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Aim: The sport of soccer is characterized by neuromuscular performance resulting in short bursts interspersed by brief recovery periods over an extended period of time. Several studies suggest that the cardiac autonomic nervous system (ANS) assessed by heart rate variability (HRV) may provide useful information regarding the functional adaptations to training stimulus. Although HRV has often been associated with aerobic power and cardiovascular fitness, the influence of sympathovagal balance on neuromuscular performance in young athletes is not well assessed. The aim of this study was to assess the influence of the autonomic system on the performance of repeated sprints, involving predominantly muscular power and anaerobic metabolism, in young soccer players. Method: Twelve young soccer players, selected for the Sicilian Regional Representative of the Italian Football Federation, mean age 15 years, were recruited. Resting HRV was measured and indices of power spectral analysis (ratio LF/HF) were calculated to evaluate the sympathovagal balance. To assess the state of physical fitness of subjects, VO2max was determined by maximal graded treadmill test. Finally, the athletes performed 10 maximal all-out 6-sec cycling sprints (RS), interspersed with 30-sec of passive recovery, to measure the peak power (PP) represented by the highest value recorded during a single sprint, and the average of the values of maximum power (AP) recorded during all sprints. Results: On the basis of their VO2max (56.22 ± 3.93 ml/Kg/min), all subjects showed good levels of physical fitness. HRV index (LF/HF = 1.31 ± 0.74) showed an inverse correlation with PP (14.05 ± 0.89 W/Kg; r = -0.709, P = 0.01), and with AP (12.82 ± 0.88 W/Kg; r = -0.606, P = 0.04). Conclusion: Our study shows that a low ratio LF/HF, which reflects a parasympathetic predominance in the ANS balance, is associated with a better anaerobic contribution to performance resulting in higher values of PP and AP during brief repeated maximal cycling sprints. The assessment of resting HRV before exercise may be useful for performance monitoring of young soccer players.

AIM: The aim of this study was to assess the influence of the autonomic system on the performance of repeated sprints, involving predominantly neuromuscular power, in young soccer players. METHODS: Twelve young soccer players, selected for the Sicilian Regional Football Representative, mean age 15 years, were recruited. Baseline heart rate variability (HRV) was measured and indices of power spectral analysis (LF, HF, and ratio LF/HF) were calculated to evaluate the sympathovagal balance. The athletes performed 10 maximal 6--sec cycling sprints (RS), interspersed with 30--sec of recovery, to measure the peak power output (PP) represented by the highest power value recorded during a 6--sec sprint, and the mean peak power output (MPP) represented by the average of all highest power values recorded within a repeated--sprint bout. RESULTS: PP was negatively correlated with LF (r = --0.685, P = 0.0141) and LF/HF (r = --0.709, P =0.0098), and positively correlated with HF (r = 0.684, P = 0.0142). MPP was negatively correlated with LF (r = --0.610, P = 0.0350) and LF/HF (r = --0.606, P = 0.0366), and positively correlated with HF (r = 0.731, P = 0.0070). CONCLUSIONS: Our study shows that a baseline parasympathetic predominance in the ANS balance is associated with a better neuromuscular contribution to performance, resulting in higher values of PP and MPP during brief repeated maximal cycling sprints. The assessment of baseline HRV before exercise may be useful to monitor the physical condition of young soccer players and their readiness status to a higher performance.

Background: Although a knee valgus position is related to the increase in injury risk in volleyball players, there is a lack of studies on the relationship between knee valgus and vertical jump (VJ) performance. Hence, the aim of this study was to investigate the effects of a postural exercise program on VJ height in young female volleyball players with knee valgus. Methods: This pilot study included 19 young female volleyball players divided into the following groups: the Valgus Experimental Group (VEG); the Valgus Control Group (VCG); and the Neutral Control Group (NCG). All three groups carried out the same volleyball training program. In addition, only the VEG underwent a 3-month postural exercise program of 30–45 min/session, twice/week. VJ performance was measured through the Sargent test before (T0), at 6 weeks (T1), and at 12 weeks (T2). Results: A significant effect from T0 to T1 (p = 0.0017) and from T0 to T2 (p = 0.0001) was found in the VEG. No significant differences were found over time in the VCG and in the NCG. Conclusion: An integrated postural exercise program might lead to a more balanced muscle efficiency inducing athletes to obtain a higher VJ performance.

Digital media are widespread among school-age children, and their incorrect use may lead to an increase in sedentary levels and the consequences associated with it. There are still few studies that have investigated whether physical activity levels could be increased through their use. The aim of this study was to systematically review the scientific literature in order to identify whether digital strategies and technologies are capable of increasing the level of physical activity. A literature search was performed using the following databases: Pubmed, Scopus, and Web of Science. The main outcomes evaluated the increase in physical activity levels, the number of steps, and the reduction of sedentary behaviors. Two trained researchers independently assessed eligible studies against eligibility criteria, extracted data, and assessed the risk of bias. The Downs and Black checklist was used to assess the quality of the included studies. A total of 15 studies (1122 children) were included in this systematic review, with a mean age of 8.45 ± 0.70 years. Quality assessment of the studies observed a “moderate quality” of the included records. The results of this systematic review highlight that digital media can be applied as a way to improve the levels of physical activity in children to contrast a sedentary lifestyle. The main limitations of the study are the heterogeneity within the exercise protocols and the paucity of studies involving school-age children. More research is needed to confirm our findings also due to continuing technological progress.

Background: Research on biomechanics in rowing has mostly focused on the lumbar spine. However, injuries can also affect other body segments. Thus, the aim of this pilot study was to explore any potential variations in the kinematics of the cervical spine during two different stroke rates on the rowing ergometer in young rowers. Methods: Twelve young rowers of regional or national level were recruited for the study. The experimental protocol consisted of two separate test sessions (i.e., a sequence of 10 consecutive strokes for each test session) at different stroke rates (i.e., 20 and 30 strokes/min) on an indoor rowing ergometer. Kinematics of the cervical spine was assessed using an inertial sensor capable of measuring joint ROM (angle of flexion, angle of extension, total angle of flexion–extension). Results: Although there were no differences in the flexion and total flexion–extension movements between the test sessions, a significant increase in the extension movement was found at the highest stroke rate (p = 0.04, d = 0.66). Conclusion: Young rowers showed changes in cervical ROM according to stroke rate. The lower control of the head during the rowing stroke cycle can lead to a higher compensation resulting in an augmented effort, influencing sports performance, and increasing the risk of injury.

