Harrogate consensus agreement: Cycling-specific sport-related concussion.

Sport-related concussion (SRC) is a common and increasingly recognised sport-related injury and accounts for between 1% and 9% of all cycling-specific injuries. Attention has been drawn to the difficulty in managing suspected SRC in a fast-paced sport such as road cycling, particularly the lack of an effective and time-efficient assessment protocol. A meeting on cycling SRC was convened in Harrogate, United Kingdom, in an attempt to resolve this problem. The aim was to agree on standard terminology, definitions, diagnostic protocols and return to play protocols for the various differing codes of cycle sport. Seven experts in the field of cycling medicine were invited to participate by the International Cycling Union and are the authors of this report. The panel recognised that the sport of cycling consists of varied disciplines, some of which provide a setting in which a sideline assessment is possible which is in line with the Berlin Consensus statement. However, other disciplines provide challenging circumstances where health care providers have limited access to participants and where participants are unable to discontinue participation and participate in sideline assessment. Consensus-based discipline-specific protocols and guidelines which recognise the limitations posed by these circumstances, but nevertheless, improve on the current situation specific to the sport of cycling are presented as a potential solution to the unique challenges posed by these cycling disciplines.

Alternate-Day Low Energy Availability During Spring Classics in Professional Cyclists.

PURPOSE: To assess energy and carbohydrate (CHO) availability and changes in blood hormones in 6 professional male cyclists over multiple single-day races. METHODS: The authors collected weighed-food records, power-meter data, and morning body mass measurements across 8 d. CHO intakes were compared with contemporary guidelines. Energy availability (EA) was calculated as energy intake minus exercise energy expenditure, relative to fat-free mass (FFM). Skinfold thickness and blood metabolic and reproductive hormones were measured prestudy and poststudy. Statistical significance was defined as P ≤ .05. RESULTS: Body mass (P = .11) or skinfold thickness (P = .75) did not change across time, despite alternate-day low EA (14 [9] vs 57 [10] kcal·kg-1 FFM·d-1, race vs rest days, respectively; P < .001). Cyclists with extremely low EA on race days (<10 kcal·kg-1 FFM·d-1; n = 2) experienced a trend toward decreased testosterone (-14%) and insulin-like growth factor 1 (-25%), despite being high EA (>46 kcal·kg-1 FFM·d-1) on days between. CHO intakes were significantly higher on race versus rest days (10.7 [1.3] vs 6.4 [0.8] g·kg-1·d-1, respectively; P < .001). The cyclists reached contemporary prerace fueling targets (3.4 [0.7] g·kg-1·3 h-1 CHO; P = .24), while the execution of CHO guidelines during race (51 [9] g·h-1; P = .048) and within acute (1.6 [0.5] g·kg-1·3 h-1; P = .002) and prolonged (7.4 [1.0] g·kg-1·24 h-1; P = .002) postrace recovery was poor. CONCLUSIONS: The authors are the first to report the day-by-day periodization of energy and CHO in a small sample of professional cyclists. They also examined the logistics of conducting a field study under stressful conditions in which major cooperation from the subjects and team management is needed. Their commentary around these challenges and possible solutions is a major novelty of the article.

Color Doppler Ultrasound Imaging in the Assessment of Iliac Endofibrosis.

Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF.