Establishing a Global Standard for Wearable Devices in Sport and Fitness: Perspectives from the New England Chapter of the American College of Sports Medicine Members.

The recent explosion of wearable technology and the associated concerns prompted the International Federation of Sports Medicine (FIMS) to create a quality assurance standard for wearable devices, which provides commissioned testing of marketing claims and endorsement of commercial wearables that test favorably. An open forum as announced in the conference advertising was held at the Annual Meeting of the New England Regional Chapter of the American College of Sports Medicine (NEACSM) November 7 to 8, 2019, in Providence, Rhode Island, USA for attending NEACSM members to voice their input on the process. Herein, we report the proceedings. The round table participants perceived the quality assurance standard to be important, but identified some practical process challenges that included the broad scope and complexity of the device universe, the need for a multiphase testing pathway, and the associated fees for product evaluation. The participants also supported the evaluation of device data analysis, behavioral influences, and user experience in the overall evaluation. Looking forward, the FIMS quality assurance standard faces the challenge of balancing these broader perspectives with practical constraints of budget, facilities, time, and human resources.

Avoiding sports-related sudden cardiac death in children with congenital channelopathy : Recommendations for sports activities.

For the past few years, children affected by an inherited channelopathy have been counseled to avoid (recreational) sports activities and all competitive sports so as to prevent exercise-induced arrhythmia and sudden cardiac death. An increased understanding of the pathophysiological mechanisms, better anti-arrhythmic strategies, and, in particular, more epidemiological data on exercise-induced arrhythmia in active athletes with channelopathies have changed the universal recommendation of "no sports," leading to revised, less strict, and more differentiated guidelines (published by the American Heart Association/American College of Cardiology in 2015). In this review, we outline the disease- and genotype-specific mechanisms of exercise-induced arrhythmia; give an overview of trigger-, symptom-, and genotype-dependent guidance in sports activities for children with long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), or short QT syndrome (SQTS); and highlight the novelties in the current guidelines compared with previous versions. While it is still recommended for patients with LQT1 and CPVT (even when asymptomatic) and all symptomatic LQTS patients (independent of genotype) to avoid any competitive and high-intensity sports, other LQTS patients successfully treated with anti-arrhythmic therapies and phenotype-negative genotype-positive patients may be allowed to perform sports at different activity levels - provided they undergo regular, sophisticated evaluations to detect any changes in arrhythmogenic risk.

Sport science internships for learning: a critical view.

Sport science has gained vast popularity with students who have an interest in both physiology and the underpinning mechanisms of exercise concerning performance and health. The high numbers of graduates each year, coupled with the low number of graduate positions working in sports, has led to a high level of competition between students. To stand out from the crowd, sport science students may undertake an internship placement as part of their course, designed to enhance theoretical, practical, and soft skills in an applied setting. In the present article, we highlight some of the positives and negatives of sport science internships and ways in which they can be implemented and facilitated. Suggestions have also been provided to make students more aware of the reality of working in professional sports, which includes awareness of the potential for long and unsociable hours of work.

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions.

Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.

Do current sports nutrition guidelines conflict with good oral health?

For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs.

Mandatory mouthguard rules for high school athletes in the United States.

High school athletes seem particularly predisposed to dental injury, but athletic mouthguards have an excellent track record of success in reducing the severity and incidence of dental injuries in sports. Therefore, it has been suggested that mouthguards be made mandatory for high school athletes who participate in sports with risk of injury. The National Federation of State High School Associations currently recommends that mouthguards be mandated for high school football, lacrosse, ice hockey, and field hockey players as well as for wrestlers who are wearing orthodontic appliances. Different states have tried to mandate additional sports with varying degrees of success. This article summarizes the process that leads to rule changes for high school athletes at the national level and discusses the history of 4 states--Minnesota, Maine, New Hampshire, and Massachusetts--that have tried to mandate mouthguards for different sports. Common complaints that lead to the cessation of mouthguard rules, such as speech considerations, breathing ability, and cleanliness, are discussed.

[Sports and athletes deserve doping hunting]. / Oui à la chasse au dopage pour la santé des athlètes et du sport!

