Surgical Management of Latissimus Dorsi and Teres Major Tears in a Water-Skiing Injury: A Case Report and Literature Review.

Tears of the latissimus dorsi and/or teres major tendons are uncommon, with no definitive management. Surgical repair has been reported in high-level athletes, mostly in baseball players. Simultaneous tears of both latissimus dorsi and teres major tendons are rare, with little known of surgical intervention outcomes. We report on the first published case of surgical repair of both latissimus dorsi and teres major tendon tears from a water-skiing injury in a 45-year-old male with favorable outcomes.

Exercise is the Most Important Medicine for COVID-19.

ABSTRACT: COVID-19 infection and long COVID affect multiple organ systems, including the respiratory, cardiovascular, renal, digestive, neuroendocrine, musculoskeletal systems, and sensory organs. Exerkines, released during exercise, have a potent crosstalk effect between multiple body systems. This review describes the evidence of how exerkines can mitigate the effects of COVID-19 in each organ system that the virus affects. The evidence presented in the review suggests that exercise should be considered a first-line strategy in the prevention and treatment of COVID-19 infection and long COVID disease.

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.

Postactivation Performance Enhancement in Healthy Adults Using a Bodyweight Conditioning Activity: A Systematic Review and Meta-analysis.

ABSTRACT: Brink, NJ, Constantinou, D, and Torres, G. Postactivation performance enhancement in healthy adults using a bodyweight conditioning activity: a systematic review and meta-analysis. J Strength Cond Res 37(4): 930-937, 2023-A systematic review and meta-analysis were conducted to review the available evidence on whether a bodyweight conditioning activity can acutely improve the performance outcome of a subsequent task through postactivation performance enhancement. Data sources included PubMed (National Library of Medicine), Web of Science (Clarivate Analytics), Google Scholar, SPORTDiscuss (EBSCO), Embase (Elsevier), and Thesis Global. Subjects were healthy, active adults who performed either a vertical jump or a linear sprint outcome measurement. All studies were randomized controlled trials where the effects of a bodyweight conditioning activity were compared with a control condition. The control group followed the same course as the experimental group excluding the intervention, with the intervention and outcome measurement carried out in the same session. The intervention was completed before the initiation of the outcome measure testing. Nineteen studies fulfilled the eligibility criteria and were included. There was a small overall effect of 0.30 (95% confidence interval 0.14-0.46, p = 0.0003) in favor of using a bodyweight conditioning activity to improve the outcome of a subsequent vertical jump or linear sprint. Secondary analysis indicated that there was no difference between the vertical jump and sprint subgroup, <5 minutes or 5 minutes and greater between the intervention and outcome measurement subgroup, or whether an intervention with the same movements or different movements was used before the outcome task subgroup. Using bodyweight conditioning activities before performing a maximal vertical jump or sprint may provide a small benefit in performance outcome.

The effects of a 3-day mountain bike cycling race on the autonomic nervous system (ANS) and heart rate variability in amateur cyclists: a prospective quantitative research design.

BACKGROUND: The acute and chronic adaptation of endurance athletes' hearts shows that increased volume of endurance exercise might cause an acute reduction in cardiac function, causing a physiological cascade that leads to the release of cardiac biomarkers specific to cardiomyocyte stress. Heart rate variability (HRV) is a valuable tool used as a physiological measurement to evaluate the autonomic nervous system (ANS). It is frequently used to assess cardiac autonomic regulation, determining a patient's risk for unfavorable events. This study set out to determine the changes in the ANS by participating in a 3-day mountain bike cycling race in amateur cyclists using HRV as an outcome measure. METHODS: Sixteen healthy participants (male and female) participating in a 3-day mountain bike cycling race underwent five-minute resting electrocardiography recordings in a supine position 2 days before the race (baseline testing). In addition, HRV measurements were recorded after each race day and 24 h post-race (recovery). RESULTS: Time-domain and frequency-domain measures showed significant changes from baseline HRV parameters after each race day (p ≤ 0.05). In addition, our data revealed that the mean heart rate and R-R variability intervals did not return to baseline values after 24 h of recovery. Thus, autonomic nervous system (ANS) alterations may be due to changes in cardiac sympatho-vagal balance. CONCLUSIONS: The main strength of this study is using HRV as a measuring and screening tool to assess cardiac autonomic activity, whereby the state of the ANS before and after endurance races can be measured. Thus, physicians, athletes, and coaches can determine the stress of endurance races on the ANS and plan recovery strategies. The reasoning is that if the ANS is in a state of sub-optimal function, susceptible amateur athletes might be at risk for a cardiovascular event or maladaptation due to the endurance race.

