Abstract

Background
Osteoarthritis (OA), the leading cause of disability among adults, has no cure and is associated with significant comorbidities. The premise of this randomized clinical trial is that, in a population at risk, a 48-month program of dietary weight loss and exercise will result in less incident structural knee OA compared to control.

Methods/design
The Osteoarthritis Prevention Study (TOPS) is a Phase III, assessor-blinded, 48-month, parallel 2 arm, multicenter randomized clinical trial designed to reduce the incidence of structural knee OA. The study objective is to assess the effects of a dietary weight loss, exercise, and weight-loss maintenance program in preventing the development of structural knee OA in females at risk for the disease. TOPS will recruit 1230 ambulatory, community dwelling females with obesity (Body Mass Index (BMI) ​≥ ​30 ​kg/m2) and aged ≥50 years with no radiographic (Kellgren-Lawrence grade ≤1) and no magnetic resonance imaging (MRI) evidence of OA in the eligible knee, with no or infrequent knee pain. Incident structural knee OA (defined as tibiofemoral and/or patellofemoral OA on MRI) assessed at 48-months from intervention initiation using the MRI Osteoarthritis Knee Score (MOAKS) is the primary outcome. Secondary outcomes include knee pain, 6-min walk distance, health-related quality of life, knee joint loading during gait, inflammatory biomarkers, and self-efficacy. Cost effectiveness and budgetary impact analyses will determine the value and affordability of this intervention.

Discussion
This study will assess the efficacy and cost effectiveness of a dietary weight loss, exercise, and weight-loss maintenance program designed to reduce incident knee OA.

Backgrounds

Osteoarthritis (OA), the leading cause of disability among adults, has no cure and is associated with significant comorbidities [1]. Its increased prevalence and severity make it burdensome for people afflicted with the disease, and for health care organizations intended to administer care [2]. Obesity and OA were first linked in 1945 and this relationship has since been verified repeatedly [[3], [4], [5], [6]]. Obesity is a major risk factor associated with knee pain; people with obesity were 2.7 times more likely to have knee OA than adults without obesity [7].

Our mechanistic model, influenced by the seminal work of Griffin and Guilak [8], supports the premise that dietary weight loss and exercise may reduce knee joint loads, lower inflammation, and increase self-efficacy resulting in a lower incidence of structural knee OA (Fig. 1). Previous work showed that weight loss decreased knee joint loads such that every pound lost was associated with a 4-pound reduction in knee compressive forces while walking. The cumulative effect of this load reduction, over thousands of steps per day, reduces microdamage to the subchondral plate and calcified cartilage [9]. These areas are close to the overlying articular cartilage and likely protect articular cartilage integrity (Fig. 1).

Discussion

Implementing a randomized clinical trial designed to prevent incident knee OA presents numerous challenges. OA disease status and severity are defined structurally via x-ray [36] or MRI [19] and clinically using a combination of symptoms reported by the patient and derived from a physical exam [66]. The primary outcome measure for TOPS is structural knee OA using MRI, due to its superior sensitivity and granularity compared to radiographic assessments. In addition, the use of radiographic assessments as the primary outcome measure to determine the presence or absence of incident knee OA would have increased the sample size by 478 participants (39 ​%), requiring additional clinical centers and greater costs to test the hypothesis effectively.

Losing weight and preventing weight regain are difficult [67]. Biological changes fight attempts to maintain weight loss; the body acts in starvation mode increasing feelings of hunger, satiety is suppressed, metabolic rate slows, all in an attempt to defend higher body weights [68]. Psychosocial obstacles include decreased self-efficacy, increased chronic perceived psychosocial stress, and using food for comfort; environmental obstacles include large food portions and food availability [69]. Our previous work provides encouragement that most of the weight-loss attained by the TOPS diet and exercise group can be retained long-term with implementation of the weight-loss maintenance program. In a subsample of the IDEA cohort (N ​= ​94), the diet-only group retained 5.8 ​kg (65 ​%) of an 8.9 ​kg weight loss 3.5 years following completion of the 18-month diet intervention [70]. Maintenance of this clinically important weight-loss occurred without any post-intervention interaction with the study staff.

