“Testing and Procedures in Sports Medicine” – what is this SEMS-course about?

Clénin German E.
Sportmedizinisches Zentrum Ittigen b.Bern, Ittigen, Switzerland

Introduction

Sports and exercise medicine is about putting things in practice. However, as many academic disciplines it suffers of a discrepancy of science in theory and practical life. To bridge this gap and to break down relevant scientific know-how in favour of athletes’ health and performance is one of the goals of all SEMS educational courses [1,2,3].

How is the course organized?

The five-day course integrates four main topics and a project day as figure 1 shows. The four topics are: athletes’ ECG and cardiopulmonary exercise testing in cardiology, asthma and exercise induced bronchoconstriction, lactate testing and cardiopulmonary exercise testing with athletes, clinical examination and practical cases in orthopedics. The first four days are characterized by a short input conference in the morning of half an hour, covering the main topics. Directly after that small group work is started and the participants work the entire day with the expert person in the field physically present the entire day. This offers the opportunity for hands on from the very beginning, many practical encounters, teaching by the expert 1:1. In the morning the topic is refreshed, measurement methods are teached and trained several times with the excellent opportunity to be test person yourself and directly after that practising the same test again with a colleague participant. In the afternoon a series of volunteer patients are invited, most of them athletes of all levels, from recreational to top cracks. The day is closed with a short plenary session with portfolio teaching reflection of the day, taking up essential information on the four main topics.

Athletes ECG and CPET in cardiology

In close collaboration with the interdisciplinary centre for cardiac rehabilitation, sport- and exercise medicine we conduct a more intensive approach to sport and cardiology based on two main pillars: First the focus lies on the athletes ECG and its interpretation. According to the most recent recommendations ECG interpretation is grouped into a green, yellow, and red-light pattern. The green given free, the yellow needing more thorough follow-up and the red leading to a cardiologic work up with further investigations. This ECG-interpretation is a “must-have-skill” for a SEMS physician. You find a nice overview on the topic with the most recent and relevant literature in the article in this issue [4].
The visit at the university hospital further integrates a couple of practical patient encounters in CPET-testing (CPET cardiopulmonary exercise testing). The main content lies on the cardiologic part of the ergospirometry, giving further insights in interpretation of the nine-field-graphic of Wassermann. An earlier article of the teaching experts gives an excellent insight in CPET in sportscardiology [11].

Exercise induced bronchoconstriction and ­asthma

When diving into this topic, one realizes that there seem to be surely more than ten types of asthma or other types of bronchoconstriction and other airway obstruction. In the morning a broader line out of pneumopathologies and exercise is presented, differential diagnosis as the exercise induced laryngeal obstruction (EILO) are added and diagnostic understanding is sharpened. Measurement methods are presented and the methacholine testing as well as the test on exercise induced bronchoconstriction are trained several times within the participants. A special time is dedicated to the vast field of possible inhalation devices and other treatments available. All this is nicely presented the article within this issue [5]. In the afternoon a series of volunteer athletes, weekend warriors and elite athletes, are investigated with history taking, measurement of a possible unspecific or exercise induced bronchoconstriction with a final therapeutic counselling.

Lactate and exercise testing (CPET) in athletes

Directly after the input conference capillary blood measurement at the ear lobe are teached and learnt: First by doing it slowly and stepwise, progressing into a more active and finally leading into the 30sec interval needed for treadmill testing. The typical Swiss Olympic protocols of exercise testing on cycle ergometry and treadmill are practically shown, as well as short VO₂max protocol. The first leading to the determination of the lactate curve and the anaerobic threshold. The two are very useful for performance prediction as well as for the determination of the training zones. Participants are given the opportunity to participate in all these tests, making it a real-life experience. In the afternoon the group works on cycle ergometry and running on the treadmill and does an exercise test with a volunteer, mostly recreational athlete. This integrates the measurement of the ­VO₂peak, the lactate curve, determination of the anaerobic threshold [6,7], the training zones as well as a final training counselling. The expert is present the whole time, does the supervision, but lets the group work as far as they get and gives teaching advices when needed. The article “What you train is what you get” within this issue gives a nice overview on the training zones in endurance sports [8].

