Older Athletes Research Articles

Exploring Relative Age Effects in Youth Ice Hockey Through a Single Team Case Study and Composite Narratives.

Relative age effects (when birthdate influences participation or performance) in sport potentially influence the experiences of sport participants, including athletes, parents, and coaches. Nearly all existing literature on relative age effects adopts a quantitative approach, limiting our understanding of the phenomenon. Thus, the purpose of this unique study was to explore relative age effects using an instrumental, descriptive case study approach with one elite, youth, male ice hockey team. This context was chosen given the high prevalence of relative age effects among such groups. Participants included 20 athletes, 19 parents, and two coaches from one team. Data were collected through biometric measures, semistructured interviews, and participant observations. Results were presented as five composite narratives: relatively older athletes, relatively younger athletes, parents of relatively older athletes, parents of relatively younger athletes, and coaching staff. The narratives demonstrated unique relative age experiences for each group of participants. Discussion aligns the results with the social agents model that explains relative age effects. Practical recommendations for sport participants are also provided.

Exercise intensity is associated with progression of coronary artery calcification in middle-aged and older athletes: findings from the MARC-2 study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation Background Recent studies have reported increased coronary artery calcification (CAC) in middle-aged male athletes, which is related to the amount and intensity of lifelong exercise. However, previous studies are limited by their cross-sectional study design. Purpose We prospectively assessed progression of CAC and its association to exercise volume and intensity in middle-aged and older athletes. Methods 318 asymptomatic middle-aged and older men were recruited in the Measuring Athlete’s Risk of Cardiovascular events (MARC) study between 2012-2014 and invited for follow-up (MARC-2) between 2019-2020. During both study visits, computed tomography imaging was performed to assess CAC. Exercise characteristics during follow-up were used to calculate exercise volumes (Metabolic equivalent of task [MET]-hours/week), whereas intensities were classified as moderate (3-6 MET), vigorous (6-9 MET) and very vigorous (>9 MET). For linear regression analyses, CAC scores were transformed (Ln delta CAC score + 1) and analyses were adjusted for baseline confounders, CAC at baseline and time between CT scans. Exercise intensities were assessed as proportion of MET-hrs/week and separately included, while adjusting for exercise volume. Results We included 289 men (54.9 ± 6.4 years) for MARC-2, with a follow-up of 6.3 ± 0.5 years. Participants exercised for 41 [25-57] MET-hrs/week, of which the median percentage was 0% [interquartile range 0-19] at moderate, 44% [0-84] at vigorous and 34% [0-80] at very vigorous intensity. At baseline, CAC was present in 151 (52%) men, and increased to 205 (71%) men at follow-up. CAC scores increased from 1 [0-32] to 31 [0-132]. Delta CAC score (26 [0-104]) was not associated with overall exercise volume. However, delta CAC score was negatively associated with vigorous intensity exercise and positively associated with very vigorous intensity exercise (Table). Conclusion Progression of CAC was not associated with overall exercise volume during 6-year follow-up. However, the degree of vigorous intensity exercise was associated with attenuated CAC progression, whereas very vigorous intensity exercise was associated with accelerated CAC progression. Linear regression analyses Progression of CAC (Ln Delta CAC score +1) B (95% CI) P-Value Exercise volume (MET-hours/week) .001 (-.005 - .008) .70 Exercise Intensity Moderate intensity (%) -.002 (-.009 - .005) .65 Vigorous intensity (%) -.005 (-.009 - .000) .03 Very vigorous intensity (%) .005 (.001 - .009) .02

Prevalence of Elevated Blood Pressure and Risk Factors for Hypertension in College Athletes.

