Sports Participation In Patients Research Articles

Brief recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).

This paper presents a brief summary of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology (EAPC) on sports-participation in patients with coronary artery disease, coronary artery anomalies or spontaneous dissection of the coronary arteries, all entities being associated with myocardial ischaemia.1 Given the wealth of evidence supporting the benefits of exercise for primary and secondary prevention of coronary artery disease, individuals should be restricted from competitive sport only when a substantial risk of adverse event or disease progression is present. These recommendations aim to encourage regular physical activity including participation in sports and, with reasonable precaution, ensure a high level of safety for all individuals with coronary artery disease. The present document is based on available current evidence, but in most instances because of lack of evidence, also on clinical experience and expert opinion.

Physical Function and Sports Participation of Patients with Hemophilia Managed in a Comprehensive Care Setting in Our Hospital

Physical Function and Sports Participation of Patients with Hemophilia Managed in a Comprehensive Care Setting in Our Hospital

Sports Participation Is an Appropriate Expectation for Recreational Athletes Undergoing Shoulder Arthroplasty.

Background:Several studies have investigated sports participation in patients who undergo total shoulder arthroplasty (TSA). However, there are limited data in the setting of hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA), particularly regarding the frequency of participation in common sports.Hypothesis:The majority of patients who undergo TSA or HA will be able to maintain active lifestyles with high levels of sports participation after their procedure, while patients who undergo rTSA will have lower levels of sports participation.Study Design:Case series; Level of evidence, 4.Methods:We identified patients who underwent TSA, rTSA, stemmed HA, or humeral head resurfacing (the latter 2 were defined collectively as the HA group) by surgeons within our department since January 2004. We excluded patients who (1) underwent revision arthroplasty, (2) had a history of chronic pain syndrome, (3) experienced septic arthritis of the involved shoulder, and/or (4) were deceased at the time of follow-up. The minimum follow-up from the time of surgery was 2 years. Qualified patients were sent a questionnaire that asked about sports participation and the frequency of participation at the time of follow-up. Frequency was rated as 0, 1 to 3, or 4 to 7 times a week. Sports were defined as lower extremity sport, volleyball, tennis, skiing, bowling, swimming, weight lifting, golf, and other sport.Results:Overall, 95% of the TSA group, 40% of the rTSA group, and 76% of the HA group who had participated in at least 1 sport before surgery indicated that they were doing so at the time of follow-up. Among active patients in the TSA and HA groups, the most common sports at the time of follow-up were weight lifting (52%), swimming (36%), and golf (25%). For the 2 active patients in the rTSA group, 1 participated in swimming and hunting and fishing, while the other participated in weight lifting. For the active patients in the TSA and HA groups who were participating in at least 1 of the 3 most common sports, most patients indicated that they were doing so 1 to 3 times a week at the time of completing the questionnaire.Conclusion:Patients undergoing shoulder arthroplasty can maintain an active lifestyle with moderate to high frequencies of participation after surgery, particularly regarding weight lifting, swimming, and golf.

Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).

This paper presents a brief summary of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology (EAPC) on sports-participation in patients with coronary artery disease, coronary artery anomalies or spontaneous dissection of the coronary arteries, all entities being associated with myocardial ischaemia.1 Given the wealth of evidence supporting the benefits of exercise for primary and secondary prevention of coronary artery disease, individuals should be restricted from competitive sport only when a substantial risk of adverse event or disease progression is present. These recommendations aim to encourage regular physical activity including participation in sports and, with reasonable precaution, ensure a high level of safety for all individuals with coronary artery disease. The present document is based on available current evidence, but in most instances because of lack of evidence, also on clinical experience and expert opinion.

Ultrasound-Mediated Gene Delivery Enhances Tendon Allograft Integration in Mini-Pig Ligament Reconstruction.