Background Goalball is a Paralympic sport for visually impaired athletes. Although it is widely practiced, a great variety of tests are adopted to evaluate athletes' physical fitness. Therefore, the objective was to identify the physical fitness tests adopted in this sport to find the common aspects between them and, eventually, to propose a standard operating procedure. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were adopted. The studies were extracted from PubMed, Web of Science, and Scopus. A selection process by title, abstract, and full-text, according to the inclusion and exclusion criteria, was performed. The results were discussed with narrative synthesis. Results A total of 7 papers and 222 participants were included. A wide variety of tests were adopted and the Brockport Physical Fitness Test (BPFT) was the only battery included to evaluate general athletes' well-being. Conclusions Although few literature exists on Goalball, the BPFT could be the battery for evaluating Goalball athletes though the test battery should be standardized to the characteristics of this sport., Public health; Quality of life; Disability; Physical activity; Aging and life course; Visually impaired people; Health-related evaluation; Standard operating procedure

Background: Congenital hypothyroidism (CH) is an endocrine disease with a precocious significant impairment of growth and neuromotor development. Thyroid hormones are essential for central nervous system development, maturation, and myelination. Furthermore, thyroid hormone deficiency affects the function of several systems, including the musculoskeletal system. The disease has a significant incidence in the general population (1:3000–1:2000 newborns in Italy). The aim of the present study was to evaluate any differences in upper and lower limb strength, body sway, and plantar loading distribution in children with CH compared to healthy children. Methods: In this study, the case group was composed of children with CH (CHG), while the control group included healthy children (CG). Both groups comprised 19 children (CHG: female = 12; CG: female = 9). The maximum isometric handgrip strength and explosive-elastic lower limb strength were assessed with the handgrip test and the Sargent test, respectively. The stabilometric and baropodometric analyses were used to measure the Center of Pressure displacements and the plantar loading distribution between feet, respectively. The differences between groups were analyzed by a univariate analysis of covariance using as covariates weight and height with the significant level set at < 0.05. Results: We found that CHG children were shorter and thinner than CG ones (p < 0.05). No significant difference in the upper and lower limb strength was found between groups. CHG exhibited a significant greater Sway Path Length (p < 0.01) and Ellipse Surface (p < 0.05) than CG. Moreover, CHG displayed an asymmetric plantar loading distribution with a significant lower percentage in the right than in the left foot (p < 0.05). Moreover, a significant lower plantar loading percentage in the right foot of CHG than in the right foot of CG was observed (p < 0.05). Conclusions: These findings seem to suggest that CH does not affect muscle strength in early treated children. However, these patients show poor postural control ability and asymmetric plantar loading distribution. Increasing the physical activity in these children could improve their body posture.

This prospective cohort study aimed to evaluate whether COVID-19 lockdown caused biological, psychological, and/or physical performance variations in footballers. We compared the 2018/2019 and 2019/2020 seasons evaluating the plasma volume, hematological parameters, iron/ferritin, creatine kinase, vitamin D, cortisol, testosterone, and physiological state of players of the Italian football major league (Serie A). Measurements were performed before the preparatory period (T0), at the beginning (T1) and in the middle (T2) of the championship, and in March (T3) and at the end of season (T4). The results showed that in the 2019/2020 season affected by the lockdown, the weight, BMI, and fat mass percentage were higher than in the previous season. Hematocrit, hemoglobin, red blood cells, and ferritin decreased during both seasons, more significantly than in the regular season. During both seasons, creatine kinase increased from T2 whilst iron concentrations decreased in T3. Testosterone increased in both seasons from T0 to T3 and returned to initial levels at T4; cortisol increased in T2 and T3 during the 2018/2019 season but not during the COVID-19 season. Physical performance tests revealed differences associated with lockdown. Thus, although from a medical point of view, none of the evaluated changes between the two seasons were clinically relevant, training at home during lockdown did not allow the players to maintain the jumping power levels typical of a competitive period.

The increase of safety and health monitor of workers has become a crucial objective to prevent excessive physical workloads, injuries, accidents and errors. Heart rate (HR) is a very important physiological indicator which could properly describe the workers’ physical status. Recently, wearable photoplethysmographic (PPG) wristband trackers have been utilized to measure HR without hindering normal gesture of workers. However, the quality of PPG signals is highly affected by human physical motions, resulting in a poor reliable HR estimation. Specifically, during different activities and gestures, PPG sensor contact pressures may have an impact on the quality of the heart rate signal. To approach the problem, an instrumented adjustable bracelet equipped with a PPG sensor and a load cell has been designed. A simple test protocol consisting of three different activities (i.e. walking, jogging and running) has been realized to test PPG signal quality. PPG sensor has been subjected to different skin-sensor contact interface conditions to take into account the effect of contact pressure. Preliminary results showed that a weak contact pressure results in a poor quality of PPG signal as the activity becomes more and more intense. These results suggest that the contact pressure exerted by the sensor affects both the arterial compliance and the arterial volume, providing different results.

Introduction Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling. Materials and methods Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis. Results Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = -0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G. Discussion and conclusions This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.

High-level young athletes need to face a wide spectrum of stressors on their journey to élite categories. The aims of the present study are (i) to evaluate session rate of perceived exertion (sRPE) at different training impulse (TRIMP) categories and the correlations between these two variables and, (ii) evaluate the correlations between sRPE, fluid loss, and carbohydrate consumption during exercise. Data on Edward’s TRIMP, sRPE, body mass loss pre- and post- exercise (∆), and carbohydrate consumption (CHO/h) during exercise have been acquired from eight male junior cyclists during a competitive season. One-way ANOVA and correlation analysis with linear regression have been performed on acquired data. sRPE resulted in a significant difference in the three TRIMP categories (p &lt, 0.001). sRPE resulted in being very largely positively associated with TRIMP values (p &lt, 0.001, R = 0.71). ∆ as well as CHO/h was largely negatively related with sRPE in all TRIMP categories (p &lt, 0.001). The results confirmed the role of fluid balance and carbohydrate consumption on the perception of fatigue and fatigue accumulation dynamics independently from the training load. Young athletes’ training load monitoring and nutritional-hydration support represent important aspects in athlete’s exercise-induced fatigue management.

