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Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

ZusammenfassungDie Behandlung der chronischen Niereninsuffizienz (chronic kidney disease, CKD) in Klinik und Praxis, auch unter der Dialysetherapie, beinhaltet stets eine umfangreiche medikamentöse Gabe und eine regelmäßige Überwachung. Die Niereninsuffizienz als chronische Erkrankung gehört zu der Gruppe von Krankheiten, die auch von einer nicht medikamentösen Therapie profitiert – nämlich von einer regelmäßigen körperlichen Aktivität. Trotz zahlreicher Publikationen zu diesem Thema werden Bewegung und körperliche Aktivität noch zu wenig bei Patienten mit CKD eingesetzt. Mit den Ergebnissen des Trainings während der Dialyse und dem Rezept für Bewegung gibt es effektive Ansätze, die Faktoren des gesunden Lebensstils in das Behandlungskonzept bei Nierenpatienten einzusetzen.

COVID-19 AND RETURN TO PLAY The world of sport has recently returned to training and competition following suspension due to the COVID-19 pandemic. It is concerning that a number of athletes have tested positive for COVID-19 after returning to competition. 1 Numerous authors have attempted to address return to play given the importance and complexity of the issue, with notable attention on possible cardiac implications.2–6 SCOPE OF THE INFOGRAPHIC The specific recommendations shown in the present infographic (figure 1) have been generated by a panel of international experts and represent a compilation of the numerous approaches used to inform resumption of regular sports during the COVID-19 pandemic. Despite the different regulations around the world and the particular characteristics of each sport, it is essential to provide informative, consistent and specific guidance for safe return to training and competition at this most difficult time. ...

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in “enclosed spaces” where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

At the end of 2019, a new coronavirus (Covid-19) outbreak occurred in Wuhan, China, and spread throughout the world despite efforts to contain the virus. At the end of January 2020, the General Director of the World Health Organization (WHO) declared a Public Health Emergency of International Concern, and by mid-May 2020, the worldwide number of known Covid-19 cases had surpassed 4.4 million including more than 300,000 deaths...

The aim of this overview was to recommend individual training plans using exercise prescriptions for adults and older adults during home-based rehabilitation. Over the last decade, many regular physical activity studies with large prospective cohorts have been conducted. Taken together, more than a million subjects have been included in these exercise studies. The risk of morbidity and mortality has been reduced by 30% to 40% as a result of exercise. These risk reductions hold true for many diseases, as well as for prevention and rehabilitation. Physical activity has also been in the treatment of many diseases, such as cardiopulmonary, metabolic or neurologic/psychiatric diseases, all with positive results. Based on these results, the prescription of exercise was developed and is now known as the exercise prescription for health in many European countries. Details have been published by the European Federation of Sports Medicine Associations (EFSMA). The exercise prescription is strongly recommended for inpatients, discharged patients and outpatients who have recovered from severe diseases. Rehabilitation improves general health, physical fitness, quality of life and may increase longevity of life.

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted – from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

