Sport Health Volume 42 Issue 3

FEATURING

• Informing Extreme Heat Policy Development in Long Distance Running: Study Overview

• Menopausal Hormone Therapy: A New Perspective on Greater Trochanetric Pain Syndrome Management

• Walk, Roll and Stroll – The Sun Safe Way

Contents

REGULARS

02

From the Chair

SMA Board Chair, Dr Kay Copeland introduces new member groups and looks forward to the 2024 Conference.

03

From the CEO

Jamie Crain on the release of SMA’s 2024-2027 Strategic Plan and highlights feature articles for this issue

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.

FEATURES

04

Closing the gap: Identifying sex specific mitochondrial adaptations in human skeletal muscle to optimise exercise prescription

Dale Taylor and Prof David Bishop explore the prevention and treatment of metabolic dysfunction through exercise induced mitochondrial adaptation.

11

Engaging and empowering the Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Workforce: The Tidda Talk Train-the-Trainer initiative

Madeleine English provides an insight into various groups focusing on social and emotional wellbeing in Aboriginal and Torres Straight Islander Youth and Women.

Publisher Sports Medicine Australia State Netball and Hockey Centre – Parkville 10 Brens Drive, Parkville VIC 3052 sma.org.au

ISSN No. 2205-1244

PP No. 226480/00028

08

SMA’s New Strategic Plan and Member Groups

A summary of our Strategic Plan for 2024 - 2027 and the new member groups.

Copy Editors

Archie Veera and Macey Fogarty

Marketing and Member

Engagement Manager

Sarah Hope

Design/Typesetting

Perry Watson Design

Cover photograph

Peopleimages | #: 628504668

Content photographs

Author supplied; www.gettyimages.com.au

18

Informing extreme heat policy development in long distance running: Study overview Chelsea Blackman investigates the implications of heat in long distance running.

24

The 2024 SMA & ACSEP Conference

We preview session highlights and the program snapshot for this year’s Conference at the MCG.

28 Walk, Roll and Stroll –The Sun Safe Way

Dr Louise Baldwin, writing for Queensland Walks, highlights the importance of being sun smart on Australia’s walking trails.

32

Menopausal Hormone Therapy: A new perspective on Greater Trochanetric Pain Syndrome Management

Dr Rachael McMillan investigates women’s susceptibility to greater trochanteric pain syndrome (GTPS)

Physician Focus: Dr Brendan de Morton

Sports Medicine Around the World: Mexico

44

5 Mins With: Dr Joshua Heerey 40

47

Sports Trainer Spotlight: Danielle Sutherland

FROM THE CHAIR

Committees, Councils and Member Groups

SMA BOARD CHAIR, DR KAY COPELAND

INTRODUCES NEW MEMBER GROUPS AND LOOKS FORWARD TO THE 2024 CONFERENCE

Welcome to the third edition of Sport Health for 2024.

Earlier this year, we actively sought input from our members and stakeholders on key priorities, potential challenges and opportunities for SMA. The consolidation of this work has formed the foundation of our 2024-2027 Strategic Plan, supplemented by our Strategy Map. We will keep you informed on our progress and, as always, welcome ongoing feedback.

SMA’s Committees and State Councils underwent a refresh including the Scientific Advisory Committee (SAC), Member Education Advisory Committee (MEAC), Conference Committee and State Councils. These groups play a crucial role in influencing the direction of sports medicine research and education, and contribute to the growth and prestige of SMA. Thank you to everyone who submitted an application. We look forward to working with all Committee and Council members. Thank you also to those who have completed their term for your contribution to SMA.

These member groups play a crucial role in influencing the direction of sports medicine research and education, and contribute to the growth and prestige of SMA.

Earlier this year, SMA collaborated with Sports and Exercise Medicine Students Australia (SEMSA) to form the SMA Student Network, aimed at advancing the careers of all students in sports medicine. The newly established SMA Student Network Committee is developing a series of engaging events and initiatives designed to educate and offer invaluable networking opportunities for SMA Student

Associates. The official launch of this Group will take place at the 2024 SMA & ACSEP Conference in October, featuring an exclusive networking event where students can connect with peers and industry veterans.

Congratulations to all who worked as an SMA-accredited sports trainer at the 2024 UniSport Nationals in Canberra in September. With over 6,000 participants, the event provided a significant opportunity for our Sports Trainers to expand their professional networks and advance their career experience.

I am excited to see many of our members at the 2024 SMA & ACSEP Conference this October. The Conference Committee has curated an exceptional scientific program, including lectures and workshops from world-leading sports and exercise medicine practitioners, complemented by an immersive social program. Make sure you register soon for this amazing Conference.

Dr Kay Copeland

FROM THE CEO

The New Strategic Plan for 2024 – 2027

JAMIE CRAIN ON THE RELEASE OF OUR 2024-2027 STRATEGIC PLAN AND FEATURE ARTICLE HIGHLIGHTS IN THIS ISSUE

What an extraordinary year it has been, with the Paris Olympics and Paralympics captivating the world and Australian teams dominating across multiple sports. It has been incredible to watch, and knowing that many of our members were there in a professional capacity, has been inspiring and embodies exactly what SMA is all about. Our members truly are the team behind the team. We are already looking forward to Brisbane 2032!

Our preparations for the annual SMA conference are well underway and we look forward to welcoming you to the historic MCG. This year we have partnered with ACSEP and expect over 800 delegates to join us across four days, with a packed program that caters for all sports and exercise medicine and sports science disciplines.

Our new Strategic Plan for 2024-2027 has been released and we are very excited to share our revised Strategy Map with its new strategic priorities that we are pursuing. The Strategic Plan was produced from a combination of member and stakeholder input

We thank our members for their valuable insights which in turn has helped us create a comprehensive Strategy Map that will serve our organisation well over the next three years.

In this edition of Sport Health, we have included research articles across multiple areas of sports medicine. The importance of understanding the underrepresentation of women in exercise research is explored with Dale Taylor and David Bishop. Another feature article that I look forward to everyone reading is a piece from QLD Walks, detailing the benefits of walking between competitions and being sun smart in Australia.

In addition, we also have a feature article by Chelsea Blackman who has researched the impacts of heat on long distance running. An article written by Madeline English explores the importance of social and emotional wellbeing (SEWB) for Aboriginal and Torres Strait Islander youth. Finally, our last feature article is research conducted by Rachael McMillan detailing the impacts of menopausal hormone theory.

collected over the past few months on a range of important topics. We thank our members for their valuable insights which in turn has helped us create a comprehensive Strategy Map that will serve our organisation well over the next three years.

Thank you for being a part of the SMA family and we look forward to seeing you in Melbourne for the Conference.

Jamie Crain

Closing the Gap

Identifying Sex-Specific Mitochondrial Adaptations in Human Skeletal Muscle to Optimise Exercise Prescription

1. Preventing and treating metabolic dysfunction through exercise-induced mitochondrial adaptation (Why will we do this?)

To provide the energy required for contraction, skeletal muscle relies on mitochondria – a structure commonly referred to as the powerhouse of the cell. Essential to our health, reduced mitochondrial function in skeletal muscle has been linked to several diseases characterised by metabolic dysfunction, including type 2 diabetes, cardiomyopathy, and various neurological disorders. The incidence of these diseases, which are primarily driven by lifestyle factors, has dramatically increased globally over the past decade, with over 1 million Australians now currently suffering from type 2 diabetes alone. Exercise is one of the main tools available for the prevention and treatment of metabolic dysfunction, with an improvement in health outcomes partially driven through alterations in skeletal muscle

mitochondria. However, the effect of exercise on the abundance of the over 1,100 individual proteins that comprise the mitochondria remains poorly understood. Due to the lack of understanding regarding specific changes in mitochondrial protein abundance that contribute to functional improvements, it remains challenging to provide effective exercise prescriptions aimed at enhancing mitochondrial characteristics. This challenge is further complicated by the fact that different individuals or groups may respond differently to exercise. To address this gap in the literature, this study aims to characterise changes in mitochondrial protein abundance resulting from exercise training and correlate these findings with improvements in mitochondrial volume density— the percentage of skeletal muscle occupied by the mitochondrial reticulum—and mitochondrial respiratory function, which reflects

the energy-generating capacity of mitochondria in skeletal muscle.

Although men are more likely to receive a diagnosis of type 2 diabetes, the varying pathological presentation and societal pressures that exist between the sexes has led to worse clinical outcomes for women with diabetes. Compounding this problem is that research into the effects of exercise for both the general population and diabetics has suffered from a drastic underrepresentation of women, with a heavy reliance on male-only participant cohorts. Although numerous differences in skeletal muscle and exercise physiology have been described between men and women, such as hormone levels, fibre type composition, and fuel utilisation, how these impact training-induced adaptations to mitochondria has remained unclear (Figure 1). Based on previous research showing sex-specific differences in

DALE TAYLOR & PROF DAVID BISHOP Institute for Health & Sport (IHES), Victoria University, Melbourne, Australia

Photo: DisobeyArt/ gettyImages

gene expression following endurance exercise, it stands to reason there are also differences in protein expression between men and women that impact training-induced mitochondrial changes. Despite the potential presence of sex-specific differences in the adaptive response to exercise, current exercise guidelines from the Australian government and Diabetes Australia do not delineate their recommendations between men and women, with the exception of women who are pregnant or post-partum.

One type of exercise that has emerged recently as well-tolerated and effective at stimulating changes in mitochondrial content and function is high-intensity interval training (HIIT). The time-effective nature of HIIT is also beneficial, with women in Australia facing an inequity in the amount of time available to exercise compared to men. Compared to other regimes, such as moderate-intensity training, HIIT may have additional positive effects for improving mitochondrial respiratory function and hence is an ideal exercise prescription to investigate sex-specific traininginduced mitochondrial adaptation. By identifying and correlating sexspecific mitochondrial protein changes that determine improvements in mitochondrial respiratory function,

One type of exercise that has emerged recently as well-tolerated and effective at stimulating changes in mitochondrial content and function is high-intensity interval training (HIIT).

will use skeletal muscle biopsies collected from 19 healthy young untrained men and 18 healthy young untrained women prior to and immediately following 8 weeks of HIIT on a stationary bicycle. Following initial screening and baseline exercise testing to determine the participant’s peak oxygen uptake (V̇O2peak), maximal power output ( Ẇmax)—the maximum resistance sustained for one minute—and lactate threshold, defined as the resistance at which lactate exponentially accumulates in the blood, was determined, a skeletal muscle sample (PRE) was obtained by a qualified medical doctor. Participants then began HIIT consisting of four 4-minute intervals set at a percentage of their Ẇmax and power at lactate threshold ( ẆLT), with each interval separated by 2 minutes of rest (Figure 2).

this study will provide a critically needed framework to guide further research on the prescription of exercise for the prevention and treatment of metabolic disease in men and women.

2. Using mass spectrometry-based proteomics to analyse mitochondrial protein abundance in skeletal muscle (How will we do this?)

To assess changes in mitochondrial protein abundance, volume density, and respiratory function, this study

Similar protocols have previously been used to induce extensive mitochondrial adaptation and improvements in cardiorespiratory fitness. Training was completed four times a week for 8 weeks and after completing the training protocol, the participants underwent a second biopsy (POST) to assess the resultant traininginduced changes.Using our stored biopsy samples, we will now assess how the abundance of individual

Figure 1. Sex-specific differences in cardiorespiratory fitness and skeletal muscle anatomy and physiology that may affect mitochondrial adaptation in response to exercise.

