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Zimmerman KA, Hain JA, Graham NSN, Rooney EJ, Lee Y, Del-Giovane M, Parker TD, Friedland D, Cross MJ, Kemp S, Wilson MG, Sylvester RJ, Sharp DJ. Prospective cohort study of long-term neurological outcomes in retired elite athletes: the Advanced BiomaRker, Advanced Imaging and Neurocognitive (BRAIN) Health Study protocol. BMJ Open 2024; 14:e082902. [PMID: 38663922 PMCID: PMC11043776 DOI: 10.1136/bmjopen-2023-082902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Although limited, recent research suggests that contact sport participation might have an adverse long-term effect on brain health. Further work is required to determine whether this includes an increased risk of neurodegenerative disease and/or subsequent changes in cognition and behaviour. The Advanced BiomaRker, Advanced Imaging and Neurocognitive Health Study will prospectively examine the neurological, psychiatric, psychological and general health of retired elite-level rugby union and association football/soccer players. METHODS AND ANALYSIS 400 retired athletes will be recruited (200 rugby union and 200 association football players, male and female). Athletes will undergo a detailed clinical assessment, advanced neuroimaging, blood testing for a range of brain health outcomes and neuropsychological assessment longitudinally. Follow-up assessments will be completed at 2 and 4 years after baseline visit. 60 healthy volunteers will be recruited and undergo an aligned assessment protocol including advanced neuroimaging, blood testing and neuropsychological assessment. We will describe the previous exposure to head injuries across the cohort and investigate relationships between biomarkers of brain injury and clinical outcomes including cognitive performance, clinical diagnoses and psychiatric symptom burden. ETHICS AND DISSEMINATION Relevant ethical approvals have been granted by the Camberwell St Giles Research Ethics Committee (Ref: 17/LO/2066). The study findings will be disseminated through manuscripts in clinical/academic journals, presentations at professional conferences and through participant and stakeholder communications.
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Affiliation(s)
- Karl A Zimmerman
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Jessica A Hain
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Neil S N Graham
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Erin Jane Rooney
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Ying Lee
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Martina Del-Giovane
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Thomas D Parker
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurodegenerative Disease, The Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel Friedland
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Matthew J Cross
- Carnegie Applied Rugby Research Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Premiership Rugby, London, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mathew G Wilson
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- HCA Healthcare Research Institute, London, UK
| | - Richard J Sylvester
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Sharp
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
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Périard JD, Girard O, Townsend N, Bourdon P, Cocking S, Ihsan M, Lacome M, Nichols D, Travers G, Wilson MG, Piscione J, Racinais S. Hematological Adaptations Following a Training Camp in Hot and/or Hypoxic Conditions in Elite Rugby Union Players. Int J Sports Physiol Perform 2023; 18:1053-1061. [PMID: 37553108 DOI: 10.1123/ijspp.2023-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To investigate the effects of a training camp with heat and/or hypoxia sessions on hematological and thermoregulatory adaptations. METHODS Fifty-six elite male rugby players completed a 2-week training camp with 5 endurance and 5 repeated-sprint sessions, rugby practice, and resistance training. Players were separated into 4 groups: CAMP trained in temperate conditions at sea level, HEAT performed the endurance sessions in the heat, ALTI slept and performed the repeated sprints at altitude, and H + A was a combination of the heat and altitude groups. RESULTS Blood volume across all groups increased by 140 mL (95%CI, 42-237; P = .006) and plasma volume by 97 mL (95%CI 28-167; P = .007) following the training camp. Plasma volume was 6.3% (0.3% to 12.4%) higher in HEAT than ALTI (P = .034) and slightly higher in HEAT than H + A (5.6% [-0.3% to 11.7%]; P = .076). Changes in hemoglobin mass were not significant (P = .176), despite a ∼1.2% increase in ALTI and H + A and a ∼0.7% decrease in CAMP and HEAT. Peak rectal temperature was lower during a postcamp heat-response test in HEAT (0.3 °C [0.1-0.5]; P = .010) and H + A (0.3 °C [0.1-0.6]; P = .005). Oxygen saturation upon waking was lower in ALTI (3% [2% to 5%]; P < .001) and H + A (4% [3% to 6%]; P < .001) than CAMP and HEAT. CONCLUSION Although blood and plasma volume increased following the camp, sleeping at altitude impeded the increase when training in the heat and only marginally increased hemoglobin mass. Heat training induced adaptations commensurate with partial heat acclimation; however, combining heat training and altitude training and confinement during a training camp did not confer concomitant hematological adaptations.
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Affiliation(s)
- Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT,Australia
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
| | - Olivier Girard
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA,Australia
| | - Nathan Townsend
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha,Qatar
| | - Pitre Bourdon
- Department of Sport Science, ASPIRE, Academy for Sports Excellence, Doha,Qatar
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA,Australia
| | - Scott Cocking
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- Department of Sport Science, ASPIRE, Academy for Sports Excellence, Doha,Qatar
| | - Mohammed Ihsan
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
| | - Mathieu Lacome
- Department of Research, Sport Laboratory, Expertise and Performance, French Institute of Sports (INSEP), Paris,France
- Department of Performance and Analytics, Parma Calcio, Parma,Italy
| | - David Nichols
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
| | - Gavin Travers
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- Space Medicine Team, European Astronaut Center, Köln,Germany
| | - Mathew G Wilson
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- Institute of Sport, Exercise and Health, University College London, London,United Kingdom
| | - Julien Piscione
- Department of Research, Sport Laboratory, Expertise and Performance, French Institute of Sports (INSEP), Paris,France
| | - Sebastien Racinais
- Department of Research and Scientific Support, Aspetar Orthopedic and Sports Medicine Hospital, Doha,Qatar
- Department of Research, Sport Laboratory, Expertise and Performance, French Institute of Sports (INSEP), Paris,France
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Read PJ, Davies WT, Bishop C, McAuliffe S, Wilson MG, Turner AN. Residual Deficits in Reactive Strength After Anterior Cruciate Ligament Reconstruction in Soccer Players. J Athl Train 2023; 58:423-429. [PMID: 37523420 DOI: 10.4085/0169-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
CONTEXT Deficits in plyometric abilities are common after anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. OBJECTIVE To examine the utility of a vertical hop test for assessing function after ACLR and establishing factors associated with performance. DESIGN Cross-sectional study. SETTING Rehabilitation program. PATIENTS OR OTHER PARTICIPANTS Soccer players with a history of ACLR (n = 73) and matched control individuals (n = 195). MAIN OUTCOME MEASURE(S) The 10-second vertical hop test provided measures of jump height, the Reactive Strength Index (RSI), and asymmetry. We also examined possible predictors of hop performance, including single-legged vertical drop jump, isokinetic knee-extension strength, and the International Knee Documentation Committee questionnaire score. RESULTS Between-limbs differences were identified only for the ACLR group, and asymmetry scores increased in those with a history of ACLR (P < .001) compared with the control group. The single-legged vertical drop jump, RSI, and knee-extension torque were significant predictors of 10-second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). CONCLUSIONS Vertical hop deficits were present after ACLR, even after participants completed a comprehensive rehabilitation program. This may have been due to reduced knee-extension and reactive strength. Vertical hop tests warrant inclusion as part of the return-to-sport test battery.
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Affiliation(s)
- Paul J Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Haddad FS, Paton BM, Plastow R, Wilson MG. Basics must improve to reduce the burden of hamstring muscle injuries. Br J Sports Med 2023; 57:252-253. [PMID: 36759139 DOI: 10.1136/bjsports-2021-105387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Fares S Haddad
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK
| | - Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Orthopaedics, Princess Grace Hospital, London, UK
| | - Mathew G Wilson
- Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK.,Princess Grace Hospital, London, UK
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Riding NR, Dorobantu DM, Williams CA, Stuart G, Fritsch P, Wilson MG, Mossialos E, Pieles G. Protecting the stars of tomorrow: do international cardiovascular preparticipation screening policies account for the paediatric athlete? A systematic review and quality appraisal. Br J Sports Med 2023; 57:371-380. [PMID: 36332982 DOI: 10.1136/bjsports-2022-105659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. DESIGN Systematic review and quality appraisal of policy documents. DATA SOURCES A systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES An article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening. RESULTS AND SUMMARY Of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12-18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%). CONCLUSION Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.
