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PubMed1998

Incorporating stress management into athletic injury rehabilitation.

OBJECTIVE: Our objective is to provide a paradigm that can assist certified athletic trainers in selecting and implementing techniques to help athletes cope with the stress associated with injury. BACKGROUND: The psychological impact of injury and the stress associated with rehabilitation are well known in the athletic training room. Specific stress management techniques should be determined by the personality of the athlete, the specific stressors associated with the injury and rehabilitation process, and the education and expertise of the certified athletic trainer. Therefore, it is important that certified athletic trainers be proficient in stress theory regarding the psychological aspects of injury, as well as the techniques to address them. DESCRIPTION: We provide a framework that applies transactional theory to athletic injury and suggests that an athlete's belief about injury plays a central role in the stress reaction. It describes the role of the certified athletic trainer in addressing the 4 components of transactional theory: 1) increased awareness, 2) information processing and appraisal, 3) modified behavior, and 4) peaceful resolution with injured athletes. CLINICAL ADVANTAGES: The application of this conceptual framework allows certified athletic trainers to differentiate stress management techniques based on the individual athlete's reaction rather than apply a generic approach.

Journal Article↗
PubMed1999

The history and evolution of athletic training education in the United States.

OBJECTIVE: To present a chronologic review of the history and evolution of athletic training education in the United States as related to the professional growth of athletic training and the National Athletic Trainers' Association. BACKGROUND: Commonly accepted characteristics of a profession are an identifiable body of knowledge, the emergence of practitioners as professional authorities, and community recognition. These characteristics establish the criteria by which the professional growth, or professionalization, of athletic training can be judged. With guidance from the National Athletic Trainers' Association, the development of athletic training education programs and credentialing of athletic trainers during the past 50 years have contributed to the professionalization of athletic training. DESCRIPTION: We present a chronology of the contributions of the National Athletic Trainers' Association to the development of athletic training education in the United States. The activities of various committees, task forces, and Association members are reviewed and traced through the past 5 decades. Early curriculum models and the development of education programs in colleges and universities are discussed. ADVANTAGES: The historical review of athletic training education in this article will enhance the reader's understanding of the relationships among education, credentialing of practitioners, and professionalism in athletic training.

Journal Article↗
PubMed2000

Psychology/Counseling: a universal competency in athletic training.

OBJECTIVE: To present the rationale that certified athletic trainers (ATCs) may require structured educational training in the psychological aspects of athletic injury. DATA SOURCES: We searched MEDLINE, Psych Lit, Psyc- INFO, First Search, and SPORT Discus databases for the years 1990 through 1999 under the search terms "psychological distress," "depression," "athletic injury," and "rehabilitation adherence." DATA SYNTHESIS: Psychological factors are significant predictors of athletic injury. Athletic injury is accompanied by significant psychological distress, which has been shown to impair rehabilitation compliance and possibly physical recovery. Although "counseling" and knowledge of psychological aspects of injury are required National Athletic Trainers' Association competencies, extant data suggest that athletic trainers may lack training in this competency. CONCLUSIONS: Evidence suggests that (1) psychological distress is prospectively associated with the incidence of athletic injury, and prolonged psychological distress, specifically depression, may occur after athletic injury; (2) psychological factors may also either hinder or facilitate rehabilitation adherence, compliance, and recovery; (3) psychological distress may persist even after physical recovery has been completed; (4) psychosocial factors related to injury occurrence and injury recovery may be overlooked by ATCs, but knowledge of these factors and appropriate use of referral sources may enhance the effectiveness of ATCs; and (5) ATCs may benefit from structured educational experiences specific to the National Athletic Trainers' Association psychology/counseling competency. RECOMMENDATIONS: With 75% of a national survey of ATCs indicating that they do not have access to a sport psychologist, it would be advantageous for ATCs to gain adequate training in the recognition, evaluation, and treatment of psychological factors associated with athletic injury. The literature also suggests that structured educational training with respect to psychological aspects of athletic injury would be well received by ATCs.

Journal Article↗
PubMed1989

Menstrual irregularities in athletic women may be predictable based on pre-training menses.

