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Purpose: To investigate the effects of bilateral dorsolateral prefrontal cortex high-definition transcranial direct-current stimulation (HD-tDCS) on physiological and performance responses during exercise at the upper limit of the severe-intensity exercise domain in elite-level road cyclists. Methods: Eleven elite-level road cyclists (VO2peak: 71.8 [3.1] mL·kg−1·min−1) underwent the HD-tDCS or SHAM condition in a double-blind, counterbalanced, and randomized order. After 20 minutes of receiving either HD-tDCS on dorsolateral prefrontal cortex (F3 and F4) or SHAM stimulation, participants completed a 10-minute constant-load trial (CLT1) at 90% of the first ventilatory threshold and a 2-minute CLT (CLT2) at peak power output. Thereafter, they performed a simulated 2-km time trial (TT). Maximal oxygen uptake, respiratory exchange ratio, heart rate, and rating of perceived exertion were recorded during CLT1 and CLT2, whereas performance parameters were recorded during the TT. Results: In 6 out of 11 cyclists, the total time to complete the TT was 3.0% faster in HD-tDCS compared to SHAM. Physiological and perceptual variables measured during CLT1 and CLT2 did not change between HD‐tDCS and SHAM. Conclusions: HD-tDCS over the dorsolateral prefrontal cortex seemed to improve cycling TT performance within the upper limit of the severe-intensity exercise domain, suggesting that an upregulation of the prefrontal cortex could be critical even in this exercise intensity domain. However, the limited dimension and the high interindividual variability require further studies to test these putative ergogenic effects.

Acute respiratory disorder is a common sub-clinical condition affecting elite cyclists. Monitoring the perturbations of the immunological cells in the respiratory tract, indicative of a likely proinflammatory state, during an International Cycling Union world tour is a challenging task. The aim of this study was to follow up on the sign and symptoms of upper way respiratory infections with or without asthma, using non-invasive methods, during a 21-day race (100° Giro d’Italia, 2017). Nine male elite cyclists of the Bahrain Merida Team were evaluated before the training season and daily during the race. Clinical history, skin prick and spirometric test, acute respiratory symptoms were measured using validated questionnaires, and values of fraction of exhaled nitric oxide were collected longitudinally. Four of the 9 athletes had allergies with/or consistent abnormal spirometric curves before the race. During the race, 5 athletes had a fraction of exhaled nitric oxide values >20 ppb which correlated with respiratory symptoms collected through questionnaires. These were related to the environmental characteristics of the places travelled through in the race. The athletes with a predisposition to chronic respiratory inflammation in the pre-competitive season were more likely to develop acute respiratory symptoms during the race.

Vinetti, G, Pollastri, L, Lanfranconi, F, Bruseghini, P, Taboni, A, and Ferretti, G. Modeling the power-duration relationship in professional cyclists during the Giro d'Italia. J Strength Cond Res XX(X): 000-000, 2022-Multistage road bicycle races allow the assessment of maximal mean power output (MMP) over a wide spectrum of durations. By modeling the resulting power-duration relationship, the critical power (CP) and the curvature constant (W') can be calculated and, in the 3-parameter (3-p) model, also the maximal instantaneous power (P0). Our aim is to test the 3-p model for the first time in this context and to compare it with the 2-parameter (2-p) model. A team of 9 male professional cyclists participated in the 2014 Giro d'Italia with a crank-based power meter. The maximal mean power output between 10 seconds and 10 minutes were fitted with 3-p, whereas those between 1 and 10 minutes with the 2- model. The level of significance was set at p0.05. 3-p yielded CP 357 ± 29 W, W' 13.3 ± 4.2 kJ, and P0 1,330 ± 251 W with a SEE of 10 ± 5 W, 3.0 ± 1.7 kJ, and 507 ± 528 W, respectively. 2-p yielded a CP and W' slightly higher (+4 ± 2 W) and lower (-2.3 ± 1.1 kJ), respectively (p0.001 for both). Model predictions were within ±10 W of the 20-minute MMP of time-trial stages. In conclusion, during a single multistage racing event, the 3-p model accurately described the power-duration relationship over a wider MMP range without physiologically relevant differences in CP with respect to 2-p, potentially offering a noninvasive tool to evaluate competitive cyclists at the peak of training.

In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.

