Category: Knee ligaments

Exercise-induced heat illness: policy adoption and influence on contextual factors reported by athletic administrators

Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Sports Health. Mar 5, 2023: 19417381231155107. doi: 10.1177/19417381231155107. E-publishing prior to printing. PMID: 36872595.

https://journals.sagepub.com/doi/10.1177/19417381231155107

Take home message

Most high school athletic administrators reported having a written heat illness policy in place, but they were often missing key components. The presence of an athletic trainer helped create a written policy that included more components.

Background

Sports administrators play an important role in policy acceptance. Policy measures such as addressing acute heat illness are critical as improper management can lead to poor outcomes. Unfortunately, we know little about the factors that promote and hinder the implementation of heat illness policies.

Study aim

The authors surveyed high school athletic administrators in the United States to describe the adoption of exertional heat illness policies and to examine factors that influence the adoption of these policies.

Methods

During the 2018-2019 academic school year, the research team emailed nearly 7,000 athletic administrators inviting them to complete a questionnaire asking about 1) demographics, 2) exercise-related illness policies, 3) monitoring and modification of written policy, and 4) enablers and barriers to policy development. The researchers used the precautionary adoption process model to assess an athletics administrator’s willingness to adopt policies. The adoption model is based on 8 phases, from not being aware to maintaining a written policy for more than 6 months.

Results

Of 466 athletics administrators (~48 years old, 82% male, 77% worked in the field for more than 15 years), 78% reported having a written policy on the prevention and treatment of exertional heat illness. Only 6% adopted all eleven essential elements of an exertional heat illness policy. Almost half of the managers indicated that they adopted fewer than 5 essential elements.

Older athletics administrators, those who had previously dealt with heat illness, or those with an athletic trainer on their staff were more likely to have a written policy. Additionally, state mandates and having a medical professional were the most commonly cited facilitators for adopting policies on exertional illness prevention and use of a rectal thermometer. Similarly, the most commonly reported barrier to comprehensive heat illness management was the lack of a full-time athletic trainer (11). Administrators also recognized budget constraints that limited the use of a cold water immersion pool (23%), and the top barriers to using a rectal thermometer were discomfort using the thermometer (32%), parent/guardian resistance (30 %), resistance from parents/guardians (30%). coaches (30%) and liability issues (27%).

Viewpoints

Nearly 80% of athletics administrators surveyed reported that they had a written policy on exertional heat illness. Few integrated or were aware of all the necessary components to meet best clinical practices. The authors found that access to athletic training services was associated with better adoption of exercise health policies. This finding is consistent with it being an athletic trainer who would implement such a policy. It’s worth recognizing that only 7% of administrators contacted completed the survey. Therefore, these results may not accurately reflect what is happening in high schools across the country. One possibility is that people more interested in policy or heat illness completed the survey. So these results may show us the best-case scenario for written policies (78%) that include all components (6%) – which is a worrying sign.

Clinical implications

Encouraging state mandates and schools to hire athletic trainers can ensure that there are written policies to address heat illness. Clinicians may also want to consider strategies to educate coaches and parents/guardians about the reasons for this policy, such as rectal thermometers and cold water plunge pools.

Questions for discussion

Are you having trouble adding rectal temperature to your exercise heat illness protocol? Do you communicate with your athletics administrator regarding the approval, implementation and annual review/practice of your emergency policy?

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2. A little more education about heat stroke due to exertion could go a long way
3. Clinical Pearl: prevention and treatment of exertional heat stroke
4. Tag us! What do coaches know about heat stroke during exertion and the role of the athletic trainer?
5. Follow guidelines to prevent exertional heat illness? Let’s reconsider these guidelines

Written by Jane McDevitt
Reviewed by Jeffrey Driban

In the current systematic review, we aimed to evaluate the impact of different triathlon events on the profile of cytokines (pro- and anti-inflammatory) and metabolic markers in triathletes. First, we verified the increase in pro-inflammatory cytokines including IL-1, IL-2, IL-6, IL-8, IL-12p40, INF-γ, MCP-1, TNF-α in PBMC, serum and plasma levels after different triathlon competitions. Second, in most studies we observed an increase in the production of anti-inflammatory cytokines (IL-4 and IL-10) at serum and plasma levels after the sprint, long-distance and Ironman races. Third, among metabolic factors, we observed an increase in the concentration of blood and plasma markers of muscle damage (CK, LDH and Myostatin), muscle fatigue (FFA and lactate), physiological stress (Cortisol) and inflammatory phase. (CRP) in athletes from different triathlon events.

