Research Articles (Sports Medicine)

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Mental health in elite athletes : International Olympic Committee consensus statement (2026)
Reardon, Claudia L.; Gouttebarge, Vincent; Kroshus-Havril, Emily; Aron, Cindy Miller; Bahr, Roald; Blauwet, Cheri; Castaldelli-Maia, Joao Mauricio; Cheng, Camille; Currie, Alan; Derevensky, Jeffrey Lee; Edwards, Carla; Fussek, Sarah; Gorczynski, Paul; Grandner, Michael; Han, Doug Hyun; Hitchcock, Mary E.; Lu, Frank; Massey, Andrew; McDuff, David; Mountjoy, Margo; Purcell, Rosemary; Putukian, Margot; Rice, Simon M.; Sloan, Scott; Soligard, Torbjorn; Sundgot-Borgen, Jorunn Kaiander; Swartz, Leslie; Thornton, Jane S.; Tshube, Tshepang; Hainline, Brian (BMJ Publishing Group, 2026-08)
This consensus statement represents an update to Mental Health in Elite Athletes: International Olympic Committee Consensus Statement (2019). To advance a more standardised, evidence-based approach to mental health in elite athletes, an International Olympic Committee (IOC) Consensus Group critically evaluated the current science via a systematic literature review, sought consensus using Delphi methodology and provided recommendations relevant to this topic. Key themes include that mental health symptoms and disorders are (1) common among elite athletes; (2) may have sport-related aetiologies and manifestations; and (3) can impact performance. Routine screening for and monitoring of mental health symptoms and disorders in elite athletes using validated instruments is recommended. Management strategies should promote mental well-being in addition to preventing and treating mental health symptoms and disorders. These strategies should address all contributors to mental health symptoms, including factors within the environments in which athletes train and compete. Treatment may include psychotherapy, medication and other culturally or contextually appropriate modalities. With appropriate support and treatment, many athletes experiencing mental health symptoms and disorders can continue to train and compete safely, but sometimes modification of sport participation may be necessary. Elite athletes who are transitioning out of sport, elite Para athletes and elite young (adolescent) athletes are relatively understudied and may have distinct mental health concerns, in addition to those impacting elite athletes in general.
Understanding working conditions in elite women’s football : a scoping review
Le, Christina Y.; Culvin, Alex; Brown, Frankie; Okholm Kryger, Katrine; Gledhill, Adam; Gouttebarge, Vincent; Emmonds, Stacey (Routledge, 2026-08)
Despite recent growth of women's football, concerns about players' working conditions persist. Therefore, this scoping review aimed to summarise and map current evidence on working conditions in elite women's football. Seven databases were searched from 1 January 2000 to 8 May 2025). Records were included if they described working conditions (factors that can influence players' performance, health, and/or well-being) in elite women's football (participating in the highest or second highest domestic league or with a national team). Primary research articles and grey literature (e.g. theses, organisational reports, governmental reports) were eligible. An inductive content analysis was used to identify working conditions categories and count the number of records that contributed to each category. Of 10,597 potential records, 111 were included. Research articles were the most common record type (n = 78; 70%). Domestic league and national team football were described by 78 (70%) and 31 records (28%), respectively. Most records were published after 2020 (n = 78; 70%), and England was the most studied country (n = 21; 19%). Six working conditions categories were identified: finances (n = 63; 57%), performance support (n = 62; 56%), health support (n = 46; 41%), team environment (n = 35; 32%), organisational environment (n = 42; 38%), and discrimination (n = 23; 21%). The six working conditions categories identified in this review offer a preliminary framework to guide future research and inform policy development toward establishing minimum working standards in the women's game. Ensuring working conditions that promote player performance, health, and well-being is essential as women's football continues to grow.