With the use of a personally conducted survey the age at menarche, incidence of menstrual irregularity, whether training occurred before or after menarche, certain personality traits (anxiety, curiosity, anger), and the type of athletic activity performed, were assessed in 161 highly competitive women athletes of various types (e.g. professional dancers, basketball players, fencers, gymnasts, field hockey players, swimmers) and 65 age-matched nonathletic women. No significant difference was found between the mean age at menarche of competitive athletes 13.2 +/- 1.4 (SD) yrs and nonathletes 12.6 +/- 1.1 yrs or between athletes who trained before menarche 13.7 +/- 1.5 (SD) yrs compared to athletes who trained after menarche 12.7 +/- 1.3 yrs. However, there were significant differences in reference to the mean age at menarche for athletes and nonathletes when compared to current menstrual frequency (p less than 0.05) and for groups of athletes currently regular 12.9 +/- 1.2 (SD) yrs when compared to those currently irregular 13.4 +/- 1.6 yrs (PR greater than F = 0.0419), regardless of athletic status. Trait personality characteristics (anxiety, curiosity, anger) based on the Spielberger State-Trait Personality Inventory (STPI), showed no significance among the various athletes, or athletes compared to non-athletes, however, athletes having the highest mean anxiety scores 19.5 +/- 4.2 (SD) and lowest mean anger scores 17.0 +/- 3.6 (SD) had irregular menses. Predictability for the development of irregular menses was done by regression and stepwise discrimination with maximum improvement technique statistics using pre-training frequency of menses and post-training frequency of menses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Subacute posteromedial impingement of the ankle in athletes: MR imaging evaluation and ultrasound guided therapy.

OBJECTIVE: To describe the use of MR imaging and efficacy of ultrasound-guided steroid injection in the diagnosis and management of athletes with clinical posteromedial impingement of the ankle. DESIGN AND PATIENTS: A retrospective analysis of imaging findings on MR was undertaken in nine elite athletes with clinical posteromedial ankle impingement. MR studies from six professional athletes with posterolateral pain were also reviewed as an imaging control group. The two reviewing radiologists were blinded to the clinical details and the proportion of control and study subjects. The nine study athletes also underwent diagnostic ultrasound and ultrasound-guided injection of steroid and anaesthetic into the posteromedial capsular abnormality. Follow-up was by telephone interview. RESULTS: Posteromedial capsular thickening was seen only in athletes with posteromedial impingement (7/9). Posteromedial synovitis was present in all athletes with posteromedial impingement; however, posterior and posterolateral synovitis was also seen in these athletes. Mild posteromedial synovitis was present in two control athletes. Ultrasound identified abnormal posteromedial soft tissue thickening deep to tibialis posterior between the medial malleolus and talus in all nine athletes. After injection all athletes returned to their previous level of sport, with eight of the nine not experiencing any residual or recurrent symptoms. CONCLUSION: If MR imaging excludes significant coexistent abnormality, ultrasound can localise posteromedial soft tissue abnormality and guide injection therapy, allowing return to athletic activity without surgical intervention.

Adult↗
PubMed2001

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment.

The purpose of this study was to evaluate the healing capacity of fatigue fractures of the pars interarticularis in young elite athletes. Between 1991 and 2000, a fatigue fracture of the pars interarticularis was diagnosed in 34 highly competitive athletes. The study group included 28 athletes with a mean age of 17.2 years at diagnosis (range 12-27 years). The average time per week dedicated to sports was 10.9 h. Diagnosis was made with both planar and single-photon-emission computed tomographic (SPECT) bone scintigraphy and computed tomographic (CT) scan. Lesions were classified into three groups according to their distribution on the scintigram: unilateral, bilateral, or "pseudo-bilateral" (asymmetrical tracer uptake). The study was limited to athletes with subtle fractures, which means that they had normal radiographs and positive bone scans. All subjects were braced for a mean time of 15.9 weeks (range 12-32 weeks). We looked at healing of the fracture, subjective outcome, and sports resumption in the three groups. The athletes were reviewed after an average of 13.2 months (range 3-51 months), and a second CT scan was performed to evaluate osseous healing. Healing of the fracture was noted in all 11 athletes with a unilateral lesion, in five out of nine athletes with a bilateral lesion and in none of the eight athletes with a pseudo-bilateral lesion. Twenty-three athletes (82.2%) rated the outcome as excellent, three athletes (10.7%) as good, and two (7.1%) as fair. Twenty-five athletes (89.3%) managed to return to their same level of competitive activity within an average of 5.5 months after the onset of treatment. There was no difference in outcome or in sports resumption between the three groups. Our data suggest that osseous healing is most likely to occur in unilateral active spondylolysis. Chances of bony healing diminish when the fracture is bilateral, and diminish even further when it is pseudo-bilateral. Non-union does not seem to compromise the overall outcome or sports resumption in the short term.