Ligament injuries occur frequently, substantially hindering routine daily activities and sports participation in patients. Surgical reconstruction using autogenous or allogeneic tissues is the gold standard treatment for ligament injuries. Although surgeons routinely perform ligament reconstructions, the integrity of these reconstructions largely depends on adequate biological healing of the interface between theligament graft and the bone. We hypothesized that localized ultrasound-mediated, microbubble-enhanced therapeutic gene delivery to endogenous stem cells would lead to significantly improved ligament graft integration. To test this hypothesis, an anterior cruciate ligament reconstruction procedure was performed in Yucatan mini-pigs. A collagen scaffold was implanted in the reconstruction sites to facilitate recruitment of endogenous mesenchymal stem cells. Ultrasound-mediated reporter gene delivery successfully transfected 40% of cells recruited to the reconstruction sites. When BMP-6 encoding DNA was delivered, BMP-6 expression in the reconstruction sites was significantly enhanced. Micro-computed tomography and biomechanical analyses showed that ultrasound-mediated BMP-6 gene delivery led to significantly enhanced osteointegration in all animals 8weeks after surgery. Collectively, these findings demonstrate that ultrasound-mediated gene delivery to endogenous mesenchymal progenitor cells can effectively improve ligament reconstruction in large animals, thereby addressing a major unmet orthopedic need and offering new possibilities for translation to the clinical setting.

Exercise participation and shared decision-making in patients with inherited channelopathies and cardiomyopathies

Sports eligibility and disqualification of patients with cardiac diseases are important considerations for adult and pediatric cardiologists. The 2005 guidelines that addressed this issue have recently been revised and updated, and the new guidelines advocate for a shared decision-making approach in which the well-informed athlete and family participate in the discussion. In this review, we focus on the benefits of sports participation and review the revised guidelines related to sports participation in patients with channelopathies and cardiomyopathies.

Sports Participation in Patients After Total Hip Arthroplasty vs Periacetabular Osteotomy: A Propensity Score-Matched Asian Cohort Study

BackgroundNo studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts. MethodsMultivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching. ResultsSports participation and UCLA score significantly increased after THA (P < .001 in both analyses). Preoperative sports participation was the factor most associated with both postoperative sports participation and UCLA score in both 524 THA patients and 487 acetabular dysplasia patients (P < .001 in all analyses). Multivariate analysis in 487 acetabular dysplasia patients demonstrated that THA, compared with PAO, was negatively associated with postoperative sports participation (P < .001), but not postoperative UCLA score (P = .22). THA patients showed significantly lower rate of postoperative sports participation (32.3% and 51.6%, respectively, P = .046), but not postoperative UCLA score (5.0 ± 1.6 and 5.2 ± 1.9, respectively, P = .47) compared with matched PAO patients. ConclusionTHA significantly increased both sports participation and activity levels. Both multivariate and propensity score-matched analyses showed that postoperative activity levels were comparable between THA and PAO cohorts.

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery

### Learning objectives 1. Review the epidemiology, histology, pathophysiology and genetics of congenital heart disease-associated aortopathies and genetic aortopathy syndromes. 2. Review and describe 1. appropriate imaging strategies for diagnosis...

Competitive Sports Participation inPatients With Catecholaminergic Polymorphic Ventricular Tachycardia: A Single Center's Early Experience.

The study sought to determine the outcomes of continued sports participation in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). Patients with CPVT are at increased risk of sudden death with exertion. Currently, CPVT patients are advised disqualification from nearly all sports in accordance with expert opinion guidelines. However, we have approached this complex issue with a shared decision making model respecting a patient's and their family's right to be a competitive athlete following institution of comprehensive CPVT-directed treatment program. A retrospective record review was performed on patients with CPVT who were >6 years of age at the time of initial evaluation to determine their athlete status and frequency/scope of subsequent CPVT-triggered events. Among 63 eligible patients with CPVT (34 females, mean age at diagnosis 16.6 ± 12.9 years), 31 (49%) were athletes at some point in their life. Compared to the nonathletes, these athletes were significantly younger at diagnosis (11.8 ± 6.6 years vs. 21.3 ± 15.6 years; p= 0.003) and more symptomatic (21 [68%] vs. 13 [41%]; p= 0.04). Following diagnosis, 21 of 24 athletes (88%) continued competition. For these 21 athletes, 16 (76%) had experienced 32 CPVT-triggered events prior to diagnosis versus 57 events in 18 nonathletes (43%; p= 0.02). During follow-up, 3 events occurred in 3 of 21 athletes (14%) compared to 7 events in 6 of 42 nonathletes (14%, p= 1.00). No event resulted in death, and all received an adjustment in their CPVT therapy. Although sports participation is a risk taking behavior in undiagnosed and untreated CPVT, the risk may be acceptable for a well-treated and well-informed athlete following the diagnosis of CPVT.