Depressive symptoms in high-performance athletes and non-athletes : a comparative meta-analysis update
Gorczynski, Paul; Bilgoe, Sharaisha Chanita; Gouttebarge, Vincent; Hitchcock, Mary E.; Currie, Alan (BMJ Publishing Group, 2026-08)
OBJECTIVE : Provide an updated comparison of the prevalence of mild or more severe depressive symptoms between high-performance athletes and non-athletes. DESIGN : Comparative OR meta-analysis. DATA SOURCES : PubMed (Medline), PsycINFO (Ebsco), Scopus (Elsevier) and SportDiscus (Ebsco). We conducted hand searches of reference lists of relevant papers. ELIGIBILITY : Studies were included that were published in full in English; compared high-performance athletes and non-athletes; used a validated measure of depressive symptoms; and provided the prevalence of individuals who indicated at least mild depressive symptoms. RESULTS : 1834 records were screened, 58 reviewed for eligibility, and five studies were included and added to five studies from our previous meta-analysis. Collectively, 10 studies reporting data on 2430 high-performance athletes and 2725 non-athletes were evaluated. A risk of bias in prevalence studies assessment demonstrated an agreement between the two evaluating authors that was considered substantial or strong with a kappa statistic of 0.75. There was no significant difference in depressive symptom prevalence between high-performance athletes and non-athletes (OR=1.016, 95% CI=0.815 to 1.267, p=0.888). Male high-performance athletes (n=1708) were no more likely than male non-athletes (n=1556) to report mild or more severe depressive symptoms (OR=0.936, 95% CI=0.710 to 1.235, p=0.641). Female high-performance athletes (n=722) were no more likely than female non-athletes (n=1157) to report mild or more severe depressive symptoms (OR=1.031, 95% CI=0.818 to 1.299, p=0.796). Male high-performance athletes (n=1019) were 47% less likely to report mild or more severe depressive symptoms than female high-performance athletes (n=722) (OR=0.527, 95% CI=0.418 to 0.664, p<0.001). Male non-athletes (n=955) were 33% less likely to report mild or more severe depressive symptoms than female non-athletes (n=1157) (OR=0.666, 95% CI=0.447 to 0.992, p=0.045). CONCLUSION : This meta-analysis found no significant difference in depressive symptom prevalence between high-performance athletes and non-athletes. However, both female high-performance athletes and non-athletes report a greater prevalence of depressive symptoms than their male counterparts.
From evidence to action : a global call to advance sleep health in sport
Grandner, Michael A.; Athey, Amy; Bender, Amy; Charest, Jonathan; Halson, Shona L.; Janse van Rensburg, Dina Christina; Lastella, Michele; Nedelec, Mathieu; Sargent, Charli; Vitale, Jacopo; Brager, Allison (BMJ Publishing Group, 2026)
Awareness of sleep health in sport has increased substantially over the past decade, yet many high-performance environments continue to operate in ways that are fundamentally misaligned with healthy sleep and circadian biology. This editorial presents evidence-based sleep health practices to better address the culture, structure and operational demands of competitive sport.
Mental health symptoms among men and women Australian professional football (soccer) players : a survey-based cross-sectional study
Mifsud, Daniela; Janse van Rensburg, Dina Christina; Busch, Beau; Mankowska, Rita; Taylor, Brett; Kerkhoffs, Gino; Gouttebarge, Vincent (BMC, 2026-03-26)
OBJECTIVES : The primary aim of this study was to determine the prevalence of mental health symptoms among men and women Australian professional footballers, drawing comparisons with prevalence rates from 2020. A secondary aim was to assess whether mental health symptoms among men and women Australian professional footballers were associated with recent injury and/or psychological resilience. DESIGN : Observational cross-sectional study. METHODS : An electronic anonymous open e-survey. RESULTS : 86% of A-Leagues players completed the e-survey. In both men and women professional footballers, sportrelated psychological distress was common, with prevalence reaching 43% and 66%, respectively. In men football players, injury in the previous 6 months was not associated with mental health symptoms, while psychological resilience was negatively associated with sport-related distress OR 0.947; p=0.005) and sleep disturbance (OR 0.956;p=0.027). In women football players, injury in the previous 6 months was associated with problem gambling (OR 3.87; p=0.035) and alcohol misuse (OR 1.94; p=0.021), while psychological resilience was negatively associated with global psychological distress (OR 0.92; p=0.01), anxiety (OR 0.90; p=0.002), substance misuse (OR 0.88; p=0.034) and disordered eating (OR 0.95; p=0.015) but not with other mental health symptoms. CONCLUSION : This population is vulnerable to a range of mental health symptoms. Understanding this may help in the development of policy and emphasizing clinical screening and education of mental health symptoms in football. Musculoskeletal injuries and psychological resilience also affect the prevalence of mental health symptoms.