Adolescent↗
PubMed2001

Carpal fractures in athletes.

A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. A college football player trains year round for just 11 or 12 hours of playing time. An athletic injury that occurs during the season can have profound consequences for the athlete's career and emotions. When defining a management plan for a particular wrist athletic injury, the time to heal the injury and the time to rehabilitate fully must be considered. The athlete must be informed fully of the length of recovery. The continued advancement of fixation methods and techniques are diminishing fracture morbidity considerably. Small-cannulated compression screws that provide rigid fixation can be inserted with decreased surgical dissection, thus preserving critical vascular supply and promoting accelerated healing and earlier rehabilitation. The arthroscope as a valuable adjunct in the management of wrist fractures was virtually unheard of years ago, but is now common. The ability to arthroscopically guide a cannulated compression screw to stabilize a scaphoid fracture without a formal open volar approach can reduce surgical morbidity significantly and allow the athlete to return to competition more quickly. Mechanisms of injury that cause osseous fractures of the wrist are fairly high energy. A high index of suspicion for associated soft tissue injuries should be kept in mind when fractures of the wrist are identified. The wrist is composed of eight carpal bones tightly interwoven with each other by intrinsic and extrinsic wrist ligaments. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective immobilization of the injury, and thorough rehabilitation. Displaced fractures of the hook of the hamate, trapezial ridge fractures, and comminuted pisiform fractures are managed best by early excision to promote uncomplicated recovery and early return to sport. For most athletes, return to competition can be expedited safely with the use of padded gloves and custom playing splints or casts. The sports medicine physician always must put the athlete's safety first when deciding the appropriate time for return to competition.

Athletic Injuries↗
PubMed2006

High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique.

BACKGROUND: Knee articular cartilage injuries in athletes present a therapeutic challenge and have been identified as an important cause of permanent disability because of the high mechanical joint stresses in athletes. PURPOSE: To determine whether microfracture treatment of knee articular cartilage injuries can return athletes to high-impact sports and to identify the factors that affect the ability to return to athletic activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two athletes who regularly participated in high-impact, pivoting sports before articular cartilage injury were treated with microfracture for single articular cartilage lesions of the knee. Functional outcome was prospectively evaluated with a minimum 2-year follow-up by subjective rating, activity-based outcome scores, and the ability for postoperative participation in high-impact, pivoting sports. RESULTS: At last follow-up, 66% of athletes reported good or excellent results. Activity of daily living, Marx activity rating scale, and Tegner activity scores increased significantly after microfracture. After an initial improvement, score decreases were observed in 47% of athletes. Forty-four percent of athletes were able to regularly participate in high-impact, pivoting sports, 57% of these at the preoperative level. Return to high-impact sports was significantly higher in athletes with age <40 years, lesion size <200 mm(2), preoperative symptoms <12 months, and no prior surgical intervention. CONCLUSION: Microfracture is an effective first-line treatment to return young athletes with short symptomatic intervals and small articular cartilage lesions of the knee back to high-impact athletics.

Activities of Daily Living↗
PubMed1996

Management of back pain in athletes.

Back pain affects millions of people. It affects 80% of the population and up to 52% at any given time. Back pain is not limited to sedentary individuals; it has significant effects on athletes as well. Depending upon the sport, incidence rates of back pain occur in athletes from 1.1% to as high as 30%. Athletes differ from the non-athletic population in that their incentives to return to activity are considerably different than non-athletes. The reasons may vary from the will to win through to significant financial considerations. Although reasons for recovery are different, the physiology and mechanics of repair of injured soft tissue in the athlete is the same as for the non-athlete. Proper management of the athlete requires ruling out emergent causes of back pain such as tumour, infection, acute fracture, progressive neurological deficit, visceral sources (e.g. pancreatitis, abdominal aortic aneurysm), and rheumatoid variants. Once a good history and physical is performed, a simple classification system can be utilised to manage the athlete presenting with back pain. This system can be expressed as: (a) regional back pain; (b) radicular leg pain; (c) radicular leg pain with progressive neurological deficit; and (d) cauda equina syndrome. Each of these categories needs to be managed in a specific manner and can provide the healthcare professional with simple, straightforward guidelines for handling the athlete with lower back pain. The key is to return the athlete to the field of play in a safe and timely manner.

