Leaving the professional tennis circuit: exploratory study of experiences and reactions from elite female athletes

In 2002, Tennis Australia commissioned a report into the experiences of elite female past players on leaving the professional tennis circuit. Australian players who were in the top 800 of the Women's Tennis Association (WTA) end of year rankings and who had left the professional circuit within the previous 15 years were asked by mail to respond to a questionnaire. The questionnaire asked players to describe their feelings about leaving the tour during the time leading up to leaving the tour to two years after retirement. The main findings of the study suggested that those who planned to leave the tour found the transition process easy, whereas those who did not plan to leave the tour found the process difficult. Most players (66%) did not regret leaving the tour, and, although the remaining players responded that they regretted leaving, none attempted a comeback. Tennis Australia has implemented strategies to assist current players on the professional tour based on the results of this study.     

Pacing during an elite Olympic distance triathlon: comparison between male and female competitors.

This study investigated whether pacing differed between 68 male and 35 female triathletes competing over the same ITU World Cup course. Swimming, cycling and running velocities (m s(-1) and km h(-1)) were measured using a global positioning system (Garmin, UK), video analysis (Panasonic NV-MX300EG), and timing system (Datasport, Switzerland). The relationship between performance in each discipline and finishing position was determined. Speed over the first 222 m of the swim was associated with position (r=-0.88 in males, r=-0.97 in females, both p<0.01) and offset from the leader, at the swim finish (r=-0.42 in males, r=-0.49 in females, both p<0.01). The latter affected which pack number was attained in bike lap 1 (r=0.81 in males, r=0.93 in females, both p<0.01), bike finishing position (both r=0.41, p<0.01) and overall finishing position (r=0.39 in males, r=0.47 in females, both p<0.01). Average biking speed, and both speed and pack attained in bike laps 1 and 2, influenced finishing position less in the males (r=-0.42, -0.2 and -0.42, respectively, versus r=-0.74, -0.75, and -0.72, respectively, in the females, all p<0.01). Average run speed correlated better with finishing position in males (r=-0.94, p<0.01) than females (r=-0.71, p<0.001). Both sexes ran faster over the first 993 m than most other run sections but no clear benefit of this strategy was apparent. The extent to which the results reflect sex differences in field size and relative ability in each discipline remains unclear.     

Injuries among male and female elite football players

All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.     

Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross‐sectional study

The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high‐impact and in strong‐effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50–5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22–0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05–1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13–0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high‐impact or strong‐effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long‐term high‐impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well.     

Female sexual function and urinary incontinence in nulliparous athletes: An exploratory study

ObjectivesTo estimate the prevalence of Female Sexual Dysfunction (FSD) and Urinary Incontinence (UI) symptom in nulliparous athletes and analyze the risk factors for these dysfunctions.DesignA cross-sectional study.SettingThe International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) and the Female Sexual Function Index (FSFI) were applied to assess the UI and the FSD.Participants50 athletes with ≥18 years old.ResultsWe found a prevalence of 48% of UI and 44% of FSD among nulliparous athletes. The rate of athletes having concomitant FSD and UI was 24%. We found a significant difference between high and low impact sports in the ICIQ-UI-SF score (p = 0.028). Hours of training (p = 0.007; R² = 0.21) was found to be a risk factor for UI. Incontinent athletes demonstrated a Relative Risk of 2.7 to develop sexual desire problem when compared to the continents (p = 0.04; 95% CIs: 1.50–4.89).ConclusionsThis study found a high prevalence of both UI and FSD among nulliparous athletes. Furthermore, nulliparous athletes practicing high-impact modalities are the most susceptible to UI. The hours of training per day was considered a risk factor to develop UI, and incontinent athletes have more chances of showing difficulties in sexual desire.     

Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration

We investigated the cardiovascular status of elite athletes in Denmark, the extent of abnormal cardiac findings – both training related and pathologic – and how participating in cardiac examination was perceived by the athletes. A standardized protocol of questionnaires, physical examination, resting electrocardiogram, and 2D echocardiography was used. In total 1347 elite athletes were invited; 516 athletes (38%) from 30 different sports participated. Results were stored in a web‐based database for future research and long‐term follow‐up. Cardiac pathology was infrequent; eight athletes (1.6%) received a cardiac diagnosis; one athlete (0.2%) diagnosed with long QT syndrome was advised against competition level sports. In total, 60 athletes (11.6%) were referred for additional testing. The athletes presented a very low level of psychological stress before and a slight decrease immediately after the examination as measured by the REST‐Q 76 Sport questionnaire. Athletes needing further examinations did not present a higher level of stress after the initial examination compared with athletes with normal test results. Overall, very few athletes were diagnosed with a cardiac condition that increased risk of sudden cardiac death. Less than half of the invited athletes volunteered, but participation was not perceived stressful by the enrolled athletes, not even when additional testing was needed.     

