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A comparison of longitudinal changes in aerobic fitness in older endurance athletes and sedentary men.

OBJECTIVES: To compare the longitudinal changes in maximal aerobic capacity (VO2max) in healthy middle aged and older athletes and sedentary men. DESIGN: A cohort study with mean follow-up of 8.7 years (range 4.0-12.8). SETTING: Outpatient research at a tertiary hospital. PARTICIPANTS: Forty-two healthy, middle aged, and older athletes (initial age 64 +/- 1 year) and 47 healthy sedentary men of comparable age recruited for research studies. MEASUREMENTS: VO2max during a maximal treadmill test. RESULTS: At baseline, the cross-sectional rates of decline in VO2max with age (slope) were virtually identical in the athletes and sedentary men (-0.42 versus -0.43 mL x kg(-1) x min(-1) x year(-1)). At follow-up, the VO2max had declined by 11.9 +/- 1.1 mL x kg(-1) x min(-1) (22%) in the athletes, a crude average rate of -1.4 +/- 0.14 mL x kg(-1)x min(-1) x year(-1). By comparison, the VO2max declined by 4.4 +/- 0.6 mL x kg(-1) x min(-1) (14%) in the sedentary men, a crude average rate of change of -0.48 +/- 0.07 mL x kg(-1) x min(-1) x year(-1). Therefore, the observed absolute rate of longitudinal decline in VO2max in the athletes was triple that of the sedentary men (P= .001) and significantly greater than the decline predicted by their baseline cross-sectional data (P= .001). Post hoc analyses of the longitudinal data in the athletes based on the training regimens over the follow-up period demonstrated that the seven individuals who continued to train vigorously ("high training") had no significant decline in VO2max (0.28% change in VO2max per year). By contrast, the VO2max declined by 2.6% per year in the "moderate training" group (N=21), 4.6% per year in the "low training" group (N=13), and 4.7% per year in the two individuals who developed cardiovascular disease. CONCLUSION: The longitudinal decline in VO2max in older male endurance athletes is highly dependent upon the continued magnitude of the training stimulus. The majority of the athletes reduced their training levels over time, resulting in longitudinal reductions in VO2max two to three times as large as those predicted by cross-sectional analyses or those observed longitudinally in their sedentary peers.

Aged↗

Haematocrit in elite athletes.

It is possible to increase haemoglobin (Hb) and haematocrit (Ht) to non-physiological values by injecting recombinant human erythropoietin (rhEPO). Although this treatment may result in a better performance of athletes, it may also cause a health risk. To prevent doping with rhEPO, the Union Cycliste Internationale has decided to exclude male cyclists with Ht>0.50 and female cyclists with Ht>0.47 from competition. These cut-off values, however, may result in a non-justified exclusion of clean athletes. To test this hypothesis, we measured the Ht of elite athletes (50 men and 41 women) during a total study period of 43 months. Ht was compared with that in healthy control subjects (134 men and 144 women). No significant differences in Ht were detected between male elite athletes and their references and female elite athletes and their references (P>0.05). In both populations, however, male subjects were found with Ht>0.50, 6 controls and 5 elite athletes (4 highlanders and 1 lowlander). In the female subjects 5 controls but not one of the athletes exceeded a Ht>0.47. "Increased" Ht values among athletes were mainly seen in highlanders. The study shows that it is very difficult to set up a decision value for Ht with regard to doping by erythropoietin.

Adult↗

The use of nutritional supplements among master athletes.

We assessed the use of nutritional supplements among master athletes focusing on their source of information and source of supply of nutritional supplements. 1560 standardized, anonymous questionnaires were distributed among participants of the World Masters Athletics Championships Indoors 2004. These questions were related to biometric parameters, social indicators, training parameters, illicit drugs, and nutritional supplements. Chi2-tests were computed to reveal meaningful associations between basic information (age, gender, family status, children, education, country of origin, disciplines, training years, smoking, and the use of alcohol, illicit drugs, and doping) and the intake of nutritional supplements. Descriptive information on the history of their use of nutritional supplements was also provided. 60.5 % of all participants reported the actual use of nutritional supplements. We found no significant differences between nutritional supplement users and non-users with regard to basic information. The substances predominantly used were vitamins (35.4 %) and minerals (29.9 %). In contrast to elite athletes who use nutritional supplements to increase their athletic performance, master athletes use these substances predominantly for health reasons and, thus, have a closer contact to the health care system. Physicians are their preferred source of information about nutritional supplements. More than half of the interviewed athletes obtain their nutritional supplements from pharmacies or physicians. The results of this study indicate that nutritional supplement users in master athletics show no specific user profile. Since it is not rare for nutritional supplements to contain trace contaminations of anabolic androgenic steroids or pro-hormones, physicians should also inform master competitive athletes of the dangers of testing positive for doping substances due to their intake of nutritional supplements and advise them accordingly.

