Sport and exercise genomics: the FIMS 2019 consensus statement update.

Rapid advances in technologies in the field of genomics such as high throughput DNA sequencing, big data processing by machine learning algorithms and gene-editing techniques are expected to make precision medicine and gene-therapy a greater reality. However, this development will raise many important new issues, including ethical, moral, social and privacy issues. The field of exercise genomics has also advanced by incorporating these innovative technologies. There is therefore an urgent need for guiding references for sport and exercise genomics to allow the necessary advancements in this field of sport and exercise medicine, while protecting athletes from any invasion of privacy and misuse of their genomic information. Here, we update a previous consensus and develop a guiding reference for sport and exercise genomics based on a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. This SWOT analysis and the developed guiding reference highlight the need for scientists/clinicians to be well-versed in ethics and data protection policy to advance sport and exercise genomics without compromising the privacy of athletes and the efforts of international sports federations. Conducting research based on the present guiding reference will mitigate to a great extent the risks brought about by inappropriate use of genomic information and allow further development of sport and exercise genomics in accordance with best ethical standards and international data protection principles and policies. This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders.

Physical fitness and anthropometric characteristics among adolescents living in urban or rural areas of Kosovo.

BACKGROUND: High physical fitness levels in childhood and adolescence are associated with positive health-related outcomes later in life. Albeit many researchers investigated rural-urban differences in physical fitness, the outcomes of these studies are inconsistent and data on Kosovo are widely missing. Thus, this study aims to examine anthropometric and physical fitness parameters in 14 to 15 year old Kosovan adolescents living in rural and urban areas. METHODS: Two schools from Pristina (mostly urban population) and two schools in the surrounding villages of the district of Deçan (mostly rural population) were selected. Anthropometric and physical fitness parameters were determined from a total of 354 adolescents (216 urban: 14.5 ± 0.4 years, 138 rural: age 14.5 ± 0.4 years) who volunteered to participate in this cross-sectional study performed in 2013/14. RESULTS: The prevalence of overweight and obesity was 18.9% in girls and 28.2% in males and excess body fat was detected in 18.2% of the girls and 15.9% of the boys with no differences between rural and urban adolescents. Rural adolescents performed slightly better in relative handgrip strength (+4.7%, p = 0.032) and running speed (10 m: +2.2%, p = 0.012; 20 m: +1.9%, p = 0.035), but no other differences were detected in standing long jump, counter movement jump, cardiorespiratory fitness and sit and reach test. A multinomial logistic regression analysis revealed that being a female was associated with a lower relative risk for overweight (RR = 0.11, 95% CI: 0.03-0.34, p < 0.001) and high body fat content (RR = 0.20, 95% CI: 0.05-0.56, p < 0.001). In addition, higher handgrip strength, longer sprinting time and lower aerobic fitness were associated with a higher relative risk for overweight and excess body fat. In contrast, lower handgrip strength increased the risk for experiencing thinness (RR = 0.92, 95% CI: 0.89-0.96, p < 0.001). CONCLUSIONS: It could be shown that there is a high prevalence of overweight and obesity, especially in 14 to 15 year old boys in Kosovo which does not differ between rural and urban areas. Worse physical performance is associated with a higher risk for overweight and obesity highlighting the importance for interventions in this area and for starting longitudinal observations of a secular trend.

Elastic band resistance training influences transforming growth factor-ß receptor I mRNA expression in peripheral mononuclear cells of institutionalised older adults: the Vienna Active Ageing Study (VAAS).

