Brage NIH (Norwegian School of Sport Sciences)
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Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: A systematic review and meta-analysis
Full text linkObjective: To evaluate the effectiveness of nonpharmacological conservative therapies for women with CPP.
Data sources: A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023.
Study eligibility criteria: Randomized controlled trials comparing a nonpharmacological conservative therapy to inert (eg, placebo, usual care) or nonconservative (eg, surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (eg, electrophysical agents, manual stretching).
Study appraisal and synthesis methods: All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using postintervention scores for data that included similar interventions and outcomes. Standardized mean differences were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the Physiotherapy Evidence Database scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations criteria.
Results: Of 5776 retrieved studies, 38 randomized controlled trials including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments in both the short (standardized mean difference −1.69, 95% confidence interval −2.54, −0.85; high certainty) and intermediate-terms (standardized mean difference −1.82, 95% confidence interval −3.13, −0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (standardized mean difference −0.18, 95% confidence interval −0.56, 0.20; moderate certainty) and a slight difference in sexual function (standardized mean difference −0.28, 95% confidence interval −0.52, −0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (standardized mean difference 1.08, 95% confidence interval −1.38, 3.54, nonstatistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence.
Conclusion: This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with chronic pelvic pain with a high certainty of evidence.publishedVersio
Part I of a two-step mixed-methods approach in developing the Growth Talent Mindsets for Sports Coaches Intervention: The design and targeting of the intervention
Full text linkThe overall aim of this two-part study was to develop an intervention targeting sports coaches’ mindsets about their talent as a coach (coach talent mindset, C-TM) and their athletes’ talent (athlete talent mindset, A-TM), called the GrowTMindS Intervention. In this Part I, the intervention was developed drawing on a user-centered design approach and implemented in a coach education program in Norway. The study involved 31 coaches (5 women, 26 men) from 22 to 69 years of age, representing the sports of bandy, golf, ski sports, swimming, and volleyball. Using a mixed-methods approach, the quantitative results showed that the coaches increased their A-TM from pretest to post-test, while their C-TM, which was high at baseline, remained more challenging to target. The qualitative findings helped us understand how most coaches, through reflective processes, perceived the delivery of the intervention as sense-making and substantiated their commitment to growth talent mindsets. The qualitative findings also highlighted areas for refinement and tailoring of the intervention to target all coaches’ talent mindsets. Overall, the study was considered a necessary first step in developing an intervention showing significant and meaningful changes in coaches’ self-reported talent mindsets, consistent with the guidelines of wise psychological intervention and behavior change.publishedVersio
Device-measured 24-hour movement behaviors and blood pressure: A 6-part compositional individual participant data analysis in the ProPASS consortium
Full text linkBackground: Blood pressure (BP)–lowering effects of structured exercise are well-established. Effects of 24-hour movement behaviors captured in free-living settings have received less attention. This cross-sectional study investigated associations between a 24-hour behavior composition comprising 6 parts (sleeping, sedentary behavior, standing, slow walking, fast walking, and combined exercise-like activity [eg, running and cycling]) and systolic BP (SBP) and diastolic BP (DBP).
Methods: Data from thigh-worn accelerometers and BP measurements were collected from 6 cohorts in the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) (n=14 761; mean±SD, 54.2±9.6 years). Individual participant analysis using compositional data analysis was conducted with adjustments for relevant harmonized covariates. Based on the average sample composition, reallocation plots examined estimated BP reductions through behavioral replacement; the theoretical benefits of optimal (ie, clinically meaningful improvement in SBP [2 mm Hg] or DBP [1 mm Hg]) and minimal (ie, 5-minute reallocation) behavioral replacements were identified.
Results: The average 24-hour composition consisted of sleeping (7.13±1.19 hours), sedentary behavior (10.7±1.9 hours), standing (3.2±1.1 hours), slow walking (1.6±0.6 hours), fast walking (1.1±0.5 hours), and exercise-like activity (16.0±16.3 minutes). More time spent exercising or sleeping, relative to other behaviors, was associated with lower BP. An additional 5 minutes of exercise-like activity was associated with estimated reductions of –0.68 mm Hg (95% CI, –0.15, –1.21) SBP and –0.54 mm Hg (95% CI, –0.19, 0.89) DBP. Clinically meaningful improvements in SBP and DBP were estimated after 20 to 27 minutes and 10 to 15 minutes of reallocation of time in other behaviors into additional exercise. Although more time spent being sedentary was adversely associated with SBP and DBP, there was minimal impact of standing or walking.