Cytokines are signaling proteins produced by immune and non-immune cells that have cell signaling functions, positive and/or negative regulation of various genes and their transcription factors, and even stimulate or restrain inflammation promoted by various stimuli, including bacteria and viruses. [32, 33]. Alves et al. 2022, through a systematic review with meta-analysis, demonstrated that exposure to high running volume (exercise time, duration and distance covered) is associated with a higher concentration of pro-inflammatory cytokines, including IL-1β, IL-8 and TNF -α. Furthermore, serum levels of IL-1ra and IL-10 increased as a result of long-term aerobic exercise [6]. However, the authors only considered long-distance modalities (half marathon, marathon and ultramarathon), with the exception of triathlon. Similarly, from the data in the current systematic table it was concluded that several triathlon races promoted an increase in PMBC, serum or plasma concentration of pro-inflammatory cytokines. [6, 9].

High concentrations of pro-inflammatory cytokines are observed at the end of triathlon races and can be explained by the volume of the race, including the intensity of the exercise. In contrast, they had no association with the triathlon distance. This result confirms studies on endurance athletes. Studies have observed leukocytosis and high serum levels of pro-inflammatory cytokines after marathon races [34,35,36]. The metabolic activity and damage observed in muscle cells as a result of long-distance races, such as triathlon, appear to serve as important catalysts for the migration of some leukocytes, along with the release of cytokines. In addition, there are neuroendocrinological and metabolic multifactorial mechanisms that involve extreme stimuli and underlying consequences. Strenuous physical exertion such as triathlon increases immunosuppression [9, 37, 38]. The possible relationship between exercise and UTRI can be explained and modeled by a “J” curve, which can occur during competitions as well as during training, usually caused by rhinovirus, adenovirus and parainfluenza virus [19, 39, 40]. Furthermore, this profile of disease involvement may affect health and performance-related physical fitness components such as maximum oxygen volume, respiratory coefficient, and lactate threshold. [35, 36].

The anti-inflammatory response was assessed by serum levels of IL10 and IL4. Studies have shown that strenuous exercise can increase IL-10 levels, allowing it to return to basal levels during the rest period [41]. Furthermore, Santos et al. (2019) have shown that the magnitude of plasma IL-10 increases is related to the duration of exercise [42]. Furthermore, there is evidence that increases in serum levels of IL-10 are correlated with low levels of chronic, low-grade inflammation and tissue health. [7]. Huang et al. An increase in plasma IL-4 was found in 2019. Nevertheless, Suzuki et al., 2006 did not see any difference between serum levels before and after IL-4. According to our findings, there is no significant improvement in IL-4 due to the different aerobic exercise protocols [43]. Furthermore, the low serum IL-4 levels observed at the end of triathlon races can be explained by the strong inhibitory effects of IL-10 and IL-6 observed after long-distance triathlon races. These jointly contribute to the prevention of excessive systemic inflammation [44].

Long-term training protocols such as triathlons are known to cause changes in other biomarkers (gene expression and protein levels) [40]. A significant expansion of EGF and VEGF levels in many hematopoietic, endothelial and smooth muscle cells of the vasculature towards epithelial cells was observed. [40]. Furthermore, evidence has shown that aerobic exercise should activate the production and release of EGF and VEGF due to physiological adaptation to exercise, such as angiogenesis, indicating that EGF and VEGF are important biomarkers of aerobic exercise. [45]. At the same time, the studies noted that plasma CK levels increased after the race. As observed in a randomized double-blind crossover study by Galan et al. In 2018, CK serum levels improved after treadmill running to exhaustion [46].

