Influence of Football on Physiological Cardiac Indexes in Professional and Young Athletes

The effect of long-term soccer training on left ventricular structure and function in elite male youth soccer players

AIMS

Cardiac adaptations in elite, male adolescent youth soccer players have been demonstrated in relation to training status. The time course of these adaptations and the delineation of the influence of volatile growth phases from the training effect on these adaptations remain unclear. Consequently, the aims of the study were to evaluate the impact of 3 years of elite-level soccer training on changes in left ventricular (LV) structure and function in a group of highly trained elite youth male soccer players (SP) as they transitioned through the pre-to-adolescent phase of their growth.

METHODS

Twenty-two male youth SP from the highest Level of English Premier League Academy U-12 teams were evaluated once a year for three soccer seasons as the players progressed from the U-12 to U-14 teams. Fifteen recreationally active control participants (CON) were also evaluated over the same 3-year period. Two-dimensional transthoracic echocardiography was used to quantify LV structure and function.

RESULTS

After adjusting for the influence of growth and maturation, training-induced increases in Years 2 and 3 were noted for: LV end diastolic volume (LVEDV; p = 0.02) and LV end systolic volume (LVESV; p = 0.02) in the SP compared to CON. Training-induced decrements were noted for LV ejection fraction (LVEF; p = 0.006) and TDI-S' (p < 0.001).

CONCLUSIONS

An increase in training volume (Years 2 and 3) were aligned with LV volumetric adaptations and decrements in systolic function in the SP that were independent from the influence of rapid somatic growth. Decrements in systolic function were suggestive of a functional reserve for exercise.

Assessment of left atrial morphological and functional differences in professional male football players: a prospective, case-control study

BACKGROUND

Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling.

AIM

This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools.

METHODS

This prospective, case-control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study's primary outcome.

RESULTS

There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001).

CONCLUSIONS

Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training.

Myocardial Work Index in Professional Football Players: A Novel Method for Assessment of Cardiac Adaptation

BACKGROUND

The global myocardial work index (GWI), a novel, valid, and non-invasive method based on speckle-tracking echocardiography, could provide value for calculating left ventricular (LV) function and energy consumption in athletes.

MATERIALS AND METHODS

We prospectively analyzed a single-center cohort of Spanish First-Division football players who attended a pre-participation screening program from June 2020 to June 2021, compared to a control group. All the individuals underwent an electrocardiogram and echocardiography, including two-dimensional speckle tracking and 4D-echo. The study aimed to evaluate the feasibility of myocardial work in professional football players and its correlations with other echocardiographic parameters.

RESULTS

The study population comprised 97 individuals (49 professional players and 48 controls). The mean age was 30.48 ± 7.20 years old. The professional football players had significantly higher values of LVEDV (p < 0.001), LVESV (p < 0.001), LV-mass index (p = 0.011), PWTd (p = 0.023), and EA (p < 0.001) compared with the control group. In addition, the professional players had lower GCW (p = 0.003) and a tendency to show lower GWI values (p < 0.001). These findings could suggest that professional football players have more remodeling and less MW, related to their adaptation to intensive training. Significant differences in GLS (p = 0.01) and GWE (p = 0.04) were observed as a function of the septal thickness of the athletes. Irrespective of the MW variable, the parameters with better correlations across all the populations were SBP, DBP, and GLS.

CONCLUSIONS

The GWI is a novel index to assess cardiac performance, with less load dependency than strain measurements. Future GWI analyses are warranted to understand myocardial deformation and other pathological differential diagnoses.

Effects of Mobile-Based Rehabilitation in Adolescent Football Players with Recurrent Lateral Ankle Sprains during the COVID-19 Pandemic

