14 yo male soccer goalie comes to your sports medicine clinic because the second goalie of his team has grown much more during the last months and the coach has moved him to the bench, favoring the taller player.
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A 16-year-old female triathlete comes in complaining of fatigue and decreased performance/stagnation. His coach thinks she has an iron deficiency... what should I do? What is the differential diagnosis, what investigations are recommended, and how should we manage this?
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The right balance between stress and recovery is important to improve an athlete’s performance (e.g., super compensation) and prevent overtraining and injuries. Although there are a number of objective (e.g., physiological or biochemical) indicators for the stress-recovery balance, they are outperformed by subjective indicators (i.e., self-reports on strain and recovery).
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While addictive disorders involving substances are well researched, the field of behavioral addictions, including exercise addiction, is in its infancy. Although exercise addiction is not yet recognized as a psychiatric disorder, evidence for the burden it imposes has gained attention in the last decade. Characterised by a rigid exercise schedule, the prioritization of exercise over one’s own health, family and professional life, and mental wellbeing, and extreme distress when exercise is halted, the phenomenon shares many feature with substance use disorders.
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Cardiopulmonary exercise testing (CPET) is recommended in pre-participation evaluation of athletes to measure their cardiorespiratory fitness and maximal exercise tolerance. It is used for the diagnosis of probable cardiovascular and pulmonary disease and for the investigation of possible risks in sports. In case of non-specific symptoms during exercise, which are frequent in athletes, CPET is useful in the evaluation of physiological responses of body organ systems to exercise. This case-based review demonstrate the potential of CPET in the assessment of fatigue and loss of performance in a competitive professional athlete.
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