Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding.

BACKGROUND/AIM: This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. METHODS: Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet. RESULTS: The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22). CONCLUSIONS: The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type.

Influence of midsole hardness of standard cushioned shoes on running-related injury risk.

BACKGROUND: In this double-blind randomised controlled trial, we tested if leisure-time runners using shoes with less compliant midsoles have a higher running-related injury (RRI) risk. METHOD: We provided 247 runners with standard running shoes having either a soft study shoes (soft-SS) or a hard study shoes (hard-SS) midsole and followed them prospectively for 5 months regarding RRI. All information about sports practice and injuries was uploaded on a dedicated internet platform and checked for consistency and completeness. RRI was defined as any first-time pain sustained during or as a result of running practice and impeding normal running activity for at least 1 day. Cox proportional hazards regressions were used to identify RRI risk factors. RESULT: The type of study shoes used for running was not associated with RRIs (HR=0.92; 95% CI 0.57 to 1.48). The hard-SS had a 15% greater overall stiffness in the heel region. The two study groups were similar regarding personal and sports participation characteristics, except for years of running experience, which was higher (p<0.05) in the hard-SS group. Global RRI incidence was 12.1 RRI/1000 h of running. No between-group differences were found regarding injury location, type, severity or category. Nevertheless, the adjusted regression model revealed positive associations with RRI risk for body mass index (HR=1.126; 95% CI 1.033 to 1.227), previous injury (HR=1.735; 95% CI 1.037 to 2.902) and mean session intensity (HR=1.396; 95% CI 1.040 to 1.874). Protective factors were previous regular running activity (HR=0.422; 95% CI 0.228 to 0.779) and weekly volume of other sports activities (HR=0.702; 95% CI 0.561 to 0.879). CONCLUSIONS: Midsole hardness of modern cushioned running shoes does not seem to influence RRI risk.

Moderate to severe injuries in football: a one-year prospective study of twenty-four female and male amateur teams.

This study aimed to realize a prospective follow-up of the injuries occurring in female and male football players involved in the highest league in the Grand-Duchy of Luxembourg. Data concerning anthropometric characteristics and football activities were gathered in 125 female and 243 male football players via questionnaires at the beginning of the study. Then, a follow-up of moderate to severe injuries (> 15 days of interruption in football practice) was performed throughout the season 2013-2014. Sixteen injuries (injury incidence = 0.7 injuries/1000 h of exposure) were observed in 13 female football players (10.4%). These injuries concerned mainly the knee (n = 7; 43.7%), with capsules and ligaments being the most often concerned tissues (n = 7; 43.7%). In male football players, 41 severe injuries (injury incidence = 0.6 injuries/1000 h of exposure) were observed in 36 players (14.8%). These injuries concerned mainly the thighs (n = 12; 29.3%) and the muscles and tendons were the most often concerned tissues (n = 18; 43.9%). Injuries in football are predominantly located at the lower limbs, particularly the knees in female football players. The predominant muscle and tendon lesions of the thighs occurring in males could reveal that physical preparation is insufficient or inadequate for a number of players. Regarding these results, it is necessary to implement an injury prevention strategy. The "FIFA 11+" programme could be used as the basic method, but should be personalized according to sex. The injury collection methodology could be optimized with the use of an electronic database, such as the Training and Injury Prevention Platform for Sports (TIPPS). Beside the systematic recording of injury data (as well as the training load) by the players or the medical staff, this system allows to share of important information between stakeholders, follow-up the players, provide risk factor warnings and increase the awareness of the injury problem.

Gait asymmetry in spatiotemporal and kinetic variables does not increase running-related injury risk in lower limbs: a secondary analysis of a randomised trial including 800+ recreational runners.

Objective: To investigate asymmetry in spatiotemporal and kinetic variables in 800+ recreational runners, identify determinants of asymmetry, investigate if asymmetry is related to greater running injury risk and compare spatiotemporal and kinetic variables between the involved and uninvolved limb at baseline in runners having sustained an injury during follow-up. Methods: 836 healthy recreational runners (38.6% women) were tested on an instrumented treadmill at their preferred running speed at baseline and followed up for 6 months. From ground reaction force recordings, spatiotemporal and kinetic variables were derived for each lower limb. The Symmetry Index was computed for each variable. Correlations and multiple regression analyses were performed to identify potential determinants of asymmetry. Cox regression analyses investigated the association between asymmetry and injury risk. Analysis of variance for repeated measures was used to compare the involved and uninvolved limbs in runners who had sustained injuries during follow-up. Results: 107 participants reported at least one running-related injury. Leg length discrepancy and fat mass were the most common determinants of asymmetry, but all correlation coefficients were negligible (0.01-0.13) and explained variance was very low (multivariable-adjusted R2<0.01-0.03). Greater asymmetry for flight time and peak breaking force was associated with lower injury risk (HR (95% CI): 0.80 (0.64 to 0.99) and 0.96 (0.93 to 0.98), respectively). No between-limb differences were observed in runners having sustained an injury. Conclusion: Gait asymmetry was not associated with higher injury risk for investigated spatiotemporal and kinetic variables. Trial registration number: NCT03115437.