Abstract

To determine the efficacy and potential protective mechanism of canagliflozin combined with aerobic exercise in treating chronic heart failure (CHF). Isoproterenol was injected into rats to create CHF models. The rats were then subsequently divided into saline, canagliflozin (3 mg/kg/d), aerobic exercise training, and canagliflozin combined with aerobic exercise training. Compared to the CHF group, the canagliflozin combined with the aerobic exercise group had superior ventricular remodeling and cardiac function. In rats treated with canagliflozin combined with aerobic exercise, the expression of cytochrome P450 (CYP) 4A3, CYP4A8, COL1A1, COL3A1, and FN1 was reduced, while the expression of CYP26B1, ALDH1A2, and CYP1A1 increased significantly. Additionally, canagliflozin combined with aerobic exercise decreased the phosphorylation of AKT and ERK1/2. Canagliflozin combined with aerobic exercise has a positive effect on the development of CHF via the regulation of retinol metabolism and the AKT/ERK signaling pathway.

Introduction

Chronic heart failure (CHF), the most prevalent form of cardiovascular illness, is a global health issue with a high death and morbidity rate.1 The disease affects about 2% of the adult population worldwide, and the 5-year mortality rate is estimated to be between 45 and 60%.2 CHF is a complex condition characterized by a cardiac muscle’s inability to maintain blood supply to peripheral tissues, resulting in decreased systemic energy metabolism.3 Multiple studies have demonstrated that regulating cardiac energy metabolism is critical for treatment.4,5 The β-oxidation of fatty acids in the mitochondria satisfies the heart’s high energy requirements. Oliveros et al. observed previously observed that a vitamin A deficit paired antioxidant defenses, promoted lipid peroxidation in the adult rat heart, and altered aortic lipid metabolism.6 The peroxisome proliferator-activated receptor (PPAR) is a ligand-activated nuclear transcription factor.7 PPAR modulates fatty acid oxidation (FAO) and mitochondrial bioenergetics, suppresses myocardial remodeling and fibrosis, and improves HF.8 Consequently, we must investigate new techniques for enhancing cardiac function by ameliorating abnormalities of cardiac energy metabolism, preventing cardiac remodeling and fibrosis, and thereby preventing or postponing the advancement of heart failure.

Canagliflozin, an inhibitor of sodium-glucose cotransporter 2 (SGLT-2), has been demonstrated to benefit HF with a lower ejection fraction.9 SGLT-2 inhibitors (canagliflozin, and so forth) for patients with CHF, improve the quality of life, and reduce mortality, morbidity, and readmission rates.10 In diabetic and nondiabetic subjects, canagliflozin treatment significantly reduced the risk of cardiovascular death, myocardial infarction, and hospitalization for hypertension.11 In addition, SGLT-2 inhibitors can improve fatty acid metabolism and utilize ketone bodies to create mitochondrial energy, so enhancing the aerobic metabolism of skeletal muscle, inhibiting anaerobic metabolism, and enhancing aerobic exercise capacity.12 Canagliflozin has been demonstrated to decrease myocardial glucose metabolism, enhance myocardial fatty acid metabolism, and increase the circulation of ketone bodies,13 thereby ameliorating heart failure via modifying myocardial energy metabolism and oxidative stress.14

Results

Canagliflozin combined with aerobic exercise improved isoproterenol-induced cardiac dysfunction
To investigate the effect of canagliflozin combined with aerobic exercise on CHF, cardiac function was assessed using echocardiography. After 10 days of ISO administration, the levels of LVEF (p < 0.001) and LVFS (p < 0.001) in the ISO group were significantly lower than in the control group, indicating that the CHF rat model was successfully established. LVEF and LVFS levels were significantly higher in the ISO+CA group (LVEF, p < 0.05; LVFS, p < 0.05), the ISO+AE group (LVEF, p < 0.05; LVFS, p < 0.05), and the ISO+AE+CA group (LVEF, p < 0.01; LVFS, p < 0.01). Moreover, compared to the ISO group, the levels of LVIDs (p < 0.05) and LVESV (p < 0.05) were significantly reduced in the ISO+AE+CA group but not in the ISO+CA group (LVIDs, p = 0.21; LVESV, p = 0.21). (Figures 1A and 1B, Table 1).

Objective
To investigate the influence of aerobic exercise on myocardial injury, NF-B expression, glucolipid metabolism and inflammatory factors in rats with Coronary Heart Disease (CHD) and explore the possible causative role.