Children and adolescents with haematological malignancies (PedHM) are characterized by a severe loss of exercise ability during cancer treatment, lasting throughout their lives once healed and impacting their social inclusion prospects. The investigation of the effect of a precision-based exercise program on the connections between systems of the body in PedHM patients is the new frontier in clinical exercise physiology. This study is aimed at evaluating the effects of 11 weeks (3 times weekly) of combined training (cardiorespiratory, resistance, balance and flexibility) on the exercise intolerance in PedHM patients. Two-hundred twenty-six PedHM patients were recruited (47% F). High or medium frequency participation (HAd and MAd) was considered when a participant joined; > 65% or between 30% and P 0.05), while the 6MWT and balance tests showed improvement only in HAd group (P 0.0001). These results support the ever-growing theory that, in the case of the treatment of PedHM, ‘exercise is medicine’ and it has the potential to increase the patient’s chances of social inclusion.

Background: The effects of anodal transcranial direct-current stimulation (tDCS) on endurance exercise performance are not yet fully understood. Different stimulated areas and low focality of classical tDCS technique may have led to discordant results. Purpose: This study investigated the effect of a bilateral anodal high-definition tDCS (HD-tDCS) of the dorsolateral prefrontal cortex on the cycling time-trial (TT) performance and physiological and perceptual response at moderate intensity in elite cyclists. Methods: A total of 8 elite cyclists (maximal oxygen consumption: 72.2 [4.3] mL·min−1·kg−1) underwent in a double-blind, counterbalanced, and randomized order the experimental treatment (HD-tDCS) or control treatment (SHAM). After 20 minutes of receiving either HD-tDCS on the dorsolateral prefrontal cortex (F3 and F4) or SHAM stimulation, the participants completed a constant-load trial (CLT) at 75% of the second ventilatory threshold. Thereafter, they performed a simulated 15-km TT. The ratings of perceived exertion, heart rate, cadence, oxygen consumption, and respiratory exchange ratio were recorded during the CLT; the ratings of perceived exertion and heart rate were recorded during the TT. Results: The total time to complete the TT was 1.3% faster (HD-tDCS: 1212 [52] s vs SHAM: 1228 [56] s; P = .04) and associated with a higher heart rate (P P = .05). None of the physiological and perceptual variables measured during the CLT highlighted differences between the HD-tDCS and SHAM condition. Conclusions: The findings suggest that bilateral HD-tDCS on the dorsolateral prefrontal cortex improves cycling TT performance without altering the physiological and perceptual response at moderate intensity, indicating that an upregulation of the prefrontal cortex could enhance endurance exercise performance.

Harness hang syncope (HHS) is a risk that specifically affects safety of harness users in mountain climbing. Aims: To evaluate individual patterns of breathing resulting from deranged cardiovascular reflexes triggering a syncopal event when a mismatch between cerebral O2 demand and supply is present. Results: Forty healthy participants [aged 39.1 (8.2) years] were enrolled in a motionless suspension test while hanging in harness. Respiratory gas exchange values were analyzed to assess the pattern of breathing (EpInWel, respiratory elastic power) and cardiovascular parameters were monitored (BP, blood pressure). Four participants experienced HHS after 30.0 (7.6) minutes, with an early manifestation of loss of control of both a sustainable EpInWel and BP, starting after 10–12 minutes. Among the other participants, two different reactions were observed during suspension: (1) group G1 tolerated 32.7 (11.4) minutes of suspension by a favorable adaptation of the EpInWel and BP parameters and (2) group G2 showed significantly shorter time of suspension 24.0 (10.4) minutes with unfavorable increase in EpInWel and BP. Conclusions: Greater resistance to HHS occurs in people developing less marked fluctuations of both respiratory and cardiovascular reflex responses. Conversely, wider fluctuations both in control of EpInWel and BP were observed in the event of decreased suspension tolerance or in syncopal events.

Il contributo, dopo aver analizzato i fattori che influenzano la capacità di affrontare e superare efficacemente situazioni di emergenza legate a rischi naturali e/o antropici, propone una soluzione implementata nell'ambito del progetto "SIMULATOR_ADS: un Sistema Integrato ModULAre per la gesTione e prevenziOne dei Rischi - Arricchito con Dati Satellitari", una piattaforma ICT originale, con un'architettura basata su servizi Web, a supporto degli operatori e delle autorità locali di Protezione Civile nelle fasi di preparazione e di gestione delle emergenze.

