Publications by authors named "Andrew M Watson"

36 Publications

Decreased Sleep and Subjective Well-Being as Independent Predictors of Injury in Female Collegiate Volleyball Players.

Orthop J Sports Med 2021 Sep 9;9(9):23259671211029285. Epub 2021 Sep 9.

Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Background: The relationship among sleep duration, subjective well-being, and injury risk in athletes is poorly defined.

Purpose: To evaluate the independent effects of sleep duration, sleep quality, and subjective well-being on in-season injuries in collegiate female volleyball athletes.

Study Design: Cohort study; Level of evidence, 2.

Methods: During a 9-month competitive season, 17 female National Collegiate Athletic Association (NCAA) Division I volleyball players reported mood, fatigue, stress, soreness, sleep duration (hours), and sleep quality every morning. Well-being measures were recorded from 0 (worst) to 5 (best), and all time-loss injuries were recorded by the team athletic trainer. Separate mixed-effects logistic regression models were used to evaluate the effects of sleep and subjective well-being on in-season injury. Each well-being variable was also included in a separate mixed-effects logistic regression model with sleep duration as a covariate.

Results: A total of 54 injuries were recorded during the study period. Compared with days without an injury, mood, fatigue, stress, soreness, sleep quality, and sleep duration were significantly worse the day before an injury occurred. In the separate prediction models, in-season injury was significantly predicted by fatigue (odds ratio [OR], 0.56 [95% CI, 0.36-0.86]; = .008), mood (OR, 0.52 [95% CI, 0.35-0.78]; = .002), stress (OR, 0.63 [95% CI, 0.42-0.94]; = .023), soreness (OR, 0.54 [95% CI, 0.38-0.79]; = .001), sleep quality (OR, 0.49 [95% CI, 0.34-0.7]; < .001), and sleep duration (OR, 0.69 [95% CI, 0.55-0.87]; = .001). In the multivariable models, sleep duration remained a significant independent predictor in each of the subsequent multivariable models (OR, 0.72-0.74; < .05 for all), as did mood (OR, 0.55 [95% CI, 0.36-0.83); = .005) and soreness (OR, 0.57 [95% CI, 0.39-0.83]; = .003), while fatigue (OR, 0.65 [95% CI, 0.42-1]; = .054) and stress (OR, 0.68 [95% CI, 0.45-1]; = .061) no longer reached statistical significance.

Conclusion: Increased sleep duration, mood, and decreased soreness were independently associated with a reduced risk of in-season injury in this cohort of female NCAA volleyball players.
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http://dx.doi.org/10.1177/23259671211029285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436316PMC
September 2021

COVID-19 Planning in United States Youth Sports: a Survey of 1880 Organizations Representing Over 500,000 Youth Athletes.

J Athl Train 2021 Sep 3. Epub 2021 Sep 3.

From the Department of Orthopedics and Rehabilitation1, University of Wisconsin School of Medicine and Public Health, Madison, WI, and.

Context: High school (HS) and youth sports organizations (YSO) that restarted participation in the fall of 2020 during the COVID-19 pandemic relied on information sources to develop risk mitigation procedures.

Objective: To compare the risk mitigation procedures being employed and the information sources being utilized by HS athletic departments and YSO.

Design: Surveys were distributed to HS athletic directors and youth sports directors throughout the US regarding sport restarting, COVID-19 cases, risk reduction procedures, and the information sources used to develop risk reduction plans in fall 2020. The proportion of HS and YSO using different procedures and information sources were compared using chi-square tests.

Setting: HS and YSO programs from across the US Participants: 1296 HS and 584 YSO responded, representing 519,241 adolescent athletes.

Main Outcome Measures: Risk reduction procedures used and information sources employed Results: HS employed more risk reduction procedures (7.1±2.1 v 6.3±2.4, p<0.001), were more likely to use symptom monitoring (93%v85%, p<0.001), temperature checks on site (66%v49%, p<0.001), face mask use for players on and off the field (37%v23%, p<0.001 and 81%v71%, p<0.001, respectively), social distancing for staff (81%v68%, p<0.001) and players off the field (83%v68%, p<0.001), and increased disinfection (92%v70%, p<0.001). While HS and YSO had similar use of information from local health authorities, there were still some differences. For example, HS were more likely to use information from the National Athletic Trainers Association (72%v15%, p<0.001) than YSO.

Conclusions: HS and YSO report using a broad range of risk reduction procedures, but the average number was higher among high schools than youth sports organizations. Use of information from the CDC and local health authorities was high overall, but low from professional healthcare organizations. Professional healthcare organizations should consider additional measures to improve information uptake among stakeholders within youth sports.
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http://dx.doi.org/10.4085/1062-6050-0296.21DOI Listing
September 2021

COVID-19 in US Youth Soccer Athletes During Summer 2020.

J Athl Train 2021 Jun;56(6):542-547

Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison.

Context: As sports are reinitiated around the United States, the incidence of COVID-19 among youth soccer athletes remains unknown.

Objective: To determine the incidence of COVID-19 among youth soccer athletes and the risk-mitigation practices used by youth soccer organizations.

Design: Cohort study.

Setting: Survey distributed to Elite Clubs National League member clubs.

Patients Or Other Participants: Youth soccer club directors throughout the United States.

Main Outcome Measure(s): Surveys were completed in late August 2020 regarding the club's current phase of return to soccer (individual only, group noncontact, group contact), date of reinitiation, number of players, cases of COVID-19, and risk-reduction procedures being implemented. Case and incidence rates were compared with national pediatric data and county data from the prior 10 weeks. A negative binomial regression model was developed to predict club COVID-19 cases using the local incidence rate and phase of return as covariates and the log of club player-days as an offset.

Results: A total of 124 respondents had reinitiated soccer, representing 91 007 players with a median duration of 73 days (interquartile range = 53-83 days) since restarting. Of the 119 clubs that had progressed to group activities, 218 cases of COVID-19 were reported among 85 861 players. Youth soccer players had a lower case rate and incidence rate than children in the United States (254 versus 477 cases per 100 000; incidence rate ratio = 0.511, 95% CI = 0.40, 0.57; P < .001) and the general population in the counties where data were available (268 versus 864 cases per 100 000; incidence rate ratio = 0.202, 95% CI = 0.19, 0.21; P < .001). After adjusting for the local COVID-19 incidence, we found no relationship between the club COVID-19 incidence and the phase of return (noncontact: b = 0.35 ± 0.67, P = .61; contact: b = 0.18 ± 0.67, P = .79). Soccer clubs reported using a median of 8 (interquartile range = 6-10) risk-reduction procedures.

