Brain pathology and symptoms linked to concussion history: beyond chronic traumatic encephalopathy.

Repeated head trauma acquired through sports injuries has been associated with the development of long-term disabling symptoms that negatively impact the quality of life. In this retrospective case series, 52 male former professional athletes involved in contact sports and with a history of multiple concussions were evaluated for chronic clinical symptoms and post-mortem neuropathological diagnoses. The clinical symptoms of 19 cases were examined in greater detail for symptom type, severity and duration. Information on neurological, psychiatric and physical symptoms, substance use profiles and concussion histories was obtained from the athletes' next of kin and assessed in relation to post-mortem neuropathological diagnoses. Cases were categorized into three different neuropathological groups: no major neuropathological findings, the presence of only chronic traumatic encephalopathy (CTE) and the diagnosis(es) of other neurodegenerative diseases. Age at death and the presence of DNA damage in the post-mortem brains were analysed for correlation with the clinical symptoms. In this case series, 14/52 (26.9%) cases (mean age 48.2 ± 11.4) had neuropathological evidence of low-stage/low-burden CTE. A total of 11/52 (21.2%) cases (mean age 38.7 ± 12.7) presented a similar profile and severity of behavioural symptoms to those with CTE, despite the lack of significant post-mortem neuropathological findings. A total of 27/52 (51.9%) cases (mean age 75.5 ± 8.7) presented with complex post-mortem neurodegenerative diagnoses, including Alzheimer's disease and other mixed pathologies, and clinical symptoms associated with language, memory and sensory dysfunction. The presence of DNA damage in the brain was found in all neuropathological groups, predominantly in the ependymal lining of ventricles, and phosphorylated histone H2AX staining was correlated with higher age at death (r = 0.59) and symptoms of language dysfunction (r = 0.56). Findings from our case series suggest that post-concussive symptoms are not driven by CTE. Our findings show that proteinopathies alone may not account for the complexity of the clinical manifestations and suggest the possibility of other drivers, such as DNA damage, as potentially useful markers of brain trauma. Broadening the search for biological markers that reflect the effects of brain injury, even when proteinopathy is not observed, and taking a symptom-driven approach are therefore advised.

Attitude towards healthy nutrition and mental toughness: a study of taekwondo athletes.

Healthy nutrition is widely considered the cornerstone of optimal athletic performance, both physically and mentally. This study investigates the critical role of healthy nutrition in shaping the physical and mental performance of athletes, with a specific focus on taekwondo. This research aims to explore the potential relationship between taekwondo athletes' attitudes towards healthy nutrition and their mental toughness. The research group comprised 276 active and licensed taekwondo athletes who voluntarily participated in the study (Age M = 17.18 ± SD = 7.13, N = 125 women, N = 151 men). Ethical approval for the research was obtained prior to the commencement of the study. Data collection instruments included the Healthy Nutrition Attitude Scale, Mental Toughness Scale, and a personal information form. Confirmatory factor analysis was conducted to confirm the validity and reliability of the scales. Descriptive statistics, correlation analysis, and regression analysis were performed to explore the relationship between the variables within the research model. The correlation analysis identified two significant, positive, and moderate correlations: (1) between knowledge about nutrition and mental toughness (r = 0.626) and (2) between positive nutrition and mental toughness (r = 0.672). The regression analysis revealed that both knowledge about nutrition (ß = 0.360) and positive nutrition (ß = 0.461) significantly contribute to mental toughness. The findings suggest that as athletes' knowledge of nutrition expands and their attitudes towards healthy eating become more positive, their mental toughness also appears to improve. These results are both important and original, adding significant new insights to the existing research landscape.

Stressed or fractured: MRI differentiating indicators of physeal injury.

OBJECTIVE: To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist. METHODS: IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared. RESULTS: Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2-17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1-16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98% vs 77%, p = 0.003). Abnormal physeal SI was more common with SH fractures (91% vs 67%, p = 0.008). ZPC discontinuity strongly suggested chronic stress injury (79% vs 49%, p < 0.004). Periosteal and/or perichondrial elevation or rupture and soft tissue edema characterized most of the acute SH fractures (p < 0.001) and were seen only in 1 chronic stress injury (< 2%). While periphyseal edema was not significantly different in the two groups (p = 0.890), a joint effusion was associated with acute SH fracture (p < 0.001). CONCLUSION: Chronic physeal stress injury of the pediatric knee and wrist shows higher incidence of ZPC discontinuity and focal physeal thickening compared to SH fracture, reflecting disruption in normal endochondral ossification. However, these findings can overlap in the 2 groups. Periosteal and/or perichondrial injury, soft tissue edema signal, and joint effusion strongly suggest SH fracture and are rarely present with chronic stress injury.

Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft.

PURPOSE: Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS: This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS: Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS: The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Nominal Differences in Acute Symptom Presentation and Recovery Duration of Sport-Related Concussion Between Male and Female Collegiate Athletes in the PAC-12.

BACKGROUND: Sport-related concussion (SRC) is a heterogenous injury that often presents with varied symptoms and impairment. Recently, research has focused on identifying subtypes, or clinical profiles of concussion to be used in assessing and treating athletes with SRC. The purpose of this study was to investigate sex differences in clinical profiles, recovery duration, and initial symptom severity after SRC in a cohort of collegiate athletes in the Pacific-12 Conference (Pac-12). METHODS: This prospective cohort study examined post-SRC symptoms, recovery, and return-to-play times using data from the Pac-12 CARE Affiliated Program and Pac-12 Health Analytics Program. Clinical profiles reported by student-athletes were defined by the number (> 50%) of specific symptoms frequently reported for each profile. Generalized linear mixed models were used to examine associations among sex, clinical profiles, time-to-recovery, and return-to-play times. RESULTS: 479 concussion incidents met inclusion criteria. The probabilities of initial presentation of each clinical profile, initial injury severity scores, and recovery times within a profile did not differ between sexes (p = 0.33-0.98). However, both males and females had > 0.75 probabilities of exhibiting cognitive and ocular profiles. Initial injury severity score was a strong nonlinear predictor of initial number of clinical profiles (p < 0.0001), which did not differ between sexes. The number of clinical profiles was also a nonlinear predictor of time-to-recovery (p = 0.03) and return-to-play times (p < 0.0001). CONCLUSIONS: Initial symptom severity was strongly predictive of the number of acute clinical profiles experienced post-SRC. As the number of clinical profiles increased, time-to-recovery and time to return-to-play also increased. Factors other than sex may be better associated with acute symptom presentation post-concussion as no sex differences were found in reported clinical profiles or recovery. Understanding the number and type of clinical profiles experienced post-SRC may help inform concussion diagnostics and management.

Suicide in National Collegiate Athletic Association athletes: a 20-year analysis.

OBJECTIVES: To determine the incidence rate of suicide from 2002 to 2022 among athletes from the National Collegiate Athletic Association (NCAA) and assess for potential differences by, sex, race, division and sport. METHODS: NCAA athlete deaths over a 20-year period from 2002 to 2022 were identified. Poisson regression models were built to assess changes in incidence rates over time. Linear and quadratic fits between year and suicide incidence for males and females were evaluated. RESULTS: Of 1102 total deaths, 128 (11.6%) deaths by suicide were reported (male n=98, female n=30). The overall incidence was 1:71 145 athlete-years (AYs). Over the last decade, suicide was the second most common cause of death after accidents. The proportion of deaths by suicide doubled from the first 10 years (7.6%) to the second 10 years (15.3%). The suicide incidence rate for males increased linearly (5-year incidence rate ratio 1.32 (95% CI 1.14 to 1.53)), whereas a quadratic association was identified among female athletes (p=0.002), with the incidence rate reaching its lowest point in females in 2010-2011 and increasing thereafter. Male cross-country athletes had the highest suicide incidence rate (1:29 815 AYs) and Division I and II athletes had a higher suicide incidence rate than Division III athletes. No significant differences in suicide incidence rates by sex, race or sport were identified. CONCLUSION: Deaths by suicide among NCAA athletes increased in both males and females throughout the 20-year study period, and suicide is now the second most common cause of death in this population. Greater suicide prevention efforts geared towards NCAA athletes are warranted.

The importance of core strength for change of direction speed.

Change of direction speed (CODS) is determined by several physical aspects, such as linear sprint speed, reactive strength and power of leg muscles. It appears that core strength may also play a role in CODS, however, its relationship to CODS remains unclear. The aim of this narrative review was to analyze the literature addressing a) the relationship between core strength and CODS and b) the effect of core strength training on CODS. This analysis revealed a significant relationship between the parameters of core strength and stability (the pressure of the activated core muscles during lower limb movement and the greatest mean force output of maximum volunteered contraction) and the time in the Agility T-Test. However, this parameter was not significantly related to the strength endurance of core muscles (total time in the plank test). Core training provides a sufficient stimulus for the development of CODS in less-skilled middle-adolescent athletes, while its effectiveness decreases in higher-skilled adult athletes. These findings indicate that core muscle strength contributes significantly to the change of direction speed. Core training is therefore useful for improving CODS.

