Exercise load monitoring: integrated approaches to advance the individualisation of exercise oncology

Whether slowing disease progression or combatting the ills of advancing age, the extensive utility of exercise training has contributed to the outright declaration by the American College of Sports Medicine that ‘exercise is medicine’. Consistent with general framework of adaptation, the advantages of exercise training are indiscriminate—benefitting even the most susceptible clinical populations. Still, the benefit of exercise training presupposes healthy adaptation wherein progressive overload matches sufficient recovery. Indeed, a difference exists between healthy adaptation and non-functional over-reaching (ie, when internal/external load exceeds recovery capacity)—a difference that may be blurred by cancer treatment and/or comorbidity. Recent advances in smartwatches make them ideally suited to non-invasively monitor the physiological stresses to exercise training. Resolving whether individuals are successfully adapting to exercise training via load monitoring bears clinical and practical relevance. While behaviour-change research aims to identify positive constructs of exercise adherence, further attention is needed to uncover how to optimise exercise prescription among cancer populations. Herein, we briefly discuss the constituents of exercise load monitoring, present examples of internal and external load and consider how such practices can be applied to cancer populations

Preventive medicine in elite sport: The role of the periodic health evaluation

Health problems are an occupational hazard for elite athletes. Medical surveillance by the International Olympic Committee reveals that up to one in six athletes are injured and one in ten experience an illness during the period of an Olympic Games. These health problems range from the common cold to catastrophic, disabling injuries, and death. In addition to health consequences, the financial and performance impacts of injury and illness can be significant to both the athlete and their team. Protecting athletes from injury and illness is an important task for all sport organizations. Preventive medicine reduces the impact of health problems by stopping them from occurring and reducing their burden. In elite sport, one aspect of preventive medicine is the periodic health evaluation (PHE). The objectives of the PHE are to comprehensively review of an athlete’s health status, assess for risk of future health problems, serve as an entry point into the healthcare system, and to monitor health over time. Several approaches to the PHE have been described, with varying levels of clinician-patient engagement, necessary resources, and clinical complexity. Despite widespread adoption, whether PHEs improve the health and wellness of athletes is unknown. Better understanding of the PHE can result in improved health for athletes, more efficient resource allocation for sport organizations, and will guide other areas of athlete health promotion research and practice. The aim of this dissertation is to describe current PHE practices in elite athlete populations and assess the value of specific elements of the PHE: the health history, iron screening, and screening for conditions that are difficult to diagnose in primary care (sleep, mental health, and allergies)

Organización y trabajo multidisciplinario en un centro olímpico de alto rendimiento en los estados unidos

La organización y metodología para proporcionar servicios a atletas a través de centros olímpicos de alto rendimiento varía entre los Comités Olímpicos Nacionales (NOC, por su sigla en inglés). Entre los NOCs hay diferencias en la composición y metodología de la entrega de servicios. Entre los servicios que se entregan habitualmente, están la medicina del deporte y el rendimiento en los deportes. Los NOCs pueden proporcionar servicios a través de un sistema centralizado en las universidades o en los centros de alto rendimiento. El Comité Olímpico de los Estados Unidos (USOC, por su sigla en inglés) proporciona servicios valiéndose de múltiples métodos a través de un modelo híbrido que incluye tres Centros de Entrenamiento Olímpico, Entidades de Gobernación Nacional (NGB, por su sigla en inglés), centros de alto rendimiento y centros de cuidado independientes de diversas especialidades. Algunas Entidades de Gobernación Nacional muy desarrolladas han hecho que ciertos centros de alto rendimiento se dediquen sólo al deporte elegido por ellos. En este manuscrito se describe la programación del modelo de medicina del deporte y de rendimientos del deporte utilizada por los Centros de Entrenamiento Olímpico del USOC

Expanding the screening toolbox to promote athlete health: how the US Olympic & Paralympic Committee screened for health problems in 940 elite athletes

Aim: To assess the value of including validated screening tools for allergies, anxiety, depression, sleep apnoea and sleep quality into an electronic patient health history questionnaire. Methods: In this descriptive study, we reviewed electronic medical records of Olympic and Paralympic athletes who completed health screenings, which included validated screens for allergies (Allergy Questionnaire for Athletes), anxiety (General Anxiety Disorder-2), depression (Patient Health Questionaire-2), sleep apnoea (Berlin Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index), using established criteria for a positive screen. We report the prevalence of positive tests and the associations between positive screening tools. Results: A total of 683 Olympic and 257 Paralympic athletes (462 male, 478 female) completed the health history between May and September of 2019. At least one positive screen was reported by 37% of athletes training for the Olympics and 48% of athletes training for the Paralympics. More than 20% of all athletes screened positive for allergies and poor sleep quality. Athletes training for the Paralympics had a significantly higher percentage of positive screens for anxiety, depression, poor sleep quality and sleep apnoea risk. Females had significantly more positive screens for allergy and poor sleep quality. Conclusions: The addition of standardised screening tools to an electronic health history resulted in the identification of potential mental health, sleep and allergy problems in both Olympic and Paralympic athletes. Strong associations between mental health and sleep disorders suggest these problems should be considered together in health screening programmes

Organization and multidisciplinary work in an olympic high performance centers in USA

The organization and methodology of providing services to athletes through Olympic high performance centers varies among the National Olympic Committees (NOC). Between NOCs, provider composition and methodology for the delivery of services differs. Services provided typically include sports medicine and sports performance. NOCs may provide service through a university-based system or high performance centers. The United States Olympic Committee (USOC) provides services using multiple approaches through a hybrid model that includes three Olympic Training Centers, National Governing Bodies (NGB) high performance centers and independent specialty care centers. Some highly developed National Governing Bodies have dedicated high performance training centers that serve only their sport. The model of sports medicine and sports performance programming utilized by the USOC Olympic Training Centers is described in this manuscript

A novel approach to assessment of perceptual-motor efficiency and training-induced improvement in the performance capabilities of elite athletes

Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement

Serum ferritin distribution in elite athletes

Objectives: It is not uncommon for athletes to be diagnosed with iron deficiency, yet there remains uncertainty whether the prevalence of suboptimal iron status in elite athletes differs from the normal population or warrants routine screening. The purpose of this study is to describe the distribution of serum ferritin (SF) in a cohort of elite athletes. Design: Retrospective cohort study. Methods: Electronic health records of 1085 elite adult athletes (570 women, 515 men) from 2012–2017 were examined retrospectively. SF values were compared to published normal population data. The proportion of athletes meeting criterion values for iron deficiency or initiation of treatment was examined. Results: SF distributions in male athletes were significantly lower than normal males aged 20 to 0.05) or aged 24 to 0.05). Using 35 ng/ml as the criterion value for stage one iron deficiency, 15% of male athletes and 52% of female athletes displayed suboptimal iron status. Conclusions: Male athletes have a significantly lower population distribution of SF values as compared to normative data on healthy males, with 15% of male athletes having suboptimal SF status. The distribution of SF values in elite female athletes did not differ from population values, however approximately half women athletes were iron deficient. These data suggest that iron screening should be considered in both male and female athlete populations

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses—The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data

Improved reporting of overuse injuries and health problems in sport: An update of the Oslo Sport Trauma Research Center questionnaires

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses -The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data. © Author(s) (or their employer(s)) 2020