V̇O2max: maximum oxygen uptake. Created with BioRender.com.

mitochondrial proteins in skeletal muscle change following 8-weeks of HIIT using mass spectrometrybased proteomics. Unlike earlier molecular techniques for assessing changes in protein abundance that can only detect a single known target using an antibody, mass spectrometry allows the detection and quantification of thousands of proteins within a single sample. This allows an unparalleled insight into the structural and metabolic changes that have occurred as a result of exercise training. Aside from the novel inclusion of women and matching men and women for V̇O2peak , our muscle biopsy collection represents the single largest training study ever applied to mass spectrometry-based proteomics.

Aside from the novel inclusion of women and matching men and women for V ̇ O2peak , our muscle biopsy collection represents the single largest training study ever applied to mass spectrometry-based proteomics

3. Correlating changes in mitochondrial protein abundance to improvements in function and cardiorespiratory fitness (What will this research tell us?)

The findings generated from using mass spectrometry-based proteomics will be correlated to several already measured changes in mitochondrial volume density and mitochondrial respiratory function following 8 weeks of HIIT. Thus, allowing the identification of potential sex-specific changes in protein abundance that contribute to specific improvements in mitochondrial characteristics from training (Figure 3). Although it has been known since the 1960’s that exercise increases the total amount of skeletal muscle mitochondrial protein, recent

Figure 2. Training study overview. ẆLT: power at lactate threshold. Ẇmax: maximum power output. Created with BioRender.com.

Figure 3. Connecting changes in mitochondrial protein abundance to changes in mitochondrial respiratory function and physiological fitness. By characterising the changes in individual mitochondrial proteins from training, the key markers for improved mitochondrial function and physiological fitness will be identified. Created with BioRender.com.

findings indicate that training-induced changes in mitochondrial proteins are non-stoichiometric. This is likely why different exercise prescriptions are able to induce increases in mitochondrial function independently of increases in total mitochondrial volume density and vice versa. By identifying the changes in mitochondrial protein abundance that are strongly correlated to desirable training-induced changes in mitochondrial volume density and respiratory function, specific proteins or patterns of expression be used as markers within future studies. In addition to modifications in mitochondrial characteristics, any sex-specific differences observed in the abundance of mitochondrial protein will be correlated to changes in physiological fitness. By determining how changes on the individual protein scale affect physiological fitness, a greater link between changes at the molecular level and wholebody health can be elucidated.

Together, these results will enable a more efficient investigation into the effects of different exercise prescriptions and training within different populations, without the need for all the expensive and laborious techniques utilised within this study. Through further evaluation of how exercise variables such as intensity, duration, and frequency affect individual mitochondrial proteins or pathways that illicit certain positive physiological changes, a greater tailoring of exercise prescription to achieve specific outcomes may be possible. This will allow sports medicine practitioners to make better-informed decisions regarding the prescription of exercise and, therefore, provide greater benefits for their patients.

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

About the Author

Dale Taylor is a current PhD candidate within the Institute for Health & Sport at Victoria University in Melbourne. His PhD project is looking at how changes in our muscle after a single session of exercise ultimately determine how our muscle adapts following long-term training. By applying multiple ‘-omics’-based techniques in conjunction with applied exercise physiology, he is hoping his research will uncover new findings that can be incorporated into how we prescribe exercise for improving both athletic performance and health.

Professor David Bishop is a world leader in muscle exercise physiology at the Institute for Health & Sport within Victoria University. At Victoria University, David leads the Skeletal Muscle and Training Research Group, which focuses on two key research areas: exercise as mitochondrial medicine and human performance. Currently, David is spearheading several ARC and NHMRC funded projects that examine how diet, exercise, and genes interact to regulate skeletal muscle adaptations, with the aim of translating this new knowledge into recommendations for more individualised exercise prescriptions to enhance health and human performance. In addition to his research contributions, David has held numerous significant leadership positions in exercise and sport science in Australia. He was the youngest-ever President of Exercise & Sport Science Australia (ESSA). During his presidency, he was the lead author of a submission to the Productivity Commission, which resulted in the inclusion of Accredited Exercise Physiologists (AEPs) in Medicare-Plus. He was also invited to the Senate Inquiry into the practice of Sports Science and served as a consultant to the Coalition of Major Professional and Participation Sports.

Photo: ChrisGorgio/

2024-2027 SMA Strategy

Earlier this year, we engaged with our members and stakeholders, seeking their input on key priorities and identifying potential challenges and opportunities for SMA.

The feedback gathered has been consolidated by the SMA Board and staff, forming the foundation of our 2024-2027 Strategic Plan.

The Plan is driven by three core themes: prioritising members, applying a commercial perspective to enhance experiences, and proactively leading the industry.

Members First:

ٚ Increase the range, accessibility, relevance and value of PD for all member categories.

ٚ Connect our members to support career growth.

ٚ Tailor services and grow value for each category throughout their membership.

Commercial Mindfulness:

ٚ Leverage our assets to deliver relevant and quality member services.

ٚ Streamline our processes to enhance the customer journey and optimise efforts.

ٚ Sustain our relationship with course participants and grow lifetime value.

Active Leaders:

A series of initiatives will be implemented over the next 2-3 years.

ٚ Lead and advocate for the industry on matters of importance in sport in our region.

ٚ Leverage our multidisciplinary nature to set us apart.

ٚ Identify and invest in new

products, services, technology, and profile-building activities.

Central to this plan is our Strategy Map, a concise, visual document outlining our organisational priorities. It encompasses our mission, vision, strategic themes, and the behaviours we, as an organisation, will embrace to achieve our goals.

To achieve these strategic objectives, we have developed a series of initiatives which will be implemented over the next 2-3 years.

We will keep you informed on our progress and, as always, welcome member feedback.

MEMBER GROUPS

To elevate the value provided to the sports medicine and sports science disciplines we represent, SMA is collaborating closely with specific Member Groups to create more specialised learning opportunities.

In July 2024, we launched a new Strategic Plan that guides the direction of SMA through to the end of the 2027 financial year.

VISION 2024-2027 STRATEGY

MISSION

GOALS

LEARNING AND GROWTH

SMA is the primary association for all sports medicine and  exercise professionals.

90% Membership satisfaction/NPS 50+

Increase the range, accessibility, relevance and value of PD for all member categories

Connect our members to support career growth

Tailor services and grow value for each category throughout their membership

We listen to the needs of our members

OUR BEHAVIOURS MEMBERS FIRST

bold Consider what’s possible

To be Australia’s leading multidisciplinary authority for sports medicine, sports science and physical activity

SMA provides an exceptional experience every time. >5% Operating Margin

Leverage our assets to deliver relevant and quality member services

Streamline our processes to enhance the customer journey and optimise efforts

Sustain our relationship with course participants and grow lifetime value

We are commercially mindful in our actions

SMA drives the industry to optimise performance, health and safety in sport.

Net Membership growth is positive in all categories

Lead and advocate for the industry on matters of importance in sport in our region

Leverage our multidisciplinary nature to set us apart

Identify and invest in new products, services, technology, and profile-building activities

We take considered risks

Adapt and learn

SMA Sports Doctors

The SMA Sports Doctors Committee is actively developing new educational courses and opportunities specifically for this Member Group. These initiatives will be introduced in 2025, and aim to enhance the professional development of sports doctors.

In July, we launched a dedicated Sports Doctors section on our website. This new section features a ‘Find a Sports Doctor’ online directory, which connects members with the public seeking qualified sports medicine professionals.

The SMA Sports Doctors pages also includes tailored content and events, providing a central hub for resources and information relevant to this discipline group.

SMA Student Network

Earlier this year, SMA partnered with Sports and Exercise Medicine Students Australia (SEMSA) to establish the SMA Student Network. This new Member Group is designed to propel the careers of students pursuing undergraduate and postgraduate degrees in sports medicine.

The SMA Student Network Committee is crafting a lineup of engaging events and initiatives that will not only educate but also create invaluable networking opportunities for SMA Student Associates and PhD Student Associates.

The Group is officially launching at the 2024 SMA & ACSEP Conference in October. The launch will feature an exclusive networking event, where students attending the Conference can connect with peers and industry veterans.

SMA Sports Trainers

In August, we launched ‘Sports Trainer Connect’, SMA’s online platform that matches accredited Sports Trainers with sporting clubs, schools, universities, or any organisation in need of first aid coverage at sporting events.

It’s a free service exclusively available to SMA Sports Trainer Associates looking to leverage their qualifications and sports trainer career.

By joining Sports Trainer Connect, our Sports Trainer Associates can secure paid coverage work and apply their accreditation across all levels of sport, expand their professional network, and boost their chances of future employment within the sports industry.

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Daily training

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Daily training, walking shoe

Midsole M: 28-20mm | F: 27-19mm

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Engaging

and Empowering

the Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Workforce

The Tidda Talk Train-the-Trainer Initiative

Social and Emotional Wellbeing in Aboriginal and Torres Strait Islander Youth

Social and emotional wellbeing (SEWB) is the foundation for physical and mental health for Aboriginal and Torres Strait Islander peoples. The culturally prescribed term more appropriately captures Aboriginal and Torres Strait Islander people’s holistic and collectivist worldview of health than Westernised deficit understandings. SEWB is unique in that it acknowledges the importance of family, community, land, spirituality, and ancestry, and how these affect the individual.

Aboriginal and Torres Strait Islander youth experience disproportionate levels of poor mental health and SEWB compared to their non-Indigenous peers as result of the traumatic and intergenerational impacts of colonisation. Young Aboriginal and Torres Strait Islander women in particular are more likely to report exposure to social-emotional risk factors and mental health conditions than young men. Compounding these issues is a lack of youth-friendly or culturally sensitive mental health services available as well as short-term funding and limited workforce capacity within the Aboriginal and Torres Strait

MADELEINE ENGLISH, University Of Technology

Sydney (2023 SMA Research Foundation Grant recipient)

Photo courtesy KARI Foundation, kari.org.au

Islander Community Controlled Health sector. The Tidda Talk program and its associated facilitator training, presents a holistic health initiative designed to address these service limitations.

The Tidda Talk Program: A Response to SEWB Challenges

The Tidda Talk program was developed in 2021 as an integrated approach to promote physical activity (PA) and SEWB among young Aboriginal and Torres Strait Islander women aged 11-16. Funded by the Department of Health and ran as a partnership between the University of Technology and KARI Foundation (an Aboriginal

The Tidda Talk Train-the-Trainer Initiative

and Torres Strait Islander community services organisation), the program’s primary aim is to create a supportive, culturally safe environment that fosters mental, physical, social and emotional health for young Aboriginal and Torres Strait Islander women in Australia.

The community codesigned program includes 8-weekly sessions, each lasting 90 minutes. These sessions combine a variety of PA and sports with interactive cultural content that address culturally relevant SEWB topics (e.g., cultural and spiritual healing, leading a healthy lifestyle and respectful relationships). The evidence-based program leverages the established relationship between PA, mental health and connection to culture in its design and structure. The Tidda Talk program is delivered by two Aboriginal or Torres Strait Islander women from the KARI Foundation with knowledge of PA and sport facilitation, SEWB and youth work.

To date, seven Tidda Talk programs have been piloted and evaluated in Greater Sydney, New South Wales. Preliminary feasibility and acceptability findings indicate participants found the program a fun and enjoyable way to learn about their culture and different ways to be healthy whilst connecting with their Indigenous peers and developing cultural pride. Furthermore, young women reported an increase in PA self-efficacy and a desire to try new sports and be active after program completion.

However, sustained health disparities suggest that successful programs alone are not enough to address the complex and intersecting mental health and SEWB challenges young Indigenous women and their communities face. As such, government health policies such as the National Aboriginal and Torres Strait Islander and Torres Strait Islander Health Plan 2021–2031, recommend a number of strategies focusing upon improving health systems and

Idea Conception

The Tidda

Talk Train-

the-Trainer Initiative plays a crucial role in developing a culturally safe and responsive Aboriginal and Torres Strait Islander SEWB health workforce.

developing enablers for change. Therefore, the Tidda Talk Train-theTrainer initiative was established.

