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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.

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 the scientific landscape, there is a growing interest in defining the role of several biomolecules and humoral indicators of the aging process and in the modifications of these biomarkers induced by physical activity and exercise. The main aim of the present narrative review is to collect the available evidence on the biohumoral indicators that could be modified by physical activity (PA) in the elderly. Online databases including Pubmed, Web of science (Medline), and Scopus were searched for relevant articles published in the last five years in English. Keywords and combination of these used for the search were the following: “biological”, “indicators”, “markers”, “physical”, “activity”, and “elderly”. Thirty-four papers were analyzed for inclusion. Twenty-nine studies were included and divided into four categories: cardiovascular (CV) biomarkers, metabolic biomarkers, inflammatory markers-oxidative stress molecules, and other markers. There are many distinct biomarkers influenced by PA in the elderly, with promising results concerning the metabolic and CV indexes, as a growing number of studies demonstrate the role of PA on improving parameters related to heart function and CV risk like atherogenic lipid profile. Furthermore, it is also a verified hypothesis that PA is able to modify the inflammatory status of the subject by decreasing the levels of pro-inflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). PA seems also to be able to have a direct effect on the immune system. There is a strong evidence of a positive effect of PA on the health of elderly people that could be evidenced and “quantified” by the modifications of the levels of several biohumoral indicators.

To verify if pre-performance vibration exposure could negatively affect the postural control in soccer players. Twenty-eight participants, 12 male soccer players (aged 22.4 ± 1.0 years) and 16 sedentary males (aged 26.8 ± 2.7 years), underwent two test sessions: in the first one, the optimal vibration frequency (OVF) was determined for each participant, and in the second one, postural sways, with open and closed eyes, were assessed at baseline, immediately, 10, 20 min after the WBV exposure. The vibration exposure consisted in five sets of 1 min each one, at OVF, with 1-min rest between each set. The elliptical area, containing the 95% of the centre of pressure (COP), displacements (AREA), the total linear distance covered by the COP (LENGTH), the average distance between the assessed COP position and the ideal COP position (AV-DIST) and variance of speed of the COP displacements (VAR-SPEED), have been analysed. RM-ANOVA did not show significant differences among the times of assessment. Significant differences in all the dependent variables, between the groups, especially in closed eyes condition, were found. Athletes with closed eyes showed a significantly smaller COP AREA (p = 0.00004), minor AV-DIST (p = 0.0001), which are good indicators of an optimal postural control. An acute bout of WBV at the OVF did not modify the COP parameters and may be used before the performance, with no side effect on balance. Athletes have developed a postural strategy on non-visual afferent inputs that could be enhanced by the WBV chronic exposure.

Talent identification plans are designed to select young athletes with the ability to achieve future success in sports. The aim of the study was to verify the predictive value of coordination and precision in skill acquisition during motor learning, as indicators of talent. One hundred gymnasts, both cadets (aged 11.5 ± 0.5 yr.) and juniors (aged 13.3 ± 0.5 years), competing at the national level, were enrolled in the study. The assessment of motor coordination involved three tests of the validated Hirtz’s battery (1985), and motor skill learning involved four technical tests, specific of rhythmic gymnastics. All the tests were correlated with ranking and performance scores reached by each gymnast in the 2011, 2012, and 2013 National Championships. Coordination tests were significantly correlated to 2013 Championships scores (p < 0.01) and ranking (p < 0.05) of elite cadet athletes. Precision, in skill acquisition test results, was positively and significantly associated with scores in 2013 (adj. R2 = 0.26, p < 0.01). Gymnasts with the best results in coordination and motor learning tests went on to achieve better competition results in three- year time.

Background Congenital coronary anomalies (CCAs) and coronary artery disease (CAD) arouse intense scientific and clinical interest in sports medicine and sports cardiology medical communities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercise stress testing represent the first instrumental assessment to evaluate electrocardiographic changes during effort. Coronary computed tomography angiography (CCTA) is an advanced accurate noninvasive imaging modality for excluding CAD and abnormalities of origin and course of coronary vessels. The aim of this study is to investigate with CCTA the clinical significance of ST depression suggestive for myocardial ischemia during exercise stress testing in athletes and to determine the prevalence of CAD and/or CCAs. Methods Sixty-five consecutive athletes showing electrocardiographic findings positive or equivocal for myocardial ischemia on exercise stress testing during pre-participation screening were investigated with CCTA. Results Among the 65 athletes investigated, 36 showed Myocardial Bridge (MB), one showed an anomalous coronary origin and seven showed CAD. Among 36 athletes with MB, 4 were associated with mild coronary artery stenosis. Three athletes with CAD needed percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. Conclusions In competitive athletes even with excellent workload capacities, in absence of cardiomyopathy, the presence of ischemic electrocardiographic abnormalities could be mainly determined by a coronary congenital or acquired pathology. In this population CCTA is a useful imaging modality of choice for the risk stratification and for the diagnostic process, to allow eligible athletes to compete and to follow-up subjects requiring medical surveillance.

