Internal and External Load Profile during Beach Invasion Sports Match-Play by Electronic Performance and Tracking Systems: A Systematic Review.

Beach variants of popular sports like soccer and handball have grown in participation over the last decade. However, the characterization of the workload demands in beach sports remains limited compared to their indoor equivalents. This systematic review aimed to: (1) characterize internal and external loads during beach invasion sports match-play; (2) identify technologies and metrics used for monitoring; (3) compare the demands of indoor sports; and (4) explore differences by competition level, age, sex, and beach sport. Fifteen studies ultimately met the inclusion criteria. The locomotive volumes averaged 929 ± 269 m (average) and 16.5 ± 3.3 km/h (peak) alongside 368 ± 103 accelerations and 8 ± 4 jumps per session. The impacts approached 700 per session. The heart rates reached 166-192 beats per minute (maximal) eliciting 60-95% intensity. The player load was 12.5 ± 2.9 to 125 ± 30 units. Males showed 10-15% higher external but equivalent internal loads versus females. Earlier studies relied solely on a time-motion analysis, while recent works integrate electronic performance and tracking systems, enabling a more holistic quantification. However, substantial metric intensity zone variability persists. Beach sports entail intermittent high-intensity activity with a lower-intensity recovery. Unstable surface likely explains the heightened internal strain despite moderately lower running volumes than indoor sports. The continued integration of technology together with the standardization of workload intensity zones is needed to inform a beach-specific training prescription.

Monitoring Heart Rate Variability and Perceived Well-Being in Brazilian Elite Beach Volleyball Players: A Single-Tournament Pilot Study.

ABSTRACT: Nakamura, FY, Torres, VBC, da Silva, LS, Gantois, P, Andrade, AD, Ribeiro, ALB, Brasileiro-Santos, MdS, and Batista, GR. Monitoring heart rate variability and perceived well-being in Brazilian elite beach volleyball players: A single-tournament pilot study. J Strength Cond Res 36(6): 1708-1714, 2022-The aim of this study was to monitor the changes in heart rate variability (HRV) and perceptual well-being status after a beach volleyball (BV) tournament day in high-level U17 and senior players. Seventeen BV players (U17 [15-16 years]: n = 08; and senior [19-41 years]: n = 09) competing at national and/or international BV level participated in this study. Resting HRV and perceptual well-being measures were recorded across 4 moments: night 1 (prematches night), morning 1 (prematches morning), night 2 (postmatches night), and morning 2 (postmatches morning). Session rating of perceived exertion was assessed 10 minutes after each match, and accumulated match loads were used for analysis. Senior players presented higher values of natural logarithm of square root of the mean squared differences of successive RR intervals (lnRMSSD) at the 4 observation moments than U17 players (p = 0.006). Within-subjects analysis showed a larger mean difference regarding both lnRMSSD and natural logarithm SD of normal R-R intervals (lnSDNN) between night 1 vs. night 2 in U17 players (effect size = 1.11 and, 0.96, respectively) compared with senior (effect size = 0.40 and 0.32, respectively). Accumulated match loads were negatively correlated with percentage change in lnRMSSD (r = -0.54; p = 0.037). U17 players showed higher well-being variation than senior (group × time; p = 0.02). In conclusion, the lnRMSSD index was able to discriminate the U17 and senior BV players, and maintaining high vagally related HRV indices is an important response to BV training and competition.

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis.

BACKGROUND: Prophylaxis for cerebral desaturation events (CDEs) during anesthesia in the beach chair position (BCP) for shoulder surgeries has not been evaluated. We systematically analyzed the effectiveness of various prophylactic measures used in this clinical setting. METHODS: We performed a meta-analysis (PROSPERO; no. CRD42020167285) of trials reporting CDEs and regional cerebral oxygen saturation (rSO2) and jugular venous oxygen saturation (SjvO2) values in anesthetized patients undergoing shoulder surgery in BCP. Considering the type of prophylactic measures used (pharmacological or non-pharmacological), a subgroup analysis was planned. Outcomes included (1) rSO2 and SjvO2 data with and without prophylactic measures for CDEs, recorded for different time intervals, and (2) the number of patients experiencing CDEs and hypotension. RESULTS: Twelve studies (786 patients) were included in the analysis. We observed lower absolute rSO2 values for early and all-time periods for vasoactive agent prophylaxis. The lowest achieved rSO2 values were also lower for vasoactive agent prophylaxis. Risk of CDEs was higher with vasoactive agent prophylaxis. Subgroup analysis identified targeted mild hypercarbia as effective in preserving cerebral oxygenation. Similarly, targeted mild hypercarbia prevented the fall in rSO2 with position change. Meta-regressions revealed statistically significant highest estimates for vasoactive agent prophylaxis in contrast to targeted mild hypercarbia. Likelihood of not developing CDEs was higher for targeted mild hypercarbia. In contrast to rSO2, most prophylactic methods reduced hypotensive episodes. CONCLUSIONS: Targeted mild hypercarbia can reduce BCP-related CDEs. Evidence does not favor prophylactic use of vasoactive agents for the prevention of cerebral desaturations irrespective of whether their use interferes with cerebral oximetry readings.