Conclusions: The incidence of COVID-19 among youth soccer athletes was relatively low when compared with the background incidence among children in the United States during the summer of 2020. No relationship was identified between the club COVID-19 incidence and the phase of return to soccer.
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http://dx.doi.org/10.4085/610-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223610PMC
June 2021

Decreased ventricular size and mass mediate the reduced exercise capacity in adolescents and adults born premature.

Early Hum Dev 2021 Sep 24;160:105426. Epub 2021 Jul 24.

Department of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States of America.

Background: Premature birth is associated with lower levels of cardiorespiratory fitness (CRF) but the underlying mechanisms responsible remain unclear. This study assessed whether differences in cardiac morphology or function mediate differences in CRF among adolescents and young adults born preterm.

Methods: Adolescents and young adults born moderately to extremely premature (gestational age ≤ 32 weeks or birth weight < 1500 g) and age-matched term born participants underwent resting cardiac MRI and maximal exercise testing. Mediation analysis assessed whether individual cardiovascular variables accounted for a significant proportion of the difference in maximal aerobic capacity between groups.

Results: Individuals born preterm had lower VO2max than those born term (41.7 ± 8.6 v 47.5 ± 8.7, p < 0.01). Several variables differed between term and preterm born subjects, including systolic and diastolic blood pressure, mean pulmonary artery pressure, indexed left ventricular end-diastolic volume (LVEDVi), right ventricular end-diastolic volume (RVEDVi), LV mass (LVMi), LV stroke volume index (LVSVi), and LV strain (p < 0.05 for all). Of these variables, LVEDVi, RVEDVi, LVSVi, LVMi, and LV longitudinal strain were significantly related to VO2max (p < 0.05 for all). Significant portions of the difference in VO2max between term and preterm born subjects were mediated by LVEDVi (74.3%, p = 0.010), RVEDVi (50.6%, p = 0.016), and LVMi (43.0%, p = 0.036).

Conclusions: Lower levels of CRF in adolescents and young adults born preterm are mediated by differences in LVEDVi, RVEDVi, and LVMi. This may represent greater risk for long-term cardiac morbidity and mortality in preterm born individuals.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105426DOI Listing
September 2021

Reported COVID-19 Incidence in Wisconsin High School Athletes in Fall 2020.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

Department of Orthopedics and Rehabilitation2, University of Wisconsin School of Medicine and Public Health, Madison, WI.

(STATE-XXX = Wisconsin).

Abstract: Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use.Design: Retrospective survey.Setting: High schools across STATE-XXX during September, 2020.Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2.Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use.Main Outcome Measurements: Reported athlete case rates compared to their county's general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school's county incidence using multivariable negative binomial regression models.Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county's general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26-1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all).Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.
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http://dx.doi.org/10.4085/1062-6050-0185.21DOI Listing
June 2021

COVID-19 Risk in Youth Club Sports: A nationwide sample representing over 200,000 Athletes.

J Athl Train 2021 May 26. Epub 2021 May 26.

Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Context: The COVID-19 pandemic has affected almost every aspect of life including youth sports. Little data exists on COVID-19 incidences and risk mitigation strategies in youth club sports.

Objective: To determine the reported incidence of COVID-19 cases among youth club sport athletes and the information sources used to develop COVID-19 risk mitigation procedures.

Design: Cross-sectional study.

Setting: Online surveys.

Patients: Soccer and volleyball youth club directors.

Intervention: A survey was completed by directors of youth volleyball and soccer clubs across the country in October 2020. Surveys included self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies.

Main Outcome Measures: Total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100,000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log(player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio (IRR) with Wald confidence intervals.

Results: A total of 205,136 athletes (soccer=165,580; volleyball=39,556) were represented by 437 clubs (soccer=159; volleyball=278). Club organizers reported 673 COVID-19 cases (soccer=322; volleyball=351), for a reported incidence rate of 2.8 cases per 100,000 player-days (soccer=1.7, volleyball=7.9). Volleyball had a significantly higher reported COVID-19 incidence rate compared to soccer (reported IRR = 3.06 [2.0-4.6], p<0.001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7 with an interquartile range of 2.

Conclusions: The incidence of self-reported cases of COVID-19 was lower in soccer clubs than volleyball clubs. Most clubs report using many COVID-19 mitigation strategies to reduce the risk of COVID-19.
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http://dx.doi.org/10.4085/1062-6050-0187.21DOI Listing
May 2021

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the CoVID-19 Pandemic.

J Athl Train 2021 Apr 22. Epub 2021 Apr 22.

University of Wisconsin-Madison.

Context: In the spring of 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of CoVID-19. The changes that took place to the physical and mental health among young athletes during this time remain unknown, however.

Objective: Identify changes in the health (mental health, physical activity and quality of life) of athletes that occurred during the CoVID-19 pandemic.

Design: Cross-sectional study.

Setting: Sample recruited via social media.

Patients Or Other Participants: 3243 Wisconsin adolescent athletes (age=16.2±1.2 yrs., female=58% female) completed an online survey in May 2020 (DuringCoVID-19). Health measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n=5231, age=15.7±1.2, 47% female) collected in 2016-2018 (PreCoVID-19).

Main Outcome Measure(s): Demographic information included: sex, grade and sports played. Health assessments included the Patient Health Questionnaire-9 Item (PHQ-9) to identify depression symptoms, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for health related quality of life (HRQoL). Univariable comparisons of these variables between groups were made via t-tests or chi-square tests. Means and 95% confidence intervals (CI) for each group were estimated by survey weighted ANOVA models.

Results: Compared to PreCoVID-19, a larger proportion of the During-CoVID-19 participants reported rates of moderate to severe levels of depression (9.7% vs 32.9%, p<0.001). During-CoVID-19 participants reported 50% lower (worse) PFABS scores (mean:12.2 [95%CI: 11.9, 12.5] vs 24.7 [24.5, 24.9] p<0.001) and lower (worse) PedsQL total scores compared to the PreCoVID-19 participants (78.4 [78.0, 78.8] vs. 90.9 [90.5, 91.3] p<0.001).

Conclusions: During the CoVID-19 pandemic, adolescent athletes reported increased symptoms of depression, decreased physical activity and decreased quality of life compared to adolescent athletes in previous years.
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http://dx.doi.org/10.4085/1062-6050-0739.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359721PMC
April 2021

Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players.

Am J Sports Med 2021 05 15;49(6):1634-1641. Epub 2021 Mar 15.

Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Background: Sports-related concussions may have a neurobiological recovery period that exceeds the period of clinical recovery, and one consequence of an extended neurobiological recovery may be the risk of subsequent musculoskeletal injuries. Most literature citing an increased risk of musculoskeletal injury after a sports-related concussion has been reported in populations other than adolescent athletes.

Purpose/hypothesis: The purpose was to prospectively determine if incidence rates of musculoskeletal injury differ between adolescent athletes with and without a previous sports-related concussion, while controlling for sex, sport, and age. A secondary aim was to determine if this relationship differs between male and female athletes of the same sport. Our hypotheses were that acute-noncontact injury rates would be higher in athletes with a previous sports-related concussion when compared with athletes without a previous sports-related concussion, and that this relationship would exist only in female athletes and not male athletes.

Study Design: Cohort study; Level of evidence, 2.

Methods: High school soccer and volleyball players were recruited in 2 prospective cohort studies that observed 4837 athletes during their sporting season (females, 80%; soccer, 57%; mean [SD] age, 15.6 [1.1] years). At preseason, all participants self-reported demographics and previous sports-related concussion within the past 12 months. During the sport season, team athletic trainers electronically recorded athlete exposures and injury data, including injury characteristics. Injury rates per 1000 athlete exposures and injury rate ratios (IRRs) with 95% confidence intervals were calculated. All injury rates and IRRs were adjusted for sex, age, and sport.

Results: The rate of acute-noncontact lower extremity injury was 87% greater (IRR, 1.87; 95% CI, 1.29-2.74) in participants with a previous sports-related concussion versus those without one. The acute-noncontact lower extremity injury rates (IRRs) for females and males with a previous sports-related concussion were 1.76 (95% CI, 1.19-2.59) and 2.83 (95% CI, 0.85-9.50), respectively. No difference was detected in acute-contact (IRR, 0.98; 95% CI, 0.56-1.73) or overuse (IRR, 1.09; 95% CI, 0.51-2.37) lower extremity injury rates by previous sports-related concussion.

Conclusion: Female adolescent athletes who reported a sports-related concussion within the past 12 months were more likely to sustain an acute-noncontact lower extremity injury during their high school sports season when compared with female athletes without a previous sport-related concussion.
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http://dx.doi.org/10.1177/0363546521997116DOI Listing
May 2021

Defining a Research Agenda for Youth Sport Specialization in the United States: The AMSSM Youth Early Sport Specialization Summit.

Clin J Sport Med 2021 Mar;31(2):103-112

Musculoskeletal Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; and.

Abstract: Sport specialization is becoming increasingly common among youth and adolescent athletes in the United States and many have raised concern about this trend. Although research on sport specialization has grown significantly, numerous pressing questions remain pertaining to short- and long-term effects of specialization on the health and well-being of youth, including the increased risk of overuse injury and burnout. Many current elite athletes did not specialize at an early age. Methodological and study design limitations impact the quality of current literature, and researchers need to prioritize pressing research questions to promote safe and healthy youth sport participation. The American Medical Society for Sports Medicine hosted a Youth Early Sport Specialization Summit in April 2019 with the goal of synthesizing and reviewing current scientific knowledge and developing a research agenda to guide future research in the field based on the identified gaps in knowledge. This statement provides a broad summary of the existing literature, gaps and limitations in current evidence, and identifies key research priorities to help guide researchers conducting research on youth sport specialization. Our goals are to help improve the quality and relevance of research on youth sport specialization and to ultimately assure that opportunities for healthy and safe sport participation continue for all youth.
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http://dx.doi.org/10.1097/JSM.0000000000000900DOI Listing
March 2021

Psychosocial Impacts of Sports-related Injuries in Adolescent Athletes.

Curr Sports Med Rep 2021 Feb;20(2):104-108

Department of Orthopedics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Abstract: Adolescence represents a time of tremendous physical, social, and emotional growth, and sport participation can provide significant mental health benefits for young athletes. Injuries are unfortunately common in sports and represent a threat to the short- and long-term health of athletes. While injury management has typically revolved around the minimization of pain and the restoration of physical function, emerging evidence suggests that the psychological consequences of injury may be significant, potentially jeopardizing return to play, increasing subsequent reinjury risk, and even leading to the development of mental health disorders. The majority of this research has been conducted in adult athletes and less is known about outcomes in youth athletes following injury. This review examines what is known about the psychosocial impact of sports injuries in youth athletes to identify areas of future research and to aid clinicians in the management of this population.
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http://dx.doi.org/10.1249/JSR.0000000000000809DOI Listing
February 2021

Defining a research agenda for youth sport specialisation in the USA: the AMSSM Youth Early Sport Specialization Summit.

Br J Sports Med 2021 Feb;55(3):135-143

Musculoskeletal Clinical Program, Intermountain Health Care Inc, Salt Lake City, Utah, USA.

Sport specialisation is becoming increasingly common among youth and adolescent athletes in the USA and many have raised concern about this trend. Although research on sport specialisation has grown significantly, numerous pressing questions remain pertaining to short-term and long-term effects of specialisation on the health and well-being of youth, including the increased risk of overuse injury and burnout. Many current elite athletes did not specialise at an early age. Methodological and study design limitations impact the quality of current literature, and researchers need to prioritise pressing research questions to promote safe and healthy youth sport participation. The American Medical Society for Sports Medicine hosted a Youth Early Sport Specialization Summit in April 2019 with the goal of synthesising and reviewing current scientific knowledge and developing a research agenda to guide future research in the field based on the identified gaps in knowledge. This statement provides a broad summary of the existing literature, gaps and limitations in current evidence and identifies key research priorities to help guide researchers conducting research on youth sport specialisation. Our goals are to help improve the quality and relevance of research on youth sport specialisation and to ultimately assure that opportunities for healthy and safe sport participation continue for all youth.
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http://dx.doi.org/10.1136/bjsports-2020-102699DOI Listing
February 2021

Mental Health, Physical Activity, and Quality of Life of US Adolescent Athletes During COVID-19-Related School Closures and Sport Cancellations: A Study of 13 000 Athletes.

