Sport Health Volume 41 Issue 3

Sport

health

FEATURING

• Advancing health outcomes for LGBTIQ+ people through tennis

• The people behind the growth of Sports Medicine Australia

• When is the best time to take your iron supplement?

Contents

REGULARS

02

From the Chair

SMA Board Chair, Kay Copeland, reflects on the growth and evolution of SMA over the past 60 years.

FEATURES 04

The People Behind the Growth of Sports Medicine Australia

To commemorate SMA’s 60th Anniversary, we invited four past presidents to share their reflections on the evolution of SMA.

03

From the CEO Jamie Crain welcomes a new major partnership for SMA and recaps this edition’s feature articles.

12

ACL injury risk in women’s football: Evaluating Clinical Assumptions

Dr Tyler Collings and Dr Matthew Bourne examine common clinical assumptions regarding ACL injuries in female footballers.

10

Evolution of Footwear Stability Technology

Major partner ASICS examine the improved stability technology for their new GEL-KAYANO™ 30 shoe.

Opinions expressed throughout the magazine are the contributors’ own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of goods or services advertised. All materials copyright. On acceptance of an article for publication, copyright passes to the publisher.

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Content photographs

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16

How Tennis is being used to advance health and wellbeing outcomes for LGBTIQ+ people in Australia

Dr Ryan Storr presents his research on the impacts of tennis on the health and wellbeing of LGBTIQ+ Australians.

22

2023 ASICS SMA Conference

We preview session highlights and the program snapshot for this year’s ASICS SMA Conference.

INTERVIEWS

34

5 Mins With: Dr Steve Reid

24

When is the best time to take your iron supplement?

Dr Alannah McKay shares her assessment of factors influencing iron supplement absorption in athletes.

38

People Who Shaped SMA: Dr Peter Harcourt

41

Sports Medicine Around the World: Latvia

29

Optimising the Power of Physical Activity for Mental Health

Dr David Lubans and colleagues provide recommendations for how to best use physical activity guidelines for mental health promotion.

44

Sports Trainer Highlight: Gabby Curran

FROM THE CHAIR

Reflecting on 60 years of SMA and looking forward to the Conference.

WHAT TO LOOK FORWARD TO AT THIS YEAR’S ASICS SMA CONFERENCE.

Welcome to the third edition of Sport Health for 2023.

As we celebrate SMA’s 60 years and enjoy the reflections of some of our Past Presidents, I myself remember joining SMA in 1985 and beginning as a committee member of the SMA Victorian Branch Sports Trainers Committee. From this early start I have now been involved for 38 years and fortunate enough to have been in many roles. I think some of the interesting conversations we will have at the 2023 Conference is where and how did you get involved in SMA – as you each have a fascinating story to tell.

The 2023 ASICS SMA Conference is just around the corner, and we are very excited to welcome our SMA Members to learn from, and network with, some of the brightest minds in sports medicine. We have prepared a sensational line-up of speakers across the event, consisting of leading figures from across the disciplines in sports and exercise science and medicine.

In particular, we look forward to welcoming our esteemed Refshauge Lecturer, Dr Rodney Whitely, who is the Assistant Director of the Rehabilitation Department at Aspetar Sports Medicine Hospital in Qatar. In his presentation, Dr Whiteley will be reflecting on the current state of the sports medicine profession and providing insights into future directions for the industry.

As part of the Conference, our new Fellows will be announced at the ASMF

Fellows Dinner. I would like to thank all those who have submitted their application for an ASMF Fellowship and look forward to welcoming our successful applicants into the Fellows community. The Fellows are the preeminent member group within SMA, who provide expert guidance on all topics related to sports medicine and promote excellence in the field.

SMA’s Research Foundation Grants are back with support from Mainstay Medical. Thank you to all our emerging postgraduate researchers who have applied for the grants. We can’t wait to reveal the successful recipients at this year’s ASICS SMA Conference.

In addition, the SMA ACT Research Award applications were opened in August. We have received a number of high-quality submissions and we are excited to announce the winners later this year.

Dr Kay Copeland

I think some of the interesting conversations we will have at the 2023 Conference is where and how did you get involved in SMA.

DR KAY COPELAND, CHAIR OF THE BOARD OF DIRECTORS (SMA), OUTLINES

FROM THE CEO

A packed schedule leading up to the 2023 ASICS SMA Conference.

the active lifestyles of Australians and improve health outcomes through knowledge, training, and participation in sport and exercise.

Welcome to the latest edition of Sport Health.

It has been an excellent few months for Australian sport on the global stage, with the Diamonds regaining the Netball World Cup title, the Men’s and Women’s Cricket teams retaining their respective Ashes trophies, and the Matildas achieving their most successful result ever at the FIFA Women’s World Cup. The Dolphins have also scored their bestever results at the World Aquatics Championships and their best results in over a decade at the Para Swimming World Championships.

There are still many exciting international sporting opportunities to come this year, with the Rugby World Cup and ICC Men’s Cricket World Cup. At SMA, we are proud to be continually supporting athletes at the elite, amateur, and recreational level through our many multidisciplinary members and their tireless efforts. We are also pleased to again partner with UniSport as the exclusive provider of sports trainer services at the upcoming

SMA has recently announced our new partnership with Mentholatum. This partnership will see Mentholatum become a supporting partner of our Safer Sport Program.

UniSport Nationals on the Gold Coast thanks to our wonderful network of Level 1 and 2 Sports Trainers.

SMA has recently announced our new partnership with Mentholatum. This partnership will see Mentholatum become a supporting partner of our Safer Sport Program. With Mentholatum’s pursuit to Make People’s Lives Healthier and Happier, we believe this partnership aligns with our goal to support

The impact of sport and physical activity on mental health and wellbeing are ever important. In this edition of Sport Health, Dr David Lubans and colleagues outline their recommendations to bridge the gap between physical activity guidelines and mental health promotion. Dr Ryan Storr also assesses the positive impacts of tennis on LGBTIQ+ people’s health and wellbeing.

Supporting athlete performance is also a key focus for SMA. Dr Alannah McKay discusses the various factors that influence the effectiveness of iron supplements, whilst Dr Tyler Collings and Dr Matthew Bourne evaluate clinical assumptions of ACL injuries in female footballers.

Our preparations for the 2023 ASICS SMA Conference are almost complete, and our finishing touches are underway. Tickets are still on sale, and we can’t wait to see you on the Sunshine Coast this October!

Jamie Crain jamie.crain@sma.org.au

A BUSY CALENDAR PROVIDES OUR MANY MULTIDISCIPLINARY MEMBERS THE CHANCE TO LEARN AND SUPPORT ATHLETES FROM GRASSROOTS TO ELITE LEVELS.

The People Behind the Growth of Sports Medicine Australia

Reflections from Past Presidents

THIS YEAR MARKS SMA’S 60TH ANNIVERSARY, AND THERE’S MUCH TO CELEBRATE. IN RECOGNITION OF THIS MILESTONE, WE HAVE BEEN SHARING A SERIES OF COMMEMORATIVE ARTICLES IN SPORT HEALTH. IN THIS EDITION, WE INVITED FOUR FORMER SMA PRESIDENTS TO SHARE THEIR THOUGHTS AND PERSPECTIVES ON THE EVOLUTION OF SMA OVER THE PAST 60 YEARS.

Emeritus Professor Tony Parker

AM: SMA President 1987-1988

I have worked throughout my career to develop and enhance the status of sports medicine (SM) and exercise and sports science (E&SS) in Australia and internationally as an academic, researcher and author and through major executive and advisory roles with professional organisations.

Starting in 1976, I became an active member of the Australian Sports Medicine Federation (ASMF) and joined the Queensland Board of the organisation in 1977. During this period, I made a significant contribution to SM in Queensland in relation to professional and community education activities and initial development of the Australian Sports Trainers Scheme. I represented Queensland in meetings of the National body and in 1982 was elected to the National Board of Directors of ASMF. I became inaugural Treasurer, Vice President (1986), President (1987-1988), and leader Order of Fellows (1986-1990).

At this time ASMF was represented by a limited number of independent

state branches forming their own activities such as scientific committees, lecture programs, and liaison with other state sporting groups.

Although a national body was finally established, some groups, unlike the medical and physiotherapy members, did not have a professional body to represent their professional interests. During my Presidency of ASMF, there was increasing awareness

of the limitations of an umbrella organisation such as ASMF in providing independent professional recognition for exercise and sports scientists.

This changed over time with the formation of AAESS in 1991 and Sport and ACSP developing clear role definitions, and increased status and recognition. I was elected President of AAESS, at the inaugural AGM held at the ASMF Conference in Perth

SMA CEO Jamie Crain alongside former President Prof Tony Parker at the 2022 SMA Conference.

(1992), a position I held until 1999. During this period, I contributed to:

ٚ Implementation of accreditation procedures for individual members,

ٚ Development of procedures for the formal professional accreditation of university programs in exercise and sports science.

A significant inaugural visit to China in 1984 by myself as Vice-President and President Bill Webb led to establishment of links with China during the ongoing development of the Chinese Sports Medicine Society. This initial visit was followed by an invitation to speak at the first International Conference in Sports Medicine held in Beijing in 1985 attended by representatives from different countries. As Chair of the Scientific Committee, I invited Chinese leaders and delegates to attend the 1986 FIMS World Congress, hosted by SMA, and held in Brisbane. This contributed to forming a longer-term relationship with China, the Asian Federation of Sports Medicine and FIMS.

ASMF continued to liaise and work together with members of the Chinese Sports Science Society (CSSS), the Chinese Sports Medicine Association (CSMA) and similar organizations in Hong Kong.

A major personal goal held for many years is to encourage the organisations in which I have been involved, both nationally and internationally, to share information. This was achieved by providing publications, research collaborations and leadership as chair of major national and international conferences.

Major events in which SMA was involved included hosting of the 2000 Pre-Olympic in Brisbane, and the International Convention on Education, Medicine and Science in Sport associated with the 2008 Beijing Olympic and Paralympic Olympic Games. I was invited to chair the international consultancy committee for the Convention which involved collaboration between the IOC, the International Paralympic Committee, ICSSPE, FIMS, and international member organisations.

I am most grateful for the support, friendship and engagements with leaders and members of sports medicine organisations nationally and internationally. Sports Medicine and Exercise and Sports Science face a very challenging future, and it is important to continue our multidisciplinary and holistic approach to provide innovative, evidence-based solutions and strategies to address new and emerging issues recognising the diversity in the sporting community.

Dr Peter Larkins: SMA

President 1994 – 1997

Sports Medicine Australia (SMA) has been a major influence in my professional life, especially during my early days in medical practice. As an enthusiastic medical student in the 1970s, there really was no opportunity to advance knowledge in the sports medicine field through any other organization – SMA (or The Australian Sports Medicine Federation, ASMF) was the leader.

In 1974 I was very fortunate to be invited to the FIMS World Congress in Sports Medicine which was held at Melbourne University. One of my mentors, Dr. Howard Toyne, was attending and I went along as a wide-eyed medical student and came away with more enthusiasm than ever. I joined ASMF as a student member as a result and am now in my 49th year as a member.

As many of you may be aware, ASMF had its’ beginnings in the lead up to the 1956 Melbourne Olympic Games when a group of enthusiastic practitioners met in Carlton in 1954 to plan medical care, particularly for the athletes living at the Heidelberg Olympic Games village. The ensuing organization was known as the Victorian Sports Medicine Association (VSMA) which

1986 ASMF Board of Directors including Prof Tony Parker (second from right).

The People Behind the Growth of Sports Medicine Australia

Reflections from Past Presidents

subsequently morphed into a National Federation of State branches and Territories in 1963, the Australian Sports Medicine Federation, now celebrating its’ 60 years of existence. Australia is well recognised on the world stage as a leader in global sports medicine, in no small part a legacy of the foresight of our pioneer colleagues.

I have had multiple roles in SMA over the years, initially on the Victorian committee in 1984 and ultimately a member of the National Board from 1987 to 1998. I spent 3 years as National President during that time and it certainly was a very active and productive time for SMA.

Some of the standout achievements for SMA during my period on the National Board were:

ٚ the establishment of a National Coverage Committee for event safety management,

ٚ the creation of a National ASMF Drugs in Sport Committee,

ٚ the establishment of National Sports Trainers Scheme (subsequently the “Safer Sport Programme”).

One outstanding innovation was at our National Conference, where the introduction of trade exhibitors during the mid-1990s meant that our Conference revenue increased considerably. The number of exhibitors changed from around 4 to 5 companies to over 30 trade exhibitors in one leap. This allowed members to gain increased product awareness in the sports medicine industry as well as provide a better profit margin for our National Conference. This took place under the care of our National CEO, Matt Reid, who was subsequently followed by another very productive CEO in Terry Sanders and finally Nello Marino during my time. I am grateful to all for their tireless devotion to progressing ASMF/ SMA at the National level.

During my National Presidency, the membership expanded dramatically, and we managed over a 3-year period to rewrite our National Constitution to better reflect national goals for our organization. Whilst this was not always warmly embraced by the State and Territory branches, it

ultimately reflected the need for sports medicine to have an alignment of all of our subgroups so that we could have a better voice and presence at Government level and helping shape the National health plan.

I have been fortunate to have been influenced by a number of more senior members during my early years at SMA and these included Dr. Howard Toyne, Dr. Jack Refshauge, Mr John Hart, Peter Duras, Dr. Andrey Kretsch, and Dr. Ken Fitch. There are many others who contributed enormously to the progress of where SMA is today, and I would particularly highlight the role that Michael Kenihan has played over the past 15 years in achieving our current position in the professional field.

Post graduate opportunities for sports medicine studies were very limited when I graduated from medicine. I am very proud that in 2023 there are so many pathways available to all disciplines including medicine, physiotherapy, podiatry, sports science, psychology, myotherapy… the list goes on.

When I reflect on the role that SMA plays for many people, there are a number of key themes that come to mind. Many of you will identify with these. My summary of what SMA means includes:

ٚ Networking

ٚ Camaraderie

ٚ Knowledge expansion

ٚ Educational opportunities

ٚ Multidisciplinary appreciation

ٚ Lifelong friendships

I continue to be a member (and Fellow) of SMA today and look forward to attending the National Conference in Queensland in 2023 to renew some old acquaintances and observe the

Dr Peter Larkins (centre) at the Common Running Problems booklet launch, 1987.

emerging and current generation of sports medicine experts across our incredible range of multidisciplinary membership in SMA. I look forward to seeing some of you there.

Mr Michael Kenihan: SMA

President 2007 – 2009 and 2012

– 2013, Current President ASMF

Order of Fellows and Member of the Board of Directors (SMA)

I decided very early in my career that I needed to be a part of Sports Medicine, and more particularly SMA. It was a great mentor of mine in my early career in Adelaide that encouraged me to join SMA and who also pushed me to work in multidisciplinary sports medicine. Sadly, Tony Williamson is now passed but I want to keep his memory alive.

Once involved in SMA, I realised that all of those I admired professionally were also members of SMA. Many assisted me to develop my professional ability as a Sports Physio but also encouraged me to take up roles in SMA. Some of those mentors were Dr Fred Better, Dr Peter Larkins, Dr Peter Bruckner, Dr Barry Oakes, Prof Warren Payne amongst many.

I left South Australia and moved to Melbourne where I was lucky to be involved in the start of one of the first multidisciplinary Sports Medicine centres in Victoria. At that time, SMA’s

Ms Marilyn Feenstra: SMA

President 2003 – 2005

I joined SMA in the late 80s. I made the decision having met some members and attending a National SMA conference. I had found this ideal group of people. A multidisciplinary organisation not restricted to individual professions thus expanding diagnosis, treatment, and injury prevention. Its goal was further expanding diagnosis and treatment in a multidisciplinary arena by knowledge dissemination. This was a great way of not restricting knowledge to individual professions thus expanding diagnosis, treatment, and a referral base to the practitioner best suited to a patient.

I joined the NSW board in the early 90s. On entering the state board, I found that there was a major falling out with NSW Board and the National Council. The angst was over a disagreement of an ownership of an SMA policy. A teething problem with a parochial dispute with the State and National Council. All was fortunately resolved. We moved ahead as a National body and I became the State representative for NSW.

In 2001, I became the National Finance Director in consolidating National finances, and with Gary Moorehead as CEO, coordinating a virtual National office with staff located in State offices.

Vic State Council meetings were held in the Finance Director’s practice and SMA had one very part-time employee. I became of member of Vic State Council in the early 90’s and moved through the roles of SMA by convening Sports Trainer courses, acting as branch treasurer, and eventually State President in the mid 90’s. I learnt the importance of good governance and quickly became a Vic State representative on the National Board. That was an interesting time for SMA as we moved from the 90’s to the naughties. It was recognised that the structure of SMA was not serving the

In 2003, I became the National President. For 2 years, with Gary Moorhead and the National Board, we worked to move past the obstacles to move completely to One SMA. We visited all states for discussions to answer and reduce any misconceptions to the path ahead. We worked very hard to soothe political friction to the move to One SMA. The path was long and fraught with many obstacles politically and parochial. The process was very clear. It was a necessity that we be a united, peak multidisciplinary authority in Sports Medicine, Sports Science & Physical Activity, working as one united national organisation for the enhancement of health outcomes of all Australians. It involved hard work by the Board and National staff over many years, but One SMA was later successfully achieved.

members well and changes needed to happen. A new structure came into effect in 2000 that included a council of disciplines who were invited to attend at National Board meetings as well as State Presidents attending as part of the Board Meetings. At this time, most of the members were members of both their own discipline group and SMA and the fledging discipline groups were growing in size and scope.

The Board realised that a further change of SMA structure was needed. By 2008 I was elected to the role as National President and the Board,

Michael Kenihan casting his OneSMA vote, 2013.

L to R: Incoming President Marilyn Feenstra, Outgoing President Dr Anita Green, and incoming Vice-President A. Prof Bruce Mitchell, 2003.

with myself as President and Mr Nello Marino as CEO, were charged with developing a new constitution for SMA that would see the change from each state and territory being governed by their own constitution and operating as separate business units with their own funds and activities, to what was phrased OneSMA. The change would see SMA have a single National governance structure with States continuing to be represented

but to not need duplication of staff and the governance of being separately constituted. The process was one of discovery and learning for all at SMA, and was confronting for the States and Territories as they believed that losing their sovereignty and control could only be bad for them. Nello and myself visited every state and territory to outline the change and gain member’s agreement to change to our new constitution. After much soul

searching and many discussions, the planned change went to a National vote and was received positively by the members with over 90% of members agreeing to vote for the change. The year was 2013. SMA has continued to grow and developed over the last 10 years to represent its members with delivery of multidisciplinary education from grass roots to the elite, and to be a voice to government and sport of Sports Medicine excellence.

Honour Board – Past Presidents

2022 – Present Dr Kay Copeland

2019 – 2022 Professor Gregory Kolt

2015 – 2019 Dr Andrew Jowett

2013 – 2015 Dr Peter Nathan

2012 – 2013 Mr Michael Kenihan

2009 – 2012 Mr Tim Pain

2007 – 2009 Mr Michael Kenihan

2005 – 2007 Associate Professor Bruce Mitchell

2003 – 2005 Ms Marilyn Feenstra

2001 – 2003 Dr Anita Green

1999 – 2001 Dr Shane Conway

1997 – 1999 Dr Graham Allen

1994 – 1997 Dr Peter Larkins

1992 – 1994 Mr David Roberts

1990 – 1992 Dr Fred Better OAM

1988 – 1990 Dr Brian Sando OAM

1987 – 1988 Emeritus Professor Tony Parker AM

1985 – 1986 Mr John Hart

1982 – 1984 Dr Bill Webb OAM

1981 – 1982 Dr Kevin Hobbs

1979 – 1981 Dr Jack Refshauge AM OBE

1978 – 1979 Adjunct Professor Ken Fitch AO

1977 – 1978 Dr Kevin Hobbs

1975 – 1977 Dr Geoffrey Vanderfield

1973 – 1975 Dr Howard Toyne CBE

1971 – 1973 Professor John Bloomfield AO

1969 – 1971 Dr Owen Bowering

1967 – 1969 Dr Brian Corrigan AM

1966 – 1967 Dr Leigh Wedlick

1965 – 1966 Dr Jim Pannell

1963 – 1965 Dr Robert Puflett

ASMF Fellows at the 2022 Conference

Evolution of

Footwear Stability Technology

STABILITY SHOES OF RECENT TIMES HAVE DRAWN CRITICISM FOR BEING STIFF AND UNCOMFORTABLE, AS THEY WERE DESIGNED TO ‘BLOCK’ MOTION RATHER THAN SUPPORT IT. FOR THE GEL-KAYANO™ 30 MODEL, ASICS HAS CHANGED THIS APPROACH COMPLETELY UTILISING BRAND NEW STABILITY TECHNOLOGY TO PROVIDE RUNNERS WITH ADAPTIVE SUPPORT, WHEN NEEDED THE MOST.

