Investigating possible retinal biomarkers of head trauma in Olympic boxers using optical coherence tomography (OCT)

Purpose: Changes to retina have been reported after a number of neurodegenerative conditions. The purpose of this study was to investigate retinal structures in Olympic boxers exposed to frequent head blows. Methods:Retinal imaging offers potential as a non-invasive biomarkers of neuropathology. Macula and retinal nerve fibre layer (RNFL) thickness was measured using optical coherence tomography (OCT) in UK Olympic boxers attending two mandatory eye screening programs, 18 months apart. Data from the two eye-screenings provide longitudinal data of retinal change over time. Sedentary healthy subjects (controls) without past or present history of concussion were also screened at the time of the second boxer screening to provide comparison cross-sectional data. Results: Sixteen Olympic boxers aged 20-33 years and 20 sedentary healthy controls, aged 24-45 years were recruited. Significant macula thickening was observed over time (18 months) in 75% of right and 50% of left eye sectors. For RNFL, left eye quadrants thickened. For right eye RNFL quadrants, thickening and thinning of this layer was observed. Cross-sectional results showed thinner macula sectors and RNFL quadrants in Olympic boxers compared to controls. Conclusion: Significant change to macula and RNFL densities, occurring over an 18 month interval is an unexpected finding in otherwise heathy elite sportsmen. In addition, macula and RNFL were thinner than healthy sedentary controls. OCT may prove clinically useful as a candidate retinal biomarker of neuropathological change after mild traumatic brain injury and/or repeat head blows

Identification of research priorities in exercise oncology: a consensus study

The growth of research in the field of exercise oncology has resulted in a large evidence base for the role of physical activity in preventing and managing cancer outcomes. Nonetheless, there remain many unanswered questions across the multidisciplinary field. This study aimed to determine the priority research questions within exercise oncology using a systematic consensus method. Forty-seven exercise oncology experts engaged in the five-step process of the Nominal Group Technique to generate a list of research questions in small groups and rank the 10 most important. One hundred questions resulted from the process and fifteen received total scores (sum of ranks) of at least 50 from a maximum score of 470. The highest ranked question (score of 125) related to the identification of functional markers of recovery. The next five questions concerned minimum exercise parameters, health professional education, translation of behavioural interventions, effects of exercise on the tumour microenvironment and development of in vitro models to study the impact of exercise on cancer cell growth and metastasis. The study has demonstrated the importance of future research across all disciplinary areas of exercise oncology and identified the priority questions to which resources might be directed

Criterion validity and reliability of an instrumented mouthguard under pendulum impactor conditions

The popularity of instrumented mouthguards (iMGs) use to measure head impact kinematics in contact sports is growing. To accurately compare between systems, mouthguards should be subjected to standardised laboratory validation testing. The study aimed to establish the validity and reliability of a mouthguard system under independently collected pendulum impactor conditions. A NOCSAE anthropometric testing device with attached mouthguard was impacted in four different locations (front, front boss, rear, rear boss) at four target linear accelerations (25, 50, 75 and 100 g) with two different impactor caps (padded and rigid). Peak linear acceleration, peak rotational velocity and peak rotational acceleration values from the mouthguard were compared against the reference data with a battery of statistical tests, namely R squared values, Lin’s concordance correlation coefficient, intraclass correlation coefficients and Bland Altman analysis. Results indicate the iMG produces valid and reliable data comparable to that of the anthropomorphic testing device reference, with all measured variables reported ‘excellent’ intraclass correlation coefficients above 0.95; concordance correlation coefficients above 0.95; minimal average bias with Bland Altman analysis and R squared values above 0.92 for all measured variables. Results indicate the iMG is appropriately valid and reliable enough to next establish on-field validity

