Search

Background There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France. Methods Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach. Results In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €. Conclusion Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.

International audience; PURPOSE: This study aimed at assessing the prevalence of adverse cardiac events, as identified in the media, in world-class athletes according to their sex and sports discipline. METHODS: All female and male’ athletes, from 30 individual Olympic sports, ranked in the international yearly top 10 between 2006-2018, were included. The name of each of them was associated in a Google search with selected key terms related to heart disease and/or acute cardiac events after their inclusion date. Global and sex-specific adverse cardiac event hazard function λ were calculated for each sport. Global and sex-specific prevalence of cardiac events were calculated, then compared (Fisher’s exact test) between all sports. RESULTS: From the 2471 athletes included, 15 cases of cardiac events (prevalence 0.61%) were reported; 2 sudden cardiac deaths (0.08%) occurred in male athletes. The other events were related to arrhythmic events (n = 13), mainly supra-ventricular arrhythmias (n = 9). All surviving athletes were able to continue their career, mostly after ablation procedure. Male endurance athletes accounted for 7 events among which 3 events occurred among short-distance triathletes. Events among women were comparatively rare (n = 4), and all were observed among short-distance triathletes. CONCLUSIONS: A relatively unexpected high prevalence of cardiac events in endurance elite athletes, was observed as compared to other sports, mainly in short-distance male and female triathletes. This raises the question of particular cardiovascular constraints in this discipline, and underlines the urge of international longitudinal follow-up studies in these kinds of athletes.

Points essentiels Le systeme immunitaire a des connexions fonctionnelles majeures avec l’axe hypothalamo-hypophyso-surrenalien et avec le tube digestif et son microbiote. L’exercice physique aigu perturbe transitoirement, plus ou moins selon ses caracteristiques, l’equilibre du systeme immunitaire. L’entrainement physique, caracterise par une repetition structuree des exercices physiques, avec un rapport effort/recuperation equilibre comme dans le cadre d’une activite physique moderee en intensite et en duree et reguliere, a raison de 3 a 4 seances par semaine, renforce le systeme immunitaire. Un entrainement physique trop intense, inadapte aux capacites individuelles, et/ou avec un rapport effort/recuperation desequilibre, surtout s’il est associe a d’autres contraintes externes et/ou alimentaires importantes, peut affaiblir le systeme immunitaire.

L’activité physique adaptée (APA) se définit comme une activité physique ou sportive adaptée aux capacités de personnes à besoins spécifiques : atteintes de maladies chroniques, vieillissantes, en situation de handicap ou vulnérables. Elle mobilise des connaissances scientifiques pluridisciplinaires pour évaluer les ressources et les besoins des individus et concevoir avec eux des dispositifs et des projets d’intervention sportifs ou artistiques adaptées à des fins de prévention, de réadaptation, d’inclusion, d’éducation ou de participation sociale. Au-delà de l’accessibilité de la pratique, elle cherche surtout à créer les conditions du développement d’un projet personnel d’activité physique durable, qui s’intègre au parcours de vie des individus. Sollicitée par le ministère des Sports, l’Inserm a réalisé une expertise collective faisant le bilan des connaissances scientifiques sur l’APA, afin d’analyser, dans le cadre des maladies chroniques, son impact et sa place dans le parcours de soin. S’appuyant sur les résultats de cette expertise collective, ce nouveau numéro de Question de Santé Publique présente le cas du diabète de type II et de la dépression. Face au vieillissement de la population, l’APA est aujourd’hui devenue un nouvel enjeu de santé publique dont les conditions politiques, sociales, organisationnelles et professionnelles de son émergence restent à définir, ainsi que les caractéristiques des programmes d’activité les plus efficients. Pour le diabète de type II et la dépression, comme pour les autres pathologies chroniques, les bénéfices des programmes d’APA sont bien supérieurs aux risques, lorsque les conseils et les recommandations de pratiques sont respectées et que celles-ci sont personnalisées en fonction des caractéristiques individuelles et du contexte de vie de chaque patient.