Furthermore, Danielsson et al., 2017 reported an increase in CK levels after an Ironman distance triathlon, which is associated with masculinity [8]. Subsequently, it was known to improve FFA and LDH levels in sprint, Ironman and long-distance triathlons. Finally, cortisol levels were increased during triathlon protocols. It is known that the physiological demands of long-distance running such as triathlon should cause an increase in FFA, LDH, cortisol and lactate levels due to adaptation to the extensive energy expenditure of long-distance training protocols. [47,48,49]. Finally, according to previous evidence, an increased Myostatin level was reported in the aftermath of the Sprint and Iron Man Triathlon. Ben-Zaken et al., 2017 found that Myostatin expression was associated with a favorable outcome in long-distance running performance [50].

Because chronic systemic inflammation can be considered a factor affecting the performance of triathlon athletes, recommendations for managing the pillars of improving physical capacity (nutrient availability, sleep behavior, strength training) are important to modulate the immune response. In addition, it reduces both physical and physiological problems and accelerates the recovery and rehabilitation process after injuries. In this regard, individuals who practice triathlon can benefit from the immunomodulatory effects of a strength training strategy in combination with training for the sport. [51, 52]. Furthermore, adequate nutrient availability is known to benefit immune function, including cell-mediated immunity and a balanced inflammatory response. Finally, studies have shown that good sleep behaviors could be a complementary approach to reducing chronic inflammation [53, 54].

Strengths and limitations

The current systematic review presents important limitations that should be taken into account when generalizing the findings. First, we considered different distances of the triathlon race, which means that the generalization of the findings must be specific. The limitations of this systematic review mainly related to the methods of the studies. For example, the lack of control over the covariates (such as age, nutritional status, sleep quality, etc.) may be an important source of bias among the included studies. Another important point is the characteristics of the recorded sample. Because we only described gender and distance of participation, additional information such as level of competition and training characteristics may be useful in future research.

Therefore, the heterogeneity in the quality of reference sources is the strength of this review, as it observed efforts of serum levels of the inflammatory cytokine, as well as biomarkers associated with performance in different triathlon races. On the other hand, it must be emphasized that the studies did not randomize their populations, a procedure recognized by PRISMA. Some studies have not examined all outcomes considered relevant in this scenario. However, we find our work equally relevant because it systematically summarizes the available evidence for future research.

Partnering with a therapist-owned physical therapy practice will improve patient care in Arizona

PHOENIX, AZ / ACCESS WIRE / November 6, 2023 / Foothills Sports Medicine Physical Therapy (Foothills PT) is proud to announce its newest addition with Camelback Sports Therapy, a therapist-owned physical therapy practice based in Phoenix, Arizona. With a combined experience of more than 40 years in the Valley, these two companies have an exciting opportunity to continue to provide comprehensive care to patients and expand their reach across a larger region

“We have been looking for a reputable business partner who can help us continue this growth trajectory, and we couldn’t be more excited to partner with Foothills PT,” said Natalie Semon, PT, MPT, CSCS, Cert. DN, CKTP, CEO of Camelback Sports Therapy. “Their established practice, with a reputation for superior customer service and quality care, is a perfect fit for us. We look forward to what our new collaboration will bring us!”

Patients with Camelback Sports Therapy will continue to receive the same high-quality care from the same familiar faces they know and trust. However, the clinical team will now have access to Foothills PT’s parent company, Confluent Health, and their established ecosystem of management services, as well as education and musculoskeletal healthcare resources. Support services include efficient community outreach, digital innovations, value-based care pathway models, and marketing and financial tools. Resources include best-in-class partnerships in physical therapy, such as the PTPN Network, continuing education programs and workforce development opportunities with Evidence in Motion, a nationally recognized training provider in residency, fellowship and certification in physical therapy and occupational therapy programs, and Fit For Work, the leading provider of worker safety.

“Since we opened our doors, our vision has been to provide the highest level of service to our patients and referring physicians at all of our clinics and throughout the state of Arizona,” said Mike Basten, PT, DPT, MTC, CEO of Foothills P.T. “We are pleased that this partnership will allow us to continue this vision and reach more residents than before.”

This partnership will further expand Foothills PT’s footprint, making it the proud owner of 41 clinics throughout Arizona. Dr. Kristi Henderson, DNP, FAAN and CEO of Confluent Health, stated, “We are extremely proud of our partnership with Foothills PT and welcome Camelback Sports Therapy to the Confluent Health family. The expertise and excellence this practice embodies will undoubtedly enhance our growth trajectory, unlocking countless opportunities for optimizing patient care.”