Background and Objectives: Heart rate recovery at first (HRR-I) and second (HRR-II) minute after exercise is accurate in estimating autonomic nervous system balance, and has been related to risk of cardiovascular events. Our aim was to determine independent predictors of HRR collected during standard cardio-pulmonary stress test (CPT) in a group of overweight/obese subjects without (N=14) and with type 2 diabetes (N=19), as compared to a sample (N=15) of healthy sedentary subjects. Methods: A graded exercise test on treadmill was performed. Oxygen uptake at rest and at peak exercise (VO2max), as well as respiratory exchange ratio at peak exercise was collected. Linear and logistic regression was used to assess association between variables collected at CPT and HRR-I and HRR-II. Results: Age, gender, as well as VO2 and HR at rest were all comparable among groups. VO2max and HRmax were both lower in diabetic patients as compared to healthy and overweight/obese groups (20 ± 4.3 vs. 28 ± 7 vs. 25.1 ± 5 ml/Kg/min respectively, p < 0.01). VO2max had the highest association to HRR-I (R2=0.47) and HRR-II (R2=0.44); VO2max < 28 and VO2max < 29 were the most accurate cut-off values to identify subjects with abnormally low HRR-I and HRR-II. Conclusions: VO2max is an independent predictor of HRR-I or HRR-II, and it is able to discriminate between patients with normal or abnormally low HRR values. Further studies are warranted to test usefulness of a customized exercise program to ameliorate autonomic nervous system balance, therefore reducing global cardiovascular risk.

We previously reported that responsiveness to methacholine (Mch) in the absence of deep inspiration (DI) decreased in healthy subjects after a short course of exercise training. We assessed whether a similar beneficial effect of exercise on airway responsiveness could occur in asthmatics. Nine patients (male/female: 3/6; mean age ± SD: 24 ± 2 yr) with mild untreated asthma [forced expiratory volume in 1 s (FEV1): 100 ± 7.4% pred; FEV1/vital capacity (VC): 90 ± 6.5%] underwent a series of single-dose Mch bronchoprovocations in the absence of DI in the course of a 10-wk training rowing program (6 h/wk of submaximal and maximal exercise), at baseline ( week 0), and at week 5 and 10. The single-dose Mch was established as the dose able to induce ≥15% reduction in inspiratory vital capacity (IVC) and was administered to each subject at every challenge occasion. Five asthmatics (male/female: 1/4; mean age ± SD: 26 ± 3 yr) with similar baseline lung function (FEV1: 102 ± 7.0% predicted; FEV1/VC: 83 ± 6.0%; P = 0.57 and P = 0.06, respectively) not participating in the exercise training program served as controls. In the trained group, the Mch-induced reduction in IVC from baseline was 22 ± 10% at week 0, 13 ± 11% at week 5 ( P = 0.03), and 11 ± 8% at week 10 ( P = 0.028). The Mch-induced reduction in FEV1 did not change with exercise ( P = 0.69). The reduction in responsiveness induced by exercise was of the same magnitude of that previously obtained in healthy subjects (50% with respect to pretraining). Conversely, Mch-induced reduction in IVC in controls remained unchanged after 10 wk (%reduction IVC at baseline: 21 ± 20%; after 10 wk: 29 ± 14%; P = 0.28). This study indicates that a short course of physical training is capable of reducing airway responsiveness in mild asthmatics.

Background: Performing complex motor skills, such as the ones performed by karate athletes, requires a great sense of balance. Because the posturo-kinetic performance seems to be improved by sport practice, especially by sports involving a lot of posturokinetic activities, the aim of this review was to critically analyse the scientific literature in order to appraise whether any positive correlation between karate and improved postural control is scientifically supported. Material/Methods: The online search engines Scirus and Medline were used for generating the data. A comprehensive literature search was conducted based on the following keywords: “karate”, “postural control” and “body sway”. Results were collected and filtered manually. Results: Four articles were identified related to karate practice and postural control, covering a period between 1998 and 2009. Although different experimental approaches were used to investigate this concept, overall the results of these studies confirm the effectiveness of karate in improving postural control. Conclusions: Practicing karate seems to elicit long term improvements in postural control. However, a much deeper approach to this fighting sport, which would take into account its technical specificities (e.g. kata & kumite), is required in order to increase our understanding of the posture-kinetic impact of this relatively unexplored sport activity.

Aim. The aim of this study was to assess the relationship between mean power during 20-s all-out rowing ergometer test and 2000-m rowing ergometer performance, in 20 young male rowers (mean age 15.2 ± 1.3 years). Methods. Mean power during 20-s all-out test (W20), maximal oxygen uptake during incremental test (VO2max), and anthropometric values, were measured and correlated with the time to perform a 2000-m trial (t2000). Results. W20 showed the highest correlation with t2000 (r = -0.947, P < 0.0001). Stepwise multiple linear regression analysis showed that W20, VO2max, and fat-free mass, were the variables most correlated with t2000, accounting for 95.1% of the variance, and that 89.7% of the variance in 2000-m rowing ergometer performance time was accounted for by W20. Conclusions. These results suggest that W20 is an important predictor of 2000-m rowing ergometer performance, and the 20-s all-out test on rowing ergometer may be a useful monitoring tool for young rowers.

