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Physical activity (PA) has positive effects on various health aspects and neuronal functions, including neuronal plasticity. Exceeding a certain exercise frequency and duration has been associated with negative effects. Our study investigated the effects of excessive PA with a marathon run (MA) and regular PA (training and recovery phases) on electrocortical activity, as measured by electroencephalography (EEG). 30 healthy marathon runners (26 male, 45 ± 9 yrs) were enrolled in the study. Four resting-state 32 channel EEG recordings were conducted: 12 − 8 weeks before MA (T-1), 14 − 4 days prior to MA (T0), 1–6 days after (T2), and 13–15 weeks after MA (T3). Power spectrum analyses were conducted using standardized Low-Resolution Electromagnetic Tomography (sLORETA) and included the following frequency bands: delta (1.5-6 Hz), theta (6.5-8.0 Hz), alpha1 (8.5–10 Hz), alpha2 (10.5–12.0 Hz), beta1 (12.5–18.0 Hz), beta2 (18.5–21.0 Hz), beta3 (21.5–30.0 Hz), and total power (1.5-30Hz). Statistical non-parametric mapping showed reduced power both in the alpha-2 (log-F-ratio= -0.705, threshold log-F-ratio = ± 0.685, p

Objectives To evaluate associations of omega-3 fatty acid (O3-FA) blood levels with cardiometabolic risk markers, functional capacity and cardiac function/morphology in patients with heart failure with preserved ejection fraction (HFpEF). Background O3-FA have been linked to reduced risk for HF and associated phenotypic traits in experimental/clinical studies. Methods This is a cross-sectional analysis of data from the Aldo-DHF-RCT. From 422 patients, the omega-3-index (O3I = EPA + DHA) was analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e′ 7.1 ± 1.5; median NT-proBNP 158 ng/L (IQR 82–298). Pearson’s correlation coefficient and multiple linear regression analyses, using sex and age as covariates, were used to describe associations of the O3I with metabolic phenotype, functional capacity, echocardiographic markers for LVDF, and neurohumoral activation at baseline/12 months. Results The O3I was below ( 11%) than the target range in 374 (93%), 29 (7%), and 1 (0.2%) patients, respectively. Mean O3I was 5.7 ± 1.7%. The O3I was inversely associated with HbA1c (r = − 0.139, p = 0.006), triglycerides-to-HDL-C ratio (r = − 0.12, p = 0.017), triglycerides (r = − 0.117, p = 0.02), non-HDL-C (r = − 0.101, p = 0.044), body-mass-index (r = − 0.149, p = 0.003), waist circumference (r = − 0.121, p = 0.015), waist-to-height ratio (r = − 0.141, p = 0.005), and positively associated with submaximal aerobic capacity (r = 0.113, p = 0.023) and LVEF (r = 0.211, p β = 15.614, p β = 0.399, p = 0.005) and LVEF (β = 0.698, p = 0.007) at 12 months. Conclusions Higher O3I was associated with a more favorable cardiometabolic risk profile and predictive of higher submaximal/maximal aerobic capacity and lower BMI/truncal adiposity in HFpEF patients. Graphic abstract Omega-3 fatty acid blood levels are inversely associated with cardiometabolic risk factors in HFpEF patients. Higher O3I was associated with a more favorable cardiometabolic risk profile and aerobic capacity (left) but did not correlate with echocardiographic markers for left ventricular diastolic function or neurohumoral activation (right). An O3I-driven intervention trial might be warranted to answer the question whether O3-FA in therapeutic doses (with the target O3I 8–11%) impact on echocardiographic markers for left ventricular diastolic function and neurohumoral activation in patients with HFpEF. This figure contains modified images from Servier Medical Art (https://smart.servier.com) licensed by a Creative Commons Attribution 3.0 Unported License.

Background Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown. Methods This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e′ 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82–298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman’s correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months. Results Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function. Conclusions In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Graphical abstract Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.

OBJECTIVE: To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surger DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Database search of MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus until March 2022. STUDY SELECTION CITERIA: Peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. DATA SYNTHESIS: We assessed bias using the Cochrane Risk of Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardised mean differences (Hedges' g) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the GRADE approach. RESULTS: Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low- to very low-certainty evidence favoured prehabilitation over no intervention for improving knee functioning before (g = 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, g = 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months, g = 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, g = 0.07; 95% CI: -0.17, 0.30). CONCLUSION: There was low- to very low-certainty evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive.

Background: Circulating long-chain (LCSFAs) and very long-chain saturated fatty acids (VLSFAs) have been differentially linked to risk of incident heart failure (HF). In patients with heart failure with preserved ejection fraction (HFpEF), associations of blood SFA levels with patient characteristics are unknown. Methods: From the Aldo-DHF-RCT, whole blood SFAs were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were 67 ± 8 years, 53% female, NYHA II/III (87%/13%), ejection fraction ≥50%, E/e’ 7.1 ± 1.5; and median NT-proBNP 158 ng/L (IQR 82–298). Spearman´s correlation coefficients and linear regression analyses, using sex and age as covariates, were used to describe associations of blood SFAs with metabolic phenotype, functional capacity, cardiac function, and neurohumoral activation at baseline and after 12-month follow-up (12 mFU). Results: In line with prior data supporting a potential role of de novo lipogenesis-related LCSFAs in the development of HF, we showed that baseline blood levels of C14:0 and C16:0 were associated with cardiovascular risk factors and/or lower exercise capacity in patients with HFpEF at baseline/12 mFU. Contrarily, the three major circulating VLSFAs, lignoceric acid (C24:0), behenic acid (C22:0), and arachidic acid (C20:0), as well as the LCSFA C18:0, were broadly associated with a lower risk phenotype, particularly a lower risk lipid profile. No associations were found between cardiac function and blood SFAs. Conclusions: Blood SFAs were differentially linked to biomarkers and anthropometric markers indicative of a higher-/lower-risk cardiometabolic phenotype in HFpEF patients. Blood SFA warrant further investigation as prognostic markers in HFpEF. One Sentence Summary: In patients with HFpEF, individual circulating blood SFAs were differentially associated with cardiometabolic phenotype and aerobic capacity.

In injury prevention, a vertical drop jump (DJ) is often used for screening athletes at risk for injury; however, the large variation in individual movement patterns might mask potentially relevant strategies when analysed on a group-based level. Two movement strategies are commonly discussed as predisposing athletes to ACL injuries: a deficient leg axis and increased leg stiffness during landing. This study investigated the individual movement pattern of 39 female and male competitive soccer players performing DJs at rest and after being fatigued. The joint angles were used to train a Kohonen self-organising map. Out of 19,596 input vectors, the SOM identified 700 unique postures. Visualising the movement trajectories and adding the latent parameters contact time, medial knee displacement (MKD) and knee abduction moment allow identification of zones with presumably increased injury risk and whether the individual movement patterns pass these zones. This information can be used, e.g., for individual screening and for feedback purposes. Additionally, an athlete's reaction to fatigue can be explored by comparing the rested and fatigued movement trajectories. The results highlight the ability of unsupervised learning to visualise movement patterns and to give further insight into an individual athlete's status without the necessity of a priori assumptions.

