Sport and Exercise Medicine (SEM) is an expanding specialty yet remains under-represented in medical school curricula. Persistent barriers limit medical students’ understanding of SEM and awareness of career pathways. Student-led conferences may address these gaps by providing targeted exposure and early engagement. This study evaluated the impact of a national, student-led SEM conference on delegates’ knowledge, preparedness, and perceptions of SEM across UK medical schools. The 2024 National Undergraduate SEM Conference was hosted by University College London and the Institute of Sport, Exercise and Health. Seventy-three delegates from sixteen UK medical schools completed pre- and post-conference questionnaires. Responses were rated on a 5-point Likert scale and analysed using Wilcoxon signed-rank tests. Free-text data was collected and underwent thematic analysis. Significant improvements (p < 0.0001) were seen in awareness of SEM career pathways (+ 55.7

Burgeoning interest in marathons necessitates an understanding of performance determinants. Research has highlighted the importance of diet, training and sleep, yet relations of circadian preference and sleep inertia with marathon performance remain largely unexplored. Because marathons generally start early-to-mid morning, these characteristics may have relevant impact. This study investigates relationships of circadian preference, sleep inertia and their interaction with marathon completion time. Consenting participants in a 2016 large mass-participation city marathon completed self-report questionnaires capturing circadian preference and sleep inertia, along with demographics and other characteristics. Circadian preference and sleep inertia were described across subgroups. Analyses examined the associations and interactions of circadian preference and sleep inertia with marathon completion times, with adjusted analyses accounting for age, sex and sleep health. Participants were marathon finishers (n = 936; 64.5% male; 66.3% young-adults), with a majority reporting morningness tendencies (60.8%). Results supported a linear association between increasing eveningness preference with slower marathon times (p = 0.003; padjusted = 0.002), while some support was provided for a linear relationship between greater sleep inertia and slower marathon times (p = 0.04; padjusted = 0.07). A significant interaction was observed (p = 0.02; padjusted = 0.01), with the directionality suggesting that the circadian preference relationship weakened when sleep inertia severity increased, and vice-versa. Our results suggest deleterious associations of increasing eveningness preference and greater sleep inertia with marathon completion time. These features may aid identifying marathoners who could be at a disadvantage, while also serving as modifiable targets for personalized training regimens preceding competition.

Objective To assess awareness and sources of concussion information in amateur football players, as well as understand trends in concussion management in this population. Design Retrospective, cross-sectional study. Setting Online questionnaire of recreational football and rugby players in the United Kingdom. Participants A total of 944 responses were returned. Of these, 102 recorded 'football/soccer' as their most played sport. Three of these were excluded on the basis of age. The remaining respondents (n=99) were included in the data analysis of this study. Respondents were categorized by age group: 19–29 years old (n=31), 30–39 years old (n=38), and 40+ years old (n=30). Outcome Measures Awareness of concussion guidelines, management of concussion, sources of concussion information. Main Results 51.5% of participants were unaware of any concussion guidelines. Only 38.4% of respondents were aware of the FA Concussion Guidelines. In our survey, of those with previously diagnosed or suspected concussions, most (60.9%) did not seek professional medical care. Furthermore, after suspecting a concussion, 64.3% did not stop playing or training, citing 'Did not want to stop playing' as the most common reason why (72.2%). 91.9% agreed that more concussion information is needed at the recreational level. The preferred source of this information differed significantly by age group(x2(2) = 10.30, p<0.01). Conclusions Concussion information is poorly disseminated amongst the amateur playing population. There is a trend towards self-management, despite insufficient knowledge for this purpose. Social media was found to be a preferred target to increase awareness of current concussion guidelines.

•Depressive symptoms among professional soccer players playing on four teams participating in the research in Japan was higher than the general population.•The rate of depressive symptoms was lower than reports from western countries but direct comparison is difficult due to different assessment tools, and timing of data collection, influence of the COVID-19 pandemic.•Despite difficulty of recruiting elite athletes to participate in mental health survey research, this investigation provides the first known study among professional soccer players in Japan. Larger scale research is necessary to make more precise estimates of the prevalence, while qualitative or mixed methods research could be used to elucidate the barriers to participation in mental health research among elite athletes.•Awareness and improved literacy about mental health issues among elite athletes and management in Japan is crucial to future investigations and for creating a supportive environment for athletes.

