Adverse Effects of Common Sports and Recreational Activities on Male Reproduction

Sauna therapy in rheumatic diseases: mechanisms, potential benefits, and cautions

Rheumatic diseases (RDs) present a major global health challenge, particularly in aging populations, due to chronic inflammation, progressive joint damage, and impaired mobility. While pharmacologic interventions, such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), remain central to RDs management, concerns regarding their side effects and incomplete symptom relief have increased interest in complementary therapies. Sauna therapy, particularly its Finnish and infrared modalities, has emerged as a promising non-pharmacologic intervention with potential anti-inflammatory, musculoskeletal, and cardiovascular benefits. Heat exposure modulates inflammatory pathways by reducing pro-inflammatory agents (TNF-α, CRP, PGE2, LTB4) while promoting IL-10-mediated anti-inflammatory effects. Additionally, sauna therapy mitigates oxidative stress and enhances neuroendocrine regulation, contributing to systemic health benefits. Clinical evidence points to benefits of sauna therapy related to alleviating pain, reducing stiffness, and improving mobility in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA). Some studies have demonstrated reductions in pain scores and inflammatory markers, improved physical function, and disease stability following infrared sauna exposure. Moreover, cardiovascular advantages of regular sauna use are particularly relevant for RD patients with cardiovascular comorbidities. Given the growing body of evidence supporting its therapeutic potential, sauna therapy represents a viable adjunctive strategy for RD management. Further research is warranted to optimize treatment protocols, assess long-term safety, and delineate patient-specific benefits. Integrating sauna therapy into comprehensive RD care may enhance symptom control, improve quality of life, and reduce reliance on pharmacologic interventions.

Fall injuries in Sub-Saharan Africa: analysis of prospective injury registry from 23 health facilities in Malawi and Tanzania

BACKGROUND

Low-and middle-income countries account for over 80% of fall-related fatalities globally. However there is little emphasis on the issue and limited high quality data to understand the burden, and to inform preventive and management strategies. We characterise the burden of fall injuries in Malawi and Tanzania.

METHODS

This multi-centre prospective descriptive study utilized trauma registry data from 10 hospitals in Malawi and 13 hospitals in Tanzania. The study included twelve months of data in Tanzania (October 2019 to September 2020), and eighteen months of data from Malawi (September 2018 to March 2020). We describe patient demographics, the causes, location, and nature of injuries, timing of arrival to hospital, and final disposition. Regression analyses were performed to determine risk factors for serious injuries.

RESULTS

There were 93,178 trauma patients in the registries of both countries, of which 44,609 (47.9%) had fall related complaints. Fall injuries accounted for 55.3% and 17.4% of all trauma cases in Malawi and Tanzania respectively. Overall the median age was 16 years (Interquartile range (IQR) 8-31 years), and 62.8% were male. Most fall injuries (69.9%) occurred at home, were unintentional (98.1%), and were due to a ground level fall (74.9%). Nearly half of patients (47.9%) arrived at a facility using public transport, with median arrival time of 10 h (IQR 8-13 h) from initial injury. Extremities (87.0%) were the most commonly injured region, followed by head and neck (4.4%). Overall 3275 (7.4%) patients had potentially serious injuries. Age > 60 years was associated with two times odds of having serious injuries than those < 5 years, and those sustaining injury at work (adjusted Odds Ratio (aOR) 1.95 95% CI; 1.56-2.43) or recreational areas (aOR 3.47 95% CI; 2.93-4.10) had higher odds of serious injuries compared to those injured at home.

CONCLUSIONS

In these facilities in Sub-Saharan Africa, fall injuries accounted for a substantial fraction of all injuries. While most common in younger males, those aged 5-13 and over 60 years were more likely to have serious injuries. Most falls occurred at home, but serious injuries were more likely to occur at recreational and work areas. Future efforts should focus on preventive strategies to mitigate these injuries.

