ECG findings in professional rugby players using international screening recommendations.

Background: While World Rugby guidelines do not mandate the inclusion of an electrocardiogram (ECG) for all players, this is required for entry into international rugby competitions. We, therefore, sought to describe sport-specific normative ECG values and evaluate the performance of contemporary athlete ECG guidelines in male and female professional rugby players. Methods: We retrospectively analysed professional rugby players' ECGs (n=356, male 79%) obtained during preparticipation screening (2010-2022), comparing by sex and playing position (forwards vs backs). ECGs were categorised as normal 'training-related', borderline and abnormal findings, as defined by the 2017 International Recommendations. Results: 84% of players had one or more normal, 'training-related' findings, with males having a higher prevalence than females (91% vs 60%, p<0.001). Most ECG findings did not vary by position. No female player had borderline or abnormal ECG findings. Borderline findings were present in 3% (n=12/356) of players. Abnormal findings were present in 2% (n=7/356) of players. Overall, 2.2% of ECGs were 'positive' (n=8/356, including n=1 ECG with two borderline findings). Conclusions: The application of contemporary ECG interpretation criteria resulted in a low positivity rate isolated to male players. These results help inform the logistic feasibility of ECG-inclusive screening, which is already required to enter major tournaments.

Midlife hypertension is a risk factor for some, but not all, domains of cognitive decline in later life: a systematic review and meta-analysis.

INTRODUCTION: Management of midlife blood pressure and hypertension status may provide a window of intervention to mitigate cognitive decline with advancing age. The aim of this review was to investigate the relationship between midlife hypertension and cognition in midlife and later life. METHODS: Online electronic databases were searched from their inception to May 2022. Studies assessing midlife (40-65 years) hypertension and cognition at mid and/or later-life were included. A random effects meta-analysis was deemed appropriate. RESULTS: One hundred forty-nine studies across 26 countries were included. Qualitative synthesis found negative relationships between midlife hypertension and later life cognition in the domains of memory, executive function, and global cognition. Metanalytical evidence revealed midlife hypertension negatively impacts memory, executive function, and global cognition but had no observed effect on attention at midlife. DISCUSSION: Hypertension at midlife has a significant negative impact on cognition in mid-life and later life, namely memory, executive function, and global cognition.

Cardiovascular risk and systemic inflammation in male professional rugby: a cross-sectional study.

Objective: To investigate cardiovascular risk factors' prevalence and association with systemic inflammation in professional male rugby players (RP). Methods: A cross-sectional investigation of 46 professional male RP (26.1±4.1 years) cardiovascular risk factors were compared by position. Inflammatory markers were compared with healthy controls (n=13) and patients with rheumatoid arthritis (RA) (n=10). Results: Twenty-six per cent of RP had no risk factors, 49% had 1-2 cardiovascular risk factors and 25% had 3-4 risk factors. Forwards had greater body fat (p<0.001), visceral fat (p<0.001), glucose (p=0.025), and C reactive protein (CRP) (p=0.023) compared with backs. RP demonstrated more favourable lipid and glucose profiles than reference values for the general population. Most RP (n=28, 61%) had elevated blood pressure (≥140/90 mm Hg). RP had higher vascular adhesion molecule-1 (VCAM-1) (p=0.004) and intracellular adhesion molecule-1 (ICAM-1) (p=0.002) than healthy controls. RP had lower CRP than patients with RA (p=0.009), while one-third (n=15) displayed equivalent ICAM-1 and VCAM-1 levels. Multivariate clustering and principal component analysis biplots revealed higher triglycerides, inflammatory markers, and worse body composition were associated with forwards. Conclusions: Despite athletic status, most of this rugby cohort had at least one cardiovascular risk factor. Concomitantly, these RP demonstrated increased levels of inflammation, with one-third, primarily forwards, displaying equivalent levels to patients with inflammatory disease. Further studies are needed to unravel the prognostic implications of increased inflammation in RP because unchecked, chronic inflammation may lead to increased cardiovascular disease risk.

