Dark Chocolate Intake Positively Modulates Gut Permeability in Elite Football Athletes: A Randomized Controlled Study.

Gut barrier disruption can lead to enhanced intestinal permeability, which allows endotoxins, pathogens, and other proinflammatory substances to move through the intestinal barrier into circulation. Intense exercise over a prolonged period increases intestinal permeability, which can be further worsened by the increased production of reactive oxygen species (ROS) and pro-inflammatory cytokines. The aim of this study was to assess the degree of intestinal permeability in elite football players and to exploit the effect of cocoa polyphenols on intestinal permeability induced by intensive physical exercise. Biomarkers of intestinal permeability, such as circulating levels of zonulin, a modulator of tight junctions, occludin, a tight junction protein, and LPS translocation, were evaluated in 24 elite football players and 23 amateur athletes. Moreover, 24 elite football players were randomly assigned to either a dark chocolate (>85% cocoa) intake (n = 12) or a control group (n = 12) for 30 days in a randomized controlled trial. Biochemical analyses were performed at baseline and after 30 days of chocolate intake. Compared to amateur athletes, elite football players showed increased intestinal permeability as indicated by higher levels of zonulin, occludin, and LPS. After 30 days of dark chocolate intake, decreased intestinal permeability was found in elite athletes consuming dark chocolate. In the control group, no changes were observed. In vitro, polyphenol extracts significantly improved intestinal damage in the human intestinal mucosa cell line Caco-2. These results indicate that chronic supplementation with dark chocolate as a rich source of polyphenols positively modulates exercise-induced intestinal damage in elite football athletes.

Physical Exercise and Mental Health: The Routes of a Reciprocal Relation.

Sport participation and exercise practice are considered to be beneficial for mental status, yielding an improved mood and better quality of life. On the other hand, good mental fitness is thought to lead to better physical status and sport performance. The key aim of this narrative review is to provide an unstructured overview on the topic with special considerations on the role of mental and physical health to summarize the evidence on their reciprocal influence. While very few papers describe the role of mental health measures in affecting physical performance, more evidence is available concerning the effect of exercise and sport in improving mental health outcomes. Furthermore, there is a consistent role of depressive and anxiety symptoms in influencing the risk of sport injury in either recreational or elite athletes. Moreover, the importance of investigating mental health issues in elite and retired athletes is highlighted. On the basis of the available literature, several biases were found to affect the provided evidence mainly because of the complexity of a proper study design in this field.

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes.

INTRODUCTION: Very limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals. METHODS: A total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7-18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center. RESULTS: Their heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001). CONCLUSIONS: Significant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.

Electrocardiographic and echocardiographic evaluation of a large cohort of peri-pubertal soccer players during pre-participation screening.

BACKGROUND: The early diagnosis of cardiac abnormalities in young athletes may be helpful not only to identify subjects potentially at risk of sudden cardiac death but also to prevent stress-related cardiac dysfunction and cardiovascular events during the life of these subjects. The aim of our study was to investigate the prevalence of cardiac abnormalities in a population of young male soccer players undergoing pre-participation screening through electrocardiogram and trans-thoracic echocardiography. METHODS: All consecutive male football players undergoing pre-participation screening comprehensive of medical history, physical examination, 12-lead electrocardiogram and trans-thoracic echocardiography at the FMSI Sport Medicine Institute in Rome between January 2008-March 2009 were enrolled in the study. RESULTS: Overall, 2261 consecutive young athletes aged 12.4 ± 2.6 years were evaluated. Training-unrelated electrocardiogram abnormalities were observed in 65 (2.9%) athletes. Abnormal trans-thoracic echocardiography was observed in 102 athletes (4.5%), including two cases of hypertrophic cardiomyopathy, eight of mild left ventricular hypertrophy, six of mild left ventricular dilation and 17 of bicuspid aortic valve. An abnormal electrocardiogram was associated with anomalous trans-thoracic echocardiography in 11/65 (16.9%) cases. All athletes requiring sport disqualification were identified by electrocardiogram. Notably, among 2216 athletes with a normal electrocardiogram, 91 had abnormal trans-thoracic echocardiography, including six cases of left ventricular dilation and six of ventricular hypertrophy. CONCLUSIONS: In a wide population of peri-pubertal male athletes, evaluation of the electrocardiogram identified all cardiac diseases requiring sport disqualification. Trans-thoracic echocardiography alone allowed the identification of cardiac abnormalities potentially leading to cardiomyopathies or major cardiovascular events over time.

Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes.

Background Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents. Design The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population. Methods We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8-18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week. Results Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight ( p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass. Conclusion Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.

Clinical significance of ST depression at exercise stress testing in competitive athletes: usefulness of coronary CT during screening.

BACKGROUND: Congenital coronary anomalies (CCAs) and coronary artery disease (CAD) arouse intense scientific and clinical interest in sports medicine and sports cardiology medical communities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercise stress testing represent the first instrumental assessment to evaluate electrocardiographic changes during effort. Coronary computed tomography angiography (CCTA) is an advanced accurate noninvasive imaging modality for excluding CAD and abnormalities of origin and course of coronary vessels. The aim of this study is to investigate with CCTA the clinical significance of ST depression suggestive for myocardial ischemia during exercise stress testing in athletes and to determine the prevalence of CAD and/or CCAs. METHODS: Sixty-five consecutive athletes showing electrocardiographic findings positive or equivocal for myocardial ischemia on exercise stress testing during pre-participation screening were investigated with CCTA. RESULTS: Among the 65 athletes investigated, 36 showed Myocardial Bridge (MB), one showed an anomalous coronary origin and seven showed CAD. Among 36 athletes with MB, 4 were associated with mild coronary artery stenosis. Three athletes with CAD needed percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. CONCLUSIONS: In competitive athletes even with excellent workload capacities, in absence of cardiomyopathy, the presence of ischemic electrocardiographic abnormalities could be mainly determined by a coronary congenital or acquired pathology. In this population CCTA is a useful imaging modality of choice for the risk stratification and for the diagnostic process, to allow eligible athletes to compete and to follow-up subjects requiring medical surveillance.

Effectiveness of a new cervical pillow on pain and sleep quality in recreational athletes with chronic mechanical neck pain: a preliminary comparative study.

BACKGROUND: The aim of this intervention study was to determine the effects of a new experimental cervical pillow, on symptomatic adults affected by chronic mechanical neck pain. METHODS: Twelve recreational athletes of both sexes (mean age 40.5 years; range 35-55), affected by grade II chronic mechanical neck pain, were evaluated with a daily diary type of self-report questionnaire, which incorporated an 11-point Numerical Rating Pain Scale, to collect the primary outcome measures of pre- and post-sleep neck pain and with the Neck Pain Disability Scale. Tympanic temperature, heart rate (HR) variability continuous monitoring during sleep, overnight pillow comfort and sleep quality were assessed. RESULTS: Average weekly scores in overall questionnaires, tympanic temperature and the HR low frequency (LF) / high frequency (HF) ratio were significantly lower (P<0.05) after the use of the DM2 pillow than the own pillow. The 80% of participants considered the DM2 "perfectly comfortable" and reported a "good" quality of sleep lying over it. CONCLUSIONS: The use of an appropriate pillow is a determinant factor in relieving neck pain, improving LF/HF ratio and enhancing-vagal activity, promoting deeper stages during the sleep. The shape of this pillow maintains an appropriate cervical curvature, reduces intra-disc pressure allowing a better distribution of loads between cervical discs. The round shaped portion of the pillow, facilitates breathing and avoids the narrowing of the airway due to the incorrect position during the sleep. The peculiar material of the DM2 pillow, contributed to lower brain temperature promoting dry heat loss from the head to the pillow, reducing sweating.

Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects.

AIM: To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes. METHODS: Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard pre-participation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram (ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured. RESULTS: Twenty-one of the 316 subjects (6.9%) showed false tendons in the left ventricle. The majority of false tendons (52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects (52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise. CONCLUSION: Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.

Ophthalmologic findings in contact sport disciplines.

