Groin Pain Syndrome Italian Consensus Conference update 2023

Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).

Effect of a lifestyle intervention program's on breast cancer survivors' cardiometabolic health: Two-year follow-up

The purpose of this study is to assess the cardiometabolic responses of a lifestyle intervention (LI) conducted at home among breast cancer (BC) survivors during the two years of COVID-19 pandemic. A 3-month LI focused on diet and exercise was performed on thirty BC survivors (women; stages 0-II; non-metastatic; aged 53.6 ± 7.6 years; non-physically active) with a risk factor related to metabolic/endocrine diseases. Anthropometrics, cardiorespiratory fitness (V ˙ O2max), physical activity level (PAL), adherence to the Mediterranean diet (MeDiet modified questionnaire), and several biomarkers (i.e., glycemia, insulin, insulin resistance [HOMA-IR] index, triglycerides, high- [HDL] and low- [LDL] density lipoproteins, total cholesterol, progesterone, testosterone, and hs-troponin) were evaluated before and 3-, 6-, 12-, and 24-month after the LI. Beneficial effects of the LI were observed on several variables (i.e., body mass index, waist circumference, MeDiet, PAL, V ˙ O2max, glycemia, insulin, HOMA-IR index, LDL, total cholesterol, triglycerides, testosterone) after 3-month. The significant effect on Mediterranean diet adherence and V ˙ O2max persisted up to the 24-month follow-up. Decreases in HOMA-IR index and triglycerides were observed up to 12-month, however did not persist afterward. This study provides evidence on the positive association between LI and cardiometabolic health in BC survivors.

Preliminary Assessment of the Acute Effects of Far Infrared-Emitting Garments: What Are the Possible Implications for Recovery and Performance?

Technical clothing has recently been brought into the spotlight as one of the most promising tools to improve sports performance and to enhance sports recovery. Among technical clothing items, garments engineered to emit far infrared (FIR) spectrum frequencies have come to the fore as a treatment for pain, muscle fatigue, and tissue healing due to their potential antioxidative and anti-inflammatory properties, with applications not only during recovery phases but also in the active phases of exercise. These garments, composed of fibers mixed with noble metals and/or bioceramics that respond to body infrared frequencies by returning an FIR emission backwards, are thought to improve muscle oxygenation and therefore recovery. In this double-blind, randomized, placebo-controlled, crossover study, ten male trail running athletes wore a whole-body-covering suit marketed as Accapì-FIR (Bruno Chiaruttini S.r.l., Rezzato, BS, Italy), while a total body suit with the same polyester fiber without metal components was used as control for the intervention. Parameters such as weight, height, bioimpedance parameters (BIVA), lactate from capillary sampling, salivary cortisol, and average temperatures of different body areas were obtained before and after a twelve-minute incremental work run protocol on a treadmill whilst wearing the two kinds of garment. Using the intervention suit, compared to control, statistically significant reductions in BIVA parameters such as body resistance (-6.7%) and reactance (-5.4%) were observed before and after exercise while a greater, but not significant, weight reduction was observed with the intervention suit. Decrease in resistance could be the result of a different distribution of fluids and ions due to FIR influence on capillary and superficial circulation, leading ultimately to more efficient management of body heat and promoting recovery and supercompensation. Further studies on larger samples will be necessary to confirm and clarify these results.

Moderate intensity active recovery improves performance in a second wingate test in cyclists

Background

The aim of the present study was to compare the effects of active (AR) vs. passive recovery (PR) between two Wingate Anaerobic Tests (WAnT) on power output, blood lactate (BLa) and oxygen consumption (VO₂) in a second WAnT.

Methods

Twelve well-trained cyclists underwent three experimental sessions. In the first session, they completed an incremental test for maximum oxygen consumption (V O₂max) and lactate threshold determination. In the second and third sessions, cyclists completed, in random order, two WAnT tests separated by 30-min recovery intervals, during which they performed an AR at 70% of the V O₂ at lactate threshold (V O₂LT) or a PR. The cardiorespiratory, metabolic, and mechanical responses in the two recovery conditions were compared.

Results

No differences were found in the VO₂-on kinetics between WAnT tests (p > 0.05). As expected, blood lactate kinetics showed a greater clearance (from the 7th to the 31st min, p < 0.001) during AR; however, no differences were found in peak BLa between conditions (p > 0.05). Mean and peak power, and total work were significantly higher in the second WAnT after AR (p < 0.001), while the power decline was also lower in this condition (p < 0.05).