Objectives. To report three cases of triathletes who presented with swimming-induced pulmonary edema (SIPE) following water immersion. They were subsequently diagnosed with Takotsubo cardiomyopathy (TCM). Design. Retrospective case series. Method. All cases were recreational athletes competing in mass participation triathlons between June 2018 and 2019. They were initially managed by the event medical team and subsequently at the local tertiary level hospital. Written consent was gained from all the subjects. Results. The three triathletes were aged between 50 and 60 years, two were females, and all presented with acute dyspnoea on exiting the water. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries. Conclusions. This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE.

Despite sleep health being critically important for athlete performance and well-being, sleep health in marathoners is understudied. This foundational study explored relations between sleep health, individual characteristics, lifestyle factors, and marathon completion time. Data were obtained from the 2016 London Marathon participants. Participants completed the Athlete Sleep Screening Questionnaire (ASSQ) along with a brief survey capturing individual characteristics and lifestyle factors. Sleep health focused on the ASSQ sleep difficulty score (SDS) and its components. Linear regression computed relations among sleep, individual, lifestyle, and marathon variables. The analytic sample (N = 943) was mostly male (64.5%) and young adults (66.5%). A total of 23.5% of the sample reported sleep difficulties (SDS ≥ 8) at a severity warranting follow-up with a trained sleep provider. Middle-aged adults generally reported significantly worse sleep health characteristics, relative to young adults, except young adults reported significantly longer sleep onset latency (SOL). Sleep tracker users reported worse sleep satisfaction. Pre-bedtime electronic device use was associated with longer SOL and longer marathon completion time, while increasing SOL was also associated with longer marathon completion. Our results suggest a deleterious influence of pre-bedtime electronic device use and sleep tracker use on sleep health in marathoners. Orthosomnia may be a relevant factor in the relationship between sleep tracking and sleep health for marathoners.

Dines, HR, Nixon, J, Lockey, SJ, Herbert, AJ, Kipps, C, Pedlar, CR, Day, SH, Heffernan, SM, Antrobus, MR, Brazier, J, Erskine, RM, Stebbings, GK, Hall, ECR, and Williams, AG. Collagen gene polymorphisms previously associated with resistance to soft-tissue injury are more common in competitive runners than nonathletes. J Strength Cond Res 37(4): 799-805, 2023-Single-nucleotide polymorphisms (SNPs) of collagen genes have been associated with soft-tissue injury and running performance. However, their combined contribution to running performance is unknown. We investigated the association of 2 collagen gene SNPs with athlete status and performance in 1,429 Caucasian subjects, including 597 competitive runners (354 men and 243 women) and 832 nonathletes (490 men and 342 women). Genotyping for COL1A1 rs1800012 (C > A) and COL5A1 rs12722 (C > T) SNPs was performed by a real-time polymerase chain reaction. The numbers of "injury-resistant" alleles from each SNP, based on previous literature (rs1800012 A allele and rs12722 C allele), were combined as an injury-resistance score (RScore, 0-4; higher scores indicate injury resistance). Genotype frequencies, individually and combined as an RScore, were compared between cohorts and investigated for associations with performance using official race times. Runners had 1.34 times greater odds of being rs12722 CC homozygotes than nonathletes (19.7% vs. 15.5%, p = 0.020) with no difference in the rs1800012 genotype distribution (p = 0.659). Fewer runners had an RScore 0 of (18.5% vs. 24.7%) and more had an RScore of 4 (0.6% vs. 0.3%) than nonathletes (p < 0.001). Competitive performance was not associated with the COL1A1 genotype (p = 0.933), COL5A1 genotype (p = 0.613), or RScore (p = 0.477). Although not associated directly with running performance among competitive runners, a higher combined frequency of injury-resistant COL1A1 rs1800012 A and COL5A1 rs12722 C alleles in competitive runners than nonathletes suggests these SNPs may be advantageous through a mechanism that supports, but does not directly enhance, running performance.

