Objective To evaluate the clinical usefulness of complete preparticipation cardiovascular screening in a large cohort of sports participants. Design Cross sectional study of data over a five year period. Setting Institute of Sports Medicine in Florence, Italy. Participants 30 065 (23 570 men) people seeking to obtain clinical eligibility for competitive sports. Main outcome measures Results of resting and exercise 12 lead electrocardiography. Results Resting 12 lead ECG patterns showed abnormalities in 1812 (6%) participants, with the most common abnormalities (>80%) concerning innocent ECG changes. Exercise ECG showed an abnormal pattern in 1459 (4.9%) participants. Exercise ECG showed cardiac anomalies in 1227 athletes with normal findings on resting ECG. At the end of screening, 196 (0.6%) participants were considered ineligible for competitive sports. Among the 159 participants who were disqualified at the end of the screening for cardiac reasons, a consistent proportion (n=126, 79.2%) had shown innocent or negative findings on resting 12 lead ECG but clear pathological alterations during the exercise test. After adjustment for possible confounders, logistic regression analysis showed that age >30 years was significantly associated with an increased risk of being disqualified for cardiac findings during exercise testing. Conclusions Among people seeking to take part in competitive sports, exercise ECG can identify those with cardiac abnormalities. Follow-up studies would show if disqualification of such people would reduce the incidence of CV events among athletes.
For publication in the International Journal of Sports Medicine (IJSM), studies must have been conducted in accordance with recog nised ethical standards and national/international laws. At submis sion, authors are required to confirm that these standards and laws have been adhered to by reading this editorial. Authors who do not provide any information regarding ethical approval will have their manuscripts rejected before the peerreview process, without any option to resubmit. In the original 2009 IJSM editorial [1], we described the ethical considerations embedded into national/international laws and pro vided specific guidance on the ethical issues which commonly arise in Sports Medicine research. While the four basic principles of bio medical ethics are, arguably, constant and timeless [2], data col lection processes, research designs and settings etc. are not and may bring changes to ethical considerations. As a result, the arti cle has been updated five times, prior to 2022, in the areas: 2011 [3] recognition of the ethical principles of other profes sional associations and treaties for research involving human par ticipants, guidance on the use of Laboratory Animals, and on links between sample size and research ethics. 2014 [4] studies of doping agents, the use of animals where the research questions appeared focussed on the enhancement of athlet ic performance and sample size in the context of participant burden. 2016 [5] changes to the Declaration of Helsinki, the use of so cial media in research, feeding back incidental and pertinent find ings to participants, issues in studies involving young people, and key differences between full and pilot studies. 2018 [6] clarification of the use of gatekeepers for accessing participant’s personal data, informed consent, breaches of confi dentiality, use of person identifiable information, open access data and secondary analysis of data and the use of placebos and partic ipant deception. 2020 [7] further detail on informed consent/assent, secondary data analysis, prestudy risk analysis and study design and the ap plication of the Principle of Justice [8] (with particular regard to gen der imbalance in sampling). In this 2022 update we have added text on: ▪ Ethical considerations where the participant’s gender and/or sex is a parameter of interest ▪ The use of remote research methods (including electronic signatures consent and data retention). During the COVID 19 (SARSCoV2) pandemic many researchers employed (or changed to, in studies already underway) remote methods of data collection (virtual or online). This brought into particular focus the ethical issues involved ▪ The use of screening tools for eligibility ▪ Studies testing substances (ingested or noningested) and/or, devices or processes hypothesised to improve health and/or enhance performance, that may be harmful and/or risk censure if detected. Ethical Standards in Sport and Exercise Science Research: 2022 Update
This study aimed to conduct an updated exploration of the ratio of male and female participants in sport and exercise science research. Publications involving humans were examined from The European Journal of Sports Science, Medicine & Science in Sport & Exercise, The Journal of Sport Science & Medicine, The Journal of Physiology, The American Journal of Sports Medicine, and The British Journal of Sports Medicine, 2014–2020. The total number of participants, the number of male and female participants, the title, and the topic, were recorded for each publication. Data were expressed in frequencies and percentages. Chi-square analyses were used to assess the differences in frequencies in each of the journals. About 5,261 publications and 12,511,386 participants were included in the analyses. Sixty-three percentage of publications included both males and females, 31% included males only, and 6% included females only (p < .0001). When analyzing participants included in all journals, a total of 8,253,236 (66%) were male and 4,254,445 (34%) were female (p < .0001). Females remain significantly underrepresented within sport and exercise science research. Therefore, at present most conclusions made from sport and exercise science research might only be applicable to one sex. As such, researchers and practitioners should be aware of the ongoing sex data gap within the current literature, and future research should address this.