For more information about Foothills PT, visit their website at foothillsrehab.com. To schedule an appointment with one of Camelback Sports Therapy’s expert therapists, visit their website at camelbacksportstherapy.com or call 602-808-8989.

Before the study, it was known that tidal volume in untrained people increases from approximately 5-15 liters per minute at rest to more than 100 l/min during exercise. Highly trained athletes even reach levels of 200 l/min. It was also known that many people have become infected with the SARS-CoV-2 virus when they exercise indoors.

However, it was unclear how exercise intensity was related to the concentration of aerosol particles in exhaled air and the actual amount of aerosols an individual exhaled per minute, and thus to the potential risk of spreading infectious diseases such as SARS-CoV-2. However, this information is urgently needed, for example to design mitigation measures for gyms and other indoor sports facilities, fitness studios or discos to avoid closures in the event of serious infection waves.

New methodology produces individually measurable aerosol values

A team led by Henning Wackerhage, professor of exercise biology at the Technical University of Munich (TUM), and Prof. Christian J. Kähler, director of the Institute for Fluid Mechanics and Aerodynamics at the Universität der Bundeswehr Munich, has developed a new research method to study questions. Their experimental equipment initially filtered the aerosols already present in the ambient air. During the subsequent ergometer stress test, the subjects inhaled the purified air through a special mask that covered the mouth and nose. Exercise intensity was gradually increased from rest to the point of physical exhaustion. The mask was connected to a two-way valve that allowed only exhaled air to escape. The amount of aerosol particles emitted per minute was then measured and directly linked to the current performance of the healthy, 18-40 year old subjects.

Moderate aerosol emissions during moderate exertion

This allowed the researchers to investigate for the first time how many aerosol particles are exhaled per minute by an individual at different levels of exercise intensity. The result: aerosol emissions during exercise initially increased only moderately, reaching an average load of about 2 watts per kilogram of body weight. However, above that point they increased exponentially. This means that someone weighing 75 kilograms reaches that threshold at an ergometer setting of approximately 150 watts. This equates to moderate exertion for a casual athlete, perhaps comparable to the exercise intensity of moderate jogging.

The aerosol output of well-trained athletes was significantly higher than that of untrained subjects at maximum exertion, due to their much higher minute ventilation. The researchers found no significant differences in particle emissions between genders.

Protective measures are important for high-intensity training

Although the aerosol experiments provide only indirect knowledge about the amount of viruses in exhaled air, the research suggests useful principles for managing indoor activities when a wave of infections combined with a poorly immunized population threatens to overwhelm the healthcare system.

“Based on our results, we distinguish between moderate endurance training with an intensity of up to 2 watts per kilogram of body weight and training at high to maximum intensity. Due to the sharp increase in aerosol emissions at high-intensity loads above that initial benchmark, special protective measures are necessary if there is a high risk of infections with serious consequences,” says research leader Prof. Wackerhage: “Ideally, that type of training would be moved outside. If that is not possible, testing should be done to ensure that there are no infected persons in the room. Participants must also keep sufficient distance and a highly efficient ventilation system must be running. In addition, infection risks are reduced by training at lower intensity and keeping sessions shorter. It could also be possible for fitness that young athletes should wear masks during training.” At low workloads, such as light to moderate intensity endurance training, less protection is needed, says Prof. Wackerhage, and the risk of infection can be controlled through distancing and ventilation systems.

The research team is currently conducting experiments to compare aerosol emissions during strength and endurance training and to correlate this with the age and physical characteristics of subjects.

In contrast, individuals with altered or dysfunctional biomechanical breathing patterns are unable to contract their diaphragm to the desired extent and begin to rely on accessory respiratory muscles to breathe. They exhibit superior rib cage movements and shoulder elevation, decreased abdominal movements, and lateral expansion of the rib cage.

Previous research suggests a strong link between altered biomechanical breathing patterns and the development of musculoskeletal disorders such as low back pain, neck pain, chronic ankle instability and temporomandibular joint disorders.