Fat-free mass predictive equation using bioelectrical impedance and maturity offset in adolescent athletes: Development and cross-validation.

OBJECTIVES: This is a cross-sectional study, aimed to develop and cross-validate a fat-free mass (FFM) predictive equation using single-frequency bioelectrical impedance (BIA), considering the predicted age at peak height velocity (PHV) as a variable. Additionally, the study aims to test the FFM-BIA obtained using a previous predictive equation that used skeletal maturity as a variable. METHOD: The participants (n = 169 male adolescent athletes) were randomly divided into two groups: development of a new predictive equation (n = 113), and cross-validation (n = 56). The concordance test between the FFM values obtained by Koury et al. predictive equation and DXA data was determined (n = 169). Bioelectrical data was obtained using a single-frequency analyzer. RESULTS: Among the models tested, the new predictive equation has resistance index (height2/resistance) and predictive age at PHV as variables and presented R2 = 0.918. The frequency of maturity status using skeletal maturity and PHV diagnosis was inadequate (Kappa = 0.4257; 95%CI = 0.298-0.553). Bland-Altman plots and concordance correlation coefficient showed substantial concordance between the FFM-DXA values (48.8 ± 11.2 kg) and the new predictive equation (CCC = 0.960). The results showed that the new equation performed better than the equation developed by Koury et al. (CCC = 0.901). CONCLUSIONS: Our results show that it is feasible to predict FFM in male adolescent athletes using predictive age at PHV, with moderate concordance. The calculation of FFM using more economical and less complex variables is viable and should be further explored.

Automatic detection of skate strokes in short-track speed skating using one single IMU: validation of a new method.

Greater impulse is a key performance indicator of success in short track speed skating. The main objective of this study was to develop a method to measure skating strokes using a single IMU. Eight elite or world-class speed skaters had one IMU placed against their skin on the lower back, and a camera setup was positioned to capture the test. A maximal speed trial was then executed by each participant, and the data were analysed to estimate agreement between the camera and IMU estimates of skate stroke events. Inter-evaluator reliability was assessed on a dataset of 22 athletes performing speed trials as well. The algorithm detected 100% of the strokes identified on the video capture system with a root mean square error of 0.06s. Bland-Altman analysis showed a bias of 0.03s between the two methods, which corresponds to the frame rate of the camera. The inter-evaluator reliability yielded an intra-class correlation of 1.00 (ICC3,1) from a dataset of 7089 strokes. This study provides an example of on-ice evaluation of speed skating strokes using a single IMU. This equipment is less expensive than that employed by previous authors and can be implemented in training situations with low invasiveness.

Prevalence of Cardiovascular Disease and Risk Factors among National Football League Alumni and Family Members.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited. OBJECTIVE: The HUDDLE trial aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events. METHODS: HUDDLE was a multi-city, cross-sectional study of NFL alumni and family members aged 50 years and above. Subjects reported their health history and participated in CVD education and screening (blood pressure [BP], electrocardiogram [EKG], and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30-days post-screening to review results and recommendations. This analysis focuses on former NFL athletes. RESULTS: Of 498 participants screened, 57.2% (N=285) were former NFL players, majority of which were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that HTN was a significant predictor of clinically-relevant structural abnormalities on TTE. CONCLUSION: The HUDDLE trial identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by HTN, affirming the role of TTE for CVD screening in this over 50 population.

Cognitive, Sleep-Arousal, Physical, and Affective Domain Scores on the Post-Concussion Symptom Scale: Added Utility in Detecting Symptom Elevations among Student-Athletes with a Remote History of Concussion.

