Glenohumeral internal rotation deficit (GIRD) in young and asymptomatic elite swimmers.

CONTEXT: Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury. The aim of our study was to assess data on passive shoulder ROM in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD) in a large sample size of asymptomatic elite swimmers with a new classification method. OBJECTIVE: to assess data on passive shoulder ROM in young elite swimmers and investigate possible association with anthropometric data and competitive practice routine. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 752 asymptomatic elite swimmers were by voluntary participation (391 males, 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition. MAIN OUTCOME MEASURE(S): GIRD and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure. RESULTS: GIRD was found in 136 participants (18.1%); aGIRD was present in 28 cases (3.7% of all) whereas pGIRD was observed in 108 cases (14.4% of all). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side and distance. Swimmers classified as pGIRD showed significant less dominant Internal rotation, Total range of motion and External rotation gain (P < 0.01) than aGIRD; conversely, aGIRD swimmers shows significant less non-dominant IR, ER and TROM than pGIRD (P < 0.01). CONCLUSIONS: GIRD is a relatively common condition in asymptomatic elite youth swimmers; In order to not overestimate this condition, anatomical and pure GIRD have to be distinguished. While they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact when facing an elite swimmer with GIRD.

The Effects of a Wetsuit on Biomechanical, Physiological, and Perceptual Variables in Experienced Triathletes.

PURPOSE: Wetsuits have been shown to change swim biomechanics and, thus, increase performance, but not all athletes are comfortable with their use because of possible modifications in motor coordination. The aim of this study was to evaluate the effects of wetsuit use on biomechanical, physiological, and perceptual variables. METHODS: Eleven national- and international-level triathletes, familiar with wetsuit use, performed 7 × 200-m front crawl at constant preset speed twice, with and without a full wetsuit. The trunk incline (TI) and index of coordination (IdC) were measured stroke by stroke using video analysis. Stroke, breaths, and kick count, and timing (as breathing/kick action per arm-stroke cycle); stroke length (SL); and underwater length were analyzed using inertial-measurement-unit sensors. Heart rate (HR), rating of perceived exertion (RPE), and swimming comfort were monitored during the task. RESULTS: A lower TI; IdC; number of strokes, kicks, and breaths; HR; and RPE for each 200 m were found in wetsuit compared with swimsuit condition. Higher values of SL and underwater length were found in wetsuit, whereas no differences were found in swimming comfort and timing of kicks and breaths. An increase for swimsuit condition in number of strokes and breaths, HR, and RPE was found during the task compared with the first 200 m. CONCLUSION: Wetsuit use reduces TI and, thus, drag; increases propelling proficiency; and shows lower fatigability, without modifying motor coordination, compared with swimsuit use at the same speed. The use of a wetsuit during training sessions is recommended to increase comfort and the positive effects on performance.

Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease.

Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.

The Impact of a 14-Day Altitude Training Camp on Olympic-Level Open-Water Swimmers' Sleep.

Despite the common belief that sleep quality at altitude is poor, the scientific evidence to support this notion is still modest. Therefore, the purpose of the present study was to evaluate possible changes of actigraphy-based and subjective sleep parameters in a group of elite open-water swimmers during a 14-day altitude training camp (ATC) at 1500 m. The study subjects were five Olympic-level open-water swimmers (mean age: 25.0 ± 3.2 years; 3 females and 2 males). All subjects wore a wrist activity monitor and filled a sleep diary for 18 consecutive nights, 4 nights before and 14 nights during ATC. The data were then analyzed at four different time points: before ATC (PRE), the first two days of ATC (T1), and after one (T2) and two weeks of ATC (T3). Training load, assessed as the covered distance (km), session rating of perceived exertion (sRPE), and heart rate (HR), was monitored during the week before and the first and second week of ATC. No significant differences in objective and subjective scores of sleep quality were detected, whereas the sleep onset time (p = 0.018; η2p = 0.83, large) and sleep offset time (p < 0.001; η2p = 0.95, large) significantly differed among PRE, T1, T2, and T3: elite athletes started to sleep and woke up ≃ 1 h earlier the first two days of ATC compared to PRE (sleep onset time: p = 0.049; sleep offset time: p = 0.016). Further, an increase in the training volume during the two weeks of the ATC was observed, with the most time spent in a low-intensity regime and an increase in time spent in a high-intensity regime compared to PRE. Sleep quality was not negatively influenced by a 14-day altitude training camp at 1500 m in a group of Olympic-level elite swimmers despite an increase in perceived exertion during training sessions. Nonetheless, early sleep onset and sleep offset times were observed for the first two nights of ATC: elite athletes started to sleep and woke up ≃ 1 h earlier compared to the baseline nights.