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Affiliation(s)
- Nathan R Riding
- Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Sport and Exercise Health (ISEH), University College London, London, UK
| | - Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
| | - Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK.,National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | | | - Mathew G Wilson
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK.,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Guido Pieles
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK .,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Paton BM, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Pollock N, Read P, Stirling B, Tulloch L, van Dyk N, Wilson MG, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 1: classification. Br J Sports Med 2023; 57:254-265. [PMID: 36650035 DOI: 10.1136/bjsports-2021-105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ricci Plastow
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health, University College London, London, UK.,British Athletics, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Goucester, Gloucester, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Princess Grace Hospital, London, UK
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7
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Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med 2023; 57:278-291. [PMID: 36650032 DOI: 10.1136/bjsports-2021-105384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,British Athletics, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers Football Club, Blackburn, UK
| | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Murphy
- Medical Services, Arsenal Football Club, London, UK
| | - Ricci Plastow
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK.,Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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8
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McClean G, Wilson MG, Riding NR, Pieles G, Watt V, Adamuz C, Shaw A, Harkness A, Johnson A, George KP, Oxborough D. A New Tool to Aid the Differential Diagnosis of Physiological Remodelling from Cardiac Pathology When Assessing Left Ventricle, Left Atrial and Aortic Structure and Function in Male Arab and Black Paediatric Athletes. J Cardiovasc Dev Dis 2023; 10:jcdd10020037. [PMID: 36826533 PMCID: PMC9963999 DOI: 10.3390/jcdd10020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/24/2023] Open
Abstract
Aim: To determine if published Z-scores for left ventricular (LV), left atrial (LA) and aortic structure as well as indices of LV function (Doppler and TDI) in paediatric athletes and non-athletes are appropriate for application in male Arab and black paediatric athletes. If inappropriate, we aim to provide new nomograms and Z-scores for clinical application. Methods: 417 (297 Arab, 120 black) male paediatric (11-18 years) athletes, were evaluated by 2D echocardiography as per British Society of Echocardiography recommendations, and biological age (by radiological X-ray) assessment. Z-scores were tested by residual and correlation analysis together with visual inspection. New Z-scores involved allometric (a*BSA(b+c*chronological age)) and second-order polynomial (y=a*chronological age2+b*chronological age+c) equations for measures of cardiac size and indices of LV function, respectively. Results: Residual linear regression, correlation analysis and visual inspection revealed published z-scores in white peri-pubertal footballers and paediatric non-athletes to be inappropriate for application in male Arab and black paediatric athletes. Residual linear regression revealed new Z-scores for measures of LV, LA and aortic root size to be independent of BSA, ethnicity, chronological and biological age. Residual linear regression revealed new Z-scores for measures of function to be independent of chronological age. Conclusion: Our new z-scores may aid differential diagnosis of suspected pathology versus physiology remodelling, in cardiac screening of the Arab and black paediatric athlete. Nomograms are provided to assist the tracking of the paediatric athlete necessitating annual follow-up and Excel z-score calculation to facilitate use in day-to-day practice.
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Affiliation(s)
- Gavin McClean
- Echocardiography Laboratory, St Bartholomew’s Hospital, Barts Health NHS, London EC1A 7BE, UK
- Echocardiography Laboratory, University College London Hospital, London NW1 2BU, UK
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Mathew G. Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
| | - Nathan R. Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
- Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Guido Pieles
- Institute of Sport Exercise and Health (ISEH), University College London, London 1T 7HA, UK
- Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8ED, UK
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Victoria Watt
- Wythenshawe Hospital, Manchester University NHS Foundation Trust (MFT), Manchester M23 9LT, UK
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Anthony Shaw
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 23833, Qatar
| | - Allan Harkness
- Colchester Hospital National Health Service Trust, Colchester CO4 5JL, UK
| | - Amanda Johnson
- Health Sciences Department, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Keith P. George
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
- Correspondence:
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9
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Périard JD, Wilson MG, Tebeck ST, Gilmore JB, Stanley J, Girard O. Influence of the Thermal Environment on Work Rate and Physiological Strain during a UCI World Tour Multistage Cycling Race. Med Sci Sports Exerc 2023; 55:32-45. [PMID: 35975926 DOI: 10.1249/mss.0000000000003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to characterize the thermal and cardiovascular strain of professional cyclists during the 2019 Tour Down Under and determine the associations between thermal indices and power output, and physiological strain. METHODS Gastrointestinal temperature ( Tgi ), heart rate (HR), and power output were recorded during the six stages (129-151.5 km) of the Tour Down Under in ≤22 male participants. Thermal indices included dry-bulb, black-globe, wet-bulb, and wet-bulb-globe (WBGT) temperature; relative humidity (RH), Heat Index; Humidex; and universal thermal climate index. The heat stress index (HSI), which reflects human heat strain, was also calculated. RESULTS Dry-bulb temperature was 23°C-37°C, and RH was 18%-72% (WBGT: 21°C-29°C). Mean Tgi was 38.2°C-38.5°C, and mean peak Tgi was 38.9°C-39.4°C, both highest values recorded during stage 3 (WBGT: 27°C). Peak individual Tgi was ≥40.0°C in three stages and ≥39.5°C in 14%-33% of cyclists in five stages. Mean HR was 131-147 bpm (68%-77% of peak), with the highest mean recorded in stage 3 ( P ≤ 0.005). Mean power output was 180-249 W, with the highest mean recorded during stage 4 ( P < 0.001; 21°C WBGT). The thermal indices most strongly correlated with power output were black-globe temperature ( r = -0.778), RH ( r = 0.768), universal thermal climate index ( r = -0.762), and WBGT ( r = -0.745; all P < 0.001). Mean Tgi was correlated with wet-bulb temperature ( r = 0.495), HSI ( r = 0.464), and Humidex ( r = 0.314; all P < 0.05), whereas mean HR was most strongly correlated with HSI ( r = 0.720), along with Tgi ( r = 0.599) and power output ( r = 0.539; all P < 0.05). CONCLUSIONS Peak Tgi reached 40.0°C in some cyclists, although most remained <39.5°C with an HR of ~73% of peak. Power output was correlated with several thermal indices, primarily influenced by temperature, whereas Tgi and HR were associated with the HSI, which has potential for sport-specific heat policy development.
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Affiliation(s)
- Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, AUSTRALIA
| | | | | | | | | | - Olivier Girard
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA, AUSTRALIA
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10
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Farley T, Barry E, Sylvester R, Medici AD, Wilson MG. Poor isometric neck extension strength as a risk factor for concussion in male professional Rugby Union players. Br J Sports Med 2022; 56:616-621. [PMID: 35197247 DOI: 10.1136/bjsports-2021-104414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Concussion is one of the highest burden injuries within professional Rugby Union ('rugby') and comes with a high health and financial cost to players and teams. Limited evidence exists as to the existence of modifiable intrinsic risk factors for concussion, leaving athletes and clinicians with few options when developing prevention strategies. OBJECTIVE To investigate whether neck strength is significantly associated with concussion incidence in professional male rugby players. METHODS 225 rugby players were assessed for neck strength at three time points throughout the 2018/2019 season using a method of isometric contraction. Associations with clinically diagnosed concussion injuries are presented as incidence rate ratios (IRRs) with 95% CIs. RESULTS Thirty concussions occurred in 29 players during the study period; a rate of 13.7 concussions per 1000 hours played. Greater neck strength was observed at mid and end of season time points versus preseason across the study population. There was a significant association between extension strength and concussion; a 10% increase for extension strength was associated with a 13% reduction in concussion rate (adjusted IRR (95% CI) 0.87 (0.78 to 0.98). No other significant associations were observed between concussion incidence and any other unique neck strength range or composite score. CONCLUSION Higher neck extension strength is associated with lower concussion rates in male rugby players. Neck strength is a modifiable intrinsic risk factor for concussion and may be an important component of a strength and conditioning regime.
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Affiliation(s)
- Theo Farley
- Division of Surgery and Interventional Science, University College London, London, UK .,Institute of Sport, Exercise and Health (ISEH), University College London, London, London, UK
| | - Ed Barry
- Georgia Rugby Federation, Tbilisi, Georgia
| | - Richard Sylvester
- Institute of Sport, Exercise and Health (ISEH), University College London, London, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - Akbar De Medici
- Institute of Sport, Exercise and Health (ISEH), University College London, London, London, UK
| | - Mathew G Wilson
- Division of Surgery and Interventional Science, University College London, London, UK.,Institute of Sport, Exercise and Health (ISEH), University College London, London, London, UK
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11
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Racinais S, Havenith G, Aylwin P, Ihsan M, Taylor L, Adami PE, Adamuz MC, Alhammoud M, Alonso JM, Bouscaren N, Buitrago S, Cardinale M, van Dyk N, Esh CJ, Gomez-Ezeiza J, Garrandes F, Holtzhausen L, Labidi M, Lange G, Lloyd A, Moussay S, Mtibaa K, Townsend N, Wilson MG, Bermon S. Association between thermal responses, medical events, performance, heat acclimation and health status in male and female elite athletes during the 2019 Doha World Athletics Championships. Br J Sports Med 2022; 56:439-445. [PMID: 35165084 PMCID: PMC8995810 DOI: 10.1136/bjsports-2021-104569] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
Purpose To determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions. Methods From 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (Tcore; ingestible pill) and skin (Tskin; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (% personal best) and did not finish (DNF) were extracted from official results. Results Peak Tcore during competition reached 39.6°C±0.6°C (maximum 41.1°C). Tskin decreased from 32.2°C±1.3°C to 31.0°C±1.4°C during the races (p<0.001). Tcore was not related to DNF (25% of starters) or medical events (p≥0.150), whereas Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were (p≤0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9% of athletes) increasing the risk of in-race medical events (71% vs 17%, p<0.001). Athletes (63%) who performed 5–30 days heat acclimation before the competition: ranked better (18±13 vs 28±13, p=0.009), displayed a lower peak Tcore (39.4°C±0.4°C vs 39.8°C±0.7°C, p=0.044) and larger in-race decrease in Tskin (−1.4°C±1.0°C vs −0.9°C±1.2°C, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19% vs 30%, p=0.273) and medical events (19% vs 32%, p=0.179). Conclusion Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events.
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Affiliation(s)
- Sebastien Racinais
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leics, UK
| | - Polly Aylwin
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leics, UK
| | - Mohammed Ihsan
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lee Taylor
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Human Performance Research Centre, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paolo Emilio Adami
- Health and Science, World Athletics, Monaco.,LAMHESS, Université Côte d'Azur, Nice, France
| | - Maria-Carmen Adamuz
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Marine Alhammoud
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Juan Manuel Alonso
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Nicolas Bouscaren
- Inserm CIC1410, CHU Reunion, La Réunion, Réunion.,Interuniversity Laboratory of Human Movement Biology-EA 7424, Université Jean Monnet Saint-Etienne, Saint-Etienne, France
| | | | - Marco Cardinale
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Nicol van Dyk
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Chris J Esh
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,School of Sport Exercise and Health Sciences, Loughborough, UK
| | - Josu Gomez-Ezeiza
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Frederic Garrandes
- Health and Science, World Athletics, Monaco.,LAMHESS, Université Côte d'Azur, Nice, France
| | - Louis Holtzhausen
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Mariem Labidi
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | | | - Alexander Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leics, UK
| | - Sebastien Moussay
- Unicaen, Inserm, Comete, GIP Cyceron, Normandie Universite, Caen, France
| | - Khouloud Mtibaa
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - Nathan Townsend
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Mathew G Wilson
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar.,Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Stephane Bermon
- Health and Science, World Athletics, Monaco.,LAMHESS, Université Côte d'Azur, Nice, France
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12
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Farooq A, Basterfield L, Adamson AJ, Pearce MS, Hughes AR, Janssen X, Wilson MG, Reilly JJ. Moderate-To-Vigorous Intensity Physical Activity and Sedentary Behaviour across Childhood and Adolescence, and Their Combined Relationship with Obesity Risk: A Multi-Trajectory Analysis. Int J Environ Res Public Health 2021; 18:7421. [PMID: 34299872 PMCID: PMC8305282 DOI: 10.3390/ijerph18147421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 01/17/2023]
Abstract
The combined role of objectively assessed moderate-vigorous intensity physical activity (MVPA) and sedentary behaviour (SB) is unclear in obesity prevention. This study aimed to identify latent groups for MVPA and SB trajectories from childhood to adolescence and examine their relationship with obesity risk at adolescence. From the Gateshead Millennium Study, accelerometer-based trajectories of time spent in MVPA and SB at ages 7, 9, 12, and 15 were derived as assigned as the predictor variable. Fat mass index (FMI), using bioelectrical impedance at age 15, was the outcome variable. From 672 children recruited, we identified three distinct multiple trajectory groups for time spent in MVPA and SB. The group with majority membership (54% of the cohort) had high MVPA and low SB at childhood, but MVPA declined and SB increased by age 15. One third of the cohort (31%) belonged to the trajectory with low MVPA and high time spent sedentary throughout. The third trajectory group (15% of the cohort) that had relatively high MVPA and relatively low SB throughout had lower FMI (-1.7, 95% CI (-3.4 to -1.0) kg/m2, p = 0.034) at age 15 compared to the inactive throughout group. High MVPA and low SB trajectories when combined are protective against obesity.
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Affiliation(s)
- Abdulaziz Farooq
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1QE, UK; (A.R.H.); (X.J.); (J.J.R.)
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha 29992, Qatar
| | - Laura Basterfield
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (L.B.); (A.J.A.); (M.S.P.)
| | - Ashley J. Adamson
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (L.B.); (A.J.A.); (M.S.P.)
- Human Nutrition Research Centre, Newcastle University, Newcastle NE4 5PL, UK
| | - Mark S. Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (L.B.); (A.J.A.); (M.S.P.)
| | - Adrienne R. Hughes
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1QE, UK; (A.R.H.); (X.J.); (J.J.R.)
| | - Xanne Janssen
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1QE, UK; (A.R.H.); (X.J.); (J.J.R.)
| | - Mathew G. Wilson
- Institute for Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK;
| | - John J. Reilly
- Physical Activity for Health Group, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1QE, UK; (A.R.H.); (X.J.); (J.J.R.)
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13
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Thomson A, Whiteley R, Hansen C, Welzel J, Racinais S, Wilson MG. Effect of speed and gradient on plantar force when running on an AlterG® treadmill. BMC Sports Sci Med Rehabil 2021; 13:34. [PMID: 33785050 PMCID: PMC8011121 DOI: 10.1186/s13102-021-00258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anti-gravity treadmills are used to decrease musculoskeletal loading during treadmill running often in return to play rehabilitation programs. The effect different gradients (uphill/downhill running) have on kinetics and spatiotemporal parameters when using an AlterG® treadmill is unclear with previous research focused on level running only. METHODS Ten well-trained healthy male running athletes ran on the AlterG® treadmill at varying combinations of bodyweight support (60, 80, and 100% BW), speed (12 km/hr., 15 km/hr., 18 km/hr., 21 km/hr., and 24 km/hr), and gradients (- 15% decline, - 10, - 5, 0, + 5, + 10 + 15% incline), representing a total of 78 conditions performed in random order. Maximum plantar force and contact time were recorded using a wireless in-shoe force sensor insole system. RESULTS Regression analysis showed a linear relationship for maximum plantar force with bodyweight support and running speeds for level running (p < 0.0001, adj. R2 = 0.604). The linear relationship, however, does not hold for negative gradients at speeds 12 & 15 km/h, with a relative 'dip' in maximum plantar force across all assisted bodyweight settings. CONCLUSIONS Maximum plantar force peaks are larger with faster running and smaller with more AlterG® assisted bodyweight support (athlete unweighing). Gradient made little difference except for a downhill grade of - 5% decreasing force peaks as compared to level or uphill running.
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Affiliation(s)
- Athol Thomson
- Aspetar Orthopaedic & Sports Medicine Hospital, PO Box 29222, Doha, Qatar. .,Discipline of Podiatry, School of Allied health, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Rodney Whiteley
- Aspetar Orthopaedic & Sports Medicine Hospital, PO Box 29222, Doha, Qatar
| | - Clint Hansen
- Kiel University Department of Neurology, UKSH campus, 24105, Kiel, Germany
| | - Julius Welzel
- Kiel University Department of Neurology, UKSH campus, 24105, Kiel, Germany
| | - Sebastien Racinais
- Aspetar Orthopaedic & Sports Medicine Hospital, PO Box 29222, Doha, Qatar
| | - Mathew G Wilson
- Institute of Sport, Exercise and Health, University College London, London, UK
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14
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Racinais S, Ihsan M, Taylor L, Cardinale M, Adami PE, Alonso JM, Bouscaren N, Buitrago S, Esh CJ, Gomez-Ezeiza J, Garrandes F, Havenith G, Labidi M, Lange G, Lloyd A, Moussay S, Mtibaa K, Townsend N, Wilson MG, Bermon S. Hydration and cooling in elite athletes: relationship with performance, body mass loss and body temperatures during the Doha 2019 IAAF World Athletics Championships. Br J Sports Med 2021; 55:1335-1341. [PMID: 33579722 PMCID: PMC8606454 DOI: 10.1136/bjsports-2020-103613] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
Purpose To characterise hydration, cooling, body mass loss, and core (Tcore) and skin (Tsk) temperatures during World Athletics Championships in hot-humid conditions. Methods Marathon and race-walk (20 km and 50 km) athletes (n=83, 36 women) completed a pre-race questionnaire. Pre-race and post-race body weight (n=74), Tcore (n=56) and Tsk (n=49; thermography) were measured. Results Most athletes (93%) had a pre-planned drinking strategy (electrolytes (83%), carbohydrates (81%)) while ice slurry was less common (11%; p<0.001). More men than women relied on electrolytes and carbohydrates (91%–93% vs 67%–72%, p≤0.029). Drinking strategies were based on personal experience (91%) rather than external sources (p<0.001). Most athletes (80%) planned pre-cooling (ice vests (53%), cold towels (45%), neck collars (21%) and ice slurry (21%)) and/or mid-cooling (93%; head/face dousing (65%) and cold water ingestion (52%)). Menthol usage was negligible (1%–2%). Pre-race Tcore was lower in athletes using ice vests (37.5°C±0.4°C vs 37.8°C±0.3°C, p=0.024). Tcore (pre-race 37.7°C±0.3°C, post-race 39.6°C±0.6°C) was independent of event, ranking or performance (p≥0.225). Pre-race Tsk was correlated with faster race completion (r=0.32, p=0.046) and was higher in non-finishers (did not finish (DNF); 33.8°C±0.9°C vs 32.6°C±1.4°C, p=0.017). Body mass loss was higher in men than women (−2.8±1.5% vs −1.3±1.6%, p<0.001), although not associated with performance. Conclusion Most athletes’ hydration strategies were pre-planned based on personal experience. Ice vests were the most adopted pre-cooling strategy and the only one minimising Tcore, suggesting that event organisers should be cognisant of logistics (ie, freezers). Dehydration was moderate and unrelated to performance. Pre-race Tsk was related to performance and DNF, suggesting that Tsk modulation should be incorporated into pre-race strategies.