Methods
45 Sprague Dawley® rats were randomized into model, control and experimental groups. A high-fat diet was adopted for generating a rat CHD model, and the experimental group was given a 4-week aerobic exercise intervention. ECG was utilized to evaluate the cardiac function of the rats; HE staining to evaluate the damage of myocardial tissue; TUNEL staining to evaluate cardiomyocyte apoptosis level; ELISA to assay the contents of inflammatory factors and glucolipid metabolism in cardiomyocytes; qPCR to assay IB- and NF-B mRNA expression; Western-blot to assay the apoptosis-related proteins and NF-B signaling pathway-related proteins expressions in myocardial tissue.

Results
In contrast to the model group, aerobic exercise strongly improved the rat’s cardiac function and glucolipid metabolism (p < 0.01), enhanced IL-10 content, Bcl-2/Bax level as well as IB- protein and mRNA expression (p < 0.01), and reduced myocardial injury and cardiomyocyte apoptosis, the contents of IL-6, IL-1 and TNF-, Caspase 3 level, NF-B mRNA and protein expression and p-p38 and p-STAT3 expressions (p < 0.01).

Conclusion
Aerobic exercise can not only effectively reduce myocardial injury, the release of inflammatory factors and NF-B expression in CHD rats, but also improve cardiac function and glucolipid metabolism. Its mechanism is likely to be related to the inhibition of the NF-B signaling pathway.

Introduction

Coronary Heart Disease (CHD) refers to coronary artery lumen stenosis or even blockage caused by atherosclerosis, which causes myocardial ischemia, hypoxia and even necrosis, and is also known as ischemic heart disease. 1 , 2 Physiological, genetic and environmental factors that cause aberrant glucolipid metabolism and inflammatory response disorders are the dominating incentives that induce atherosclerosis and the primary pathophysiological basis of CHD. 3 , 4 With the improvement in living standards, the incidence of CHD is increasing year by year, posing a huge economic burden on families and countries. Reducing the mortality and extending the survival time of CHD patients is a major challenge that cardiovascular disease researchers and clinicians urgently need to solve.

Considerable evidence shows that vascular endothelial injury will raise the adhesion and permeability of vascular endothelium, and then multiple inflammatory factors will gather and produce an inflammatory fiber proliferation reaction, which eventually gives rise to atherosclerosis. 7 , 8 , 9 Nuclear Factor Kappa B (NF-B) takes part in not only the occurrence but also the development of inflammatory response. NF-B inhibitor protein IB- can accelerate the dissociation of NF-B. The dissociated NF-B can be rapidly transferred to the nucleus, modulating the transcription and translation processes of diverse inflammatory factors and adhesion factors, and is an important cytokine that modulates the activation and cascade amplification of inflammatory factors. 10 , 11 Schiffmann et al. 12 have demonstrated that CHD patients will have apparent glucolipid metabolism disorder. Over-nutrition and sedentary behaviors will strikingly accelerate the accumulation of fat and glucose in the body, which in turn will aggravate the vascular endothelial damage of patients. Substantial evidence indicates that aerobic exercise can efficaciously regulate glucolipid metabolism in the body, reduce the activity of lipoprotein lipase, lower blood lipid and blood sugar levels, and reduce body weight. 13 , 14 Ornish et al. 15 demonstrated that long-term aerobic exercise can apparently reduce blood lipid levels and reduce vascular endothelial damage in patients with cardiovascular disease. At present, there are few studies on the impact of aerobic exercise on myocardial damage, glucolipid metabolism, and inflammation in CHD. This investigation aimed to build a rat CHD model to study the influence of aerobic exercise on myocardial damage, NF-B expression, glucolipid metabolism and inflammatory responses in CHD rats, as well as to further explore its possible causative role.

Abstract

Introduction
Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted.

Research question
We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations.

Materials and methods
A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education.

Results
Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines.

Discussion and conclusion
SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.

Introduction

A concussion can be defined as a transient and sudden alteration of consciousness following traumatic biomechanical forces transmitted to the brain either directly or indirectly (Khurana and Kaye, 2012). Sport-related concussion (SRC) has been a growing concern over several years and has been attracting further attention amongst athletes and healthcare professionals due to recently publicised effects on both their immediate and long-term neurological health. Soccer is a sport with high concussion rates in comparison with others (Pierpoint and Collins, 2021). The injury rates amongst athletes of the National Collegiate Athletic Association (NCAA) being 0.28 and 0.41 per 1000 game exposures for male and female soccer athletes respectively. This is in comparison with other contact sports such as men’s wrestling (0.25), American football (0.37), basketball (0.16), ice hockey (0.41); and women’s basketball (0.22), gymnastics (0.16), and field hockey (0.18) (Hootman et al., 2007). High concussion rates were also seen in a 2020 study by Vedung et al., where the concussion incidence was 1.19 per 1000 game hours (Vedung et al., 2020).