Background: The training of elite skiers follows a systematic seasonal periodization with a preparation period, when anaerobic muscle strength, aerobic capacity, and cardio-metabolic recovery are specifically conditioned to provide extra capacity for developing ski-specific physical fitness in the subsequent competition period. We hypothesized that periodization-induced alterations in muscle and metabolic performance demonstrate important variability, which in part is explained by gene-associated factors in association with sex and age. Methods: A total of 34 elite skiers (20.4 ± 3.1 years, 19 women, 15 men) underwent exhaustive cardiopulmonary exercise and isokinetic strength testing before and after the preparation and subsequent competition periods of the World Cup skiing seasons 2015–2018. Biometric data were recorded, and frequent polymorphisms in five fitness genes, ACE-I/D (rs1799752), TNC (rs2104772), ACTN3 (rs1815739), and PTK2 (rs7460, rs7843014), were determined with specific PCR reactions on collected DNA. Relative percentage changes of cardio-pulmonary and skeletal muscle metabolism and performance over the two seasonal periods were calculated for 160 data points and subjected to analysis of variance (ANOVA) to identify hypothesized and novel associations between performance alterations and the five respective genotypes and determine the influence of age × sex. A threshold of 0.1 for the effect size (h2) was deemed appropriate to identify relevant associations and motivate a post hoc test to localize effects. Results: The preparation and competition periods produced antidromic functional changes, the extent of which varied with increasing importance for anaerobic strength, aerobic performance, cardio-metabolic efficiency, and cardio-metabolic/muscle recovery. Only peak RER (−14%), but not anaerobic strength and peak aerobic performance, and parameters characterizing cardio-metabolic efficiency, differed between the first and last studied skiing seasons because improvements over the preparation period were mostly lost over the competition period. A number of functional parameters demonstrated associations of variability in periodic changes with a given genotype, and this was considerably influenced by athlete “age”, but not “sex”. This concerned age-dependent associations between periodic changes in muscle-related parameters, such as anaerobic strength for low and high angular velocities of extension and flexion and blood lactate concentration, with rs1799752 and rs2104772, whose gene products relate to sarcopenia. By contrast, the variance in period-dependent changes in body mass and peak VO2 with rs1799752 and rs2104772, respectively, was independent of age. Likely, the variance in periodic changes in the reliance of aerobic performance on lactate, oxygen uptake, and heart rate was associated with rs1815739 independent of age. These associations manifested at the post hoc level in genotype-associated differences in critical performance parameters. ACTN3 T-allele carriers demonstrated, compared to non-carriers, largely different periodic changes in the muscle-associated parameters of aerobic metabolism during exhaustive exercise, including blood lactate and respiration exchange ratio. The homozygous T-allele carriers of rs2104772 demonstrated the largest changes in extension strength at low angular velocity during the preparation period. Conclusions: Physiological characteristics of performance in skiing athletes undergo training period-dependent seasonal alterations the extent of which is largest for muscle metabolism-related parameters. Genotype associations for the variability in changes of aerobic metabolism-associated power output during exhaustive exercise and anaerobic peak power over the preparation and competition period motivate personalized training regimes. This may help to predict and maximize the benefit of physical conditioning of elite skiers based on chronological characteristics and the polymorphisms of the ACTN3, ACE, and TNC genes investigated here.

Problem: Depression is a widespread disorder and among the leading causes of disability worldwide. In this article, we perform an umbrella review on the association between depression and excess mortality, cardiovascular disease (CVD), and cardiovascular risk factors. We also provide an overview of mechanisms that explain these associations. Finally, we discuss clinical implications from a general perspective and discuss the potential of physical activity to favorably influence the relationship between depression and premature mortality. Methods: Meta-analyses were identified via PubMed. Only works on unipolar depression were included. Results: The association between depression and excess mortality is a robust epidemiological finding. This association can be attributed to the fact that people with depression are at increased risk for CVD and accumulate more cardiovascular risk factors. However, the causal associations are complex. While depression is associated with incident CVD, depression can also be a consequence of cardiac events. Regular physical activity and higher cardiorespiratory fitness levels mitigate the risk of premature mortality associated with depression. Discussion: More attention should be paid to the physical health of psychiatric patients. High priority should be given to the promotion of physical activity and fitness, as they are beneficial for both physical and mental health. Key Words: Fitness, Cardiovascular Disease, Physical Activity, Mortality

Head injuries are common in competitive and recreational sport. Nomenclature, though inconsistent, identifies mild traumatic brain injury (mTBI) based on acute diagnostic criteria, whereas a sport-related concussion (SRC) is event-related and specific to mTBI experienced while participating in athletic activity. The effects of SRC are often neurological, neuropsychological and/or psychiatric with a variety of symptoms. Different organizations categorize these symptoms differently and this variance demonstrates that no uniform clinical classification system has been agreed upon. Diagnosis of SRC is based on clinical examination. Numerous symptom checklists and assessments are available for clinical diagnosis, but their validity is somewhat limited. There is increasing awareness regarding the psychiatric deficits associated with SRC and the potential for developing post-concussion syndrome (PCS). In addition to complex, causal SRC-associated symptoms, reactive psychological complaints may also occur, as well as social mistreatment on recovery from SRC. Pre-existing mental health conditions are associated with an increased risk for developing PCS. This often necessitates the implementation of psychiatric or psychotherapeutic care after SRC. As with mTBI and SRC, no standardized classification has been established for PCS. Multi-stage rehabilitation strategies can help injured athletes navigate a successful recovery and prevent premature return to play. Further research on the utility of psychotherapy, psychopharmacotherapy, and exercise therapy of PCS is needed. Key Words: Concussion, Mental Health, Post-Concussion Syndrome, Interdisciplinarity

Background: There are concerns that the Latarjet procedure results in loss of glenohumeral rotation and strength and in subscapularis dysfunction. The long-term effects of this procedure on subscapularis quality, glenohumeral rotation, and strength are unknown. Purpose/Hypothesis: To analyze the long-term effect of the primary open Latarjet procedure using a muscle-splitting approach on internal and external rotation and strength, as well as subscapularis muscle quality as compared with the healthy contralateral side. We hypothesized that the primary open Latarjet procedure is associated with a reduction of long-term shoulder strength and function and decreased subscapularis quality. Study Design: Case series; Level of evidence, 4. Methods: A total of 42 patients who underwent a primary open Latarjet procedure for recurrent anterior shoulder instability at a mean age of 26 years (range, 18-36) were reviewed after a mean follow-up of 8.4 years (range, 5-12). The subscapularis muscle volume and fat fraction of both shoulders were assessed. Bilateral active internal rotation (IR) and external rotation (ER), as well as IR and ER strength, were assessed by isokinetic testing (concentric, eccentric, and fatigability). Results: Active IR (0.6-point difference, P < .001) and ER (4° difference, P = .010) were significantly greater in healthy contralateral shoulders. The IR strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric and eccentric testing (range of deficit, 4%-6%; P < .05). Also, the ER strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric testing (11% deficit, P < .05). Subscapularis muscle volume was significantly greater in the operated shoulder (4% difference, P = .022), and there was no significant difference in fat fraction ( P = .114). Conclusions: The primary open Latarjet procedure was associated with significantly decreased active IR and ER and strength when compared with the healthy contralateral shoulder. The clinical influence of these findings is yet to be defined. There was no increased subscapularis muscle fatty degeneration but a minimal hypertrophy on the operated side at long-term follow-up.

