The 100 Most Influential Studies in Sports Medicine

Just one measure of the effect of a scientific concept is how frequently it gets cited by other experts. The top rated-cited paper of all time, in accordance to a 2014 examination by Nature, has now been cited by 344,007 other scientific article content because its publication in 1951. (The subject? You’d in no way guess, for explanations we’ll get into down below.) Researchers’ job potential clients are motivated by their h-index, a measure that benefits owning a significant range of intensely cited papers (and perhaps, while no 1 would truly admit it, by their Kardashian index, which compares their cumulative citations to the range of Twitter followers they have).

You can also use comparable strategies to examine overall fields, which is what a new analyze led by Omeet Khatra of the University of British Columbia attempts for sports activities and work out medicine. In the Orthopaedic Journal of Athletics Medication, Khatra and his colleagues set collectively a listing of the 100 article content with the most citations in the industry, featuring a snapshot of the affect of both person papers and broader traits. There are a bunch of fascinating results, but perhaps the most telling is this: only 1 of the 100 papers is a randomized managed trial, which is the gold-common type of experimental proof.

The Subject

Just one vital caveat for this examination is that the boundaries of sports activities and work out medicine are quite hazy. Khatra’s definition involves managing sports activities accidents, boosting athletic performance, and the use of work out to enhance overall health. That’s extremely wide, but the approach utilised to detect top rated papers was a small extra idiosyncratic. They commenced by determining a listing of 46 journals concentrated on sports activities and work out medicine, and then discovered the 100 most-cited article content from inside individuals journals.

That suggests substantial papers printed in non-professional journals really do not display up on the listing. A.V. Hill’s initial 1923 study on VO2 max was printed in the Quarterly Journal of Medication Karlman Wasserman’s 1964 paper on the anaerobic threshold was printed in the American Journal of Cardiology. In simple fact, you’d hope that the most floor-breaking results are the most possible to make it into generalist journals like Nature and Science (where by, for example, a vintage 1937 paper on the aerobic energy of world file-placing runners was printed).

So it’s not a complete listing, but it even now addresses a significant portion of the industry. It is dominated by Medication & Science in Athletics & Exercising, the flagship journal of the American College or university of Athletics Medication, which contributes no less than 49 of the papers. Up coming on the listing are the American Journal of Athletics Medication, with 18, and Athletics Medication, with seven. The oldest paper on the listing is from 1973, reflecting the field’s rather current emergence as a distinct discipline: MSSE, for example, was only released in 1969.

The Winner

Topping the listing with seven,228 citations was Gunnar Borg’s 1982 paper, “Psychophysical bases of perceived exertion.” Borg is the guy who superior the principle of a subjective scale of perceived effort, which initially ran from 6 to 20, while there is a extra rational modified version that runs from zero to 10. He commenced acquiring this concept in the 1960s, but the 1982 English-language paper is the 1 that gets cited each time people today communicate about perceived effort. (A different 1 of Borg’s papers on the subject, from 1973, displays up at forty eighth on the listing.)

You may not believe that asking people today to assign a range to how hard they are doing work is a important scientific breakthrough. But Borg’s do the job has experienced a massive affect. He argued that his scale is “the one greatest indicator of the diploma of physical pressure,” integrating signals from the muscle tissue, lungs, coronary heart, and mind. In the final two a long time, extra and extra scientists have taken that argument very seriously as they’ve attempted to explain the brain’s part in figuring out our physical limits, and also as a realistic tool for guiding schooling. Bottom line: I’d say Borg’s paper is a worthy winner.

The Themes

The most significant group of papers on the listing target on methodological applications: how to run a VO2 max exam, how to calculate entire body composition, how to calibrate your pedometers and accelerometers, what validated questionnaires to use to check with your subjects about their work out habits, and so on. That’s also what is observed in other fields: the all-time most cited paper that I outlined at the top rated is a techniques paper on “protein measurement with the folin phenol reagent.”

Approaches papers may perhaps not seem all that interesting, but they can surely be controversial. Quite a few of the papers on the listing target on figures, which includes the range nine paper, from 2008, by Will Hopkins and colleagues: “Progressive figures for research in sports activities medicine and work out science.” That technique to figures is intended to tease out subtle performance effects in research with little sample dimensions. But it has come less than extreme criticism, most notably pursuing a 2018 short article in FiveThirtyEight by Christie Aschwanden arguing that it is extra possible to deliver wrong-good results than standard statistical techniques.

A different huge bucket is formal tips, primarily the types issued by the American College or university of Athletics Medication on topics which includes resistance schooling, training with most cancers, hydration, pounds reduction, blood stress, and exercises for older adults. These are practical overviews to cite in the introduction to an short article when you want to back again up normal statements like “exercise is superior for you” or no matter what, but they are not especially floor-breaking.

Soon after that, it’s extra of a mixed bag. The most well known component of the anatomy is the knee, which is the target of fifteen papers, primarily relating to ACL accidents. Up coming is the mind, which features in three papers on concussion in sport. Two other themes that rack up multiple mentions: the enduring mystery of delayed-onset muscle mass soreness, and the emerging overall health scourge of far too a great deal sitting.

There are three papers on the physiology of soccer, 1 on the biomechanics of baseball pitching, and 1 on Hakan Alfredson’s famed heel-drop protocol for Achilles tendinosis, which squeaks in at 98th position. (Humorous backstory: Alfredson is an orthopedic surgeon who experienced Achilles troubles back again in the nineteen nineties. When his manager refused to give him time off for medical procedures for the reason that the affliction was not major more than enough, he determined to aggravate his Achilles with agonizing heel drops—but accidentally healed himself.)

The Evidence

I outlined at the top rated that only 1 of the research on the listing is a randomized managed trial, meaning that subjects ended up randomly assigned to either acquire either an intervention or a placebo. In its place, most of the experimental papers use lower stages of proof these kinds of as cohort research and circumstance sequence, neither of which use randomization or regulate groups. The largest one group, with 38 papers, is narrative critiques, which survey the final results of multiple research on a subject but really do not pool them into 1 huge meta-examination.

I believe most sports activities experts would concur that the industry requires extra randomized trials, along with other methodological advancements like even bigger issue groups and extra innovative statistical analyses. But the faults in the top rated-100 listing likely aren’t certain to sports activities science. Watson and Crick’s discovery of the framework of DNA and Einstein’s idea of normal relativity really do not make their respective lists either: the largest breakthroughs develop into textbook substance that doesn’t even require a citation. “If citations are what you want,” Yale University chemist Peter Moore explained to Nature, “devising a approach that will make it possible for people today to do the experiments they want at all, or extra conveniently, will get you a great deal further more than, say, identifying the key of the Universe.”

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