Sports participation in adults with congenital heart disease

BackgroundIt is unclear whether sports participation in adults with repaired congenital heart disease is safe and has benefits. MethodsCongenital heart disease (ConHD) patients who underwent corrective surgery for Atrial Septal Defect, Ventricular Septal Defect, Pulmonary Stenosis, Tetralogy of Fallot or Transposition of the Great Arteries in our center between 1968 and 1980 were included, and participated in our longitudinal follow-up study with serial evaluations in 2001 and 2011. At both time points patients filled in questionnaires on sports participation, subjective physical functioning and quality of life. Exercise testing, echocardiogram and 24-hour continuous ambulatory ECG-monitoring were performed in both 2001 and 2011. All clinical events (re-intervention, arrhythmia, heart failure) were prospectively recorded. ResultsNo relationship was found between practicing sports and the occurrence of sudden death, PVCs or SVTs. Patients with moderate/complex forms of ConHD practiced fewer hours of sports compared with the general Dutch normative population. Patients with both simple and moderate/complex ConHD who practiced sports showed a higher exercise capacity. More favorable subjective physical functioning was found for moderate/complex patients who practiced sports. ConclusionsAdults with repaired ConHD are less often involved in sports than the Dutch general population. The patients that were engaged in sports show a higher exercise capacity than those who did not. Sports participation in patients with ConHD was not associated with an increased incidence of adverse cardiac events.

Sports Participation in Genotype Positive Children With Long QT Syndrome

ObjectivesThe study sought to examine the prevalence and outcomes of sports participation (both competitive and recreational) in our single-center LQTS genotype positive pediatric population. BackgroundThe risks of sports participation in patients with long QT syndrome (LQTS) are not clearly elucidated. MethodsA retrospective review was performed on genotype positive patients referred for the evaluation and management of LQTS between 1998 and 2013 at the Children’s Hospital of Philadelphia. Pediatric patients participating in competitive or recreational sports were included in the analysis and their charts were reviewed for documented LQTS events during follow-up. ResultsThe cohort of genotype-positive LQTS patients included 212 patients, and 103 patients (49%, female n = 53, average follow-up 7.1 ± 4.0 years, average QTc 468 ± 42 ms) participated in sports. A total of 105 LQTS disease-causing mutations were identified: KCNQ1 n = 60 (58%), KCNH2 n = 36 (35%), SCN5A n = 6 (6%), KCNE1 n = 1 (1%), and KCNE2 n = 2 (2%). All patients were treated with beta-blockade, with noncompliance in 1 patient and intolerance in 1 patient. Twenty-six patients participated in competitive sports (26%, female n = 15, average follow-up 6.9 ± 4.1 years, average QTc 461 ± 35 ms). Seventy-seven patients (75%, female n = 35, average follow-up 7.3 ± 3.9 years, average QTc 470 ± 43 ms) participated in recreational sports. No patients had LQTS symptoms during sports participation. Five appropriate implantable cardioverter-defibrillator shocks occurred in 2 patients, though none were related to sports participation. ConclusionsIn this series no cardiac events and no deaths were observed in treatment-compliant LQTS children while participating in sports in 755 patient-years of follow-up.

