Epidemiologia de lesões e doenças em paratletas: relação com sono, fadiga, dor muscular e estresse em um estudo prospectivo de um ano

Abstract

Para sport has shown exponential growth, where with the increase in Para athletes performance, there can be a high risk of health problems (injuries and illnesses) in this population. In addition to pre-existing medical conditions, Para athletes face unique physiological and psychological demands that can influence both the occurrence of injuries and the recovery process. The main aim of this thesis was to establishing the epidemiology and burden of injuries and illnesses in Para athletes and investigate the relationship of stress, fatigue, sleep quality, and muscle soreness with the prevalence and time loss of injuries. The first study investigated the prevalence, incidence, severity, and burden of health problems in Para athletes from athletics, swimming, powerlifting, and taekwondo at the Brazilian Paralympic Reference Center, in Belo Horizonte, and the Brazilian Paralympic Center, in São Paulo, over one-year and compared the prevalence of health problems among modalities. The OSTRC-HP (Oslo Sports Trauma Research Center Questionnaire on Health Problems) was applied weekly through an online platform to assess the health problems of Para athletes. The prevalence, incidence, and severity of sudden- and gradual-onset injuries, as well as illnesses, were calculated. Additionally, the burden of health problems was calculated and visualized in a risk matrix graph. A total of 102 Para athletes participated in the study, where most injuries occurred in the shoulder and ankle, and most illnesses caused respiratory symptoms. The average weekly prevalence and incidence of sudden-onset injuries were 39.8% and 9.9 injuries per 1000 athlete-hours, respectively. Taekwondo had the highest prevalence of injuries and the lowest prevalence of illnesses, while swimming had the lowest prevalence of injuries. Powerlifting exhibited the highest burden of injuries. The second study investigated the relationship between stress, fatigue, sleep quality, and muscle soreness with the prevalence and time loss due to injuries in Para athletes. For this aim, a one-year prospective study was conducted in which the Hooper questionnaire was administered daily by the coaches of athletics, swimming, powerlifting, and taekwondo before the first training session and prior to competitions. The prevalence and time loss related to the reported injuries were collected weekly using the OSTRC-HP questionnaire described in Study 1. A multilevel approach was applied to assess the association of the variables from the Hooper Index with the prevalence of gradual-onset injuries, sudden-onset injuries, substantial gradual-onset injuries, and substantial sudden-onset injuries during the follow-up period. These models were adjusted for injury status in the preceding week by including it as a covariate. Additional covariates included sex and training hours. The lowest level ("low") of the hooper variables was used as the reference category, with estimated coefficients representing comparisons of the "moderate" and "high" levels relative to this reference. In total, 61 Para athletes participated. Stress was associated with gradual-onset injuries in the following week compared to those with low stress levels. In addition, fatigue was associated with substantial gradual-onset injuries in the previous week compared to those with low fatigue levels. Para athletes with moderate fatigue levels and muscle soreness experienced fewer time loss if compared to those with low fatigue levels. Moderate sleep quality was associated with a more time loss compared to high sleep quality levels. The findings of this thesis contribute to improving the monitoring of injuries and illnesses in para-athletes, in addition to understanding the associations between physiological and psychological factors and the occurrence of injuries in this population.