To compare the prevalence and risk factors for hypertension (HTN) in college athletes using the new (≥130/80 mm Hg) versus prior (≥140/90 mm Hg) US hypertension guidelines. Retrospective cohort study. Eleven Pacific-12 Conference institutions. Of the 8602 athletes enrolled in the primary study, 4977 (57.9%) met inclusion criteria. Athletes were included in the study if age <30 and blood pressure (BP), baseline demographics (age, weight, height, sex, and race), and primary sport were available. Age, sex, race, height, weight, body mass index, and primary sport. Elevated BP of ≥130/80 mm Hg and/or ≥140/90 mm Hg. Normal BP (<130/80) was present in 3214 (64.6%) athletes and 1763 (35.4%) had BP ≥ 130/80, including 460 (9.2%) with BP ≥ 140/90. Male athletes had a higher prevalence of BP ≥ 130/80 (46.7% vs 21.5%; P < 0.001) and BP ≥ 140/90 (14.2% vs 3.1%; P < 0.001) compared to female athletes. Independent risk factors from multivariate analyses for BP ≥ 130/80 included: older age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.00-1.11, P = 0.04), male sex (OR = 1.97, 95% CI 1.65-2.35, P < 0.001), heavier weight (OR = 1.03, 95% CI 1.02-1.03, P < 0.001), and baseball as the primary sport (OR = 1.47, 95% CI 1.14-1.90, P < 0.01). Independent risk factors for BP ≥ 140/90 mm Hg included: male sex (OR = 3.54, 95% CI 2.55-4.97, P < 0.001) and heavier weight (OR = 1.03, 95% CI 1.02-1.04, P < 0.001). In a large, diverse cohort of matriculating college athletes from multiple institutions, over one-third presented with elevated BP ≥ 130/80 mm Hg, which was more common in older male athletes with larger body size and baseball players.

Nutrition for Older Athletes: Focus on Sex-Differences.

Regular physical exercise and a healthy diet are major determinants of a healthy lifespan. Although aging is associated with declining endurance performance and muscle function, these components can favorably be modified by regular physical activity and especially by exercise training at all ages in both sexes. In addition, age-related changes in body composition and metabolism, which affect even highly trained masters athletes, can in part be compensated for by higher exercise metabolic efficiency in active individuals. Accordingly, masters athletes are often considered as a role model for healthy aging and their physical capacities are an impressive example of what is possible in aging individuals. In the present review, we first discuss physiological changes, performance and trainability of older athletes with a focus on sex differences. Second, we describe the most important hormonal alterations occurring during aging pertaining regulation of appetite, glucose homeostasis and energy expenditure and the modulatory role of exercise training. The third part highlights nutritional aspects that may support health and physical performance for older athletes. Key nutrition-related concerns include the need for adequate energy and protein intake for preventing low bone and muscle mass and a higher demand for specific nutrients (e.g., vitamin D and probiotics) that may reduce the infection burden in masters athletes. Fourth, we present important research findings on the association between exercise, nutrition and the microbiota, which represents a rapidly developing field in sports nutrition.

Generation "Social Media": use of modern media to gain information regarding sports injuries

Digital media have found their way into almost all areas of daily life. The aim of this study was to analyse the extent to which injured athletes use online media to gather information on sports injuries or on how to prevent them. Between 07-2017 and 12-2019, both recreational and competitive climbing athletes were surveyed on their use of various media with regard to sports medicine and prevention. 488 athletes were included in the study (70.9 % male, 29.1 % female, 33.2 ± 10.3 (13-71) years of age). 69.9 % of the athletes use web-based medical content, with the video platform YouTube being most frequently used for specific searches (24.4 %). Younger athletes (< 30y) use video platforms significantly more often than older athletes (p = 0.011). Sports-specific literature is most frequently used by the age group 30-50 years (37.4 %). The age group > 50 uses this medium significantly less frequently (18.8 %; p = 0.013). Competitive athletes use web-based medical content significantly more often than recreational athletes (p = 0.005). The general interest in injury prevention is high, with competitive athletes using relevant content more often. Almost 9 % of all patients interviewed visited a sports-orthopaedic facility because of their online research work. Internet-based medical information is used by 69.9 % of athletes, with the video platform YouTube being most frequently used. Video platforms and sports-specific literature are used significantly more often by younger athletes than by older athletes. Web-based medical content is accessed significantly more often by professional athletes than by recreational athletes. The general interest in injury prophylaxis is high, with competitive athletes using or browsing medical content more often.

The relative age effect is more than just participation bias in badminton

Background: Annual age grouping is a widely used strategy to allocate players to age categories for more equal and fair opportunities considering the developmental differences. Although it is a well-intended strategy, certain (dis)advantages occur because of the subtle age-related differences within the same age groups. Objective: The purpose of the current study was to investigate the relative age effect among badminton players reaching the podium in the last three consecutive European U15, U17 and Junior (U19) Badminton Championships. Methods: A total of 288 medal owners from 20 countries were evaluated in the study. Chi-square (χ2) goodness-of-fit tests were used to compare the obtained birth month distributions across the quartiles (Q), and odds ratios and 95% confidence intervals were calculated in order to compare quartiles with each other. Results: Statistically significant relative age effects were determined favouring relatively older athletes in the total sample (χ2 = 82.278, p < .001). Statistically significant distribution differences were noted in both singles and doubles categories in total (χ2 = 18.778, p < .001; χ2 = 63.815, p < .001, respectively). Striking findings were determined in Q1-Q4 and Q2-Q4 comparisons as players in Q1 and Q2 were more than five and four times as likely to reach the podium than players in Q4, respectively. Conclusions: Results of this study confirm the presence of relative age effect among award-winning badminton players which goes beyond the classical participation trends findings, and stress the importance of the issue for talent development, selection and success.

Cortical and Subcortical Brain Volume Alterations Following Endurance Running at 38.6 km and 119.2 km in Male Athletes.

BackgroundAlthough several studies have shown that ultramarathon running causes severe physical and mental stress and harms organ systems, its effect on brain tissue remains unclear. The purpose of this study was to investigate the volumetric change of cortical and subcortical brain structures following 38.6-km and 119.8-km mountain races.Material/MethodsA total of 23 healthy male runners (age, 49.05±5.99 years) were classified as short-trail (ST; n=9) and ultra-trail (UT; n=14) endurance running. Pre- and post-test scanning of brain tissue was performed by using a 3-Tesla magnetic resonance imaging (MRI). Pre- and post-race differences in cortical and subcortical volumes in the ST and UT groups were separately determined by Wilcoxon signed-rank test.ResultsCortical gray matter (GM) and cerebral GM volume significantly increased after the race in both ST and UT groups, whereas the volume of the thalamus, caudate, pallidus, and hippocampus significantly increased only in the UT group. Cerebrospinal fluid (CSF) and white-matter (WM) volumes did not change after endurance running and remained unaltered in both groups.ConclusionsEndurance running has a site-specific acute effect on cortical and subcortical structures and may attenuate GM volume decrease in older adult male athletes. The increased volume of subcortical structures might be a response of physical exercise and additional physical stress experienced by ultramarathon runners.

Lifelong exercise is associated with more homogeneous motor unit potential features across deep and superficial areas of vastus lateralis

Motor unit (MU) expansion enables rescue of denervated muscle fibres helping to ameliorate age-related muscle atrophy, with evidence to suggest master athletes are more successful at this remodelling. Electrophysiological data has suggested MUs located superficially are larger than those located deeper within young muscle. However, the effects of ageing and exercise on MU heterogeneity across deep and superficial aspects of vastus lateralis (VL) remain unclear. Intramuscular electromyography was used to record individual MU potentials (MUPs) and near fibre MUPs (NFMs) from deep and superficial regions of the VL during 25% maximum voluntary contractions, in 83 males (15 young (Y), 17 young athletes (YA), 22 old (O) and 29 master athletes (MA)). MUP size and complexity were assessed using area and number of turns, respectively. Multilevel mixed effects linear regression models were performed to investigate the effects of depth in each group. MUP area was greater in deep compared with superficial MUs in Y (p<0.001) and O (p=0.012) but not in YA (p=0.071) or MA (p=0.653). MUP amplitude and NF MUP area were greater, and MUPs were more complex in deep MUPs from Y, YA and O (all p<0.05) but did not differ across depth in MA (all p>0.07). These data suggest MU characteristics differ according to depth within the VL which may be influenced by both ageing and exercise. A more homogenous distribution of MUP size and complexity across muscle depths in older athletes may be a result of a greater degree of age-related MU adaptations.

Resting Energy Expenditure of Master Athletes: Accuracy of Predictive Equations and Primary Determinants.