OBJECTIVE: The evaluation of self-reported symptoms is a standard component of concussion assessment and management. Clinicians typically evaluate a total symptom severity score rather than scores corresponding to specific symptom domains (i.e., cognitive, sleep-arousal, physical, and affective symptoms). This study examined (i) whether elevations in specific symptom domains would be missed when interpreting only the total symptom severity score and (ii) if a single symptom domain elevation was more common than having elevated symptoms across multiple domains. METHOD: Adolescent student-athletes (N = 1,008) with concussion history (i.e., ≥6 months since last concussion) completed the Post-Concussion Symptom Scale (PCSS). The PCSS total score and cognitive, sleep-arousal, physical, and affective domain scores were calculated. To determine if symptoms were elevated, scores were compared to normative data matched on gender and pre-existing conditions, with scores considered elevated if they were ≥84th percentile. The frequency of total and domain score elevations were calculated and stratified by gender and number of prior concussions (i.e., 1 or ≥2 prior concussions). RESULTS: Overall, 26% of student-athletes had an elevated symptom domain score without being elevated on the total score. The most common symptom presentation was to have a single elevated symptom domain (21%), followed by two (11%), three (8%), or four elevated domains (6%). CONCLUSIONS: Interpreting PCSS symptom domains may be beneficial in detecting student-athletes with elevated symptoms following a remote concussion. Roughly a quarter of student-athletes have domain-specific symptom elevations that would be missed by interpreting the total score alone.

Outcomes of Flexibility Sport Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Analysis at Minimum 2-Year Follow-up.

BACKGROUND: Hip arthroscopy has proved successful in treating femoroacetabular impingement syndrome (FAIS) in patients with and without borderline hip dysplasia (BHD). Despite a high prevalence of BHD in patients who participate in sports with high flexibility requirements, a paucity of literature evaluates the efficacy of hip arthroscopy in treating FAIS in flexibility sport athletes with BHD. PURPOSE: To compare minimum 2-year patient-reported outcomes (PROs) and achievement of clinically significant outcomes in flexibility sport athletes with BHD undergoing primary hip arthroscopy for FAIS with capsular plication with results in flexibility sport athletes without dysplasia. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were prospectively collected for patients undergoing primary hip arthroscopy for FAIS with BHD, defined as a lateral center-edge angle of 18° to 25°, who reported participation in a sport with a high flexibility requirement, including dance, gymnastics, figure skating, yoga, cheerleading, and martial arts, according to previous literature. These patients were matched 1:2 to flexibility sport athletes without dysplasia, controlling for age, sex, and body mass index. Preoperative and minimum 2-year postoperative PROs were collected and compared between groups. Cohort-specific minimal clinically important difference and patient acceptable symptom state achievement was compared between groups. RESULTS: In total, 52 flexibility sport athletes with BHD were matched to 104 flexibility sport athletes without BHD. Both groups showed similar sport participation (P = .874) and a similar level of competition (P = .877). Preoperative lateral center-edge angle (22.2°± 1.6° vs 31.5°± 3.9°; P < .001) and Tönnis angle (10.9°± 3.7° vs 5.8°± 4.4°; P < .001) differed between groups. Capsular plication was performed in all cases. Both groups achieved significant improvement in all PROs (P < .001) with no differences in postoperative PROs between groups (P≥ .147). High minimal clinically important difference (BHD group: 95.7%; control group: 94.8%) and patient acceptable symptom state (BHD group: 71.7%; control group: 72.2%) achievement for any PRO was observed with no differences between groups (P≥ .835). CONCLUSION: Flexibility sport athletes with BHD achieved similar outcomes as those of flexibility sport athletes without BHD after hip arthroscopy for FAIS with capsular plication.

Can neuromuscular differences manifest by early adolescence in males between predominantly endurance and strength sports?

INTRODUCTION: Although neuromuscular function varies significantly between strength and endurance-trained adult athletes, it has yet to be ascertained whether such differences manifest by early adolescence. The aim of the present study was to compare knee extensor neuromuscular characteristics between adolescent athletes who are representative of strength (wrestling) or endurance (triathlon) sports. METHODS: Twenty-three triathletes (TRI), 12 wrestlers (WRE) and 12 untrained (CON) male adolescents aged 13 to 15 years participated in the present study. Maximal voluntary isometric contraction (MVIC) knee extensor (KE) torque was measured, and 100-Hz magnetic doublets were delivered to the femoral nerve during and after KE MVIC to quantify the voluntary activation level (%VA). The doublet peak torque (T100Hz) and normalized vastus lateralis (VL) and rectus femoris (RF) EMG (EMG/M-wave) activities were quantified. VL and RF muscle architecture was also assessed at rest using ultrasound. RESULTS: Absolute and relative (to body mass) KE MVIC torques were significantly higher in WRE than TRI and CON (p < 0.05), but comparable between TRI and CON. No significant differences were observed between groups for %VA, T100Hz or either VL or RF muscle thickness. However, VL EMG/M-wave was higher, RF fascicle length longer, and pennation angle smaller in WRE than TRI and CON (all p < 0.05). CONCLUSION: The wrestlers were stronger than triathletes and controls, potentially as a result of muscle architectural differences and a greater neural activation. Neuromuscular differences can already be detected by early adolescence in males between predominantly endurance and strength sports, which may result from selection bias and/or physical training.