Adult↗

Ample use of physician-prescribed medications in Finnish elite athletes.

The present study aimed at determining the use of physician-prescribed medication in a large number of elite athletes compared with a representative control sample of the general population. Of all the athletes (N = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3 %) in 2002. A control group (N = 1503, response rate 80.1 %) comprised an age-matched sample from the population-based study collected by the National Public Health Institute. Any prescribed medication was used by 34.5 % of the athletes and 24.9 % of the controls during the past seven days. The most frequently reported physician-prescribed medications among athletes during the previous seven days were anti-allergic medicines (12.6 % of the respondents), non-steroidal anti-inflammatory drugs (NSAIDs; 8.1 %), anti-asthmatic medicines (7.0 %), and oral antibiotics (2.7 %). The adjusted odds ratios (95 % CI) for the physician-prescribed medications used during the previous seven days was 2.42 (1.69 - 3.46), 3.63 (2.25 - 5.84), 3.42 (2.05 - 5.70), and 2.15 (1.03 - 4.45) for use of anti-allergic medication, NSAIDs, anti-asthmatic medication, and oral antibiotics, respectively, in the athletes compared with controls. Every fifth athlete reported some NSAID-related adverse effect. In conclusion, the athletes used NSAIDs, antibiotics, anti-asthmatic and anti-allergic medication significantly more often than a representative sample of age-matched controls. All these medicines have potential adverse effects that may have a deleterious impact on the maximum exercise performance of elite athletes. Adverse effects were commonly reported in connection with NSAID use.

Adult↗

Endogenous anabolic and catabolic steroid hormones in male and female athletes during off season.

Peripheral serum hormone levels during the off season were analysed in 10 male and 10 female athletes, all belonging to the Swedish national teams in skiing and orienteering and in age matched sedentary controls (15 males, 13 females). No clinical signs of overuse strain were observed in any of the athletes. No significant differences in hormone variables were found between male athletes and controls. The female athletes had significantly higher levels of cortisol and significantly lower ratios between total testosterone and cortisol, between non-SHBG-bound testosterone and cortisol and between 4-androstene-3, 17-dione and cortisol than the sedentary controls. The increased levels of cortisol found in the female athletes probably reflect an adaptation to several years of hard training. A decrease of the free T/cortisol ratio has earlier been shown to indicate an overuse distress. One may speculate that the low androgen/cortisol ratios found in the female athletes in contrast to the males could indicate that the female athletes might need longer time to recover from hard exercise than male athletes, or could suggest an insufficient dietary intake.

Adaptation, Physiological↗

Survey of menstrual function in young Nigerian athletes.

Menstrual function was assessed comparatively in different categories of 155 Nigerian athletes, aged 13-19 years, and 135 nonathletes, aged 12-18 years, who answered questionnaires and were interviewed. Menstruation was more regular and normal in the nonathletes (44%) than the athletes (21%). Although both groups generally had similar patterns of menstrual dysfunction, secondary amenorrhea or oligomenorrhea (O/A) was more prevalent in the athletes (25%) than the nonathletes (10%). Among the athletes, only the distance runners were significantly lighter and leaner than nonathletes and athletes of other sports (P less than 0.05). Regardless of sports activity, oligomenorrheic subjects had substantially lower body weight relative to stature and were leaner than subjects of the other menstrual categories. In the oligomenorrheic group, a greater proportion of the athletes (59%) and nonathletes (57%) had lean body mass values below the 41st percentile. The premenarche-trained athletes (48%) reported a higher incidence of menstrual cycle irregularities than the athletes who began training after the menarche. Results support the role of body composition-related factors in the etiology of exercise-associated O/A.

Adolescent↗

Blood sampling in doping control. First experiences from regular testing in athletics.