The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes.

BACKGROUND: Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes. METHODS: Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race. RESULTS: The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race (p < 0.0001), and more athletes developed ECG criteria for right atrial enlargement (p < 0.0001). Most of the athletes (97%) had ≥1 premature atrial beats (PAB) during the 24-h monitoring, also organised in triplets (17%) and non-sustained supraventricular tachycardias (NSSVTs) (19%). In contrast, exercise-induced PABs, triplets, and NSSVTs were rare. One athlete developed acute atrial fibrillation during the race. After the race, no significant differences were found in biatrial dimensions. Biatrial function, estimated by peak atrial longitudinal and contraction strains, were normal both before and after the race. CONCLUSIONS: In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.

SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed?

BACKGROUND: SARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who are less susceptible to adverse clinical outcomes and are often asymptomatic. OBJECTIVES: We conducted this prospective multicentre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return to play. METHODS: Junior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting ECG, echocardiogram and exercise ECG testing. Further investigations were performed in cases of abnormal findings. RESULTS: A total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%) and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation was found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return to play was achieved after complete clinical resolution. CONCLUSIONS: The prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.

Carbohydrate supplementation during a simulated 10-km open water swimming race: effects on physiological, perceptual parameters and performance.

The aim of the present study was to test the effect of carbohydrate ingestion, simulating a 10-km open water race competition on energy cost (Csw), perceived exertion (RPE), heart rate (HR), stroke rate (SR) and performance. We hypothesized that carbohydrate ingestion would reduce Csw and RPE in elite open water swimmers (OW-swimmers) and improve performance. Eight elite OW-swimmers swam for 3 × 30 min with 20-s of interval necessary to collect data in the swimming flume at a pre-set pace corresponding to their 10-km race pace, followed by a time to exhaustion test (TTE) at 100% of the peak oxygen uptake (V̇O2peak). During the set, OW-swimmers ingested 45-g of carbohydrates (CHO) in 550-mL of water (8% solution) during each of the two intervals or a placebo solution (PLA). HR, RPE, V̇O2 and SR were measured. Shapiro-Wilk test was used to verify the normal distribution of data. Two-way repeated measures ANOVA and t-test was performed (p < 0.05). A significant difference emerged in TTE between the trials (169.00 ± 91.06 s in CHO; 102.31 ± 57.47 s in PLA). HR, RPE and SR increased during the TTE but did not differ between trials. Csw did not show a significant main effect between the two conditions and in time course in both conditions. CHO ingestion significantly increased TTE at 100% of V̇O2peak after 90-min of swimming at 10-km race pace. These findings indicate that CHO intake during a 10-km open water swimming competition should have a beneficial impact on performance in the final part of the race.

New aspects for match analysis to improve understanding of game scenario and training organization in top-level male water polo players.