International Ski and Snowboard Federation (FIS) consensus statement on return- to- performance in competitive alpine and freestyle skiers and snowboarders
Sporri, Jorg; Muller, Philippe O.; Bonell Monsonis, Oriol; Bahr, Roald; Beck, Lisa; Brucker, Peter U.; Engbretsen, Lars; Fink, Christian; Horterer, Hubert; Jordan, Matthew J.; Mitterbauer, Gerald; Moksens, Havard; Okell, Abi; Santelli, Jaron; Scherr, Johannes; Schobersberger, Wolfgang; Stolz , Annika; Taylor , Jim; Valtonen , Maarit; Weirather, Tina; Gouttebarge, Vincent; Bolling, Caroline; Verhagen, Evert (BMJ Publishing Group, 2026-02)
Returning to a high level of performance after injury is a significant challenge for athletes. However, current best practices for return- to- performance in competitive snow sports are not well understood due to a lack of research evidence and international harmonisation. The International Ski and Snowboard Federation commissioned this consensus statement to provide recommendations for the safe and successful return of competitive alpine and freestyle skiers and snowboarders to competitive performance. An international consensus panel was formed to contribute their knowledge and perspectives on return- to- performance. The panel included experts with extensive experience in return- to- performance. The panel consisted of 23 experts (7 women and 16 men) from various skiing and snowboarding disciplines and levels of competition. It included 16 researchers, 6 snow sports or International Olympic Committee officials, 9 physicians, 6 physical therapists, 2 sports psychologists, 2 coaches and 2 former athletes, some of whom had two backgrounds/functions. However, it was disproportionately European (78%) and North American (13%), with minimal representation from South America (4%) and Africa (4%) and no representation from Asia or Australasia. The RAND- UCLA Appropriateness Method was adopted for the underlying consensus process. First, the panel discussed which topics and questions should be included in the consensus statement before developing an overall structure. The consensus process then involved providing key content based on the literature or statements from experts/panel members. These were voted on three times by all the panel members, resulting in a list of 196 statements. The jointly developed overall structure and the final statement list then formed the basis for preparing the manuscript. This consensus statement aims to assist athletes, coaches and medical staff of international and national federations in planning and implementing safe and successful return to- performance strategies for competitive alpine and freestyle skiers and snowboarders.
Mental health in tennis : a cross-organisational hybrid summit-Delphi consensus process
Kroshus-Havril, Emily; Capel-Davies, Jamie; Ellenbecker, Todd; Gouttebarge, Vincent; Martin, Kathy; Miller, Stuart; Mountjoy, Margo; Reardon, Claudia L.; Stroia, Kathleen; Hainline, Brian (BMJ Publishing Group, 2026-07)
We sought to generate recommendations for the tennis community regarding the provision of mental healthcare and the promotion of mental wellness among elite tennis athletes, including junior tennis athletes. Recommendations were generated using a multimethod approach that included an in-person summit held during the 2022 US Open Tennis Championships in New York, New York, USA, and an asynchronous Delphi consensus process. Participants (n=83) were purposively selected to ensure diverse representation from all seven governing bodies of tennis and the broader tennis ecosystem, including: current and former elite adult and junior players, coaches, sport administrators, parents, physiotherapists, athletic trainers, physicians (sports medicine, psychiatry, neurology), other licensed mental health providers, epidemiologists and other academic subject matter experts. The summit included expert presentations and cross-organisation group discussion, which were used to generate provisional consensus statements. Statements were rated anonymously and refined iteratively based on synthesis of open-ended feedback until predetermined numeric thresholds were reached. The summit also included discussion of implementation challenges and priorities. As a result of this process, 2 foundational principles and 25 actionable recommendations were adopted, covering 5 domains: (1) standards of care, (2) education, (3) media and social media, (4) safeguarding and (5) research. The foundational principles emphasised that mental health must be prioritised by tennis governing bodies and that these bodies should collaborate across the tennis ecosystem. This output is a starting point for coordinated mental health efforts in tennis. More broadly, this pragmatic process is a replicable model for cross-organisational collaboration in other high-performance sports.
