IOC consensus statement on recommendations and regulations for sport events in the heat.

This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes' behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

Repeated Short-Term Bouts of Hyperoxia Improve Aerobic Performance in Acute Hypoxia.

ABSTRACT: Faulhaber, M, Schneider, S, Rausch, LK, Dünnwald, T, Menz, V, Gatterer, H, Kennedy, MD, and Schobersberger, W. Repeated short-term bouts of hyperoxia improve aerobic performance in acute hypoxia. J Strength Cond Res 37(10): 2016-2022, 2023-This study aimed to test the effects of repeated short-term bouts of hyperoxia on maximal 5-minute cycling performance under acute hypoxic conditions (3,200 m). Seventeen healthy and recreationally trained individuals (7 women and 10 men) participated in this randomized placebo-controlled cross-over trial. The procedures included a maximal cycle ergometer test and 3 maximal 5-minute cycling time trials (TTs). TT1 took place in normoxia and served for habituation and reference. TT2 and TT3 were conducted in normobaric hypoxia (15.0% inspiratory fraction of oxygen). During TT2 and TT3, the subjects were breathing through a face mask during five 15-second periods. The face mask was connected through a nonrebreathing T valve to a 300-L bag filled with 100% oxygen (intermittent hyperoxia) or ambient hypoxic air (placebo). The main outcome was the mean power output during the TT. Statistical significance level was set at p < 0.05. The mean power output was higher in the intermittent hyperoxia compared with the placebo condition (255.5 ± 49.6 W vs. 247.4 ± 48.2 W, p = 0.001). Blood lactate concentration and ratings of perceived exertion were significantly lower by about 9.7 and 7.3%, respectively, in the intermittent hyperoxia compared with the placebo condition, whereas heart rate values were unchanged. IH application increased arterial oxygen saturation (82.9 ± 2.6% to 92.4 ± 3.3%, p < 0.001). Repeated 15-second bouts of hyperoxia, applied during high-intensity exercise in hypoxia, are sufficient to increase power output. Future studies should focus on potential dose-response effects and the involved mechanisms.

Low-Molecular-Weight Heparin Resistance and Its Viscoelastic Assessment in Critically Ill COVID-19 Patients.

Critically ill COVID-19 patients present an inflammatory and procoagulant status with a high rate of relevant macro- and microvascular thrombosis. Furthermore, high rates of heparin resistance have been described; yet, individualized anticoagulation by drug monitoring has not been sufficiently researched. We analyzed data from critically ill COVID-19 patients treated at Innsbruck Medical University Hospital with routinely adapted low-molecular-weight heparin (LMWH) doses according to anti-Xa peak levels, and regularly performed ClotPro analyses (a viscoelastic hemostatic whole blood test). A total of 509 anti-Xa peak measurements in 91 patients were categorized as below (<0.008 IU/mL/mg), within (0.008-0-012 IU/mL/mg) or above (> 0.012 IU/mL/mg) expected ranges with respect to the administered LMWH doses. Besides intergroup comparisons, correlations between anti-Xa levels and ClotPro clotting times (CTs) were performed (226 time points in 84 patients). Anti-Xa peak levels remained below the expected range in the majority of performed measurements (63.7%). Corresponding patients presented with higher C-reactive protein and D-dimer but lower antithrombin levels when compared with patients achieving or exceeding the expected range. Consequently, higher enoxaparin doses were applied in the sub-expected anti-Xa range group. Importantly, 47 (51.6%) patients switched between groups during their intensive care unit (ICU) stay. Anti-Xa levels correlated weakly with IN test CT and moderately with Russell's viper venom (RVV) test CT. Critically ill COVID-19 patients present with a high rate of LMWH resistance but with a variable LMWH response during their ICU stay. Therefore, LMWH-anti-Xa monitoring seems inevitable to achieve adequate target ranges. Furthermore, we propose the use of ClotPro's RVV test to assess the coagulation status during LMWH administration, as it correlates well with anti-Xa levels but more holistically reflects the coagulation cascade than anti-Xa activity alone.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness.

Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections.

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

Supplemental O 2 During Recovery Does Not Improve Repeated Maximal Concentric-Eccentric Strength-Endurance Performance in Hypoxia.