Cardiac screening of the athlete: pro? Moderate and regular sports practice is beneficial for health. Cardiac events related to sport are rare. In France, a preparticipation evaluation is legally recommended serious. Cardiac evaluation must at least combine clinical exam and resting ECG. The other exam and particularly stress test should be targeted according to the applicant's age, symptoms, sports practice and cardiovascular risk. All in all, if a preparticipation evaluation is legally required, cardiovascular screening is essential and its content must be individually targeted.Screening cardiaque du sportif : pour ! Une activité sportive modérée et régulière qui est bénéfique doit toujours être encouragée. Les accidents cardiovasculaires lors de sa pratique sont rares mais potentiellement graves. En France, une visite de non-contre-indication à la pratique sportive est légalement recommandée pour les adultes licenciés et les compétiteurs non licenciés. Le bilan cardiovasculaire de base doit associer examen clinique et électrocardiogramme de repos. Les autres examens, et en particulier l’épreuve d’effort, doivent être ciblés en fonction de l’âge, des symptômes, de la pratique sportive et du risque cardiovasculaire du demandeur. Au total, si une visite de non-contre-indication est légalement imposée, un screening cardiovasculaire est indispensable, et son contenu doit être ciblé individuellement.

Background Cardiac rehabilitation (CR) is the right place to optimize the medical treatment in coronary artery disease (CAD) patients. Aims To report the medical management in CAD patients during CR and evaluate the consequences. Methods CAD patients who attended a CR program within less than three months of an acute coronary syndrome (ACS), a percutaneous coronary intervention (PCI), or a coronary artery bypass graft (CABG) were included in a prospective multicenter study. Medical treatments were analyzed at the beginning and at discharge of the CR stay. Results of exercise tests were compared between 4 groups. G1: unchanged medication, n=443, G2: beta-blockers or bradycardic agents adaptation n=199, G3: renin-angiotensin system (RAS) inhibitors adaptation, n=194, G4: both medications adaptation, n=164. Results One thousand consecutive patients were included in 23 French CR centers (85.3% males; mean age 59.9 ± 11 years). The index event was ACS (68.5%), PCI (62.6%) and CABG (36.3%). During CR, we noted an adaptation for beta-blockers in 32.1%, in other bradycardic agents (ivabradine, verapamil, diltiazem, amiodarone) in 9.5%, and in RAS inhibitors in 36.3%. Patients of group 1 had an initial resting heart rate lower than in group 2 and 4, but at the final exercise testing, the range of the decrease was more important in group 2 and 4. The combination of physical training and therapeutic modifications resulted in similar exercise capacities in the four groups, from 5.2, 5.3, 5.4 and 5.2 MET (p=0.68), to 6.3, 6.5, 6.5 and 6.1 MET (p=0.44), respectively. Conclusion The METRO study showed that significant alteration in medical treatment during cardiac rehabilitation programs could take part in improving physical capacity.

Points essentiels Les effets benefiques de la pratique sportive sur la maladie asthmatique sont formellement prouves. La pratique sportive tres/trop intense dans certains sports favorise la survenue d’une hyperreactivite bronchique a l’effort qui peut etre sportivement penalisante. La pratique intense de l’endurance associee a des periodes hyperventilations marquees prolongees et repetees favorisent l’hyperreactivite bronchique a l’effort (HRBE). Le diagnostic d’HRBE doit etre confirme par une spirometrie (boucle debit-volume) toujours associee a un test de reversibilite et selon le resultat a un test de provocation bronchique. Le traitement associe une adaptation de la pratique sportive et un traitement medicamenteux reposant sur les beta-2-mimetiques de courte duree d’action et parfois les antileucotrienes en association avec un corticoide inhale. La plupart des beta-2 agonistes sont interdits en competition (reglement anti-dopage). L’inclusion de l’HRBE dans la liste des maladies professionnelles a ete proposee pour certains sportifs.