BACKGROUND: The aim of the study was to investigate the prevalence and the incidence of ocular complications in contact sport disciplines in a large population of professional and amateur athletes over a period of 3 years. METHODS: We performed a retrospective review of 694 medical records from athletes examinated from 2008 to 2011. The following data were collected during the routine visit for agonistic sports eligibility: medical history, age, weight, years of sport practice, approximate number of matches, head and eyes injuries during and beyond of the match and a through ocular history. All athletes underwent a detailed ophthalmological evaluation. The follow-up of each athlete was carried out during the following routine visit for agonistic sports eligibility. RESULTS: Most common disorders observed were: peripheral retinal degeneration, blepharitis, conjunctival and corneal diseases with a prevalence of 7%, 4%, 7% and 4% respectively. It was observed a positive correlation between peripheral retinal degeneration and age in amateur male boxers. Moreover, we noticed an incidence of 6% of laser therapeutic treatments as a result of retinal holes or degenerations, during the follow-up. CONCLUSIONS: Contact sport disciplines did not result in higher prevalence of severe ocular lesion. Both conjuntival diseases and peripheral retinal degenerations represented the ophthalmologic disorders with the higher prevalence in our sample. In particular, peripheral retinal degeneration is remarkable because of the increased risk of retinal detachment. Dyschromatopsie, even if quite rare, should be considered when analysing the reception of shots, since gloves in most cases are either red or blue.

Myocarditis in athlete and myocardial bridge: An innocent bystander?

Myocarditis is a bacterial or viral inflammatory disease, often unnoticed or misdiagnosed. Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death. In the present report, we describe a case of an asymptomatic, apparently healthy, competitive athletes, who was diagnosed a myocarditis and as incidental finding a myocardial bridging. We focused the attention on the importance of anamnesis, electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up, focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis, especially for the athletes.

Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram.

OBJECTIVE: T wave inversion (TWI) has been associated with cardiomyopathies. The hypothesis of this study was that TWI has relevant clinical significance in peri-pubertal athletes. METHODS: Consecutive male soccer players, aged 8-18 years, undergoing preparticipation screening between January 2008 and March 2009 were enrolled. Medical and family histories were collected; physical examinations, 12-lead ECGs and transthoracic echocardiogram (TTE) were performed. TWI was categorised by ECG lead (anterior (V1-V3), extended anterior (V1-V4), inferior (DII-aVF) and infero-lateral (DII-aVF/V4-V6/DI-aVL)) and by age. RESULTS: Overall, 2261 (mean age 12.4 years, 100% Caucasian) athletes were enrolled. TWI in ≥2 consecutive ECG leads was found in 136 athletes (6.0%), mostly in anterior leads (126/136, 92.6%). TWI in anterior leads was associated with TTE abnormalities in 6/126 (4.8%) athletes. TWI in extended anterior (2/136, 1.5%) and inferior (3/136, 2.2%) leads was never associated with abnormal TTE. TWI in infero-lateral leads (5/136, 3.7%) was associated with significant TTE abnormalities (3/5, 60.0%), including one hypertrophic cardiomyopathy (HCM) and two LV hypertrophies. Athletes with normal T waves had TTE abnormalities in 4.4% of cases, including one HCM with deep Q waves in infero-lateral leads. CONCLUSIONS: In this broad population of peri-pubertal male athletes, TWI in anterior leads was associated with mild cardiac disease in 4.8% of cases, while TWI in infero-lateral leads revealed HCM and LV hypertrophy in 60% of cases. ECG identified all cases of HCM.

Oxidative stress responses to a graded maximal exercise test in older adults following explosive-type resistance training.

We recently demonstrated that low frequency, moderate intensity, explosive-type resistance training (EMRT) is highly beneficial in elderly subjects towards muscle strength and power, with a systemic adaptive response of anti-oxidant and stress-induced markers. In the present study, we aimed to evaluate the impact of EMRT on oxidative stress biomarkers induced in old people (70-75 years) by a single bout of acute, intense exercise. Sixteen subjects randomly assigned to either a control, not exercising group (n=8) or a trained group performing EMRT protocol for 12-weeks (n=8), were submitted to a graded maximal exercise stress test (GXT) at baseline and after the 12-weeks of EMRT protocol, with blood samples collected before, immediately after, 1 and 24h post-GXT test. Blood glutathione (GSH, GSSG, GSH/GSSG), plasma malonaldehyde (MDA), protein carbonyls and creatine kinase (CK) levels, as well as PBMCs cellular damage (Comet assay, apoptosis) and stress-protein response (Hsp70 and Hsp27 expression) were evaluated. The use of multiple biomarkers allowed us to confirm that EMRT per se neither affected redox homeostasis nor induced any cellular and oxidative damage. Following the GXT, the EMRT group displayed a higher GSH/GSSG ratio and a less pronounced increase in MDA, protein carbonyls and CK levels compared to control group. Moreover, we found that Hsp70 and Hsp27 proteins were induced after GXT only in EMRT group, while any significant modification within 24h was detected in untrained group. Apoptosis rates and DNA damage did not show any significant variation in relation to EMRT and/or GXT. In conclusion, the adherence to an EMRT protocol is able to induce a cellular adaptation allowing healthy elderly trained subjects to cope with the oxidative stress induced by an acute exercise more effectively than the aged-matched sedentary subjects.

