Elite Athletes Research Articles

Carbon monoxide supplementation: evaluating its potential to enhance altitude training effects and cycling performance in elite athletes.

Altitude training is a cornerstone for endurance athletes for improving blood variables and performance, with optimal effects observed at ∼2,300-2,500 meters above sea level (m.a.s.l.). However, elite cyclists face challenges such as limited access to such altitudes, inadequate training facilities, and high expenses. To address these issues, a novel method involving daily exposure to carbon monoxide (CO) has been proposed to amplify altitude training adaptations at suboptimal altitudes. Thirty-one male cyclists were assigned to three groups: Live-High Train-High with CO inhalation (LHTHCO), Live-High Train-High (LHTH), and Live-Low Train-Low (LLTL). The LHTHCO group underwent CO inhalation twice daily in the afternoon/evening to elevate carboxyhemoglobin concentration to ∼10%. Hematological variables, in vivo muscle oxidative capacity, and physiological indicators of cycling performance were assessed before and after a 3-week altitude training camp at 2,100 m.a.s.l. LHTHCO demonstrated a larger increase in hemoglobin mass (Hbmass) compared to both LHTH and LLTL. Although there were no statistical differences between LHTHCO and LHTH in submaximal and maximal performance measures, LHTHCO displayed greater improvements in 1-min maximal power output during incremental testing (Wmax), power output at lactate threshold, and maximal oxygen consumption (V̇o2max) compared to LLTL. LHTH demonstrated a larger improvement than LLTL in Wmax and V̇o2max, with no group differences in Hbmass or submaximal measures. Muscle oxidative capacity did not differ between groups. These findings suggest that combining moderate-altitude training with daily CO inhalation promotes hematological adaptations more effectively than moderate altitude alone and enhances cycling performance metrics in cyclists more than sea-level training.NEW & NOTEWORTHY Three weeks of training at moderate altitude with exposure to low doses of CO can significantly enhance hematological adaptations in elite cyclists compared to moderate-altitude training alone. Cycling performance determinants improved more with CO inhalation at moderate altitude compared to sea-level training, whereas there were no differences in submaximal and maximal performance measures compared to moderate-altitude training alone. This study highlights the potential of CO supplementation as an effective adjunct to altitude training regimens.

Differences in cardiac magnetic resonance imaging bi-atrial strain between elite athletes and atrial fibrillation patients

Abstract Background Elite athletes frequently demonstrate outspoken bi-atrial dilation, even exceeding volumes seen in patients with atrial fibrillation (AF). Hence, distinguishing atrial exercise-induced adaptation from maladaptation or atrial pathology cannot be done using volumes only. However, data on bi-atrial strain in athletes compared with AF patients investigated using cardiac magnetic resonance imaging (CMR). Methods We performed a retrospective cross-sectional analysis of CMR data comparing three groups: (1) elite athletes included in the ELITE-cohort at the Amsterdam UMC (> 16 years of age and train ≥ 10 hours/week at (inter)national or Olympic level, (2) paroxysmal- (PAF) and persistent AF patients awaiting PVI and (3) healthy controls. All participants underwent CMR in sinus rhythm. Left- and right atrial (LA/RA) reservoir (RES), conduit (CD) and contractile (CT) strain were analysed by automatic feature tracking (FT). Results We included a total of 340 elite athletes (median age 28 years [17, 67]; female n=145 (42.6%)), 103 AF patients (median age 60 [29, 75], female n=36 (35%), PAF n=74 (71.8%), persistent AF n=29 (28.2%), and 85 healthy controls (median age 28 [16, 72], female n=39 (45.9%). Elite athletes had similar indexed maximal left atrial volumes (LAVI) compared to AF patients (49.6 ml/m2 [41.9, 58.3] vs 47.9 ml/m2 [40.5 ml/m2], p = .25), but larger indexed maximal right atrial volumes (RAVI) (59.3 ml/m2 [50.7, 70.7] vs 44.7 ml/m2 [37.0, 55.7], p < .001). Elite athletes had lower LA RES strain (42.8% [36.7. 49.2]) than controls (47.5% [40.6, 54.3], p < .001) but a higher LA RES than AF patients (34.7% [27.4, 41.6], p < .001). Athletes demonstrated higher LA CD/CT ratio (2.2 [1.8, 2.8]) than healthy controls (1.8 [1.4, 2.2], p < .001) and AF patients (1.4 [1.1, 1.9], p < .001) caused by a higher LA CD in athletes (29.2% [24.7, 34.2] compared to healthy controls (29.1% [24.0, 36.2], p < .001) and AF patients (20.1% [16.2, 25.6], p < .001) and a lower LA CT in both athletes (13.0% [22.1, 15.8] and controls (20.1% [16.2, 25.6], compared to healthy controls (17.2% [14.1, 19.9], p < .001). Elite athletes had lower RA RES strain (51.5% [42.8. 63.4]) than controls (57.3% [48.0, 73.5], p = .001) and higher RA RES than AF patients (44.7% [34.1, 55.0], p < .001). AF patients had lower RA CD (28.3% [20.1, 36.8] than elite athletes (35.9% [28.9, 45.5], p < .001) and healthy controls (41.9% [32.4, 51.1], p < .001). Elite athletes had higher RA CD/CT ratio than AF patients (2.5 [1.9, 3.2] vs 1.9 [1.2, 2.4], p < .001). Conclusion Compared with healthy controls and patients with AF, athletes demonstrate unique bi-atrial characteristics. While LAVI is similar in both elite athletes and AF patients, elite athletes demonstrate larger RAVI and a unique strain profile characterized by a higher bi-atrial CD/CT ratio compared with AF patients, but a reduced bi-atrial RES strain relative to healthy controls yet elevated compared to AF patients.Differences in bi-atrial strain