Aims: Heart rate recovery after exercise (HRR) is an estimate of autonomic modulation of the heart, and has been shown to be inversely associated with insulin resistance, metabolic syndrome, and type 2 diabetes [1]. Type 2 diabetes is associated with poor exercise tolerance and maximal aerobic capacity (VO2max) [2]. Aim of our study was to assess the relationship between HRR and VO2max in sedentary patients with type 2 diabetes. Methods: Maximal treadmill exercise testing using standard or modified Bruce protocol was performed in 16 (8 males and 8 females) sedentary patients with type 2 diabetes (T2D), and in 16 (9 males and 7 females) age-matched sedentary non-diabetic controls (ND). HRR (bpm) was defined as the difference between maximum heart rate during the exercise test and heart rate 2 minutes after cessation of the exercise (Fig. 1). The recovery protocol consisted of walking on treadmill at 2.0 Km/h of speed and 0% of grade. Oxygen uptake was recorded and VO2max (ml/Kg/min) was defined as the highest 30 seconds average achieved during the test. For the statistical analysis of the data, Student’s t-test for independent samples and linear regression analysis were used. Results: The characteristics of subjects are shown in Table 1. The two groups were similar in age and body weight. BMI was higher in T2D (30.1 ± 3.6 vs. 26.9 ± 4.2, p = 0.029). VO2max was significantly lower in T2D compared to ND (20.6 ± 8.4 vs. 28.2 ± 8.1 ml/Kg/min, p = 0.002) and, according to “Normative Table by age and gender" from ACMS, the aerobic capacity was classified very poor in all T2D and in 11/16 of ND. HRR was significantly lower in T2D (28 ± 8.4 vs. 37 ± 8.9 bpm, p = 0.008). A significant correlation between HRR and VO2max has been found in both T2D (Fig. 2) and ND (r = 0.672, p = 0.004 and r = 0.620, p = 0.010 respectively). Conclusions: The results of our study showed that both HRR and VO2max were significantly reduced in T2D versus ND. The positive linear correlation between HRR and VO2max suggests that in T2D the heart rate recovery after exercise, index of autonomic modulation, might improve in response to a training aimed to increase aerobic capacity.

Am J Physiol Regul Integr Comp Physiol. 2005 Nov;289(5):R1496-503. Epub 2005 Jul 14. Supramaximal exercise mobilizes hematopoietic progenitors and reticulocytes in athletes. Morici G, Zangla D, Santoro A, Pelosi E, Petrucci E, Gioia M, Bonanno A, Profita M, Bellia V, Testa U, Bonsignore MR. SourceDepartment of Experimental Medicine, University of Palermo, Italy. Abstract Marathon runners show increased circulating CD34+ cell counts and postexercise release of interleukin-6 (IL-6), granulocyte-colony stimulating factor (G-CSF) and flt3-ligand (Bonsignore MR, Morici G, Santoro A, Pegano M, Cascio L, Bonnano A, Abate P, Mirabella F, Profita M, Insalaco G, Gioia M, Vignola AM, Majolino I, Testa U, and Hogg JC. J Appl Physiol 93: 1691-1697, 2002). In the present study we hypothesized that supramaximal ("all-out") exercise may acutely affect circulating progenitors and reticulocytes and investigated possible mechanisms involved. Progenitor release was measured by flow cytometry (n = 20) and clonogenic assays (n = 6) in 20 young competitive rowers (13 M, 7 F, age +/- SD: 17.1 +/- 2.1 yr, peak O2 consumption: 56.5 +/- 11.4 ml.min(-1).kg(-1)) at rest and shortly after 1,000 m "all-out." Release of reticulocytes, cortisol, muscle enzymes, neutrophil elastase, and several cytokines/growth factors was measured. Supramaximal exercise doubled circulating CD34+ cells (rest: 7.6 +/- 3.0, all-out: 16.3 +/- 9.1 cells/mul, P < 0.001), and increased immature reticulocyte fractions; AC133+ cells doubled, suggesting release of angiogenetic precursors. Erythrocyte burst forming units and colony forming units for granulocytes-monocytes and all blood series increased postexercise by 3.4-, 5.5-, and 4.8-fold, respectively (P < 0.01 for all). All-out rowing acutely increased plasma cortisol, neutrophil elastase, flt3-ligand, hepatocyte growth factor, VEGF, and transforming growth factor-beta1, and decreased erythropoietin; K-ligand, stromal-derived factor-1, IL-6, and G-CSF were unchanged. Therefore, all-out exercise is a physiological stimulus for progenitor release in athletes. Release of reticulocytes and proangiogenetic cells and mediators suggests tissue hypoxia as possibly involved in progenitor mobilization. PMID:16020520[PubMed - indexed for MEDLINE]

Heart rate recovery (HRR) is the rate at which the heart rate returns to baseline after a period of exercise. HRR is a marker of autonomic function and a predictor of cardiovascular fitness in healthy subjects and in those with cardiovascular diseases. Moreover, HRR has been proposed as a marker of training status in athletes. Our aim was to perform a review of studies that evaluated HRR after exercise in trained and untrained healthy subjects and assessed its relationship with training status. Several studies suggest that the assessing of HRR after exercise may be useful to distinguish trained from untrained individuals and to establish an athlete’s state of training. However, standardization of measuring is required to compare between individuals.

Aim: To date, assessment of the anaerobic components to determine performance in rowers is not part of standard evaluation or monitoring set for training. The aim of this study was to evaluate the relation between anaerobic power output and ergometer rowing performance over 2000 meters, in a group of 14 -17 years old rowers (n = 11). Methods: Each subject performed, in three separate days, two “all-out” tests, over 20 and 60 seconds, and a 2000 meters trial, using a Concept II rowing ergometer. Mean power values over 20 sec (W20) and 60 sec (W60) were measured and compared with the time to perform the 2000 m trial (t2000). Results: Statistical analysis showed high and significant correlation between 2000 meters performance (6.90 ± 0.1 min) and anaerobic power over 20 sec (479.5 ± 93.90 watts; r = 0.941, P = 0.00002) and 60 sec (435.5 ± 64.60 watts; r = 0.964, P = 0.000002). Conclusions: The data of our study confirm that parameters of anaerobic power strongly affect the performance and that the determination of these variables by testing on rowing ergometer can be an useful tool for planning and monitoring of training in young rowers.