Bioelectrical impedance vector-analysis (BIVA) describes cell-mass, cell function and hydration status of an individual or a group. The goal of the present investigation was to provide bioelectrical impedance data for 525 male road cyclists (155 professionals, 79 elite, 59 elite-youth, and 232 amateurs) at the time of their optimal performance level. Data were plotted on the resistance-reactance (R-Xc) graph to characterize cyclists group vectors using BIVA. Compared to the general male population, the mean vector position of the road cyclists indicates a higher body cell mass (BCM) and phase angle (p

Lanfranconi, Francesca, Luca Pollastri, Giovanni Corna, Manuela Bartesaghi, Massimiliano Novarina, Alessandra Ferri, and Giuseppe Andrea Miserocchi. The elusive path of brain tissue oxygenation and cerebral perfusion in harness hang syncope in mountain climbers. High Alt Med Biol. 18:363-371, 2017. Aim: Harness hang syncope (HHS) is a risk that specifically affects wide ranges of situations requiring safety harnesses in mountains. An irreversible orthostatic stasis could lead to death if a prompt rescue is not performed. We aimed at evaluating the risk of developing HHS and at identifying the characteristics related to the pathogenesis of HHS. Results: Forty adults (aged 39.1 [8.2] years) were enrolled in a suspension test lasting about 28.7 (11.4) minutes. We measured cardiovascular parameters, and near infrared spectroscopy (NIRS) was used to assess cerebral hypoxia by changes in the concentration of oxyhemoglobin (Δ[HbO2]) and de-oxyhemoglobin (Δ[HHb]). In the four participants who developed HHS: (1) systolic and diastolic blood pressure showed ample oscillations with a final abrupt drop (∼30 mmHg); (2) Δ[HbO2] increased after 8-12 minutes of suspension and reached a plateau before HHS; and (3) Δ[HHb] decreased with a final abrupt increase before syncope. Conclusions: Participants who developed HHS failed to activate cardiovascular reflexes that usually safeguard O2 availability to match the metabolic needs of the brain tissue. Since cerebral hypoxia was detected as an early phenomenon by Δ[HbO2] and Δ[HHb] changes, NIRS measurement appears to be the most important parameter to monitor the onset of HHS.

We compared by non-invasive technique the adaptive response of alveolar capillary network to edemagenic conditions (exercise and high altitude [HA, P I O 2 107 mm Hg] in subjects with different resting sea level (SL) capillary blood volume (normalized to alveolar volume, Vc/Va): Group 1 (N = 10, Vc/Va = 16.1 ± 6.8 ml/L- mean ± SD) and Group 2 (N = 10, Vc/Va = 25 ± 7.7). In Group 1 Vc/Va remained unchanged in HA at rest and increased during exercise at SL (26.3 ± 8.6) and HA (28.75 ± 10.2); in Group 2 Vc/Va significantly decreased in HA (19 ± 6) and did not increase in exercise at SL and HA. We hypothesize that Group2 exerts a tight control on Vc/Va being more exposed to the risk of lung edema due to inborn greater microvascular permeability. Conversely, Group 1 appears more resistant to lung edema given the large capillary recruitment in the most edemagenic condition. The 4-fold increase in frequency dependence of respiratory resistance in Group2 in HA stems for greater proneness for lung water perturbation compared to Group 1.

The aim of the study was to investigate changes in hydration status by means of bioelectrical impedance vector analyses (BIVA) and to assess its influence on power output and rating of perceived exertion (RPE) during the Giro d'Italia 2014. Daily bioelectrical impedance analysis were performed on 9 professional road cyclists (age: 28.2 ± 4.7 yr, height: 176.0 ± 5.5 cm, weight: 64.7 ± 3.4 kg) during the race. Additionally, body weight, RPE, and power output were recorded throughout the race. Impedance vectors shortened during the race, whereas body weight remained unchanged at the end of the tour when compared to pre-tour. Vector changes were not related to power output or RPE. The shortening of the BIVA vector indicates that fluid gain occurred during the Giro d'Italia. This fluid gain was not reflected by body weight measurements and might be mainly attributed to muscle edema and/or haemodilution. Furthermore, power output and RPE, mostly depending on team tactic, were not affected by the body water increases.

An investigation of whether body water changes during the Giro d'Italia affected average maximal mean power (MMP) of different time durations and to establish whether phase-angle and body cell mass (BCM) are related to MMP in elite cyclists. Approximately 2 h after each stage of the race, a bioelectrical impedance analysis was performed on 8 cyclists and analysed according to bioelectrical impedance vector analyses. Additionally, MMP of different time durations were recorded during each stage. Body mass increased (p