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Gender verification of female Olympic athletes.

Gender verification of female athletes has long been criticized by geneticists, endocrinologists, and others in the medical community. Problems include invalid screening tests, failure to understand the problems of intersex, the discriminatory singling out of women based only on laboratory results, and the stigmatization and emotional trauma experienced by individuals screened positive. Genuine sex-impostors have not been uncovered by laboratory-based genetic testing; however, gender verification procedures have resulted in substantial harm to a number of women athletes born with relatively rare genetic abnormalities. Individuals with sex-related genetic abnormalities raised as females have no unfair physical advantage and should not be excluded or stigmatized, including those with 5-alpha-steroid-reductase deficiency, partial or complete androgen insensitivity, and chromosomal mosaicism. In 1990, the International Amateur Athletics Federation (IAAF) called for ending genetic screening of female athletes and in 1992 adopted an approach designed to prevent only male impostors from competing. The IAAF recommended that the "medical delegate" have the ultimate authority in all medical matters, including the authority to arrange for the determination of the gender of the competitor if that approach is judged necessary. The new policy advocated by the IAAF, and conditionally adopted by the International Olympic Committee, protects the rights and privacy of athletes while safeguarding fairness of competition, and the American Medical Association recommends that it become the permanent approach.

Disorders of Sex Development↗

Back pain and radiologic changes in the thoraco-lumbar spine of athletes.

Back pain and radiological changes of the thoraco-lumbar spine were investigated in 142 top athletes, representing wrestling, gymnastics, soccer and tennis (age range 14-25 years). All groups of athletes reported back pain at high frequencies (50-85%). Male gymnasts had significantly increased incidence and severity of back pain as compared to the rest of the athletes. Radiological abnormalities occurred in 36-55% of the athletes. Reduced disc height, Schmorl's nodes and change of configuration of vertebral bodies correlated with back pain (P less than 0.05, P less than 0.01 and P less than 0.05). Significant covariation between these types of abnormalities was found. Athletes with great demands on the back are thus subjected to an increased risk of symptomatic damage of the spine.

Adolescent↗

Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis.

The incidence and nature of stress fractures and the relationship of potential risk factors to stress-fracture history were investigated retrospectively in a group of 53 female competitive track-and-field athletes. Forty-five stress fractures, diagnosed by clinical findings and bone scan, radiograph, or CT scan, were reported in 22 women. Tibial fractures were the most common (33%). There was no significant difference in bone mineral density at the lumbar spine and tibia/fibula or in percentage body fat and total lean mass when comparing the groups with and without a stress-fracture history. Athletes with a past stress fracture were significantly older at menarche and were more likely to have experienced a history of menstrual disturbance (p < 0.05). Analysis of dietary behavior found that athletes with stress fractures scored significantly higher on the EAT-40 test and were more likely to engage in restrictive eating patterns and dieting. Multiple logistic regression showed that athletes with a history of oligomenorrhea were six times more likely to have sustained a stress fracture in the past, while those who were careful about their weight were eight times more likely. Prevention and treatment of stress fractures in female athletes should include a thorough assessment of menstrual characteristics and dietary patterns.

Adipose Tissue↗

The asthmatic athlete, inhaled beta agonists, and performance.

INTRODUCTION: The large increase in the number of athletes who apply to use inhaled beta agonists (IBAs) at the Olympic Games is a concern to the medical community. This review will examine the use of IBAs in the asthmatic athlete, the variability that exists between countries and sport, and outline a plan to justify the use of these medications. DATA SOURCES: Much of this article is a result of an International Olympic Committee (IOC) Medical Commission-sponsored meeting that took place in May 2001. Records of the use of IBAs at previous Olympics were reviewed. MEDLINE Searches (PubMed interface) were performed using key words to locate published work relating to asthma, elite athletes, performance, treatment, and ergogenic aids. MAIN RESULTS: Since 1984 there have been significant increases in the use of IBAs at the Olympic Games as well as marked geographical differences in the percentage of athletes requesting the use of IBAs. There are large differences in the incidence of IBA use between sports with a trend towards increased use in endurance sports. There are no ergogenic effects of any IOC-approved IBA given in a therapeutic dose. CONCLUSIONS: In many cases, the prescription of IBAs to this population has been made on empirical grounds. Beginning with the 2002 Winter Games, athletes will be required to submit to the IOC Medical Commission clinical and laboratory evidence that justifies the use of this medication. The eucapnic voluntary hyperpnea test will be used to assess individuals who have not satisfied an independent medical panel of the need to use an IBA.