Recreational beach tennis reduces 24-h blood pressure in adults with hypertension: a randomized crossover trial.

PURPOSE: To evaluate the effect of a beach tennis session on 24-h ambulatory blood pressure in adults with hypertension. METHODS: In this randomized crossover trial, 24 participants (12 men and 12 women) randomly performed two experimental sessions: a beach tennis session and a non-exercise control session. The beach tennis session started with a standardized 5-min warm-up consisting of basic techniques, followed by three 12-min beach tennis matches with 2-min intervals between them. Heart rate was continuously recorded and rating of perceived exertion was assessed in the middle and at the end of each set during the beach tennis session. Enjoyment was also assessed after the beach tennis session. The control session was performed in seated rest. Both experimental sessions lasted 45 min. Ambulatory blood pressure was measured continuously for 24 h after sessions. RESULTS: Systolic blood pressure (24-h: 6 mmHg, P = 0.008; daytime: 6 mmHg, P = 0.031; nighttime: 6 mmHg, P = 0.042) and diastolic blood pressure (24-h: 3 mmHg, P = 0.021; daytime: 3 mmHg, P = 0.036; nighttime: 4 mmHg, P = 0.076) decreased after beach tennis when compared with control. The participants presented a reserve heart rate of 59-68%, and a rating of perceived exertion score of 3.4-4.7 using Borg's CR10 Scale. The enjoyment scores after beach tennis session were higher than 90%. CONCLUSION: A single session of recreational beach tennis reduces 24-h ambulatory blood pressure in adults with hypertension. Additionally, the participants can achieve a high physiological stress but perceive less effort during the practice. TRIAL REGISTRATION: Date: April 10, 2019; identifier number NCT03909308 (Clinicaltrials.gov).

Usefulness of Linear Mixed-Effects Models to Assess the Relationship between Objective and Subjective Internal Load in Team Sports.

Internal load can be objectively measured by heart rate-based models, such as Edwards' summated heart rate zones, or subjectively by session rating of perceived exertion. The relationship between internal loads assessed via heart rate-based models and session rating of perceived exertion is usually studied through simple correlations, although the Linear Mixed Model could represent a more appropriate statistical procedure to deal with intrasubject variability. This study aimed to compare conventional correlations and the Linear Mixed Model to assess the relationships between objective and subjective measures of internal load in team sports. Thirteen male youth beach handball players (15.9 ± 0.3 years) were monitored (14 training sessions; 7 official matches). Correlation coefficients were used to correlate the objective and subjective internal load. The Linear Mixed Model was used to model the relationship between objective and subjective measures of internal load data by considering each player individual response as random effect. Random intercepts were used and then random slopes were added. The likelihood-ratio test was used to compare statistical models. The correlation coefficient for the overall relationship between the objective and subjective internal data was very large (r = 0.74; ρ = 0.78). The Linear Mixed Model using both random slopes and random intercepts better explained (p < 0.001) the relationship between internal load measures. Researchers are encouraged to apply the Linear Mixed Models rather than correlation to analyze internal load relationships in team sports since it allows for the consideration of the individuality of players.

Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction.

Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.