Aims: To evaluate variations in biometrics, physiological and performance parameters over a seasonal training – from September to March - in club level young rowers. Methods: Six young rowers, age 13-15, affiliated with a rowing club member of the Italian Rowing Federation, were assessed three times at regular three-months intervals (September, December, and March) during the 2011 season. Biometrics evaluations included stature, body mass and body composition, whereas physiological assessments on rowing ergometer included maximum oxygen uptake (VO2max) obtained during an incremental test, and average power output values obtained during a 2000m trial (W2000) and during a 20-sec (W20) and a 60-sec (W60) maximal effort tests. The time to complete the 2000m trial (t2000) on rowing ergometer was chosen as index of performance. Results: From September to March body mass decreased not significantly while the stature, due to growth for age, increased from 162.2 cm to 165.3 cm (+1.95%, p=0.0006) so that BMI decreased significantly (-5.85%, p=0.008). Body fat mass decreased not significantly from 22.0% to 19.2%. Maximum oxygen uptake decreased from 59.8 ml/Kg/min in September to 54.3 ml/Kg/min in December (-9.2%, p=0.015), before rising to 66.6 ml/Kg/min in March (+22.8%, p=0.002). Average power over 20-sec and 60-sec increased respectively from 300 to 366 W (+21.7%, p=0.009), and from 309 to 353 W (+14.2%, p=0.045). The time to complete 2000m on rowing ergometer decreased from 8’08” in September to 7’36” in March (-6.6%, p=0.0001). Conclusions: Seasonal variation in body mass and body composition was minimal, while body height, an important but not trainable factor in rowing performance, increased due to the growth. The main physiological factor correlated with rowing ergometer performance (VO2max) increased, although in a variable manner. The indices of anaerobic power (W20 and W60) continuously increased from the initial phase of training to workout. The current findings suggest that seasonal training in club level young rowers was effective in increasing maximal oxygen uptake and muscle power output, correlated with performance on 2000m rowing ergometer.

Un allenamento regolare di grado moderato, e di tipo prevalentemente aerobico ha effetti positivi sul benessere generale ed in particolare sulla performance cardiovascolare, apportando un contributo significativo nella prevenzione primaria delle cardiopatie, in quanto elemento essenziale del trattamento di malattie metaboliche quali obesità, diabete mellito, dislipidemia, o dell’aterosclerosi, condizioni riconosciute come fattori di rischio di eventi cardiovascolari. L’esercizio moderato è inoltre essenziale nella prevenzione secondaria e nella fase riabilitativa della cardiopatia ischemica o dell’insufficienza cardiaca. Gli effetti benefici non sono però così chiari quando l’attività fisica diventa estremamente intensa, o strenua: negli atleti spesso si evidenziano modificazioni cardiache, elettriche e strutturali, indicate genericamente con il termine di “cuore d’atleta”, che rappresentano una risposta adattativa all’aumentato lavoro cardiaco, e che sono influenzate da fattori quali l’allenamento ad una specifica disciplina sportiva, il sesso e la razza. Sebbene questi adattamenti siano generalmente valutati come fisiologici e reversibili, alcune recenti osservazioni indicano che un esercizio strenuo (come l’ultra-maratona) danneggia il tessuto miocardio e riduce la performance sistolica sia del ventricolo sinistro che del ventricolo destro ed il rimodellamento atriale e ventricolare destro potrebbero rappresentare adattamenti patologici, predisponenti ad aritmie e morte cardiaca improvvisa.

Aims: Rowing performance over 2000m is dependent upon the functional capacity of both the aerobic and anaerobic energy pathways. Although several studies have indicated that maximal oxygen uptake is strongly related to rowing performance and it is the best predictor of performance in elite rowers, some evidence is that muscle power output could be an important predictor of performance. The aim of this study was to investigate the possible relationship between anaerobic power and rowing ergometer performance over 2000m in young rowers, and whether anaerobic power assessed could identify athletes with the best performance. Methods: We collected biometric characteristics and energy data, including average power during 20 sec. (W20) and 60 sec (W60) maximal efforts, and maximum oxygen consumption (VO2max), in 20 club and national level young rowers (mean age 14.7 ± 1.1 years). Enrolled athletes were divided in 2 groups by performance: high-performance athletes (N=7) completed 2000m indoor row in ≤ 425 sec, and low-performance group (N=13) in > 425 sec. A simple linear regression model was used to assess relation between time to complete 2000 meters and biometric data, W20 , W60 , and VO2max. Receiver operating characteristic (ROC) curves were used to determine if significant predictors identified by linear regression modeling might be accurate in discriminating athletes with the best performance (HP Group) from those with a less good performance (LP Group). Results: Indexed W20 and W60 were greater in high-performance compared to low-performance athletes (7.77 ± 0.3 vs. 6.34 ± 0.5 W/Kg, p = 0.005 for W20 , and 6.77 ± 0.7 vs. 5.99 ± 0.5 W/Kg, p = 0.04 for W60 ). Indexed VO2max (62.5 ± 8.5 vs. 60.1 ± 7.5 ml/Kg/min, p = 0.44) was not different in the groups. At ROC analysis, indexed W20 ≥ 7.19 W/Kg was able to identify athletes with the best performance in 100% of the cases, while W60 ≥ 6.68 W/Kg and VO2max ≥ 65.6 ml/Kg/min had a discriminatory power of 86% and 59%, respectively. Conclusions: Anaerobic power evaluated by W20 was the most significant predictor of indoor rowing performance, and more accurate than W60 or VO2max in identifying athletes with best performance.

In the last ten years, the effects of exercise on bronchial epithelial cells and inflammatory cells in the airways have been studied in detail, and such new information has been combined with previous knowledge on bronchial reactivity and asthma evoked by exercise in asthmatic patients and athletes. The resulting picture is very complex, and the potential clinical consequences are often contradictory, suggesting the opportunity to define different phenotypes of exercise-associated airway changes (Lee & Anderson, 1985; Haahtela et al., 2008; Moreira et al., 2011a). Studies in asthmatic athletes in the 90’ had began to explore the possibility that airway inflammation might be involved in exercise-associated respiratory symptoms. However, studies in non-asthmatic athletes also found increased number of inflammatory cells not only at rest, but also after strenuous endurance exercise (Bonsignore et al., 2001). It was therefore hypothesized that endurance exercise may physiologically cause influx of inflammatory cells into the airways, associated with low or absent inflammatory activation (Bonsignore et al., 2003a). Subsequent studies in athletes and animal models have extended these finding, but the mechanisms of inflammatory cell recruitment into the airways and the tight control of inflammatory activation physiologically associated with exercise remain poorly understood. Exercise is a known cause of bronchoconstriction in asthmatic patients (Cabral et al., 1999) and athletes (Parsons & Mastronarde, 2005). A large number of asthmatic elite athletes participate to international top-level competitions, and guidelines regarding management of asthmatic athletes (Fitch et al., 2008) and rules on the use of anti-asthmatic drugs have been issued (World Anti-Doping Agency, WADA, Oct. 18 2010 report). However, exercise is a powerful physiologic stimulus for bronchodilatation, and some reports underlined that exercise training may actually downmodulate bronchial reactivity in normal subjects (Scichilone et al., 2005, 2010), asthmatic children (Bonsignore et al., 2008) and animal models of asthma (Hewitt et al., 2010). This chapter will summarize the changes induced by acute exercise and training in bronchial reactivity and airway cells in both humans and animal models. It will also discuss the changing paradigm regarding the impact of physical activity in patients with bronchial asthma, and the new perspectives of exercise-based rehabilitation in patients with respiratory diseases such as chronic obstructive pulmonary disease (COPD).