Football is a sport involving dynamic movements, and ankle sprains are common sports injuries experienced by football players. Ankle sprains exhibit a high recurrence rate, and rehabilitation training is effective; however, expert-supervised rehabilitation (SVR) at training centers is difficult due to the recent COVID-19 pandemic. This study investigated the effects of mobile-based rehabilitation (MBR) performed at home by high school football players. Sixty players (SVR: 30 and MBR: 30) with recurrent ankle sprains were analyzed. The rehabilitation program consisted of strength and balance training, and the training intensity was gradually increased from week 1 to week 8. The SVR group underwent training at the center with experts, and the BMR group were provided with programs and feedback using mobile devices. Ankle muscle strength was evaluated by measuring isometric eversion, inversion, plantarflexion, and dorsiflexion contraction using a hand-held dynamometer, and dynamic balance was assessed using the Y-balance test (YBT; anterior, posteromedial, and posterolateral); the Foot and Ankle Outcome Score (FAOS) was used for the subjective evaluation. Measurements were conducted at weeks 1, 4, and 8. The patients visited the clinic within 1 week after the injury, and the first test was conducted after consent to participate in the research. Patients underwent the second test at an average of 3.2 weeks after the first test, and the last test at an average of 4.4 weeks after the second test. Although only the SVR group exhibited improvement in strength (eversion and dorsiflexion), YBT and subjective satisfaction at week 4, these measurements improved in both the SVR and MBR groups at week 8. Therefore, mobile–based rehabilitation could be a suitable alternative for high school athletes with ankle sprains who cannot undergo supervised rehabilitation.

Optimizing the Explosive Force of the Elite Level Football-Tennis Players through Plyometric and Specific Exercises

The aim of the research was to implement an athletic program to improve the explosive force in order to optimize physical fitness at the level of elite football-tennis players and evaluate the progress made through specific tests using the Opto Jump. The research included 10 elite European and world-class players, on whom an experimental program was applied in order to improve the explosive force of the limbs in conditions of speed, endurance, and dynamic balance. Study tests: five vertical jumps on the spot, on the left/right leg; five back and forth jumps on the left/right leg; five left/right side jumps on the left/right leg; vertical jumps on both legs 60 s; BFS vertical jumps. For each test, the following parameters specific to the explosive force were statistically analyzed: contact time (s); flight time (s); jump height (cm), jump power (w/kg); RSI—Reactive Strength Index, defined as Height (m/s). In the study, the average value of the parameters specific to the jumps performed in each test was taken into account. During the study, the tests were performed and processed on the Opto Jump device and software. In all tests of the experiment monitored through Opto Jump, significant progress was made in the final test compared to the initial one, which demonstrates the efficiency of the physical training program implemented for the development of explosive force, with an impact on the sports performance of elite players. The most relevant results obtained for the left leg regarding the improvement of the explosive force of the lower limbs materialized in the jump height parameter was in the test of five vertical jumps on one leg on the spot, and for the right leg in the tests of: five back and forth jumps and five left/right side jumps. The most significant advances in the study were in the tests, in descending order of their weight: 60 s vertical jumps on both legs; five back-and-forth jumps and five left/right side jumps, five vertical jumps on one leg standing, and BFS vertical jumps.

Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance

The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.

Coordination Aspects of an Effective Sprint Start

The aim of the present study was to examine differences in the movement structure and the coordination aspects expressed by bioelectrical tension indicators between a group of experts/sprinters and a group of novices/students. A group consisted of 20 sprinters and a control group consisted of 35 master's physical education students. A 16-channel surface electromyography (14 muscles) and two cameras with recording speed of 250 frames/per second were used. Significant differences were found between reaction time (p < 0.005) and time at 30 m of the covered sprinting distance (p < 0.001) between the students and advance athletes. Furthermore, the sprinters activated the back foot (taking off the starting blocks) and the front foot (first ground contact) earlier, which correlated with the attained times at 5 (r = 0.66) and 10 m (r = 0.62) of the covered sprinting distance. The most important component of the sprint start, apart from the muscle strength of the legs, is the appropriate motor coordination, which greatly affects the generation of power in the legs at the right time and optimal duration.

The Effect of Heart Rate on Jump-Shot Accuracy of Adolescent Basketball Players

Basketball is a team sport, where fundamental skills - fundamentals - are key determinants for success. Jump-shot (JS) is a basketball fundamental used frequently during game. It is interesting to spread light on the relationship between effort intensity and JS ability. Study aim was to investigate different heart rates (HRs) effect on JS accuracy (JS%) in 22 male youth (15.7 ± 0.9 years) players. Experimental sessions consisted of 10 JSs from five spots 5 m from basket at three different HRs: rest (0HR) and after warm-up (50% [50HR] and 80% maximal HR [80HR]). Analysis of variance showed differences in JS% over sessions (42.27 ± 14.78% at 0HR, 38.18 ± 10.53% at 50HR, and 30.00 ± 16.62% at 80HR; P = 0.018). Least significant difference test did not show any significant difference between 50HR and 0HR JS% (P = 0.343), while 80HR elicited significantly lower values with respect to both 0HR (P = 0.006) and 50HR (P = 0.049). Study provided practical indications on maintaining high JS%: preliminary warm-up (even if injury-protecting) does not improve JS%, because between 50HR and 0HR difference was not significant; and 80HR significantly decreases JS%. Therefore, to maximize JS scoring players have to rest as much as possible during game-play pauses, and coaches should manage timeouts and substitutions accordingly, especially during final minutes of close games.