Abstract: Introduction: The mental health of elite athletes has been recognised as of great importance. There have been relatively few studies examining the prevalence of mental health problems in swimmers. None have commented on the range of psychosocial problems associated with mental ill-health. The aim of this study was to identify the prevalence of common mental health problems and psychosocial problems in elite swimmers. Methods: The study was conducted on a national swimming squad competing at the international level. All athletes (n=55) were invited to participate. The response rate was 63.3% (n=36). The study was cross-sectional in design. Data was collected using a battery of psychometric tests yielding information on distress (The Distress Screener), anxiety and depression (PHQ-9, K10), sleep disturbance (PROMIS scale), alcohol consumption (AUDIT-C), smoking behaviour, adverse nutrition behaviour, career satisfaction (Career Satisfaction Scale) and mental toughness (Mental Toughness Index). Results: The prevalence of depression was 14% (n=5). Six percent (n=2) reported suicidal ideation in the last 2 weeks. Fourteen percent met criteria for distress. There were positive correlations between depression and sleep disturbance (r=.343, p<.05), between anxiety/depression and distress (r=.380, p<.05), and between depression and distress (r=.531, p<.01). Career dissatisfaction was identified in 46% of participants and was inversely correlated with mental toughness (r=.485, p<.01). Low mental toughness and adverse alcohol use were identified in 37% and 23% of participants, respectively. Conclusions: Elite swimmers experience common mental illnesses and associated psychosocial problems. There is a relationship between career dissatisfaction and low mental toughness. Sport governing bodies should assess their own athlete populations and implement programmes to support mental health.

Sport and exercise medicine (SEM) is a new specialism in the UK NHS. As the NHS long-term plan leans towards a focus on preventive health and streamlining budgets, using SEM physicians in promoting exercise medicine as part of the holistic treatment of patients, and in creating active hospitals, to encourage people to move more and reduce ‘pyjama paralysis’, can be a way for NHS Trusts to achieve these goals. SEM physicians would improve the healthcare burden of musculoskeletal conditions on public services. These physicians are trained in musculoskeletal medicine, exercise medicine, sports and team care. They can be a great asset to primary or secondary care settings, treating sport and physical activity-related injuries or conditions, as well as promoting physical activity for staff and patients alike. Many patients end up with complex musculoskeletal injuries that inevitably cause a reduction in physical activity levels, and seeing an SEM physician can prevent this happening. They can translate the lessons learned from elite sport and use this to treat the general population. This article focuses on key topics in which an SEM can be used, from concussion to overuse injuries.

Background Medical encounters in mass-participation community-based cycling events are not uncommon and may be related to underlying chronic disease or risk factors for chronic disease in race participants. Objective To describe the prevalence of medical conditions, including cardiovascular disease (CVD) risk factors, amongst participants in a mass-participation community-based cycling race. Design Cross-sectional observational study. Setting 100mile mass-participation community-based cycling race. Participants All participants who had registered to take part in the event were invited to complete an online medical survey in the week before the event. 4099 cyclists (16.8% of 24431 finishers) completed the survey and were included in the analysis. Assessment of Risk Factors Prevalence (%) of cyclists with risk factors including age and gender, medical history, smoking and use of medication. Results The average age of respondents was 46 years (range 18–80 years; 41% were >50 years) and 76% were male. Respondents trained for an average 83 miles per week over 16 weeks for the event. 28% of all respondents reported using a prescription medication while the prevalence of a long-term medical condition (LTMC) was 23%. The prevalence of specific CVD risk factors or medical conditions in all respondents was: males > 50 years (34.8%; n=1428), current or ex-smokers (32.1%; n=1314), hypertension (4.2%; n=171), a known cardiac disease (including atrial fibrillation and myocardial infarction) (2.2%; n=91). 3.6% were taking medication for hyperlipidaemia (n=149). Conclusions In a sample of entrants for a mass-participation community-based 100-mile cycling event, approximately 1 in 3 participants reported prescription medication use, and 1 in 4 reported a long-term medical condition. Risk factors for CVD were reported by a third of entrants, while 2.2% reported a known CVD. Medical teams at such events should be prepared to manage medical complications related to long term medical conditions and CVD risk.

