[Identifying and assisting sedentary patients: a practical guide]. / Identifier et accompagner les patient-es sédentaires : un guide pratique.

A sedentary lifestyle is a significant cardiovascular risk factor and increases premature mortality. Engaging in routine physical activity (PA) provides a wide range of health benefits. Accordingly, physical inactivity must be identified and sedentary patients supported systematically to achieve recommended levels of PA. The level of PA can be assessed by taking patients' history and using specific tools. Support begins by assessing PA contraindications and patients' level of motivation to change their lifestyle. Patients are then encouraged to adopt a more active lifestyle through tailored advice, and if necessary, referred to specialists with expertise in exercise medicine. This article details the key aspects of accompanying sedentary patients, to help healthcare professionals integrate them into their practice.

La sédentarité est un facteur de risque cardiovasculaire et de mortalité prématurée important et la pratique d'une activité physique (AP) procure un éventail large de bénéfices pour la santé. Elle doit donc être identifiée et adressée de manière systématique en consultation médicale. Le niveau d'AP peut être évalué par l'anamnèse et des outils spécifiques. L'accompagnement débute par une évaluation des contre-indications à la pratique d'une AP et du niveau de motivation des patient-es à changer leur mode de vie. Ceux-ci sont ensuite encouragé-es à adopter un mode de vie plus actif à travers des conseils adaptés, et si nécessaire, adressé-es à d'autres spécialistes. Cet article détaille les aspects clés de l'accompagnement des patient-es sédentaires afin d'aider les professionnel-les de la santé à les intégrer dans leur pratique.

[Practical management of post-COVID-19 condition. Update and illustration by clinical situations]. / Prise en charge pratique de l'affection post-Covid-19. Mise à jour et illustration par des situations cliniques.

Persistent manifestations of COVID-19, known as «long COVID¼ or post-COVID-19 condition (RA02, CIM-11), affect many infected individuals, with a 24-month prevalence depending on the studies context (18 % in a recent Swiss study). The diversity of clinical presentation, the sometimes complex diagnostic methods, and the multidisciplinary management highlight the importance of a holistic approach, with practical advice for assessing work capacity in the outpatient setting. This article offers an update and synthesis of current knowledge concerning post-COVID-19 condition with practical recommendations for primary care medicine, illustrated by real clinical situations.

Les manifestations persistantes du Covid-19, connues sous le nom de « Covid long ¼ ou affection post-Covid-19 (RA02, CIM-11), concernent un nombre significatif de personnes infectées, avec une prévalence à 24 mois de l'infection variant en fonction des études et du contexte (18 % dans une étude suisse récente). La diversité de présentation clinique, les méthodes diagnostiques, parfois complexes, et les approches multidisciplinaires pour la prise en charge soulignent l'importance d'une approche holistique. Cet article propose une mise à jour et une synthèse des connaissances actuelles concernant l'affection post-Covid-19, avec des recommandations pratiques de prise en charge en médecine de premiers recours, illustrées par des situations cliniques réelles et des conseils pratiques pour l'appréciation de la capacité de travail.

[Promoting physical activity in primary care practices. Review fifteen years after the launch of PAPRICA training]. / Promotion de l'activité physique au cabinet médical. Bilan quinze ans après le lancement de la formation PAPRICA.

This article reviews the PAPRICA (Physical Activity promotion in PRImary CAre) program fifteen years after the first training course in physical activity counseling for primary care physicians in French-speaking Switzerland. Subsequent developments are also presented, based on the PAPRICA experience. The article then looks at the national strategy for promoting physical activity in the medical practice, the issues involved in financing the services, and the situation in other comparable countries. The article concludes with a discussion of new challenges and future prospects for a program like PAPRICA.

Cet article dresse un bilan du programme PAPRICA (Physical Activity promotion in PRImary CAre) quinze ans après la première formation au conseil en activité physique destinée aux médecins de premier recours en Suisse romande. Sont également présentés les développements ultérieurs qui se sont appuyés sur l'expérience de PAPRICA. Cet état des lieux se penche ensuite sur la stratégie nationale en matière de promotion de l'activité physique au cabinet médical, les enjeux de financement des prestations, ainsi que la situation dans d'autres pays comparables. L'article se termine par l'évocation de nouveaux enjeux et les perspectives d'évolution pour un programme comme PAPRICA.

Multisensing Wearables for Real-Time Monitoring of Sweat Electrolyte Biomarkers During Exercise and Analysis on Their Correlation With Core Body Temperature.