Administration, Inhalation↗

Response of soluble transferrin receptor and iron-related parameters to iron supplementation in elite, iron-depleted, nonanemic female athletes.

OBJECTIVES: To assess the effect of short-term iron supplementation on soluble transferrin receptor (sTfR) and the soluble transferrin receptor/log ferritin ratio in a group of elite, iron-depleted, nonanemic female athletes and to assess the relationship between soluble transferrin receptor and serum ferritin in a group of elite, iron-depleted female athletes. DESIGN: A prospective, interventional study and an observation at 1 point in time. The primary inclusion criteria for each component of the study was serum ferritin less than 30 ng/mL and hemoglobin greater than 12 g/dL. The exclusion criteria were use of iron supplementation within 1 month of the initial assessment, acute or chronic infectious or inflammatory disease, hematological disorders, and recent musculoskeletal injury. SETTING: The Department of Sports Medicine at the Australian Institute of Sport. SUBJECTS: For the prospective study, 51, and for the observational study, 85 elite, iron-depleted (serum ferritin <30 ng/mL), nonanemic (hemoglobin <12 g/dL for the prospective study only) female athletes. Athletes were participants at the elite level in netball, basketball, gymnastics, rowing, volleyball, track and field, soccer, sailing, and cricket. INTERVENTION: Ingestion of 1 iron tablet (325 mg dried ferrous sulfate, equivalent to 105 mg elemental iron) plus one 500-mg tablet of vitamin C each morning for 60 days. RESULTS: Following supplementation, the following changes were statistically significant. Serum ferritin increased (19.7 to 37.4 ng/mL; P < 0.00005), serum transferrin decreased (3.34 to 3.16 g/L; P = 0.023), sTfR decreased (3.46 to 3.16 mg/L; P = 0.006), and sTfR/log ferritin index decreased (1.34 to 1.00; P < 0.00005). If it is assumed that iron stores are depleted when serum ferritin is less than 12 ng/mL and that sTfR could be expected to be elevated below that level of serum ferritin, the following figures can be calculated for the value of sTfR in relation to absent iron stores: sensitivity, 33%; specificity, 96%; positive predictive value, 50%; and negative predictive value, 92%. CONCLUSIONS: Short-term iron supplementation increases iron stores and leads to reductions in sTfR and the sTfR/log ferritin index in elite female athletes. sTfR is not an accurate predictor of serum ferritin less than 12 ng/mL in this group.

Adolescent↗

Methodology of dietary assessment in athletes: concepts and pitfalls.

PURPOSE OF REVIEW: Evaluation of an athlete's diet is important in both clinical practice and research. The main purpose of this review is to provide health professionals with guidance regarding the special issues that are likely to be encountered when assessing the dietary intake of sportspersons. RECENT FINDINGS: A number of methods may be used for the dietary assessment of individuals and/or groups of athletes, including retrospective (diet recall, food-frequency questionnaire, and diet history) and prospective (diet record, duplicate portion) techniques. A 3-4-day estimated diet record is the most widely used approach, but collection of single or multiple diet recalls is also common. Care must be taken, however, to ensure that days of diet monitoring accurately reflect usual food consumption during the period of interest. Under-reporting of habitual energy intake is widespread among athletes, and its magnitude should be carefully addressed when interpreting the results of dietary assessment. Other issues, specifically related to sportspersons, that are often neglected include adequacy of standard portion sizes, frequency of snacking, fluid intake, supplement use, weight-control practices, and seasonality of sport activities and food consumption. SUMMARY: There are subtle methodological differences in the dietary assessment of athletes and non-athletes, which, when taken into consideration, may substantially increase the quality of intake data and optimise the outcome of dietary intervention.

Diet↗

Special nutritional concerns for the female athlete.

Inadequate dietary intake is the primary nutritional concern of today's female athlete. As these athletes fail to consume enough energy to support the physical demands of training, they become at risk for disordered eating, amenorrhea, and osteoporosis, conditions collectively identified as the female athlete triad. This review addresses nutritional concerns of the female athlete, identification of those at risk, relationship of energy intake to menstrual irregularities, and recently identified chronic diseases associated with the female athlete triad. Strategies are offered to prevent harmful behaviors leading to the comorbidities associated with inadequate dietary intakes.

Adolescent↗

ESC study group of sports cardiology position paper on adverse cardiovascular effects of doping in athletes.