WITHDRAWAL: Sports Participation in Genotype Positive Children With Long QT Syndrome

The study sought to examine the prevalence and outcomes of sports participation (both competitive and recreational) in our single-center LQTS genotype positive pediatric population. The risks of sports participation in patients with long QT syndrome (LQTS) are not clearly elucidated. A retrospective review was performed on genotype positive patients referred for the evaluation and management of LQTS between 1998 and 2013 at the Children’s Hospital of Philadelphia. Pediatric patients participating in competitive or recreational sports were included in the analysis and their charts were reviewed for documented LQTS events during follow-up. The cohort of genotype-positive LQTS patients included 212 patients, and 103 patients (49%, female n = 53, average follow-up 7.1 ± 4.0 years, average QTc 468 ± 42 ms) participated in sports. A total of 105 LQTS disease-causing mutations were identified: KCNQ1 n = 60 (58%), KCNH2 n = 36 (35%), SCN5A n = 6 (6%), KCNE1 n = 1 (1%), and KCNE2 n = 2 (2%). All patients were treated with beta-blockade, with noncompliance in 1 patient and intolerance in 1 patient. Twenty-six patients participated in competitive sports (26%, female n = 15, average follow-up 6.9 ± 4.1 years, average QTc 461 ± 35 ms). Seventy-seven patients (75%, female n = 35, average follow-up 7.3 ± 3.9 years, average QTc 470 ± 43 ms) participated in recreational sports. No patients had LQTS symptoms during sports participation. Five appropriate implantable cardioverter-defibrillator shocks occurred in 2 patients, though none were related to sports participation. In this series no cardiac events and no deaths were observed in treatment-compliant LQTS children while participating in sports in 755 patient-years of follow-up.

Sports participation in patients with implantable cardioverter–defibrillators

The safety of sports participation for patients with implantable cardioverter-defibrillators (ICDs) is not yet defined, and current recommendations in both Europe and the US restrict these patients from competative sports more vigorous than golf or bowling. Postulated risks include increased frequency of arrhythmias, inability of the ICD to terminate ventricular arrhythmias during the metabolic changes accompanying extreme exercise, injury to the patient, or damage to the ICD system. However, survey data suggest that many ICD patients do participate in sports, and risks may be fewer than postulated. Ongoing research will better delineate the risks of sports for patients with ICDs.

Habitual Physical Activity and Sports Participation after Total Ankle Arthroplasty

Background There is a lack of detailed information about habitual physical activity levels and the sports participation of patients after total ankle arthroplasty. Hypothesis The proportion of sports active patients increases after total ankle arthroplasty, and the majority of patients will meet current recommendations for health-enhancing physical activity. Study Design Case series; Level of evidence, 4. Methods The authors assessed the pre- and postoperative participation in sports and recreational activities of 101 patients at a mean of 3.7 years after total ankle arthroplasty. Activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The International Physical Activity Questionnaire (IPAQ) was used to quantify habitual physical activity levels and to calculate the proportion of patients meeting current guidelines for health-enhancing physical activity. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used as the clinical outcome measure. Radiographs were studied for tibial and talar radiolucencies, and any association between radiolucencies, activity levels, and sports participation was determined. Results Preoperatively, 62.4% of the patients were active in sports; 66.3% were active after surgery (P = .56). The patients were active in 3.0 ± 1.8 different sports and recreational activities preoperatively and in 3.0 ± 1.6 activities after surgery (P = 1.0). The sports frequency remained unchanged, with 2.0 ± 1.6 sessions per week before total ankle arthroplasty and 2.3 ± 1.7 sessions per week postoperatively (P = .19). Overall, the patients were active in sports and recreation for 3.9 ± 3.8 hours per week preoperatively, and for 4.7 ± 3.9 hours per week after surgery (P = .14). The most common disciplines after total ankle arthroplasty were swimming, cycling, and fitness/weight training. Sixty-five percent of the patients stated that surgery had improved their sports ability. The UCLA activity levels increased significantly from 4.3 ± 2.2 to 6.2 ± 1.6 (P < .001); AOFAS scores also improved significantly from 45.5 ± 16.6 to 84.3 ± 13.3 (P < .001). Patients suffering from posttraumatic ankle osteoarthritis were less satisfied with surgery than those with primary or inflammatory ankle osteoarthritis. Seventy-nine percent of the patients met the current guidelines for health-enhancing physical activity according to the IPAQ. Neither sports participation nor activity levels were associated with the presence of periprosthetic radiolucencies. Conclusion Two-thirds of the patients were active in sports after total ankle arthroplasty, and the majority of the patients met current health-enhancing physical activity recommendations. The clinical outcome as determined by AOFAS scores and the patient satisfaction were favorable. The present study found no association between sports participation, increased physical activity levels, and the appearance of periprosthetic radiolucencies 3.7 years after total ankle arthroplasty. However, these results have to be confirmed after longer follow-up, in particular of those patients regularly participating in sports with higher impact.

