Analysis of Quality of Life among Caregivers of Patients with Thalassemia Major by Cross-Sectional Examination at a Tertiary Care Hospital

Introduction: Patients with thalassemia major are among the vulnerable subsets of population who need to be frequently admitted for transfusions. Thus, their caregivers are at an elevated risk of developing psychiatric comorbidities as they better understand the course of disease, prognosis and anticipate the impending burden. There is a lacuna in literature about our understanding of these caregivers’ experience with psychiatric illness, quality of life, coping skills and the effect these have on them as well as their patient

Facilitators and barriers associated with youth player transition to professional first-team football: A key stakeholder perspective

The transition of elite youth footballers through academy systems towards the first team is highly complex, competitive, and often unsuccessful. A myriad of factors including technical competence, physical prowess, and the development environment combine to determine youth player progression. Current research has focused on broad investigations of multiple clubs and stakeholders, providing a valuable overview of the key aspects associated with elite youth player transition. This study aimed to provide an in-depth, context-specific investigation of key stakeholders within an elite level club in the United Kingdom (UK). Seven key stakeholders including the head of the academy (n = 1), the head of sports science (n = 1), coaches (n = 3), and lead sports scientists (n = 2) were recruited. Framework analysis led to the development of a practical framework outlining the key facilitators and barriers of youth-to-first-team transition. Facilitators of transition included overcoming adversity, high-level physical prowess, exceptional technical competence, and possessing at least one elite-level attribute. Barriers to transition included a lack of opportunity, lucrative youth player contracts and a lack of development-specific coaching. In addition, the developmental environment and developing individuals within a team environment were key influences on youth-to-first-team transition. This study complements recent broad investigations of the UK and global stakeholders by corroborating many of their findings while providing transferable, context-specific accounts of applied issues related to successful transition to first-team football

The influence of training status on right ventricular morphology and segmental strain in elite pre-adolescent soccer players.

Cardiac modifications to training are a product of the genetic pre-disposition for adaptation and the repetitive haemodynamic loads that are placed on the myocardium. Elite pre-adolescent athletes are exposed to high-intensity training at a young age with little understanding of the physiological and clinical consequences. It is unclear how right ventricular (RV) structure and function may respond to this type of stimulus. The aim of this study was to compare RV structure and strain across the cardiac cycle and within individual segments in elite soccer players (SP) and controls (CON). METHODS: Twenty-two highly trained, male pre-adolescent SP and 22 age-and sex-matched recreationally active individuals CON were investigated using 2D echocardiography, including myocardial speckle tracking to assess basal, mid-wall, apical and global longitudinal strain and strain rate during systole (SRS) and diastole (SRE and SRA). RESULTS: greater RV cavity size was identified in the SP compared to CON (RVD1 SP: 32.3 ± 3.1 vs. CON: 29.6 ± 2.8 (mm/m2)0.5; p = 0.005). No inter-group differences were noted for peak global RV strain (SP: - 28.6 ± 4.9 vs CON: - 30.3 ± 4.0%, p = 0.11). Lower mid-wall strain was demonstrated in the SP compared to CON (SP: - 27.9 ± 5.8 vs. CON: - 32.2 ± 4.4%, p = 0.007). CONCLUSION: Soccer training has the potential to increase RV size in pre-adolescent players. The unique segmental analyses used in this study have identified inter-group differences that were masked by global strain evaluations. The clinical and physiological implications of these findings warrant further investigation

Superior cardiac mechanics without structural adaptations in pre-adolescent soccer players.