The healing of a muscle injury is a complex and dynamic process characterized by different overlapping phases resulting in the restoration of the anatomic continuity and function. This process, triggered by the tissue injury itself, is modulated by different growth factors capable of directing the recruitment, duplication, activation, and differentiation of different cell types. This key role played by different growth factors is the basis of the use of platelet-rich plasma in several circumstances, all of them characterized by the need of activating or ameliorating the process of tissue repair. There is an extensive documentation of in vitro and in vivo studies demonstrating the safety and efficacy of growth factors in the muscle healing process. Unfortunately, for many different reasons, experimental results are usually difficult to interpret, clinical results are controversial, and the relevance of use is still debatable. The present article aims to review the available scientific literature with particular focus on actual clinical applications.

BACKGROUND The aim of this intervention study was to determine the effects of a new experimental cervical pillow, on symptomatic adults affected by chronic mechanical neck pain. METHODS Twelve recreational athletes of both sexes (mean age 40.5 years; range 35-55), affected by grade II chronic mechanical neck pain, were evaluated with a daily diary type of self-report questionnaire, which incorporated an 11-point Numerical Rating Pain Scale, to collect the primary outcome measures of pre- and post-sleep neck pain and with the Neck Pain Disability Scale. Tympanic temperature, heart rate (HR) variability continuous monitoring during sleep, overnight pillow comfort and sleep quality were assessed. RESULTS Average weekly scores in overall questionnaires, tympanic temperature and the HR low frequency (LF) / high frequency (HF) ratio were significantly lower (P

The aim of the study was to determine which kind of physical activity could be useful to inmate populations to improve their health status and fitness levels. A repeated measure design was used to evaluate the effects of two different training protocols on subjects in a state of detention, tested pre- and post-experimental protocol.Seventy-five male subjects were enrolled in the studyand randomly allocated to three groups: the cardiovascular plus resistance training protocol group (CRT) (n = 25; mean age 30.9 ± 8.9 years),the high-intensity strength training protocol group (HIST) (n = 25; mean age 33.9 ± 6.8 years), and a control group (C) (n = 25; mean age 32.9 ± 8.9 years) receiving no treatment. All subjects underwent a clinical assessmentandfitness tests. MANOVA revealed significant multivariate effects on group (p < 0.01) and group-training interaction (p < 0.05). CRT protocol resulted the most effective protocol to reach the best outcome in fitness tests. Both CRT and HIST protocols produced significant gains in the functional capacity (cardio-respiratory capacity and cardiovascular disease risk decrease) of incarcerated males. The significant gains obtained in functional capacity reflect the great potential of supervised exercise interventions for improving the health status of incarcerated people.

The aim of the study was to investigate the prevalence and the incidence of ocular complications in contact sport disciplines in a large population of professional and amateur athletes over a period of 3 years.We performed a retrospective review of 694 medical records from athletes examinated from 2008 to 2011. The following data were collected during the routine visit for agonistic sports eligibility: medical history, age, weight, years of sport practice, approximate number of matches, head and eyes injuries during and beyond of the match and a through ocular history. All athletes underwent a detailed ophthalmological evaluation. The follow-up of each athlete was carried out during the following routine visit for agonistic sports eligibility.Most common disorders observed were: peripheral retinal degeneration, blepharitis, conjunctival and corneal diseases with a prevalence of 7%, 4%, 7% and 4% respectively. It was observed a positive correlation between peripheral retinal degeneration and age in amateur male boxers. Moreover, we noticed an incidence of 6% of laser therapeutic treatments as a result of retinal holes or degenerations, during the follow-up.Contact sport disciplines did not result in higher prevalence of severe ocular lesion. Both conjuntival diseases and peripheral retinal degenerations represented the ophthalmologic disorders with the higher prevalence in our sample. In particular, peripheral retinal degeneration is remarkable because of the increased risk of retinal detachment. Dyschromatopsie, even if quite rare, should be considered when analysing the reception of shots, since gloves in most cases are either red or blue.