J Athl Train 2021 Jan;56(1):11-19

Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison.

Context: In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of coronavirus disease 2019 (COVID-19). It is critical to understand the mental and physical health of adolescent athletes during this time.

Objective: To describe the health of athletes during COVID-19-related school closures and sport cancellations.

Design: Cross-sectional study.

Setting: A national sample recruited via social media.

Patients Or Other Participants: A total of 13 002 US adolescent athletes (age = 16.3 ± 1.2 years, females = 52.9%, males = 47.0%) completed an anonymous online survey.

Main Outcome Measure(s): Demographic information collected was sex, grade, sport(s) played, and zip code. Assessments used were the General Anxiety Disorder 7-Item for anxiety, Patient Health Questionnaire 9-Item for depression, the Pediatric Functional Activity Brief Scale for physical activity, and the Pediatric Quality of Life Inventory 4.0 for quality of life. Mental health, physical activity, and health-related quality-of-life variables were compared among sex, grade, sport(s) played, and poverty level using means and 95% confidence intervals (CIs) from the survey-weighted analysis of variance.

Results: Females reported a higher prevalence of moderate to severe anxiety symptoms (females = 43.7% versus males = 28.2%). The Pediatric Functional Activity Brief Scale score was highest (best) for grade 9 (mean = 14.5, 95% CI = 14.0, 15.0) and lowest for grade 11 (mean = 10.9, 95% CI = 10.5, 11.3). The prevalence of depression symptoms was highest in team sport (74.1%) and lowest in individual sport (64.9%) participants. The total Pediatric Quality of Life Inventory score was lowest (worst) for athletes from counties with the highest poverty levels (high: mean = 74.5, 95% CI = 73.7, 75.3; middle: mean = 78.9, 95% CI = 78.0, 79.8; and low: mean = 78.3, 95% CI = 77.4, 79.1).

Conclusions: The health of US adolescents during the COVID-19-related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation, and level of poverty. Health policy experts should consider these findings in the future when creating and implementing policies to improve the health of adolescents in the United States.
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http://dx.doi.org/10.4085/1062-6050-0478.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863599PMC
January 2021

The Health Of Us Adolescent Athletes During Covid-19 Related School Closures And Sport Cancellations.

J Athl Train 2020 Nov 5. Epub 2020 Nov 5.

*University of Wisconsin-Madison.

Context: In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of COVID-19. It is critical to understand the mental and physical health of adolescent athletes during this time.

Objective: Describe the health of athletes during COVID-19 related school closures and sport cancellations.

Design: Cross sectional.

Setting: A national sample recruited via social media.

Patients Or Other Participants: 13,002 US adolescent athletes (age=16.3+1.2 yrs., female=53.1%) completed an anonymous online survey.

Main Outcome Measure(s): Demographic information included: sex, grade, sports played and zip code. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. Mental health, physical activity and quality of life variables were compared between sex, grade, sports played and poverty level using means and 95%CI from the survey weighted ANOVA.

Results: Females reported a higher prevalence of moderate to severe anxiety symptoms (females=43.7% vs. males=28.2%). The PFABS score (mean [95%CI] was highest (best) for grade 9 (14.5 [14.0,15.0]) and lowest for grade 11 (10.9 [10.5,11.3]. The prevalence of depression symptoms was highest in team sport (74.1%) and lowest for individual sport participants (64.9%). The total PedsQL score was lowest (worst) for athletes from counties with the highest poverty levels (high=74.5[73.7,75.3], middle=78.9[78.0,79.8], low=78.3 [77.4,79.1]).

Conclusions: The health of US adolescents during the COVID-19 related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation and level of poverty. Health policy experts should consider these findings when creating and implementing policies to improve the health of adolescents in the US in the future.
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http://dx.doi.org/10.4085/478-20DOI Listing
November 2020

Training Load and Injury Among Middle School-Aged Athletes.

J Athl Train 2020 Sep;55(9):954-959

Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison.

Context: Young athletes are encouraged to participate in high-intensity sport programs. However, most research on the association between training volume (TV) and injury has been performed on adult or professional athletes.

Objective: To evaluate the association between acute and chronic TV (hours/week) and reported injury (yes/no) and evaluate the relationship between acute : chronic TV and injury while controlling for sex, age, and prior injury in young athletes.

Design: Cohort study.

Setting: Online surveys.

Patients Or Other Participants: Middle school-aged adolescents.

Main Outcome Measure(s): We conducted a baseline survey at the start of the 2017-2018 academic year. The baseline survey solicited information regarding demographics, injury history, and primary sport. Subsequent surveys were delivered electronically at the start of each week. Information obtained with the weekly survey included weekly TV and injuries sustained the previous week. Injuries were reported and classified (eg, acute or gradual onset) by the participants. Weekly TV was aggregated as rolling averages over the prior 2, 3, and 4 weeks. Acute:chronic TV was calculated for each participant for every week as the prior week TV divided by the TV during the prior 2 (1 : 2), 3 (1 : 3), and 4 (1 : 4) weeks of the study period.

Results: A total of 244 recruits participated. Higher average TV over the prior 4 weeks (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.93, 1.00; P = .05) was associated with fewer reported injuries. Additionally, higher average TV over the prior 2 (OR = 0.96; 95% CI = 0.93, 0.99; P = .04), 3 (OR = 0.95; 95% CI = 0.91, 0.99; P = .02), and 4 (OR = 0.95; 95% CI = 0.91, 0.99; P = .05) weeks was associated with fewer reported acute injuries the following week. Acute:chronic TV and any injury type were not related.

Conclusions: Consistent, higher levels of physical activity may offer protection against acute injury in young athletes.
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http://dx.doi.org/10.4085/1062-6050-435-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534934PMC
September 2020

Blunted cardiac output response to exercise in adolescents born preterm.

Eur J Appl Physiol 2020 Nov 30;120(11):2547-2554. Epub 2020 Aug 30.

Department of Pediatrics, University of Wisconsin-Madison, Madison, USA.