Codesign: Centring Aboriginal and Torres Strait Islander Voices in Development of the Tidda Talk Train-the-Trainer Initiative

The idea for the Tidda Talk Train-theTrainer Initiative emerged during the pilot phase of the Tidda Talk program when local Aboriginal and Torres Strait Islander health and community service providers expressed a strong desire to be upskilled to sustainably deliver the program within their own communities. Recognising that Aboriginal and Torres Strait Islander people are best positioned to support their communities, the University of Technology of Sydney in partnership with the KARI Foundation secured funding from the City of Sydney to bring this initiative to life and address local priorities.

Project Design Process

The project design followed an iterative codesign process that actively centred Aboriginal and Torres Strait Islander voices and expertise, viewing community members as an asset to be leveraged. Critical to this process were initial design meetings amongst the interdisciplinary research team of UTS academics and KARI Foundation staff (Aboriginal and Torres Strait Islander

Photo courtesy KARI Foundation, kari.org.au

members = 6 and non-Indigenous members = 2), where the project scope, structure, and deliverables were defined. These discussions led to the development of a 2-day facilitator training workshop and an accompanying facilitation manual. During these meetings, feedback from the original Tidda Talk participants and facilitators was thoroughly reviewed, revealing key opportunities for program enhancement, which are detailed further below.

The project was further refined during a codesign workshop led by the KARI Foundation’s Cultural Support & Training Specialist. This workshop brought together a diverse group of participants, including the Community Programs Manager, past Tidda Talk facilitators, and a member of the UTS research team from the original Tidda Talk project with PA and sport expertise. All attendees were Aboriginal and Torres Strait Islander women, except for the UTS research team member, who identifies as a non-Indigenous woman. During the workshop, pilot materials were thoroughly reviewed and reworked, leading to several fundamental changes in the training initiatives including the addition of weekly activity cards to complement the facilitation manual.

After the workshop, some PA and SEWB sessions were piloted at the KARI Foundation’s Women’s Wellbeing Conference, ensuring that the delivery resonated with the broader community of Aboriginal and Torres Strait Islander women. Sessions were well received and with minor adjustments made.

Translating Codesign into Practice

The Tidda Talk Train-the-Trainer Initiative consists of three comprehensive training components designed to empower Aboriginal and Torres Strait Islander women facilitators: a detailed facilitation manual, a set of weekly activities and a 2-day train-the-train workshop.

Facilitation Manual and Activity Cards

The Tidda Talk Training Manual offers comprehensive details, starting with the history and evidence behind the Tidda Talk program. It includes extensive educational content on SEWB topics and key considerations for engaging young Aboriginal and Torres Strait Islander women in PA and sport such as common barriers and facilitators to participation. The manual also incorporates reflection components for facilitators to consider their own SEWB before starting program delivery.

To support new facilitators, the manual is paired with simplified and prescriptive activity cards that facilitate session delivery. Additional repeating routines, such as a weekly Acknowledgement of Country and a group check-in, have been embedded into the program’s structure to reduce recall load and address the developmental needs of young Aboriginal and Torres Strait Islander women. Based on past Tidda Talk program participant feedback, the manual has new group cohesion activities designed to help participants make new friends.

A quality control debriefs page prompts facilitators to debrief after each weekly session, ensuring that any delivery issues are identified early and that program standards are maintained.

The manual’s visual work features the initial Tidda Talk logo by Wiradjuri artist Peta-Joy Williams, with further artwork commissioned from fellow Wiradjuri artist Anna Gannon. In alignment with Aboriginal and Torres Strait Islander storytelling traditions, artwork has been designed to tell the story of women supporting women and personal growth reflecting the nature of the Tidda Talk program.

Training Workshop

The two-day Train-the-Trainer workshop, scheduled for late October 2024, is designed to be hands-on and practical, providing facilitators with the tools and confidence they need to deliver the Tidda Talk program efficiently, effectively and in a way that is meaningful to them. The workshop is divided into two main sections, each focused on equipping facilitators with a comprehensive set of skills to engage groups of young Aboriginal and Torres Strait Islander women with diverse needs and preferences.

SEWB

Trainers will develop their group facilitation skills, learning how to effectively lead and manage group dynamics. The workshop will also cover strategies for engaging youth, including managing intergroup conflict, handling common behavioural challenges, and addressing instances of non-participation. Cultural skills will be a key focus, with future workshop participants sharing knowledge and personal experiences to deepen a connection to and promote cultural continuity. Additionally, trainers will receive education on adapting activities based on the needs and preferences of their participants, ensuring that each session is relevant and engaging.

Figure 1. Initial draft of the Tidda Talk Facilitator Manual

The Tidda Talk Train-the-Trainer Initiative

PA

Trainers will build confidence in delivering and adapting PA and sport sessions for participants with varying abilities, addressing a specific development area identified by past facilitators in the codesign process. Workshop participants will be introduced to key principles from Sports Medicine Australia and the Australian Psychological Society’s joint consensus statement on optimising the effects of PA on mental health and educated on how these can be practically applied.

This component of the workshop will also provide behaviour change strategies for dealing with nonengagement in physical activities, offering practical solutions to keep all program participants motivated and involved as this was a reported challenge for original Tidda Talk facilitators. To complement the heavier content, the workshop will include practical sessions where

trainers actively participate in physical activities, providing a handson experience and a break from the more intensive discussions.

Overall, the workshop aims to offer a well-rounded skill set for trainers, preparing them to effectively support and engage young Aboriginal and Torres Strait Islander women in both social and physical aspects of the Tidda Talk program.

Evaluation and Continuous Improvement

The commitment to codesign extends beyond the initial development phase into the evaluation of the Tidda Talk Train-the-Trainer Initiative. A combined process and impact evaluation will be conducted to assess the feasibility, acceptability, and effectiveness of the training resources and workshop. This evaluation uses a mixed methods approach and includes questionnaires and culturally prescribed Yarning sessions (i.e., semi-structured

interviews), to gather comprehensive feedback from participants. Specifically, trainers and participants will be asked to reflect on their experiences, providing insights into what worked well and what could be improved. This feedback loop is essential for the continuous improvement of the Tidda Talk facilitator training and program, ensuring that it remains responsive to the needs of the community.

Significance and Broader Implications

The Tidda Talk Train-the-Trainer Initiative goes beyond merely providing education and upskilling; it plays a crucial role in developing a culturally safe and responsive Aboriginal and Torres Strait Islander SEWB health workforce. By equipping local Aboriginal and Torres Strait Islander women with the skills and knowledge to deliver SEWB services, this program addresses the urgent need for culturally competent care. This not only enhances service delivery but also empowers these women to assume leadership roles in health promotion within their communities.

The skills and knowledge gained through this initiative are highly transferable, extending their impact across various health services and programs. This contributes to the overall capacity of Aboriginal and Torres Strait Islander communities to engage in broader mental health promotion and SEWB service delivery. Moreover, as the initiative expands to new communities, it has the potential to reach more young Aboriginal and Torres Strait Islander women, who may otherwise miss out on the mental, physical, social, and emotional benefits of the Tidda Talk program.

The codesign approach, which involved Aboriginal and Torres Strait Islander community members as coresearchers and equal partners, directly supports self-determination and community control, aligning with best practice recommendations for

Figure 2. Outcomes and stakeholders involved in the Tidda Talk Train-the-Trainer Initiative

Young Aboriginal and Torres Strait Islander women are more likely to report exposure to social-emotional risk factors and mental health conditions than young men.

designing and delivering health services for Aboriginal and Torres Strait Islander peoples. By engaging Aboriginal and Torres Strait Islander stakeholders in the design process, the initiative has successfully developed culturally appropriate and responsive training resources and processes that align with the needs and future goals of Aboriginal and Torres Strait Islander communities.

Thus, the Tidda Talk Train-the-Trainer Initiative exemplifies the power of codesign in creating health initiatives that are not only effective but also culturally relevant and empowering. By adopting a strengths-based approach and placing Aboriginal and Torres Strait Islander peoples at the centre of the development process, the initiative ensures it reflects the community’s priorities and is grounded in Aboriginal and Torres Strait Islander ways of knowing, being, and doing. As the initiative continues to evolve and expand, it offers a valuable model for other community-led Aboriginal and Torres Strait Islander health promotion initiatives across Australia.

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

Acknowledgements

I would like to acknowledge the Gadigal people of the Eora Nation upon whose land this research is currently being conducted. I pay my respect to Elders past and present and recognise the strength and resilience of all Aboriginal and Torres Strait Islander people today.

I am particularly thankful for the guidance and support from my Aboriginal and Torres Strait Islander mentors and coresearchers (Associate Professor Karla Canuto, Dr. Danielle Manton, Colleen Fricker, Jasmine Garzaniti, Teliah Edwards and Anna Gannon) who have shared their culture, knowledge and time so generously.

I would also like to acknowledge the City of Sydney and Sports Medicine Australia for their financial contributions to the initiative.

About the Author

Maddy English is a PhD candidate (BHumSc, BSES - Hons) at the University of Technology Sydney. Her research primarily focuses on using physical activity to enhance mental, social, and emotional wellbeing in young Aboriginal and Torres Strait Islander females, including the co-design and co-evaluation of the Tidda Talk program (a physical activity and social-emotional health education intervention). In addition to her research, Maddy has professional experience developing, delivering, and evaluating community-based health promotion initiatives for a range of priority populations including low socioeconomic and culturally and linguistically diverse groups. She has worked in community development and health education roles for Cricket New South Wales and South Western Sydney Local Health District.

Photo courtesy KARI Foundation, kari.org.au

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

Official journals of Sports Medicine Australia

JSAMS – most cited paper in 2024

Australian guidelines for physical activity in pregnancy and postpartum

Wendy J. Brown, Melanie Hayman, Lene A. H. Haakstad, Tayla Lamerton, Gabriela P. Mena, Anita Green, Shelley E. Keating, Grace A.O. Gomes, Jeff S. Coombes, Gregore I. Mielke

2023 Journal Impact Factor*

3.0

*Journal Citation Reports (Clarivate Analytics, 2024)

JSAMS Plus – most downloaded paper published in 2024

The ultra mentality – Foundations for maximising athletic mental performance

Andrew J. Gardner and Robert Gilbert

JSAMS Plus – Call for papers for Special Issue: Physical Activity for People Living with Disability

Deadline: 30th September 2024

Guest Editors: Leanne Hassett, Catherine Sherrington, Nora Shields, Rae Anderson

Ask the JSAMS Authors

Video Interviews exploring Editor’s

Choice Articles with Key Authors

A Note From the Editor-In-Chief

PROFESSOR TIM MEYER MD PHD Editor-in-Chief, JSAMS

The Journal of Science and Medicine in Sport (JSAMS) is an Australia-based scientific journal with an international reach. It is published by Elsevier on behalf of SMA. Research from a broad spectrum of sport-related fields in subsections of Sport & Exercise Medicine, Sport Injury, Sport Science and Physical Activity is considered. Each subsection has a responsible Deputy Editor, with specific expertise in the area, plus several dedicated Associate Editors to assist in building each issue. This illustrates that JSAMS has a comprehensive quality assurance system with the goal of attracting high-level, clinically relevant papers as well as other research in the field. For this purpose, the spectrum of article categories include:

ٚ Original Research

ٚ Review Articles (systematic/scoping reviews and meta-analyses only)

ٚ Brief Reports

ٚ Research Letters

ٚ Short Communication

ٚ Case Reports

ٚ Letters-to-the-Editor

ٚ Viewpoint

ٚ Consensus Statements and Clinical Practice Guidelines

ٚ Registered Reports

Only by invitation we consider:

ٚ Cornerstone Reviews

ٚ Counterpoint to a Viewpoint

ٚ Editorials

JSAMS wishes to continue building the strong AUS-NZ community as evidenced by the Editorial Board membership and the support of SMA. However, there is room for interested and skilled scientists to join the JSAMS Editorial Board. We currently have a particular focus on qualitative research as we receive more and more of these contributions.