Complete inclusion of adaptive rowing only 1000 m ahead.

Adaptive rowing (AR) at the Paralympic level is accessible for rowers with physical disability. AR was included for the first time in the Beijing 2008 Paralympic Games. Racing distance for all AR events is currently 1000 m, which impedes public recognition of this sport and leads to many organisational challenges during the inclusive World Rowing Championships. The aim of this report was to discuss the feasibility of increasing AR race distance to 2000 m from a sports injury and athletic health perspective. As limited data on injury and illness risks exist in AR, knowledge and experiences had to be taken from other Paralympic sports. The anticipated duration of 2000 m AR competitions is either comparable or considerably lower than that of the other Paralympic disciplines with similar characteristics. AR has inherent injury and health risks especially within thorax, shoulders and low back region, but they are not expected to be significantly modified by increased racing times. Specific considerations need to be taken into account for athletes with a spinal cord injury, like in other sport disciplines. There are no distinctive contra-indications for AR events of 2000 m based on the current literature review and a 10-year experience in this sport. Long-term follow-ups are needed to understand fully the injury and health risk associated with AR and to develop appropriate prevention strategies.

Resting ECG findings in elite football players.

The purpose of the study was to evaluate ECG abnormalities in a large sample of elite football players. Data from 566 elite male football players (57 of them of African origin) above 16 years of age were screened retrospectively (age: 20.9 ± 5.3 years; BMI: 22.9 ± 1.7 kg · m(-2), training history: 13.8 ± 4.7 years). The resting ECGs were analysed and classified according to the most current ECG categorisation of the European Society of Cardiology (ESC) (2010) and a classification of Pelliccia et al. (2000) in order to assess the impact of the new ESC-approach. According to the classification of Pelliccia, 52.5% showed mildly abnormal ECG patterns and 12% were classified as distinctly abnormal ECG patterns. According to the classification of the ESC, 33.7% showed 'uncommon ECG patterns'. Short-QT interval was the most frequent ECG pattern in this group (41.9%), followed by a shortened PR-interval (19.9%). When assessed with a QTc cut-off-point of 340 ms (instead of 360 ms), only 22.2% would have had 'uncommon ECG patterns'. Resting ECG changes amongst elite football players are common. Adjustment of the ESC criteria by adapting proposed time limits for the ECG (e.g. QTc, PR) should further reduce the rate of false-positive results.

Injury incidence in a sports school during a 3-year follow-up.

PURPOSE: This study prospectively analysed sports injury incidence over 3 seasons in a regional sports school within an injury surveillance project, involving 372 athletes (12-19 years) from 16 different disciplines. METHODS: A personal sports diary was used to record all sporting activities daily for every athlete. Injuries (time-loss definition) were registered via a standardized questionnaire. RESULTS: Sports injury incidence (injuries/1,000 h) evolved from 3.9 in the first year to 4.8 in the second (p < 0.01) and down to 2.8 in the third (p < 0.001, compared to the preceding periods). Significant decreases of injury incidence in the third year were also observed when classifying injuries as traumatic or overuse, and as new or recurrent. The proportion of recurrent injuries was lower in the third period (11 %) when compared to the first (19.5 %, p < 0.05) and the second one (26.3 %, p < 0.05). Injury incidence was lowest during the third period for all severity categories. The same was found when considering injuries within racket, team and individual sports. CONCLUSIONS: Implementing an injury surveillance system in this setting was associated with a lower injury incidence in the third observation period. This project may have influenced stakeholders' awareness and attitude towards the sports injury problematic.

Impact of COVID-19 Vaccination on Short-Term Perceived Change in Physical Performance among Elite Athletes: An International Survey.