Musculoskeletal and cardiovascular considerations for transgender athletes.

OBJECTIVE: Participation in athletics is essential for the overall well-being of transgender athletes and should be included as part of gender-affirming care. Surveys show physicians and athletic trainers want to provide appropriate care for transgender athletes but lack the proper knowledge and training to do so. Gender Affirming Hormone Therapy (GAHT) is part of gender-affirming care, yet the effects of GAHT on the cardiovascular and musculoskeletal health of transgender athletes is not well-understood. The purpose of this review was to discuss important musculoskeletal and cardiovascular considerations unique to transgender athletes and improve physician understanding in caring for transgender athletes. METHODS: A representative selection of literature on the effects of GAHT on cardiovascular and musculoskeletal health was included in this review. RESULTS: Estrogen therapy may increase the risk of venous thromboembolism (VTE) and stroke, and decrease blood pressure levels among transgender women, while studies on lipid profile are inconsistent among both transgender men and women. Transgender women receiving GAHT may also be at greater risk for bone fracture and ligamentous injuries. CONCLUSION: Exercise is essential for the well-being of transgender individuals and special considerations regarding the cardiovascular and musculoskeletal health of transgender athletes should be incorporated into standard medical education. Educational programs for transgender patients and their support team should focus on preventative measures that can be taken to reduce the risk of adverse musculoskeletal and cardiovascular events. The PPE is an invaluable tool available to physicians to monitor the health and safety of transgender athletes and should be regularly updated as research on the health of transgender individuals continues to grow. Longitudinal and prospective studies should examine the effects of GAHT on the musculoskeletal and cardiovascular health of transgender athletes. Lastly, health care providers play an important role in the advancement of gender-neutral policies.

A grounded theory of youth athlete concussion under-reporting decisions.

BACKGROUND: Sport-related concussions leave youth vulnerable to significant health, physical, social, and educational disruptions. Many youth athletes under-report concussions, but the scope of the issue for this population is not well understood, nor are the underlying motivations for (under)reporting. It is necessary to examine the relationship between sport-related concussion knowledge and reporting and invite athletes to share their decision-making processes. The purpose of the research was to understand how athletes' attitudes, experiences and beliefs regarding concussions influence their under-reporting decisions and behaviours. METHODS: We conducted semi-structured interviews with 17 elite athletes, aged 16-18 years, from individual and team sports. Data were analyzed using constructivist grounded theory and a substantive theoretical model of sport-related concussion under-reporting was developed. RESULTS: The model demonstrates personal, social, cultural, and biophysical processes that contribute to under-reporting decisions and identifies multiple interconnected processes that contribute to 'high-risk' situations of under-reporting. Youth athletes navigate various barriers and facilitators to under-reporting, including their own desire to play, perceived stigma, concussion sense-making, and social influences. Results suggest that under-reporting by youth athletes implicates a collective, rather than individual, responsibility. CONCLUSIONS: A theoretical grounded model for youth sport-related concussion under-reporting highlights the complexity of the decision-making process. This study offers a new framework for understanding why youth athletes may hide concussion symptoms. The model offers potential to be used to develop concussion interventions and tools for improved decision-making, and to address issues of risk and responsibility concerning concussion reporting.

Cardiovascular screening of elderly athletes.