Recent evidence from 2019 (Scotland) and 2023 (Sweden) showed that former elite soccer players are more likely to die from neurogenerative disease, which was attributed to the frequency of concussions and repetitive heading during their playing days (Mackay et al., 2019; Ueda et al., 2023). There has also been coverage from mainstream media reporting on former athletes that have developed neurodegenerative disease after sustaining SRC’s during their playing careers. For example, in an article from 2020, forty ex-soccer players were reported to take legal action against the English Football Association for dementia-related negligence due to brain injuries sustained (PA Media, 2020). Increasing attention has therefore been brought to this issue, which has raised questions on the effectiveness and utilisation of concussion protocols currently in place.

Conclusion

This scoping review identified discrepancies between soccer-specific SRC guidelines published by different official bodies. The major discrepancies identified were found in the timeframes for the return-to-sport protocol; the time recommended for the initial rest phase; and the decision to allow same day return-to-play after a suspected concussion. Possible implications of these discrepancies are that athletes could be managed in vastly different ways without any clarity on which guidelines would be best. This could lead to outcomes where, for example, athletes could be rested for too long or the opposite where athletes could be rushed back into play prematurely. Furthermore, the discrepancies could be putting certain populations at a higher risk of subsequently poorer neurocognitive outcomes after sustaining a concussion; for example, amateur athletes that do not have access to facilities like an individualised management plan with close monitoring of their progression through the different steps of the return-to-sport protocol. Due to the lack of studies in this area, it is unclear whether these discrepancies are detrimental to athletes and whether they may pose a risk, both at short-and long term. Soccer is one of the most popular sports in the world and SRCs continue to be a relevant issue. This is a field of growing interest amongst healthcare professionals and considerations for additional specific information about risk prevention and the use of neuroimaging should be made to include them within future guidelines.

It is fortunate that the most recent update from the CISG was concluded with the 6th International Conference on Concussion in Sport, held in 2022 (Patricios et al., 2023). This consensus statement was only just published in June 2023 and includes updated strategies for return-to-sport and material such as the Sport Concussion Assessment Tool-6 (SCAT-6), the Child SCAT-6, the Concussion Recognition Tool-6 (CRT-6), the Sport Concussion Office Assessment Tool-6 (SCOAT-6), and the Child SCOAT-6. These updates provide a fresh opportunity for soccer associations to update their guidelines in a consistent and collaborative manner.

Abstract

Background
High blood pressure (BP) is a major contributor to mortality and cardiovascular diseases. Despite the known benefits of exercise for reducing BP, it is crucial to identify the most effective physical activity (PA) intervention. This systematic review and network meta-analysis (NMA) aimed to evaluate the available evidence on the effectiveness of various PA interventions for reducing BP and to determine their hierarchy based on their impact on BP.

Methods
A search of PubMed, SPORTDiscus, PsycINFO, Web of Science, CINAHL, Cochrane, and Eric databases was conducted up to December 2022 for this systematic review and NMA. Randomized controlled trials and quasi-experimental studies targeting healthy children and adolescents aged 6–12 years old were included in this study. Only studies that compared controlled and intervention groups using PA or exercise as the major influence were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent investigators performed the literature screening, data extraction, and risk of bias assessment. We used Bayesian arm-based NMA to synthesize the data. The primary outcomes were systolic BP and diastolic BP. We calculated the mean differences (MDs) in systolic BP and diastolic BP before and after treatment. Mean treatment differences were estimated using NMA and random-effect models.

Results
We synthesized 27 studies involving 15,220 children and adolescents. PA combined with nutrition and behavior change was the most effective intervention for reducing both systolic BP and diastolic BP ((MD: –8.64, 95% credible interval (95%CI):–11.44 to –5.84); (MD: –6.75, 95%CI: –10.44 to –3.11)), followed by interventions with multiple components ((MD: –1.39, 95%CI: –1.94 to –0.84); (MD: –2.54, 95%CI: –4.89 to –0.29)).

