Sports Classification Research Articles

Patterns and predictors of concussion symptom presentations in NCAA athletes

ABSTRACT Sport-related concussion (SRC) is a complex injury, and SRCs are notably prevalent among National Collegiate Athletic Association (NCAA) athletes. We analysed SRCs and associated exposure data collected within the NCAA Injury Surveillance Program during 2014–2019. A total of 1,709 SRCs were reported with complete symptom profiles during the study period (Women’s sports n = 499; Men’s sports n = 1,210). Event type and academic class year most commonly predicted specific symptom presentations among athletes in men’s sports, while symptom presentation among athletes in women’s sports was most commonly predicted by class year and sport classification. We observed 78 and 69 significant pairwise symptom dependencies in men’s and women’s sports athletes, respectively; odds of longer symptom resolution time were higher with greater counts of symptoms with strongest cross-domain associations. Our findings highlight several contextual predictors of specific symptom presentations and identify parsimonious symptom subsets that may indicate protracted recovery among men’s and women’s sports athletes.

COVID-19 Lockdown: A Global Study Investigating the Effect of Athletes' Sport Classification and Sex on Training Practices.

To investigate differences in athletes' knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification. Athletes (12,526; 66% male; 142 countries) completed an online survey (May-July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed. During lockdown, athletes practiced body-weight-based exercises routinely (67% femalesand 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%-49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%-28%) during lockdown. The proportion of athletes (81%) training ≥60min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%). Changes in athletes' training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes withspecific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.

Relationship between Type and Intensity of Sports Activities and the Prevalence of Overweight in Serbian School Children

This study aimed to explore the relationship between different forms and intensities of sports activities and the prevalence of overweight in primary school children. Using International Obesity Task Force BMI criteria, we have identified body weight status in a group of 2893 children aged 9–15 years participating in 27 different sports and within a group of 4987 non-active children of the same age. We have compared the prevalence of overweight and obesity between these groups, as well as between genders and different forms and intensities of sports, within the group of active children. We have found lower prevalence of overweight (Χ2 = 41.689, DF = 1, p < 0.001), as well as prevalence of obesity (Χ2 = 175.184, DF = 1, p < 0.001) in physically active children compared with their non-active counterparts, as expected. Overweight (including obesity) had the highest prevalence in mixed sports of the Classification of Sports of the European Association of Preventive Cardiology, in boys (p = 0.003), as well as in girls (p = 0.043). A lower prevalence of overweight was noted in boys (p = 0.001), as well as in girls (p = 0.025) with more than 7 years of training. Regarding the number of hours of training per week, a lower prevalence of overweight was noted only in girls with 4 and more hours of training per week (p = 0.025). Concerning intensity, we have found a significant drop in the prevalence of overweight in children with sports activities whose intensity is more than 60 MET-hours per week. We conclude that a significant relationship between sports and the prevalence of overweight is found in children with more than 60 MET-hours of sports activities per week, as well as among children involved in mixed sports, and after more than 7 years spent in regular sports training.

TYPOLOGICAL CHARACTERISTICS OF MULTIFUNCTIONAL SPORTS COMPLEXES (Part I)

The article gives a classification of sports and modern multifunctional sports complexes. The terminology of the concept of multifunctional sports complex has been unified. The analysis of modern domestic and foreign multifunctional sports complexes is carried out that allows to define a number of obvious tendencies of development of the sports environment. The construction of sports facilities is included in the general plans of cities in the form of microdistricts, districts and cities. A study of the development of modern sports complexes. Trends in the development of the spatial structure of the sports environment have been identified. The sports infrastructure of Ukraine is analyzed for the possibility of holding international sports competitions. It is determined that according to the existing norms and rules, all multifunctional sports facilities can be divided into main, auxiliary and devices-devices for spectators. The classification of multifunctional sports complexes by location in the structure of the city is given. Multifunctional buildings are, if possible, adapted for various sports. In order to determine the role and place of multifunctional sports complexes in the structure of the city, sports centers available in natural and urban areas were analyzed. The basic requirements to be presented to modern sports complexes at designing are defined. The work consists of two parts. In the first part, the development of the sports environment is studied and the classification of modern sports complexes is given. In the second part, the features of the typological characteristics of multifunctional sports complexes are formulated.