The landmark 30th iteration of the iconic GELKAYANO™ series is the result of ASICS Design Philosophy. This unique approach embodies ASICS’ long-standing commitment to rigorous user testing, biomechanical science, sustainability and decades of continuous innovation to create products that feel best for both body and mind.

The inclusion of new 4D GUIDANCE SYSTEM™ technology combines midsole geometry features to provide on-demand stability. Instead of bracing the feet to restrict movement, the integrated design works with movement of the body as the runner fatigues to continue providing optimum stability and enhanced comfort

GEL-KAYANO™ 30 has also been specially developed to deliver softer landings thanks to its new PureGEL™ technology, providing increased shock absorption and smoother transitions for the runner. In addition, the shoe features improved comfort through a combination of lightweight FF BLAST™ PLUS ECO cushioning, and an increased 4mm in stack height.

Chad Mullavey, Global Product Line Manager for stability products, said: “Powered by our unrelenting belief and commitment to ASICS’ unique Design Philosophy, we have been working for years to find a way to create a shoe that delivers the reliable stability that runners have come to expect from the GEL-KAYANO™ series, while reaching new levels of comfort. We are delighted in what we have achieved with GELKAYANO™ 30, and are excited to see the impact it can have for runners in delivering enhanced stability and comfort for the full duration of a run.”

As ASICS has done with many of its recent shoes, it partnered with Dr Chris Bishop PhD and his team at The Biomechanics Lab to understand the response of GEL-KAYANO™ 30 within a subgroup of recreational runners when considering not just its predecessor (GEL-KAYANO™ 29), but also comparator shoes in the market.

Explaining the design of the study, Dr Bishop said: “Researchers around the world have shown athletic footwear to have a significant influence on function and performance. It was our role to understand the interaction

of this new GEL-KAYANO™ 30 with the consumer.” He added, “Despite such innovative change to the midsole, it was important we considered the shoe’s performance in recreational runners, running at recreational speeds. This is the GEL-KAYANO™’s target market.”

To do this, The Biomechanics Lab designed a twophased research project to understand the influence of the GEL-KAYANO™ 30 on its consumer. Firstly, a detailed biomechanical study compared the influence of GEL-KAYANO™ 29 and GEL-KAYANO™ 30 on the mechanics of the foot whilst running. Dr Bishop said, “We recruited 30 flat-arched runners and investigated the mechanics of the foot inside each shoe whilst running at recreational running speeds (10-12 km/h). Despite the difference in design between shoes, there were no differences in biomechanical function of the foot or ankle identified. Even better, running in the GEL-KAYANO™ 30 was deemed to be more comfortable”.

Once proven in the Gait Lab, Phase 2 was developed. The research team recruited 100 recreational runners, getting them to run in four deidentified shoes on an instrumented treadmill, whilst instrumented insoles measured the normalised forces acting on the foot in different regions. And the results? Dr Bishop explains, “GELKAYANO™ 30 stacks up very well and was largely perceived superior to GEL-KAYANO™ 29 and the market comparator shoes. No doubt it’s a

different looking and feeling GELKAYANO™ but based on our results, for those that doubt the shoe based on visual appearance, it is essential that the shoe gets on the foot to appreciate the true effect/substance of the shoe. It is a fantastic result that total medial foot force was reduced when running in the GEL-KAYANO™ 30 – that’s exactly what you want a stability shoe to do.”

Over the past 30 years, the GELKAYANO™ series has continually been a source of technology milestones that have revolutionized running for millions of runners. We’re excited to see what the future holds for this iconic series.

ACL injury risk in women’s football

Evaluating clinical assumptions

An anterior cruciate ligament (ACL) injury is one of the most devastating injuries to sustain while playing sports. The impact of ACL rupture on joint function and stability typically requires surgical reconstruction to return to pivoting sports and extensive rehabilitation for up to 9-12 months or more before returning to play. After this, many players are unable to regain the same level of pre-injury performance or competition. Alarmingly, in some sports, approximately 1/3 of players will sustain a second ACL injury to the same or opposite leg. Long term, those with ACL reconstruction demonstrate persistent deficits in strength and biomechanics and have a greater risk of developing early-onset osteoarthritis.

When it comes to ACL injury rates, Australia has one of the highest rates per capita of ACL reconstructions performed annually in the world. Furthermore, the population rates of ACL injuries in males and females have continued to increase over the last two decades. Women participating in the football sporting codes appear to have the greatest risk of ACL rupture, reported to be between 3-8 times greater than men of the same sport. With the increasing participation in women’s football and demand for greater physical performance, particularly at the elite level, ACL injury rates for both men and women are projected to cement Australia’s place as ACL injury world leaders.

The ACL injury problem is certainly not new and has been extensively researched. However, despite the large amount of research conducted many fundamental questions remain unanswered, such as: What causes ACL rupture to occur seemingly out of nowhere? Why are women at greater risk of ACL injury than males? And what are the critical aspects of training and rehabilitation required to reduce ACL injury risk? Without definitive answers to these questions, those working in sports medicine are left without a clear direction as to how to approach preventing injury. As a result, practice tends to be based on “clinical assumptions” that may seem to make sense on the surface, but in fact lack high-quality evidence.

Addressing clinical assumptions and developing evidence-based strategies to reduce injury risk is one of the key areas of research being conducted at

Griffith University with support from VALD and Sports Medicine Australia.

Clinical assumption: “Weaker players are at greater risk of ACL injury”. Current evidence suggests muscle strength is not associated with a greater risk of ACL injury. Based on a systematic review of prospective studies in female team field and court sport athletes, there is either no association or conflicting evidence between knee extensor, knee flexor, hip extensor, and hip abductor strength and ACL injury risk. Likewise, in our study of 322 elite junior and senior women’s soccer and Australian football players, hip abductor, hip adductor,

When it comes to ACL injury rates, Australia has one of the highest rates per capita of ACL reconstructions performed annually in the world.

DR TYLER COLLINGS (2021 ASICS SMA e-Conference Best Poster Winner –Sports Injury Prevention) AND DR MATTHEW BOURNE

and eccentric hamstring strength were not associated with non-contact ACL injury risk (although the ratio of hip adductor to abductor strength was associated with ACL injury). Nevertheless, the absolute amount of lower limb strength does not appear to be a leading factor in ACL injury.

From a biomechanical perspective, the ability to generate maximum force (i.e. muscle strength) is less relevant for ACL injury due to the short time in which injury occurs (<50ms) than other neuromuscular characteristics, such as rate of force development or pre-activation. Furthermore, muscles that are commonly emphasised in ACL

prevention, such as the quadriceps, are in fact responsible for increasing ACL strain by applying an anterior force to the tibia. If aiming to unload the ACL during dynamic movements, the only muscles capable of supporting the ACL are the hamstrings, gluteus maximus, gluteus medius, and soleus due to their line of action to oppose knee abduction and internal rotation moments and anterior tibial force. Whether strengthening or other forms of training are capable of increasing the contribution of these muscles to unload the ACL during dynamic movements is yet to be fully established.

Clinical assumption:

“Between-leg asymmetries increase ACL injury risk”. Between-leg asymmetries are often cited as a predisposing factor to injury

due to the potentially greater loads applied to one leg over the other.

Symmetry between legs is also a common metric to indicate progress in rehabilitation, such as jump/landing force plate metrics. However, there is little evidence to support that betweenleg asymmetries are associated with a greater risk of ACL injury or reinjury. In our work, we observed that asymmetry in countermovement jump force plate variables and hip strength did not increase noncontact ACL injury risk. Data from this prospective study in elite women’s footballers indicated that players who went on to sustain a non-contact ACL injury can demonstrate ‘normal’ ranges of asymmetry, as well as both ‘extreme’ asymmetries favouring the injured or uninjured leg (Figure 1).

Photo: angkhan/ gettyImages

Figure 1. Between-leg asymmetry for strength and countermovement jump (CMJ) force plate variables from approximately 300 women’s junior and senior soccer and Australian football players in pre-season. Blue distributions indicate the range of values observed in players who did not go on to sustain a non-contact ACL injury. Red dots indicate the players who sustained a non-contact ACL injury in the following 18 months.

ACL injury risk in women’s football

Evaluating clinical assumptions

Clinical assumption: “A single test will predict ACL injury” Or “ACL injury can’t be predicted”. Two common and opposing views of injury prediction are either that a single test/variable can identify individuals at high risk of injury or that future ACL injury can’t be predicted. However, both of these assumptions are not the case.

Currently, there is no single test or variable that can predict ACL injury with sufficient accuracy to be useful in clinical practice. For example, providing high-risk players with additional training and resources requires distinguishing between players who do vs. don’t sustain a future ACL injury with sufficient combined test sensitivity (true positives) and specificity (true negatives). The majority

of studies attempting to use a single variable to predict injury have shown very poor combined sensitivity and specificity that are no better than guessing. For studies that do claim to achieve high prediction accuracy, few (if any) have been validated on new data that was not used to create the original statistical model and are therefore unlikely to generalise beyond the study participants.

However, that is not to say that ACL injury prediction is not feasible if sufficient data can be acquired, and appropriate methods applied. To date, no study has measured all of the contributing factors to injury (anatomical, biomechanical, neuromuscular) while accounting for confounding factors (exposure,

There is little evidence to support that between-leg asymmetries are associated with a greater risk of ACL injury or re-injury.

Photo: mkitina4/ gettyImages

fluctuations in variables over time).

While a single test/variable cannot predict injury, and probably never will be able to, multivariable prediction models based on a series of tests that capture relevant information about

Author Bios

anatomy, strength, and biomechanics are much more promising. For example, we found combining fieldbased tests of dynamic knee valgus during single leg hopping, peak vertical ground reaction forces during jumping,

Dr Tyler Collings is an early career researcher and lecturer at Griffith University within the Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Gold Coast, Australia. He was a recipient of a SMA Research Foundation Grant in 2019 and has been a finalist for paper of the year at the SMA conference. His primary research interests are in ACL injury prevention, rehabilitation, and field/clinic-based technology for assessing biomechanics. He has published several articles in top sports medicine journals on topics such as risk factors for lower limb injuries in female athletes, the impact of prior injury on strength and biomechanics, muscle forces during resistance exercises, and assessing landing biomechanics.

and prior ACL injury history were able to correctly identify 74% of players who sustain a non-contact ACL injury in the following 18 months, while also correctly identifying 71% of players who did not sustain an ACL injury (Figure 2).