ABSTRACT: Dünnwald, T, Morawetz, D, Faulhaber, M, Gatterer, H, Birklbauer, C, Koller, A, Weiss, G, and Schobersberger, W. Supplemental O 2 during recovery does not improve repeated maximal concentric-eccentric strength-endurance performance in hypoxia. J Strength Cond Res 36(11): 3065-3073, 2022-An alpine ski racing training session typically includes repeated bouts of maximal exercise at high altitude. We evaluated whether hyperoxic recovery between 5 sets of high-intensity strength-endurance exercises, which resembled ski racing activity and were performed in hypoxia, has beneficial effects on performance and acid-base status. In this randomized, single blinded crossover study, 15 highly skilled ski athletes (4 f/11 m; 29.7 ± 5.7 years) performed 5 90 seconds flywheel sets (S) in a normobaric hypoxic chamber (3,500 m). The flywheel sets were separated by 4 15-minute recovery periods. During recovery, subjects received either 100% O 2 (hyperoxic setting [HS]) or hypoxic air (nonhyperoxic setting [NHS]; FiO 2 : 0.146). Performance outcomes (e.g., power output [PO], concentric peak power [Con peak ], and eccentric peak power [Ecc peak ]) and physiological parameters (e.g., heart rate, blood gases, and blood lactate) were evaluated. Mean PO, Con peak , and Ecc peak from S1 to S5 did not differ between settings (146.9 ± 45 W and 144.3 ± 44 W, 266.9 ± 80 W and 271.2 ± 78 W, and 271.0 ± 93 W and 274.1 ± 74 W for HS and NHS, respectively; p ≥ 0.05). SpO 2 , PaO 2 , and CaO 2 were higher during recovery in HS than in NHS ( p ≤ 0.001). Lactate levels were significantly lower in the last recovery phase in HS than in NHS ( p = 0.016). Hyperoxic recovery has no impact on performance in a setting resembling alpine ski racing training. Positive effects on arterial oxygen content and cellular metabolism, as indicated by reduced blood lactate levels during recovery in the hyperoxic setting, seem to be insufficient to generate a direct effect on performance.

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020.

OBJECTIVES: This document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management. METHODS: Members of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management. RESULTS: Sports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site. CONCLUSIONS: A coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018).

OBJECTIVES: We describe compliance with the 'IOC Needle Policy' at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro. METHOD: All needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively. RESULTS: In total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD. CONCLUSION: A limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.

Sex-Related Differences After a Single Bout of Maximal Eccentric Exercise in Response to Acute Effects: A Systematic Review and Meta-analysis.

Morawetz, D, Blank, C, Koller, A, Arvandi, M, Siebert, U, and Schobersberger, W. Sex-related differences after a single bout of maximal eccentric exercise in response to acute effects: a systematic review and meta-analysis. J Strength Cond Res 34(9): 2697-2707, 2020-The most prominent effects after unaccustomed eccentric exercise are muscle damage, muscle soreness, strength loss, and higher concentrations of muscle proteins in the plasma. The aim of this systematic review is to evaluate sex-related differences in these acute effects. A systematic literature search in MEDLINE following the PRISMA guidelines was performed. Inclusion criteria were the difference in absolute outcomes between sexes in eccentric muscle strength, strength loss after eccentric exercise, blood concentrations of creatine kinase (CK), and delayed onset muscle soreness (DOMS). Results for maximal eccentric torque and CK data were pooled using a random-effect meta-analysis. A meta-regression was conducted to explain heterogeneity. Based on the 23 included trials, men showed significantly higher absolute eccentric strength. No sex-related differences were detected when normalizing strength for body mass, cross-sectional area of the muscle, or fat-free mass. Women displayed a tendency toward greater relative strength loss immediately after exercise. The absolute CK concentrations of men were significantly higher after exercise-induced muscle damage. No significant difference was found between sexes in DOMS. Untrained men and women display similar responses in all measures of relative muscle strength and DOMS. Apart from the enzymatic activity after exercise and the levels of absolute eccentric torque, there is no evidence for sex-related differences immediately after eccentric exercise. Therefore, eccentric training might have the same impact on men and women. One potential sex difference with practical relevance would be the possible difference in fatigue pattern immediately after eccentric exercise.

Supervised Short-term High-intensity Training on Plasma Irisin Concentrations in Type 2 Diabetic Patients.

