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Medical clearance is an essential part for participation is recreational and professional sports events, including participation in the Russian physical culture training system “Ready for labour and defence” («Gotov k Trudu i Oborone» - abbreviated as GTO, in Russian). The Order № 134 of the Ministry of Health of Russia, dated March 1, 2016, defines the procedures for medical clearance of athletes, including those with disabilities. However some questions remaining the assessment of the health condition of the latter still remain open. There is no consensus agreement on contraindications for medical clearance giving and the terms of the validity of such clearance. In this paper we discuss the optimal terms for medical assessment of the disabled athletes, legal procedures, as well as give recommendation on medical clearance for athletes of different disability groups.

This study aimed to establish the optimal cut-off point(s) between classes in a new, evidence-based classification system for VI judo. We collected results from international VI judo competitions held between 2012 and 2018. Data on visual acuity (VA) and visual field (VF) measured during classification were obtained. Performance was determined by calculating a win ratio for each athlete. VA was significantly associated with judo performance (r = −.33, p

PurposeTo test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones.MethodsA total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.28.0 years, and 33 with different health conditions, mean age 37.89.9 years) and in four sport type groups (skill, power, intermittent-mixed metabolism-and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete.ResultsThe prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p=0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 +/- 5.70 ml kg(-1) min(-1)). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 +/- 10.0 vs 33.6 +/- 8.9 ml kg(-1) min(-1)p=0.03), and in those with 3-4 risk factors (19.09 +/- 5.34 ml kg(-1) min(-1)) than those with 2 risk factors (27.1 +/- 5.50 ml kg(-1) min(-1)), 1 risk factor (31.6 +/- 8.55 ml kg(-1) min(-1)), or none (36.4 +/- 8.76 ml kg(-1) min(-1)) (p, Open access funding provided by Universita degli Studi dell'Aquila within the CRUI-CARE Agreement.

Spinal cord injury (SCI) is a devastating condition that affects mostly young and active individuals but also impacts their family members and results in significant challenges for medical care and social integration. In addition to obvious motor impairment (tetraplegia/paraplegia), these individuals also suffer from a variety of less obvious but devastating autonomic nervous system dysfunctions that negatively impact their health and affect various aspects of daily living. Physical training and sports are essential components of rehabilitation and leaser activities for people with disabilities. Number of individuals with SCI who run an active lifestyle is increasing. Physical activity puts an additional stress on various organs and body systems. The presented manuscript describes in detail cardiovascular dysfunctions in physically active individuals with a SCI, including those engaged in Paralympic sports: low resting blood pressure, orthostatic hypotension, arrhythmias, and the phenomenon of «autonomic dysreflexia». We also address issues related to self-induced episodes of autonomic dysreflexia in order to improve athletic performance ― a phenomenon known as «boosting». Boosting may improve sports performance in short term but is associated with the risk of serious cardiovascular disorders and even sudden death. This practice is considered as anti-doping rule violation by the International Paralympic Committee and thus prohibited. Understanding of the changes occurring in the body of a physically active individual after SCI is necessary for general practitioners, neurologists, rehabilitation specialists, sports medicine physicians, as well as for specialists of adapted physical education and sports.

Sport-related injury patterns among Para athletes have been described with increasing frequency. This review summarizes musculoskeletal injuries in Para athletes. Seated Para athletes sustain upper extremity injuries more commonly; ambulant Para athletes frequently sustain lower extremity injuries. The upper extremity is the most commonly injured anatomic area in all Para athletes, unlike able-bodied athletes. Advanced age and spinal cord injury may increase the risk of upper extremity injury. Injury data for recreational and youth Para athletes are sparse. Summarizing current injury epidemiology data may help to accelerate the development of injury prevention strategies and lifetime injury models for Para athletes.

Aim of the study. The identification of the variability of morphofunctional status of female students (16-20 years) between surveys in 20 years with the development of ways to optimize medical monitoring and improvement programs improving physical culture in preparation for the implementation of standards of the all-Russian sports complex «Ready for labour and defence» (ARSC GTO) in 2014. Material and methods. The normative results of the various test types and test program, the GTO period 1970-1980-ies «Ready for labor and defense of the USSR» - in 1987 and ARSC GTO - 2014. Results. For analysis and comparison for compliance with the physical health of students in the framework of preparations for civil defense (GTO), the GTO selected two different periods, the period of the USSR 1970-1980-ies that used the all Union physical culture complex «Ready for labour and defence of the USSR» (VFK GTO USSR) - 1987 period TRP in Russia - all-Russian sports complex «Ready for labour and defence» (ARSC GTO) in 2014. In the study, it was found that some kinds of testing under ARSC GTO - 2014 simpler and easier to execute (compared to the requirements of VFK GTO USSR - 1987), for example, running 100 meters, long jump, 500- and 700-gram throwing ball, ski races, cross-country, swimming and shooting. You should pay attention to the fact that the total number of trials of ARSC GTO - 2014 less than in the system VFK GTO USSR - 1987. Conclusion. Standards of performance standards of ARSC GTO - 2014 complete easier and simpler in most tests compared with the Soviet period in the framework of VFK GTO USSR - 1987. A study of anthropometric and morphofunctional characteristics of female students (16-20 years old) showed that our results require careful analysis for compliance with the physical development and health of young people aged 16-20 years with the requirements for the standards system of ARSC GTO - 2014.