This demonstrates promising accuracy in identifying high-risk players with multivariable approaches, which is likely to get even better with more data and refinement of the tests/variables included.

For article references, please email info@sma.org.au

Dr Matthew Bourne is a Senior Lecturer and Senior Research Fellow at Griffith Centre ofbiomedical and Rehabilitation Engineering (GCORE) and currently holds an Advance Queensland Mid-Career Industry Research Fellowship. His research focuses on the development and application of next-generation, clinic-friendly technologies to identify athletes at risk of hamstring and knee injuries and inform the design of evidence-based prevention strategies. Dr Bourne’s team partners with industry to democratise access to technology and generate high-impact applied research, with global outcomes.

Currently, there is no single test or variable that can predict ACL injury with sufficient accuracy to be useful in clinical practice.

Figure 2. Multivariable prediction model for non-contact ACL injury in the subsequent 18 months for women’s elite footballers.

How Tennis is being used to advance health and wellbeing outcomes for LGBTIQ+ people in Australia

Sport is often lauded as a social leveller and tool to advance agendas such as social cohesion, social connection, and tackling adversity. However, for some diverse communities, sport can be used to exclude, discriminate, and resist social change. This is true for people of diverse sexualities and genders, or LGBTIQ+ people. This year alone, there has been an increase in resistance and backlash to LGBTIQ+ equalities, and unfortunately, sport and movement settings have been used to advance such resistance. For example, trans athletes have been banned from competing in some elite and community sporting competitions, and LGB athletes still experience discrimination in sport and movement settings. There is a lack of research in how sport can be used in positive ways to help improve outcomes for LGBTIQ+ people. This article highlights recent national research which explored how tennis is being used to advance health and wellbeing outcomes for LGBTIQ+ people in Australia.

Tennis Australia funded the research, to better understand the experiences of LGBTIQ+ people in tennis, and to explore the outcomes associated with playing tennis. They were specifically interested in understanding how LGBTIQ+ tennis clubs, those clubs that are ran and operated by and for

LGBTIQ+ people, provided benefits to the community, and under what conditions. We used the concept of social capital to analyse and understand how LGBTIQ+ people created networks and social value through playing tennis is safe and affirming club environments and tournaments. Social capital is defined as a form of value and social currency through participation and membership to a group or society, which ultimately benefits and has value to both the group and individual. For example, in a tennis context, a LGBTIQ+ person may develop friends through being a member at a LGBTIQ+ tennis club, and through these friendships, they create value for the person through attending social activities such as going out for dinner or attending events, catching a lift to games, or being able to turn to support in times of hardship or crisis.

Our research found that social capital was fostered and created by LGBTIQ+ people through active participation in tennis, through clubs, tournaments, and online activity in groups and social media channels. However, the conditions for such capital to be created and fostered, centred around inclusion and affirming environments. When LGBTIQ+ people do not feel they can be themselves, or have to hide their sexuality or gender identity, or manage or moderate behaviour –

DR RYAN STORR

through identity management – then social capital and the benefits are not accrued or developed. This is why fostering inclusive environments is crucial for social and physical benefits to be developed, because each person must be able to be themselves, feel a sense of inclusion and belonging, and be free to be their authentic selves, free from shame and judgement.

Our research team travelled to states across all Australia, and conducted individual interviews, focus groups, and participant observations. We spoke

to people who identified as LGBTIQ+, in both LGBTIQ+ specific clubs, and mainstream clubs, to understand several key aims. Firstly, it explored the experiences of LGBTIQ+ tennis players in Australia, and secondly, explored the positive role that sport, specifically tennis, can play in the lives of LGBTIQ+ people. The majority of the sample were gay men, of all ages, but predominately over 35, and in total we spoke to 27 participants, in addition to several observational hours.

Analysis of the data identified four key

themes from our research: bonding through community club culture, being your authentic self, benefits for all life stages, and social connections in social and physical spaces.

Bonding through community culture

LGBT+ sport clubs and organisations create environments where people can learn new skills, as well as build social capital to further meaningful personal relationships. Being part of a tennis club allowed people to bond over tennis and their shared

Photo: Jacob Wackerhausen/ gettyImages

identity of being LGBTIQ+. Many participants bonded over the earlier experiences in sport, which were characterised by homophobia and discrimination. However, many participants saw the tennis spaces as opportunities to build new inclusive cultures for all community members. As one participant identified:

“A lot of people are finding friends, communities that used to find through apps and things like that. Now you have a social place to get to know people, build friendships. You make friendships with people you wouldn’t necessarily have become friends with if it wasn’t for that “(Interview).

Through regular participation in tennis clubs, members can build trust and reciprocity between themselves, and develop new connections. This was seen as an important avenue, beyond traditional ways of socialising in the gay community –through drinking and nightclubs.

Being your authentic self

A standout theme related to participants speaking at length about their ability to be themselves, and not have to worry about being LGBTIQ+. This is especially true for the older participants, who grew up in the 70s/80/90s where being gay was illegal, extremely stigmatised, and had hidden or concealed their true identity for many years. Therefore, being able to play sport and have fun, without having to worry about anyone finding out they were gay, or making discriminatory comments or remarks, was seen as liberating and affirming. Some comments below from participants outline this sentiment:

“To see every, united colours of Benetton, every colour expressed at [LGBT+ tennis club], as part of the community, opened my eyes to the fact that you don’t have to fit a certain box, you can be whoever you want to be, and you’re still in the club, and you’re still loved, and you’re still accepted. And tennis to me was the area where I got

that awareness that I didn’t have to change, I could just be me” (Interview).

“I think in this sort of world, in like the queer tennis space, you tend to develop deeper relationships with people, and I think a lot of it is just you can relate to people, and a lot of likeminded people as well” (Interview).

An important takeaway for sport and exercise professionals is understanding whether your organisation and staff are creating inclusive environments where LGBTIQ+ can be themselves, and bring their authentic selves to the workplace or your business. Visibility is important in this regard, which will be discussed in the final theme.

Benefits for all life stages

There was a good mix of ages in our sample, but a good number in the older age category, which does not happen often in sport-based research, especially LGBTIQ+ sportbased research. Some older men spoke about the challenges of social

Photo: JackF/ gettyImages

How Tennis is being used to advance health and wellbeing outcomes for LGBTIQ+ people in Australia

isolation and feeling disconnected from their community and society, and playing tennis allowed them to address this. We heard stories of some club members experiences relationship breakdowns, drug and alcohol abuse, and the tennis community had provided a source of support for those members. Some older gay men, who had recently retired, also spoke about the positive way that being part of the tennis clubs had helped him transition into retirement – something he had not been looking forward to. Some comments below illustrate this theme:

“We have a member who plays with us and he is one of the first people to sign up to every tournament and he comes to every event, he plays every season of competition. He’s

there early, he comes to every Sunday social. Now he’s had a lot of drug and alcohol issues in the past … for me it’s all about people participating, I really want people to play, and for me, he is the ideal, because he never makes excuses. He never has – there are no barriers for him” (Interview)

“And so for quite a few years, well I’ve been retired three and a half now, that was the first thing in my diary for the week ahead, you know. Wednesday’s tennis, Saturday’s tennis. And of course when competition’s on, I’ve always played competition, that’s another night of the week. So there’s three nights where I’m going to be interacting with people. And it’s quite difficult in Hobart, you know, during the second half of winter. I mean you

really don’t want to go out because it’s dark and it’s cold but you’ve got tennis so you go. You know, and I don’t, if I didn’t have tennis I don’t know what I would have done, you know, because I would have just become a hermit. I wouldn’t get the sunshine that I need, probably” (Interview).

Our data showed that being part of the LGBTIQ+ tennis community provided strong social connections and support for those who needed it the most, and for older gay men in particular who may be vulnerable to social isolation.

Social connections in social and physical spaces

Our findings showed that the physical tennis space including the courts and clubhouse with visible symbols such as the rainbow flag, demonstrate clearly that that these tennis spaces are considered safe spaces. However,

Photo: RossHelen/ gettyImages

it is important to note that just by putting up a rainbow flag does not automatically mean it is a safe space – but the work behind it and work undertaken to ensure it is a safe space. With the establishment of a safe space, social connections were able to be developed and fostered, as people could be themselves, and let their guards down. One powerful comment explains this point well:

“Sporting places, if it doesn’t have a rainbow flag I will assume that it’s not inclusive and it’s a place to be in the closet. Yeah, that’s just … it just makes you feel safe, this is somewhere that I can go and be me without having to watch every word. I mean I’m a lawyer so if anybody is homophobic against me I will stand up and very firmly defend my position, but that’s uncomfortable. And when you’re playing a sport you want to be there to have fun and enjoy yourself, and not feel, you don’t want life to intrude. And I think without the rainbow flag there there’s always the possibility of that happening. Another thing, I think the rainbow means that the club will hold people accountable for their actions. Well without it, you don’t necessarily, but if somebody comes up and says something that you have any protection or support or help from the club” (Interview)

The quote above, highlights the importance of creating and fostering safe spaces for LGBTIQ+ people. It is important to also note that some people may be comfortable and a time in their life where they share their sexuality or gender identity. It is up to an individual to come out – or invite people in, in sharing their LGBTIQ+ identity or status, when it is right for them. Further, organisations need to consider, “are we creating a safe space and culture which allows people to feel comfortable to be open and share their identity with us?”. Participants often identify that they may not be out in some sporting spaces, or even the workplace, but they don’t feel culturally safe, or choose not to disclosure their identifies through fear of judgement.

This short article has summarised the positive ways that playing tennis in safe and affirming clubs can

benefit LGBTIQ+ people. At a time when sport is being used to advance resistance and opposition to LGBTIQ+ equalities, it is important for sport and exercise providers and professionals, allied health professionals, to ensure that sport is used in positive and meaningful ways to enrich the lives of LGBTIQ+ people. The research on LGBTIQ+ people to date, shows that LGBTIQ+ people experience discrimination and exclusion in sport and movement settings, but there is a great opportunity to change this narrative and improve outcomes for marginalised people. To get support or find out ways to improve inclusion for diverse communities, reach out to The Diversity Storr (www.thediversitystorr.com).