BACKGROUND: We intended to verify through time-motion analysis the characteristics of the sequences of actions in terms of occurrence during water polo matches: number, duration, and possible relationships with technical-tactical aspects. METHODS: Water polo matches played at the 18th FINA World Championships 2019, Gwangju, South Korea, were chosen for examination, and the analysis involved both single actions and Trains of Actions (ToAs). A ToA is a sequence of actions that occurs during the match without actual game interruption. RESULTS: A total of 1261 game actions were evaluated in the 17 matches analyzed. In 89% of cases the actions occurred in ToAs while in 11% of cases they took place as single actions. On average, each match included 74.4±5.3 actions; of these, only 7.9±3.4 (CI at 95%: lower bound 6.1 and upper bound 9.6) were single actions while 66.2±5.5 occurred in sequences (ToA2=29.6±9.0%; ToA3=26.1±9.7%; ToA4=16.5±10.6%). The winning team performed on average more actions than the losing one (42.1±6.1 vs. 32.0±6.4; effect size: 1.67; P value: 0.001). The ToAs had different compositions, from 2 to 18 actions, and then very different durations, from about 1 minute up to 8 minutes. 66% of goals were scored after ToAs and 34% after single actions. CONCLUSIONS: The study of ToAs provides useful information on the physiological demand of the game, which may help to plan and organize physical training making it as specific as possible. The description of ToAs can help coaches to better define the game scenario and understand which technical and tactical measures are needed to improve game organization.

Causes of sudden cardiac death in young athletes and non-athletes: systematic review and meta-analysis: Sudden cardiac death in the young.

INTRODUCTION: The etiology of sudden cardiac death (SCD) in young people continues to attract much attention. This meta-analysis aimed to identify the most frequent causes of SCD in individuals aged ≤35 years, the differences between athletes and non-athletes and geographic areas. METHODS: Studies published between 01/01/1990 and 01/31/2020 and evaluating post-mortem the aetiology of SCD in young individuals (≤35 years) were included. Individuals were divided into athletes and non-athletes. Studies that did not report separate data between athletes and non-athletes were excluded. RESULTS: Thirty-four studies met the inclusion criteria, and a total population of 5,060 victims of SCD were analyzed (2,890 athletes, 2,170 non-athletes). Comparing the causes of SCD between athletes and non-athletes, non-ischemic left ventricular scar (NILVS) (5.1% vs. 1.1%, p=0.01) was more frequent in the former, while coronary artery disease (CAD) (19.6% vs. 9.1%, p=0.009), arrhythmogenic cardiomyopathy (ACM) (11.5% vs. 4.7%, p=0.03) and channelopathies (8.4% vs. 1.9%, p=0.02) were more frequent in the latter. In studies published in the last decade, hypertrophic cardiomyopathy (HCM) (p=0.002), dilated cardiomyopathy (p=0.047), and anomalous origin of coronary arteries (AOCA) (p=0.009) were more frequently the causes of SCD in athletes while aortic dissection (0.022) was the cause in non-athletes. HCM (p=0.01) and AOCA (p=0.004) were more frequently the causes of SCD in the US while ACM (p=0.001), structurally normal heart (p=0.02), and channelopathies (p=0.02) were more frequent in Europe. CONCLUSIONS: Among the causes of SCD, NILVS was the more frequent cause in athletes, while CAD, ACM and channelopathies were more frequent causes in non-athletes. The causes of SCD differ between the US and Europe.

Post-Acute Sequelae of COVID-19: The Potential Role of Exercise Therapy in Treating Patients and Athletes Returning to Play.

Post-acute sequelae of coronavirus disease 19 (COVID-19) (PASC) describe a wide range of symptoms and signs involving multiple organ systems occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, representing a growing health problem also in the world of sport and the athletic population. Patients with PASC have new, returning, or persisting symptoms four or more weeks after the infection. Among the most frequent symptoms, patients complain of fatigue, dyspnea, exercise intolerance, and reduced functional capacity that interfere with everyday life activity. The role of exercise programs in PASC patients will be identified, and upcoming studies will establish the magnitude of their benefits. However, the benefits of exercise to counteract these symptoms are well known, and an improvement in cardiopulmonary fitness, functional status, deconditioning, and quality of life can be obtained in these patients, as demonstrated in similar settings. Based on this background, this review aims to summarise the current evidence about the PASC syndrome and the benefit of exercise in these patients and to provide a practical guide for the exercise prescription in PASC patients to help them to resume their functional status, exercise tolerance, prior activity levels, and quality of life, also considering the athletic population and their return to play and sports competitions.