COVID-19 vaccination raised concerns about its potential effects on physical performance. To assess the impact of COVID-19 vaccination on the perceived change in physical performance, we conducted an online survey among elite athletes from Belgium, Canada, France and Luxembourg, with questions about socio-demographics, COVID-19 vaccination, perceived impact on physical performance and perceived pressure to get vaccinated. Full vaccination was defined as two doses of mRNA or vector vaccine or a heterologous vaccine scheme. Among 1106 eligible athletes contacted, 306 athletes answered the survey and were included in this study. Of these, 72% perceived no change in their physical performance, 4% an improvement and 24% a negative impact following full COVID-19 vaccination. For 82% of the included athletes, the duration of the negative vaccine reactions was ≤3 days. After adjustment for potential confounding variables, practicing an individual sport, a duration of vaccine reactions longer than 3 days, a high level of vaccine reaction and the perceived pressure to get vaccinated were independently associated with a perceived negative impact on physical performance of more than 3 days after the vaccination. The perceived pressure to get vaccinated appears to be a parameter associated with the negative perceived change in the physical performance and deserves further consideration.

Intensity control in swim training by means of the individual anaerobic threshold.

This study aimed at evaluating the homogeneity of physiological responses during swim training bouts with intensities prescribed by reference to the individual anaerobic threshold (IAT). Eighteen competitive front crawl swimmers (female 5, male 13, 10 long-distance, and 8 short-distance swimmers [LDSs, SDSs], age: 17 ± 1.7 years, training history: 7.0 ± 2.8 years, training volume per week: 35 ± 5.7 km) performed an incremental swimming test to determine the IAT. Within a maximum of 3 weeks, 4 training programs were conducted: 20 × 100-m low-intensity endurance training (EN(low), 97% IAT), 5 × 400-m high-intensity endurance training (EN(high), 101% IAT), 5 × 200 m (IT1, 105% IAT), and 10 × 100 m (IT2, 108% IAT) intensive interval training. Blood lactate concentrations (bLa) were determined during each training session. The results are given as median (25th and 75th percentiles). During EN(low) and EN(high), the mean bLas were 1.8 mmol·L(-1) (1.3/3.0 mmol·L(-1)) and 4.4 mmol·L(-1) (3.9/6.4 mmol·L(-1)). The bLas were higher during both IT programs: IT1, 6.3 mmol·L(-1) (5.6/7.2 mmol·L(-1)); IT2, 5.8 mmol·L(-1) (5.0/6.5 mmol·L(-1)). The bLas of most individuals were close to the median values (±2.4 mmol·L(-1)). However, in each of the training programs, some subjects showed bLa values that were clearly above (3-7 mmol·L(-1) higher). In particular, SDSs reached higher bLas at the same intensity compared with LDSs. It is concluded that intensity prescriptions by means of IAT seem to elicit an expected metabolic response in approximately 85% of swim training sessions. The observed average bLa is in the range of those recommended in the scientific literature.

Spatiotemporal and Ground-Reaction Force Characteristics as Risk Factors for Running-Related Injury: A Secondary Analysis of a Randomized Trial Including 800+ Recreational Runners.

BACKGROUND: Running biomechanics may play a role in running-related injury development, but to date, only a few modifiable factors have been prospectively associated with injury risk. PURPOSE: To identify risk factors among spatiotemporal and ground-reaction force characteristics in recreational runners and to investigate whether shoe cushioning modifies the association between running biomechanics and injury risk. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Recreational runners (N = 848) were tested on an instrumented treadmill at their preferred running speed in randomly allocated, standardized running shoes (with either hard or soft cushioning). Typical kinetic and spatiotemporal metrics were derived from ground-reaction force recordings. Participants were subsequently followed up for 6 months regarding running activity and injury. Cox regression models for competing risk were used to investigate the association between biomechanical risk factors and injury risk, including stratified analyses by shoe version. RESULTS: In the crude analysis, greater injury risk was found for greater step length (subhazard rate ratio [SHR], 1.01; 95% CI, 1.00-1.02; P = .038), longer flight time (SHR, 1.00; 95% CI, 1.00-1.01; P = .028), shorter contact time (SHR, 0.99; 95% CI, 0.99-1.00; P = .030), and lower duty factor (defined as the ratio between contact time and stride time; SHR, 0.95; 95% CI, 0.91-0.98; P = .005). In the stratified analyses by shoe version, adjusted for previous injury and running speed, lower duty factor was associated with greater injury risk in those using the soft shoes (SHR, 0.92; 95% CI, 0.85-0.99; P = .042) but not in those using the hard shoes (SHR, 0.97; 95% CI, 0.91-1.04; P = .348). CONCLUSION: Lower duty factor is an injury risk factor, especially for softer shoe use. Contrary to widespread beliefs, vertical impact peak, loading rate, and step rate were not injury risk factors in recreational runners. REGISTRATION: NCT03115437 (ClinicalTrials.gov identifier).

