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The 2nd Edition of Mountain Sports Activities: Injuries and Prevention

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Sport and Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 22289

Special Issue Editor

Special Issue Information

Dear Colleagues,

The popularity of mountain sports activities is growing fast all over the world and particularly in the Alps. Millions of people are practicing one or more recreational sports, such as downhill or cross-country skiing, ski mountaineering, mountain hiking, rock or ice climbing, high-altitude mountaineering, mountain biking, paragliding, etc. Although it is indisputable that leisure-time exercise is generally associated with health benefits, especially outdoor activities also bear an inherent risk of injury due to both objective and subjective risk factors. Whereas many epidemiological data are available on the prevalence of injuries during different recreational mountain sports activities, much less is known on risk factors, causes and mechanisms of such injuries, and even less on the outcomes of targeted preventive measures.

This Special Issue seeks research papers on injuries occurring during various types of recreational mountain sport activities, focusing on risk factors, underlying causes and mechanisms, outcomes of, and/or suggestions for prevention studies. We especially encourage the submission of interdisciplinary work and multicountry collaborative research. We welcome original research papers as well as systematic reviews and meta-analyses.

Prof. Dr. Martin Burtscher
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • public health aspects of mountain sports activities
  • prevalence, risk factors, causes and mechanisms of injuries during various types of mountain sports activities
  • outcomes of and suggestions for targeted injury prevention

Published Papers (11 papers)

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Editorial

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3 pages, 265 KiB  
Editorial
Editorial on the Research Topic the 2nd Edition of Mountain Sports Activities: Injuries and Prevention
by Martin Burtscher, Urs Hefti, Gerhard Ruedl and Jacqueline Pichler Hefti
Int. J. Environ. Res. Public Health 2022, 19(15), 9510; https://doi.org/10.3390/ijerph19159510 - 02 Aug 2022
Viewed by 1239
Abstract
Mountain sports are continuously gaining popularity, currently fueled by the post-pandemic period expanding travel opportunities and the desire to escape the increasingly hot environmental conditions of urban areas—ambient temperature decreases by about 6 [...] Full article