Athletic Injuries↗
PubMed2004

Elite volunteer athletes of different sport disciplines may have elevated baseline GH levels divorced from unaltered levels of both IGF-I and GH-dependent bone and collagen markers: a study on-the-field.

Seventy-seven Italian eliteathletes(42 M, 35 F, mean age +/- SE: 24.4-0.7 yr, age range: 17-47 yr) of different sport disciplines (sprinters, triathletes, middle-distance runners, road-walkers, cyclists, rowing athletes, skiers, roller hockey players, swimmers) were sampled on-the-field (before a training session) for the determination of basal GH, IGF-I, C-terminal cross-linked telopeptide of type I collagen (ICTP) and amino-terminal propeptide of type III procollagen (PIIINP) levels, two GH-dependent peripheral markers of bone and collagen turnover, respectively. Basal GH concentrations were significantly higher (p<0.001) in female (5.8 +/- 1.0 ng/ml) vs male athletes (1.8 +/- 0.5 ng/ml), with a large spread of values in either gender. Mean GH levels of athletes were significantly higher than those recorded in age-matched sedentary controls (females: 2.5 +/- 0.5 ng/ml, p<0.001; males: 0.5 +/- 0.2 ng/ml, p<0.05). Among female athletes, 7/35 had basal GH values higher than the upper limit of control values (>9.5 ng/ml), while among males 7/42 had values higher than the upper limit of male sedentary controls (>3.6 ng/ml). No significant differences in basal GH concentrations were found between females taking oral contraceptives (OC) and those who did not receive this treatment (5.0 +/- 2.1 vs 6.0 +/- 1.2 ng/ml). IGF-I levels (236.4 +/- 7.8 ng/ml) were in the normal range for age in all athletes (except for 1 athlete with slightly increased levels), no significant correlation being found between GH and IGF-I levels (R2=0.0393). Mean ICTP (4.6 +/- 0.2 ng/ml) and PIIINP (4.4-0.1 ng/ml) concentrations of elite athletes were not significantly different from those recorded in age and matched healthy sedentary subjects; 4 athletes showed increased PIIINP levels and 2 had increased ICTP levels. ICTP and PIIINP levels were positively correlated with chronological age (p<0.001), a positive correlation being also found between the two markers (p<0.001). On the contrary, no significant correlation was found between basal GH/IGF-I levels and ICTP/PIIINP levels. In conclusion, the present study demonstrates that: 1) elite athletes (particularly females), which have frequently increased basal GH on-the-field, have actually normal IGF-I levels; 2) ICTP and PIIINP levels of athletes are similar to those recorded in healthy sedentary, being significantly higher in younger subjects of both groups; 3) the presence of increased basal GH levels, being associated with normal IGF-I, ICTP and PIIINP levels, is probably the result of a transient GH peak in this study group. Further additional studies are requested to verify the possible use of these peripheral GH-dependent markers for detecting exogenous chronic administration of recombinant GH in athletes.

Adolescent↗
PubMed2002

Assessment of right heart function in the athlete's heart.