Diagnostic Accuracy of a Portable ECG Device in Rowing Athletes.

BACKGROUND: Athletes can experience exercise-induced transient arrythmias during high-intensity exercise or competition, which are difficult to capture on traditional Holter monitors or replicate in clinical exercise testing. The aim of this study was to investigate the reliability of a portable single channel ECG sensor and data recorder (PluxECG) and to evaluate the confidence and reliability in interpretation of ECGs recorded using the PluxECG during remote rowing. METHODS: This was a two-phase study on rowing athletes. Phase I assessed the accuracy and precision of heart rate (HR) using the PluxECG system compared to a reference 12-lead ECG system. Phase II evaluated the confidence and reliability in interpretation of ECGs during ergometer (ERG) and on-water (OW) rowing at moderate and high intensities. ECGs were reviewed by two expert readers for HR, rhythm, artifact and confidence in interpretation. RESULTS: Findings from Phase I found that 91.9% of samples were within the 95% confidence interval for the instantaneous value of the changing exercising HR. The mean correlation coefficient across participants and tests was 0.9886 (σ = 0.0002, SD = 0.017) and between the two systems at elevated HR was 0.9676 (σ = 0.002, SD = 0.05). Findings from Phase II found significant differences for the presence of artifacts and confidence in interpretation in ECGs between readers' for both intensities and testing conditions. Interpretation of ECGs for OW rowing had a lower level of reader agreement than ERG rowing for HR, rhythm, and artifact. Using consensus data between readers' significant differences were apparent between OW and ERG rowing at high-intensity rowing for HR (p = 0.05) and artifact (p = 0.01). ECGs were deemed of moderate-low quality based on confidence in interpretation and the presence of artifacts. CONCLUSIONS: The PluxECG device records accurate and reliable HR but not ECG data during exercise in rowers. The quality of ECG tracing derived from the PluxECG device is moderate-low, therefore the confidence in ECG interpretation using the PluxECG device when recorded on open water is inadequate at this time.

A 6-Month Randomized Trial of a Smartphone Application, UControlDrink, in Aiding Recovery in Alcohol Use Disorder.

BACKGROUND AND AIMS: Alcohol use disorder (AUD) is a substantial problem, causing early death and great economic burden. Research has highlighted the potential positive impact of technological interventions, such as smartphone applications (app) in treatment of AUD. The aim of this study was to explore the effectiveness of a smartphone app, incorporating computerized cognitive behavioural therapy and text messaging support, on alcohol outcomes over 6 months in a post-rehabilitation setting. METHODS: A total of 111 participants with AUD were recruited into this randomized controlled trial, following completion of a 30-day rehabilitation programme. The intervention group (n = 54) used the smartphone app "UControlDrink" (UCD) over 6 months with treatment as usual (TAU), and the control group (n = 57) received TAU. All subjects suffered from AUD as the primary disorder, with other major psychiatric disorders excluded. All intervention subjects used the UCD smartphone app in the treatment trial, and all subjects underwent TAU consisting of outpatient weekly support groups. Drinking history in the previous 90 days was measured at baseline and at 3- and 6-month follow-ups. Additional measurements were made to assess mood, anxiety, craving, and motivation. Results were analysed using intention-to-treat analyses. RESULTS: Retention in the study was 72% at 3 months and 52% at 6 months. There was a significant reduction in heavy drinking days in the intervention group relative to TAU over the 6 months, p < 0.02. CONCLUSIONS: The UCD smartphone app demonstrates a significant benefit to reducing heavy drinking days over a 6-month post-rehabilitation period in AUD.

It's not all about power: a systematic review and meta-analysis comparing sex-based differences in kicking biomechanics in soccer.