Conclusions: Study findings reiterate the importance of exercise for BP control, suggesting that small additional amounts of exercise are associated with lower BP in a free-living setting.publishedVersio
Subordinates' perceptions of the need-supportive, need-thwarting, and need-indifferent behaviors used by their supervisors: A person-centered investigation
Full text linkAdopting a recent tripartite operationalization of subordinates' perceptions of their supervisors' behaviors, anchored in self-determination theory (SDT), this person-centered study considers the co-existence of subordinates' perceptions of their supervisors' need-supportive, need-thwarting, and need-indifferent behaviors. Moreover, we also consider how these various combinations (or profiles) of perceived supervisor behaviors relate to subordinates' levels of work motivation, well-being, attitudes, behaviors, and work–home functioning. A sample of 596 French employees (Mage = 31.22; 73.5% women) participated in this study. Our results revealed six profiles of subordinates characterized by distinct configurations of perceived need-related behaviors from supervisors (globally unfavorable, globally favorable and supportive, moderate-indifferent, moderately favorable and involved, moderately unfavorable, and moderately favorable). Consistent with our expectations, these profiles displayed well-differentiated patterns of associations with all of the outcomes considered in this study. These findings underscored the key role of subordinates' specific perceptions of need-supportive, need-thwarting, and need-indifferent behaviors, over and above their global perceptions of their supervisors' behaviors, in determining how beneficial or harmful supervisory profiles are. In particular, our results also highlighted the critical role played by need-indifferent behaviors, which prove to be a very important, and yet typically neglected, component of subordinates' perceptions of their supervisors' behaviors.publishedVersio
Knowledge and communication about the menstrual cycle among rhythmic gymnasts, ballerinas, and dancers
Full text linkWhile moderate exercise supports regular menstrual cycle (MC) function, many female athletes experience MC symptoms that negatively influence their training and performance. Hereby, knowledge and communication about this topic are important to promote an athlete’s health and wellbeing. Hence, this study aimed to assess the knowledge and communication surrounding the MC among Norwegian rhythmic gymnasts, ballerinas, and dancers. In total, 116 rhythmic gymnasts, ballerinas, and dancers aged ≥ 16 years training ≥ 3 days per week completed an electronic questionnaire. Of these, 63% (n = 73) reported a lack of knowledge about the MC’s influence on physical fitness and performance, and 39% (n = 45) rated their coaches’ or pedagogues’ knowledge as low. With only 32% of participants discussing the MC with their coaches/pedagogues, communication was found to be limited. Seventy-three percent felt uncomfortable during training or competition due to their attire and recommended darker colors and more options in size and layering. The study highlights a significant gap in knowledge and communication about the MC among female athletes and coaches/pedagogues in aesthetic sports. It also recommends improving athletes’ choice of attire for greater comfort and confidence.publishedVersio
Effects of exercise training on mitochondrial and capillary growth in human skeletal muscle: A systematic review and meta-regression
Full text linkBackground: Skeletal muscle mitochondria and capillaries are crucial for aerobic fitness, and suppressed levels are associated with chronic and age-related diseases. Currently, evidence-based exercise training recommendations to enhance these characteristics are limited. It is essential to explore how factors, such as fitness level, age, sex, and disease affect mitochondrial and capillary adaptations to different exercise stimuli.
Objectives: The main aim of this study was to compare the effects of low- or moderate intensity continuous endurance training (ET), high-intensity interval or continuous training (HIT), and sprint interval training (SIT) on changes in skeletal muscle mitochondrial content and capillarization. Secondarily, the effects on maximal oxygen consumption (VO2max), muscle fiber cross-sectional area, and fiber type proportion were investigated.
Methods: A systematic literature search was conducted in PubMed, Web of Science, and SPORTDiscus databases, with no data restrictions, up to 2 February 2022. Exercise training intervention studies of ET, HIT, and SIT were included if they had baseline and follow-up measures of at least one marker of mitochondrial content or capillarization. In total, data from 5973 participants in 353 and 131 research articles were included for the mitochondrial and capillary quantitative synthesis of this review, respectively. Additionally, measures of VO2max, muscle fiber cross-sectional area, and fiber type proportion were extracted from these studies.
Results: After adjusting for relevant covariates, such as training frequency, number of intervention weeks, and initial fitness level, percentage increases in mitochondrial content in response to exercise training increased to a similar extent with ET (23 ± 5%), HIT (27 ± 5%), and SIT (27 ± 7%) (P > 0.138), and were not influenced by age, sex, menopause, disease, or the amount of muscle mass engaged. Higher training frequencies (6 > 4 > 2 sessions/week) were associated with larger increases in mitochondrial content. Per total hour of exercise, SIT was ~ 2.3 times more efficient in increasing mitochondrial content than HIT and ~ 3.9 times more efficient than ET, while HIT was ~ 1.7 times more efficient than ET. Capillaries per fiber increased similarly with ET (15 ± 3%), HIT (13 ± 4%) and SIT (10 ± 11%) (P = 0.556) after adjustments for number of intervention weeks and initial fitness level. Capillaries per mm2 only increased after ET (13 ± 3%) and HIT (7 ± 4%), with increases being larger after ET compared with HIT and SIT (P 0.116), but ET and SIT exhibited opposing effects (P = 0.041). VO2max increased similarly with ET, HIT, and SIT, although HIT showed a tendency for greater improvement compared with both ET and SIT (P = 0.082), while SIT displayed the largest increase per hour of exercise. Higher training frequencies (6 > 4 > 2 sessions/week) were associated with larger increases in VO2max. Women displayed greater percentage gains in VO2max compared with men (P = 0.008). Generally, lower initial fitness levels were associated with greater percentage improvements in mitochondrial content, capillarization, and VO2max. SIT was particularly effective in improving mitochondrial content and VO2max in the early stages of training, while ET and HIT showed slower but steady improvements over a greater number of training weeks.