The aim of our study was to determine the self-reported incidence and prevalence of running-related injuries among participants of the 18A customized questionnaire was distributed over registration. Independent samples of t-test and chi-square test were used to calculate the differences in risk factors occurrence in the injured and non-injured group. Factors which appeared significantly more frequently in the injured group were included further into multiple logistic regression analysis.The reported lifetime running injury (absence2 weeks) incidence was: 46% none, 47% rarely, 4% occasionally, and 2% often. Most commonly injured body regions were: knee (30%), ankle and Achilles' tendon (24%), foot (15%), and calf (12%). Male gender, running history of 1-3 years, and history of previous injuries were risk factors for life-time running injury. In the season preceding the event, 65% of participants had not experienced any running injuries, 19% of them reported minor problems (max 2 weeks absenteeism), but 10% and 7% suffered from moderate (absence 3-4 weeks) or major (more than 4 weeks pause) injuries. BMI was identified as the solely risk factor.This self-reported study revealed a 53% lifetime prevalence of running-related injuries, with the predominate involvement of knee, ankle and Achilles' tendon. One out of three recreational runners experienced at least one minor running injury per season. It seems that male gender, short running experience, previous injury, and BMI do increase the probability for running-related injuries.V pretekli dekadi se je število rekreativnih udeležencev teka na dolge proge v Sloveniji pomembno zvišalo in znaša 40.000 tekačev, kar predstavlja približno 2 % prebivalstva. Leta 2013 se je 18. Ljubljanskega maratona udeležilo skoraj 20.000 tekačev. Več kot 1400 jih je nastopilo na maratonu, 6500 jih je teklo polmaraton, ostali so se udeležili teka na 10 km. Namen naše raziskave je bil določiti incidenco in prevalenco prijavljenih tekaških poškodb udeležencev 18. Ljubljanskega maratona in opredeliti dejavnike tveganja za njihov nastanek.Ob prijavi smo 14.176 udeležencem po elektronski pošti poslali povezavo do spletnega vprašalnika, ki je vseboval splošne podatke, tekaško zgodovino in življenjsko/sezonsko prevalenco/incidenco tekaških poškodb. Sodelovanje v raziskavi je bilo prostovoljno in anonimno. Odgovori so predstavljeni z ustreznimi merami opisne statistike. Statistično značilnost razlik v dejavnikih tveganja med poškodovanimi in nepoškodovanimi udeleženci smo vrednotili s Studentovim t-testom oziroma testom hi-kvadrat. Za dejavnike, ki so se izkazali za značilno pomembne v bivariatni analizi, smo v modelu multiple logistične regresije določali njihovo neodvisno napovedno vrednost za tekaško poškodbo.V raziskavi je sodelovalo 340 žensk in 357 moških. Njihova povprečna starost je bila 42 let, povprečen ITM je bil 23,1 kg/m2. Glede na pretečeno razdaljo je bila razporeditev naslednja: maraton 132, polmaraton 412 in tek na 10 km 153 udeležencev. Življenjska incidenca tekaških poškodb (odsotnost s teka 2 tedna ali več) je bila naslednja: 322 (46 %) nikoli, 328 (47 %) redko, 31 (4 %) občasno in 16 (2 %) pogosto. Najpogosteje poškodovani telesni deli so bili: koleno (30 %), gleženj in Ahilova tetiva (24 %), stopalo (15 %) in meča (12 %). Kot dejavniki tveganja za življenjsko tekaško poškodbo so bili opredeljeni moški spol, ukvarjanje s tekom 1–3 leta in zgodovina poškodb. V sezoni pred dogodkom 65 % udeležencev ni imelo tekaške poškodbe, 19 % jih je prijavilo manjšo težavo (največ 2 tedna odsotnosti s teka), 10 % jih je utrpelo zmerno poškodbo (odsotnost s teka 3–4 tedne) in 7 % večjo (več kot 4 tedne premora). ITM je bil edini ugotovljeni dejavnik tveganja.Raziskava prijavljenih poškodb udeležencev 18. Ljubljanskega maratona je pokazala 53-odstotno življenjsko incidenco tekaških poškodb; prevladujejo poškodbe kolena ter gležnja in Ahilove tetive. Eden od treh rekreativnih tekačev utrpi vsaj eno manjšo tekaško poškodbo na sezono. Dejavniki, ki povečajo tveganje za nastanek tekaške poškodbe, so moški spol, kratkotrajno ukvarjanje s tekom, pretekla poškodba in ITM.