Objective To determine the incidence, clinical correlates and exposure risk of medical encounters during community-based physical activity events in the UK. Methods An analysis of medical data from weekly, community-based physical activity events (parkrun) at 702 UK locations over a 6-year period (29 476 294 participations between 2014 and 2019) was conducted in order to define the incidence and clinical correlates of serious life-threatening, non-life-threatening and fatal medical encounters. Results 84 serious life-threatening encounters (overall incidence rate=0.26/100 000 participations) occurred including 18 fatalities (0.056/100 000 participations). Statistical modelling revealed that the probabilities of serious life-threatening encounters were exceptionally low, however, male sex, increasing age, slower personal best parkrun time and less prior running engagement/experience (average number of runs per year and number of years as a parkrun participant) were associated with increased probability of serious life-threatening encounters. These were largely accounted for by cardiac arrest (48/84, 57%) and acute coronary syndromes (20/84, 24%). Non-life-threatening medical encounters were mainly attributed to tripping or falling, with a reported incidence of 39.2/100 000 participations. Conclusions Serious life-threatening and fatal medical encounters associated with parkrun participation are extremely rare. In the context of a global public health crisis due to inactivity, this finding underscores the safety and corollary public health value of community running/walking events as a strategy to promote physical activity.

PURPOSEGenetic polymorphisms have been associated with the adaptation to training in maximal oxygen uptake (V˙O2max). However, the genotype distribution of selected polymorphisms in athletic cohorts is unknown, with their influence on performance characteristics also undetermined. This study investigated whether the genotype distributions of 3 polymorphisms previously associated with V˙O2max training adaptation are associated with elite athlete status and performance characteristics in runners and rugby athletes, competitors for whom aerobic metabolism is important.METHODSGenomic DNA was collected from 732 men including 165 long-distance runners, 212 elite rugby union athletes, and 355 nonathletes. Genotype and allele frequencies of PRDM1 rs10499043 C/T, GRIN3A rs1535628 G/A, and KCNH8 rs4973706 T/C were compared between athletes and nonathletes. Personal-best marathon times in runners, as well as in-game performance variables and playing position, of rugby athletes were analyzed according to genotype.RESULTSRunners with PRDM1 T alleles recorded marathon times ∼3 minutes faster than CC homozygotes (02:27:55 [00:07:32] h vs 02:31:03 [00:08:24] h, P = .023). Rugby athletes had 1.57 times greater odds of possessing the KCNH8 TT genotype than nonathletes (65.5% vs 54.7%, χ2 = 6.494, P = .013). No other associations were identified.CONCLUSIONSThis study is the first to demonstrate that polymorphisms previously associated with V˙O2max training adaptations in nonathletes are also associated with marathon performance (PRDM1) and elite rugby union status (KCNH8). The genotypes and alleles previously associated with superior endurance-training adaptation appear to be advantageous in long-distance running and achieving elite status in rugby union.

Purpose : Genetic polymorphisms have been associated with the adaptation to training in maximal oxygen uptake ( V̇ O 2 max). However, the genotype distribution of selected polymorphisms in athletic cohorts is unknown, with their influence on performance characteristics also undetermined. This study investigated whether the genotype distributions of three polymorphisms previously associated with V̇ O 2 max training adaptation are associated with elite athlete status and performance characteristics in runners and rugby athletes, competitors for whom aerobic metabolism is important. Methods: Genomic DNA was collected from 732 men, including 165 long-distance runners, 212 elite rugby union athletes and 355 non-athletes. Genotype and allele frequencies of PRDM1 rs10499043 C/T, GRIN3A rs1535628 G/A and KCNH8 rs4973706 T/C were compared between athletes and non-athletes. Personal best marathon times in runners, as well as in-game performance variables and playing position of rugby athletes, were analysed according to genotype. Results: Runners with PRDM1 T alleles recorded marathon times ~3 min faster than CC homozygotes (02:27:55 ± 00:07:32 h vs. 02:31:03 ± 00:08:24 h, p = 0.023). Rugby athletes had 1.57 times greater odds of possessing the KCNH8 TT genotype than non-athletes (65.5% vs. 54.7%, χ 2 = 6.494, p = 0.013). No other associations were identified. Conclusions: This study is the first to demonstrate that polymorphisms previously associated with V̇ O 2 max training adaptations in non-athletes are also associated with marathon performance ( PRDM1 ) and elite rugby union status ( KCNH8 ). The genotypes and alleles previously associated with superior endurance training adaptation appear to be advantageous in long-distance running and achieving elite status in rugby union.

