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The Milano Cortina 2026 Olympic Winter Games are projected to be the most gender-balanced Winter Games to date, with women comprising an estimated 47% of athletes. However, this numerical balance has outpaced the scientific evidence base informing the training and health support of elite female winter sport athletes. This expert-led narrative review synthesizes the biological foundations of sex-based performance differences, evaluates corresponding training and health considerations specific to female winter sport athletes. Biological divergence emerging at puberty, particularly in hemoglobin mass, cardiac dimensions, skeletal muscle mass, and body composition, underpins persistent sex differences in absolute performance. When normalized to body mass or lean mass, many physiological differences are attenuated, with hemoglobin concentration and body fat percentage remaining as primary determinants of the performance gap. Despite these differences, contemporary evidence indicates that when training is prescribed relative to individual capacity, women exhibit comparable physiological adaptations to men after puberty. Thus, the principles of effective training are largely shared across sexes, emphasizing the need for sport-specific and individualized training prescriptions. Health is a critical enabler of performance. Female athletes face elevated risks of iron deficiency, relative energy deficiency in sport (REDs), and menstrual dysfunction, conditions that can compromise adaptation, increase injury risk, and threaten career longevity. Addressing these challenges requires integrated, sex-specific monitoring and prevention strategies. By translating biological insights into individualized training and health practices, this review provides evidence-based support to enhance the performance and health of elite female winter Olympians at Milano Cortina 2026 and beyond.

Background: The use of digital technology in higher education can enhance students’ motivation, knowledge and skills. In medical and nursing education, digital scenario-based simulation is an evidence-based way to improve skills and knowledge. In physiotherapy, a biopsychosocial and person-centred approach is recommended to support self-management and promote health-related behaviour changes in patients. Using Experiential Learning Theory (ELT) in developing simulation tools can support students’ learning and confidence. The aim of this study was to explore content and features desired by stakeholders for the development of a digital scenario-based simulation prototype to stimulate physiotherapy students’ learning of clinical skills.Summary of work: Four co-design workshops with 5-10 participants, including two physiotherapy students, one newly graduated physiotherapist, four educators, four clinical instructors and one representative from an educational company, were conducted. The participants discussed and presented ideas for the desired content and features of the digital scenario-based simulation. ELT and Kolb’s learning cycle were used to encourage discussion and idea presentation and in the analysis.Summary of results: The preliminary results highlight desired key content and features: interactive reality-based patient cases with video and audio recordings to create realistic experiences; individual and peer reflection through reflective questions and self-recording videos; varied examples of formulated analysis, hypotheses, SMART goals and interpretation of patient information with encouragement to formulate these independently; support for making choices, prioritizing and decision-making, with opportunities to follow up on decisions and evaluate outcomes. Participants emphasized the importance of contextual pedagogical elements providing constructive feedback, flexibility to individual needs, and user-friendly, engaging design with gamification features.Discussion and Conclusion:  Overall, the participants desired content and features that align with simulations in medical and nursing education. However, what uniquely distinguished the desired content and features for physiotherapy was the emphasis on supporting learning a holistic and person-centered approach, including setting individual goals and creating personalized treatment plans. The importance of long-term patient follow-up and outcome evaluation was also highlighted. Given that digital scenario-based simulation is relatively unexplored in physiotherapy, these findings are particularly significant. These insights may also be relevant for other health professions to adopt a holistic and person-centered approach.