Conclusion

The submaximal active recovery strategy used in the present study can induce an improvement in mechanical power and total work during a second WAnT. This suggests that AR of submaximal intensity can induce a post-activation performance enhancement when used during the recovery phase between maximal anaerobic efforts.

Movement and health beyond care, MoviS: study protocol for a randomized clinical trial on nutrition and exercise educational programs for breast cancer survivors

BACKGROUND

Breast cancer (BC) is the most common invasive cancer in women, and exercise can significantly improve the outcomes of BC survivors. MoviS (Movement and Health Beyond Care) is a randomized controlled trial aimed to evaluate the potential health benefits of exercise and proper nutritional habits. This study aims to assess the efficacy of aerobic exercise training in improving quality of life (QoL) and health-related factors in high-risk BC.

METHODS

One hundred seventy-two BC survivor women, aged 30-70 years, non-metastatic, stage 0-III, non-physically active, 6-12 months post-surgery, and post chemo- or radiotherapy, will be recruited in this study. Women will be randomly allocated to the intervention arm (lifestyle recommendations and MoviS Training) or control arm (lifestyle recommendations). The MoviS training consists of 12 weeks of aerobic exercise training (2 days/week of supervised and 1 day/week of unsupervised exercise) with a progressive increase in exercise intensity (40-70% of heart rate reserve) and duration (20-60 min). Both arms will receive counseling on healthy lifestyle habits (nutrition and exercise) based on the World Cancer Research Fund International (WCRF) 2018 guidelines. The primary outcome is the improvement of the QoL. The secondary outcomes are improvement of health-related parameters such as Mediterranean diet adherence, physical activity level, flexibility, muscular fitness, fatigue, cardiorespiratory fitness (estimated maximal oxygen uptake), echocardiographic parameters, heart rate variability (average of the standard deviations of all 5 min normal to normal intervals (ASDNN/5 min) and 24 h very low and low frequency), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein).

DISCUSSION

This trial aims to evaluate if supervised exercise may improve QoL and health-related factors of BC survivors with a high risk of recurrence. Findings from this project could provide knowledge improvement in the field of exercise oncology through the participation of a multidisciplinary team that will provide a coordinated program of cancer care to improve healthcare quality, improve prognosis, increase survival times and QoL, and reduce the risk of BC recurrence.

TRIAL REGISTRATION

ClinicalTrials.gov  NCT04818359 . Retrospectively registered on March 26, 2021.

Modulation of the Circulating Extracellular Vesicles in Response to Different Exercise Regimens and Study of Their Inflammatory Effects

Exercise-released extracellular vesicles (EVs) are emerging as a novel class of exerkines that promotes systemic beneficial effects. However, slight differences in the applied exercise protocols in terms of mode, intensity and duration, as well as the need for standardized protocols for EV isolation, make the comparison of the studies in the literature extremely difficult. This work aims to investigate the EV amount and EV-associated miRNAs released in circulation in response to different physical exercise regimens. Healthy individuals were subjected to different exercise protocols: acute aerobic exercise (AAE) and training (AT), acute maximal aerobic exercise (AMAE) and altitude aerobic training (AAT). We found a tendency for total EVs to increase in the sedentary condition compared to trained participants following AAE. Moreover, the cytofluorimetric analysis showed an increase in CD81⁺/SGCA⁺/CD45^- EVs in response to AAE. Although a single bout of moderate/maximal exercise did not impact the total EV number, EV-miRNA levels were affected as a result. In detail, EV-associated miR-206, miR-133b and miR-146a were upregulated following AAE, and this trend appeared intensity-dependent. Finally, THP-1 macrophage treatment with exercise-derived EVs induced an increase of the mRNAs encoding for IL-1β, IL-6 and CD163 using baseline and immediately post-exercise EVs. Still, 1 h post-exercise EVs failed to stimulate a pro-inflammatory program. In conclusion, the reported data provide a better understanding of the release of circulating EVs and their role as mediators of the inflammatory processes associated with exercise.

Relationship between Muscle-Tendon Stiffness and Drop Jump Performance in Young Male Basketball Players during Developmental Stages

BACKGROUND

The relationship between stiffness and drop jump performance in athletes in various stages of development has yet to be fully investigated. The first aim of this study was to investigate the association between the stiffness of the patellar and quadriceps tendon (PT, QT), gastrocnemius-Achilles tendon unit (GAT), and rectus femoris (RF) using drop jump (DJ) performance in young basketball players. The second aim was to investigate possible variations in the stiffness levels of those tissues in different developmental stages.

METHODS

The stiffness levels of the GAT, PT, QT, and RF were measured in both limbs in 73 male basketball players aged 12 to 18 years. The reactive strength index (RSI), contact time (CT) and jump height (JH) during 30 and 40 cm DJs were also measured.

