Exercise Selection and Common Injuries in Fitness Centers: A Systematic Integrative Review and Practical Recommendations

Gym and Fitness Injuries amongst those Aged 16-64 in New Zealand: Analysis of Ten Years of Accident Compensation Corporation Injury Claim Data

BACKGROUND

To provide epidemiological data for minor and moderate-to-serious injury claims for gym and fitness related injuries amongst those aged 16-64 in New Zealand, to inform the development of an injury prevention program.

METHODS

Retrospective analytical review of gym and fitness related injury entitlement minor and moderate- to-serious Accident Compensation Corporation (ACC) claims from 1 July 2011 to 30 June 2020. Data were analysed by cause of injury, geographical region, sex, age, body site and injury type. Qualitative analysis of free text describing the activity causing the injury was conducted.

RESULTS

Over the ten-year period, 16-64 year olds made 345,254 injury claims, costing ACC NZ$241,298,275 in treatment charges. Soft tissue injuries were the most prevalent making up 96% (331,343) of all claims and 88% (NZ$213,049,197) of the total charges. Strenuous movement with lifting (n = 154,467, 47%), strenuous movement without lifting (n = 84,469, 25%), impact/contact with object (n = 39,610, 12%) and impact/contact with ground (n = 25,351, 8%) were the top four mechanisms resulting in injury, accounting for 92% of soft tissue injuries. Males and females aged 21 to 30 years old were most frequently injured. The four most injured body sites (lower back/spine, shoulder, knee, neck/back of head) accounted for 63% of injuries in females, and 65% in males.

CONCLUSIONS

The most common cause of injury from gym and fitness activity claims in 16-64 year olds in New Zealand was lifting/carrying/strain resulting in lower back/spine and shoulder (including clavicle/blade) soft tissue injuries. Soft tissue injuries accounted for 96% of the total claims. Males and females aged 21 to 30 years old were most frequently injured age group.

Supporting athletes during a challenging situation: recommendations from a global insight of COVID-19 home-based training experience

BACKGROUND

For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown.

METHODS

This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences.

RESULTS

Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges.

CONCLUSIONS

Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

Energy expenditure, oxygen consumption, and heart rate while exercising on seven different indoor cardio machines at maximum and self-selected submaximal intensity

Objective

One of the main objectives of practicing indoor cardiovascular exercise is to maximize caloric expenditure. This study aimed to compare energy expenditure (EE), oxygen consumption (VO2), and heart rate (HR) recorded in middle-aged adults while exercising on seven different indoor cardiovascular machines at self-selected maximal and submaximal intensity.

Method

Thirty recreational-active adult males (Age: 41.69 ± 4.64) performed 12-min bouts at RPE (Rate of perceived exertion) 17 and maximum intensity (MAX INT) on the following indoor cardio machines: Recumbent bike (r_BIKE), upright bike (u-BIKE), spin bike (s-BIKE), rowing machine (ROW), elliptical trainer (ELLIP), stair climber (STAIR), and treadmill (TMILL). Heart rate (HR) and oxygen consumption (VO2) were measured during exercise, whereas EE (energy expenditure) was calculated indirectly.

Results

Overall, TMILL induced the highest levels of EE, VO2, and HR, followed by STAIR, ELLIP, s_BIKE, u_BIKE, ROW, and r_BIKE. RPE was reliable across exercise modalities (r_BIKE, u-BIKE, s-BIKE, ROW, ELLIP, STAIR, and TMILL) and intensities (RPE 17 and MAX INT) for EE, HR, and VO2 measurements.

Conclusion

To maximize EE while performing indoor cardiovascular exercise for recreational active middle-aged male participants, the TMILL is the best option, followed by the STAIR and the ELLIP. The least recommended options are, respectively, s_BIKE, u_BIKE, ROW, and r_BIKE. Beyond caloric expenditure considerations, promoting exercises that participants genuinely enjoy can enhance adherence, fostering sustained health benefits. Furthermore, RPE is a reliable tool for assessing EE, VO2, and HR across different exercise modalities and intensities.