For article references, please email info@sma.org.au

Author Bio

Dr Ryan Storr is a multi-disciplinary researcher and consultant in diversity and inclusion. He is currently a Research Fellow at the Sport Innovation Research Group at Swinburne University, and founder of the Diversity Storr, a consultancy specialising in diversity and inclusion. His PhD explored the enactment and implementation of diversity policies within community sport clubs by volunteers. He has led a number of diversity related research projects, receiving funding from a range of bodies, including both Federal and State Government, professional sports clubs and organisations, and health promotion agencies. He co/founded the charity Proud2Play, which is the peak organisation for LGBTIQ+ inclusion in sport in Victoria, Australia. He is a current recipient of a VicHealth Research Impact award, focusing on collecting LGBTIQ+ participation rates in sport and physical activity. He is available for education and training, consulting services, and keynote presentations and speeches.

Photo: PeopleImages/ gettyImages

2023 ASICS

SMA Conference

Highlights

THE 2023 ASICS SMA CONFERENCE PROGRAM IS FOUNDED ON ACADEMIC EXCELLENCE, KNOWLEDGE SHARING ACROSS ALL SPORTS MEDICINE AND SPORTS SCIENCE DISCIPLINES, AND CREATING CONNECTIONS.

WORKSHOPS & SYMPOSIA

The keynote speaker sessions are complemented by clinical workshops and research symposia delivered by global leaders and emerging researchers. Some session highlights include:

ٚ A practical shoulder workshop by Dr Rodney Whiteley

ٚ Workshop on assessment of hip and groin pain in athletes by Dr Andrea Mosler

ٚ Athlete Series symposium by Paula Peralta

ٚ “Reducing concussions in rugby league” symposium led by Prof Ben Jones

ٚ “Athletes as mothers” symposium led by Dr Sharon Stay

ٚ ACL rehabilitation workshop led by Dr Natalie Sharp and Dr Peter Garbutt

20+ HOURS OF HIGH-QUALITY PAPER PRESENTATIONS ACROSS THE FOLLOWING TOPICS

ٚ Foot and ankle

ٚ Priority populations

ٚ Heat adaptation

ٚ Injury epidemiology

ٚ Soft tissue

ٚ Women athletes and pregnancy

ٚ Hip and groin

ٚ Diverse sporting realms

ٚ Cultural experiences, gender and concussion

ٚ ACL biomechanics

ٚ High performance sport settings

ٚ Diet and sleep

ٚ Hamstring health

ٚ Knees

PROGRAM SNAPSHOT

DAY 1

Wednesday 11 October

ٚ UQ Sports Physiotherapy Masterclass (separate registration)

ٚ Judges Showcase

ٚ 2023 Refshauge Lecture

ٚ Welcome Cocktails

DAY 3

Friday 13 October

ٚ Keynote Sessions

ٚ Workshops & Symposia

ٚ JSAMS Forum

ٚ SEPA Sessions

ٚ Free Paper Presentations

ٚ Scientific Poster Session

DAY 2

Thursday 12 October

ٚ ASICS Run Club

ٚ Keynote Sessions

ٚ Workshops & Symposia

ٚ Free Paper Presentations

ٚ ASICS Presentation

ٚ SMA AGM

ٚ ASMF Fellows Dinner (by invite only)

DAY 4

Saturday 14 October

ٚ Keynote Sessions

ٚ Workshops & Symposia

ٚ Free Paper Presentations

ٚ Best of the Best

ٚ Gala Dinner

OUR SPONSORS, PARTNERS AND EXHIBITORS*

Industry partners

Session sponsors

Trade exhibitors

*As of 31 August 2023

When is the best time to take your iron supplement?

IRON IS A FUNDAMENTAL MICRONUTRIENT THAT HAS SIGNIFICANT ROLE IN MANY BIOLOGICAL PROCESSES, SUCH AS ENERGY METABOLISM, RED BLOOD CELL PRODUCTION AND IMMUNOLOGICAL AND NEUROLOGICAL FUNCTIONING. THESE FUNCTIONS ARE PARTICULARLY IMPORTANT FOR ATHLETES AND UNDERPIN OPTIMAL PERFORMANCE AND HEALTH.

Despite iron’s importance, the prevalence of iron deficiency in athletic populations is high, with between ~5-11% of male, and ~15-35% of female’s athletes reported to be iron deficient. In athletes, we categorise iron deficiency in 3 stages depending on severity. Stage 1 (Iron Depletion) is characterised by a reduction in serum ferritin concentrations (<35 ug/L), indicating that the bodies iron stores are beginning to deplete. Stage 2 (Iron Deficiency Non-Anaemia) occurs when serum ferritin concentrations are further depleted (<20 ug/L) causing erythropoiesis to diminish as the iron supply to the erythroid marrow is reduced (marked by a decline in transferrin saturation). Stage 3 (Iron Deficiency Anaemia) is the most severe stage where iron status is so low that haemoglobin production is compromised (<12 g/dL and 13 g/ dL for females and males respectively). Known symptoms of iron deficiency include fatigue, lethargy, irregular heartbeat, shortness of breath, headache, weakness, and reduced concentration. Generally, the incidence and severity of symptoms increase as the stage of iron deficiency progresses. Published frameworks exist for the screening of iron deficiency in athletes, addressing both athlete presentation for a blood sample and frequency of testing.

DR ALANNAH MCKAY

Photo: Paul Bradbury/ gettyImages

Despite iron’s importance, the prevalence of iron deficiency in athletic populations is high, with between ~5-11% of male, and ~15-35% of female’s athletes reported to be iron deficient.

There are numerous factors which contribute to sub-optimal iron status in athletes. Firstly, iron cannot be synthesised by the body, meaning the body relies solely on exogenous iron consumption to meet daily requirements, primarily from dietary iron sources. Heme iron sources have the highest bioavailability and can be found in animal-based products (red meat, chicken and fish). Non-iron sources typically make up a significant amount of daily iron intake and are often found in carbohydrate based fortified foods (breakfast cereals and breads), nuts, seeds, and legumes. Accordingly, athletes adhering to vegetarian or vegan diets, low calories diet and/or low carbohydrate diets may be at increased risk of iron deficiency due to insufficient dietary iron intake. In athletes there are also exercise-associated avenues of iron loss which increase their susceptibility to iron deficiency, such as via sweat, haemolysis, gastrointestinal

bleeding, and haematuria. The magnitude of these losses will likely be dependent on the training volumes performed. Furthermore, the inflammatory response to exercise upregulates concentrations of the body’s master iron regulatory hormone, hepcidin, peaking ~3-6 h post-exercise. When hepcidin concentrations are increased, iron absorption and recycling is impaired.

When treating an iron deficiency, an initial strategy may be a ‘food-first’ approach, where a concentrated effort is made to increase the amount of dietary iron consumed within the diet. A consultation with a sports dietitian is a recommended starting point for this approach. In the case of more severe deficiencies, an oral iron supplement may be required to ensure adequate iron is made available. There are many factors a practitioner must consider when advising an athlete about oral iron supplementation. Firstly, a

Emerging evidence suggests that consuming a supplement every alternate day, compared to every day may be equally, if not more effective at improving iron status and may be associated with less gastrointestinal side effects.

Photo: HEMARAT/ gettyImages

sufficient iron dose must be provided (usually 60-100 mg of elemental iron) to correct an iron deficiency. However, it is important to note that high iron doses can be associated with an increased risk of gastrointestinal side effects, and this may affect athlete adherence. Emerging evidence suggests that consuming a supplement every alternate day, compared to every day may be equally, if not more effective at improving iron status and may be associated with less gastrointestinal side effects. However, greater evidence in athlete populations is required to confirm this approach.

One avenue of research that has gained recent interest is the timing of iron supplementation to maximise iron absorption, relative to both time of day and time of exercise. Our novel study lead by Dr Rachel McCormick at the University of Western Australia showed that the ingestion of iron in the morning was superior to afternoon intake, as evidenced by an increase in fractional iron absorption from a stable iron isotope tracer. This is supported by data showing that the diurnal variations in the iron regulatory hormone hepcidin are lowest in the morning, allowing for greater iron absorption to occur during this period. Caitlin Attwell at the University of Western Australia lead a recent a randomised control trial to follow up on this work in female dancers. In this study, we assigned dancers with low iron stores (serum ferritin <50 ug/L) to receive 100 mg of elemental iron either in the morning (0600-0800) or evening (1700-1900) for an 8-week period. Compared to a control group (no supplementation) both groups were able to increase their serum ferritin stores to a similar level, suggesting that both morning and evening supplementation regimes may be equally effective. This study supports a “supplement when convenient” approach. While strategically manipulating the timing

of iron supplementation may be beneficial due to its increased fractional iron absorption, over the duration of a

full supplementation schedule small changes in iron bioavailability may not greatly affect overall iron status.

Nevertheless, when considering how to optimise iron supplementation strategies for athletes’ it has also been shown that iron ingestion 30 min post-exercise (compared to when no exercise occurs) results in enhanced iron absorption. Our team at Australian Catholic University undertook a recent investigation aimed at further defining the guidelines for iron supplement intake timing relative to exercise. We recruited 18 highly trained male runners to undertake two

Our novel study showed that the ingestion of iron in the morning was superior to afternoon intake.

When is the best time to take your iron supplement?

Photo: MarianVejcik/ gettyImages

experimental trials, where during both trials athletes completed 60 min of treadmill running at 65% VO2max. During one trial, athletes consumed a stable iron isotope 30-min pre-exercise, and during the other trial the isotope was consumed 30 min post-exercise. In order to determine the fractional iron absorption of each iron dose, a blood sample was collected 14 days after ingestion to determine how much of the iron isotope made it into the red blood cell. We found no differences in fractional iron absorption occurred when consumed pre- (7.3%) or postexercise (6.2%) (p=0.058). Outcomes of the current study allow us to update our recommendations to athletes, widening the timeframe where optimal iron absorption is thought to occur. Here, we suggest athletes supplement either pre-exercise, or up to 30 min post-exercise to maximize the potential absorption window prior to the increase in post-exercise hepcidin levels. Importantly, it has been clearly shown that iron absorption is impaired 2 h post-exercise onwards, which coincides with increases in exerciseinduced hepcidin concentrations. Therefore, late supplementation is not advised to maximise absorption.