It is known that the heart of an athlete has been physiologically adapted by prolonged training. There are a large number of echocardiographic studies which have focused on left ventricular wall thickness and dilatation, but there are few studies concerning right heart function in the athlete's heart. The aim of this study was to assess right heart function in elite athletes by conventional and new echocardiographic methods. The study population consisted of 36 elite highly-trained male athletes and 16 age-matched healthy sedentary controls. Right atrial, right ventricular, and inferior vena cava dimensions, and pulsed Doppler measurements of tricuspid inflow and right ventricular outflow were obtained, and systolic (preejection period, ejection time, preejection time/ejection time, QV peak, isovolumic contraction time) and diastolic (E peak, A peak, E/A ratio, decelaration time, isovolumic relexation time) function parameters were measured. The myocardial performance index was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. In addition, right ventricular systolic and diastolic functions were determined by Pulsed wave tissue Doppler imaging (S, E, and A velocities) at the lateral corners of the tricuspid annulus. The left ventricular mass index (P < 0.005), and right atrial (P < 0.001), right ventricular (P < 0.001), and inferior vena cava dimensions (P < 0.001) were significantly greater in athletes than in controls. Tricuspid E peak, A peak, E/A ratio, deceleration time, isovolumic relaxation time, preejection period, right ventricular ejection time, preejection time/ejection time, isovolumic contraction time, QV peak, and myocardial performance index were found to be similar in athletes and in controls (P > 0.05). Systolic, early diastolic, and late diastolic tissue Doppler imaging velocities were not significantly different in athletes and controls (P > 0.05). Left ventricular hypertrophy (LV mass index >134 g/m2) was found in 15 of the athletes. Right atrial dimension was greater in the athletes with left ventricular hypertrophy than in those without hypertrophy (P < 0.05). All right ventricular systolic and diastolic echocardiographic parameters were similar in athletes with and without left ventricular hypertrophy (P > 0.05). The results of this study indicate that right ventricular systolic and diastolic functions do not deteriorate in the athlete's heart despite significant chamber dilatation. They suggest that these changes are a normal physiologic adaptation to prolonged training.

Adult↗
PubMed2004

Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up.

AIMS: To study the course and circumstances of atrial fibrillation in endurance sports. BACKGROUND: Atrial fibrillation is the main cause of symptoms in athletes and frequently disturbs the performance during the practising of sport. The course of the arrhythmia is seldom reported in this population. METHODS: In 1993 and 2002 symptoms and clinical presentation of atrial fibrillation were evaluated in 30 well-trained athletes with a specially designed questionnaire. RESULTS: In 1993 paroxysmal atrial fibrillation was present in 30 male athletes at the mean age of 48.1 +/- 7.8, 3 (10%) of them also had paroxysmal atrial flutter. Three (10%) of the athletes died before 2002. In 2002 paroxysmal atrial fibrillation continued in 15 (50%) athletes, permanent atrial fibrillation emerged in 5 (17%) athletes and 7 (23%) of them showed no further atrial fibrillation. In 1993 paroxysms of atrial fibrillation started at a relatively low level of training intensity compared with the mean maximal training intensity of 11 +/- 7 versus 8 +/- 4 h/week (p < 0.05). The first attack of adrenergically induced paroxysmal atrial fibrillation was more often present in younger athletes (p < 0.005) and vagally induced paroxysmal atrial fibrillation was more apparent in older athletes (p < 0.05). In 10 (38%) of the athletes a familiar form of paroxysmal atrial fibrillation was present. CONCLUSION: A small proportion of the athletes (26%) was asymptomatic. Paroxysmal atrial fibrillation remained stable in half of the athletes whereas the arrhythmia changed into permanent atrial fibrillation in a minority of this population.

Adult↗
PubMed2006

Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death in China.

The cardiovascular pre-participation screening proposal for young competitive athletes has the potential to save young lives. This study aimed to identify individuals at risk for potentially lethal cardiovascular diseases in athletes before competition. Between June 2005 and July 2005, 351 (170 male and 181 female) elite Chinese athletes from 21 sports were profiled. The 12-lead electrocardiogram and echocardiography were employed to evaluate cardiovascular diseases. The vast majority had no definitive evidence of cardiovascular disease. However, abnormal ECGs were identified in 16 athletes (4.5%), including 4 with distinctly abnormal and 12 with mildly abnormal patterns. Only 13 athletes (3.7%) had echocardiographic evidence of relatively mild valve regurgitation that had not been previously suspected. In three athletes with relatively mild ventricular septal hypertrophy (13-14 mm), it was not possible to discern with absolute certainty whether the wall thickening was a manifestation of hypertrophic cardiomyopathy or secondary to athletic conditioning ("athlete heart"). This screening protocol identified no athletes with definite evidence of hypertrophic cardiomyopathy, Marfan's syndrome or other cardiovascular diseases that convey a significant potential risk for sudden death or disease progression during athletic activity. This is largely due to the relative low prevalence of conditions resulting in sudden cardiac death in young athletes and high false positive/negative rates in the tests used as part of the screening process (due to a large overlap between cardiovascular changes due to pathology and those due to intense training).