Influence of peak exercise-induced blood pressure on basal to apical myocardial wall thickness in elite athletes: a sex-specific CMR study

Abstract Background Understanding the sex-specific physiological remodelling response of the myocardial walls to peak exercise-induced blood pressure (SBPpeak) is essential for distinguishing healthy adaptation from pathological remodelling in athletes. Purpose We investigated how SBPpeak relates to myocardial wall thickness measured using cardiac magnetic resonance imaging (CMR) in elite athletes. Methods Cross-sectional analysis of healthy elite athletes included in the ELITE study who underwent both cardiopulmonary exercise testing (CPET) and CMR. Imaging software’s built-in AI option determined average end-diastolic wall thicknesses of all sixteen AHA-defined segments on short-axis cine images with four-chamber long-axis reference. Our primary metrics of interest were Spearman's correlations between SBPpeak and left ventricular mass indexed to body surface area (LVM/BSA), as well as average wall thickness across the sixteen myocardial segments, stratified by sex and endurance/non-endurance sports status. Secondary analyses involved regression models to evaluate the influence of SBPpeak on myocardial wall thickness, adjusting for sex, body size, CPET variables and sport type. Results In 75 athletes (median age: 24; 71% female; 61% engaged in endurance sports), CPET and CMR were performed within a median interval of 5 months [interquartile range: 1-13 months]. SBPpeak was similar in female and male athletes (170 [160-180] vs. 174 [169-184] mmHg, p=0.121, respectively) and in endurance and non-endurance athletes (both 170 [160-180] mmHg, p=0.625). Female elite athletes showed weak to moderate positive correlations between SBPpeak and the majority of basal and mid-ventricular AHA segments (rho = 0.27 – 0.48, Figure). This was most pronounced in the mid-ventricular anterolateral segment (AHA06: rho = 0.48, p<0.001). LVM/BSA in females was positively correlated with SBPpeak (rho = 0.31, p=0.025). Male elite athletes demonstrated greater absolute wall thickness across all AHA segments compared to females, however, there was a moderate correlation with SBPpeak exclusive to the basal anterior segment (AHA01: rho = 0.48, p=0.028). Backward stepwise multivariate regression analyses (Table) revealed SBPpeak as an independent predictor of the thickness of all basal AHA segments except for the basal inferoseptal segment (AHA03), and the mid-anterior and anterolateral segments. Associationswere maintained after adjustment for maximum wattage, body surface area, and sex, with type of sports consistently excluded from the models. Conclusion In the extreme phenotypes of elite athletes, SBPpeak correlates especially with basal myocardial thickness, independent of sex, BSA and maximum work rate influences. We found stronger associations between SBPpeak and myocardial adaptation in female athletes. These findings suggest a paramount role of exercise-induced blood pressure on basal myocardial remodelling surpassing the effect of sports type.Figure:segmental polar plot (heat map)Table:GAM regression models

Structural echocardiographic parameters in male and female Asian athletes: a systematic review and meta-analysis