International Olympic Committee Sport Mental Health Assessment Tool 2 (IOC SMHAT2) : development, content validity and feasibility
Gouttebarge, Vincent; Bindra, Abhinav; Blauwet, Cheri; Currie, Alan; Hainline, Brian; Kroshus-Havril, Emily; McDuff, David; Purcell, Rosemary; Putukian, Margot; Reardon, Claudia L.; Rice, Simon M.; Sloan, Scott; Thornton, Jane; Mountjoy, Margo (BMJ Publishing Group, 2026-08)
OBJECTIVE : To describe the evidence- and practice-based processes that led to the International Olympic Committee Sport Mental Health Assessment Tool 2 (IOC SMHAT2). METHODS : Seven stages were conducted including: (1) reviewing the scientific literature related to the use (eg, uptake by physicians) of the IOC SMHAT-1; (2) gathering the view (eg, experience with the tool, advice for improvements) of IOC SMHAT-1 users; (3) exploring the misclassification and measurement properties of the IOC SMHAT-1; (4) performing misclassification analysis of available IOC SMHAT-1 data; (5) designing the initial IOC SMHAT2; (6) evaluating the content validity and feasibility of the initial IOC SMHAT2; and (7) finalising the IOC SMHAT2. RESULTS : The IOC SMHAT2 was developed for sports medicine physicians and other licensed/registered health professionals with the objective of identifying elite athletes (defined as professional, Olympic, Paralympic or collegiate level; 16 years of age and older) potentially experiencing mental health symptoms and disorders. The IOC SMHAT2 is comprised of a three-step approach: (1) universal screening as step 1, including five disorder-specific screening questionnaires and two single questions; (2) conditional screening as step 2, including two disorder-specific screening questionnaires; and (3) an aid to clinical assessment and treatment as step 3 that should be conducted by sports medicine physicians or licensed/registered mental health professionals. CONCLUSION : Based on scientific and anecdotal reflections on its first version, we developed the IOC SMHAT2 as a second updated version of the tool to identify elite athletes potentially experiencing mental health symptoms and disorders.
What evidence supports primary prevention strategies for sport-related concussion? An umbrella review
Trabelsi, Khaled; Boukhris, Omar; Chebbi, Souhail; Husain, Waqar; Ammar, Achraf; Holtzhausen, Louis; Chtourou, Hamdi; Chamari, Karim; Jahrami, Haitham (Termedia Publishing House, 2026-07-13)
This umbrella review aimed to systematically evaluate and synthesize evidence from published systematic reviews on the effectiveness of primary prevention strategies for sport-related concussion (SRC) in athletes, and to identify areas of uncertainty relevant to policy and practice. A comprehensive search of the Cochrane Database of Systematic Reviews, Epistemonikos, ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science was conducted from 2001 to April 2025, with an updated search in November 2025. Peer reviewed systematic reviews, with or without meta-analyses, assessing primary prevention strategies to reduce SRC incidence in competitive athletes of any age or sex were eligible. Interventions included rule or policy changes, protective equipment, educational programs and training-based strategies. Twenty-five systematic reviews were included, eight of which contained meta-analyses; all were rated as critically low quality using the AMSTAR-2 tool. Rule and policy changes, particularly the disallowance of body checking in youth ice hockey, demonstrated the most consistent evidence for reducing SRC incidence. Meta-analyses evaluating mouthguards and headgear showed substantial overlap of primary studies and inconsistent effects. Educational interventions and training-based programs, including structured warm-up programs such as FIFA 11+ Kids, produced inconclusive findings. Evidence specific to female athletes was limited and insufficient to support any particular prevention strategy. Overall, rule and policy changes that reduce exposure to high-risk contact currently have the strongest supporting evidence for SRC prevention, whereas evidence for equipment, education and training remains mixed. Given the critically low methodological quality of existing reviews, higher-quality evidence syntheses and robust primary studies are urgently needed.
Mapping mental health problems in elite female athletes—a scoping review. Emphasising limited research in Africa and South America
Naidoo, Dhavina; Chantler, Jessica; Gouttebarge, Vincent; Janse van Rensburg, Dina Christina; MacMillan, Candice (Elsevier, 2026)
BACKGROUND : Mental health symptoms and disorders are growing concerns among elite athletes facing unique psychological stressors from high-performance competition. While prevalence has been studied in male athletes and regions like Europe and Australia, significant gaps exist regarding elite female athletes from underrepresented regions, including Africa. OBJECTIVES : To conduct a scoping review on the literature of mental health symptoms and disorders in elite female athletes globally, identify geographic research gaps, and summarise key contributing factors and methodologies. DESIGN : Scoping review. METHODS : While focusing on mental health symptoms and disorders among elite female athletes, studies including both female and male participants were considered to provide a comprehensive overview. A search was conducted in PubMed, PsycINFO, CINAHL, and Scopus databases. Two reviewers independently screened studies, extracted data, and charted results on study characteristics, descriptive study-level prevalence estimates, associated factors, and methodologies. RESULTS : Fifty-nine studies were included. Only seven investigated elite female athletes, 22 reported sex-disaggregated prevalence estimates, and 30 presented aggregated results. Most studies (88.1%) were cross-sectional. Only three studies investigated disorders, and the remaining 56 investigated symptoms such as depression, anxiety, and disordered eating. Risk associations included injury, illness, career dissatisfaction, financial stress, and gender. Research originated mainly from Europe (n = 27), with only one study from Africa and three from South America. CONCLUSIONS : Mental health symptoms are prevalent among elite female athletes, yet evidence is skewed toward high-income regions and often lacks female-specific data. More geographically inclusive, longitudinal, and sex-disaggregated research is needed, particularly in Africa and South America, to ensure the development of equitable interventions and policies.