[Cardiopulmonary exercise testing: an essential tool for a tailored exercise prescription in patients with cardiac disease]. / Il test da sforzo cardiopolmonare: uno strumento fondamentale per una prescrizione personalizzata dell'esercizio fisico nei pazienti con malattia cardiovascolare.

Cardiovascular diseases are the leading cause of death in high-income countries. Exercise prescription is an effective tool for primary and secondary cardiovascular prevention and the cardiovascular benefits of physical activity are well established, ranging from improving the quality of life to reducing mortality. A tailored approach based on patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. The use of cardiopulmonary exercise testing is well-established for a tailored exercise prescription, as ventilatory thresholds allow to define exercise intensity in a highly individualized manner.

Wetsuit Use During Open Water Swimming. Does It "Suit" Everybody? A Narrative Review.

PURPOSE: Although wearing a wetsuit while swimming, when permitted, is primarily for safety reasons (ie, to protect against hypothermia), changes in buoyancy, biomechanics, and exercise performance have been reported. This narrative review covers the benefits of different wetsuit models on performance in swimming and triathlon. METHODS: A computer search of online databases was conducted to locate relevant published research until March 2021. After the screening process, 17 studies were selected for analysis. RESULTS: Most of the selected studies involved pool swimmers or triathletes completing short or middle distances in a pool while using a full or a long sleeveless wetsuit. Swimming with wetsuit elicited significant improvements in performance (maximum 11%), mainly by decreasing drag and energy cost, by increasing buoyancy, and by affecting technique. Different rates of change in each factor were found according to swimming ability and wetsuit model. In addition, wearing a wetsuit was often rated as uncomfortable by athletes. CONCLUSIONS: Although improvement in swimming performance by wearing a wetsuit has been reported in the literature, the amplitude of the improvement remains questionable. The enhancement in swimming performance is attributable merely to improvements in propulsion proficiency and buoyancy, as well as a reduction in drag. The extent to which athletes are familiar with the use of a wetsuit, their swimming ability, and the wetsuit model may play important roles in this improvement. More studies simulating competition and comparing elite versus nonelite athletes are needed.

The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects.

BACKGROUND: Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1 ) and second ventilatory thresholds (VT2 ) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations. METHODS: We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2 , peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations. RESULTS: VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2  values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively). CONCLUSIONS: EI definition based on percentages of peak HR and peak VO2  may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.

A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: Implications for a safe return-to-play.

OBJECTIVES: The COVID-19 pandemic has shocked the sports world because of the suspension of competitions and the spread of SARS-CoV-2 among athletes. After SARS-CoV-2 infection, cardio-pulmonary complications can occur and, before the resumption of sports competitions, a screening has been recommended. However, few data are available and discrepancies exist in the screening modalities. We conducted this prospective study to investigate the incidence of cardiovascular consequences following SARS-CoV-2 infection in young adult competitive athletes and the appropriate screening strategies for a safe return-to-play. METHODS: Ninety competitive athletes (24 ± 10 years) after asymptomatic or mildly symptomatic SARS-CoV-2 infection were screened by physical examination, blood testing, spirometry, 12­lead resting ECG, 24-h ambulatory ECG monitoring, echocardiogram, and cardiopulmonary exercise testing (CPET). RESULTS: Sixty-four athletes (71.1%) were male, and most (76.7%) were mildly symptomatic. After SARS-CoV-2 infection, spirometry and resting ECG were normal in all athletes. Ambulatory ECG monitoring demonstrated <50/24 h supraventricular and ventricular premature beats in 53.3% and 52.2% of athletes, respectively, in the absence of malignant arrhythmias. CPET did not demonstrate cardiopulmonary limitations. Echocardiography showed pericardial effusion in 3 athletes (all females) with symptomatic SARS-CoV-2 infection (3.3%; 4.4% in the symptomatic group) with a definitive diagnosis of myopericarditis in 1 athlete (1.1%) and pericarditis in 2 athletes (2.2%). CONCLUSIONS: Cardiac consequences of SARS-CoV-2 infection were found in 3.3% of competitive athletes. An appropriate screening primarily based on the detection of uncommon arrhythmias and cardiac symptoms should be recommended in competitive athletes after SARS-CoV-2 infection to detect a cardiac involvement and guarantee a safe return-to-play.

