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This paper propose five tennis-specific tests performed on hardcourt to analyze coordination of lower limbs and laterality. Times to complete one 20 meters linear sprint and four 4 x 5 meters shuttle sprints (180° change of direction) in: a) open stance, b) neutral stance, c) forehand and d) backhand, were recorded in 342 youth tennis players aged 11-16 yrs. Differences between times in the 20 meters and 4 x 5 meters sprints in open stance greater than 3.13 and 2.91 seconds denote inadequate on-court displacement capacity of females and males respectively. The difference between open and neutral shuttle sprints assess the on-court coordination capacities of lower limbs with expected optimal result below 0.43 and 0.39 seconds for females and males respectively. The difference between forehand and backhand shuttle sprints should tend towards zero seconds in symmetric players indicating the capacity to move in the court with the same acceleration/deceleration capabilities regardless laterality. These tests can be proposed at any age as they give an idea of the coordination capacities of lower limbs and laterality related to specific tennis movements. The earlier age assessment may serve to address any coordination/laterality deficits sooner versus later.

Outcomes following long-term injuries such as anterior cruciate ligament rupture are unsatisfactory. To improve outcomes, we must improve rehabilitation practices. One aspect of the return-to-sport process that has received limited attention is on-field rehabilitation. This article is part 1 of a 2-part series aimed at discussing the important elements of on-field rehabilitation and illustrating how they can be applied across a 5-stage on-field rehabilitation program following anterior cruciate ligament reconstruction. The intention of on-field rehabilitation is to support athletes in their transition back to sport after injury, from standard rehabilitation to return to the team or practice. In part 1, we describe 4 pillars of high-quality on-field rehabilitation: (1) restoring movement quality, (2) physical conditioning, (3) restoring sport-specific skills, and (4) progressively developing chronic training load. In part 2, we describe how these pillars may be combined into a 5-stage on-field rehabilitation program to help athletes transition to team practice and match play following anterior cruciate ligament reconstruction.

BACKGROUND Muscle weakness, incorrect body water distribution and reduced exercise tolerance are the main characteristics found in renal transplant recipients after surgical treatment. Regular physical supervised exercise programs, at moderate intensity, have been promoted to contrast these aspects, while few data are available for long-term unsupervised mixed exercise plans. Bioelectrical impedance vector analysis (BIVA) provides a semi-quantitative evaluation of body cell mass and body water. This study aims to approach the role of the BIVA analysis in the follow-up of Renal Transplant Group (RTG) and analyze the impact of unsupervised exercise program. METHODS Thirteen male RTG and ten healthy subjects, adherent to a tailored exercise program, at moderate intensity and prescribed in an unsupervised way, have been followed up for one year. Every six months all the subjects have been submitted to the ergometric test, echocardiographic exam and an analysis of body composition by bioimpedance. They were compared to a healthy control group (HG). RESULTS A significant reduction of the BMI was observed at the end of the study in the RTG group (T0 24.8±3.2, T12 24.2±3.2 kg/m2; P

Background: Despite the benefits of physical activity on cardiovascular risk in kidney transplant recipients (KTRs), the long-term effects of exercise have been poorly investigated. This is a three-year observational study comparing graft function and cardiovascular risk factors in active KTRs (AKTRs) vs. sedentary KTRs (SKTRs). Methods: KTRs with stable renal function were assigned to active or sedentary group in relation to the level of daily physical activity based on World Health Organization (WHO) recommendations (&lt, 150 or &gt, 150 minutes/week, respectively). Complete blood count, renal function indices, lipid profile, blood pressure and anthropometric measures were collected yearly for an observation period of three years. The comparisons between the two groups were performed by repeated measures analyses of covariance (ANCOVAs), with age as a covariate. Results: Fifty-four subjects were included in the study. Thirty of them were identified as AKTRs (M/F 26/4, aged 45 &plusmn, 12 years) and 24 as SKTRs (M/F 18/6, aged 51 &plusmn, 14 years). Baseline characteristics were similar between the groups except body mass index (BMI) that was significantly higher in SKTRs (p = 0.043). Furthermore, over the three-year observation period, BMI decreased in AKTRs and increased in SKTRs (p = 0.006). Graft function was stable in AKTRs, while it showed a decline over time in SKTRs, as indicated by the rise in serum creatinine levels (p = 0.006) and lower eGFR (p = 0.050). Proteinuria, glucose and uric acid levels displayed a decrease in AKTRs and an increase in SKTRs during the three-year period (p = 0.015, p = 0.004 and p = 0.013, respectively). Finally, concerning lipid profiles, AKTRs had a significant reduction over time of triglycerides levels, which conversely showed a clinically relevant increase in SKTRs (p = 0.014). Conclusions: Our findings indicate that regular weekly exercise training may counteract the increased cardiovascular risks and also prevent graft function decline in KTRs.