RESULTS

Pearson correlation coefficients showed a significant association between DJ performance and PT, QT, GAT, and RF dynamic stiffness. Moreover, the youngest subjects were found to have lower stiffness values than the older ones.

CONCLUSIONS

Tissue stiffness can affect athletic performance by modifying the stretch-shortening cycle in young basketball players. Stiffness of muscles and tendons increases during the maturation process. Further investigations could shed light on the effect of training on the stiffness of muscles and tendons.

Barbell load distribution and lifting velocity affect bench press exercise volume and perceived exertion

OBJECTIVE

The intensity of barbell bench press exercise is generally prescribed as the load to be lifted for a specific number of repetitions; however, other factors (e.g., execution velocity) can affect bench press exercise intensity. Moreover, no study assessed whether load distribution (i.e., the distance between the disc stacks on the two sides of the barbell) affects exercise intensity. The present study aims to assess how different combinations of load, velocity, and barbell load distribution affect the number of repetitions to failure (REPfailure), and rating of perceived exertion (RPEfatigue) and number of repetitions (REPfatigue) at fatigue onset.

METHODS

Ten males (age 23.3±1.8 years) performed bench press exercises to exhaustion using random combinations of three loads (50%, 65%, and 80% of 1 repetition maximum), three execution velocities (50%, 70%, and 90% of maximal concentric velocity), and two load distributions (narrow and wide). Three separate three-way repeated-measures ANOVAs were performed to assess the effect of load, velocity, and load distribution on REPfailure, RPEfatigue, and REPfatigue expressed as a percentage of REPfailure.

RESULTS

REPfailure was affected by load (p<0.001), velocity (p<0.001), and distribution (p = 0.005). The interactions between load and velocity (p<0.001) and load and distribution (p = 0.004) showed a significant effect on REPfailure, whereas the interaction between velocity and distribution was not significant (p = 0.360). Overall, more REPfailure were performed using lower loads, higher velocities, and a wider distribution. RPEfatigue and REPfatigue were affected by load (p<0.001 and p = 0.007, respectively) and velocity (p<0.001 and p<0.001, respectively), and not by distribution (p = 0.510 and p = 0.571, respectively) or the two-way interaction effects. Overall, using higher loads yielded higher RPEfatigue but lower REPfatigue, while RPEfatigue and REPfatigue were higher when slower velocities were used.

CONCLUSION

The current investigation shows that not only load but also velocity and barbell load distribution may influence bench press training volume and perceived exertion.

Segmental Bioimpedance Analysis as a Predictor of Injury and Performance Status in Professional Basketball Players: A New Application Potential?

Bioelectrical impedance vector analysis (BIVA) is a technique used for the assessment of body composition based on the electrical properties of biological tissues and for evaluating variations related to hydration and nutrition status changes. The present study aimed to investigate the possibility of predicting performance status and injuries using segmental BIVA analysis. Data were collected from 14 professional male athletes aged between 20 and 39 years of Caucasian and Afro-American ethnicity belonging to the US Victoria Libertas Pallacanestro Pesaro team in the Italian Serie A basketball championship. From an analysis of training injuries, the data highlight a possible positive link between the number of training injuries and upper hemisoma reactance (XCEmsSup) (t = 2.881, p = 0.007), an inverse relationship between training injury duration and higher right lower limb reactance (XCLegDx) (t = −4.213, p < 0.001), and an inverse relationship between injury duration and higher body mass index (t = −4.213, p < 0.001), highlighting how higher cellularity seems less prone to severe training injuries. Analyzing match-day injuries, right upper-limb higher reactance (XCArmdx) negatively correlates with match-day number of injuries (t = −4.469, p < 0.001), right upper limb resistance (RZArmDx) negatively correlates with lower match-day injury duration (t = −4.202, p < 0.001), and trunk resistance (RZTrunk) positive correlates with lower match-day injury duration (t = 2.803, p = 0.008), in contrast with the training data analysis. Analyzing the relationship between the BIVA parameters and performance indicators, right upper limb resistance (RzArmDx) has a positive link with plus−minus (t = 2.889, p = 0.007); however, RzArmDx negatively correlates with assist number (t = −3.362, p = 0.002), and BMI is directly proportional to assist number (t = 2.254, p = 0.032). These first data suggest a good correlation between the cellularity of different body districts and the risk of injuries in training but still leave several doubts surrounding the concrete predictive potential regarding performance and injuries during competitions while considering the numerous factors involved. Further studies on BIVA and similar applications could provide tools for managing athlete health and physical integrity preservation and potentially help us better understand the factors involved in improving performance.

