Considerations and best practices for elite football officials return to play after COVID-19 confinement

The recent COVID-19 pandemic resulted in a total lockdown of the major football leagues, aiming to prevent the threat of an uncontrolled spread of infections, and forcing the players and match officials to home-based physical training. Differently from players, no health and physical fitness maintenance guidelines were published for match officials. Before the return to structured conditioning and officiating, match officials must perform a medical assessment, as well as systematic COVID-19 testing and detailed pulmonary function evaluation. The hygienic-sanitary prevention strategies for virus transmission must be strictly followed. In the remaining part of the present season, alterations of the game rules, namely halves of 30-40 min and no allowance for lost time, aiming to reduce the match officials physiological load may result as a safer option. Nonetheless, match officials' cognitive and physical demands, will probably be exacerbated by the increased number of substitutions per game, proposed to reduce players' match load. The proposed match scenario further stresses the importance of well-developed aerobic and anaerobic fitness in elite level match officials. Therefore, the aim of this paper was to guide a safe and successful return to play for match officials.

Abnormal exercise adaptation after varying severities of COVID-19: A controlled cross-sectional analysis of 392 survivors.

HIGHLIGHTS: Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values.A severe or critical COVID-19 case was an independent predictor for low aerobic capacity.In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.

Factors Associated with Musculoskeletal Injuries in Pre-Professional Modern Dancers before and after the COVID-19 Pandemic

The Chester Step Test showed that dancers with higher aerobic fitness were injured less. Pre-professional modern dancers who followed a strength exercise regimen were injured less when compared to those who only danced. Dance training programs should consider adapting evidence-based sports training methods and integrating aerobic and strength training. Mental support for dancers should be considered, at a minimum during times of perceived high stress. Highlights: The prevalence of dance-related injuries is high, yet risk factors remain unclear in modern dance. The COVID-19 pandemic has affected the continuity and nature of dance programs. The objectives were to investigate factors associated with musculoskeletal injuries in pre-professional modern dancers before and after the pandemic and to qualitatively describe the dancers' experiences during COVID-19. We examined 31 modern dancers (19.42 ± 1.57 years) pre-COVID-19 and re-examined 21 participants after one-year post-COVID-19, using objective physical tests for upper and lower body strength, aerobic fitness, hip ranges, injury history, and training hours' data. The injury rate remained mostly unaffected (0.87 ± 0.88 pre-, 0.76 ± 0.83 post-COVID-19), but weekly dance hours were reduced (33 pre-, 21.40 post-COVID-19). Dancers significantly improved their push-up score (p = 0.016) and decreased their compensated turnout (p = 0.022). Notably, non-injured dancers scored higher in the pre-COVID-19 Chester Step Test (p = 0.033) and practiced more strength training independently post-COVID-19 (p = 0.024). No significant differences were found between injured and non-injured dancers in the other parameters. Dancers reported negative thoughts and difficulty maintaining their fitness during the pandemic. In conclusion, strength training and aerobic fitness were identified as potentially important factors related to injury risk in modern dance and should be examined further for their injury prevention value. © 2023 by the authors.

Normal reference values for aerobic fitness in cystic fibrosis: a scoping review.

Objective: The importance of aerobic fitness (VO2peak) in cystic fibrosis (CF) is well established, and regular exercise testing is recommended. To standardise VO2peak, a 'percentage of predicted' (%pred) derived from normative reference values (NRV), as promoted by the 2015 European Cystic Fibrosis Society Exercise Working Group (ECFS EWG), can be reported. However, the NRVs used in CF and their relative frequency is unknown. Method: A scoping review was performed via systematic database searches (PubMed, Embase, Web of Science, SciELO, EBSCO) and forward citation searches for studies that include people with CF and report VO2peak as %pred. Studies were screened using Covidence, and data related to patient demographics, testing modality and reference equations were extracted. Additional analyses were performed on studies published in 2016-2021, following the ECFS EWG statement in 2015. Results: A total of 170 studies were identified, dating from 1984 to 2022, representing 6831 patients with CF, citing 34 NRV. Most studies (154/170) used cycle ergometry, 15/170 used treadmills, and the remainder used alternative, combination or undeclared modalities. In total, 61/170 failed to declare the NRV used. There were 61 studies published since the ECFS EWG statement, whereby 18/61 used the suggested NRV. Conclusion: There is a wide discrepancy in NRV used in the CF literature base to describe VO2peak as %pred, with few studies using NRV from the ECFS EWG statement. This high variance compromises the interpretation and comparison of studies while leaving them susceptible to misinterpretation and limiting replication. Standardisation and alignment of reporting of VO2peak values are urgently needed.

Oxygen uptake kinetics and chronotropic responses to exercise are impaired in survivors of severe COVID-19.

The post-acute phase of coronavirus disease 2019 (COVID-19) is often marked by several persistent symptoms and exertional intolerance, which compromise survivors' exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (V̇o2) kinetics and cardiopulmonary function in survivors of severe COVID-19 about 3-6 mo after intensive care unit (ICU) hospitalization. Thirty-five COVID-19 survivors previously admitted to ICU (5 ± 1 mo after hospital discharge) and 18 controls matched for sex, age, comorbidities, and physical activity level with no prior history of SARS-CoV-2 infection were recruited. Subjects were submitted to a maximum-graded cardiopulmonary exercise test (CPX) with an initial 3-min period of a constant, moderate-intensity walk (i.e., below ventilatory threshold, VT). V̇o2 kinetics was remarkably impaired in COVID-19 survivors as evidenced at the on-transient by an 85% (P = 0.008) and 28% (P = 0.001) greater oxygen deficit and mean response time (MRT), respectively. Furthermore, COVID-19 survivors showed an 11% longer (P = 0.046) half-time of recovery of V̇o2 (T1/2V̇o2) at the off-transient. CPX also revealed cardiopulmonary impairments following COVID-19. Peak oxygen uptake (V̇o2peak), percent-predicted V̇o2peak, and V̇o2 at the ventilatory threshold (V̇o2VT) were reduced by 17%, 17%, and 12% in COVID-19 survivors, respectively (all P < 0.05). None of the ventilatory parameters differed between groups (all P > 0.05). In addition, COVID-19 survivors also presented with blunted chronotropic responses (i.e., chronotropic index, maximum heart rate, and heart rate recovery; all P < 0.05). These findings suggest that COVID-19 negatively affects central (chronotropic) and peripheral (metabolic) factors that impair the rate at which V̇o2 is adjusted to changes in energy demands.NEW & NOTEWORTHY Our findings provide novel data regarding the impact of COVID-19 on submaximal and maximal cardiopulmonary responses to exercise. We showed that V̇o2 kinetics is significantly impaired at both the onset (on-transient) and the recovery phase (off-transient) of exercise in these patients. Furthermore, our results suggest that survivors of severe COVID-19 may have a higher metabolic demand at a walking pace. These findings may partly explain the exertional intolerance frequently observed following COVID-19.