AIMS: This study aimed to evaluate left ventricular structure, function and mechanics, in highly-trained, pre-adolescent soccer players compared with age- and sex-matched controls. DESIGN: The study design was a prospective, cross-sectional comparison of left ventricular structure, function and mechanics. METHODS: Twenty-two male soccer players from two professional youth soccer academies (age: 12.0 ± 0.3 years) and 22 recreationally active controls (age: 11.7 ± 0.3 years) were recruited. Two-dimensional conventional and speckle tracking echocardiography were used to quantify left ventricular structure, function and peak/temporal values for left ventricular strain and twist, respectively. RESULTS: End-diastolic volume index was larger in soccer players (51 ± 8 mm/(m2)1.5vs. 45 ± 6 mm/(m2)1.5; p = 0.007) and concentricity was lower in soccer players (4.3 ± 0.7 g/(mL)0.667vs. 4.9 ± 1.0 g/(mL)0.667; p = 0.017), without differences in mean wall thickness between groups (6.0 ± 0.4 mm vs. 6.1 ± 0.5 mm; p = 0.754). Peak circumferential strain at the base (-22.2% ± 2.5% vs. -20.5% ± 2.5%; p = 0.029) and papillary muscle levels (-20.1% ± 1.5% vs. -18.3% ± 2.5%; p = 0.007) were greater in soccer players. Peak left ventricular twist was larger in soccer players (16.92° ± 7.55° vs. 12.34° ± 4.99°; p = 0.035) and longitudinal early diastolic strain rate was greater in soccer players (2.22 ± 0.40 s-1vs. 2.02 ± 0.46 s-1; p = 0.025). CONCLUSIONS: Highly-trained soccer players demonstrated augmented cardiac mechanics with greater circumferential strains, twist and faster diastolic lengthening in the absence of differences in wall thickness between soccer players and controls

The Influence of Age and Exercise Training Status on Left Ventricular Systolic Twist Mechanics in Healthy Males-An Exploratory Study.

Age-related differences in twist may be mitigated with exercise training, although this remains inconclusive. Moreover, temporal left ventricular (LV) systolic twist mechanics, including early-systolic (twistearly), and beyond peak twist (twistpeak) alone, have not been considered. Therefore, further insights are required to ascertain the influence of age and training status on twist mechanics across systole. Forty males were included and allocated into 1 of 4 groups based on age and training status: young recreationally active (YRA, n = 9; 28 ± 5 years), old recreationally active (ORA, n = 10; 68 ± 6 years), young trained (YT, n = 10; 27 ± 6 years), and old trained (OT, n = 11, 64 ± 4 years) groups. Two-dimensional speckle-tracking echocardiography was performed to determine LV twist mechanics, including twistearly, twistpeak, and total twist (twisttotal), by considering the nadir on the twist time-curve during early systole. Twisttotal was calculated by subtracting twistearly from their peak values. LV twistpeak was higher in older than younger men (p = 0.036), while twistpeak was lower in the trained than recreationally-active (p = 0.004). Twistpeak is underestimated compared with twisttotal (p < 0.001), and when early-systolic mechanics were considered, to calculate twisttotal, the age effect (p = 0.186) was dampened. LV twist was higher in older than younger age, with lower twist in exercise-trained than recreationally-active males. Twistpeak is underestimated when twistearly is not considered, with novel observations demonstrating that the age effect was dampened when considering twistearly. These findings elucidated a smaller age effect when early phases of systole are considered, while lower LV systolic mechanics were observed in older aged trained than recreationally-active males

Seasonal training and match load and micro-cycle periodization in male Premier League academy soccer players

We quantified on pitch external loading of English Premier League (EPL) academy soccer players (n=76; U12-U18 age groups) over an entire competitive season. Mean accumulative weekly duration and total distance, respectively, was similar in the U12 (329±29 min; 19.9±2.2 km), U13 (323±29 min; 20.0±2.0 km) and U14 (339±25 min; 21.7±2.0 km; P>0.05 for all comparisons) age-groups, though all teams were less than U15 (421±15 min; 26.2±2.1 km), U16 (427±20 min; 25.9±2.5 km) and U18 (398±30 min; 26.1±2.6 km) players (P0.05 for all pairwise comparisons) though all squads were less than U15 (657±242 m and 49±98 m), U16 (749±152 m and 95±55 m) and U18 (979±254 m and 123±56 m) age-groups (P<0.05 for all pairwise comparisons). Data demonstrate that absolute weekly training volume in EPL academy soccer players increases throughout the academy pathway. Furthermore, although U16-U18 players are capable of achieving similar training and match volumes as previously reported in adult EPL players, they do not yet achieve the absolute intensities of adult EPL players

The effect of long-term soccer training on left ventricular structure and function in elite male youth soccer players.