Effects of a Home-Based Lifestyle Intervention Program on Cardiometabolic Health in Breast Cancer Survivors during the COVID-19 Lockdown

This study aimed to evaluate the cardiometabolic effects of a home-based lifestyle intervention (LI) in breast cancer survivors (BCSs) during the COVID-19 lockdown. In total, 30 BCSs (women; stages 0-II; non-metastatic; aged 53.5 ± 7.6 years; non-physically active; normal left ventricular systolic function) with a risk factor for recurrence underwent a 3-month LI based on nutrition and exercise. Anthropometrics, Mediterranean diet adherence, physical activity level (PAL), cardiorespiratory fitness (VO2max), echocardiographic parameters, heart rate variability (average standard deviation of NN intervals (ASDNN/5 min) and 24 h very- (24 hVLF) and low-frequency (24 hLF)), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein (hs-CRP)) were evaluated before (T0) and after (T1) the LI. After the LI, there were improvements in: body mass index (kg/m2: T0 = 26.0 ± 5.0, T1 = 25.5 ± 4.7; p = 0.035); diet (Mediet score: T0 = 6.9 ± 2.3, T1 = 8.8 ± 2.2; p < 0.001); PAL (MET-min/week: T0 = 647 ± 547, T1 = 1043 ± 564; p < 0.001); VO2max (mL·min-1·kg-1: T0 = 30.5 ± 5.8, T1 = 33.4 ± 6.8; p < 0.001); signs of diastolic dysfunction (participants: T0 = 15, T1 = 10; p = 0.007); AS-DNN/5 min (ms: T0 = 50.6 ± 14.4, T1 = 55.3 ± 16.7; p = 0.032); 24 hLF (ms2: T0 = 589 ± 391, T1 = 732 ± 542; p = 0.014); glycemia (mg/dL: T0 = 100.8 ± 11.4, T1 = 91.7 ± 11.0; p < 0.001); insulin resistance (HOMA-IR score: T0 = 2.07 ± 1.54, T1 = 1.53 ± 1.11; p = 0.005); testosterone (ng/mL: T0 = 0.34 ± 0.27, T1 = 0.24 ± 0.20; p = 0.003); hs-CRP (mg/L: T0 = 2.18 ± 2.14, T1 = 1.75 ± 1.74; p = 0.027). The other parameters did not change. Despite the home-confinement, LI based on exercise and nutrition improved cardiometabolic health in BCSs.

Effects of a commercially available branched-chain amino acid-alanine-carbohydrate-based sports supplement on perceived exertion and performance in high intensity endurance cycling tests

Background

Sports nutritional supplements containing branched-chain amino acids (BCAA) have been widely reported to improve psychological and biological aspects connected to central fatigue and performance in endurance exercise, although the topic is still open to debate. The aim of the present study was to determine whether the intake of a commercially available BCAA-based supplement, taken according to the manufacturer’s recommendations, could affect the rating of perceived exertion (RPE) and performance indexes at the beginning (1d) and end of a 9-week (9w) scheduled high intensity interval training program, with an experimental approach integrating the determination of psychometric, performance, metabolic and blood biochemical parameters.

Methods

This was a randomized double-blind placebo-controlled study. Thirty-two untrained, healthy young adults (20 males and 12 female) were enrolled. A high-intensity endurance cycling (HIEC) test was used to induce fatigue in the participants: HIEC consisted in ten 90 s sprints interspersed by ten 3 min recovery phases and followed by a final step time to exhaustion was used. In parallel with RPE, haematological values (creatine kinase, alanine, BCAA, tryptophan, ammonia and glucose levels), and performance indexes (maximal oxygen consumption - VO_2max, power associated with lactate thresholds - W_LT1, W_LT2 and time to exhaustion - TTE) were assessed. All subject took the supplement (13.2 g of carbohydrates; 3.2 g of BCAA and 1.6 g of L-alanine per dose) or placebo before each test and training session. Dietary habits and training load were monitored during the entire training period.

Results

The administration of the supplement (SU) at 1d reduced RPE by 9% during the recovery phase, as compared to the placebo (PL); at 9w the RPE scores were reduced by 13 and 21% during the sprint and recovery phase, respectively; at 9w, prolonged supplement intake also improved TTE and TRIMP. SU intake invariably promoted a rapid increase (within 1 h) of BCAA serum blood levels and prevented the post-HIEC tryptophan: BCAA ratio increase found in the PL group, at both 1d and 9w. There was no difference in dietary habits between groups and those habits did not change over time; no difference in glycemia was found between SU and PL. VO_2max, W_LT1 and W_LT2 values improved over time, but were unaffected by supplement intake.