Abstract Introduction Following repetitive structured and intense physical training, elite athletes’ hearts undergo physiological cardiac remodelling, including increased left ventricular (LV) size and LV wall thickness. These changes may mimic those seen in pathological cardiac conditions such as dilated and hypertrophic cardiomyopathy, posing a challenge for accurate diagnosis. Reference ranges for common echocardiographic parameters in elite Caucasian and Black athletes have been reported, facilitating differentiation between physiological and pathological changes in these demographics. However, there remains a paucity of data for Asian athletes despite their increasing representation in global sport. Methods We searched MEDLINE via PubMed, Embase, and the Cochrane Database for relevant studies from inception till 20th November 2023. We included observational studies that reported relevant echocardiographic parameters in elite Asian athletes. Studies that did not report gender-specific cardiac imaging parameters were excluded. After study selection and data extraction, random-effects meta-analysis of means was performed to obtain the weighted mean and 95% confidence intervals (CI) of common echocardiographic parameters stratified by gender. Results Our final search yielded 10 studies comprising a total of 1,111 elite athletes (996 male, 115 female; 53% Japanese, 21% uncategorised, 14% South-East Asian). Athletes participating in skill and power disciplines were excluded from analysis post-hoc due to a paucity of data and extreme data ranges. In male athletes, mean LV wall thickness was 9.4 mm (95% CI 8.5-10.3, I2 = 98.9%), mean LV end diastolic diameter was 54.7 mm (95% CI 52.5-57.0, I2 = 98.6%), mean LV mass indexed to body surface area was 97.5 g/m2 (95% CI 90.5-104.5, I2 = 97.5%) and mean aortic root diameter was 31.9 mm (95% CI 29.2-34.7, I2 = 99.5%). In female athletes, mean LV wall thickness was 7.9 mm (95% CI 7.5-8.4, I2 = 85.4%), mean LV end diastolic diameter was 47.1 mm (95% CI 45.8-48.3, I2 = 77.3%), mean LV mass indexed to body surface area was 79.5 g/m2 (95% CI 69.2-89.7, I2 = 92.8%) and mean aortic root diameter was 27.5 mm (95% CI 26.9-28.1). Conclusion This meta-analysis describes commonly reported echocardiographic parameters in elite Asian athletes from endurance and mixed sport disciplines. The absolute values of all reported parameters appear to fall far below reported limits for non-Asian athletes, highlighting substantial ethnic and regional variation in cardiac remodelling in elite athletes. While our results facilitate preliminary referencing of expected normal ranges in this demographic group, further studies are necessary to fully define the cardiac characteristics of Asian athletes.

Unveiling a hide side of the athlete's heart: a CMR focus on the left atrium.

Abstract Background cardiac magnetic resonance (CMR) is the gold standard to evaluate cardiac chambers’ dimensions and function, but data on left atrium (LA) dimensions and function among elite athletes are lacking. Objective to describe LA size and function among a cohort of elite athletes and evaluate eventual differences based on sports discipline and gender. Methods We enrolled 120 Olympic athletes with un-remarkable cardiovascular pre-participation screening tests (mean age 25±5 years, 50% males, 25% skill, 25% power, 25% mixed, 25% endurance). All the athletes underwent CMR without contrast administration. LA dimensions, in terms of absolute and indexed area and volume, were computed using 4- and 2-chamber steady state precession cine-sequences. LA ejection fraction (LAEF) and LA coupling index (LACI index, as the ratio between LA and LV end-diastolic volumes) were calculated. Cine-images were also used to analyse atrial deformation with a dedicated offline software to measure LA global longitudinal strain. LA dimensions and function were compared between males and females and athletes of different sports categories based on European classification. Results Among the entire cohort, endurance athletes showed the greatest remodelling in terms of LA and LV dimensions (Table). There were no significant differences in LAEF and LV-EF between athletes of different sport categories (p=0.121 and p=0.679). A trend in increasing LA volumes and decreasing LA strain consistent with a growing cardiovascular demand was observed, but the only statistically significant difference was between skill athletes and all the other groups for LA volumes (p<0.001), while there were no significant differences in LA strain (p=0.170). LACI did not differ between athletes of different sports categories (p=0.170). Female athletes showed higher LAEF and LA strain than males (respectively 55±5 vs 52±6% p=0.012 and 35±7 vs 32±7%, p=0.009) while LACI did not differ based on gender (19±5% for both females and males, p=0.385). Conclusion Among our cohort of Olympics, LA remodelling was observed in all athletes, being less evident in skill group, as for the LV. Thus, the ratio between LA and LV did not differ between sport categories. LAEF and LA strain were not significantly different between athletes of different sports categories although LA strain was slightly lower in endurance. Female athletes showed higher LAEF and LA strain than males, while LACI was not different based on gender.