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Affiliation(s)
- Sebastien Racinais
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Mohammed Ihsan
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- Human Potential Translational Research Program, NUS Yong Loo Lin School of Medicine, Singapore
| | - Lee Taylor
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Human Performance Research Centre, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Marco Cardinale
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | | | - Juan Manuel Alonso
- Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | | | | | - Chris J Esh
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Josu Gomez-Ezeiza
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | | | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leics, UK
| | - Mariem Labidi
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Gunter Lange
- Health and Science Department, World Athletics, Monaco
| | - Alexander Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leics, UK
| | - Sebastien Moussay
- Normandie Univ, UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, Caen, Normandie, France
| | - Khouloud Mtibaa
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - Nathan Townsend
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Ad Dawhah, Qatar
| | - Mathew G Wilson
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Stephane Bermon
- Health and Science Department, World Athletics, Monaco
- Human Motricity Laboratory Expertise Sport Health, Cote d'Azur University, Nice, Provence-Alpes-Côte d'Azu, France
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15
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Whiteley R, Hansen C, Thomson A, Sideris V, Wilson MG. Lower limb EMG activation during reduced gravity running on an incline. Speed matters more than hills irrespective of indicated bodyweight. Gait Posture 2021; 83:52-59. [PMID: 33075719 DOI: 10.1016/j.gaitpost.2020.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Progressive loading of the lower limb muscles during running on a positive pressure or reduced gravity (Alter-G™) treadmill is suggested as a rehabilitation strategy after muscle and tendon injury but the influence of running up or downhill and at higher speeds is not known, nor are the interaction effects of speed, inclination, and indicated bodyweight. RESEARCH QUESTION What are the lower limb EMG activation levels and cadence when running up and downhill in normal and reduced gravity? METHODS 10 recreationally active male athletes ran on a positive-pressure Alter-G™ treadmill at: 3 indicated bodyweights (60 %, 80 %, and 100 %); 5 speeds (12, 15, 18, 21, and 24 km/h); for incline, decline, and flat conditions (-15 %, -10 %, -5%, 0%, 5%, 10 %, and 15 %); while monitoring the surface EMG of 11 leg muscles as well as cadence (strides per minute). RESULTS AND SIGNIFICANCE Linear mixed models showed significant effect of running speed, inclination, and indicated bodyweight, with interaction effects observed. Increasing running speed was associated with the largest change in activity, with smaller effects for increasing bodyweight and inclination. Downhill running was associated with reduced activity in all muscle groups, and more tightly clustered activity patterns independent of speed. Substantial variation in sEMG activity occurred in the flat and uphill conditions. Subject responses were quite variable for sEMG, less so for cadence. For the conditions examined, increasing running speed induced the largest changes in EMG of all muscles examined with smaller changes seen for manipulations of inclination and bodyweight.
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Affiliation(s)
- Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar.
| | - Clint Hansen
- Neurogeriatrics Kiel, Kiel University, Department of Neurology, UKSH Campus Kiel, Kiel, Germany
| | - Athol Thomson
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar
| | - Vasileios Sideris
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Rehabilitation Department, Doha, Qatar; Institute of Sport, Exercise and Health, University College London, London, United Kingdom
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16
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Read PJ, Davies WT, Bishop C, Mc Auliffe S, Wilson MG, Turner AN. Residual deficits in reactive strength indicate incomplete restoration of athletic qualities following anterior cruciate ligament reconstruction in professional soccer players. J Athl Train 2020:446981. [PMID: 33150442 DOI: 10.4085/169-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Deficits in plyometric abilities are common following anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. OBJECTIVE Examine the utility of a vertical hop test to assess function following ACLR and establish factors associated with performance. DESIGN Cross-sectional Setting: Rehabilitation Participants: Soccer players with a history of ACLR (N = 73) and matched controls (N = 195) Main outcome measures: 10 second vertical hop test including measures of jump height, reactive strength index (RSI) and asymmetry. We also examined possible predictors of hop performance including single leg vertical drop jump (SLDVJ), isokinetic knee extension strength, and the international knee documentation committee questionnaire. RESULTS Significant between-limb differences were identified for the ACLR group only and asymmetry scores increased in those with a history of ACLR (P < 0.001) compared to controls. SLDVJ RSI and knee extension torque were significant predictors of 10 second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). CONCLUSIONS Vertical hop deficits are present following ACLR even after completing a comprehensive rehabilitation program. This may be due to reduced knee extension and reactive strength. Vertical hop tests warrant inclusion as part of return to sport test battery.
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Affiliation(s)
- Paul J Read
- 1. Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
- 2. University of Gloucestershire, Gloucester, UK
| | - William T Davies
- 1. Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
| | - Chris Bishop
- 3. London Sports Institute, Middlesex University, London, UK
| | - Sean Mc Auliffe
- 1. Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
- 4. Qatar University, Physiotherapy Program, Qatar University, Doha, Qatar
| | - Mathew G Wilson
- 1. Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar
- 3. London Sports Institute, Middlesex University, London, UK
- 5. Institute of Sport, Exercise and Health, University College London, London, UK
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17
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Wilson MG, Hull JH, Rogers J, Pollock N, Dodd M, Haines J, Harris S, Loosemore M, Malhotra A, Pieles G, Shah A, Taylor L, Vyas A, Haddad FS, Sharma S. Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians. Br J Sports Med 2020; 54:1157-1161. [PMID: 32878870 PMCID: PMC7513247 DOI: 10.1136/bjsports-2020-102710] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.
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Affiliation(s)
- Mathew G Wilson
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK .,The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom
| | - James H Hull
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,English Institute of Sport, London, United Kingdom
| | - John Rogers
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Noel Pollock
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,British Athletics, London, United Kingdom
| | - Miranda Dodd
- The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom
| | - Jemma Haines
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,NIHR Manchester BRC and University of Manchester, Manchester, United Kingdom
| | - Sally Harris
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Mike Loosemore
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,English Institute of Sport, London, United Kingdom
| | - Aneil Malhotra
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Department of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
| | - Guido Pieles
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | - Anand Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Department of Infectious Diseases Epidemiology, Imperial College London, London, United Kingdom
| | - Lesley Taylor
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,The Wilmslow Hospital (HCAHealthcareUK), Wilmslow, United Kingdom
| | - Aashish Vyas
- Manchester Institute of Health & Performance (MHIP), Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Lancashire Teaching Hospitals Trust, Lancashire, United Kingdom
| | - Fares S Haddad
- Institute for Sport Exercise and Health (ISEH), University College Hospital London, London, UK.,The Princess Grace Hospital (HCA Healthcare UK), London, United Kingdom.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, London, United Kingdom
| | - Sanjay Sharma
- St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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18
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Read P, Mc Auliffe S, Wilson MG, Myer GD. Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review. Br J Sports Med 2020; 55:23-29. [PMID: 32522734 PMCID: PMC7788201 DOI: 10.1136/bjsports-2019-101245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Background/aim There is a lack of consistency in return to sport (RTS) assessments, in particular hop tests to predict who will sustain a reinjury following anterior cruciate ligament (ACL) reconstruction. Inconsistent test battery content and methodological heterogeneity might contribute to variable associations between hop test performance and subsequent injury. Our aim was to investigate whether commonly used hop tests are administered in a consistent manner and in accordance with reported guidelines. Methods We conducted a narrative review of studies that examined whether hop testing could differentiate RTS pass rates, reinjury and rerupture in athletes after ACL reconstruction. Our specific focus was on the methodological procedures of hop testing as this component is widely used to evaluate patients’ function and readiness to RTS. Main findings Substantial variation exists in RTS hop test administration, scoring and interpretation. Authors often failed to report important details of methods such as warm up activities, randomisation, number of trials, rest periods and landing requirements. Conclusion We recommend researchers provide clearer descriptions of how hop tests are performed to increase standardisation and promote accurate data collection. Absence of reporting to describe test methods and using different test procedures makes it difficult to compare study findings.
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Affiliation(s)
- Paul Read
- Research Department, Aspetar Orthopeadic and Sports Medicine Hospital, Doha, Qatar .,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy and Rehabilitation Sciences, Qatar University, Doha, Qatar
| | - Mathew G Wilson
- Research Department, Aspetar Orthopeadic and Sports Medicine Hospital, Doha, Qatar.,Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics and Orthopaedic Surgery, College of Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Boston, MA, USA
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19
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Read PJ, Michael Auliffe S, Wilson MG, Graham-Smith P. Lower Limb Kinetic Asymmetries in Professional Soccer Players With and Without Anterior Cruciate Ligament Reconstruction: Nine Months Is Not Enough Time to Restore "Functional" Symmetry or Return to Performance. Am J Sports Med 2020; 48:1365-1373. [PMID: 32293904 DOI: 10.1177/0363546520912218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Residual between-limb deficits are a possible contributing factor to poor outcomes in athletic populations after anterior cruciate ligament reconstruction (ACLR). Comprehensive appraisals of movement strategies utilized by athletes at key clinical milestones during rehabilitation are warranted. PURPOSE To examine kinetic parameters recorded during a countermovement jump with a force platform in healthy professional soccer players and to compare their performance with those who had undergone ACLR at different stages of their rehabilitation. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 370 male professional soccer players attended a physical screening assessment where they performed at counter jump movement protocol on dual force plates and were divided into 4 groups: group 1 (<6 months post-ACLR), group 2 (6-9 months post-ACLR), group 3 (>9 months post-ACLR), and group 4 (healthy matched controls). RESULTS Players in the later phases of rehabilitation increased their jump performance; however, values were significantly lower than those of healthy matched controls (P > .05). Significant between-limb differences were present for both eccentric- and concentric-phase variables (P < .05), with effect sizes ranging from moderate to very large (d = 0.42-1.35). Asymmetries were lower in players who were further away from surgery; however, between-limb differences remained significantly greater in players >9 months after ACLR versus matched controls-specifically, for concentric impulse, concentric peak force, eccentric deceleration impulse, and eccentric deceleration rate of force development asymmetry (P < .05). Logistic regression identified concentric impulse asymmetry as being most strongly associated with a history of ACLR when group prediction analysis was performed (ACLR group 1, 2, or 3 vs matched controls), with odds ratios ranging from 1.50 to 1.91. CONCLUSION Between-limb deficits in key eccentric and concentric loading parameters remain >9 months after ACLR, indicating a compensatory offloading strategy to protect the involved limb during an athletic performance task. Concentric impulse asymmetry could be considered an important variable to monitor during rehabilitation.