Varios modelos teóricos de distrés relacional sugieren que las reacciones fuertes y negativas al conflicto están directamente asociadas con niveles más bajos de satisfacción con la relación. De acuerdo con esta suposición, hay pruebas sustanciales que vinculan los niveles más altos de emoción negativa subjetiva, las expresiones más marcadas y frecuentes de afecto negativo, y los niveles más altos de conductas de comunicación negativa con niveles más bajos de satisfacción con la relación (p. ej.: Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). Sin embargo, las pruebas que conectan la respuesta fisiológica relacionada con el estrés durante el conflicto en la relación y la satisfacción con la relación son menos convincentes de lo que se esperaría según la teoría. Proponemos que estos resultados teóricamente inesperados, pero bien reproducidos empíricamente, pueden ser el resultado de diferentes patrones que asocian la reactividad fisiológica y la satisfacción con la relación en el caso de las parejas con estilos variados en cuanto a cómo perciben normalmente el comportamiento no deseado en el otro. El presente estudio evalúa las atribuciones negativas para las conductas no deseadas de la pareja como moderadoras de la asociación entre la reactividad de la frecuencia cardíaca (RFC) durante el conflicto en la relación y la satisfacción con la relación en una muestra de 60 parejas casadas. Surgió una interacción significativa entre la RFC y las atribuciones negativas de la conducta de la pareja a la hora de predecir la satisfacción con la relación, de manera que niveles más altos de RFC estuvieron asociados con niveles más bajos de satisfacción con la relación en personas que normalmente hicieron más atribuciones negativas para las conductas no deseadas de la pareja, pero con niveles más altos de satisfacción con la relación para las personas que normalmente hicieron menos atribuciones negativas para las conductas no deseadas de la pareja. Se debaten las implicancias para conceptualizar la reactividad durante el conflicto en la relación y las intervenciones en la pareja.

Improving the safety of shoulder arthroscopy in the beach chair position: a prospective randomized trial investigating the effect of compression stockings on cerebral desaturation events in obese patients.

BACKGROUND: Devastating transient and permanent postoperative neurocognitive complications in previously healthy, low-risk patients have been observed after elective shoulder arthroscopy in the beach chair position (BCP). Continuous monitoring of cerebral oxygen saturation has been recommended to identify cerebral desaturation events (CDEs) and improve patient safety. However, the relatively high cost and limited availability of monitoring may not be cost-effective. More cost-effective and available measures, including the use of thigh-high compression stockings (CS), have been investigated. However, efficacy data of CS usage is limited, especially for obese patients, who have been shown to be at increased risk for CDEs. The purpose of this was study was to determine if the intraoperative addition of thigh-high compression stockings decreases the incidence, frequency, and magnitude of CDEs in obese patients undergoing shoulder arthroscopy in the BCP. METHODS: Thirty-three patients in the treatment group wore both thigh-high compression stockings (CS) and sequential compression devices (SCDs), and the remaining 33 patients in the control group wore SCDs alone. Cerebral oximetry was monitored during surgery using near-infrared spectroscopy. RESULTS: The incidence of CDEs was equal between groups, with 9 patients (27%) in each experiencing desaturation events. The median number of CDEs per patient was 3 for the control group and 1 for patients wearing CS (P = .29). There was no difference between groups in terms of median time from induction of anesthesia to onset of CDE (P = .79), median time from upright positioning to onset of CDE (P = .60), mean CDE duration per patient (P = .22), and median cumulative CDE duration (P = .19). The median maximal desaturation from baseline was also not different between groups: 27.6% in the control group and 24.3% in the treatment group (P = .35). CONCLUSION: The combination of thigh-high CS and SCDs did not decrease the incidence, frequency, or magnitude of CDEs in patients undergoing shoulder arthroscopy in the BCP. Twenty-seven percent of patients undergoing shoulder arthroscopy in the BCP demonstrated CDEs with or without the use of CS. Therefore, further research is required to identify cost-effective, minimally invasive, and universally available methods of decreasing the incidence of CDEs during this common surgical procedure.

Speed and heart rate variation during marathon running in a hot environment / Variación de la velocidad y la frecuencia cardiaca durante un maratón en un ambiente caluroso

Abstract The purpose of the study was to analyze the variation of running speed and heart rate in amateur runners during a marathon in a hot environment. Eighteen runners (weight: 65.2 ± 12.21 kg, height: 168.4 ± 10.6 cm, VO2max: 52.9 ± 7.1 ml/kg/min) took part of a beach-side marathon (42195 m) under a temperature of 27.8 ± 3.52 ºC and at 0-80 m altitude. Pearson's correlation showed a significant linear relationship between the increase in thermal stress index (WGBT) and the speed variation (r= 0.168, p= 0.049). In this respect, the total duration of the race revealed a direct relationship with speed (r= 0.675, p= 0.003) and heart rate (r= 0.631, p= 0.007) variation. Multiple regressions analysis showed that 61.6% of the final race time was explained by the speed variation in the 26 to 30 km course section (r 2 = 0.61; F= 26.17; p< 0.001) and 37% by the heart rate variation in the 31 to 35 km section (r 2 = 0.37; F= 10.38; p< 0.001). In conclusion, an increase in the environmental temperature provoked a decrease in running pacing, with a stronger effect in the second half of the race. Therefore, coaches should take these aspects into account in training and strategies to mitigate the impact of these conditions on the physical and physiological performance of amateur runners.