Aims Cardiac adaptations in elite, male adolescent youth soccer players have been demonstrated in relation to training status. The time course of these adaptations and the delineation of the influence of volatile growth phases from the training effect on these adaptations remain unclear. Consequently, the aims of the study were to evaluate the impact of 3 years of elite-level soccer training on changes in left ventricular (LV) structure and function in a group of highly trained elite youth male soccer players (SP) as they transitioned through the pre-to-adolescent phase of their growth. Methods Twenty-two male youth SP from the highest Level of English Premier League Academy U-12 teams were evaluated once a year for three soccer seasons as the players progressed from the U-12 to U-14 teams. Fifteen recreationally active control participants (CON) were also evaluated over the same 3-year period. Two-dimensional transthoracic echocardiography was used to quantify LV structure and function. Results After adjusting for the influence of growth and maturation, training-induced increases in Years 2 and 3 were noted for: LV end diastolic volume (LVEDV; p = 0.02) and LV end systolic volume (LVESV; p = 0.02) in the SP compared to CON. Training-induced decrements were noted for LV ejection fraction (LVEF; p = 0.006) and TDI-S′ (p < 0.001). Conclusions An increase in training volume (Years 2 and 3) were aligned with LV volumetric adaptations and decrements in systolic function in the SP that were independent from the influence of rapid somatic growth. Decrements in systolic function were suggestive of a functional reserve for exercise

Cross-sectional comparison of body composition and resting metabolic rate in Premier League academy soccer players: Implications for growth and maturation

For the first time we aimed to: (1) assess fat-free mass (FFM) and RMR in youth soccer players, (2) compare measured RMR to estimated RMR using previously published prediction equations, and (3) develop a novel population-specific prediction equation. In a cross-sectional design, 99 males from a Premier League academy underwent assessments of body composition (DXA) and RMR (indirect-calorimetry). Measured RMR was compared to estimated values from five prediction equations. A novel RMR prediction equation was developed using stepwise multiple regression. FFM increased (P0.05). RMR in the U12s (1655±195 kcal.day−1), U13s (1720±205 kcal.day−1) and U14s (1846±218kcal.day−1) was significantly lower than the U15s (1957±128 kcal.day−1), U16s (2042±155 kcal.day−1), U18s (1875±180 kcal.day−1) and U23s (1941±197 kcal.day−1) squads (P>0.05). FFM was the single best predictor of RMR (r2=0.43; P<0.01) and was subsequently included in the novel prediction equation: RMR (kcal.day−1) = 1315 + (11.1 x FFM in kg). Both FFM and RMR increase from 12-16 years old, thus highlighting the requirement to adjust daily energy intake to support growth and maturation. The novel prediction RMR equation developed may help to inform daily energy requirements

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation

There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes’ LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load

Energy Requirements of Male Academy Soccer Players from the English Premier League.

PURPOSE: To inform the energy requirements of highly trained adolescent soccer players, total energy expenditure (TEE) was quantified in academy soccer players from the English Premier League (EPL). METHODS: Twenty-four male adolescent soccer players from an EPL academy (n=8 U12/13; n=8 U15; n=8 U18) were assessed for baseline maturity (maturity offset), body composition (DXA) and resting metabolic rate (RMR; indirect calorimetry). Subsequently, TEE, energy intake (EI) and physical loading patterns were assessed over a 14-day in-season period using doubly labelled water, the remote food photographic method and global positioning system technology, respectively. RESULTS: Under-18 players presented with greater RMR (2236±93 kcal⋅day) and TEE (3586±487 kcal⋅day; range: 2542-5172 kcal⋅day) than both U15 (2023±162 and 3029±262 kcal⋅day, respectively; TEE range: 2738-3726 kcal⋅day) and U12/13 players (1892±211 and 2859±265 kcal⋅day, respectively; TEE range: 2275-3903 kcal⋅day) (all P U15: 42.9±5.8 kg > U12/13: 31.1±3.5 kg; all P<0.01). Within age-groups, no differences were apparent between EI and TEE (U12/13: -29±277 kcal⋅day, P=0.78; U15: -134±327 kcal⋅day, P=0.28; U18: -243±724 kcal⋅day, P=0.37), whilst U18 players (3180±279 kcal⋅day) reported higher EI than both U15 (2821±338 kcal⋅day; P=0.05) and U12/13 players (2659±187 kcal⋅day; P<0.01). CONCLUSION: The TEE of male academy soccer players progressively increase as players progress through the academy age-groups. In some individuals (evident in all age-groups), TEE was greater than that previously observed in adult EPL soccer players