Purpose: Premature birth is associated with lasting effects, including lower exercise capacity and pulmonary function, and is acknowledged as a risk factor for cardiovascular disease. The aim was to evaluate factors affecting exercise capacity in adolescents born preterm, including the cardiovascular and pulmonary responses to exercise, activity level and strength.

Methods: 21 preterm-born and 20 term-born adolescents (age 12-14 years) underwent strength and maximal exercise testing with thoracic bioimpedance monitoring. Baseline variables were compared between groups and ANCOVA was used to compare heart rate, cardiac output (Q) and stroke volume (SV) during exercise between groups while adjusting for body surface area.

Results: Preterm-borns had lower maximal aerobic capacity than term-borns (2.0 ± 0.5 vs. 2.5 ± 0.5 L/min, p = 0.01) and lower maximal power (124 ± 26 vs. 153 ± 33 watts, p < 0.01), despite similar physical activity scores. Pulmonary function and muscular strength did not differ significantly. Although baseline Q and SV did not differ between groups, preterm adolescents had significantly lower cardiac index (Qi) at 50, 75 and 100% of maximal time to exhaustion, driven by SV volume index (SVi, 50% max time: 53.0 ± 9.0 vs. 61.6 ± 11.4; 75%: 51.7 ± 8.4 vs. 64.3 ± 11.1; 100%: 51.2 ± 9.3 vs. 64.3 ± 11.5 ml/m, all p < 0.01), with similar heart rates.

Conclusion: Otherwise healthy and physically active adolescents born very preterm exhibit lower exercise capacity than term-born adolescents. Despite similar baseline cardiovascular values, preterm-born adolescents demonstrate significantly reduced Qi and SVi during incremental and maximal exercise.
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http://dx.doi.org/10.1007/s00421-020-04480-9DOI Listing
November 2020

Sport specialization and sport participation opportunities and their association with injury history in female high school volleyball athletes.

Phys Ther Sport 2020 Sep 12;45:86-92. Epub 2020 Jul 12.

Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, Madison, WI, United States.

Objective: Determine the association of sport specialization in female volleyball athletes with previous injury history and determine the association of sport specialization with volleyball participation opportunities.

Design: Cross-sectional.

Setting: Recruitment occurred from 83 Wisconsin high schools during the 2018 volleyball season.

Participants: Female volleyball athletes (N = 1,588, grades 9-12, age = 15.6 ± 1.1 years).

Main Outcomes: Participants completed a pre-season questionnaire soliciting information regarding 1) demographics, 2) sport specialization, 3) sport participation, and 4) sport-related injuries in the previous 12 months. Univariable logistic regression models were used to identify associations with previous injury. Chi-square analyses were used to investigate associations between sport specialization classification and other sport participation opportunities.

Results: Both moderately and highly specialized athletes were more likely to report a previous injury compared to low specialized athletes (moderate OR: 1.84 [1.29-2.62]; p < 0.001 and high OR: 2.30 [1.64-3.24]; p < 0.001). Highly specialized athletes were more likely to report participating in club volleyball, summer tournaments, and training camps in the past 12 months. Participants who reported participating in club volleyball, summer competitions, and training camps last year were more likely to report an injury.

Conclusions: Specialization was associated with injury history and year-round volleyball opportunities among female adolescent volleyball athletes.
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http://dx.doi.org/10.1016/j.ptsp.2020.06.005DOI Listing
September 2020

Association Between Preterm Birth and Arrested Cardiac Growth in Adolescents and Young Adults.

JAMA Cardiol 2020 Aug;5(8):910-919

Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.

Importance: Premature birth is associated with substantially higher lifetime risk for cardiovascular disease, including arrhythmia, ischemic disease, and heart failure, although the underlying mechanisms are poorly understood.

Objective: To characterize cardiac structure and function in adolescents and young adults born preterm using cardiac magnetic resonance imaging (MRI).

Design, Setting, And Participants: This cross-sectional cohort study at an academic medical center included adolescents and young adults born moderately to extremely premature (20 in the adolescent cohort born from 2003 to 2004 and 38 in the young adult cohort born in the 1980s and 1990s) and 52 age-matched participants who were born at term and underwent cardiac MRI. The dates of analysis were February 2016 to October 2019.

Exposures: Premature birth (gestational age ≤32 weeks) or birth weight less than 1500 g.

Main Outcomes And Measures: Main study outcomes included MRI measures of biventricular volume, mass, and strain.

Results: Of 40 adolescents (24 [60%] girls), the mean (SD) age of participants in the term and preterm groups was 13.3 (0.7) years and 13.0 (0.7) years, respectively. Of 70 adults (43 [61%] women), the mean (SD) age of participants in the term and preterm groups was 25.4 (2.9) years and 26.5 (3.5) years, respectively. Participants from both age cohorts who were born prematurely had statistically significantly smaller biventricular cardiac chamber size compared with participants in the term group: the mean (SD) left ventricular end-diastolic volume index was 72 (7) vs 80 (9) and 80 (10) vs 92 (15) mL/m2 for adolescents and adults in the preterm group compared with age-matched participants in the term group, respectively (P < .001), and the mean (SD) left ventricular end-systolic volume index was 30 (4) vs 34 (6) and 32 (7) vs 38 (8) mL/m2, respectively (P < .001). Stroke volume index was also reduced in adolescent vs adult participants in the preterm group vs age-matched participants in the term group, with a mean (SD) of 42 (7) vs 46 (7) and 48 (7) vs 54 (9) mL/m2, respectively (P < .001), although biventricular ejection fractions were preserved. Biventricular mass was statistically significantly lower in adolescents and adults born preterm: the mean (SD) left ventricular mass index was 39.6 (5.9) vs 44.4 (7.5) and 40.7 (7.3) vs 49.8 (14.0), respectively (P < .001). Cardiac strain analyses demonstrated a hypercontractile heart, primarily in the right ventricle, in adults born prematurely.

Conclusions And Relevance: In this cross-sectional study, adolescents and young adults born prematurely had statistically significantly smaller biventricular cardiac chamber size and decreased cardiac mass. Although function was preserved in both age groups, these morphologic differences may be associated with elevated lifetime cardiovascular disease risk after premature birth.
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http://dx.doi.org/10.1001/jamacardio.2020.1511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240643PMC
August 2020

Sport-Specific Associations of Specialization and Sex With Overuse Injury in Youth Athletes.