Dynamics of Recovery of Physiological Parameters After a Small-Sided Game in Women Soccer Players

Purpose: Training methods based on small-sided game (SSG) seem to promote physiological and tactical benefits for soccer players as they present characteristics more specific to the game. Thus, the main objective of the present study was to analyze the hormonal, biochemical, and autonomic parameters in an acute manner and the recovery dynamics (up to 72 h after) in a SSG. Methods: Thirteen professional female soccer players participated in the study (18.8 ± 0.8 years, body mass 59.4 ± 6.2 kg, and height 1.68 ± 0.05 m). During and after the SSG session (4 min × 4 min separated by 3 min of passive interval and 120 m² coverage per player), autonomic modulation was analyzed in the time and frequency domains using heart rate variability, and blood samples (5 ml) were collected before (0 h) and after (10 min and 24, 48, 72 h) the SSG for biochemical and hormonal analysis. Results: The SSG induced an increase effect for LF (low frequency) (92,52%; Very likely increase) and a decrease effect for HF (high frequency) values (-65,72%; Very likely decrease), after 10 min of recovery. The LF/HF increase after 10 min of recovery (386,21%; Very likely increase). The RMSSD (square root of the mean squared differences of the successive N-N intervals) and pNN50 (measure of the number of adjacent NN intervals which differ by more than 50 ms) values presented a decrease effect 10 min after SSG (61,38%; Very likely decrease and-90%; Very likely decrease). The CK (creatine kinase) values presented no changes 10 min after SSG. The LDH (lactate dehydrogenase) values presented an increase effect 10 min after the SSG (19,22%; Likely increase). Both testosterone and cortisol concentrations presented the same behavior after SSG, where no alterations were observed with after 10 min (<0,37%; Most likely trivial). Conclusion: The SSG promoted significant cardiovascular stress that was restored within the first 24 h of recovery. Parasympathetic parameters continued to increase while sympathetic parameters declined significantly during the 72 h of recovery. In addition, the reduced game did not alter biochemical or hormonal responses during the 72 h.

Physical Activity, Immune System, and the Microbiome in Cardiovascular Disease

Cardiovascular health is a primary research focus, as it is a leading contributor to mortality and morbidity worldwide, and is prohibitively costly for healthcare. Atherosclerosis, the main driver of cardiovascular disease, is now recognized as an inflammatory disorder. Physical activity (PA) may have a more important role in cardiovascular health than previously expected. This review overviews the contribution of PA to cardiovascular health, the inflammatory role of atherosclerosis, and the emerging evidence of the microbiome as a regulator of inflammation.

The Association Between Endurance Training and Heart Rate Variability: The Confounding Role of Heart Rate

Heart rate variability (HRV) is a widely used marker of cardiac autonomic nervous activity (CANA). Changes in HRV with exercise training have often been interpreted as increases in vagal activity. HRV is strongly associated with heart rate, which in turn, is associated with heart size. There is strong evidence from basic studies that lower heart rate in response to exercise training is caused by morphological and electrical remodeling of the heart. In a cross-sectional study in participants of a 10 mile race, we investigated the influence of endurance exercise on HRV parameters independently of heart size and heart rate. One-hundred-and-seventy-two runners (52 females and 120 males) ranging from novice runners with a first participation to an endurance event to highly trained runners, with up to 15 h of training per week, were included in the analysis. R-R intervals were recorded by electrocardiography over 24 h. Left ventricular end diastolic volume indexed to body surface area (LVEDVI) was assessed by transthoracic echocardiography and peak oxygen consumption (VO2peak) by cardiopulmonary exercise testing. Exercise was quantified by VO2peak, training volume, and race performance. HRV was determined during deep sleep. HRV markers of vagal activity were moderately associated with exercise variables (standardized β = 0.28-0.40, all p < 0.01). These associations disappeared when controlling for heart rate and LVEDVI. Due to the intrinsic association between heart rate and HRV, conclusions based on HRV parameters do not necessarily reflect differences in CANA. Based on current evidence, we discourage the use of HRV as a marker of CANA when measuring the effect of chronic exercise.