Technology Innovation and Guardrails in Elite Sport: The Future is Now.

A growing number of companies are developing or using wearable sensor technologies that can monitor, analyse and transmit data from humans in real time that can be used by the sporting, biomedical and media industries. To explore this phenomenon, we describe and review two high-profile sporting events where innovations in wearable technologies were trialled: the Tokyo 2020 Summer Olympic Games (Tokyo 2020, Japan) and the 2022 adidas Road to Records (Germany). These two major sporting events were the first time academic and industry partners came together to implement real-time wearable solutions during major competition, to protect the health of athletes competing in hot and humid environments, as well as to better understand how these metrics can be used moving forwards. Despite the undoubted benefits of such wearables, there are well-founded concerns regarding their use including: (1) limited evidence quantifying the potential beneficial effects of analysing specific parameters, (2) the quality of hardware and provided data, (3) information overload, (4) data security and (5) exaggerated marketing claims. Employment and sporting rules and regulations also need to evolve to facilitate the use of wearable devices. There is also the potential to obtain real-time data that will oblige medical personnel to make crucial decisions around whether their athletes should continue competing or withdraw for health reasons. To protect athletes, the urgent need is to overcome these ethical/data protection concerns and develop wearable technologies that are backed by quality science. The fields of sport and exercise science and medicine provide an excellent platform to understand the impact of wearable sensors on performance, wellness, health, and disease.

Recent Improvements in Marathon Run Times Are Likely Technological, Not Physiological.

Every women's and men's world records from 5 km to the marathon has been broken since the introduction of carbon fibre plate (CFP) shoes in 2016. This step-wise increase in performance coincides with recent advancements in shoe technology that increase the elastic properties of the shoe thereby reducing the energy cost of running. The latest CFP shoes are acknowledged to increase running economy by more than 4%, corresponding to a greater than 2% improvement in performance/run time. The recently modified rules governing competition shoes for elite athletes, announced by World Athletics, that includes sole thickness must not exceed 40 mm and must not contain more than one rigid embedded plate, appear contrary to the true essence and credibility of sport as access to this performance-defining technology becomes the primary differentiator of sporting performance in elite athletes. This is a particular problem in sports such as athletics where the primary sponsor of the athlete is very often a footwear manufacturing company. The postponement of the 2020 Summer Olympics provides a unique opportunity for reflection by the world of sport and time to commission an independent review to evaluate the impact of technology on the integrity of sporting competition. A potential solution to solve this issue can involve the reduction of the stack height of a shoe to 20 mm. This simple and practical solution would prevent shoe technology from having too large an impact on the energy cost of running and, therefore, determining the performance outcome.

Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport.

The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees' health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology's availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.

Wearable and telemedicine innovations for Olympic events and elite sport.

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic.

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.

Establishing a Global Standard for Wearable Devices in Sport and Exercise Medicine: Perspectives from Academic and Industry Stakeholders.

Millions of consumer sport and fitness wearables (CSFWs) are used worldwide, and millions of datapoints are generated by each device. Moreover, these numbers are rapidly growing, and they contain a heterogeneity of devices, data types, and contexts for data collection. Companies and consumers would benefit from guiding standards on device quality and data formats. To address this growing need, we convened a virtual panel of industry and academic stakeholders, and this manuscript summarizes the outcomes of the discussion. Our objectives were to identify (1) key facilitators of and barriers to participation by CSFW manufacturers in guiding standards and (2) stakeholder priorities. The venues were the Yale Center for Biomedical Data Science Digital Health Monthly Seminar Series (62 participants) and the New England Chapter of the American College of Sports Medicine Annual Meeting (59 participants). In the discussion, stakeholders outlined both facilitators of (e.g., commercial return on investment in device quality, lucrative research partnerships, and transparent and multilevel evaluation of device quality) and barriers (e.g., competitive advantage conflict, lack of flexibility in previously developed devices) to participation in guiding standards. There was general agreement to adopt Keadle et al.'s standard pathway for testing devices (i.e., benchtop, laboratory, field-based, implementation) without consensus on the prioritization of these steps. Overall, there was enthusiasm not to add prescriptive or regulatory steps, but instead create a networking hub that connects companies to consumers and researchers for flexible guidance navigating the heterogeneity, multi-tiered development, dynamicity, and nebulousness of the CSFW field.

The Use of Technology to Protect the Health of Athletes During Sporting Competitions in the Heat.

During the 2019 IAAF World Championships in Athletics in Doha and the 2020 Olympic Games in Tokyo, minimum daily temperatures are expected to be in excess of 30°C. Due to the metabolic demands of the sporting events and the high environmental temperatures, the risk of exertional heat stroke (EHS) is high. Careful planning by event organizers are needed to ensure that athletes are protected from irreversible long-term health damage, or even death during sporting competitions in the heat. Efforts typically have included standard medical plans, equipment, protocols, and expert medical teams. In addition, the importance of responding quickly to a hyperthermic athlete cannot be understated, as minimizing treatment time will greatly improve the chances of full recovery. Treatment time can be minimized by notifying medical personnel about the health status of the athlete and the extent of any pre-competition heat acclimatization. Technology that allows the live transmission of physiological, biomechanical, and performance data to alert medical personnel of potential indicators of EHS should be considered. Real time monitoring ecosystems need to be developed that integrate information from numerous sensors such as core temperature-monitoring "pills" to relay information on how an athlete is coping with competing in intense heat. Medical/support staff would be alerted if an athlete's responses were indicating signs of heat stress or EHS signs and the athlete could be withdrawn under exceptional circumstances. This technology can also help provide more rapid, accurate and dignified temperature assessment at the road/track side in medical emergencies.