Irisin is a myokine involved in adipocyte transformation. Its main beneficial effects arise from increased energy expenditure. Irisin production is particularly stimulated by physical exercise. The present study investigates the changes of plasma irisin in type 2 diabetic patients performing 2 different training modalities. Fourteen type 2 diabetic patients underwent 4 week of supervised high-intensity interval training (HIT; n=8) or continuous moderate-intensity training (CMT; n=6), with equivalent total amounts of work required. Plasma samples were collected in the resting state atbaseline and one day after the exercise intervention to analyse resting plasma irisin, blood lipids, blood glucose, hsCRP, Adiponectin, Leptin and TNF-α concentrations. In addition, body composition and VO2peak were determined Resting plasma irisin increased after HIT (p=0.049) and correlated significantly with plasma fasting glucose at follow-up (r=0.763; p=0.006). CMT did not significantly change the amount of plasma irisin, although follow-up values of plasma irisin correlated negatively with fat-free mass (r=-0.827, p=0.002) and with fasting plasma glucose (r = - 0.934, p=0.006). Plasma irisin was found to increase with higher training intensity, confirming the assumption that exercise intensity, in addition to the type of exercise, may play an important role in the stimulation of the irisin response.

Combined Hyperbaric Oxygen Partial Pressure at 1.4 Bar with Infrared Radiation: A Useful Tool To Improve Tissue Hypoxemia?

Tissue hypoxia contributes to the pathogenesis of several acute and chronic diseases. Hyperbaric oxygen therapy (HBO) and whole-body warming using low-temperature infrared technology (LIT) are techniques that might improve hypoxemia. Combining HBO and LIT as hyperbaric oxygen therapy combined with low-temperature infrared radiation (HBOIR) might be an approach that results in positive synergistic effects on oxygenation. LIT increases blood flow and could reduce HBO-induced vasoconstriction, and hyperoxia could compensate for the increased metabolic oxygen requirements mediated by LIT. Both LIT and HBO increase the oxygen diffusion distance in the tissues. HBOIR at 0.5 bar has been shown to be safe and feasible. However, physiological responses and the safety of HBOIR at an increased oxygen (O2) partial pressure of 1.4 bar or 2.4 atmospheres absolute (ATA) still need to be determined. The hope is that should HBOIR at an increased oxygen partial pressure of 1.4 bar be safe, future studies to examine its efficacy in patients with clinical conditions, which include peripheral arterial disease (PAD) or wound healing disorders, will follow. The results of pilot studies have shown that HBOIR at an overload pressure is safe and well tolerated in healthy participants but can generate moderate cardiovascular changes and an increase in body temperature. From the findings of this pilot study, due to its potential synergistic effects, HBOIR could be a promising tool for the treatment of human diseases associated with hypoxemia.

Story behind meldonium-from pharmacology to performance enhancement: a narrative review.

Recent reports from the World Anti-Doping Agency (WADA) indicate an alarming prevalence in the use of meldonium among elite athletes. Therefore, in January 2016, meldonium was added to WADA's prohibited list after being monitored since 2015. Meldonium has been shown to have beneficial effects in cardiovascular, neurological and metabolic diseases due to its anti-ischaemic and cardioprotective properties, which are ascribed mainly to its inhibition of ß-oxidation and its activation of glycolysis. Despite its widespread use, there are only a few clinical studies or clinical trials available. Meldonium is registered in most Baltic countries and is easily accessible through the internet with no serious adverse effects reported by the manufacturer so far. Among athletes, meldonium is used with the purpose of increasing recovery rate or exercise performance. The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative and is discussed without sound scientific evidence. This narrative review provides a detailed overview of the drug meldonium, focusing on the main topics pharmacology and biochemical actions, clinical applications, pharmacokinetics, methods of detection and potential for performance enhancement in athletes.

The effects of a 3-month controlled hiking programme on the functional abilities of patients following total knee arthroplasty: a prospective, randomized trial.

PURPOSE AND HYPOTHESIS: Improvements in pain, function and sports activity are the main goals of patients following total knee arthroplasty (TKA). Participation in sports has become an increasingly important contributor to patients' quality of life (QoL). Hiking is one of the most popular summer activities among elderly people in alpine regions. Consequently, this randomized controlled trial investigates the impact of a 3-month guided hiking programme on patients' functional abilities and QoL following TKA. It was hypothesized that patients who participate in this programme would demonstrate improvements in functional and QoL parameters compared with a control group. METHODS: Forty-eight TKA patients were included and randomized into either the intervention group (IG; n = 25) or the control group (CG; n = 23). The IG participated in a 3-month hiking programme (2-3 times a week), whereas the CG performed activities of daily living. The stair climb test (SCT), QoL questionnaires and isokinetic force measurements were completed at three time points (i.e. pre-test, post-test, retention-test). ANOVAs for repeated measurements were conducted for the SCT results. The Friedman test and the Mann-Whitney U test were performed for the QoL parameters. RESULTS: After the 3-month hiking programme, the IG achieved faster overall walking times on the SCT. The time decreased from 4.3 ± 0.6 s (pre-test) to 3.6 ± 0.4 s (post-test) for the stair ascent (p = 0.060) and from 3.6 ± 0.6 s (pre-test) to 3.2 ± 0.5 s (post-test) for the stair descent (p = 0.036). The IG showed significant improvement on some of the subscales of the Knee Injury and Osteoarthritis Outcome Score from pre-test to retention-test (p < 0.01). In the CG, no significant changes were observed (n.s.). CONCLUSIONS: The results indicate moderate improvement in the functional abilities and QoL of TKA patients who participated in a 3-month guided hiking programme compared with the patients in the CG. Hiking did not have any acute detrimental effects on the TKA patients during this study period. LEVEL OF EVIDENCE: II.

