Sports Health During the SARS-Cov-2 Pandemic

Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement

There are countless types of portable heart rate monitoring medical devices used variously by leisure-time exercisers, professional athletes, and chronically ill patients. Almost all the currently used heart rate monitors are capable of detecting arrhythmias, but this feature is not widely known or used among their millions of consumers. The aims of this paper were as follows: (1) to analyze the currently available sports heart rate monitors and assess their advantages and disadvantage in terms of heart rate and rhythm monitoring in endurance athletes; (2) to discuss what types of currently available commercial heart rate monitors are most convenient/adjustable to the needs of different consumers (including occasionally physically active adults and cardiac patients), bearing in mind the potential health risks, especially heart rhythm disturbances connected with endurance training; (3) to suggest a set of "optimal" design features for next-generation smart wearable devices based on the consensus opinion of an expert panel of athletes, coaches, and sports medicine doctors. Ninety-two experts aged 20 years and over, involved in endurance sports on a daily basis, were invited to participate in consensus-building discussions, including 56 long-distance runners, 18 cyclists, nine coaches, and nine physicians (sports medicine specialists, cardiologists, and family medicine doctors). The overall consensus endorsed by these experts indicates that the "optimal" sports heart rate monitor should be a one-piece device of the smartwatch type (with two or more electrodes), with integrated smartphone features, and able to collect and continually transmit data without exhibiting artifacts. It should continuously record at least a single-lead electrocardiography, send an alert after an unexpected fall, be of reasonable weight, come at an affordable price, and be user friendly.

Professional Athletes Maintain High TNF-Alpha or IFN-Gamma Related Inflammatory Status after Recovering from COVID-19 Infection without Developing a Neutralizing Antibody Response

INTRODUCTION

Professional athletes are endangered by COVID-19 and belong to the high-risk population due to their lifestyle. To obtain information on the behavior of COVID-19 in professional athletes, serological, cytokine, and virus neutralization capacities were analyzed.

MATERIALS AND METHODS

Hungarian national teams participated in international sports events during the early phases of the COVID-19 epidemic in 2020. Altogether, 29 professional athletes volunteered to donate plasma. Their serological status was evaluated by IgA, IgM, and IgG ELISAs and the highest virus neutralization titer in an in vitro live tissue assay. Plasma cytokine patterns were analyzed with a Bioplex multiplex ELISA system.

RESULTS

Surprisingly, only one athlete (3%) had anti-SARS-CoV-2 IgG, while IgA was more common (31%). Neither plasma showed direct virus neutralization in a titer over 1:10; hence, they were not suitable for reconvalescent treatment. The 'cytokine storm' markers IL-6 and IL-8 were at baseline levels. In contrast, either the TNF-alpha-related cytokines or the IFN-gamma-associated cytokines were elevated. There was a strong negative correlation between the TNF-alpha- or IFN-gamma-related cytokines.

CONCLUSIONS

Professional athletes are susceptible to the SARS-CoV-2 infection without developing long-term immunity through neutralizing immunoglobulins. Elevated secretory and cellular immunity markers indicate that these systems are probably responsible for virus elimination in this subpopulation.

Influence of the COVID-19 Lockdown and Restart on the Injury Incidence and Injury Burden in Men's Professional Football Leagues in 2020: The UEFA Elite Club Injury Study

BACKGROUND

Studies on football and the coronavirus disease 2019 (COVID-19) have mainly focused on the lockdown consequences for player fitness, the resumption of football training, and how to safely restart the league play, but injury data are scarce.

OBJECTIVE

To describe the injury incidence and injury burden in men's professional football teams during the pandemic year of 2020.

METHODS

Nineteen teams in 12 countries prospectively registered data on player-exposure and time-loss injuries throughout 2020. All major football leagues were paused as a direct response to the pandemic in March 2020 and were thereafter completely cancelled or restarted after a lockdown interval of at least two months. Historical data from 43 teams in the same cohort during the five preceding years (2015-2019) were used as reference. Between-season and within-season comparisons were made for injury incidence (number of injuries per 1000 h) and injury burden (number of absence days per 1000 h) with 95% confidence intervals and interquartile ranges.

RESULTS

There was no increased match injury incidence or injury burden following the restart in 2020 compared with other time periods of 2020 and the corresponding periods 2015-2019. There was an increased training injury incidence and injury burden immediately during the lockdown in 2020, and they remained elevated also following the restart, being higher in 2020 compared with 2015-2019, respectively. The injury characteristics during the first months of the new 2020/21 season (August/September-December) were similar between the five teams that cancelled their 2019/20 season in March 2020 and the 14 teams that restarted their season in May/June 2020.

CONCLUSIONS

There was no increased match injury incidence or injury burden following the COVID-19 lockdown and restart of the football season in 2020, but training injury incidence and injury burden were elevated and higher than in 2015-2019.

Handball Training and Competition With Facemasks in Galicia: The FISICOVID-DXTGALEGO Protocols Experience

Objective

COVID-19 caused a complete stop in non-professional sports. The use of face masks for team sports is not a widely used measure in non-professional sports. The study aimed to evaluate the perception about using the mask and the adaptation difficulties related to training and competition in team sports following the FISICOVID-DXTGALEGO protocol.

Methods

Seven hundred eighty-seven handball players from the Galician Handball Federation were followed during their return to participation after months of confinement through an electronic questionnaire of perception and experience on the use of a mask.

Results

There is an excellent adaptation to the mask in training and competition with medium and high correlations. The 86,41% of players reported an adaptation to the mask in 3 weeks with a three times a week training frequency. The negative opinion on the mask was drastically reduced (-66.86%) after use. The 80,44% of players considered the use of a mask as an essential measure to resume competitions.

Conclusions

It is very feasible to adapt to training and compete with a mask (hygienic or surgical) in a short period. The use of a mask following these protocols changed previous opinions on the disadvantages of the mask during training and competition.

Safety of surgical masks during phisical activity evaluated with graded cycle ergometry test

AIMS

At the time of the coronavirus disease 2019 (COVID-19) pandemic wearing surgical mask (SM) is recommended for the prevention of contracting or exposing others to airborne transmission of COVID-19. It is somewhat controversial whether wearing SM during exercise affects performance and health status and/or may influence the results. In order to give an answer we planned a prospective, randomized, crossover study to evaluate the effects of wearing a SM or no-SM in 33 (17 male) physically active helthy subjects during a graded exercise cycle ergometry test.

METHODS

The two tests were performed in random order in the same subjects. The participants were all tested the same day, after a recovery time of at least of one hour, in order to avoid interferences on physical performances. Arterial oxygen saturation, heart rate and arterial blood pressure were assessed throughout the exercise tests every step of two minutes, at the end of exercise, performed at the same time with and without mask.

RESULTS AND CONCLUSIONS

Wearing SM had no effect on performance, since the duration of cycle ergometry test with SM and without SM median, respectively, was 14.2, [lower-upper quartile 13.9-14.8] versus 14.3 [13.9-15.5] minutes, p=0.094, and median peak power was 150 W [150-180] versus 150 W [120-180] p=0.754. When expressed relative to peak exercise performance, no differences were found between wearing or not wearing SM regarding arterial oxygen saturation, or heart rate at any time during the exercise tests. Wearing SM during vigorous exercise had no detrimental effect on cardiovascular parameters, as well as on exercise metrics in all participants. No ventricular repolarization abnormalities and no arrhythmias were reported on the electrocardiograms.

Relationships among Physical Self-Concept, Physical Activity and Mediterranean Diet in Adolescents from the Province of Granada

The aim of the present research was to analyse the relationships among physical self-concept, physical activity engagement and Mediterranean diet adherence in a sample of 1650 secondary school students from the province of Granada. The study design was descriptive-exploratory, cross-sectional and ex post facto. Measurements were taken from a single group. The PSQ, PAQ-A and KIDMED questionnaires were used to measure diet quality. Results showed the presence of a positive relationship among all dimensions of physical self-concept and physical activity engagement, with better outcomes being achieved in this self-perception with increasing engagement in sport. With regard to diet quality and its repercussions on physical self-concept, it was highlighted that the dimensions of the general self-concept, physical attractiveness and strength tended to be more positive as quality improved. In contrast, worse outcomes were produced in those with a low-quality diet. In this way, it was deemed necessary to continue investigating psychosocial factors with the aim of clarifying the relationships with psychological factors and health indicators. This would enable the development of prevention and intervention programs focused on promoting wellbeing in adolescents.

