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Background: The impact of the corona pandemic on competitive sports has not yet been studied in a larger group of athletes.Methods: Using an online questionnaire, junior and adult elite athletes from Germany and Austria were asked about their infection status, potential symptoms of COVID-19, and the impact of the pandemic on their athletic activity.Results: Between April 21, 2020 and February 16, 2021, a total of 2981 questionnaires were recorded (50.3% female, 25.7% professional athletes, 37.9% national team members). 78 athletes (2.6%) reported a positive PCR test result for SARS-CoV-2. In addition, 67 (2.3%) athletes reported that they had experienced the disease but were self-diagnosed. In 19 athletes (0.6%), infection was suspected by a physician but without testing. 841 (28.2%) athletes stated that they were in quarantine at least once. At least one symptom that might be associated with COVID-19 was observed in 38.7% of all athletes. Cardiac symptoms were reported significantly more often in PCR-positive athletes than in the group of athletes without confirmed infection or no infection. 15 athletes (0.5%) were admitted to hospital due to COVID-19, 8 of them were hospitalized for more than 1 week.Conclusion: The corona pandemic has a massive impact on competitive sports. In addition to indirect consequences due to quarantine measures or cancellation of competitions, infections with SARS-CoV-2 occurred in a significant proportion of athletes. Severe courses with hospitalization were also recorded among competitive athletes.Key Words: SARS-CoV-2, COVID-19, Infection, Questionnaire, Competitive Sports

Hydration management is challenging, but adequate hydration is of importance for health and performance in elite and recreational athletes. This brief, scoping review summarizes important aspects of hydration management in sports and offers practical guidance. We focus on the health risks of hypo- and hyperhydration and highlight preventive and therapeutic strategies. References may guide the interested reader towards more extensive literature on further aspects related to hydration and nutrient management during competition, training, and recovery.The physiological loss of fluid during prolonged exercise (i.e. marathon running, repeated training sessions within a day, multi-match sports event) occurs mainly through sweat, metabolic water and respiration. Substantial hypohydration (i.e., >2-4% of body mass) is likely to decrease performance and should be avoided. If athletes seek to prevent hypohydration by overdrinking, this can impose exercise associated hyponatremia and life-threatening cerebral edema. Overdrinking can generally be avoided by drinking to thirst, but individual rehydration strategies for training and competition may be advisable when barriers such as competition stress or poor availability are present. A variety of methods exists to assess hydration status in laboratory settings or in the field. Urine and blood markers combined with body mass changes currently offer the optimum of feasibility and validity.Key Words: Dehydration, Hypohydration, Rehydration, Hyperhydration, Plasma Osmolality, Urine Specific Gravity, Sweat, Sodium, Hydration Assessment, Exercise

Background and rationale: Resting ECG is an essential diagnostic tool in sports medicine. Modern mobile 22-lead Vector ECG device (V-ECG) using only four electrodes has become available to record ECG via mobile devices. In order to implement the V ECG in sports medicine, it is essential that the V-ECG is diagnostically equal to the standard 12-lead resting ECG (R-ECG). This study was designed to present a head-to-head comparison of the V-ECG with the R-ECG in elite athletes.Methods: In 102 adult eliteathletes the V-ECG was recorded additionally to the R-ECG. These ECGs were compared in standard parameters and in the international criteria of electrocardiographic interpretation in athletes.Results: Differences were registered in the cardiac axis, absolute QRS amplitudes, signs of ventricular hypertrophy, R/S ratio and polarity of the T wave. Consequently, differences in sports related ECG findings (increased QRS voltage, incomplete right bundle branch block, T wave inversion and pathologic Q wave) were observed.Summary: Due to the simple handling, V-ECG is a technically beneficial method of ECG registration. At the moment, it can only be used as a supplement to the R-ECG in sports medicine. It is essential that the characteristic differences are always considered when interpreting the V ECG. Key Words: International Criteria of Electrocardiographic Interpretation in Athletes, Preparticipation Evaluation in Athletes, Mobile Device, Sudden Cardiac Death, Sports Cardiology

Introduction: An infection with SARS-CoV-2 is relevant especially in high-performance sport due to possible organ damage and reduced performance which occurs in individual cases. Various recommendations are found in the literature concerning when safe return to sports is possible and what examinations are suitable to support this decision. The dominance of other virus variants than those at the start of the pandemic makes revision of earlier recommendations necessary. Methods and Analysis: The recommended actions are based on the currently-available scientific knowledge of the pathogenicity of the virus and on clinical experiences in general and elite athletes. Twenty-one recommended actions were proposed by the Scientific Council of the DGSP, discussed and agreed on in consensus with experts from German-language sports-medical facilities and evaluated by an independent co-author. The resultant position paper was subsequently released by mutual agreement. Results: The recommendations are oriented to the severity of the course and the symptoms. The required medical diagnostic is deduced therefrom. During persistent symptoms, sports should be paused and training only begun again at low intensity after a three-day symptom-free period. If COVID-19-associated complaints recur, physical exertion should be stopped and a doctor consulted. After moderate and serious course, medical diagnostics are required prior to the start of training. Summary: To prevent a health risk due to sports and thereby resultant organ damage after a SARS-CoV-2 infection, a procedure adapted to the symptoms and course before return to training and finally to competitive sports is recommended.

This article summarises the state of the science on the role of the gut microbiota (GM) in diabetes from a recent international expert forum organised by Diabetes, Diabetes Care, and Diabetologia, which was held at the European Association for the Study of Diabetes 2023 Annual Meeting in Hamburg, Germany. Forum participants included clinicians and basic scientists who are leading investigators in the field of the intestinal microbiome and metabolism. Their conclusions were as follows: (1) the GM may be involved in the pathophysiology of type 2 diabetes, as microbially produced metabolites associate both positively and negatively with the disease, and mechanistic links of GM functions (e.g. genes for butyrate production) with glucose metabolism have recently emerged through the use of Mendelian randomisation in humans; (2) the highly individualised nature of the GM poses a major research obstacle, and large cohorts and a deep-sequencing metagenomic approach are required for robust assessments of associations and causation; (3) because single time point sampling misses intraindividual GM dynamics, future studies with repeated measures within individuals are needed; and (4) much future research will be required to determine the applicability of this expanding knowledge to diabetes diagnosis and treatment, and novel technologies and improved computational tools will be important to achieve this goal.

Adequate intake of high quality proteins and amino acids is essential for the body in order to build up structures such as muscle, tendons, ligaments and bone. Protein intake also regulates and affects various metabolic processes, including hormonal regulation. Accordingly, proteins and amino acids are, to varying extents, able to stimulate or inhibit anabolic signal transduction pathways and the synthesis and secretion of various hormones such as insulin, growth hormone and insulin-like growth factor 1 (IGF-1).This means that tailoring protein intake to an athletes specific type of sport and exercise intensity can be helpful in supporting the training process and improving performance. The aims of adjusting intake in this way may include maintaining or building muscle mass or muscle strength, preventing a catabolic state, and improving recovery following exercise.Even though the importance of protein intake in the field of sport is increasingly well-known, there is still much controversy regarding intake levels, types of protein sources, optimal amino acid composition, and ideal timing of intake. The lay press and commercial websites in particular often provide biased or incorrect recommendations without scientific evidence.This position paper summarizes the current state of knowledge regarding the physiological effects of protein intake in sports, paying particular attention to the aspects of intake level and the dose-response relationship. Key Words: Metabolic Processes, Amino Acids, Muscle, Dose-Response Relationship, Performance, Regeneration

