This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.

Background In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athletedays). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common.

Objectives To describe the incidence of injury in the precompetition and competition periods of the Rio 2016 Summer Paralympic Games. Methods A total of 3657 athletes from 78 countries, representing 83.4% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Injury data were obtained daily from teams with their own medical support. results A total of 510 injuries were reported during the 14-day Games period, with an injury incidence rate (IR) of 10.0 injuries per 1000 athlete days (12.1% of all athletes surveyed). The highest IRs were reported for football 5-a-side (22.5), judo (15.5) and football 7-a-side (15.3) compared with other sports (p<0.05). Precompetition injuries were significantly higher than in the competition period (risk ratio: 1.40, p<0.05), and acute traumatic injuries were the most common injuries at the Games (IR of 5.5). The shoulder was the most common anatomical area affected by injury (IR of 1.8). Conclusion The data from this study indicate that (1) IRs were lower than those reported for the London 2012 Summer Paralympic Games, (2) the sports of football 5-a-side, judo and football 7-a-side were independent risk factors for injury, (3) precompetition injuries had a higher IR than competition period injuries, (4) injuries to the shoulder were the most common. These results would allow for comparative data to be collected at future editions of the Games and can be used to inform injury prevention programmes.

We used three techniques of precooling to test the hypothesis that heat strain would be alleviated, muscle temperature (Tmu) would be reduced, and as a result there would be delayed decrements in peak power output (PPO) during exercise in hot, humid conditions. Twelve male team-sport players completed four cycling intermittent sprint protocols (CISP). Each CISP consisted of twenty 2-min periods, each including 10 s of passive rest, 5 s of maximal sprint against a resistance of 7.5% body mass, and 105 s of active recovery. The CISP, preceded by 20 min of no cooling (Control), precooling via an ice vest (Vest), cold water immersion (Water), and ice packs covering the upper legs (Packs), was performed in hot, humid conditions (mean +/- SE; 33.7 +/- 0.3 degrees C, 51.6 +/- 2.2% relative humidity) in a randomized order. The rate of heat strain increase during the CISP was faster in Control than Water and Packs (P < 0.01), but it was similar to Vest. Packs and Water blunted the rise of Tmu until minute 16 and for the duration of the CISP (40 min), respectively (P < 0.01). Reductions in PPO occurred from minute 32 onward in Control, and an increase in PPO by approximately 4% due to Packs was observed (main effect; P < 0.05). The method of precooling determined the extent to which heat strain was reduced during intermittent sprint cycling, with leg precooling offering the greater ergogenic effect on PPO than either upper body or whole body cooling.

Objective-To examine the eVects of a GP exercise referral programme on modifiable coronary heart disease risk factors. Design-Randomised controlled trial. A battery of validated measures were carried out at 0, 8, 16, 26, and 37 weeks. Setting-Two community health centres and a leisure centre in Hailsham, East Sussex. Subjects-389 patients (smokers, hypertensive or overweight) were selected from medical records, screened for contraindications to exercise and 345 were invited into the study. Of 142 patients randomly allocated, 40 (41%) completed the study in the exercise group and 31 (69%) in the control group. Sixty (35%) invited smokers (48% of non-smokers), 71 (38%) invited hypertensive patients (45% of non-hypertensive patients), and 107 (45%) overweight patients (33% of non-overweight patients) were randomised. Of those randomised, 27 (45%) smokers, 52 (48%) overweight, and 43 (61%) hypertensive patients completed the study. Intervention-The exercise group was oVered 20, half price sessions over 10 weeks at a leisure centre. Patients engaged in moderate and vigorous aerobic type activity on various exercise machines, in a semi-supervised, informal environment. Results-87% of those referred used the prescription and 28% (high adherers)(45% of obese patients) did at least 15 sessions. The exercise group reduced sum of skinfolds by 8.1% (2.9 to 13.3, 95% confidence intervals) more than the control group, up to 16 weeks after baseline. High adherers reduced sum of skinfolds by 9.2% (0.9 to 17.5) more than the control group, up to 26 weeks. High adherers reduced systolic blood pressure by 7.2% (−0.7 to 14.9) (that is, 9 mm Hg) more than low adherers, up to 37 weeks. Non-smokers and obese patients attended more prescribed sessions than smokers and non-overweight patients.Conclusions-Reduction in sum of skinfolds was maintained up to 26 weeks, among high adherers compared with controls. Reduction in systolic blood pressure was evident up to 37 weeks among high adherers, but only in comparison with low adherers. Selection of appropriate referees and use of other strategies to improve exercise adherence will help to maximise the benefits from GP exercise prescription schemes. (J Epidemiol Community Health 1998;52:595-601) Physical inactivity has been identified as an endemic coronary heart disease (CHD) risk factor. 1-5Increasing physical activity in the population may also modify other risk factors such as body fat and hypertension. For example, in a review, 6 net changes in systolic blood pressure, associated with endurance training, were reported to be −6.2, and −9.9 mm Hg among borderline hypertensive and hypertensive patients, respectively.A growing interest has emerged in the promotion of physical activity through primary health care. 7 8 Many schemes involve GPs referring patients to leisure centre based exercise programmes. However, some scepticism is held by health service managers and others 9 about the eVectiveness of a programme of prescribed exercise for chronic health problems. Such schemes ha...

The general consensus among sport and exercise genetics researchers is that genetic tests have no role to play in talent identification or the individualised prescription of training to maximise performance. Despite the lack of evidence, recent years have witnessed the rise of an emerging market of direct-to-consumer marketing (DTC) tests that claim to be able to identify children's athletic talents. Targeted consumers include mainly coaches and parents. There is concern among the scientific community that the current level of knowledge is being misrepresented for commercial purposes. There remains a lack of universally accepted guidelines and legislation for DTC testing in relation to all forms of genetic testing and not just for talent identification. There is concern over the lack of clarity of information over which specific genes or variants are being tested and the almost universal lack of appropriate genetic counselling for the interpretation of the genetic data to consumers. Furthermore independent studies have identified issues relating to quality control by DTC laboratories with different results being reported from samples from the same individual. Consequently, in the current state of knowledge, no child or young athlete should be exposed to DTC genetic testing to define or alter training or for talent identification aimed at selecting gifted children or adolescents. Large scale collaborative projects, may help to develop a stronger scientific foundation on these issues in the future.

Objective.  To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.  Methods.  A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems. \ud Results.  There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)). \ud Conclusions.  In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games

Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.