Collectively, emerging research has started to examine how factors associated with oral iron supplementation protocols can be manipulated to enhance absorption. We have progressed the current knowledge around the time of day and time of exercise an oral iron supplement should be consumed, however there is a lot still to learn about the formulation, dose and frequency of iron ingestion to not only enhance supplement efficacy but ensure compliance by minimising the incidence of gastrointestinal side-effects.

For article references, please email info@sma.org.au

Author Bio

Dr Alannah McKay completed a Bachelor of Science (Exercise, Health and Sports Science) at the University of Western Australia in 2014. Subsequently, Alannah completed a post-graduate position within the Physiology department at the Australian Institute of Sport, where she was involved in the preparation of many Australian athletes prior to the 2016 Rio Olympic and Paralympic games. Since, Alannah has submitted her PhD titled “The Effect of Dietary Manipulation on Iron Metabolism and the Immune System in Elite Athletes”, which was undertaken in partnership with the Australian Institute of Sport, Western Australian Institute of Sport and the University of Western Australia. Alannah joined Australian Catholic University as a Postdoctoral Research Fellow in 2020, where her research has continued to explore the impact of diet and exercise on a range of health outcomes in athletes, with a specific interest in iron metabolism.

Photo: jacoblund/ gettyImages

Journal of Science and Medicine in Sport and sister journal JSAMS Plus

JSAMS most cited 2023

Physical activity, mental health and well-being of adults during initial COVID-19 containment strategies: A multi-country cross-sectional analysis

https://doi.org/10.1016/j.jsams.2020.11.016

JSAMS Plus most downloaded in 2023

Knee osteoarthritis in Australia: A 20-year case study of funding-system failure with poor outcomes

https://doi.org/10.1016/j.jsampl.2022.100009

JSAMS Plus – Call for papers for Special Issue on Exercise Oncology

Guest Editors: David Mizrahi, Rob Newton, Carolina Sandler, Erika Rees-Punia

Check website for more details

Optimising the Power of Physical Activity for Mental Health

A summary of the joint consensus statement from Sports Medicine Australia and the Australian Psychological Society

In this article, we describe the connection between physical activity and mental health, and how research evidence can change the way we promote physical activity for well-being.

Following the Clinical Consensus Statement protocol, our expert group set out to identify the optimal characteristics of physical activity from a mental health perspective. The resulting expert consensus statement, endorsed by Sports Medicine Australia and the Australian Psychological Society College of Sport

and Exercise Psychology, provides actionable recommendations that bridge the gap in current physical activity guidelines, and will enable professionals and individuals to harness the full potential of physical activity for mental health promotion.

The science behind physical activity and mental health: Participating in physical activity triggers changes in the body and the mind. Although most people focus on fitness and weight management benefits; physical activity also impacts

Physical activity can be a powerful tool for building new relationships and fostering a sense of belonging, both of which are critical for long-term wellbeing.

Photo: Drazen Zigic/ gettyImages

Optimising the Power of Physical Activity for Mental Health

our mind, brain, and emotions. A bout of physical activity can stimulate the release of neurotransmitters, such as dopamine and serotonin that might promote feelings of happiness and enhance our sense of well-being. But that’s just the tip of the iceberg.

The psychological benefits of physical activity extend far beyond temporary mood elevation. Research has demonstrated that regular activity can promote neuroplasticity, enhancing brain structure and function. As people master new skills and challenges and experience a sense of progress, their belief in their ability can also improve. This means physical activity can boost self-esteem and self-efficacy, and provide a sense of confidence, both in relation to physical activity, and more generally. Engaging in physical activity also provides opportunities for a world of social connections. Physical activity can provide opportunities for building new relationships and fostering a sense of belonging, both of which are critical for long-term wellbeing. Joining a fitness class, participating in team sports, or embarking on

group hikes for example, all provide opportunities to offer and receive, support and encouragement, and increase one’s network of friends.

Consideration of contextual factors

What are the critical elements that shape the mental health benefits of physical activity? It’s not just about how often, how hard, or how long you are active for. The context in which you engage in physical activity holds the key to unlocking its full potential. Whether you’re an individual seeking to enhance your mental well-being or a practitioner guiding others, consideration of contextual factors can maximise the mental health benefits. We identified five distinct categories of contextual factors that influence the mental health benefits of physical activity: Type (e.g., aerobic versus resistance exercise); Delivery (e.g., instructional style, mode of delivery, supervised versus self-initiated); Social environment (e.g., group or team versus individual participation); Physical environment (e.g., indoor versus outdoor environments; green or blue space versus man-made

environments); and, Domain (e.g., leisure time versus occupational physical activity) (Figure 1).

Type

Our consensus statement concludes that the specific type of physical activity doesn’t significantly impact mental health on its own. Whether you’re a fan of heart-pumping aerobic workouts, muscle-building resistance training, graceful yoga sessions, or the adrenaline rush of sports, the key is finding what you enjoy. Personal preference and factors related to long-term adherence and enjoyment should guide your activity selection, as all activity types have the

Personal preference and factors related to long-term adherence and enjoyment should guide your activity selection, as all activity types have the potential to improve mental health.

Figure 1: Descriptive model of the influence of contextual; factors on mental health and wellbeing

potential to improve mental health. By embracing activities that align with your interests and needs, you’ll experience greater satisfaction, making it easier to stick with your routine and reap mental health benefits.

Delivery

Instructors and coaches play a pivotal role in creating an environment that fosters autonomy and social connection. By adopting an instructional style that includes, providing choice, acknowledging participants’ feelings, praising effort and improvement, building rapport, and minimising pressure, instructors and coaches can support participants’ psychological needs,

thereby enhancing the mental health benefits of physical activity. Moreover, supervised sessions, where facilitators can interact with participants, offer additional support and increase adherence, may be particularly helpful for those with clinically diagnosed mental health problems.

Social environment

Engaging in physical activity with others who provide support, positive interactions, and a sense of belonging may amplify the mental health benefits. Peer belonging, social connectedness, and social support act as powerful mediators between physical activity and mental well-being. The joy of participating

in group activities, team sports, or partner workouts positively impacts your mental health. However, individual preferences should be respected, as some individuals prefer the solitude afforded by exercising alone. Balancing social connection with personal preferences is key.

Physical environment

Where you engage in physical activity matters. Time spent in natural outdoor environments, such as lush green spaces and serene blue water settings, produces greater mental health benefits compared to indoor settings. The rejuvenating power of nature can reduce stress, restore attention, and allow a respite from

Photo: Valerii Apetroaiei/ gettyImages

Optimising the Power of Physical Activity for Mental Health

mentally draining urban landscapes. However, if your access to natural environments is limited, you still have options. Engaging in physical activity indoors can still yield positive effects for mental health, especially if the indoor setting incorporates elements of nature through thoughtful design, like indoor plants or large windows for sunlight.

Domain

The aspect of your daily life (life domain) in which you incorporate physical activity also influences mental health outcomes. Many people engage in physical activity during their leisuretime (your own free time to spend how you choose) or as a method of transport. Some people also happen to be active as part of their work or school day, or while completing domestic/ household duties. Physical activity during leisure-time is more likely to offer greater mental health benefits

Contextual factor Recommendation

Type Activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type.

Delivery Facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals’ basic psychological needs (i.e., autonomy, competence, and relatedness). We also recommend the use of supervised physical activity sessions for clinical populations, which appear to be more beneficial than unsupervised sessions.

Social environment

Physical environment

Domain

Some physical activity be undertaken with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone.

Where possible and appropriate, some physical activity be undertaken outside in pleasant natural environments (e.g., green or blue spaces).

At least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one enjoys or personally chooses to undertake.

because leisure-time activities provide opportunities for autonomy, enjoyment, self-efficacy, and social support.

While leisure-time activity might be optimal for mental health promotion, transport-related and school-related physical activity also show promising results, while the impact of occupational physical activity on mental health remains unclear. Overall, the key lies in choosing activities that you enjoy, experience a sense of satisfaction, or can connect with either important people in your life, or with yourself.

Conclusions

While we all know physical activity is good for us, using this expert consensus statement, gives us a roadmap to rethink our movement and promote activities that might have more optimal effects on our mental health. But remember, physical activity is not a one-size-fits-all prescription.

Table 1: Summary of physical activity contextual factors and recommendations

Photo: vorDa/ gettyImages

It’s about finding what moves you, both physically and emotionally. Whether you prefer to dance, hike, lift weights, or explore the great outdoors, choose activities that align with your passions and preferences. Seek out supportive environments, surround yourself with uplifting individuals, and let the power of social connections fuel your mental well-being.

Although the recommendations ( Table 1) in our consensus statement provide valuable guidance, they are not rigid rules. Flexibility is key. We encourage you to adapt the recommendations to your circumstances and constraints. Embrace the fact that even small changes can yield significant mental health benefits. Whether it’s a leisurely

Authors

walk in the park, a virtual exercise class, or a lively game with friends, try and incorporate at least some of the recommendations into your routine. Activity doesn’t need to be extreme, or intense, or exhaust you beyond your physical limits, to have benefits for your mental health.

So, lace up those sneakers, grab your yoga mat, of dance like nobody’s watching. Embrace the joy, the satisfaction or accomplishing new things, and the good company. Remember that you’re not alone in your physical activity journey. You can rely on a community of experts and enthusiasts to cheer you on and help unlock the mental health benefits that physical activity can bring. The choice is yours!

Disclosure: The initial draft of this paper contained a summary of the authors’ previous publications generated by ChatGPT. All authors reviewed and edited the content and take full responsibility for the resulting content of this publication.

Peer belonging, social connectedness, and social support act as powerful mediators between physical activity and mental well-being.

David R. Lubans

Rhiannon L. White

Simon Rosenbaum

Christian Swann

Stewart A. Vella Eugene Aidman Megan Teychenne Jordan J. Smith

5 minutes with Dr Steve Reid

What inspired you to pursue a career in sports medicine?

I grew up in the UK and went to university there. I took part in a range of sports, and I was a little disappointed with the sport and exercise medicine expertise that I was offered if I got injured. For instance, the approach that I got from my GP when I had an injury while training for a marathon was “Well, just stop the running”, which was not what I wanted to hear in my 20s. After I graduated, I went to New Zealand to travel and work. Very early on in New Zealand I went to a hospital grand round that was given by Dr Chris Milne. Chris later became President of the Australasian College of Sport and Exercise Physicians (ACSEP). After hearing him speak I realized that there were people who practiced Sport and Exercise Medicine who understood the importance of keeping the community active and involved in sport. I approached Chris after the grand round. He was very welcoming and encouraged me to get involved with sports medicine in the local community. He was my initial inspiration to think, actually, this is something I am really interested in. It was a career path that I could see was still evolving in New Zealand in the early 1990s. There weren’t a lot of doctors who were working full time in sports medicine. Generally, they were doing General Practice and completing a Post Graduate Diploma in Sports Medicine. That was the pathway that I decided to follow at that stage.