Introduction The few epidemiologic studies published previously about different forms of mountain running (ie, fell running, sky running, and ultratrail running) have not reported on fatal events. This report aims to contribute to the literature on mountain running fatalities, recording and classifying fatal events related to mountain running competitions found in online literature searches over a 12-y period. Methods From 2008 to 2019, searches on mountain sport, mountain races, and newspaper websites were periodically performed, looking for fatal events related to running competitions in the mountains. Data are presented as mean±SD or percentage, as appropriate. Results Fifty-one fatal events, involving 45 men (88%) and 6 women (12%), aged 50±11 and 46±6 y, respectively, were recorded in the 2008 to 2019 period in Western Europe. These events occurred during races (n=35; 69%), during training (n=13; 25%), and after races (n=3; 6%); 43% were sudden cardiac death, 32% due to falls (blunt trauma), 16% due to hypothermia, 4% due to both blunt trauma and hypothermia, 4% due to lightning strike injuries, and 2% due to animal attack (injuries from deer). Conclusions Understanding all of the causes of fatal events is necessary to institute preventative efforts and to organize rescues. Preventative efforts should be implemented by race organizers and by athletes themselves, and rescue teams can be trained and equipped to address all of these possible events. The relatively high percentage of sudden cardiac deaths stresses the need for preparticipation cardiovascular screenings. Further longitudinal studies are necessary to better understand the real impact of fatal events on the mountain running population.

This paper is part 2 of a 2-part series aimed at discussing the key elements of on-field rehabilitation training. In part 1, we described 4 pillars underpinning high-quality on-field rehabilitation: (1) restoring movement quality, (2) physical conditioning, (3) restoring sport-specific skills, and (4) progressively developing chronic training load. In part 2, we describe how the pillars contribute to a 5-stage on-field rehabilitation program to help injured players transition to team practice and match play. We use the example of a soccer player with ambitions to return to sport after anterior cruciate ligament reconstruction. The program moves through 5 field-based training stages: (1) linear movement, (2) multidirectional movement, (3) soccer-specific technical skills, (4) soccer-specific movement, and (5) practice simulation. The staged program is research based and facilitates communication, planning, control, and safety in return to sport following long-term injury.

Background Following the positive experience of the national project “A transplant...and now it’s time for sport,” the Transplant Reference Center of the Emilia-Romagna Region has pursued the promotion of pre- and post-transplant physical exercise by developing a network. Methods The path involved the transplant centers and operative units (UU.OO) who wanted to target transplant and waiting list patients, who are clinically stable, to perform personalized exercise through a program (supervised or not) prescribed by a specialist in sports medicine. With the collaboration of the Collective Prevention and Public Health Service, the network was established, consisting of the sports medicine centers and the gyms that promote health for adapted physical activity (PS-AMA). To implement the network, training courses for all the professionals involved (doctors, nurses, exercise specialists) and operational meetings in the transplant centers-nephrology units with patients’ associations have been organized. Results To date, there are 14 transplant centers and UU.OO, 9 sports medicine centers, and 45 PS-AMA involved in this network. Seven training courses were organized with the participation of 193 health professionals. Since January 2016, there have been 65 transplanted patients and 5 patients on the waiting list who practice the prescribed exercise. Of these, 45 carry out supervised exercise in PS-AMA; 25 perform autonomous exercise. Each patient is monitored every 6 months. No problems related to the exercise performance were recorded. Conclusions The development of a network of professionals and associations is the key element to raise awareness of physical activity among transplanted and waiting-for-transplant patients, reducing the pathologies associated with a sedentary lifestyle.

