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The aim of this study was to analyze the variations of acute load (AL), acute: chronic workload ratio (ACWR), training monotony (TM), and training strain (TS) of accelerometry-based GPS measures in players who started in three matches (S3M), two matches (S2M), and one match (S1M) during congested weeks. Nineteen elite professional male players from a Portuguese team (age: 26.5 ± 4.3 years) were monitored daily using global positioning systems (GPSs) over a full season (45 weeks). Accelerometry-derived measures of high metabolic load distance (HMLD), high accelerations (HA), and high decelerations (HD) were collected during each training session and match. Seven congested weeks were classified throughout the season, and the participation of each player in matches played during these weeks was codified. The workload indices of AL (classified as ACWR, TM, and TS) were calculated weekly for each player. The AL of HMLD was significantly greater for S2M than S1M (difference = 42%; p = 0.002; d = 0.977) and for S3M than S1M (difference = 44%; p = 0.001; d = 1.231). Similarly, the AL of HA was significantly greater for S2M than S1M (difference = 25%; p = 0.023; d = 0.735). The TM of HD was significantly greater for S2M than S3M (difference = 25%; p = 0.002; d = 0.774). Accelerometry-based measures were dependent on congested fixtures. S2M had the greatest TS values, while S3M had the greatest TM.

Knechtle, B, Stjepanovic, M, Knechtle, C, Rosemann, T, Sousa, CV, and Nikolaidis, PT. Physiological responses to swimming repetitive "Ice Miles." J Strength Cond Res XX(X): 000-000, 2018-"Ice Mile" swimming (i.e., 1,608 m in water of below 5° C) is becoming increasingly popular. Since the foundation of the International Ice Swimming Association (IISA) in 2009, official races are held as World Cup Races and World Championships. Ice swimming was a demonstration sport at the 2014 Winter Olympics in Sochi, Russia. This case study aimed to identify core body temperature and selected hematological and biochemical parameters before and after repeated "Ice Miles." An experienced ice swimmer completed 6 consecutive Ice Miles within 2 days. Three Ice Miles adhered to the strict criteria for the definition of Ice Miles, whereas the other 3 were very close (i.e., 5.2, 6.1, and 6.6° C) to the temperature limit. Swimming times, changes in core body temperatures, and selected urinary and hematological parameters were recorded. The athlete showed after each Ice Mile a metabolic acidosis (i.e., an increase in lactate and TCO2; a decrease in base excess and HCO3) and an increase in blood glucose, cortisol, and creatine kinase concentration. The decrease in pH correlated significantly and negatively with the increase in cortisol level, indicating that this intense exercise causes a metabolic stress. The change in core body temperature between start and finish was negatively associated with metabolic acidosis. The increase in creatine kinase suggests skeletal muscle damages due to shivering after an Ice Mile. For athletes and coaches, swimming in cold water during Ice Miles leads to a metabolic acidosis, which the swimmer tries to compensate with a respiratory response. Considering the increasing popularity of ice swimming, the findings have practical value for swimmers and practitioners (e.g., coaches, exercise physiologists, and physicians) working with them because our results provi

Stefania Di Gangi,1 Christophe Bagnoud,2 Giuseppe Pichierri,1 Thomas Rosemann,1 Andreas Plate1 1Institute of Primary Care, University and University Hospital Zurich, Zürich, Switzerland; 2Groupe Mutuel, Martigny, SwitzerlandCorrespondence: Stefania Di GangiInstitute of Primary Care, University and University Hospital Zurich, Pestalozzistrasse 24, Zürich, CH-8091, SwitzerlandTel +41 44 255 75 02Fax +41 44 255 90 97Email Stefania.DiGangi@usz.chPurpose: Low back pain (LBP) is one of the most frequent reasons for medical consultations. Literature suggests a large evidence-performance gap, especially regarding pain management. Therefore, the monitoring of treatment patterns is important to ensure high quality of treatment. This study aimed to describe treatment patterns specific to patients with diagnostic imaging of the spine for LBP.Patients and Methods: The study was retrospective observational and based on health claims data from 2015 to 2019 provided by a Swiss health insurance company covering around 12% of the population. Patients, ≥ 18 years of age, with diagnostic imaging of the spine were included and observed 12 months before and after imaging. Patients with back surgery or comorbidities associated with the use of pain medications were excluded.Results: In total, 60,822 patients (mean age: 53.5 y, 56.1% female) were included and 85% received at least one pain medication. Of these, non-steroidal anti-inflammatory drugs, paracetamol, or opioids were prescribed in 88.6%, 70.7%, and 40.3% of patients, respectively. Strong opioids were used in 17% of patients given opioids. Patients with combinations of diagnostic imaging methods had the highest odds of receiving pain medication prescriptions (1.81, 95% CI: 1.66, 1.96, P < 0.001). Prescribed defined daily doses corresponded to short-term therapies.Conclusion: Although the majority of patients received non-opioid short-term therapies, we found a substantial use of opioids, and in particular, a relative high u