Resting energy expenditure (REE) is determined mainly by fat-free mass (FFM). FFM depends also on daily physical activity. REE normally decreases with increased age due to decreases in FFM and physical activity. Measuring REE is essential for estimating total energy expenditure. As such, there are a number of different equations in use to predict REE. In recent years, an increasing number of older adults continue to participate in competitive sports creating the surge of master athletes. It is currently unclear if these equations developed primarily for the general population are also valid for highly active, older master athletes. Therefore, we tested the validity of six commonly-used equations for predicting REE in master athletes. In conjunction with the World Masters Athletic Championship in Malaga, Spain, we measured REE in 113 master athletes by indirect calorimetry. The most commonly used equations to predict REE [Harris & Benedict (H&B), World Health Organization (WHO), Müller (MÜL), Müller-FFM (MÜL-FFM), Cunningham (CUN), and De Lorenzo (LOR)] were tested for their accuracies. The influences of age, sex, height, body weight, FFM, training hours per week, phase angle, ambient temperature, and athletic specialization on REE were determined. All estimated REEs for the general population differed significantly from the measured ones (H&B, WHO, MÜL, MÜL-FFM, CUN, all p < 0.005). The equation put forward by De Lorenzo provided the most accurate prediction of REE for master athletes, closely followed by FFM-based Cunningham’s equation. The accuracy of the remaining commonly-used prediction equations to estimate REE in master athletes are less accurate. Body weight (p < 0.001), FFM (p < 0.001), FM (p = 0.007), sex (p = 0.045) and interestingly temperature (p = 0.004) are the significant predictors of REE. We conclude that REE in master athletes is primarily determined by body composition and ambient temperature. Our study provides a first estimate of energy requirements for master athletes in order to cover adequately athletes’ energy and nutrient requirements to maintain their health status and physical performance.

Cardiovascular Risk Assessment in the Older Athlete

Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes. Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020). Clinical review. Level 3. Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended. We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.

Isokinetic Muscle Strength and Postural Sway of Recreationally Active Older Adults vs. Master Road Runners.

Trunk muscle strength and control is an important prerequisite for everyday activities among elderly people decreasing the predisposition to falls. High levels of physical exercise performed by older athletes could offer benefits to core/trunk muscle strength and postural control compared with recreational physical activities and among elderly people with lower levels of physical activity. The present study aimed to compare trunk muscle strength and postural control of older running athletes vs. older physically active adults. Participants were master road runners (RUN, n = 15, six women, 64.3 ± 3.6 years) and physically active elderly (control group, CON, n = 15, six women, 65.4 ± 5.0 years) people that were submitted to the evaluations: esthesiometer, posturography (force plate), and isokinetic test (Biodex dynamometer) of trunk muscle extension and flexion. RUN presented higher values for relative peak torque of trunk extensor muscles at 60°/s (p = 0.046) and 180°/s (p = 0.007) and relative average power during trunk extension at 60°/s (p = 0.008) and 180°/s (p = 0.004) compared to CON. CON had a higher medial-lateral oscillation speed of the center of pressure in the stable condition with eyes closed (p = 0.004) compared to RUN. RUN presented higher isokinetic torque of extensor trunk muscles and better postural control than CON. This supposedly could help with postural control and balance and contribute to the prevention of falls among the elderly. The practice of running systematically by master athletes may partially explained our findings.

Biomechanical characteristics of the metatarsal part of the foot in swimmers in walking

Objective: to investigate the characteristics of the distribution of pressure under the foot during walking in swimmers of various ages and experience.Materials and methods. The study involved swimmers aged 11.4 ± 1.9 years, of both sexes, with at least 4 years of training experience (n = 23) and masters of sports in swimming, 19.3 ± 1.5 years old with 12.2 ± 1.3 years of experience (n = 23). The study used a podometric footscan® platform from RSscan company. Kinematic and dynamic parameters of pressure under the foot during natural walking were recorded. The focus was on the indicators of contact with the support in the zones of the metatarsal part of the foot. The peak pressure value in each metatarsal zone and the time to reach it were taken into account.Results. In the course of the study, the order in which the maximum pressure under the metatarsal zones manifests was understood, which appeared in a sequence: fifth, fourth, first, third and second metatarsal zones. It was found that in young athletes the transverse arch of the foot during walking undergoes a relatively greater load than in older athletes. Moreover, relatively high values were noted in the zones of the second and third metatarsals in both age groups.Conclusions: the swimmer’s foot experiences a significant professional transformation associated with specific sports activities, which dictates the need to introduce certain preventive and corrective measures into sports training.

Machine Learning Algorithms Predict Functional Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Athletes.