BACKGROUND: Ageing, inactivity and obesity are associated with chronic low-grade inflammation contributing to a variety of lifestyle-related diseases. Transforming growth factor-ß (TGF-ß) is a multimodal protein with various cellular functions ranging from tissue remodelling to the regulation of inflammation and immune functions. While it is generally accepted that aerobic exercise exerts beneficial effects on several aspects of immune functions, even in older adults, the effect of resistance training remains unclear. The aim of this study was to investigate whether progressive resistance training (6 months) with or without nutritional supplementation (protein and vitamins) would influence circulating C-reactive protein and TGF-ß levels as well as TGF-ß signalling in peripheral mononuclear cells (PBMCs) of institutionalised adults with a median age of 84.5 (65.0-97.4) years. RESULTS: Elastic band resistance training significantly improved performance as shown by the arm-lifting test (p = 0.007), chair stand test (p = 0.001) and 6-min walking test (p = 0.026). These results were paralleled by a reduction in TGF-ß receptor I (TGF-ßRI) mRNA expression in PBMCs (p = 0.006), while circulating inflammatory markers were unaffected. Protein and vitamin supplementation did not provoke any additional effects. Interestingly, muscular endurance of upper and lower body and aerobic performance at baseline were negatively associated with changes in circulating TGF-ß at the early phase of the study. Furthermore, drop-outs of the study were characterised not only by lower physical performance but also higher TGF-ß and TGF-ßRI mRNA expression, and lower miRNA-21 expression. CONCLUSIONS: Progressive resistance training with elastic bands did not influence chronic low-grade inflammation but potentially affected TGF-ß signalling in PBMCs through altered TGF-ßRI mRNA expression. There appears to be an association between physical performance and TGF-ß expression in PBMCs of older adults, in which the exact mechanisms need to be clarified.

The acute effects of graded physiological strain on soccer kicking performance: a randomized, controlled cross-over study.

PURPOSE: The aim of the present study was to examine the acute effects of graded physiological strain on soccer kicking performance. METHODS: Twenty-eight semi-professional soccer players completed both experimental and control procedure. The experimental protocol incorporated repeated shooting trials combined with a progressive discontinuous maximal shuttle-run intervention. The initial running velocity was 8 km/h and increasing for 1 km/h every 3 min until exhaustion. The control protocol comprised only eight subsequent shooting trials. The soccer-specific kicking accuracy (KA; average distance from the ball-entry point to the goal center), kicking velocity (KV), and kicking quality (KQ; kicking accuracy divided by the time elapsed from hitting the ball to the point of entry) were evaluated via reproducible and valid test over five individually determined exercise intensity zones. RESULTS: Compared with baseline or exercise at intensities below the second lactate threshold (LT2), physiological exertion above the LT2 (blood lactate > 4 mmol/L) resulted in meaningful decrease in KA (11-13%; p < 0.05), KV (3-4%; p < 0.05), and overall KQ (13-15%; p < 0.01). The light and moderate-intensity exercise below the LT2 had no significant effect on soccer kicking performance. CONCLUSIONS: The results suggest that high-intensity physiological exertion above the player's LT2 impairs soccer kicking performance. In contrast, light to moderate physiological stress appears to be neither harmful nor beneficial for kicking performance.

Effects of elastic band resistance training and nutritional supplementation on muscle quality and circulating muscle growth and degradation factors of institutionalized elderly women: the Vienna Active Ageing Study (VAAS).

PURPOSE: Regular resistance exercise training and a balanced diet may counteract the age-related muscular decline on a molecular level. The aim of this study was to investigate the influence of elastic band resistance training and nutritional supplementation on circulating muscle growth and degradation factors, physical performance and muscle quality (MQ) of institutionalized elderly. METHODS: Within the Vienna Active Ageing Study, 91 women aged 83.6 (65.0-92.2) years were randomly assigned to one of the three intervention groups (RT, resistance training; RTS, resistance training plus nutritional supplementation; CT, cognitive training). Circulating levels of myostatin, activin A, follistatin, IGF-1 and GDF-15, as well as MQ and functional parameters were tested at baseline as well as after 3 and 6 months of intervention. RESULTS: MQ of lower extremities significantly increased in the RT group (+14 %) and RTS group (+12 %) after 6 months. Performance improved in the RT and RTS groups for chair stand test (RT: +18 %; RTS: +15 %). Follistatin increased only in the RT group (+18 %) in the latter phase of the intervention, accompanied by a decrease in the activin A-to-follistatin ratio (-7 %). IGF-1, myostatin and GDF-15 levels were not affected by the intervention. CONCLUSION: Our data confirm that strength training improves physical performance and MQ even in very old institutionalized women. This amelioration appears to be mediated by blocking muscle degradation pathways via follistatin rather than inducing muscle growth through the IGF-1 pathway. As plasma levels of biomarkers reflect an overall status of various organ systems, future studies of tissue levels are suggested.