International audience

Summary Aims Cardiovascular events occurring during physical activity are becoming a public health problem. Besides medical exams screening for cardiac abnormalities, better prevention could make such accidents less frequent. This study assessed the lack of awareness of cardiovascular risk factors and behaviors in the general sporting population. Methods A survey was conducted by questionnaire in 3590 regular sports practitioners in 6 sport medicine centers. Results Among the 3590 practitioners, mean age was 30.7 ± 16 years, 71% were men, 9.5% were smokers, 5.5% had hypercholesterolemia, 4.4% had high blood pressure and 0.9% were diabetics. In subjects 40 years old, only 54% had undergone a pre-participation exercise test. Among the entire sample, 17% were not aware of the danger of smoking before and just after exercising, and 67%, 47% and 32% did not know the risks of training with fever, exercising in low or high temperature, respectively. The risks of doping, lack of warm-up or proper hydration were unknown to 22%, 2% and 3%, respectively. Finally, the need to report palpitation, dizziness and chest pain related to exercise was unknown to 18%, 7% and 11%, respectively. Recreational athletes had a higher correct response rate than competitive ones, especially those training Conclusion The lack of awareness about cardiovascular events remains significant among sports practitioners. Better education about such risks seems necessary to reduce the rate of accidents in the future.

We performed a prospective cohort study of 311 outpatients with non-severe COVID-19 (187 women, median age 39 years). Of the 214 (68.8%) who completed the 6-week follow-up questionnaire, 115 (53.7%) had recovered. Others mostly reported dyspnea (n = 86, 40.2%), weight loss (n = 83, 38.8%), sleep disorders (n = 68, 31.8%), and anxiety (n = 56, 26.2%). Of those who developed ageusia and anosmia, these symptoms were still present at week 6 in, respectively, 11/111 (9.9%) and 19/114 (16.7%). Chest CT scan and lung function tests found no explanation in the most disabled patients (n = 23). This study confirms the high prevalence of persistent symptoms after non-severe COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-021-04261-y.

This article provides an overview of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology on sports participation in individuals with valvular heart disease (VHD). The aim of these recommendations is to encourage regular physical activity including sports participation, with reasonable precaution to ensure a high level of safety for all affected individuals. Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is an increasing group of younger individuals with valvular defects. The diagnosis of cardiac disorders during routine cardiac examination often raises questions about on-going participation in competitive sport with a high dynamic or static component and the level of permissible physical effort during recreational exercise. Although the natural history of several valvular diseases has been reported in the general population, little is known about the potential influence of chronic intensive physical activity on valve function, left ventricular remodelling pulmonary artery pressure, and risk of arrhythmia. Due to the sparsity of data on the effects of exercise on VHD, the present document is largely based on clinical experience and expert opinion.

International audience; The value of echocardiography in the screening of athletes in addition to the electrocardiogram is debated and still unclear. 336 rugby players in French professional divisions (Top 14, Pro D2) were prospectively assessed with electrocardiogram and echocardiography. 75% were Caucasian, 16.4% Pacific Islanders, and 8.6% Afro-Caribbean. Six (1.8%) players had electrocardiogram abnormalities, exclusively negative T waves. Twenty-one (6.25%) of them had abnormal echocardiography findings: one possible early hypertrophic cardiomyopathy, one anomalous origin of coronary artery, two left ventricular dilatations, one isolated bicuspid aortic valve, two aortic regurgitations, and 14 ascending aortic dilatations. The median aortic diameter was modestly correlated with age: 32 mm [23-48] in players aged ≤25 years vs 33.5 mm [24-50] in those aged >25 years (P = 0.02, correlation coefficient -.01). This tendency increased with cumulative hours of weight training: 34 mm [24-50] in forwards vs 32 mm [25-44] in backs (P = 0.01); and ethnicity, with Pacific Islanders having higher values in both raw data and body surface area or height-indexed data than Afro-Caribbeans and Caucasians: 34 [25-50] vs 32 [27-48] and 33 [23-49] mm (P = 0.017); 15 [12.2-21] vs 14.8 [11-19.9] and 14.8 [10-20.9] mm/m(2) (P