Although a substantial body of literature has explored the relationship between sleep and exercise, comprehensive reviews and definitive conclusions about the impact of exercise interventions on sleep are lacking. Electronic databases were searched for articles published between January 2013 and March 2017. Studies were included if they possessed either objective or subjective measures of sleep and an exercise intervention that followed the guidelines recommended by the American College of Sports Medicine. Thirty-four studies met these inclusion criteria. Twenty-nine studies concluded that exercise improved sleep quality or duration; however, four found no difference and one reported a negative impact of exercise on sleep. Study results varied most significantly due to participants' age, health status, and the mode and intensity of exercise intervention. Mixed findings were reported for children, adolescents, and young adults. Interventions conducted with middle-aged and elderly adults reported more robust results. In these cases, exercise promoted increased sleep efficiency and duration regardless of the mode and intensity of activity, especially in populations suffering from disease. Our review suggests that sleep and exercise exert substantial positive effects on one another; however, to reach a true consensus, the mechanisms behind these observations must first be elucidated.
Hyeon-Ki Kim, Yui Nakayama, Tsukasa Yoshida
et al.
Abstract The escalating effects of climate change, particularly global warming, are posing an increasing burden on human health. Older adults are particularly susceptible to the impact of extreme heat. Adequate water intake is essential to prevent dehydration in hot environments. Therefore, it is important to understand water turnover (WT) and intake. WT of older adults in hot environments remains unknown. This study aimed at investigating the seasonal effects on WT, total energy expenditure (TEE), and physical activity using doubly labeled water (DLW) and a triaxial accelerometer. A total of 26 older Japanese adult males and females aged ≥ 65 years participated in the study. WT and TEE were measured using DLW in May and August 2012. The mean values of maximum, mean, and minimum temperatures and mean humidity of the measurement days were 24 °C, 19 °C, 14 °C, and 57% in May (spring) and 35 °C, 29 °C, 25 °C, and 66% in August (summer) 2012, respectively. The mean (standard deviation, SD) age of the participants was 73.7 (5.4) years. Total body water increased significantly from 31.1 (4.6) to 31.9 (5.2) kg (+ 0.8 kg, P = 0.009) from May to August. TEE decreased significantly from 2271 (280) to 2123 (470) kcal/day (- 149 kcal/d, P = 0.036), while WT increased significantly from 2.939 (0.625) to 3.579 (0.943) L/day (+ 0.640 L/d, P < 0.001). WT increased by 640 mL/day during summer compared to that during spring, when the average temperature was 19 °C. Our findings indicate that WT increases during hot weather in older adults, reflecting seasonal adaptation.
Abstract Background Depression and anxiety are among the most common mental health problems affecting children and adolescents worldwide. Exercise is a widely used and potentially cost-effective non-pharmacological approach that may improve mood and mental health. However, the optimal exercise modalities and doses for alleviating depressive and anxiety symptoms in children and adolescents remain uncertain. Previous evidence has primarily relied on pairwise meta-analyses or conventional network meta-analyses: the former are unable to compare multiple exercise formats simultaneously, while the latter, although capable of integrating different interventions, have not quantified dose characteristics such as intensity, frequency, and duration. Consequently, systematic dose–response evidence regarding depressive and anxiety symptoms in children and adolescents is lacking. This study aims to examine the quantitative relationship between exercise dose and changes in depressive and anxiety symptoms. Methods This protocol outlines a systematic review and Bayesian model-based dose–response network meta-analysis. A systematic search will be conducted of PubMed, Embase, Web of Science, the Cochrane Library, Scopus, PsycINFO, SPORTDiscus, and the China National Knowledge Infrastructure databases through May 2026. Randomized controlled trials enrolling children and adolescents aged 6–18 years with depressive or anxiety symptoms and comparing different types and doses of exercise training will be eligible for inclusion. Study quality will be appraised using the Cochrane Risk of Bias 2.0 tool. Exercise interventions will be categorized by type (e.g., aerobic, resistance, mind–body, and combined exercise-only) prior to dose–response modeling. A Bayesian model-based dose–response network meta-analysis will be performed, with exercise dose quantified as weekly metabolic equivalent of task (MET) minutes (MET-min/week) by integrating intensity, session duration, and frequency. Nonlinear dose–response curves will be fitted for distinct exercise modalities. Meta-classification and regression tree (meta-CART) analysis will be employed to identify potential effect modifiers. Discussion This study will systematically evaluate the nonlinear dose–response relationships between exercise dose and changes in depressive and anxiety symptoms in children and adolescents, and estimate dose ranges associated with symptom change across exercise modalities. The findings may help inform future evidence-based recommendations and provide methodological guidance for dose–response research in child and adolescent mental health. Systematic review registration This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD420251174947.