Long-Term Effects of a Kinematic Bikefitting Method on Pain, Comfort, and Fatigue: A Prospective Cohort Study

The purpose of this study is to analyze the long-term riders' subjective responses to a standardized bikefitting method on their bicycles. Eighty-six amateur mountain bikers had their riding posture and bicycle components ergonomically adjusted through a 3D kinematic bikefitting method. Validated subjective scales (Feeling, OMNI, and Numerical Rating Pain Scale) were used to assess their overall riding comfort and fatigue along with localized pain for six body parts. Data were collected just before intervention (baseline or pre), immediately after (or post), and 30, 60, 90, and 120 days after the bikefit session. A Student's t-test comparing before bikefit and after 120 days showed significant (p < 0.05) reduction in localized pain for all six body parts and riding comfort along with a large effect size effect (d = 1.18) for riding comfort. Although initially reduced, fatigue scores gradually increased over the months, showing a high correlation (r = 0.946) with increased monthly training volume. In conclusion, overall riding discomfort and pain were significantly decreased after a standardized kinematic bikefit session even after 120 days post intervention. However, fatigue scores began to rise after 30 days, showing a high correlation with increasing monthly training volume.

Association of occupations with decreased semen quality in eastern China: a cross-sectional study of 12 301 semen donors

OBJECTIVES

This study aims to examine the association between occupational factors and semen quality in semen donors in eastern China.

METHODS

We recruited 12 301 semen donors from 2006 to 2020 as the studying population. A self-designed questionnaire was applied for collecting lifestyle and work style information. Semen samples were analysed according to WHO guidelines. A crude and adjusted linear regression model was used to analyse the association between occupational factors and semen quality.

RESULTS

College students accounted for 36.2% of all semen donors. The majority (81.3%) of semen donors were between 18 year and 30 years. Soldiers or the police had the highest semen volume (the median value=3.8 mL), however, they had the lowest sperm concentration (53.6×10⁶/ml) and sperm motility (45.5%). Workers in finance or insurance had an elevated risk of low semen volume, sperm concentration and total sperm count (OR=1.43, 1.57 and 1.98, respectively). Unemployed men had a high risk of low sperm concentration and low total sperm count (OR=1.84 and 1.58, respectively). Working in the information technology industry had a deleterious effect on the progressive motility of sperm (OR=1.27, 95% CI 1.03 to 1.57).

CONCLUSION

Our study indicated that sedentary work style and intensive sports in certain professions might be associated with decreased semen quality. We reported evidence of becoming unemployed on the damage to semen quality. Hence, we advocate a healthy work style to improve semen quality in eastern China.

Invited Commentary: Vaccines and Fertility-Why Worry?

In a recent issue of the Journal, Wesselink et al. (Am J Epidemiol. 2022;191(8):1383-1395) presented findings that indicate that the coronavirus disease 2019 (COVID-19) vaccine does not cause any reduction in fertility in either men or women, while COVID-19 infection may reduce fertility temporarily among men. These are reassuring findings for those seeking pregnancy, as well as for clinicians and the public. There was no scientific reason to be concerned about effects of the COVID-19 vaccine on fertility, so some of the psychological, ethical, and historical reasons for concern are discussed. These include perceptions of risk around "unnatural," unusual, or dreaded outcomes; vaccine resistance as part of a social and political identity; and the tendency for moral panics to occur around women's reproductive capacity. On this and other topics, there is a broad need for reproductive health to be better incorporated into clinical trials, and for fertility research to advance in measurement and include a more diverse and global population.

Evaluation of patient compliance with the use of scrotal cooling devices

Objective

To evaluate the compliance of infertile men with the use of scrotal cooling devices. As a secondary objective, sperm parameters, deoxyribonucleic acid fragmentation, and hormone profiles were examined.

Design

This exploratory study on scrotal cooling provided scrotal cooling devices to men with primary infertility and abnormal semen parameters. Feedback on the devices after their use was gathered in the form of a questionnaire, and semen parameters were examined after device use.