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Affiliation(s)
- Paul J Read
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Sport and Exercise Sciences, University of Gloucestershire, Gloucester, UK
| | | | - Mathew G Wilson
- Institute of Sport Exercise and Health, London, UK.,University College London, London, UK
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20
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Cocking S, Ihsan M, Jones H, Hansen C, Timothy Cable N, Thijssen DHJ, Wilson MG. Repeated sprint cycling performance is not enhanced by ischaemic preconditioning or muscle heating strategies. Eur J Sport Sci 2020; 21:166-175. [PMID: 32223385 DOI: 10.1080/17461391.2020.1749312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Both ischaemic preconditioning (IPC) and muscle heat maintenance can be effective in enhancing repeated-sprint performance (RSA) when applied individually, acting mechanisms of these interventions, however, likely differ. It is unclear if, when combined, these interventions could further improve RSA. Methods: Eleven trained cyclists undertook experimental test sessions, whereby IPC (4 × 5-min at 220 mmHg) and SHAM (4 × 5-min at 20 mmHg) were each performed on two separate visits, each combined with either passive muscle heating or thermoneutral insulation prior to an "all-out" repeated-sprint task (10 × 6-s sprints with 24-s recovery). Primary outcome measures were peak and average power output (W), whist secondary measures were muscular activation and muscular oxygenation, measured via Electromyography (EMG) and Near-infrared spectroscopy (NIRS), respectively. Results: IPC did not enhance peak [6 (-14-26)W; P = 0.62] or average [12 (-7-31)W; P = 0.28] power output versus SHAM. Additionally, no performance benefits were observed when increasing muscle temperature in combination with IPC [5 (-14-19) watts; P = 0.67], or in isolation to IPC [9 (-9-28)W; P = 0.4] versus SHAM. No changes in EMG or microvascular changes were present (P > 0.05, respectively) between conditions. Conclusion: Overall, neither IPC, muscle heating, or a combination of both enhances RSA cycling performance in trained individuals.
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Affiliation(s)
- Scott Cocking
- Department of Sport Science, Aspire Academy, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Mohammed Ihsan
- Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Helen Jones
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - N Timothy Cable
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.,Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mathew G Wilson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.,Research and Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Institute of Sport, Exercise and Health, University College London, London, UK
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21
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Farooq A, Martin A, Janssen X, Wilson MG, Gibson AM, Hughes A, Reilly JJ. Longitudinal changes in moderate-to-vigorous-intensity physical activity in children and adolescents: A systematic review and meta-analysis. Obes Rev 2020; 21:e12953. [PMID: 31646739 PMCID: PMC6916562 DOI: 10.1111/obr.12953] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/08/2019] [Accepted: 09/08/2019] [Indexed: 01/22/2023]
Abstract
Moderate-to-vigorous-intensity physical activity (MVPA) is important for childhood obesity prevention and treatment, yet declines with age. Timing and magnitude of the decline in MVPA in children and adolescents are unclear but important for informing effective obesity intervention development. This systematic review aimed to determine and compare the year-to-year changes in MVPA among children and adolescents. Longitudinal studies were identified by searching 10 relevant databases up to December 2018. Studies were eligible for inclusion if they reported accelerometer-assessed MVPA (min day-1 ) separately for boys and girls and had follow-up duration of at least 1 year. After screening 9,232 studies, 52 were included representing 22,091 aged 3 to 18 year olds (boys=8,857; girls=13,234). Pooled-analysis of the relative change in MVPA per year showed a decline of -3.4% (95% CI, -5.9 to -0.9) in boys and -5.3% (95% CI, -7.6 to -3.1) in girls, across all age groups. There were notable declines in MVPA at age 9 for both boys (-7.8%, 95% CI, -11.2 to -4.4) and girls (-10.2%, 95% CI, -14.2 to -6.3). The relative decline in MVPA affects both sexes from an early age; however, it is greater among girls. Interventions to promote MVPA should start before adolescence.
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Affiliation(s)
- Abdulaziz Farooq
- Research and Scientific Support Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Psychological Science and Health, University of Strathclyde, Glasgow, UK
| | - Anne Martin
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Xanne Janssen
- School of Psychological Science and Health, University of Strathclyde, Glasgow, UK
| | - Mathew G Wilson
- Research and Scientific Support Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - Ann-Marie Gibson
- School of Psychological Science and Health, University of Strathclyde, Glasgow, UK
| | - Adrienne Hughes
- School of Psychological Science and Health, University of Strathclyde, Glasgow, UK
| | - John J Reilly
- School of Psychological Science and Health, University of Strathclyde, Glasgow, UK
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22
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Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J 2019; 39:1466-1480. [PMID: 28329355 DOI: 10.1093/eurheartj/ehw631] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/08/2016] [Indexed: 12/14/2022] Open
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Sanjay Sharma
- Cardiology Clinical Academic Group, St George's, University of London, UK
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Aaron Baggish
- Division of Cardiology, Massachusettes General Hospital, MA, USA
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's, University of London, UK
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Andre La Gerche
- Department of Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, MN, USA
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, SC, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina School of Medicine, NC, USA
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, IN, USA
| | | | - Hein Heidbuchel
- Department of Cardiology, Arrhythmology Hasselt University, Hasselt, Belgium.,Department of Cardiology, Antwerp, Belgium
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | | | - Gordon Cohen
- Division of Pediatric Cardiothoracic Surgery, University of California San Francisco School of Medicine, CA, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Baylor College of Medicine, TX, USA
| | - Josef Niebauer
- University Institute of Sports Medicine, Paracelsus Medical University, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, CA, USA
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Tess Saarel
- Pediatric Cardiology, Cleveland Clinic, OH, USA
| | | | - David M Shipon
- Heart Center of Philadelphia, Jefferson University Hospitals, PA, USA
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Italy
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23
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Affiliation(s)
| | - Julien D Périard
- Aspetar Orthopaedic and Sports Medicine Hospital, Qatar.,Research Institute of Sport and Exercise, University of Canberra, Australia
| | - Carmen Adamuz
- Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
| | | | - Victoria Watt
- Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
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24
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Abstract
Swimming-induced pulmonary edema is an infrequently encountered cause of acute respiratory distress in open-water swimmers. The condition can be challenging, with athletes often wanting answers to three main questions regarding (i) a definitive and robust diagnosis, (ii) the risk of recurrence, and (iii) what can be done to avoid recurrence. This commentary provides an overview of the best available evidence, in light of a recently published systematic review.
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Affiliation(s)
- James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, SW3 6HP, UK.
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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25
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McClean G, Riding NR, Pieles G, Sharma S, Watt V, Adamuz C, Johnson A, Tramullas A, George KP, Oxborough D, Wilson MG. Prevalence and significance of T-wave inversion in Arab and Black paediatric athletes: Should anterior T-wave inversion interpretation be governed by biological or chronological age? Eur J Prev Cardiol 2018; 26:641-652. [PMID: 30426769 DOI: 10.1177/2047487318811956] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND International electrocardiographic (ECG) recommendations regard anterior T-wave inversion (ATWI) in athletes under 16 years to be normal. DESIGN The aim of this study was to identify the prevalence, distribution and determinants of TWI by ethnicity, chronological and biological age within paediatric athletes. A second aim was to establish the diagnostic accuracy of international ECG recommendations against refinement within athletes who present with ECG variants isolated to ATWI (V1-V4) using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis. METHODS Four hundred and eighteen Arab and 314 black male athletes (11-18 years) were evaluated by ECG, echocardiogram and biological age (by radiological X-ray) assessment. RESULTS A total of 116 (15.8%) athletes presented with ATWI (V1-V4), of which 96 (82.8%) were observed in the absence of other ECG findings considered to be abnormal as per international recommendations for ECG interpretation in athletes; 91 (12.4%) athletes presented with ATWI confined to V1-V3, with prevalence predicted by black ethnicity (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.3-3.5) and biological age under 16 years (OR 2.0, 95% CI 1.2-3.3). Of the 96 with ATWI (V1-V4) observed in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes, diagnostic accuracy was 'fail' (OR 0.47, 95% CI 0.00-1.00) for international recommendations and 'excellent' (OR 0.97, 95% CI 0.92-1.00) when governed by biological age under 16 years, providing a positive and negative likelihood ratio of 15.8 (95% CI 1.8-28.1) and 0.0 (95% CI 0.0-0.8), respectively. CONCLUSION Interpretation of ECG variants isolated with ATWI (V1-V4) using international recommendations (chronological age <16 years) warrants caution, but governance by biological age yielded an 'excellent' diagnostic accuracy. In the clinical context, the 'chance' of detecting cardiac pathology within a paediatric male athlete presenting with ATWI in the absence of other ECG findings considered to be abnormal, as per international recommendations for ECG interpretation in athletes (positive likelihood ratio 15.8), was 14.4%, whereas a negative ECG (negative likelihood ratio 0.0) was 0%.
