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To determine the number of training days lost due to COVID-19 and vaccination against COVID-19 in elite athletes.Retrospective cohort study.The questionnaire on the impact of vaccination and COVID-19 on training plans was filled out by 1073 elite Polish athletes who underwent routine medical screening between September and December 2021.COVID-19 was diagnosed in 421 subjects (39 %), of whom 26 % were asymptomatic. On the 10-point scale,1 % of athletes had perceived severity of the disease above 8, whereas for 64 % it was 4 or below. Vaccination against COVID-19 was administered in 820 athletes (76 %), and adverse events were observed more frequently after the first dose than the second (69 % vs. 47 %). Influence on training (modified or lost) was declared by 369 of 421 (88 %) COVID-19 athletes, and by 226 of 820 vaccinated athletes (28 %). During the observation period, the average number of lost training days was 8.1 for COVID-19 and 2.6 for vaccination (p 0.001). The cumulative number of person-days lost due to COVID-19 was 1041 versus 295 after vaccination thus, the average loss ratio was 1041/1073 = 0.97 vs. 295/820 = 0.36, respectively, p 0.01.Athletes have a considerable loss of training days due to COVID-19. Vaccination against COVID-19 causes significantly smaller and predictable loss. This supports the inclusion of vaccination into prevention policies for athletes whenever they are available.

Study aim: The aim of the study was to analyse the lifespan of Polish male Olympic medallists in comparison to the general male population. Material and methods: The study included 238 Polish male Olympic medallists who participated in the Olympic games in 1924–1992. Duration of life in relation to the general Polish population was assessed. The age of acquiring their first medal, type and number of medals won and sports discipline were taken into consideration. Results: Polish male Olympic medallists born before 1940 lived over 8 years longer in comparison to the general population (p < 0.0001, d = 0.689 and d = 0.750). Over 80% of them lived up to 65 years of age and over 40% up to 80. In the general population only Conclusions: Polish male Olympic medallists lived significantly longer than the general population of Polish men. The longevity of male Olympic medallists was affected by the age of acquiring their first medal and by the category of sport practised.

(1) Background: The purpose of this study was to investigate the concerns and beliefs of Olympians and elite athletes toward COVID-19 vaccination. (2) Methods: The study was framed by a quantitative method and was conducted using the PAPI (pen and paper interview) technique among 895 Polish elite athletes representing 34 sports. (3) Results: Three-quarters (76.3%) of the athletes were vaccinated against COVID-19; statistically participants were more likely to be women, and athletes who participated in the Olympic Games. Four in ten (39.2%) were in favor of vaccination. Athletes were mainly concerned that COVID-19 would exclude them from training/competition (19.3%) and could have a long-term impact on their health (17.2%). Athletes who were vaccinated reported much higher confidence in the composition of the vaccine and the doctors who recommended vaccination than unvaccinated athletes. Athletes who competed at the Olympic level were more likely than others to disbelieve that vaccines were produced too quickly and were not well tested. National-level athletes showed the highest degree of distrust in the government regarding COVID-19 vaccination, with one in six respondents distrusting doctors with respect to COVID-19 vaccination. Four in ten respondents said they were in favor of vaccination. (4) Conclusions: Athletes’ attitudes toward COVID-19 vaccination were significantly influenced by their environment—especially coaches and relatives. The power of social norms with respect to the decision to vaccinate against COVID-19 was very strong. Therefore, it is essential to build awareness about preventive policies among athletes and their social environment.

The current diagnostic procedures for assessing physiological response to exercise comprise blood lactates measurements, ergospirometry, and electrocardiography. The first is not continuous, the second requires specialized equipment distorting natural breathing, and the last is indirect. Therefore, we decided to perform the feasibility study with impedance pneumography as an alternative technique. We attempted to determine points in respiratory-related signals, acquired during stress test conditions, that suggest a transition similar to the gas exchange threshold. In addition, we analyzed whether or not respiratory activity reaches steady states during graded exercise. Forty-four students (35 females), practicing sports on different levels, performed a graded exercise test until exhaustion on cycloergometer. Eventually, the results from 34 of them were used. The data were acquired with Pneumonitor 2. The signals demonstrated that the steady state phenomenon is not as evident as for heart rate. The results indicated respiratory rate approaches show the transition point at the earliest (more than 6 min before the end of the exercise test on average), and the tidal volume ones at the latest (less than 5 min). A combination gave intermediate findings. The results showed the impedance pneumography appears reasonable for the transition point estimation, but this should be further studied with the reference.