JSAMS is a journal with a profile that has a standpoint, positioning itself in many current debates within the scientific community. Thus, we aim to make our processes align with our opinions. Good examples to illustrate this are our policies on

original research submissions which do not include both sexes. We also have policies for the handling of studies on publicly available data and for our own management of reviewing processes. This transparency is upheld in journal-related online documents and editorial pieces.

JSAMS targets the broad audience of sports medicine, physiotherapy and sport science professionals including related disciplines (podiatry, biomechanics, exercise physiology, motor control and learning, sport and exercise psychology, sports nutrition, public health, rehabilitation and others). This is also true for our online-only sister journal, JSAMS Plus, which currently has a Call for Papers for a very relevant topic:

‘Physical Activity for People Living with Disabilities’. The latest special issue is titled Sports Oncology

With such an abundance of opportunities, wouldn´t it be surprising if you do not find a space for your research within these outlets?

Informing Extreme Heat Policy Development in Long Distance Running Study Overview

CHELSEA BLACKMAN, University of South Australia (2023 SMA Research Foundation Grant - Dr Brian Sando Clinical Sports Medicine Award recipient)

Exertional heat illness

Exertional heat illness is a spectrum of conditions which will only become more prevalent under the continued charge of climate change. The illness occurs during sport and exercise activities and includes a range of conditions that are graded by severity, ranging from muscle cramps to stroke-like symptoms.

Exertional heat exhaustion is a result of the high physiological strain during exercise in the heat that stems from competition for available blood to support both high skin (for heat dissipation) and muscle (for exercising metabolism) blood flow. Ultimately, an overwhelmed system will result in an impairment of exercise capabilities and increase the risk of heat illness. Exertional heat stroke is the most severe manifestation and is a multisystem illness characterised by profound central nervous system disturbances (i.e. loss of consciousness), tissue damage and failure of organs, and a core temperature

≥40°C. Fortington et al. 2021 reported 38 exertional heat-related deaths in Australia from sport and exercise participation between 2001 and 2018. Furthermore, exertional heat stroke victims under intensive care have a mortality rate of up to 26.5%, with survivors experiencing long-term neurological and cardiovascular complications.

Heat policies in sport and exercise

Heat policies are vital in improving safety and reducing the risk of heat illness during outdoor sport and exercise. Sports Medicine Australia (SMA) released a revised national heat policy in 2005 with the aim to provide graded risk ratings and an activity cancellation policy according to critical environmental thresholds.

Photo: Marcio

Binow Da Silva/ gettyImages

In 2021, SMA released an updated extreme heat policy that provides heat illness risk recommendations for five different categories of sport and exercise activities, each stratified as low, moderate, high, and extreme risk according to environmental conditions.

The Wet Bulb Globe Temperature (WBGT) index was invented and first used in the 1950s following a campaign to reduce heat illness in military training camps in the United States. The American College of Sports Medicine (ACSM) then introduced a heat policy in 1975 utilising the WBGT, which was subsequently updated in 1979, 1984, 2021, 2007, and 2023. The policy uses a tiered risk coloured flag system (green, yellow, orange, and red) based upon the WBGT index, which is a measure of environmental stress. Each risk coloured band details an operating WBGT range and provides recommendations around how the activity should be modified, or if it should be postponed or cancelled.

We will report on core temperature, heart rate, mean skin temperature, sweat rate, perceived discomfort, and time-trial performance of participants.

Heat stress during long distance running

The operating WBGT range for each risk band is stratified according to whether the exercise is considered continuous (i.e. long-distance running) or non-continuous (i.e. football codes).

The highest rates of exertional heat illness across sports occur in long distance running (674 per 10,000 athlete-exposures), highlighting the importance of accurate and implementable heat policy guidelines. A rate of exercise-associated collapse due to hyperthermia was noted at the Twin Cities Marathon and the Cincinnati Marathon (3.0 per 10,000 and 12.9 per 10,000 respectively) over multiple years. Others recorded incidence rates increase between 0.9 and 10.0 per 10,000 athlete-exposures during half-marathon races and between 10.0 and 21.0 per 10,000 athleteexposures during 10km road races. This increase is due to comparatively shorter long-distance races having a faster average running speed and therefore a higher rate of metabolic heat production, which accelerates a rise in core body temperature. The Falmouth Road Race, an annual 7-mile (11.3 km) race held in Massachusetts, America in August with an average air

Photo: Pavel1964/ gettyImages

Informing Extreme Heat Policy Development in Long Distance Running Study Overview

temperature of 23°C (at ~70% relative humidity) is famous for high heat illness rates. Data collected over 18 years demonstrates an average of 15 exertional heat stroke cases per year.

The 2019 World Athletics Championships held in Doha, Qatar is another example of the serious health implications of exercising in the heat. The women’s marathon was scheduled to start at midnight to avoid a high solar heat load (i.e. effect of the sun); however, the race still occurred in an air temperature of 32°C and 77.9 % relative humidity (WBGT of 29.6°C). Despite additional cooling interventions used in Doha, 41% (28 of 68) of the athletes failed to complete the race with most (n=26) withdrawing before completing 15 km of the total 42.2 km race. It does not explicitly state how many of these withdrawals were due to heat related illness, however research indicates that female marathon performance is reduced by 5.4% at a WBGT between 20°C and 25°C. In Doha marathon performance was reduced by a huge 14.7% compared to personal best times, emphasizing the influence of the extreme environment (WBGT ~30°C).

The 2020 Tokyo Olympics is another example of a high incidence rate of heat illness during events in stressful environmental conditions. During the men’s marathon 28.3% (30 from 76) did not finish. Across five longdistance events (men’s/women’s 20 km race walk; men’s 50 km race walk; men’s/women’s marathon) 50 athletes were transferred to the medical station 48 exhibiting signs and

In 2021, SMA released an updated extreme heat policy that provides heat illness risk recommendations for five different categories of sport and exercise activities, each stratified as low, moderate, high, and extreme risk according to environmental conditions.

symptoms of exertional heat illness. This included heat exhaustion (n=22), muscle cramps (n=12), heat syncope (n=2) and exertional heat stroke (n=2).

Exercise in the heat is associated with increased thermoregulatory, cardiovascular and pulmonary strain as well as altered muscle metabolism and cerebral function resulting in greater fatigue and hence, slower endurance performance. Marathon performance is known to be impacted in hot and humid conditions, and as WBGT increases there is a progressive slowing of marathon performance. This is true for both men and women across a variety of abilities, even more so for slower runners.

Aims and overview of the research. The aim of this research is to inform heat policy risk classifications provided by Sports Medicine Australia (SMA) and the American College of Sports Medicine (ACSM) for continuous long-distance running. Both policies propose heat illness risk classifications for sport and exercise; but the next step in the development of these policies is to validate these risk classifications by observing the thermoregulatory (core and skin temperature, sweat loss), cardiovascular (heart rate), perceptual (perceived thermal sensation and discomfort), and performance responses of individuals during different environmental risk classifications (moderate, high, and extreme). Ultimately, these observations will help to gauge the agreement between the policy risk levels and the level of observed human strain during long distance running. We hypothesise that there will be a progressively graded and higher response in thermal (core body and skin temperature, sweat loss), cardiovascular (heart rate), and perceptual (perceived discomfort) measures that will be observed from moderate to high and to extreme risk, with a concurrent worsening of performance time as risk increases.

Study Design

This study is a cross over randomised control experiment where each participant will undergo one familiarisation session followed by three experimental trials. The familiarisation session includes a health screening, incremental test

to exhaustion on a treadmill, and a 10 km time trial in environmental conditions that constitute moderate risk conditions (30°C and 45% relative humidity). Subsequently, all experimental trials require the participants to complete a 10 km selfpaced running time trial on a treadmill in an environmental chamber set to conditions that constitute moderate (RISKmoderate;30°C and 45% relative humidity), high (RISKhigh;28.5°C and 76% relative humidity), and extreme (RISKextreme;32.5°C and 68% relative

humidity) risk (as defined by both SMA and ACSM). Ethics approval for the study has been provided by the University of South Australia Human Ethics Committee (#205513).

We will recruit participants from Adelaide, South Australia, between the ages of 18-55 who have passed ESSA stage 1 pre-exercise screening; and training at least three times per week. All participants must provide written consent before partaking. An a-priori sample size calculation for a

repeated-measures demonstrates that at least 15 participants will be recruited for this study.

Rationale for choosing the 10 km time trial as a representation of long distance running Endurance running events falls under the categorization of ‘continuous activity’ by the ACSM policy, while SMA refers to ‘long distance running’, therefore both policies encapsulate a range of running events. The 10 km event distance was chosen to

Informing Extreme Heat Policy Development in Long Distance Running Study Overview

represent continuous long distance running as this requires participants to maintain a challenging intensityduration trade-off. The event is a competition sanctioned distance that is considered as ‘long distance running’ by World Athletics and is a popular approximate community fun run distance in Australia (i.e. Adelaide City to Bay [12 km], Perth City to Surf [12 km]). The 10 km running distance therefore aligns with both elite population competition and popular community level.

Rationale for choosing the environmental conditions

The experimental conditions for the study reside within each of the moderate, high, and extreme risk bands for both the SMA and ACSM heat policies and the chosen environmental conditions for this experimental study replicate real world observations that have occurred in long distance events. These include the 2019 Men’s Marathon World Championships in Doha (RISKmoderate); 2003 Falmouth Road Race (RISKhigh), and 2019 Women’s 20 km race walk World Championships in Doha (RISKextreme).

Results and interpretation

We will report on core temperature, heart rate, mean skin temperature, sweat rate, perceived discomfort, and time-trial performance of participants. We expect to recruit a total of 15 participants in order to meet our statistical power calculation. While formal results cannot be currently reported, there are outcomes that we are expecting to observe.

Core temperature is expected to rise close to 40°C during the RISKextreme

condition, which is typically (but not always) associated with a similar internal temperature that is observed in heat illness cases (especially sub-elite athletes). The other trials should have a comparatively lower response of core temperature. Thermal discomfort (“how uncomfortable are the conditions to exercise in?”) and thermal sensation (“how cold/hot do you feel during exercise?”) are expected to degrade, and the rating of perceived exertion (RPE) is expected to be higher when participants exercise in RISKmoderate through to RISKextreme.

Cardiovascular strain (heart rate) is expected to increase when participants exercise in RISKmoderate through to RISKextreme trials due to the greater sympathetic nervous system response in stressful conditions and to accommodate the greater competition between blood flow for heat dissipation and to the muscle for exercise metabolism. Throughout each of the risk categories (RISKmoderate through to RISKextreme), these integrated responses will mean that participants are expected to have

Exercise in the heat is associated with increased thermoregulatory, cardiovascular and pulmonary strain as well as altered muscle metabolism and cerebral function resulting in greater fatigue and hence, slower endurance performance.

slower time-trial completion times as environmental stress becomes greater.

The two heat policies provide risk ratings based upon the expected response of individuals to sport and exercise in the heat. Observing the actual physiological and perceptual response of individuals to exercise under different risk categories is an important step in validating the underlying assumptions of extreme heat policies. To do this, first, formal data analysis will determine if the risk bands can be considered independent of each other (i.e. there is a graded change [increase/ decrease] of all outcomes). Second, the absolute values for each physiological and perceptual outcome will be compared against known thresholds of physiological strain (i.e. low through

Fig 1. Expected result for end core temperature across the three risk categories.

to high strain), such as comparing the end exercise core temperature response of the participants against documented cases of heat illness.