Despite previous reports of improvements for athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), many do not achieve clinically relevant outcomes. The purpose of this study was to develop machine learning algorithms capable of providing patient-specific predictions of which athletes will derive clinically relevant improvement in sports-specific function after undergoing hip arthroscopy for FAIS. A registry was queried for patients who had participated in a formal sports program or athletic activities before undergoing primary hip arthroscopy between January 2012 and February 2018. The primary outcome was achieving the minimal clinically important difference (MCID) in the Hip Outcome Score-Sports Subscale (HOS-SS) at a minimum of 2 years postoperatively. Recursive feature selection was used to identify the combination of variables, from an initial pool of 26 features, that optimized model performance. Six machine learning algorithms (stochastic gradient boosting, random forest, adaptive gradient boosting, neural network, support vector machine, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and applied to an independent testing set of patients. Models were evaluated using discrimination, decision-curve analysis, calibration, and the Brier score. A total of 1,118 athletes were included, and 76.9% of them achieved the MCID for the HOS-SS. A combination of 6 variables optimized algorithm performance, and specific cutoffs were found to decrease the likelihood of achieving the MCID: preoperative HOS-SS score of ≥58.3, Tönnis grade of 1, alpha angle of ≥67.1°, body mass index (BMI) of >26.6 kg/m2, Tönnis angle of >9.7°, and age of >40 years. The ENPLR model demonstrated the best performance (c-statistic: 0.77, calibration intercept: 0.07, calibration slope: 1.22, and Brier score: 0.14). This model was transformed into an online application as an educational tool to demonstrate machine learning capabilities. The ENPLR machine learning algorithm demonstrated the best performance for predicting clinically relevant sports-specific improvement in athletes who underwent hip arthroscopy for FAIS. In our population, older athletes with more degenerative changes, high preoperative HOS-SS scores, abnormal acetabular inclination, and an alpha angle of ≥67.1° achieved the MCID less frequently. Following external validation, the online application of this model may allow enhanced shared decision-making.

Life Satisfaction, Positive Affect, and Sleep Impairment in Masters Athletes: Modulation by Age, Sex, and Exercise Type.

IntroductionThe masters athlete has been proposed as a model of successful aging. Research studies investigating psychological outlook in older athletes have primarily addressed negative affects including depression, anxiety, and stress. The impact of lifelong exercise on positive affect and life satisfaction as well as sleep impairment that could impact on these psychological states is largely unknown.MethodsA series of questionnaires (general life satisfaction, positive affect, and sleep-related impairment) were administered to 240 masters athletes participating in the World Masters Athletics Championships. Total raw scores were converted into T scores for comparison with the general population. Meaningful difference was defined by the PROMIS® as one-half standard deviation from the centering sample.ResultsMeaningful differences were observed for improved general life satisfaction and reduced sleep impairment for all masters athletes. Positive affect did not reach the meaningful difference threshold. No significant sex differences were found for any of the questionnaires (all p > 0.05). Similarly, no significant differences were found between endurance, sprint, and strength/power sports for general life satisfaction (p = 0.18), positive affect (p = 0.46), and sleep impairment (p = 0.77). In general, life satisfaction increased with age (r = 0.15, p = 0.02), and sleep impairment trended towards reduction with age (r = −0.13, p = 0.05). Positive affect demonstrated no correlation with age (r = 0.09, p = 0.18).ConclusionThis study demonstrates that the lifestyles of masters athletes contribute to improved general life satisfaction and reduced sleep impairment but not improved positive affect. The beneficial effects were observed irrespective of age, gender, and sporting types.

Basal myokine levels are associated with quality of life and depressed mood in older adults.

In an aging society, late‐life depression has become an increasing problem. There is evidence that physical activity ameliorates depressive symptoms and increases the quality of life (QoL). However, the underlying mechanisms are still poorly understood. Myokines are molecules secreted in response to muscle contraction. Some of them can cross the blood‐brain barrier, making them promising candidates for mediating the beneficial effects of physical activity on mood. The present study aims to compare circulating myokine levels to depression/QoL in older athletes and controls. 55 athletes, 57 controls >59 years were enrolled. The assessment included ergometry, magnetic resonance imaging, blood withdrawal, and neuropsychological testing. Serum interleukin‐6 (IL‐6), irisin, brain‐derived neurotrophic factor (BDNF), kynurenine, and cathepsin B were analyzed and compared to surrogates of depression and quality of life. Athletes presented with higher levels of Cathepsin B. Among controls, all myokines but irisin were associated with age. Also, among controls, kynurenine and IL‐6 correlated inversely with specific dimensions of quality of life questionnaires, and IL‐6 further with depressive symptoms and decreased physical performance. No such associations could be found among athletes. Irisin levels were inversely associated with mild depression and low‐grade white matter‐lesions in the brain and predicted impaired QoL. The circulating levels of several myokines/muscle activity‐related factors appear to be associated with depressive symptoms and impaired QoL among older adults. However, in athletes, some of these connections seem ameliorated, suggesting additional stressors (as f.e. age) or a different pathomechanism among athletes.

