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Includes bibliographical references (leaves 121-128). / Background: Previous clinical research of football players participating in international tournaments has mainly focussed on documentation of injuries and risk factors for injury. However, despite anecdotal evidence that medical symptomatology, illness and medical complaints are common during travel to international competitions, the epidemiology of medical conditions before, during or after elite level football tournaments, has not been well documented. Objective: The aims of the research presented in this dissertation were: 1) to determine the prevalence of medical conditions in elite football players 2) to determine the incidence and nature of medical conditions and illness in the elite football players participating in an international tournament (2009 FIFA Confederations Cup tournament) and 3) to provide data for the medical planning and management of elite football players during future events. Methods: The first component of this dissertation consisted of a comprehensive review of the current literature describing the prevalence and incidence of medical conditions and illness in athletes. The original research component of this dissertation consisted of two parts, and both studies were conducted during the FIFA Confederations Cup tournament, which was held in South Africa in June 2009. All the players in the 8 participating teams (23 players per team – a total of 184 players) were approached by the FIFA Medical Assessment and Research Centre (F-MARC) through their team physicians and invited to participate as research subjects in the studies. Part 1 (descriptive cross-sectional study): Prior to the tournament, all the players completed a previously validated medical history and illness questionnaire. Furthermore, the questionnaire contained sections on player demographics, training history, medication and supplement use, life-style history, family history of atopy, current and past history of medical conditions and detailed sections pertaining to upper respiratory tract infections (URTI), allergies, asthma, exercise associated muscle cramping (EAMC) and history of previous surgery. Part 2 (prospective cohort study): During the 15 days of the tournament each team physician was requested to complete a daily injury, medical illness and treatment log for each player. Finally, data on the environmental conditions at each venue were collected, as recorded by the South African Weather Service. Results: The main findings in part 1 of this study were: 1) exercise associated muscle cramping (EAMC) was the most prevalent medical condition reported, with 64 (46%) of the players reporting a history of EAMC, 2) the prevalence of allergy was 27 (20%) and asthma 6 (4%), 3) the prevalence of dermatological conditions was 16 (12%), 4) the prevalence of gastro-intestinal conditions was 10 (7%) and central nervous system conditions was 6 (4%), 5) URTI one week before the tournament was reported by 7 (5%) of the players, 6) 68 (49%) of the players reported a history of previous surgery and 7) 72 (52%) of the players reported the use of supplements or vitamins and 11 (8%) the use of medication. Knee surgery was the most common anatomical area operated with 33 (24%) of the players reporting previous knee surgery. This was followed by a much lower prevalence of ankle surgery, 8 (6%). In part 2 of the study, a total of 56 injuries and 35 illnesses were recorded during the tournament. The main findings in this study were: 1) an overall injury rate of 64.4 injuries per 1000 match hours or 2.1 injuries per match, 2) an overall rate of 2.7 injuries and 1.7 illnesses per 100 player days, 3) that 0.88 days were lost per injury and 0.46 days were lost per illness, 4) the lower limb was the most commonly injured body part, 5) 11 (20%) of the injuries reported were to the thigh, 6) 15 (44%) of the injuries reported were due to a contusion, 6) 13 (37%) of the illnesses reported were due to ENT conditions, and 7) 7 (20%) were due to respiratory tract symptoms. Summary and conclusion: Illness and injury are common during an international football tournament. The pattern of injury was similar to that previously reported. However, the novel finding of this dissertation was that illness is a significant component to the medical care to a travelling team and needs to be considered by team physicians managing the medical needs of elite football teams.

Includes bibliographical references / Background: Illness in athletes is an inevitable part of participation in sports, and can significantly interfere with training, during tournaments or at competition time. The incidence of illness in sports varies in different sporting codes and across different tournaments and competitions. The Super Rugby competition is a particularly demanding 16-week tournament among countries in the Southern Hemisphere, and is associated with a high incidence of illness. In this tournament, 15 rugby union teams compete and play international level matches every week, which involves travel across numerous time zones and therefore may be associated with a higher incidence of illness in players. Objective: The main objectives of this dissertation were to 1) review the epidemiology and risk factors for illness in athletes participating in tournaments or competitions, and 2) determine which intrinsic risk factors predispose players to illness during the 2010 Super Rugby tournament. Methods: This dissertation consisted of two main phases. In phase I, a systematic review of the literature was undertaken, using evidence-based criteria, to determine which risk factors predispose athletes to illness during tournaments. In phase II, a prospective cohort research study was undertaken, involving 239 players from South Africa and New Zealand, over the 16-week duration of the 2010 Super 14 Rugby Union tournament. For phase II, a pre-season medical questionnaire was administered to determine baseline medical data. Collection of data then took place each day of the competition, beginning 7 days before the first game the team played, and ending when each team played their final game. Each team physician completed a daily "medical illness log" for every player. Booklets were supplied that contained daily illness report forms. Results: The main findings of the review (phase I) were good evidence (level I and II) indicating that 1) international travel, and the duration of a tournament are extrinsic risk factors for illness in athletes, and 2) that prolonged and high intensity training, older age, and nutritional deficiencies are intrinsic risk factors for illness in athletes. The main findings of the prospective cohort study (phase II) were that an increased number of training days in the 2 weeks before the tournament was an independent risk factor for any illness, respiratory system illness, and digestive system illness; the % time spent on endurance training in the 15 weeks before the tournament was an additional independent risk factor associated with respiratory system illness; the use of anti-inflammatory medication was an independent risk factor associated with respiratory system illness. Summary and conclusion: In summary, novel intrinsic risk factors for illness in rugby players participating in the Super Rugby tournament were training more days/hours per week in the 2 weeks before the tournament, as well as endurance-type training 15 weeks before the tournament. These data can form the basis of planning preventative strategies to reduce the risk of illness in the Super Rugby tournament.