Conclusion
Our findings suggest that PA interventions incorporating nutrition and behavior change, followed by interventions with multiple components, are most effective for reducing both systolic blood pressure and diastolic blood pressure in children and adolescents.

Introduction

High blood pressure (HBP), or hypertension, occurs when the blood exerts too much pressure against the walls of blood vessels due to systolic and diastolic forces.1 It is a significant risk factor for cardiovascular diseases, contributing to 10.1 million deaths and 208.1 million cases of overall disease burden worldwide in the past 2 decades.2 The death rate attributable to HBP increased to 34.2% between 2009 and 2019,3, 4, 5 with hypertension projected to affect 41% of US adults by 2030.6,7 The economic burden of hypertension is expected to rise significantly, with direct costs projected to triple to USD 389.9 billion and indirect costs to double to USD 42 billion by 2030.6,8,9 Around 50% of reported cases of hypertension have a genetic component,10, 11, 12 while modifiable factors like lifestyle, diet, and physical activity (PA) contribute to the other half.13,14

The American Heart Association highlighted that the significance of HBP in children was previously underestimated. Recent studies show that many children and adolescents in the United States face hypertension risks. Data reveals that 5% of this demographic has HBP, while 18% exhibit elevated BP.15 Similarly, the Centers for Disease Control and Prevention reported that among youth aged 12–19, 1 in 25 has hypertension, and 1 in 10 experiences elevated BP.16 Considering these findings, both American Heart Association and Centers for Disease Control and Prevention emphasize the increasing incidence of HBP in young individuals, which could lead to health complications in adulthood. As a result, it’s imperative to implement preventive measures to counteract the rising trend of HBP in this age group. While medical research explores various approaches for monitoring and controlling genetically-based hypertension, non-medical approaches may be more feasible and effective in the interim.

Conclusion

Although medication-based treatments are essential for young individuals with hypertension, non-drug strategies have demonstrated effectiveness for lowering BP among healthy youth. Thus, integrating PA with other alterable factors early on can serve as a protective shield against future health issues. Notably, interventions that amalgamate PA, nutrition, and behavioral adjustments tend to be notably superior at decreasing both SBP and DBP compared to interventions focused solely on PA. Moreover, further investigation is required to classify PA modalities in terms of content, length, and intensity before concluding that PA-only intervention is the least effective approach for reducing BP.

Abstract

     Recent advances in wearable sensing and machine learning have created ample opportunities for “in the wild” movement analysis in sports, since the combination of both enables real-time feedback to be provided to athletes and coaches, as well as long-term monitoring of movements. The potential for real-time feedback is useful for performance enhancement or technique analysis, and can be achieved by training efficient models and implementing them on dedicated hardware. Long-term monitoring of movement can be used for injury prevention, among others. Such applications are often enabled by training a machine learned model from large datasets that have been collected using wearable sensors. Therefore, in this perspective paper, we provide an overview of approaches for studies that aim to analyze sports movement “in the wild” using wearable sensors and machine learning. First, we discuss how a measurement protocol can be set up by answering six questions. Then, we discuss the benefits and pitfalls and provide recommendations for effective training of machine learning models from movement data, focusing on data pre-processing, feature calculation, and model selection and tuning. Finally, we highlight two application domains where “in the wild” data recording was combined with machine learning for injury prevention and technique analysis, respectively.

Introduction

     Measuring sports movement during training and competition allows monitoring athletes’ performance and their risk of injury (Camomilla et al., 2018, Cust et al., 2019). Performance monitoring is relevant to assess motor capacity and physical demand, as well as to analyze technique and how technique impacts performance (Camomilla et al., 2018). In the complementary perspective of sport-related injuries, monitoring can be oriented to preventing, assessing, and informing the recovery from injuries (Preatoni et al., 2022).

     The state-of-the-art approach to measure movement is to perform a biomechanical analysis from data recorded in a lab environment using optical motion capture (OMC) systems and force plates. Such an analysis includes calculating spatio-temporal variables, as well as joint angles, joint moments, and ground reaction forces. Musculoskeletal models can provide additional insights into muscle forces and activations, which cannot be measured directly. However, these state-of-the-art measurement techniques can only be used in a laboratory environment and are limited by high costs, a stationary setup, and a short duration.