Can you tell us about your educational and research background?

I went to the University of London. I initially did a science degree and then a PhD in human bone development. My interest at that time was in metabolic bone disease, but the science pathway felt remote from offering clinical care to people. I completed a medical degree after my PhD. Once I moved to New

Zealand, my early medical progression involved doing a vocational training program in General Practice and a Post Graduate Diploma in Sports Medicine at the University of Auckland. As a result, I worked as a GP with an interest in sports medicine, including working as a team doctor for the Waikato Chiefs Super 12 rugby franchise. By that stage I was working at the same medical practice as Chris Milne, and we shared the Waikato Chiefs medical role. Once I became involved with the Australasian College of Sport and Exercise Physicians it was apparent that Sport and Exercise Medicine could offer a career path in its own right. So, in the late 1990s I went back and did the full ACSEP specialist training program and became a Sport and Exercise Physician. My sporting research background started when I was a Sport and Exercise Medicine Registrar. I became interested in studying hydration and sodium levels in endurance athletes. There was a lot of research going on into ExerciseAssociated Hyponatremia (EAH) in Ironman triathletes. But there was less research into whether participants in shorter events, such as marathon runners, could develop EAH. So, I studied athletes at the Christchurch marathon. Subsequently I became involved with the International Exercise-Associated Hyponatremia Consensus Group which was put together principally by Professor Tim

Noakes in South Africa. I took part in two of the EAH Consensus meetings. Working alongside someone as eminent in Sport and Exercise Medicine as Professor Noakes was a real academic highlight for me.

Throughout your career you have worked across many different sporting disciplines including rugby union, tennis, and rowing. Do you have any notable or memorable experiences you’d like to share?

My initial experience of working in an elite sport environment was doing Super Rugby in New Zealand between 1997 and 2002. Rugby went fully professional in 1996 and so when I came on board in ‘97, it was still very new. It was new for the for the players and the teams, and I was still relatively new to sport and exercise medicine. It was exciting to be involved at that professional level and to travel to Australia and South Africa during the season. Living in New Zealand where

rugby is a passion, it was fantastic to be involved with the sport and to meet some of the legends of All Black rugby. The late Jonah Lomu played for the Chiefs during my time with the team. Certainly, going to the Rio Olympics was a career highlight. Between 2013 and 2016, I’d done an entire Olympic cycle working with the Australian Rowing Team. As a result of that, I got nominated for the headquarters medical team for Rio. You become close to some of the athletes and coaches as you go through a four-year cycle. So, to go to Rio and witness the successes of some of those athletes that I’d looked after for four years was fantastic. It culminated with Kim Brennan winning the gold medal in the single scull. Also, I’d have to say that working each year with the wonderful Player Medical Team at the Australian Open Tennis is an annual highlight for me.

How did you first become involved with the Australian Olympic and Paralympic teams?

Starting to travel with the Australian Rowing Team in 2013 was the beginning of that involvement. One of the really nice things about rowing was that, at many regattas, there were able bodied and para-rowing events on the same program. So, I had really had good exposure to parasport throughout the time that I worked with the Australian Rowing Team. Once I started working at the Australian Open Tennis in 2018, I began to look after wheelchair tennis players as well. So, from 2013

Dr Steve Reid

onwards my involvement in Olympic and Paralympic sport gradually developed over time. Between 2019 and 2023 I was Chief Medical Officer for the Tasmanian Institute of Sport which increased the diversity of Olympic sports that I was exposed to. Then in 2022 I had the opportunity to go away with the Australian Paralympic team to the Winter Games in Beijing. That was a fantastic experience; lovely team atmosphere, a great Performance Services Team, and wonderful cohesion among athletes and staff. It was super to witness how much the athletes hold each other in high regard and support one another not only within the Australian Paralympic Team, but also across different nations.

As Chief Medical Officer for Paralympics Australia, what are your main objectives at the Paris 2024 Paralympics?

This breaks down into several areas. I think Paralympics Australia have put together a wonderful multidisciplinary team of doctors, physiotherapists, sports psychologists, massage therapists and sports scientists. My number one priority is to work with that team to help our athletes enjoy their Paralympic experience and to come away feeling that everything has

been done to enable them to perform at their best. Not everyone is going to come away with a medal, but I think if people leave the Games feeling that they’ve put down absolutely the best performance they could, then that’s really what we’re there to support –that high performance goal. From a leadership perspective, I also want to make sure that the Performance Services Team feel supported and able to enjoy the experience themselves. I would like them to look back and see the Paris 2024 Paralympics as a career highlight. Certainly, that’s how I look back on my involvement in the Rio Summer Olympics and Beijing Winter Paralympics. With the Brisbane 2032 Games in mind, it is important that these high caliber clinicians and performance support staff leave Paris enthused to remain involved in Paralympic sport. As host nation, Australia will get entries into every Paralympic event in Brisbane. So, I hope that we’re going to see increasing community involvement in Paralympic sport over the next 8 to 9 years. Making sure that we have experienced performance support personnel to work with these Paralympic athletes is going to be very important. Finally, with a big picture in mind, I’m keen to develop an international network of clinicians who work in Paralympic sport, so that if an Australian team goes overseas without a doctor, I’ve got international colleagues that I can reach out to for assistance if a medical issue develops. I’ve recently organized an initial meeting with Paralympic CMO’s from other nations to start that process.

What is the best piece of advice you have received in your career?

There are two pieces of advice and they’re linked. As I mentioned, when I first started sports medicine in the early to mid-1990s, there was a less defined career path for doctors in Sport and Exercise Medicine. I had completed a vocational training program in General Practice and a Post Graduate Diploma in Sports Medicine and had

a comfortable mix where I was a GP, but doing 50% Sports Medicine and looking after a Super 12 Rugby team. However, Chris Milne, my mentor in the early part of my career, advised me that Sport and Exercise Medicine was going to be recognized as a specialty in New Zealand and that if I wanted to pursue Sport and Exercise Medicine full time, then I should really go back and get the Fellowship of the Australasian College of Sport and Exercise Physicians. By that time, I was in my mid-30s and married with young children. I was uncertain about whether I wanted to go back to the beginning of a four-year training program, particularly knowing that I couldn’t do it all where we were living in New Zealand – we’d have to move either to the South Island of New Zealand or to Australia for two years of the program. That was a big conversation to have with my wife, but her advice was “I think you’ll probably always look back and regret it if you don’t do it.” So, I took both pieces of advice and I’ve never looked back and regretted it. From a family point of view, the fact that we moved made us really solid as a family unit. And we’ve had some fantastic experiences as a result, because my family have traveled with me to both domestic and international events at different times.

People Who Shaped SMA

Dr Peter Harcourt

What made you decide on a career in sports medicine?

It was early in my career, I moved away from thinking about specialist medicine and going into general practice. When I set up my general practice, in the early days, I was working alongside a guy that also did sports medicine. I got a lot of his patients coming to me as well, so I had to quickly adapt and take it on board. I love sport anyway and played a lot of sport at the time, so it was something which I embraced. Sports Medicine Australia played a key role in how I got involved in sports medicine because, at the time, they were really the only functioning body that allowed some sort of professional development related to sports medicine. I did a course that SMA ran to help GPs in translating some of the stuff that comes out of sports science and sports medicine into their practice. That was an important part of it all because it created a structure around why this was going to work.

How did you first become involved with organisations such as the AFL, Basketball Australia, and

Commonwealth Games Australia? In terms of getting involved, it was through that SMA course, as you had to do some practical training. Rather than just focusing on my clinic, I started getting involved in basketball and working with a team called the Coburg Giants which were in the National Basketball League. Within three or four months, I was then working with the National Team because Coburg had four players in the national squad and three players made the actual team. I went down to a training camp to help those guys get through the training sessions and by the end of the camp, I was treating every player.

So, Lindsey Gaze asked me to be the team doctor for the Boomers. From starting the course at SMA and getting interested, within four months I was working for an NBL team and working for the National Basketball team! AFL came later. Because basketball was international, there was a lot of travel. The involvement in international sport led to Olympic Games, World Championships, and significant events like that. Through that I got exposed to doping issues, how you navigate the strict drug codes, as well as other tricky issues such as gender eligibility when I was with the Opals. The AFL was having some difficulties with drug related issues in the 90s. I was at the Victorian

Institute of Sport at that time and Rod Austin from the AFL asked me to help them get up to speed in that area. That’s how I got involved with AFL, and in a similar way with Cricket Australia.

In the early 90s, I was Medical Coordinator for the VIS and the Australian Institute of Sport in Victoria. Because of that connection, I had a lot to do with Olympic Games and Commonwealth Games athletes from many sports. When Melbourne was bidding for the 2006 Commonwealth Games, they got me involved in helping to secure that bid by being involved on their Sport and Technical committee. Later, I was appointed as Chief Medical Officer for the 2006 Games so that’s really how my work in Commonwealth Games kicked off. In 2002 they sent me to Manchester with the Australian team because of my position with the Melbourne Games coming up. More roles in the Commonwealth Games flowed on from there, to the point where I’m now Medical Adviser to the Commonwealth Games Federation Executive Board and Chair of the CGF Anti-Doping Medical Commission. So, my career has been one logical step that leads to the next opportunity. You put your hand up for something and something

else comes along. That’s one thing I’ve learned in life, it is to say yes… don’t say no! Have a crack at things and good things happen. And if they don’t, you move on and try something else.

What do you believe has been your most important contribution to your industry?

I think it’s probably been to have a go and get involved in sporting organisations, moving beyond just being a team doctor or a doctor. If you start to get involved in policy development and governance around the sport, it creates other opportunities to actually support sporting organisations like Commonwealth Sports Australia, the AFL, Cricket Australia, and Basketball Australia.

In terms of other contributions, I’ve written quite a bit of policy. I did a lot of work during the COVID-19 Pandemic developing protocols to assist sports. I helped several sporting organisations navigate the pandemic from very early on, both international, national, and state organisations. At the moment, I’m working on gender eligibility policy for a few sporting organisations. That issue is very challenging. There’s an opportunity for sports medicine practitioners to deliver value at a higher level than to athletes going into battle.