Superior physical performance and the prevention of musculoskeletal injuries are critical for athletes to perform their best in competitive sports. Evidence from previous studies suggests that athletes with diaphragmatic breathing patterns exhibit improved physical and psychological performance. But since athletes with altered breathing patterns may be at greater risk of developing musculoskeletal injuries, identifying the prevalence of altered breathing patterns is of paramount importance to prevent them from developing injuries.

Now a team of researchers led by Dr. Terada of Ritsumeikan University in Japan conducted a new study, published in The Journal of Strength and Conditioning Researchto investigate the prevalence of dysfunctional and diaphragmatic breathing patterns in an athletic population, and to determine the biomechanical dimensions of these breathing patterns.

The team tested 1,933 competitive athletes from schools in Japan, across multiple sports and ages, in 2017 and 2020 using a Hi-Lo test – a test that identifies an individual’s breathing pattern. Scores for the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The team further classified these participants into thoracic dominant and abdominal-only breathers based on the presence of abdominal excursion.

Findings show that an alarmingly high percentage (91%) of athletes showed dysfunctional breathing patterns, while only 9.4% of them showed diaphragmatic breathing patterns. In fact, among athletes who played baseball, there was a higher rate of diaphragmatic breathing pauses than among those who played tennis, basketball, badminton and volleyball. This indicates that athletes’ breathing patterns vary depending on the type of sport they practice, as each sport has different energy needs and limitations.

Additionally, the team found that the majority of dysfunctional breathers were high school student athletes, followed by elementary school student athletes and high school student athletes. The proportion of collegiate athletes with dysfunctional breathing patterns was slightly lower in comparison.

Furthermore, among the population identified as having dysfunctional breathers, 61% of athletes were thoracic-dominant breathers, compared to the 39% who performed only abdominal breathing.

These findings suggest an overall high prevalence of dysfunctional breathing patterns in the athletic population across all age groups, which should be immediately addressed as an important sports medicine problem.

When asked about the implications of these findings, Dr. Terada: “Clinicians should consider screening breathing patterns and implementing corrective approaches that target specific components of dysfunctional breathing patterns. They should also consider evaluating sport-specific breathing adjustments and implementing sport-specific modifications. breathing training protocols.”

The findings also highlight the importance of the Hi-Lo test in recognizing the differences between subcategories (thoracic dominant and abdominal only) of breathing patterns. An understanding of these breathing patterns can help develop individualized intervention plans. Dr. Terada says: “Integrating diaphragmatic breathing exercises and techniques may have beneficial effects on restoring optimal recruitment and motor control patterns of respiratory muscles, improving the efficiency of breathing biomechanics, and reducing psychological stress in athletes with dysfunctional breathing patterns.”

Other studies have examined how exercise influences the microbiome, but this study is one of the few to examine the converse: how gut bacteria also influence voluntary exercise behavior. Voluntary exercise involves both motivation and athleticism.

The researchers’ methods and results are now detailed in the journal Behavioral processes.

“We believed that an animal’s collection of gut bacteria, its microbiome, would influence digestive processes and muscle function, as well as motivation for various behaviors, including exercise,” said Theodore Garland, UCR evolutionary physiologist in whose laboratory the study was conducted. “Our study reinforces this belief.”

Researchers confirmed through stool samples that after ten days of antibiotics, gut bacteria were reduced in two groups of mice: some bred for high levels of running, and others not.

Neither group of mice showed any sign of sickness behavior as a result of antibiotic treatment. So when cycling was reduced by 21 percent in the athletic mice, researchers were confident that damage to the microbiome was responsible. Furthermore, the high runner mice did not recover their running behavior even 12 days after antibiotic treatment was stopped.

The behavior of the normal mice was not significantly affected during or after treatment.

“A normal athlete with a minor injury wouldn’t suffer much. But for a world-class athlete, a small setback can be much bigger,” says Monica McNamara, PhD candidate in evolutionary biology at UCR and first author of the paper . “That’s why we wanted to compare the two types of mice.” Disabling the normal gut microbiome can be compared to an injury.

One way the microbiome may influence exercise in mice or humans is through its ability to convert carbohydrates into chemicals that travel through the body and affect muscle performance.