Sports Health 2020 Jan/Feb;12(1):36-42. Epub 2019 Nov 14.

Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin.

Background: Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport.

Hypotheses: Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport.

Study Design: Cross-sectional study.

Level Of Evidence: Level 3.

Methods: Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year.

Results: A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; < 0.05) were associated with overuse injury only among volleyball athletes.

Conclusion: Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization.

Clinical Relevance: Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.
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http://dx.doi.org/10.1177/1941738119886855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931179PMC
January 2020

A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches.

J Athl Train 2019 Oct;54(10):1074-1082

Department of Kinesiology, University of Wisconsin-Madison.

Context: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown.

Objective: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams.

Design: Cross-sectional survey.

Setting: Online questionnaire.

Patients Or Other Participants: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training.

Main Outcome Measure(s): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid).

Results: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, < .001) and competitions (57.9% versus 31.2%, < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training ( < .001).

Conclusions: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.
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http://dx.doi.org/10.4085/1062-6050-207-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805070PMC
October 2019

A Comparison of Team Sport Volume Surveyed Between High School and Club Sport Coaches.

Orthop J Sports Med 2019 Apr 8;7(4):2325967119836484. Epub 2019 Apr 8.

Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Background: Club sport participation is increasingly common among high school athletes. Sport participation characteristics may vary widely between the high school and club sport settings. However, there have been no large-scale comparisons of sport participation volume between high school and club teams from similar sports.

Purpose/hypothesis: The purpose of this study was to compare the sport participation characteristics of high school and high school-aged club teams. We hypothesized that club team athletes would participate in more months per year and hours per week and would take more overnight trips than high school athletes and that club team coaches would be less likely to track their athletes' sport volume than high school coaches.

Study Design: Cross-sectional study.

Methods: A total of 769 coaches (266 female; 34.6%) from 3 sports (basketball, volleyball, soccer) completed an anonymous online questionnaire regarding their team's sport volume and their knowledge, attitudes, and beliefs regarding sport specialization. Coaches were eligible to participate if they had served as the head or assistant coach of a high school sport team or high school-aged club sport team in the past 12 months.

Results: Overall, 64.6% (n = 497) were coaches of a high school team, and 35.4% (n = 272) were coaches of a club team with high school-aged athletes. Club coaches' teams played more months out of the year and took more overnight trips for competitions than high school coaches' teams but participated in fewer hours per week of practices or competitions during their season. There were no differences between club and high school coaches in tracking their athletes' sport volume, with most coaches in both settings reporting that they do not track the amount of time that their athletes participate in other sports.

Conclusion: Significant differences in sport participation volume exist between the teams of high school and club coaches.
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http://dx.doi.org/10.1177/2325967119836484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454658PMC
April 2019

Heart rate recovery after maximal exercise is impaired in healthy young adults born preterm.

Eur J Appl Physiol 2019 Apr 11;119(4):857-866. Epub 2019 Jan 11.

Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.

Purpose: The long-term implications of premature birth on autonomic nervous system (ANS) function are unclear. Heart rate recovery (HRR) following maximal exercise is a simple tool to evaluate ANS function and is a strong predictor of cardiovascular disease. Our objective was to determine whether HRR is impaired in young adults born preterm (PYA).

Methods: Individuals born between 1989 and 1991 were recruited from the Newborn Lung Project, a prospectively followed cohort of subjects born preterm weighing < 1500 g with an average gestational age of 28 weeks. Age-matched term-born controls were recruited from the local population. HRR was measured for 2 min following maximal exercise testing on an upright cycle ergometer in normoxia and hypoxia, and maximal aerobic capacity (VO) was measured.

Results: Preterms had lower VO than controls (34.88 ± 5.24 v 46.15 ± 10.21 ml/kg/min, respectively, p < 0.05), and exhibited slower HRR compared to controls after 1 and 2 min of recovery in normoxia (absolute drop of 20 ± 4 v 31 ± 10 and 41 ± 7 v 54 ± 11 beats per minute (bpm), respectively, p < 0.01) and hypoxia (19 ± 5 v 26 ± 8 and 39 ± 7 v 49 ± 13 bpm, respectively, p < 0.05). After adjusting for VO, HRR remained slower in preterms at 1 and 2 min of recovery in normoxia (21 ± 2 v 30 ± 2 and 42 ± 3 v 52 ± 3 bpm, respectively, p < 0.05), but not hypoxia (19 ± 3 v 25 ± 2 and 40 ± 4 v 47 ± 3 bpm, respectively, p > 0.05).

Conclusions: Autonomic dysfunction as seen in this study has been associated with increased rates of cardiovascular disease in non-preterm populations, suggesting further study of the mechanisms of autonomic dysfunction after preterm birth.
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http://dx.doi.org/10.1007/s00421-019-04075-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100254PMC
April 2019

Early Pulmonary Vascular Disease in Young Adults Born Preterm.

Am J Respir Crit Care Med 2018 12;198(12):1549-1558

Department of Pediatrics.

Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature. Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics. Preterm subjects ( = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (≤1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects ( = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress. Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP ≥ 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure. Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.
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http://dx.doi.org/10.1164/rccm.201710-2016OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298636PMC
December 2018

Socioeconomic status of parents with children participating on youth club sport teams.

Phys Ther Sport 2018 Jul 17;32:126-132. Epub 2018 May 17.

Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA; Wisconsin Injury in Sport Laboratory, University of Wisconsin - Madison, Madison, WI, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, Madison, WI, USA.

Objectives: To describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams.

Design: Cross-sectional survey.

Setting: Local sport events.

Participants: 949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire.

Main Outcome Measures: SES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization.

Results: Parents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport.

Conclusion: The current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system.
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http://dx.doi.org/10.1016/j.ptsp.2018.05.014DOI Listing
July 2018

Knowledge, Attitudes, and Beliefs of Youth Club Athletes Toward Sport Specialization and Sport Participation.

Orthop J Sports Med 2018 May 4;6(5):2325967118769836. Epub 2018 May 4.

Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Background: There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation.

Purpose: The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs.

Results: Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either "quite a bit" or "a great deal." However, 91% of athletes believed that specialization increased their chances of getting better at their sport either "quite a bit" or "a great deal." Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either "quite a bit" or "a great deal." Overall, 15.7% of athletes believed that they were either "very" or "extremely" likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ = 18.8; = .001).