Resumo O presente estudo teve como objetivo analisar a variação da velocidade da corrida e a frequência cardíaca em corredores amadores durante uma maratona em um ambiente de alto índice térmico. Dezoito corredores amadores (peso: 65,2 ± 12,21 kg, altura: 168,4 ± 10,6 cm, VO2max: 52,9 ± 7,1 ml/kg/min) correram uma maratona (42195 m) em proximidade ao mar, sob um índice térmico de 27,8 ± 3,52 ºC e com percurso de 0-80 metros acima do nível do mar. O teste de Pearson apresentou uma correlação significativa entre o aumento do índice de estresse térmico (IBUTG) e a variação da velocidade (r= 0,168, p= 0,049). Neste sentido, a duração total da corrida apresentou uma relação direta com a velocidade (r= 0,675, p= 0,003) e a variação da frequência cardíaca (r= 0,631, p= 0,007). O tempo final da corrida se interpretou em 61,6% e 37% pela variação da velocidade de 26 a 30 km (r 2 = 0,61; F= 26,17; p< 0,001) e pela variabilidade da frequência cardíaca no lapso de 31 a 35 km (r 2 = 0,37; F= 10,38; p< 0,001), respectivamente. Em suma, o índice térmico provoca uma diminuição no ritmo da velocidade, sendo esse efeito maior na segunda metade da corrida. Devido a isso, os preparadores devem planejar treinamentos e estratégias para mitigar o impacto dessas condições no desempenho físico e fisiológico dos corredores amadores.

Resumen El objetivo del presente estudio fue analizar la variación de la velocidad de carrera y la frecuencia cardíaca en corredores aficionados durante un maratón en un entorno de alto índice térmico. Dieciocho corredores aficionados (peso: 65.2 ± 12.21 kg, altura: 168.4 ± 10.6 cm, VO2max: 52.9 ± 7.1 ml/kg/min) corrieron un maratón (42 195 m) en cercanía al mar bajo un índice térmico de 27.8 ± 3.52ºC y con recorrido de 0-80 m.s.n.m. La prueba de Pearson mostró una correlación significativa entre el aumento del índice de estrés termal (TGBH) y la variación de la velocidad (r = 0.168, p = 0.049). En este sentido, la duración total de la carrera presentó una relación directa con la velocidad (r = 0.675, p = 0.003) y la variación de la frecuencia cardíaca (r= 0.631, p = 0.007). El tiempo final de carrera se explicó en un 61.6% y 37% por la variación de la velocidad de 26 a 30 km (r 2 = 0.61; F = 26.17; p < 0.001) y por la variabilidad de la frecuencia cardíaca en el lapso de 31 a 35 km (r 2 = 0.37; F= 10.38; p < 0.001) respectivamente. En conclusión, el índice térmico provoca una disminución en el ritmo de la velocidad, este efecto mayor en la segunda mitad de la carrera. Por lo anterior, entrenadores deben planificar entrenamientos y estrategias para mitigar el impacto de estas condiciones en el desempeño físico y fisiológico de los corredores amateur.

Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi-beach chair position.

BACKGROUND: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. METHODS: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%. RESULTS: Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi-beach chair positioning. Patients experienced the largest oxygen saturation drop during semi-beach chair positioning. Transition from baseline to semi-beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi-beach chair interval (10%, P < .01) and the semi-beach chair to incision interval (7%, P < .01). CONCLUSIONS: Most patients experienced an intraoperative CDE, with greatest incidence during semi-beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi-beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.

Match analysis and heart rate of top-level female beach volleyball players during international and national competitions.