Background: Moderate intensity continuous training (MICT) ameliorates dysmetabolism in patients with metabolic syndrome (MetS). The impact of low- (1HIIT) versus high-volume high-intensity interval training (4HIIT) versus MICT on central adiposity, insulin resistance, and atherogenic dyslipidemia in patients with MetS has not yet been reported. Methods: Twenty-nine patients with MetS according to International Diabetes Federation criteria (nine females, age 61 ± 5 years, body mass index 31.1 ± 3.7 kg/m2, waist circumference (WC) ♀ 102.2 ± 10.6 cm, ♂ 108.5 ± 8.6 cm) were randomized (1:1:1) to 16 weeks of (1) MICT (5 × 30 min/week, 35%-50% heart rate reserve (HRR), (2) 1HIIT (3 × 17 min/week incl. 4 min @80%-90% HRR), and (3) 4HIIT (3 × 38 min/week incl. 4 × 4 min @80%-90% HRR). Peak oxygen uptake ([Formula: see text]O2peak), WC and anthropometric/metabolic indices indicative of MetS, fasting glucose/insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), dyslipidemia, and respiratory exchange ratio (RER) at warm-up were quantified at baseline and study completion. Analysis of variance and paired t tests were used for statistical analysis. Analyses were performed after checking for parametric distribution. Results: There were no significant differences between groups in waist-to-height ratio (♀: Δ -0.10 ± -0.05, ♂: Δ -0.08 ± -0.06, P = 0.916), WC (♀: Δ -1.4 ± -0.1 cm, ♂: Δ 0.1 ± 0.9 cm, P = 0.590), fasting glucose (Δ -1.18 ± 16.7 μU/mL, P = 0.773), fasting insulin (Δ 0.76 ± 13.4 μU/mL, P = 0.509), HOMA-IR (Δ 0.55 ± 4.1, P = 0.158), atherogenic dyslipidemia [triglycerides (TAG) Δ -10.1 ± 46.9 mg/dL, P = 0.468, high-density lipoprotein cholesterol (HDL-C) Δ 1.5 ± 5.4, P = 0.665, TAG/HDL-C -0.19 ± 1.3, P = 0.502], [Formula: see text]O2peak (P = 0.999), or RER (P = 0.842). In the entire group, waist-to-height-ratio and [Formula: see text]O2peak significantly improved by a clinically meaningful amount (Δ 2.7 ± 0.9 mL/min/kg; P < 0.001) and RER at warm-up significantly decreased (Δ -0.03 ± 0.06, P = 0.039). Conclusion: In patients with MetS, there was no significant difference between HIIT, irrespective of volume, to MICT for improving exercise capacity or metabolic health.

Background Physical activity has beneficial effects on depression, as well as on other mental and somatic diseases. The amount of recommended exercise is still under discussion. We investigated whether marathon runners (MA) exhibit less or more depressive symptoms and negative affects compared to sedentary controls (SC) and how their mood changes in the context of marathon training and marathon running. Methods We included 100 amateur marathon runners and 46 age- and gender matched sedentary controls in the ReCaP (Running effects on Cognition and Plasticity) study. Questionnaires contained Beck Depression Inventory (BDI), Hamilton Depression Scale (HAMD), Oxford Happiness Questionnaire (OHQ), Visual Analogue Scale (VAS), Positive And Negative Affect Schedule (PANAS), Global Assessment of Functioning (GAF). SC were evaluated one time at baseline, MA six times during the six months study period. Results Compared to SC, marathon runners (281.80 ± 131.44 running min/week) exhibited less depressive symptoms, more positive affects (PANAS-PA) and a higher level of functioning (GAF). Within the marathon group, negative affect (PANAS-NA) decreased and general mood states (VAS) further improved throughout the study period with a maximum 24 h after the marathon. Discussion MA had less depressive symptoms and a higher level of functioning compared to SC. Higher amounts than the recommended duration of 150 min/week aerobic training (WHO/ACSM) and the participation in a marathon seem to even further improve negative affect. These findings give new insight into the relationship between exercise and mood parameters. They can be implemented in future preventive strategies for depressive symptoms.

In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers’ trunk stabilization performance during deadbug bridging (DBB) exercises has been shown to be associated with both skiing performance and overuse complaints of the lower back in skiers under 16 years of age (U16). However, to date, little is known about the corresponding stabilization abilities in younger skiers, i.e., 6- to 15-year-old skiers. As part of a biomechanical field experiment during a national off-snow fitness competition, a total of 101 youth competitive alpine skiers were tested with respect to their trunk stabilization performance during DDB exercise. The maximum contralateral displacement of the pelvic drop during leg lift (DBBdisplacement) was quantified using reflective markers and a motion capture system (Vicon, Oxford, UK). Potential age group and sex differences in DBBdisplacement were assessed using analysis of variance (ANOVA) at p < 0.05. Within each subgroup, the associations of DBBdisplacement with age, anthropometrics and maturity offset were analysed using Pearson’s correlation (p < 0.05). Female skiers under 15 years of age (U15) showed better DBB performance than male U15 skiers, while there was no sex difference at the under 10-year (U10) level. In female U10 skiers, DBBdisplacement was moderately associated with body height, while in all other subgroups, no confounding associations with anthropometrics or biological maturation were found. Biomechanically quantifying DBB performance may be considered a feasible and nonconfounded screening test approach in young skiers older than 6 years. Body height may represent a confounding bias in exclusively the U10 female skier cohort and, therefore, should be considered when interpreting the test results. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners.

Vitamin D (VitD) and its physiological function in regulating calcium/phosphorus absorption and bone remineralization werefirst described in the early 20thcentury. A better understanding of VitD signaling has advanced our understanding of the importance of adequate VitD status to human health and performance. Tissues relevant to athletes which depend on VitD for optimal function include innate and adaptive immune system, skeletal muscle, and bone. Cross-sectional studies have shown that more than half of athletes are deficient and/or insufficient in VitD. Correcting insufficiency, the suggested target of25(OH)D blood levels above 30 ng/ml has the potential to optimize various aspects related to performance and regeneration in VitD insufficient athletes. This might help athletes to reach their full potential. Of note, there is no evidence pointing to actual or potential health risks of VitD levels within the recommended limits. VitD is therefore not on the list of prohibited substances of the world anti-doping agency. To avoid toxicity, VitD status should be monitored and supplementation strategies should be individualized and target-oriented. In terms of effectiveness and safety, low-dosed, continuous supplementation strategies of VitD are superior to intermittent application of supraphysiological boluses. The concept of synergy between nutrients lends qualified support tothe assumption that VitD bioavailability and function depend on meal context and onthefat-soluble vitamins A and K2 as well as the minerals magnesium and zinc.