BackgroundHeart rate (HR) and HR variability (HRV) indices are established tools to detect abnormal recovery status in athletes. A low HR and vagally mediated HRV index change between supine and standing positions reflected a maladaptive training stress-recovery status.ObjectivesOur study was focused on a female multistage cycling event. Its overall aim was twofold: (1) quantify the correlation between (a) the change in HR and HRV indices during an active orthostatic test and (b) subjective/objective fatigue, physical load, and training level indicators; and (2) formulate a model predicting the stress-recovery status as indexed by Δ⁢R⁢R¯ and ΔLnRMSSD (defined as the difference between standing and supine mean RR intervals and LnRMSSD, respectively), based on subjective/objective fatigue indicators, physical load, and training levels.MethodsTen female cyclists traveled the route of the 2017 Tour de France, comprising 21 stages of 200 km on average. From 4 days before the beginning of the event itself, and until 1 day after its completion, every morning, each cyclist was subjected to HR and HRV measurements, first at rest in a supine position and then in a standing position. The correlation between HR and HRV indices and subjective/objective fatigue, physical load, and training level indicators was then computed. Finally, several multivariable linear models were tested to analyze the relationships between HR and HRV indices, fatigue, workload, and training level indicators.ResultsHR changes appeared as a reliable indicator of stress-recovery status. Fatigue, training level, and Δ⁢R⁢R¯ displayed a linear relationship. Among a large number of linear models tested, the best one to predict stress-recovery status was the following: Δ⁢R⁢R¯=1,249.37+12.32V̇O2max + 0.36 km⋅week–1−8.83 HRmax−5.8 RPE−28.41 perceived fatigue with an adjusted R2 = 0.322.ConclusionThe proposed model can help to directly assess the adaptation status of an athlete from RR measurements and thus to anticipate a decrease in performance due to fatigue, particularly during a multistage endurance event.

According to recent epidemiologic studies, myocarditis represents one of the major causes of sudden cardiac death among young competitive athletes. Myocarditis can be caused by infectious agents (with viral myocarditis being the leading cause), systemic auto-immune diseases, medical drugs and toxic agents. Since myocarditis is an acquired disease, systematic screening programs will fail to depict this disease. Nevertheless, an adapted prevention can decrease its incidence in athletes. Information on not to train in case of infection and systemic symptoms and on the potential adverse effects of doping agents and recreational drugs is essential for the prevention of myocarditis in athletes. The diagnosis of myocarditis is challenging, due to the heterogeneity of its clinical presentation. Cardiovascular symptoms, ECG and echocardiographic changes, as well as elevation of troponin are rather unspecific. If these first line examinations are suggestive, cardiac MRI should be performed, and the diagnosis should be based on the Lake Louise Consensus criteria. Endomyocardial biopsy, the gold standard for diagnosis, should be limited to recent-onset, high-risk major clinical syndromes not responding to conventional medical therapy. In case of myocarditis, the treatment is essentially symptomatic and based on the management of arrhythmic and heart failure complications. Sport restriction is of course warranted in order to prevent potential lethal arrhythmias and to decrease the risk of negative ventricular remodelling. Athletes with a diagnosis of myocarditis should be restricted from exercise programs for a period of 3–6 months. Asymptomatic patients might be able to resume training and competition if serum markers of myocardial injury, inflammation, and heart failure have normalized, if ventricular systolic function has returned to the normal range, and if no significant arrhythmia occurs on a 24-h ECG monitoring and during an exercise test.

The benefits of regular physical activity whether in primary- or secondary prevention of cardiovascular disease are now irrefutable. Despite its well proven benefits, exercise training remains underused because of lack of insight and familiarity of the majority of cardiologists. This review offers cardiologists the necessary informations about the pathophysiological mechanisms, effects and limitations of the predominantly used training methods in various kardiovascular diseases.