Kicking is fundamental in many field-based sports. Most studies investigating kicking performance have been conducted with male athletes, resulting in a dearth of specific data to inform coaching of this skill in female players. This systematic review aimed to compare kicking biomechanics in male and female athletes in field-based sports. As per PRISMA guidelines, articles were retrieved from searches across five online databases. Studies investigating kicking biomechanics in field-based athletes of both sexes were eligible for inclusion. Articles were screened using Covidence and data extracted based on STROBE recommendations. The review included 23 studies, featuring 455 soccer players. Male athletes produced significantly greater ball velocities and linear velocities of the ankle, foot, and toe than females. Males had greater ankle plantarflexion angles than females at ball strike, while females used larger trunk flexion ranges than males. Hip and knee torques and ball-to-foot velocity ratios were greater in men than women. Skilled players generated power using tension arcs; a technique not seen in novices. Skill level within sex may have a greater influence on kicking performance than differences between the sexes. This review highlights the need for further research investigating kicking performance in both sexes across the spectrum of sports.

Body Mass and Body Composition Changes over 7 Years in a Male Professional Rugby Union Team.

The purpose of this study was to investigate longitudinal body mass and body composition changes in one professional rugby union team (n=123), (i) according to position [forwards (n=58) versus backs (n=65)], analysis of players with 6 consecutive seasons of DXA scans (n=21) and, (iii) to examine differences by playing status [academy and international], over 7 years. Players [mean age: 26.8 y, body mass index: 28.9+kg.m2] received DXA scans at fourtime points within each year. A modest (but non-significant) increase in mean total mass (0.8 kg) for professional players was reflected by increased lean mass and reduced body fat mass. At all-time points, forwards had a significantly greater total mass, lean mass and body fat percentage compared to backs (p<0.05). Academy players demonstrated increased total and lean mass and decreased body fat percentage over the first 3 years of senior rugby, although this was not significant. Senior and academy international players had greater lean mass and lower body fat percentage (p<0.05) than non-international counterparts. Despite modest increases in total mass; reflected by increased lean mass and reduced fat mass, no significant changes in body mass or body composition, irrespective of playing position were apparent over 7 years.

Increases in DXA-Derived Visceral Fat Across One Season in Professional Rugby Union Players: Importance of Visceral Fat Monitoring in Athlete Body Composition Assessment.

INTRODUCTION: In rugby, the average player body mass has increased by approximately 25% since 1955. Visceral adipose tissue (VAT) is associated with low grade inflammation, and chronic diseases, such as cardiovascular diseases. The purpose of this study was to investigate changes in VAT in relation to other indices of body composition, across 1 season in professional rugby. METHODOLOGY: One hundred and sixteen male rugby union players' (age: 26.2 ± 4.6 y, BMI: 29.40 ± 3.22 kg.m2) total body composition dual energy X-ray absorptiometry scans from 4 time points across the season (baseline, preseason, midseason, and postseason) were analyzed. Players were grouped by playing position, forwards (n = 65) and backs (n = 51). Players followed individually tailored diet plans. RESULTS: Mean baseline VAT was 404.67 ± 229.43 g (forwards: 469.36 ± 263.16 g, backs: 311.40 ± 121.15 g). Total mass, lean mass, body fat percentage (%BF), and VAT were greater in forwards than backs at all 4 timepoints. Meaningful increases in VAT across the season, were observed in 37.5% of backs and 53.6% of forwards. There was a positive linear relationship between lean mass and total mass, up to 116.04 kg total mass. Beyond this threshold, lean mass accumulation reduced and %BF and VAT mass increased. There were significant relationships between %BF, VAT, and BMI (p < 0.001), but no physiological relevant pattern was discerned. CONCLUSIONS: Despite regular high-intensive exercise and individually tailored dietary control across a professional rugby season, players from both playing positions demonstrated increases in VAT, although the cause remains unknown. Our findings indicate the importance of monitoring VAT in athletes alongside standard measures of body composition. Additionally, our findings suggest there may be an upper threshold of body mass beyond which lean mass may not increase further and instead %BF and VAT are more likely to accumulate. Further research is required to identify how increasing player size may impact long-term cardiometabolic health given the known links between VAT and cardiometabolic risk.

