Current and Future Trends in Strength and Conditioning for Female Athletes

Use of Hormonal Contraceptives Is Associated With Decreased Incidence of Anterior Cruciate Ligament Injuries Requiring Reconstruction in Female Patients

PURPOSE

To investigate associations between hormonal contraceptive use and female patients who had sustained an anterior cruciate ligament (ACL) injury requiring reconstruction.

METHODS

Deidentified data collected from female patients aged 15 to 35 years between 2011 and 2024 were obtained from the Colorado Health Data Compass database. The study patients were separated into female patients who sustained an ACL injury that was treated by arthroscopic ACL reconstruction and female patients without a history of ACL injury. Among these groups, non-contraceptive users, total hormonal systemic contraceptive users (including oral contraceptive pills [OCPs], implants, rings, injections, and patches), and OCP users (including formulations of norethindrone [NE] only, drospirenone plus ethinyl estradiol (EE), NE plus EE, and norgestimate plus EE) were included in the analysis.

RESULTS

The 2,120,628 female patients in the systemic hormonal contraceptive use group had a lower incidence of ACL injury (0.079%; 95% confidence interval [CI], 0.075%-0.083%) than the 12,766,138 female patients in the non-contraceptive use group (0.12%; 95% CI, 0.118%-0.121%). In addition, the 745,062 female patients in the OCP use group had a lower ACL injury incidence (0.088%; 95% CI, 0.081%-0.095%), suggesting an association between contraceptive use and ACL injury. When data were stratified by 5-year age intervals, the 15- to 19-year-old group showed no difference in the ACL injury incidence between the OCP use group (0.101%; 95% CI, 0.081%-0.125%) and the non-contraceptive use group (0.118%; 95% CI, 0.114%-0.122%), whereas all other age groups showed a lower ACL injury incidence in the OCP use group. All age groups in the systemic hormonal contraceptive use group had a lower ACL injury incidence than the non-contraceptive use group. Additionally, different contraceptive formulations showed a similar injury incidence, with a lower proportion of ACL injuries in NE-only users (0.03%) compared with norgestimate-EE users (0.093%), NE-EE users (0.099%), and drospirenone-EE users (0.096%).

CONCLUSIONS

Systemic hormonal contraceptive use is associated with a lower incidence of ACL injury requiring ACL reconstruction compared with no contraceptive use in female patients aged 15 to 35 years, with a stronger association with progestin-only OCPs. Female patients aged 15 to 19 years showed no difference in the association with the ACL injury incidence between OCP use and no contraceptive use.

LEVEL OF EVIDENCE

Level III, prognostic retrospective comparative study.

How the Menstrual Cycle Can Be Utilized During Sports Training, Performance, and Recovery through Wearable Technology: A Narrative Review for Researchers, Physicians, Coaches, and Athletes

The menstrual cycle (MC) serves as a vital indicator of overall health and metabolic function, regulated by the hypothalamic-pituitary axis and involving a complex interplay of hormones. Understanding these hormonal dynamics is crucial for deciphering an individual's physiological status and performance potential, particularly in athletes. Studies regarding the MC's impact on athletic performance and training often lack inclusivity, standardized methodologies, and inconsistent biological definitions, hindering comprehensive conclusions. Moreover, societal inequalities contribute to the underrepresentation of female athletes in research, exacerbating the lack of understanding regarding female physiology in sports medicine. Leveraging wearable technology presents a promising avenue for both tracking MCs and optimizing athletic training/recovery. Wearables offer real-time monitoring of biometrics that often correlate with hormonal fluctuations, and lifestyle trends (diet, sleep, stress) aiding in personalized training schedules and performance optimization. Integrating data collected by MC dynamics and wearable technology into athletic training has the potential to decrease the generally perceived negative impacts MC has on athletic performance. Addressing gaps in research methodologies and promoting awareness among athletes, coaches, and healthcare professionals are essential steps toward maximizing the potential of MC-informed training strategies.

Using the Isometric Mid-Thigh Pull to Predict Three-Repetition Maximum Squat Values in Female Athletes

Prescribing correct training loads in strength- and power-based sports is essential to eliciting performance improvements for athletes. Concurrently, testing strength for the prescription of training loads should be accurate and safe with minimal disruption or fatigue inducement to the athlete. The purpose of this study was to develop a prediction equation in female athletes for the three-repetition maximum (3RM) squat using the isometric mid-thigh pull and basic anthropometric assessments that could be practically applied to support training prescriptions. Female athletes (n = 34) were recruited from netball, volleyball, basketball, and soccer across a spectrum of competitive standards. Each athlete's weight, standing height, seated height, arm span, and biacromial breadth were recorded, and then, on separate occasions separated by at least 48 h, each athlete completed a 3RM squat test and an isometric mid-thigh pull (IMTP) assessment. IMTP variables of peak force and time-dependent force at 50, 100, 150, 200, and 250 ms, as well as anthropometric measures, were used to develop a prediction equation. Squat strength was low-to-moderately correlated with peak force (r = 0.386); force at 100 ms (r = -0.128), 150 ms (r = -0.040), and 200 ms (r = -0.034); standing height (r = 0.294); and biacromial breadth (r = -0.410). Stepwise multiple regression significantly (p < 0.05) explained 26% of the 3RM squat strength variation using peak force and force at 100 ms, resulting in the following equation: Predicted 3RM squat (kg) = [6.102 + (Peak Force × 0.002) - (Force@100 ms × 0.001)]2. The reported equation's predictive accuracy was tested using the same testing protocols following 6-8 weeks of training in a sub-cohort of athletes (n = 14). The predicted and actual recorded 3RM values were not significantly (p = 0.313) different, supporting the use of the IMTP as a test that contributes informative values for use in a predictive equation for training prescription and thus reducing the testing and fatigue-inducing impost on female athletes. However, the 95% CI (-4.18-12.09) indicated predicted values could differ in excess of 10 kg. This difference could lead to an excessive load prescription for an athlete's training program, indicating caution should be taken if using the described method to predict 3RM squat values for programming purposes.

Effects of blood flow restriction training on physical fitness among athletes: a systematic review and meta-analysis

Blood flow restriction training (BFRT) is an effective, scientific and safe training method, but its effect on the overall quality of athletes remains unclear. The aim of this systematic review with meta-analysis was to clarify the effects of BFRT on the physical fitness among athletes. Based on the PRISMA guidelines, searches were performed in PubMed, Web of Science, SPORTDiscus, and SCOUPS, the Cochrane bias risk assessment tool was used to assess methodological quality, and RevMan 5.4 and STATA 15.0 software were used to analyze the data. A meta-analysis of 28 studies with a total sample size of 542 athletes aged 14-26 years and assessed as low risk for quality was performed. Our results revealed that the BFRT intervention had small to large improvements in the athletes' strength (ES = 0.74-1.03), power (ES = 0.46), speed (ES = 0.54), endurance (ES = 1.39-1.40), body composition (ES = 0.28-1.23), while there was no significant effect on body mass (p > 0.05). Subgroup analyses revealed that moderator variables (training duration, frequency, load, cuff pressure, and pressurization time) also had varying degrees of effect on athletes' physical fitness parameters. In conclusion, BFRT had a positive effect on the physical fitness parameters of the athletes, with significantly improved strength, power, speed, endurance and body composition, but not body mass parameters. When the training frequency ≥ 3 times/week, cuff pressure ≥ 160 mmHg, and pressurization time ≥ 10 min, the BFRT group was more favorable for the improvement of physical fitness parameters.

Effects of complex training compared to resistance training alone on physical fitness of healthy individuals: A systematic review with meta-analysis

Combining traditional resistance and ballistic exercises in a complex training (CT) format has shown improved physical fitness compared to the control conditions. However, no meta-analysis has directly compared CT with traditional resistance training (RT) alone. A systematic search was conducted in PubMed, Scopus, and WoS. Thirty-two studies involving 726 participants were included. Both RT and CT similarly improved one-repetition maximum (1RM) squat and bench press, 10 m and 30-60 m linear sprint time, squat jump height, jump power, reactive strength index, and standing long jump distance. Compared to RT, CT favoured 5-m (ES = 0.96) and 20-m linear sprint (ES = 0.52), change-of-direction speed (CODS; ES = 0.39), and countermovement jump height (CMJ; ES = 0.36). Furthermore, moderating effects of training frequency, duration, and complex training type were reported. Certainty of evidence was considered low for 5-m and 20-m linear sprints and CODS and very low for other outcomes. Compared to traditional resistance training, complex training may improve 5-m and 20-m linear sprints, CODS, and CMJ height. The effects of complex training may be optimised by longer interventions (≥7 weeks), with ~ 3 weekly training sessions, and using ascending and contrast training formats. However, the certainty of evidence ranges from very low to low.