Salome Landolt,1 Thomas Rosemann,1 Eva Blozik,1,2 Beat Brüngger,2 Carola A Huber1,2 1Institute of Primary Care, University of Zürich, University Hospital Zürich, Zürich, Switzerland; 2Department of Health Sciences, Helsana Insurance Group, Zürich, SwitzerlandCorrespondence: Carola A HuberHelsana Insurance Group, P.O. 8081, Zürich, SwitzerlandTel + 41 43 340 6341Fax +41 43 340 0434Email carola.huber@helsana.chPurpose: This study aimed to give a nationwide comprehensive picture of the prevalence and prescription patterns of benzodiazepines (BZ) and Z-drugs (ZD) in Switzerland and to analyze the association with adverse health care outcomes.Patients and Methods: A population-based, cross-sectional study was conducted, using a large health insurance database in Switzerland. Records from all adult patients with ≥ 1 prescription for a benzodiazepine and/or a Z-drug in 2018 were included. We calculated the prevalence of BZ and ZD user (extrapolated to the Swiss general population), the number of prescriptions and the type of provider (among each BZ and ZD only user). Multivariate logistic regression models were performed to estimate the association between drug prescription and the risk of hospitalization in different healthcare settings.Results: Of a total of 844ʹ692 patients, 95ʹ179 had ≥ 1 BZ and/or ZD prescription in 2018. The extrapolated one-year prevalence for the general Swiss population was 8.1% for a BZ prescription, 3.5% for a ZD prescription, and 10.5% for a BZ and/or ZD prescription, and continuously increased with age. The majority of the elderly (over 65 years) had ≥ 1 prescription (BZ: 51.9%; ZD: 56.9%; BZ and/or ZD: 53.5). The proportion of patients with ≥ 6 prescriptions per year was 23.1% for BZ only user and 35.2% for ZD only user. Most patients had ≥ 1 prescription from a general practitioner. Regression models showed a higher likelihood to be admitted to acute c

Frangiskos Frangopoulos,1 Ivi Nicolaou,1 Savvas Zannetos,2 Nicholas-Tiberio Economou,3 Tonia Adamide III,1 Andreas Georgiou,1 Pantelis Theodoros Nikolaidis,4 Thomas Rosemann,5 Beat Knechtle,5 Georgia Trakada3 1Respiratory Department, Nicosia General Hospital, Nicosia, Cyprus; 2Health Economics and Statistics, Neapolis University, Paphos, Cyprus; 3Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece; 4School of Health and Caring Sciences, University of West Attica, Athens, Greece; 5Institute of Primary Care, University of Zurich, Zurich, SwitzerlandCorrespondence: Georgia TrakadaDepartment of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Vas Sofias 80, Athens, 11528, GreeceTel +30 210 3381488Fax +30 213 2162889Email gtrakada@hotmail.comIntroduction: Circadian rhythm sleep-wake disorder (CRSWD) is an often-misdiagnosed group of sleep disturbances with limited data concerning diagnostic and therapeutic algorithms in the general population. Therefore, reported prevalence varies in the literature due to different case definitions, methodological, and environmental factors.Objectives: The purpose of our cross-sectional study was to estimate the prevalence of CRSWD in the general population of Cyprus and to suggest clinical parameters for the assessment of atypical sleep schedules. The estimation was carried out by introducing normal preset sleep time limits, according to the imposed local environment and by administering well-established questionnaires for symptoms and consequence dysfunction, as objective evaluation tools.Methods: In a nationwide epidemiological survey, 4118 Cypriot adult participants, selected and stratified to represent the general population, were interviewed on sleep habits and complaints by computer-assisted telephone interviewing (CATI). In the second stage, 250 adults were

Background and objective: Existing research shows that the sex differences in distance-limited ultra-cycling races decreased with both increasing race distance and increasing age. It is unknown, however, whether the sex differences in time-limited ultra-cycling races will equally decrease with increasing race distance and age. This study aimed to examine the sex differences regarding performance for time-limited ultra-cycling races (6, 12, and 24 h). Methods: Data were obtained from the online database of the Ultra-Cycling Marathon Association (UMCA) of time-limited ultra-cycling races (6, 12, and 24 h) from the years 1983–2019. A total of 18,241 race results were analyzed to compare cycling speed between men and women by calendar year, age group (<29; 30–39; 40–49; 50–59; 60–69; >70 years), and race duration. Results: The participation of both men (85.1%) and women (14.9%) increased between 1983 and 2019. The age of peak performance was between 40 and 59 years for men and between 30 and 59 years for women. Between 2000 and 2019, more men (63.1% of male participants and 52.2% of female participants) competed in 24 h races. In the 24 h races, the sex difference decreased significantly in all age groups. Men cycled 9.6% faster than women in the 12 h races and 4% faster in the 24 h races. Both women and men improved their performance significantly across the decades. Between 2000 and 2019, the improvement in the 24 h races were 15.6% for men and 21.9% for women. Conclusion: The sex differences in cycling speed decreased between men and women with increasing duration of ultra-cycling races and with increasing age. Women showed a greater performance improvement than men in the last 20 years. The average cycling speed of men and women started to converge in the 24 h races.