Cardio-Respiratory Fitness and Cardiovascular Disease Risk Factors Among South African Medical Students.

Cardiovascular disease (CVD) risk factors have been associated with CVD mortality, and physicians use CVD risk factor profiles (smoking, dyslipidemia, hypertension, etc.) to address patient health. Furthermore, cardio-respiratory fitness (CRF) has been shown to be an independent risk factor for CVD and all-cause mortality. Cardio-respiratory fitness is also the risk factor that contributes the highest percentage to all-cause deaths when compared to other traditional risk factors. In addition, studies have reported that adding CRF to established CVD risk factors improves the precision of prediction for CVD morbidity and mortality. Medical students tend to adopt sedentary and unhealthy lifestyles during the course of their education that negatively affect CVD risk factors and CRF. The majority of research on CVD risk, health status and lifestyle factors of medical students has used self-reported data and questionnaires for CVD risk factors and not included CRF in the health status measurements. In addition, studies have found that future medical doctors' own health and lifestyle practices influence their counselling activities. Allowing future medical doctors to assess their personal CVD risk factors and CRF may thus be important in their use of physical activity counselling with patients' lifestyle management for health benefits and improvement. A descriptive, cross-sectional cohort study design was used with the aim to determine CVD risk factors using CRF measures and physical activity levels in a cohort of South African medical students. The most significant finding was that they were not meeting the PA levels recommended to maintain health and lower CVD risk.

Comparative Effectiveness of Lifestyle Intervention on Fasting Plasma Glucose in Normal Weight Versus Overweight and Obese Adults With Prediabetes.

Background. It is hypothesized that normal weight individuals develop diabetes through different pathophysiological mechanisms and that methods of prevention may differ in the absence of overweight/obesity. In this study, we compared the effect of lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight, overweight, and obese US adults with prediabetes. Methods. Subjects were 1358 individuals who completed baseline and follow-up evaluations as part of an LHC program (follow-up = ~6 months). Participants were stratified, based on baseline body mass index (BMI), into normal weight (n = 129), overweight (n = 345), and obese (n = 884) cohorts. LHC included counseling, predominantly via telehealth, on exercise and nutrition. Results. BMI decreased (P < .001) in the overweight and obese participants but was unchanged in the normal weight participants. FPG decreased (P < .001) in all 3 cohorts, and the magnitude of decrease did not differ significantly among cohorts. FPG decreased to <5.6 mmol/L in 58.1%, 49.3%, and 41.4% of the normal weight, overweight, and obese participants, respectively. Conclusions. To our knowledge, this study is the first outside of Asia to show that LHC is as effective in managing FPG in normal weight adults with prediabetes versus those who are overweight/obese.

Use, Perceptions and Attitudes of Cognitive and Sports Performance Enhancing Substances Among University Students.

The use of prohibited performance enhancing substances (PESs) is well-documented among athletes, and includes student athletes in institutions of higher learning. In addition to using PESs to enhance sporting performance, they may be used for cognitive and academic achievement, specifically through the use of neuroactive substances. The latter in particular is under-researched and poses public health risks. Understanding the extent and reasons for using or not using PESs by university students will assist in addressing further research, and means to deter their use. This study aimed to explore the prevalence, attitude, and perceptions of the use of both sport and academic performance-enhancing substances by students at two universities in Johannesburg, South Africa. The study utilized a cross-sectional, descriptive survey design using a self-administered online questionnaire. All registered students were invited to participate via email using the university communications modes, with a link to a Google Forms questionnaire. Ethical approval was granted for the study and data were collected anonymously. The sample size of responses with completed data was 548, comprising predominantly female and undergraduate students, with 32 (6%) indicating current or past use of PESs. Among the prohibited substances used, neuroactive drugs were mostly used, with cannabis the highest followed by stimulants. The most popular reasons reported were for academic and cognitive performance. Most responded with what would be deemed ethically appropriate answers on the perception of PES use and 72% of the participants believe that a drug-testing program will prevent their use in the university, and further, that educational programs will help improve students' knowledge of PES. Although relatively low usage, university students use performance enhancing substances, mostly for cognitive enhancement using neuroactive stimulants. Most believe that the use of all forms of PESs is high among their peers; and favor education and testing programs, suggesting that intervention programs may be effective. Better defined research should be conducted to unpack the broad findings in this study.