Background and aims Despite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients. Methods LT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B). Aerobic capacity, muscle strength, metabolic profile, liver and kidney function, and health-related quality of life were assessed at baseline and after 6 and 12 months. Group A attended supervised training sessions 3 times per week for 12 months. Group B received general recommendations about home-based exercise. Results Forty patients from 6 Italian LT centers were randomized. Twenty-nine (72.5%, men-to-women ratio 23:6, mean age, 52 ± 8 years) LT recipients completed the study. Baseline characteristics were similar between groups except for body mass index and time from LT. No episode of acute rejection nor increase of transaminases occurred. Maximum workload and body mass index increased in both groups over time, but fasting glucose significantly decreased in group A (94.0 ± 15.0 mg/dL vs 90.0 ± 17.0 mg/dL; P = .037) and increased in controls (95.0 ± 24.0 mg/dL vs 102.0 ± 34.0 mg/dL, P = .04). Upper limb muscle strength increased only in supervised LT recipients. Vitality and general and mental health domains significantly improved after physical exercise. Conclusions Supervised combined training was safe and effective in increasing aerobic capacity, muscle strength, and quality of life and in improving glucose metabolism in stable LT recipients.

The traditional functional recovery model and return to sport (RTS) decision-making process after long-term injury is insufficient in the real world of sports medicine. There are lower than ideal numbers of athletes returning to competitions after certain injury types.1 2 Additionally, those who do RTS have heightened risk of reinjury,3 may not return to preinjury performance levels,4 or may be unable to sustain the same level of competitive play in the subsequent years after injury.5 This paper provides an update on the RTS process, reflecting the new literature and knowledge in the area as well as applied practice, to support practitioners working with athletes after injuries and in particular after severe injuries (>28 days).6 A dichotomous conception of functional recovery was common in the past (and often still present) which involved the separation of clinical rehabilitation and RTS. Initially, the patient begins with the medical team before been transferred to the performance team (coaching and fitness staff) for sport-specific training and RTS. There is often little or no overlap in the process, and limited communication and sharing of knowledge during the functional recovery process. When there is a need to prepare the athlete for direct re-entry into sport after injury, it is necessary to consider an overlap of the rehabilitation and RTS processes. This area of overlap …

Objective To investigate the prevalence and outcomes of surgery for lumbar disc herniation in professional football players. Design Retrospective case series. Setting Sports rehabilitation center. Participants A period of 10 seasons of the Italian Football First League (Serie A) was retrospectively investigated. Thirty-three teams (for a total of 1960 players) took turns in the 10 seasons, and 42 team doctors were requested to provide information about the number of players who underwent surgery for lumbar disc herniation. Intervention Survey distributed to team doctors. Main outcome measures Prevalence and match incidence of the lumbar discectomy, proportion of players returning to competition after surgery, recovery time and preintervention and postintervention number of appearances in official matches were analyzed. Results Eleven players underwent the surgical intervention during the considered period. The prevalence of the surgical treatment was 0.6%, whereas the match incidence was 0.09 cases/1000 match hours. All players returned to competitions 6.0 (3.5-7.7) months after surgery, with no significant difference between different roles. The number of appearances in official matches was comparable during the seasons before and after surgery. Conclusions The lumbar discectomy must be considered a rare surgical procedure performed in professional football players. All players returned to competitions after surgery. The postintervention number of appearances in official matches was comparable with the preintervention one.

AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations. METHODS Ninety-nine kidney transplant recipients (KTRs) were assigned to interventional exercise (Group A; n = 52) and a usual care cohort (Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life (HRQoL) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities. RESULTS Eighty-five KTRs completed the study (Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload (+13 W, P = 0.0003), V’O2 peak (+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor (+12 kg, P = 0.0368), height in the countermovement jump (+1.9 cm, P = 0.0293) and decreased in Body Mass Index (-0.5 kg/m2, P = 0.0013). HRQoL significantly improved in physical function (P = 0.0019), physical-role limitations (P = 0.0321) and social functioning scales (P = 0.0346). No improvements were found in Group B. CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.

The aim of the study was to investigate the effects of sport activity on health-related quality of life (HRQoL) of solid organ transplant recipients participating in sports competitions. A group of 168 sportive transplanted patients (STP), a group of 97 nonsportive transplanted patients (NSTP), and a group of 152 sportive healthy controls (SHC) were compared on the eight scales of the SF-36 questionnaire. STP and NSTP reported significantly lower scores than SHC on the physical functioning scale. STP did not differ from SHC in the Role-Physical, General Health, and Vitality scales, while NSTP reported significantly lower scores. STP obtained higher scores than NSTP and SHC on Mental Health. Among STP, the effect of quantity of sport activity was significant on General Health and Role Emotional, with more sport activity associated with higher HRQoL. Organ failure and post-transplant therapies may have negative consequences on HRQoL. Sports activities and participation in sports competitions can reduce this impact, improving general and psychological functioning of solid organ transplant recipients.

This narrative and literature review discusses the relevance of Rate of Force Development (RFD) (the slope of the force time curve) for Return To Sport (RTS), its determinants and the influence of training practices on it expression, with the purpose to enhance clinicians' awareness of how RFD training may enhance RTS success. RFD is considered functionally more relevant than maximal muscle strength during certain very fast actions including rapid joint stabilisation following mechanical perturbation. Deficits in RFD are reported following conventional rehabilitation programmes despite full restoration of maximal strength, which may contribute to the less than satisfactory RTS outcomes reported in the literature. RFD determinants vary as a function of time from force onset with a diminishing role of maximal strength as the time available for force development decreases. Factors such as neural activation, fibre type composition and muscle contractile properties influence RFD also and to a much greater extent during the early periods of rapid force development. Conventional resistance training using moderate loads typical of most rehabilitation programmes is insufficient at restoring or enhancing RFD, thus incorporating periodised resistance training programmes and explosive training techniques in the final stages of rehabilitation prior to RTS is recommended. Level of evidence V.

Running at altitude is gaining greater popularity but it may expose participants to the risk of acute mountain sickness (AMS). The study investigated electroencephalographic (EEG) changes and eventual symptoms suggestive of AMS in 5 well-trained lowland native male runners (average age, 38.2 ? 4.6 years; VO2 peak 61.4 ? 2.7 mL?kg–1?min–1 at sea level; best marathon performance at sea level under 3 hours), who completed a marathon at 4300 m altitude. EEG, percentage of peripheral arterial oxygen saturation (% SpaO2) and heart rate (HR) were recorded during wakefulness at rest (supine position) and in comfort: 1) at sea level; 2) at 3600 m after 32 - 38 hours of acute acclimatization; 3) at 4300 m after 145 - 153 hours of chronic acclimatization; and 4) at 4300 m immediately after a marathon race. Symptoms of AMS were evaluated with the Lake Louise questionnaire before any ECG recording. There was a significant decrease in low-voltage high-frequency activities at rest after acute hypoxic-hypobaric exposure at 3600 m as compared to sea level. After six days of acclimatization at 4300 m there was a significant increase in the power of low-voltage high-frequency activities, particularly beta and gamma, indicating an aroused waking state and an integrated activity across widely distributed cortical regions. An increase in the power of low-voltage high-frequency activities over the entire cortex was observed, particularly after completion of the marathon at 4300 m. The increase in the high-frequency activities was probably due to direct and indirect reflex activation of the forebrain and reticular activating system involved in behavioral and metabolic integration of autonomic control and arousal and due to residual activation of the somatomotor and parietal cortex after the end of the marathon. Lake Louise score always resulted lower than 3, indicating no signs of AMS in all the runners. The results of this study indicate that in well-trained and acclimatized athletes, arousal has a protective role in preventing excessive oxygen deprivation also after an endurance exercise performed at high altitude. The absence of AMS fond in our study bear out that well trained and acclimatized runners, can safely participate in a marathon at high altitude that gives rise to temporary EEG changes without inducing paroxysmal phenomena.

Background Organ transplant recipients frequently have chronic inflammation, with a weighty impact on cardiovascular risk. These patients can benefit from exercise, although the role of intense training is unclear. We evaluated the effect of a 130-km cycling race on inflammatory cytokines and adiponectin levels in transplant recipients. Methods Circulating interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and adiponectin were assayed in 35 healthy subjects vs 19 transplant recipients (10 kidney, 8 liver, 1 heart), matched for sex, age, body mass index, and preparation workout. The determinations were performed before the race, at the end, and after 18 to 24 hours. Baseline values of 32 sedentary transplant recipients also were evaluated to explore the possible chronic impact of lifestyle. Results All cyclists had 6- to 8-fold increased IL-6 levels after the race that decreased, without returning to baseline, the day after. Conversely, serum TNF-α and IFN-γ showed a progressive increase starting during physical performance and enduring for the next 18 to 24 hours in healthy subjects, whereas they were unchanged over time in cyclists with transplants. In transplant recipients who did not perform exercise, all of the analytes were significantly higher in comparison to basal levels of physically active subjects. Conclusions Our data suggest that clinically stable and properly trained transplant recipients can safely perform and progressively benefit from exercise, even at a competitive level. The changes in inflammation parameters were temporary and parallel with those of the healthy subjects. The comparison with sedentary transplant recipients revealed an overall amelioration of inflammatory indexes as a possible effect of regular physical activity on systemic inflammation.