(1) Background: Recent studies analyzed the participation and performance trends of historic races such as the oldest ultra-marathon (Comrades) or the oldest 100-km ultra-marathon (Biel). One of the toughest and historic ultra-marathons in the world is the 'Spartathlon' (246-km ultra-marathon from Athens to Sparta). The present study aimed to analyze the trends in participation and performance of this race. (2) Methods: Different general linear models were applied as follows: the first model was a two-way ANOVA (Decade × Sex), with separate models for all participants and for only the top five finishers in each race; the second model was a two-way ANOVA (Age Group × Sex); the third model was a two-way ANOVA (Nationality × Sex). (3) Results: Between 1982 and 2019, 3504 ultra-marathoners (3097 men and 407 women) officially finished the Spartathlon at least once. Athletes from Japan were the majority with 737 participants, followed by far by runners from Germany (n = 393), Greece (n = 326), and France (n = 274). The nations with the highest numbers of athletes amongst the top five performers were Japan (n = 71), followed by Germany (n = 59), and Great Britain (n = 31). Runners from the USA were the fastest in men, and runners from Great Britain were the fastest in women. Female and male runners improved performance across the decades. The annual five fastest women and men improved their performance over time. Runners achieved their best performance earlier in life (20-29 and 30-39 years) than female runners (30-39 and 40-49 years). Runners in age group 30-39 years were the fastest for all nationalities, except for Greece. (4) Conclusions: Successful finishers in the Spartathlon improved performance in the last four decades and male runners achieved their best performance ~10 years earlier in life than female runners. Keywords: athlete; endurance; female; male; performance; ultra-marathon.

Background: It is well known that athletes originating from a specific region or country can master specific sports disciplines (e.g., East-African runners in long-distance running). In addition, physical and athletic performance are the result of an interaction between genetic, environmental and epigenetic factors. However, little is known about on what determines sports success and performance for long-distance master swimmers such as origin. The aim of the study was to investigate the participation and performance trends of elite master open-water swimmers competing in the World Championships (WC) in 3000 m open-water swimming between 1986 and 2019. Methods: A total of 9247 valid participants were analyzed using generalized linear models (GLMs) with a gamma probability distribution and log link function. Resultsː Most of the starters were from Italy (1646 participations), followed by the United States of America (USA) (1128 participations) and Germany (959 participations). Swimmers from Italy were significantly faster than swimmers from Canada, Germany, USA, Great Britain and also from all other countries grouped (p < 0.005). The age group from 35–39 years old was significantly faster than athletes from age groups of 25–29 years old, 30–34 years old, 40–44 years old, 45–49 years old and 50–54 years old (p < 0.005). The percentage of local athletes in WC was 36% and varied from 36% (Italy, 2004) to 43 % (Germany), 53% (Italy, 2012) and up to 68 % (USA, 1992). Conclusions: Swimmers from Italy were the faster and the most numerous starters during this period of 27 years and 15 editions all over the world in 3000 m master open-water swimming.

BACKGROUND Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors. OBJECTIVE Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals. DESIGN AND SETTING Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás. METHODS The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed). RESULTS In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%. CONCLUSIONS The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.

BACKGROUND The sticking region is considered an intervening factor in the performance of the bench press with high loads. OBJECTIVE To evaluate the strength indicators in the sticking point region in Powerlifting Paralympic athletes. METHODS Twelve Brazilian Powerlifting Paralympic athletes performed maximum isometric force (MIF), rate of force development (RFD), time at MIF, velocity, dynamic time in sticking, and surface electromyography in several distances from the bar to the chest. RESULTS For velocity, there was a difference between the pre-sticking and sticking region (1.98 ± 0.32 and 1.30 ± 0.43, p = 0.039) and dynamic time between the pre-sticking and the sticking region (0.40 ± 0.16 and 0.97 ± 0.37, p = 00.021). In static test for the MIF, differences were found between 5.0 cm and 15.0 cm (CI 95% 784; 1088; p = 0.010) and between 10.0 cm and 5.0 cm (CI 95% 527; 768; p < 0.001). Regarding the RFD, differences were found (CI 95% 938; 1240; p = 0.004) between 5.0 cm and 25.0 cm and between 10.0 cm and 25.0 cm (CI 95% 513; 732; p < 0.001). In relation to time, there were differences between 5.0 cm and 15.0 cm (CI 95% 0.330; 0.515; p < 0.001), 5.0 cm, and 25.0 cm (CI 95% 0.928; 1.345; p = 0.001), 10.0 cm and 15.0 cm (p < 0.05) and 15.0 cm and 25.0 cm (p < 0.05). No significant differences were observed between the muscles in electromyography, although the triceps showed the highest muscle activation values. CONCLUSIONS The maximum isometric force, rate of force development, time, velocity, and dynamic time had lower values, especially in the initial and intermediate phases in the sticking region.