How and when did you first join SMA? What was your initial role?

I joined SMA in 1981 when I started to get interested in sports medicine and completed the SMA course in around 1982. Going to annual conferences was a very important part of my professional development. SMA was the only sports medicine training for healthcare professionals in Australia at that time and they played a really important role. I got involved in the

Victorian State SMA Council around that time. At a later date, I was asked by Michael Kenihan to get involved at the National SMA board level which I did for five or six years. Sports Medicine Australia has been an integral part of my development as a sports physician. It’s something that I really value.

People Who Shaped SMA Dr Peter Harcourt

How has being part of SMA helped you in your career?

I don’t think I would have a career in sports medicine if it wasn’t for SMA. They created a structure and brought interested healthcare practitioners like myself together to discuss what we were doing. It gave us the opportunity to develop our skills. SMA ultimately led to the rise of sports medicine in the Australian sport. SMA’s drive at that time generated the start of a lot of scientific research. Even though they may not have funded it, they were the conduit for actually driving a research agenda. A good example is when I was in my sports medicine practice at Alphington Sports Medicine Clinic with the sports physio Jill Cook, who is a legend in tendon research and management. That outcome came out of that clinic and SMA encouraging us to stretch the boundaries of our knowledge.

SMA was very multidisciplinary. You had sports science and sports medicine. You had nutrition, physiotherapy, and soft tissue therapists. By bringing all these different people together, what it did was inadvertently create a real multidisciplinary approach. I think SMA still has a role in everyone understanding that sports medicine is essentially multidisciplinary in nature.

It might seem odd but one of the things which my sports medicine career led to was getting involved in compensation medicine. I was appointed as clinical convener for the Transport Accident Commission and WorkSafe and that was directly because of my involvement in sports medicine. That generated a whole lot of other employment opportunities for practitioners that work in sports medicine because the real skills of managing soft tissue injuries and musculoskeletal injuries with normal non-surgical type stuff sat with that group. That’s why today, those organisations have such a strong presence of physiotherapists and doctors that come from the

Building Confidence. Together.

sports medicine background, many of them through SMA. So, it’s an important contribution that sports medicine has made beyond sport.

What is your advice to those starting their career in sports medicine?

Have a go and say yes rather than no. Don’t worry too much about the time it takes because you’re going to meet some wonderful people. More than anything, the thing I would take from my involvement in sport is, sport has terrific people who you enjoy working with. The positivity of the industry is fantastic. So, I would encourage people to have a go, and the professional and emotional rewards will flow.

Sports Medicine in Latvia

Latvia is one of the three wonderful Baltic countries located on the coast of the Baltic Sea. Latvia is a small country, with only 1.8 million inhabitants, but an extremely beautiful one, rich in forests, rivers and lakes. The field of sport and exercise medicine (SEM) in Latvia is very important, one of the medical priorities, and the implementation of its national plans are carried out not only by sport and

exercise medicine physicians, but also by physiotherapists, cardiologists, endocrinologists, pulmonologists and all the other medical specialties, as well as coaches. However, it should be emphasized that the duties and competences of a sport and exercise physician cannot be replaced by specialists from other fields.

It is possible to obtain medical education at one of the two medical

faculties – the University of Latvia or the Riga Stradins University, which are both located in Riga, the country’s capital. The study program for medical degree lasts 6 years, and within it, medical students learn all the essential preclinical and clinical subjects, however sports and exercise medicine are not taught very seriously. The first encounter with the effects of physical exertion on the human body and on health takes place in

Photo: RossHelen/ gettyImages

Sports Medicine in Latvia

the 2nd year of the medical school, when in the courses of “Human Physiology” and “Biochemistry” students perform a clinical exercise test and analyse the results, learning the basics of exercise physiology. Later, in the 5th year at the University of Latvia, there is an insight into the subject “Sport and Exercise Medicine and Physical Rehabilitation”, as well as the basics of a healthy lifestyle.

Sport and exercise physician is a recognized basic medical specialty in Latvia. In order to become a sports doctor, one must study in the residency study program “Sports Medicine”, which lasts another 4 years, and this program can be studied at both above mentioned universities. It should be noted that in order to enter this residency program, one has to pass a competition, and every year only 1 or 2 new specialists are admitted. Therefore, already during undergraduate studies, those who want to connect their life with SEM should try to gain additional practical and scientific experience by volunteering or getting involved in scientific work in research centres operating in the field of sport and exercise medicine and science. When entering the residency, both the average grade during the 6 years of undergraduate studies, the topic of the diploma thesis

(whether it is related to sport and exercise medicine) and evaluation, as well as recommendations from professionals in the field of SEM and the voluntary and scientific activities performed during the studies are taken into account. Those who meet the following criteria are invited to an interview, during which the residency commission evaluates the candidate’s motivation and suitability for a sport and exercise medicine residency.

Since Latvia is not a big country, sports medicine specialists are also an exclusive phenomenon. There are a total of 50 certified sport and exercise medicine physicians and 10 SEM residents in Latvia. So, if you meet a sports doctor from Latvia, then you know that you have met a representative of a very rare species! As you can understand, even for such a small population as Latvia, there are not enough sport and exercise medicine doctors, because the opportunities to work are very diverse, the demand for sports medicine specialists is high, and it will only increase in near future – not only athletes need a sports doctor’s consultation, but it is important to find

suitable physical activities for every patient, regardless of the background of chronic and acute diseases.

There are various job opportunities for a sport and exercise medicine physician in Latvia. First, there is the option of choosing to work either in the public or in the private sector. If you decide to work in a state institution, then this includes specialized sports schools in the largest cities of Latvia, the State Sports Medicine Centre, which provides health care and medical supervision of children engaged in organized physical activities and sport, and the Latvian Olympic unit, amongst others. On the other hand, when working privately, there is an opportunity to receive patients on an outpatient basis in various private clinics, to perform physical exercise testing of athletes and patients (cardiopulmonary fitness and musculoskeletal readiness), and to work with representatives of individual sports or in a sports team. Taking into account that there are so few sport and exercise medicine physicians in Latvia and there is a pronounced shortage of representatives of this

Photo: RossHelen/ gettyImages

Photo: Xantana/ gettyImages

specialty, most specialists combine various jobs, for example working both in a sports team and accepting outpatients. In addition, they are also often involved in academic work, educating medical students, sports medicine residents and coaches.

In Latvia, sport and exercise medicine physicians are represented by the Latvian Sports Medicine Association, which works with the aim of promoting the prestige and development of sport and exercise medicine as a multidisciplinary field of medicine and the specialty of sports doctor in Latvia, to increase the knowledge of other specialists about the knowledges of sport and exercise medicine, as well as to carry out the certification of sports doctors and, of course, to promote healthy lifestyle and to educate the Latvian population about the importance of physical activities in maintaining and improving health. The Latvian Sports Medicine Association does not publish its own journal, but cooperates with multidisciplinary professional journals in Latvia, regularly publishing informative articles on various SEM topics. The association

also organizes monthly seminars for both sport and exercise physicians and other specialists related to the SEM field. Every five years, the Baltic Sports Medicine Congress is organized by the Baltic countries – Latvia, Lithuania and Estonia. The 2023 Congress will be held in Lithuania, Kaunas, 21-23 in September and everyone is more than welcome to join!

Author Bio

Laila Usacka

Sport and exercise medicine resident in University of Latvia. Sport and exercise physician in National Armed Forces of Latvia.

Associate Editor inbMJ Open Sport and Exercise Medicine.

Lecturer in the Master’s study program “Sports Science” and at the Faculty of Medicine at the University of Latvia. Lecturer in the education program for coaches.

Photo: Ingus Kruklitis/ gettyImages

Trainer

Gabby Curran

How did you first become involved with sports training?

I originally started at university with a double degree in Secondary Education and Health and Sports Science. In one of my first-year units, all the content in that unit was very closely aligned to what is required in the Level One Sports Trainer handbook. So, my university teamed up with Sports Medicine Australia and said if you pay this extra amount and take one extra exam, then you can get your Level One Sports Trainer qualification. At the time, I just saw it as an opportunity for a practice exam. I didn’t fully understand what that qualification meant or what I

could do with it. It wasn’t until a couple of years later when a co-worker in a completely different industry said to me, “Hey, I need a sports trainer. I know you have that qualification. Would you like to come on board and give it a go?” and that completely opened me up to the world of being a sports trainer.

What do you enjoy most about being a sports trainer?

I really enjoy being able to make connections with people in whatever capacity they need me to be there for them. People have so many different reasons that they come to you as a sports trainer asking for your help and

I really like being able to help them. It’s also a great challenge for me to be able to mold myself to be the person that they need at the time.

Are there any particular highlights or challenges that stand out to you from your experience working as a sports trainer?

I really like the connections and community that being a sports trainer has brought me. Particularly working with Sports Medicine Australia, I’ve started getting to know a lot of people in the industry that I wouldn’t have met otherwise. It has brought up many opportunities for me as an individual

to try out things that I would never have had the opportunity to do before. That’s been really exciting that it does that for me. Challenges, as I said earlier, I’m constantly having to change who I am to meet the needs of those who are around me. Sometimes that can be a little bit difficult but at the end of the day, it’s not about me, it’s about the person who needs my help.

How has being part of SMA helped your career so far?

It’s helped me to have a deeper understanding of what a sports trainer is in the first place and what kind of roles a sports trainer plays. I feel like being a sports trainer, you wear so many different hats when it comes to assisting athletes. Not only are you helping them with their recovery from injuries, you’re also helping to prevent injuries. You’re the center of their healthcare team, especially in amateur sports, where they don’t actually have a team of professionals around them like with elite athletes. You’re helping to get them connected to physios and all that to

Do you have any advice for people wanting to get involved in sports training?

Give it a go, and give different sports and different levels of sports a go as well. Reaching out to multiple clubs in a sport that you’re interested in is a great starting point for becoming a sports trainer. Having an open mindset to trying multiple sports and levels of those sports is a great way to establish yourself as a trainer and become confident in yourself and your skills. Especially in my background, I have a lot of experience in AFL. I find that the difference between amateur and elite level AFL is amazing. Because of those differences, getting experience in all different sports and in all those different levels is so valuable. As for networking, SMA events and local sports trainer Facebook groups are great for connecting with other sports trainers in your area and finding other sports trainer opportunities that you may be interested in.