Factors associated with return-to-sport outcomes following pathogen-confirmed acute respiratory infections in athletes : AWARE X study
Jooste, Marcel; Sewry, Nicola Ann; Valtonen, Maarit; Dyer, Marlise; Jordaan, Esme; Schwellnus, Martin Peter (BMJ Publishing Group, 2026-07)
OBJECTIVE : To identify factors associated with return-to-sport (RTS) outcomes following confirmed acute respiratory infections (ARinf) in athletes. METHODS : This prospective cohort study included 114 confirmed ARinf cases among athletic individuals. Causative pathogens were identified using multiplex PCR testing, and illness severity was classified per International Olympic Committee consensus (mild, moderate and severe). RTS outcomes included time (days) to return-to-training (RTT), return-to-full-training (RTFT) and return-to-full-performance (RTFP). Cox regression models (HRs) assessed associations between RTS outcomes and demographics, sport participation, pathogen groups and illness severity. RESULTS : The median (IQR) days to RTT were 3.5 (0–7), RTFT 8 (6–11) and RTFP 11 (7–14). Amateur athletes had prolonged RTS outcomes (HR range=0.51–0.59; p≤0.03) compared with professional athletes. RTS outcomes differed between the most common pathogen groups: influenza and SARS-CoV-2 had longer RTS than rhinovirus (HR range=0.11–0.23; p≤0.003). Severe illness was associated with prolonged RTS outcomes compared with mild and moderate illnesses (HR range=0.17–0.31; p<0.0001). Pathogen-related differences in RTS persisted within each severity group. Within mild/moderate illnesses, the influenza/SARS-CoV-2 subgroup had longer RTS than rhinovirus (HRs: RTT=0.35; RTFT=0.05; RTFP=0.06; p<0.05) and within severe illnesses (HRs: RTT=0.23; RTFT=0.21; RTFP=0.13; p≤0.01). CONCLUSION : Factors associated with RTS outcomes following ARinf in athletes are level of sport participation, illness severity at presentation and the causative pathogen. Clinical assessment of illness severity remains valuable in RTS decision-making, particularly in low-resource settings. However, identifying the causative pathogen may provide additional predictive value and refine RTS clinical decision-making.
Navigating adversity : non-completion and evacuation of trail runners at the 2022 Magoebaskloof Forest Marathon
Maleka, Thabo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Ramkilawon, Gopika Devi; Ramagole, Dimakatso Althea; Nair, Anoop; Janse van Rensburg, Dina Christina (South African Sports Medicine Association, 2026-04-22)
BACKGROUND : Trail running occurs on natural, uneven terrain. The literature is limited in exploring factors that contribute to trail runners not completing a race. OBJECTIVES : This study firstly investigated self-reported reasons for runners who did not finish (DNF) the 2022 Magoebaskloof Forest Marathon across 10km, 20km, 34km, and 50km distances, and secondly assessed runners' evacuation methods. METHODS: A descriptive cross-sectional study of consenting trail runners (n=429) who completed the post-race DNF survey (10km, 20km, 34km and 50km distances). Within two weeks post-race, runners reported whether they finished, reasons for discontinuing and evacuation methods. We report numbers (n) and point prevalence (%). RESULTS : Of the 228 runners who completed the post-race survey, 16 (7%) DNF. DNF runners entered the 34 km (19%) and 50 km distance (81%) and were aged 31–50 years (94%). No DNFs occurred in the 10km and 20km races. Approximately 27% did not meet cut-off times, while 19% got lost despite trail directions. Other contributing factors included pre-existing and new injuries (23%), illnesses (15%), and inadequate training (8%). While 50% of the DNF group had >5 years total running experience, only 19% had >5 years of trail running experience. Runners who finished the trail race had significantly more trail running experience than those who DNF (p=0.0082). The primary evacuation method was hiking back to the nearest aid station (63%), with 19% subsequently transported by shuttle. CONCLUSION : Multiple factors may have contributed to the race non-completion. Many DNF runners started with injuries or illnesses, inadequate training, or limited trail-running experience. Event planners should improve measures to prevent runners from getting lost. These findings emphasise the importance of preparation, navigation skills, and race management in ensuring trail running safety and success.
