Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Recommendations for return to sport during the SARS-CoV-2 pandemic

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted - from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

Running Injuries in the Participants of Ljubljana Marathon

INTRODUCTION

The aim of our study was to determine the self-reported incidence and prevalence of running-related injuries among participants of the 18^th Ljubljana Marathon, and to identify risk factors for their occurrence.

METHODS

A customized questionnaire was distributed over registration. Independent samples of t-test and chi-square test were used to calculate the differences in risk factors occurrence in the injured and non-injured group. Factors which appeared significantly more frequently in the injured group were included further into multiple logistic regression analysis.

RESULTS

The reported lifetime running injury (absence >2 weeks) incidence was: 46% none, 47% rarely, 4% occasionally, and 2% often. Most commonly injured body regions were: knee (30%), ankle and Achilles' tendon (24%), foot (15%), and calf (12%). Male gender, running history of 1-3 years, and history of previous injuries were risk factors for life-time running injury. In the season preceding the event, 65% of participants had not experienced any running injuries, 19% of them reported minor problems (max 2 weeks absenteeism), but 10% and 7% suffered from moderate (absence 3-4 weeks) or major (more than 4 weeks pause) injuries. BMI was identified as the solely risk factor.

CONCLUSIONS

This self-reported study revealed a 53% lifetime prevalence of running-related injuries, with the predominate involvement of knee, ankle and Achilles' tendon. One out of three recreational runners experienced at least one minor running injury per season. It seems that male gender, short running experience, previous injury, and BMI do increase the probability for running-related injuries.

Effect of hypobaric hypoxia on heart rate variability during exercise: a pilot field study

The influence of hypoxia on heart rate variability (HRV) has been studied under resting conditions with mixed results. Differences have been found in physiological responses to normobaric versus hypobaric hypoxia. Our aim was to study the influence of hypobaric hypoxia on HRV during physical exercise to determine whether HRV changes due to the exercise-induced heart rate (HR) increase or whether hypoxia itself exerts an influence. We tested nine healthy non-acclimatised white males (age = 43 +/- 7 years) at 400 and 4,200 m during exercises. At 400 m HRV was measured at 50% and 75% maximal oxygen uptake (VO(2) max). At 4,200 m HR was kept equal as during exercise at 400 m by adjusting the intensity of step testing. The Poincaré plot as a non-linear method of HRV analysis was used, where the shape of the ellipse depending on HRV is expressed by two parameters, SD1 and SD2 (correlating to parasympathetic activity and both sympathetic and parasympathetic activity, respectively). We established a decrease in SD2 and an insignificant decrease in SD1 at medium HR at 4,200 m compared to 400 m. Both parameters showed similar tendencies during high-intensity exercise. Our results indicate that hypobaric hypoxia itself exerts an influence on HRV at a moderate HR.

Linear and nonlinear assessment of heart rate variability in nonacclimatized middleaged subjects at different hypoxic levels

Studies of autonomic cardiac nervous system activity during acute exposure to hypobaric hypoxia have suggested a depression of autonomic functions and a shift in the sympatho-vagal balance towards relatively more sympathetic and less parasympathetic activity at higher hypoxic levels . This study was performed on nine non-acclimatized middle-aged healthy men (age 43.7 +/- 7.3 years), to evaluate the linear (autoregressive spectra) and non-linear (Poincaré plot, b coefficient, fractal dimension) heart rate variability (HRV) parameters at rest in supine position at three different altitudes: 400 m, 3200 m and 4200 m. A statistically significant increase of heart rate (HR) was detected at both higher altitudes in comparison with the reference level as well as comparing the values observed at 3200 m and 4200 m, respectively. Acute exposure to both hypoxic levels (3200 m and 4200 m) induced a shift of sympatho-vagal balance towards more sympathetic and less parasympathetic activity in comparison to the basal condition at 400 m asl, as indicated by autoregressive LF and HF spectral components and in particular by LF/HF ratio. The non-linear ss coefficient values demonstrated a statistically significant decrease of the complexity of the system at both hypoxic conditions as effect of hypobaric hypoxia on ANS activity of myocardium. However this fact was not confirmed by the fractal dimension parameter.