Exertional heat stroke (EHS) means an elevated body core temperature above 40°C with central nervous system (CNS) dysfunction that occurs during physical activity. EHS and its progression to multiorgan-dysfunction syndrome are due to a complex interplay among the acute physiological alterations associated with hyperthermia, the direct cytotoxicity of heat, the inflammatory response of the host and coagulation system failure. There are only a few studies regarding epidemiology of exertional heat stroke among different sports and it occurs at a rate of 1.20 per 100,000 athletes from known data. A 31-year old woman participated in 12.5 km road race. Before the run, she drank only 250 millilitres of water. She was generally healthy and one month ago, she finished a marathon without any problems but this time her friends had to encourage her to run after 90 minutes of running and approximately 5 km uphill. She was hot and her friends started to cool her after she sat down. She drank another 2 decilitres of water. Then she stopped talking and lost her consciousness but was still breathing. At the arrival of the emergency medical team her rectal temperature was 41.5°C (Figure 1), oxygen saturation 97%, blood glucose 7.0 mmol/l, and heart rate and blood pressure as shown on Figure 2. She started vomiting and got generalised convulsions. Cooling measures were instituted immediately using 1500 ml of ice-cold saline solution and 500 ml of colloid solution intravenously (i.v.) and ice packs were applied to the neck, groin and axilla. She was intubated. She was cooled further with cold saline solution (1500 ml i.v.) and ice packs at Emergency department (ED). In the ED, patient’s vital functions were supported (Figure 2). First electrocardiogram (ECG) revealed sinus tachycardia with ST depression in inferior (II, III, aVF) and precordial (V3-V6) leads. Second ECG showed sinus rhythm with a rate of 86 beats per minute with inverted T waves in inferior leads (III and aVF) and ST depression was gone. Because of elevated troponin and ECG changes, the echocardiogram was done but did not present any significant abnormal finding except very mild mitral valve regurgitation in parasternal long axis view. Wet-bulb globe temperature (WBGT) at start was 13.73°C and at the time of collapse it was 15.65°C which is not defined as increased risk for EHS according to the literature. The patient suffered from hyperthermia and associated complications because of inadequate hydration. Dehydration and hypovolemia combined with excessive vasodilatation led to hypotension that was treated with aggressive fluid replacement and vasoactive drugs. Elevated Troponin I and ECG changes were caused by direct heat-induced heart tissue injury and an exercise-induced increase in myocardial sarcolemmal permeability. EHS is a life-threatening condition thus prompt recognition and treatment with rapid cooling are crucial for survival. It can occur in any weather condition, so EHS should be considered as the differential diagnosis in all collapsed athletes and rectal temperature should be checked. References Bouchama A, Knochel JP. Heat Stroke. N Engl J Med. 2002 Jun;346:1978–1988. Lim CL, Mackinnon LT. The roles of exercise-induced immune system disturbances in the pathology of heat stroke: the dual pathway model of heat stroke. Sports Med. 2006;36(1):39–64. Pryor RR, et al. Exertional Heat Stroke: Strategies for Prevention and Treatment From the Sports Field to the Emergency Department. Clinical PaediatricPediatric Emergency Med. 2013 Dec;14(4):267–278. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. Exertional heat illness during training and competition. Medicine and Science in Sports and Exercise. 2007 Mar;39(3):556–572.

Firefighters are among occupations with the highest rate of work injury absence. Yearly more than 8–11% of firefighters are injured at work which contributes to 144 paid sick days per 100 firefighters. Recent studies have shown an important correlation between work absence and obesity among firefighters. Higher body mass index (BMI) is associated with higher rate of work injury absence. In the USA the costs associated with work-related injuries and illnesses among obese class II and III (BMI ≥ 35) firefighters were estimated at $1,682.90 yearly, among obese class I (BMI 30.0 – 34.9) firefighters at $254.00 yearly and among overweight (BMI 25.0 – 29.9) firefighters at $74.41. The aim of our study was therefore to evaluate the prevalence of obesity among voluntary firefighters in Slovenia, to find its correlation to other chronic diseases in this specific population, and according to results, to prepare specific practical programs to improve it. 100 voluntary firefighters from 5 fire departments in Slovenia were included in the study. Their mean age was 35 (min 17, max 63). 85% were men. 50 of them belong to basic group and 50 to group which uses self-contained breathing apparatus. The data for the study were obtained from results of mandatory regular preventive medical check-ups conducted by two specialists in occupational and sports medicine. For presentation of sample group and prevalence of obesity and other chronic diseases descriptive methods were used. Pearson chi-squared test was used to evaluate the differences between obese/non-obese group and basic/demanding group. α 50% of firefighters were non-smokers, 38,1 % smokers and 11,9 % ex-smokers. 55,2 % of firefighters were physically active enough according to EFSMA recommendations. 37% had normal weight, 42% were overweight and 21% were obese (Figure 1). The prevalence of chronic diseases in our study group was as follows: musculoskeletal disorders 24%, hypertension 10%, lung disease 4%, heart disease 2%, diabetes mellitus 1%, and mental disorders 1%, no cancer in our study group. Firefighters belonging to the basic group were more obese (p = 0,005) than firefighters from the group with self-contained breathing apparatus. Obese firefighters in both groups have significantly more chronic diseases (p = 0,000) especially due to higher incidence of hypertension (p = 0,002) and heart diseases (p = 0,022). To improve health status of voluntary firefighters, the implementation of specific preventive and therapeutic strategies, focused especially on lowering the incidence and prevalence of obesity, hypertension, heart diseases and musculoskeletal disorders is necessary. Fire departments in Slovenia are very appropriate way to reach groups of people to implement preventive strategies because their members gather regularly on weekly basis. So our next step is to introduce European Federation of Sports Medicine Associations (EFSMA) Exercise Prescription for Health (EPH®) in all five fire departments. References Janssen I, Bacon E, Pickett W. Obesity and its relationship with occupational injury in the canadian workforce. J Obes 2011;2011:531403. Piha K, Laaksonen M, Martikainen P, Rahkonen O, Lahelma E. Socio-economic and occupational determinants of work injury absence. Eur J Public Health. avgust 2013;23(4):693–8. Kuehl KS, Elliot DL, Goldberg L, Moe EL, Perrier E, Smith J. Economic benefit of the PHLAME wellness programme on firefighter injury. Occup Med Oxf Engl. april 2013;63(3):203–9. Kim P, Hayden JA, Mior SA. The cost-effectiveness of a back education program for firefighters: a case study. J Can Chiropr Assoc. marec 2004;48(1):13–9.