Acute impact of inhaled short acting b2-agonists on 5 km running performance

Whilst there appears to be no ergogenic effect from inhaled salbutamol no study has investigated the impact of the acute inhalation of 1600 µg, the World Anti-Doping Agency (WADA) daily upper limit, on endurance running performance. To investigate the ergogenic effect of an acute inhalation of short acting ?2-agonists at doses up to 1600 µg on 5 km time trial performance and resultant urine concentration. Seven male non-asthmatic runners (mean ± SD; age 22.4 ± 4.3 years; height 1.80 ± 0.07 m; body mass 76.6 ± 8.6 kg) provided written informed consent. Participants completed six 5 km time-trials on separate days (three at 18 °C and three at 30 °C). Fifteen minutes prior to the initiation of each 5 km time-trial participants inhaled: placebo (PLA), 800 µg salbutamol (SAL800) or 1600 µg salbutamol (SAL1600). During each 5 km time-trial HR, VO2, VCO2, VE, RPE and blood lactate were measured. Urine samples (90 ml) were collected between 30-180 minutes post 5 km time-trial and analysed for salbutamol concentration. There was no significant difference in total 5 km time between treatments (PLA 1714.7 ± 186.2 s; SAL800 1683.3 ± 179.7 s; SAL1600 1683.6 ± 190.7 s). Post 5 km time-trial salbutamol urine concentration between SAL800 (122.96 ± 69.22 ug·ml(-1)) and SAL1600 (574.06 ± 448.17 ug·ml(-1)) were not significantly different. There was no improvement in 5 km time-trial performance following the inhalation of up to 1600 µg of salbutamol in non-asthmatic athletes. This would suggest that the current WADA guidelines, which allow athletes to inhale up to 1600 µg per day, is sufficient to avoid pharmaceutical induced performance enhancement. Key pointsInhaling up to 1600 µg of Salbutamol does not result in improved 5 km time trial performance.The position of Salbutamol on the World Anti-Doping Agency list of prohibited appears justified.Athletes who use up to 1600 µg Salbutamol in one day need to review their therapy as it would suggest their respiratory condition is not under control

The Effect of 400 µg Inhaled Salbutamol on 3 km Time Trial Performance in a Low Humidity Environment

The Objectives of the study were to investigate whether 400 µg inhaled salbutamol influences 3 km running time-trial performance and lung function in eucapnic voluntary hyperpnoea positive (EVH+ve) and negative (EVH-ve) individuals. Fourteen male participants (22.4 ± 1.6yrs; 76.4 ± 8.7kg; 1.80 ± 0.07 m); (7 EVH+ve; 7 EVH-ve) were recruited following written informed consent. All participants undertook an EVH challenge to identify either EVH+ve (?FEV1>10%) or EVH-ve (?FEV110% from baseline) in FEV1 following any time-trial. Administration of 400µg inhaled salbutamol does not improve 3 km time-trial performance in either mild EVH+ve or EVH–ve individuals despite significantly increased HR and FEV1

The Long-Term Ergogenic Effect of Long Acting ?2-Agonists

Background: The WADA List of Banned Substances and Methods stipulates that athletes can use up to 54 µg inhaled Formoterol and inhaled Salmeterol as directed by the manufacturer. It is unknown whether large daily therapeutic doses of Formoterol and Salmeterol can improve sprint and strength performance. Purpose: To investigate the impact of inhaling 100 µg of Salmeterol (SAL) or 12 µg of Formoterol (FOR) twice daily over a 5 week period on sprint, strength and power performance. Methods: In a randomised single blind study 24 male and 15 female non-asthmatic and active participants were recruited (mean ± SD; Males age 28.0 ± 5.5 years; weight 72.1 ± 10.5 Kg; height 164.7 ± 7.1 cm; Females age 24.1 ± 4.1 years; weight 65.4 ± 9.5 Kg; height 168.0 ± 4.3 cm). Participants completed three standardised whole body strength and power training sessions per week for five weeks. All the training sessions were supervised by a personal trainer who recorded work performed in each session. During the five week training period participants were assigned to either SAL, FOR or a placebo (PLA) group. Participants took their inhaler twice per day as instructed. Participants completed assessments of sprint, strength and power at week 0 and after 5 weeks of strength and power training. The assessments included 30 m sprint, vertical jump, 1 RM bench press, 1 RM leg press, peak torque flexion and extension, anthropometric evaluation and Rest-Q questionnaires. Mixed Model Repeated Measures ANOVA were performed to investigate the changes in the sprint, strength and power assessments between groups over the course of the 5 week training session. Results: 30 m Sprint time was significantly lower in FOR group (– 0.29 ± 0.11 s; p=0.049) and SAL (– 0.35 ± 0.05 s; p=0.04) when compared with compared with Placebo (+0.01 ± 0.11 s; P=0.000). No significant change was found in 1RM Leg, Squat and Bench Press or during Isokinetic evaluation performed at 60° range in flex/ext movement. Jump performance as well as anthropometric measures didn’t differ between groups. Discussion: The significant changes in FOR and SAL 30m sprint time when compared to PLA suggest the long term use of inhaled ?2-agonnists may provide ergogenic advantage. This finding suggests a review of the use of inhaled doses of FOR and SAL by athletes in training and official competition may be necessary

Integrated sports and respiratory medicine in the aftermath of COVID-19.