Anxiety, sleep quality and mood in elite athletes during the COVID-19 pandemic: a preliminary study

BACKGROUND

The social isolation (quarantine) caused by COVID 19 has generated several consequences for the physical and mental health of the general population, however little is known about the effects of this disease on elite athletes. We seek to assess the effect of social isolation on anxiety, sleep quality and quality of life for elite athletes.

METHODS

206 athletes from collective and individual sports (116 men and 90 women) participated in the present study, with an average age of 24.61 ± 8.73 years. Time devoted to physical training before and during the pandemic was assessed. Assessment of anxiety symptoms, sleep quality and mood were assessed using semi-structured questionnaires.

RESULTS

There was a reduction in hours dedicated to training, as well as in training sessions for both groups evaluated. There is a high prevalence (> 90%) of anxiety symptoms (medium and high) in both groups. There were no major losses in the sleep quality of the athletes (> 75% presented regular to very good sleep).

CONCLUSIONS

There are no differences regarding the traits and state of anxiety between athletes of collective and individual modalities. However, both groups showed traces of anxiety, which, from the point of view of health, becomes worrying.

Effects of a 48-Day Home Quarantine during the Covid-19 Pandemic on the First Outdoor Running Session among Recreational Runners in Spain

COVID-19-induced quarantine may lead to deleterious effects on health status as well as to impaired performance and increased injury risk when re-starting training after lockdown. We investigated the physical activity (PA) habits of recreational runners in Spain during a 48-day home quarantine during the COVID-19 pandemic and the characteristics of the first outdoor running session after confinement. A cross-sectional study, including a self-reported running questionnaire completed after the first outdoor running session after quarantine, was performed. Three hundred recreational runners (74% males; 60% 18-40 years old; most typical running experience >3 years, 10-30 km weekly running distance distributed in 3-4 sessions) were considered for analysis. Advanced runners ran, at least, 4 days/week and participated in running events. They performed significantly longer and more non-supervised weekly training sessions during confinement (p < 0.01 for both) than novice and amateur runners. Most runners performed their first outdoor running session on asphalt (65.3%) and ran 5 to 10 km (61%) at a pace above 5 min/km (60%), reporting no pain before (77%), during (64%), and 24 h after (76%) the session. Advanced runners performed a significantly longer running session, at a higher pace, and covered a greater distance (p < 0.01 for all) than novice and amateur runners, while enjoyment and motivation tended to be significantly higher when runners' level increased (p < 0.05). Higher training levels prior to and during confinement may lower the collateral effects (e.g., detraining, injury risk) of home quarantine when runners return to previous PA levels.

Sporting Resilience During COVID-19: What Is the Nature of This Adversity and How Are Competitive Elite Athletes Adapting?

The COVID-19 pandemic is a global health issue which has severely disrupted and deferred several landmark international sporting competitions. Like the general population, athletes have faced direct psychological consequences from COVID-19 in addition to cancelation of events, loss of support, lack of training, loss of earnings, hypervigilance, and anxiety among others. The aim of the present research was to identify the adversity experiences of athletes caused by COVID-19 (study 1) and explore the process of resilience used by competitive elite athletes for positive adaptation (study 2). Research has indicated psychological resilience to be a protective factor against similar adversities in the sporting context. The study uses an across-cases qualitative design comparing the real-time lived experiences of athletes during COVID-19 using narrative analysis. Data were collected from 10 competitive elite athletes from various countries, as part of a larger doctoral dissertation study during the lockdown period, using in-depth experiential interviews. Study 1 presents detailed narratives on the loss and incongruence, which were the two major adversities experienced. Study 2 outlines the process of resilience as narrated by the participants through the emergent and minimal-impact resilience trajectories. We discuss recommendations for interventions and the role of sports psychologists, coaches, and sporting organizations in ensuring athletes' mental health and their rehabilitation into post-COVID sports life.

Dealing with the impact of the COVID-19 outbreak: Are some athletes' coping profiles more adaptive than others?