An injury has a multifactorial nature and produces tissue damage, resulting in clinical symptoms and different degrees of immobilization and rest that affects the performance capacity of the athlete as a whole person. Therefore each injury needs to be viewed in the setting of the entire athlete, so functional recovery after injury may be considered a multivariate psycho-biological phenomenon involving the whole injured athlete. The safe return to competitions after injury is a process that must involve the injured athlete as a whole person, where the rehabilitation team must work together to consider the biological, neuro-mechanical, metabolic and psycho-sociological aspects of the rehabilitation, with particular emphasis on the end phases of the functional recovery that must be performed on the field.

Case report.To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery.The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity.The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee.This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises.

Summary We observed athletes performing marathons and ultramarathons in altitude over several years to study the behaviour of haematological parameters in order to screen eventual paraphysiological or pathological conditions (sports anaemia). We collected samples from 124 athletes participating in seven races; 23 athletes were recruited in different races: 16 for four times, four for three times, and three for two times. The pre- and post-race values of erythrocytes, haemoglobin and packed cell volume did not show statistically significant differences in the studied athletes. The erythrocytes’ indices (MCV, MCH, MCHC) and red cell distribution width (RDW) also were not significantly modified by the strenuous effort. The leukocytes were significantly increased because of immunological involvement during the endurance performance. Platelets and relative indices were not significantly modified. The stability of packed cell volume and haemoglobin in athletes performing training and races in altitude is strong evidence for the use of these parameters as an index of general health status and for illustrating possible abnormal increase because of exogenous stimulation of bone marrow. The preanalytical and analytical accuracy is crucial to assure clinical validity of the collected data: we strictly observed international recommendations in this field.

Serum leptin concentrations are reduced in the presence of a negative energy balance. It has been demonstrated, however, that strenuous and prolonged exercise, which induces a marked negative energy balance, is not always followed by a reduction in serum leptin levels. We therefore analysed serum leptin concentrations before and after three endurance races, which differed in duration and energy expenditure (EE), with the aim of clarifying the relationship between the level of EE and the reduction in leptin levels. Forty-five males participated in one of three competitive endurance races, a half-marathon run [21.097 km, estimated EE 1,400 kcal (5,852 kJ)], a ski-alpinism race [about 45 km, estimated EE 5,000 kcal (20,900 kJ)], and an ultramarathon race [100 km, estimated EE 7,000 kcal (29,269 kJ)]. Blood samples for analysis of serum leptin, and plasma free fatty acids (FFA) were collected before and after the races. Pre-race leptin values were significantly correlated with both body mass index and body fat mass ( r=0.672 and r=0.699, respectively; P

Background/Aims: The role of physical activity in transplanted patients is often underestimated. We discuss the Italian National Transplant Centre experience, which started in 2008 studying transplanted patients involved in sports activities. The study was then developed through a model of cooperation between surgeons, sports physicians and exercise specialists. Methods: A multicentre study was realized in 120 transplanted patients of which 60 treated with supervised physical activity (three sessions/week of aerobic and strengthening exercises) and 60 controls. We present the results of the first 26 patients (16 males, 10 females; 47.8±10.0 years; 21 kidney, 5 liver transplanted; time from transplant 2.3±1.4 years) who completed 12 months of supervised physical activity. Results: Data showed an increase of peak aerobic power (t=4.535; PConclusion: These preliminary results confirm the positive effects of supervised physical exercise. It can be considered as an input to promote other detailed exercise protocols.

Most of the difficulties when trying to realize the proposal to prescribe physical activity for transplantation patients come from patient attitudes and cultural beliefs that ignore the benefits of exercise, but there also are organizational aspects arising from the difficulties that these patients face in accessing supervised exercise facilities. To address these difficulties, the Italian study project "Transplant … and Now Sport" was developed based on a model of cooperation among transplantation specialists, sports physicians, and exercise specialists organized as a team combining their specific skills to effectively actuate the physical exercise programs. This preliminary report is based on 26 patients (16 male, 10 female; 47.8±10.0 years old; 21 kidney and 5 liver transplantations; time from transplantation 2.3±1.4 years) who performed prescribed and supervised exercises consisting of 3 sessions per week of aerobic and strengthening exercises for 1 year. Preliminary results show a significant decrease in body mass index (t=1.966; P