Background Acute illness during training for an endurance running event reduces the likelihood of completing the event. A greater understanding of the risk factors for acute illness during training may inform prevention strategies and advice. Objective To describe training factors and acute medical conditions amongst participants in mass-participation community-based marathon events. Design Observational questionnaire-based study. Setting Two large UK city mass-participation marathon events. Patients (or Participants) Entry to both events was open to novice runners, with no qualifying time for general entry. All registered participants were invited to complete an online questionnaire in the week preceding the event. 11809 runners completed the survey. Interventions (or Assessment of Risk Factors) Demographics including age, gender, experience and training history. Results The average age of respondents was 40.9y (range 18–83y) and 54.1% were male. 22.3% of respondents developed a new illness in the 4 weeks prior to the event. Upper respiratory tract infection (URTI) was most common (64.3%), followed by GI problems (15.4%) and headache/migraine (14.6%). 28.5% of respondents who had been training for <2 months developed an acute illness, compared with 19.8% of those trained for >6 months (p=0.0002). Lower average weekly training distance (22.9% of those training from <20 to 40 miles/week vs. 18.7% training from 40 to >50 miles/week; p<0.05) and shorter longest training run (24.4% whose longest run was <20 miles vs. 19.4% whose longest training run was >20 miles; p<0.05) were associated with higher incidence of acute illness. 25.0% of novice runners (running <1y) developed an acute illness compared to 20.3% of those who had been running >10y (p<0.05). Conclusions Novice runners who train for <2 months with low average weekly training mileage were more likely to develop an acute illness during marathon training than more experienced runners. Further research is needed to establish the direction and relationship between these factors before guidance can be issued.

Background The average age of participants in mass-participation community-based endurance running events is slowly increasing. The prevalence of long-term medical conditions in marathon participants can inform medical planning for such events. Objective To describe the prevalence of long-term medical conditions (LTMC), including cardiovascular disease (CVD) risk factors, in participants of mass-participation community-based marathon events. Design Observational questionnaire-based study. Setting Two large UK city mass-participation marathon events. Patients (or Participants) Entry to both events was open to novice runners, with no qualifying time for general entry. All registered participants were invited to complete an online questionnaire in the week preceding the event. 11809 runners completed the survey. Interventions (or Assessment of Risk Factors) Demographics including age, gender, medical history, medication and smoking. Results The average age of respondents was 40.9y (range 18–83y) and 54.1% were male. 42.3% of respondents had never completed a marathon event before. 1995 (16.9%) of all respondents had a LTMC. Most (95.7%) were aware of their condition prior to entering but only 47.0% had seen a doctor about their health with respect to the event. Respiratory conditions such as asthma were the most common LTMC (36.2%). 363 (18.2%) of LTMCs were related to a cardiovascular cause (hypertension, hypercholesterolaemia, previous myocardial infarction or angina, previous stroke/TIA or Type 2 diabetes mellitus). 35.1% were current or ex-smokers. 72.0% of those with aLTMC were taking prescribed medication (compared to 11.2% of those without a LTMC). Conclusions In this study on runners in mass-participation community-based marathon events, approximately 1 in 6 respondents had a long-term medical condition. Further study will improve our ability to counsel individuals who wish to participate in endurance running events and help event organisers and medical teams to plan for reasonably anticipated medical conditions.