Monitoring Rating of Perceived Exertion Time in Zone: A Novel Method to Quantify Training Load in Elite Open-Water Swimmers?

PURPOSE: To analyze training-intensity distribution (TID) using different independent monitoring systems for internal training load in a group of elite open-water swimmers. METHODS: One hundred sixty training sessions were monitored in 4 elite open-water swimmers (2 females and 2 males: 23.75 [4.86] y, 62.25 [6.18] kg, 167 [6.68] cm) during 5 weeks of regular training. Heart-rate-based methods, such as time in zone (TIZ), session goal (SG), and hybrid (SG/TIZ), were used to analyze TID. Similarly to SG/TIZ, a new hybrid approach, the rating of perceived exertion (RPE)/TIZ for a more accurate analysis of TID was used. Moreover, based on the 3-zone model, the session ratings of perceived exertion of the swimmers and the coach were compared. RESULTS: Heart-rate- and RPE-based TID methods were significantly different in quantifying Z1 (P = .012; effect size [ES] = 0.490) and Z2 (P = .006; ES = 0.778), while no difference was observed in the quantification of Z3 (P = .428; ES = 0.223). The heart-rate-based data for Z1, Z2, and Z3 were 83.2%, 7.4%, and 8.1% for TIZ; 80.8%, 8.3%, and 10.8% for SG/TIZ; and 55%, 15.6%, and 29.4% for SG. The RPE-based data were 70.9%, 19.9%, and 9.2% for RPE/TIZ% and 41.2%, 48.9%, and 9.7% for the session rating of perceived exertion. No differences were observed between the coach's and the swimmers' session ratings of perceived exertion in the 3 zones (Z1: P = .663, ES = -0.187; Z2: P = .110, ES = 0.578; Z3: P = .149, ES = 0.420). CONCLUSION: Using RPE-based TID methods, Z2 was significantly larger compared with Z1. These results show that RPE-based TID methods in elite open-water swimmers are affected by both intensity and volume.

Prescribing, dosing and titrating exercise in patients with hypertrophic cardiomyopathy for prevention of comorbidities: Ready for prime time.

The benefits of physical activity are well established, leading to both cardiovascular and non-cardiovascular benefits, improving quality of life and reducing mortality. Despite such striking body of evidence, patients with hypertrophic cardiomyopathy are often discouraged by health professionals to practice physical activity and personalised exercise prescription is an exception rather than the rule. As a result, hypertrophic cardiomyopathy patients are on average less active and spend significantly less time at work or recreational physical activity than the general population. Exercise restriction derives from the evidence that vigorous exercise may occasionally trigger life-threatening arrhythmias and sudden cardiac death. However, while participation in competitive sports should be prudentially denied, hypertrophic cardiomyopathy patients can benefit from the positive effects of regular physical activity, aimed to reduce the risk of comorbidities and improve the quality of life. Based on this rationale, exercise should be prescribed and titrated just like a drug in hypertrophic cardiomyopathy patients, considering individual characteristics, symptoms, past medical history, objective individual response to exercise, previous training experience and stage of disease. Type, frequency, duration, and intensity should be defined on a personal basis. Yet exercise prescription in hypertrophic cardiomyopathy and its long-term effects represent major gaps in our current knowledge and require extensive research. We here review existing evidence regarding benefits and hazards of physical activity, with specific focus on viable modalities for tailored and safe exercise prescription in these patients, highlighting future developments and relevant research targets.

Clinical management of young competitive athletes with premature ventricular beats: A prospective cohort study.