Sweat secreted by the human eccrine sweat glands can provide valuable biomarker information during exercise. Real-time non-invasive biomarker recordings are therefore useful for evaluating the physiological conditions of an athlete such as their hydration status during endurance exercise. This work describes a wearable sweat biomonitoring patch incorporating printed electrochemical sensors into a plastic microfluidic sweat collector and data analysis that shows the real-time recorded sweat biomarkers can be used to predict a physiological biomarker. The system was placed on subjects carrying out an hour-long exercise session and results were compared to a wearable system using potentiometric robust silicon-based sensors and to commercially available HORIBA-LAQUAtwin devices. Both prototypes were applied to the real-time monitoring of sweat during cycling sessions and showed stable readings for around an hour. Analysis of the sweat biomarkers collected from the printed patch prototype shows that their real-time measurements correlate well (correlation coefficient ≥ 0.65) with other physiological biomarkers such as heart rate and regional sweat rate collected in the same session. We show for the first time, that the real-time sweat sodium and potassium concentration biomarker measurements from the printed sensors can be used to predict the core body temperature with root mean square error (RMSE) of 0.02 °C which is 71% lower compared to the use of only the physiological biomarkers. These results show that these wearable patch technologies are promising for real-time portable sweat monitoring analytical platforms, especially for athletes performing endurance exercise.

Antibody-Coated Wearable Organic Electrochemical Transistors for Cortisol Detection in Human Sweat.

The dysregulation of the hormone cortisol is related to several pathological states, and its monitoring could help prevent severe stress, fatigue, and mental diseases. While wearable antibody-based biosensors could allow real-time and simple monitoring of antigens, an accurate and low-cost antibody-based cortisol detection through electrochemical methods is considerably challenging due to its low concentration and the high ionic strength of real biofluids. Here, a label-free and fast sensor for cortisol detection is proposed based on antibody-coated organic electrochemical transistors. The developed devices show unprecedented high sensitivities of 50 µA/dec for cortisol sensing in high-ionic-strength solutions with effective cortisol detection demonstrated with real human sweat. The sensing mechanism is analyzed through impedance spectroscopy and confirmed with electrical models. Compared to existing methods requiring bulky and expensive laboratory equipment, these wearable devices enable point-of-care cortisol detection in 5 min with direct sweat collection for personalized well-being monitoring.

Predicting Hydration Status Using Machine Learning Models From Physiological and Sweat Biomarkers During Endurance Exercise: A Single Case Study.

Improper hydration routines can reduce athletic performance. Recent studies show that data from noninvasive biomarker recordings can help to evaluate the hydration status of subjects during endurance exercise. These studies are usually carried out on multiple subjects. In this work, we present the first study on predicting hydration status using machine learning models from single-subject experiments, which involve 32 exercise sessions of constant moderate intensity performed with and without fluid intake. During exercise, we measured four noninvasive physiological and sweat biomarkers including heart rate, core temperature, sweat sodium concentration, and whole-body sweat rate. Sweat sodium concentration was measured from six body regions using absorbent patches. We used three machine learning models to determine the percentage of body weight loss as an indicator of dehydration with these biomarkers and compared the prediction accuracy. The results on this single subject show that these models gave similar mean absolute errors, while in general the nonlinear models slightly outperformed the linear model in most of the experiments. The prediction accuracy of using the whole-body sweat rate or heart rate was higher than using core temperature or sweat sodium concentration. In addition, the model trained on the sweat sodium concentration collected from the arms gave slightly better accuracy than from the other five body regions. This exploratory work paves the way for the use of these machine learning models to develop personalized health monitoring together with emerging, noninvasive wearable sensor devices.

Paediatric and adolescent athletes in Switzerland: age-adapted proposals for pre-participation cardiovascular evaluation.

High-level sports competition is popular among Swiss youth. Even though preparticipation evaluation for competitive athletes is widespread, screening strategies for diseases responsible for sudden death during sport are highly variable. Hence, we sought to develop age-specific preparticipation cardiovascular evaluation (PPCE) proposals for Swiss paediatric and adolescent athletes (under 18 years of age). We recommend that all athletes practising in a squad with a training load of at least 6 hours per week should undergo PPCE based on medical history and physical examination from the age of 12 years on. Prior to 12 years, individual judgement of athletic performance is required. We suggest the inclusion of a standard 12-lead electrocardiogram (ECG) evaluation for all post-pubertal athletes (or older than 15 years) with analysis in accordance with the International Criteria for ECG Interpretation in Athletes. Echocardiography should not be a first-line screening tool but rather serve for the investigation of abnormalities detected by the above strategies. We recommend regular follow-up examinations, even for those having normal history, physical examination and ECG findings. Athletes with an abnormal history (including family history), physical examination and/or ECG should be further investigated and pathological findings discussed with a paediatric cardiologist. Importantly, the recommendations provided in this document are not intended for use among patients with congenital heart disease who require individualised care according to current guidelines.