Nano-flow liquid chromatography tandem mass spectrometry (nano-flow LC–MS/MS) is the mainstay in proteome research because of its excellent sensitivity but often comes at the expense of robustness. Here we show that micro-flow LC–MS/MS using a 1 × 150 mm column shows excellent reproducibility of chromatographic retention time (2000 samples of human cell lines, tissues and body fluids. Deep proteome analysis identifies >9000 proteins and >120,000 peptides in 16 h and sample multiplexing using tandem mass tags increases throughput to 11 proteomes in 16 h. The system identifies >30,000 phosphopeptides in 12 h and protein-protein or protein-drug interaction experiments can be analyzed in 20 min per sample. We show that the same column can be used to analyze >7500 samples without apparent loss of performance. This study demonstrates that micro-flow LC–MS/MS is suitable for a broad range of proteomic applications., Mass spectrometry-based proteomics typically relies on highly sensitive nano-flow liquid chromatography (LC) but this can reduce robustness and reproducibility. Here, the authors show that micro-flow LC enables robust and reproducible high-throughput proteomics experiments at a very moderate loss of sensitivity.

Various tests are available to assess athletes for factors associated with their susceptibility and risk of anterior cruciate ligament (ACL) injury or reinjury; however, it is unclear which tests are clinically meaningful and what should be considered when using them. Therefore, the aim of this scoping review was to screen and summarize testing and to derive evidence-based recommendations for clinicians, practitioners and future research. Five databases were searched to identify studies addressing musculoskeletal morphology or functional-performance-related screening tests with a clear conceptual link or an evidence-based relationship to ACL (re)injury. A quality rating was carried out using the National Institutes of Health (NIH) Study-Quality Assessment Tool. Six different categories of common screening tests were identified: balance and postural control, gait- and running-related tests, joint laxity, joint morphology and anthropometrics, jump tests and strength tests. Predicting future injury in a complex, dynamic system based on a single screening test is methodologically challenging, which is also reflected in the highly controversial findings in the literature regarding potential associations between specific screening tests and the occurrence of ACL injuries and reinjuries. Nonetheless, various screening tests can provide clinically relevant information on ACL-(re)injury-related factors and help to provide tailored preventive measures. A selection of corresponding evidence-based recommendations is derived and presented in this scoping review.

Background: The current gold standard biomarker for myocardial infarction (MI), cardiac troponin (cTn), is recognized for its high sensitivity and organ specificity; however, it lacks diagnostic specificity. Numerous studies have introduced circulating microRNAs as potential biomarkers for MI. This study investigates the MI-specificity of these serum microRNAs by investigating myocardial stress/injury due to strenuous exercise. Methods: MicroRNA biomarkers were retrieved by comprehensive review of 109 publications on diagnostic serum microRNAs for MI. MicroRNA levels were first measured by next-generation sequencing in pooled sera from runners (n = 46) before and after conducting a full competitive marathon. Hereafter, reverse transcription quantitative real-time PCR (qPCR) of 10 selected serum microRNAs in 210 marathon runners was performed (>10,000 qPCR measurements). Results: 27 potential diagnostic microRNA for MI were retrieved by the literature review. Eight microRNAs (miR-1-3p, miR-21-5p, miR-26a-5p, miR-122-5p, miR-133a-3p, miR-142-5p, miR-191-5p, miR-486-3p) showed positive correlations with cTnT in marathon runners, whereas two miRNAs (miR-134-5p and miR-499a-5p) showed no correlations. Upregulation of miR-133a-3p (p = 0.03) and miR-142-5p (p = 0.01) went along with elevated cTnT after marathon. Conclusion: Some MI-associated microRNAs (e.g., miR-133a-3p and miR-142-5p) have similar kinetics under strenuous exercise and MI as compared to cTnT, which suggests that their diagnostic specificity could be limited. In contrast, several MI-associated microRNAs (miR-26a-5p, miR-134-5p, miR-191-5p) showed different release behavior; hence, combining cTnT with these microRNAs within a multi-marker strategy may add diagnostic accuracy in MI.

Continuous monitoring of metabolites in exhaled breath has recently been introduced as an advanced method to allow non-invasive real-time monitoring of metabolite shifts during rest and acute exercise bouts. The purpose of this study was to continuously measure metabolites in exhaled breath samples during a graded cycle ergometry cardiopulmonary exercise test (CPET), using secondary electrospray high resolution mass spectrometry (SESI-HRMS). We also sought to advance the research area of exercise metabolomics by comparing metabolite shifts in exhaled breath samples with recently published data on plasma metabolite shifts during CPET. We measured exhaled metabolites using SESI-HRMS during spiroergometry (ramp protocol) on a bicycle ergometer. Real-time monitoring through gas analysis enabled us to collect high-resolution data on metabolite shifts from rest to voluntary exhaustion. Thirteen subjects participated in this study (7 female). Median age was 30 years and median peak oxygen uptake (VO2 max) was 50 mL·/min/kg. Significant changes in metabolites (n = 33) from several metabolic pathways occurred during the incremental exercise bout. Decreases in exhaled breath metabolites were measured in glyoxylate and dicarboxylate, tricarboxylic acid cycle (TCA), and tryptophan metabolic pathways during graded exercise. This exploratory study showed that selected metabolite shifts could be monitored continuously and non-invasively through exhaled breath, using SESI-HRMS. Future studies should focus on the best types of metabolites to monitor from exhaled breath during exercise and related sources and underlying mechanisms., Metabolites, 11 (12), ISSN:2218-1989

Objectives: During the COVID-19 pandemic, increased patterns of substance use have been reported in the general population. However, whether this also applies to athletes is not yet clear. This study aimed to detect changes in alcohol consumption and cannabis use in elite athletes and bodybuilders during the first COVID-19 lockdown in Switzerland.Methods: Between April 25 and May 25, 2020, a cross-sectional online survey was conducted among bodybuilders and Swiss elite athletes who were active in Olympic sports and disciplines approved by the International Olympic Committee (IOC) on at least the national level. The collected data included information on alcohol and cannabis use during the last month (lockdown) and in the year before COVID-19 lockdown (pre-lockdown), daily training times, existential fears on a scale from 1 to 100, Patient Health Questionnaire-9 for depression (PHQ-9), Insomnia Severity Index (ISI), and State-Trait Anxiety Inventory (STAI).Results:N = 275 athletes (elite athletes: n = 193; bodybuilders: n = 82) was included in this study. Both pre-lockdown and during lockdown, more bodybuilders used cannabis (both time points: p < 0.001) than elite athletes, and more elite athletes drank alcohol (pre-lockdown: p = 0.005, lockdown: p = 0.002) compared to bodybuilders. During lockdown, fewer athletes drank alcohol compared to before, but those who continued drinking did so on more days per week (p < 0.001, Eta2 = 0.13). Elite athletes were more likely to increase their drinking with 17.7 vs. 8.2% in bodybuilders. When compared to pre-lockdown measures, the number of athletes using cannabis did not change during lockdown. Only three of 203 elite athletes reported using cannabis during lockdown; this contrasts with 16 of 85 bodybuilders. In a multivariate regression model, existential fears and a lower ISI score were significant predictors for increased alcohol consumption during the lockdown in the entire sample. In a model based on elite athletes only, male sex and a lower ISI score predicted increased alcohol consumption. In a bodybuilder-based model, predictors of increased alcohol consumption were existential fears and trait anxiety.Conclusion: We suggest identifying athletes who are at risk for increased alcohol and cannabis use; we suggest this to be able to professionally support them during stressful times, such as the COVID-19 pandemic.

The COVID-19 pandemic and the associated first lockdown measures may have had a relevant impact on the mental health of competitive athletes. This study aimed to evaluate the prevalence of various mental health issues in a Swiss elite athletes’ cohort during the first lockdown of the pandemic, and to assess their association with different potential risk factors. Elite athletes from different disciplines were interviewed during the first lockdown in spring 2020 by means of an online questionnaire on symptoms of existing anxieties, depression and sleep disorders, as well as on training circumstances and physical performance before and during the lockdown. Additionally, the economic situation, secondary occupations and current physical health problems were surveyed. A total of 203 (92 female, 111 male) athletes met the inclusion criteria and participated in the survey. Training volume and intensity decreased significantly during lockdown from 3.1 to 2.7 h/day. Financial existential fears increased and were associated with higher training volumes and higher trait anxiety scores. Depressive symptoms and insomnia were present but not exceptionally frequent during the lockdown. Depressive symptoms were associated with higher anxiety scores, higher insomnia severity scores, lower training intensity and worse coping with the measures taken by the authorities against the pandemic. Changes in training and daily habits due to the first lockdown may have affected the mental health of elite athletes. Longitudinal studies should, however, further investigate the long-term effects of the pandemic on mental health.

While evidence exists for metabolic changes after exercise, little is known about metabolic alterations during exercise. Therefore, we aimed to assess real-time changes of metabolism during exercise tests via exhaled breath. We measured exhaled metabolites using real-time secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS) during cardiopulmonary exercise tests on a bicycle ergometer. Simultaneous SESI-HRMS and breath-by-breath gas analysis enabled us to collect high-resolution data on metabolism from rest to maximal exercise. Mass spectrometric data was processed and analysed with MATLAB. Exhalations were extracted automatically and features clustered over time. 13 subjects (median age 31y, 7 females) participated. Median peak aerobic capacity was 50 ml/min/kg. The SESI-MS analysis revealed changes in metabolism of subjects during exercise and with increasing load. We identified 346 features with matching courses in comparison to the breath-by-breath gas analysis, possibly allowing identifying key changes in energy metabolism during incremental exercise. Figure 1 shows the time course of the features for each of the 13 subjects. SESI-HRMS of exhaled breath is a non-invasive, real-time method that allows to track changes in key metabolites involved in energy supply during exercise and to get information about various metabolic changes during exercise.

Objectives(1) To update experts’ priorities of perceived key injury risk factors in alpine ski racing based on a framework and list derived 10 years ago, (2) to identify additionally emerging risk factors since then and (3) to compile a list with countermeasure suggestions.MethodsA sample of 532 expert stakeholders (athletes, coaches, team medical staff, Ski Racing Suppliers (SRS) and International Ski Federation (FIS) representatives) from the World Cup (WC), European Cup (EC) and FIS-race level participated in a cross-sectional online survey. Experts were asked to name those risk factors with the highest believed impact on injury risk and rank them according to their current priority from a predefined list. In addition, experts were encouraged to name additional (not listed) risk factors and to suggest countermeasures.ResultsRegardless of stakeholder role and competition level, snow-related factors appeared to have the highest perceived priority. However, WC athletes’ and coaches’ perceptions were also related to equipment, while at the EC and FIS-race level fatigue and physical fitness-related factors were considered important. Athletes’ perceptions were largely in agreement with SRS (ie, snow-related and equipment-related factors). At the same time, while coaches, team medical staff and FIS representatives additionally emphasised fatigue and physical fitness-related factors.ConclusionExperts’ perceptions on key injury risk factors in alpine ski racing depend on the stakeholder role and differ between the competition levels. Thus, to develop effective prevention measures and to successfully implement them, all relevant stakeholders should be given a voice, and prevention efforts should be targeted to the specific level.

Zusammenfassung Ende 2019 wurde erstmals ein neues Virus der Corona-Familie, das severe acute respiratory syndrome coronavirus 2 (kurz SARS-CoV-2) beschrieben, welches die coronavirus disease 2019 (kurz COVID-19) verursacht. Nachdem es initial galt, zuerst einmal die akuten durch das SARS-CoV2 hervorgerufenen Veranderungen naher zu evaluieren, zeigten sich schnell klinische Hinweise, dass auch persistierende Veranderungen und somit klinische Beschwerden durch das SARS-CoV-2 hervorgerufen werden konnen. Neben den Veranderungen des Immunsystems scheint auch das Gefas-System und hierbei vor allem das Endothel eine entscheidende Rolle zu spielen. Da diese beiden Systeme nahezu ubiquitar im menschlichen Korper vorkommen, sind die Langzeitfolgen (auch bekannt als Long-COVID) entsprechend vielfaltig. Hierbei wird bis zu einer Dauer von 3-4 Wochen von einem akuten COVID-19, einer Dauer zwischen 4 und 12 Wochen von einem postakuten COVID-19 und einer Dauer uber 12 Wochen von einem chronischen COVID oder Long-COVID gesprochen. In dem vorliegenden Review sollen die zugrundeliegenden Pathophysiologien/-mechanismen sowie die relevantesten hieraus resultierenden klinischen Veranderungen dargestellt werden.

Background: Physical exercise has been linked to beneficial effects on brain plasticity. One potential key mechanism for this relationship is an exercise-induced increase of brain-derived neurotrophic factor (BDNF). However, the kinetics of BDNF in athletes during training phase, extreme exercise competition, and recovery period have not been investigated so far.Methods: We assessed serum BDNF concentrations in 51 marathon runners (23% female, mean age 43 years) in a longitudinal study design over a period of 6 months. Assessments were conducted during the training period before the marathon and after the marathon race during short-term (24 to 72 h) and long-term (3 months) follow-ups. Potential confounders (fitness level, sex, and platelet count) were included in subsequent linear-model analyses.Results: Linear mixed-model analyses revealed a main effect of time for BDNF concentrations over the study period (F(4,89.389) = 4.296, p = 0.003). Values decreased significantly with the lowest values at 72 h after the marathon compared to baseline (p = 0.025), a finding that was more pronounced in the larger male cohort.Conclusion: Prolonged exercise induces a significant decrease in serum BDNF concentration 72 h post-exercise. We assume that this observation is mainly driven by regenerative mechanisms and a higher muscular utilization.

Pre-Participation Examination (PPE) is recommended in many countries prior to or during the practice of competitive sports. The dedicated exploration of psychological complaints and illnesses in the sense of a psychiatric basic assessment within the PPE is not yet the rule. The implementation of a Psychiatric Basic Assessment (PBA) in the PPE is proposed and presented in terms of content. Abnormal findings in the PBA, crises, emergencies as well as conspicuous changes in behaviour should lead to further sports psychiatric evaluation (SPE) by child, adolescent and adult psychiatrists and psychotherapists qualified for this purpose. The goal is to use diagnostic and procedural standards to identify risks to mental health, stress, and already manifest illnesses in a timely manner and to provide qualified, specialized medical or psychiatric treatment. The diagnostic standards are intended to promote research and the benefits are to be verified by studies. Key Words: Psychiatric Basic Assessment (PBA), Sports Psychiatric Evaluation (SPE), Mental Health, Mental Disorders, Pre-Participation Examination (PPE)

Mental stress and illness are common health problems in competitive sports that can reduce performance and have effects beyond the end of a career as sport-specific and unspecific disorders. The promotion of mental health and safe handling of mental problems and illnesses require appropriate education and train-ing. However, child, adolescent and adult psychiatrists with specific expertise in competitive sports (sports psychiatrists) are not yet an integral part of the structure of medical care provision in competitive sports. This position paper gives an overview about existing care structures in competitive sports for the promotion of mental health, and investigated them with proposals for the further development of sports psychiatric care in competitive sports. Sports physicians, sports psychiatrists, as well as interdisci-plinary and interprofessional collaboration, are at the center of mental health efforts in competitive sports. Further aspects that will be discussed are the education and training of athletes and the environment in competitive sports, as well as the promotion of coaches’ health. Key Words: Elite sports, Prevention, Mental health problems and disorders, Sports psychiatry, Sports Medicine

Objectives:To evaluate the association of Omega-3 fatty-acid (O3-FA) blood levels with cardiometabolic risk markers, functional capacity and cardiac function/morphology in HFpEF patients.Background:O3-FA demonstrated favorable effects on heart failure and associated phenotypic traits in experimental/clinical studies. In patients with heart failure with preserved ejection fraction (HFpEF), the association of O3-FA status with patient characteristics is unknown.Methods:This is a cross-sectional analysis of baseline data from the Aldo-DHF-RCT. From 422 patients, the omega-3-index (O3I=EPA+DHA) was analyzed in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e´ 7.1±1.5; median NT-proBNP 158 ng/L (IQR 82-298). Pearson's correlation coefficient was used to describe associations of the O3I with metabolic phenotype, exercise capacity, echocardiographic markers for LVDF, and neurohumoral activation.Results:The O3I was below(11%) than the target range in 374 (93%)/29 (7%)/1 (0.2%) patients respectively. Mean O3I was 5.7±1.7%. The O3I was inversely associated with HbA1c (r=-0.139, p=0.006), triglycerides-to-HDL-C ratio (r=-0.12, p=0.017), triglycerides (r=-0.117, p=0.02), non-HDL-C (r=-0.101, p=0.044), body-mass-index (r=-0.149, p=0.003), waist circumference (r=-0.121, p=0.015), waist-to-height ratio (r=-0.141, p=0.005), and positively associated with submaximal aerobic capacity (r=0.113, p=0.023) and LVEF (r=0.211, pConclusions:Higher O3I was associated with a more favorable cardiometabolic risk profile and better submaximal aerobic capacity in HFpEF patients but did not correlate with echocardiographic markers for left ventricular filling pressures, left ventricular relaxation or neurohumoral activation.

Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle–disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.

SARS‐CoV‐2 infection has emerged as not only a pulmonary but also potentially multi‐organ disease, which may cause long‐term structural damage of different organ systems including the lung, heart, vasculature, brain, liver, kidney, or intestine. As a result, the current SARS‐CoV‐2/COVID‐19 pandemic will eventually yield substantially increased numbers of chronically diseased patients worldwide, particularly suffering from pulmonary fibrosis, post‐myocarditis, chronic heart failure, or chronic kidney disease. Exercise recommendations for rehabilitation are complex in these patients and should follow current guidelines including standards for pre‐exercise medical examinations and individually tailored exercise prescription. It is of utmost importance to start exercise training at an early stage after COVID‐19 infection, but at the same time paying attention to the physical barriers to ensure safe return to exercise. For exercise recommendations beyond rehabilitation programs particularly for leisure time and elite athletes, more precise advice is required including assessment of sports eligibility and specific return‐to‐sports exercise programs. Because of the current uncertainty of long‐term course of SARS‐CoV‐2 infection or COVID disease, long‐term follow‐up seems to be necessary., publishedVersion

Background: Physical exercise has been linked to beneficial effects on brain plasticity. One potential key mechanism for this relationship is an exercise-induced increase of brain-derived neurotrophic factor (BDNF). However, the kinetics of BDNF in athletes during training phase, extreme exercise competition, and recovery period have not been investigated so far. Methods: We assessed serum BDNF concentrations in 51 marathon runners (23% female, mean age 43 years) in a longitudinal study design over a period of 6 months. Assessments were conducted during the training period before the marathon and after the marathon race during short-term (24 to 72 h) and long-term (3 months) follow-ups. Potential confounders (fitness level, sex, and platelet count) were included in subsequent linear-model analyses. Results: Linear mixed-model analyses revealed a main effect of time for BDNF concentrations over the study period (F(4,89.389) = 4.296, p = 0.003). Values decreased significantly with the lowest values at 72 h after the marathon compared to baseline (p = 0.025), a finding that was more pronounced in the larger male cohort. Conclusion: Prolonged exercise induces a significant decrease in serum BDNF concentration 72 h post-exercise. We assume that this observation is mainly driven by regenerative mechanisms and a higher muscular utilization.

INTRODUCTION Physical activity has beneficial effects on both cardiovascular and neurocognitive parameters, and these two modalities are known to interact at rest. However, findings on their interaction during exercise are inconclusive. PURPOSE Therefore, this longitudinal study aimed to investigate the effects of different forms of exercise (training period, marathon race, and recovery period) on both parameters and their interaction. METHODS We included 100 marathon runners (MA) (mean ± SD age = 43.6 ± 10.0 yr, 80 males) and 46 age- and sex-matched sedentary controls (SC, for baseline comparison). Over the 6-month study period with six visits (12 and 2 wk before the marathon; immediately, 24 h, 72 h, and 12 wk after the marathon), we assessed cognitive parameters by evaluating the 1- to 3-back d prime, the d2 task, and the Trail Making Tests A (TMT A) and B (TMT B), and the retinal vessel parameters by assessing arteriolar-to-venular ratio (AVR), central retinal arteriolar equivalent (CRAE), and central retinal venular equivalent (CRVE). RESULTS In the long-term analysis, 3-back d prime correlated positively with AVR (P = 0.024, B = 1.86, SE = 0.824) and negatively with CRVE (P = 0.05, B = -0.006, SE = 0.003), and TMT B correlated negatively with CRAE (P = 0.025, B = -0.155, SE = 0.069), even after correcting for age and systolic blood pressure as possible confounders. Acute effects were inconsistent with maximal cognitive improvement 24 h after the marathon. AVR was significantly smaller in SC compared with MA. CONCLUSION Chronic exercise seems to prime the central nervous system for acute, intensive bouts of exercise. Our findings indicate a possible relationship between cognitive performance in high-demand tasks and retinal vasculature and support the idea of a neuroplastic effect of exercise.

The term athlete’s heart describes structural, functional and electrical adaptations of the cardiovascular system due to repetitive intense exercise. Physiological cardiac adaptations in athletes, however, may mimic features of cardiac diseases and therefore make it difficult to distinguish physiological adaptions from disease. Furthermore, regular exercise may also lead to pathological adaptions that can promote or worsen cardiac disease (eg, atrial dilation/atrial fibrillation, aortic dilation/aortic dissection and rhythm disorders). Sudden cardiac death (SCD) is a major concern in sports cardiology, and preparticipation screening (PPS) has demonstrated to be effective in identifying athletes at risk for SCD. In Europe, PPS is advocated to include personal and family history, physical examination and ECG, with further workup including echocardiography only if the initial screening investigations show abnormal findings. We review the current available evidence for echocardiography as a screening tool for conditions associated with SCD in recreational and professional athletes and advocate to include screening echocardiography to be performed at least twice in an athlete’s career. We recommend that the first echocardiography is performed during adolescence to rule out structural heart conditions associated with SCD that cannot be detected by ECG, especially mitral valve prolapse, coronary artery anomalies, bicuspid aortic valve and dilatation of the aorta. A second echocardiography could be performed from the age of 30–35 years, when athletes age and become master athletes, to especially evaluate pathological cardiac remodelling to exercise (eg, atrial and/or right ventricular dilation), late onset cardiomyopathies and wall motion abnormalities due to myocarditis or coronary artery disease.