Neuromuscular Fatigue in Cerebral Palsy Football Players after a Competitive Match According to Sport Classification and Playing Position.

This study aimed to determine the rated perceived exertion (RPE) and match load (RPE-ML) to compare pre-post-match vertical jump (VJ) capacity according to cerebral palsy (CP) players’ sport classes (i.e., FT1–FT3) and playing positions and to explore whether the neuromuscular performance variation is associated with the internal load of para-footballers with CP. Fifty-six male para-footballers performed two VJ tests before and immediately after a competitive CP football match, followed by measurements of the players’ RPE and RPE-ML. There were no significant differences (p > 0.05) in the pairwise comparisons for RPE and RPE-ML according to sport classes and playing position. A significant reduction in the VJ performance was found for each player sport class and playing position in squat jump (SJ) (p < 0.01; 0.24 < dg < 0.58) and countermovement jump (CMJ) (p < 0.05; 0.22 < dg < 0.45). Regarding the pairwise comparisons, players with the minimal impairment criteria (FT3) obtained higher deficit scores during SJ than those belonging to the FT1 and FT2 (p = 0.003; 1.00 < dg < 1.56). Defenders experienced the lowest performance compared to midfielders and attackers in SJ performance (p = 0.027; 0.94 < dg < 1.28). Significant correlations were obtained between ΔSJ or ΔCMJ and RPE or RPE-ML (r = −0.58 to −0.75; p < 0.001). These findings provide novel information supporting the notion that fatigue induced after a competitive match causes notable impairments in VJ performance differentiated according to sport class and playing position in para-footballers with CP.

Hemodynamic forces in olympic athletes assessed by cardiac magnetic resonance: a new non-invasive screening tool?

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive evaluation of left ventricular hemodynamic forces (HDFs) by Cardiac Magnetic Resonance (CMR) is a promising tool to improve systolic and diastolic evaluation. No data are available on athletic population. Purpose To provide the range of normal values of HDFs in Olympic athletes and to evaluate the possible influence of different sport categories. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed by a feature-tracking based software to estimate HDFs. HDFs were measured in apex-base (AB) and latero-septal (LS) directions, over the entire heartbeat, in systole and diastole. Athletes were divided in subgroups according to ESC sport classification for comparison. They were also divided according to the ejection fraction (EF ≤ or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) were enrolled. HDFs in AB and LS direction were 20.5%± 4.3 and 2.9%± 0.7 in the entire heartbeat, 32.6% ± 7 and 3.6%± 1 in systole, 11%± 4.1 and 2.3%± 0.8 in diastole. Comparing athletes of different sport category and sedentary controls no significant differences were found between groups (Table). Comparing athletes with ejection fraction (EF) £ 53% and &amp;gt; 53%, the former showed lower values of AB-HDFs assessed in the entire heartbeat and in systole (18.9 ± 4.6 % vs 20.9 ± 4.1; p= 0.024 and 29.6 ± 6.3 vs 33.3 ± 7; p= 0.024, respectively), but within the normal range. Conclusion We provide normal range for HDFs assessed by CMR in elite athletes and no differences were observed between sedentary controls and athletes involved in different sport categories. Comparing athletes with low-normal and normal ejection fraction, the former showed lower values of AB-HDFs but within the normal range.

Left ventricle myocardial deformation in olympic athletes assessed by cardiac magnetic resonance: does the sex and discipline matter?