Conclusions: The magnitude of change in mitochondrial content, capillarization, and VO2max to exercise training is largely determined by the initial fitness level, with greater changes observed in individuals with lower initial fitness. The ability to adapt to exercise training is maintained throughout life, irrespective of sex and presence of disease. While training load (volume × intensity) is a suitable predictor of changes in mitochondrial content and VO2max, this relationship is less clear for capillary adaptations.publishedVersio
Predicting anterior cruciate ligament: Reconstruction outcome machine learning analysis of National Knee Ligament Registries
Full text linkAvhandling (doktorgrad) - Norges idrettshøgskole, 2025Introduction: Anterior cruciate ligament (ACL) injuries are common, and surgery is often performed to improve function. Many factors have been identified that may influence the risk of a poor outcome following ACL reconstruction (ACLR). However, putting those risk factors into context and applying them to an individual patient to accurately estimate their specific risk of a poor outcome is challenging. The ability to accurately quantify risk at a patient-specific level is desirable as it can lead to more informed discussions and surgical decision-making, and can guide efforts at decreasing risk.
Machine learning is a branch of artificial intelligence that enables the development of algorithms capable of predicting clinical outcomes based on analysis of large databases. These novel techniques can tease out relationships between variables that may be more complex than can be realized through traditional statistical analyses. The purpose of this thesis was to apply machine learning analysis to the Norwegian Knee Ligament Register (NKLR) and Danish Knee Reconstruction Registry (DKRR) to develop easy-to-use models capable of predicting postoperative outcomes (revision surgery and inferior patient reported outcome) for patients undergoing ACLR and identify the factors that are most important for making the outcome predictions. The hypothesis was that this analysis would lead to the development of accurate and externally valid clinical prediction tools that clinicians could use to predict the risk of revision surgery or inferior patient reported outcome for their patients undergoing ACLR.
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Conclusion: The most significant findings from these studies are: 1) machine learning analysis of the NKLR and DKRR enabled the development and validation of prediction models that demonstrated moderate accuracy for predicting revision surgery and inferior outcome following ACLR and identified the most important factors used to predict these outcomes, 2) a rigorous approach to clinical prediction modeling has been described, laying the foundation for future innovation, 3) more work is needed to evaluate the performance of the prediction models on patients from outside Scandinavia and to determine the threshold for clinical relevance regarding ACLR outcome prediction, 4) the development and validation of clinical prediction tools may be limited by both the quality and quantity of the available data, and 5) the data collected by the registries should be expanded to include more variables that have been associated with outcome. Although these studies enabled the development of several risk estimation tools for patients
undergoing ACLR, the performance of these models was limited by the data contained within the registries. More specifically, they were limited by the lack of some important relevant variables associated with outcome such as pre-operative knee laxity, posterior tibial slope, and rehabilitation factors. The choice of outcomes (revision surgery and low KOOS scores) may have also limited the model performance. In addition, external validation outside of Scandinavia was limited by poor data quantity in the STABILITY I cohort. Evolution of the national knee ligament registries to capture more variables is required to improve the ability to predict outcome using these databases. Overall, the processes outlined in these studies can serve as a guide for the pursuit of clinical prediction models in the future; however, the current clinical utility of the ACLR prediction models remains unknown. Prior to widespread adoption and implementation of these prediction algorithms, their performance relative to predictions made by surgeons must be ascertained. This represents an important next step because until it is known how well surgeons can predict outcome, it will never be known if prediction tools driven by artificial intelligence confer an advantage and, therefore, are clinically relevant.Institutt for idrettsmedisinske fag / Department of Sports Medicin
Pivotal moments in needs-supportive environments: Experiences of Active Rehabilitation camps for individuals with acquired brain injury
Full text linkAvhandling (doktorgrad) - Norges idrettshøgskole, 2025Peer support is recognised as a tool for assisting individuals with a disability in managing their health and facilitating their full inclusion and participation in life (United Nations, 2006; World Health Organization & World Bank, 2011). However, despite being recommended by key stakeholders such as the World Health Organization, the utilisation of peer support in rehabilitation settings remains limited. This is believed to result from insufficient knowledge about integrating peer support into rehabilitation settings, coupled with the scarcity of research and ambiguous findings on the subject. To address this issue, the aim of this PhD project was to explore experiences of peer mentorship activity camps for individuals with an acquired neurological injury.
