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sports medicine

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This interview was conducted by Dr Boris Gojanovic after the Lausanne 2020 Youth Olympic Games. Richard, can you please introduce yourself, as a medical doctor and an athlete. I am the medical and scientific director for the IOC and I started off in life as a rower. As an athlete, I had the privilege to compete in the 1984 Olympic Games in Los Angeles, and I won a gold medal there.
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L’attribution des Jeux Olympiques de la Jeunesse (JOJ) à Lausanne a déclenché dans toute la Romandie un engouement extraordinaire pour la préparation des Jeux, avec la volonté affirmée de faire des Jeux pour les jeunes, avec les jeunes et par les jeunes. En tant qu’étudiant-e-s en médecine, nous avons eu le privilège de participer aux JOJ du 4 au 24 janvier 2020; un groupe de 20 étudiant-e-s en 6e année ont eu l'occasion d’effectuer un stage de médecine du sport, validé dans le catalogue de l’année à option, dans le cadre de la troisième édition hivernale des Jeux Olympiques de la Jeunesse à Lausanne, plus connus sous l’appellation Lausanne 2020.
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There seems to be a lack of consensus among medical associations, professional sports bodies and medical professionals about when pre-participation evaluations (PPE) are indicated and how they should be designed. Although it is generally accepted that the primary purpose of the PPE is the identification of cardiovascular disease and risk factors for sudden cardiac death in competitive athletes, there is an ongoing debate on which methods are most apt in the screening process. Furthermore, the need of PPE has been questioned all together in leisure or hobby athletes.
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The actual significance and definition of hypertensive response to exercise (HRE) is still debated. Up to now, there is consensus in defining it as a systolic blood pressure value of either ≥ 210 mmHg in men and ≥ 190 mmHg in women or a diastolic blood pressure ≥ 110 mmHg during maximal exercise stress test. The mechanisms underlying an exaggerated blood pressure response to exercise are poorly understood; however, there are studies suggesting that HRE may represent a preclinical stadium of essential hypertension, which shares several common pathological mechanisms mostly related to an endothelial dysfunction and vascular stiffness.
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Myocarditis is defined as an inflammation of the heart muscle and its presentation, especially in athletes, is heterogeneous. Underlying causes include in most of the cases viruses, and less often bacteria, toxins, vasculitic diseases or pharmaceutical agents. Cardiac magnetic resonance (CMR) imaging is the primary imaging tool to diagnose myocarditis following laboratory test, electrocardiogram and echocardiography. In certain cases, endomyocardial biopsy is required, especially in unclear cases with reduced systolic left ventricular ejection fraction.
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Sudden death of an athlete is the most devastating medical event in sports. While accidents account for more than 50% of these cases, sudden cardiac deaths (SCD) are less frequent (approx. 15%), but the leading medical cause of deaths. The risk depends on age, sex, ethnicity, type of sport and sport level. There are large variations in the methods of registration of SCD in recreational and competitive sports. This must be taken into account when interpreting reported incidences and causes. High data quality in registries is a prerequisite for meaningful preventive strategies (e.g. ECG screening and safety at sports facilities).
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Through continuous improvement of diagnostic accuracy of ECG criteria for athletes sensitivity as well as specificity have grown so much that foregoing this screening tool is not feasible anymore. The most updated guidelines, the so-called “International (Seattle) Criteria” globally exhibit the most important reference publication, currently. The criteria were created with the purpose that particularly “non-cardiologists” should be able to use them before clearly pathological findings lead to further follow-up examinations at a specialist. On the other hand, physiologic ECG findings should not prompt expensive further evaluations, as it used to happen quite frequently.
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Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes.
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Back pain is common among elite cyclists. Experiences of athletes and observations of coaches show that it may influence training quality and sometimes even limit performance during competition. Therefore the following study questions were investigated: 1) How many athletes of the Swiss cycling national teams suffer back pain during training or competition? 2) How good is athletes’ core strength? 3) What correlation exists between back pain and core strength? 4) Does an intensified core strength training reduce back pain? A total of 111 elite cyclists, 45 athletes (38 m, 7f; 19.6 ± 3.5y) of technical disciplines (BMX, Trial, Downhill, 4X) and 66 athletes (39 m, 27f; 19.5 ± 5.8y) of endurance disciplines (road, MTB, Cyclo-cross) all members of Swiss cycling national teams, took part in in the study.
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