An in-depth analysis of wound incidence and injury status among professional athletes: A comprehensive review

This review aims to synthesize current knowledge on the incidence, characteristics and management of wounds and injuries among professional ice hockey athletes, with the specific focus on the emerging population of Chinese female players. An extensive literature search was conducted across several databases to gather data on injury patterns and wounds, causes, severity and prevention strategies in ice hockey. Special attention was given to studies involving female athletes and unique challenges faced by players in developing regions like China. The review also examined the impact of training modalities, protective equipment and medical interventions on injury rates. The findings reveal a significant seasonal fluctuation in wound incidence, with marked reduction following the preseason period. This trend underscores the effectiveness of adjusted training programmes and essential role of medical teams in injury prevention and rehabilitation. Analysis did not show significant difference in wound rates between technical and physical training sessions, suggesting that injuries are pervasive risk across all training activities. Skating, collisions and inadequate warm-ups were identified as the leading causes of wounds, highlighting areas for targeted preventive measures. The distribution of wounds across various body regions pointed to knee, lower back and wrist as the most vulnerable sites, necessitating focused protection and training adjustments. Ice hockey, particularly among female athletes in China, presents complex injury landscape characterized by the wide range of wounds. The study emphasizes the necessity of comprehensive, multidisciplinary approach to injury prevention that includes training modifications, enhanced protective gear and strategic medical oversight. By addressing the specific causes and patterns of injuries identified, stakeholders can better protect athletes from the inherent risks of the sport, promote safer play and extend career longevity.

The Evolution of World-Class Endurance Training: The Scientist's View on Current and Future Trends

BACKGROUND

Elite sport is continuously evolving. World records keep falling and athletes from a longer list of countries are involved.

PURPOSE

This commentary was designed to provide insights into present and future trends associated with world-class endurance training based on the perspectives, experience, and knowledge of an expert panel of 25 applied sport scientists.

RESULTS

The key drivers of development observed in the past 10-15 years were related to (1) more accessible scientific knowledge for coaches and athletes combined with (2) better integration of practical and scientific exchange across multidisciplinary perspectives within professionalized elite athlete support structures, as well as (3) utilization of new technological advances. Based on these perspectives, we discerned and exemplified the main trends in the practice of endurance sports into the following categories: better understanding of sport-specific demands; improved competition execution; larger, more specific, and more precise training loads; improved training quality; and a more professional and healthier lifestyle. The main areas expected to drive future improvements were associated with more extensive use of advanced technology for monitoring and prescribing training and recovery, more precise use of environmental and nutritional interventions, better understanding of athlete-equipment interactions, and greater emphasis on preventing injuries and illnesses.

CONCLUSIONS

These expert insights can serve as a platform and inspiration to develop new hypotheses and ideas, encourage future collaboration between researchers and sport practitioners, and, perhaps most important, stimulate curiosity and further collaborative studies about the training, physiology, and performance of endurance athletes.

Amateur Female Athletes Perform the Running Split of a Triathlon Race at Higher Relative Intensity than the Male Athletes: A Cross-Sectional Study

Maximal oxygen uptake (V˙O2max), ventilatory threshold (VT) and respiratory compensation point (RCP) can be used to monitor the training intensity and the race strategy, and the elucidation of the specificities existing between the sexes can be interesting for coaches and athletes. The aim of the study was to compare ventilatory threshold (VT), respiratory compensation point (RCP), and the percentage of the maximal aerobic speed (MAS) that can be maintained in a triathlon race between sexes. Forty-one triathletes (22 men and 19 women), 42.1 ± 8.4 (26 to 60) years old, that raced the same Olympic triathlon underwent a cardiorespiratory maximal treadmill test to assess their VT, RPC, and MAS, and race speed. The maximal oxygen uptake (V˙O2max) (54.0 ± 5.1 vs. 49.8 ± 7.7 mL/kg/min, p < 0.001) and MAS (17 ± 2 vs. 15 ± 2 km/h, p = 0.001) were significantly higher in male than in female athletes. Conversely, there were no sex differences according to the percentage of V˙O2max reached at VT (74.4 ± 4.9 vs. 76.1 ± 5.4%, p = 0.298) and RCP (89.9 ± 3.6 vs. 90.6 ± 4.0%, p = 0.560). The mean speed during the race did not differ between sexes (12.1 ± 1.7 km/h and 11.7 ± 1.8 km/h, p = 0.506, respectively). Finally, men performed the running split at a lower percentage of speed at RCP than women (84.0 ± 8.7 vs. 91.2 ± 7.0%, respectively, p = 0.005). Therefore, male and female athletes accomplished the running split in an Olympic triathlon distance at distinct relative intensities, as female athletes run at a higher RCP percentage.