Adolescent↗
PubMed2000

Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes.

OBJECTIVES: The purpose of this study is to characterize the clinical profile and identify clinical markers that would enable the detection during life of anomalous coronary artery origin from the wrong aortic sinus (with course between the aorta and pulmonary trunk) in young competitive athletes. BACKGROUND: Congenital coronary artery anomalies are not uncommonly associated with sudden death in young athletes, the catastrophic event probably provoked by myocardial ischemia. Such coronary anomalies are rarely identified during life, often because of insufficient clinical suspicion. However, since anomalous coronary artery origin is amenable to surgical treatment, timely clinical identification is crucial. METHODS: Because of the paucity of available data characterizing the clinical profile of wrong sinus coronary artery malformations, we reviewed two large registries comprised of young competitive athletes who died suddenly, assembled consecutively in the U.S. and Italy. RESULTS: We reported 27 sudden deaths in young athletes, identified solely at autopsy and due to either left main coronary artery from the right aortic sinus (n = 23) or right coronary artery from the left sinus (n = 4). Each athlete died either during (n = 25) or immediately after (n = 2) intense exertion on the athletic field. Fifteen athletes (55%) had no clinical cardiovascular manifestations or testing during life. However, in the remaining 12 athletes (45%) aged 16 +/- 7, certain clinical data were available. Premonitory symptoms had occurred in 10, including syncope in four (exertional in three and recurrent in two, 3 to 24 months before death) and chest pain in five (exertional in three, all single episodes, < or =24 months before death). All cardiovascular tests were within normal limits, including 12-lead electrocardiogram (ECG) pattern (in 9/9), stress ECG with maximal exercise (in 6/6) and left ventricular wall motion and cardiac dimensions by two-dimensional echocardiography (in 2/2). CONCLUSIONS: With regard to congenital coronary artery anomalies of wrong aortic sinus origin in young competitive athletes, 1) standard testing with ECG under resting or exercise conditions is unlikely to provide clinical evidence of myocardial ischemia and would not be reliable as screening tests in large athletic populations, 2) premonitory cardiac symptoms not uncommonly occurred shortly before sudden death (typically associated with anomalous left main coronary artery), suggesting that a history of exertional syncope or chest pain requires exclusion of this anomaly. These observations have important implications for the preparticipation screening of competitive athletes.

Adolescent↗
PubMed2002

Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes.

OBJECTIVES: The aim of this study was to clarify the clinical relevance of ventricular tachyarrhythmias assessed by 24-h ambulatory electrocardiograms (ECG) in a large, unique, and prospectively evaluated athletic population. BACKGROUND: For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved. METHODS; We assessed 355 competitive athletes with ventricular arrhythmias (VAs) on a 24-h ambulatory (Holter) ECG that was obtained because of either palpitations, the presence of > or = 3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both. RESULTS: Athletes were segregated into three groups: Group A with > or = 2,000 PVDs/24 h (n = 71); Group B with > or = 100 <2,000 PVDs/24 h (n = 153); and Group C with only <100 PVDs/24 h (n = 131). Cardiac abnormalities were detected in 26 of the 355 study subjects (7%) and were significantly more common in Group A (21/71, 30%) than in Group B (5/153, 3%) or Group C athletes (0/131, 0% p < 0.001). Only the 71 athletes in Group A were excluded from competition. During follow-up (mean, 8 years), 70 of 71 athletes in Group A and each of the 284 athletes in Groups B and C have survived without cardiovascular events. The remaining Group A athlete died suddenly of arrhythmogenic right ventricular cardiomyopathy while participating in a field hockey game against medical advice. Frequent and complex ventricular tachyarrhythmias are common in trained athletes and are usually unassociated with underlying cardiovascular abnormalities. Such VAs (when unassociated with cardiovascular abnormalities) do not convey adverse clinical significance, appear to be an expression of "athlete's heart syndrome," and probably do not per se justify a disqualification from competitive sports.

Adolescent↗
PubMed1987

Results of screening a large group of intercollegiate competitive athletes for cardiovascular disease.