Safety of Sports Participation in Patients with Implantable Cardioverter Defibrillators: A Survey of Heart Rhythm Society Members

Safety of Sports Participation in Patients with Implantable Cardioverter Defibrillators: A Survey of Heart Rhythm Society Members

Safety of Sports Participation in Patients with Implantable Cardioverter Defibrillators: A Survey of Heart Rhythm Society Members

Safety of Sports for ICD Patients. The safety of sports participation for patients with implantable cardioverter defibrillators (ICDs) is unknown, and recommendations among physicians may vary widely. The purposes of this study were to determine current practice among patients with ICDs and their physicians regarding sports participation, and to determine how many physicians have cared for patients who have sustained adverse events during sports participation. A survey was mailed to all 1,687 U.S. physician members of the Heart Rhythm Society. Among 614 respondent physicians, recommendations varied widely. Only 10% recommended avoidance of all sports more vigorous than golf. Seventy-six percent recommended avoidance of contact, and 45% recommend avoidance of competitive sports. Most (71%) based restrictions on patients' underlying heart disease. Regardless of recommendations, most physicians (71%) reported caring for patients who participated in sports, including many citing vigorous, competitive sports, most commonly cited were basketball, running, and skiing. ICD shocks during sports were common, cited by 40% of physicians. However, few adverse consequences were reported. One percent of physicians reported known injury to patient (all but 3 minor); 5%, injury to the ICD system, and <1%, failure of shocks to terminate arrhythmia. The most common adverse event reported was lead damage attributed to repetitive-motion activities, most commonly weightlifting and golf. Physician recommendations for sports participation for patients with ICDs varies widely. Many patients with ICDs do participate in vigorous and even competitive sports. While shocks were common, significant adverse events were rare.

Tall stature.

1. Bruce S. Alpert, MD* 1. 2. *Plough Foundation Professor of Pediatrics; Director, Pediatric Clinical Research Center, University of Tennessee, Memphis, TN. In 1984, Flo Hyman led the USA women’s volleyball team to the Olympic gold medal. She was a head taller than her teammates and continued to play volleyball after the Olympic Games. In February 1985 she met her untimely death while competing. Her image on the cover of Sports Illustrated pointed out to many of us the dangers of sports participation for patients who have Marfan syndrome (previously undiagnosed in Ms. Hyman). Almost annually, a young athlete, usually playing basketball, collapses during competition or practice and dies from aortic rupture. The majority of tall individuals, of course, do not have Marfan syndrome. The purpose of this article is to discuss the differential diagnosis of tall stature and briefly review the restrictions and therapy pertinent to patients who have Marfan syndrome. An individual is “tall” if he or she is greater than 2.5 standard deviations above the mean for age and gender. In adults this is more than 192 cm in males and more than 179 cm in females. The Table⇓, which shows the major diseases associated with being tall, does not include the largest group of tall people—those who are “normal,” usually associated with tall parents and relatives. Endocrine causes of tall stature include conditions that result from overproduction of growth hormone or thyroid hormone. Three of the diagnoses rely on chromosomal analyses: fragile X syndrome, Klinefelter syndrome (XXY), and XYY syndrome. Homocystinuria may be excluded by amino acid determination, especially among patients who have a negative family history and developmental delay. View this table: Table 1. TABLE. Conditions That Include Tall Stature There is no consistent …