The use of doping substances and methods is extensive not only among elite athletes, but also among amateur and recreational athletes. Many types of drugs are used by athletes to enhance performance, to reduce anxiety, to increase muscle mass, to reduce weight or to mask the use of other drugs during testing. However, the abuse of doping substances and methods has been associated with the occurrence of numerous health side-effects. The adverse effects depend on the type of the consumed drug, as well as the amount and duration of intake and the sensitivity of the body, since there is a large inter-individual variability in responses to a drug. Usually the doses used in sports are much higher than those used for therapeutic purposes and the use of several drugs in combination is frequent, leading to higher risk of side-effects. Among biomedical side-effects of doping, the cardiovascular ones are the most deleterious. Myocardial infarction, hyperlipidemia, hypertension, thrombosis, arrythmogenesis, heart failure and sudden cardiac death have been noted following drug abuse. This paper reviews the literature on the adverse cardiovascular effects after abuse of prohibited substances and methods in athletes, aiming to inform physicians, trainers and athletes and to discourage individuals from using drugs during sports.

Adrenergic Agents↗

Serum ferritin as a marker of potential biochemical iron overload in athletes.

OBJECTIVES: Beyond hematological manipulation, iron supplementation therapy is commonplace in athletes to counterbalance physiological or pathologic anemia and to prevent physiologic dysfunction. However, misuse of iron therapy, occasionally resulting in iron overload, is not free from metabolic risks. DESIGN: We planned to measure baseline serum ferritin concentration in sedentary individual and athletes. SETTING: The Institute of Clinical Biochemistry of the Verona University. PARTICIPANTS Serum ferritin was measured in 60 male healthy sedentary controls, 80 amateur road cyclists, 42 male professional cross-country skiers, and 88 professional male road cyclists. ASSESSMENT OF RISK FACTORS: The biochemical iron overload was ascertained by measuring baseline serum ferritin concentration as a reliable approach that mirrors the total body iron content. MAIN OUTCOME MEASUREMENTS: The concentration of serum ferritin in healthy controls was 112 +/- 78 ng/mL, whereas that of amateur cyclists, professional skiers, and professional cyclists was 127 +/- 76 ng/mL (P = 0.185), 183 +/- 130 ng/mL (P = 0.001), and 332 +/- 218 ng/mL (P < 0.001), respectively. RESULTS: Both categories of professional athletes showed significantly increased concentrations of serum ferritin, whereas the concentration of amateur cyclists was comparable to that of healthy sedentary controls. CONCLUSIONS: Professional endurance athletes have serum ferritin concentrations that are 2-fold to 3-fold higher than those of matched sedentary individuals and amateur athletes, exceeding the threshold for the diagnosis of biochemical iron overload and unveiling potential metabolic risks.

Bicycling↗

Behaviour of haematological parameters in athletes performing marathons and ultramarathons in altitude ('skyrunners').

We observed athletes performing marathons and ultramarathons in altitude over several years to study the behaviour of haematological parameters in order to screen eventual paraphysiological or pathological conditions (sports anaemia). We collected samples from 124 athletes participating in seven races; 23 athletes were recruited in different races: 16 for four times, four for three times, and three for two times. The pre- and post-race values of erythrocytes, haemoglobin and packed cell volume did not show statistically significant differences in the studied athletes. The erythrocytes' indices (MCV, MCH, MCHC) and red cell distribution width (RDW) also were not significantly modified by the strenuous effort. The leukocytes were significantly increased because of immunological involvement during the endurance performance. Platelets and relative indices were not significantly modified. The stability of packed cell volume and haemoglobin in athletes performing training and races in altitude is strong evidence for the use of these parameters as an index of general health status and for illustrating possible abnormal increase because of exogenous stimulation of bone marrow. The preanalytical and analytical accuracy is crucial to assure clinical validity of the collected data: we strictly observed international recommendations in this field.

Adolescent↗

Abnormal exercise electrocardiograms in master athletes after three months of deconditioning.