Elevating the game : pathway structures and the operationalisation of talent identification and development systems across world netball
Rongen, Fieke; Till, Kevin; Hill, Megan; Backhouse, Susan H.; Janse van Rensburg, Dina Christina; Hayburn, Jess; Navin, Anita; Whitehead, Sarah (Routledge, 2026)
Sporting pathways and talent identification and development systems (TIDS) are commonly used worldwide to identify and develop future elite athletes. However, limited research explores the structure of sporting pathways and the operationalisation of TIDS as part of them globally, especially in women’s sports, including netball. Therefore, representatives from 10 global netball governing bodies participated in semi-structured interviews to help describe the structure of their netball pathway and operationalisation of their TIDS. Utilising reflexive thematic analysis three themes were generated: ‘Netball pathways are multilayered but not always consistently connected’, ‘Traditional and forward-thinking talent identification and development practices’, and ‘Limited resources make talent identification and development challenging’. These findings provide organisations with an understanding of the structure of sporting pathways, and the operationalisation of TIDS in netball and the challenges of optimising them. To address these challenges, prioritising coach and practitioner education across the pathway to deliver inclusive, ethical, and appropriate practices to maximise player retention and player development is needed. Organisations are encouraged to consider how they can collaborate to maximise the use of resources within the sport.
From GPT-4 to expert-endorsed athlete guidance : a Delphi consensus on sleep and jet lag
Vitale, Jacopo; McCall, Alan; Athlete Travel & Sleep Interest Group (ATSIG); Halson, Shona; Janse van Rensburg, Dina Christina (Springer, 2026)
BACKGROUND : Large language models (LLMs) like GPT-4 are increasingly used to generate health information, but concerns persist about their accuracy and relevance, particularly for elite athletes. OBJECTIVE : This study used GPT-4-generated frequently asked question (FAQ) responses on sleep and jet lag as the starting material for expert evaluation and consensus development, with the goal of producing consensus-based, athlete-specific guidance while identifying the limitations of AI-generated content. METHODS : Between November 2024 and March 2025, n=17 international sleep and circadian experts from the Athlete Travel & Sleep Interest Group (ATSIG) participated in a two-round Delphi process. Experts rated 20 GPT-4-generated FAQ responses (10 on sleep, 10 on jet lag) for appropriateness using a 6-point Likert scale and provided qualitative feedback. Items were revised after Round 1 using inductive thematic coding. Consensus was defined as ≥70% of participants rating an item as appropriate (scores 5–6) and ≤15% as non-appropriate (scores 1–2). Statistical analyses included Wilcoxon signed-rank tests, convergence metrics, and dissent detection (outlier and bipolarity analysis). RESULTS : In Round 1, 15 of 20 items (75%) met consensus; by Round 2, 18 of 20 (90%) achieved consensus. For sleep items, 7 of 10 reached consensus in Round 1 and 9 in Round 2; for jet lag, 8 items reached consensus in Round 1 and 9 in Round 2. Sleep Q6 (sleep and injury risk) narrowly missed the consensus threshold with 64.7% agreement, while Jet Lag Q9 (melatonin and sleep aids) remained below the 70% threshold. No item showed bimodal score distributions, suggesting no polarized disagreement. Descriptive rating patterns, increased consensus, and qualitative expert feedback indicated improved clarity, accuracy, and athlete-specific relevance after the Delphi process, although item-level statistical comparisons did not remain significant after Bonferroni correction for multiple testing. Qualitative analysis identified common concerns: for sleep items—imprecise or misleading content (55%), lack of athlete-specific relevance (30%), and outdated evidence (11%); for jet lag—outdated evidence (36%), imprecise or misleading content (34%), and formatting issues (17%). CONCLUSION : GPT-4-derived content may serve as useful preliminary material for expert discussion but should not be used as standalone guidance. Expert evaluation improved the clarity, safety, and athlete-specific relevance of most sleep and jet-lag responses, while the final outputs should be interpreted as consensus-based guidance rather than definitive proof of correctness. KEY POINTS 1. Expert-endorsed, consensus-based guidance on athlete sleep and jet lag was developed through a structured Delphi process using GPT-4-derived FAQ draft material as the starting point. 2. Consensus was achieved on 90% of items, suggesting improved expert agreement on most responses; however, this should be interpreted as consensus-based guidance rather than definitive proof of correctness. 3. The study shows that large language models can effectively support sports science communication when their outputs are reviewed and validated by domain experts.