Research

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12 pages, 913 KiB  
Article
Flat versus Simulated Mountain Trail Running: A Multidisciplinary Comparison in Well-Trained Runners
by Kristina Skroce, Simone Bettega, Samuel D’Emanuele, Gennaro Boccia, Federico Schena and Cantor Tarperi
Int. J. Environ. Res. Public Health 2023, 20(6), 5189; https://doi.org/10.3390/ijerph20065189 - 15 Mar 2023
Viewed by 1965
Abstract
This paper compares cardiopulmonary and neuromuscular parameters across three running aerobic speeds in two conditions that differed from a treadmill’s movement: flat condition (FC) and unpredictable roll variations similar to mountain trail running (URV). Twenty well-trained male runners (age 33 ± 8 years, [...] Read more.
This paper compares cardiopulmonary and neuromuscular parameters across three running aerobic speeds in two conditions that differed from a treadmill’s movement: flat condition (FC) and unpredictable roll variations similar to mountain trail running (URV). Twenty well-trained male runners (age 33 ± 8 years, body mass 70.3 ± 6.4 kg, height 1.77 ± 0.06 m, V˙O2max 63.8 ± 7.2 mL·kg−1·min−1) voluntarily participated in the study. Laboratory sessions consisted of a cardiopulmonary incremental ramp test (IRT) and two experimental protocols. Cardiopulmonary parameters, plasma lactate (BLa), cadence, ground contact time (GT) and RPE values were assessed. We also recorded surface electromyographic (sEMG) signals from eight lower limb muscles, and we calculated, from the sEMG envelope, the amplitude and width of peak muscle activation for each step. Cardiopulmonary parameters were not significantly different between conditions (V˙O2: p = 0.104; BLa: p = 0.214; HR: p = 0.788). The amplitude (p = 0.271) and width (p = 0.057) of sEMG activation peaks did not change between conditions. The variability of sEMG was significantly affected by conditions; indeed, the coefficient of variation in peak amplitude (p = 0.003) and peak width (p < 0.001) was higher in URV than in FC. Since the specific physical demands of running can differ between surfaces, coaches should resort to the use of non-traditional surfaces, emphasizing specific surface-related motor tasks that are normally observed in natural running environments. Seeing that the variability of muscle activations was affected, further studies are required to better understand the physiological effects induced by systematic surface-specific training and to define how variable-surface activities help injury prevention. Full article
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22 pages, 19849 KiB  
Article
The Telomere-Telomerase System Is Detrimental to Health at High-Altitude
by Qadar Pasha, Manjari Rain, Sana Tasnim, Hema Kanipakam, Tashi Thinlas and Ghulam Mohammad
Int. J. Environ. Res. Public Health 2023, 20(3), 1935; https://doi.org/10.3390/ijerph20031935 - 20 Jan 2023
Viewed by 1410
Abstract
The hypobaric-hypoxia environment at high-altitude (HA, >2500 m) may influence DNA damage due to the production of reactive molecular species and high UV radiation. The telomere system, vital to chromosomal integrity and cellular viability, is prone to oxidative damages contributing to the severity [...] Read more.
The hypobaric-hypoxia environment at high-altitude (HA, >2500 m) may influence DNA damage due to the production of reactive molecular species and high UV radiation. The telomere system, vital to chromosomal integrity and cellular viability, is prone to oxidative damages contributing to the severity of high-altitude disorders such as high-altitude pulmonary edema (HAPE). However, at the same time, it is suggested to sustain physical performance. This case-control study, comprising 210 HAPE-free (HAPE-f) sojourners, 183 HAPE-patients (HAPE-p) and 200 healthy highland natives (HLs) residing at ~3500 m, investigated telomere length, telomerase activity, and oxidative stress biomarkers. Fluidigm SNP genotyping screened 65 single nucleotide polymorphisms (SNPs) in 11 telomere-maintaining genes. Significance was attained at p ≤ 0.05 after adjusting for confounders and correction for multiple comparisons. Shorter telomere length, decreased telomerase activity and increased oxidative stress were observed in HAPE patients; contrarily, longer telomere length and elevated telomerase activity were observed in healthy HA natives compared to HAPE-f. Four SNPs and three haplotypes are associated with HAPE, whereas eight SNPs and nine haplotypes are associated with HA adaptation. Various gene-gene interactions and correlations between/among clinical parameters and biomarkers suggested the presence of a complex interplay underlining HAPE and HA adaptation physiology. A distinctive contribution of the telomere-telomerase system contributing to HA physiology is evident in this study. A normal telomere system may be advantageous in endurance training. Full article
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10 pages, 1678 KiB  
Article
Cardiovascular Risk Profiles and Pre-Existing Health Conditions of Trekkers in the Solu-Khumbu Region, Nepal
by Miriam Haunolder, Christian Apel, Daniela Bertsch, Carina Cerfontaine, Michael van der Giet, Simone van der Giet, Maren Grass, Nicole Maria Heussen, Nina Hundt, Julia Jäger, Christian Kühn, Sonja Musiol, Lisa Timmermann, Knut Wernitz, Ulf Gieseler, Audry Morrison, Volker Schöffl and Thomas Küpper
Int. J. Environ. Res. Public Health 2022, 19(24), 16388; https://doi.org/10.3390/ijerph192416388 - 07 Dec 2022
Cited by 2 | Viewed by 1296
Abstract
Background: High-altitude tourist trekking continues to grow in popularity on the Everest Trek in Nepal. We examined which pre-existing cardiovascular and health conditions these global trekkers had and what health issues they encountered during the trek, be it exacerbations of pre-existing conditions, or [...] Read more.
Background: High-altitude tourist trekking continues to grow in popularity on the Everest Trek in Nepal. We examined which pre-existing cardiovascular and health conditions these global trekkers had and what health issues they encountered during the trek, be it exacerbations of pre-existing conditions, or new acute ones. Method: Trekkers (n = 350) were recruited from guesthouses along the Everest Trek, mostly at Tengboche (3860 m). After completing a questionnaire on their health and travel preparation, they underwent a basic physical examination with an interview. Results: Almost half (45%) had pre-existing conditions, mostly orthopaedic and cardiovascular diseases. The average age was 42.7 years (range 18–76). The average BMI was 23.4 kg/m2, but 21% were overweight. A third were smokers (30%), and 86% had at least one major cardiovascular risk factor. A quarter (25%) were suffering from manifest acute mountain sickness (AMS), and 72% had at least one symptom of AMS. Adequate pre-travel examination, consultation, and sufficient personal preparation were rarely found. In some cases, a distinct cardiovascular