We report the results from blood sampling taken for the first time during doping control in athletics. The study includes samples from 99 athletes tested during IAAF-meetings in 1993-94. Blood doping with allogenic blood was not detected. The distribution of haemoglobin levels in athletes did not differ markedly from that found in controls. Erythropoietin (EPO) values were markedly lower in athletes than in controls, and 58% had EPO lower than the detection limit for the assay. This may be due to high-altitude residence prior to testing. Measurements of growth hormone (GH) and insulin-like growth factor 1 did not suggest GH-misuse in any athlete tested. One third of the male athletes had testosterone levels that were lower than the normal reference interval. This may at least partly be due to the combination of sampling at night and after strenuous exercise. One female athlete was found to have a grossly elevated testosterone level. In conclusion, the present results show the importance of taking into account the special circumstances during sampling when interpreting results from blood testing in athletes. Future research should focus on developing more sensitive and specific tests to detect doping with endogenous substances such as GH and EPO.

Bilirubin↗

Assessment of vitamin B6 status of strength and speedpower athletes.

OBJECTIVE: The investigation was designed to obtain information concerning the vitamin B6 status in high-performance athletes. SUBJECTS: Fifty-seven strength and speedpower athletes were available for examination. METHODS: Vitamin B6 status was determined by a 7-day weighed food record, enzyme activity (alpha-EGOT) measurement, whole blood concentrations (Saccharomyces carlsbergenisis and 4-pyridoxinic acid (4-PA) excretion (high-pressure liquid chromatography). RESULTS: The absolute vitamin B6 intake in > 30% of the athletes was below the German recommended dietary allowance (GRDA) and, in relation to the protein intake (GRDA 0.20 mg vitamin B6/g protein), > 60% of the athletes had values below the GRDA. More than 90% of the athletes did not attain the reference value (0.88 nmol/mL) for untrained individuals in vitamin B6 whole blood concentration, and only a few athletes (< 5%) had alpha-EGOT values above the reference value of alpha-EGOT > 1.50). The 4-PA excretion was below the reference value of > 2.73 mumol/g creatinine in 18% of all athletes examined. CONCLUSIONS: Vitamin B6 status can be quantified using the weighed food record, microbiological whole blood determination, and 4-PA excretion; however, limits of the individual methods must be taken into account. Vitamin B6 supply of the athletes still cannot be definitively assessed because there are no generally valid reference values.

Aspartate Aminotransferases↗

NCAA coaches survey: the role of the coach in identifying and managing athletes with disordered eating.

The primary objective of the present study was to survey collegiate coaches with respect to how female athletes with disordered eating or eating disorders are identified, how coaches are involved, and the identification criteria used. An additional objective was to determine how symptomatic athletes are managed regarding treatment and sport participation. Participants were 2,894 coaches representing 23 sports. Findings indicated that athletic trainers, teammates, and coaches are frequently involved in identification. Eating disorder symptoms were most often used to identify symptomatic athletes, and athletes from high-risk sports were more often identified. Coaches rated symptoms as being serious, both in terms of how they affect the athlete's health and her athletic performance, with amenorrhea being a notable exception. Implications of the study were discussed in terms of education and training of coaches and athletic trainers.

Journal Article↗

ACTN3 genotype is associated with human elite athletic performance.

There is increasing evidence for strong genetic influences on athletic performance and for an evolutionary "trade-off" between performance traits for speed and endurance activities. We have recently demonstrated that the skeletal-muscle actin-binding protein alpha-actinin-3 is absent in 18% of healthy white individuals because of homozygosity for a common stop-codon polymorphism in the ACTN3 gene, R577X. alpha-Actinin-3 is specifically expressed in fast-twitch myofibers responsible for generating force at high velocity. The absence of a disease phenotype secondary to alpha-actinin-3 deficiency is likely due to compensation by the homologous protein, alpha-actinin-2. However, the high degree of evolutionary conservation of ACTN3 suggests function(s) independent of ACTN2. Here, we demonstrate highly significant associations between ACTN3 genotype and athletic performance. Both male and female elite sprint athletes have significantly higher frequencies of the 577R allele than do controls. This suggests that the presence of alpha-actinin-3 has a beneficial effect on the function of skeletal muscle in generating forceful contractions at high velocity, and provides an evolutionary advantage because of increased sprint performance. There is also a genotype effect in female sprint and endurance athletes, with higher than expected numbers of 577RX heterozygotes among sprint athletes and lower than expected numbers among endurance athletes. The lack of a similar effect in males suggests that the ACTN3 genotype affects athletic performance differently in males and females. The differential effects in sprint and endurance athletes suggests that the R577X polymorphism may have been maintained in the human population by balancing natural selection.