Therefore, the results will validate and inform ongoing policy development by assisting to determine the comparative distinctiveness of each risk band, and how conservative or liberal the modelled risk bands are. The work is expected to have tangible impact given the widespread popularity of running across the community. The importance of implementable heat policies to ensure the wellbeing, health, and safety of people during exercise will only become more important as global warming escalates.

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

About the Author

Chelsea Blackman is a final year Master of Research Student at the University of South Australia with a research interest in exercise physiology. Following her attainment of a Bachelors degree in Exercise and Sport Science in 2022, her accomplished grades provided an opportunity to conduct a research degree, focusing on heat physiology. Chelsea has previously been awarded the Dr Brian Sando Research Foundation Award at the 2023 ASICS Sports Medicine Australia Conference for this same project. Her research is being supervised by Dr Samuel Chalmers (University of South Australia), Dr Clint Bellenger (University of South Australia), Prof Julien Périard (University of Canberra), and Prof Ollie Jay (The University of Sydney).

Chelsea’s masters research aims to inform heat policy risk classifications for continuous long-distance running by analysing within person thermoregulatory changes in different environmental risk categories to assist in the ongoing development of accurate heat policy guidelines.

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2024 SMA & ACSEP Conference

INTRODUCTION

The 2024 SMA & ACSEP Conference is our region’s most important Conference dedicated to excellence in sports and exercise medicine, sports science and physical activity. Spanning across four days at the iconic MCG, and with an expected attendance of over 800 delegates representing the multidisciplinary field of sports and exercise medicine, it promises to expand knowledge and networks.

HIGHLIGHTS

ٚ A/Prof Clare Minahan delivering the 2024 Refshauge Lecture on “Why the advancement of athletic performance in women is essential to understanding human potential”.

ٚ Dr Dinesh Palipana OAM presenting the 2024 Vince Higgins Lecture focuses on the importance of being bold, embracing innovation, and championing inclusion.

ٚ Presentations on Anti-Doping including WADA updates, and diagnosis and management of ADHD.

ٚ A symposium titled “Rethinking the way we manage acute knee injuries: ACL healing, meniscal tear rehabilitation and a new Australian knee injury registry” led by Dr Marc-Olivier Dubé

ٚ A Paediatric Sports Medicine stream featuring growth plate injuries, exercise prescription in children with metabolic disorders, and constructing Australia’s future sports stars.

ٚ Dr Sarah Warby delivering a symposium on operative vs. nonoperative management of shoulder instability, and an ultrasound rehabilitation workshop for the same.

ٚ “Pressure injuries and skin health in para sport” symposium led by Dr Steve Reid and Sarah Direen.

ٚ ACSEP’s pre-conference courses

– an MSK ultrasound workshop, a masterclass in sacroiliac joint mechanical injury with A/Prof Jeni Saunders, and the MOST (Management of Sports Trauma) course

Over 26 hours of high-quality podium paper presentations across the following topics:

ٚ Biomechanics and motor control

ٚ Women’s health and female performance

ٚ Elite athlete health and injury

ٚ Knee/ACL injuries

ٚ Hip morphology, structure, function and pain`

ٚ Hip FAI and dysplasia

ٚ Clinical shoulder

ٚ Assessment and monitoring for performance and health

ٚ Tendons

ٚ Cardiovascular and thermoregulation

ٚ Musculoskeletal surgery

ٚ Back pain and bone stress

ٚ Concussion

ٚ Neuroplasticity and injury

PROGRAM SNAPSHOT

Day 1 – Wednesday 16 October:

ٚ ACSEP Registrars Conference

ٚ SMA Judges Showcase

ٚ Welcome to Country

ٚ Vince Higgins Lecture

ٚ Refshauge Lecture

ٚ Welcome Cocktail Party

Day 2 – Thursday 17 October:

ٚ ASICS Run Club

ٚ Workshops and Symposia

ٚ Keynote and Invited Sessions

ٚ Medical Streams and Updates

ٚ Free Papers Presentations

ٚ JSAMS Editorial Board Meeting

ٚ Women in SEM Event

ٚ ASMF Fellows Dinner

Day 3 – Friday 18 October:

ٚ Workshops and Symposia

ٚ Keynote and Invited Sessions

ٚ Medical Streams and Updates

ٚ Free Papers Presentations

ٚ Afternoon Golf

ٚ SEPA AGM

ٚ Scientific Poster Session

ٚ SMA Student Networking Night

Day 4 – Saturday 19 October:

ٚ Workshops and Symposia

ٚ Keynote and Invited Sessions

ٚ Medical Streams and Updates

ٚ Free Paper Presentations

ٚ Best of the Best Awards

ٚ ACSEP Conference Dinner

ٚ SMA Gala Dinner

Walk, Roll and Stroll – The Sun Safe Way

DR LOUISE BALDWIN, writing for Queensland Walks

As the weather warms up and spring starts to shine, it’s a wonderful time of year to include walking as part of your regular outdoor physical activity and between competitions. It’s important that sports scientists and health professionals emphasise the importance of heat and sun safety for wellbeing.

It’s no surprise that walking is the most popular recreational activity, and we’re seeing many of our elite teams and athletes incorporate pre- and postgame walks between competitions.

With the ever-increasing evidence of the benefits of physical activity for everyone it’s important to identify how we can ensure communities can be physically active in the most effective, safe and enjoyable manner. Our built environment and sporting and recreational facilities play an important role in being physically active every day. Suitable environments help to protect our bodies from sun or heat injuries.

Whilst we know that walking as a form of physical activity lowers your risk of developing heart disease including heart attacks, high blood pressure and heart failure, it also brings many other benefits. You can also lower your cancer risk - physical inactivity is associated with a higher risk of some cancers such as 12% of colon cancers and 3.2% of breast cancers. Cancer

State of Queensland (Queensland Health)

Council Australia notes that for people who are not active, there is an increased risk of bowel and breast cancer and possibly prostate, uterine and lung cancer (https://cancer.org.au/cancerinformation/causes-and-prevention/ diet-and-exercise/move-your-body )

Recent research on physical activity for cancer treatment has seen the Clinical Oncological Society of Australia (COSA) calling for exercise to be embedded as a standard practice in cancer care and for all members of multidisciplinary teams (MDTs) to promote physical activity (Hayes et al, 2019; Cormie at al, 2018). The benefits of walking and physical activity for mental health are also well cited, including opportunities to connect with friends and get to know local members of your community.

Walking as accessible physical activity

Walking, rolling and strolling are some of the easiest ways for our communities to be physically active every day.

Queensland Walks is a communitybased organisation which advocates for more walkable places in our communities. This means that ultimately people can walk, roll or stroll for exercise and for active transport, walking to the shops or for connecting with friends and family as an intrinsic part of their everyday.

Part of Queensland Walks’ advocacy focuses on safe, accessible and connected pathways and accessways in our communities. This includes connected pathways for recreation walking and rolling and connected areas for community mobility to access shops, services and local facilities. The design of connected pathways includes multiple factors such as the width of the pathways, the distance from roads and traffic, reduction in trip and fall hazards and ensuring inclusivity and age friendly spaces. Queensland Walks advocates for well shaded, connected and accessible sports and athletic precincts which are inclusive to staff, community and athletes. Queensland Walks also advocates for good quality and safe spaces for women and girls to be active in the cooler parts of the early evening or morning.

One of these safety issues relates to sun protection. Queensland Walks’ own data from the Walk My Street survey shows that heat and lack of shade are the top reasons which inhibit people walking or strolling for recreation and physical activity. This is becoming more prevalent in the hotter summers experienced in Australia.

About UV, heat and the sun

Whilst these days tracking the UV levels via smart watches and weather apps is relatively accessible, it’s also important to understand what these numbers mean. Cancer Council Australia provide some handy tips:

Advocating for shade to be included in all new and upgraded outdoor facilities especially in local neighbourhoods is a key role for Queensland Walks

ٚ Ultraviolet radiation or ‘UV’ radiation is a form of energy released by the sun

ٚ It cannot be seen or felt by humans

ٚ There are three types of UV rays which are categories by wavelengths, simply known as UVA, UVB and UVC.

ٚ UVA causes sunburn, cell damage in the skin and skin cancer

ٚ UVB causes skin damage and skin cancer.

ٚ UVC does not reach the earth’s surface as ozone in the atmosphere absorbs UVC (cancer.org.au)

The UV Index is an internationally recognised scale which divides UV into levels from low to extreme. In Australia, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) measures the real time data for UV on a daily basis. This helps to provide predications of UV Indexes and real time readings. The UV radiation levels are outlined in the box below:

UV Index levels:

Low 1-2

Moderate 3-5

High 6-7

Very high 8-10

Extreme 11 and above

So what does this mean for sun protection? In Australia, when the UV index is over 3, we need sun protection. That might seem low and you might see weather forecasts where the

Photo: naruedom/ gettyImages

Walk, Roll and Stroll –The Sun Safe Way

temperatures are quite cool and the UV index remains over 3 – so why is this?

It’s a common misconception that the sun can’t damage your skin in cooler weather. This isn’t true. UV radiation is not the heat rays from the sun – those are the infra-red rays. UV rays cannot be seen or felt meaning that in cooler weather it’s still important to be sun safe. In northern areas of Australia (all of Queensland, the Northern Territory, northern WA and even northern New South Wales), the UV levels remains above 3 most of the year. Across the year all parts of Australia have times when the UV is over 3. This means that sun protection should be part of Australians everyday habits.

Cancer Council Australia’s SunSmart program outlines five easy steps:

1. Slip on covering clothing: that covers as much skin as possible –including long sleeves and a high collar. You may find some clothing carries a rating for sun protection.

2. Slop on SPF50 or 50+ broad spectrum, water resistant sunscreen. The broad spectrum means it blocks out UVA and UVB rays and the water resistance is also important in humid climates when we tend to sweat more, even if we’re actively going in the water. The key is effective sunscreen use of applying to clean, dry skin 20 minutes before going outside and reapplying every two hours or after water activity or excessive sweating. The amount of sunscreen is very important. The average-sized adult will need a teaspoon of sunscreen for their head and neck, each limb and the front and back of the body. That’s about seven teaspoons (35mL) for a full body application.

3. Slap on a hat – make sure it’s a broad brimmed hat to cover the

These five steps are a combination –not one or the other – so make sure you tick all five boxes to help reduce your or your clients’ exposure to UV (cancer.org.au).

In Australia, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) measures the real time data for UV on a daily basis.

neck and ears and hold it to the light to make sure you can’t see through it – as that helps with ensuring the hat is a tight weave fabric which will help block the UV.

4. Seek shade - trees, built shade or portable canopies can help reduce UV exposure.

5. Slide on sunglasses which fit closely to the face and carry a rating from the Australian Standards AS/NSZ 1067.

The necessity for shading in our built environment

Just like individual sun protection needs to be carefully chosen to be effective, so does shade in our local environments to help reduce UV exposure, reduce heat and ultimately make local environments more user -friendly for walking, rolling and strolling and generally being physically active.

Using a combination of shade and personal protection is important as UV can reflect off the ground up underneath shade structures. That’s why sometimes you might find you have been under shade but still become sun burnt. Sand at the beach can cause up to 25% reflection of UV and snow not only reflects UV, but the UV increase as the altitude increases.

To be effective, shade also needs to be dense – either in the form of trees, or the density of the fabric.

State of Queensland (Queensland Health)

Well-designed shade needs to block heat and UV which means it casts a dense shadow over the useable space. Similar to the trick of holding a hat to the light to check how dense the weave is, so too you can use this trick with shade. The more dense the weave or fabric or the canopy of the tree and the less light coming through the ‘holes’ – the more likely it is that the UV is being blocked. This might seem obvious, but next time you’re out and about walking, see how easy it is to find dense shade in your local areas. The siting of the shade is also very important – if you are using portable shade, make sure you position it to cast shade over the space you are using, and move it as the sun angles move.