Conclusion

     In this perspective paper, we have discussed different opportunities and challenges regarding analysis of “in the wild” movement data using machine learning. We have highlighted the importance of careful data recordings. This is important when recording movement in general, to collect the correct data at the correct point in time, but becomes even more important when machine learning is used for processing, to ensure that the trained model works for the data it should be analyzing, and that the correct analysis is performed. We have discussed several considerations regarding both data recording in general and specific to training of machine learning models, to ensure that in future researchers can properly address these in experiments. Furthermore, we highlighted how “in the wild” movement data can be used in two application domains, specifically monitoring injury risk and technique analysis.

     By combining machine learning with “in the wild” recordings, the main advantages are the potential for real-time feedback, while analyses can also be performed on large datasets. The real-time potential can be used to enhance the performance of athletes during training and competition. Its advantages for large datasets can be exploited when performing long-term monitoring to forecast injuries, especially by developing personalized models, while statistical features could be found that provide more insight than traditional parameters as well. The combination of real-time feedback with analysis on large datasets allows for computationally efficient calculation of many variables, e.g. joint angles of a kinematic model, which can then be used to create avatars of athlete’s movements to provide actionable insights. In conclusion, this perspective paper provides researchers with guidance and directions for future development of machine learning models for movement analysis “in the wild”.

Abstract

     The aim of this study is to examine whether students of a sport management undergraduate course can gain knowledge in the management of a professional soccer club, by participating in a commercial serious game. Serious is considered the cyber game that its purpose exceeds entertainment. For this case study, the serious sport club management game was “Top Eleven”. The theoretical model that this study was based on, is Misfeldt’s “scenarios based learning” for the transformation of a serious game into an educational means. It includes dimensions that cover part of the sport management class content in the National and Kapodistrian University of Athens, School of Physical Education and Sport Science. The transformation consisted of educational scenarios vested to the serious game, in order to add educational parameters to its basic elements with the purpose to relate further to the sport management class. The application showed that Top Eleven covers adequately Misfeldt’s model dimensions; therefore it can be used as an educational tool. Furthermore, an evaluation of the class gamification was conducted by the participating students (n = 62). The data collected showed that the majority of the students (f = 61, 98.4%) agreed that the participation in the serious game was “helpful” to their sport management class education process. They further agreed that they gained “very” or “very much” knowledge related to the management of a professional soccer club (f = 41, 66.1%) and that 59.7% (f = 37) of them would choose to work in a position of “sport club manager” as a result of the experience they gained by participating in the serious game.

Introduction

     Technology dominates modern times. Smart devices and internet are present in everyday life. Part of it is virtual reality, used to imitate the human activity in many areas, with a way increasingly like physical life. This allows using technology for fun, but also for gaining experiences that would not otherwise be possible, especially when it involves risk; economic, social, or physical. Therefore, such technology has also been entered the feld of education to better train learners (Baalsrud et al., 2013; Boskic & Hu, 2015). The main reason is that due to students’ inexperience, they cannot address work problems or make decisions that would jeopardize an organization’s relationship with its customers, investors, suppliers, or governmental agencies. Consequently, in education, especially in higher education, digital programs in form of simulators and/or serious games run as virtual work environments with complex conditions, very close to reality. As a result, learners can see, almost immediately, the efects of their work decisions as they apply the knowledge they have acquired during their professional education. Another reason for using serious games in higher education is the cost for obtaining the very expensive stimulators (Carvalho, 2017; Aldrich, 2009).

Conclusion

     The purpose and the original contribution of this study compared to current research already published is that it investigated the feasibility of converting a commercial, online, popular, and free to use serious sports club management game, into a simulator for providing the students with relevant awareness/knowledge using a game environment, The innovative approach to this was that we extended the original concept of the game by vesting educational assignments that students need to complete by using data and situations extracted from the game. It also provides lengthy sport management education scenarios, which ft to vest the serious game Top Eleven in order this popular, user-friendly, no cost game, applies as an auxiliary educational means, for an introductory class of sport management. On that, the students who participated in the study, admitted that they acquired knowledge on what it means to manage a soccer club and therefore based on their simulating job experience can now express their opinion on whether they would like to pursue this career path. It further presents one of the most attractive and no cost simulators, for teaching an introduction to sport management, which is missing from the current relevant bibliography.