Diagnosis and prediction of the occurrence of acute mountain sickness measuring oxygen saturation--independent of absolute altitude?

PURPOSE: Commercialization of trekking tourism enables untrained persons to participate in trekking tours. Because hypoxia is one of the main purported triggers for acute mountain sickness (AMS), pulse oximetry, which measures arterial oxygen saturation (SPO2), is discussed to be a possible and useful tool for the diagnosis of AMS. The purpose of this study was to evaluate possible associations between SPO2 values and the occurrence of AMS. METHODS: In 204 trekkers, SPO2 values (pulse oximetry) were measured and the Lake Louise Self-assessment Score (LLS) was administered over the first 7 days of their trekking tours. RESULTS: During treks at altitudes of 2500-5500 m in Nepal, India, Africa, and South America, 100 participants suffered from mild AMS, 3 participants suffered from severe AMS, and 9 participants reported both mild and severe AMS. The lowest mean SPO2 was 85.5 (95 % confidence interval (CI), 83.9-86.1 %) on day 5. SPO2 and LLS exhibited a weak to moderate negative correlation for all days of the study (ρ ranging from -0.142 to -0.370). Calculation of time-shifted associations of 24 and 48 h resulted in the disappearance of most associations. Susceptibility to headaches (odds ratio (OR) 2.9-7.2) and a history of AMS (OR 2.2-3.1) were determined to be potential risk factors for the development of AMS. CONCLUSION: Since there is no strong altitude-independent association between AMS and SPO2 during the first week of high-altitude adaptation, the implementation of pulse oximetry during trekking in order to detect and predict AMS remains questionable.

Short-term effects of bright light therapy in adults with chronic nonspecific back pain: a randomized controlled trial.

OBJECTIVE: The present trial evaluated incorporation of bright light therapy in the treatment of chronic nonspecific back pain (CNBP). DESIGN: A prospective, randomized, controlled, multicenter, open design with three parallel trial arms was used. SETTING: Subjects received a novel therapeutic, an expected therapeutic ineffective low dose, or no light exposure at three different medical centers. PATIENTS: A total of 125 CNBP patients reporting pain intensity of ≥3 points on item 5 of the Brief Pain Inventory (BPI) were included. INTERVENTION: Over 3 weeks, 36 active treatment, 36 placebo controls, and 33 controls received 3 or no supplementary light exposures of 5.000 lx or 230 lx, respectively. OUTCOME MEASURES: Changes in self-reported scores of pain intensity (BPI sub-score 1) and depression (Hospital Anxiety and Depression Questionnaire) were the primary outcome measures. Secondary outcome measures were changes in self-reported overall pain sensation (BPI total score), grade of everyday life impairment (BPI sub-score 2), mood (visual analog scale), and well-being (World Health Organization-Five Well-Being Index). RESULTS: Changes in pain intensity were higher (1.0 [0.8-1.6]) in the bright light group compared with controls (0.3 [-0.1-0.8]; effect size D = 0.46). Changes in the depression score were also higher in the intervention group (1.5 [0.0-2.5]) compared with controls (0.0 [0.0-2.0]; effect size D = 0.86). No differences were seen in change scores between intervention vs sham group. CONCLUSION: The present randomized controlled trial shows that light therapy even in low dose could improve depressive symptoms and reduce pain intensity in CNBP patients. Further research is needed for optimizing parameters of frequency, dose, and duration of therapeutic light exposure.

Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review.

