Mental, physiological and medical considerations for elite football players in the Saudi Pro League: a call for action

Navigating the multifaceted challenges of elite football in KSA As outlined in figure 1 and table 1, the challenging stressors that threaten the newly recruited players range from the pathophysiological responses to hyperthermic conditions and high mechanical load, to the mental health implications of cultural transition.3 It is imperative for the healthcare staff supporting these players to adopt a comprehensive, evidence-based approach, (1) not only addressing the immediate risks of heat-related illnesses and overuse injuries but (2) also proactively managing the mental health and well-being of players and their families as they adapt to a new and markedly different professional and personal landscape. Table 1 Pathophysiological responses, clinical consequences and interventions in elite football players: the case of the Saudi Pro League Match conditions Pathophysiological responses Potential clinical consequences Evidence-based interventions A hyperthermic and humid environment Impaired thermoregulation Elevated core temperature Altered electrolyte balance EHS Exercise-associated hyponatremia Heat syncope Rhabdomyolysis EHS Emergency preparedness (ie, immediate access to CWI) Individualised heat acclimatisation protocols WBGT monitoring Isotonic fluid replacement strategies Post-exertional CWI High mechanical and metabolic load Musculotendinous overload Metabolic acidosis Central and peripheral fatigue Tendinopathies Stress fractures Exercise-induced hypoventilation Overtraining syndrome Kinematic load monitoring Personalised periodization and recovery plans Respiratory muscle training Blood lactate threshold testing Ambient air pollution bronchial hyperresponsiveness Altered pulmonary gas exchange Systemic inflammatory response Exercise-induced bronchoconstriction Hypoxemia Real-time air quality monitoring Inhaled corticosteroids and LABA Match rescheduling based on AQI Trans meridian travel and jet lag Circadian rhythm disruption Sleep architecture alterations Hormonal imbalance Insomnia Reduced neuromuscular performance Increased injury risk due to altered proprioception Chronobiological interventions Controlled light exposure and melatonin supplementation Sleep extension and napping strategies Nutritional and cultural adaptation Altered macronutrient and micronutrient intake Gastrointestinal dysbiosis Energy availability imbalance Vitamin D deficiency Relative energy deficiency in sport Iron-deficiency anaemia GI distress Culturally adapted, individ