Actinin↗

Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes.

AIMS: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death in young athletes, and substantial interest persists in strategies for timely identification. We assessed the diagnostic efficacy of Italian pre-participation screening programme with 12-lead ECG (in addition to history and physical examination) for identification of HCM. METHODS AND RESULTS: Four thousand four hundred and fifty members of the Italian national teams, initially judged eligible for competition as a result of systematic pre-participation screening across Italy, subsequently underwent clinical and echocardiographic examination at the Institute of Sports Medicine and Science (Rome) to assess the presence of previously undetected HCM. None of the 4450 athletes showed clinical evidence of HCM. Other cardiac abnormalities were detected in only 12 athletes, including myocarditis (n=4), mitral valve prolapse (n=3), Marfan's syndrome (n=2), aortic regurgitation with bicuspid valve (n=2), and arrhythmogenic right ventricular cardiomyopathy (n=1). In addition, echocardiography identified four athletes with borderline left ventricular wall thickness (i.e. 13 mm) in the 'grey zone' of overlap between HCM and athlete's heart. In two of these athletes, subsequent genetic analysis or clinical changes over an average 8-year follow-up resulted, respectively, in a definitive or possible diagnosis of HCM. CONCLUSION: The Italian national pre-participation screening programme including 12-lead ECG appears to be efficient in identifying young athletes with HCM, leading to their timely disqualification from competitive sports. These data also suggest that routine echocardiography is not an obligatory component of broad-based screening programmes designed to identify young athletes with HCM.

Adolescent↗

Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study.

OBJECTIVE: To assess whether athletes with strength imbalance of the hip musculature would be more likely to require treatment for low back pain (LBP) over the ensuing year. DESIGN: The study population included 163 National Collegiate Athletic Association Division I college athletes (100 males and 63 females) undergoing preparticipation sports physicals. Institutional review board approval was obtained to acquire and analyze hip muscle strength data. A commercially available dynamometer (Chatillon, Lexington, KY) incorporated into a specially designed anchoring station was used for testing the hip extensors and abductors. The maximum force generated for the hip abductors and extensors was used to calculate a percentage difference between the right and left hip extensors and abductors. Treatment of athletes by the athletic trainers for LBP unrelated to blunt trauma over the ensuing year was recorded. RESULTS: Of all athletes, 5 of 63 females and 8 of 100 males required treatment for LBP. Logistic regression analysis indicated that for female athletes, the percentage difference between the right and left hip extensors was predictive of whether treatment for LBP was required over the ensuing year (P = 0.05). There was no significant association noted for the percentage difference between the right and left hip abductors in females and for the percentage difference between both the right and left hip abductors and right and left hip extensors in males requiring treatment for LBP. CONCLUSIONS: These data support our results from our previous cohort study, adding validity to the concept of hip muscle imbalance being associated with LBP occurrence in female athletes. This research further supports the need for the assessment and treatment of hip muscle imbalance in individuals with LBP.

Female↗

Weight and diet concerns in Finnish female and male athletes.

UNLABELLED: PURPOSES AND METHODS: Factors related to eating disorders were studied in five groups of female (N = 173) and male (N = 190) athletes, and in female (N = 79) and male (N = 61) controls. Factors associated with menstrual status were also examined. RESULTS: The sum of drive for thinness and body dissatisfaction subscales in the Eating Disorders Inventory was higher (P < 0.05) in female controls (median: 5; 25th and 75th percentiles: 1 and 14) than in endurance athletes (0; 0 and 2). The male groups did not differ from each other (P = 0.08) or from female subjects (P = 0.62). The preferred weight loss in the female controls (-4.0 kg; -6.2 and -2.0) was larger (P < 0.05) than in most athletic groups. Males, on average, did not want to lose weight (different from females, P < 0.001). The prevalence of weight reduction attempts (85%) in female weight-class athletes was higher (P < 0.05) compared with endurance and ballgame athletes and the controls (29-58%). In males, the frequency (93%) of weight reduction attempts was also highest in the weight-class athletes (P < 0.05). The prevalence of menstrual disturbances was 27-37% in aesthetic, endurance, and weight-class athletes, and 5% in controls (P = 0.06). CONCLUSIONS: The results confirmed that the risk for eating disorders is dependent on the type of sport. The claim that some female athlete groups are at greater risk than controls did not receive evidence.