This position paper deals with safety aspects of the use of dietary supplements (DS) in sports. DS are legally classified as foodstuffs and may contain vitamins, minerals and other substances with a nutritional or physiological effect. In the case of other substances with a nutritional or physiological effect, it is currently not specifically regulated, with a few exceptions, which individual substances may be added, provided the products are still classified as foods. DS are offered in a wide variety and can be purchased worldwide via the internet. In Germany, they are only subject to a notification requirement before being launched on the market; they are not subject to safety assessment by state authorities. The manufacturers/distributors of the DS are responsible for their safety and for ensuring that consumers are not misled by the product presentation and promotion.For athletes, a balanced diet that is adapted to their needs is a basic requirement and one of the preconditions for good athletic performance. DS are no replacement for a balanced diet.In sports, the use of DS or products that contain micronutrients and other substances with a nutritional or physiological effect should not be conducted uncritically. Possible risks, such as an unintentional violation of anti-doping regulations or potential health risks, should be considered. Key Words: Doping Risk, Wada Prohibited List, Health Risks, Vitamins, Minerals, Caffeine

Athletes expend greater amounts of energy as a result of their training. However, these amounts vary during the competition year and are influenced by such factors as the training period and intensity.Measuring energy expenditure is a complex process that is often achieved through indirect calorimetry. A calculation is possible when certain limitations are taken into consideration.Energy expenditure corresponds to energy requirements. Energy requirements should be covered by energy intake adapted to individual needs. Low energy intake can lead to reduced energy availability. Low energy availability not only has a negative impact on the bone metabolism and menstrual cycle there may also be consequences of a hematological, metabolic, psychological, gastrointestinal and immunological nature. This has adverse effects on the performance capacity, training adjustment, concentration and coordination, and can lead to an increased risk of injury.Matching energy intake to energy expenditure is an important cornerstone in the diet of athletes and a significant prerequisite for maintaining their health and performance. KEY WORDS: Athletes, Calorimetry, Energy Availability, Resting Energy Expenditure, Metabolic Equivalent

An adequate intake of minerals and vitamins is essential for health and performance of athletes. Depending on the type of sport and the intensity and scope of physical performance, as well as individual factors (such as dietary behavior, perspiration rate and composition of perspiration), athletes may be at increased risk of suboptimal micronutrient supply.This position paper will provide an overview of the potential causes of deficient micronutrient supply in athletes, such as increased requirements as a result of enhanced energy metabolism, higher losses associated with physical activity, and special diets associated with sport in general or particular types of sport. This position statement will also present the proven effects of insufficient micronutrient supply on the health and performance of athletes, and the effects on their supply situation.In summary, it can be concluded that with a balanced diet that covers energy requirements, the D-A-CH reference values for micronutrients can usually be attained without any problems. However, in certain situations (such as strenuous endurance exercise or weight reduction, or in the case of lopsided eating habits or hypocaloric diets), iron, calcium, sodium and vitamin D may be critical nutrients for athletes.A diet that is adapted to the individual and covers all requirements is achievable even in the case of high metabolic demands, and such a diet can reduce the risk of nutrient deficiencies. Key Words: Micronutrients, Requirements of Athletes, Health, Exercise Performance

This position paper represents the current scientific recommendations for fluid management in sports. Sporting activities should always be commenced with a balanced fluid level (apparent by urine color, which is light yellow in the case of balanced fluid level).The loss of fluids during exercise depends on numerous factors such as the state of exercise, the intensity, duration, type of exercise and environmental factors. The weighing method to determine individual fluid loss offers guidance for the optimal fluid intake during exercise. In principle however, athletes should trust their own feeling of thirst.Generally in the case of activities lasting less than 30-40 minutes, fluid intake is not necessary, minor fluid deficits during exercise are tolerable. In the case of longer-lasting activity (>1.5 hours) it is advisable to take in beverages rich in carbohydrates and sodium. Therefore, the optimal sports drink should contain 400-1100 mg / l sodium in addition to carbohydrates (4-8%). After sport, fluids and electrolytes must be replaced. If there is no renewed physical activity in the next 24 hours and the body weight is reduced by less than 5%, consumption of normal meals and snacks in combination with an adequate supply of water is sufficient to restore fluid and electrolyte balance.For quick and complete rehydration, approximately 1.5 l of fluid per kg weight loss is recommended. KEY WORDS: Sports Drink, Fluid Intake, Fluid Balance, Electrolyte Balance