Background Blind Football has the highest rate of injury of any Paralympic sport. Head injuries, including concussion, represent a large proportion of these injuries. Blind athletes are less able to anticipate impacts. It has been shown in other sports that athletes with greater neck strength are better able to resist head impacts in a laboratory, and that they are less likely to sustain a concussion. Objective To establish whether isometric neck strength influenced head impact forces in Blind Football. Design Observational study. Setting International Blind Football training and matches over six-months. Patients (or Participants) England Blind Football squad (7 males, mean age 28.6y) Interventions (or Assessment of Risk Factors) Isometric neck strength was measured once during preseason using a hand-held dynamometer. Head impact data was recorded using a head mounted accelerometer and gyroscope (GForce Tracker) attached to player's mandatory blindfolds. Main Outcome Measurements Head impact location (front, back, left or right) was recorded. Linear regression was performed to compare mean linear acceleration and rotational velocity to isometric cervical strength (flexion, extension, left lateral flexion and right lateral flexion) with movements paired to the impact direction they oppose. Results A total of 212.5 player hours were recorded (192.5 hours in training and 20 hours in matches). Increased cervical strength was associated with reduced mean linear acceleration (R2= 0.1912, p=0.020) when comparing opposing movement to respective impact location. There was no association between cervical strength and rotational velocity (R2= 0.001, p=0.861) or between number of impacts (R2=0.4354 p=0.1068). Conclusions Elite Blind Football players with greater cervical strength were subject to head impacts with smaller linear acceleration. This is consistent with existing research in able-bodied athletes and provides an additional factor of the live game play setting in Blind Football. Further research is required to determine if cervical strength training can reduce the risk of concussion in Blind Footballers.

PurposeThe aim was to investigate the effect of dietary nitrate supplementation (in the form of beetroot juice, BRJ) for 20 days on salivary nitrite (a potential precursor of bioactive nitric oxide), exercise performance and high altitude (HA) acclimatisation in field conditions (hypobaric hypoxia).MethodsThis was a single-blinded randomised control study of 22 healthy adult participants (12 men, 10 women, mean age 28 ± 12 years) across a HA military expedition. Participants were randomised pre-ascent to receive two 70 ml dose per day of either BRJ (~12.5 mmol nitrate per day; n = 11) or non-nitrate calorie matched control (n = 11). Participants ingested supplement doses daily, beginning 3 days prior to departure and continued until the highest sleeping altitude (4800 m) reached on day 17 of the expedition. Data were collected at baseline (44 m altitude), at 2350 m (day 9), 3400 m (day 12) and 4800 m (day 17).ResultsBRJ enhanced the salivary levels of nitrite (p = 0.007). There was a significant decrease in peripheral oxygen saturation and there were increases in heart rate, diastolic blood pressure, and rating of perceived exertion with increasing altitude (p=<0.001). Harvard Step Test fitness scores significantly declined at 4800 m in the control group (p = 0.003) compared with baseline. In contrast, there was no decline in fitness scores at 4800 m compared with baseline (p = 0.26) in the BRJ group. Heart rate recovery speed following exercise at 4800 m was significantly prolonged in the control group (p=<0.01) but was unchanged in the BRJ group (p = 0.61). BRJ did not affect the burden of HA illness (p = 1.00).ConclusionsBRJ increases salivary nitrite levels and ameliorates the decline in fitness at altitude but does not affect the occurrence of HA illness.

Paralympic Blind Association Football has the highest rate of injury of any Paralympic sport and head injuries are common. This study aims to quantify head impact incidence and magnitude in Blind Football, and to examine contributing factors. This Observational study based on a Blind Football Team comprising seven male athletes 28.63 years (SD 9.74, range 16-46) over 6 months. Head mounted impact sensors were used to measure the frequency and location of impacts, as well as their linear acceleration and rotational velocity. Cervical isometric strength and proprioception was measured. There were 374 impacts recorded in 212.5 athlete hours. There was a higher rate of impacts in matches than training (Incidence Risk Ratio 2.58, 95% CI 2.01-3.30). Greater cervical strength was associated with reduced linear acceleration of impacts (R2 = 0.1912, p = .020). Blind Football players are exposed to a greater number of head impacts in matches than training. Neck muscle strength may influence magnitude of head impact forces in this sport but further study is required to further investigate.