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People participate in many different types of physical activity, both daily and across their life span, but research on human movement is often siloed by type (sport, exercise, active transportation, etc.). Models developed for understanding participation in specific types of physical activity remain useful in those contexts, but are insufficient for describing, explaining, or enhancing movement at the individual or societal level. Physical literacy has the potential to serve this purpose, but its current application does not fulfill its potential for holistic and inclusive promotion of movement. This paper therefore introduces a new framework for physical literacy, Four Domains for Development for All (4D4D4All). This framework highlights the interrelations among the physical, psychological, social, and creative aspects of movement, and emphasizes how development across all four domains can be supported through the interrelations of individuals and their contexts. In this paper, we introduce the 4D4D4All framework and present ideas for its application in research and practice. Specifically, this individualized, holistic, and inclusive approach to physical literacy is an alternative to models that emphasize the production of podium-driven athletes or focus on meeting physical activity guidelines, and is therefore better suited to facilitate the
development of flourishing active people. Lay summary: Current models of sport and physical activity participation do not adequately describe the developmental experiences of individuals moving in a variety of contexts. Our new physical literacy framework, Four Domains for Development for All (4D4D4All), enables all movement contexts to better support well-being through a focus on holistic individual development.

Background : established norms for fitness and performance measures are lacking in circus arts. These would assist healthcare professionals and coaches to screen for readiness to participate in training or performance, determine post-injury return to performance, and develop targeted conditioning programs.
Purpose : the purpose of this research was to establish norms for trunk and extremity physical exam and performance measures in circus artists by professional status, assigned sex at birth (ASAB), and age.
Study Design : descriptive laboratory study
Methods : Circus artists (n=201; ages 13-69y; 172 females ASAB, 29 males ASAB) from 10 cities across the United States underwent a baseline physical examination including shoulder, hip and trunk measures of passive (PROM) and active (AROM) range of motion, measures of flexibility (shoulder and hip), strength (manual muscle tests, grip strength), cardiovascular fitness (3 minute-step test), balance (single limb and handstand), and performance, (pull-ups, and the closed kinetic chain upper extremity stability test [CKCUEST]). ANOVAs were used to determine between group differences by age and T-tests to discern differences by ASAB or professional status.
Results : differences existed by professional status for shoulder external rotation PROM, hip PROM, hip flexibility, shoulder and abdominal strength, and cardiovascular fitness. Sex differences were seen in active scapular upward rotation, hip and shoulder PROM and flexibility, hip and grip strength, and for functional performance measures (pull-ups, CKCUEST). Differences by age were limited to active scapular upward rotation, shoulder PROM, flexibility and strength, cardiovascular fitness, and balance. Overall, professionals outperformed pre-professionals for lower abdominal strength, pull-ups, handstand
balance, cardiovascular fitness, hamstring, and straddle flexibility. Generally, males ASAB demonstrated greater shoulder flexibility and upper body functional strength while females ASAB had greater hip and lumbar flexibility and hip strength. No measures showed consistent declines with increasing age, though some showed differences between adolescents and adults.
Conclusion : these normative values for physical characteristics and functional performance in pre-professional and professional circus artists may be used to guide screening for readiness to participate in advanced training or performance, return to performance after injury, and the development of targeted strength and conditioning programs.

Objective This prospective cohort study quantified injury patterns related to specific circus discipline exposure in preprofessional and professional circus artists.

Methods Circus artists (n=201; ages 13–69; 172 female, 29 male assigned sex at birth) were enrolled in 10 cities across the USA. Participants were followed for 1 year from enrolment, completing a weekly training log and undergoing a physical therapist evaluation for injuries. The circus-specific extension of the International Olympic Committee 2020 consensus on recording injury and illness in sports was used to analyse injury patterns.

Results The study completion rate was 77% (n=155). Data were analysed by participant subgroup (age, professional status, sex at birth). The highest injury rates in participant subgroups were for males (5.69/1000 exposures) and related to discipline subgroups, were in aerial with ground elements (5.93/1000 exposures) and aerial (4.26/1000 exposures). Adults had more injuries related to aerial, whereas adolescents had more related to ground disciplines (χ2 (2)=10.62, p=0.005) and non-time loss injuries (χ2 (1)=5.45, p=0.02). Females had a higher proportion of repetitive injuries (70% vs 55%) than males (χ2 (1) = 4.43, p=0.035). Individuals with an eating disorder history had more (p<0.004) injuries (mean 2.27±2.29) than those without (mean=1.48±0.96).

Conclusions This study showed that intrinsic factors (age, sex at birth and history of eating disorder) and extrinsic factors (circus discipline exposure) affect injury risk. We need to account for the intersectionality of these factors to address risk management at an individual and group level.

Indepth knowledge of injury and illness epidemiology in circus arts is lacking. Comparing results across studies is difficult due to inconsistent methods and definitions. In 2020, the International Olympic Committee (IOC) consensus group proposed a standard method for recording and reporting epidemiological data on injuries and illnesses in sports and stated that sport-specific extension statements are needed to capture the context of each sport. This is the circus-specific extension to be used with the IOC consensus statement. International circus arts researchers in injury and illness epidemiology and performing arts medicine formed a consensus working group. Consensus statement development included a review of literature, creation of an initial draft by the working group, feedback from external reviewers, integration of feedback into the second draft
and a consensus on the final document. This consensus statement contains circus-specific information on (1) injury definitions and characteristics; (2) measures of severity and exposure, with recommendations for calculating the incidence and prevalence; (3) a healthcare practitioner report form; (4) a self-report form capturing health complaints with training and performance exposure; and (5) a demographic, health history and circus experience intake questionnaire. This guideline facilitates comparing results across studies and enables combining data sets on injuries in circus arts. This guideline informs circus-specific injury prevention, rehabilitation, and risk management to improve the performance and health of circus artists.