Background: During the COVID-19 pandemic, the Swedish healthcare system was challenged, and the need for knowledge regarding how to treat, rehabilitate and evaluate patients was acknowledged from healthcare professionals’ perspective. In March 2020, three clinical researchers constructed a digital platform to facilitate communication among physiotherapists at a national level in Sweden. The purpose of this study is to describe the development process of the Swedish Physiotherapy Platform (SwePPt) and further, to evaluate the need for support and knowledge for physiotherapists in Sweden during the COVID-19 pandemic. Methods: A descriptive study, containing a process evaluation based on retrospective quantitative and qualitative data from the platform, field notes, memos and a digital survey about the use of the platform. Results: From April 2020 to January 2023, 26 webinars were held, reaching a minimum of 25 and a maximum of 204 computers. A total of 1854 visitors registered at SwePPt. The visitors represented 20 of 21 regions of Sweden and worked in hospitals, regional or municipal primary health care, private care, and other areas. The survey was answered by 228 participants (86% female, mean 51 (9.2) years) with 98% being physiotherapists. The majority (28.9%), worked in hospitals. Material from the SwePPt was used in clinical everyday life, as reported by 89%, and 61% downloaded materials related to treatment methods (80%), assessment instruments (61%) and articles (50%) and 70% reported they shared the information with others. Conclusion: The evaluation of the SwePPt discovered that the digital platform was an important source of reliable, up-to-date knowledge and was used to facilitate clinical knowledge mobilization. Furthermore, it is recommended to establish a structured approach for knowledge sharing to be prepared for future crises. Trial registration: An ethical statement was registered by the Swedish Ethical Review Authority, with Dnr 2023-00040-01. 

ObjectiveRheumatoid arthritis (RA) is a common chronic systemic inflammatory disease that causes musculoskeletal impairments and fatigue. Physical activity is recommended for individuals with RA, and health-enhancing physical activity (HEPA) has been shown to improve health perception and physical fitness in this group. However, the molecular adaptations of skeletal muscle in response to an exercise intervention are still unexplored in individuals with RA. This study aimed to assess the skeletal muscle response to a 2-year HEPA intervention in individuals with RA.MethodsThirteen individuals with RA (65 +/- 2 years old, 13 +/- 2 years disease duration) participated. The 2-year HEPA intervention involved 150 min of weekly moderately intense aerobic activity and twice-weekly circuit training. Practical and theoretical physiotherapist support was available the first year, but not the second year. Skeletal muscle biopsies, functional assessments, and mass spectrometry-based proteomics analysis were conducted.ResultsCompliance was high the first year but dropped significantly the second year. Functional improvements in strength, endurance, and lower extremity muscle function (TST) were observed after year 1. Proteomics analysis revealed significant enrichment of mitochondrial proteins including COX8A, citrate synthase, M2OM, NDUFA6, NDUFS2, and VDAC3 after year 1, indicating positive muscle adaptations. However, these changes regressed to baseline levels by year 2.ConclusionHEPA can induce beneficial mitochondrial adaptations in skeletal muscle of individuals with RA. However, insufficient compliance and progression in HEPA exercise load led to a reversal of these adaptations. Continuous support and motivation are crucial for maintaining and progressing exercise levels and muscle health in individuals with RA. Key points center dot Health-enhancing physical activity (HEPA) can induce beneficial mitochondrial adaptations in the skeletal muscle proteome of individuals with RA.center dot Positive effects on mitochondrial protein levels aligned with the participants compliance to the HEPA intervention.center dot Results emphasizes that sustaining and progressing exercise regimen is crucial to maintain beneficial adaptations for individuals with RA.

Exposure to critical body weight comments in youth athletes could lead to decreased self-esteem, affect body image, and increase the risk of eating disorders and cause depressive symptoms. The aim was to explore differences between sex, body mass index, sports type, with regards to body weight satisfaction, exposure to critical body weight comments from their coach and nutrition status in adolescent elite athletes. A questionnaire about body weight, critical body weight comments and nutrition was distributed to 489 adolescent elite athletes and injury prevalence was monitored across 20 weeks. The results showed that almost one in four athletes (n=116, 24%) was not satisfied with their weight and 12% (n=59) had received critical body weight comments from their coach. Of the athletes who were unsatisfied with their body weight (n=116), 47% wanted to lose weight (n=55). A significant (p<0.05) higher proportion of ice hockey players and swimmers used nutritional supplements, were unsatisfied with their body weight, and were more exposed to critical body weight comments compared to athletes from other sports. Adolescent elite athletes as young as 15-16 years old are exposed to critical body weight comments from their coach and experience challenges with body weight satisfaction that is partly dependent on the sport-specific context.