Atrial and ventricular arrhythmias in young, lifelong and retired elite endurance athletes

Abstract Background Whilst endurance athletes are known to have an overall higher prevalence of atrial fibrillation (AF), the prevalence of other non-sustained and sustained atrial arrhythmias (AAs) and ventricular arrhythmias (VAs) remains poorly defined. Purpose We aimed to define the prevalence of non-sustained and sustained AAs (including AF) and VAs in a healthy cohort of young, lifelong and retired elite endurance athletes. We also sought to assess associations between arrhythmias, fitness and measures of cardiac structure. Methods Holter monitors in healthy endurance athletes (n=288) from an international cohort of elite endurance athletes (the Pro@Heart consortium) were analysed for the presence of sustained and non-sustained AAs and VAs. Athletes were sub-divided into young elite athletes (n=176) and former elite athletes (n=112) of which 60 were lifelong (≥2.5 hours/week) and 52 retired (<2.5 hours/week) athletes (determined by current high-intensity exercise activity). Each athlete underwent cardio-pulmonary exercise testing, echocardiography and contrast-enhanced cardiac MRI. Participants with known structural or electrical cardiac disease were excluded. Independent T-test / One-Way ANOVA (parametric data) or Mann-Whitney U / Kruskal-Wallis Tests (non-parametric data) assessed for differences between the groups. Results Young athletes (n=176, 70.5% male) were significantly fitter with a greater degree of cardiac remodelling as compared with lifelong (n=60, 63.3% male) and retired (n=52, 82.7% male) athletes (Figure 1). The prevalence of non-sustained AAs (young: 4.0% vs lifelong: 66.7% vs retired: 61.5%, p<0.001), sustained AAs (young: 0.6% vs lifelong: 8.3% vs retired: 15.4%, p<0.001) and non-sustained VAs (young: 1.7% vs lifelong: 18.3% vs retired: 23.1%, p<0.001) was higher in lifelong and retired athletes compared with young athletes (Figure 2). Non-sustained VAs were predominately monomorphic (85%), short and moderate rate (median duration 2.8 seconds and heart rate 154 beats per minute). No athletes developed sustained VAs and/or sudden cardiac arrest. Young athletes had less VAs that were multifocal in origin compared with lifelong and retired athletes (young: 29.5%, lifelong: 37.3%, retired: 53.5%, p=0.027). There was no difference in prevalence of any arrhythmia between lifelong and retired athletes. There were no significant correlations between arrhythmias and fitness or cardiac imaging parameters. Conclusion Healthy athletes have a significant prevalence of non-sustained atrial and ventricular arrhythmias and sustained atrial arrhythmias that is more prevalent in older athletes. In older athletes, the prevalence of arrhythmias is similar regardless of whether athletes are actively engaged in training or retired suggesting that pro-arrhythmic remodelling in athletes is sustained, not immediately reversible and may be minimally responsive to detraining.Arrhythmias and cardiac imagingArrhythmias amongst athlete groups

Relation between wearable heart rate monitor derived training load and cardiac adaption in endurance athletes