A study by Parisi and colleagues (2019) showed that shade cloth is less effective in providing sun protection and instead our outdoor spaces should be favouring solid rooves like structural shading. Similarly, tree species provide different levels of shade and some species will grow better in certain areas versus others.

Being active in Australia means being aware of sun protection. Working with clients, teams or exercising yourself means being aware of sun protective options.

ٚ Choosing shady routes when outside

ٚ Advocating to government and representatives locally for increased and connected shade and safe spaces for being active in your local area

ٚ Avoiding exercising in the peak UV and heat times of the day

ٚ Choosing clothing, sunglasses and a hat that is comfortable to exercise in

ٚ Regularly applying sunscreen – at least 20 minutes before going outside and reapplying very two hours when in water or excessively swimming

Physical inactivity is associated with a higher risk of some cancers such as 12% of colon cancers and 3.2% of breast cancers.

To help us collect local data, we need you as citizen scientists to help us collect data on local streets walkability

which includes heat and shade issues. Share your thoughts in the Queensland Walks ‘Walk my Street’ survey: https://queenslandwalks. org.au/walk-my-street/ and join us on socials to help advocate for more walkable, rollable, safe and shaded local environments for our communities to walk and be physically active.

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

About the Author

Dr Louise Baldwin (PhD), writing for Queensland Walks

An innovative leader in health promotion, social impact and system change in Australia and globally, Louise brings a wealth of high-level strategic planning, management, evaluation, evidencebased approaches and innovative thinking to any role. Passionate about healthy communities and the nonprofit sector, Louise is known for her ‘out of the box’ approaches and expertise in program and service design  and healthy built environments. She has over two decades of leadership, practice and research experience at the local, state, national and global levels and is a successful health promotion consultant. She has won several awards for her commitment to building healthy communities in Queensland. She is proud co-editor of the book Health Promotion in the 21st Century: New approaches to achieving health for all (Fleming andbaldwin, 2020) and the Introduction to Public Health 5th edition (2023).  Louise holds roles on the national Board of the Australian Health Promotion Association and the Queensland Advisory Board, Heart Foundation.

Menopausal hormone therapy

A new perspective on greater trochanteric pain syndrome management

Dr RACHAEL MCMILLAN (2021

SMA e-Conference

Early Career Researcher – Clinical Sports Medicine Award), Emeritus Professor JILL COOK, Associate Professor ADAM SEMCIW, Associate Professor TANIA PIZZARI

Greater trochanteric pain syndrome (GTPS) refers to pain in the region of the greater trochanter. Pain in this area is a result of pathology in, and subsequent irritation to, the gluteus medius and minimus tendons, and less frequently, associated bursae. Pain in this region is associated with compression of the gluteal tendons against the greater trochanter in positions of hip adduction, such as occurs with sitting in a cross-legged position. The condition is also commonly known or referred to as ‘trochanteric bursitis’ and ‘gluteal tendinopathy’.

Risk factors for developing tendon pathology include older age, use of corticosteroids, and reduced oestrogen levels. Tendon pathology rarely correlates with symptoms. Excessive or sudden changes in load and/or compression on pathological tendons can result in tendinopathy. A consensus statement in 2020 defined tendinopathy as persistent tendon pain and loss of function related to mechanical loading. Imaging is not recommended for diagnosis.

Historically, inflammation of the trochanteric bursa was considered the primary cause of pain in the region of the greater trochanter. It has

Photo: Staras/ gettyImages

Menopausal hormone therapy

A new perspective on greater trochanteric pain syndrome management

since been shown that trochanteric bursa involvement may not be present in diagnosed cases of GTPS. A retrospective review of sonographic examinations in fact identified that only 8% of GTPS patients presented with isolated bursitis, compared with 41% with gluteal tendon abnormalities (mostly gluteus medius tendinosis) and 29% with iliotibial band (ITB) thickening. Dysfunction of the gluteal tendons and/or trochanteric bursae should therefore be considered as parts of the same condition.

Greater trochanteric pain syndrome is seen in both men and women across the lifespan, although women are more likely to suffer from GTPS due to wider or flared pelvic brim, reduced femoral neck shaft angle,

Post-menopausal women are most burdened by the condition, as they are a population with reduced female sex hormones.

with reduced female sex hormones (oestrogen and progesterone) and are at an increased risk of developing tendinopathy and tendon rupture.

Assessment & Diagnosis

increased width at the level of the superior greater trochanter, and greater body adiposity. Post-menopausal women are most burdened by the condition, as they are a population

Greater trochanteric pain syndrome is a clinical diagnosis and imaging is not required. There is poor correlation between pathology on imaging and symptoms. A thorough subjective assessment is required. Screen for any change in load (i.e. commencing walking program or new exercises) or change in usual activities, and potential positions where the tendon may be compressed (i.e. sitting with legs crossed and lying on (either) side). Investigation into the patient’s overall health in terms of menopausal status and/or other conditions which

Photo: Martin Zubiria Kage/ gettyImages

may be associated with changes in female sex hormones is critical.

Night pain is commonly reported as a symptom of GTPS, usually due to compression of the gluteal tendons in a side (both contra- and ipsilateral) lying position. Other common subjective reports include; pain with sit to stand, after a period of sitting, and walking up and down stairs or slopes. Asking patients about their ability to manipulate shoes and socks can aid differentiation between GTPS and hip osteoarthritis (OA). Those with GTPS typically are not restricted in functional range of motion, so are not impaired when putting on shoes and socks.

There is no single objective test that can be relied upon to provide an accurate diagnosis. A battery of clinical tests are recommended to rule in the condition. The most sensitive objective measure is palpation over and around the greater trochanter. Other valuable pain provocation tests for ruling in the diagnosis of GTPS include: Patrick’s or FABER test, resisted hip abduction, the resisted external derotation test, and Trendelenburg sign (with spontaneous reproduction of patient’s concordant pain, with or without contra-lateral pelvic drop indicating a positive test). A positive FABER and other tests to rule in GTPS must include reports of pain specifically in the lateral hip region.

Treatment

Corticosteroid injection (CSI) not recommended

A local CSI, aimed peritendinously, can have an adverse effect on tendon and the response to injections can vary between sites of tendinopathy. There is no difference in outcomes between fluoroscopically guided CSI into the trochanteric bursa and blind CSI for GTPS. Benefits of CSI’s are short-term only, with high rates of recurrence.

Robust evidence demonstrates that exercise and education about avoiding gluteal tendon compression is better than guided CSI in the longterm. A single, ultrasound-guided, intratendinous platelet-rich plasma (PRP) injection is better than a sngle CSI for patients with chronic gluteal tendinopathy. However, evidence from a randomised controlled trial (RCT) has shown a single PRP injection into the trochanteric bursa and associated gluteal tendons is no better than placebo. Both the PRP and placebo groups in the RCT received exercise after the single injection and both groups improved. Corticosteroid and PRP injections have a limited role in the management of this condition.

Exercise plus education about avoiding gluteal tendon compression is most beneficial

Exercise is helpful for people with GTPS and (strength based) exercise

prescribed in conjunction with education about avoiding gluteal tendon compression and advice regarding load management, provides the most benefit. Education involves instruction to avoid positions of hip adduction including (but not limited to): avoid sitting in a position with legs crossed, stand evenly on both feet and hip width apart, avoid lying on (either) side but if side lying is the only option then ensure a pillow is placed between the legs to avoid the top leg falling into a position of adduction (Figure 1), and avoid stairs in the short-term.

Avoid stretching

Gluteal stretching is not recommended and will delay recovery due to compression of the gluteal tendons. Isometric loading (Figure 2) has been advocated over dynamic movements in targeting gluteus medius and gluteus minimus for healthy post-menopausal women.

Figure 1. Sleeping positions to avoid compression of the gluteal tendon; A Lying on the contra-lateral side, with affected hip superior and pillows between thighs to ensure the superior hip does not drop into adduction; B Lying on back with pillow under knees.

Menopausal hormone therapy

A new perspective on greater trochanteric pain syndrome management

Figure 2. Demonstration of isometric loading of the gluteal tendons (standing hip hitch from flat surface). The patient is instructed to lightly place their fingertips on a wall or bench, while hitching their unaffected limb off the floor approximately 2cm. This results in targeted gluteal tendon loading on the affected (weight-bearing) side. Patients are instructed to ensure both knees remain straight and their unaffected foot is completely off the floor.

Exercise that avoids gluteal tendon compression is beneficial. A number of non-significant trends seen in results of a recent RCT suggest a targeted gluteal tendon loading program with kinetic chain strengthening may be better than a global low-load program in the long-term. Specific postural education, activity modifications and improved lumbo-pelvic control are integral to managing the condition.

Menopausal hormone therapy when body mass index (BMI)<25

In the post-menopausal population with GTPS, it is worthwhile considering options to increase levels of oestrogen (and progesterone) as clinically appropriate. An RCT investigating menopausal hormone therapy (MHT) and exercise as interventions for postmenopausal women with GTPS found that MHT (applied transdermally) with exercise and education is better than placebo (transdermal cream) when BMI<25 (Figure 3). There is currently no evidence to support MHT use in postmenopausal women when BMI≥25.

Perceptions surrounding menopausal hormone therapy

Figure 3. Results from randomised clinical trial (Cowan et al. 2022): Menopausal hormone therapy (MHT) with exercise and education is better than placebo with exercise and education when BMI<25. VISA-G = Victorian Institute of Sport Assessment – Gluteal Tendon, primary outome measure used in Cowan et al. (2022).

Beliefs surrounding menopausal hormone therapy

A retrospective review of sonographic examinations in fact identified that only 8% of GTPS patients presented with isolated bursitis, compared with 41% with gluteal tendon abnormalities and 29% with iliotibial band (ITB) thickening.

A review undertaken in 2023 accessed therapeutic resources for menopause and concluded MHT has a proven ‘real health benefit’ for women across the globe. Revisiting the history of MHT or hormone replacement therapy (HRT), from when it was first introduced in 1942, significant developments are evident. Research and subsequent media reports communicated multiple risks associated with its use in the 2000s, creating great concern and fear in the community. In 2002, reports of an increased risk of venous thromboembolism, cardiovascular disease and breast cancer were communicated. In 2013, research showed there was no increased risk

of breast cancer with transdermal administration and in fact, there may be additional benefits, including cardio-protection, improved glucose levels and insulin sensitivity, fracture prevention and improved quality of life. In 2017, the World Health Organisation released a statement advising the use of hormone replacement therapy is highly individual and the clinician must consider benefit, safety profile, time of initiation of the regimen, route of administration, patient’s age, menopausal time and associated conditions. It was clear that decisions to proceed with this treatment are complex and multi-factorial. Fast forward to 2023, despite knowledge surrounding safe use of MHT, there is still a common avoidance of the therapy due to fear of cancer or other negative effects, despite a growing body of evidence showing the clear benefits and no increased risk of breast cancer with continued use for less than or equal to 5 years.

A new perspective on managing GTPS

In summary, avoid a local CSI as this can have an adverse effect on the tendon and potential benefits are short-term only. Exercise is better in the long-term. Deliver education about avoiding gluteal tendon compression in all activities of daily living and exercise. Prescribe exercise that avoids gluteal tendon compression for guidance on appropriate exercise and load management. Consider MHT with exercise and education, for post-menopausal women with GTPS when BMI<25.