Adolescent↗

Asthma and wheezing among Norwegian elite athletes.

PURPOSE: The objectives were to estimate the prevalence of self-reports of asthma and wheezing among Norwegian elite athletes compared with the general population and to estimate the associations between asthma and types of sports, exercise and team level. METHODS: The study population included all Norwegian elite athletes on the national junior and senior teams in 1997 (N = 1620) and a random sample from the general population (N = 1680). The surveys included items for asthma, respiratory symptoms, the history of participation in sports, sports events, and exercise and team level. The associations between the exposure variables and the outcomes adjusting for potential confounding factors were estimated using logistic regression. Crude (c) and adjusted odds ratio (aOR) with 95% confidence interval (CI) are presented. RESULTS: The prevalence of asthma was greater among athletes (10.0%) compared with that in the general population (6.9%) and remained so after controlling for confounders, aOR = 1.5 (95%CI 1.1-2.1). The risk of asthma was highest in sports requiring strength and endurance. This was the case for comparisons between athletes and the general population, aOR = 3.5 (1.6-7.6) for strength and aOR = 2.2 (1.4-3.5) for endurance sports. Comparisons within the sample of athletes using technical sports as the reference category revealed similar results, aOR = 3.0 (1.1-8.0) and aOR = 2.0 (1.0-4.3), respectively. Furthermore, asthma was more common among female than male athletes (aOR 1.7 (1.1-2.7)). Training more than 20 h x wk(-1) was associated with asthma when compared with levels of training less than 10 h x wk(-1) (aOR 1.9 (1.0-4.1)). CONCLUSION: These results indicate that asthma is more common among athletes compared with the general population. Asthma among athletes may define a subgroup of asthma cases for whom etiology is related to extensive exercise.

Adult↗

Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge.

PURPOSE: The purpose of this study was to compare a laboratory based exercise challenge (LBC) to a field based exercise challenge (FBC) for pulmonary function test (PFT) exercise-induced asthma (EIA) screening of elite athletes. METHODS: Twenty-three elite cold weather athletes (14 men, 9 women) PFT positive for EIA (FBC screened) served as subjects. Twenty-three gender and sport matched controls (nonasthmatics) were randomly selected to establish PFT reference values for normal elite athletes. Before FBC, athletes completed a medical history questionnaire for EIA symptoms. FBC evaluations consisted of baseline spirometry, actual or simulated competition, and 5, 10, and 15 min postexercise spirometry. PFT positive athletes were evaluated in the laboratory using an exercise challenge simulating race intensity (ambient conditions: 21 degrees C, 60% relative humidity). PFT procedures were identical to FBC. RESULTS: 91% of PFT positive and 48% of PFT normal athletes reported at least one symptom of EIA, with postrace cough most frequent. Baseline spirometry was the same for PFT positives and normal controls. Lower limit reference range (MN - 2 SD) of FEV1 for controls suggests that postexercise decrements of greater than approximately -7% indicate abnormal airway response in this population. Exercise time duration did not effect bronchial reactivity; 78% of FBC PFT positives were PFT normal post-LBC. CONCLUSION: Self-reported symptoms by elite athletes are not reliable in identifying EIA. Reference range criterion for FEV1 decrement in the elite athlete postexercise contrasts current recommended guidelines. Moreover, a large number of false negatives may occur in this population if EIA screening is performed with inadequate exercise and environmental stress.

Adolescent↗

Incidence of exercise-induced bronchospasm in Olympic winter sport athletes.