Abstract Background No studies have effectively measured training load (TL) from wearable heart rate (HR) monitors and determined its relation to exercise induced left and right ventricular (LV, RV) remodeling. A better insight into drivers of exercise induced cardiac remodeling is of clinical relevance to guide training advice in athletes at risk of adverse remodeling. Purpose We determined the TL, based on HR monitoring by commercial wearables[1]. The number and duration of training sessions was quantified during a period of 3 months. Training-intensity was calculated as Edwards TRIMP (eTRIMP) based on the product of training duration in one of 5 HR zones (1=light, 5=very vigorous) and the coefficient related to the respective HR zone. Methods Training data was collected in 2 prospective multicenter studies. Master@Heart comprises endurance trained middle-aged men aged 45 to 70years[2]. Pro@Heart consists of elite athletes aged 16 to 23years[3]. For this analysis, all male athletes with complete training data recorded using a chest-worn HR monitor for 3 months were included. Using an in-house developed pipeline, maximal HR and TL were calculated from raw training data. Cardiac magnetic resonance imaging was performed to measure indexed LV/RV end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume (LVESVi, RVESVi), ejection fraction (LVEF, RVEF) and LV mass (LVMi). Results Pro@Heart athletes (n=69; age 21.9 ± 4.2 years) trained more than Master@Heart athletes (n=82; age 55.2 ± 6.5 years) and their total 3-month TL (eTRIMP) was also higher (9718 ± 3190 vs. 5499 ± 3775min; P<0.05 and 22339 ± 7350 vs. 13438 ± 8880 AU; P< 0.05; Table 1). Considering all athletes, there was a strong correlation between both training duration and eTRIMP and LVEDVi, LVESVi, LVMi, RVEDVi and RVESVi. Training duration in zone 1&2 correlated well with LVEDVi, LVESVi, LVSV, LVMi, RVEDVi and RVESVi (Table 2). We found small significant negative correlations between duration and eTRIMP compared to LVEF and RVEF (Table 2). To filter out individual training factors influencing cardiac remodeling we used a partial least squares method which included time and percentage of time spent in training zones and age. Accordingly, training duration in zone 1&2 and age were the main predictors of cardiac volumes and LVMi. For LVEF, age and time in zone 3 was most predictive, whereas for RVEF zone 3 and to a lesser degree zone 1&2 were the main predictors, irrespective of age. Interestingly, time spent in high intensity zones 4 and 5 was not predictive. Conclusion We prospectively quantified TL in comparison to CMR-derived measures of cardiac remodeling and demonstrated that training duration in low intensity training zones is most predictive for cardiac volumes and mass, whereas LVEF and RVEF are more closely associated to time in zone 3. Very vigorous intensity exercise was not predictive, likely due to limited time training in zone 4 and 5.

Surfing a culturally-relevant physical activity: a new wave for health promotion

Abstract Background Surfing originated with Native Hawaiians prior to Western contact. It has since gained worldwide popularity, with an estimated 50 million surfers globally, and recently became an official Olympic sport. Associations have been reported between surfing and mental and physical health outcomes, greater community cohesion, and stronger intra-family relationships. Despite this evidence, surfing is deeply understudied in the context of health promotion. Purpose Surfing was analyzed from a mixed methods perspective to explore factors associated with lifetime participation and current engagement, including gender, race/ethnicity, chronic disease, social context, meaning, and average time of participation. Methods Hawai’i adult residents (n = 1066) completed an online or phone questionnaire. Modified Poisson regression models were fit for lifetime engagement and having a self-reported chronic disease, adjusting for primary race/ethnicity, age, gender, and education. Results Over their lifetime, 42% of respondents (50% men and 37% women) had participated in surfing. Engagement was highest during youth and young adulthood, and decreased with age, yet trends varied notably by race/ethnicity, gender, and generation. Lifetime surfing engagement was significantly related to lower likelihood of diabetes (aPR:0.72; 95%CI:0.56-0.92;p=0.009). Individuals who regularly participated in surfing typically did so with friends (78%) or family (61%); average surfing session duration was 209 minutes. Qualitative results revealed the relevance of surfing across levels of influence for health and wellbeing from physical fitness to community, culture, history and spirituality. Conclusions This work provides insights on the health promotion opportunities of surfing across the life-course and populations, including disease prevention and management. This study has implications for planning and policy locally and globally to achieve optimal community and planetary health. Key messages • Surfing is not only a sport for elite athletes, but also an activity that can support community and individual health and wellbeing in many populations over the lifespan. • Promotion of surfing and public ocean access can support multidimensional influences for wellbeing and should be a focus of cross sector collaborations for optimal community and planetary health.