Clinical examination in orthopedics and ­practical clinical cases

The day with an orthopedic surgeon and SEM physician allows a refresher of all clinical tests. The day is started with the core stability testing lead by a sport physiotherapist. Everybody executes the tests and realizes, what is needed to fulfil the criteria and what exercises could be chosen to maintain or if needed improve core stability. After that the group leader takes up the needs and questions of the group, they always wanted to challenge an orthopedic surgeon. In the afternoon a series of patients is seen, as in a clinic. The patient are all volunteers, typically seen in a sportsmed physician clinic. History taking and physical examination are done, imaging is looked at followed by a synthesis and case discussion on the final diagnosis and treatment options. This allows an integrated approach and improvement of the individual skills of the participants. As clinical examination was the topic in an earlier issue of the SEMS journal two other articles are shared within this issue [9,10].

Project day 5: How to put exercise testing on field in place and other practical applications

In order to see how things may be organised on field with athletes the last day of the week is dedicated to work on a little project. In small groups the participants gather already during the week around a couple of easy scientific questions. With the measurements during the week but new exercise tests done the same day three groups work on different project questions. In the last few years the following questions were chosen, e.g.:

• Lactate threshold testing on the treadmill compared to the same running speed on the track – measurement of running speed, heart rate, lactate, borg
• What values in running speed, lactate, heart rate can be determined on the track if an athlete is asked to keep up running at Borg 15?
• What VO₂max values can be determined in two athletes on a cycling ergometer, running treadmill, rowing ergo­meter, and hand cycling ergometer?
• How are training zones experienced running outdoors based on lactate threshold testing on a treadmill? Can they be confirmed by the measurement of speed, lactate, HR, Borg?
• How compare team sport activities as uni-hoc and basketball at varied intensities to intensity zones determined by lactate testing on a treadmill?
• How does deepwater running (aquafit) compare physiologically to running on a treadmill?
• How does the critical power concept in cycling compare to the threshold concept in lactate testing?

The findings are collected, briefly put together and presented to the audience in order to share the experiences made by these measurements. This plenary session with the presentations, impressions, and discussions around these practical applications close this five-day course.

Corresponding author

German E. Clénin, Dr. med. et MME
Sportmedizinisches Zentrum Ittigen bei Bern
Haus des Sports, Talgutzentrum 27, 3063 Ittigen
http://www.smzbi.ch
german.clenin@smzbi.ch

References

1. SEMS Logbook, 2013, SEMS, Rabbentalstrasse 83, 3013 Bern, Switzerland. Download 23.8.2025 https://sems.ch/weiter-/-fortbildung/weiterbildung/logbook.
2. Liddle DG, Changstrom B, Senter C, Meirick P, Stern N, Putukian M, Shah S, Powell A, Dixit S, Eerkes K, Moran B, Barnes KP, Dal Molin C, Myers R, Waterbrook AL. Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training. Curr Sports Med Rep. 2021 Feb 1;20(2):113-123. doi: 10.1249/JSR.0000000000000811. PMID: 33560036.
3. Irvine S, Martin J. Bridging the gap: from simulation to clinical practice. Clin Teach. 2014 Apr;11(2):94-8. doi: 10.1111/tct.12060. PMID: 24629244.
4. Rieß J., E.A. Schmidt, D.Niederseer. The Athlete‘s ECG SEMS Journal 2/2025.
5. Pichler J. Asthma or exercise induced bronchoconstriction – a diagnostic challenge. SEMS Journal 2/2025.
6. Clénin G.E. Leistungsdiagnostik im Ausdauersport– anaerobe Schwelle, VO2max, aerobe Kapazität– wohin geht die Reise?. Swiss Sports & Exercise Medicine, 67 (1), 6–14, 2019.
7. Manual Leistungsdiagnostik, Swiss Olympic, Ittigen b. Bern, 2015.
8. Clénin G.E. What you train is what you get: About the rationale of training zones in endurance sports. SEMS Journal 2/2025.
9. Leumann A., I. Schmidt, E.Smirnov, M. Loeffler. Acute Ankle Sprains – a clinical algorithm for a common injury. SEMS Journal 2/2025.
10. Schmidt I., D. Cadosch, T. Loeffler, A. Leumann Encouraging sports participation after total hip arthroplasty: a desirable objective! SEMS Journal 2/2025.
11. Sakellaropoulos S, Zimmermann AJ, Bengel C, Wilhelm M. Cardiopulmonary Exercise Testing in Sports Cardiology. published online on 01.11.2019 https://doi.org/10.34045/SSEM/2019/3.