Our world-first randomised clinical trial has changed the way clinicians manage the burdensome condition and provided sound evidence for use of MHT as an adjunct to treatment (in addition to exercise and education). Our research team will be investigating the dose response that appeared to be evident in this trial, with a clear benefit for post-menopausal women when BMI was less than 25 but no benefit when BMI was greater than or equal to 25. For those patients who do not respond to a good quality rehabilitation

program for at least 3 months and fit the profile of being a candidate for MHT, consider a discussion with your patient surrounding the use of MHT and referral to a medical practitioner. These patients may benefit from MHT as an adjunct to your existing management plan.

Publication

Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med. 2022 Feb;50(2):515-525. doi: 10.1177/03635465211061142. Epub 2021 Dec 13. PMID: 34898293.

The publication was the first study to investigate menopausal hormone therapy (MHT) and exercise as interventions for postmenopausal women with greater trochanteric pain syndrome (GTPS).

Conflicts of interest

The authors have no conflicts of interest to disclose.

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

Key tips

ٚ Exercise with education about avoiding gluteal tendon compression and advice regarding load management is beneficial for managing greater trochanteric pain syndrome (GTPS)

ٚ Menopausal hormone therapy (MHT) with exercise and education may be considered for post-menopausal women with GTPS when BMI<25

ٚ Exercise plus education about avoiding gluteal tendon compression is better than corticosteroid injection (CSI) in the long-term

ٚ Imaging is not routine for the diagnosis of GTPS as pathology in the gluteal tendons and/ or associated bursae is common in older women and findings on imaging do not correlate with symptoms

ٚ Menopausal hormone therapy is safe when used for 5 consecutive years or less. Always consult a medical professional.

About the Author

Dr Rachael McMillan (previously Dr RM Cowan) is a musculoskeletal and clinical sports medicine researcher at Deakin University (Victoria), who practices clinically as a physiotherapist (PhD) in Emergency Department and elite sport settings.  Dr McMillan successfully led the first randomised clinical trial (RCT) to investigate menopausal hormone therapy (MHT) and exercise as interventions for postmenopausal women with greater trochanteric pain syndrome (GTPS), which has positively influenced clinical practice worldwide.  Dr McMillan has won multiple national and international awards for her research, including the Early Career Researcher in Clinical Sports Medicine Award at the 2021 Sports Medicine Australia e-Conference.  Rachael is frequently invited to present on the topic of GTPS/ gluteal tendinopathy in Australia and to a global audience.

Dr Brendan de Morton Physician Focus

What was your journey into sports medicine and what drew you to the field?

I graduated 50 years ago and there was really no discipline of sports medicine in those days. I garduated through The University of Melbourne and St. Vincent’s Hospital. I planned to be a physician in the broadest sense, but 2 years after graduation, I decided that hospital life was not for me.

In those days, I decided to leave and go into general practice. I went through the RACGP training program, which was in its rudimentary stages in 1977 when I left the hospital system. I was lucky enough to work at and subsequently join a general practice which I am still part of 47 years later.

I always had an interest in sport. I was an okay footballer. I was a good squash player. And later on, I became quite a reasonable marathon runner.

An ongoing interest in sport/sports medicine resulted in me signing up for a very intensive three-day course in sports medicine run jointly by SMA and RACGP in late 1990. To receive the “certificate” in sports medicine one had to be attached (if possible) to an elite sports club for 20 hours, as well as spend 20 hours with a high-level sports medicine mentor. I was lucky enough to work with Dr Bruce Reid & Dr Ian Reynolds, who were the doctors

at Essendon Football Club at that time. I approached Bruce and 20 hours turned into four years and 200 hours.

For my placement, I was most fortunate to get a placed with Dr Karim Khan, who with Dr Peter Brukner wrote the Clinical Sports Medicine textbook, which is the Australian Sports Medicine textbook. I spent 20 hours at Melbourne Olympic Park with him while he was with South East Melbourne Magic in the NBL. When he left to become a Professor at the University of British Columbia, he asked me to take over his role at Sout East Melbourne Magic. So, I did six seasons of basketball from about 1996 to 2001. I was also lucky to look after the Australian Under-23 Men’s Basketball team in 1997 in Melbourne (we won the world championship) and then again in 2001 in Japan. The other person who helped me enormously along the way was the Head Physio at both South-East Melbourne Magic

and the under-23 Australian Men’s Basketball team (the late) Steve Evans who nurtured me in my early days of practical sports medicine.

As a result of being involved in the basketball I was lucky enough to work, mostly as a volunteer, mostly in basketball at the 2000 Sydney Olympics – one of the greatest sport experiences of my life. The side-benefit of having an “infinity” pass at an Olympic Games was quite extraordinary, as it meant, when I wasn’t working, I could go anywhere and watch any event.

Was there any reason which led you to work with the AFL for so long?

I’ve always been an Essendon supporter, which helps when you work with the team you support. Having been at Essendon for 4 years however at the end of 1994, it was decided three doctors was too many. So, I didn’t do footy for a couple of

years. And then Carlton approached me, so I worked there for seven years (1998 – 2005) and during the last three, I was the head doctor.

I decided not to continue at Carlton at the end of 2005. I felt I needed a break and had a couple of years off from football. I did a couple of years for Fremantle in the East Coast games from 2008-09. After that, Dr Ian Reynolds asked me if I’d like to return to Essendon as he was retiring. And I’ve been there since the end of 2009 which is almost 15 years now.

I credit SMA in conjunction with the RACGP for their course at the end of 1990. That really was the absolute catalyst to get me into sports medicine and working with the AFL, NBL, Sydney Olympics.

What was your academic career like, particularly in relation to sports medicine?

I realised at the end of 1994 when I finished up at Essendon, that I needed to get more qualifications in sports

I credit SMA

in conjunction with the RACGP for their course at the end of

1990. That really was the absolute catalyst to get me into sports medicine and working with the AFL, NBL, Sydney Olympics.

medicine, so I looked to obtain more qualifications in Sports Medicine.

I’d heard very good reports about the Masters of Sports Medicine course at University of New South Wales and I enrolled and completed this starting in1997 and completed by the latter part of 1999. That was a fantastic course. The course is now defunct but gave me a lot of extra knowledge that I needed to function well in an elite sports area.

From an SMA perspective, the other thing I was involved in was with Sports Doctors Australia (SDrA), which was a very active group for many years. I was president for a couple of years and on the committee for many years.

I was very happy to become a Fellow of the Australian Sports Medicine Federation in 2006. That was a nice accolade that I received from SMA, and it was predominantly because of my involvement with SDrA which functioned under the SMA umbrella.

Do you have any goals for the future of your career?

I would like to think I’ll probably work in sport and general practice for quite a few more years. AFL has made it much more interesting because I think if I just did general practice alone, I probably would have been a bit bored by now.

Photo: Cameron Spencer/ gettyImages

Physician Focus

Dr Brendan de Morton

It’s fantastic working for Essendon Football Club working with young fit athletes. I’m certainly the oldest staff member, working with all these very keen, relatively younger people (Doctors, physios, strength & conditioning) who have excellent technical knowledge.

Do you have a specific outlook on what the future of sports medicine looks like?

I think it’s very bright because Australians are generally a very sporty population. We have a huge interest in things like football and cricket, as well as the upcoming Olympics. But I guess if Doctors are really serious about getting into sports medicine now, they’ve really got to look at the sports physician course or do a similar course to masters in Sports Medicine with the benefit of associated GP training. One of my colleagues at Essendon is a sports physician and I really enjoy working with him. But the thing he says to me is that they also need doctors with general practice skills, particularly if they’re travelling. And people like Dr Peter Harcourt, Dr Peter Baquie and Dr Peter Brukner, who are all well-known sports physicians, were all GPs before they became sports physicians. Whereas now, the younger sports physicians often will not have done much general practice.

In general, Medicine has become more complicated. Most universities now want you to do the four years of pre-med, which then leads into several courses after. Obviously one can decide after, whether to do general practice or another specific specialty or not. There are a couple of universities that still follow the old system, but most of them now have made it longer than what it used to be. So, it’d be much harder for someone like me now to go into sports medicine. Thankfully, I’ve got a fair bit of grandfathering with my accumulated knowledge over the years.

I started going virtually every year to the SMA Annual conference and other courses mostly run wasfantastic from a knowledge point of view.

What’s your experience with SMA and would you recommend it to other people who have similar experience to you?

When I did the SMA and RACGP sports medicine course, I started going virtually every year to the SMA Annual conference and other courses mostly run by SMA. I just found it fantastic from a knowledge point of view. Back then I wouldn’t have used the word networking, but it helped by getting

For elite performance

Sports Medicine in Mexico

DISCUSSING SPORTS MEDICINE IN MEXICO MEANS DISCUSSING A RELATIVELY NEW MEDICAL SPECIALTY. IT WAS NOT UNTIL 1986 THAT IT FORMALLY BEGAN, STEMMING FROM THE NEED TO PROVIDE A MORE ACTIVE SOLUTION FOR ATHLETE PATIENTS, NOT ONLY ACHIEVING FULL RECOVERY FROM INJURIES BUT ALSO AVOIDING PROLONGED PERIODS OF REST OR INACTIVITY.

It started as a specialty focused on injury care and improving sports performance. However, in the past two decades, it has gained significant strength, thanks to major technological advances that now allow us to evaluate, monitor, and obtain precise information about the current state of our athletes. This information enables us to know where to focus for their improvement.

Few Places to Train

In Mexico, Sports Medicine exists as a specialization after completing a medical degree. Unlike other countries, where it is a surgical specialty, in Mexico, it is clinical.

The number of positions offered for Physical Activity and Sports Medicine has varied between 40 and

DR. VICTOR MONTES FELISART

50 annually. Out of the 165 medical schools in the country, a doctor can train as a sports medicine specialist at only five institutions: the National Autonomous University of Mexico (1986), the Autonomous University of Nuevo León (1997), the National Rehabilitation Institute (1992), the Autonomous University of the State of Mexico (1990), the National Polytechnic Institute (1989), and the Autonomous University of Yucatán (2005). Once the necessary score for the specialty is achieved, the approximately 2,500 candidates must undergo a series of exams and interviews at each institution to be selected and complete 3 to 4 years of academic training.

Pursuing this specialty involves daily academic sessions, working in a clinic attending patients, and

strengthening education with various rotations in hospitals, national institutes, imaging centers, as well as national sports centers and sports clubs. In most cases, a social service must be completed during the entire process, caring for one or more sports teams representing the university.

Types of Sports Physicians in Mexico

The profile of graduates in our specialty has evolved significantly. It is no longer limited to medical care on the playing field, as was mistakenly believed at the outset. While this is indeed one of the essential characteristics of a sports physician, the field of work has also expanded exponentially. Here are some of the current types of sports medicine professionals we can find:

ٚ Clinical doctors who diagnose sports injuries and focus on treatments through rehabilitation and physical exercise.

ٚ Doctors specialized in improving athletic performance for both elite athletes and recreational sports enthusiasts. This can be achieved through public or private means. In this field, we also find doctors working with national teams, university representative teams, or sports clubs, responsible for treating and preventing sports injuries. They may also oversee the nutritional care of athletes, always supported by other experts in the area.

ٚ Doctors focused on health treatment through therapeutic exercise, meaning personalized prescriptions are created for treating chronic non-communicable conditions such as hypertension, obesity, dyslipidemias, oncology patients, etc.

ٚ Doctors for high-performance teams who accompany athletes throughout their Olympic or world competition processes. They manage

Photo: Argelis Rebolledo/ gettyImages

Photo: emicristea/ gettyImages

Sports Medicine in Mexico

the athlete’s health during training and preparation periods, as well as during various international competitions, focusing on both preventive and curative medicine. They lead a multidisciplinary team, fostering a special bond between all members for the athlete’s benefit.

ٚ Doctors responsible for controlling and preventing sports doping, a task that falls to the treating sports physician and the technical staff (always guided by a medical expert on the subject).

ٚ Doctors focused on body composition change, hypertrophy, or sports competitions related to bodybuilding.