Increased mortality rate and suicide in Swedish former elite male athletes in power sports

Physical training has been shown to reduce mortality in normal subjects, and athletes have a healthier lifestyle after their active career as compared with normal subjects. Since the 1950s, the use of anabolic androgenic steroids (AAS) has been frequent, especially in power sports. The aim of the present study was to investigate mortality, including causes of death, in former Swedish male elite athletes, active 1960–1979, in wrestling, powerlifting, Olympic lifting, and the throwing events in track and field when the suspicion of former AAS use was high. Results indicate that, during the age period of 20–50 years, there was an excess mortality of around 45%. However, when analyzing the total study period, the mortality was not increased. Mortality from suicide was increased 2–4 times among the former athletes during the period of 30–50 years of age compared with the general population of men. Mortality rate from malignancy was lower among the athletes. As the use of AAS was marked between 1960 and 1979 and was not doping‐listed until 1975, it seems probable that the effect of AAS use might play a part in the observed increased mortality and suicide rate. The otherwise healthy lifestyle among the athletes might explain the low malignancy rates.     

Mobility and muscle strength in male former elite endurance and power athletes aged 66−91 years

The aim of this cross‐sectional study was to compare mobility and muscle strength in male former elite endurance and power athletes aged 66?91 years (n = 150; 50 men in both former elite athlete groups and in their control group). Agility, dynamic balance, walking speed, chair stand, self‐rated balance confidence (ABC‐scale), jumping height, and handgrip strength were assessed. Former elite power athletes had better agility performance time than the controls (age‐ and body mass index, BMI‐adjusted mean difference ?3.6 s; 95% CI ?6.3, ?0.8). Adjustment for current leisure time physical activity (LTPA) and prevalence of diseases made this difference non‐significant (P = 0.214). The subjects in the power sports group jumped higher than the men in the control group (age‐ and BMI‐adjusted mean differences for vertical squat jump, VSJ 4.4 cm; 95% CI 2.0, 6.8; for countermovement jump, CMJ 4.0 cm; 95% CI 1.7, 6.4). Taking current LTPA and chronic diseases for adjusting process did not improve explorative power of the model. No significant differences between the groups were found in the performances evaluating dynamic balance, walking speed, chair stand, ABC‐scale, or handgrip strength. In conclusion, power athletes among the aged former elite sportsmen had greater explosive force production in their lower extremities than the men in the control group.     

The reliability and validity of the measurement of lateral trunk motion in two-dimensional video analysis during unipodal functional screening tests in elite female athletes

ObjectiveTo investigate the reliability and validity of the measurement of lateral trunk motion (LTM) in two-dimensional (2D) video analysis of unipodal functional screening tests.DesignObservational study.SettingResearch laboratory.ParticipantsForty-three injury-free female athletes.Main outcome measuresKnee valgus (KV) and lateral trunk motion (LTM) angles were measured with a standard digital camera during the single leg squat and the single leg drop vertical jump (SLDVJ). Three-dimensional motion analysis was used during the SLDVJ to measure peak external knee abduction moment (pKAM). Intraclass correlation coefficients were calculated to assess the intra- and intertester reliability of the LTM angle. Correlations between 2D angles and pKAM were calculated for the SLDVJ.ResultsExcellent intraclass correlation coefficients for the LTM angle were found within (0.99–1.00) and between testers (0.98–0.99). The sum of KV and LTM was significantly correlated with the pKAM during the SLDVJ for the dominant (r = −0.36; p = 0.017) and non-dominant leg (r = −0.32; p = 0.034), while either angle alone was not.ConclusionsLTM can be measured with excellent intra- and intertester reliability. The combination of KV and LTM was moderately associated with pKAM and thus including LTM may aid assessment of movement quality and injury risk.     

Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes

Tendons adapt in response to sports‐specific loading, but sometimes develop tendinopathy. If the presence of ultrasound changes like hypoechoic areas and neovascularization in asymptomatic tendons precede (and predict) future tendon problems is unknown. The aim of this prospective cohort study was to investigate the relationship between the development of ultrasound changes in the patellar and quadriceps tendons and symptoms of jumper's knee, as well to examine the medium‐term effects of intensive training on tendon thickness among adolescent athletes. Elite junior volleyball athletes were followed with semi‐annual ultrasound and clinical examinations (average follow‐up: 1.7 years). Of the 141 asymptomatic athletes included, 22 athletes (35 patellar tendons) developed jumper's knee. In a multivariate logistic regression analysis, a baseline finding of a hypoechoic tendon area (odds ratio 3.3, 95% confidence interval 1.1 to 9.2) increased the risk of developing symptoms of jumper's knee. Patellar tendon thickness among healthy athletes did not change (Wilk's lambda, P = 0.07) while quadriceps tendon thickness increased (P = 0.001). In conclusion, ultrasound changes at baseline were risk factors for developing symptoms of jumper's knee. Also, among healthy athletes, we observed a 7–11% increase in quadriceps tendon thickness, while there was no increase in patellar tendon thickness.     

Sex-specific characteristics of cardiac function, geometry, and mass in young adult elite athletes

PURPOSE: To study young adult elite athletes with age- and sex-matched sedentary controls to assess sex-specific differences for left ventricular (LV) and right ventricular (RV) volumes and mass as well as for LV contraction and relaxation. MATERIALS AND METHODS: A total of 23 male athletes (mean age 25 +/- 4 years, training 22 +/- 7 hours/week in rowing, swimming, or triathlon) and 20 female athletes (mean age 24 +/- 4 years, training 19 +/- 5 hours/week in rowing, swimming, or triathlon) and age- and sex-matched sedentary controls (21 male/17 female) underwent cardiovascular magnetic resonance (CMR) imaging (1.5 Tesla). Cardiac phase contrast imaging using a black-blood k-space segmented gradient echo sequence was used for analysis of cardiac contraction and relaxation and steady-state free-precession cine images were acquired for determination of cardiac volumes and mass. RESULTS: Male and female athletes showed similar increases in LV and RV volume and mass indices when compared to controls (ranging between 15% and 42%). No sex-specific differences in training effect on LV and RV volumes, mass indices, and ejection fractions, as well as LV to RV ratios of these volume and mass indices (parameters of balanced LV and RV dilatation and hypertrophy) were observed (all P for interaction >0.05). Similarly, no sex-specific differences in training effect on cardiac contraction and relaxation were found (all P for interaction >0.05). CONCLUSION: Young adult elite athletes do not show sex-specific adaptive structural and functional changes to exercise training in accordance with the benign nature of the hypertrophy associated with athlete's heart.     

Acute effects of high-intensity exercise on hematological and iron metabolic parameters in elite male and female dragon boating athletes

Objective: To investigate the acute effects of high-intensity exercise on blood hepcidin levels and other iron metabolic and hematological parameters in highly trained athletes of dragon boating as a sport performed in a sitting position.

Methods: We conducted an exercise intervention study with a pre- and posttest blood measurement to determine the effects of high-intensity training on hematological and iron metabolic parameters in both male (n = 19) and female (n = 12) elite athletes of the German national dragon boating team. The study took place during the final training camp before the European championships. Blood samples were collected at baseline and 3 h after 3 consecutive high-intensity training bouts at the same day, each one lasting 1 h in duration.

Results: After exercise, leukocytes, CPK, CKMB, and hepcidin levels increased significantly both in men and women. In contrast, iron concentrations decreased significantly. No gender-related differences were found. Compared with baseline, the postexercise concentrations of serum iron decreased significantly both in men [99.3 ± 46.3 to 61.2 ± 20.9 µg/dL (p < 0.001)] and in women [116.3 ± 34 to 67.1 ± 21.8 µg/dL (p < 0.001)] without a gender difference (p = 0.28). Hepcidin levels increased significantly both in men [9.1 ± 6.5 to 12.2 ± 5.8 ng/mL (p < 0.001)] and in women [8.0 ± 4.6 to 11.7 ± 5.7 ng/mL (p < 0.001)] without a significant gender difference in hepcidin changes (p = 0.34).

Conclusions: In conclusion, three consecutive high-intensity training bouts lead to elevated hepcidin levels and decreased iron levels in elite athletes of dragon boating. The increase in hepcidin levels may contribute to the risk of anemia in these athletes.     