Background/aim The injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school. The primary aim was therefore to explore the risk of injury when the athlete starts to study at a sports high school. A secondary aim was to identify risk factors for injury. Methods A total of 489 athletes (age 15–16 years) were followed for 20 weeks, including 10 weeks before and 10 weeks after the athlete had started to study at a sports high school. Substantial injury was monitored in adolescent elite athletes using the Oslo Sports Trauma Research Centre Questionnaire. Results The results showed that the mean difference (md) in injury prevalence was significantly (p=0.001) higher across the 10 weeks after school had started (md 3.6; 95% CI 1.5 to 5.8), compared with the 10 weeks before. Female athletes had significantly (p<0.001) higher injury prevalence (md 6.4%; 95% CI 3.0 to 9.8) across the 10 weeks after school had started, whereas male athletes (md 0.9%; 95% CI -1.8 to 3.6) had not (p=0.530). Three significant (p<0.05) risk factors were identified; previous injury within the past 12 months (OR 3.23), higher training volume (OR 0.97) and lower well-being (OR 0.71). Conclusions Our results provide supporting evidence for increased injury risk in female adolescent elite athletes after the athletes had started to study at a sports high school.

Even though injuries are common in elite youth sports, rehabilitation experiences are limited explored in young athletes. This study explored rehabilitation experiences in athletes with a previous injury studying at sports high schools. Twenty-six (14/12 females/males) young elite athletes (age 15–19 years) from 11 individual/team sports were interviewed in focus groups about the rehabilitation experiences following a sports injury. Data were analysed using content analysis. The results led to four main categories identified: ‘High-quality rehabilitation’, ‘Lack of communication between healthcare and coach’, ‘Various consequences of injury’ and ‘No clear path to accessing rehabilitation’. The athletes valued that the healthcare providers had high expertise, were clear and signalled secureness and confidence. It was also important to receive help with rehabilitation as rapidly as possible. The athletes perceived that they felt responsible for providing information regarding rehabilitation progression between healthcare providers and their coach. It was also challenging not to be able to participate in training and competition while injured — causing a sense of frustration and fear of falling behind their peer athletes in terms of development and performance. The athletes described that no well-defined medical teams at the sports high schools were available— instead medical help was offered in several other ways. Based on our findings, the collaboration and communication between the healthcare providers and coaches need to be improved, addressing the rehabilitation content, progress and access to rehabilitation. Through these actions, the rehabilitation process will be more adjusted to the needs of young elite athletes.

Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.

BackgroundAdolescent elite athletes have a high injury risk and many risk factors for injury have been suggested. However, there is a lack of prospective studies in adolescent elite athletes of age 15-16 years.AimThe aim of the study was to prospectively explore risk factors associated with different injury prevalence profiles in adolescent elite athletes.MethodsSubstantial injury was monitored in adolescent elite athletes (n=422) using the validated Oslo Sports Trauma Research Center Questionnaire over 20 weeks. Athletes were categorised in tertiles based on injury prevalence.ResultsThe median substantial injury prevalence for all athletes was 10% (IQR 0%-20%). Compared with the 'no injury' group, previous injury (p<0.001, OR 3.91) and well-being (p<0.001, OR 0.93) were associated with the 'high injury' group, and previous injury (p=0.006, OR 1.96) and being a female athlete (p=0.002, OR 2.08) with the 'low injury' group. A female athlete with a previous injury and low perceived well-being (25th percentile) had a 48% risk (95% CI 36% to 59%) of belonging to the 'high injury' group, compared with 7% (95% CI 4% to 12%) for a male athlete with no previous injury and high well-being (75th percentile).ConclusionMedical personnel should be aware of the high injury risk and risk factors for injury in adolescent elite athletes, and closely monitor the rehabilitation post-injury as a previous injury is such a strong risk factor for a new injury.