Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Lacrosse

Participation in women’s lacrosse has increased in popularity over the last 20 years with a subsequent rise in sports-related injuries. Despite this increase, there is a paucity of research examining this population, particularly regarding guidelines for safe return to lacrosse after anterior cruciate ligament (ACL) reconstruction. A lacrosse-specific functional rehabilitation program is critical to the success of the athlete. The athlete must be prepared and demonstrate the ability to cut, pivot, jump, pass, and shoot with the incidental contact required for sport clearance. A criterion-based program delineating a progression of range of motion, mobility, strength, neuromuscular control, agility, and cardiovascular training is an essential part of ACL rehabilitation. Early incorporation of lacrosse-specific skills emphasizing multiplanar neuromuscular control should gradually progress to more challenging field-based tasks as the athlete transitions through their rehabilitation program. A multidisciplinary team of physicians, physical therapists, athletic trainers, strength and conditioning specialists, coaches, and parents must collaborate effectively to reduce the athlete’s risk for reinjury, meet the demands of the sport, and facilitate returning to the field without complications. Associated video content

The Role of Aerobic Exercise in Erectile Dysfunction: A Review of Randomized Controlled Trials

PURPOSE:This study aimed to determine the role or applicability of aerobic exercise in erectile dysfunction.METHODS:This narrative review was conducted by searching terms such as ‘impotence,’ ‘erectile dysfunction,’ ‘erection dysfunction,’ ‘sexual dysfunction,’ ‘aerobic exercise,’ ‘aerobic training,’ ‘cardiovascular exercise,’ ‘cardiovascular training,’ ‘human,’ ‘randomized controlled trials,’ and ‘randomized clinical trials’ in the titles or abstracts in PubMed, Google Scholar, Scopus, Wiley Online Library, and Science Direct databases.RESULTS: Nine articles met the inclusion criteria. Aerobic exercise of light (low)-vigorous (high) intensity was found to be effective in erectile dysfunction in seven articles.CONCLUSIONS: In case of mild-moderate erectile dysfunction accompanied by high blood pressure, obesity, physical inactivity, metabolic syndrome, acute myocardial infarction, and ischemic heart disease, it is suggested that following an aerobic exercise program has potential advantages. Further clinical research is required to compare nonlinear aerobic exercise with linear aerobic exercise in the population with erectile dysfunction.

Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States

Background The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach. Methods A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers. Results A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004). Conclusion The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.

Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial

Background Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. Methods A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). Results Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. Conclusions Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. Trial registration The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN 12613000822785) on 25/07/2013.

The Need For A Cardio-Nephrology Subspecialty

Chronic kidney disease (CKD) has structural and functional repercussions for the cardiovascular system that facilitate the development of cardiovascular disease (CVD). In fact, cardiovascular complications are frequent in the CKD population thus having a great clinical, public health and economic burden. Despite this challenge, the prevention and management of cardiovascular complications is one among several aspects of CKD that meets criteria of unmet medical need. This probably has to do with a misperception by the nephrologist of the global relevance of CVD in the CKD patient which, in turn, may be due to insufficient cardiovascular training during nephrology specialization. Therefore, a change of approach is necessary to understand CKD as a disease in whose clinical course the manifestations and complications related to CVD become so frequent and important that they require dedicated multidisciplinary clinical management. From this perspective, it makes sense to consider training in the subspecialty of cardio-nephrology as a need for the adequate cardiovascular care of CKD patients by the nephrologist. In addition, the cardio-nephrology subspecialist would be better able to interact with other specialists in multidisciplinary care settings created to achieve a deeper understanding and more effective clinical handling of the interactions between CKD and CVD.

Effect of cardiovascular training on functional capacity in post-acute rehabilitation of COVID-19 patients

Introduction: In the overall strategy of developing the optimal treatment of patients after COVID-19 infection, recommended by the World Health Organization, rehabilitation plays one of the key roles in improving the functional capacity of these patients and thus their quality of life. The aim of this study was to investigate the effect of cardiovascular training during post-acute rehabilitation on the functional capacity of patients after moderate COVID-19 pneumonia. Methods: The prospective study included 84 patients of both sexes, mean age 57.92 ± 11.79 years, who were hospitalised at the Institute of Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'' Banja Luka due to moderate pneumonia caused by the COVID-19 virus and after they finished acute rehabilitation. All patients underwent cardiovascular training three times per week and occupational therapy during 28 days of stationary post-acute rehabilitation. The follow-up parameter was a six-minute walk (6-MWT) test at admission and discharge from post-acute rehabilitation. Student t-test for paired samples was used for statistical analysis, and the value of p < 0.05 was taken as statistical significance. Results: The functional capacity of the cardiovascular and respiratory system was statistically significantly improved at discharge compared to admission (p < 0.05). Conclusion: Targeted cardiovascular training during post-acute rehabilitation leads to improvement of functional capacities of patients after moderate COVID-19 pneumonia.

Hormonal Contraceptive Use, Menstrual Dysfunctions, and Self-Reported Side Effects in Elite Athletes in Denmark

Objective: To identify the prevalence of hormonal contraceptive (HC) use, menstrual cycle disturbances, and self-perceived physical and emotional symptoms related to the menstrual cycle/pill cycle in elite female athletes. Methods: One hundred eighty-six Danish elite female athletes completed an online questionnaire to assess menstrual status and history, use of HCs, and self-perceived physical and emotional symptoms related to the menstrual cycle or HC use. Results: Fifty-seven percent of elite female athletes in Denmark use HC, with 74% using combined HCs and 26% using progestin only. Sixty percent of oral contraceptive users reported having manipulated their menstrual cycle by continuous oral contraceptive use. Forty-nine percent of non-HC users had a regular menstrual cycle, while 51% experienced menstrual disturbances, with 1 athlete being primary amenorrheic and 13 athletes having secondary amenorrhea. Menstrual disturbances were experienced by a larger proportion of endurance athletes (69%) compared with athletes performing power and technical disciplines. In endurance athletes amenorrhea was associated with a higher cardiovascular training volume (P < .001). Negative symptoms related to the menstrual/pill cycle were reported by both HC and non-HC users, whereas positive physical symptoms were experienced more often among the non-HC (14%) versus HC users (2%) (P < .01). Notably, 13% of the athletes reported that negative symptoms sometimes/always caused them to not participate in or complete the scheduled training. Conclusion: HC use is common among elite athletes, and continuation of HC is used to manipulate the menstrual cycle in relation to sport competitions. HC use does not abolish dysmenorrhea, but it may reduce emotional-related side effects. Menstrual disturbances are frequent in endurance athletes and are associated with cardiovascular training volume.