Abstract Funding Acknowledgements Type of funding sources: None. Background Sport induces structural and functional cardiac adaptation with different entity related to several factors including type of training and gender. Cardiovascular Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of athletes’ heart and commonly relies on ventricular volume, wall thickness and ejection fraction (EF) assessment. Data on myocardial deformation (MD) are limited to echocardiography and are scarce. Purpose To assess MD in Olympic athletes and to evaluate the possible influence of sport categories and gender. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed for volume and function evaluation and to assess global longitudinal strain (GLS) and global circumferential strain (GCS) by feature-tracking software. Athletes were divided in subgroups according to ESC sport classification. Male and female athletes were compared. Athletes were also divided based on EF (≤53% or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) and 18 controls were enrolled. No differences in terms of EF were observed, while endurance athletes showed the greater LV remodeling (Table). GLS and GCS values of the entire population were -22.5±2.7% and -30.7±3.4%, respectively. No significant differences were found comparing athletes of different sport categories and sedentary controls for GLS (p= 0.940) and GCS (p=0.072). Female athletes showed higher GLS compared to male (-23.5±2.8% vs-21.9±2.8%, p=0.002) but not differences in terms of GCS (-31.5±3.1% vs-30.2±3.5%, p=0.076). Athletes with EF≤53% had lower GLS values compared with those with &amp;gt;53% but within normal limits (Figure). Conclusion No differences were observed in MD assessed by CMR between different sport categories and controls. Female athletes showed higher longitudinal but not circumferential strain compared with male. Athletes with lower EF presented lower values of strain but within normal range with the potentiality to be used as a tool for differential diagnosis between normal adaptation and disease.

Design of Sports Event Evaluation and Classification Method Based on Deep Neural Network.

Large-scale sports events with high-level competition as the main content will have a great impact on the host city whether from the economic level or from the social level. With the improvement of human civilization, people realize that the holding of large-scale sports events not only has a positive impact on the economy and society but also brings some negative effects, such as waste of resources and environmental pollution, which have attracted the attention of the government and investors. Therefore, how to scientifically, comprehensively, and reasonably evaluate large-scale sports events, especially the accurate evaluation of their economic and social effects, has become the focus of attention. The evaluation of large-scale sports events mainly includes two levels: economic and social. Through the specific analysis of the evaluation content and the weight calculation of the evaluation index, the overall optimization of the evaluation of large-scale sports events is realized, and the reference experience is provided for the holding and evaluation of large-scale sports events in the future. Based on this, this article proposes a sports event evaluation and classification method based on the deep neural network. Firstly, on the basis of literature review and field investigation, the evaluation index system of sports events is established. Deep learning models have strong fitting power and robustness and have been applied to many real-world tasks. Then the deep neural network is used to evaluate the holding effect of sports events. The experimental results show that the model has high evaluation accuracy and is of great significance to the supervision and guidance of sports events.

Rethinking the classification of games and sports in physical education: a response to changes in sport and participation

ABSTRACT Background Through changing the way games are represented, classification systems have increased possibilities for teaching game forms beyond structured adult and singular official versions of popular sports. At the time of inception, the four-game form approach to classification (target, net/wall, striking/fielding, and invasion games) enabled modified, small sided conditioned games to be adapted to suit individual attributes, whilst reinforcing a core set of tactical and technical elements for transfer. With global shifts in patterns of sport participation, it is timely to review this dominant classification frame and the role it plays within physical education (PE). Purpose This paper proposes changes to classification boundaries around games and sports in PE to establish a classification system that is inclusive of a wider range of games and sports and growing forms of participation that we contend are important for PE. The paper also argues for a broader conceptualisation of tactics, with social, environmental and affective dimensions a focal point for a revised, contemporary classification framework. Methods The paper draws on Bernstein’s notions of classification and frame to explore the pedagogical utility of the dominant games and sport classification used in PE and ways in which it could be revised. Each author independently undertook a structured mapping exercise designed to facilitate exploration and potential classification of a wide range of contemporary activities potentially relevant for physical education. Results The paper proposes the addition of lap or circuit sports, route or journey sports, rush or action sports, stunts or tricking sports and rhythmic or aesthetic sports to broaden the learning and participation possibilities for young people and tune teachers into contemporary movement forms. The paper proposes sample questions that extend the tactical foci inherent in classification to encompass meaning, social, and ecological considerations for learning in PE.

Evidence-Based Classification in Powerchair Football: Determining the Determinants.

The purpose of this study was to initiate the development of an evidence-based sport classification system for powerchair football, a sport that serves athletes with physical impairments. Sport classification is designed to increase participation by minimizing the impact of impairment on competition outcome, and powerchair football lacks an evidence-based system of classification which is required of Paralympic sports. A number of approaches were used to build the theoretical model of sport performance (Step 2 of the International Paralympic Committee model). Key sport activities were identified through surveys of stakeholders and underlying determinants of those key activities were identified through game and database analyses. Current findings support drive control, ball control, communication, and adjustment to the ball as key activities in powerchair football with joint-specific strength and range of motion, sensory, and neurological variables identified as underlying determinants.