OBJECTIVE: To determine the effects of 3 months of voluntary deconditioning on cardiac function in master athletes. DESIGN: A prospective study. SETTING: Research participants at the University of Maryland School of Medicine and Johns Hopkins Bayview Medical Center. PARTICIPANTS: Ten older (59 +/- 8 years, mean +/- SD), highly conditioned (maximal aerobic capacity VO2 max 50 +/- 5 mL/kg/min), aerobically trained athletes. MEASUREMENTS AND RESULTS: Three months after the cessation of training, three of the 10 athletes had unexpected, new, markedly asymptomatic, ischemic-appearing, exercise-induced ST-segment depression on their maximal exercise tests. After retraining, the ST-segment changes disappeared in two of the subjects, but it persisted, although at a higher work load, in one of the athletes. CONCLUSION: In three master athletes, voluntary cardiopulmonary deconditioning was associated with the development of new, asymptomatic, exercise-induced ST-segment depression on exercise ECG. The mechanisms underlying these new ischemic-appearing ST-segment changes accompanying detraining and their clinical significance are not known and warrant further investigation.

Adult↗

Patterns of QT dispersion in athletic and hypertensive left ventricular hypertrophy.

OBJECTIVE: The objective of this article is to assess whether left ventricular hypertrophy (LVH) due to physical training or of hypertensive patients shows similarities in QT length and QT dispersion. METHODS: A total of 51 subjects were studied: 17 essential hypertensive patients (27.7 +/- 5.6 years), 17 athletes involved in agonistic activity (canoeing) (24.8 +/- 6.1 years), and 17 normotensive healthy subjects as control group (24.8 +/- 3.6 years). The testing protocol consisted of (1) clinic BP measurement, (2) echocardiography, (3) 12-lead electrocardiographic examination (QT max, QTc max, QT min, QTc min, DeltaQT, DeltaQTc). RESULTS: There were no significant differences between the body surface area, height, and age of the three groups. Clinic blood pressure was higher in hypertensives (146.5 +/- 45.2/93.5 +/- 4.9 mmHg) versus athletes (120.9 +/- 10.8/77.1 +/- 6.0 mmHg) and controls (123.5 +/- 4.8/78.8 +/- 2.9 mmHg) by definition. Indexed left ventricular mass (LVM/BSA) was significantly greater in both athletes (148.9 +/- 21.1 g/m2) and hypertensives (117.1 +/- 15.2 g/m2) versus controls (81.1 +/- 14.5 g/m2; P < 0.01), there being no statistical difference among them. LVH (LVMI > 125 g/m2) was observed in all athletes, while the prevalence in hypertensives was 50%. In spite of this large difference in cardiac structure there were no significant differences in QT parameters between athletes and the control group, while hypertensive patients showed a significant increase in QT dispersion versus the two other groups (DeltaQT 82 +/- 2.1, 48 +/- 1.3, 49 +/- 2.3 ms; P < 0.01; DeltaQTc 88 +/- 2.0, 47 +/- 1.4, 54 +/- 2.7; P < 0.01). CONCLUSIONS: LVH induced by physical training activity is not associated with an increase in QT dispersion, whereas pathological increase in LVM secondary to hypertension is accompanied by an increased QT dispersion.

Adult↗

The role of achievement goal orientations and perceived ability upon somatic and cognitive indices of sport competition trait anxiety. A study of young athletes.

Goal orientation theory and competence motivation theory were used to examine the relationships between young athletes' achievement goals and indices of somatic and cognitive trait sport competition anxiety. Included in these analyses were also the potential mediating and moderating role of the athletes' perceived competence in sport. We examined 136 young athletes aged 13 to 18 years involved in organized sport within a community in northern Norway. Whereas no association was found between an ego oriented achievement goal and indices of anxiety, multiple regression analyses revealed that both a high task goal orientation and high perceived sport competence predicted a reduced tendency to report cognitive anxiety when competing in sport. In addition, athletes who perceived their competence in sport as high were found to be less predisposed to experiencing somatic anxiety in the form of elevated physiological arousal when competing than those who doubt their competence. The results further showed that perceived competence did not mediate or moderate the relationships between achievement goal orientations and somatic and cognitive indices of trait sport competition anxiety. The findings suggest that being task oriented in sport as well as having a sense of being competent are important in order to prevent sport competitions giving rise to elevated cognitive anxiety in young athletes.

Achievement↗

The Coach-Athlete Relationship Questionnaire (CART-Q): development and initial validation.