Whole-body vibration (WBV) has been shown to enhance muscle activity via reflex pathways, thus having the potential to contrast muscle weakness in individuals with rupture of the anterior cruciate ligament (ACL). The present study aimed to compare the magnitude of neuromuscular activation during WBV over a frequency spectrum from 20 to 45 Hz between ACL-deficient and healthy individuals. Fifteen males aged 28±4 with ACL rupture and 15 age-matched healthy males were recruited. Root mean square (RMS) of the surface electromyogram from the vastus lateralis in both limbs was computed during WBV in a static half-squat position at 20, 25, 30, 35, 40 and 45 Hz, and normalized to the RMS while maintaining the half-squat position without vibration. The RMS of the vastus lateralis in the ACL-deficient limb was significantly greater than in the contralateral limb at 25, 30, 35 and 40 Hz (P

There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale(,) test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F1.19=9.420; p

Talent identification plans are designed to select young athletes with the ability to achieve future success in sports. The aim of the study was to verify the predictive value of coordination and precision in skill acquisition during motor learning, as indicators of talent. One hundred gymnasts, both cadets (aged 11.5 ± 0.5 yr.) and juniors (aged 13.3 ± 0.5 years), competing at the national level, were enrolled in the study. The assessment of motor coordination involved three tests of the validated Hirtz's battery (1985), and motor skill learning involved four technical tests, specific of rhythmic gymnastics. All the tests were correlated with ranking and performance scores reached by each gymnast in the 2011, 2012, and 2013 National Championships. Coordination tests were significantly correlated to 2013 Championships scores (p0.01) and ranking (p0.05) of elite cadet athletes. Precision, in skill acquisition test results, was positively and significantly associated with scores in 2013 (adj. R(2) = 0.26, p0.01). Gymnasts with the best results in coordination and motor learning tests went on to achieve better competition results in three- year time. Key pointsIn talent identification and selection procedures it is better to include the evaluation of coordination and motor learning ability.Motor learning assessment concerns performance improvement and the ability to develop it, rather than evaluating the athlete's current performance.In this manner talent identification processes should be focused on the future performance capabilities of athletes.

Rhabdomyolysis is a rare but potentially life-threatening disorder. The long list of known risk factors includes trauma, drug intoxication, alcoholism, hyperpyrexia, vascular occlusion, infections, electrolyte imbalances, heat intolerance, seizures, severe exertion, and substance abuse. Exercise-induced muscle damage is commonly experienced after physical activity, and different studies showed that the amount of protein consumed seems to affect its magnitude. In this regard, some concern has been raised about vegetarian athletes. We present a case of rhabdomyolysis that occurred in a young athlete following a poorly planned vegetarian diet. The athlete experienced progressive weakness and intermittent muscle aches particularly in the legs, malaise, episodic tachycardia, and nausea. Serum creatine kinase was markedly elevated (9952 units/liter), and a mild alteration of transaminase values was observed. The patient was hydrated intravenously and recovered fully within 5 days. The controlled introduction of a planned amount of protein in the diet allowed the athlete to carry on with his sporting activity fully without any further muscle problems. Physical exercise mainly engages the muscular system, and a balanced diet is essential to ensure the energy demands and the anabolic response. A vegetarian diet per se is not associated with detrimental effects in athletes, but an optimal protein intake should be achieved through careful planning with an emphasis on protein-rich plant foods.

Objective: Regular physical activity is associated with a reduction of cardiovascular morbidity and mortality; however, evidence of unfortunate cardiovascular events accompanying elite sport involvement continues to accumulate. To date, no information is available on possible peculiarities of the cardiovascular risk profile in athletes. Design: The aim of this study was to evaluate plasma homocysteine levels in a group of athletes and to search for relationship with vitamin status and other metabolic variables in order to confirm the existence of a “sport-related hyperhomocysteinaemia” and to explain its clinical significance. The study population was composed of 82 athletes (59 male and 23 female) practising different sports and 70 healthy age-matched subjects (40 male and 30 female) as a control group. Besides the general clinical and analytical determinations, the assessed variables included homocysteine, folate, vitamin B12, total and high-density lipoprotein (HDL) cholesterol, lactate dehydrogenase (LDH), creatine kinase (CPK) and interleukin-6 (IL-6). Results: The prevalence of hyperhomocysteinaemia (>15 μmol/l) in athletes and controls was 47% and 15%, respectively. No correlation was found between homocysteine and any of the other investigated variables, in particular plasma folate, blood pressure, LDH, CPK, total and HDL cholesterol and IL-6. Conclusion: The results of this study confirm the existence of a sport-related hyperhomocysteinaemia which appears linked neither to the same variables found in the general population, nor to specific training-related variables. We suggest that it would represent an adaptation to training but the possibility of a secondary vascular damage cannot be excluded.