Unpacking the impact of travel and jet lag on sleep and performance of athletes : a narrative review
Fabunmi, Oyesanmi A.; Jansen van Rensburg, Audrey; Vitale, Jacopo A.; Stevens, David; Lenting, Andrea; Janse van Rensburg, Dina Christina (Springer, 2026-04-22)
PURPOSE OF REVIEW : Travel is an essential aspect of an athlete's professional career. Yet, the embodiment of travel can lead to travel fatigue and jet lag, leading to a cascade of undesirable outcomes related to sleep and athletic performance. This review aims to synthesize the current evidence on the impact of long-haul travel and jet lag on the sleep and performance of athletes. RECENT FINDINGS : Emerging evidence suggests that travel fatigue and jet lag negatively impact sleep, particularly total sleep time, efficiency, and onset latency, and impair the cognitive and physical performance of elite athletes. However, some studies report neutral or positive effects, often due to prior travel experience, targeted interventions, or favorable conditions like business class seating. SUMMARY : Jet lag and travel fatigue pose a multifactorial risk to both sleep and performance in athletes. Implementing proactive, evidence-based travel management strategies is vital for optimizing athlete readiness, well-being and competitive success.
Improving social support among sports medicine practitioners : a call to action
Hendricks, Sharief; Zondi, Phathokuhle Cele; Janse van Rensburg, Dina Christina; Gordon, Leigh; Rotunno, Adrian; Ganda, Janesh; Naidoo, Dhavina; Dalton, Caroline; Isaacs, Natheema; Jones, Ben; Patricios, Jon S. (BMJ Publishing Group, 2026-05)
No abstract available.
One step further : integrating evidence-based guidelines into practice to address environmental challenges at the Men’s 2026 FIFA World Cup
Esh, Chris J.; Carter, Sarah; Bougault, Valerie; Girard, Olivier; Janse van Rensburg, Dina Christina; Chrismas, Bryna C.R.; Meyer, Tim; Taylor, Lee (Springer, 2026-03-23)
The Men’s 2026 Fédération Internationale de Football Association (FIFA) World Cup (Canada, Mexico and the USA) will expose teams to an unprecedented combination of environmental challenges (heat, altitude, air pollution, allergens and travel). Conditions will vary significantly between host cities, creating a significant threat to player health and performance. These unique stressors may require teams to adopt and adapt strategies to best protect player health and performance. A related open access Sports Medicine review outlines these environmental challenges and the evidence-based guidelines to prepare for and mitigate their effects. Motivation for the present review stems from the unique practical and logistical complexities of ‘tournament football’—especially at the expanded 2026 FIFA World Cup—alongside the limitations of previous football-facing reviews, where ‘evidence-informed practice’ is often not underpinned by football-specific research and thus limits external/ecological validity. Building on the recommendations of the main review, this partner review focuses on integrating those guidelines into practice. It aims to provide teams with a practice-compatible framework to implement evidence-based strategies to protect player health and optimise performance at the 2026 FIFA World Cup.
Tennis in the heat : a panel discussion
Pluim, Babette M.; Jay, Ollie; Alsma, Jelmer; Daanen, Hein; Ellenbecker, Todd; Stroia, Kathleen; Hainline, Brian (South African Sports Medicine Association, 2026-02-04)
Tennis is played globally across diverse climates and surfaces, exposing athletes to variable levels of environmental heat stress. With rising global temperatures and more frequent heat events, protecting players’ health has become a major priority in the sport. This panel discussion aimed to synthesize current evidence and expert perspectives on measuring, managing, and mitigating heat stress in tennis, with a focus on harmonizing policies across governing bodies and player groups. Experts from sport science, medicine, and tournament operations reviewed recent advances in heat measurement tools, including the limitations of the Wet Bulb Globe Temperature (WBGT) and the emergence of tennis-specific heat stress models. Evidence-based cooling strategies—such as ice towels, shaded recovery, and cold-water immersion—were discussed alongside differentiated policy needs for men, women, juniors, seniors, and wheelchair athletes. The discussion further highlighted challenges in achieving effective heat acclimatisation within professional travel schedules and underscored the importance of proactive medical readiness and player education. Enhanced consistency in heat policies, improved access to cooling resources, and continued collaboration between scientists and governing bodies are essential to safeguard player health and performance under increasing environmental heat stress.