Modular and removable structure, variable in height, to be fixed/anchored to the bottom of the swimming pool/tank through sliding tracks suitable for the two cables located at both sides of the swimming-pool along the same modules.On the one hand, the diving guide was designed to allow blind divers to move inside the pool autonomously and safely, without the help of instructors even when more than one diver is present in the pool/lane. On the other hand, the diving guide can be stretched to reach various lengths when needed.

We previously reported that after a short course of rowing training the responsiveness to methacholine (Mch) in the absence of deep inspiration (DI) decreased in healthy subjects. We assessed whether a similar beneficial effect of exercise on airway responsiveness could occur in asthmatics. Nine patients (M/F: 3/6; mean age±SD: 24±2 yrs) with mild untreated asthma (FEV(1): 100±7.4% pred, FEV(1)/VC 90±6.5%) underwent a series of single dose Mch bronchoprovocations in the absence of DI in the course of a indoor rowing training consisted of two to three sessions per week for 10 weeks (total 28 sessions). Each session included a warm-up period for 20 min (running and stretching), and a specific training on rowing ergometer (Concept II, Morrisville, VT) for 40 to 70 minutes. In order to document power output, strokes, and mean maximal speed for each individual, a 1000-m all-out rowing test was first performed after a 20 min warm-up. Based on the performance, watt stroke-1 and strokes min-1 recorded in the 1000-m all-out test, a certified European rowing coach created personalized training programs. At week 0, 5 and 10, 1000- and 2000-m all-out rowing tests were performed to evaluate performance and re-assess the individualized workload. The 10-week training program included 20% of all training time at maximal power output, 10% of all training time at 75-90% of maximal power output and 70% of all training time at 60-65% of maximal power output. All sessions were supervised by a certified training instructor and a pulmonologist. The single dose Mch was established as the dose able to induce at least 15% reduction in IVC, and was administered to each subject at every challenge occasion. Five asthmatics (M/F: 1/4; mean age±SD: 26±3 yrs) with similar baseline lung function (FEV1: 102±7.0% pred, and FEV(1)/VC: 83±6.0%; p=0.57 and p=0.06, respectively) not participating in the rowing training program, served as controls. In the trained group, the Mch-induced reduction in IVC from baseline was 22±10% at week 0, 13±11% at week 5 (p=0.03), 11±8% at week 10 (p=0.028). The Mch-induced reduction in FEV(1) did not change with exercise (p=0.69). The reduction in responsiveness induced by exercise was of the same magnitude of that previously obtained in healthy subjects (50% with respect to pre-training). Conversely, Mch-induced reduction in IVC in controls remained unchanged after 10 weeks (% reduction IVC at baseline: 21±20%; after 10 weeks: 29±14%, p=0.28). This study indicates that a short course of rowing training is capable of reducing airway responsiveness in mild asthmatics.

EFFETTI DI UN PROGRAMMA DI ESERCIZIO FISICO SUL GRADO DI REATTIVITÀ BRONCHIALE NEGLI ASMATICI N. Scichilone 1, G. Morici 2, D. Zangla 3, R. Arrigo 1, I. Cardillo 1, V. Bellia 1, M.R. Bonsignore 1 1 DIBIMIS, Università degli Studi di Palermo, 2 BIONEC, Università degli Studi di Palermo, 3 DISMOT, Università degli Studi di Palermo SCOPO DEL LAVORO: Il nostro gruppo ha recentemente dimostrato che il grado di reattività bronchiale in assenza di respiri profondi si riduce negli individui sani in seguito ad un intenso programma di allenamento. Nello studio corrente, abbiamo valutato se un simile effetto benefico dell’esercizio fisico potesse realizzarsi negli asmatici. MATERIALI E METODI: Nove asmatici lievi (M/F: 3/6; età media±SD: 24±2 anni; FEV1: 100±7.4% pred, FEV1/VC 90±6.5%) si sono sottoposti ad una serie di test di stimolazione bronchiale con metacolina (Mch) in assenza di respiri profondi prima (tempo 0), durante (dopo 5 settimane) e al termine dell’allenamento (dopo 10 settimane). Il programma di allenamento ha previsto 6 ore di attività fisica submassimale o massimale al remoergometro per ciascuna settimana. La dose singola di Mch è stata identificata per ciascun soggetto quale dose in grado di indurre una riduzione della capacità vitale inspiratoria (IVC) di almeno il 15% rispetto ai valori basali. La stessa dose di Mch è stata impiegata in ciascun individuo nei tre test previsti dallo studio. Cinque asmatici (M/F: 1/4; età: 26±3 anni) con pari grado di ostruzione bronchiale (FEV1: 102±7.0% pred, e FEV1/VC: 83±6.0%; p=0.57 and p=0.06, rispettivamente) non partecipanti al programma di allenamento, hanno rappresentato il gruppo di controllo. RISULTATI: Nel gruppo sottoposto ad allenamento, la riduzione dell’IVC dopo inalazione di Mch è risultata pari a 22±10% al tempo 0, 13±11% alla quinta settimana (p=0.03), 11±8% alla decima settimana (p=0.01). Il livello di riduzione della reattività bronchiale osservato dopo il programma di esercizio fisico ha rispecchiato quanto già ottenuto su soggetti sani (50% rispetto ai valori di reattività bronchiale pre-allenamento). Al contrario, il grado di riduzione dell’IVC indotto dalla dose singola di Mch nei controlli è rimasto immutato dopo 10 settimane (% di riduzione dell’IVC al tempo 0: 21±20%; alla decima settimana: 29±14%, p= 0.28). CONCLUSIONI: I risultati dello studio indicano che un breve ciclo di allenamento è in grado di ridurre il livello di iperreattività bronchiale negli asmatici. Queste osservazioni contribuiscono all’approfondimento delle conoscenze sui meccanismi patogenetici dell’iperreattività bronchiale e suggeriscono approcci terapeutici non farmacologici nell’asma lieve.