“Metabolic end products from bacteria in the gut can be reabsorbed and used as fuel,” Garland said. “Less good bacteria means less available fuel.”

In the future, the researchers want to identify the specific bacteria responsible for increased athletic performance. “If we can identify the right microbes, there is the potential to use them as a therapeutic agent to help average people exercise more,” Garland said.

Lack of exercise is known to be a major risk factor for aspects of mental health, including depression, as well as physical health, including metabolic syndrome, diabetes, obesity, cardiovascular disease, cancer and osteoporosis. Many in the public health community would like to promote physical activity, but few have found ways to do so successfully.

“Although we study mice, their physiology is very similar to that of humans. The more we learn from them, the greater our chances of improving our own health,” Garland said.

Certain foods can also increase desirable gut bacteria. As research on “probiotics” develops, Garland recommends that those interested in promoting overall health follow a balanced diet in addition to regular exercise.

“We know from previous studies that the Western diet, which is high in fat and sugar, can have a negative effect on the biodiversity in your gut and probably, by extension, on athletic ability and possibly even motivation to exercise. Garland said.

Previous research has consistently suggested that youth participation in organized sports can help protect against mental health problems. However, some studies have linked youth sports participation to poorer mental health. Thus, more detailed research is needed to determine which approaches to sport may be most beneficial.

To shed new light, Hoffmann and colleagues analyzed data on the exercise habits and mental health of 11,235 children aged 9 to 13. Parents and guardians reported on various aspects of the children’s mental health by completing a form known as the Child Behavior Checklist. The researchers looked for any links between the mental health data and the children’s exercise habits, while also taking into account other factors that may influence mental health, such as family income and overall physical activity.

In line with the researchers’ expectations, the analysis showed that children involved in team sports were less likely to show signs of anxiety, depression, withdrawal, social problems and attention problems.

The researchers also expected that individual sports would be associated with fewer mental health problems, albeit to a lesser extent than team sports. Instead, however, they found that children who played only individual sports tended to have greater mental health problems than those who played no sports at all. Nevertheless, participation in both team and individual sports for girls was associated with a lower likelihood of rule-breaking behavior than participation in non-sport activities.

Overall, these findings add to a growing body of evidence that team sports participation is positively associated with the mental health of children and adolescents. The authors suggest that further research could help clarify the link between individual sports and worse mental health problems, and longitudinal observations are needed to investigate any causal relationships between sports participation and mental health.

The authors add: “Children and adolescents who played exclusively team sports, such as basketball or football, had fewer mental health problems than those who did not participate in any organized sports. But to our surprise, young people who only participated in individual sports, such as gymnastics or tennis, had more mental health problems than those who did not participate in organized sports.”

“Genetic testing for potentially lethal variants is more accessible than ever before and this paper focuses on which athletes should be tested and when,” said author Dr. Michael Papadakis of St George’s, University of London, UK. “Athletes should be informed of the possible outcomes prior to genetic testing as it could mean exclusion or limited play.”

In most cases, the clinical evaluation will determine whether preventive therapy is needed, such as a defibrillator and advice about exercise and participation in competitive sports. Dr. Papadakis explained: “Even if a genetic abnormality is found, recommendations on treatment and return to play usually depend on how severe the disease is clinically. Does it cause symptoms such as fainting? Is the heart excessively weak or fat? Can we see many irregularities in the heart rhythm (arrhythmias) and do they get worse during exercise? If the answer to any of these questions is ‘yes’, there is a good chance the game will be restricted in some way.”

One example is an inherited condition that can cause sudden cardiac death in athletes called hypertrophic cardiomyopathy (HCM), in which the heart muscle is abnormally thick. Dr. Papadakis noted: “We used to be very conservative, but now our advice is more liberal. Athletes with HCM should undergo a comprehensive clinical evaluation to assess their risk of sudden cardiac death and then be offered an exercise prescription. Genetic testing for this condition does. in most cases no impact management. Asymptomatic athletes who are considered to be at low risk may be able to participate in competitive sports after an informed discussion with their doctor. Others at higher risk may be limited to moderate-intensity exercise. The training prescription should be as specific as possible and outline how often, how long, at what intensity and which exercise or sport is safe.”