Therapeutic horseback riding in breast cancer survivors: a pilot study.

PURPOSE: To evaluate the physiologic and psychological effects of an equine-assisted therapy protocol (EAT) in breast cancer survivors. METHODS: Twenty women (mean age, 45.61±2.71 years) whose breast cancer treatment had concluded at least 6 months previously underwent a screening protocol to certify their eligibility to participate in noncompetitive sports. The patients were randomly assigned to an intervention group (n=10) or a control group (n=10). Intervention patients participated in a 16-week EAT protocol consisting of 2 hours of activity per week. All patients were tested before and after the intervention for maximal oxygen consumption (VO2max), fat mass percentage, total body water percentage, strength of principal muscular groups (measured on five weight-lifting machines [leg press, leg extension, leg curl, shoulder press, vertical traction]), and quality of life using the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire (FACIT-F). RESULTS: After intervention, the intervention group showed an improvement in VO2max (28.29%; p<.001), a decrease in fat mass percentage (change, -7.73%; p<0.002), an increase in total body water percentage (6.90%; p=0.027), and an increase in strength (leg press, 17.75% [p=0.018]; leg extension, 21.55% [p=0.005]; leg curl, 26.04% [p<0.001]; shoulder press, 49.72% [p=0.003]; vertical traction, 19.27% [p=0.002]). Furthermore, the increase in the three FACIT-F scores (FACIT-F trial outcome: 9.29% [p=0.010]; Functional Assessment of Cancer Therapy-General total score, 14.80% [p=0.022]; FACIT-F total score, 11.48% [p=0.004]) showed an increase in quality of life. No significant changes for any variable were found for the control group. CONCLUSIONS: EAT had positive effects on both physiologic and psychological measures, enhancing quality of life of breast cancer survivors. RESULTS suggest a new method for rehabilitation intervention strategies after cancer in a nonmedical environment.

Pre-participation screening for the prevention of sudden cardiac death in athletes.

Pre-partecipation screening is the systematic practice of medically evaluating large populations of athletes before participation in sport activities for the purpose of identifying abnormalities that could cause disease progression or sudden death. In order to prevent sudden cardiac death (SCD), cardiovascular screening should include a strategy for excluding high-risk subjects from athletic and vigorous exercise. There are two major screening programmes in the world. In the United States competitive athletes are screened by means of family and personal history and physical examination. In Italy there is a mandatory screening for competitive athletes, which includes a resting electrocardiogram (ECG) for the detection of cardiac abnormalities. The most important issue to be addressed is whether a screened subject is really guaranteed that she/he is not suffering from any cardiac disease or at risk for SCD. Conceivably, the introduction of echocardiogram during the pre-participation screening, could be reasonable, despite the discrete sensitivity of ECG, in raising clinical suspicions of severe cardiac alterations predisposing to SCD. It is clear that the cost-benefit ratio per saved lives of the ECG screening is a benchmark of the Public Health policy. On the contrary, the additional introduction of echocardiography in a large population screening programme seems to be too much expansive for the Public Health and for this reason not easily practicable, even if useful and not invasive. Even if we strongly believe that a saved life is more important than any cost-efficacy evaluation, the issue of the economical impact of this approach should be further assessed.

Consumption and biochemical impact of commercially available plant-derived nutritional supplements. An observational pilot-study on recreational athletes.