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Affiliation(s)
- Gavin McClean
- 1 Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar.,2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Nathan R Riding
- 1 Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Guido Pieles
- 3 National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Bristol Royal Hospital for Children and Bristol Heart Institute, UK
| | - Sanjay Sharma
- 4 Department of Cardiovascular Sciences, St Georges University of London, UK
| | - Victoria Watt
- 5 Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Carmen Adamuz
- 5 Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Amanda Johnson
- 6 Aspire Academy Sports Medicine Centre, Aspire Academy, Qatar
| | | | - Keith P George
- 2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - David Oxborough
- 2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Mathew G Wilson
- 1 Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar.,2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
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26
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Rekik RN, Tabben M, Eirale C, Landreau P, Bouras R, Wilson MG, Gillogly S, Bahr R, Chamari K. ACL injury incidence, severity and patterns in professional male soccer players in a Middle Eastern league. BMJ Open Sport Exerc Med 2018; 4:e000461. [PMID: 30498577 PMCID: PMC6241976 DOI: 10.1136/bmjsem-2018-000461] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 11/11/2022] Open
Abstract
Aim To ascertain ACL injury incidence, severity (injury burden) and patterns (contact/non-contact and reinjuries) in a professional male football league in the Middle East over five consecutive seasons. Methods Prospective epidemiological study reporting ACL injuries in professional male soccer players in the Qatar Stars League, with complete matches/training exposure over five seasons (2013–2014 to 2017–2018), corresponding to 2243 player seasons and 729 team months. Results 37 complete ACL ruptures occurred in 37 players during 486 951 hours of player exposure. The overall ACL injury rate was 0.076 injuries/1000 hours of exposure (season range 0.045–0.098). Injury incidence during matches and training was 0.41 and 0.04 injuries/1000 hours of exposure, respectively. Match injury incidence was greater than that of training (OR 11.8, 95% CI 6.21 to 23.23, p<0.001). Average injury-related time-loss following ACL injury was 225 days±65 (range 116–360). Overall injury burden was 16.3 days lost/1000 hours of exposure. Conclusion The overall ACL injury rate in professional male soccer players competing in the Middle East was 0.076 injuries/1000 hours of exposure, match injury incidence was greater than training, while the average ACL time-loss was 225 days.
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Affiliation(s)
- Raouf Nader Rekik
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Superior Institute For Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | | | | | | | - Rachid Bouras
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Scott Gillogly
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Oslo Sports Trauma Research Center, Norwegian University of Sport & Physical Education, Oslo, Norway
| | - Karim Chamari
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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27
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McClean G, Riding NR, Pieles G, Watt V, Adamuz C, Sharma S, George KP, Oxborough D, Wilson MG. Diagnostic accuracy and Bayesian analysis of new international ECG recommendations in paediatric athletes. Heart 2018; 105:152-159. [PMID: 30228247 DOI: 10.1136/heartjnl-2018-313466] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Historically, electrocardiographic (ECG) interpretation criteria for athletes were only applicable to adults. New international recommendations now account for athletes ≤16 years, but their clinical appropriateness is unknown. We sought to establish the diagnostic accuracy of new international ECG recommendations against the Seattle criteria and 2010 European Society of Cardiology (ESC) recommendations in paediatric athletes using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis. METHODS 876 Arab and 428 black male paediatric athletes (11-18 years) were evaluated by medical questionnaire, physical examination, ECG and echocardiographic assessment. ECGs were retrospectively analysed according to the three criteria. RESULTS Thirteen (1.0%) athletes were diagnosed with cardiac pathology that may predispose to sudden cardiac arrest/death (SCA/D) (8 (0.9%) Arab and (5 (1.2%) black)). Diagnostic accuracy was poor (0.68, 95% CI 0.54 to 0.82) for 2010 ESC recommendations, fair (0.70, 95% CI 0.54 to 0.85) for Seattle criteria and fair (0.77, 95% CI 0.61 to 0.93) for international recommendations. False-positive rates were 41.0% for 2010 ESC recommendations, 21.8% for Seattle criteria and 6.8% for international recommendations. International recommendations provided a positive (+LR) and negative (-LR) post-test likelihood ratio of 9.0 (95% CI 5.1 to 13.1) and 0.4 (95% CI 0.2 to 0.7), respectively. CONCLUSION In Arab and black male paediatric athletes, new international recommendations outperform both the Seattle criteria and 2010 ESC recommendations, reducing false positive rates, while yielding a 'fair' diagnostic accuracy for cardiac pathology that may predispose to SCA/D. In clinical context, the 'chance' of detecting cardiac pathology within a paediatric male athlete with a positive ECG (+LR=9.0) was 8.3%, whereas a negative ECG (-LR=0.4) was 0.4%.
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Affiliation(s)
- Gavin McClean
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Nathan R Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Guido Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK
| | - Victoria Watt
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Sanjay Sharma
- Department of Cardiovascular Sciences, St Georges University of London, London, UK
| | - Keith P George
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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Riding NR, Sharma S, McClean G, Adamuz C, Watt V, Wilson MG. Impact of geographical origin upon the electrical and structural manifestations of the black athlete’s heart. Eur Heart J 2018; 40:50-58. [DOI: 10.1093/eurheartj/ehy521] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nathan R Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gavin McClean
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Victoria Watt
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
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Abstract
Many sporting organisations recommend a pre-participation ECG to screen for disorders which predispose to sudden cardiac arrest (SCA). The ability of the ECG to perform accurately is dependent on the ECG criteria used and the experience of the operator. There have been several ECG criteria over the last decade, though these were recently superseded with the publication of the 'International Consensus Criteria for ECG Interpretation in Athletes'. These criteria use the latest evidence to improve specificity while maintaining sensitivity for ECG-detectable pathologies associated with SCA. Accordingly, this review describes the normal, borderline and abnormal ECG findings in an asymptomatic athlete aged 12-35 years.
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Affiliation(s)
- Jordan M Prutkin
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington, USA
| | - Mathew G Wilson
- Sports Medicine Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Athlete Health and Performance Research Centre, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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30
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Knight A, Alsaey M, Farooq A, Wilson MG. Alarmingly poor oral health in international athletes competing in the Middle East. Br J Sports Med 2018; 53:1038-1039. [PMID: 29691290 DOI: 10.1136/bjsports-2017-098770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Ashley Knight
- Sports Dentistry Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mohammed Alsaey
- Sports Dentistry Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Doha, UK.,Research Institute of Sport and Exercise Sciences, University of Canberra, Canberra, Australia
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31
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Cocking S, Cable NT, Wilson MG, Green DJ, Thijssen DHJ, Jones H. Conduit Artery Diameter During Exercise Is Enhanced After Local, but Not Remote, Ischemic Preconditioning. Front Physiol 2018; 9:435. [PMID: 29740345 PMCID: PMC5928322 DOI: 10.3389/fphys.2018.00435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: The ability of ischemic preconditioning (IPC) to enhance exercise capacity may be mediated through altering exercise-induced blood flow and/or vascular function. This study investigated the hypothesis that (local) IPC enhances exercise-induced blood flow responses and prevents decreases in vascular function following exercise. Methods: Eighteen healthy, recreationally trained, male participants (mean ±SD: age 32 ± 8 years; BMI 24.2 ± 2.3; blood pressure 122 ± 10/72 ± 8 mmHg; resting HR 58 ± 9 beats min-1) received IPC (220 mmHg; 4 × 5-min bilateral arms), REMOTE IPC (220 mmHg; 4 × 5-min bilateral legs), or SHAM (20 mmHg; 4 × 5-min bilateral arms) in a counterbalanced order prior to 30-min of submaximal (25% maximal voluntary contraction) unilateral rhythmic handgrip exercise. Brachial artery diameter and blood flow were assessed every 5-min throughout the 30-min submaximal exercise using high resolution ultrasonography. Pre- and post-exercise vascular function was measured using flow-mediated dilation (FMD). Results: IPC resulted in enlarged brachial artery diameter during exercise [0.016 cm (0.003–0.03 cm), P = 0.015] compared to REMOTE IPC, but blood flow during exercise was similar between conditions (P > 0.05). Blood flow (l/min) increased throughout exercise (time: P < 0.005), but there was no main effect of condition (P = 0.29) or condition ∗ time interaction (P = 0.83). Post-exercise FMD was similar between conditions (P > 0.05). Conclusion: Our data show that local (but not remote) IPC, performed as a strategy prior to exercise, enhanced exercise-induced conduit artery diameter dilation, but these changes do not translate into increased blood flow during exercise nor impact post-exercise vascular function.