This position statement represents the current state of scientific knowledge regarding the recommended fat intake in ambitious recreational and high level sports. It also addresses dietary strategies (fat-loading methods) and food supplements that are designed to influence fat metabolism during physical exercise.No recommendation has so far been established for sports-specific fat intake in absolute numbers (g/kg body weight [BW]/d), in line with international practices regarding carbohydrate and protein. However, there is consensus among scientific sports medicine associations that fat consumption should not exceed 30% of the energy intake (E%), nor fall below 20 E%, particularly in endurance sports.Before competitions, some athletes practice fat-loading strategies which include a ketogenic diet. This procedure is not advisable, as there is no scientific evidence of improvement in either endurance (>70% VO2max) or sprint/strength performance. Moreover, the extensive restriction of carbohydrate intake is not in accordance with the internationally-accepted nutritional guidelines for athletes, and the food choice is unbalanced according to the recommendations of the German Nutrition Society (DGE).The current use of dietary supplements which are supposed to improve the availability/oxidation of fatty acids, e.g. caffeine, carnitine, fish oil, middle chain triglycerides (MCT), is also generally discouraged. Key Words: Dietary Supplements, Ketogenic Diet, Carnitine, Fish Oil, Middle Chain Triglycerides (MCT)

Osteoarthritis (OA) is a pro-infl ammatory, degenerative disease of the joints. Since the osteoarthritis risk pro le overlaps with that of other lifestyle-related diseases, such as obesity, type 2 diabetes mellitus (T2DM), or cardiovascular disease, a ected individuals are often multi-morbid. Physical activity has been demonstrated to be a valuable preventive and therapeutic tool in OA and also in almost all other lifestyle-related diseases. us, a ected individuals might bene t from an exercise program in multiple respects. To monitor e cacy of such training interventions, a set of reliable biomarkers, preferentially such that can be assessed from easily accessible biological uids, in particular urine or blood, would be desirable.In this short review, we give an overview of potential blood and urine biomarkers that might be used to monitor e cacy of exercise interventions in osteoarthritis patients, with a speci c focus on multi-morbidity. Currently, the most-extensively studied markers are in ammation-related factors, such as C-reactive protein (CRP) or interleukin-6 (IL-6), but also metabolic markers, for example the adipokines adiponectin, leptin, and resistin, and products of cartilage decay, such as C-telopeptide of type II collagen (CTX-II), or cartilage oligomeric protein (COMP). Finally, recent studies also point to circulating microRNAs (miRNAs) as potential biomarkers in OA, suggesting that they might also have the potential to be studied in the context of training interventions. KEY WORDS: Degenerative Joint Disease, Lifestyle-Related Diseases, Physical Activity, Blood and Urine Markers

People are increasingly eager to know more about themselves through technology. To date, technology has primarily provided information on our physiology. Yet, with advances in wearable technology and artificial intelligence, the current advent of consumer neurotechnology will enable users to measure their cognitive activity. We see an opportunity for research in Human-Computer Interaction (HCI) in the development of these devices. Neurotechnology offers new insights into user experiences and facilitates the development of novel methods in HCI. Researchers will be able to create innovative interactive systems based on the ability to measure cognitive activity at scale in real-world settings. In this paper, we contribute a vision of how neurotechnology will transform HCI research and practice. We discuss how neurotechnology prompts a discussion about ethics, privacy, and trust. This trend highlights HCI’s crucial role in ensuring that neurotechnology is developed and utilised in ways that truly benefit people.