The 100 Most Influential Studies in Sports Medicine

One measure of the effect of a scientific notion is how typically it receives cited by other scientists. The major-cited paper of all time, in accordance to a 2014 evaluation by Character, has now been cited by 344,007 other scientific article content because its publication in 1951. (The subject? You’d hardly ever guess, for causes we’ll get into down below.) Researchers’ work potential customers are affected by their h-index, a evaluate that rewards obtaining a substantial quantity of heavily cited papers (and maybe, however no just one would in fact confess it, by their Kardashian index, which compares their cumulative citations to the amount of Twitter followers they have).

You can also use very similar approaches to evaluate total fields, which is what a new research led by Omeet Khatra of the University of British Columbia tries for sports and workout medicine. In the Orthopaedic Journal of Sporting activities Drugs, Khatra and his colleagues place with each other a listing of the 100 articles with the most citations in the area, presenting a snapshot of the impact of each particular person papers and broader tendencies. There are a bunch of fascinating findings, but maybe the most telling is this: only a single of the 100 papers is a randomized controlled demo, which is the gold-normal kind of experimental evidence.

The Area

A single important caveat for this investigation is that the boundaries of sports and exercising medicine are fairly hazy. Khatra’s definition involves taking care of athletics accidents, enhancing athletic general performance, and the use of training to improve health and fitness. That is quite wide, but the strategy employed to establish major papers was a little additional idiosyncratic. They begun by identifying a listing of 46 journals centered on athletics and exercise medication, and then recognized the 100 most-cited posts from in all those journals.

That indicates sizeable papers published in non-professional journals do not exhibit up on the listing. A.V. Hill’s unique 1923 study on VO2 max was posted in the Quarterly Journal of Medication Karlman Wasserman’s 1964 paper on the anaerobic threshold was printed in the American Journal of Cardiology. In point, you’d anticipate that the most ground-breaking conclusions are the most possible to make it into generalist journals like Nature and Science (where, for example, a common 1937 paper on the aerobic energy of world record-placing runners was printed).

So it is not a complete listing, but it still handles a massive portion of the industry. It’s dominated by Drugs & Science in Sports activities & Work out, the flagship journal of the American College or university of Sports Medicine, which contributes no considerably less than 49 of the papers. Up coming on the list are the American Journal of Sporting activities Medicine, with 18, and Sporting activities Medication, with 7. The oldest paper on the list is from 1973, reflecting the field’s somewhat new emergence as a distinct willpower: MSSE, for case in point, was only released in 1969.

The Champion

Topping the record with 7,228 citations was Gunnar Borg’s 1982 paper, “Psychophysical bases of perceived exertion.” Borg is the person who superior the concept of a subjective scale of perceived hard work, which at first ran from six to 20, although there’s a a lot more rational modified model that runs from zero to 10. He began developing this concept in the 1960s, but the 1982 English-language paper is the one particular that will get cited each time persons converse about perceived hard work. (A further a single of Borg’s papers on the subject matter, from 1973, shows up at 48th on the listing.)

You may not believe that asking folks to assign a variety to how tough they are performing is a major scientific breakthrough. But Borg’s work has experienced a large affect. He argued that his scale is “the solitary greatest indicator of the degree of actual physical pressure,” integrating signals from the muscles, lungs, heart, and mind. In the past two decades, far more and extra researchers have taken that argument severely as they’ve attempted to reveal the brain’s position in figuring out our physical limits, and also as a sensible resource for guiding education. Base line: I’d say Borg’s paper is a worthy winner.

The Themes

The greatest team of papers on the listing emphasis on methodological tools: how to run a VO2 max check, how to determine system composition, how to calibrate your pedometers and accelerometers, what validated questionnaires to use to request your subjects about their training behaviors, and so on. That is also what is observed in other fields: the all-time most cited paper that I mentioned at the top is a techniques paper on “protein measurement with the folin phenol reagent.”

Methods papers may well not audio all that remarkable, but they can unquestionably be controversial. Several of the papers on the record focus on data, such as the number 9 paper, from 2008, by Will Hopkins and colleagues: “Progressive data for scientific tests in sports activities medication and workout science.” That tactic to data is intended to tease out refined performance consequences in scientific studies with smaller sample sizes. But it has arrive beneath powerful criticism, most notably adhering to a 2018 short article in FiveThirtyEight by Christie Aschwanden arguing that it is extra most likely to generate bogus-constructive conclusions than classic statistical approaches.

Yet another significant bucket is formal recommendations, generally the kinds issued by the American College or university of Sports activities Medicine on subjects together with resistance instruction, performing exercises with most cancers, hydration, bodyweight decline, blood tension, and workouts for older older people. These are beneficial overviews to cite in the introduction to an article when you want to back again up standard claims like “exercise is very good for you” or what ever, but they’re not especially ground-breaking.

Just after that, it’s a lot more of a combined bag. The most preferred part of the anatomy is the knee, which is the focus of 15 papers, generally relating to ACL accidents. Up coming is the brain, which characteristics in three papers on concussion in activity. Two other themes that rack up numerous mentions: the enduring mystery of delayed-onset muscle mass soreness, and the emerging health and fitness scourge of much too much sitting.

There are three papers on the physiology of soccer, 1 on the biomechanics of baseball pitching, and one on Hakan Alfredson’s well known heel-drop protocol for Achilles tendinosis, which squeaks in at 98th spot. (Humorous backstory: Alfredson is an orthopedic surgeon who had Achilles challenges again in the 1990s. When his manager refused to give him time off for surgery for the reason that the situation was not critical sufficient, he decided to irritate his Achilles with unpleasant heel drops—but unintentionally healed himself.)

The Evidence

I mentioned at the best that only one particular of the scientific studies on the record is a randomized controlled demo, this means that subjects ended up randomly assigned to both obtain either an intervention or a placebo. Alternatively, most of the experimental papers use lessen amounts of evidence this kind of as cohort scientific tests and scenario collection, neither of which use randomization or control teams. The largest solitary group, with 38 papers, is narrative reviews, which study the effects of a number of experiments on a subject matter but never pool them into one huge meta-assessment.

I assume most sporting activities scientists would agree that the discipline requires more randomized trials, together with other methodological enhancements like even bigger subject matter groups and additional subtle statistical analyses. But the faults in the top rated-100 record probably are not certain to athletics science. Watson and Crick’s discovery of the composition of DNA and Einstein’s concept of typical relativity really do not make their respective lists both: the biggest breakthroughs develop into textbook materials that doesn’t even need a quotation. “If citations are what you want,” Yale College chemist Peter Moore explained to Mother nature, “devising a system that would make it possible for folks to do the experiments they want at all, or a lot more easily, will get you a large amount further than, say, finding the mystery of the Universe.”

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