Previous Exercise Levels and Outcome in Patients with New Atrial Fibrillation: 'Past Achievements Do Not Predict the Future'.

INTRODUCTION: Long-term endurance exercise is suspect to elevate the risk of atrial fibrillation (AF),but little is known about cardiovascular outcome and disease progression in this subgroup of AF patients. We investigated whether previous exercise level determines cardiovascular outcome. METHODS: In this post hoc analysis of the RACE 4 randomized trial, we analyzed all patients with a completed questionnaire on sports participation. Three subgroups were made based on lifetime sports hours up to randomization and previous compliance to the international physical activity guidelines. High lifetime hours of high dynamic activity patients were defined as more than 150 min/week of high intense physical exercise. The primary endpoint was a composite of cardiovascular death and hospital admissions. RESULTS: A total of 879 patients were analyzed, divided in 203 high lifetime hours of high dynamic activity -, 192 high lifetime hours of activity- and 484 low lifetime hours of activity patients. Over a mean follow up of 36 months (±14), the primary endpoint occurred in 61 out of 203 (30%) high lifetime hours of high dynamic activity -, 53 out of 192 (27%) high lifetime hours of activity- and 135 out of 484 low lifetime hours of activity patients (28%) (p = 0.74). During follow up 42 high lifetime hours of high dynamic activity- (35%), 43 high lifetime hours of activity- (32%) and 104 low lifetime hours of activity patients (34%) with paroxysmal AF received electrical or chemical cardioversion or atrial ablation (p = 0.90). CONCLUSIONS: In patients included in the RACE 4, there appears to be no relation between previous activity levels and cardiovascular outcome and the need for electrical or chemical cardioversion or atrial ablation. Cardiovascular outcome was driven by AF related arrhythmic events.

Early recovery after endoscopic totally extraperitoneal (TEP) hernia repair in athletes with inguinal disruption: A prospective cohort study.

BACKGROUND: Groin pain is a common problem in athletes which results in loss of playing time. Moreover, it can be for the cause of athletic career termination. A common cause of groin pain in athletes is inguinal disruption; pain in the groin area near the pubic tubercle were no obvious other pathology exists to explain the symptoms. Aim of this study was to evaluate the effect of endoscopic totally extraperitoneal (TEP) hernia repair in athletes with inguinal disruption. METHODS: Thirty-one athletes with chronic groin pain due to inguinal disruption, who had undergone conservative therapy without any effect, were included in this prospective cohort study. Prior to surgery patients were assessed by clinical examination, ultrasound of the inguinal region, x-ray and a radionuclide bone scan with single photon-emission computed tomography and CT (SPECT-CT). TEP hernia repair was performed and a lightweight polypropylene mesh was placed pre-peritoneally. Additionally the athletes' perception about their groin disability was assessed preoperatively and 6 weeks postoperatively by means of the Hip and Groin Outcome Score (HAGOS). The HAGOS consists of six subscales: Pain, Symptoms, Physical function in daily living, Physical function in Sport and Recreation, Participation in Physical Activities, and hip and/or groin-related Quality of Life. RESULTS: No complications occurred during and after surgery. After six weeks patients improved in all the separate subscales of the Hip and Groin Outcome Score (HAGOS). Within 6 weeks of surgery, 26 patients (84%) returned to sports activities with no or less groin pain. CONCLUSIONS: This study showed that endoscopic totally extraperitoneal (TEP) hernia repair is an effective surgical treatment of inguinal disruption in athletes with chronic groin pain.

The electrocardiographic manifestations of athlete's heart and their association with exercise exposure.

