ArticleBMJ open sport & exercise medicine2026
Daily stress, sleep, fatigue and muscle soreness and their associations with injury and time loss in Para athletes: a 50-week prospective study.
Article in BMJ open sport & exercise medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: To study the associations between daily self-reported stress, sleep quality, muscle soreness and fatigue in the previous week and weekly injury status and injury-related time loss in the following week among Para athletes. Methods: Data were collected from January to December 2022 at two Brazilian Paralympic Reference Centers, including Para athletes from swimming, athletics, powerlifting and taekwondo. The OSTRC-H2 questionnaire was administered weekly to record injuries, while the Hooper questionnaire was applied daily to assess sleep quality, stress, muscle soreness and fatigue. Multilevel logistic regression estimated ORs and 95% CIs for associations between daily Hooper variables in the previous week and injury status and injury-related time loss in the following week. Results: Sixty-one Para athletes participated. High stress levels were associated with greater odds of presenting a gradual-onset injury status in the following week compared with low stress levels (OR 1.73, 95% CI 1.10 to 2.72). High fatigue levels were associated with increased odds of presenting a substantial gradual-onset injury status (OR 1.99; 95% CI 1.16 to 3.45). Moderate fatigue (OR 0.69; 95% CI 0.53 to 0.89) and muscle soreness (OR 0.76; 95% CI 0.57 to 0.99) were associated with lower odds of injury-related time loss, while moderate sleep quality was linked to increased odds of time loss (OR 1.50; 95% CI 1.16 to 1.93). Conclusion: Monitoring self-reported stress, fatigue and muscle soreness may help identify athletes more likely to report gradual-onset or substantial gradual-onset injury status or to experience injury-related time loss, highlighting the value of tailored injury prevention strategies in Para sports.
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