[Sweat as an indicator of health]. / La sueur comme indicateur de la santé.

Sweat is a body fluid produced by the sweat glands and is mainly composed of water. Sweat has various functions, the two main ones being the evacuation of heat produced by the body, especially during exercise, and the maintenance of skin homeostasis. Its production is highly variable and depends on many individual and environmental factors. Various diseases or conditions affect its proper functioning. This article presents an overview of the characteristics, the main health issues, and the current and potential applications related to sweat.

La sueur est un fluide corporel produit par les glandes sudoripares et composé principalement d'eau. La transpiration remplit diverses fonctions, dont les principales sont l'évacuation de la chaleur produite par l'organisme, en particulier durant l'effort physique, et le maintien de l'homéostasie de la peau. Sa production est très variable quantitativement et qualitativement et dépend de multiples facteurs individuels et environnementaux. Différentes pathologies ou conditions altèrent son bon fonctionnement. Cet article présente un aperçu des caractéristiques, des principaux problèmes de santé et des applications actuelles et potentielles en lien avec la sueur.

[Sports dermatology]. / Dans la peau des sportif·ve·s: dermatologie du sport.

Athlete's skin is under great stress and its integrity is essential. Knowledge and prevention of sports-related dermatoses are fundamental to athlete's the management. Hereby we review common sport-related affections classified by their etiologies (traumatic, infectious, inflammatory and environmental dermatoses).

La peau est soumise à des contraintes importantes lors des activités sportives et son intégrité est essentielle mais souvent banalisée. La connaissance et la prévention des dermatoses liées aux différents sports sont fondamentales pour une prise en charge optimale. Cet article rappelle les diverses dermatoses liées au sport classées par étiologies (traumatiques, infectieuses, inflammatoires et liées à l'environnement).

[Plantar fasciitis: update 2021]. / Aponévropathie plantaire : mise au point 2021.

Plantar heel pain affects 4 to 9% of the population and is a common reason for consultation. Plantar fasciitis is the most frequent cause. Its diagnosis is essentially clinical, possibly supported initially by combination of X-ray/ultrasound. Ultrasound is the modality of choice to confirm the diagnosis. The prognosis is favorable, but the evolution can be long. Its management should be structured in a progressive manner, based on therapeutic education and physical measures. These simple measures have the highest level of evidence of effectiveness and should be implemented before proposing, sometimes too early, second-line therapies.

Les talalgies plantaires touchent 4 à 9 % de la population et sont un motif fréquent de consultation en médecine générale et en médecine du sport. L'aponévropathie plantaire en est la cause la plus fréquente. Son diagnostic est essentiellement clinique, éventuellement complété en première intention par le couple radiographie/échographie. Cette dernière est l'examen de choix permettant de confirmer le diagnostic. De pronostic favorable, sa durée d'évolution peut être longue. Sa prise en charge doit être structurée de façon progressive en s'appuyant sur l'éducation thérapeutique et des mesures physiques. Ces mesures simples montrent le niveau de preuve d'efficacité le plus élevé et doivent impérativement être mises en place avant de proposer, parfois trop précocement, des thérapeutiques de seconde intention.

Impact of early sports specialisation on paediatric ECG.

Athletes of pediatric age are growing in number. They are subject to a number of risks, among them sudden cardiac death (SCD). This study aimed to characterize the pediatric athlete population in Switzerland, to evaluate electrocardiographic findings based on the International Criteria for electrocardiography (ECG) Interpretation in Athletes, and to analyze the association between demographic data, sport type, and ECG changes. Retrospective, observational study of pediatric athletes (less than 18 years old) including medical history, physical examination, and a 12-lead resting ECG. The primary focus was on identification of normal, borderline, and abnormal ECG findings. The secondary observation was the relation between ECG and demographic, anthropometric, sport-related, and clinical data. The 891 athletes (mean 14.8 years, 35% girls) practiced 45 different sports on three different levels, representing all types of static and dynamic composition of the Classification of Sports by Mitchell. There were 75.4% of normal ECG findings, among them most commonly early repolarization, sinus bradycardia, and left ventricular hypertrophy; 4.3% had a borderline finding; 2.1% were abnormal and required further investigations, without SCD-related diagnosis. While the normal ECG findings were related to sex, age, and endurance sports, no such observation was found for borderline or abnormal criteria. Our results in an entirely pediatric population of athletes demonstrate that sex, age, and type of sports correlate with normal ECG findings. Abnormal ECG findings in pediatric athletes are rare. The International Criteria for ECG Interpretation in Athletes are appropriate for this age group.