Objectives Low back pain is one of major health problems in rowing that can lead to significant training and competition absences but there is still a lack of data in which age group it actually starts to appear. We have therefore decided to study the incidence of low back pain in Slovenian rowers of different age groups and to find out potential age-dependent risk factors. Methods 86 rowers who had been training and competing on regular basis participated in the study. 56 of them were men aged 11 to 28 and 30 of them were women aged 12 to 28. Each of them was asked to fill in a questionnaire based on Standardised Nordic questionnaire for musculo-skeletal symptoms assessment in working population (Bahr et al, 2004) adjusted to focus on workloads in rowing. Incidence rate of low back pain in different age groups (boys and girls, juniors B, juniors A, masters) was shown by the mean of frequency distribution. Hi-square test was used to evaluate the differences between gender and age groups and for correlations between low back pain and risk factors with categorical values and Pearson correlation coefficient was used to calculate the correlations between low back pain and risk factors with continuous values. P value Results The incidence of low back pain increases until junior A category when it reaches 52.6% in one-year period. There is a significant difference in incidence between gender (see Figure 1) in each age group. There is also a significant difference between risk factors for low back pain in different age groups. Male gender was proved to be an important risk factor for low back pain in junior A group (p = 0.008). Hours of training per week and hours of training per day were also proved to be important risk factors in male and female juniors A (p = 0.037 and p = 0.008). Number of training hours on ergometer was on the other hand confirmed to be an important risk factor in boys and girls, (p = 0.001) and juniors B (p = 0.009). Change of rowing style is an important risk factor in juniors A (p = 0.050) and presence of skeletal muscle disorders was confirmed to be an important risk factor in the whole rowing population (p = 0.003), but especially in boys and girls (p = 0.012). Also positive family history for musculo-skeletal disorders was shown to be an important risk factor for low back pain in Slovenian rowing population (p = 0.045). Conclusions The incidence of low back pain is very high in Slovenian rowers reaching one peak already in junior B group and maximum rate in masters in females and maximum rate in junior A group in males. There is a significant difference in incidence between males and females and there were different risk factors identified in different age groups. References Bahr R, Andersen SO, Loken S, Fossan B, Hansen T, Holme, I. Low back pain among endurance athletes with and without specific back loading-a cross-sectional survey of crosscountry skiers, rowers, orienteerers, and nonathletic controls. Spine 2004:29(4):449–54. Newlands C, Reid D, Parmar, P. The prevalence, incidence and severity of low back pain among international-level rowers. British Journal of Sports Medicine 2015:0:1–6. Stallard MC. Backache in oarsman. British Journal of Sports Medicine 1980:14:105–108.