The connection to the public's preferred sports analysis and physical education curriculum.

People have their favorite type of sport, but such preferences tend to be shared for nearly a lifetime. How this preference persists remains inconclusive; hence, this study attempts to determine why people have different viewpoints on sports. It is reasonable to infer that these differences arise from differences in culture, occupation, and race. Therefore, we collected the following data and conducted research in Korea, the United States, and Japan, countries with various differences. The types of sports that people play were collected through surveys and comparisons among sports networks. Namely, "Sport Classification," "The K-12 Physical Education System (textbooks)," "Survey (actual physical activity)," "Simple Notification Service (SNS) Activity" have been examined to deduce the reason why any particular sport is played. Firstly, Korea, the United States, and Japan conduct different physical education courses. Hence, the results affect people's preferences. Secondly, what people post on SNS and their actual physical activities are different. Thirdly, the degree of connection between sports-type varied as well. Lastly, sports that serve the purpose of being regarded as hubs among sports-type were common in Korea, the United States, and Japan.

Ramadan intermittent fasting induced poorer training practices during the COVID-19 lockdown: A global cross-sectional study with 5529 athletes from 110 countries.

Ramadan intermittent fasting during the COVID-19 lockdown (RIFL) may present unique demands. We investigated training practices (i.e., training load and training times) of athletes, using pre-defined survey criteria/questions, during the ‘first’ COVID-19 lockdown, comparing RIFL to lockdown-alone (LD) in Muslim athletes. Specifically, a within-subject, survey-based study saw athletes (n = 5,529; from 110 countries/territories) training practices (comparing RIFL to LD) explored by comparative variables of: sex; age; continent; athlete classification (e.g., world-class); sport classification (e.g., endurance); athlete status (e.g., professional); and level of training knowledge and beliefs/attitudes (ranked as: good/moderate/poor). During RIFL (compared to LD), athlete perceptions (ranges presented given variety of comparative variables) of their training load decreased (46–62%), were maintained (31–48%) or increased (2–13%). Decreases (≥ 5%, p < 0.05) affected more athletes aged 30–39 years than those 18–29 years (60 vs 55%); more national than international athletes (59 vs 51%); more team sports than precision sports (59 vs 46%); more North American than European athletes (62 vs 53%); more semi-professional than professional athletes (60 vs 54%); more athletes who rated their beliefs/attitudes ‘good’ compared to ‘poor’ and ‘moderate’ (61 vs 54 and 53%, respectively); and more athletes with ‘moderate’ than ‘poor’ knowledge (58 vs 53%). During RIFL, athletes had different strategies for training times, with 13–29% training twice a day (i.e., afternoon and night), 12–26% at night only, and 18–36% in the afternoon only, with ranges depending on the comparative variables. Training loads and activities were altered negatively during RIFL compared to LD. It would be prudent for decision-makers responsible for RIFL athletes to develop programs to support athletes during such challenges.

Features of coping behavior in injured athletes

Coping behavior plays a significant role in the recovery of an injured athlete. Identifying the features of coping behavior can make an invaluable contribution to the development of such a problem as the psychological rehabilitation of an athlete. The objective of this study was to examine the features of coping behavior of injured athletes. The study sample consisted of 279 professional athletes of various sports, who, for the purposes of the study, filled out the following questionnaires: a balanced scale of life satisfaction (basic needs) and a scale of emotional state of E.Diener and a COPE questionnaire designed to measure situational coping strategies and dispositional styles. Depending on the gender, the classification of the sport, the number and severity of injuries, the athlete gravitates towards different coping strategies. We have found a link between the general well-being of the injured athlete and coping strategies such as positive reformulation, emotional focus, and humor. Based on the results of the one-way analysis of variance, we partially confirmed our hypothesis that there are differences in the coping strategies used by athletes representing different categories: gender, sport classification, number of injuries, and severity of injury. The performed correlation partly confirmed our assumption that there is a relationship between the general well-being of the injured athlete and the coping strategies used. Despite the fact that the correlation coefficients showed low values, we believe that this is due to the heterogeneity of our sample.