Measure of efficiency and knee isokinetic strength in bike messengers and non-cyclist athletes.

BACKGROUND: Gross efficiency in cycling (GE) seems correlated with lower-body strength. This study investigated GE at four different pedaling rates and its relationship with an isokinetic strength test in bike messengers (BM) and experienced athletes non-bike messengers (NBM). METHODS: Eight BM and eight NBM completed a maximal incremental test to determine maximal aerobic power (MAP) and maximal oxygen consumption (V̇O2max). GE, V̇O2, heart rate (HR) and blood lactate concentration (BLC) were measured at different cadences (60, 70, 90 and 100 rpm) during an efficiency test at 50% of MAP and participants then performed an isokinetic test of the right knee. RESULTS: A difference in GE (except at 90 rpm), BLC and MAP/kg was found in favor of BM. The most efficient cadence was 60 rpm in both groups. Increased cadence resulted in decreased GE and increased HR and V̇O2 in both groups. BLC only increased in the NBM. We found no relationships between GE at different cadence, peak torque relative to bodyweight and muscle fatigability. CONCLUSIONS: This study is the first investigating performance and efficiency among BM. At equivalent power output, BM show a better GE than NBM. Those results are in line with previously described analysis in cyclists and explained by better aerobic capacity and training status. Isokinetic knee maximal strength and fatigability were not linked with GE, and thus does not appear appropriate for evaluating GE in cycling.

The Association between Type and Intensity of Sport and Tobacco or Nicotine Use-A Cross-Sectional Study among Young Swiss Men.

The objective of this study was to assess the association between tobacco/nicotine use and type and intensity of sport. Data were drawn from the second follow-up of the Cohort Study on Substance Use Risk Factors. Young Swiss men completed a questionnaire about tobacco/nicotine use (cigarette, vaping, snus, snuff), type and intensity of sport and other demographic and medical variables. Among the 5414 included participants (mean age 25.5), 3434 (63.4%) reported regularly practicing a sport. They had a lower rate of cigarette smoking (32.3%) compared with participants not practicing a sport (44.6%) but a higher rate of snus use (15.0% vs. 10.0%). In adjusted models, individual-sport participants were less likely to use snus and snuff (OR = 0.63, 95% CI = 0.51-0.77 and OR = 0.73, 95% CI = 0.61-0.88), compared with team-sport participants. The association was inversed for vaping users (OR = 1.54, 95% CI = 1.03-2.30). Furthermore, participants who practiced high-intensity sports had a lower likelihood to smoke cigarettes (OR = 0.63, 95% CI = 0.52-0.78) compared with low-intensity sports. Our findings suggest that type and intensity of sport are associated with tobacco/nicotine use. Youth who practice an individual sport are less likely to use snus or snuff and more likely to vape compared with a team sport. This could help better target smoking prevention in young people.

[Cryotherapy chambers and cold-water immersion : therapeutic use and risks]. / Chambres de cryothérapie et immersion en eau froide†: utilisation thérapeutique et risques.

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a «â€…natural ¼ method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known.

La cryothérapie du corps entier se pratique principalement soit par immersion en eau froide, soit en chambre de cryothérapie. Pratiquée depuis l'Antiquité et considérée comme une méthode «â€…naturelle ¼, la cryothérapie tend à attirer de plus en plus d'adeptes. Des effets bénéfiques pour la santé ont été décrits dans la littérature. Néanmoins, l'interprétation de ses effets est difficile en raison de la faible qualité des études actuelles. La cryothérapie pourrait toutefois être utile en complément des thérapies classiques dans diverses pathologies et situations, à condition de connaître les risques, les contre-indications et les règles de bonnes pratiques.

[Heart rate variability: methods, limitations and clinical examples]. / Analyse de la variabilité de la fréquence cardiaque†: méthodes, limites et exemples cliniques.

Heart rate variability (HRV) is an analysis of milliseconds variations in intervals between heartbeats and has become an increasingly used tool for clinical investigation of fatigue, especially in athletes. Eliciting an indirect index of the autonomic nervous system regulation on the heart rate, HRV correlates with different fatigue states and appears to be a powerful biomarker in their monitoring. This article presents the tools to familiarize with this method while detailing good practices for use and interpretation. A method allowing characterization of different fatigue states is also presented for a clinical use with a systemic approach.