Test-retest reliability and construct validity of Inosen’s Silat Momentum Test

Problem Statements: The kick in Pencak Silat has a magnitude called momentum, which requires a tool capable of measuring several variables based on the International System of Units (SI) in real-time. Nowadays, there are affordable and reliable sensor technologies to meet these needs. Purpose: The research aimed to design a test instrument that utilizes sensor technology to measure kick momentum in the sparring category of Pencak Silat following the applicable SI, and to test its reliability and validity. The resulting instrument is named Inosen’s Silat Momentum Test. Approach: This study followed Johnson and Nelson’s seven-test construction process. Twenty-four Pencak Silat athletes, consisting of 12 elite and 12 non-elite participants, were involved in the evaluation process. The test’s reliability was assessed by examining the correlation between the test and retest results. The construct validity test was conducted by comparing the results of the front kick tests of elite and non-elite Pencak Silat athletes. Data analysis was performed using Pearson correlation and independent t-tests using Minitab 21.4.1 software. Results: The results of the test and retest indicate a very high correlation (r = 0.923), demonstrating the consistent ability of Inosen’s Silat Momentum Test to measure kick momentum. The study found a statistically significant difference in the Inosen’s Silat Momentum Test scores (p < 0.05) between the elite fighter group (average score of 463.3 kg.m/s) and the non-elite fighter group (average score of 375 kg.m/s). The results indicate that Inosen’s Silat Momentum Test is an effective instrument for differentiating kick momentum based on fighter performance. Conclusions: Based on the findings, it is inferred that Inosen’s Silat Momentum Test is a reliable and valid instrument for measuring Pencak Silat kick momentum according to SI standards. Keywords: biomechanics, kick momentum, pencak silat, performance test, sensor technology.

Diagnostic effectiveness of the Sport Mental Health Assessment Tool 1 supplemented with a brief clinical intake interview in a cohort of Polish elite Olympic athletes

ObjectiveSeveral studies have used the Sport Mental Health Assessment Tool 1 (SMHAT-1) among athletes but none have combined SMHAT-1 with a subsequent clinical intake interview. The aim of this study...

Rapid Liquid Chromatography–Tandem Mass Spectrometry Method for Determination of Total and Free Testosterone in Human Serum and Its Application to Monitoring Biomarker Response of Elite Athletes

Total testosterone (TT) and free testosterone (FT) are important biochemical markers for anabolism of the human body, and can also serve as early screening indicators for overtraining syndrome (OTS). Presently, there is no fast and reliable serum TT and FT determination method in the field of sport science that can meet the requirements of sports research. Thus, a rapid and accurate determination method for serum TT and FT to fill the gap is needed urgently in sports training. Herein, a simple and reliable liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of TT and FT in serum was developed and fully validated, followed by the application of professional athletes in training monitoring. Efficient pretreatments based on only one-step liquid–liquid extraction (LLE) for TT and one-step LLE after a 20 min ultrafiltration for FT were adopted in this study, and the isotope internal standard of testosterone-13C3 was used to ensure the reliability of the whole procedure. A linear range of four orders of magnitude with 0.02–100 ng/mL can meet the concentration range requirement between a higher limit for male TT and a lower limit for female FT. The accuracy, precision, stability, and matrix effect were all within the limits of the guidelines. The serum TT and FT levels of 200 professional athletes (98 male athletes and 102 female athletes) were investigated by this method. Serum TT, FT, and FT/TT levels of professional athletes were significantly higher than the general population, and serum TT levels were significantly higher by LC-MS/MS than by a chemiluminescence immunoassay. In conclusion, the LC-MS/MS method for TT and FT measurement developed in this study is time-saving and easy to operate, which can be used as a reliable method for the determination of serum TT and FT in sports training, offering valuable information for monitoring anabolism of athletes and screening OTS in the early stage.

Chronotype, sleep hygiene, and sleep characteristics among athletes of different disciplines.

The objective of the study was to assess chronotype, sleep hygiene, and sleep characteristics of Italian athletes in order to identify differences among sport disciplines (team- vs individual-sports), level of competition (Elite vs Non-Elite) and sexes. Moreover, correlations between chronotype, sleep hygiene and sleep quality were evaluated. Two hundred eighty Italian athletes (Females:113; Males:167) participated in the study. They completed the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Index (SHI) and the MorningnessEveningness Questionnaire (MEQ). Among the athletes, 66.4% were intermediate-type, 21.8% were morning-type and 11.8% were evening-type. 55.4% of the sample was classified as good sleeper (PSQI<5), while 16.1% had poor sleep hygiene (SHI≥35). Females had higher total sleep time (p=0.022) than males. Individual-sports showed more morning-oriented score (p=0.001) and lower PSQI (p=0.006) and SHI (p<0.001) scores, with earlier timing of sleep (bedtime:p<0.001; wake-up time:p<0.001) compared to teamsports. Elite athletes exhibited greater sleep efficiency (p=0.009), and lower sleep latency (p=0.018) and wake after sleep onset (p=0.043) than Non-Elite athletes. Additionally, significant correlations were found between PSQI and SHI (r=0.43, p<0.001), and between MEQ and SHI (r=-0.35, p<0.001). This study yields crucial insights into the sleep behaviors of Italian athletes, revealing that nearly half of the sample were bad sleepers.