The positive effects of light to moderately intensive physical activity during pregnancy are not in question. Corresponding exercise recommendations can be found in national and international guidelines, which show a relatively solid evidence base. However, there are large knowledge gaps with respect to training recommendations for ambitious amateur sportswomen and elite athletes. Therefore, among both athletes and their supporting staff there is a large degree of uncertainty, which sports activity and to what extent it can be maintained safely without risk to the mother and her unborn child. In addition to the consideration of contraindications, where sporting activities must be avoided, there are certain training-associated precautions (e.g. when training at high altitude or in hot conditions) that should be respected. Also, in view of the manifold physiological changes that pregnancy entails (e.g. anatomical, hormonal, metabolic, cardiovascular and pulmonary), competitive sports-oriented training should be directed individually under close observation of mother's and child's well-being.

Background Regular physical exercise and standardized exercise training (ET) programmes positively affect a number of metabolic and cardiovascular risk factors. Yet, response to ET varies between patients and between individual risk parameters. We investigated inter-individual responses regarding blood pressure, heart rate, lipids and glucose metabolism, as well as physical fitness to a 16-weeks supervised exercise training protocol in patients with metabolic syndrome (MetS). Methods 29 MetS patients (20M/9F, age 52–70 y, BMI 24.9–38.2 kg/m2) exercised for 16 weeks in a supervised setting with varying volume and intensity. At baseline and at completion of the programme, blood pressure, heart rate, plasma lipids, glucose and insulin levels, as well as physical fitness were assessed, as were quantitative and morphological leukocyte parameters, cytokines and 86 metabolically relevant plasma proteins. Associations between individual risk parameters, leukocyte profile and plasma proteins were explored by recursive partitioning and network analysis. T-distributed stochastic neighbor embedding and hierarchical clustering were used for clustering based on cardiometabolic target parameters at 16 weeks. Results In the whole cohort, VO2peak increased and plasma counts of total leukocytes, neutrophils, monocytes (classical and intermediate), NK cells and effector and regulatory CD4+ lymphocytes, as well as circulating endothelial microvesicles were reduced at the end of the ET programme versus baseline. Plasma levels of carboxylesterase 1 decreased and soluble interleukin-7 receptor increased. Based on patient's cardio-metabolic parameters, three clusters were identified: cluster 1 had lower values of triglycerides, total and LDL cholesterol, cluster 2 had higher levels of triglycerides and cluster 3 had a greater heart rate recovery and lower insulin levels, but higher total and LDL cholesterol levels at follow-up. In cluster 1, absolute and relative NK cell counts were decreased and no morphological activation was observed. In cluster 2, reduced relative counts of NK-T cells were decreased, but their size was increased. In cluster 3, size of most effector leukocyte subtypes (CD8+, CD4+ Teff, NK-T, neutrophils) was increased at follow-up versus baseline. Network analysis suggested four distinct networks of (1) triglycerides, (2) VO2peak, (3) diastolic BP and (4) a cluster containing total and LDL cholesterol, insulin and HR recovery, each associated with partly distinct sets of plasma proteins and leukocyte parameters. Conclusion Despite improved physical fitness in all patients participating in the 16 weeks ET programme, inter-individual differences regarding cardio-metabolic target parameters and leukocyte activation was evident. Identification of specific leukocyte responses and of plasma protein “fingerprints” might help to optimize patient-specific prevention programmes, integrating medication and lifestyle optimization. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): DZHK, DSHF

Although complementary medicine is frequently used in Germany, there is almost no information about complementary medicine use in competitive sports. The aim was to assess the use of complementary medicine among elite athletes in Germany.A cross-sectional study among athletes was performed between March 2012 and September 2013. Athletes of both sexes who visited a sports medical outpatient clinic in Munich, Bavaria were included. Data about the use of complementary medicine were collected by means of a standardized measurement instrument, the German version of the international complementary and alternative medicine questionnaire.Of the 334 athletes (female 25%, mean age 20.2 ± 6.6 years) who completed all 4 sections of the questionnaire, 69% reported the use of at least one type of complementary medicine within the last 12 months. 505 athletes (female 26%, mean age 20.5 ± 7.0 years) completed at least one section of the questionnaire entirely. Within 12 months, the osteopath (11%), herbal medicine (17%), vitamins/minerals (32%), and relaxation techniques (15%) were the most frequently visited/used in relation to the respective sections of the questionnaire.Complementary medicine is frequently used by athletes in Germany. The efficacy, safety, and costs of complementary medicine should be investigated in clinical trials among athletes in the future.Hintergrund: Obgleich die Komplementärmedizin in Deutschland häufig eingesetzt wird, gibt es fast keine Informationen zum Einsatz im Bereich des Leistungssports. Ziel war es daher, den Einsatz der Komplementärmedizin bei Leistungssportlern in Deutschland zu untersuchen. Patienten und Methoden: Eine Querschnittsstudie unter Leistungssportlern wurde zwischen März 2012 und September 2013 durchgeführt. Eingeschlossen wurden Leistungssportler beiderlei Geschlechts, die eine sportmedi­zinische Ambulanz in München, Bayern besuchten. An­gaben zur Nutzung von Komplementärmedizin wurden mit Hilfe eines standardisierten Messinstruments, der deutschen Version des internationalen Fragebogens für Komplementär- und Alternativmedizin, erhoben. Ergebnisse: Von den 334 Leistungssportlern (25% weiblich, Durchschnittsalter 20,2 ± 6,6 Jahre), welche alle vier Abschnitte des Fragebogens ausgefüllt hatten, gaben 69% an, innerhalb der letzten 12 Monate mindestens eine Art von Komplementärmedizin angewendet zu haben. 505 Leistungssportler (26 % weiblich, Durchschnittsalter 20,5 ± 7,0 Jahre) füllten mindestens einen Abschnitt des Fragebogens vollständig aus. Innerhalb der letzten 12 Monate wurden, in Bezug auf die jeweiligen Abschnitte des Fragebogens, der Osteopath (11%), die Phytotherapie (17%), Vitamine und Mineralien (32%) und Entspannungstechniken (15%) am häufigsten besucht/verwendet. Schlussfolge­rung: Komplementärmedizin wird von Leistungssportlern in Deutschland häufig eingesetzt. Die Wirksamkeit, Sicherheit und Kosten der Komplementärmedizin sollten in Zukunft in klinischen Studien bei Sportlern untersucht werden.