However, in some cases, genetic testing can dictate management. An example is long QT syndrome (LQTS), an inherited electrical disorder of the heart. Identification of different genetic subtypes (LQT 1-3) can provide insight into the risk of arrhythmias, identify potential triggers to avoid, and aid in targeting medical therapies and planning exercise advice. Dr. Papadakis said: “For example, sudden immersion in cold water is more likely to cause life-threatening arrhythmias in LQT type 1 than in types 2 or 3, so one should be more cautious with swimmers who have the genetic subtype type 1 than runners.”

The one situation where genetic testing alone can result in exclusion from the game is a heart muscle disorder called arrhythmogenic cardiomyopathy (ARVC). “Even if an athlete has no clinical evidence of the disease but does have the gene for the condition, he or she should refrain from intense and competitive sports,” says Dr. Papadakis.2 “This is because studies show that people with the gene who exercise at a high level tend to develop the disease earlier in life and tend to develop a more severe disease that can cause a life-threatening cardiac arrhythmia during exercise.”

Genetic counseling should be conducted prior to testing to discuss the implications for athletes and their families. For example, an athlete’s mother is clinically diagnosed with ARVC and has the causal gene. The athlete is then screened and all clinical tests are normal. The athlete has two choices: 1) clinical monitoring, probably annually, to check for signs of disease; or 2) genetic testing. “The athlete should know that if the test is positive, it could mean the end of his or her career, even if there is no clinical evidence of disease,” said Dr. Papadakis. “On the other hand, if genetic testing is refused, the condition may worsen. Post-test counseling is critical given the potential psychosocial, financial and mental health consequences, especially if the athlete is excluded from the game.”

For child athletes, genetic counseling at an expert pediatric center with assistance from a pediatric mental health specialist may be necessary. Dr. Papadakis pointed out: “The psychological impact of a positive genetic test result can be significant for the child, especially if it leads to exclusion from sport, even in the absence of clinical disease, as with ARVC.”

In children with a clinical diagnosis of a hereditary condition, genetic testing can confirm the diagnosis and in some cases help predict the risk of sudden death during exercise. For example, having the gene for an electrical disturbance of the heart called catecholaminergic polymorphic ventricular tachycardia (CPVT) can lead to advice for preventive therapies, such as beta-blockers, and dictate decisions about exercise. “This is important because CPVT predisposes to cardiac arrhythmias during exercise and can cause sudden death at a very young age,” said Dr. Papadakis. “In contrast, the timing of genetic testing in children with a family history of HCM is controversial because it rarely causes sudden death in childhood in the absence of clinical symptoms.”

The scientific statement was prepared by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology, the European Heart Rhythm Association, the ESC Working group on myocardial and pericardial Diseases, the ESC Council on Cardiovascular Genomics, the European Society of Human Genetics and the Society for European Pediatric and Congenital Cardiology.

In fact, teams and players who fight more often are also responsible for a disproportionate number of violent penalties across the league.

The results refute league officials’ arguments for continuing to fight in the game, said Michael Betz, author of the study and associate professor of humanities at Ohio State University.

“The issue of fighting is polarizing within the hockey community and for casual fans. As a former hockey player and researcher, I wanted to see if the arguments in support of fighting held up,” said Betz, who played as a college goalie at Ohio State and briefly as a professional in the ECHL (East Coast Hockey League).

“What I found was that none of the approaches I tried produced any evidence that fighting or even the threat of fighting deters more violent play in the NHL.”

The study was published today (June 22, 2022) in the journal PLOS ONE.

The issue is especially important now with the increased understanding of the consequences of traumatic brain injury, Betz said.

“Fighting increases the risk of brain injury but is not essential to hockey and removing it would not fundamentally change the sport,” he said.

For the study, Betz examined data on all regular season penalties from 2010 through 2019. He divided penalties into tactical penalties (designed to give a player a strategic advantage) and violent penalties, which are aimed at intimidating or injuring players . an opponent.

Violent punishments included boarding fines, assaults, elbowing, front bashing and large hurdles. If fighting were a deterrent, it should reduce the number of violent penalties that could injure a player, Betz said.