Includes bibliographical references. / The International Paralympic Committee (IPC) has witnessed growing participation in the Games since its inception and has made strong efforts to collect comprehensive injury and illness data during the London 2012 Paralympics. Until now, no studies have comprehensively evaluated upper limb injuries at the Paralympic Games. To describe the epidemiology and clinical characteristics of upper limb injuries in athletes participating in the London 2012 Paralympic Games and identify the groups of athletes at risk. This study forms a component of the large prospective cohort study conducted over the 14-day period of the London 2012 Paralympic Games, coordinated through the IPC Medical Committee. Data were collected in two phases. Phase 1 involved the determination of the incidence and severity for 3,565 athletes (85% of the Paralympic athletes) from a collation of three data sources, providing 46,606 athlete days of data for analysis. Phase 2 involved the collection of more detailed medical data using a novel web-based surveillance system for 3,329 athletes participating in the study (80% of Paralympic athletes). Incidence proportion (IP) has been defined as the number of injuries per 100 athletes (%) during the study period. Incidence rate (IR) has been defined as the number of injuries per 1000 athlete days for the study period and 95% confidence intervals (CI) are reported in parentheses.

Epidemiological data is important to better understand injury and illness patterns in para athletes. Medical teams used a web-based injury and illness surveillance system (WEB-IISS system) to all the para-athlete injuries and illnesses during the 2012 London Paralympic games. All team physicians could access the system at any time to log data, providing a vast database for potential research. The relative ease of data collection permits large amounts of data to be analysed, providing important surveillance data on injury and illness. Data on the South African para-athletes, provided by the team's Chief Medical Officer, were assessed and compared to all countries. This study aimed to describe the illness and injury profiles in South African elite paraathletes who participated in the 2012 Summer Paralympic Games; and compare these profiles to data from the other countries that participated. A retrospective sub-analysis of the data-set collected from a large prospective study of injury and illness at the London Summer Paralympic Games in 2012 was compared to data collected on all para-athletes from input by team physicians into the WEB-ISS system. In total, 62 South African para-athletes presented with 19 injuries, with an injury rate of 21.9 per 1000 athlete days. Twenty-five para-athletes presented illness, with an illness rate of 28.8 per 1000 athlete days. The overall injury and illness rate in the South African para-athletes was higher than the injury and illness rate in all para-athlete participants at the London Paralympic Games. The anatomical distribution of injuries (lower limbs, axial and upper limbs) and the nature of illness (respiratory, skin & subcutaneous and digestive systems) were however similar. Causative factors are not evident and need to be further studied. Increased efforts in injury and illness surveillance and preventative programmes should be employed to reduce the incidence of injury and illness, and their severity . Such efforts in para-athlete care should be ongoing with surveillance to monitor and manage trends to ensure the culmination of Paralympic competition does not result in high rates of injury and illness. Education of healthcare providers, para-athletes, coaches and others in the management of para-athletes, is key.

The main objectives of this dissertation was: 1) to review the available evidence with respect to the period prevalence of pre-race upper respiratory tract infections (the week before a distance running event) in distance runners, the relationship between exercise and infections, and the possible health consequences of participating in sport whilst suffering from an acute infective illness; 2) to document the period prevalence of runners with an acute illness in the 7-day period prior to an endurance race; 3) to determine the period prevalence of runners who "fail" the "neck check", and would be advised not to participate in the race, 4) to determine the incidence of runners with an acute illness, and who received educational information and guidelines, and who then not start the race, 5) to determine the incidence of runners with an acute illness who chose to start the race, but do not finish the race, and 6) to determine the incidence of runners with an acute illness who chose to start the race, but develop medical complications during the race.