To determine the feasibility of detecting cardiovascular disease in a large group of young competitive athletes, a prospective screening evaluation of intercollegiate student athletes was undertaken at the University of Maryland. Initial clinical screening (including personal and family history, physical examination and 12 lead electrocardiogram) was performed in 501 athletes. Ninety of these subjects had positive findings on one or more of the three studies and agreed to further cardiologic evaluation. The vast majority (75 [84%] of 90) had no definitive evidence of cardiovascular disease, although 1 athlete had mild systemic hypertension and 14 (15%) had echocardiographic evidence of relatively mild mitral valve prolapse that had not been previously suspected. In three athletes with relatively mild ventricular septal hypertrophy (14 to 15 mm), it was not possible to discern with absolute certainty whether the wall thickening was a manifestation of hypertrophic cardiomyopathy or secondary to athletic conditioning ("athlete heart"). Therefore, this screening protocol identified no athletes with definite evidence of hypertrophic cardiomyopathy, Marfan's syndrome or other cardiovascular diseases that convey a significant potential risk for sudden death or disease progression during athletic activity. This failure to identify such diseases could have been due to a lack of sensitivity of the screening tests or to the low frequency with which these diseases occur in youthful healthy athletes. A systematic preparticipation screening program (such as the present one) does not appear to be an efficient means of detecting clinically important cardiovascular disease in young athletes.

Adolescent↗
PubMed2002

Elite athletes: effects of the pressure to be thin.

This study represented the first attempt to examine the prevalence of eating disorders in a large sample of both male and female elite athletes compared to a matched control group of non-athletes. The subjects were 263 Australian elite athletes representing a variety of sports, and 263 non-athletes. All subjects were interviewed using the Composite International Diagnostic Interview and completed a number of self-report questionnaires. Both male and female athletes competing in sports that emphasise a lean body shape or a low body weight evidenced a significantly higher prevalence of eating disorders and eating disorder symptoms than other athletes and non-athletes. The results suggest that athletes do, in fact, have a higher prevalence of eating disorders than non-athletes. However, it is not so much being an athlete that places an individual at increased risk for developing an eating disorder; rather it is athletes competing in sports which emphasise the importance of a thin body shape or a low body weight who appear to be particularly vulnerable.

Adolescent↗
PubMedDate not supplied

Emergency medical care in the athletes' village: World University Games 1993.

OBJECTIVE: Little information exists concerning special medical needs at the athletes' residence (as distinct from the sport venues) at major international sporting events. During the summer of 1993, Buffalo, New York became the first city in the United States to host the World University Games. Approximately 6,000 athletes and accompanying staff from 118 countries attended. This report seeks to characterize emergency medical care use and the degree of language difficulty encountered at the athletes' village medical center (AVMC) set up at the athletes' residence for this event. METHODS: Demographic data were collected prospectively for each athlete or staff member housed in the athletes' village who presented to AVMC for medical evaluation rather than being cared for by a team physician or at one of the venues. Difficulty in medical treatment secondary to language differences was assessed by the treating physician on a scale of 0-3. RESULTS: Over the 14 days that the AVMC was in operation, for 24 hours a day, a total of 362 athletes (mean age: 22.9 +/- 2.9 years, 257 males, 105 females) and 149 accompanying staff (mean age: 39.8 +/- 11.6 years, 110 males, 39 females) were treated. More than 90% of the patients were seen between the hours of 0800 and 2400. A broad spectrum of minor medical problems occurred, with musculoskeletal injuries accounting for most of the visits for both athletes (54%) and staff (27%). Nonsteroidal anti-inflammatory agents and oral antibiotics were the most commonly prescribed medications. On-site radiographic facilities were used for 22% of the athletes and 11% of the staff treated. The majority of patients (92% of athletes, 91% of staff) were discharged from the AVMC. Four of the 12 patients that were transferred to a hospital-based emergency department were admitted to the hospital. Language problems, as assessed by the treating physician, were mostly minor; 25% of the patients had accompanying interpreters. One volunteer physician, and two to three nurses adequately staffed each shift. CONCLUSION: The AVMC provided medical care for a large variety of medical problems that could be treated on-site without transfer to a higher-level facility, thereby providing directed medical care for this special population in a secure environment. Language differences were perceived as a minor problem. This report should be valuable in the planning of medical care at the athletes' residences for similarly large sporting events.

Adult↗