Regression Analysis of Perceived Stress among Elite Athletes from Changes in Diet, Routine and Well-Being: Effects of the COVID-19 Lockdown and "Bubble" Training Camps.

The COVID-19 pandemic has affected the lifestyles and training of elite athletes around the world. The detrimental effects of lockdown periods may vary among individuals, as well as among sports and sexes. This study investigated the changes in dietary habits, and the predictors of perceived stress during lockdown and a “bubble” training camp. This cross-sectional, online survey involved 76 elite and world-class athletes from six able-bodied sports and nine parasports, all of whom were involved in a 30-day “bubble” training camp. Questions were asked on socio-demographics, training routines and wellbeing, perceived stress, and dietary habits, pertaining to “normal” training (prelockdown), lockdown training, and “bubble” camp training periods. Changes in perceived stress were trivial to small during lockdown compared to “normal” training, and trivial to moderate during a “bubble” camp, compared to lockdown. Para-athletes, males, older athletes, less experienced athletes, married individuals, and specific ethnicities appeared to be more detrimentally affected (increased perceived stress) by lockdown. These negative experiences, however, were largely reversed during “bubble” camps. During lockdown, more athletes reported increased evening snack consumption (+8%), later meal-times (+6%), decreased fluid intake (−6%), and no breakfast (+7%). These changes were reversed during “bubble” camps (12–18% improvements). Sport classification accounted for 16% of the increased perceived stress (p = 0.001) during lockdown. Overall, socio-demographic factors, improvements in training routines, well-being, and dietary habits explained 28% of the decreased perceived stress during a “bubble” camp. In conclusion, better dietary habits, training routines and well-being have implications for reduced perceived stress. During lockdown, “bubble” camps may be beneficial, but this observation may be a case-by-case consideration, and short split “bubble” periods are recommended.

Asian Pacific Society of Cardiology Consensus Recommendations for Pre-participation Screening in Young Competitive Athletes.

Sports-related sudden cardiac death is a rare but devastating consequence of sports participation. Certain pathologies underlying sports-related sudden cardiac death could have been picked up pre-participation and the affected athletes advised on appropriate preventive measures and/or suitability for training or competition. However, mass screening efforts – especially in healthy young populations – are fraught with challenges, most notably the need to balance scarce medical resources and sustainability of such screening programmes, in healthcare systems that are already stretched. Given the rising trend of young sports participants across the Asia-Pacific region, the working group of the Asian Pacific Society of Cardiology (APSC) developed a sports classification system that incorporates dynamic and static components of various sports, with deliberate integration of sports events unique to the Asia-Pacific region. The APSC expert panel reviewed and appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. Consensus was reached when 80% of votes for a recommendation were agree or neutral. The resulting statements described here provide guidance on the need for cardiovascular pre-participation screening for young competitive athletes based on the intensity of sports they engage in.

Data-driven clustering supports adaptive remodeling of athlete's hearts: An echocardiographic study from the Taipei Summer Universiade

Sport-specific adaptations of athlete's hearts are still under investigation. This study sought to 1) identify athlete groups with similar characteristics by clustering echocardiographic data; 2) externally validate the data-driven clusters with sport classifications of various dynamic or static loads to support the conventional hypothesis-driven approach in delineating the athlete's heart. Anthropometric, echocardiographic and electrocardiographic assessments were collected during the 2017 Summer Universiade in Taiwan. Besides standard echocardiography and strain measurements, ventricular-arterial coupling (VAC) was assessed by the ratio of effective arterial elastance (Ea) to left ventricular end-systolic elastance (Ees) as calculated by a modified single-beat algorithm. We grouped 598 elite athletes (348 male, age 23±2.5 years, across 24 disciplines) using Mitchell's classification. The hypothesis-driven analysis showed dynamic training-related adaptations in heart rate and morphology, including ventricular size, mass, and stroke volume. In comparison, the unsupervised approach found two clusters for each sex. Male athletes participating in high dynamic-load exercises had larger chambers, supranormal diastolic functions, depressed Ees, lower Ea and preserved optimal VAC implicating the resting status of a reservoir-rich pump, which affirmed sport-specific adaptation. The female athletes could be clustered with more noticeable functional alterations, such as depressed biventricular strain. However, the imbalanced number between clusters impeded the validation of load-related remodeling. Hierarchical clustering could analyze complicated multiparametric interactions among numerous echocardiography-derived phenotypes to discern the adaptive propensity of the athlete's heart. The endorsement or generation of hypotheses by a data-driven approach can be applied to various domains.