Sensorimotor Synchronization Abilities for Polyrhythmic Tasks in Artistic Swimming: A Comparison Between Elite, Novice, and Non-Artistic Swimmers.

We investigated sensorimotor synchronization abilities across swimmers of different artistic expertise levels. Elite, novice, and non-artistic female swimmer participants completed finger and foot tapping tasks involving single and polyrhythmic patterns that were intended to simulate the rhythmic coordination required in artistic swimming. Although no significant group differences were found in basic sensorimotor synchronization skills, elite athletes exhibited superior performance on polyrhythmic tasks. This observed superior performance could be partly attributable to a pre-existing predisposition for such motor skills and/or the effects of rigorous training. These findings highlight the critical impact of sport-specific demands on temporal control skills and suggest important implications for training methodologies in artistic swimmers.

Sportomics Analyses of the Exercise-Induced Impact on Amino Acid Metabolism and Acute-Phase Protein Kinetics in Female Olympic Athletes

Background: Exercise can be used as a model to understand immunometabolism. Biological data on elite athletes are limited, especially for female athletes, including relevant data on acute-phase proteins and amino acid metabolism. Methods: We analyzed acute-phase proteins and amino acids collected at South American, Pan-American, and Olympic Games for 16 Olympic sports. We compared female and male elite athletes (447 vs. 990 samples) across four states (fasting, pre-exercise, post-exercise, and resting) to understand sex-specific immunometabolic responses in elite athletes. Results: Considering all states and sports, we found that elite female athletes exhibited higher concentrations of C-reactive protein, lipopolysaccharide-binding protein, myeloperoxidase, haptoglobin, and IGF1, with ratios ranging from 1.2 to 2.0 (p &lt; 0.001). Women exhibited lower concentrations of most amino acids, except for glutamate and alanine. Although almost 30% lower in women, branched-chain amino acids (BCAAs) showed a similar pattern in all states (ρ ≥ 0.9; p &lt; 0.001), while aromatic amino acids (AAAs) showed higher consumption during exercise in women. Conclusion: We established sex dimorphism in elite athletes’ metabolic and inflammatory responses during training and competition. Our data suggest that female athletes present a lower amino acid response towards central fatigue development than male athletes. Understanding these differences can lead to insights into sex-related immuno-metabolic responses in sports or other inflammatory conditions.

Psychological resilience and performance under pressure: a study of elite badminton players - a systematic review

Psychological resilience is a critical factor influencing athlete performance in many sports, including badminton. This study aims to systematically review the existing literature to understand the relationship between psychological resilience and elite badminton athlete performance. The research background details the importance of psychological factors in the context of sport, particularly under competitive pressure. Focusing on elite badminton players, the study aimed to identify consistency and variation in previous research findings and detail the practical implications for athlete training and coaching. Research materials and methods included a systematic design with explicit inclusion and exclusion criteria. A thorough literature search was conducted to identify relevant studies that met the inclusion criteria. A careful study selection process was completed, and data were extracted for systematic analysis. Data analysis methods used included synthesizing findings from multiple studies, potentially using meta-analysis where appropriate. The results present the main findings regarding the relationship between psychological resilience and the performance of elite badminton athletes. The analysis of findings from multiple studies highlights the consistency in this relationship while acknowledging the variation that may occur due to differences in competitive context and athlete characteristics. The practical implications of these findings are explained in the context of training and coaching badminton athletes to enhance their psychological resilience under competitive pressure.The research conclusions highlight the vital contribution of this study to understanding psychological factors in badminton. This research provides a foundation for developing more effective training strategies and coaching of athletes that can enhance their psychological resilience, thereby improving their performance at the elite level. As such, this study provides scientific insights and practical guidance for the potential development of elite badminton athletes under competitive pressure.