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.

Postactivation performance enhancement (PAPE) using a vertical jump to improve vertical jump performance.

BACKGROUND: Postactivation performance enhancement (PAPE) is a principle that suggests that an acute bout of high intensity voluntary exercise will be followed by an improvement in strength, power, and speed of a subsequent task. This study intended to demonstrate how a maximal vertical jump (VJ) can enhance the outcome of a subsequent VJ compared to a multiple jump series (MJ) and a control. METHODS: In a randomized controlled, double blind trial, adult professional soccer players (N.=69) undertook maximal VJs at baseline and at 2 and 6 minutes postintervention after 1 of 3 interventions; 2 repetitions of a maximal VJ, 40 repetitions of a MJ or a walking control (CON). RESULTS: All baseline outcomes were similar between all the groups. Relative to the baseline there was a significant improvement for VJ in jump height and power output at 2 minutes of 1.89cm and 114.45W and relative to the baseline, MJ also had a significant improvement at 2 minutes of 1.51cm and 91.60W. By 6 minutes both groups had reverted to baseline values. There was no change in CON across the experiment and no significant difference between CON and the interventions. CONCLUSIONS: These findings suggest that 2 maximal VJs may enhance the outcome of a subsequent maximal VJ after 2 minutes and as much as a series of 40 jumps. However, these enhancements were not sustained for a further 4 minutes in either group.

Postactivation performance enhancement (PAPE) of sprint acceleration performance.

Postactivation performance enhancement (PAPE) is a principle that an acute bout of high-intensity voluntary exercise is followed by an enhancement in strength, speed or power production. This study intended to show a direct correlation between intensity, specificity and the outcome of a maximal task of sprint accelerations compared to a previously defined weighted plyometric intervention. In a randomised controlled, double-blind trial, professional footballers undertook 20 m maximal sprint accelerations at a baseline and at 2 and 6 min post-intervention after 1 of 3 interventions; 2 repetitions of 20 m sprint accelerations (S), 3 × 10 alternative leg weighted bounding (P) and control (C). Relative to the baseline there was a significant improvement for S over 10 and 20 m at 2 min of 0.12m.s-1 and 0.11m.s-1 and 6 min of 0.11m.s-1 and 0.12m.s-1. Relative to the baseline P also had a significant improvement over 10 and 20 m at 2 min 0.09m.s-1 and 0.09m.s-1 and 6 min of 0.11m.s-1 and 0.09m.s-1. There was a significant improvement in C between 2 and 6 min post-intervention at 10 and 20 m of 0.06m.s-1 and 0.08m.s-1. This finding suggests a maximal sprint acceleration may enhance the outcome of a subsequent maximal sprint acceleration at 2 min, but the latter results could not be directly attributed to the interventions as previous testing is likely to have influenced these outcomes.

Comparison of High-Intensity Training Versus Moderate-Intensity Continuous Training on Cardiorespiratory Fitness and Body Fat Percentage in Persons With Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: High-intensity training is comprised of sprint interval training (SIT) and high-intensity interval training (HIIT). This study compared high-intensity training with moderate-intensity continuous training (MICT) on cardiorespiratory fitness (CRF) and body fat percentage for overweight or obese persons. METHODS: A systematic search of randomized controlled trials using the health science databases occurred up to April, 2020. Twenty-six studies were included for complete analysis. A total of 784 participations were analyzed. The unstandardized mean difference for each outcome measurement was extracted from the studies and pooled with the random effects model. RESULTS: MICT was significantly better at improving CRF compared with SIT (mean difference = -0.92; 95% confidence interval, -1.63 to -0.21; P = .01; I2 = 10%). Furthermore, there was no significant difference between MICT versus HIIT on CRF (mean difference = -0.52; 95% confidence interval, -1.18 to 0.13; P = .12; I2 = 23%). There was no significant difference in body fat percentage between MICT versus HIIT and MICT versus SIT. CONCLUSIONS: MICT was significantly better at improving CRF than SIT in overweight or obese persons.

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

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.