There is a less common role in sports medicine that, over time, has gained greater relevance and in which I have found my professional development. I am the Medical Director of the World Para-Taekwondo Federation and the

Pan American Taekwondo Union. My work involves various responsibilities, notably coordinating the local medical team at each competition. These teams, though highly qualified in their respective specialties, often lack experience in this specific sport and in making medical decisions aligned with the particular rules of taekwondo. Under my leadership, we implement international protocols that ensure fair assessment for athletes, regardless of their country of origin. I also lead the medical meeting previous to

competition to ensure that each nation’s teams understand these procedures. During competition days, I am responsible for evaluating injuries on the mat and deciding whether the athlete can continue or not. My most recent participation was at the Paris 2024 Paralympic Games, in the Para-Taekwondo modality.

In reality, the sports physician in Mexico is well-prepared and must be knowledgeable about various sports in which they may be involved. They must be capable of properly managing injuries and emergencies on the field, guiding an athlete’s rehabilitation, conducting physical tests to assess various aspects of health and sports performance (cardiopulmonary exercise tests, biomechanical tests, etc.), prescribing appropriate exercise for patients with comorbidities or complications, and creating new knowledge through continuous research and study of developments in the field.

Currently, there are few sub-specialties available in the country for sports physicians. The most important include Cardiac Rehabilitation, HighPerformance Sports, and Exercise Physiology. It is expected that in

Photo: Cinthia Aguilar/ gettyImages

Photo:

gettyImages

the coming years, the demand for these sub-specialties will increase, as the role of a sports physician is not limited to the playing field but has permeated other areas of medicine.

Sports Medicine and Its Important Role in Cardiac Rehabilitation

Thanks to Dr. Luis Camas, the sports physician has begun to take on a particularly significant role in the field of Cardiac Rehabilitation. He was the first sports medicine specialist to complete a sub-specialty in Cardiac Rehabilitation (2022). As part of a multidisciplinary team that includes cardiologists, rehabilitation physicians, and physiotherapists specializing in cardiac pathologies, he has demonstrated that our specialized knowledge is invaluable in patients with cardiac conditions. We focus not only on the heart muscle but also on the entire body to improve overall capacities, achieving significant results that can change the prognosis and quality of life of patients. To date, there are three sub-specialists, as previously, only cardiologists were allowed into this program. Thanks to these doctors, the importance of sports medicine in this field has been recognized, and it is now an additional sub-specialization option.

Sports Medicine is a specialty that knows no monotony, where no two days are the same.

In a continuously evolving, active society, sports medicine has found new niches where its knowledge has enriched the processes of both athletes and patients in general. The field is vast, and the demand is greater than the number of graduates each year, making it an excellent option for doctors looking to specialize in a comprehensive field of medicine that offers many ways to practice. It is a specialty that knows no monotony, where no two days are the same.

About the Author

Victor Montes Felisart MD is a leading Sports Medicine Physician, founder and Medical Director of Grupo Quore, based in Mexico City. Grupo Quore, a pioneer in comprehensive physical care, integrates a multidisciplinary team of experts in sports medicine, physiotherapy, nutrition, performance training, sports psychology, and cardiac rehabilitation. Dr. Montes played a key role in Paris 2024, serving as the physician for Mexico’s National Artistic Swimming Team and as the Medical Director for ParaTaekwondo at the Paralympic Games. He also holds key roles in Taekwondo, including Medical Director for the PanAmerican Taekwondo Union and doctor for World Taekwondo.

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5 Minutes With Dr Joshua Heerey

Please explain your current role, particularly with the Young Athlete’s Hip Research Collaboration. Currently I have two roles. I’m a physiotherapist and work at LifeCare Prahan Sports Medicine in Melbourne, one day a week, where I see patients with hip and groin conditions. I still really enjoy my clinical work and I find that the different patients I see often inform the research that I am undertaking at La Trobe University.

Secondly, I’m a postdoctoral researcher at La Trobe Sport and Exercise Medicine Research Centre. I am predominantly researching hip osteoarthritis (OA) across the lifespan, ranging from adolescents to older adults. I have a particular interest in understanding the importance of imaging finding in hip pain and hip OA development.

However, the Young Athlete’s Hip Research (YAHiR) Collaboration is

Dr Joshua Heerey (middle)

separate to my research job. It is a multidisciplinary group of researchers and clinicians, that also includes patients. Within the collaboration there are physiotherapists, orthopaedic surgeons, sports physicians, radiologists and patients with lived experience of hip pain and hip osteoarthritis.

The main goal for the YAHiR Collaboration is to improve the management of young active people living with hip pain and/or hip OA. We met in 2022 and have produced several consensus statements around the classification of hip pain conditions and set priorities for future research. There’s another meeting planned for Oxford University in 2024, where there’ll be two days of lectures and practical workshops then a consensus meeting on the third day looking at trying to streamline our research priorities.

How was your experience presenting at various SMA events, specifically at the 2022 SMA Conference and last year’s symposium on ‘Sporting Hip and Groin’?

The 2022 SMA Conference was a great Conference and the thing I always like about the conference is the good mix of professions, which makes it very multidisciplinary. The great thing about it as well is there’s a lot of people who are involved not only in clinical practice, but also in research. So, it provides a nice blend of presentations.

Regarding the Sporting Hip and Groin symposium, everyone provided unique insights about how to best manage people with hip and groin pain. Obviously SMA have a pretty good track record of putting on good symposia. And this was an example of that. My presentation focussed on the relationship between hip

joint imaging findings (what you see on X-ray or MRI) and hip pain. In this presentation I outlined that many people without pain also have hip joint imaging findings which suggests we should not automatically assume these imaging findings are relevant in someone with hip pain.

Is there a specific area of research that you would like to move onto in the future?

I enjoy doing research with young adults and adolescents with hip and groin conditions. What we’re probably moving more into is conducting longitudinal studies to understand if specific conditions are associated with poor prognosis, including early onset

hip OA. That means following these young people over time to see if we can work out who actually develops hip OA quicker than others and why. I also want to keep developing and evaluating treatments that we give and that are often used in our clinical practice. One area of interest is understanding the effectiveness of injection therapies for young adults with hip pain. Injection therapies are often used in young adults with hip pain, but there is limited scientific evidence to know who will benefit from this type of treatment and how long the benefit will last for. I would still like to have a strong role in looking at the importance of imaging findings and how they relate to pain and people’s function.

Dr Joshua Heerey

Can you provide some insight into your upcoming symposium at the 2024 SMA & ACSEP Conference in Melbourne?

In our symposium, we have a good mixture of, again, clinicians and researchers. We have four physiotherapists and one orthopaedic surgeon, and all of us work in not only

clinical practice, but also in research. Often, we work together when we’re managing patients. I think it brings a unique combination which helps to achieve the best outcomes for patients.

For 2024, it’s going to be a wellrounded, multidisciplinary presentation. What we want to do is get across the

The Young Athlete’s Hip Research (YAHiR)

Collaboration is a multidisciplinary group of physiotherapists, orthopaedic surgeons, sports physicians, radiologists and patients with lived experience of hip pain and hip osteoarthritis.

complexities of managing patients but also the importance of working together with other disciplines and professionals to optimise outcomes.

So far, what’s your association been like with SMA?

My initial experience with SMA was attending the annual Conferences. I think the first Conference I attended was at the MCG in 2016.Then I joined the Victorian committee for three years and during that time, we arranged a lot of professional development symposia. I always loved the multidisciplinary nature of the organisation, and their desire to improve the management and outcomes for active people or people with particular conditions.

When I’ve usually attended SMA Conferences, I’ve presented my research work and also been involved in a few different symposia. It’s always been an enjoyable Conference to attend. As I’ve mentioned before, the multidisciplinary nature is a real strength of the SMA conferences. Its scientific qualities are also very high standard and I think that is very important for clinicians and researchers.

Photo: Boyloso/ gettyImages

Danielle Sutherland Sports Trainer Spotlight

What motivated you to become a sports trainer through SMA?

I started out in a completely different career as a conveyancing paralegal which I did for five years. As a kid I played a lot of sport so I wanted to be involved in sport in some way, whether it was to be a physio or something similar. I joined Broadbeach AFL club as a water runner and through that I met sport trainers who helped me learn about the profession. They steered me to SMA to gain my accreditation. At the time I was planning to have kids so the flexibility of being a sports trainer really worked well. I stayed with Broadbeach AFL club for a couple of years, gaining experience and knowledge and then moved onto other things.

Has there been a particular event that’s been a career highlight?

Definitely being involved with the Masters Games and UniSport Games was an amazing experience, however, I think the best experience was working with the Gold Coast Suns. After working with Broadbeach AFL for four years, I applied and worked with the Suns for seven years. For three of those I was actually Head Trainer. The role involved a lot of travel as well as gaining experience across disciplines such as physios, physicians and even dietitians. This was truly an exciting career highlight for me.

Danielle Sutherland

However, after having kids and as they got older, I did have to pull back a little bit as sports trainer work was getting a quite taxing. Though, I continued doing work for School Sport Australia. I eventually picked up contract work at Griffith University. They have what’s known as a GAPS Program (Gather, Adjust, Prepare, Sustain) which is in combination with the Commonwealth Games Federation. It’s a program developed to enable athletes from less developed countries, to learn more about their potential, learn better training techniques and improve nutrition, through carious camps. I have works mostly with the Oceania countries. They also work

with lots of para-athletes which has been a very rewarding experience for me, especially understanding their injuries and adjusting their training program accordingly.

Is there any sport that you want to move onto?

At the moment I’m happy to keep working with the GAPS Program. I’ve had a lot of opportunities with them such as travelling to Birmingham and being involved with lots of different people and sports. Another highlight is hosing the Gold Coast for camps. Leading up to it, there’s a lot of interesting operational preparation such as getting a list of injuries, seeing

who we’re dealing with and what countries they are from. To me that is so fascinating. However, I do love School Sport as well specifically in the south coast region such as the Gold Coast. Being able to give kids knowledge and looking after them during and post the game is really important for the future of sport.

What’s your experience been like with SMA, and would you recommend it to others?

The main thing I’ve found with SMA is the incredible support. They’re easy

I also think the membership for SMA is something important to have as it not only covers you for insurance but you get a lot of extras with it.

Julia Penaluna

to call up, easy to get information from and it’s been great getting reaccredited by the same person, Lyall Ferguson. Over the years he’s been great to talk too and bounce ideas and different techniques from.

The staff at SMA are always knowledgeable, always know what they’re talking about and ready to show you new things. I also think the membership for SMA is something important to have as it not only covers you for insurance but you get a lot of extras with it. There’s conferences, mail outs and new information all the time. I’d always recommend SMA to anyone looking to become a sports trainer or build a career in sport medicine.

From MICHAEL A. KENIHAN

President – ASMF (SMA) Order of Fellows, Past SMA Board Chair

With sadness, ASMF advises the recent passing of Mrs Julia Penaluna. Julia, her husband Max and members of the St John Ambulance Division at Broadmeadows in Victoria, initially started the St John Sports First Aid program and later as it became the SMA Sports Trainers Level 1 program, commencing in the early 1980’s. I was pleased to meet Julia at that time and remember fondly the level of expertise Julia provided and the high expectation she had of the program graduates.

Julia created great ‘friendships’ and ensured a culture where participants achieved higher levels of both participation and performance in their subsequent roles as Sports Trainers. The program that Julia and others started has blossomed into a National program where upwards of 10,000 persons graduate across Australia every year and the program has also been conducted in many countries in our region, initially in Malaysia where Julia contributed as a lead trainer.

Julia leaves a lasting legacy, and we thank her for her vision, enthusiasm, leadership and expertise in making such a program thrive in Australia and beyond.

Photo: xxx/ gettyImages