BACKGROUND: Premature ventricular beats (PVBs) are not an unusual finding and their interpretation is sometimes challenging. Unfortunately, few data on the characteristics of PVBs that correlate with the risk of an underlying heart disease are available in athletes. OBJECTIVES: The aim of this prospective study was to investigate the diagnostic and prognostic value of PVBs characteristics in competitive athletes. METHODS: From a cohort of 1751 athletes evaluated at our sports cardiology centre, we enrolled 112 competitive athletes <40 years of age (mean age 21 ± 10 years) and with no known heart disease referred for PVBs. All athletes underwent physical examination, ECG, 12­lead ambulatory ECG monitoring, exercise testing, and echocardiography. Further investigations including cardiac magnetic resonance were performed for abnormal findings at first-line evaluation or for specific PVBs characteristics. RESULTS: The majority (79%) of athletes exhibited monomorphic PVBs with a fascicular or infundibular pattern (common morphologies). A definitive diagnosis of cardiac disease was reached in 26 athletes (23% of the entire population) and correlated with uncommon PVBs morphology (p < 0.001) and arrhythmia complexity (p < 0.001). The number of PVBs/24-h was lower in athletes with cardiac disease than in those with normal heart (p < 0.05). During the follow-up a spontaneous reduction of PVBs and no adverse events were observed. CONCLUSIONS: Infundibular and fascicular PVBs were the most common morphologies observed in athletes with ventricular arrhythmias referred for cardiological evaluation. Morphology and complexity of PVBs, but not their number, predicted the probability of an underlying disease. Athletes with PVBs and negative investigation showed a good prognosis.

Pacing and Hazard Score of Elite Open Water Swimmers During a 5-km Indoor Pool Race.

PURPOSE: The sensation of fatigue experienced at a certain point of the race is an important factor in the regulation of pacing. The rating of perceived exertion (RPE) is considered one of the main mediators utilized by athletes to modify pacing. The aim was to analyze the relationship between pacing and RPE of elite open water swimmers during national indoor pool championships. METHODS: A total of 17 elite open water swimmers (males, n = 9; females, n = 8) agreed to provide RPE every 500 m during the finals of the national championships 5-km indoor pool race. Time splits, stroke rate, and RPE were collected every 500 m. The Hazard score was calculated by multiplying the momentary RPE by the remaining fraction of the race. Athletes were placed in one of two categories: medalists or nonmedalists. For all variables, separate mixed analysis of variances (P ≤ .05) with repeated measures were used considering the splits (ie, every 500 m) as within-subjects factor and the groups (ie, medalists and nonmedalists) as between-subjects factor. RESULTS: Average swimming speed showed a significant main effect for split for both males and females (P < .001). A significant interaction was observed between average swimming speed and groups for females (P = .032). RPE increased in both groups (P < .001) with no difference observed between groups. However, the female nonmedalists showed a disproportionate nonlinear increase in RPE (5.20 [2.31]) halfway through the event that corresponded to the point where they started significantly decreasing speed. CONCLUSIONS: The results of the present study show different pacing strategies adopted by medalists and nonmedalists despite a similar RPE.

The benefits of exercise in cancer patients and the criteria for exercise prescription in cardio-oncology.

Cancer and cardiovascular diseases are the leading causes of death in high-income countries. Cardiovascular complications can be found in cancer patients, being the result of so-called 'cardio-toxicity'. Therefore, it becomes essential to thoroughly investigate the origin of cardiac damage and the strategy to prevent it or to reverse the negative remodelling associated with cardiotoxicity. In this review the beneficial effects of physical exercise in cancer patients were analysed, particularly to prevent cardio-toxicity before its clinical manifestation. According to the relevance of exercise, we suggest strategies for exercise prescription with a tailored approach in these patients. In conclusion, physical exercise seems to be a promising and effective treatment for cancer patients during and after therapy and seems to counteract the negative effects induced by drugs on the cardiovascular system. Exercise prescription should be tailored according to patient's individual characteristics, to the drugs administered, to the personal history, and to his/her response to exercise, taking into account that different types of training can be prescribed according also to the patient's choice. A cardiological evaluation including exercise testing is essential for an appropriate prescription of exercise in these patients.