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Promoting physical activity in vulnerable adults “at risk” of homelessness: A Randomised Controlled Trial Protocol

Introduction: People who are homeless, or at risk of homelessness, have substantially poorer health. Sustained and regular participation in physical activity is beneficial for both mental and physical health. Limited data suggests that levels of physical activity in the homeless and those at risk of homelessness are low, and access to community-based exercise is limited or non-existent for this population. Nonetheless, exercise programs for the homeless could provide a feasible and scalable intervention for providing beneficial effects on physical and mental health in this population. The primary aim of this studyis to evaluate the impact of a group exercise intervention on activity levels in people who are homeless or at risk of homelessness in central London, UK. The secondary aim is to evaluate the impact of the intervention on mental and physical health outcomes. Method and analysis: A 2-arm, individually randomised controlled trial in people who are homeless and those vulnerable and at risk of homelessness in central London, UK. Participants will be recruited through a London-based homeless charity, Single Homeless Project. Following baseline assessments and allocation to intervention (exercise classes) or control (usual care), participants will be followed up at 3, 6, 9 and 12 months. The primary outcomes will be change in objective physical activity. The secondary outcomes will includechange in fitness assessments and mental health parameters. Changes in drug use and alcohol dependency will also be explored. Ethics and dissemination: Ethical approval was obtained through the Anglia Ruskin University Department of Sport and Exercise Sciences Research Ethics Committee. Results of this study will be disseminated through peer-reviewed publications and scientific presentations

An instrumented mouthguard for real-time measurement of head kinematics under a large range of sport specific accelerations

Background: Head impacts in sports can produce brain injuries. The accurate quantification of head kinematics through instrumented mouthguards (iMG) can help identify underlying brain motion during injurious impacts. The aim of the current study is to assess the validity of an iMG across a large range of linear and rotational accelerations to allow for on-field head impact monitoring. Methods: Drop tests of an instrumented helmeted anthropometric testing device (ATD) were performed across a range of impact magnitudes and locations, with iMG measures collected concurrently. ATD and iMG kinematics were also fed forward to high-fidelity brain models to predict maximal principal strain. Results: The impacts produced a wide range of head kinematics (16–171 g, 1330–10,164 rad/s2 and 11.3–41.5 rad/s) and durations (6–18 ms), representing impacts in rugby and boxing. Comparison of the peak values across ATD and iMG indicated high levels of agreement, with a total concordance correlation coefficient of 0.97 for peak impact kinematics and 0.97 for predicted brain strain. We also found good agreement between iMG and ATD measured time-series kinematic data, with the highest normalized root mean squared error for rotational velocity (5.47 ± 2.61%) and the lowest for rotational acceleration (1.24 ± 0.86%). Our results confirm that the iMG can reliably measure laboratory-based head kinematics under a large range of accelerations and is suitable for future on-field validity assessments

What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review

BACKGROUND : Sideline detection is the first and most significant step in recognising a potential concussion and removing an athlete from harm. This systematic review aims to evaluate the critical elements aiding sideline recognition of potential concussions including screening tools, technologies and integrated assessment protocols. DATA SOURCES : Bibliographic databases, grey literature repositories and relevant websites were searched from 1 January 2000 to 30 September 2016. A total of 3562 articles were identified. STUDY SELECTION : Original research studies evaluating a sideline tool, technology or protocol for sports-related concussion were eligible, of which 27 studies were included. DATA EXTRACTION : A standardised form was used to record information. The QUADAS-2 and Newcastle-Ottawa tools were used to rate risk of bias. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation Working Group system. DATA SYNTHESIS : Studies assessing symptoms, the King-Devick test and multimodal assessments reported high sensitivity and specificity. Evaluations of balance and cognitive tests described lower sensitivity but higher specificity. However, these studies were at high risk of bias and the overall strength of evidence examining sideline screening tools was very low. A strong body of evidence demonstrated that head impact sensors did not provide useful sideline concussion information. Low-strength evidence suggested a multimodal, multitime-based concussion evaluation process incorporating video review was important in the recognition of significant head impact events and delayed onset concussion. CONCLUSION : Conclusion In the absence of definitive evidence confirming the diagnostic accuracy of sideline screening tests, consensus-derived multimodal assessment tools, such as the Sports Concussion Assessment Tool, are recommended. Sideline video review may improve recognition and removal from play of athletes who have sustained significant head impact events. Current evidence does not support the use of impact sensor systems for real-time concussion identification.The National Institute for Health Research and World Rugby.http://bjsm.bmj.comhj2017Sports Medicin