Conclusions

On the whole, these results suggest that i) the intake of the BCAA-based commercially available supplement used in this study reduces RPE as a likely consequence of an improvement in the serum tryptophan: BCAA ratio; ii) over time, reduced RPE allows subjects to sustain higher workloads, leading to increased TRIMP and TTE.

Muscle and Systemic Molecular Responses to a Single Flywheel Based Iso-Inertial Training Session in Resistance-Trained Men

Growing evidence points to the effectiveness of flywheel (FW) based iso-inertial resistance training in improving physical performance capacities. However, molecular adaptations induced by FW exercises are largely unknown. Eight resistance-trained men performed 5 sets of 10 maximal squats on a FW device. Muscle biopsies (fine needle aspiration technique) and blood samples were collected before (t0), and 2 h (t1) after FW exercise. Blood samples were additionally drawn after 24 h (t2) and 48 h (t3). Paired samples t-tests revealed significant increases, at t1, of mRNA expression of the genes involved in inflammation, in both muscle (MCP-1, TNF-α, IL-6) and peripheral blood mononuclear cells (IkB-α, MCP-1). Circulating extracellular vesicles (EVs) and EV-encapsulated miRNA levels (miR-206, miR-146a) significantly increased at t1 as well. Conversely, muscle mRNA level of genes associated with muscle growth/remodeling (IGF-1Ea, cyclin D1, myogenin) decreased at t1. One-way repeated measure ANOVAs, with Bonferroni corrected post-hoc pairwise comparisons, revealed significant increases in plasma concentrations of IL-6 (t1; t2; t3) and muscle creatine kinase (t1; t2), while IGF-1 significantly increased at t2 only. Our findings show that, even in experienced resistance trained individuals, a single FW training session modifies local and systemic markers involved in late structural remodeling and functional adaptation of skeletal muscle.

Effect of water-based recovery on blood lactate removal after high-intensity exercise

This study assessed the effectiveness of water immersion to the shoulders in enhancing blood lactate removal during active and passive recovery after short-duration high-intensity exercise. Seventeen cyclists underwent active water- and land-based recoveries and passive water and land-based recoveries. The recovery conditions lasted 31 minutes each and started after the identification of each cyclist's blood lactate accumulation peak, induced by a 30-second all-out sprint on a cycle ergometer. Active recoveries were performed on a cycle ergometer at 70% of the oxygen consumption corresponding to the lactate threshold (the control for the intensity was oxygen consumption), while passive recoveries were performed with subjects at rest and seated on the cycle ergometer. Blood lactate concentration was measured 8 times during each recovery condition and lactate clearance was modeled over a negative exponential function using non-linear regression. Actual active recovery intensity was compared to the target intensity (one sample t-test) and passive recovery intensities were compared between environments (paired sample t-tests). Non-linear regression parameters (coefficients of the exponential decay of lactate; predicted resting lactates; predicted delta decreases in lactate) were compared between environments (linear mixed model analyses for repeated measures) separately for the active and passive recovery modes. Active recovery intensities did not differ significantly from the target oxygen consumption, whereas passive recovery resulted in a slightly lower oxygen consumption when performed while immersed in water rather than on land. The exponential decay of blood lactate was not significantly different in water- or land-based recoveries in either active or passive recovery conditions. In conclusion, water immersion at 29°C would not appear to be an effective practice for improving post-exercise lactate removal in either the active or passive recovery modes.

The effect of topical thiocolchicoside in preventing and reducing the increase of muscle tone, stiffness, and soreness: A real-life study on top-level road cyclists during stage competition

In professional road cyclists, the majority of overuse injuries affect the lower limbs and are mostly represented by contractures or muscle shortening, characterized by an increase of tone and stiffness and a variation of elasticity. Treatment and prevention of these specific conditions may include physical, supplementary, and pharmacologic support. The aim of this real-life study was to determine: first, the alterations of tone, stiffness, elasticity, and soreness of rectus femoris (RF) and biceps femoris (BF) in top class cyclists engaged in 3 multistage races, and second, whether any variable in the management of the athletes may affect the prevention and/or reduction of such alterations.Twenty-three professional cyclists competing in 3 international, cycling stage races were assessed. Athletes could receive, upon the approval of the medical staff, physical, dietary, and/or pharmacological management which could include treatments with topical over-the-counter myorelaxants to prevent and/or reduce muscle contractures. MyotonPro was used to daily measure tone, stiffness, and elasticity in RF and BF in relaxed and contracted state after every stage. In parallel, BF and RF soreness was also assessed with a Likert scale.All athletes received the same general massage management; none of them received dietary supplements; some of the athletes were treated with a topical myorelaxant thiocolchicoside (TCC 0.25%) foam 3 times daily. TCC was identified as the only variable able to affect these muscle parameters in the cyclists. Tone, stiffness (regardless of the state), and soreness significantly increased over time either in BF or RF in all athletes. In the group of athletes that used TCC (n = 11; TCC+) the increase in tone, stiffness, and soreness was significantly lower than in the group not receiving TCC (n = 12; No-TCC). Elasticity varied coherently with tone and stiffness.A very intense and protracted sport activity increases muscular tone, stiffness, and soreness over time. Topical TCC foam significantly attenuates these alterations and might represent an efficient strategy both to prevent and manage contractures and their consequences in professional cyclists as well in athletes from other disciplines involving similar workloads.