PURPOSE: Performance over 2000m on a rowing ergometer is dependent upon the functional capacity of both the aerobic and anaerobic energy pathway. The purpose of this study was to assess the relationship between anaerobic power and indoor performance over 2000m in youth rowers. METHODS: Six youth rowers, 3 males and 3 females mean age 14 (range 13 – 15), performed, on a separate occasion, two maximal ergometer power tests, on 20” and on 60”, and a maximal 2000m ergometer time trial. All evaluations were performed on a Concept II model D air braked rowing ergometer (Concept2, Nottingham, UK). Average speed over 2000m (V) and average power over 20” (W20) and over 60” (W60) were measured. The data is shown as mean values ± standard error of the mean. Pearson’s product-moment correlation and stepwise regression analysis were employed to examine the relationship between V, W20 and W60. RESULTS: The average of rowing speed over 2000m was 4.26 ± 0.17 m/s. The average power over 20” and over 60” was respectively 366 ± 46.94 W and 353 ± 41.35 W. Significant correlations were observed between V and W20 (r=0.95 p < 0.004) and W60 (r=0.98 p < 0.0005). Stepwise multiple regression identifies W20 and W60 as determinants of performance over 2000m on a rowing ergometer, accounting for 96.80% of the variance, P

PURPOSE: Physical activity is recommended as a component of weight management. Exercise intensity has been showed to be one of the most important factors in determining substrate utilization. Purpose of our study was to determine the level at which physical exercise elicits maximal fat oxidation. METHODS: Fifteen healthy sedentary subjects, 8 men and 7 women, mean age 53 (range 37 – 71), BMI 26,6  1,33 performed an incremental exercise test to exhaustion on treadmill, using Bruce protocol. Breath-by-breath measurements of VO2 (ml/Kg/min) were detected throughout exercise and FAT rate (mg/Kg/min) was determined using indirect calorimetry (Cosmed, Quark CPET). The data is shown as mean values ± standard error of the mean. For the statistical analysis of the data, linear regression analysis was used. RESULTS: The average VO2max was 28,63±2,03 ml/Kg/min (men 30,91±3,27; women 26,03±2,08 ml/Kg/min). FATmax of 7,19±0,77 mg/Kg/min (men 0,80±1,22; women 6,26±0,84 mg/Kg/min) was reached at VO2 of 18,23±1,28 ml/Kg/min (men 18,85±2,03; women 17,51±1,59 ml/Kg/min) and it was located at 64±2,05 %VO2max (men 61±2,06; women 68±4,96 %VO2max). A positive linear correlation between FATmax and VO2 at FATmax (r=0,85, p

J Appl Physiol. 2010 Aug;109(2):288-94. Epub 2010 Jun 10. Effects of exercise training on airway responsiveness and airway cells in healthy subjects. Scichilone N, Morici G, Zangla D, Chimenti L, Davì E, Reitano S, Paternò A, Santagata R, Togias A, Bellia V, Bonsignore MR. SourceDept. of Internal Medicine, Div. of Pulmonology (DIBIMIS Univ. of Palermo, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, 90146 Palermo, Italy. n.scichilone@libero.it Abstract Airway responsiveness to methacholine (Mch) in the absence of deep inspirations (DIs) is lower in athletes compared with sedentary individuals. In this prospective study, we tested the hypothesis that a training exercise program reduces the bronchoconstrictive effect of Mch. Ten healthy sedentary subjects (M/F: 3/7; mean + or - SD age: 22 + or - 3 yr) entered a 10-wk indoor rowing exercise program on rowing ergometer and underwent Mch bronchoprovocation in the absence of DIs at baseline, at weeks 5 and 10, as well as 4-6 wk after the training program was completed. Exercise-induced changes on airway cells and markers of airway inflammation were also assessed by sputum induction and venous blood samples. Mean power output during the 1,000 m test was 169 + or - 49 W/stroke at baseline, 174 + or - 49 W/stroke at 5 wk, and 200 + or - 60 W/stroke at 10 wk of training (P < 0.05). The median Mch dose used at baseline was 50 mg/ml (range 25-75 mg/ml) and remained constant per study design. At the pretraining evaluation, the percent reduction in the primary outcome, the inspiratory vital capacity (IVC) after inhalation of Mch in the absence of DIs was 31 +/- 13%; at week 5, the Mch-induced reduction in IVC was 22 + or - 19%, P = 0.01, and it further decreased to 15 + or - 11% at week 10 (P = 0.0008). The percent fall in IVC 4-6 wk after the end of training was 15 + or - 11% (P = 0.87 vs. end of training). Changes in airway cells were not associated with changes in airway responsiveness. Our data show that a course of exercise training can attenuate airway responsiveness against Mch inhaled in the absence of DIs in healthy subjects and suggest that a sedentary lifestyle may favor development of airways hyperresponsiveness. Comment in J Appl Physiol. 2010 Aug;109(2):267-8. PMID:20538849[PubMed - in process]