The Holistic MAP to Athletic Wellness: A Narrative Review

You can’t use an old map to explore a new world. —Albert Einstein We are at a fork in the evolutionary road to athletic wellness. While elite athletes are achieving unsurpassed magnificence in strength, endurance, power, and skill, much of our population is experiencing a devolution from poor lifestyle choices that negatively influence both human and planetary health. The alarming descent to a lesser state of collective health puts most of our sedentary population at greater risk of injury, disease, dysfunction, and chronic pain. The father of sports medicine, Herodicus, was the first known physician to recommend exercise for the treatment of disease, recognizing its powerful influence on quality of life and health span. Athletic participation is linked with improved physical and mental health, as well as reduced obesity, disability, and disease. However, sports may also result in physical, psychological, social, athletic, professional, and financial repercussions.1 The international scientific community has rallied with tremendous research over the past decades to promote sustainable athletic participation and healthy active living. While tremendous efforts have been launched to engage in this challenging endeavor, a significant problem remains due to the multifactorial nature of athletic injuries. The full potential for body-mind-spirit resilience and wellness is achieved through the balance of all interdependent components, considering all possible biological, psychological, social, and spiritual factors influencing each athlete to establish an individualized, holistic mindset, agility, and personalization (MAP) approach toward injury-free sports and active living.

Epidemiology of ankle sprain and chronic ankle instability in elite adolescent dancesport athletes

ABSTRACT Background Dancesport is performed in high-heeled shoes. Dancesport athletes may have a higher prevalence and incidence of ankle sprains, which can affect their performance. However, the occurrence of ankle sprains among dancesport athletes remains unclear. This study aimed to determine the prevalence and incidence of ankle sprains among elite dancesport athletes and to investigate the related information. Method We conducted a mixed descriptive epidemiological study (cross-sectional and longitudinal) involving 198 elite adolescent dancesport athletes, using past medical records and questionnaires administered to the participants. Data on the occurrence of ankle sprains among all participants were compiled using medical records and information on injury mechanisms, missed days, severity types, and countermeasures for ankle sprains were collected. The prevalence of chronic ankle instability (CAI) among the participants was assessed using a questionnaire. Following the initial survey, we conducted a one-year follow-up study to investigate the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence of ankle sprains. Result The cross-sectional study and longitudinal study included 198 participants and 92 elite dancesport athletes, respectively. The prevalence of ankle sprains and CAI was 49.5% and 45.1%, respectively. Of all ankle sprains, 88% were medial injuries. The most common injury mechanisms were turning (46.9%) and jumping (46.9%). The average number of missed days due to ankle sprains was 11.2 days. Most injuries were managed with rest, and only one male athlete underwent surgery due to an ankle sprain sustained during dancing. During the one-year follow-up, the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence rate of ankle sprains were 46.6% (male, 41.2%; female, 48.8%), 0.65 ankle sprains/1000 h, and 35.3%, respectively. No sex-related differences were observed. Conclusion It is crucial to focus on the occurrence of ankle sprains and CAI in dancesport athletes with high heels. Future research should clarify the impact of ankle sprains on dancesport performance and develop preventive measures to reduce the incidence and recurrence of these associated injuries.

Career duration and later-life health conditions among former professional American-style football players

ObjectivesCareer duration is often used as a metric of neurotrauma exposure in studies of elite athletes. However, as a proxy metric, career length may not accurately represent causal factors, and...

Management and Return to Play of the Elite Athlete for Common Sports-Related Injuries About the Foot

Foot injuries are one of the most commonly injured areas of the body in many collegiate and professional sports. The wide range of pathology, pathophysiology, mechanisms of injury, differences in sport demands, evolution of treatment, and variable return-to-play time lines make it difficult, at times, for physicians to treat these injuries. Modern diagnostic tools, surgical treatment devices, and rehabilitation protocols have allowed for more accurate and rapid diagnosis, an improved ability to reestablish normal anatomy, and accelerated return to play for many sports-related foot injuries. This summary will provide the most up-to-date, evidence-based treatment options for common sports-related foot injuries along with the authors’ preferred method of treatment and return-to-play algorithms for the elite athletes.

Transferability of the competences acquired in the elite athlete career to the project manager role analysis

What personal competences of successful project managers are determined by their former career as an elite athlete? To answer the question, comprehensive research is carried out, implemented as part of the EEIG-EU/P-Kr/06.12/23 project. The primary aim is to establish conclusively which particular personality traits, identified and analysed using the Big Five Inventory-2 and supplemented by structured interviews, directly contribute to the success of former elite athletes transitioning into roles as effective project managers. We found that successful project managers who were also elite athletes possess personality traits that can be identified as positive determinants of success in either sport or professional careers. Among these personality traits, we can include a low level of neuroticism and a high level of conscientiousness, then extraversion and agreeableness. This paper contributes to a nuanced understanding of how the realms of sports and management intersect and overlap. The presented paper can serve as a basis for further research in the field of personality psychology and management studies.