Part I: epidemiology and risk factors for stress fractures in female athletes

ABSTRACT

Objectives: Stress fractures (SFx) are a common athletic injury, occurring in up to 40% of athletes at some point in their career. These injuries can cause pain, permanent disability, financial burden, and loss of playing time. This review presents updated epidemiology and comprehensive analysis of risk factors for stress fractures, especially as it pertains to female athletes.

Results: Stress fractures (SFx) account for up to 10% of all orthopedic injuries and up to 20% of injuries seen in sports medicine clinics, with an incidence among female athletes as high as 13%. Lower extremity SFx represent 80–95% of SFx, and the increased popularity of endurance running has contributed to the tibia (49% prevalence) replacing the metatarsals (9%) as the most common location for lower extremity SFx. Studies have demonstrated that 50% of peak bone mass is acquired during adolescence, a ‘peak time’ for eating disorder and female athlete triad development; furthermore, catch-up growth cannot be expected in athletes with diminished bone growth in this critical period. The female athlete triad (low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density) are well-known risk factors for SFx; the risk of SFx for female athletes presenting with a single aspect of the triad is 15–20%, and this risk increases to 30–50% for female athletes presenting with multiple aspects of the triad.

Conclusion: This review provides a basis for how to identify populations at greatest risk for SFx. Prompt recognition of the intrinsic and extrinsic risk factors for SFx in female athletes is imperative to early diagnosis and to develop targeted strategies to prevent SFx occurrence or recurrence.     

Fluid balance,thermoregulation and sprint and passing skill performance in female soccer players

Ten females performed 90 min of the Loughborough Intermittent Shuttle Test (LIST) on two occasions separated by 7 days. Water [3 mL/kg body mass (BM)] was provided every 15 min during exercise (FL); no fluid was given in the other trial (NF). Participants performed the Loughborough Soccer Passing Test (LSPT) before and every 15 min during the LIST. Core temperature (T_c) was measured throughout using ingestible temperature sensors. Heart rate (HR), blood lactate ([La^?]) and ratings of perceived exertion (RPE) were collected at regular intervals during exercise. Participants experienced greater BM loss in NF (2.2 ± 0.4%) than FL (1.0 ± 0.4%; P<0.001). Sprint performance deteriorated by 2.7% during exercise (P<0.001) but there was no difference between trials (P=0.294). No significant differences in LSPT performance were detected between trials (P=0.31). T_c was higher during exercise in NF and was 38.6 ± 0.3 °C (NF) and 38.3 ± 0.3 °C (FL; P<0.01) after 90 min. HR (P<0.001), [La^?] (P<0.01) and RPE (P=0.009) were higher during exercise in NF. Ingesting water during a 90‐min match simulation reduces the mild dehydration seen in female soccer players when no fluid is consumed. However, there was no effect of fluid ingestion on soccer passing skill or sprint performance.     

Effect of resistance training on body composition,self‐efficacy,depression, and activity in postpartum women

This study assessed the effect of resistance training (RT) in 60 healthy postpartum women. Participants were randomized to 18 weeks of RT or an active comparison group (flexibility training). RT and flexibility training (FT) exercises were completed twice‐weekly based on the American College of Sports Medicine recommendations. Study outcomes included muscular strength, body composition (dual‐energy x‐ray absorptiometry), exercise self‐efficacy, depressive symptoms [Center for Epidemiological Studies Depression Scale (CES‐D)], and physical activity (accelerometery). For completers (n = 44), the RT group showed greater strength gains than the FT group, respectively (bench press: +36% vs +8%, P < 0.001; leg press: +31% vs +7%, P < 0.01; abdominal curl‐ups: +228% vs +43%, P < 0.01); however, body composition changes were not different. There was a significant group × time interaction for exercise self‐efficacy (F = 5.33, P = 0.026). For CES‐D score, the RT group decreased (F = 4.61, P = 0.016), while the FT group did not; however, the group × time interaction in CES‐D score was not significant (F = 1.33, P = 0.255). Sedentary time decreased (F = 5.27, P = 0.027) and light‐intensity activity time increased (F = 5.55, P = 0.023) more in the RT than FT group. Intent‐to‐treat analyses did not alter the results. Twice‐weekly RT increases strength and may be associated with better exercise self‐efficacy and improved physical activity outcomes compared with FT in postpartum women.