BACKGROUND: This case-study compared match activities and time spent in selected heart rate intensity zones in top-level female beach volleyball players during National and International competitions. METHODS: A Blocker (180.2 cm; 72.7 kg; 35 years) and a Defender (179.3 cm; 73.5 kg; 20 years) activity profile were measured from Global Positioning Satellite and percentage of maximum heart rate systems (%HRmax) in different zones during 66 International and 33 National Brazilian Championship. Magnitude-based inference and Cohen's effect sizes were used for statistical comparisons. RESULTS: Both competition (i.e., International and National), the Blocker presented a higher time spent in 50-59% (100/0/0: almost certainly; 95/5/0: likely), 60-69% (97/3/0: very likely; 88/11/1:likely), and 90-100% (100/0/0: almost certainly), but lower time in 70-79% (0/1/99: very likely) and 80-89% (0/0/100: almost certainly) of HRmax than the Defender. Higher distances covered in walking (94/6/0: likely), low-intensity [LIR] (99/1/0: very likely), medium-intensity [MIR] (100/0/0: almost certainly) and high-intensity running [HIR] (86/10/3: likely), as well as acceleration (m/s2) in 0.5-0.99 (89/11/0: likely) and 2-2.99 (80/19/1: likely), and peak velocity (89/11/0; 95/5/0: likely) were seen in the Blocker compared to the Defender. Compared to National competitions, International demonstrated higher values in total distance (88/12/0: likely), peak velocity (100/0/0: almost certainly), match profile in LIR (100/0/0: almost certainly), MIR (100/0/0: almost certainly), HIR (100/0/0: almost certainly; 93/2/4: likely), 1-1.99 (100/0/0: almost certainly), 2-2.99 (100/0/0: almost certainly), >3 (96/4/6: very likely) acceleration; and in 1-1.99 (100/0/0: almost certainly), 2-2.99 (100/0/0: almost certainly), >3 (98/2/0: very likely; 100/0/0: almost certainly) deceleration; as well as during 90-100% of HRmax (94/6/0: likely). CONCLUSIONS: Blocker athlete and International competitions presented higher physical demands than their pairs during the matches, suggesting that the position and the level of competition are influenced by match demands.

[Cardiorespiratory effects of perioperative positioning techniques]. / Kardiorespiratorische Effekte perioperativer Positionierungsmaßnahmen.

The supine position is still the most frequently used type of positioning during surgical procedures. Positions other than the supine position lead to physiological alterations that have a relevant influence on the course of anesthesia and surgery. As a matter of principle, hemodynamic stability is at risk because venous blood is pooled in the lower positioned body parts. In addition, head down positions (Trendelenburg position) may lead to an impairment of respiratory function by reducing lung volumes as well as lung compliance. Upright positions (beach chair position) are characterized by a relative hypovolemia accompanied by a reduction of mean arterial pressure, cardiac output and stroke volume, whereas pulmonary functions remain unchanged. Some severe adverse events have been described in the literature (e.g. intraoperative apoplexy, postoperative blindness). The pathophysiological principles and effects of hemodynamic alterations as well as potential strategies to avoid complications are presented and discussed in this lead article. Head down positions, especially the Trendelenburg position, cause a relative (intrathoracic) hypervolemia and an increase in cardiac preload that is usually well-tolerated in patients without heart problems; however, the Trendelenburg position, especially if combined with a capnoperitoneum, significantly impairs pulmonary function, can have a negative effect on intracerebral pressure and may reduce blood flow of intra-abdominal organs. The pathophysiological intraoperative changes caused by Trendelenburg positioning are described and approaches suitable for risk reduction are discussed. The prone position and lateral decubitus position have little influence on the intraoperative homeostasis. Nevertheless, there is an ongoing discussion concerning the efficacy of a 15° left lateral position during caesarean section, which is also discussed in a separate section of this review.

Kinematics and thermal sex-related responses during an official beach handball game in Costa Rica: a pilot study / Respuestas cinemáticas y termorreguladoras relacionadas con el sexo durante un partido oficial de balonmano playa en Costa Rica. Un estudio piloto

Beach handball is a sport characterized by being a complex, dynamic, fluid of constant exchange of offensive and defensive plays. The objectives of this study was describe and analyzing the kinematics and thermal responses in male and female beach handball players during an official game in Costa Rica. Sixteen beach handball players participated, eight women and eight men. All participants were grouped by sex in two teams, male team and female team and every team played against the same adversary. Every game had two periods, 10 min each, 5 min rest, were made. GPS devices were used to quantify the kinematics responses, heart rate was obtained through cardiac monitors, internal temperature was measured using CorTemp pills and body weight loss, sweating rate and fluid intake were calculated. The main results shown significant differences between men and women in the total distance (m) (p< .01), average speed (km/h) (p< .01), maximum speed (km/h) (p= .022), total impacts (g) (p< .01), body weight change (%) (p= .038), sweat rate (ml/min) (p< .01), and liquid intake (ml) (p< .01). Internal temperature (°C) was different between men and women after warn-up (p= .044) and final first period (p= .007). Also, it found a significant decreased in the maximum speed (km/h) (p= 0.10) and body load (AU) (p= .026) in the second period both in men and women. In conclusion, beach handball is a sport that is played a medium-high intensity [HR mean (men= 156.1±17.5 bpm, women= 158.1±19.8 bpm)]. As a practical implication, this study provides information that may be used as a base or support to plan and designing training methodologies according to the specific kinematics and thermal requirements of beach handball player