To investigate the potential use of large language models (LLMs) in orthopaedics by presenting queries pertinent to anterior cruciate ligament (ACL) surgery to generative pre-trained transformer (ChatGPT, specifically using its GPT-4 model of March 14th 2023). Additionally, this study aimed to evaluate the depth of the LLM’s knowledge and investigate its adaptability to different user groups. It was hypothesized that the ChatGPT would be able to adapt to different target groups due to its strong language understanding and processing capabilities. ChatGPT was presented with 20 questions and response was requested for two distinct target audiences: patients and non-orthopaedic medical doctors. Two board-certified orthopaedic sports medicine surgeons and two expert orthopaedic sports medicine surgeons independently evaluated the responses generated by ChatGPT. Mean correctness, completeness, and adaptability to the target audiences (patients and non-orthopaedic medical doctors) were determined. A three-point response scale facilitated nuanced assessment. ChatGPT exhibited fair accuracy, with average correctness scores of 1.69 and 1.66 (on a scale from 0, incorrect, 1, partially correct, to 2, correct) for patients and medical doctors, respectively. Three of the 20 questions (15.0%) were deemed incorrect by any of the four orthopaedic sports medicine surgeon assessors. Moreover, overall completeness was calculated to be 1.51 and 1.64 for patients and medical doctors, respectively, while overall adaptiveness was determined to be 1.75 and 1.73 for patients and doctors, respectively. Overall, ChatGPT was successful in generating correct responses in approximately 65% of the cases related to ACL surgery. The findings of this study imply that LLMs offer potential as a supplementary tool for acquiring orthopaedic knowledge. However, although ChatGPT can provide guidance and effectively adapt to diverse target audiences, it cannot supplant the expertise of orthopaedic sports medicine surgeons in diagnostic and treatment planning endeavours due to its limited understanding of orthopaedic domains and its potential for erroneous responses. V.
P. Zeppilli, Alessandro Biffi, M. Cammarano
et al.
Nearly 35 years after its initial publication in 1989, the Italian Society of Sports Cardiology and the Italian Federation of Sports Medicine (FMSI), in collaboration with other leading Italian Cardiological Scientific Associations (ANCE - National Association of Outpatient Cardiology, ANMCO - National Association of Inpatient Cardiology, SIC - Italian Society of Cardiology), proudly present the 2023 version of the Cardiological Guidelines for Competitive Sports Eligibility. This publication is an update of the previous guidelines, offering a comprehensive and detailed guide for the participation of athletes with heart disease in sports. This edition incorporates the latest advances in cardiology and sports medicine, providing current information and recommendations. It addresses various topics, including the details of the pre-participation screening in Italy and recommendations for sports eligibility and disqualification in competitive athletes with various heart conditions. This revised version of the Cardiological Guidelines for Competitive Sports Eligibility, recorded in the Italian Guidelines Registry of the Italian Minister of Health, stands as a crucial resource for sports medicine professionals, cardiologists, and healthcare providers, marked by its completeness, reliability, and scientific thoroughness. It is an indispensable tool for those involved in the care, management and eligibility process of competitive athletes with heart conditions.
Lia Jiannine, Catherine Holen, Tobin Silver
et al.
Background The primary aim of this study was to assess the effectiveness of an energy drink vs. a caffeine-matched control on measures of sustained attention.Methods Using a randomized, double-blind design (n = 107), subjects were assigned to an energy drink (C4 – Nutrabolt®) or a caffeine-matched control (200 mg caffeine). The following assessments were conducted before and approximately 45 minutes after consuming an energy drink or caffeine-matched control: psychomotor vigilance test (PVT), Memtrax (memory), handgrip strength, and wall-sit endurance.Results Both the energy drink and the caffeine-matched control improved pre vs. post for the PVT; however, there were no differences in the delta score. The energy drink group had a significant decrease in the Memtrax assessment (% correct) whereas reaction time increased with no change in the control; however, there were no differences in the delta score between groups for either the % correct score or reaction time. There were no significant differences in the handgrip or wall-sit assessments for either group.Conclusions Consuming 200 mg of caffeine, whether it is part of an energy drink or is a stand-alone ingredient, induces significant improvements in sustained attention and alertness (i.e. reaction time assessed by the PVT). However, there were no differences in memory, handgrip strength, or wall-sit endurance.
Large Language Models (LLMs) are transforming healthcare through the development of LLM-based agents that can understand, reason about, and assist with medical tasks. This survey provides a comprehensive review of LLM-based agents in medicine, examining their architectures, applications, and challenges. We analyze the key components of medical agent systems, including system profiles, clinical planning mechanisms, medical reasoning frameworks, and external capacity enhancement. The survey covers major application scenarios such as clinical decision support, medical documentation, training simulations, and healthcare service optimization. We discuss evaluation frameworks and metrics used to assess these agents' performance in healthcare settings. While LLM-based agents show promise in enhancing healthcare delivery, several challenges remain, including hallucination management, multimodal integration, implementation barriers, and ethical considerations. The survey concludes by highlighting future research directions, including advances in medical reasoning inspired by recent developments in LLM architectures, integration with physical systems, and improvements in training simulations. This work provides researchers and practitioners with a structured overview of the current state and future prospects of LLM-based agents in medicine.
A major concern when deploying LLMs in accuracy-critical domains such as sports reporting is that the generated text may not faithfully reflect the input data. We quantify how input structure affects hallucinations and other factual errors in LLM-generated summaries of NBA play-by-play data, across three formats: row-structured, JSON and unstructured. We manually annotated 3,312 factual errors across 180 game summaries produced by two models, Llama-3.1-70B and Qwen2.5-72B. Input structure has a strong effect: JSON input reduces error rates by 69% for Llama and 65% for Qwen compared to unstructured input, while row-structured input reduces errors by 54% for Llama and 51% for Qwen. A two-way repeated measures ANOVA shows that input structure accounts for over 80% of the variance in error rates, with Tukey HSD post hoc tests confirming statistically significant differences between all input formats.