Objective. Considering the importance of sport activity for enhancing quality of life, the aim of this study was to investigate the effects of regular sport activity on quality of life of kidney transplant recipients. Methods. Health-related quality of life (HRQoL) was assessed with the use of the SF-36 questionnaire on a group of 118 active kidney transplant patients (AKTPs) practicing different sports at low to moderate intensity (5 4 h/wk). Scores were compared with those of 79 sedentary kidney transplant patients (SKTPs) and with 120 active healthy control subjects (AHCs). Results. AKTPs reported higher scores than SKTPs in the SF-36 scales of Physical Functioning (P < .05), Role Limitations due to Physical Problems (P < .05), General Health (P < .01), Vitality (P < .05), Social Functioning (P < .05), Role Limitations due to Emotional Problems (P < .05), and Mental Health (P < .01). AKTPs obtained higher scores than AHCs on the Mental Health (P < .01) and Social Functioning scales (P < .01) and similar scores (P > .05) on all the other scales. The effect of quantity of sport activity was significant on the General Health (P < .01; h2 ¼ 0.05), and Role Physical scales (P ¼ .04; h2 ¼ 0.03), with higher sport activity associated with higher HRQoL. The effect of sex was significant for Bodily Pain (P ¼ .05; h2 ¼ 0.02), Vitality (P ¼ .08; h2 ¼ 0.06), Social Functioning (P ¼ .08; h2 ¼ 0.05), and Mental Health (P ¼ .05; h2 ¼ 0.02), with male participants scoring higher than female participants. Conclusions. This study indicates that regular sport activity significantly improves different dimensions of HRQoL among kidney transplant recipients. The benefits of sport activity go beyond its impact on physical health to involve psychologic and social components of quality of life. Spontaneous and low to moderate sport activity may play an important role after kidney transplantation that has been largely underestimated in the literature.

No abstract available

Limited information has been published about sporting activities in solid organ transplant recipients. The aim of this study was to assess "in the field" performance capacities of a group of transplant recipients involved in an alpine skiing competition. We studied 16 transplant recipients (13 men and 3 women) who had undergone transplantations (11 kidney, 4 liver, and 1 heart) at 89 +/- 68 months prior while participating in an alpine skiing race. The patients performed a countermovement jumping test to measure the explosive power of the lower limbs. In all patients blood lactate concentrations (La) were measured at the end of a giant slalom race. The maximum displacement of the center of mass during the jumping test was 22.4 +/- 9.3 cm; the time to complete the giant slalom was 75.5 +/- 16.5 seconds and La was 3.5 +/- 0.8 mmol/L. We observed significant linear relationships between race time and La (R(2) = 0.4733; P < .01) and between race time and performance in the jumping test (R(2) = 0.3655; P < .05). This study indicated that recovery of anaerobic and technical sporting activities is possible in organ transplant recipients. Muscular power and anaerobic performances among a selected group of solid organ transplant recipients were similar to those of the general untrained population.

Requests for medical assistance during an amateur road cycling race, which included 56,700 cyclists over 6 consecutive races between 2006 and 2011, were analysed with the aim of improving injury prevention and medical coverage. Medical assistance was requested by a small percentage of participants (1.7 ± 1.0%), but the actual number seeking assistance was quite high due to the large total number of participants (162 ± 51). 0.17% of all participants did not finish the race for medical reasons. No fatal injuries were recorded. The incidence rate of requests for medical assistance was 0.108/1000 km, and the incidence of withdrawal was 0.011/1000 km of the race. Of all medical requests, those due to direct trauma caused by falls accounted for 63%, requests for overload injuries accounted for 4% and requests for non-traumatic complaints accounted for 22% of the total; 11% of requests were not classified. Weather conditions may affect the type and the incidence of requests: requests for traumatic injuries increase if raining; requests for heat-related illnesses if hot. Prevention techniques are aimed at guaranteeing and promoting health and safety and should be implemented by both the race organisers and the cyclists.

Football (soccer) is a highly motivating leisure activity with important potential as a health-promoting activity also for transplant recipients. The aim of this study was to assess the "on the field" energy expenditure during football games and the quality of life of transplant recipients practicing football. Twenty-two recipients of kidney (n = 11), bone marrow (n = 7), liver (n = 3) or corneal (n = 1) transplantations had an overall mean age of 37 ± 9 years, body mass index of 23.5 ± 2.4 kg/m(2), and time after transplantation of 9.3 ± 6.4 years. They were compared with 25 healthy football players of mean age 41 ± 10 years and body mass index of 26.3 ± 3.9 kg/m(2). There were no significant differences between transplant recipients and controls regarding mean energy expenditure (393 ± 113 vs 392 ± 132 kcal/h) number of steps (3.978 ± 1.317 vs 3.933 ± 1.563) during, and capillary blood lactate concentrations (4.8 ± 0.9 vs 5.2 ± 1.3 mmol/L) after the matches. The SF-36 questionnaire administered before the matches showed transplant recipient players to score significantly worse in the scales of general (P < .05) and mental health (P < .01). This study indicated that transplant recipients involved in football matches attained a level of energy expenditure and a quality of life consistent with a healthy lifestyle. Football has the potential to be implemented as a permanent health-promoting activity also for transplant recipients.