OBJECTIVE: The aim of this study was to define the minimum amount of exercise per week ('current exposure') and the total amount of exercise ('lifetime exposure') needed to lead to the electrocardiographic changes fitting athlete's heart. METHODS: All the pre-participation screenings (including electrocardiograms (ECGs)) from collegiate athletes performed at University Sports Medical Center in 2013 and 2014 were collected. Data on height, weight, sex, age, current sport(s) participation and lifetime sport(s) participation were collected. Current exposure was categorised into 0-3, 3-6, 6-10 and >10 hours/week. Lifetime sport exposure was divided into five categories: 0-1000, 1001-2000, 2001-3000, 3001-4000 and >4000 hours. RESULTS: The study population consisted of 1229 athletes (current exposure) and 1104 athletes (lifetime exposure). Current sport exposure: There was a significant increase in training-related ECG changes in the category 3-6 vs. <3 hours/week. When looking at individual parameters, we found an association with a significant difference in sinus bradycardia and QRS voltage (<3 vs. 3-6 hours/week) and first-degree AV-block (<3 vs. >10 hours/week).Lifetime sport exposure: There was an increase in training-related ECG changes that reached significance at an exposure >3000 hours. When looking at individual parameters, we found an association with a significant difference in sinus bradycardia (0-1000 vs. 2001-3000), QRS voltage (0-1000 vs. 3001-4000) and first-degree AV-block (0-1000 vs. >4000). CONCLUSION: A minimum of ≥3 hours/week of current exposure and a lifetime exposure of >3000 hours is needed to lead to the electrocardiographic changes fitting athlete's heart.

Gender differences in the electrocardiogram screening of athletes.

OBJECTIVES: Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the cardiovascular screening of young athletes. DESIGN: Observational cross-sectional study. METHODS: In 2013 and 2014 all the ECGs from the cardiovascular screenings performed at University Sports Medical Centre in Groningen of the student athletes who wanted to participate in a college sports program were collected. The ECG characteristics were scored using computer-based measurements and the Seattle ECG criteria. RESULTS: The study population included 1436 athletes, of which 72% were male. Male athletes were older (19.3 years vs. 18.6 years), participated in sports more frequently (4.0/week vs. 3.8/week) and spent more hours per week practising sports (6.4h/week vs. 5.8h/week) than female athletes. Male athletes had significantly higher PR intervals (149ms vs. 141ms), lead voltages and QRS duration (98ms vs. 88ms). Female athletes had significantly higher resting heart rates (69/min vs. 64/min) and QTc intervals (407ms vs. 400ms). Male athletes also had significantly higher amounts of sinus bradycardia (38.3% vs. 23.0%), incomplete RBBB (15.0% vs. 3.7%), early repolarisation (4.5% vs. 1.0%) and isolated QRS voltage criteria for LVH (26.3% vs. 4.6%). All P-values were ≤0.001. CONCLUSIONS: ECGs of young athletes demonstrate gender-related differences. These differences could be considered in their cardiovascular screening. For the Seattle ECG criteria we advise additional research into the clinical implications of using gender-based cut-off values for the QRS duration in the intraventricular conduction delay criterion.

Cross-Cultural Adaptation and Validation of the Dutch Version of the Hip and Groin Outcome Score (HAGOS-NL).

BACKGROUND: Valid and reliable questionnaires to assess hip and groin pain are lacking. The Hip and Groin Outcome Score (HAGOS) is a valid and reliable self-reported measure to assess symptoms, activity limitations, participation restrictions and quality of life of persons with hip and/or groin complaints. The purpose of this study was to translate and cross-culturally adapt the HAGOS into Dutch (HAGOS-NL), and to evaluate its internal consistency, validity and reliability. METHODS: Translation and cross-cultural adaption of the Dutch version of the HAGOS (HAGOS-NL) was performed according to international guidelines. The study population consisted of 178 adult patients who had undergone groin hernia repair surgery in the previous year. All respondents filled in the HAGOS-NL, the SF-36, and the SMFA-NL for determining construct validity of the HAGOS-NL. To determine reliability, 81 respondents filled in the HAGOS-NL after a time interval of two weeks. RESULTS: Factor analysis confirmed the original six-factor solution of the HAGOS. Internal consistency was good for all the subscales of the HAGOS-NL. High correlations were observed between the HAGOS-NL and the SF-36 and SMFA-NL, indicating good construct validity. The HAGOS-NL showed high reliability, except for the subscale Participation in Physical Activities which was moderate. CONCLUSIONS: The HAGOS was successfully translated and cross-culturally adapted from English into Dutch (HAGOS-NL). This study shows that the HAGOS-NL is a valid and reliable instrument for the assessment of functional status and health-related quality of life in patients with groin complaints.

