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Within the last twelve years, many consensus conferences and working groups have reported new recommendations for ECG interpretation in endurance exercise athletes. New data have improved validity and reliability of resting ECG in athletes, reducing especially false positive findings. In particular, these new recommendations classify ECG signs of hypertrophy and enlargement of ventricles or atria, or axis deviation in isolation as borderline findings. Conversely, signs of hypertrophy or enlargements associated with other abnormal findings require further evaluation. In addition, procedures for the diagnostic evaluation of abnormal findings are described in detail. With this recommendation, the reliability of the resting ECG is superior to anamnesis and clinical examination in the recognition of abnormal findings, and should be a mandatory part of pre-participation examination for all athletes. Even though the reliability is supported by integrated PC-assisted ECG analysis, special cardiological knowledge in ECG interpretation is required. Therefore, special education in sports cardiology is strongly recommended for all qualified sports physicians.KEY WORDS: ECG, Interpretation, Consensus, Athletes, ECG Device

Goals of pre-participation examination (PPE)in athletes are primarily to protect health of athletes. This applies for children, adolescents, leisure time and top athletes.To recognise early possible risks, history and clinical examination is agreed to be the basis of PPE. However, there is a long-standing controversy about whether ECG at rest should also be mandatory for all athletes. ECG is rejected in the US but included in most European countries. In addition, some large sports organisations also requireECG in PPE of athletes. The resting ECG can detect potential life-threatening diseases such as cardiomyopathies or ion-channel diseases, thus avoiding sudden cardiac events or even death. The present paper discusses many arguments pro and contra ECG in athletes screening. Arguments against are organisational problems, as sports physicians are not present nationwide in the US. Main arguments against are the lack of large prospective studies demonstrating reduced mortality by ECG, and the low sensitivity, specificity and predictive values of the ECG. However, current studies,new stringent and reliable criteria for ECG interpretation (e.g. Seattle criteria) increased the validity: false positive and negative findings decrease significantly. This is also supported by new, athlete-related ECG interpretation software in ECG devices, which are more reliable than visual analysis. This also may reduce legal problems, whereas psychological problems are of low importance as has been shown recently. Therefore, ECG recording in all athletes is strongly recommended in Europe. ECG is superior to history and clinical exam in detecting hidden and congenital diseases. However, special education in sports cardiologyis advised, courses and training in ECG interpretation in athletes, as well as special ECG devices are mandatory for correct ECG interpretation in athletes.KEY WORDS:ECG, Athlete, Pre-Participation Examination, PC-Analysis of ECG, Sports Cardiology

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Background: Recent studies show that habits detrimental to health are becoming established ever earlier in life. Because most of these investigations focus on adolescents up to the age of 18 years, it is largely unknown whether and to what extent negative behavioral modifications are intensified in young adults.Methods: Within the cross-sectional study 'Fit fürs Leben' (Fit for Life) 12 835 volunteers aged 16 to 25 years were anthropometrically investigated and interviewed about their lifestyle and habits (sporting activity, nutrition and health-related behavior).Results: Data on anthropometric (BMI, waist circumference, body fat) and health-relevant (lack of exercise, smoking) characteristics as well as the frequency of cardiovascular risk factors show a clear increase in unhealthy attributes, particularly among those aged 20 to 25 years. Fifty percent of 25-year-old men are overweight, 60% smoke, and around one third do not participate in sport. Although only one quarter of women aged 16 to 25 years are overweight, women engage in sport much less frequently. Only one quarter of all study participants display none of the investigated cardiovascular risk factors.Discussion: The health-detrimental tendencies increase considerably after the age of 20. Efficient cross-institutional prevention campaigns are urgently necessary to promote and continually support a health-conscious life-style. [ABSTRACT FROM AUTHOR]

Introduction: Preventive medical checkups may help to lower the health risks incurred by participation in sporting activity. However, there are no epidemiologically relevant data on either utilization or implementation of such checkups. Methods: An internet questionnaire (www.dshs-koeln.de/pace) and personal interviews of long-distance runners were used to obtain information on the acceptance and realization of medical checkups. Results: Only 50% of 10 025 runners had undergone preventive medical screening. Beginners and returnees to long-distance running are significantly less likely to have themselves checked than performance-oriented athletes (42.0% vs. 59.9%; p < 0.01). Moreover, the survey revealed deficiencies in many sports medical tests; for example, over 15% of runners screened stated that their checkup had not included physical examination. Resting ECG was performed in only 67.4% of cases. Discussion: The findings underline the need for qualified pre-emptive sports medical screening. If current public health campaigns are successful, higher numbers of overweight, untrained persons of all age groups will have to be examined and advised. [ABSTRACT FROM AUTHOR]

The closing volume maneuvre allows the instillation of a gas bolus into the upper parts of the lung. During expiration heart synchronous partial pressure oscillations are likely to occur in phases II, III, and IV. The very distanct and constant oscillations observed during the CV maneuvre are appropriate for a detailed form analysis. In addition, this single-breath method allows an estimation of the influence of ventilatory distribution on the amplitude of the oscillations. For the formation of heart synchronous oscillations in the alveolar plateau of inert gases, two conditions have to be assumed: an inhomogeneous distribution of inspired gases during mixing from different lung compartments and a pulsatile change of gas flow. From this investigation it is evident that flow changes are directly caused by the pulsation of the large vessels in the thorax. Immersion has proved to be useful in demonstrating a close correlation between the oscillation and the radialis pulse. [ABSTRACT FROM AUTHOR]

Eleven healthy male subjects aged 23 to 38 years (including 2 smokers) were exposed to purified air (= control experiment), to NO, O, and SO alone, to mixtures of NO + SO, and NO + O in MAK concentration, and to a mixture of NO + SO + O in MAK and MIK concentrations for 2 h. Nine of these subjects underwent a bronchial challenge by inhaling in a standardized procedure, an aerosol containing 1%, 2%, and 3% acetylcholine after a 2-h exposure to clean air and to a mixture of NO + SO + O in MAK and MIK concentrations, respectively. The following results were obtained: From the results of this study and previous data there is a special need for re-evaluation of the present NO MAK concentration (5 ppm; 9 mg/m). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to atrial fibrillation and endurance training, published in previous issue.

Despite significant prevention efforts, the numbers of physically inactive individuals, chronic illnesses, exhaustion syndromes and sick leaves are increasing. A still unresolved problem with exercise promotion is the low participation of sedentary persons. This collective term covers heterogeneous subgroups. Their engagement with movement campaigns and resistance to change are influenced by numerous factors. Our aim was to analyse survey data on health, performance, lifestyle habits and the approachability to physical activity campaigns obtained from the Germany-wide ActIv survey. From 2888 study participants aged 50-60 years, 668 persons were categorised into the subgroups "never-athletes", "sports-dropouts", "always-athletes" and "sports-beginners". Large and significant group differences were found for BMI, assessment of quality of life, health and fitness, risk factors and health problems. In total, 42.5% of "never-athletes" and 32.5% of "sports-dropouts" did not state any barriers to sport. There are substantial disparities between the non-athlete groups in terms of their motivation to exercise. In contrast, there are comparatively minor differences in motivation between "sports-dropouts" and "sports-beginners", whose health and fitness are the primary motivators for sport. Our analyses suggest that (i) negative health and performance trends cannot be compensated for by appeals for voluntary participation in exercise programmes and (ii) powerful incentive systems are required.

Sports medicine is a medical specialty that supports the performance of professional and amateur athletes while maintaining their health. Sports medicine professionals need to ensure the safe participation of athletes in sports activities achieved through a periodical preparticipation evaluation (PPE) and a regular medical monitoring of the athletes' health in accordance with the latest recommendations regarding health condition and medical history, physical working capacity, training period and programme, recovery, nutrition, use of supplements, injuries prevention and safe return to play. In order to harmonise these national variations in the content and application of the PPE, the EFSMA Scientific and Educational Commission proposes a 'gold standard' for elite athletes across Europe. Important objectives of PPE are early detection and prevention of severe complications during sports activities both in leisure time and competitive sports. The PPE should entail the following diagnostic components: health status, anthropometry, functional and exercise capacity. It is of utmost importance to develop and implement preventive strategies such as the PPE. Besides monitoring the health status of athletes, the PPE plays an important role in the selection process, bringing valuable information for coaches and supporting a personalised treatment approach. Screening of athletes through a standardised digital PPE could be beneficial for a better understanding of the impact of long-term physical activity. Furthermore, PPE leads the scientific community to a way of working closer together in the interest of the athletes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Competing Interests: Competing interests: None declared.