Setting

Single center infertility clinic in Toronto, Ontario, Canada.

Patient(s)

Patients with primary infertility and abnormal semen parameters were prospectively evaluated before and after scrotal cooling.

Intervention(s)

One of two scrotal cooling devices (Underdog or Snowballs) was used, on the basis of patient preference.

Main Outcome Measure(s)

Questionnaires were completed by patients on compliance with device use and concerns about and recommendations for improving the cooling devices. Baseline deoxyribonucleic acid fragmentation index, sperm parameters, and hormones were measured at the initial visit (t = 0) and at subsequent visits (t = 4–12 weeks). Statistical comparison of values before and after scrotal cooling was performed.

Result(s)

Forty patients were enrolled in the study, and the questionnaire was completed by 65.0% (n = 26). Most respondents (76.9%) used scrotal cooling less than the recommended duration. Respondents believed that the devices were uncomfortable (31.5%), impeded work (21.0%), and lost cooling rapidly (14.3%). Significant increases in sperm motility and vitality (from 25.4 % to 29.0% and from 64.8% to 71.7%, respectively) were demonstrated after scrotal cooling.

Conclusion(s)

Most patients were not compliant with the recommended use of the scrotal cooling devices because of issues of comfort, convenience, and concealability. Further work on improving scrotal cooling devices is necessary to enhance their potential as a therapeutic tool for men with abnormal sperm parameters and infertility.

Extensive Assessment of Underlying Etiological Factors in Primary Infertile Men Reduces the Proportion of Men With Idiopathic Infertility

OBJECTIVE

Up to 40% of infertile men remain without a recognized cause (i.e., idiopathic infertility). We aimed to identify, categorize, and report the supposed causes of male infertility in a cohort of white-European men presenting for primary couple's infertility, by using a thorough and extensive baseline diagnostic work-up.

MATERIAL AND METHODS

Cross-sectional study of 1,174 primary infertile men who underwent a thorough diagnostic work-up including: detailed medical history, physical examination, hormonal assessment, genetic testing, semen analyses; semen and urine cultures; testis color Duplex US. Men without any identified causal factor were considered as idiopathic. Six different etiological categories were established, and their prevalence was estimated. Logistic regression models estimated the risk of missing causal identification.

RESULTS

A possible causal factor was identified in 928 (81%) men. Hypogonadism was the most frequent identified cause (37%), followed by varicocele (27%). Genetic abnormalities were found in 5% of patients. A causal factor was more easily identifiable for the more severe infertility cases, and azoospermic men were those less likely to be defined as idiopathic (OR and 95% CIs: 0.09; 0.04-0.20). Relative proportion of identified causes remained constant during the 10-year study period (p>0.43).

CONCLUSIONS

Due to a more comprehensive and extensive diagnostic work-up, at least one underlying cause of male infertility factor in 4 out of 5 infertile men can be identified. Men with a less severe phenotype remain a clinical challenge in terms of establishing a possible etiologic factor. Further studies are needed to assess which subset of infertile men deserves a more extensive work-up.

Sport and pelvic floor dysfunction in male and female athletes: A scoping review

AIMS

The aims of the present scoping review were to systematically map and summarize findings to identify any study that reported epidemiological data on pelvic floor dysfunction (PFD) among male and female athletes.

METHODS

Six medical databases were searched up to March 2020. No language, study design, and publication type restrictions were applied. Additional studies were identified through gray literature and the reference lists of articles were screened. The results were presented numerically and thematically.

RESULTS

A total of 4358 records were identified with an initial search. A hundred studies met the criteria for inclusion. The number of studies published annually increased over the years. Cross-sectional studies (n = 62), urinary incontinence (n = 64), multiple sports (n = 58), and female athletes (n = 83) are the most investigated study design, condition, sport, and population, respectively. Only 12 studies explored PFD in the male population. Authors focused selectively on elite athletes in 21 studies.