Muscular viscoelastic characteristics of athletes participating in the European Master Indoor Athletics Championship

PURPOSE

To investigate how the viscoelastic characteristics of muscles (non-neural tone, elasticity and stiffness) vary as a function of age and gender in a sample of track and field master athletes. To compare these findings with data on related sedentary subjects in literature.

METHODS

A total of 390 athletes (aged 35-99) were assessed during the European Master Athletics Indoor Championship 2016. A non-invasive measurement device called MyotonPro was used to measure tone, stiffness, and elasticity in the biceps brachii and rectus femoris muscles at rest. Linear regression analysis was used to assess the correlation between age and the measured parameters. To compare our results with previously reported data, we stratified participants according to gender and age.

RESULTS

Tone was found to not be dependent on age, whereas stiffness was found to be age dependent. Elasticity was found to be both physical activity and age dependent. Tone (only for men), elasticity, and stiffness were lower in master athletes than in sedentary subjects.

CONCLUSIONS

Tone, elasticity, and stiffness change with aging; nevertheless, our findings suggest that physical activity can delay the effects of muscular aging, improving fitness in older people.

Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.

Path Linearity of Elite Swimmers in a 400 m Front Crawl Competition

In the frontal crawl, the propulsive action of the limbs causes lateral fluctuations from the straight path, which can be theoretically seen as the best time saving path of the race. The purpose of the present work was to analyze the head trajectory of 10 elite athletes, during a competition of 400 m front crawl, in order to give information regarding the path linearity of elite swimmers. The kinematic analysis of the head trajectories was performed by means of stereo-photogrammetry. Results showed that the forward speed and lateral fluctuations speed are linearly related. Multiple regression analysis of discrete Fourier transformation allowed to distinguish 3 spectral windows identifying 3 specific features: strokes (0.7-5 Hz), breathings (0.4-0.7 Hz), and voluntary adjustments (0-0.4 Hz), which contributed to the energy wasting for 55%, 10%, and 35%, respectively. Both elite swimmers race speed and speed wastage increase while progressing from the 1(st) to the 8(th) length during a 400 m front crawl official competition. The main sources of the lateral fluctuations that lead to the increasing speed wastage could be significantly attributed to strokes and voluntary adjustments, while breathings contribution did not reach statistical significance. In conclusion, both strokes and voluntary adjustments are the main energy consuming events that affect path linearity. Key pointsThe lateral fluctuations (LF) represent indexes of elite performance swimmers during 400 m competitions.The voluntary adjustments needed to go back to the ideal trajectory are more energy consuming than the movements of the swimmer for maintaining the path linearity.The diverge from the ideal swimming trajectory during a high level competition explain about 14.7% of the variations of the average forward velocity during the race.

Physiological and biomechanical responses to walking underwater on a non-motorised treadmill: effects of different exercise intensities and depths in middle-aged healthy women

Non-motorised underwater treadmills are commonly used in fitness activities. However, no studies have examined physiological and biomechanical responses of walking on non-motorised treadmills at different intensities and depths. Fifteen middle-aged healthy women underwent two underwater walking tests at two different depths, immersed either up to the xiphoid process (deep water) or the iliac crest (shallow water), at 100, 110, 120, 130 step-per-minute (spm). Oxygen consumption (VO2), heart rate (HR), blood lactate concentration, perceived exertion and step length were determined. Compared to deep water, walking in shallow water exhibited, at all intensities, significantly higher VO2 (+13.5%, on average) and HR (+8.1%, on average) responses. Water depth did not influence lactate concentration, whereas perceived exertion was higher in shallow compared to deep water, solely at 120 (+40%) and 130 (+39.4%) spm. Average step length was reduced as the intensity increased (from 100 to 130 spm), irrespective of water depth. Expressed as a percentage of maximum, average VO2 and HR were: 64-76% of peak VO2 and 71-90% of maximum HR, respectively at both water depths. Accordingly, this form of exercise can be included in the "vigorous" range of exercise intensity, at any of the step frequencies used in this study.