Fluctuations in autonomic cardiovascular regulation during exposure to high altitude may increase the risk of heart attack during waking and sleep. This study compared heart rate variability (HVR) and its components during sleep at low altitude and after 30 - 41 hours of acclimatization at high altitude (3480 m) in five mountain marathon runners controlled for diet, drugs, light-dark cycle and jet lag. In comparison to sea level, RR-intervals during sleep at high altitude decreased significantly (P < 0.001). The significant increase in sympathetic autonomic cardiovascular modulation at high altitude protects against excessive oxygen deprivation during sleep. Increases in R-R intervals can require longer periods of acclimatization at 3480 m to mitigate the effects of altitude/hypoxia on sympathetic tone, thus reducing cardiovascular distress at rest during waking and sleep and probably before during and after athletic performance at altitude.

Background: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. Study Design: Case series. Hypothesis: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. Methods: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests. Results: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant ( P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. Conclusions: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Summary Objective Translating, culturally adapting and validating an Italian version of the Knee injury and Osteoarthritis Outcome Score (KOOS-I) to allow its use with Italian-speaking patients with knee complaints. Design The KOOS-I was developed by means of forward–backward translation, a final review by an expert committee, and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included analysis of dimensionality using item-scale correlation after correction for overlap, reliability by means of internal consistency (Cronbach's alpha) and test–retest reliability (Intraclass Correlation Coefficients), and construct validity using an a priori hypothesised Pearson correlations with a Numerical Rating Scale (NRS) and the Short-Form 36 Health Survey (SF-36). Results The questionnaire was administered to 224 subjects with knee injuries and proved to be acceptable. Hypothesised item-to-domain correlations were observed for all of the items. The questionnaire showed good internal consistency (0.782–0.977), and a high level of test–retest reliability (0.850–0.949). Construct validity was supported by the confirmation of the a priori hypothesised correlations. Conclusions The KOOS outcome measure was successfully translated into Italian, and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes in patients with knee injuries.

Cortisol, testosterone, free testosterone and the ratio between free testosterone and cortisol (FTCR) were monitored in six athletes participating in a marathon starting at 3,860 and finishing at 3,400 m, having reached the top at 5,100 m altitude. Blood was drawn at sea level before the departure for the mountain area, after a week of acclimatization, immediately after the marathon and after a 24-hour recovery period from the run. Cortisol increased after acclimatization and especially after the marathon; it decreased to normal values after recovery. Testosterone decreased after acclimatization, especially after the run; it presented a partial recovery 24 h after the race. Free testosterone did not decrease after acclimatization and presented partial recovery. FTCR could also be useful for monitoring fitness, overtraining and overstrain in strenuous and ultraendurance exercise.

A sedentary lifestyle is an important risk factor leading to cardiovascular disease. Cardiovascular disease is particularly frequent in kidney transplant recipients, with a mortality rate of 38%. In this population, besides the classic risk factors (genetics, age, smoking, etc.) and disease-related factors (chronic renal failure, dialysis vintage) there are the side effects of immunosuppressive therapy such as diabetes and metabolic syndrome. Despite the general advice given on an appropriate lifestyle, most transplanted patients lead a sedentary life which may result in overweight. In this study the physiopathological effects of a sedentary lifestyle were analyzed with reference to the recent literature regarding the efficacy of physical activity in transplanted patients. Studies in the general population have demonstrated the beneficial effect of physical activity on the prevention of cardiovascular disease. There are only few studies within the kidney transplant population regarding regular physical activity and these studies were performed with heterogeneous protocols and different observation periods, and are therefore difficult to compare. Overall, positive results in terms of maximal aerobic capacity, muscle strength and perception of well-being have been obtained in the short and medium term (1 year). Further studies are necessary to verify the effect of physical activity on long-term patient and graft survival. In order to enhance physical activity in transplanted patients, local programs in collaboration with sports rehabilitation centers are to be recommended.