Manned spaceflight requires research in diverse areas, including neuropsychology and human physiology. For these subjects, the Lunares Analog Research Station was established in Pila, Poland. It allows testing of crew members under space-like conditions. One experiment, Lunar Expedition I, was performed on a group of 6 analogue astronauts over 14 days. All were studied for their subjective perception of time and also asked to carry out mission-specific activities, like digging or repairing a rover during an extravehicular activity (EVA). The aims of the study were to measure cardiorespiratory signals using ECG and impedance pneumography devices under those conditions; to evaluate the quality of the data and the level of motion artefacts; and to assess the subjects’ status and adaptation. We used our own prototype, Pneumonitor 2, that enables registering respiratory-related impedance curve, a single-lead ECG and 3-axis accelerometer signals. Due to problems with a detachment of electrodes, we ultimately collected 10 full registrations from 5 astronauts. All signals were pre-processed and annotated. The set of cardiorespiratory parameters, including heart and respiratory activity indicators, was calculated for 3 main states: at rest, doing squats and performing various activities during EVA. We compared the results with normative values collected from elite athletes. The considered parameters were found to be in the normal range, typically slightly worse than the average for the athletes. The physiological responses are in line with expectations. Impedance pneumography enables to measure quantitative parameters of breathing like tidal volume and may be used during dynamic conditions. Combined with the ECG signal provides an objective astronaut’s cardiorespiratory profile. One can use it to assess the adaptation and to plan the schedule of the mission. However, there is a need for development of a wearable electronic textile solution for the target electrodes, to deal with sweating occurring while wearing a three-layer EVA suit.

Exercise-induced respiratory symptoms describe acute airway narrowing that occurs as a result of exercise. It includes exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA) issues. To provide clinicians with practical guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB/EIA and to develop evidence-based guidelines for the diagnosis and treatment. Recommendations for the diagnosis and treatment of EIB were developed. High-intensity exercise in polluted environment (cold air, humidity, contamination, allergens) may increase the risk of EIB and asthma symptoms in athletes. Diagnostic procedures should include history taking, physical examination, atopy assessment and functional tests of the respiratory system. A strong recommendation was made for regular use of inhaled glucocorticosteroids and avoidance of short-acting β2-agonists as the only treatment. The treatment of asthma in athletes should always take into account current anti-doping regulations. This position paper reflects the currently available evidence.

OBJECTIVES: The aim of the study was to identify predictors determining the course of COVID-19 and antibody response in elite athletes. DESIGN: Observational study. METHODS: Routine medical screening with physical examination, resting ECG, and laboratory tests including antibody response was performed 12-68 days after the diagnosis of COVID-19 in 111 athletes of different sports. RESULTS: Clinical symptoms were observed in 84% of subjects. The severity of COVID-19 was mild in 82% of athletes and moderate in 2% of cases. Athletes aged above 26 and male were more likely to develop symptomatic COVID-19. Asymptomatic subjects were younger and predominantly female. In 18% of subjects, symptoms were still present 20 (12-68) days (median and range) since positive diagnosis. Antibody response was observed in 88% of athletes, and its magnitude correlated with time since diagnosis of COVID-19 (RT-PCR), fatigue, fever, and conjunctivitis. There were no differences in antibody response between groups distinguished by sports discipline (p = 0.50), and sex (p = 0.59), and antibody response did not correlate with BMI (p = 0.12), age (p = 0.13), the number of symptoms (p = 0.43) or their duration (p = 0.19). CONCLUSIONS: The severity of COVID-19 in elite athletes is predominantly mild and without complications. Athletes can return to sport after two symptom-free weeks and additional heart screening is usually not required. Determination of antibodies has been shown to be a useful indicator of a previous COVID-19 disease, and some symptoms can be used as predictors of antibody response.

Background: Athletes and coaches believe in the ergogenic effect of vitamin B12 (which results from enhanced erythropoiesis) and they often insist on its unjustified supplementation. Therefore, our study aimed to assess the vitamin B12 status in Polish elite athletes and its influence on red blood cell parameters. Methods: In total, 1131 blood samples were collected during six years from 243 track and field athletes divided into strength and endurance groups, as well as according to the declared use of vitamin B12 injections. Results: An average vitamin B12 concentration in all subjects was 739 &plusmn, 13 pg/mL, with no cases of deficiency. A weak but significant relationship was found between vitamin B12 and hemoglobin concentrations. A significant increase in hemoglobin appeared from very low vitamin B12 concentration and up to approx. 400 pg/mL, while hemoglobin did not significantly change from 700 pg/mL and onwards. Vitamin B12 injections were used by 34% of athletes, significantly more often by endurance than by strength athletes. In athletes who declared no use of injections, a higher concentration of vitamin B12 was observed in the endurance group. Conclusion: The main finding of the present study is the determination of the range of vitamin B12 concentration which may favor better hemoglobin synthesis in athletes. They should regularly monitor vitamin B12 concentration and maintain the range of 400&ndash, 700 pg/mL as it may improve red blood cell parameters. We might suggest application of a supplementation if necessary. Special attention is required in athletes with a vitamin B12 concentration below 400 pg/mL.

Background: Athletes and coaches believe in the ergogenic effect of vitamin B12 (which results from enhanced erythropoiesis) and they often insist on its unjustified supplementation. Therefore, our study aimed to assess the vitamin B12 status in Polish elite athletes and its influence on red blood cell parameters. Methods: In total, 1131 blood samples were collected during six years from 243 track and field athletes divided into strength and endurance groups, as well as according to the declared use of vitamin B12 injections. Results: An average vitamin B12 concentration in all subjects was 739 ± 13 pg/mL, with no cases of deficiency. A weak but significant relationship was found between vitamin B12 and hemoglobin concentrations. A significant increase in hemoglobin appeared from very low vitamin B12 concentration and up to approx. 400 pg/mL, while hemoglobin did not significantly change from 700 pg/mL and onwards. Vitamin B12 injections were used by 34% of athletes, significantly more often by endurance than by strength athletes. In athletes who declared no use of injections, a higher concentration of vitamin B12 was observed in the endurance group. Conclusion: The main finding of the present study is the determination of the range of vitamin B12 concentration which may favor better hemoglobin synthesis in athletes. They should regularly monitor vitamin B12 concentration and maintain the range of 400–700 pg/mL as it may improve red blood cell parameters. We might suggest application of a supplementation if necessary. Special attention is required in athletes with a vitamin B12 concentration below 400 pg/mL.

It has been demonstrated that regular sport activity in children leads to physiological changes in the heart including increased left ventricular (LV) myocardial thickness and mass (LVM). The aim of the study was to establish the first specific normal values of LVM for child and adolescent athletes. Parasternal long-axis, 2D-guided echocardiographic measurements were obtained from a group of 791 Caucasian child athletes (age 5–18 years, 58.7% boys). For the preparation of normative data, LVM-for-lean body mass (LBM) reference curves were constructed using the LMS method. Then, a simple correlation plot was constructed to analyse the concordant and discordant indications of left ventricular hypertrophy (LVH), defined as LVM-for-LBM above the 95th percentile, according to the newly created and previously published normative data on LVM-for-LBM in the general population of children. Reference scatter plots of LVM-for-LBM for boys and girls in the analysed group of children practicing sports were presented, showing mean values of LVM and z-scores. The application to the studied group of reference centiles established for the general population of children would lead to false positive misclassification of increased LVH in 5.8% of the girls and 17.0% of the boys. We present the first specific normative data for LV mass in relation to lean body mass in Caucasian children and adolescents engaged in regular sport activities. The application of specific normative data for LV mass results in fewer false positive findings of left ventricular hypertrophy in this group than that of reference values for general paediatric population.

Intensive exercise modifies airway inflammation and infection susceptibility. We aimed to determine the effect of exercise on pro- and anti-inflammatory cytokine (TNF-α, IL-1ra, IL-10) and innate immunity protein (HSPA1, sCD14) levels in exhaled breath condensate (EBC) and nasal secretions of competitive athletes, non-exercising asthmatics and healthy controls (HC).The study group consisted of 15 competitive athletes (five speed skaters and ten swimmers) aged 15-25. The control groups comprised 10 mild-to-moderate asthmatics (AC) and seven HC. Athletes were assessed in- and off-training while asthmatics and controls at one time point. Nasal lavages and EBC were collected before and after a treadmill exercise challenge. Protein levels were assessed using ELISA.TNF-α levels in EBC were significantly higher in athletes than HC, but similar to asthmatic patients. In contrast, IL-1ra EBC concentrations were significantly lower in athletes than in HC, but again similar to asthmatics. Significant positive correlations were seen between baseline concentrations of TNF-α in EBC and fall in FEV1 following exercise challenge in athletes during training period (R=0.74, p0.01) and in asthmatics (R=0.64, p0.05). In nasal secretions, baseline IL-1ra levels were significantly higher in athletes and asthmatics than in HC. Exercise caused a slight, yet significant, increase in EBC HSPA1 in athletes (p=0.02). The exercise challenge did not considerably influence TNF-α, IL-1ra, HSPA1 and sCD14 in EBC or nasal secretions.Dysregulation of the TNF-α/IL-1ra balance in EBC and nasal secretions from athletes may reflect the presence of airway inflammation induced by repeated strenuous exercise.

Physical training is associated with changes in cardiac morphology called the “athlete’s heart”, which has not been sufficiently studied in children. The aim of the study was to analyze cardiac adaptation to exercise in pre-adolescent soccer players. Thirty-six soccer players (mean age 10.1 ± 1.4 years) and 24 non-athlete male controls (10.4 ± 1.7 years) underwent cardiac magnetic resonance. Measurements of myocardial mass, end-diastolic and end-systolic volume, stroke volume and ejection fraction for left and right ventricle (LV, RV) were performed. Additionally, left and right atrial (LA, RA) areas and volumes were analysed. Relative wall thickness (RWT) was calculated to describe the pattern of cardiac remodeling. Interventricular wall thickness and LV mass were significantly higher in athletes, but remained within the reference (6.9 ± 0.8 vs. 6.2 ± 0.9 mm/√m2, p = 0.003 and 57.1 ± 7.4 vs. 50.0 ± 7.1 g/m2, p = 0.0006, respectively) with no changes in LV size and function between groups. The RWT tended to be higher among athletes (p = 0.09) indicating LV concentric remodeling geometry. Soccer players had significantly larger RV size (p

INTRODUCTION Periostin is a matricellular protein expressed by many tissues. Its release may be enhanced, among others, through mechanical stimulation of muscles and bones as well as by cytokines of allergic inflammation. OBJECTIVES Our aim was to assess periostin levels in serum and exhaled breath condensate (EBC) of professional athletes, asthmatics and healthy controls. We also sought to determine whether acute treadmill exercise influences serum and EBC periostin. METHODS Study groups included 9 competitive swimmers, 10 mild-to-moderate asthmatics and 7 healthy controls. Athletes were assessed twice (in- and off-training period) while asthmatics and controls in one time-point. Data on demographics, allergy symptoms and exercise load were acquired through Allergy Questionnaire for Athletes (AQUA) and International Physical Activity Questionnaire (IPAQ). Serum and EBC were collected before and after treadmill exercise challenge. RESULTS Baseline serum periostin in swimmers during training period was significantly higher (5- to 7-fold) than in asthmatics (P = .01) and controls (P < .05). In EBC, lowest periostin levels were seen in athletes in-training as compared with off-training period (P < .01) and with asthmatics (P < .03). Acute bout of exercise did not induce significant changes neither in serum nor in EBC periostin in any group. CONCLUSION Increased serum, but not EBC, periostin levels in competitive athletes are probably because of permanently increased exercise load leading to stimulation, injury and regeneration of musculoskeletal tissues. Periostin may be considered marker of long-term exercise overload after confirmation in larger groups.

Introduction Regular training modulates airway inflammation and modifies susceptibility to respiratory infections. The impact of exercise and ambient conditions on airway hyperreactivity and innate immunity has not been well studied. We aimed to assess exercise-related symptoms, lung function, airway hyperresponsiveness and innate immunity proteins in relation to meteorological conditions and exercise load in competitive athletes. Material and methods Thirty-six speed skaters were assessed during winter (WTP) and summer (STP) periods. The control group comprised 22 non-exercising subjects. An allergy questionnaire for athletes (AQUA) and IPAQ (International Physical Activity Questionnaire) were used to assess symptoms and exercise. Meteorological parameters were acquired from World Meteorological Organization resources. Serum innate immunity proteins were measured by ELISA. Results Exercise-associated respiratory symptoms were reported by 79.4% of skaters. Despite similar exercise load and lung parameters during both periods, positive methacholine challenge was more frequent during winter (p = 0.04). Heat shock protein HSPA1 and IL-1RA were significantly decreased during STP compared to WTP and controls. During WTP, IL-1RA was elevated in skaters reporting exercise-induced symptoms (p = 0.007). sCD14 was elevated in athletes versus controls in both periods (p < 0.05). HSPA1 was significantly higher in WTP compared to STP irrespective of presence of respiratory tract infections (RTIs). IL-1RA in WTP was elevated versus STP (p = 0.004) only in RTI-negative athletes. Serum IL-1RA negatively correlated with most meteorological parameters during WTP. Conclusions Ambient training conditions, but not training load, influence bronchial hyperreactivity and the innate immune response in competitive athletes assessed during winter. The protective effect of regular exercise against respiratory infections is associated with a shift in serum innate immunity proteins.

Background: The objective of this study is to check whether the type of sport is important for the development of the dual career in professional sport. Material/Methods: This study utilised the Chi-square test of the independence measurement model and student’s T test. It also analysed 7 scenarios. A final survey-list consisted of the 38 items of competences and it was completed by 243 young people who took part in this study; the sample included 151 (67.7%) athletes training individual disciplines and 72 (32.3%) team disciplines. Results: The statistically significant results between the groups are in terms of competence(scenarios 3 and 6). There were no statistically significant differences between the groups in terms of life experience. Conclusions: Results in both parts of the study confirmed the three hypotheses. It turned out that the type of sport does not affect the course of the dual career in professional athletes.

In addition to different injuries, infections are the most common reason for giving up training altogether or reducing its volume and intensity, as well as a lack of opportunities to participate in sports competitions. Nowadays, a slow but constant re‑emergence of pertussis, especially among teenagers and young adults, including athletes, can be observed. This paper describes an outbreak of pertussis among professional Polish shooters, focusing on the transmission of Bordetella pertussis infection between members of the national team, its influence on performance capacity and adverse event analysis. From 9 June, 2015 to 31 July, 2015, a total of 4 confirmed and suspected cases of pertussis were reported among members of the Polish Sport Shooting National Team, their relatives and acquaintances. Pertussis significantly decreased exercise performance of the first athlete, a 35-year-old woman, interrupted her training, and finally resulted in failure to win a medal or quota place. Pertussis also significantly decreased performance of the second athlete, a 25-year-old shooter. The other cases emerged in their families. Whooping cough is a real threat to athletes and should be prevented. Preventive measures include appropriate immunization, constant medical supervision, as well as early isolation, diagnostic tests and treatment of all infected sport team members. Regular administration of booster doses of the acellular pertussis vaccine (Tdpa) every 5 years seems reasonable.

BackgroundNormalization for body size is required for reliable left ventricular mass (LVM) evaluation, especially in children due to the large variability of body size. In clinical practice, the allometrically adjusted ratio of LVM to height raised to the power of 2.7 is often used. However, studies presenting normative LVM data for children recommend centile curves as optimal for the development of normative data. This study aimed to assess whether the allometrically adjusted LVM-to-height ratio can reliably reproduce the results of LVM normalization for height based on the centile curves method.MethodsLeft ventricular mass was computed for 464 boys and 327 girls, 5-18 years old, based on echocardiographic examination. Normalized data representing LVM for height were developed using the centile curves construction method and two variants of the allometrically adjusted ratio method: one variant with the allometric exponents specific to the study groups, and one variant with the universal exponent of 2.7. The agreement between the allometric methods and the centile curves method was analyzed using the concordance correlation coefficient, sensitivity, and specificity.ResultsFor both the specific allometric variant and the universal variant, the analysis of concordance has indicated high reproducibility compared to the centile curves method. The respective coefficient values were 0.9917 and 0.9916 for girls, and 0.9886 and 0.9869 for boys. The sensitivity and specificity test has also shown high agreement. However, for girls, the sensitivity was higher for the specific variant (100% vs. 90.9%).ConclusionThe results of the study show that allometric scaling of LVM for height can very reliably reproduce the results of LVM normalization for height based on the centile curves method. However, the analysis of sensitivity and specificity indicates greater agreement for the allometric normalization with the group-specific allometric exponents.

OBJECTIVE The aim of the study was to evaluate the safety and tolerance of influenza vaccines for the northern and southern hemispheres in Polish elite athletes participating in the Rio 2016 Olympics. DESIGN Prospective, observational, cohort study. SETTING Institutional level. PARTICIPANTS Ninety-seven athletes vaccinated only with the northern hemisphere vaccine; 98 athletes received the southern hemisphere vaccine alone, whereas 39 athletes were vaccinated with both vaccines. INTERVENTIONS The athletes were vaccinated with a trivalent, inactivated influenza vaccine recommended for the northern hemisphere 2015/2016 and then with the vaccine recommended for the southern hemisphere 2016. Athletes kept a diary of adverse events and effects (if any) on training for 6 days after vaccination. MAIN OUTCOME MEASURES The percentage of general and local adverse events, number of lost or modified training sessions. RESULTS Significantly more local adverse events (pain and redness) were found in the group immunized with the vaccine for the northern hemisphere. There were no differences in the frequency of general adverse events and influence on training between groups. Of total 273 athletes who had 1911 training days during 6 days after vaccination, 6 athletes (2.2%) lost 13 training days (0.7%) and 16 athletes (5.9%) had to modify 34 (1.7%) training days within first 2 days after vaccination. CONCLUSIONS Athletes tolerated influenza immunization well. If they are going to travel to the other hemisphere during the influenza season, the use of the second influenza vaccine should be advised. Athletes should anticipate modification of trainings for 2 days after vaccination.

Training of elite athletes requires regular physiological and medical monitoring to plan the schedule, intensity and volume of training, and subsequent recovery. In sports medicine, ECG-based analyses are well established. However, they rarely consider the correspondence of respiratory and cardiac activity. Given such mutual influence, we hypothesize that athlete monitoring might be developed with causal inference and that detailed, time-related techniques should be preceded by a more general, time-independent approach that considers the whole group of participants and parameters describing whole signals. The aim of this study was to discover general causal paths among cardiac and respiratory variables in elite athletes in two body positions (supine and standing), at rest. ECG and impedance pneumography signals were obtained from 100 elite athletes. The mean HR, the RMSSD, its natural logarithm, the mean respiratory rate, the breathing activity coefficients, and the resulting breathing regularity were estimated. Several causal discovery frameworks were applied: generalized correlations, CAM, FGES, GFCI, and two Bayesian network learning algorithms: Hill-Climbing and Tabu. The main, still mild, rules best supported by data are: for supine - tidal volume causes heart activity variation, which causes HR, which causes respiratory timing; and for standing - normalized respiratory activity variation causes average heart activity. The presented approach allows data-driven and time-independent analysis of elite athletes as a particular population, without considering prior knowledge. However, the results seem to be consistent with the medical background. Causality inference is an interesting mathematical approach to the analysis of biological responses, which are complex. One can use it to profile athletes and plan appropriate training., Comment: Accepted for publication on September 25, 2018; 24 pages; 16 figures; 3 tables; 68 references

Being frequent travelers, the elite athletes are advised to undergo an influenza vaccination. The aim of the study was to describe the antibody response to repeated trivalent, inactivated, split influenza vaccine, of different antigenic content, recommended for the Northern and the Southern Hemisphere, administered to sportsmen before the Olympic Games in Brasil in 2016. Fourteen athletes were included in the study. For both A/California/7/209/pdm09 A/H1N1/ antigen and A/Switzerland/971593/2013/A/H3N2/ antigen, higher seroconversion rates were obtained after the first than the second vaccination (10.2 vs. 1.5 and 10.6 vs. 3.0, respectively; p 0.05 both). Conversion rates for B/Phuket/3073/2013, B/Brisbane/60/2008, and A/HongKong/4801/2014/A/H3N2/ antigens were lower. Nonetheless, the protection rate was greater than 70% for all antigens contained in both vaccines. The proportion of individuals demonstrating a high level of both protection rate and response rate was greater after the first than the second vaccination. We conclude that the immunological response after influenza vaccination is good in elite athletes and remains so after a second influenza vaccination required due to a different vaccine composition recommended for different hemispheres.

BACKGROUND Application of normative data for echocardiographic measurements to children practicing sports may lead to false positive findings. The aim of the study was to define the normative data of basic echocardiographic measurements for this group and to compare them to the previously published normative data for the pediatric population. METHODS Parasternal long-axis 2D-guided echocardiographic measurements were obtained from a group of 791 child athletes (ages 5-18 years). According to the methodology presented previously by Pettersen et al. (2008), the regression equations for basic cardiac dimensions against body surface area were derived and individual Z-scores values were computed, using both Pettersen's equations and newly derived ones. RESULTS Z-scores computed based on Pettersen's equations were found to differ significantly from those based on the new equations, for all the analyzed parameters (p

Being frequent travelers, the elite athletes are advised to undergo an influenza vaccination. The aim of the study was to describe the antibody response to repeated trivalent, inactivated, split influenza vaccine, of different antigenic content, recommended for the Northern and the Southern Hemisphere, administered to sportsmen before the Olympic Games in Brasil in 2016. Fourteen athletes were included in the study. For both A/California/7/209/pdm09 A/H1N1/ antigen and A/Switzerland/971593/2013/A/H3N2/ antigen, higher seroconversion rates were obtained after the first than the second vaccination (10.2 vs. 1.5 and 10.6 vs. 3.0, respectively; p < 0.05 both). Conversion rates for B/Phuket/3073/2013, B/Brisbane/60/2008, and A/HongKong/4801/2014/A/H3N2/ antigens were lower. Nonetheless, the protection rate was greater than 70% for all antigens contained in both vaccines. The proportion of individuals demonstrating a high level of both protection rate and response rate was greater after the first than the second vaccination. We conclude that the immunological response after influenza vaccination is good in elite athletes and remains so after a second influenza vaccination required due to a different vaccine composition recommended for different hemispheres.

Introduction Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes. Objectives Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data. Methods Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA2LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist. Results At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes. Conclusions High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that – in diagnosis of EIA – lung function testing alone is not useful, whereas reversibility tests are of limited value.

Background: Intensive exercise may affect the innate immunity, influence inflammatory response and increase susceptibility to respiratory infections. Aim: To assess if exercise modifies expression of innate immune response molecules in peripheral blood leukocytes (PBL) of competitive athletes, asthmatics and healthy subjects. Methods: Study included 15 athletes (speed skaters and swimmers), 9 mild-to-moderate asthmatics (AC) and 7 healthy non-exercising subjects (HC).Treadmill exercise challenge was done and PBLs were isolated before, immediately after and 1 hour post-exercise. Following RNA isolation relative gene expression was assessed by qPCR and calculated using 2 -Δ ΔCt method with pre-exercise expression as reference. Results: Significant decrease in mRNA expression immediately post-exercise was observed for IL-1ra in athletes (mean decrease 72%;p Conclusions: Acute exercise decreases innate immune response in PBLs to similar extent in competitive athletes and healthy subjects.

Aims: The athlete’s heart is a widely discussed topic regarding the adaptation of the left ventricle (LV) to regular training. The data on the morphology and—even more—the function of the right ventricle (RV) are less well studied. The aim of the study was to assess the influence of prolonged exertion on morphology and function of the RV. Methods and Results: We examined 38 elite athletes, members of the Polish Olympic Team and a control group of 41 age and sex-matched healthy volunteers. Specifically, we assessed the details of RV size and function including: RV enlargement, transtricuspid systolic gradient, and dilatation of main pulmonary artery (PA) as compared with the values derived from the control group. There was no significant difference in the function of the RV assessed using tissue Doppler echocardiography (TDE) between the athletes and controls (S’: 15.0 cm/sec vs. 14.0 cm/ sec; E’: 15.8 cm/sec vs. 15.7 cm/sec; A’: 9.9 cm/sec vs. 10.4 cm/sec), but the athletes had a higher transtricuspid systolic gradient (23.6 mm Hg vs. 19.0 mm Hg, P = 0.004). There were no significant differences in TDE velocities in athletes with dilated RV or PA. However, those with elevated tricuspid regurgitation velocity had lower systolic velocities of the tricuspid annulus then the rest (S’: 12.3 cm/ sec vs. 15.5 cm/sec, P = 0.01). Conclusions: RV enlargement in professional athletes is not connected with deterioration of diastolic or systolic RV function. Athletes with elevated pulmonary systolic pressure at rest, however, present with lower longitudinal systolic velocities of RV assessed using TDE. (Echocardiography 2011;28:753-760)

Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes.Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data.Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA(2) LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist.At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes.High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that - in diagnosis of EIA - lung function testing alone is not useful, whereas reversibility tests are of limited value.

Background Respiratory epithelium integrity impairment caused by intensive exercise may lead to exercise-induced bronchoconstriction. Clara cell protein (CC16) has anti-inflammatory properties and its serum level reflects changes in epithelium integrity and airway inflammation. This study aimed to investigate serum CC16 in elite athletes and to seek associations of CC16 with asthma or allergy, respiratory tract infections (RTIs) and immune response to respiratory pathogens. Methods The study was performed in 203 Olympic athletes. Control groups comprised 53 healthy subjects and 49 mild allergic asthmatics. Serum levels of CC16 and IgG against respiratory viruses and Mycoplasma pneumoniae were assessed. Allergy questionnaire for athletes was used to determine symptoms and exercise pattern. Current versions of ARIA and GINA guidelines were used when diagnosing allergic rhinitis and asthma, respectively. Results Asthma was diagnosed in 13.3% athletes, of whom 55.6% had concomitant allergic rhinitis. Allergic rhinitis without asthma was diagnosed in 14.8% of athletes. Mean CC16 concentration was significantly lower in athletes versus healthy controls and mild asthmatics. Athletes reporting frequent RTIs had significantly lower serum CC16 and the risk of frequent RTIs was more than 2-fold higher in athletes with low serum CC16 (defined as equal to or less than 4.99 ng/ml). Athletes had significantly higher anti-adenovirus IgG than healthy controls while only non-atopic athletes had anti-parainfluenza virus IgG significantly lower than controls. In all athletes weak correlation of serum CC16 and anti-parainfluenza virus IgG was present (R = 0.20, p Conclusions Regular high-load exercise is associated with decrease in serum CC16 levels. Athletes with decreased CC16 are more susceptible to respiratory infections. Atopy may be an additional factor modifying susceptibility to infections in subjects performing regular high-load exercise.

Vitamin D does not only influence the musculoskeletal health and mineral homeostasis but it also affects cardiovascular, endocrine, nervous, immune and mental functions, thus it is of considerable importance for both physically active people and elite athletes. However, vitamin D deficiency is common worldwide and results from inadequate endogenous skin synthesis (insufficient ultraviolet B exposure) and diet. To improve the vitamin D status elite athletes often travel to lower latitude during winter. The aim of the study was to evaluate the seasonal vitamin D status in Polish elite athletes according to the sun exposure and oral supplementation. Serum concentration of 25-hydroxyvitamin D (25(OH)D) was measured in the years 2010–2014 in 409 elite athletes, who were divided into the following groups: OUTD—outdoor sports, represented by track and field athletes, who trained in Poland; IND—weightlifters, handball and volleyball players who trained indoors in Poland; SUN—track and field athletes who trained during Polish winter in lower latitude with high sunshine exposure; SUPL—track and field athletes who trained in Poland, had an inadequate vitamin D status (25(OH)D < 30 ng/ml) and were supplemented orally. Inadequate Vitamin D status was observed in 80% of OUTD and 84% of IND athletes in winter, whereas in summer the values amounted to 42% and 83%, respectively. The athletes exposed to sun in winter had significantly higher vitamin D concentration than OUTD group. Oral supplementation improved vitamin D concentration by 45%, whereas winter sun exposure caused its increase by 85%. Except for a few summer months an inadequate status of vitamin D was found in the majority of Polish elite athletes, with the deficiency level being similar to the one observed in non-athletic population. The most serious deficiency was observed in indoor disciplines. Adequate vitamin D status can be achieved by both increased sun exposure, especially in winter, and oral supplementation. Athletes should therefore routinely assess their vitamin D status and be educated how to approach their sunlight exposure, diet and supplementation.

Previous investigations from this laboratory have demonstrated that during graded exercise with exercise intensities increasing every 3 min until exhaustion the multiple choice reaction time (RT) decreased until the intensity exceeded the lactate threshold (LT) by approximately 25%, and then rapidly increased. The aim of this study was to follow up changes in RT during prolonged exercise at constant intensities above and below LT and to relate these changes to changes in venous blood lactate [La−]b, and plasma catecholamine [CA]pl concentration responses to the exercise. For this purpose eight young soccer players exercised for 20-min on a cycle ergometer at 10% above LT, and nine exercised for 60 min at an intensity 30% below LT. During both tests RT, heart rate (HR), as well as [La−]b, and [CA]pl were measured. Above LT, RT decreased from the 5th min until the end of exercise, whilst HR, [La−]b, and [CA]pl increased progressively. Significant inverse correlations were ascertained between RT and plasma adrenaline (r = − 0.651) and noradrenaline concentrations (r = − 0.678). During exercise below LT, RT decreased up to approximately 40 min, then it reached a nadir, and stabilized at this level. This was accompanied by only small changes in [La−]b and [CA]pl. The present findings would indicate that young athletes are able to maintain for a relatively long time, or even increase, their psychomotor performance during endurance exercise both below and above the LT.

Systematic physical activity is a necessary element of normal development of a young human body.1 2 From early childhood, people should participate in sports and recreational activities involving movement. However, organised and systematic learning of a given form of motor activity (physical training), particularly participation in sport competitions, may result in development of certain abnormalities connected with excessive physical and mental load of a young body, including injuries.3,–,6 In recent years, athletes begin specialised training for their sport at increasingly younger ages.7 8 This may be due, in part, to increasing pressure from adults (trainers, parents or teachers) on young people to achieve results in sports.9,–,11 The current recommendations involve the revised and updated position of the Polish Society of Sports Medicine (PSSM) concerning age criteria when qualifying for training and competitions in selected sport disciplines, previously presented in the sports medical textbook ‘Medycyna Sportowa’ from 2005,12 considering current knowledge of the issue.13,–,18 The main aim of this study is to promote participation in systematic motor activity among children and youth, including organised training and competitions, with maximal safety and health protection assurance. This consensus agreement is based on experts' opinions and growing perception of increasing dangers for participation in competitive sports by children and youth. Evidence-based data concern anatomy, physiology and psychology of children and adolescents. Although several studies have reviewed sport-related injury risk in children and youth,19,–,26 data concerning injury incidence are not complete. Especially, only a few studies have assessed long-term effects of participating in competitive sports in children and youth.27,–,32 Several recent studies also provided new data on mechanisms …

The athlete's heart is a widely discussed topic regarding the adaptation of the left ventricle (LV) to regular training. The data on the morphology and-even more-the function of the right ventricle (RV) are less well studied. The aim of the study was to assess the influence of prolonged exertion on morphology and function of the RV.We examined 38 elite athletes, members of the Polish Olympic Team and a control group of 41 age and sex-matched healthy volunteers. Specifically, we assessed the details of RV size and function including: RV enlargement, transtricuspid systolic gradient, and dilatation of main pulmonary artery (PA) as compared with the values derived from the control group. There was no significant difference in the function of the RV assessed using tissue Doppler echocardiography (TDE) between the athletes and controls (S': 15.0 cm/sec vs. 14.0 cm/sec; E': 15.8 cm/sec vs. 15.7 cm/sec; A': 9.9 cm/sec vs. 10.4 cm/sec), but the athletes had a higher transtricuspid systolic gradient (23.6 mm Hg vs. 19.0 mm Hg, P = 0.004). There were no significant differences in TDE velocities in athletes with dilated RV or PA. However, those with elevated tricuspid regurgitation velocity had lower systolic velocities of the tricuspid annulus then the rest (S': 12.3 cm/sec vs. 15.5 cm/sec, P = 0.01).RV enlargement in professional athletes is not connected with deterioration of diastolic or systolic RV function. Athletes with elevated pulmonary systolic pressure at rest, however, present with lower longitudinal systolic velocities of RV assessed using TDE.

The ventricular septum defect (VSD) is one of the congenital heart diseases that in developed countries can be rarely found in adults. We present a case of young athlete, member of the Polish Olympic Team, diagnosed with VSD during medical check-up. The congenital heart disease did not prevent the athlete from participating in sport on world-class level.

One of the most important aims of modern sports cardiology is prevention of sudden cardiac death among athletes. Adequate pre-participation screening is a crucial part of prevention, however, current ACC, AHA or ESC guidelines are not uniform in this context. There is recently ongoing discussion on implementation of 12-lead ECG to the screening protocol.To assess the prevalence of alterations of resting 12-lead ECG in a population of top-level professional athletes - members of the Polish Olympic Team - using recently accepted criteria.During the period of intensive training before the Summer Olympic Games in Beijing (2008), a 12-lead, resting ECG was performed in 73 members (20 women and 53 men) of the Polish Olympic Team. Commonly accepted criteria were used to assess the ECG, and alterations were divided into two groups according to recent publications: group I - 'benign', common - thought to be consistent with the athlete's heart syndrome (i.e.: sinus bradycardia, 1st degree atrioventricular block, early repolarisation, right bundle branch hemiblock, isolated signs of left ventricular hypertrophy); and group II - 'suspected', uncommon - which may occur due to organic heart disease (i.e. complete bundle branch block, ventricular arrhythmia, inverse T wave or pathological QRS axis deviation).Completely normal ECG was present in 11% of those examined, common (group I) findings were observed in 65% and 'suspected' (group II) in 23%. The most commonly occurring 'benign' findings were bradycardia incomplete, right bundle branch block and isolated left ventricular hypertrophy, found in 75, 71 and 41%, respectively. From 'suspected' (group II) the most frequent was left posterior fascicular hemiblock, present in 10% of those examined; other findings were complete right bundle branch block, left atrial hypertrophy, inverse T waves and left anterior fascicular hemiblock in single cases.1. Most of the observed alterations in resting ECG of professional athletes belong to the 'common' group and result from adaptation to exercise. 2. Frequent occurrence of left posterior fascicular hemiblock, which is thought to be 'potentially malignant', requires further investigation.

Echocardiography is the basic, non-invasive diagnostic method in assessment of heart's structure and function in elite athletes. The aim of a study was to assess the heart's structure and function of Olympic-class athletes, enduring intensive training in log-term. An attempt was also made to compare types of physiological heart hypertrophy after extreme physical exercise load depending on gender and sport discipline.79 athletes (24 women and 55 men) aged 19-37 (median of 26) took part in the study, they represented wide range of sports. In all cases single transthoracic echocardiography was performed. Body surface area was considered for better comparison of outcomes.High percentage of results exceeded echocardiographic norms for general population. In case of LVEDd (left ventricle end diastolic diameter) it was 27.8% of examined, for LA (left atrium) 32.9%, for RV (right ventricle) 84.8%, 53.2% for IVSd (interventricle sept diameter) and 11.4% for Ao (aorta diameter). Some of results exceeded also norms used in sport medicine. In 6.3% examined "sport" norms for IVSd were exceeded and in 19.9% for LV relative wall thickness (RWT). Higher than trace mitral valve insufficiency was observed in 6.3% cases, while in tricuspid valve this fraction reached 25%. Only in males the trace aortic insufficiency was observed (7% of all examined). 53% examined exceeded norm's range for E/A proportion (E/A2). Significant differences in adaptive heart hypertrophy were observed between men and women and between athletes from sport disciplines with different static exertion load. These differences included both morphology and valve function.(1) Adaptive heart hypertrophy observed in echocardiography in Olympic-class athletes exceeds not only the norms for general population but also norms used in sport medicine. (2) Adaptive heart hypertrophy in female elite athletes leads to more eccentric type of remodelling then in men. (3) High static exertion load in performed sport is connected with concentric type of heart remodelling and with significant differences in systolic and diastolic parameters. (4) Considering body surface area allows a proper comparing of morphologic parameters between different genders and athletes practicing different sport disciplines.