The cardiovascular response to underwater pedaling at different intensities: a comparison of 4 different water stationary bikes

AIM

Among the fitness activities, cycling in water immersion performed with water stationary bikes (WSB) has become very popular. However, there is a lack of information concerning their physiological demand. The aim of the present study was to assess the cardiovascular responses to four WSBs.

METHODS

Twenty-two healthy participants underwent a graded exercise test on a cycle ergometer. Sixteen of them, 8 males (age 31.5 + or - 8.2 years) and 8 females (age 31.9 + or - 5.8 years) with the same level of peak oxygen consumption (VO(2peak)) were chosen and submitted, in random order, to four incremental testing sessions performed with four different models of WSB, one with no resistance (WSB1), two with resistance added to the bottom bracket axle (WSB2 and WSB3), one with resistance added to the pedals (WSB4). The VO(2peak) and heart rate peak (HR(peak)) were measured in all five conditions.

RESULTS

Since no significant main effect for gender was detected, the data were grouped and analyzed all together. No significant differences were found in VO(2peak) and HR(peak) within the five testing conditions, whilst time to exhaustion (P<0.01) and pedaling frequency (RPM) at volitional exhaustion (P<0.01) were both significantly different across the four WSBs. When pedaling at 70 RPM, the oxygen consumption and heart rate response (as % of VO(2peak) and HR(peak)) were approximately 45% and 60% for WSB1, 60% and 70% for WSB3, 90% and 90% for WSB2 and WSB4, respectively.

CONCLUSIONS

The present results provide useful information for instructors and practitioners because they demonstrate that different models of WSBs could elicit very different cardiovascular responses.

The assessment of path linearity in swimming: a pilot study

The lateral-medial displacement (LF) and the overall drift from a straight path (DT) were quantified and compared in 5 top-level (TLS) and 5 low-level (LLS) crawl swimmers. Sixteen repetitions of 25-m crawl at increasing intensity were performed and videotaped. The performances were divided into 3 intensities (< 80 %, 80 - 90 % and > 90 % of maximal speed). LF was expressed as overlength swum (OLS) and coefficient of variation (CV) of the Z-component movement. OLS revealed a significant main effect for swimmer level (p < 0.01), intensity (p < 0.01) and their interaction (0.48, 0.37, 0.31-m for TLS and 0.47, 0.43, 0.44-m for LLS, p < 0.05). CV was significantly higher in LLS at the lowest (0.69 vs. 0.22, p < 0.05) and highest intensity (0.71 vs. 0.33, p < 0.05). DT, expressed as the slope of the linear regression of position data vs. time, was significantly higher in LLS only at the highest intensity (0.025 vs. 0.013, p < 0.05). The amount of dissipated energy due to LF, quantified by means of discrete Fourier analysis, revealed a difference only when the 0 - 5 Hz and 5 - 10 Hz spectral windows were analysed separately. While LF has a practical significance since it contributes to increase drag, DT is negligible at least for short-distance events.

Assessment of post-competition peak blood lactate in male and female master swimmers aged 40-79 years and its relationship with swimming performance

The main purpose of this study was to measure the post-competition blood lactate concentration ([La](b)) in master swimmers of both sexes aged between 40 and 79 years in order to relate it to age and swimming performance. One hundred and eight swimmers participating in the World Master Championships were assessed for [La](b) and the average rate of lactate accumulation (La'; mmol l(-1) s(-1)) was calculated. In addition, 77 of them were also tested for anthropometric measures. When the subjects were divided into 10-year age groups, males exhibited higher [La](b) than women (factorial ANOVA, P < 0.01) and a steeper decline with ageing than female subjects. Overall, mean values (SD) of [La](b) were 10.8 (2.8), 10.3 (2.0), 10.3 (1.9), 8.9 (3.2) mmol l(-1) in women, and 14.2 (2.5), 12.4 (2.5), 11.0 (1.6), 8.2 (2.0) mmol l(-1) in men for, respectively, 40-49, 50-59, 60-69, 70-79 years' age groups. When, however, [La](b) values were normalised for a "speed index", which takes into account swimming speed as a percentage of world record, these sex-related differences, although still present, were considerably attenuated. Furthermore, the differences in La' between males and females were larger in the 40-49 age group (0.34 vs 0.20 mmol l(-1) s(-1) for 50-m distance) than in the 70-79 age group (0.12 vs 0.14 mmol l(-1) s(-1) for 50-m distance). Different physiological factors, supported by the considered anthropometric measurements, are suggested to explain the results.