Effect of shoe cushioning on landing impact forces and spatiotemporal parameters during running: results from a randomized trial including 800+ recreational runners.

AbstractIn a recent randomized trial including 800+ recreational runners, injury risk was lower in those who received the Soft shoe version compared to those using the Hard version (Hazard ratio = 1.52; 95% Confidence Interval = 1.07-2.16). Here, we investigated the effect of shoe cushioning on ground reaction forces (GRF) and spatiotemporal parameters in the same cohort, with a special focus on Vertical Impact Peak Force (VIPF) and Vertical Instantaneous Loading Rate (VILR). Healthy runners (n = 848) randomly received one of two shoe prototypes that differed only in their cushioning properties (Global stiffness: 61 ± 3 and 95 ± 6 N/mm in the Soft and Hard versions, respectively). Participants were tested on an instrumented treadmill at their preferred running speed. GRF data was recorded over 2 min. VIPF was higher in the Soft shoe group compared to the Hard shoe group (1.53 ± 0.21 vs. 1.44 ± 0.23 BW, respectively; p < 0.001). However, the proportion of steps with detectable VIPF was lower in the Soft shoe group (84 vs. 97%, respectively; p < 0.001) and Time to VIPF was longer (46.9 ± 8.5 vs. 43.4 ± 7.4 milliseconds, respectively; p < 0.001). No significant differences were observed for VILR (60.1 ± 13.8 vs. 58.9 ± 15.6 BW/s for Soft and Hard shoe group, respectively; p = 0.070) or any other kinetic variable. These results show that the beneficial effect of greater shoe cushioning on injury risk in the present cohort is not associated with attenuated VIPF and VILR. These GRF metrics may be inappropriate markers of the shoe cushioning-injury risk relationship, while delayed VIPF and the proportion of steps displaying a VIPF could be more relevant.Trial registration: ClinicalTrials.gov identifier: NCT03115437..

Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19.

In regular times, implementing exercise-based injury prevention programs into the training routine of high-level and professional athletes represents a key and challenging aspect to decrease injury risk. Barriers to implementing such prevention programs have previously been identified such as lack of resources, logistic issues or motivation. The COVID-19 pandemic associated with restrictions on daily life dramatically impacted sports participation from training to competition. It is therefore reasonable to assume that such lockdown-like context has exacerbated the challenge to implement exercise-based injury prevention programs, potentially leading to a greater musculoskeletal injury risk. In this narrative review, recommendations are proposed for building an expertise- and evidence-based Standard Operating Procedure for injury prevention in lockdown-like contexts for high-level and professional athletes. The following recommendations can be provided: (1) assess the global and sport-specific risks in the light of the ongoing cause of isolation; (2) adapt remote training materials and programs; (3) ensure regular quality communication within the staff, between athletes and the staff as well as between athletes; (4) follow the athlete's mental well-being; and (5) plan for a safe return-to-sports as well as for an ongoing monitoring of the load-recovery balance. These key domains should further be addressed to comply with local policies, which are subject to change over time in each individual country. The use of these recommendations may improve the readiness of athletes, coaches, physicians and all sports stakeholders for future lockdown-like contexts.

Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners.

BACKGROUND: Shoe cushioning is expected to protect runners against repetitive loading of the musculoskeletal system and therefore running-related injuries. Also, it is a common belief that heavier runners should use footwear with increased shock absorption properties to prevent injuries. PURPOSE: The aim of this study was to determine if shoe cushioning influences the injury risk in recreational runners and whether the association depends on the runner's body mass. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Healthy runners (n = 848) randomly received 1 of 2 shoe prototypes that only differed in their cushioning properties. Global stiffness was 61.3 ± 2.7 and 94.9 ± 5.9 N/mm in the soft and hard versions, respectively. Participants were classified as light or heavy according to their body mass using the median as a cut-off (78.2 and 62.8 kg in male and female runners, respectively). They were followed over 6 months regarding running activity and injury (any physical complaint reducing/interrupting running activity for at least 7 days). Data were analyzed through time-to-event models with the subhazard rate ratio (SHR) and their 95% confidence interval (CI) as measures of association. A stratified analysis was conducted to investigate the effect of shoe cushioning on the injury risk in lighter and heavier runners. RESULTS: The runners who had received the hard shoes had a higher injury risk (SHR, 1.52 [95% CI, 1.07-2.16]), while body mass was not associated with the injury risk (SHR, 1.00 [95% CI, 0.99-1.01]). However, after stratification according to body mass, results showed that lighter runners had a higher injury risk in hard shoes (SHR, 1.80 [95% CI, 1.09-2.98]) while heavier runners did not (SHR, 1.23 [95% CI, 0.75-2.03]). CONCLUSION: The injury risk was higher in participants running in the hard shoes compared with those using the soft shoes. However, the relative protective effect of greater shoe cushioning was found only in lighter runners. REGISTRATION: NCT03115437 (ClinicalTrials.gov identifier).

Motivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials.

OBJECTIVE: This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients. METHODS: Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior. RESULTS: Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention. CONCLUSION: Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate.

Injuries, risk factors and prevention initiatives in youth sport.

BACKGROUND: Sports injuries in young athletes are a public health issue which deserves special attention. Effective prevention can be achieved with training programmes originating from the field of physical therapy and medicine. SOURCES OF DATA: A systematic literature search on injury prevention in youth sport was performed in the MEDLINE database. AREAS OF AGREEMENT: For prevention programmes to reduce sports injuries, critical factors must be considered, such as training content, duration and frequency, as well as athlete compliance. AREAS OF CONTROVERSY: Home-based programmes could be inferior to supervised training, but are efficient if compliance is high. So far prevention programmes have focused on team sports and their efficiency in individual sports remains to be proven. GROWING POINTS: Active prevention programmes focusing specifically on the upper extremity are scarce. Initiatives enhancing the awareness of trainers, athletes and therapists about risk factors and systematic prevention measures should be encouraged.

T-wave variability detects abnormalities in ventricular repolarization: a prospective study comparing healthy persons and Olympic athletes.

BACKGROUND: Sudden cardiac death in athletes is more common than in the general population. Routine screening procedures are performed to identify competitors at risk. A new Holter-based parameter analyzes variation of the ventricular repolarization (TVar). The aim of this study was to evaluate differences in electrocardiogram (ECG), Echo, and Holter (H) in competitive athletes compared to a healthy control group consisting of medical students (MS). METHODS: A total of 40 athletes (19 females, Olympic team, Luxembourg) and 40 MS (22 females) were examined by means of a resting ECG, treadmill exercise (TE), echocardiogram (Echo), as well as H recordings during a routine screening visit. To analyze TVar, a 20-minute H recording at rest (sampling rate 1000 per second) was performed. Moreover, heart rate variability (HRV) as well as HR turbulence (HRT) was computed. RESULTS: No differences in demographic variables were detected. Quantification of HRV detected a significant increase in the vagal component of autonomic cardiac modulation. In contrast, no differences for HRT were found. Echo parameter demonstrated a thicker septal wall without differences of the posterior wall. TVar values were normal in range, but did differ significantly between the two groups. No correlation between TVar and echo as well as Holter parameters was detected. CONCLUSIONS: TVar was able to demonstrate significant differences in terms of alterations of ventricular activation. This might indicate an early change of myocardial repolarization representing a substrate for life-threatening arrhythmia. Larger studies on the predictive value of TVar including follow-up are necessary to confirm this preliminary finding.

Cardiac tissue Doppler imaging in sports medicine.

The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard. Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions. For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI. Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking. An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.

[Ongoing medical problems in the anti-doping fight]. / Problèmes médicaux actuels de la lutte antidopage.

Over the last 20 years systematic doping has become a major threat for elite sport. So far, there is no clear information about the daily practice of doping. Repeated scandals and recent personal statements have added to our knowledge. Several more recent doping agents like Erythropoietin (EPO) and, probably, growth hormone (GH) enhance performance in a highly effective way and, together with the well known anabolic steroids (AAS), belong to the major doping categories. The introduction of EPO has really changed the paradigm in endurance sports allowing a good middle class athlete to become a champion. It is evident that doping practices are influenced by the possibilities of the anti-doping control system. Unethical, criminal medical doctors play a decisive role in the ongoing practice of major doping. Apart from the already mentioned substances AAS, EPO and GH several novel drugs appear on the horizon. They are highly effective and there is no doubt that they will be used in attempts to improve performance. During the last years, doping control systems have also been improved: EPO can now be detected in urine samples and the detection of AAS has also become much more sensitive. However GH hormone detection is not possible at the moment and this remains a major weakness of doping control. Other problems are the control procedures which are far from being optimal. In the future the quality of doping controls will be decisive and not only the quantity; controls will have to be "intelligent". The effective fight against doping in the next years will decide about the survival of elite sport.