BACKGROUND: A growing consumption of natural (plant-derived) dietary supplements with ergogenic aims, with particular regard for ecdysteroids, phytoestrogens and vegetal sterols, has been registered over the last years among "recreational" athletes. The present study was carried out in order to evaluate the real knowledge of plant-derived nutritional supplements among physically active people as well as their real consumption. Additional aim was to evaluate the effects of these supplements on the health profile of the users. METHODS: Twenty-three trained subjects who habitually used natural dietary supplements, and 30 matched controls were analyzed for plasma biochemical markers and hormonal profile. RESULTS: The laboratory tests revealed the absence of any sign of organ toxicity/damage in both athletes and controls. On the contrary, hormone profiles revealed marked alterations in 15 (65%) out of the 23 of investigated athletes. Specifically, 10 males presented increased plasma levels of progesterone, 15 subjects presented abnormal estrogen levels, including 5 (2 F and 3 M) presenting a "dramatic" increased estrogen values and 2 two males with increased estrogen levels, increased testosterone levels and associated suppression of luteinizing hormone and follicle-stimulating hormone. CONCLUSIONS: The results of the present study highlighted that the habitual consumption of plant-derived nutritional supplements is frequently associated with significant hormonal alterations both in male and female subjects. Although these biochemical alterations were not associated with signs or symptoms of organ toxicity/damage at the moment of the study, it cannot be excluded that, in the mid/long-term, these subjects would suffer of health problems secondary to chronic exposure to heavily altered hormonal levels. Further large scale studies are needed to confirm the results of this pilot study as well as to investigate the biological mechanisms at the base of the observed hormonal alterations.

Structural cardiac disease diagnosed by echocardiography in asymptomatic young male soccer players: implications for pre-participation screening.

PURPOSE: To evaluate the prevalence of structural cardiac lesions using echocardiography in apparently healthy boys referred for pre-participation screening (PPS). SUBJECTS AND METHODS: 3100 male soccer players were evaluated by echocardiography in addition to the standard PPS. RESULTS: In 56 subjects (1.8%), a structural cardiac lesion with potential future complication was detected. Specifically, hypertrophic cardiomyopathy (HCM) was found in two boys; bicuspid aortic valve (BAV) in 24; mitral valve prolapse in 10 and atrial septal defects (ASDs) in 20. Resting physical examination (PE) failed to identify any abnormalities in the majority of the subjects. All the boys presented an uncomplicated echocardiography, except two boys with HCM, one with BAV associated with aortic dilatation and one with a large ASD. CONCLUSION: Asymptomatic young athletes may have a structural cardiac alteration with the potential of present or future haemodynamic and arrhythmic consequences. A majority of mild cardiac lesions are difficult to diagnose or suspect by the current screening based on medical history, PE and ECG. Transthoracic echocardiography significantly improves the diagnostic power of screening in the detection of both mild and serious cardiac conditions in the athletic population.

Quantification of facial movements by surface laser scanning.

Quantification of facial mimic ability represents a need for comparative investigation in facial medicine and surgery. The aim of the current study was to develop a simple, noninvasive, repeatable three-dimensional method for measuring facial mobility in clinical and research setup. The faces of 20 healthy adult subjects (10 men and 10 women) and 12 primary school children (6 boys and 6 girls), without craniofacial pathologic injuries or previous treatments, were captured by a Cyberware 3030RGB laser scanner (Cyberware, Inc, Monterey, CA) in rest position and during voluntary movements. Data were processed by Cyberware Echo (Cyberware, Inc) and Inus Rapidform 2004 software (INUS Technologies Inc, Seoul, South Korea). Each movement was assigned a main landmark. The facial movements were described for surface displacement using clearance vector mapping and three-dimensional tracing of the skin landmarks. The mean landmark displacement vector was also calculated for every movement. The study showed that movements were characterized by similar displacement in the same facial areas in all subjects. Minor differences were recorded between adult subjects and children. Descriptive statistics concerning the amount and direction of movements were provided. A case of unilateral postsurgical nerve palsy was prospectively analyzed to test applicability of the method in clinical investigation. A numerical scale based on the mean movements was constructed and used to monitor recovery of function.The method developed seems easy, noncontact, and effective to quantify facial movements in normal and pathologic conditions. It may be usefully applied to the investigation and the clinical monitoring of different medical and surgical pathologic conditions.