El balonmano de playa es un deporte caracterizado por ser complejo, dinámico y fluido de constante intercambio de acciones defensivas y ofensivas. El objetivo de este estudio fue describir y analizar las respuestas cinemáticas y termorreguladoras en jugadores masculinos y femeninos de balonmano de playa durante un partido oficial en Costa Rica. Dieciséis jugadores participaron, ocho hombres y ocho mujeres. Todos los participantes fueron agrupados según su sexo en dos equipos, masculino y femenino, cada equipo jugó un partido contra otro equipo. Cada partido tuvo dos periodos de 10 min cada uno, con 5 min de descanso. Se utilizaron dispositivos GPS para cuantificar las respuestas cinemáticas, la frecuencia cardiaca fue obtenida mediante monitores cardiacos, se midió la temperatura interna utilizando píldoras TemCorp y se calculó la pérdida de peso corporal, la tasa de sudoración y la ingesta de líquido. Los principales resultados mostraron diferencias significativas entre hombres y mujeres en la distancia total recorrida (m) (p< 0,01), velocidad promedio (km/h) (p< 0,01), velocidad máxima (km/h) (p= 0,022), impactos totales (g) (p< 0,01), cambio en el peso corporal (%) (p= 0,038), tasa de sudoración (ml/min) (p< 0,01), y líquido ingerido (ml) (p< 0,01). La temperatura interna (°C) entre hombres y mujeres fue diferente después del calentamiento (p= 0,044) y al final del primer tiempo (p= 0,007). También, se encontró una disminución significativa en la velocidad máxima (km/h) (p= 0,10) y carga corporal (UA) (p= 0,026) en el segundo periodo en hombres y mujeres. En conclusión, el balonmano de playa es un deporte que se juega a intensidad media a alta [FC promedio (hombres= 156,1±17,5 lpm, mujeres= 158,1±19,8 lpm)]. Como implicación práctica, este estudio aporta información que puede ser usada como base para diseñar metodologías de entrenamiento acorde con los requerimientos cinemáticos y termorreguladores de los jugadores de balonmano de playa

DOES THE ANESTHESIA TECHNIQUE AFFECT ARTERIAL PRESSURE AND REGIONAL CEREBRAL OXYGEN SATURATION DURING SHOULDER ARTHROSCOPY IN THE BEACH CHAIR POSITION?

- This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.

¿Es útil la monitorización con espectroscopia de infrarojo cercano en la cirugía artroscópica de hombro con anestesia regional y sedación? / Is near-infrared spectroscopy (NIRS) monitoring useful for patients undergoing shoulder surgery under regional anaesthesia and sedation?

BACKGROUND: Shoulder surgery in beach chair position is a very common procedure in our daily practice. It has been associated to regional cerebral saturation impairment detected by near-infrared spectroscopy (NIRS) under general anaesthesia. Severe neurological complications were previously reported, even in previously healthy patients. An anaesthetic protocol under regional anaesthesia and biespectral index (BIS) guided sedation seems to be a safer strategy in order to prevent complications. OBJECTIVE: To find out, in a group of patients undergoing shoulder surgery in beach chair position under regional anaesthesia and sedation, the prevalence of cerebral desaturation events detected by NIRS (defined as a decrease ≥ 20% from baseline or absolute value < 55%). MATERIAL AND METHOD: In this descriptive study, 30 patients undergoing shoulder surgery in beach chair position under regional anaesthesia (ultrasound guided interescalene brachial plexus block) and propofol infusion BIS guided sedation were enrolled to assess the prevalence of cerebral desaturation events. The baseline data for regional cerebral oxygen saturation and bispectral index and non invasive blood pressure measured at heart level were taken prior to surgery after beach chair positioning and thereafter all 5 min until discharge. RESULTS: No cerebral desaturation events were detected during this study. CONCLUSIONS: Although monitoring regional cerebral saturation with NIRS detects decreased cerebral perfusion allowing a rapid intervention, we consider it is not essential under this anaesthesia regimen, considering that no cerebral desaturation events were reported.

