6,10, 10. Guido Pieles1,11, 11. Anand Shah3,12, 12. Lesley Taylor5,7, 13. Aashish Vyas5,6,13, 14. Fares S Haddad1,2,14, 15. Sanjay Sharma15

Abstract:

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.

Read the full article here: RTP Covid

Fig 1 RTP pathway in those elite athletes confirmed (or suspected) COVID-19 positive. *History and physical examination should also consider other organ systems where COVID-19 can have pathological consequences such as neurological, gastrointestinal and dermatological. CPET,
cardiopulmonary exercise test; CRP, C reactive protein; CXR, chest X-ray; ECG, electrocardiogram; ECHO, echocardiography; hs-cTnT; high-sensitivity cardiac troponin T; MRI, magnetic resonance imaging; RTP, return to play.

Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study

Interesting study regarding Injury risk reduction in Hamstrings. worth a read. Published only 10 days ago.

Authors
Johan Lahti ,Jurdan Mendiguchia, Juha Ahtiainen, Luis Anula, Tuomas Kononen, Mikko Kujala,6 Anton Matinlauri,  Ville Peltonen,  Max Thibault, Risto-Matti Toivonen, Pascal Edouard, Jean Benoit Morin

Lahti J, et al.

ABSTRACT

Introduction Hamstring muscle injuries (HMI) continue to plague professional football. Several scientific publications have encouraged a multifactorial approach; however, no multifactorial HMI risk reduction studies have been conducted in professional football. Furthermore, individualisation of HMI management programmes has only been researched in a rehabilitation setting. Therefore, this study aims to determine if a specific multifactorial and individualised programme can reduce HMI occurrence in professional football

Read Full Article here: Hamstring Study

 

Match and Training Injuries in Women’s Rugby Union: A Systematic Review of Published Studies

Another interesting study originating this time from Australia aimed at Women’s Rugby specifically a systematic review of all published studies until July 2019. To understand the conclusions read the full study.

Authors: Doug King · Patria Hume · Cloe Cummins · Alan Pearce · Trevor Clark · Andrew Foskett · Matt Barnes https://link.springer.com/article/10.1007/s40279-019-01151-4 

Background

There is a paucity of studies reporting on women’s injuries in rugby union.

Objective

The aim of this systematic review was to describe the injury epidemiology for women’s rugby-15s and rugby-7s match and training environments.

Methods

Systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords.

Results

Ten articles addressing the incidence of injury in women’s rugby union players were retrieved and included. The pooled incidence of injuries in women’s rugby-15s was 19.6 (95% CI 17.7–21.7) per 1000 match-hours (h). Injuries in women’s rugby-15s varied from 3.6 (95% CI 2.5–5.3) per 1000 playing-h (including training and games) to 37.5 (95% CI 26.5–48.5) per 1000 match-h. Women’s rugby-7s had a pooled injury incidence of 62.5 (95% CI 54.7–70.4) per 1000 player-h and the injury incidence varied from 46.3 (95% CI 38.7–55.4) per 1000 match-h to 95.4 (95% CI 79.9–113.9) per 1000 match-h. The tackle was the most commonly reported injury cause with the ball carrier recording more injuries at the collegiate [5.5 (95% CI 4.5–6.8) vs. 3.5 (95% CI 2.7–4.6) per 1000 player-game-h; χ2(1) = 6.7; p = 0.0095], and Women’s Rugby World Cup (WRWC) [2006: 14.5 (95% CI 8.9–23.7) vs. 10.9 (95% CI 6.2–19.2) per 1000 match-h; χ2(1) = 0.6; p = 0.4497; 2010: 11.8 (95% CI 6.9–20.4) vs. 1.8 (95% CI 0.5–7.3) per 1000 match-h; χ2(1) = 8.1; p = 0.0045] levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation.

Discussion

Women’s rugby-7s had a higher un-pooled injury incidence than women’s rugby-15s players based on rugby-specific surveys and hospitalisation data. The incidence of injury in women’s rugby-15s and rugby-7s was lower than men’s professional rugby-15s and rugby-7s competitions but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparison of results.