SLAP Tears in the Throwing Shoulder: A Review of the Current Concepts in Management and Outcomes

A symptomatic tear involving the superior labrum (SLAP) has long been considered one of the most devastating injuries to the career of an overhead throwing athlete. Historically, return to play and previous level of performance outcomes have been unsatisfactory in this challenging population. As a result, there is a significant interest in studying this topic in terms of management and associated outcomes. This review aims to critically evaluate the existing literature and give an overview of the current concepts. The authors found that despite significant advancements in treatment, outcomes after sustaining a SLAP Tear in overhead throwers remain poor. The overall return to play (RTP) rate for baseball players is greater than 60% with the subset of throwers managed surgically experiencing a 50%-60% RTP rate. Arthroscopic repair with suture anchors is the gold standard for operative repair but recently, biceps tenodesis has emerged as an excellent option for surgical management in active patients and athletes. However, the results remain inadequate in baseball pitchers. The current recommendations for managing SLAP tears suggest that arthroscopic repair should be the primary operative management following failure of conservative treatment. Biceps tenodesis is an excellent primary surgical option in older patients and athletes with biceps tendon pathology, but should be reserved for revision procedures in overhead throwers.

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort.

Background:Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain.Purpose:To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort.Results:Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; P < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; P < .001), female (59.3% vs 35.6%; P = .03), and competitive athletes (100% vs 84.5%; P = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2).Conclusion:BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment—most commonly female competitive athletes with prolonged symptoms—represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.

Mental Performance Consultants' Perspectives on Content and Delivery of Sport Psychology Services to Masters Athletes.

In the absence of sport psychology resources for Masters Athletes, mental performance consultants could benefit from information to assist consultancy with older adult athletes. We conducted semistructured interviews to explore 10 Canadian professional mental performance consultants' (two men and eight women) perspectives of targeted content and the nature of service delivery to Masters Athletes. Following inductive thematic analysis, results for Content of Sport Psychology related to performance readiness (e.g.,preparatory routines, mental focus plans); prioritizing sport (e.g.,balance/time management, recruiting social support); preserving sport enjoyment (e.g.,self-reflection, gratitude/sport as opportunity); and age-related considerations (e.g.,managing changing physical realities). Results pertaining to Addressing and Delivering Sport Psychology Services included considerations toward age-related attributes (e.g.,values/identity, engaged/invested clients) and accommodating barriers/constraints (e.g.,time, stigma). Our results show there are novel considerations when consulting with Masters Athletes, and we discuss what these findings mean for adult-oriented approaches in applied practice.

An Analysis of Participation and Performance of 2067 100-km Ultra-Marathons Worldwide.

This study aimed to analyze the number of successful finishers and the performance of the athletes in 100-km ultra-marathons worldwide. A total of 2067 100-km ultra-marathon races with 369,969 men and 69,668 women competing between 1960 and 2019 were analyzed, including the number of successful finishers, age, sex, and running speed. The results showed a strong increase in the number of running events as well as a strong increase in the number of participants in the 100-km ultra-marathons worldwide. The performance gap disappeared in athletes older than 60 years. Nevertheless, the running speed of athletes over 70 years has improved every decade. In contrast, the performance gap among the top three athletes remains persistent over all decades (F = 83.4, p < 0.001; pη2 = 0.039). The performance gap between the sexes is not significant in the youngest age groups (20–29 years) and the oldest age groups (>90 years) among recreational athletes and among top-three athletes over 70 years. In summary, especially for older athletes, a 100-km ultra-marathon competition shows an increasing number of opponents and a stronger performance challenge. This will certainly be of interest for coaches and athletes in the future, both from a scientific and sporting point of view.

Triathlon – is it safe for everybody?

Triathlon has become an increasingly popular endurance activity in Poland, particularly among adult recreational athletes. It is connected with healthy lifestyle including such benefits as regular exercise, change in nutrition and, as a consequence, reduction of body mass and better wellbeing. Unfortunately the number of race-related fatalities during triathlon seems to be twice higher comparing to running competition but efficiency of resuscitation significantly lower. The article presents identified cases of race-related deaths occurring during triathlons in Poland between 2014 and 2020. Current regulations in Poland do not protect older recreational athletes from loss of life and health because medical screening before taking part in competition is voluntary, not obligatory. Health professionals should be responsible for education of athletes and informing about an existing danger and importance of medical screening before taking part in competition.