La cirugía de hombro en posición de sentado constituye un procedimiento frecuente en la práctica diaria. Bajo anestesia general, se ha asociado con caída de la saturación regional cerebral de oxígeno (Src02) detectada por espectrospcopia infraroja (NIRS), reportándose complicaciones neurológicas severas, incluso en pacientes previamente sanos. El empleo de una técnica de anestesia regional más sedación titulada con índice biespectral (BIS) parecería ser una estrategia más segura a fin de evitar dichos eventos. OBJETIVO: Conocer, en pacientes sometidos a artroscopia de hombro en posición de sentado bajo anestesia regional más sedación, la prevalencia de episodios de desaturación cerebral (ECDs) determinada por NIRS (SrcO2 inferior a 55% o disminución del 20% respecto al basal). MATERIAL Y MÉTODO: Se realizó un estudio descriptivo en 30 pacientes sometidos a artroscopía de hombro en posición de sentado bajo anestesia regional (bloqueo interescalénico ecoguiado) más sedación titulada (infusión de propofol guiada por BIS). Se tomaron valores de referencia de Src02, BIS y presión no invasiva a nivel del corazón luego del posicionamiento y, consecutivamente en forma continua para las primeras dos variables y cada 5 minutos hasta el final para la última. Se ocultaron a los anestesiólogos los valores de Src02. RESULTADOS: No se ha detectado ningún EDC en la población estudiada. CONCLUSIÓN: Consideramos que el monitoreo de la perfusión cerebral con tecnología NIRS resulta útil aunque no imprescindible bajo este protocolo anestésico, dada la incidencia casi nula de eventos.

Background anaesthetic agents do not influence the impact of arginine vasopressin on haemodynamic states and cerebral oxygenation during shoulder surgery in the beach chair position: a prospective, single-blind study.

BACKGROUND: Administration of arginine vasopressin (AVP) is associated with reducing jugular venous (SjvO2) and regional cerebral (rScO2) oxygen saturation under propofol-remifentanil (P/R) anaesthesia. We determined whether background anaesthetics modulate the effect of AVP on cerebral oxygenation and haemodynamics. METHODS: We randomly allocated 60 adult patients scheduled for shoulder surgery in the beach chair position (BCP) into 4 groups, to receive either an intravenous bolus of saline (groups PR-S and SN-S) or 0.05 U/kg AVP (groups PR-AVP and SN-AVP) under P/R or sevoflurane-nitrous oxide (S/N) anaesthesia (n = 15 each). Haemodynamic variables, SjvO2 and rScO2 were measured. RESULTS: AVP significantly increased mean arterial blood pressure (MAP) and decreased rScO2 in either anaesthetic group. AVP also decreased SjvO2 in the P/R groups but not in the S/N groups. The AVP-treated groups showed higher MAP and cerebral desaturation (>20% rScO2 decrease from baseline), along with lower HR and rScO2 in the BCP than those in the saline-treated groups. In contrast, AVP did not affect SjvO2 values or the incidence of SjvO 2  < 50%. Baseline SjvO2 was lower and the magnitude of its reduction in the BCP was greater in the PR-AVP group than in the SN-AVP group, and the lowest SjvO2 values were 37 ± 6 and 57 ± 8%, respectively (P < 0.001). CONCLUSIONS: The choice of anaesthetic regimen did not affect cerebral oxygenation or haemodynamics of AVP in the BCP. However, the negative effect of AVP on cerebral oxygenation should be considered, especially under P/R anaesthesia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01687894 , registered on September 18, 2012.

Match analysis of an elite beach soccer team.

BACKGROUND: The aim of this study was to investigate the physiological demands and technical-tactical performances of field players in Italian elite beach soccer team. METHODS: Three official matches of the Italian First Division beach soccer tournament were analyzed to evaluate the heart rate (HR) and time-motion analysis considering: standing, walking, jogging, running and sprinting, and technical-tactical aspects. Repeated-measures ANOVAs were used to determine the effects of time on the physiological measures and time motion analysis. RESULTS: The mean heart rate (HR) was 161±20 b·min-1 corresponding to an overall mean of 84.3±10.5% of maximum heart rate (HRmax). Beach soccer players spent 52.5% of the time exercising at HR>85% of their HRmax. The time motion analysis results showed that for 50% of the match the players performed very low intensity activities. The notational analysis showed that during the 52.8% of the offensive actions 2 players were involved and the 42.6% of the offensive actions was performed by one pass. CONCLUSIONS: These findings demonstrate that the beach soccer is an intermittent high intensity sport with a significant involvement of anaerobic metabolism. The results of time motion analysis and notational analysis underscored that the sand does not support the movements of players overall high intensity running. Team work is difficult to implement due to irregular rebounds and it does not consent precise passes. Furthermore this study suggests that it is important to include an intermittent training with high intensity and short recovery to improve the athlete's performance.

Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study / 대한마취과학회지

BACKGROUND: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. METHODS: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. RESULTS: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. CONCLUSIONS: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.

Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position / Patient State Index e alterações do fluxo sanguíneo cerebral durante artroscopia do ombro em posição de cadeira de praia

Abstract Background and objectives: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. Methods: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients’ internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5 min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4) min. Results: There was a significant decrease between T0 and T1 in heart rate (80.5 ± 11.6 vs. 75.9 ± 14.4 beats/min), MAP (105.8 ± 21.9 vs. 78.9 ± 18.4 mmHg) and PSI (88.5 ± 8.3 vs. 30.3 ± 9.7) (all p < 0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Conclusion: Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20 min.

Resumo Justificativa e objetivos: Demonstrar as possíveis alterações hemodinâmicas e do fluxo sanguíneo cerebral (FSC) em pacientes que foram posicionados de supinação para cadeira de praia (CP) e detectar se a mudança de posição causa alguma alteração na atividade cortical como mensurado pelo monitor de EEG com quatro canais. Métodos: Foram incluídos 35 pacientes. Antes da indução, os valores da PAM e do IEP foram registrados (T0). Após a intubação, ultrassonografias com Doppler da carótida interna e artérias vertebrais dos pacientes foram avaliadas para adquirir os valores do FSC a partir da fórmula. Em supinação, os valores da PAM, IEP e FSC foram registrados (T1) e o paciente foi posicionado em CP. Após cinco minutos, todas as mensurações foram repetidas (T2). As mensurações do IEP e PAM foram repetidas após 20 (T3) e 40 minutos (T4). Resultados: Houve uma diminuição significativa entre T0 e T1 na FC (80,5 ± 11,6 vs. 75,9 ± 14,4 bpm), PAM (105,8 ± 21,9 vs. 78,9 ± 18,4 mmHg) e IEP (88,5 ± 8,3 vs. 30,3 ± 9,7) (p < 0,05 para todos). A PAM diminuiu significativamente após a mudança de posição e permaneceu diminuída em relação a T1. A análise global dos valores do IEP (T1-T4) não mostrou mudança significativa, mas a comparação de apenas T1 e T2 resultou em redução estatisticamente significativa do IEP. Houve redução significativa do FSC após o posicionado em CP. Conclusão: O posicionado em CP foi associado à diminuição do FSC e dos valores do IEP. O IEP foi afetado pela mudança gravitacional do FSC; no entanto, ambos os fatores não estavam diretamente correlacionados. Além disso, a diminuição do valor do IEP foi transitória e voltou aos valores normais dentro de 20 minutos.

Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position.

BACKGROUND AND OBJECTIVES: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. METHODS: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients' internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4)min. RESULTS: There was a significant decrease between T0 and T1 in heart rate (80.5±11.6 vs. 75.9±14.4beats/min), MAP (105.8±21.9 vs. 78.9±18.4mmHg) and PSI (88.5±8.3 vs. 30.3±9.7) (all p<0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. CONCLUSION: Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20min.

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study.

BACKGROUND: The objective of this study was to describe changes in cerebral tissue oxygen saturation (SctO2) due to changes in body position in healthy volunteers and in patients undergoing surgery under general anesthesia in the beach chair position (BCP) and lateral decubitus position (LDP). METHODS: In this prospective observational study, SctO2 was measured in 85 awake volunteers serially positioned every 15 min, beginning with the supine position (SP) and followed by the beach chair, supine, and lateral decubitus positions. Cerebral tissue oxygen saturation was also measured supine and in either the BCP or the LDP in 195 patients (according to surgical preference) undergoing elective arthroscopic shoulder surgery. We measured the lowest stable SctO2 values in each position as well as changes in blood pressure and heart rate. RESULTS: In healthy volunteers, the median (interquartile range [IQR]) lowest stable SctO2 value in the SP was 69 [66-71] %. A change in position to the BCP caused a small but statistically significant decrease in the median [IQR] lowest SctO2 value to 67 [65-70] % (P = 0.028 compared with baseline). This decrease was associated with an increase in median [IQR] arterial pressure from 83 [78-88] mmHg in the SP to 85 [81-93] mmHg in the BCP (P < 0.001 compared with baseline). In patients undergoing surgery in the BCP, the median [IQR] lowest stable SctO2 value was 55 [51-59] %, which was significantly lower (P < 0.001) than the median [IQR] lowest SctO2 value in patients in the LDP (66 [62-69] %). More patients in the BCP group (57%) showed SctO2 values ≤ 55% and/or a decrease of ≥ 20% from baseline (57%) compared with the LDP group (5% and 6%, respectively; P < 0.001 for each comparison). CONCLUSIONS: More than 55% of patients undergoing arthroscopic shoulder surgery in the BCP experience cerebral desaturation events. In volunteers without anesthesia, no desaturation events were observed. The clinical importance of these findings needs further investigation.