This article reviews the evidence-based ergogenic potential adverse effects of the most common products in use by recreational and elite athletes today. This is an aggressively marketed and controversial area of sports medicine wordwide. It is therefore important for the scientific societies, clinicians, dieticians sports federations to be well versed in the more popular supplements and drugs in order to have an important role in information and prevention attitudes that can lead to health risks or addictions!

King-Devick Test Reliability in National Collegiate Athletic Association Athletes: A National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research and Education Report.

CONTEXT: The King-Devick (KD) test has received considerable attention in the literature as an emerging concussion assessment. However, important test psychometric properties remain to be addressed in large-scale independent studies. OBJECTIVE: To assess (1) test-retest reliability between trials, (2) test-retest reliability between years 1 and 2, and (3) reliability of the 2 administration modes. DESIGN: Cross-sectional study. SETTING: Collegiate athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: A total of 3248 intercollegiate student-athletes participated in year 1 (male = 55.3%, age = 20.2 ± 2.3 years, height = 1.78 ± 0.11 m, weight = 80.7 ± 21.0 kg) and 833 participated in both years. MAIN OUTCOME MEASURE(S): Time, in seconds, to complete the KD error free. The KD test reliability was assessed between trials and between annual tests over 2 years and stratified by test modality (spiral-bound cards [n = 566] and tablet [n = 264]). RESULTS: The KD test was reliable between trials (trial 1 = 43.2 ± 8.3 seconds, trial 2 = 40.8 ± 7.8 seconds; intraclass correlation coefficient [ICC] (2,1) = 0.888, P < .001), between years (year 1 = 40.8 ± 7.4 seconds, year 2 = 38.7 ± 7.7 seconds; ICC [2,1] = 0.827, P < .001), and for both spiral-bound cards (ICC [2,1] = 0.834, P < .001) and tablets (ICC [2,1] = 0.827, P < .001). The mean change between trials for a single test was -2.4 ± 3.8 seconds. Although most athletes improved from year 1 to year 2, 27.1% (226 of 883) of participants demonstrated worse (slower) KD times (3.2 ± 3.9 seconds) in year 2. CONCLUSIONS: The KD test was reliable between trials and years and when stratified by modality. A small improvement of 2 seconds was identified with annual retesting, likely due to a practice effect; however, 27% of athletes displayed slowed performance from year 1 to year 2. These results suggest that the KD assessment was a reliable test with modest learning effects over time and that the assessment modality did not adversely affect baseline reliability.

Access to Athletic Trainer Services in California Secondary Schools.

CONTEXT: California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies. OBJECTIVE: To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Representatives of 1270 California high schools. MAIN OUTCOME MEASURE(S): Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch. RESULTS: More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values < .001). CONCLUSIONS: With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.

Analysis of States' Barriers to and Progress Toward Implementation of Health and Safety Policies for Secondary School Athletics.

CONTEXT: Implementation of health and safety best practices for the leading causes of sudden death and catastrophic injury has been shown to mitigate risk. However, to our knowledge, no authors have examined progress toward health and safety policy implementation at the state level. OBJECTIVE: To investigate the progress made by state secondary school leaders in developing and implementing health and safety policies (ie, exertional heat stroke, sudden cardiac arrest, concussion, emergency action plans) and to explore perceived barriers to and strategies for implementation. DESIGN: Mixed-methods study. SETTING: State high school athletics associations and sports medicine advisory committees. PATIENTS OR OTHER PARTICIPANTS: Collaborative Solutions for Safety in Sport meeting attendees participated in this study. Thirty-five state leaders (current role experience = 8 ± 6 years) completed the survey. Ten of the 35 participated in follow-up interviews. DATA COLLECTION AND ANALYSIS: A survey assessing progress on health and safety policy implementation was administered. Respondents indicated whether their state had implemented a policy, made progress without implementation, or made no progress. We conducted follow-up telephone interviews so they could expand on the survey responses. The data were analyzed using descriptive statistics and the general inductive approach. RESULTS: A total of 89% of respondents reported their states made progress on or implemented health and safety policies during the 2015-2016 academic year. Barriers to policy implementation included cost, a lack of understanding regarding policies versus recommendations, the content and value of policy change, and a false sense of security. Strategies for implementation included varying approaches to change, education of all constituents, and collaborative relationships among key stakeholders. CONCLUSIONS: Although a majority of respondents reported progress in implementing health and safety policies in their states, perceived barriers pointed to the need for the continued education of state leaders in charge of developing and implementing health and safety policies. Despite these barriers, collaboration among key stakeholders is crucial to successful implementation of best-practice policies in secondary school athletics.