BACKGROUND In the International Blind Sports Federation (IBSA) judo Sports Classes B1, B2, and B3 compete against each other within weight- and gender-specific categories. B1 athletes are totally blind, whereas B2 and B3 are partially sighted. The aim of this study was to examine the impact of the degree of vision impairment on fight outcomes. METHODS We analyzed 1936 fights from official competitions and compare win ratio in fights between discordant Sports Classes. RESULTS B1 won B2 ratio was 34.8%, B1 won B3 ratio was 36.5%, B2 won B3 ratio = 50.6%. The B1 percent of IBSA judo athletes decreased from 25.9% in 2007 to 19.4% in 2016, while the total number of participants increased over this period. CONCLUSIONS These findings confirm that blind athletes have fewer chances to win a fight in IBSA Judo and become a member of National Team. Loss of vision functions affects movement coordination, balance, and emotional state, which are important for martial arts and may explain why B1 athletes are more likely to lose competitions against either B2 or B3. Creation of the evidence-based and sport-specific classification system and/or improvement of the technical rules are necessary for fair IBSA Judo competitions.

Sport-related injury patterns among Para athletes have been described with increasing frequency. This review summarizes musculoskeletal injuries in Para athletes. Seated Para athletes sustain upper extremity injuries more commonly; ambulant Para athletes frequently sustain lower extremity injuries. The upper extremity is the most commonly injured anatomic area in all Para athletes, unlike able-bodied athletes. Advanced age and spinal cord injury may increase the risk of upper extremity injury. Injury data for recreational and youth Para athletes are sparse. Summarizing current injury epidemiology data may help to accelerate the development of injury prevention strategies and lifetime injury models for Para athletes.

Prolonged altitude exposure even with acclimatization continues to present a physiological challenge to all organ systems including the central nervous system. We describe a case of a 41-year-old Caucasian female climber who suffered severe visual loss that was due to possible optic nerve pathology occurring during a high altitude expedition in the Himalayas. This case is atypical of classic high altitude cerebral oedema and highlights yet another danger of prolonged sojourn at extreme altitudes.

Objectives Reports of Ischaemic Heart Disease (IHD) in athletes who have retired from sports have increased over the past few years. To date there are few available data on how stable angina (SA) progresses in this special population, and little is known about the impact prior physical activity has on the treatment of stable angina. The goal of our study was to investigate the influence of previous regular sports activities on the rehabilitation outcomes in patients with SA. Methods 64 patients: 28 females and 36 males, mean age – 61,2 ± 4,1 with SA (classes II-III) were divided into two groups: G1 – former elite athletes (n = 32) who have a history of practicing endurance sports 8 years and longer; G2 – sedentary people (n = 32). Patients in G1, once retired, had a similar to the sedentary group level of physical activity. Patients of both groups developed SA at similar ages, had comparable duration of the disease, and similar echocardiography parameters at the beginning of the study. Both groups were provided with the same standard rehabilitation program. Patients were followed prospectively over a 6-month period. The number of hospital admissions (HA) and the number of myocardial infarction (MI) were recorded. The treadmill ergospirometry test (MOD Bruce protocol) was performed at baseline and after 6 months. We performed a regression analysis between an increase in physical work capacity (PWC) and age, duration of SA, baseline PWC (in both groups) and, additionally, in G1, between increase in PWC and the age at the beginning of sports career, duration of sports career, and time after retirement. Results After 6 months the improvements in PWC were +23 ± 8,6 W in G1, and +14 ± 2,5 W in G2. Clinical outcomes in G1: HA – 1 (hypertensive crisis); G2 – HA – 3 incl. 2 with MI. There were no significant correlations between age, duration of SA, baseline PWC and increase in PWC in either group. In G1 there were strong negative correlation (r = − 0.66) between age at the beginning, very weak negative correlation (r = − 0.12) between time after finishing and increase in PWC. Very strong positive correlation (r = 0.88) between duration of sports career and increase in PWC was found (Figure 1). Conclusions Retired elite athletes with SA had better clinical outcomes under similar treatment after 6 months rather than sedentary individual. The changes in PWC in former elite athletes, who practice sports for 10 years or more, were more pronounced compared to sedentary patients or those who practiced for less than 10 years. During our study we noticed better compliance and adherence to treatment in the athlete group. The obtained results show that a history of regular sports activities has beneficial effect on compensatory abilities of the cardiovascular system in patients with IHD, even after a significant break in training (20 years and more) and a lack of regular physical activity post retirement. Further studies are needed to clarify what causes the improvement in PWC in retired athletes with SA: are they related to the heart changes, e.g. better microcirculation as a result of activation of previously developed collaterals, more efficient heart metabolism, or is it due to better compliance?