A career in sport does not eliminate risk of cardiovascular disease: A systematic review and meta-analysis of the cardiovascular health of field-based athletes.

OBJECTIVES: To determine the prevalence of cardiovascular disease (CVD) risk factors in current field-based athletes. DESIGN: Meta-analysis. METHODS: This review was conducted and reported in accordance with PRISMA and pre-registered with PROSPERO. Articles were retrieved via online database search engines, with no date or language restriction. Studies investigating current field-based athletes (>18years) for CVD risk factors according to the European Society of Cardiology and American Heart Association were screened. Full texts were screened using Covidence and Cochrane criteria. Eligible articles were critically appraised using the AXIS tool. Individual study estimates were assessed by random-effect meta-analyses to examine the overall effect. RESULTS: This study was ascribed a 1b evidence level, according to the Oxford Centre for Evidence-based Medicine. 41 studies were identified, including 5546 athletes from four sports; American football; soccer; rugby and baseball mean ages: 18-28. Despite participation in sport, increased body mass was associated with increased total cholesterol, low-density lipoprotein, triglycerides, hypertension, systolic blood pressure, and decreased high-density lipoprotein. Linemen had increased prevalence of hypertension compared to non-athletes. Conflicting findings on fasting glucose were prevalent. There were inconsistencies in screening and reporting of CVD risk factors. Sport specific anthropometric demands were associated with elevated prevalence of CVD risk factors, most notably: elevated body mass; dyslipidemia; elevated systolic blood pressure and; glucose. CONCLUSIONS: There are elevated levels of risk for CVD in some athletes, primarily football players. Lifestyle behaviours associated with elite athleticism, particularly football linemen potentially expose players to greater metabolic and CVD risk, which is not completely offset by sport participation.

Cardiovascular Health of Retired Field-Based Athletes: A Systematic Review and Meta-analysis.

BACKGROUND: Retirement from elite sport participation is associated with decreased physical activity, depression, obesity, and ischemic heart disease. Although engagement in physical activity through sport is recognized as cardioprotective, an estimated one-quarter of deaths in American football players are associated with cardiovascular disease (CVD), predominately in players classified as obese. PURPOSE: To systematically investigate the cardiovascular health profile of retired field-based athletes. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: This review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and preregistered with PROSPERO. Four databases (PubMed, CINAHL, Embase, and Web of Science) were systematically searched from inception to October 2018 using MeSH terms and keywords. Inclusion criteria were retired field-based athletes, age >18 years, and at least 1 CVD risk factor according to the European Society of Cardiology and the American Heart Association. Review articles were not included. Control groups were not required for inclusion, but when available, an analysis was included. Eligible articles were extracted using Covidence. Methodological quality was assessed independently by 2 reviewers using the AXIS tool. The accuracy of individual study estimates was analyzed using a random-effects meta-analysis. RESULTS: This review yielded 13 studies. A total of 4350 male retired field-based athletes from 2 sports (football and soccer; age range, 42.2-66 years) were included. Eight studies compared retired athletes with control groups. Retired athletes had elevated systolic blood pressure in 4 of 6 studies; approximately 50% of studies found greater high-density lipoprotein, approximately 80% found lower triglyceride levels, and all studies found greater low-density lipoprotein for retired athletes compared with controls. The prevalence and severity of coronary artery calcium and carotid artery plaque were similar to controls. Retired linemen had double the prevalence of cardiometabolic syndrome compared with nonlinemen. CONCLUSION: The overall findings were mixed. Inconsistencies in the reporting of CVD risk factors and methodological biases reduced the study quality. Retired athletes had a comparable CVD risk profile with the general population. Retired athletes with an elevated body mass index had an increased prevalence and severity of risk factors. Significant gaps remain in understanding the long-term cardiovascular effects of elite athleticism.