Conclusion: Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship.
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http://dx.doi.org/10.1177/2325967118769836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946645PMC
May 2018

Impaired autonomic function in adolescents born preterm.

Physiol Rep 2018 03;6(6):e13620

Department of Pediatrics, University of Wisconsin, Madison, Wisconsin.

Preterm birth temporarily disrupts autonomic nervous system (ANS) development, and the long-term impacts of disrupted fetal development are unclear in children. Abnormal cardiac ANS function is associated with worse health outcomes, and has been identified as a risk factor for cardiovascular disease. We used heart rate variability (HRV) in the time domain (standard deviation of RR intervals, SDRR; and root means squared of successive differences, RMSSD) and frequency domain (high frequency, HF; and low frequency, LF) at rest, as well as heart rate recovery (HRR) following maximal exercise, to assess autonomic function in adolescent children born preterm. Adolescents born preterm (less than 36 weeks gestation at birth) in 2003 and 2004 and healthy age-matched full-term controls participated. Wilcoxon Rank Sum tests were used to compare variables between control and preterm groups. Twenty-one adolescents born preterm and 20 term-born controls enrolled in the study. Preterm-born subjects had lower time-domain HRV, including SDRR (69.1 ± 33.8 vs. 110.1 ± 33.0 msec, respectively, P = 0.008) and RMSSD (58.8 ± 38.2 vs. 101.5 ± 36.2 msec, respectively, P = 0.012), with higher LF variability in preterm subjects. HRR after maximal exercise was slower in preterm-born subjects at 1 min (30 ± 12 vs. 39 ± 9 bpm, respectively, P = 0.013) and 2 min (52 ± 10 vs. 60 ± 10 bpm, respectively, P = 0.016). This study is the first report of autonomic dysfunction in adolescents born premature. Given prior association of impaired HRV with adult cardiovascular disease, additional investigations into the mechanisms of autonomic dysfunction in this population are warranted.
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http://dx.doi.org/10.14814/phy2.13620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875539PMC
March 2018

Knowledge, Attitudes, and Beliefs of Youth Sports Coaches Regarding Sport Volume Recommendations and Sport Specialization.

J Strength Cond Res 2020 Oct;34(10):2911-2919

Department of Kinesiology, University of Wisconsin, Madison, Madison, Wisconsin.

Post, EG, Trigsted, SM, Schaefer, DA, Cadmus-Bertram, LA, Watson, AM, McGuine, TA, Brooks, MA, and Bell, DR. Knowledge, attitudes, and beliefs of youth sports coaches regarding sport volume recommendations and sport specialization. J Strength Cond Res 34(10): 2911-2919, 2020-Overuse injuries in youth athletes are becoming increasingly common, which may be a result of the prevalence of year-round specialized sport participation. Previous research has identified sport volume recommendations related to months per year, hours per week, and simultaneous participation in multiple sports leagues. Coaches are a primary influence on a youth athlete's decision to specialize in a single sport. Therefore, identifying coaches' baseline beliefs and perceptions is important for developing strategies to educate coaches about safe sport participation. A total of 253 youth sport coaches (207 males) completed an anonymous online questionnaire regarding knowledge of sport volume recommendations and attitudes and beliefs regarding sport specialization. Eligible participants were required to serve as a head or assistant coach of a youth sport team in the past 12 months whose members were between the ages of 12 and 18 years. Most coaches were unaware of recommendations regarding the maximum number of months per year (79.4%), hours per week in 1 sport (79.3%), or number of simultaneous leagues for an athlete to participate in to reduce injury (77.6%). Fewer than half (43.2%) of all coaches were "very" or "extremely" concerned about the risk of injury in youth sports. A majority (60.1%) believed that sport specialization was either "quite a bit" or "a great deal" of a problem. Two-thirds (67.2%) responded that year-round participation in a single sport was either "very" or "extremely" likely to increase an athlete's risk of injury. Although the responses to this survey were predominantly from coaches from 1 state, our results suggest that coaches are unaware of sport volume recommendations but are concerned about specialization. Future efforts are needed to communicate these recommendations to coaches to reduce the risk of overuse injury in youth sports.
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http://dx.doi.org/10.1519/JSC.0000000000002529DOI Listing
October 2020

In-season changes in ventricular morphology and systolic function in adolescent female athletes.

Eur J Sport Sci 2018 May 12;18(4):534-540. Epub 2018 Feb 12.

c Department of Biology , University of Wisconsin , Madison , WI , USA.

Purpose: To evaluate the influence of physical maturity on the changes in ventricular morphology and function with sport training in female youth athletes.

Methods: Thirty-two female athletes (age 13-18 years) underwent height and weight measurement and 2-D echocardiographic evaluation immediately prior to, and following, a 20-week soccer season. Pre- and post-season left ventricular end-diastolic diameter (LVEDD), end-diastolic volume (LVEDV), ejection fraction (LVEF), stroke volume (LVSV), mass (LVM), and posterior wall thickness (LVPWT), right ventricular end-diastolic diameter (RVEDD), end-diastolic area (RVEDA), and fractional area change (RVFAC), and interventricular septal thickness (IVST) were compared. In-season change in each variable was compared across pre-season hours of vigorous physical activity (0-1, 2-3, >3 hours).

Results: Significant increases were identified in LVEDV (51.3 ± 10.4 v 56.4 ± 9.6 ml/m, p = 0.001) and RVEDA (10.5 ± 1.9 v 11.3 ± 2.5 cm/m, p = 0.040), but not LVEDD, LVM, LVPWT, LVSV, RVEDD, RVEDA, RVFAC, or IVST (p > 0.05 for all). In-season changes in echocardiographic variables did not differ across hours of pre-season vigorous physical activity (p > 0.05 for all).

Conclusion: Among female adolescent soccer players, in-season training elicits changes in resting ventricular volume, but not wall thickness or systolic function. These adaptations do not appear to be influenced by pre-season physical activity level.
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http://dx.doi.org/10.1080/17461391.2018.1435725DOI Listing
May 2018

Sport Specialization Characteristics Between Rural and Suburban High School Athletes.

Orthop J Sports Med 2018 Jan 19;6(1):2325967117751386. Epub 2018 Jan 19.

Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA.

Background: Sport specialization has been associated with overuse injuries and is more common in larger high schools, which are often located in more urban/suburban settings. However, sport participation characteristics have not been compared between suburban and rural high schools.

Purpose/hypothesis: The purpose of this study was to examine the differences in sport participation characteristics between athletes at suburban and rural high schools. It was hypothesized that suburban high school students would be more likely to be highly specialized, participate in more athletic competitions per year, and play in a league outside of school. We also hypothesized that suburban high school students would start playing their primary sport at a younger age, would have participated in their primary sport for longer, and would play more months per year and hours per week.

Study Design: Cross-sectional study.

Methods: High school athletes from 4 high schools (2 suburban and 2 rural) participated in this study (N = 354 [222 females]; mean age, 15.7 ± 1.2 years). Athletes were on a school-sponsored athletic team in 1 of 4 sports (volleyball, tennis, basketball, soccer). The suburban schools (study enrollment, n = 226) had total school enrollments of 2271 and 622 students, while the rural schools (study enrollment, n = 128) had total school enrollments of 443 and 297. Participants completed a questionnaire prior to the start of their high school sport season. The questionnaire consisted of demographic information, a sport specialization scale, and sport participation information. Primary sport competition volume in the previous 12 months was classified as high (>60 primary sport competitions), moderate (30-60), or low (<30). Sport specialization status was classified via a 3-point scale as low, moderate, or high.

Results: As compared with athletes at rural schools, athletes at suburban schools started playing their primary sport at a younger age (suburban, 7.8 ± 2.9 years; rural, 9.7 ± 3.2 years; < .001) and participated for more years (suburban, 7.9 ± 3.1 years; rural, 6.1 ± 3.3 years; < .001), more months per year (suburban, 7.6 ± 3.6 months; rural, 5.6 ± 2.8 months; < .001), and more hours per week (suburban, 15.2 ± 5.1 hours; rural, 12.9 ± 3.3 hours; < .001). Athletes at suburban schools were more likely than rural athletes to be classified as highly specialized (χ = 52.5, < .001), participate in more competitions (χ = 16.5, < .001), play in a league outside of school (χ = 18.4, < .001), and train in their primary sport for >8 months per year (χ = 27.8, < .001) and >16 hours per week (χ = 15.0, < .001).

Conclusion: High school athletes at suburban schools are more likely to exhibit sport participation patterns that are associated with increased risk of overuse injury. These include being classified as highly specialized, playing their primary sport >8 months per year and >16 hours per week, engaging in a high competition volume, and participating in a sport league (eg, club) outside of school. Efforts aimed at safe sport participation should target these groups, as they seem more likely to violate safe sport recommendations.
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http://dx.doi.org/10.1177/2325967117751386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777568PMC
January 2018

Sleep and Athletic Performance.

Authors:
Andrew M Watson

Curr Sports Med Rep 2017 Nov/Dec;16(6):413-418

Division of Sports Medicine, Department of Orthopedics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Sleep is an essential component of health and well-being, with significant impacts on physical development, emotional regulation, cognitive performance, and quality of life. Along with being an integral part of the recovery and adaptive process between bouts of exercise, accumulating evidence suggests that increased sleep duration and improved sleep quality in athletes are associated with improved performance and competitive success. In addition, better sleep may reduce the risk of both injury and illness in athletes, not only optimizing health but also potentially enhancing performance through increased participation in training. Despite this, most studies have found that athletes fail to obtain the recommended amount of sleep, threatening both performance and health. Athletes face a number of obstacles that can reduce the likelihood of obtaining proper sleep, such as training and competition schedules, travel, stress, academic demands, and overtraining. In addition, athletes have been found to demonstrate poor self-assessment of their sleep duration and quality. In light of this, athletes may require more careful monitoring and intervention to identify individuals at risk and promote proper sleep to improve both performance and overall health. This review attempts to highlight the recent literature regarding sleep issues in athletes, the effects of sleep on athletic performance, and interventions to enhance proper sleep in athletes.
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http://dx.doi.org/10.1249/JSR.0000000000000418DOI Listing
March 2018

Short-Term Heart Rate Recovery is Related to Aerobic Fitness in Elite Intermittent Sport Athletes.

J Strength Cond Res 2017 Apr;31(4):1055-1061

Departments of 1Pediatrics; and 2Orthopedics, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; Departments of 3Kinesiology; and 4Athletics, University of Wisconsin, Madison, Wisconsin.

Watson, AM, Brickson, SL, Prawda, ER, and Sanfilippo, JL. Short-term heart rate recovery is related to aerobic fitness in elite intermittent sport athletes. J Strength Cond Res 31(4): 1055-1061, 2017-Although heart rate recovery (HRR) has been suggested as a measure of fitness, minimal data exist among athletes. The purpose of this study was to determine if HRR is related to aerobic fitness in elite athletes and whether this relationship is influenced by sex or body composition. Eighty-four collegiate athletes (45 male athletes) underwent body fat percentage (BF%) determination by dual-energy x-ray absorptiometry and maximal treadmill testing followed by 5 minutes of recovery. V[Combining Dot Above]O2max and heart rate (HRmax) were determined, and HRR was calculated as a percentage of HRmax at 10 seconds, 30 seconds, and 1, 2, 3, 4, and 5 minutes after test completion. After stratifying by sex, participants were grouped as high fit or low fit based on V[Combining Dot Above]O2max median split. Heart rate recovery was compared between sexes and fitness level at each time point. Multivariable regression analysis was used to identify independent predictors of HRR using V[Combining Dot Above]O2max, BF%, and sex as covariates. Heart rate recovery did not differ significantly between sexes and was faster among high-fit participants at 10 and 30 seconds, but at no other time. V[Combining Dot Above]O2max was significantly correlated with HRR at 10 and 30 seconds (r = -0.34, p < 0.001 and r = -0.28, p = 0.008) only. After controlling for BF% and sex, V[Combining Dot Above]O2max remained significantly associated with HRR at 10 seconds (p = 0.007) but not at 30 seconds (p = 0.067) or any time thereafter. Aerobic capacity is related to faster HRR during the first 30 seconds only, suggesting that only very short term HRR should be used as a measure of aerobic fitness in intermittent sport athletes.
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http://dx.doi.org/10.1519/JSC.0000000000001567DOI Listing
April 2017
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