Exercise and Atrial Fibrillation: The Dose Makes the Poison? A Narrative Review

"All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison" (Paracelsus, ~ 1538 AD). This well-known quote seems to aptly summarize the current understanding of the interaction between exercise and atrial fibrillation (AF). A host of data strongly suggests that regular exercise has a protective effect against developing AF. A small but well-conducted group of trials also demonstrates beneficial effects of exercise in the treatment of AF. Recently, however, potentially detrimental effects of large volumes of high-intensity exercise on the probability of developing AF have moved into the sports-cardiological focus. This effect is well documented for elite athletes; data regarding the general population is less clear. This review presents the current data regarding the protective, therapeutic and potentially risk-enhancing effects of exercise regarding AF. The authors demonstrate that the benefits are clear and strongly outweigh the potential disadvantages.

Cellular Integrative Immune Markers in Elite Athletes

The integrative immune markers neutrophil-lymphocyte-ratio (NLR), platelet-lymphocyte-ratio (PLR) and systemic immune inflammation index (SII) are established markers in clinical patient care. Adoption of these markers in elite athletics might prove beneficial for monitoring training and health. Blood samples of 195 healthy national Olympic squad athletes were collected before a graded bicycle-ergometric exercise test until complete exhaustion. Measurements included white blood cells, lymphocytes and platelets, allowing for the calculation of the integrative immune markers. Correlations between athlete characteristics (sex, age, sporting discipline, training experience, training volume) and integrative immune marker-values were assessed. In a subgroup analysis a second blood sample was collected from 25 athletes at 1 minute after exercise test to assess its effect on the immune marker levels.An inverse correlation between peak power output and SII-level (Pearson correlation coefficient=-.270, p<.001) and NLR-level (Pearson correlation coefficient=-.249, p<.001) was found. Athletes with higher aerobic fitness had significantly lower values of SII and PLR compared to athletes with lower aerobic fitness. An elevated SII (p=.003) and a reduced PLR (p=.001) was documented as acute response to the exercise test. The integrative immune markers might be a promising tool for monitoring training and health in elite athletes.

Sports, Myocarditis and COVID-19: Diagnostics, Prevention and Return-to-Play Strategies

Myocarditis is an umbrella term for non-ischemic myocardial inflammation and remains a leading cause of sudden cardiac death in active individuals and athletes. Accurate diagnosing is challenging and diseases could often remain undetected. In the majority of cases, acute myocarditis resolves favourably. However, a relevant proportion of patients may have an increased risk of prognostically relevant cardiac arrhythmias and/or the development and progression of maladaptive myocardial remodelling (dilated cardiomyopathy). This review provides current knowledge on myocarditis and sports with special regard to the COVID-19 pandemic. Possible causes, common symptoms and proposed diagnostics are summarized. The relevance of temporary avoidance of intensive sports activities for both the prevention and therapy of acute myocarditis is discussed. Risk stratification, specific return-to-play recommendations and proposed follow-up diagnostics (also after COVID-19 infection) are presented.

Evaluation des Gesundheitsverhaltens Studierender

Im Rahmen der Gesundheitsinitiative „Healthy Campus” werden an der Universität Bonn über Online-Befragungen Gesundheits- und Lebensstilparameter der Studierenden evaluiert. Einen zentralen Bestandteil der Befragungen bilden Skalen, die verschiedene gesundheitsbezogene Kompetenzen abbilden. An einer semesterübergreifenden Stichprobe von N = 1 879 Studierenden (67 % Frauen, 33 % Männer) konnte ein in vorangegangenen Studien erarbeitetes Modell der Gesundheitskompetenz erstmals an einer substantiellen studentischen Stichprobe repliziert werden. Zusätzlich konnte anhand eines MIMIC-Modells die Modellgültigkeit sowie die Messäquivalenz für weibliche und männliche Studierende nachgewiesen werden. Darüber hinaus konnten durch das Modell 40 % der Varianz in der Häufigkeit gesundheitlicher Beschwerden vorhergesagt werden. Die Ergebnisse legen nahe, dass neben einer an den Bedürfnissen und Erfordernissen der Studierenden ausgerichteten Modifikation universitärer Angebote eine gezielte Stärkung gesundheitsbezogener Kompetenzen zu einer Verbesserung der psychischen und körperlichen Gesundheit der Studierenden beitragen könnte. Die Erfassung der Gesundheitskompetenz kann daher zur differentiellen Entwicklung individueller Interventionen genutzt werden.