Perspectives of a new sport-specific Para Shooting classification system for athletes with vision impairment

The International Paralympic Committee (IPC) and individual sports federations have established the need to develop evidence-based systems of classification for athletes with vision impairment (VI) that may differ depending on the visual demands of each sport. As a consequence, research has been conducted that led to a new classification system for athletes competing in VI shooting. The purpose of this study was to canvas the experiences of key stakeholders (athletes, coaches and classifiers) when the new system of classification was implemented. Twenty-eight participants (17 athletes, 7 coaches and 4 classifiers) completed a questionnaire to rate their experiences of the previous and new classification systems and were interviewed to gain richer insights into their opinions. It was apparent that the changes to the classification system were not adequately communicated to the athletes in particular, and that the classifiers may require a better understanding of the principles of evidence-based classification. The new system was perceived to be significantly more specific for VI shooting and intentional misrepresentation was observed to be significantly less likely than when using the old system. This research provides valuable insights into both the positive and negative experiences of key stakeholders experiencing change in a classification system

The incidence and patterns of illness at the Sochi 2014 winter paralympic games : a prospective cohort study of 6564 athlete days

OBJECTIVE To describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games. METHODS A total of 547 athletes from 45 countries were monitored daily for 12 days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems. RESULTS The total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35–63 years) had a significantly higher IR than younger athletes (14–25 years, p=0.049). CONCLUSIONS The results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.IOC Research Centre (South Africa) Grant, IPC Research Grant.http://bjsm.bmj.comam2016Sports Medicin

Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk

PurposeTo test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones.MethodsA total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.28.0 years, and 33 with different health conditions, mean age 37.89.9 years) and in four sport type groups (skill, power, intermittent-mixed metabolism-and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete.ResultsThe prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p=0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 +/- 5.70 ml kg(-1) min(-1)). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 +/- 10.0 vs 33.6 +/- 8.9 ml kg(-1) min(-1)p=0.03), and in those with 3-4 risk factors (19.09 +/- 5.34 ml kg(-1) min(-1)) than those with 2 risk factors (27.1 +/- 5.50 ml kg(-1) min(-1)), 1 risk factor (31.6 +/- 8.55 ml kg(-1) min(-1)), or none (36.4 +/- 8.76 ml kg(-1) min(-1)) (p<0.001).ConclusionsThe present study suggests that having higher VO2peak seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment.Open access funding provided by Universita degli Studi dell'Aquila within the CRUI-CARE Agreement

Efficacy of mirabegron in patients with and without prior antimuscarinic therapy for overactive bladder: a post hoc analysis of a randomized European-Australian Phase 3 trial

Background Antimuscarinic agents are currently the predominant treatment option for the clinical management of the symptoms of overactive bladder (OAB). However, low rates of persistence with these agents highlight the need for novel, effective and better-tolerated oral pharmacological agents. Mirabegron is a β3-adrenoceptor agonist developed for the treatment of OAB, with a mechanism of action distinct from that of antimuscarinics. In a randomized, double-blind, placebo- and active-controlled Phase 3 trial conducted in Europe and Australia (NCT00689104), mirabegron 50 mg and 100 mg resulted in statistically significant reductions from baseline to final visit, compared with placebo, in the co-primary end points – mean number of incontinence episodes/24 h and mean number of micturitions/24 h. We conducted a post hoc, subgroup analysis of this study in order to evaluate the efficacy of mirabegron in treatment-naïve patients and patients who had discontinued prior antimuscarinic therapy because of insufficient efficacy or poor tolerability. Methods Patients were randomized to placebo, mirabegron 50 or 100 mg, or tolterodine extended release (ER) 4 mg orally, once-daily, for 12 weeks. For the post hoc analysis, the primary patient population was divided into the following subgroups: (1) patients who had not received any prior antimuscarinic OAB medication (treatment-naïve) and (2) patients who had received prior antimuscarinic OAB medication. The latter subgroup was further subdivided into patients who discontinued due to: (3) insufficient efficacy or (4) poor tolerability. Analysis of the co-primary efficacy endpoints by subgroup was performed using analysis of covariance with treatment group, subgroup, sex, geographical region, and subgroup-by-treatment interaction as fixed factors; and baseline value as a covariate. Results Mirabegron, 50 mg and 100 mg once-daily, demonstrated similar improvements in the frequency of incontinence episodes and micturitions in OAB patients who were antimuscarinic-naïve and who had discontinued prior antimuscarinic therapy. While mirabegron demonstrated improvements in incontinence and micturition frequency in patients who had discontinued prior antimuscarinic therapy due to insufficient efficacy, the response to tolterodine was similar to that of placebo. Conclusion In this post hoc subgroup analysis, mirabegron provided treatment benefits in OAB patients who were antimuscarinic treatment-naïve and in patients who had received prior antimuscarinic treatment