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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

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.

Background: Keeping patients active is an essential goal of cardiac rehabilitation (CR). This research aims to analyze the development of steps/day after CR.Methods: 126 adult, stable cardiac patients who had completed treatment for their acute condition, usually acute coronary syndrome or heart failure, were enrolled during CR and advised for daily step recording up to one year post CR. Mean number of steps during and for 3 weeks post CR were compared by paired t-test. Furthermore, influence of gender, age, smoking, NYHA, EF, BMI, day of the year, and length of time post CR on steps/day were estimated using a generalized additive regression model.Results: Compared to CR, steps/day increased on average by 925steps/day in the first 3 weeks (p0.05), whereas seasonal correlations existed, indicating a summer increase and a winter decline (p

Sinann Al Najem,1,2 Andreas Groll,3,4 Axel Schmermund,5,6 Bernd Nowak,5,6 Thomas Voigtländer,5,6 Ulrike Kaltenbach,5 Peter Dohmann,5 Dietrich Andresen,7 Jürgen Scharhag2,8 1German Heart Foundation, Frankfurt, Germany; 2Institute of Sports and Preventive Medicine, Saarbrücken, Germany; 3Chair of Statistics, Georg August University, Göttingen, Germany; 4Faculty of Statistics, Technical University Dortmund, Dortmund, Germany; 5Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany; 6Bethanien Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany; 7Lutheran Hospital Hubertus, Berlin, Germany; 8Outpatients’ Clinic for Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany Background: A total of 6,500 to 8,000 steps per day are recommended for cardiovascular secondary prevention. The aim of this research was to examine how many steps per day patients achieve during ambulant cardiac rehabilitation (CR), and if there is a correlation between the number of steps and physical and cardiological parameters. Methods: In all, 192 stable CR patients were included and advised for sealed pedometry. The assessed parameters included maximum working capacity and heart rate, body mass index (BMI), New York Heart Association (NYHA) class, ejection fraction (EF), coronary artery disease status, beta-blocker medication, age, sex, smoking behavior, and laboratory parameters. A regularized regression approach called least absolute shrinkage and selection operator (LASSO) was used to detect a small set of explanatory variables associated with the response for steps per day. Based on these selected covariates, a sparse additive regression model was fitted. Results: The model noted that steps per day had a strong positive correlation with maximum working capacity (P=0.001), a significant negative correlation with higher age (P=0.01) and smoking (smoker: P40: 6,077±1,567). Conclusion: Walking activity during CR is reduced in patients who are unfit, older, smoke, or used to smoke. In addition to training recommendations, estimated steps per day during CR could be seen as a baseline orientation that helps patients to stay generally active or even to increase activity after CR. Keywords: step recommendation, steps/day in cardiac patients, pedometer

Objective: To construct quantile reference values for peak oxygen uptake (VO2peak) measured by cycle ergometer-based incremental cardiopulmonary exercise tests.Design: Cross-sectional study using quantile regressions to fit sex- and age-specific quantile curves. Exercise tests were conducted using cycle ergometry. Maximal effort in the exercise tests was assumed when RER 1.1 or lactate 8mmol*L-1or maximal heart rate 90% of the age-predicted maximal heart rate. This was assessed retrospectively for a random subsample with an a priori calculated sample size of n=252 participants. A network of private outpatient clinics in three German cities recorded the results of cycle ergometer-based cardiopulmonary exercise tests to a central data base (Prevention First Registry) from 2001 to 2015.Participants: 10,090 participants (6,462 men, 3,628 women) from more than 100 local companies volunteered in workplace health promotion programs. Participants were aged 467 years, were free of acute complaints, and had primarily sedentary working environments.Results: Peak oxygen uptake was measured as absolute VO2peak in L*min-1and relative VO2peak in mL*min-1*kg-1. Median relative VO2peak was 36 and 30mL*min-1*kg-1 at 40 to 49 years, as well as 32 and 26mL*min-1*kg-1 at 50 to 59 years for men and women, respectively. An estimated proportion of 97% of the participants performed the exercise test until exertion.Conclusions: Reference values and nomograms for VO2peak were derived from a large cohort of preventive health care examinations of healthy white-collar workers. The presented results can be applied to participants of exercise tests using cycle ergometer who are part of a population that is comparable to this study. KEY WORDS: Exercise Test, Physical Fitness, Peak Oxygen Uptake, VO2peak, Reference Values

Compared to white athletes, African/Afro-Caribbean (black) athletes exhibit cardiovascular specifities. In the ECG, early repolarization is much more common. The prevalence of T-wave inversions in black athletes is present in up to 23%, and in white athletes in 2-4%. Domed ST segment elevation combined with T-wave inversion in the anterior leads is a typical finding in black athletes. In addition, left ventricular hypertrophyis more pronounced. 12-18% develop wall thicknesses >12mm (maximal 16mm) compared to 2-4% in white athletes (maximal 14mm). There are no significant differences in left ventricular end-diastolic diameter, systolic and diastolic function and the right ventricle. As early as in adolescence, black athletes reveal thicker chamber walls (maximal 15mm), and repolarization changes are more frequent than in white athletes. Similar to males, black female athletes present a greater left ventricular hypertrophy than white female athletes, and T-wave inversions are more frequent. In conclusion,the gray zone between physiological and pathological left ventricular hypertrophy is greater in black athletes.KEY WORDS: Ethnic Differences, Cardiovascular Specifities, ECG, Echocardiography, Hypertrophy

In the context of her check up for sports eligibility, an 11-year-old professional female gymnast reported a retrosternal pain during high intensity parts of the fitness training. The physical examination revealed a 2/6 systolic murmur in the second left intercostal space without radiation and a fixed splitting of the second heart sound. Resting ECG showed right heart overload with right axis deviation, incomplete right bundle branch block as well as terminal negative T-waves in V1-V3. Transthoracic echocardiography revealed a relevant atrial septal defect (ASD) of secundum type with a left to right shunt and consecutive right heart overload. This finding could be confirmed both angiographically and by means of transoesophageal echocardiography. Due to the size of the defect and the lack of sufficient caudal septal rim, transcatheter closure with implantation of an Amplatzer Septal Occluder could not be successfully performed. Thus, the indication was given for a surgical repair of the ASD which was performed with direct suture closure (primary closure). The postoperative course was uneventful. No signs of chest pain were noticedafterresumption of her usual training in the same intensity. Isolated chest pain during exercise is an unusual leading symptom in ASD patients and should always be clarified with cardiac imaging. Based on this case report, the important role of the resting ECG and echocardiography in the setting of preparticipation screening can be emphasized.KEY WORDS:Thoracic Pain, ASD, Echocardiography, Sports Eligibility