Bayesian detection of abnormal hematological values to introduce a no-start rule for heterogeneous populations of athletes.

Sports authorities exclude athletes with abnormal levels of blood parameters. Here, the consideration of longitudinal blood profiles together with heterogeneous factors such as ethnicity and age produces a model with enhanced sensitivity to detect blood doping. Sports disciplines with heterogeneous populations now have a general method to introduce the no-start rule.

The Size and Scope of Collegiate Athletic Training Facilities and Staffing.

CONTEXT: Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified. OBJECTIVE: To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs. MAIN OUTCOME MEASURE(S): Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students. RESULTS: The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft2 (290.3 ± 411 m2) for the central athletic training facility, 1013 ± 1521 ft2 (94 ± 141 m2) for satellite athletic training facilities, 1272 ± 1334 ft2 (118 ± 124 m2) for game-day athletic training facilities, 388 ± 575 ft2 (36 ± 53 m2) for athletic training offices, and 424 ± 884 ft2 (39 ± 82 m2) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P < .001). Differences among other levels of competition were not as well defined. Expansion or renovation of facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for the near future. CONCLUSIONS: This study provides benchmark descriptive data on athletic training staffing and facilities. The results (1) suggest that the ATs were satisfied with their facilities and (2) highlight the differences in resources among competition levels.

Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal.

Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health.

CONTEXT: Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. OBJECTIVE: To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. DESIGN: Cross-sectional study. SETTING: College sports medicine departments. PATIENTS OR OTHER PARTICIPANTS: Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). MAIN OUTCOME MEASURE(S): Electronic survey of departmental mental health screening activities. RESULTS: A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. CONCLUSIONS: The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.

Sports drug testing using complementary matrices: Advantages and limitations.

Today, routine doping controls largely rely on testing whole blood, serum, and urine samples. These matrices allow comprehensively covering inorganic as well as low and high molecular mass organic analytes relevant to doping controls and are collecting and transferring from sampling sites to accredited anti-doping laboratories under standardized conditions. Various aspects including time and cost-effectiveness as well as intrusiveness and invasiveness of the sampling procedure but also analyte stability and breadth of the contained information have been motivation to consider and assess values potentially provided and added to modern sports drug testing programs by alternative matrices. Such alternatives could be dried blood spots (DBS), dried plasma spots (DPS), oral fluid (OF), exhaled breath (EB), and hair. In this review, recent developments and test methods concerning these alternative matrices and expected or proven contributions as well as limitations of these specimens in the context of the international anti-doping fight are presented and discussed, guided by current regulations for prohibited substances and methods of doping as established by the World Anti-Doping Agency (WADA). Focusing on literature published between 2011 and 2015, examples for doping control analytical assays concerning non-approved substances, anabolic agents, peptide hormones/growth factors/related substances and mimetics, ß2-agonists, hormone and metabolic modulators, diuretics and masking agents, stimulants, narcotics, cannabinoids, glucocorticoids, and beta-blockers were selected to outline the advantages and limitations of the aforementioned alternative matrices as compared to conventional doping control samples (i.e. urine and blood/serum).

Pregnant athletes: a summary review of the legal issues.

This summary review is not, and should not be relied upon as, legal advice. It has been prepared at the request of the Journal of Science and Medicine in Sport as a discussion paper for the purposes of providing a background in the legal issues arising from the participation of pregnant women in sport. The discussion is necessarily pitched at a very general level, and without any specific circumstances in mind. Readers with particular concerns, or with specific issues to be addressed, should seek independent legal advice.