To achieve this project’s overall aim, we conducted four studies, which led to four corresponding papers. In Study 1 (Paper I), we investigated the characteristics and outcomes of structured and time-limited peer mentorship activity interventions for individuals with acquired spinal cord or brain injury. The knowledge gained from Study 1 steered the focus of Studies 2–4 (Papers II–IV), wherein we sought to explore experiences of a specific model of peer mentorship interventions—namely, Active Rehabilitation camps for individuals with acquired brain injury. We sought to include various perspectives on peer mentorship experiences, including those receiving peer support (mentees and caregivers) and those providing support (peer mentors).
More specifically, in Study 1, we conducted a systematic literature review. We included quantitative and qualitative results from 10 empirical studies and analysed the data using an advanced convergent qualitative meta-integration synthesis design. In Studies 2–4, data were generated through field observations at two Active Rehabilitation camps and individual interviews with 27 mentees (children and adults), 16 peer mentors, and 10 caregivers. The mentees and caregivers were interviewed twice, first immediately after the camp and then approximately six months later. The peer mentors were interviewed once, immediately after their camp participation. In Study 2, we analysed the data using an abductive thematic analysis; in Study 3, we used systematic text condensation; and in Study 4, we applied a narrative approach. Moreover, in Studies 2–4, we used Self-determination theory (Ryan & Deci, 2018) to interpret and discuss the results and found organismic integration theory, basic psychological needs theory, and relationships motivation theory particularly useful.
Study 1 revealed that most reviewed studies examined interventions based on the Active Rehabilitation model and included adults with a spinal cord injury. We found variations in the interventions’ aims, content, and duration. The key outcomes for mentees were improved wheelchair skills and increased injury-related knowledge, confidence, motivation, and support networks.
Studies 2–4 showed that both mentees and peer mentors experienced feelings of mastery and motivation to be physically active and participate in their local community. Furthermore, mentees, peer mentors, and caregivers reported positive changes regarding their knowledge about brain injury, coping strategies, confidence, self-esteem, and support networks. Albeit not to a great extent, some challenging camp experiences were also reported in Studies 2–4. These challenges included not finding someone to relate to at camp, difficulties finding opportunities to rest, and peer mentors’ insecurity about their capabilities.
Study participants described the camp environment as safe, supportive, and empathic, allowing them to be open about their injury and share experiences, while the peer mentors provided encouragement and hope for the future. We conclude that Active Rehabilitation camps have the potential to mitigate experienced challenges and meet some rehabilitation needs voiced by individuals with an acquired brain injury and, therefore, support the World Health Organization’s goal of enhancing community-based rehabilitation for individuals with a disability (World Health Organization, 2015).Institutt for idrett og samfunnsvitenskap / Department of Sport and Social Science
The impact of injuries on sports-related analgesic use in Danish youth elite athletes: A 4-week prospective cohort study
Full text linkObjectives: Investigate the association between injury severity and sports-related analgesic use, and explore the types and reasons for analgesic use in Danish youth elite athletes.
Design: 4-week prospective cohort study.
Methods: 713 youth elite athletes (44 % female) aged 15–20 years provided information on demographics, sports specific questions, and injury severity. We categorized injury severity based on the amount of impact on sports participation: 1) no injury (reference), 2) injury not affecting sports participation, 3) injury causing modifications in sports participation, and 4) injury causing complete absence from sport. Participants were asked weekly over 4 weeks about the number of days with sports-related analgesic use, types, and reasons for use. Mixed-effects regression models were used to assess the association between injury severity and prevalence (yes/no) and frequency (days/week) of analgesic use.
Results: Analgesic use at least once during the four weeks was reported by 224 athletes (31 %), with a mean weekly prevalence of 13 %. The odds of analgesic use increased with injury severity compared with the reference group; injury not affecting sports participation: OR 2.6 (95 % CI 1.6–4.2), injury causing modifications in sports participation: OR 3.2 (95 % CI 2.0–5.2), injury causing complete absence from sport: OR 3.6 (95 % CI 1.5-8.7) (test for trend; p = ＜0.001). The rate (frequency) of analgesic use also increased with injury severity (test for trend; p = 0.003). Athletes most commonly used analgesics to treat pain/injury after sports participation (62 %), and paracetamol was most frequently used (84 %).
Conclusions: Injury severity was associated with increased odds and rate of analgesic use.publishedVersio