risk profile was assessed. Hypertensive patients showed moderately elevated blood pressure, and cholesterol levels were favourable in most cases. No cardiovascular emergencies were found, which was fortunate as timely, sufficient care was not available during the trek. Conclusion: The results of earlier studies in the Annapurna region should be revalidated. Every trekker to the Himalayas should consult a physician prior to departure, ideally a travel medicine specialist. Preventative measures and education on AMS warrant special attention. Travellers with heart disease or with a pronounced cardiovascular risk profile should be presented to an internal medicine professional. Travel plans must be adjusted individually, especially with respect to adequate acclimatisation time and no physical overloading. With these and other precautions, trekking at high altitudes is generally safe and possible, even with significant pre-existing health conditions. Trekking can lead to invaluable personal experiences. Since organized groups are limited in their flexibility to change their itinerary, individual trekking or guided tours in small groups should be preferred. Full article
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9 pages, 1838 KiB  
Article
Initial Treatment of High-Altitude Pulmonary Edema: Comparison of Oxygen and Auto-PEEP
by Markus Tannheimer and Raimund Lechner
Int. J. Environ. Res. Public Health 2022, 19(23), 16185; https://doi.org/10.3390/ijerph192316185 - 03 Dec 2022
Cited by 2 | Viewed by 1521
Abstract
Background: Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, [...] Read more.
Background: Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, against the application of bottled oxygen (O2-Pat) in two patients suffering from HAPE. Methods: We compare the effect of these two different therapies on oxygen saturation measured by pulse oximetry (SpO2) over time. Result: In both patients SpO2 increased significantly from 65–70% to 95%. Above 80% this increase was slower in AP-Pat compared with O2-Pat. Therapy started immediately in AP-Pat but was delayed in O2-Pat because of organizational and logistic reasons. Conclusions: The well-established therapies of HAPE are always the option of choice, if available, and should be started as soon as possible. The advantage of Auto-PEEP is its all-time availability. It improves SpO2 nearly as well as 3 L/min oxygen and furthermore has a positive effect on oxygenation lasting for approximately 120 min after stopping. Auto-PEEP treatment does not appear inferior to oxygen treatment, at least in this cross-case comparison. Its immediate application after diagnosis probably plays an important role here. Full article
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13 pages, 1562 KiB  
Article
Mortality in Recreational Mountain-Biking in the Austrian Alps: A Retrospective Study over 16 Years
by Elena Pocecco, Hamed Wafa, Johannes Burtscher, Peter Paal, Peter Plattner, Markus Posch and Gerhard Ruedl
Int. J. Environ. Res. Public Health 2022, 19(19), 11965; https://doi.org/10.3390/ijerph191911965 - 22 Sep 2022
Cited by 4 | Viewed by 1747
Abstract
Despite recreational mountain-biking’s growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the [...] Read more.
Despite recreational mountain-biking’s growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the Austrian Alps over the past 16 years. For this purpose, a retrospective study based on Austrian institutional documentation from 2006 to 2021 was conducted. In total, 97 fatalities (1 woman) with a mean age of 55.6 ± 13.9 years were recorded by the Austrian Alpine Police. Of those, 54.6% died due to a non-traumatic (mostly cardio-vascular) and 41.2% due to a traumatic event. Mountain-bikers fatally accidented for non-traumatic reasons frequently belonged to older age classes (p = 0.05) and mostly (73.6%) died during the ascent, whereas traumatic events mainly (70.0%) happened during the descent (p < 0.001). Throughout the examined period, the absolute number of fatalities slightly increased, whereas the mortality index (proportion of deaths/accidented victims) did not (mean value: 1.34 ± 0.56%). Factors such as male sex in general, above average age and uphill riding for non-traumatic accidents, as well as downhill riding for traumatic events, seem to be associated with fatalities during recreational mountain-biking in the Austrian Alps. These results should be considered for future preventive strategies in recreational mountain-biking. Full article
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13 pages, 1519 KiB  
Article
The EDN1 Missense Variant rs5370G > T Regulates Adaptation and Maladaptation under Hypobaric Hypoxia
by Tsering Palmo, Bilal Ahmed Abbasi, Neha Chanana, Kavita Sharma, Mohammed Faruq, Tashi Thinlas, Malik Z. Abdin and Qadar Pasha
Int. J. Environ. Res. Public Health 2022, 19(18), 11174; https://doi.org/10.3390/ijerph191811174 - 06 Sep 2022
Cited by 2 | Viewed by 2036
Abstract
Endothelin 1 (EDN1) encodes a potent endogenous vasoconstrictor, ET1, to maintain vascular homeostasis and redistribution of tissue blood flow during exercise. One of the EDN1 missense polymorphisms, rs5370 G/T, has strongly been associated with cardiopulmonary diseases. This study investigated the [...] Read more.
Endothelin 1 (EDN1) encodes a potent endogenous vasoconstrictor, ET1, to maintain vascular homeostasis and redistribution of tissue blood flow during exercise. One of the EDN1 missense polymorphisms, rs5370 G/T, has strongly been associated with cardiopulmonary diseases. This study investigated the impact of rs5370 polymorphism in high-altitude pulmonary oedema (HAPE) disorder or maladaptation and adaptation physiology in a well-characterized case–control study of high-altitude and low-altitude populations comprising 310 samples each of HAPE-patients, HAPE-free controls and native highlanders. The rs5370 polymorphism was genotyped, and the gene expression and plasma level of EDN1 were evaluated. The functional relevance of each allele was investigated in the human embryonic kidney 293 cell line after exposure to hypoxia and computationally. The T allele was significantly more prevalent in HAPE-p compared to HAPE-f and HLs. The EDN1 gene expression and ET1 bio-level were significantly elevated in HAPE-p compared to controls. Compared to the G allele, the T allele was significantly associated with elevated levels of ET-1 in all three study groups and cells exposed to hypoxia. The in silico studies further confirmed the stabilizing effect of the T allele on the structural integrity and function of ET1 protein. The ET1 rs5370 T allele is associated with an increased concentration of ET-1 in vivo and in vitro, establishing it as a potent marker in the adaptation/maladaptation physiology under the high-altitude environment. This could also be pertinent in endurance exercises at high altitudes. Full article
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Review