L'analyse de la variabilité de la fréquence cardiaque (VFC) s'intéresse à l'observation des variations en millisecondes des intervalles entre les battements cardiaques et devient un outil d'investigation clinique de la fatigue de plus en plus utilisé, notamment chez les athlètes. Les paramètres étudiés reflètent indirectement la régulation de la fréquence cardiaque par le système nerveux autonome et la VFC est corrélée à différents états de fatigue, se révélant être un puissant biomarqueur dans le suivi de ces derniers. Cet article vise à donner les bases permettant de cerner la thématique et précise les bonnes pratiques quant à son utilisation et son interprétation. Une méthode permettant de caractériser différents états de fatigue est également présentée et donne des pistes pour une utilisation en clinique avec une approche systémique.

[Physical activity counseling Referring to an adapted physical activity specialist†: example of the Step by Step+ project]. / Conseil en activité physique - Sa délégation vers une spécialiste en activité physique adaptée†: le projet Pas à Pas.

The health benefits of regular physical activity are undeniable. There is a dose-response relationship between total physical activity and health outcomes, and thus every opportunity should be seized to exercise more. Among the methods used to increase the level of physical activity, physical activity counselling delivered in clinical practice is effective. The Pas à Pas+ project presented in this article allows to extend the advice from the healthcare professional and to lead up the patient to a physically more active lifestyle, providing a support in physical activity on prescription. There are several -challenges that need to be addressed in order to anchor definitely physical activity counselling and its delegation to professionals in adapted physical activity in the healthcare setting.

Les bénéfices d'une activité physique régulière pour la santé sont indéniables. Il existe une relation dose-réponse entre la quantité totale d'activités physiques pratiquées et la santé, si bien que chaque occasion doit être saisie pour bouger davantage. Parmi les moyens permettant d'augmenter le niveau d'activité physique de la population, le conseil réalisé en pratique clinique est ­efficace. Le projet Pas à Pas+ présenté dans cet article permet de prolonger le conseil du ou de la professionnelle de santé et d'accompagner concrètement le ou la patiente vers un mode de vie plus actif à travers une prestation de suivi en activité physique sur délégation médicale. Plusieurs défis doivent être relevés afin d'ancrer solidement dans le domaine des soins le conseil en ­matière d'activité physique et sa délégation vers des profes­sionnelles de l'activité physique adaptée.

The Determinants of the Preferred Walking Speed in Individuals with Obesity.

BACKGROUND: The preferred walking speed (PWS), also known as the "spontaneous" or "self-selected" walking speed, is the speed normally used during daily living activities and may represent an appropriate exercise intensity for weight reduction programs aiming to enhance a more negative energy balance. OBJECTIVES: The aim of this study was to examine, simultaneously, the energetics, mechanics, and perceived exertion determinants of PWS in individuals with obesity. METHODS: Twenty-three adults with obesity (age 32.7 ± 6.8 years, body mass index 33.6 ± 2.6 kg/m2) were recruited. The participants performed 10 min of treadmill familiarization, and PWS was determined. Each subject performed six 5-min walking trials (PWS 0.56, 0.83, 1.11, 1.39, and 1.67 m/s). Gas exchanges were collected and analyzed to obtain the gross energy cost of walking (GCw), rated perceived exertion (RPE) was measured using a 6-20 Borg scale, and the external mechanical work (Wext) and the fraction of mechanical energy recovered by the pendular mechanism (Recovery) were computed using an instrumented treadmill. Second-order least-squares regression was used to calculate the optimal walking speed (OWS) of each variable. RESULTS: No significant difference was found between PWS (1.28 ± 0.13 m/s) and OWS for GCw (1.28 ± 0.10 m/s), RPE cost of walking (1.38 ± 0.14 m/s), and Recovery (1.48 ± 0.27 m/s; p > 0.06 for all), but the PWS was significantly faster than the OWS for Wext (0.98 ± 0.56 m/s; p < 0.02). Multiple regression (r = 0.72; p = 0.003) showed that ∼52% of the variance in PWS was explained by Recovery, Wext, and height. CONCLUSION: The main finding of this study was that obese adults may select their PWS in function of several competing demands, since this speed simultaneously minimizes pendular energy transduction, energy cost, and perceived exertion during walking. Moreover, recovery of mechanical work, external work, and height seem to be the major determinants of PWS in these individuals.