The purpose of the present study was to develop and validate a self-report instrument that measures the nature of the coach-athlete relationship. Jowett et al.'s (Jowett & Meek, 2000; Jowett, in press) qualitative case studies and relevant literature were used to generate items for an instrument that measures affective, cognitive, and behavioral aspects of the coach-athlete relationship. Two studies were carried out in an attempt to assess content, predictive, and construct validity, as well as internal consistency, of the Coach-Athlete Relationship Questionnaire (CART-Q), using two independent British samples. Principal component analysis and confirmatory factor analysis were used to reduce the number of items, identify principal components, and confirm the latent structure of the CART-Q. Results supported the multidimensional nature of the coach-athlete relationship. The latent structure of the CART-Q was underlined by the latent variables of coaches' and athletes' Closeness (emotions), Commitment (cognitions), and Complementarity (behaviors).

Factor Analysis, Statistical↗

Shoulder terminal range eccentric antagonist/concentric agonist strength ratios in overhead athletes.

OBJECTIVE: The agonist-antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes. METHOD: The dominant and non-dominant shoulders of 40 asymptomatic military overhead athletes were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Cybex NORM isokinetic dynamometer at a speed of 90 degrees /s. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. RESULTS: The terminal range ratios during external rotation (20 degrees of internal rotation - 10 degrees of external rotation) were found to be 2.09 and 1.58 for the dominant and non-dominant shoulders, respectively, whereas the terminal range ratios during internal rotation (60-90 degrees of internal rotation) were 1.03 and 1.19 for the dominant and non-dominant shoulders, respectively. These ratio differences between the dominant and non-dominant shoulders were significant (P<0.01 for external and internal rotation). CONCLUSION: The muscle torque ratios of eccentric antagonist/concentric agonist are different between dominant and non-dominant shoulders of skilled overhead athletes at terminal ranges. This functional assessment of strength testing that reflects dynamic shoulder joint stability during the throwing activity at these specific ranges may provide valuable information either during preventive exercise programs or in the evaluation of the injured shoulder of the overhead athlete. We recommended functional exercises that improve eccentric external rotation strength on the dominant shoulder during the rehabilitation and prevention programs in overhead athletes.

Adolescent↗

Susceptibility to infections in elite athletes: the S-curve.

The susceptibility to upper respiratory tract infections (URTIs) after physical exercise has been described with a J-shaped curve, suggesting protection from infections with moderate exercise and increased risk for URTI's in elite athletes. Several factors such as time of inoculation, previous infections, pathogen exposure, other stressors than exercise etc. can influence infection outcome. Observed infections in athletes can, therefore, be either the result of increased susceptibility to a novel pathogen, or more severe symptoms of an already established infection. Moreover, the definitions of "strenuous" exercise and "elite" athletes are equivocal, making comparisons between studies difficult. Because absence of infections is inevitable to become and maintain status as an elite athlete, it is suggested that there is an S-shaped relationship between exercise load and risk of infections. To become an elite athlete one has to possess state-of-the-art physique, including an immune system able to withstand infections even during severe physiological and psychological stress.

Disease Susceptibility↗

A cost-benefit analysis of preparticipation sports examinations of adolescent athletes.

A cost-benefit analysis of preparticipation sports exams of 763 adolescents was based on data from parallel programs conducted on affluent white and indigent black populations. After initial exams, 16 athletes (2.1%) were referred for further evaluation before participation was allowed; 15 of 16 reported their problems on the history form. Two were disqualified and one was treated. The cost of identifying the three athletes with significant problems was $4,537 per athlete. An additional 163 athletes (21.6%) had significant medical problems unrelated to safe sports participation and 89% of students sought routine health care only to obtain permission to play sports. Preparticipation sports exams have an unfavorable cost-benefit ratio even if costs are carefully controlled. The ratio might be improved if significant health problems not relevant to safe sports participation are sought or if exams are limited to athletes with positive responses on a preliminary history form.

Adolescent↗

Coaches' attitudes toward smokeless tobacco and intentions to intervene with athletes.

Smokeless tobacco use among athletes is alarming. Most of these athletes report beginning smokeless tobacco use in middle or high school. West Virginia has significantly higher rates of smokeless tobacco use among adolescent and adult males than the general population. Since West Virginia athletes may be particularly vulnerable to smokeless tobacco use, West Virginia coaches can be critical agents in smokeless tobacco prevention and intervention. This study surveyed West Virginia middle and high school coaches' 1) attitudes toward smokeless tobacco, 2) actions toward athletes who use smokeless tobacco, 3) intentions to provide intervention for users, and 4) tobacco use history. Results indicated coaches had unfavorable attitudes toward smokeless tobacco, perceived it as a problem, and were willing to help athletes quit. These findings provide support for development of training programs for middle and high school coaches to act as smokeless tobacco intervention agents.

Adolescent↗