This study aimed to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed-2000 dynamometer for knee flexion and extension peak torque (PT) measurements in a concentric test in athletes. Two IsoMed-2000 isokinetic dynamometers were used, an old one that was well-used and a new one that was less-used. Thirty-seven weight-lifting athletes (12 female, 25 male) were included in this study. Both legs of each athlete were tested twice on each isokinetic dynamometer at 60°/s and 180°/s. The Intraclass Correlation Coefficients (ICC), Standard Error Measurement (SEM), Smallest Detectable Change (SDC), SDC% and 95% limits of agreement were calculated to evaluate the intra- and inter-rater reliability of a well-used and a less-used IsoMed 2000 dynamometer for knee flexion and extension peak torque in athletes. Intra-rater reliability was moderate to excellent (ICCs: 0.516–0.928) for knee muscle strength parameters, and the highest SDC and SEM values were 0.76 N/kg and 0.28 N/kg, respectively. Inter-rater reliability was moderate to excellent (ICCs: 0.519–915) for knee muscle strength parameters, and the highest SDC and SEM values were 0.81 N/kg and 0.29 N/kg, respectively. At least 89.2% of the obtained values of parameters fell within the 95% limits of agreement. Our findings demonstrate the intra and inter-rater reliability of a Well-Used and a Less-Used IsoMed 2000 Dynamometer for Knee Flexion and Extension Peak Torque in Athletes.

In soccer, accurate kicking skills are important determinants of successful performance. A successful kick must meet several criteria, including speed, accuracy, and timing. In fact, players who are able to kick the ball more accurately under various difficulties, such as time pressure, space constraints, the opponent’s pressure, and the distance between the kicking point and the goal, have a clear advantage during soccer games. The aim of the present study was to investigate the effect of exercise difficulty and time-of-day on perceived task difficulty and kicking performance. Accordingly, 32 boys (age: 11 ± 0.7 years; height: 1.45 ± 0.07 m; body-mass: 38.9 ± 7.8 kg) performed shooting accuracy tests under two difficulty levels (distance (long-distance (LD) vs. short-distance (SD)) and time pressure (Without-time-pressure (WTP) vs. With-time-pressure (TP)) at 08:00 h and 17:00 h. Absolute-error, variable-error, and constant-error were evaluated during the kicking tasks, in addition to ball velocity and shooting quality. Moreover, rating-of-perceived-exertion score (RPE), feeling-scale (FS), and perceived difficulty were completed immediately at the end of each test. The results showed that shooting quality was not affected by the time-of-day, but it was better in WTP vs. TP (p < 0.05), and in SD vs. LD (p < 0.05), respectively. Higher values for FS and lower values for RPE were observed in the morning compared to the afternoon (p < 0.05) and in WTP vs. TP (p < 0.05). In conclusion, specific soccer skills of boys were not time-of-day dependent, but they may be associated with time pressure and task difficulty.

The aim of the present study is to evaluate the effect of Ramadan observance (RAM) on decision-making in Kung-Fu athletes. Fourteen male Kung-Fu athletes (mean age = 19 ± 3 years) completed two test sessions: before Ramadan (BR) and at the end of Ramadan (ER). In the afternoon of each session (between 16:00 h and 18:00 h), participants completed: Epworth Sleepiness Scale (ESS), Profile of Mood States (POMS), and Pittsburg Sleep Quality Index (PSQI). Subjects also reported subjective fatigue, alertness, and concentration. Additionally, all participants performed video-based decision-making tasks (i.e., reaction time and decision-making). Results indicated that reaction time decreased by 30% at ER vs. BR (p < 0.01). However, decision-making decreased by 9.5% at ER vs. BR (p < 0.05). PSQI results indicated sleep quality score, sleep duration, and sleep efficiency were negatively affected at ER compared to BR (p < 0.05). ESS was higher at ER compared to BR (p < 0.05). In addition, fatigue scores, estimated by the POMS and current subjective feelings (i.e., fatigue, concentration, and alertness), were also negatively affected at ER compared to BR (p < 0.05). In conclusion, Ramadan observance was associated with an adverse effect on sleep and decision making, as well as feelings of fatigue, alertness, and concentration.