INTRODUZIONE E’ stato dimostrato che l’appiattimento dell’angolo di lordosi lombare unitamente a tensioni muscolari statiche sono cause principali di rischio nella degenerazione dei dischi intervertebrali e nell’insorgenza di dolore lombare. Nessuno studio in letteratura ha studiato i canoisti kayaker. In particolare abbiamo chiesto di applicare la tecnica e il movimento utilizzato da canoisti di elevata qualificazione a giovani atleti con un movimento abituale diverso, registrando le forze applicate alla pagaia. SCOPO DEL LAVORO Analisi delle variazioni di forza applicate dai canoisti kayaker alla pagaia in funzione delle variazioni dell’angolo di lordosi lombare. MATERIALI E METODI Abbiamo esaminato al pagaiergometro 14 giovani canoisti, 7 uomini e 7 donne con le seguenti caratteristiche medie ± SD: età 16,6 ± 1,7 anni, altezza 169,0 ± 7,1 cm, peso 60,6 ± 12,1 kg. Con condizioni uguali per ogni atleta abbiamo filmato il movimento e registrato con due celle di carico le forze applicate in una sequenza di 10 colpi nella rispettiva posizione abituale del rachide e altri 10 colpi con una posizione più eretta ottenuta in modo soggettivo. Le variazioni delle posizione del rachide sono state analizzate dai dati video con il programma Kinovea, per la significatività statistica dei valori di forza applicati (p183°, con variazione pari al 2,1%; gli altri 10 soggetti (3 U, 7 D) avevano invece posizioni abituali con angoli medi di 195,3° ± 1,5 e posizioni più erette con angoli medi di 191,8° ± 1,8, con un variazione media dell’angolo della posizione pari al 1,8%. RISULTATI (II) Le forze applicate alla pagaia sono state registrate con due celle di carico sensibili a variazioni di 100gr. Tutti i valori medi di ogni soggetto sono stati analizzati con il t-test per dati appaiati. Escludendo i 4 soggetti che avevano posizioni abituali con angoli ≤ 187°, le variazioni di forza registrate nei 10 atleti sono risultate statisticamente significative con p=0,01. Inserendo i valori dei 4 atleti con rachide più eretto nella posizione abituale l’analisi statistica dell’intero gruppo è risultata non significativa con p=0,16. DISCUSSIONE La posizione dei due atleti campioni olimpionici presenta un appiattimento dell’angolo di lordosi lombare ma non l’evidente inversione della curva così come spesso accade nei principianti. Ci siamo chiesti quindi se questa posizione oltre ad essere più corretta per la prevenzione di patologie rachidee fosse anche funzionale per una prestazione migliore. Confrontando i risultati ottenuti abbiamo osservato che il gruppo dei 14 giovani atleti presenta una inversione della curva lombare, ma per quattro soggetti i valori erano di poco superiori a quelli osservati nei kayaker olimpionici. Dall’analisi dei risultati appare evidente la variazione di forza applicata in virtù di una minima modifica dell’angolo di lordosi lombare per tutti i soggetti che presentano una abituale inversione evidente. Non appare significativa la variazione di forza per i quattro soggetti con un angolo abituale di lordosi lombare più corretto. L’utilità dello studio appare sia dal punto di vista della prevenzione che della prestazione individuale, argomento al quale i giovani atleti e i loro allenatori sono sempre più sensibili. CONCLUSIONI L’appiattimento dell’angolo della lordosi lombare è un evento comune in atleti praticanti discipline in attitudine di appoggio seduta (canoisti, canottieri, ciclisti). Il mantenimento di un angolo corretto, oltre a prevenire disturbi e alterazioni del rachide, è anche alla base di una maggiore prestazione. Infatti i canoisti dello studio che presentavano una inversione della curva lombare più accentuata hanno avuto significativi incrementi di forza nella posizione più corretta pur con variazioni dell’angolo di lordosi lombare inferiori al 2%.

OBJECTIVES: To examine whether the assumption of extra virgin olive oil enriched with E-vitamin and Q10-coenzyme may improve the plasma anti-oxidant/pro-oxidant balance and be associated with favorable changes in heart rate variability (HRV). METHODS: Four male athletes, mean age 22 (range 21-24), were recruited. They assumed 20 ml per day of the integrator (20 mg Q10 and 15 mg Vit E) for one month. The plasma antioxidant capacity (AC) was evaluated by the crocin bleaching assay. The frequency-domain analysis of HRV was carried out using Cardioline Cube recorder and specific software to obtain, from an autoregressive power spectrum approach, the power in normalized units (nu) of the low-(LF) and high-frequency (HF) bands and LF/HF ratio. HRV was recorded between 8.00 and 13.00, after a 5-min rest, for 10-15 min with the subject seated. We used for the HRV calculation short-term (5 min) interval between the 3rd-8th min of the recording. Data, shown as mean values ± standard error of the mean, was collected before the integration, then after one month since the assumption and finally after one month since the wash-out. RESULTS: An increase of the AC was observed after supplementation (from 582.7+121 to 890.2+253). Furthermore, a reduction in the LF/HF (from 9,1±6 to 3.6±2) and in LFnu (from 72,1±9 to 63,7±8) have been observed and there was also an increase in the HFnu (from 19,9±7 to 25,1±6). CONCLUSIONS: These findings suggest that the extra-virgin olive oil enriched with E-vitamin and Q10-coenzyme increased the AC and induced favorable changes in cardiac autonomic function. These results are preliminary observations that need to be confirmed.

Le attività sportive agonistiche comportano adattamenti cardiaci morfologici e funzionali che permettono di ottimizzare la funzione cardiaca durante l’esercizio fisico. Il principale adattamento funzionale cardiaco è rappresentato dalla bradicardia a riposo, conseguente al raggiungimento di un nuovo equilibrio della bilancia simpato-vagale. Il principale adattamento morfologico dell'apparato cardiocircolatorio all’esercizio fisico è rappresentato dall'ipertrofia miocardica, caratterizzata da un aumento della massa cardiaca che deve essere armonico e proporzionale al grado ed al tipo di attività fisica praticata. Tale ipertrofia coinvolge sia la componente miocitaria che quella vascolare per mantenere un’adeguata vascolarizzazione della massa muscolare cardiaca aumentata. La componente fibrocitaria risulta non aumentare come nelle forme di ipertrofia cardiaca patologica, evitando quindi diminuzioni della distensibilità cardiaca o incrementi dello stress parietale, che rappresentano le conseguenze negative delle forme patologiche irreversibili. Tali adattamenti variano in relazione a fattori ereditari (genotipo), età ed epoca di inizio dell’attività sportiva e tipo ed intensità dei programmi di allenamento, in quanto i modelli di allenamento [resistenza (endurance); potenza (power/strenght); misto (resistenza/potenza)] determinano differenti adattamenti morfologici e funzionali. I dati riportati in questa review permettono di individuare i parametri di studio degli adattamenti cardiaci strutturali e funzionali e di definire i limiti di normalità. Particolare attenzione deve essere riservata alla valutazione della massa, degli spessori di parete e delle dimensioni interne del ventricolo sinistro. Conoscendo i valori massimi di questi parametri morfologici è possibile differenziare il cuore d’atleta, condizione fisiologica, dalla cardiomiopatia ipertrofica e dalla cardiomiopatia dilatativa, condizioni che predispongono ad aritmie cardiache potenzialmente fatali durante l’esercizio fisico.