Background Athletes are generally considered a healthy population, but due to intensive training they can often experience health problems. Regular endurance exercise training induces structural and electrical cardiac remodelling, which enable optimal oxygen delivery for increased metabolic requirements. Electrical adaptations seen as heart rate and heart rate variability (HRV) changes depend mostly on autonomic nervous system activity adaptations to endurance training. HRV analysis has been proved as useful non-invasive method for evaluating the overall state of cardiovascular system, as well as the state of autonomic nervous system that regulates cardiac activity. In comparison with sedentary people, parasympathetic nervous system of well-trained athletes often has higher tone, which is reflected in increased high-frequency (HF) component of HRV. Aim The aim of this study was to evaluate the correlation of cardiac electrical remodelling (as reflected in HRV) with athlete’s training status, their maximal oxygen consumption (VO2max), and structural cardiac remodelling (reflected in cardiac output). Methods Cross-sectional study was conducted on a group of 33 Slovenian male and female rowers (age 18.9 ± 3.5 years), as rowing is one of the sport disciplines associated with the highest oxygen consumption, therefore a substantial cardiac remodelling effect of endurance exercise training was assumed for our subjects. Five minute resting enhanced ECG was recorded in order to examine HRV parameters. VO2max was determined by the ergometer testing and ultrasound measurements were used to estimate cardiac output. Results No statistically significant differences (p > 0.05) were observed in HRV parameters between athletes with short-term training status ( 0.05) in HRV parameters between athletes with lower VO2max ( 0.05) was observed between HRV parameters and cardiac output. Conclusions There is substantial variability in the studied parameters among athletes. However, changes in cardiac electrical remodelling as reflected in HRV among athletes with long-term training status and among athletes with maximal oxygen consumption (VO2max) were observed.

Studies of autonomic cardiac nervous system activity during acute exposure to hypobaric hypoxia have suggested a depression of autonomic functions and a shift in the sympatho-vagal balance towards relatively more sympathetic and less parasympathetic activity at higher hypoxic levels . This study was performed on nine non-acclimatized middle-aged healthy men (age 43.7 +/- 7.3 years), to evaluate the linear (autoregressive spectra) and non-linear (Poincaré plot, b coefficient, fractal dimension) heart rate variability (HRV) parameters at rest in supine position at three different altitudes: 400 m, 3200 m and 4200 m. A statistically significant increase of heart rate (HR) was detected at both higher altitudes in comparison with the reference level as well as comparing the values observed at 3200 m and 4200 m, respectively. Acute exposure to both hypoxic levels (3200 m and 4200 m) induced a shift of sympatho-vagal balance towards more sympathetic and less parasympathetic activity in comparison to the basal condition at 400 m asl, as indicated by autoregressive LF and HF spectral components and in particular by LF/HF ratio. The non-linear ss coefficient values demonstrated a statistically significant decrease of the complexity of the system at both hypoxic conditions as effect of hypobaric hypoxia on ANS activity of myocardium. However this fact was not confirmed by the fractal dimension parameter.

The influence of hypoxia on heart rate variability (HRV) has been studied under resting conditions with mixed results. Differences have been found in physiological responses to normobaric versus hypobaric hypoxia. Our aim was to study the influence of hypobaric hypoxia on HRV during physical exercise to determine whether HRV changes due to the exercise-induced heart rate (HR) increase or whether hypoxia itself exerts an influence. We tested nine healthy non-acclimatised white males (age = 43 +/- 7 years) at 400 and 4,200 m during exercises. At 400 m HRV was measured at 50% and 75% maximal oxygen uptake (VO(2) max). At 4,200 m HR was kept equal as during exercise at 400 m by adjusting the intensity of step testing. The Poincaré plot as a non-linear method of HRV analysis was used, where the shape of the ellipse depending on HRV is expressed by two parameters, SD1 and SD2 (correlating to parasympathetic activity and both sympathetic and parasympathetic activity, respectively). We established a decrease in SD2 and an insignificant decrease in SD1 at medium HR at 4,200 m compared to 400 m. Both parameters showed similar tendencies during high-intensity exercise. Our results indicate that hypobaric hypoxia itself exerts an influence on HRV at a moderate HR.