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9 pages, 601 KiB  
Review
Winter Sports Injuries in Elite Female Athletes: A Narrative Review
by Cristina Rotllan and Ginés Viscor
Int. J. Environ. Res. Public Health 2023, 20(10), 5815; https://doi.org/10.3390/ijerph20105815 - 13 May 2023
Cited by 2 | Viewed by 1641
Abstract
There is a lack of reviews covering the topic of the parallel high prevalence of injuries in female winter sport elite athletes. We aimed to review the data on incidence and patterns of injuries in female athletes participating in official competitions of winter [...] Read more.
There is a lack of reviews covering the topic of the parallel high prevalence of injuries in female winter sport elite athletes. We aimed to review the data on incidence and patterns of injuries in female athletes participating in official competitions of winter sports. We conducted a comprehensive literature search on epidemiological data and etiological information on alpine skiing, snowboarding, ski jumping and cross-country skiing. The most common location of injury was the knee among skiers and ski jumpers and the incidence of severe ACL events was 7.6 per 100 ski racers per season (95% CI 6.6 to 8.9) in female alpine skiers. Snowboarders and cross-country skiers were more affected in the ankle and the foot. The most common cause was contact trauma with stagnant objects. The injury risk factors include training volume, knee pre-injuries, the period of the season and the technical equipment. Females are at greater risk of suffering from overuse injuries during the competitive season, as opposed to male athletes who are more likely to suffer from traumatic injuries. Our findings can be used to inform coaches and athletes and to guide future injury prevention plans. Full article
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12 pages, 1002 KiB  
Review
A Life Dedicated to Climbing and Its Sequelae in the Fingers—A Review of the Literature
by Tatjana Pastor, Andreas Schweizer, Octavian Andronic, Léna G. Dietrich, Till Berk, Boyko Gueorguiev and Torsten Pastor
Int. J. Environ. Res. Public Health 2022, 19(24), 17050; https://doi.org/10.3390/ijerph192417050 - 19 Dec 2022
Viewed by 4192
Abstract
Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads [...] Read more.
Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one’s career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic. Full article
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23 pages, 4737 KiB  
Review
Current Perspectives of Cross-Country Mountain Biking: Physiological and Mechanical Aspects, Evolution of Bikes, Accidents and Injuries
by Rhaí André Arriel, Hiago L. R. Souza, Jeffer Eidi Sasaki and Moacir Marocolo
Int. J. Environ. Res. Public Health 2022, 19(19), 12552; https://doi.org/10.3390/ijerph191912552 - 01 Oct 2022
Cited by 3 | Viewed by 2849
Abstract
Mountain biking (MTB) is a cycling modality performed on a variety of unpaved terrain. Although the cross-country Olympic race is the most popular cross-country (XC) format, other XC events have gained increased attention. XC-MTB has repeatedly modified its rules and race format. Moreover, [...] Read more.
Mountain biking (MTB) is a cycling modality performed on a variety of unpaved terrain. Although the cross-country Olympic race is the most popular cross-country (XC) format, other XC events have gained increased attention. XC-MTB has repeatedly modified its rules and race format. Moreover, bikes have been modified throughout the years in order to improve riding performance. Therefore, the aim of this review was to present the most relevant studies and discuss the main results on the XC-MTB. Limited evidence on the topic suggests that the XC-MTB events present a variation in exercise intensity, demanding cardiovascular fitness and high power output. Nonetheless, these responses and demands seem to change according to each event. The characteristics of the cyclists differ according to the performance level, suggesting that these parameters may be important to achieve superior performance in XC-MTB. Moreover, factors such as pacing and ability to perform technical sections of the circuit might influence general performance. Bicycles equipped with front and rear suspension (i.e., full suspension) and 29″ wheels have been shown to be effective on the XC circuit. Lastly, strategies such as protective equipment, bike fit, resistance training and accident prevention measures can reduce the severity and the number of injuries. Full article
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Other