A Muscle Load Feedback Application for Strength Training: A Proof-of-Concept Study

Muscle overload injuries in strength training might be prevented by providing personalized feedback about muscle load during a workout. In the present study, a new muscle load feedback application, which monitors and visualizes the loading of specific muscle groups, was developed in collaboration with the fitness company Gymstory. The aim of the present study was to examine the effectiveness of this feedback application in managing muscle load balance, muscle load level, and muscle soreness, and to evaluate how its actual use was experienced. Thirty participants were randomly distributed into 'control', 'partial feedback', and 'complete feedback' groups and monitored for eight workouts using the automatic exercise tracking system of Gymstory. The control group received no feedback, while the partial feedback group received a visualization of their estimated cumulative muscle load after each exercise, and the participants in the complete feedback group received this visualization together with suggestions for the next exercise to target muscle groups that had not been loaded yet. Generalized estimation equations (GEEs) were used to compare muscle load balance and soreness, and a one-way ANOVA was used to compare user experience scores between groups. The complete feedback group showed a significantly better muscle load balance (β = -18.9; 95% CI [-29.3, -8.6]), adhered better to the load suggestion provided by the application (significant interactions), and had higher user experience scores for Attractiveness (p = 0.036), Stimulation (p = 0.031), and Novelty (p = 0.019) than the control group. No significant group differences were found for muscle soreness. Based on these results, it was concluded that personal feedback about muscle load in the form of a muscle body map in combination with exercise suggestions can effectively guide strength training practitioners towards certain load levels and more balanced cumulative muscle loads. This application has potential to be applied in strength training practice as a training tool and may help in preventing muscle overload.

Effect of different loads on the shoulder in abduction postures: a finite element analysis

Load can change the mechanical environment of dynamic and static stable structures of the shoulder joint, increase the risk of tissue damage and affect the stability of the shoulder joint, but its biomechanical mechanism is still unclear. Therefore, a finite element model of the shoulder joint was constructed to analyze the mechanical index changes of shoulder joint abduction under different loads. The stress of the articular side on the supraspinatus tendon was higher than that of the capsular side, with a maximum difference of 43% due to the increased load. For the deltoid muscle and glenohumeral ligaments, increases in stress and strain were obvious in the middle and posterior deltoid muscles and inferior glenohumeral ligaments. The above results indicate that load increases the stress difference between the articular side and the capsular side on the supraspinatus tendon and increases the mechanical indices of the middle and posterior deltoid muscles, as well as the inferior glenohumeral ligament. The increased stress and strain in these specific sites can lead to tissue injury and affect the stability of the shoulder joint.

Adaptogens on Depression-Related Outcomes: A Systematic Integrative Review and Rationale of Synergism with Physical Activity

Depression is considered the most important disorder affecting mental health. The aim of this systematic integrative review was: (i) to describe the effects of supplementation with adaptogens on variables related to depression in adults; and (ii) to discuss the potential combination with physical exercise to aid planning and commissioning future clinical research. An integrative review was developed complementing the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PROSPERO registration: CRD42021249682). A total of 41 articles met the inclusion criteria. With a Price index of 46.4%, we found that: (i) Hypericum perforatum (St. John's Wort) is the most studied and supported adaptogen (17/41 [41.46%], three systematic reviews with meta-analysis) followed by Crocus sativus L. or saffron (6/41 [14.63%], three systematic reviews with meta-analysis and two systematic reviews); (ii) it is possible that the significantly better performance of adaptogens over placebo is due to the reduction of allostatic load via the action of secondary metabolites on BDNF regulation; and, (iii) the number of studies reporting physical activity levels is limited or null for those that combine an exercise program with the consumption of adaptogens. Aware of the need for a multidisciplinary approach for depression treatment, this systematic integrative review provides an up-to-date view for supporting the use of St. John's Wort and saffron as non-pharmacological strategies while also help commissioning future research on the efficacy of other adaptogens. It also contributes to the design of future clinical research studies that evaluate the consumption of herbal extracts plus physical exercise, mainly resistance training, as a potentially safe and powerful strategy to treat depression.