The central nervous system is highly sensitive to reductions in oxygen availability but the neurophysiological responses in healthy human lowlanders are not well understood. In severe hypoxia, whole-body exercise tolerance is impaired and neuromuscular fatigue, defined as any exercise-induced reduction in the ability of a muscle to generate force or power, reversible by rest, may be largely due to cerebral perturbations. The primary aim of this thesis was to determine the mechanisms of exercise-induced neuromuscular fatigue and the related neurophysiological responses to acute, chronic and intermittent severe hypoxia in healthy humans. In acute severe hypoxia (AH), exercise tolerance was, in part, mediated by a hypoxia-sensitive source of central fatigue, measured as a decrease in voluntary activation (VA) of the knee extensors (Study 1 – 4). This coincided with a significant challenge to systemic (arterial oxygen saturation [SpO2] ≈ 70%, Study 1 - 4) and cerebral oxygen availability at end-exercise (Study 3 - 4). The rate of development of peripheral locomotor muscle fatigue was blunted at task failure in AH in comparison to normoxia (Study 1 – 2). Corticospinal excitability and the neuromuscular mechanisms of fatigue were measured after a prolonged (two-week) exposure to high altitude in Study 3 (5260 m above sea level, Mount Chacaltaya, Bolivia). This was the first study to show that acclimatisation to chronic severe hypoxia (CH) alleviates the development of supraspinal fatigue induced by whole-body exercise in AH. This occurred in parallel to an improved cerebral oxygen delivery and cerebral oxygenation. Interestingly, the neurophysiological responses at rest in CH were characterised by an increased corticospinal and muscle membrane excitability. The peripheral contribution to neuromuscular fatigue was not attenuated following acclimatisation to high altitude. In study 4, a two-week protocol of intermittent hypoxia (IH) attenuated exercise-induced supraspinal fatigue measured in AH and substantially improved constant-power cycling in severe hypoxia. Total haemoglobin mass was unaltered by IH, but arterial oxygen content was improved due to an increase in SpO2, secondary to an enhanced ventilatory response to exercise. Peripheral locomotor muscle fatigue was lower following IH, which may be related to exercise training in hypoxia. Although corticospinal excitability was unchanged following a single 2-h exposure to severe hypoxia, repeated exposures of IH resulted in a transient increase in motor cortex excitability without changes in intracortical inhibition. (Study 5). In conclusion, in acute severe hypoxia, whole-body exercise tolerance is impaired through oxygensensitive mechanisms which exacerbate central fatigue. The acute response can be alleviated following both chronic and intermittent severe hypoxia.

Prolonged moderate intensity cycle exercise is associated with a gradual and progressive reduction in gross efficiency (GE). It was speculated that this loss of GE might reflect a reduction in maximal muscle function and result in a parallel decline in aerobic performance. The effect of prolonged moderate intensity cycle exercise on maximal muscle function and anaerobic performance has not been clearly established. This thesis examined the impact of 1-2 h of cycling exercise at 60-65% maximal aerobic power in well-trained cyclists on subsequent changes in aerobic and anaerobic performance, GE and maximal muscle function.

The current work is novel in that it investigated in vivo analysis of glucose metabolism during and following hypoxic exposure in type 2 diabetics. Using moderate levels of hypoxia, study one found that 60 min of resting hypoxic (Hy Rest) exposure reduced blood glucose concentrations in type 2 diabetics. Insulin sensitivity was also found to be significantly greater following hypoxic exposure when compared to the normoxic control. The second study showed that exercise under hypoxic (Hy Ex) conditions acutely reduced arterialised blood glucose concentrations. The total area under the curve for insulin was also significantly lower subsequent to an intravenously administered glucose load (IVGTT) in the 4 hr following Hy Ex versus normoxic exercise. The third study demonstrated that glucose disposal was acutely enhanced in exercise bouts lasting 60 and 40 min (of equal work) in hypoxia.

This thesis investigates the England Visually Impaired Cricket Team, whose squad members comprise sixteen men aged 18-54, and their lived experiences' of playing visually impaired cricket. This is the first piece of research to examine elite visually impaired cricket and the first to explicitly analyse the social dynamics of any visually impaired sports team. Through an embodied theoretical approach, that accounts for the corporeal experience of impairment alongside the role of social institutions and discourse in the high performance culture of modern disability sport, this thesis establishes the significant aspects of this previously unexamined research 'site', both on and off the pitch. This study consisted of ten months of ethnographic fieldwork using participant observation and semi-structured interviews shaped by a new method of recording and eliciting data. To capture the participants' sensorial experiences of playing visually impaired cricket, 'soundscape elicitation', the process of composing auditory 'tracks' of the players' participation and then using these recordings during semi-structured interviews to prompt sensorial discussions, was utilised. This original and innovative method was central to the production of previously unexamined knowledge and is a significant methodological advancement in the wider field of sensory studies. The findings present a number of original contributions to knowledge regarding 'sporting bodies', the sensorial experiences of sport, and the construction of identity through disability sport. The participants' embodied experiences of playing visually impaired cricket reveal an alternative way of 'being' in sport and physical activity. However, it is the inescapable ocularcentric value of 'sight' that inhibits the resistive potential of the game. Instead of the presumed empowering experience, elite visually impaired cricket is disempowering for many participants due to the irreversible relationship of blind cricket institutions with mainstream cricketing bodies. Furthermore, a 'hierarchy of sight' based upon the official sight classification process emerges that highly values those players with the highest sight classifications and marginalises the blind players. All of these factors inform visually impaired cricket players’ construction of their own identities. Although many players view visually impaired cricket as a way of demonstrating their 'normality', it actually accentuates the impairment that they are attempting to dissociate from and is one of the few social situations where they are 'outed' as disabled or blind.