Injury prevalence and characteristics among tennis coaches in the Netherlands : a cross-sectional survey
Terink, Rieneke; Baart, Mireille; De Jong, Nynke; Wies, Monika; Pluim, Babette M.; Zwerver, Johannes (BMJ Publishing Group, 2026-04-10)
OBJECTIVES : To describe the prevalence and characteristics of injuries among tennis coaches in the Netherlands and examine associations with individual and occupational factors. METHODS : In this cross-sectional survey, all 1902 licensed tennis coaches in the Netherlands were invited to complete an online questionnaire. Data were collected on injuries during a 2-year recall period, as well as mental health problems, pain-medication use, healthcare utilisation and work-related characteristics. RESULTS : 900 coaches (74.8% men) completed the survey and 37% reported at least one injury in the previous 2 years. Injuries most frequently affected the lower back (19.5%), shoulder (12.0%), knee (11.6%), neck (7.4%) and elbow (6.2%), with overuse injuries accounting for the largest proportion. Injury prevalence did not differ significantly between male and female coaches. Coaches reporting injuries were taller and had a higher body mass index than uninjured coaches, although differences were small. Approximately one-third of coaches reported that injuries interfered with their ability to teach or play tennis. Pain medication use during tennis instruction was reported by 23% of coaches. Among coaches with health problems, 35% consulted a physiotherapist, 35% a general practitioner and 9% attended an emergency department. CONCLUSIONS : Musculoskeletal injuries are common among tennis coaches and most frequently affect the lower back and lower extremities. Many coaches continue teaching despite ongoing injuries and functional complaints, often accompanied by substantial healthcare utilisation and pain medication use. These findings provide insight into the musculoskeletal health burden associated with tennis coaching and highlight the need to include coaches in tennis injury prevention initiatives.
Tennis serve biomechanics, joint load mechanics and overuse injuries: a narrative review
Martin, Caroline; Touzard, Pierre; Fourel, Loic; Pluim, Babette M. (Springer, 2026-04)
BACKGROUND : The tennis serve is a fundamental stroke in a player’s performance during matches. But it may be also eminently traumatic as it causes very high joint mechanical loading which can lead to injury regardless of the player’s experience, sex or age. This narrative review aims to synthesize current scientific knowledge on the key factors contributing to changes in joint mechanical loadings during the tennis serve and its potential association with overuse shoulder, elbow, wrist and lower back injuries. MAIN BODY : The databases PubMed, Google Scholar, ScienceDirect and SPORTDiscus were used to search the related literatures. The publications that evaluated joint mechanical loadings through 3D biomechanical serve motion capture or video analysis in tennis players of all ages, sexes and competitive levels, with or without epidemiological monitoring of injuries were included. Most studies have involved small populations of expert able-bodied male players and focused only on the flat first serve. The results show that multiple factors – including skill level, energy flow, waiter’s serve technique, temporal kinematics, fatigue and racket specifications - seem to influence upper limb and lower back loadings, thereby influencing injury risks. The impact of serve type (kick, slice or flat), leg drive and backswing style (full or abbreviated) on joint loadings remains unclear. CONCLUSIONS : Teaching proper serving technique, choosing appropriate equipment and training conditions can limit the intensity of forces and moments applied on the joints and therefore decrease the risk of injury. However, further research is needed on this topic, especially in under-represented populations such as female, lower-level, juniors, and wheelchair tennis players. KEY POINTS • Various factors, including skill level, energy flow, pathomechanics, racket characteristics, and serving conditions influence lower back and upper limb joint loadings during the tennis serve, impacting the risk of overuse injuries while stance technique has no effect. • The impact of serve type (kick, slice or flat) and backswing style (full or abbreviated) on joint loading, as well as whether an efficient leg drive reduces load, remains uncertain. These questions require further research and debate. • Most studies have involved small populations of expert, able-bodied male players. To fill the gaps and improve the quality of evidence, future research should include broader player demographics, particularly female athletes, lower-level players, juniors, and wheelchair players

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