Overall, fights in the NHL decreased dramatically during the period of the study, with the 2018-2019 season seeing 65% fewer fights per game than the 2010-2011 season. Much of that decline is attributed to the league having access to faster, experienced players and needing fewer players who rely on intimidation.

But if fighting is necessary as a deterrent, there should have been an increase in violent punishment as the number of fights decreased. But the exact opposite happened. Although all types of punishment decreased during the study period, violent punishment fell more than twice as fast as tactical punishment (25% versus 12%), the study found.

Another team-level analysis also showed that fighting did not protect a team’s players from more violent play: in fact, each additional fight a team was involved in was associated with more violent penalties taken against them.

“If anything, the fighting seemed to encourage more violence against teams involved in brawls,” Betz said.

Even within games, the results showed similar patterns. Betz found that the number of violent penalties in a match increased instead of decreased after a fight.

The study also found that a fight between two teams early in a season did not significantly reduce the number of violent penalties in a second match between the teams later that season.

One possible explanation is that having a top fighter on your team who can take on any opponent in a fight reduces violence against the fighting player’s team. Betz investigated this by looking at the three players who had the most fights in the 2018/19 season (6) and a player who had one (5) fewer fights that year.

Whether or not these top fighters were in the lineup had no statistically significant effect on the number of violent penalties their opponents imposed on their teams, the results showed.

If fighting ever deterred more blatant violence against players, this study shows that is no longer the case in the modern NHL, Betz said.

“The league may have other reasons why they want to keep fighting in the game – there is evidence that more fighting increases the number of fans at matches,” he said.

“But they just need to get that out there and not hide behind the deterrent effect, because there is no evidence for that.”

Betz said he is particularly concerned about the junior hockey leagues in the United States and Canada, which serve as the main training ground for players ages 16 to 19 who aspire to play in college and the professional ranks. These junior leagues follow the NHL’s lead and, unlike colleges, allow fighting.

“These younger players are not getting paid, and their developing brains are more vulnerable to traumatic brain injuries. The evidence shows that fighting does not protect them from other violence, so there is a real ethical issue here if the fighting continues,” he says . said.

New research in the American Journal of Preventive Medicine, published by Elsevier, examines consumer product-related traumatic brain injury (CP-TBI) in school-age children over a 20-year period by differentiating age groups, education levels and gender and evaluating trends with the time-point regression method. Their findings reveal insights that have implications for effective preventive strategies and policies.

This serial cross-sectional study used National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) data for initial emergency department (ED) visits for CP/TBI from January 2000 to December 2019 for 6.2 million children under the age of 5. 18 years.

The study documents a significant increase in CP-TBI incidents since 2000, accounting for more than 12% of all US hospital emergency room visits by school-age children in 2019, up from 4.5% in 2000. The rate of increase stabilized overall, after peaking in 2012, to an annual level of 3.6% over the entire study period. This may be partly due to widespread media attention and public health policies that have resulted in greater risk awareness regarding contact sports, increased reporting of incidents, and more effective prevention and treatment.

The incidence of CP-TBI was higher in boys than in girls. However, annual percentage increases since 2013 have been significantly greatest among girls, especially among high school-age girls.

“While it appears that efforts to reduce TBI in children’s sports have been effective, our findings suggest that more targeted efforts are needed among girls,” said lead investigator Tuan D. Le, MD, DrPH, Department of Epidemiology and Biostatistics, School of Community and Rural Health, The University of Texas at Tyler Health Science Center, Tyler; and Research Directorate, US Army Institute of Surgical Research, JBSA-Fort Sam Houston, TX, USA.

CP-TBI has a negative impact not only on affected individuals, but also on their families, schools and healthcare systems. “Parents, sports and activities staff and coaches, educators, caregivers and support members, and the children themselves all need more awareness and training about screening and when to seek care for mild and more severe TBI in children. Improved point-of-care screening should be developed and promoted to identify and treat injuries that are not always immediately visible,” explains Dr. Le.

He added: “Since inactivity in children is also a serious problem, we are faced with a difficult balancing act: how do we develop awareness of how to avoid risky activities without discouraging children from participating in healthy and fun exercise?”