The public health policies and sanitary measures taken by governments in various countries to stem the spread of the COVID-19 pandemic (e.g. lockdown, social distancing) have major implications for athletes. The radical changes are challenging and risk causing significant career disruption to athletes, with subsequent negative psychological effects. Thus, the ways athletes cope with such adversity is of critical importance. The present study aimed to identify athletes' coping profiles using a person-centred approach, based on their reported use of multiple coping strategies in response to the impact of the COVID-19 outbreak, and to compare levels of anxiety, stress appraisals, interpersonal coping strategies, and availability and appreciation of the major sources of support across profiles. A total of 526 French athletes competing at national to elite levels answered an online questionnaire during the lockdown. Latent profile analysis results yielded four distinct coping profiles (i.e. self-reliant, engaged, avoidant, active and social). The MANOVA showed that athletes belonging to the four profiles differed on anxiety, stress appraisals, social support, and interpersonal coping. In particular, avoidant copers reported high levels of anxiety, threat, and uncontrollability, and appeared less able to regulate responses to the impact of the COVID-19 outbreak. Using a person-centred approach, the findings could inform the development of more adequate care, support, and intervention for athletes, especially avoidant copers, who were characterized by the least effective coping skills and resources. Accordingly, stress reappraisal and stress mindset interventions could be promising approaches to effectively manage pandemic-related impact during and after the COVID-19 crisis.Highlights The COVID-19 outbreak has major implications for athletes and is causing significant disruption to their careers. Using a person-centred approach, four coping profiles emerge showing athletes' preferred use of several coping strategies in response.The four coping profiles (i.e. self-reliant, engaged, avoidant, active and social) differentiate distinct groups of athletes in relation to anxiety, stress appraisals, social support, and interpersonal coping.Avoidant copers were characterized by the least effective coping skills and social context of coping. Management of the COVID-19 situation may be more problematic for them than other in mitigating its negative psychological effects.Using a person-centred approach, the findings could inform the development of more adequate care, support, and intervention for athletes, especially avoidant copers, who were characterized by the least effective coping skills and resources.

Sport and exercise participation in time of Covid-19-A narrative review of medical and health perspective

Coronavirus outbreak during 2020 brought enormous challenges for the world of sport and exercise. Much debated lockdown finished with the first wave in most countries and the “new normal” was the new beginning for professional and recreational sport activities. The aim of this narrative review is to acknowledge the most important medical and health aspects of sport and exercise participation until COVID‐19 pandemic is resolved. Management of existing crisis creates numerous opportunities for medical advances. Remote testing, tele‐health, field laboratories, continuous follow‐up of professional athletes, technological advances and artificial intelligence in new sporting environment using multidisciplinary, and systematic approach can be now thoroughly evaluated and defined for the best SEM practices. Sports and exercise medicine expertise in prevention can have a decisive role in dealing with ongoing and future pandemics.

Return to training in the COVID-19 era: The physiological effects of face masks during exercise

COVID-19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short-term strenuous workout. This was a multiple cross-over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ± 4 years and 28.72 ± 3.78 kg/m² , respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end-tidal carbon dioxide (EtCO₂ ) levels. The differences were more prominent as the load increased, reaching 8 mm Hg at exhaustion (none vs N95, P = .001). In conclusion, in healthy subjects, short-term moderate-strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO₂ . Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.

Global Challenges of Being a Strength Athlete during a Pandemic: Impacts and Sports-Specific Training Considerations and Recommendations

The ongoing global pandemic brought about by Coronavirus II (SARS-Cov-2 or COVID-19) has caused an ongoing cessation of sporting competitions and training facility closures. This is a fundamental challenge for amateur and elite sporting professionals. Although recommendations have been provided for team-sport athletes to maintain general and sport-specific conditioning, these methods are often not optimal for strength athletes (i.e., powerlifting (PL) and weightlifting (WL)) due to the unique and narrow set of performance requirements posed by these sports. The purpose of this review is to provide evidence-based information and recommendations and highlight potential strategies and approaches that may be used by strength (PL and WL) athletes during the current global crisis. Collectively, we provide evidence from resistance training literature regarding the loss of muscle strength, power and mass, minimum training frequencies required to attenuate such losses and training re-adaptation. Additionally, we suggest that time off training and competition caused by ongoing restrictions may be used for other purposes, such as overcoming injury and improving movement quality and/or mobility, goal setting, psychological development and emphasizing strength sports for health. These suggestions are intended to be useful for coaches, strength athletes and organizations where existing training strategies and recommendations are not suitable or no longer feasible.