Conclusion

Women’s rugby-7s resulted in a higher injury incidence than women’s rugby-15s. The head/face was the most commonly reported injury site. The tackle was the most common cause of injury in both rugby-7s and rugby-15s at all levels. Future studies are warranted on injuries in women’s rugby-15s and rugby-7s.

Study :Full Paper

 

 

Head impact exposures in women’s collegiate rugby

Original Research

Authors: Taylor L. Langevin ,Daniel Antonoff,Christina Renodin,Erin Shellene,Lee Spahr,Wallace A. Marsh &John M. Rosene

Published online: 01 Jun 2020 https://www.tandfonline.com/doi/abs/10.1080/00913847.2020.1770568?journalCode=ipsm20

OBJECTIVES: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women’s rugby season.

METHODS: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR].

RESULTS: Players sustained 120 head impacts ≥ 15g (18.1g – 78.9g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2g and PRV of 13.5 rad.sec-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8g and PRV of 15.7 rad.sec-1. Four concussions were reported and monitored.

CONCLUSION: The incidence and magnitude of head impacts in collegiate level women’s rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.

Cumulative Sport‑Related Injuries and Longer Term Impact in Retired Male Elite‑ and Amateur‑Level Rugby Code Athletes and Non‑contact Athletes: A Retrospective Study

Interesting study by Durham University on the impact of the accumulation of injuries on both professional and amateur rugby players, important role on the Concussion.
Rugby union and rugby league are popular team contact sports, but they bring a high risk of injury. Although previous studies have reported injury occurrence across one or several seasons, none have explored the total number of injuries sustained across an entire career.
Reading the paper efforts should be prioritized to reduce the occurrence and recurrence of injuries in rugby codes at all levels of the sport.
Strategies should be developed for supporting specific physical health needs of both codes athlete’s post-retirement.
To read the full Article click on the PDF : Durham Study

Concurrent Training Intensities: A Practical Approach for Program Design

National Strength and Conditioning Association

VOLUME 42 | NUMBER 2 | APRIL 2020

ABSTRACT Sports performance is influenced by the interaction of several physical variables.

For this reason, most sports need both strength and endurance capacities to maximize overall performance.

Therefore, a combination of resistance and aerobic training, usually called concurrent training (CT), has been used recently as a way of simultaneously improving strength and aerobic performances according to the needs of a specific sport. This combination can be challenging and can influence training adaptations, being a problematic issue for coaches.

The main objective is to provide coaches with a practical proposal for CT to improve athletes’ performance in different sports.

Strength and conditioning professionals have been advised to prescribe programs that include both strength and aerobic training concurrently to obtain better results with more efficiency and quickness .

For this reason, coaches and professionals should know how to program a specific CT regarding volume, intensity, duration, periodization models, to conjugate the loads, and to obtain increased performances. Thus, the main objective of this article is to provide the knowledge and recommendations to enable coaches to efficiently design a CT training regime that will improve sports performance.

To read the full article: Click on the Link: Concurrent Training Intensities A Practical

A Team Sport Risk Exposure Framework to Support the Return to Sport

With Amateur Sports returning to training this is a timely reminder how to training and player proximity interactions when following guidelines in minutiae.

BLOG: British Journal of Sports Medicine Published 1/7/2020

Useful for sports to quantify risk in training & matches, & help guide contact tracing

Authors : Ben Jones 1,2,3,4,5, Gemma Phillips 2,6, Simon PT Kemp 7,10, Steffan A Griffin 7,8, Clint Readhead 4,9, Neil Pearce 10, Keith A Stokes 7,11

Background

The COVID-19 pandemic has resulted in global disruption to many sports. There are a number of challenges in returning to sport, especially given the unprecedented duration of time that athletes have not been able to train or compete in normal environments(1), the potential health risk to athletes, their coaches, support staff, the wider public, and the limited evidence base available to inform decisions. Every sport will carry different infection risks, given the specific match demands and training requirements(2). Furthermore, considerations regarding the return to training and match play will be greatly influenced by the national impact of COVID-19(3). A good example is the comparison of United Kingdom (COVID-19 mortality of >42,000), vs. Australia and New Zealand (COVID-19 mortality of <150)(4). In particular, New Zealand has now eliminated SARS-CoV-2, and rugby and other sports are now occurring ‘as normal’.

Full Blog can be found here:Blogs BJSM

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