Differences in kinetic variables between injured and noninjured novice runners: a prospective cohort study.

OBJECTIVES: This prospective study examined differences in kinetic variables between injured and noninjured novice female and male runners and their potential contribution to RRIs. DESIGN: A prospective cohort study. METHODS: At baseline vertical ground reaction forces were assessed with an instrumented treadmill equipped with three force measuring transducers. Female participants ran at 8 and 9kmh(-1) and male runners ran at 9 and 10kmh(-1). Primary outcome measure was a running related injury (RRI). Participants were novice female and male recreational runners and were followed during a 9-week running program with three running sessions a week. RESULTS: One hundred thirty three female and seventy seven male runners participated in this study. Mean age was 37.2years and the BMI was 23.9kgm(-2). During the nine week running program 16.2% of the participants sustained an injury and no difference in incidence between female and male runners was seen. In injured male runners loading rate was significantly higher compared to noninjured male runners at both running speeds and contact time in the injured male group was significantly shorter at 9kmh(-1). In the group of female injured and noninjured runners no differences on kinetic or spatio-temporal variables were observed. Female runners had significantly higher loading rates compared to male runners but this did not have an effect on the incidence of RRIs. CONCLUSIONS: This study showed that male injured runners had higher loading rates and shorter contact times than noninjured male runners. In female runners, however, no differences in kinetic or spatio-temporal variables were observed between injured and noninjured novice runners.

The effectiveness of a preconditioning programme on preventing running-related injuries in novice runners: a randomised controlled trial.

OBJECTIVES: There is no consensus on the aetiology and prevention of running-related injuries in runners. Preconditioning studies among different athlete populations show positive effects on the incidence of sports injuries. HYPOTHESIS: A 4-week preconditioning programme in novice runners will reduce the incidence of running-related injuries. STUDY DESIGN: Randomised controlled clinical trial; level of evidence, 1. METHODS: Novice runners (N=432) prepared for a four-mile recreational running event. Participants were allocated to the 4-week preconditioning (PRECON) group (N=211) or the control group (N=221). The PRECON group started a 4-week training programme, prior to the running programme, with walking and hopping exercises. After the 4-week period both groups started a 9-week running programme. In both groups information was registered on running exposure and running-related injuries (RRIs) using an internet-based running log. Primary outcome measure was RRIs per 100 runners. An RRI was defined as any musculoskeletal complaint of the lower extremity or lower back causing restriction of running for at least a week. RESULTS: The incidence of RRIs was 15.2% in the PRECON group and 16.8% in the control group. The difference in RRIs between the groups was not significant (χ(2)=0.161, df=1, p=0.69). CONCLUSION: This prospective study demonstrated that a 4-week PRECON programme with walking and hopping exercises had no influence on the incidence of RRIs in novice runners.

Effects of imagery motor training on torque production of ankle plantar flexor muscles.

The aim of this study was to investigate in control subjects the effect of imagery training on the torque of plantar-flexor muscles of the ankle. Twenty-nine subjects were allocated to one of three groups that performed either imagery training, low-intensity strength training, or no training (only measurements). The low-intensity training served as an attention control group. Plantar-flexor torques were measured before, during, directly after, and 4 weeks after the training period. At the end of a 7-week training program, significant differences were observed between the maximal voluntary torque production of the imagery training group (136.3 +/- 21.8% of pretraining torque) vs. the low-intensity training group (112.9 +/- 29.0%; P < 0.02) and the control group (113.6 +/- 19.2%; P < 0.02). The results of this study show that imagery training of lower leg muscles significantly increased voluntary torque production of the ankle plantar-flexor muscles and that the force increase was not due to nonspecific motivational effects. Such muscle strengthening effects might be beneficial in rehabilitation for improving or maintaining muscle torque after immobilization.