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To determine the incidence, severity, and nature of injuries sustained by female trail runners and investigate selected training variables as risk factors for injuries. Cross-sectional, retrospective cohort study. Online questionnaire (Jisc Online Surveys). Female trail runners (n = 62) aged 39.1 ± 12.4 years. Training metrics (average weekly number of running sessions, mileage (km), session duration (mins), pace (min/km), ascent (m) and descent (m), number of running doubles per week, number of cross training doubles per week, type of cross training), incidence, severity and nature of trail running injuries sustained in the previous 12 months. The injury incidence was 14.3 injuries per 1000 h and mean severity score (OSTRC- H) was 80.95 ± 21.74. The main anatomical region affected was the lower limb (63.4%), primarily the ankle (13.9%), knee (13.0%) and lower leg (12.2%). The most common injury was tendinopathy (25.2%). A higher number of injuries sustained in the previous 12 months was weakly associated with a higher average duration of other (not trail) weekly running sessions (p = 0.017). Findings from this study could inform future injury prevention and treatment strategies. Prospective, longitudinal data on injuries in female trail runners is needed. •An Injury incidence of 14.3 injuries per 1000 h.•Injuries had a high mean severity score.•Most injuries were in the lower limb, had a gradual onset, occurred in training, caused by a self-reported training error.•Number of injuries weakly associated with duration of 'other' running sessions per week.

SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. Cross-sectional, experimental study. Male and female athletes (age = 24.2 ± 6.3 years) with a recent (<28 days) SARS-CoV-2 infection (n = 72). A COVID-19 Recovery Clinic for athletes. Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P = .0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P = .0007) and increased body mass index (BMI; P = .009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P = .006) and total number (P = .004) of symptoms during the acute phase of infection. A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport.

ContextSARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported.ObjectiveThis study aimed to: 1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with recent SARS-CoV-2 infection, and 2) identify factors affecting exercise responses.DesignThis was a cross-sectional, experimental study.Patients or Other ParticipantsMale and female athletes (age 24.2 ± 6.3 years) with recent (<28 days) SARS-CoV-2 infection (n=72).SettingA ‘COVID-19 Recovery Clinic' for athletes.Main outcome measure(s)HR, SBP and RPE were measured during submaximal exercise (Modified Bruce protocol) at 10–28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, co-morbidities, pre-infection training variables and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models.ResultsHR, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (p=0.0001). At stage 5 (10.1 METs), a higher HR and SBP during exercise was associated with younger age (p=0.0007) and increased body mass index (BMI) (p=0.009) respectively. Higher RPE during exercise was significantly associated with greater number of whole body (p=0.006) and total number (p=0.004) of symptoms during the acute phase of infection.ConclusionGreater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes with 10–28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection as this may indicate disease severity and be valuable to track progress, recovery, and return-to-sport.

ObjectiveTo determine the days until return to sport (RTS) after acute respiratory illness (ARill), frequency of time loss after ARill resulting in >1 day lost from training/competition, and symptom duration (days) of ARill in athletes.DesignSystematic review and meta-analysis.Data sourcesPubMed, EBSCOhost, Web of Science, January 1990–July 2020.Eligibility criteriaOriginal research articles published in English on athletes/military recruits (15–65 years) with symptoms/diagnosis of an ARill and reporting any of the following: days until RTS after ARill, frequency (%) of time loss >1 day after ARill or symptom duration (days) of ARill.Results767 articles were identified; 54 were included (n=31 065 athletes). 4 studies reported days until RTS (range: 0–8.5 days). Frequency (%) of time loss >1 day after ARill was 20.4% (95% CI 15.3% to 25.4%). The mean symptom duration for all ARill was 7.1 days (95% CI 6.2 to 8.0). Results were similar between subgroups: pathological classification (acute respiratory infection (ARinf) vs undiagnosed ARill), anatomical classification (upper vs general ARill) or diagnostic method of ARinf (symptoms, physical examination, special investigations identifying pathogens).ConclusionsIn 80% of ARill in athletes, no days were lost from training/competition. The mean duration of ARill symptoms in athletes was 7 days. Outcomes were not influenced by pathological or anatomical classification of ARill, or in ARinf diagnosed by various methods. Current data are limited, and future studies with standardised approaches to definitions, diagnostic methods and classifications of ARill are needed to obtain detailed clinical, laboratory and specific pathogen data to inform RTS.PROSPERO registration numberCRD42020160479.

BackgroundThere are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP).ObjectiveTo determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI.DesignCross-sectional descriptive study.SettingOnline survey.ParticipantsAthletes with confirmed/suspected COVID-19 (ARICOV) (n=45) and athletes with other ARI (ARIOTH) (n=39).MethodsParticipants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: ‘nose and throat’, ‘chest and neck’ and ‘whole body’. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARICOV versus ARIOTH subgroups.ResultsThe symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was ‘excessive fatigue’ (75%; p<0.0001), ‘chills’ (65%; p=0.004), ‘fever’ (64%; p=0.004), ‘headache’ (56%; p=0.006), ‘altered/loss sense of smell’ (51%; p=0.009), ‘Chest pain/pressure’ (48%; p=0.033), ‘difficulty in breathing’ (48%; p=0.022) and ‘loss of appetite’ (47%; p=0.022). ‘Excessive fatigue’ remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARIOTH, the ARICOV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043).ConclusionSymptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).

BackgroundThe severity of SARS-CoV-2 infection [days to return to sport (RTS)] in athletes has been associated with the total number of acute symptoms. Data on the association between acute symptoms and demographics, sport participation, co-morbidities/allergies and organ involvement are however lacking.ObjectiveTo explore if the number of acute SARS-CoV-2 symptoms in athletes is associated with organ involvement, adjusting for possible confounders: demographics, sport participation (level/type), history of co-morbidities/allergies.DesignProspective cohort study with cross-sectional analysis.SettingMedical evaluation 10–28 days after the onset of SARS-CoV-2 symptoms. Participants 95 Competitive athletes of varying levels of participation (professional/amateur) and different sport types. Assessment of risk factorsGroup differences were explored for demographics, sport participation, history of co-morbidities/allergies and organ involvement (defined as residual symptoms, abnormal clinical signs or selected laboratory investigations). Main outcome measurementsThe association between number of acute SARS-CoV-2 symptoms in 3 subgroups [by number of symptoms (1=≤5, 2=6–9, or 3=≥10)] and demographics, sport participation, history of co-morbidity/allergies and organ involvement. ResultsThere was a significantly higher% of females (p=0.007) in subgroup 3 vs. 1 (p=0.005) or 2 (p=0.017). The% endurance athletes (p=0.022) was significantly higher in subgroups 3 vs. 1 (p=0.021) or 2 (p=0.037). The mean number of co-morbidities (p=0.003) was significantly lower in subgroup 2 vs. 1 (p=0.02) and allergies were more frequent in subgroup 3 vs. 1 (37.5% vs. 13.8%; p=0.037). After adjusting for sex and co-morbidities, number of organ systems involved was greater in subgroups 3 (2.4; p=0.0001) and 2 (2.3; p=0.0001) vs. 1(1.2).ConclusionsMore acute SARS-CoV-2 symptoms (>5) in athletes were associated with higher number of organ involvement, independent of sex or history of co-morbidities. Number of acute symptoms is a valuable measure of disease severity, which is the first step in clinical RTS decision making after recent SARS-CoV-2 infection.