Regular moderate physical activity (PA) has been linked to beneficial adaptations in various somatic diseases (e.g. cancer, endocrinological disorders) and a reduction in all-cause mortality from several cardiovascular and neuropsychiatric diseases. This study was designed to investigate acute and prolonged exercise-induced cardio- and neurophysiological responses in endurance runners competing in the Munich Marathon. ReCaP (Running effects on Cognition and Plasticity) is a multimodal and longitudinal experimental study. This study included 100 participants (20-60 years). Six laboratory visits were included during the 3-month period before and the 3-month period after the Munich marathon. The multimodal assessment included laboratory measurements, cardiac and cranial imaging (MRI scans, ultrasound/echocardiography) and neurophysiological methods (EEG and TMS/tDCS), and vessel-analysis (e.g. retinal vessels and wave-reflection analyses) and neurocognitive measurements. The ReCaP study was designed to examine novel exercise-induced cardio- and neurophysiological responses to marathon running at the behavioral, functional and morphological levels. This study will expand our understanding of exercise-induced adaptations and will lead to more individually tailored therapeutic options.

Current algorithms for assessing risk of atherosclerotic cardiovascular disease (ASCVD) and, in particular, the reliance on low-density lipoprotein (LDL) cholesterol in conditions where this measurement is discordant with apoB and LDL-particle concentrations fail to identify a sizeable part of the population at high risk for adverse cardiovascular events. This results in missed opportunities for ASCVD prevention, most notably in those with metabolic syndrome, prediabetes, and diabetes. There is substantial evidence that accumulation of ectopic fat and associated metabolic traits are markers for and pathogenic components of high-risk atherosclerosis. Conceptually, the subset of advanced lesions in high-risk atherosclerosis that triggers vascular complications is closely related to a set of coordinated high-risk traits clustering around a distinct metabolic phenotype. A key feature of this phenotype is accumulation of ectopic fat, which, coupled with age-related muscle loss, creates a milieu conducive for the development of ASCVD: atherogenic dyslipidemia, nonresolving inflammation, endothelial dysfunction, hyperinsulinemia, and impaired fibrinolysis. Sustained vascular inflammation, a hallmark of high-risk atherosclerosis, impairs plaque stabilization in this phenotype. This review describes how metabolic and inflammatory processes that are promoted in large measure by ectopic adiposity, as opposed to subcutaneous adipose tissue, relate to the pathogenesis of high-risk atherosclerosis. Clinical biomarkers indicative of these processes provide incremental information to standard risk factor algorithms and advanced lipid testing identifies atherogenic lipoprotein patterns that are below the discrimination level of standard lipid testing. This has the potential to enable improved identification of high-risk patients who are candidates for therapeutic interventions aimed at prevention of ASCVD.

Coronary artery calcification (CAC) is a strong marker of subclinical coronary atherosclerosis and leading authorities recommend CAC scoring to help inform patient management decisions in cardiovascular disease (CVD) prevention.1 2 This will result in an increasing number of athlete-patients with subclinical coronary atherosclerosis presenting to sport and exercise medicine physicians, raising questions about exercise recommendations in this subgroup. With a specific focus on the recent outcomes data of DeFina and colleagues3 we extend our recent discussion of the topic2 by focusing on how to manage athlete-patients with elevated CAC in the sport and exercise medicine setting. A breakthrough in reporting the association of CAC and mortality risk across different activity levels came from a recent study of 21 758 healthy male participants without prevalent CVD. Higher levels of leisure-time physical activity were associated with a lower risk of mortality at any given level of CAC.3 The authors reported a higher risk metabolic profile (ie, higher baseline blood pressure, higher glucose concentrations and higher triglycerides) in the high volume exercise group with elevated CAC ≥100 AU …

Changes in public life, isolation, quarantine, and associated constraints within usual routine, as well as anxieties and concerns, are just some of many examples of psychiatric burdens caused by the COVID-19 pandemic [1]. Not only the general population, but professional athletes in particular, are exposed to these challenges, as professional sports came to an abrupt halt upon occurrence of COVID-19.

BackgroundIn contrast to the well-accepted benefits of moderate exercise, recent research has suggested potential deleterious effects of repeated marathon running on the cardiovascular system. We t...

Die Weltgesundheitsorganisation (WHO) betont in ihren Empfehlungen «Coping with stress du-ring the 2019-nCoV outbreak» die Bedeutung von Bewegung und der Beibehaltung eines gesunden Lebensstils (11). Diese Empfehlungen gehoren zu Informationsmaterial, das die WHO wahrend der COVID-19-Pandemie zu verschiedenen Aspek-ten der psychischen Gesundheit herausgegeben h a t (1 2) .

Psychische und soziale Belastungen sind wie korperliche Belastungen fester Bestandteil des Leistungssports. Bis vor wenigen Jahren wurde angenommen, dass es im Leistungssport keine ernsthaften psychischen Probleme und Erkrankungen geben kann und das mentale Starke gleichzeitig auch psychische Gesundheit bedeutet (3). Durch immer zahlreich werdende Veroffentlichungen wissen wir mittlerweile, dass psychische Belastungen und Erkrankungen haufige Gesundheitsprobleme im Leistungssport sind, die sich sportspezifisch manifestieren und die Leistung vermindern konnen (5). Erfolgreiche Spitzensportler lehrten uns zudem mit ihren mutigen Interviews, dass ihre mentale Starke und Wettkampfpersonlichkeit kein Garant fur eine anhaltende psychische Gesundheit sein muss.

Background Endurance exercise in general and marathon running in particular have become increasingly popular over the past decades. Recent investigations about personality structures in this cohort and comparisons to non-active cohorts are lacking. Methods In the ReCaP study (Running effects on Cognition and Plasticity), a total of 100 marathon runners and 46 sedentary controls were recruited. After elimination of Minnesota Multiphasic Personality Inventory 2 Restructured Form (MMPI-2-RF) profiles with insufficient validity, 79 marathon runners (MA) and 27 sedentary controls (SC) remained for final analyses. Depressive symptoms were evaluated with Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD). Results Marathon runners had lower scores in scales measuring somatic and cognitive complaints, stress, demoralization, hopelessness and distrust. Within the marathon group, committed runners exhibited hypomanic traits compared to regular runners. Discussion and Conclusion Personality differences could be summarized as (sub-)depressive personality traits in SC compared to MA rather than typical (sub-) depressive symptoms in the meaning of depressive disorders. Future studies should further evaluate cause and consequence of endurance training and hypomanic or euthymic symptoms, as a two-way interaction exists. Trial Registration http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00012496.

Strenuous exercise results in transient but minor alterations in left ventricular diastolic function (LVDF). The aim of this study is to describe and interpret the kinetics of the well-established 2D parameters of diastolic function and the novel and very sensitive 3D parameters before/after a marathon race. LVDF was evaluated by transthoracic echocardiography (TEE) in 212 healthy male [aged 42 (36–49) years)] marathon runners (all Be-MaGIC-study) in the week prior to (V1), immediately after (V2), 24 h after (V3) and 72 h after (V4) a marathon race. Real time three-dimensional echocardiography (RT3DE) included maximal and minimal left atrium (LA) volume, total LA ejection fraction (Total-EF), total LA stroke volume (Total-SV), true ejection fraction (True-EF) and atrial stroke volume (ASV). After adjustment for possible confounders (heart rate and systolic blood pressure), 2D Parameters of left ventricular inflow (E/A-ratio) decreased from pre- to immediately post-race (− 0.3 ± 0.06, p

IntroductionProlonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area.Methods and analysisIn this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography.DiscussionThis longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years.Trial registration numberNCT04166903.