The decline of swimming performance with advancing age: a cross-sectional study

The aim of this cross-sectional study was to measure the swimming parameters-speed (V), stroke frequency (SF), and stroke length (SL)- in 162 male athletes aged 50-90 (divided into 7 age groups, from A to G) participating in the World Master Championships in the 200-m freestyle event, and to analyze the rates and magnitudes of their age-associated declines. The swimmers were video-recorded by 2 digital cameras during the competitions and the swimming parameters related to every 50-m section (lap) and to the entire race (average) subsequently measured or calculated. Lap V and SF decreased in the second and third quarter (11 and 4% on average) and increased (3% on average) in the fourth quarter of the race, whereas lap SL decreased from the first to the last 50-m section. Average V (m.s(-1)) decreased from 1.39 +/- 0.09 (group A) to 0.84 +/- 0.11 (group G); average SL (m) decreased from 2.10 +/- 0.20 (group A) to 1.78 +/- 0.19 (group G); and average SF (cycles.s(-1)) decreased from 0.67 +/- 0.06 (group A) to 0.47 +/- 0.04 (group G). One-way analysis of variance showed significant declines in average V, SL, and SF (p < 0.01) across the 7 groups. The swimming parameters were normalized to the highest values (set equal to 100); thereafter, a linear regression curve was fitted and the regression equations calculated. Decline of SF was about 2.5 times steeper than that of SL. It was highlighted that (a) among the swimming parameters, SL is less affected by the ageing process; (b) SL decreased from group A through group C and thereafter tended to keep steady, whereas the trend for SF was opposite. The results have the potential to give master swimmers and their coaches useful information for training program design.

Physiological responses to fitness activities: a comparison between land-based and water aerobics exercise

This study compared the heart rate (HR) and blood lactate (BL) responses in young healthy women performing the same routine of aerobics exercise in 3 different conditions: on land, in shallow water (0.8 m), and in deep water (1.4 m). The average age and body mass index (BMI) of the group were 27.4 years and 22.6 kg.m(-2), respectively. The highest HR and BL values were reached during land aerobics (median HR values were 138.0 and 161.5 b.min(-1), and lactate values were 3.10 and 5.65 mmol.L(-1) at slow and at faster pace, respectively). These parameters were progressively reduced going from shallow water (121.5 and 154.0 b.min(-1), 1.75 and 3.15 mmol.L(-1)) to deep water (97.5 and 113.5 b.min(-1), 1.70 and 1.75 mmol.L(-1)). The HR measured as percentage of maximum HR varied from 48.43% to 77.53% depending on the water depth and the pace. These data indicate that exercise in water significantly reduces HR and BL production compared with the same exercise performed on land.

The use of lipid emulsions for the i.v. administration of a new water soluble polyene antibiotic, SPK-843

Venous tolerance of a new water soluble polyene antibiotic, SPK-843, in 5% glucose solution for infusion is low in laboratory animals. The use of Intralipid 10% emulsion was therefore proposed, in which the antibiotic remained chemically stable for at least 2 h in a mildly acid or nearly neutral environment and at concentrations of 0.1-0.5 mg/mL, producing no alterations in the emulsion structure. Tolerance was assessed through repeated infusions in the ear marginal vein of rabbits and was found much more satisfactory than the tolerance observed when the vehicle used was 5% glucose solution. The study of the effect of some variables (concentration, volume infused, dose per kg) on venous toxicity offered the possibility to plan optimal administration conditions of presumed therapeutic doses.

Clonazepam microencapsulation in poly-D,L-lactide-co-glycolide microspheres

The work is aimed at the preparation and characterization of biodegradable microspheres of poly-D,L-lactide-co-glycolide (PLGA), for the controlled release of clonazepam. The solubility characteristics of this drug make it an interesting example to evaluate the performances of the two most widely used microencapsulation techniques, emulsification solvent evaporation and spray-drying. Several biodegradable PLGA copolymers have been evaluated (RG 502H, RG 503H, RG 503, Boerhinger Ingelheim). They differ in terms of molecular weight and physico-chemical characteristics. The microspheres obtained have been characterized for their morphology, physico-chemical properties (DSC) and in vitro dissolution behaviour. Between the two preparation methods, only spray-drying was suitable for the microencapsulation of clonazepam in PLGA microspheres. In vitro dissolution tests highlight that more sustained release of drug is achieved with the higher (molecular weight) polymer.