Influence of age and physical fitness on miRNA-21, TGF-ß and its receptors in leukocytes of healthy women.

The TGF-ß superfamily has been shown to play an important role in a wide range of physiological as well as pathological processes including ageing, immune modulation, atherosclerosis and cancer development. The aim of the current study was to investigate (i) whether TGF-ß signalling in peripheral blood mononuclear cells (PBMCs) would differ between young and old females and (ii) whether physical performance parameters of elderly women would be related to the expression of TGF-ß or its receptors. Sixteen healthy young (22-28 years; YF) and 90 healthy older (65-92 years; OF) females participated in the study. In addition to several components of health-related physical fitness, circulating CRP and TGF-ß levels were determined together with the mRNA expression of TGF-ß, TGF-ßRI, TGF-ßRII, and miRNA-21 (known to interfere with TGF-ß signalling) in PBMCs. Physical fitness as determined by 6-minutes walking test (YF:median 932 (range 573-1254) m; OF:360 (114-558) m), handgrip strength (YF: 32 (24-39) kg; OF:18(10-30) kg), relative isokinetic peak torque of knee extensors (YF:1.9 (1.2- 2.3) Nm/kg; OF:1.0 (0.2-1.9) Nm/kg and flexors (YF: 1.1 (0.7- 1.5) Nm/kg; OF: 0.5 (0.2-1.0) Nm/kg was substantially lower in older women (p<0.001 for all comparisons). These changes were paralleled by an increase in hs-CRP (YF: 0.9 (0.1-4.3)mg/L; OF: 2.3 (0.3-56.7)mg/L,p<0.001). Serum levels of TGF-ß and TGF-ß mRNA levels from PBMCs did not differ between young and old women whereas, both TGF- ßRI/GAPDH (YF: 4.07 (1.38-14.60); OF: 2.08 (0.14-28.81); p=0.020) and TGF-ßRII/GAPDH levels (YF: 3.16 (1.14- 10.25); OF: 1.71 (0.51-14.86); p=0.020) were lower with respect to old age. In elderly women, only TGF-ßRΙ expression correlated negatively with miRNA-21 expression in PBMCs (ρ=-0.315; p=0.004). Interestingly, hs-CRP and miRNA correlated positively with handgrip strength (ρ=0.237 and ρ=243, p<0.05), while none of the TGF-ß-related parameters were related to physical performance. The results suggest that age affects TGF-ß signalling in leukocytes by altering the expression levels of its receptors. These changes seem to occur independently of physical fitness of old women.

Advancing the preparticipation physical evaluation: an ACSM and FIMS joint consensus statement.

: While the preparticipation physical evaluation (PPE) is widely accepted, its usage and content are not standardized. Implementation is affected by cost, access, level of participation, participant age/sex, and local/regional/national mandate. Preparticipation physical evaluation screening costs are generally borne by the athlete, family, or club. Screening involves generally agreed-upon questions based on expert opinion and tested over decades of use. No large-scale prospective controlled tracking programs have examined PPE outcomes. While the panel did not reach consensus on electrocardiogram (ECG) screening as a routine part of PPE, all agreed that a history and physical exam focusing on cardiac risk is essential, and an ECG should be used where risk is increased. The many areas of consensus should help the American College of Sports Medicine and Fédération Internationale du Médicine du Sport in developing a universally accepted PPE. An electronic PPE, using human-centered design, would be comprehensive, would provide a database given that PPE is mandatory in many locations, would simplify PPE administration, would allow remote access to clinical data, and would provide the much-needed data for prospective studies in this area.

Advancing the preparticipation physical evaluation (PPE): an ACSM and FIMS joint consensus statement.

While the preparticipation physical evaluation (PPE) is widely accepted, its usage and content are not standardized. Implementation is affected by cost, access, level of participation, participant age/sex, and local/regional/national mandate. PPE screening costs are generally borne by the athlete, family, or club. Screening involves generally agreed-upon questions based on expert opinion and tested over decades of use. No large-scale prospective controlled tracking programs have examined PPE outcomes. While the panel did not reach consensus on electrocardiogram screening as a routine part of PPE, all agreed that a history and physical exam focusing on cardiac risk is essential, and an ECG should be used where risk is increased. The many areas of consensus should help the American College of Sports Medicine and the Fédération Internationale du Médicine du Sport in developing a universally accepted PPE. An electronic PPE, using human-centered design, would be comprehensive, would provide a database given that PPE is mandatory in many locations, would simplify PPE administration, would allow remote access to clinical data, and would provide the much-needed data for prospective studies in this area.