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Affiliation(s)
- Scott Cocking
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - N T Cable
- Department of Sport Science, Aspire Academy, Doha, Qatar.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Daniel J Green
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom.,Sport and Exercise Science, School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Helen Jones
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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32
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Eijsvogels TMH, Oxborough DL, O'Hanlon R, Sharma S, Prasad S, Whyte G, George KP, Wilson MG. Global and regional cardiac function in lifelong endurance athletes with and without myocardial fibrosis. Eur J Sport Sci 2017; 17:1297-1303. [PMID: 28910586 DOI: 10.1080/17461391.2017.1373864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to compare cardiac structure as well as global and regional cardiac function in athletes with and without myocardial fibrosis (MF). Cardiac magnetic resonance imaging with late gadolinium enhancement was used to detect MF and global cardiac structure in nine lifelong veteran endurance athletes (58 ± 5 years, 43 ± 5 years of training). Transthoracic echocardiography using tissue-Doppler and myocardial strain imaging assessed global and regional (18 segments) longitudinal left ventricular function. MF was present in four athletes (range 1-8 g) and not present in five athletes. MF was located near the insertion points of the right ventricular free wall on the left ventricle in three athletes and in the epicardial lateral wall in one athlete. Athletes with MF demonstrated a larger end diastolic volume (205 ± 24 vs 173 ± 18 ml) and posterior wall thickness (11 ± 1 vs 9 ± 1 mm) compared to those without MF. The presence of MF did not mediate global tissue velocities or global longitudinal strain and strain rate; however, regional analysis of longitudinal strain demonstrated reduced function in some fibrotic regions. Furthermore, base to apex gradient was affected in three out of four athletes with MF. Lifelong veteran endurance athletes with MF demonstrate larger cardiac dimensions and normal global cardiac function. Fibrotic areas may demonstrate some co-localised regional cardiac dysfunction, evidenced by an affected cardiac strain and base to apex gradient. These data emphasize the heterogeneous phenotype of MF in athletes.
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Affiliation(s)
- Thijs M H Eijsvogels
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK.,b Department of Physiology , Radboud University Medical Center , Nijmegen , Netherlands
| | - David L Oxborough
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Rory O'Hanlon
- c St. Vincent's University Hospital and The Blackrock Clinic , Dublin , Ireland
| | - Sanjay Sharma
- d Department of Heart Muscle Disorders and Sports Cardiology , St. Georges Hospital , London , UK
| | - Sanjay Prasad
- e Department of Cardiac Magnetic Resonance Imaging , Royal Brompton and Harefield National Health Service Trust , London , UK
| | - Greg Whyte
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Keith P George
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Mathew G Wilson
- f ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
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Allison RJ, Farooq A, Cherif A, Hamilton B, Close GL, Wilson MG. Why don’t serum vitamin D concentrations associate with BMD by DXA? A case of being ‘bound’ to the wrong assay? Implications for vitamin D screening. Br J Sports Med 2017; 52:522-526. [DOI: 10.1136/bjsports-2016-097130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 05/04/2017] [Accepted: 06/28/2017] [Indexed: 11/04/2022]
Abstract
BackgroundThe association between bone mineral density (BMD) and serum25-hydroxyvitamin D (25(OH)D) concentration is weak, particularly in certain races (eg, BlackAfrican vs Caucasian) and in athletic populations. We aimed to examine if bioavailable vitamin D rather than serum 25(OH)D was related to markers of bone health within a racially diverse athletic population.MethodsIn 604 male athletes (Arab (n=327), Asian (n=48), Black (n=108), Caucasian (n=53) and Hispanic (n=68)), we measured total 25(OH)D, vitamin D-binding protein and BMD by DXA. Bioavailable vitamin D was calculated using the free hormone hypothesis.ResultsFrom 604 athletes, 21.5% (n=130) demonstrated severe 25(OH)D deficiency, 37.1% (n=224) deficiency, 26% (n=157) insufficiency and 15.4% (n=93) sufficiency. Serum 25(OH)D concentrations were not associated with BMD at any site. After adjusting for age and race, bioavailable vitamin D was associated with BMD (spine, neck and hip). Mean serum vitamin D binding protein concentrations were not associated with 25(OH)D concentrations (p=0.392).ConclusionRegardless of age or race, bioavailable vitamin D and not serum 25(OH)D was associated with BMD in a racially diverse athletic population. If vitamin D screening is warranted, clinicians should use appropriate assays to calculate vitamin D binding protein and bioavailable vitamin D levels concentrations than serum 25(OH)D. In turn, prophylactic vitamin D supplementation to ‘correct’ insufficient athletes should not be based on serum 25(OH)D measures.
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34
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Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol 2017; 69:1057-1075. [PMID: 28231933 DOI: 10.1016/j.jacc.2017.01.015] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom.
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Papadakis
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Andre La Gerche
- Department of Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, South Carolina
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Hein Heidbuchel
- Department of Cardiology, Arrhythmology Hasselt University, Belgium; Department of Cardiology, Antwerp, Belgium
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | | | - Gordon Cohen
- Division of Pediatric Cardiothoracic Surgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
| | - Josef Niebauer
- University Institute of Sports Medicine, Paracelsus Medical University, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Tess Saarel
- Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | | | - David M Shipon
- Heart Center of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Italy
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Racinais S, Wilson MG, Gaoua N, Périard JD. Heat acclimation has a protective effect on the central but not peripheral nervous system. J Appl Physiol (1985) 2017; 123:816-824. [PMID: 28684590 DOI: 10.1152/japplphysiol.00430.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to clarify the pathway mediating hyperthermia-induced alterations in neural drive transmission and determine if heat acclimation protects voluntary muscle activation and cognitive function in hyperthermic humans. Electrically evoked potentials (H reflex and M wave), executive function (special planning and working memory), and maximal voluntary isometric contractions (120 s) were assessed in 14 participants in control conditions [CON, 24°C, 40% relative humidity (RH)] and in a hyperthermic state (HYP, 44-50°C, 50% RH) on consecutive days in a counterbalanced order. Thereafter, participants were passively heat acclimated for 11 days (1 h per day, 48-50°C, 50% RH) before repeating the initial assessments. Heat acclimation decreased rectal temperature in CON (-0.2°C, P < 0.05), but participants were maintained at ~39°C in HYP. Heat acclimation increased the time required to reach 39°C (+9 min), along with sweat rate (+0.7 l/h), and serum extracellular expression of heat shock protein 72 (eHSP72; +20%) in HYP (P < 0.05). M-wave and H-reflex amplitudes were lower in HYP than CON (P < 0.05) and were not protected by heat acclimation. Nerve conduction velocity was faster in HYP than CON (P < 0.05) without being influenced by heat acclimation. These results suggest that peripheral neural drive transmission in the hyperthermic state is primarily affected by axonal conduction velocity rather than synaptic failure. Executive function, voluntary activation, and the ability to sustain torque were impaired in HYP (P < 0.05). However, despite no perceptual changes (P > 0.05), heat acclimation restored executive function, while protecting the ability to sustain voluntary activation and torque production during a prolonged contraction in hyperthermia (P < 0.05). Ultimately, heat acclimation induces beneficial central but not peripheral neural adaptations.NEW & NOTEWORTHY Heat acclimation restores planning accuracy and working memory in hyperthermic humans, together with the supraspinal capacity to sustain motor drive during a sustained maximal voluntary contraction. Electrically evoked potential data (M wave, H reflex) indicate that heat acclimation does not protect against hyperthermia-induced impairments in peripheral neural drive transmission. Heat acclimation induces beneficial central but not peripheral neural adaptations.
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Affiliation(s)
- Sebastien Racinais
- Aspetar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar; .,University of Queensland, Centre for Sensorimotor Neuroscience, School of Human Movement Studies, Brisbane, Australia
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar
| | - Nadia Gaoua
- School of Applied Sciences, London South Bank University, London, United Kingdom; and
| | - Julien D Périard
- Aspetar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Doha, Qatar.,University of Canberra, Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
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36
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Merghani A, Maestrini V, Rosmini S, Cox AT, Dhutia H, Bastiaenan R, David S, Yeo TJ, Narain R, Malhotra A, Papadakis M, Wilson MG, Tome M, AlFakih K, Moon JC, Sharma S. Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile. Circulation 2017; 136:126-137. [PMID: 28465287 DOI: 10.1161/circulationaha.116.026964] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. METHODS We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. RESULTS Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P=0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P=0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. CONCLUSIONS Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.
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Affiliation(s)
- Ahmed Merghani
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Viviana Maestrini
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Stefania Rosmini
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Andrew T Cox
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Harshil Dhutia
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Rachel Bastiaenan
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Sarojini David
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Tee Joo Yeo
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Rajay Narain
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Aneil Malhotra
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Michael Papadakis
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Mathew G Wilson
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Maite Tome
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Khaled AlFakih
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - James C Moon
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.)
| | - Sanjay Sharma
- From Cardiology Clinical and Academic Group, St Georges, University of London, UK (A.M., A.T.C., H.D., R.B., R.N., A.M., M.P., M.T., S.S.); The Barts Heart Centre, University College London, UK (V.M., J.C.M.); Department of Cardiovascular, Respiratory, Geriatric, Anesthesiologic, and Nephrologic Sciences, Sapienza University of Rome, Italy (V.M., K.A.); University Hospital Lewisham, London, UK (S.R., S.D.); National University Heart Centre, Singapore (T.J.Y.); and Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar (M.G.W.).
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McClean G, Riding NR, Ardern CL, Farooq A, Pieles GE, Watt V, Adamuz C, George KP, Oxborough D, Wilson MG. Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis. Br J Sports Med 2017; 52:230. [DOI: 10.1136/bjsports-2016-097052] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
AimTo describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.DesignSystematic review with meta-analysis.Data sourcesSix electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.Inclusion criteria(1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.ResultsData from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.ConclusionsThe paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.
