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Call to increase statistical collaboration in sports science, sport and exercise medicine and sports physiotherapy.
Sainani, KL, Borg, DN, Caldwell, AR, Butson, ML, Tenan, MS, Vickers, AJ, Vigotsky, AD, Warmenhoven, J, Nguyen, R, Lohse, KR, et al
British journal of sports medicine. 2021;(2):118-122
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From theory to practice: operationalizing a climate vulnerability for sport organizations framework for heat hazards among US High schools.
Grundstein, AJ, Scarneo-Miller, SE, Adams, WM, Casa, DJ
Journal of science and medicine in sport. 2021;(8):718-722
Abstract
BACKGROUND Sport organizations must comprehensively assess the degree to which their athletes are susceptible to exertional heat illnesses (i.e. vulnerable) to appropriately plan and adapt for heat-related hazards. Yet, no heat vulnerability framework has been applied in practice to guide decision making. OBJECTIVES We quantify heat vulnerability of state-level requirements for health and safety standards affecting United States (US) high school athletes as a case study. DESIGN Observational. METHODS We utilize a newly developed climate vulnerability to sports organizations framework (CVSO), which considers the heat hazard of each state using summer maximum wet bulb globe temperature (WBGT) in combination with an 18-point heat safety scoring system (18 = best policy). Heat vulnerability is categorized as "problem" [higher heat (>27.9°C) and lower policy score (≤9)], "fortified" [higher heat (>27.9°C) and higher policy score (>9)], "responsive" [lower heat (<27.9°C) and lower policy score (≤9)], and "proactive" [lower heat (<27.9°C) and higher policy score (>9)]. RESULTS Across the US, the mean WBGT was 28.4±2.4°C and policy score was 6.9±4.7. In combination, we observed organizations within each of the four vulnerability categories with 16% (n=8) in fortified, 16% (n=8) in proactive, 29% (n=15) in problem, and 39% (n=20) in responsive. CONCLUSIONS The CSVO framework allowed us to identify different degrees of vulnerability among the state's and to highlight the 29% (n=15) of states with immediate needs for policy revisions. We found the CSVO framework to be highly adaptable in our application, suggesting feasibility for use with other sports governing bodies.
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Blood Biomarker Profiling and Monitoring for High-Performance Physiology and Nutrition: Current Perspectives, Limitations and Recommendations.
Pedlar, CR, Newell, J, Lewis, NA
Sports medicine (Auckland, N.Z.). 2019;(Suppl 2):185-198
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Abstract
Blood test data were traditionally confined to the clinic for diagnostic purposes, but are now becoming more routinely used in many professional and elite high-performance settings as a physiological profiling and monitoring tool. A wealth of information based on robust research evidence can be gleaned from blood tests, including: the identification of iron, vitamin or energy deficiency; the identification of oxidative stress and inflammation; and the status of red blood cell populations. Serial blood test data can be used to monitor athletes and make inferences about the efficacy of training interventions, nutritional strategies or indeed the capacity to tolerate training load. Via a profiling and monitoring approach, blood biomarker measurement combined with contextual data has the potential to help athletes avoid injury and illness via adjustments to diet, training load and recovery strategies. Since wide inter-individual variability exists in many biomarkers, clinical population-based reference data can be of limited value in athletes, and statistical methods for longitudinal data are required to identify meaningful changes within an athlete. Data quality is often compromised by poor pre-analytic controls in sport settings. The biotechnology industry is rapidly evolving, providing new technologies and methods, some of which may be well suited to athlete applications in the future. This review provides current perspectives, limitations and recommendations for sports science and sports medicine practitioners using blood profiling and monitoring for nutrition and performance purposes.
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Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters.
Schwellnus, M, Swanevelder, S, Derman, W, Borjesson, M, Schwabe, K, Jordaan, E
British journal of sports medicine. 2019;(10):634-639
Abstract
OBJECTIVES To examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races. METHODS This was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period. RESULTS In comparison to the CON period (2008-2011: 65 865 starters), the INT period (2012-2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9-9.4); INT=6.1 (5.6-6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4-5.9); INT=4.1 (3.6-4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1-16.3); INT=9.0 (7.9-10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5-0.9); INT=0.2 (0.1-0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods. CONCLUSION All medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.
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Hypertensive Medications in Competitive Athletes.
Pelto, H
Current sports medicine reports. 2017;(1):45-49
Abstract
Hypertension is the most common cardiovascular disease in athletes. It is an important cause of long-term morbidity and mortality, even in a fit, athletic population. Management options to reduce these long-term risks exist that have minimal impact on athletic performance. Identification and management of underlying lifestyle factors and diseases that may lead to secondary hypertension is critical. These include substance abuse, medications, and underlying medical conditions. After evaluation and management of these issues, medications can be used to reduce blood pressure. In the athletic population, first-line medication treatment should include ACE inhibitors, angiotensin II receptor blockers (ARB), and calcium channel blockers (CCB). The response to treatment should be followed closely to ensure adequate blood pressure control. Athletic participation in sports with high dynamic load should be limited in individuals with stage 2 hypertension or stage 1 hypertension with evidence of end organ damage.
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Potential harmful effects of dietary supplements in sports medicine.
