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The current manuscript has been adapted from the official position statement of the UK Strength and Conditioning Association on youth resistance training. It has subsequently been reviewed and endorsed by leading professional organisations within the fields of sports medicine, exercise science and paediatrics. The authorship team for this article was selected from the fields of paediatric exercise science, paediatric medicine, physical education, strength and conditioning and sports medicine.

Training in the medical specialty of sport and exercise medicine is now available in many, but not all countries. Lack of resources may be a barrier to the development of this important specialty field and the International Syllabus in Sport and Exercise Medicine Group was convened to reduce one potential barrier, the need to develop a syllabus. The group is composed of 17 sport and exercise medicine specialists residing in 12 countries (Australia, Canada, India, Ireland, Malaysia, the Netherlands, Qatar, South Africa, Sweden, Switzerland, the UK and USA). This paper presents the first phase of this project covering the domains and general learning areas of a specialist training syllabus in sport and exercise medicine.

The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.

BackgroundDespite the known mental health benefits of exercise the prevalence of mental health symptoms and disorders in high performance athletes appears to be slightly higher than in the general population and athletes with disabilities may be especially at risk. However data is scarce and valid comparisons are difficult.ObjectiveTo gauge the prevalence of psychological distress and the level of wellbeing amongst UK Olympic and Paralympic programme athletes.DesignCross-sectional questionnaire cohort study.SettingUK Olympic and Paralympic, summer and winter sport athletes.Patients (or Participants)394 athletes from 29 sports.Interventions (or assessment of risk factors)Between October 2018 and June 2019, participants completed the Kessler Psychological Distress Scale (K10) and the World Health Organisation-Five Well-Being Index (WHO5) questionnaires that indicate levels of psychological distress and subjective wellbeing respectively.Main outcome measurementsPercentage of athletes reporting low, moderate, high and very high psychological distress. Percentage of athletes reporting high and low wellbeing.Results24% of athletes reported high or very high psychological distress. More Paralympic that Olympic athletes reported high/very high distress (27% vs 22%). The mean distress score was comparable to age matched population samples. 19% of athletes reported low psychological wellbeing and this was more common in Paralympic athletes than Olympic athletes (23% vs 17%). The mean wellbeing score was comparable to age matched population samples.ConclusionsUK Olympic and Paralympic athletes report psychological distress and wellbeing levels similar to aged matched populations. Paralympic athletes have slightly higher levels of distress and lower wellbeing than Olympic athletes and this may relate to disability specific stressors. Sport programmes should have robust mental health support plans that includes regular athlete screening and commensurate support services with additional specific support for athletes with disabilities.

The scientific literature seems to show no clear consensus on the relative merit and cost effectiveness of particular investigations within the realm of cardiovascular screening. 3, 4, 6, 7 Although electrocardiography (ECG) is known to augment the benefits of history and examination alone, 8 clearly, echocardiography is the preferred screening tool when sensitivity alone is the major consideration.

While it was acknowledged that there were fundamental differences between the sports, including but not limited to current and future competition schedules, financial and personnel resources, potential risks of COVID-19 transmission between participants and their ability to align with any relaxation of population social distancing (SD), a collaborative approach to planning ‘how’ elite sport might restart was agreed to be the most effective manner to inform a single dialogue with government and Public Health England. The guidance has also needed to accommodate our rapidly evolving understanding of the science while not adversely affecting the whole population R number, nor negatively impacting key healthcare resources, including personal protective equipment. The guidance provides a framework for each sport in the UK to progress, from the 23 March position f(stage 0) to stage 1 (the organised training of individual elite athletes) in hygiene optimised performance facilities while maintaining SD at all times. Table 1 A summary of the key considerations for stages 1–3 Stage 1 Individuals or groups of individuals training but adhering to strict social distancing at all times Stage 2 Close contact training for groups of athletes or teams where strict social distancing cannot be observed at all times Stage 3 Domestic competition – no spectators Maintenance of strict SD both within and outside of the training environment, Named COVID-19 officer and medical leads Risk assessment and risk mitigation plan.

Ensuring that all parties act in the athlete's best medical interest is a key role of the physician. [...]the practitioner's skill set must include keen altruistic, interpersonal skills. PERFORM Provision of best medical care through periodic evaluation, preventive strategies, rapid diagnosis and best management Education of athletes, coaches, parents, staff-and self Research, innovation and audit Facilitating an integrated interdisciplinary medical and sciences approach to individual and team care Optimisation of performance through good medical care, helping to promote safe and effective training and recovery Reliability, accessibility, concordance Maintenance of highest standards and reinforcement of codes of ethics and best practice The physician contributes to performance optimisation by leading and facilitating the cohesive working of the IMAST and working to establish illness and injury prevention strategies.

In the UK, three initiatives by primarycare trusts have shown that a multidisciplinary sports and exercise medicine approach, before hospital referral, improved the conversion rate of orthopaedic outpatient appointments to surgery from about 40% to 70%.16 Almost 30 years ago, a proposal was made that sports and exercise medicine ought to be included in the UK undergraduate curriculum because of its importance in public health.17 However, in a 2010 survey18 of UK undergraduate training, 25 (76%) of 33 medical schools contacted responded: all included musculoskeletal medicine in their curricula, 17 (68%) taught about exer cise and obesity, and only 10 (40%) taught any sports and exercise medicine. Large cohort studies from the USA have shown that low cardiorespiratory fitness is the single biggest risk factor for all-cause mortality.19 The importance of sports and exercise medicine, in particular the benefits of physical activity in non-communicable disease prevention and chronic disease management, should be incorporated in the core undergraduate medical programme.