Nutritional Strategies in the Rehabilitation of Musculoskeletal Injuries in Athletes: A Systematic Integrative Review

It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.

Promoting Physical Activity and Health in the Workplace: A Qualitative Study among University Workers, Spain

The social changes we have been experiencing in recent years are generating anxiety that, together with sedentary lifestyles and poor health habits, are leading to premature ageing of society, in addition to the high rates of obesity and associated morbidity. In order to improve the lifestyles of the university community, the objective of this research project was the implementation of the UAL Activa programme based on physical activity. The beneficiaries were UAL staff from different sections, a total of 68 participants aged between 28 and 61 years (Mage = 49.36). Additionally, a total of 12 final year students of the degree in physical activity and sport sciences were responsible for designing and developing the exercise tasks. In-depth interviews were held with the participants of this project about the different benefits that their participation had brought them. The results obtained from the analysis with Nvivo v.10. showed five thematic blocks on the perceived improvements in physical fitness, physical condition, mood and emotional state, assessment of the new lifestyle, and social relations. In conclusion, the benefits of physical activity and the need to continue implementing action and intervention plans to encourage and promote its practice in all sectors of the population were highlighted.

The Effect of Strength Training on Undetected Shoulder Pathology in Asymptomatic Athletes: An MRI Observational Study

BACKGROUND

Data on the effects of weight training on joint morphology are mostly restricted to muscle gain. However, in many circumstances, it is not stated if there are negative consequences for the joints and their surrounding components. This study was conducted to explore whether long-term excessive resistance training (RT) causes hidden pathological alterations in the shoulder.

METHODS

A total of eleven asymptomatic sportsmen (22 shoulders) underwent clinical and radiological examination of both shoulder joints. All participants had engaged in bodybuilding for at least four years, at least three times per week, and for at least four hours per week. All participants were examined clinically using the Constant Murley Score (CMS), Simple Shoulder Test (SST), UCLA Activity Test, and a specially designed questionnaire. All participants received a bilateral shoulder MRI. The MRI scans were checked for pathology using a checklist.

RESULTS

Maximum scores were observed for the SST and UCLA Activity Test. The CMS was 97.7 points on average (range, 87-100). RT had been conducted for a mean of 10.7 years (range, 4-20), for an average of 8.8 h a week (range, 4-12). MRI examinations revealed two supraspinatus tendinopathies (9.1%), one labral change (4.5%), three humeral tuberosity cysts (13.6%), fourteen acromioclavicular (AC) joint hypertrophies (63.6%), five AC joint osteophytes (22.7%), and ten signs of AC joint inflammation (45.5%).

CONCLUSIONS

The research results show that strength is associated with MRI-documented AC joint pathology. However, it appears that RT may not negatively affect other anatomical structures of the shoulder.

Characteristics of Fitness-Related Injuries in The Netherlands: A Descriptive Epidemiological Study

Although general information is available, specifically detailed information on gym-based fitness-related injuries in the general recreational fitness population is lacking. The aim of our study was to obtain more insight into injuries occurring as a result of gym-based fitness activities. A descriptive online epidemiological study was conducted in November 2020. The survey was distributed by a market research agency to members of their research panel. A total of 494 Dutch fitness participants aged ≥ 18 years (mean 38.9; 59% male) who had sustained a fitness-related injury in the preceding 12 months were included in the study. Most injuries occurred during strength training, individual cardio exercise, yoga/Pilates, cardio exercise in group lessons, and CrossFit. The shoulder, leg, and knee were the most common injured body parts; 73.1% of the injuries occurred during unsupervised gym-based fitness activities, and 46.2% of the injuries occurred during one specific exercise or when using a specific fitness device: running (e.g., on the treadmill) (22.8%); bench press (11.8%); or squats (9.6%). Overuse or overload (n = 119), missteps and sprains (n = 48), or an incorrect posture or movement (n = 43) were most often mentioned as causes of injury. Conclusions: Most self-reported gym-based fitness-related injuries occur during strength training and individual cardio exercise. Special attention should be given to the shoulder during strength training and to the lower extremities during cardio exercise. Injury prevention interventions should be able to be carried out without supervision.