Objectives Elbow angle (EA) measurement is one of the major procedures in International Paralympic Committee Para Powerlifting (IPC PO) classification. There is a general historic consensus around the relative mechanical instability of the elbow joint associated to the 20° deficit of extension. Therefore in IPC PO athletes with such deficiency were classed as non-eligible to compete for safety reasons. However there is lack of evidence-based approach on measuring EA in sport specific setting. Methods EA in 60 healthy sedentary individuals aged 19-75 with visually flat arms and no extension deficit at the elbow joints was measured twice: between three bone landmarks (3LM): (1) top of the acromion, (2) lateral epicondyle of the humerus, (3) radial styloid process, and along the bone axes (ABA) with clinical goniometers. Measurements were done between 9 and 11 am, and patients were asked to avoid any physical activity prior to the investigation. EA in 11 patients were also measured with X-Rays goniometry. Results The study has shown that in a person with a visually flat arm (estimated elbow angle 0°) the angle measured with the 3LM method was 10.42° +/0.49° (p Coclusions We presume the EA in a healthy sedentary person with a visually flat arm to be 0° (180°). However, the evidence shows that measured by different methods it could be either 2° (ABA) or 11° (3LM). This shows a need to be explicit and consistent about exactly what is meant by the elbow angle. We suggest that a true elbow angle (TEA), which can be defined as an angle between the axis of the humerus and the axis of the radial bone should be distinguished from an arm curve angle (ACA), which is an angle between three abovementioned landmarks. So the reasonable approach to measure the TEA would be to use the 3LM method to carry out the measurement and find the ACA, and then deduct 11°. However one of the possible limitations for extrapolation of these findings are athletes with achondroplasia. They have severe deformities in the skeleton, thus the acromion cannot be used as a reference point when measuring the TEA or another formula should be applied. Further investigations are needed to define the difference between the ACA and the TEA in this special population. Our findings could be used in the sports specific classification in Paralympic sports for precise measurements of the EA. They also give a better understanding of difference between the TEA and the ACA, which might be useful in medical rehabilitation of patients with musculoskeletal problems and physiotherapy. By the recent decision of IPC PO Sports Technical Committee extension deficit of 20° in elbow joint was excluded from eligibility criteria. Acknowledgments We would like to thank Dr. Evgeny Shuporin, for his help in conducting the current research and the group of IPC Powerlifting Technical and Classification experts: Derek Groves, Lt Cdr Kadir, Dr. Bassam Qasrawi, Jorge Moreno, Sam Munkley, and others for their support in this work.

Objectives Paralympic Judo is a combat sport for athletes with visual impairments. It became an official Paralympic discipline in 1988 for men, and in 2004 for women. Following IBSA rules the classification panel groups athletes into three classes according their vision ability: B3 – moderate vision loss, B2 – severe vision loss, and B1 – totally blind athletes. Athletes in Para judo with different degree of vision impairment compete against each other in different weight categories. Many athletes, coaches and officials argued that this fact can influence the outcome of a fight, and that B1 athletes have less chances of winning against B2 or B3 athletes. That may lead to a situation where B1 athletes have fewer chance of being selected for the National Team and therefore will no longer stay in the sport. The goal of this study was to validate the above mentioned assumptions and to determine the win:lose ratios in fights between athletes of different classes, and also to analyse the number of athletes in different classes. Methods We analysed the outcomes of 1,640 official fights across a total of 8 major international Para judo competitions for the period of 2007–2015. The results were obtained from the IBSA website. The win:lose ratio in fights B1 against B2, B1 against B3, B2 against B3 in both male and female athletes in all weight categories was analysed. We calculated the percentage of competing athletes of different classes through all weight categories. Results B1 won B2 ratio was 36.1%, B1 won B3 ratio was 31.4%, whereas the B2 won B3 ratio = 50.4%, and B3 won B2 ratio = 49.6%. The number of B1 athletes decreased by 7% over this period: 26% in 2007 and 19% in 2015, the number of B2 athletes increased by 6%: 43% in 2007 and 49% in 2015, the number of B3 athletes did not changed significantly: 31% in 2007 and 32% in 2015 (Figure 1). Conclusions The results indicate a significant correlation between the level of vision function and the fight outcomes: totally blind athletes have fewer chances of winning against athletes with some retained vision. It might be due to the fact that athletes’ performance is significantly determined by vision impairment. Vision has a great impact on the functional capabilities of the athlete, such as the ability to train and to operate an effective daily routine. Athletes with partial vision loss of a different degree (B2 and B3) have comparable chances of winning each fight. Our study demonstrated that the total number of competing judo athletes increased over recent years, but the number of totally blind (B1) athletes is decreasing. That may be because of the reduced opportunities to win fights against B2 or B3 class athletes. Taken together this data highlights the importance of including functional assessment tests during classification in IBSA Judo. Therefore modification and improvement of classification procedures and/or technical rules of IBSA judo will ensure fair competitions for all athletes. Further research of sport specific parameters such as coordination, posture stability etc., and assessment of the impact of vision loss on the training and daily activity of the athletes is necessary for the development of a sport specific evidence based classification tests in IBSA judo.