EP News: Pediatric and Congenital Electrophysiology

Tobert et al (J Am Coll Cardiol 2021;78:594, PMID 34330632) reported outcomes of athletes with genetic heart disease (GHD) at risk for sudden death after return to play (RTP). The study used shared medical decision making and an evaluation protocol including education for patients/families to decide on RTP. This retrospective study included 672 athletes, of whom 494 had long QT syndrome (LQTS) (mean age 14.8 ± 10.5 years; mean follow-up 4.2 ± 4.8 years: 50% LQTS type 1; 16% symptomatic before diagnosis; and 11.7% with an implantable cardioverter-defibrillator). The LQTS group had a breakthrough cardiac event in 15 (3%) during the RTP period, with only 3 (0.6%) occurring during exercise. The rate of breakthrough cardiac event was 1.16 per 100 athlete-years. The group of 178 athletes with non-LQTS GHD (mean follow-up 4.8 ± 3.7 years) had 14 subjects with ≥1 breakthrough cardiac event during the RTP period (8%) with a rate of 3.3 per 100 athlete-years. There was no significant difference in the event rate on the basis of LQTS genotype (P = .45) or on the basis of sports classification. In 2056 combined years of follow-up, there were no deaths related to GHD in this study. The authors conclude that after thorough evaluation and shared medical decision making with patients and families, athletes with GHD can safely return to play.

Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines

Background: Current recommendations on safe return to sports (RTS) after total hip arthroplasty (THA) are subjective and based on studies of varying quality. Purpose: The aim of this study was to synthesize systematic reviews and meta-analyses on post-THA RTS to propose practice guidelines identifying which sports can be resumed, when they can be resumed, and what risks are present. Study Design: Systematic review; Level of evidence, 4. Methods: This umbrella review followed the Joanna Briggs Institute (JBI) protocol and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Embase, Medline, and Cochrane databases were searched. Included studies were either systematic reviews or meta-analyses addressing primary or secondary outcomes. Outcomes of interest included safe sports after THA, time to RTS, prognostic indicators of RTS, reasons patients do not RTS, percentage of patients who RTS, implant complications, and objective classification of sports by impact level. Included reviews had data extracted and were assessed for methodological quality using the JBI protocol. The authors defined RTS as “returning to a sport the patient participated in at any point preoperatively.” Results: Patients demonstrated a trend toward lower-impact sports postoperatively. Sports were classified as low (eg, walking), moderate (eg, downhill skiing), or high impact (eg, soccer). A total of 82% (range, 55%-104%) of patients were able to RTS at a mean time of 6 months (range, 4-7 months). The best prognostic indicator for RTS was previous experience in that sport. The main reason patients did not RTS was surgeon recommendation. Aseptic loosening was the most cited complication after RTS. Conclusion: Most patients are able to return to preoperative levels of low- (eg, walking) and moderate-impact (eg, hiking) sports between 7 and 12 months after THA. Patients planning a return to high-impact (eg, singles tennis) sports should be counseled on the possible risks of traumatic injuries and aseptic loosening and monitored closely.

Fairness, technology and the ethics of Paralympic sport classification

ABSTRACT Fairness in sport is a widely shared meritocratic norm. Its application is usually restricted to equality of opportunity to compete for victory. Paralympic sports lay down a further challenge in that equality of opportunity must be shaped by considerations of fairness, evidenced by the development of discrete competition categories to construct fair and meaningful contests. In this article, we extend these philosophical ideas to consider how Fair Equality of Opportunity might operate in the context of Paralympic sports classification. We articulate three conceptions of fairness relevant to these sports: (i) background fairness; (ii) procedural fairness; and (iii) stakes fairness. We critically review the International Paralympic Committee’s Policy on Sport Equipment in relation to the first two conceptions and argue that greater clarification, theorization and rule modification is required if physical prowess, as opposed to equipment technology, is to be assured as the dominant determinant of Paralympic athletic success.

Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis

BackgroundEarly repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years.Methods and ResultsEight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively.ConclusionsERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.