Background: A few patients, after receiving solid organ transplantation, return to performing various sports and competitions; however, at present, data no study had evaluated the effects of endurance cycling races on their renal function. Methods: Race times and short form (36) health survey questionnaires of 10 kidney transplant recipients (KTR) and 8 liver transplant recipients (LTR) transplanted recipients involved in a road cycling race (130 km) were compared with 35 healthy control subjects (HCS), also taking laboratory blood and urine tests the day before the race, at the end of the race, and 18 to 24 hours after competing. Results: The 3 groups showed similar race times (KTR, 5 hours 59 minutes ± 0 hours 39 minutes; LTR, 6 hours 20 minutes ± 1 hour 11 minutes; HCS, 5 hours 40 minutes ± 1 hour 28 minutes), similar short form (36) health survey scores, and similar trend of laboratory parameters which returned to baseline after 18 to 24 hours. After the race, there was an increase in creatinine (0.24 mg/dL; effect size [ES] = 0.78; P < 0.001), urea (22 mg/dL; ES = 1.42; P < 0.001), and a decrease of estimated glomerular filtration rate (−17 mL/min; ES = 0.85; P < 0.001). The increase of blood uric acid was more remarkable in HCS and KTR (2.3 mg/dL; ES = 1.39; P < 0.001). The KTR showed an increase of microalbuminuria (167.4 mg/L; ES = 1.20; P < 0.001) and proteinuria (175 mg/mL; ES = 0.97; P < 0.001) similar to LTR (microalbuminuria: 176.0 mg/L; ES = 1.26; P < 0.001; proteinuria: 213 mg/mL; ES = 1.18; P < 0.001), with high individual variability. The HCS had a nonsignificant increase of microalbuminuria (4.4 mg/L; ES = 0.03; P = 0.338) and proteinuria (59 mg/mL; ES = 0.33; P = 0.084). Conclusions: Selected and well-trained KTR and LTR patients can participate to an endurance cycling race showing final race times and temporary modifications of kidney function similar to those of HCS group, despite some differences related to baseline clinical conditions and pharmacological therapies. Patients involved in this study represent the upper limit of performance currently available for transplant recipients and cannot be considered representative of the entire transplanted population.

Oremek and Sieffert (1) suggested that extensive physical activity increases prostate-specific antigen (PSA) concentrations. They demonstrated the increase after a standardized exercise on a cycloergometer for 15 min at 75–100 W in many healthy men with different ages. We performed PSA measurements during various sport performances to establish if strenuous exercise increases the serum PSA in young men. We measured PSA on 30 men with a mean age of 27 years (range 18–45) participating in ultraendurance performances of different sports. Twelve men participated in the Pine 24-h, an ultraendurance nonstop 24-h speed ice skating competition (February …

Although there are various descriptive reports concerning exercise-induced gastrointestinal distress, the role of gastrointestinal hormones and/or enzymes is not definitively established. In this study we investigated the behaviour of pepsinogens (PCI and PGII) after an endurance race performed at an altitude of 4,300 m by 13 well-trained marathon runners, with the aim to establish their interrelationship with gastrointestinal distress and with the modifications of gastrin and cortisol. The athletes showed a significant rise in gastrin (p < 0.01) and in cortisol (p < 0.01) and a significant decrease in PGI (p < 0.01) and PGII (p

Physical activity could modify platelet count and platelet indices. Previous reports showed modifications after exercise linked to type and duration of sports performances. The shortage of studies in this field stems from the crucial methodological problem of EDTA (ethylenediaminetetraacetic acid)-dependent, mean platelet volume modifications: the published data on platelets count and indices were obtained by using a light-scattering system without standardization of the period elapsed from drawing to measurement. We present a study of platelet indices performed in athletes participating in an "extreme" performance, a race of 30 km in altitude (6,700 m of ascents and descents), using standardized measurement by an aperture-impedance instrument transferred in the field. The platelet count and mean platelet volume significantly increased in athletes, whereas platelet distribution width decreased. The mean initial values were 240.6*10(9)/L for platelet count, 8.79 fL for mean platelet volume, and 15.79% for platelet distribution width. The correspondent mean final values were 288.4*10(9)/L, 9.14 fL, and 15.48%. The modifications of platelet count and indices were always in the physiological reference range. The entity and the rapidity of platelet count and indices modifications suggest that the more probable source of variation is the recruitment of noncirculating pools of mature platelets. Strenuous exercise does not show abnormal changes of platelet parameters.