British Cycling

Abstract Introduction The athlete's heart demonstrates complex remodelling with variation by sex, sport, and body size. Current guidelines recommend standard linear scaling of cardiac parameters to body surface area (BSA), yet this inadequately accounts for allometric relationships. Elite athletes will often exceed conventional thresholds of left ventricular (LV) size using standard scaling, potentially leading to unnecessary onward investigation. Sport-specific prediction equations incorporating allometric scaling could improve diagnostic accuracy in pre-participation cardiac screening (PPCS) of competitive cyclists. Purpose To develop allometric scaling equations for LV structural parameters in elite cyclists, accounting for body size, sex, discipline, and heart rate, and to compare with conventional BSA indexing. Methods We evaluated 181 elite cyclists (96% white British ethnicity) with a normal PPCS (105 males, 76 females; age 22.7±5.5 years; discipline 128 endurance, 53 sprint) to develop sport-specific prediction equations. Comprehensive echocardiography was performed. Weighted least squares allometric regression was used to determine optimal scaling exponents for height, mass, and BSA. Statistical models were evaluated, advancing to more complex models only when they significantly improved prediction accuracy. For each parameter, equations were developed to predict expected values and calculate z-scores using piecewise linear regression on ln(pp). Results Males had larger standard scaled LV dimensions than females (LVEDVi: 81.7±13.3 vs. 70.3±11.3 ml/m2; LVMi: 95.4±19.7 vs 79.5±12.6 g/m2, both p<0.001). Using ASE 2015 guidelines, 69.6% exceeded thresholds for LVEDVi, 62.9% for LVESVi and 14.9% for LVMi. Allometric scaling with height provided superior fit, with a stronger coefficient than either mass or BSA. RR interval, reflecting variability in resting heart rate and discipline focus emerged as important determinants and were incorporated into the models. Prediction equations: LVEDV=47.5×Height1.7×1.15(if male)×1.09 (if endurance) [R²=0.59]; LVESV=19.4×Height1.7×1.19(if male)×1.05(if endurance) [R²=0.47]; LV mass=51.4×Height1.7×RR0.1×1.22(if male)×1.14(if endurance) [R²=0.57]. The prediction equations yield z-scores, and percentage predicted values for each measured parameter. Values falling within the 95% reference interval (2.5th-97.5thpercentiles) are classified as normal physiologic adaptation. Conclusions Allometric scaling with height provides superior indices of LV structure versus BSA indexing. Sport-specific equations accounting for height, sex, heart rate, and discipline offer improved diagnostic precision. Current guideline thresholds may be inappropriate for elite cyclists, and allometric scaling could reduce unnecessary further investigations.LVEDVFor image description, please refer to the figure legend and surrounding text. LVMFor image description, please refer to the figure legend and surrounding text.

Background: Elite cycling can be dichotomised into road (endurance cycling) and track (sprint cycling) events that are associated with different training components and athlete physiology. Evidence of disproportionate right ventricular (RV) remodelling in endurance athletes places importance on defining physiological and athletic phenotypes. Therefore, the elite cyclist serves as an ideal model to study training-specific adaptations in the right heart. Methods: One hundred and eighty-six (110 males and 76 females) elite international-level cyclists (mean age 23 ± 5 years) were grouped by discipline (endurance cycling and sprint cycling) and sex (male cyclists and female cyclists). RV and right atrial (RA) structure and function was assessed with 2D, tissue Doppler, and strain echocardiography. Structural data were scaled allometrically to body size. Group comparisons were made with a two-way ANOVA. Results: Significantly larger absolute and scaled RV and RA structural values were seen in male and endurance cyclists (RV end diastolic area index: male endurance 14 ± 2 cm2/m2, male sprint 13 ± 2 cm2/m2) than female and sprint cyclists (female endurance 13 ± 2 cm2/m2, female sprint 11 ± 2 cm2/m2), respectively. Endurance training exposure was significantly correlated to structural parameters (RA area index: r = 0.53; p < 0.001). Sex and discipline showed significant impact on resting RV function with reduced RV strain values in male and endurance cyclists (RV basal strain: male endurance −17.5 ± 4.0%, male sprint −19.4 ± 4.6%) compared to female and sprint cyclists (female endurance −19.9 ± 3.9%, female sprint −22.1 ± 5.1%), respectively. There were no significant correlations between training exposure and resting RV function. Conclusions: Athlete sex and cycling discipline exert significant effects on RV and RA structure and function in elite cyclists. The strong correlations observed between endurance training exposure and right heart structure emphasise the importance of consideration of sporting discipline in elite athletes.

INTRODUCTION:There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity. AIMS:To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies. METHODS:A scoping review of TGD policies from the 15 major UK sporting organisations. RESULTS:Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete's eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits. CONCLUSIONS:There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.

INTRODUCTION:A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC?AIMS:To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC).METHODS:All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines.RESULTS:Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39).CONCLUSIONS:This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.

OBJECTIVES:The British Athletics Muscle Injury Classification (BAMIC) correlates with return to play in muscle injury. The aim of this study was to examine hamstring injury diagnoses and outcomes within elite track and field athletes following implementation of the British Athletics hamstring rehabilitation approach.METHODS:All hamstring injuries sustained by elite track and field athletes on the British Athletics World Class Programme between December 2015 and November 2019 that underwent an MRI and had British Athletics medical team prescribed rehabilitation were included. Athlete demographics and specific injury details, including mechanism of injury, self-reported gait phase, MRI characteristics and time to return to full training (TRFT) were contemporaneously recorded.RESULTS:70 hamstring injuries in 46 athletes (24 women and 22 men, 24.6±3.7 years) were included. BAMIC grade and the intratendon c classification correlated with increased TRFT. Mean TRFT was 18.6 days for the entire cohort. Mean TRFT for intratendon classifications was 34±7 days (2c) and 48±17 days (3c). The overall reinjury rate was 2.9% and no reinjuries were sustained in the intratendon classifications. MRI variables of length and cross-sectional (CSA) area of muscle oedema, CSA of tendon injury and loss of tendon tension were associated with TRFT. Longitudinal length of tendon injury, in the intratendon classes, was not associated with TRFT.CONCLUSION:The application of BAMIC to inform hamstring rehabilitation in British Athletics results in low reinjury rates and favourable TRFT following hamstring injury. The key MRI variables associated with longer recovery are length and CSA of muscle oedema, CSA of tendon injury and loss of tendon tension.