CONCLUSIONS

This is the first scoping review to provide a comprehensive overview of the topic. The major gaps in the literature include studies focused on male participants, other PFD (e.g., anal incontinence, pelvic organ prolapse, and pelvic pain), with appropriate study design. This review may be useful to raise awareness of the issue among clinicians and stakeholders in sport and it may represent a starting point for future research.

Impact of environmental toxin exposure on male fertility potential

Idiopathic infertility is the most common individual diagnosis in male infertility, representing nearly 44% of cases. Research studies dating over the last half-century consistently demonstrate a decline in male fertility that is incompletely explained by obesity, known genetic causes, or diet and lifestyle changes alone. Human exposures have changed dramatically over the same time course as this fertility decline. Synthetic chemicals surround us. Some are benevolent; however, many are known to cause disruption of the hypothalamic-pituitary-gonadal axis and impair spermatogenesis. More than 80,000 chemicals are registered with the United States National Toxicology Program and nearly 2,000 new chemicals are introduced each year. Many of these are known toxins, such as phthalates, polycyclic aromatic hydrocarbons, aromatic amines, and organophosphate esters, and have been banned or significantly restricted by other countries as they carry known carcinogenic effects and are reproductively toxic. In the United States, many of these chemicals are still permissible in exposure levels known to cause reproductive harm. This contrasts to other chemical regulatory legislature, such as the European Union's REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) regulations which are more comprehensive and restrictive. Quantification of these diverse exposures on an individual level has proven challenging, although forthcoming technologies may soon make this data available to consumers. Establishing causality and the proportion of idiopathic infertility attributable to environmental toxin exposures remains elusive, however, continued investigation, avoidance of exposure, and mitigation of risk is essential to our reproductive health. The aim of this review is to examine the literature linking changes in male fertility to some of the most common environmental exposures. Specifically, pesticides and herbicides such as dichlorodiphenyltrichloroethane (DDT), dibromochloropropane (DBCP), organophosphates and atrazine, endocrine disrupting compounds including plastic compounds phthalates and bisphenol A (BPA), heavy metals, natural gas/oil, non-ionizing radiation, air and noise pollution, lifestyle factors including diet, obesity, caffeine use, smoking, alcohol and drug use, as well as commonly prescribed medications will be discussed.

Pituitary dysfunction due to sports-related traumatic brain injury

PURPOSE

After traumatic brain injury was accepted as an important etiologic factor of pituitary dysfunction (PD), awareness of risk of developing PD following sports-related traumatic brain injury (SR-TBI) has also increased. However there are not many studies investigating PD following SR-TBIs yet. We aimed to summarize the data reported so far and to discuss screening algorithms and treatment strategies.

METHODS

Recent data on pituitary dysfunction after SR-TBIs is reviewed on basis of diagnosis, clinical perspectives, therapy, screening and possible prevention strategies.

RESULTS

Pituitary dysfunction is reported to occur in a range of 15-46.6% following SR-TBIs depending on the study design. Growth hormone is the most commonly reported pituitary hormone deficiency in athletes. Pituitary hormone deficiencies may occur during acute phase after head trauma, may improve with time or new deficiencies may develop during follow-up. Central adrenal insufficiency is the only and most critical impairment that requires urgent detection and replacement during acute phase. Decision on replacement of growth hormone and gonadal deficiencies should be individualized. Moreover these two hormones are abused by many athletes and a therapeutic use exemption from the league's drug policy may be required.

CONCLUSIONS

Even mild and forgotten SR-TBIs may cause PD that may have distressing consequences in some cases if remain undiagnosed. More studies are needed to elucidate epidemiology and pathophysiology of PD after SR-TBIs. Also studies to establish screening algorithms for PD as well as strategies for prevention of SR-TBIs are urgently required.