The permanently growing interest in amateur and professional sports activities among young, middle-aged and elderly athletes raises serious concerns about athletes' health, the safety of physical training, and the sports-related risk of sudden cardiac death and other cardiovascular complications during exercise. In recent years there has been an increasing number of cases of sudden cardiac death during physical effort. At present, life expectancy in the most developed countries grows rapidly and the number of people >65 years dramatically increases. Moreover, biological age of the population is lower. Subsequently, relevant increase in the number of elderly athletes involved in various types of sports activities has been reported in many countries. It was also demonstrated that physical activity has strong beneficial effect on cognitive functions, psychomotor performance and thus exercise capacity, which is very important for the elderly people in their everyday routine activities. Nonetheless, it should be remembered that participation in amateur and professional sports activities may be associated with risk of serious cardiovascular events in the elderly athletes often suffering from various civilization diseases. It is also reported that the number of elderly people after interventional cardiology procedures, open heart surgery and cancer treatment (chemotherapy, radiotherapy), who wish to participate in various sports activities, systematically grows. The authors of the paper conduct a literature review on cardiovascular risk assessment in the elderly athletes including the contemporary cardiology diagnostic methods and diagnostic schemes to prevent sudden cardiac death and other cardiovascular events during exercise. The controversies over efficacy of particular diagnostic tools to detect cardiovascular diseases in the elderly athletes and worldwide epidemiologic data concerning risk of sudden cardiac death during physical exercise have been also presented. Here, the authors have derived suggestions for establishment of comprehensive diagnostic schemes to prevent sudden cardiac death during sports activities.

Changes in mental health levels among Chinese athletes from 1995 to 2023.

Objective: In recent years, with the increasing intensity of sports competition and social pressure, the issue of mental health among athletes have gradually attracted attention. Understanding the changing trends of athletes' mental health is of great significance for formulating effective intervention measures and safeguarding the mental health of athletes. Methods: A total of 306 articles were accumulated from September to November 2023 by selecting literature from databases that measured the mental health of Chinese athletes using the Symptom Checklist-90 (SCL-90). Based on the screening criteria, 28 articles (N = 4,227) were finally included. A cross-sectional historical meta-analysis of these 28 studies using the SCL-90 between 1995 and 2023 was conducted. Based on cross-sectional historical meta-analysis methods, specific statistical methods, such as correlation and regression analyses, were used to examine trends over time in the scores of the nine SCL-90 factors measured by the athletes in the studies, as well as athlete type and gender differences. Results: (1) Athletes' scores on the depression, hostility, phobic anxiety, and paranoid ideation factors gradually increased with the change of era, and the explanation rate of the variation of each factor by era ranged from 18.8 to 27.2%; (2) During the period from 1995 to 2023, the mental health of athletes in China gradually deteriorated on the factors of depression, hostility, and phobic anxiety, the rate of change was rapid, with a medium to large magnitude (0.28-0.42); (3) The scores of female athletes on the depression and psychoticism factors scores showed a significant upward trend, while male mental health scores for each factor did not improve significantly over the years; (4) College athletes' scores on the depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism factors showed an upward trend as the years changed. Conclusion: Chinese athletes' mental health has been on a downward trend for the past 28 years, which needs to be a cause for concern.

Evaluation of Orexin-A Salivary Levels and its Correlation with Attention After Non-invasive Brain Stimulation in Female Volleyball Players.

BACKGROUND: The capacity to change attention from one area to another depending on the many environmental circumstances present is a crucial aspect of selective attention and is strictly correlated to reaction time. The cholinergic system of the basal forebrain is crucial for attentive abilities. Several inputs, particularly orexin neurons, whose cell bodies are found in the postero-lateral hypothalamus, can activate the cholinergic system. The aim of this study was to investigate if high frequencies rTMS at dorsolateral prefrontal cortex (DLPFC) in highly trained volleyball players can change Orexin-A levels, attention and reaction time. This study was a double-blinded (participant and evaluator) matched-pair experimental design. Twenty right-handed female volleyball players were recruited for the study (age 24.6 ± 2.7 years; height 177.0 ± 5.5 cm; body mass 67.5 ± 6.5 kg; BMI 21.5 ± 1.2). RESULTS: The main finding of this study was that 10 Hz rTMS to the DLPFC seems to increase Orexin-A salivary levels and the percentage of correct answers, while decreasing RT. After rTMS, the athletes show an increase in the percentage of correct answers immediately after the end of stimulation, and also after 15 and 30 min. Moreover, the athletes show decreases in reaction time after the end of stimulation and after 15 and 30 min to the end of stimulation, while no differences were found at the end of stimulation. Finally, the athletes show significant increases in Orexin-A salivary levels after stimulation with a peak after 30' of the end. CONCLUSION: The results of our study seem to indicate that there is a relationship between salivary Orexin-A levels and RT. These results could provide useful tools for modulating sports training; in fact, if confirmed, they could lead coaches to offer their athletes rTMS sessions appropriately integrated with training. In fact, alternating attention is a mental flexibility that enables people to change their point of focus and switch between tasks requiring various levels of cognition.