This randomized controlled study was designed to investigate the short-term effects of an 8-wk whole-body vibration protocol on muscle performance and flexibility in female competitive athletes.Twenty-six young volunteer female athletes (ages 21-27 yrs) were randomized to either the vibration group or control group. The vibration intervention consisted of an 8-wk whole-body vibration 3 times a week employed by standing on a vertical vibration platform. As outcome measures, three performance tests (counter-movement jump, extension strength of lower extremities with an isokinetic horizontal leg press, and a sit-and-reach test for flexibility) were performed initially and after 8 wks.A total of 24 athletes completed the study properly. In the vibration group (n = 13) whole-body vibration induced significant improvement of bilateral knee extensor strength (P0.001), counter-movements jump (P0.001), and flexibility (P0.001) after 8 wks of training. No significant changes were found for all the outcome measures for the control group (n = 11).Whole-body vibration is a suitable training method to improve knee extension maximal strength, counter-movement jump, and flexibility in a young female athlete if it is properly designed. Not only do the optimal frequency, amplitude, and g-forces need to be identified but also the level of muscle activation that would benefit more from vibration stimulation. The improvement of flexibility is important not only for performance but also for the prevention of muscle-tendon injury.

Background: The effectiveness of cardiovascular screening in minimising the risk of athletic field deaths in master athletes is not known. Objective: To evaluate the prevalence and clinical significance of ST segment depression during a stress test in asymptomatic apparently healthy elderly athletes. Methods: A total of 113 male subjects aged over 60 were studied (79 trained and 34 sedentary); 88 of them (62 trained and 26 sedentary) were followed up for four years (mean 2.16 years for athletes, 1.26 years for sedentary subjects), with a resting 12 lead electrocardiogram (ECG), symptom limited exercise ECG on a cycle ergometer, echocardiography, and 24 hour ECG Holter monitoring. Results: A significant ST segment depression at peak exercise was detected in one athlete at the first evaluation. A further case was seen during the follow up period in a previously "negative" athlete. Both were asymptomatic, and single photon emission tomography and/or stress echocardiography were negative for myocardial ischaemia. The athletes remained symptom-free during the period of the study. One athlete died during the follow up for coronary artery disease: he showed polymorphous ventricular tachycardia during both the exercise test and Holter monitoring, but no significant ST segment depression. Conclusions: The finding of false positive ST segment depression in elderly athletes, although still not fully understood, may be related to the physiological cardiac remodelling induced by regular training. Thus athletes with exercise induced ST segment depression, with no associated symptoms and/or complex ventricular arrhythmias, and no adverse findings at second level cardiological testing, should be considered free from coronary disease and safe to continue athletic training.

Preparticipation screening may prevent sudden cardiac deaths in sporting events The American Board of Medical Specialties lists sports medicine as a broad area of health care that includes: 1. exercise as an essential component of health care throughout life; 2. medical management and supervision of recreational and competitive athletes and others who exercise on a regular basis; 3. exercise for prevention and treatment of disease and injury. It combines disciplines from applied physiology to those encompassing clinical, therapeutic, and rehabilitative topics. The preventive aspects of sports medicine are coming of age. Sport is a vehicle for wellbeing and prevention and treatment of diseases, although it can sometimes also represent a risk to health in cases of unacknowledged or asymptomatic pathologies, the most dramatic resulting in sudden cardiac death (SCD) which occasionally strikes apparently healthy athletes.1,2 SCD is a most tragic event, stirring public opinion and commanding a high profile. It is rare, and identifying athletes at risk is a daunting problem. By considering the epidemiology of SCD in athletes and using preparticipation screening (PPS),3–5 as well as estimating the efficacy of instrumental investigations, adequate prevention can be implemented. Compared with the risk of sudden death in general, the incidence of sports related SCD is low—about 1 event per 100 000 adult athletes per year. The risk increases with age and is more common in men. There are striking geographical differences. In North America, hypertrophic cardiomyopathy (HCM) is the leading cause of SCD in athletes. In Italy, the most common cause is right ventricular cardiomyopathy. In Germany, there is a high proportion of myocarditis. In China, a major cause is Marfan syndrome. In athletes younger than 35, the most common cause is almost invariably severe coronary artery disease. A primary goal for prevention should be to identify cardiac pathology …