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration.

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.

Effects of low and high cadence interval training on power output in flat and uphill cycling time-trials.

This study tested the effects of low-cadence (60 rev min(-1)) uphill (Int(60)) or high-cadence (100 rev min(-1)) level-ground (Int(100)) interval training on power output (PO) during 20-min uphill (TT(up)) and flat (TT(flat)) time-trials. Eighteen male cyclists ([Formula: see text]: 58.6 ± 5.4 mL min(-1) kg(-1)) were randomly assigned to Int(60), Int(100) or a control group (Con). The interval training comprised two training sessions per week over 4 weeks, which consisted of six bouts of 5 min at the PO corresponding to the respiratory compensation point (RCP). For the control group, no interval training was conducted. A two-factor ANOVA revealed significant increases on performance measures obtained from a laboratory-graded exercise test (GXT) (P (max): 2.8 ± 3.0%; p < 0.01; PO and [Formula: see text] at RCP: 3.6 ± 6.3% and 4.7 ± 8.2%, respectively; p < 0.05; and [Formula: see text] at ventilatory threshold: 4.9 ± 5.6%; p < 0.01), with no significant group effects. Significant interactions between group and uphill and flat time-trial, pre- versus post-training on PO were observed (p < 0.05). Int(60) increased PO during both TT(up) (4.4 ± 5.3%) and TT(flat) (1.5 ± 4.5%). The changes were -1.3 ± 3.6, 2.6 ± 6.0% for Int(100) and 4.0 ± 4.6%, -3.5 ± 5.4% for Con during TT(up) and TT(flat), respectively. PO was significantly higher during TT(up) than TT(flat) (4.4 ± 6.0; 6.3 ± 5.6%; pre and post-training, respectively; p < 0.001). These findings suggest that higher forces during the low-cadence intervals are potentially beneficial to improve performance. In contrast to the GXT, the time-trials are ecologically valid to detect specific performance adaptations.

Blood lactate concentration at the maximal lactate steady state is not dependent on endurance capacity in healthy recreationally trained individuals.

The aim of the study was to investigate the independent relationship between maximal lactate steady state (MLSS), blood lactate concentration [La] and exercise performance as reported frequently. Sixty-two subjects with a wide range of endurance performance (MLSS power output 199 ± 55 W; range: 100-302 W) were tested on an electronically braked cycle ergometer. One-min incremental exercise tests were conducted to determine maximal variables as well as the respiratory compensation point (RCP) and the second lactate turn point (LTP2). Several continuous exercise tests were performed to determine the MLSS. Subjects were divided into three clusters of exercise performance. Dietary control was employed throughout all testing. No significant correlation was found between MLSS [La] and power output at MLSS. Additionally, the three clusters of subjects with different endurance performance levels based on power output at MLSS showed no significant difference for MLSS [La]. MLSS [La] was not significantly different between men and women (average of 4.80 ± 1.50 vs. 5.22 ± 1.52 mmol l(-1)). MLSS [La] was significantly related to [La] at RCP, LTP2 and at maximal power. The results of this study support previous findings that MLSS [La] is independent of endurance performance. Additionally, MLSS [La] was not influenced by sex. Correlations found between MLSS [La] and [La] at maximal power and at designated anaerobic thresholds indicate only an association of [La] response during incremental and MLSS exercise when utilizing cycle ergometry.

Does a Physical Activity Intervention on Classroom-Based Ergometers During Teaching Lessons Effect Physical Fitness, Body Composition, and Health-Related Blood Parameters? A Pilot Cluster Randomized Controlled Study.