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Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche AL, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med 2017; 51:704-731. [PMID: 28258178 DOI: 10.1136/bjsports-2016-097331] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/16/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, US
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andre La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Paediatric, Mayo Clinic, Rochester, Minnesota, USA.,Department of Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mats Borjesson
- Department of Neuroscience, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden.,Department of Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, Washington, US
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Gordon Cohen
- Division of Paediatric Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Division of Cardiothoracic Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Silvana Molossi
- Division of Pediatric, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Josef Niebauer
- University Institute of Sports Medicine, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tess Saarel
- Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - David M Shipon
- Heart Centre of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Victoria L Vetter
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Domenico Corrado
- Department of Cardiac Science, University of Padua Medical School, Padua, Italy.,Department of Thoracic Sciences, University of Padua Medical School, Padua, Italy.,Department of Vascular Sciences, University of Padua Medical School, Padua, Italy
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Bakken A, Targett S, Bere T, Adamuz MC, Tol JL, Whiteley R, Wilson MG, Witvrouw E, Khan KM, Bahr R. Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players. Br J Sports Med 2016; 50:1142-50. [PMID: 27012663 DOI: 10.1136/bjsports-2015-095829] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the widespread use of periodic health evaluation (PHE) to detect and prevent injury and illness in athletes, its effectiveness in detecting health conditions and relevant risk factors is still debated. AIM To assess health conditions detected by a comprehensive PHE in professional male football players and evaluate their consequences for participation clearance. METHODS A total of 558 professional football players in Qatar completed a PHE prior to the 2013 or 2014 seasons: history, general medical (including blood test), cardiovascular (12-lead ECG and echocardiography) and a musculoskeletal examination, including a specific test battery targeting lower extremity strength and flexibility. On the basis of the PHE, players were either cleared or not cleared for participation. RESULTS In 533 players (95.5%), at least one health condition was detected requiring treatment or follow-up. Vitamin D deficiency or insufficiency (≤30 ng/mL) was the most common medical condition (n=499, 89.4%), followed by hepatitis B non-immunity or infection (n=164, 29.4%). Cardiac screening identified 48 players (8.6%) with one or more abnormal findings (ECG (n=19, 3.4%) and echocardiography (n=14, 2.5%)). Musculoskeletal conditions were observed in 180 players (32.3%); injuries to or strength deficits of the hip/groin and thigh accounted for the largest proportion. Medical clearance was temporarily not given in 69 players (12.4%), while further examinations were being conducted. One player was disqualified from competitive football. CONCLUSIONS PHE revealed a high prevalence of health conditions requiring treatment or follow-up in professional footballers; however, only 12.4% of conditions impacted on final clearance for participation.
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Affiliation(s)
- Arnhild Bakken
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Stephen Targett
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tone Bere
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | | | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, Amsterdam, The Netherlands Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK Research Institute of Sport and Exercise Sciences, University of Canberra, Australia
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Karim M Khan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Schnell F, Riding N, O'Hanlon R, Lentz PA, Donal E, Kervio G, Matelot D, Leurent G, Doutreleau S, Chevalier L, Guerard S, Wilson MG, Carré F. Response to Letter Regarding Article, "Recognition and Significance of Pathological T-Wave Inversions in Athletes". Circulation 2015; 132:e181-2. [PMID: 26438775 DOI: 10.1161/circulationaha.115.016786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frédéric Schnell
- Department of Physiology, Rennes1 University, Department of Sport Medicine, Pontchaillou Hospital, INSERM UMR 1099, Rennes, France
| | - Nathan Riding
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rory O'Hanlon
- Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland
| | | | - Erwan Donal
- INSERM UMR 1099, Department of Cardiology, Pontchaillou Hospital, Rennes, France
| | | | | | | | | | | | - Sylvain Guerard
- Department of Cardiology, Desgenettes Hospital, Lyon, France
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - François Carré
- Department of Physiology, Rennes1 University, Department of Sport Medicine, Pontchaillou Hospital, INSERM UMR 1099, Rennes, France
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Wilson MG, Carré F. What's the big deal about T-wave inversion in athletes? A guide to clinical interpretation. Br J Sports Med 2015; 50:72-3. [DOI: 10.1136/bjsports-2015-094636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 11/04/2022]
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Riding NR, Sheikh N, Adamuz C, Watt V, Farooq A, Whyte GP, George KP, Drezner JA, Sharma S, Wilson MG. Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes. Heart 2015; 101:384-90. [PMID: 25502812 PMCID: PMC4345900 DOI: 10.1136/heartjnl-2014-306437] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/30/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An increasing number of sporting bodies report unacceptably high levels of false-positive ECGs when undertaking pre-participation cardiac screening. To address this issue, modified ECG interpretation criteria have become available for use within athletes. OBJECTIVE This study assessed the accuracy of the new 2014 'Refined Criteria' against the 2013 Seattle Criteria and the 2010 European Society of Cardiology (ESC) recommendations in a cohort of Arabic, black and Caucasian athletes. METHODS 2491 male athletes (1367 Arabic, 748 black and 376 Caucasian) undertook pre-participation screening including a 12-lead ECG, with further investigation(s) upon indication. RESULTS Ten athletes (0.4%) were identified with cardiac pathology; seven with hypertrophic cardiomyopathy (HCM; five black and two Arabic) and three Arabs with Wolff-Parkinson-White syndrome (WPW). All three ECG criteria were 100% sensitive identifying all cases of HCM and WPW. The 2014 Refined Criteria reduced (p<0.0001) the prevalence of an abnormal ECG to 5.3% vs 11.6% (Seattle Criteria) and 22.3% (2010 ESC recommendations). The 2014 Refined Criteria significantly (p<0.0001) improved specificity (94.0%) across all ethnicities compared with the Seattle Criteria (87.5%) and ESC recommendations (76.6%). Black athletes continue to present a higher prevalence (p<0.0001) of abnormal ECGs compared with Arabic and Caucasian athletes (10% vs 3.6% and 2.1%). CONCLUSIONS The 2014 Refined Criteria for athlete ECG interpretation outperformed both the 2013 Seattle Criteria and the 2010 ESC recommendations by significantly reducing the number of false-positive ECGs in Arabic, black and Caucasian athletes while maintaining 100% sensitivity for serious cardiac pathologies.
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Affiliation(s)
- Nathan R Riding
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Nabeel Sheikh
- Department of Cardiovascular Sciences, St Georges University of London, UK
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Victoria Watt
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gregory P Whyte
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Keith P George
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington USA
| | - Sanjay Sharma
- Department of Cardiovascular Sciences, St Georges University of London, UK
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Schnell F, Riding N, O’Hanlon R, Axel Lentz P, Donal E, Kervio G, Matelot D, Leurent G, Doutreleau S, Chevalier L, Guerard S, Wilson MG, Carré F. Recognition and Significance of Pathological T-Wave Inversions in Athletes. Circulation 2015; 131:165-73. [DOI: 10.1161/circulationaha.114.011038] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations.
Methods and Results—
Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease.
Conclusions—
PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
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Affiliation(s)
- Frédéric Schnell
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Nathan Riding
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Rory O’Hanlon
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Pierre Axel Lentz
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Erwan Donal
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Gaelle Kervio
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - David Matelot
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Guillaume Leurent
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Stéphane Doutreleau
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Laurent Chevalier
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Sylvain Guerard
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Mathew G. Wilson
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - François Carré
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
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Abstract
Sudden cardiac death (SCD) is the leading medical cause of death in athletes; however, the precise incidence is unknown. The objectives of this review were to examine studies on the rate of SCD in athletes, assess the methodological strengths and weaknesses used to arrive at estimates, compare studies in athletes with estimates in similar populations and arrive at an approximation of the incidence of SCD based on the best available evidence. A comprehensive literature search was performed in PubMed using key terms related to SCD in athletes. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 40. The reference list from each manuscript was reviewed for additional relevant articles. The methods for case identification were examined, as well as the inclusion and exclusion criteria and the precision of the population denominator studied. Thirteen studies were found investigating the rate of SCD in athletes who ranged in age from 9 to 40. An additional 15 incidence studies were located examining the rate of SCD in other populations under the age of 40. Rates of SCD varied from 1:917,000 to 1:3000. Studies with higher methodological quality consistently yielded incidence rates in the range of 1:40,000 to 1:80,000. Some athlete subgroups, specifically men, African-American/black athletes and basketball players, appear to be at higher risk. The incidence of SCD in athletes is likely higher than traditional estimates which may impact the development of more effective prevention strategies.
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Affiliation(s)
- Kimberly G Harmon
- Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Mathew G Wilson
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hosptial, Doha, Qatar
| | - Sanjay Sharma
- Cardiovascular Sciences Research Center, St George's University of London, London, UK
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Allison RJ, Close GL, Farooq A, Riding NR, Salah O, Hamilton B, Wilson MG. Severely vitamin D-deficient athletes present smaller hearts than sufficient athletes. Eur J Prev Cardiol 2014; 22:535-42. [DOI: 10.1177/2047487313518473] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard J Allison
- National Sports Medicine Program, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Graeme L Close
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, Merseyside, UK
| | - Abdulaziz Farooq
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital Qatar
| | - Nathan R Riding
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, Merseyside, UK
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital Qatar
| | - Othman Salah
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Bruce Hamilton
- High Performance Sport New Zealand, Auckland, New Zealand
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
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