8 pages, 692 KiB  
Brief Report
Mountain Hiking: Prolonged Eccentric Muscle Contraction during Simulated Downhill Walking Perturbs Sensorimotor Control Loops Needed for Safe Dynamic Foot–Ground Interactions
by Inge Werner, Francisco J. Valero-Cuevas and Peter Federolf
Int. J. Environ. Res. Public Health 2023, 20(7), 5424; https://doi.org/10.3390/ijerph20075424 - 06 Apr 2023
Viewed by 1396
Abstract
Safe mountain hiking requires precise control of dynamic foot–ground interactions. In addition to vision and vestibular afferents, limb proprioception, sensorimotor control loops, and reflex responses are used to adapt to the specific nature of the ground contact. Diminished leg dexterity and balance during [...] Read more.
Safe mountain hiking requires precise control of dynamic foot–ground interactions. In addition to vision and vestibular afferents, limb proprioception, sensorimotor control loops, and reflex responses are used to adapt to the specific nature of the ground contact. Diminished leg dexterity and balance during downhill walking is usually attributed to fatigue. We investigated the supplementary hypothesis that the eccentric contractions inherent to downhill walking can also disrupt muscle proprioception, as well as the sensorimotor control loops and reflex responses that depend on it. In this study, we measured leg dexterity (LD), anterior–posterior (AP) and medio–lateral (ML) bipedal balance, and maximal voluntary leg extension strength in young and healthy participants before and after 30 min of simulated downhill walking at a natural pace on a treadmill at a 20° decline. Post–pre comparisons of LD (p < 0.001) and AP balance (p = 0.001) revealed significant reductions in dynamic foot–ground interactions after eccentric exercise without an accompanying reduction in leg extension strength. We conclude that eccentric contractions during downhill walking can disrupt the control of dynamic foot–ground interactions independently of fatigue. We speculate that mountaineering safety could be improved by increasing conscious attention to compensate for unadjusted proprioception weighting, especially in the descent. Full article
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