Deldicque, L, Francaux, M
Current opinion in clinical nutrition and metabolic care. 2016;(6):439-445
Abstract
PURPOSE OF REVIEW The purpose of this article is to collect the most recent data regarding the safety of well-known or emerging dietary supplements used by athletes. RECENT FINDINGS From January 2014 to April 2016, about 30 articles have been published in the field. New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen. Additional data accumulate toward the safety of nitrate ingestion. In the last 2 years, the safety of emerging supplements such as higenamine, potentially interesting to lose weight, creatine nitrate and guanidinoacetic acid has been evaluated but still needs further investigation. SUMMARY The consumption of over-the-counter supplements is very popular in athletes. Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements. In addition to the risks linked to overdosage and cross-effects when combining different supplements at the same time, inadvertent or deliberate contamination with stimulants, estrogenic compounds, diuretics or anabolic agents may occur.
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Consensus Recommendations on Training and Competing in the Heat.
Racinais, S, Alonso, JM, Coutts, AJ, Flouris, AD, Girard, O, González-Alonso, J, Hausswirth, C, Jay, O, Lee, JK, Mitchell, N, et al
Sports medicine (Auckland, N.Z.). 2015;(7):925-38
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Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise-heat exposures over 1-2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.
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How to Practice Sports Cardiology: A Cardiology Perspective.
Lawless, CE
Clinics in sports medicine. 2015;(3):539-49
Abstract
The rigorous cardiovascular (CV) demands of sport, combined with training-related cardiac adaptations, render the athlete a truly unique CV patient and sports cardiology a truly unique discipline. Cardiologists are advised to adopt a systematic approach to the CV evaluation of athletes, taking into consideration the individual sports culture, sports-specific CV demands, CV adaptations and their appearance on cardiac testing, any existing or potential interaction of the heart with the internal and external sports environment, short- and long-term CV risks, and potential effect of performance-enhancing agents and antidoping regulations. This article outlines the systematic approach, provides a detailed example, and outlines contemporary sports cardiology core competencies.
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Innovative Operations Measures and Nutritional Support for Mass Endurance Events.
Chiampas, GT, Goyal, AV
Sports medicine (Auckland, N.Z.). 2015;(Suppl 1):S61-9
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Abstract
Endurance and sporting events have increased in popularity and participation in recent years worldwide, and with this comes the need for medical directors to apply innovative operational strategies and nutritional support to meet such demands. Mass endurance events include sports such as cycling and running half, full and ultra-marathons with over 1000 participants. Athletes, trainers and health care providers can all agree that both participant outcomes and safety are of the utmost importance for any race or sporting event. While demand has increased, there is relatively less published guidance in this area of sports medicine. This review addresses public safety, operational systems, nutritional support and provision of medical care at endurance events. Significant medical conditions in endurance sports include heat illness, hyponatraemia and cardiac incidents. These conditions can differ from those typically encountered by clinicians or in the setting of low-endurance sports, and best practices in their management are discussed. Hydration and nutrition are critical in preventing these and other race-related morbidities, as they can impact both performance and medical outcomes on race day. Finally, the command and communication structures of an organized endurance event are vital to its safety and success, and such strategies and concepts are reviewed for implementation. The nature of endurance events increasingly relies on medical leaders to balance safety and prevention of morbidity while trying to help optimize athlete performance.
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Description and implementation of U-Turn Medical, a comprehensive lifestyle intervention programme for chronic disease in the sport and exercise medicine setting: pre-post observations in 210 consecutive patients.
Derman, W, Schwellnus, M, Hope, F, Jordaan, E, Padayachee, T
British journal of sports medicine. 2014;(17):1316-21
Abstract
BACKGROUND Non-communicable disease (NCD) is increasing, but management remains mostly curative, disease-centred and focused on single interventions. We describe the development and implementation of a patient-centred, comprehensive, multidisciplinary lifestyle intervention programme (LIP) for patients with NCD in the sport and exercise medicine (SEM) setting (part 1) and present preliminary observational data (part 2). METHODS Part 1 is a description of the programme development and implementation. In part 2, 210 participants with NCD underwent a 12-week LIP (U-Turn Medical). Physiological, functional and metabolic outcomes were assessed at baseline and at completion. RESULTS 84% of patients had two or more comorbidities, requiring additional considerations for exercise rehabilitation. On completion, there were decreases in % body fat (29.8±6.7% vs 28.5±6.6%), waist (100.2±16.2 vs 97.3±14.8 cm) and hip circumference (105.4±13 vs 104±12 cm), resting heart rate (74.2±13.4 vs 71.4±11.9 bpm), resting systolic blood pressure (125.7±16.1 vs 120.1±13 mm Hg) and cholesterol (4.7±1.2 vs 4.3±0.9 mmol/L), low-density lipoprotein (3±0.9 vs 2.7±0.8 mmol/L) and triglyceride (1.4±0.7 vs 1.3±0.6 mmol/L), and increases in flexibility (12.1±11.6 vs 16.1±10.8 cm) and 6 min walk distance (559.4±156.6 vs 652.3±193.6 m; all p<0.05). CONCLUSIONS A 12-week comprehensive, patient-centred LIP can be implemented successfully in the SEM setting in patients with NCDs with multiple comorbidities. Observed results show improvements in the majority of outcome variables.