PURPOSE: The purpose of this project was to determine the incidence of exercise-induced bronchospasm (EIB) among U.S. Olympic winter sport athletes. METHODS: Subjects included female and male members of the 1998 U.S. Winter Olympic Team from the following sports: biathlon, cross-country ski, figure skating, ice hockey, Nordic combined, long-track speedskating, and short-track speedskating. Assessment of EIB was conducted in conjunction with an "actual competition" (Olympic Trials, World Team Trials, World Cup Event, U.S. National Championships) or a "simulated competition" (time trial, game), which served as the exercise challenge. Standard spirometry tests were performed preexercise and at 5, 10, and 15 min postexercise. An athlete was considered EIB-positive based on a postexercise decrement in FEV1 > or = 10%. RESULTS: For the seven sports evaluated on the 1998 U.S. Winter Olympic Team, the overall incidence of EIB across all sports and genders was 23%. The highest incidence of EIB was found in cross-country skiers, where 50% of the athletes (female = 57%; male = 43%) were diagnosed with EIB. Across the seven sports evaluated, the prevalence of EIB among the female and male athletes was 26% and 18%, respectively. Among those individuals found to be EIB-positive were athletes who won a team gold medal, one individual silver medal, and one individual bronze medal at the Nagano Winter Olympics. CONCLUSIONS: These data suggest that: 1) EIB is prevalent in several Olympic winter sports and affects nearly one of every four elite winter sport athletes; 2) the winter sport with the highest incidence of EIB is cross-country skiing; 3) in general, EIB is more prevalent in female versus male elite winter sport athletes; and 4) athletes may compete successfully at the international level despite having EIB.

Asthma, Exercise-Induced↗

RAS genes influence exercise-induced left ventricular hypertrophy: an elite athletes study.

PURPOSE: The association of ACE I/D polymorphism with changes in LV mass in response to physical training has been observed, but no association has been found with AT1R A1166C polymorphism. We investigated the ACE I/D, AT1R A1166C, and AT1R CA microsatellite polymorphisms genotype distribution in elite athletes and whether the presence of AT1R C1166 variant, in addition to ACE D allele affects the training-induced LV mass alterations in elite trained athletes. METHODS: The study population comprised 28 healthy players recruited from an Italian elite male soccer team and 155 healthy male subjects. LV mass, LV mass adjusted for body surface area, septal thickness, posterior wall, end-diastolic and end-systolic ventricular dimension, and ejection fraction were determined by echocardiography in pretrained period, at rest and 7 months later during the training. All subjects were genotyped for ACE I/D, AT1R A1166C, and CA microsatellite polymorphisms. RESULTS: Training induced an LV mass increase in all but six athletes. The percentage of athletes in whom an increase of LV mass was found after training was statistically different in relation to the ACE D allele: no increase was observed in three of 24 D allele carriers and in three of four II genotype players (Fisher's exact test, P = 0.02). As AT1R is concerned, no increase was observed in 4 of 15 C allele carriers and in 2 of 13 AA genotype athletes (Fisher's exact test, P > 0.05). The contemporary presence of ACE D and AT1R C allele did not affect the changes after training. No difference has been observed in the CA microsatellite marker allele frequencies between athletes and controls (P = 0.46). CONCLUSION: In this study, we provide the evidence that soccer play does not select athletes on genotype basis. Training-induced LV mass changes in male elite athletes are significantly associated with the presence of ACE D allele, but not of AT1R C allele.

Adult↗

Self-reported symptoms and exercise-induced asthma in the elite athlete.

PURPOSE: The purpose of this study was to compare self-reported symptoms for exercise-induced asthma (EIA) to postexercise challenge pulmonary function test results in elite athletes. METHODS: Elite athletes (N = 158; 83 men and 75 women; age: 22 +/- 4.4 yr) performed pre- and post-exercise spirometry and were grouped according to postexercise pulmonary function decrements (PFT-positive, PFT-borderline, and PFT-normal for EIA). Before the sport/environment specific exercise challenge, subjects completed an EIA symptoms-specific questionnaire. RESULTS: Resting FEV1 values were above predicted values (114--121%) and not different between groups. Twenty-six percent of the study population demonstrated >10% postexercise drop in FEV1 and 29% reported two or more symptoms. However, the proportion of PFT-positive and PFT-normal athletes reporting two or more symptoms was not different (39% vs. 41%). Postrace cough was the most reported symptom, reported significantly more frequently for PFT-positive athletes (P < 0.05). Sensitivity/specificity analysis demonstrated a lack of effectiveness of self-reported symptoms to identify PFT-positive or exclude PFT-normal athletes. Postexercise lower limit reference ranges (MN-2SDs) were determined from normal athletes for FEV1, FEF25--75% and PEF to be -7%, -12.5%, and -18%, respectively. CONCLUSION: Although questionnaires provide reasonable estimates of EIA prevalence among elite cold-weather athletes, the use of self-reported symptoms for EIA diagnosis in this population will likely yield high frequencies of both false positive and false negative results. Diagnosis should include spirometry using an exercise/environment specific challenge in combination with the athlete's history of asthma symptoms.

Adolescent↗