BACKGROUND: Time constraints comprise one limiting factor for implementing school-based physical activity programs. The aim of this pilot cluster randomized controlled study was to explore the effects of a cycle ergometer intervention during regular lessons on physical fitness, body composition, and health-related blood parameters. METHODS: Participants attended one of 2 classes selected from one school, which were randomly assigned to an intervention group (n = 23, 11.2 [0.5] y) consisting of cycling on classroom-based ergometers during 3 lessons per week at a self-selected intensity and a control group (n = 21, 11.3 [0.5] y) not receiving any treatment. Prior to and after the 5-month intervention period, physical fitness (with ventilatory threshold as primary outcome), body composition, and parameters of glucose and lipid metabolism were assessed. RESULTS: A significant time × group interaction was revealed for ventilatory threshold (P = .035), respiratory compensation point (P = .038), gross efficiency (P < .001), maximal aerobic power (P = .024), triglycerides (P = .041), and blood glucose levels (P = .041) with benefits for the intervention group. Peak oxygen uptake and body composition were not affected. CONCLUSIONS: Children's aerobic capacity benefited from the low-intensity school-based cycling intervention, while body composition and most blood parameters were not affected. The intervention using cycle ergometers is a feasible and time-saving strategy to elevate submaximal physical fitness.

Resistance training with or without nutritional supplementation showed no influence on muscle thickness in old-institutionalized adults: a secondary analysis of the Vienna Active Ageing Study.

BACKGROUND: Resistance training and protein supplementation are recommended strategies to combat sarcopenia. AIM: Quantification of muscle thickness (MT) by musculoskeletal ultrasound is a promising method to follow changes in skeletal muscles. The aim of this study was to investigate the effect of six months of resistance training with or without nutritional supplementation on MT of M. quadriceps in institutionalized old adults. DESIGN: This is a prospective, randomized, multi-arm parallel and controlled intervention study. SETTING: This study was conducted in five different retirement care facilities. POPULATION: Institutionalized individuals (mean age 82.6±6.2 years) were randomly assigned to an elastic band resistance training (N.=41), training with nutritional supplementation (N.=36) or control group (N.=40). METHODS: Health status and handgrip strength were investigated at baseline. MT of all parts of M. quadriceps of the left leg was assessed using musculoskeletal ultrasound at baseline and after six months. Linear regression models adjusted for age, BMI and sex were calculated to investigate the influence of baseline characteristics on MT. Multivariable regression analyses were performed for investigation of study intervention on MT. Follow-up examinations were performed after 12 and 18 months. RESULTS: Handgrip strength of both hands was significantly correlated with MT of M. vastus lateralis. Moreover, the sum of regularly taken medication was significantly correlated to MT of all parts of quadriceps. Six months of training or nutritional supplementation was not able to alter MT. However, participants with lower baseline MT values or a higher number of diseases and medications at baseline showed significant higher increases in MT after intervention. CONCLUSIONS: Resistance training using elastic bands with or without nutritional supplementation did not alter MT of M. quadriceps of old institutionalized individuals. However, baseline values and health status had a significant influence on the training effect. CLINICAL REHABILITATION IMPACT: As old individuals are very heterogenic according to their health and muscle status; further studies might focus on individualizing training regimes with particular emphasize on accompanied diseases and medications of this population.

Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations.

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Longitudinal monitoring of power output and heart rate profiles in elite cyclists.

Power output and heart rate were monitored for 11 months in one female (V(.)O(2max): 71.5 mL · kg⁻¹ · min⁻¹) and ten male (V(.)O(2max): 66.5 ± 7.1 mL · kg⁻¹ · min⁻¹) cyclists using SRM power-meters to quantify power output and heart rate distributions in an attempt to assess exercise intensity and to relate training variables to performance. In total, 1802 data sets were divided into workout categories according to training goals, and power output and heart rate intensity zones were calculated. The ratio of mean power output to respiratory compensation point power output was calculated as an intensity factor for each training session and for each interval during the training sessions. Variability of power output was calculated as a coefficient of variation. There was no difference in the distribution of power output and heart rate for the total season (P = 0.15). Significant differences were observed during high-intensity workouts (P < 0.001). Performance improvements across the season were related to low-cadence strength workouts (P < 0.05). The intensity factor for intervals was related to performance (P < 0.01). The variability in power output was inversely associated with performance (P < 0.01). Better performance by cyclists was characterized by lower variability in power output and higher exercise intensities during intervals.