PURPOSE: Allergic bronchial asthma is one of the most common chronic diseases worldwide. For many years, the climate at moderate altitude has been used as an alternative therapy for patients suffering from bronchial asthma. The aim of such therapy is to reduce the medication dose and to improve the quality of life for each patient. The aim of our current work was to assess published data evaluating the effects of climate therapy at moderate altitude on the health status of patients with bronchial asthma. The health status is represented through surrogate parameters for the pulmonary function (forced expiratory volume in one second (FEV1)), bronchial hyperresponsiveness (PC20), and inflammation (total number of eosinophils, eosinophilic cationic protein, and exhaled nitric oxide). METHODS: Our systematic review included randomized controlled trials (RCTs) and single-armed studies with adults and children participating. Included in our review were climate therapies occurring at moderate altitudes between 1,500 and 2,500 m and evaluation of patient FEV1 or PC20 values. RESULTS: A literature research in MEDLINE and EMBASE identified three RCTs, two clinically controlled trials, and 15 single-armed studies. Analysis revealed a lack of evidence regarding the moderate altitude therapy arising from small sample sizes, deficits in documentation, and heterogeneous results. Most of the studies, however, showed a tendency for improvement of the analyzed parameters. CONCLUSIONS: The currently available data do not allow for valid and generalizable recommendations with respect to moderate altitude therapy for patients with allergic bronchial asthma. There is a need for additional, qualitatively strong research including larger sample sizes and randomized, controlled trial design.

Effects of hiking at moderate and low altitude on cardiovascular parameters in male patients with metabolic syndrome: Austrian Moderate Altitude Study.

OBJECTIVE: Physical activity is a cornerstone in therapy for patients with metabolic syndrome. Walking and hiking in a mountain scenery represents an ideal approach to make them move. The Austrian Moderate Altitude Study (AMAS) 2000 main study is a randomized controlled trial to investigate the cardiovascular effects of hiking at moderate altitude on patients with metabolic syndrome compared with a control group at low altitude, to assess a potential altitude-specific effect. METHODS: Seventy-one male patients with metabolic syndrome were randomly assigned to a moderate altitude group (at 1700 m), with 36 participants, or to a low altitude group (at 200 m), with 35 participants. The 3-week vacation program included 12 hiking tours (4 per week, average duration 2.5 hours, intensity 55% to 65% of heart rate maximum). Physical parameters, performance capacity, 24-hour blood pressure, and heart rate profiles were obtained before, during, and after the stay. RESULTS: In both groups, we found a significant mean weight loss of -3.13 kg; changes in performance capacity were minor. Systolic, diastolic, and mean arterial pressures and circadian heart rate profiles were significantly reduced in both groups, with no differences between them. Consequently, the pressure-rate product was reduced as well. All study participants tolerated the vacation well without any adverse events. CONCLUSIONS: A 3-week hiking vacation at moderate or low altitude is safe for patients with metabolic syndrome and provides several improvements in their cardiovascular parameters. The cardiovascular benefits achieved are more likely to be the result of regular physical activity than the altitude-specific effect of a mountain environment.

Effects of resistance training on respiratory function in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

PURPOSE: Over the last decade, the potential use of resistance training (RT) for patients with chronic obstructive pulmonary disease (COPD) has gained increasing attention. Many COPD patients experience muscle dysfunction and reduced muscle mass, primarily as a result of chronic immobilization. These symptoms have been associated with reduced exercise tolerance and complaints of fatigue and dyspnea (even after minimal exertion). This paper presents findings from a systematic review that sought to: (1) present a meta-analysis of randomized controlled trials (RCT) investigating the effects of RT on respiratory function measures in patients with COPD and (2) investigate the existence of a dose-response relationship between intensity, duration and frequency of RT and assessed outcomes. METHODS: A systematic literature search of MEDLINE electronic database (January 1980 to December 2009) produced a body of research on the effects of RT with a control group in patients with COPD. Data analysis involved a random effects meta-analysis, in order to determine weighted mean differences with 95 confidence intervals (95% CI) for each endpoint. All data were analyzed with the software package Review Manager V 4.2.10 (of the Cochrane Collaboration); 14 RCTs were included in the meta-analysis. RESULTS: Findings demonstrated that RT did not substantially increase forced expiratory volume in 1 s. In addition, the weighted mean difference was 2.71% of predicted (95% CI, -1.86 to 7.27; p = 0.25) or by absolute 0.08 L (95% CI, -0.03 to 0.19; p = 0.14). It appeared that maximum minute ventilation increased by 3.77 L/min (95% CI, -0.51 to 8.04; p = 0.08). CONCLUSIONS: Based on findings from the meta-analysis, RT produces a clinically and statistically significant effect on respiratory function (such as forced vital capacity) and is therefore recommended in the management of COPD.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches.

Introduction: Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings. Methods: Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach. Results: In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples. Discussion: Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.