ObjectivesAsthma and bronchial hyperresponsiveness is common in athletes, particularly in sports with high ventilatory demands or exposure to irritants such as cold, dry air, polluted air, or trichloramines. The mechanisms behind asthma in athletes remain unclear, but repeated high-volume ventilation and exposures to irritants, as well as airway inflammation and remodelling likely contribute. Symptoms resemble those of asthma, and airway hyperresponsiveness plays a key role, even in athletes with no other classic asthma features. Treatment of asthma in athletes follows the same approach as asthma in the general population. Use of asthma medication is commonly reported by athletes on doping control forms (DCFs). Thus, this study aimed to investigate the use of different anti-asthmatic medications among doping-controlled athletes.MethodsThis was an observational cross-sectional study, evaluating retrospective data from athletes′ DCFs obtained during 2015–2019 as part of Anti-doping Norway′s national testing program in Norwegian sport, some of whom reappearing in the data set with multiple forms.ResultsOf 10 418 DCFs, 1702 (16.3%) contained one or more anti-asthmatic medications. Bronchodilators were most frequently reported, with anticholinergics being most common. DCFs reported from females, national level athletes, and athletes with high risk of asthma contained significantly more anti-asthmatic medications compared to their counterparts (p < 0.01). Usage was highest among athletes aged 30–34, and in those in endurance sports.ConclusionDespite the limitation of athletes’ reappearance in the dataset, this study provides insight into guideline adherence and asthma medication use among athletes in Norway. Further research is needed in this area.

Breathing reserve (BR) is the remaining proportion of achievable minute ventilation that remains unutilized at total exhaustion during exercise. Previous studies have found a smaller BR in endurance-trained athletes compared to untrained controls. However, most of these studies have examined men. Given that women have a greater ventilatory limitation than stature-matched men, the present cross-sectional study aimed to investigate how this sex difference influences BR and lung function tests in endurance-trained females compared to matched, untrained females. To obtain further insight, we also aimed to investigate whether VO2max serves as a predictor of BR. We examined 15 female elite runners and 15 healthy, matched female controls aged 24-33 years with regard to pulmonary function, MVV, VEmax, BR, and VO2max. The elite runner group had a median BR of 5%, while that of the controls was 21%, representing a significant difference. Lung function tests showed no differences between the two groups. A moderate association was found between VO2max and BR. The female elite runners demonstrated a lower BR than the group of matched, untrained controls, which was lower than that found for male elite athletes in previous studies. This may indicate a greater ventilatory demand in female relative to male endurance athletes.

Objectives This study studied how multiple cross-country ski races affect respiratory function and symptoms in different age groups. Methods Eighteen >= 19 and 18 <= 18 years of age skiers performed morning spirometry, post-race/training spirometry and recorded respiratory symptoms daily over a National Championship (baseline day, 3 races and 2 training days). Results Races decreased resting spirometry and a rest day increased spirometry in both groups. Overall resting maximal mean decline was 4.6 +/- 8.8%; 2.5 +/- 8.2% for forced expiratory flow in 1 second (FEV1) and 6.3 +/- 2.7%; 4.5 +/- 2.7% forced vital capacity (FVC) in >= 19 and <= 18 aged skiers respectively. FEV1 decreased in 50% of skiers post-race, mean symptoms were 3.3 +/- 0.5 (<= 18 yrs); and 2.5 +/- 0.5 (>= 19 yrs). Post-race cough (86%) was most common symptom. Conclusions Multiple races reduced resting function, especially FVC in both age groups. Greater cough and decreased function in FEV1 pre-post-race in older skiers indicate potential age-related change. This study is the first to show how multiple ski races affect respiratory function and symptoms cumulatively.

Background Exercise induced laryngeal obstruction (EILO) causes inspiratory distress in the upper airway in many adolescent athletes. The nature of EILO is not fully understood, and effective management strategies are lacking. This study aimed to assess the effectiveness of a multidimensional individually tailored intervention, including Norwegian Psychomotor Physiotherapy (NPMP), elements of cognitive behavioural therapy and a rehabilitation plan, in reducing inspiratory distress and dysfunctional breathing in adolescent athletes with EILO. Methods A mixed methods design, which combined qualitative and quantitative research, was used. Data, including subjective experiences of respiratory distress, findings from body examinations and objective measurements of lung function and aerobic capacity were gathered before and after a five month intervention involving 18 participants. Results Following the intervention, the participants showed a reduction in respiratory distress and anxiousness associated with their breathing difficulties. Furthermore, the participants reported to be more in control of their breathing. The body assessments revealed a more functional breathing motion and improved posture, which imply that the breathing was less thoracic and more diaphragmatic in rest and exercise in all participants after the intervention. Conclusions Our results suggest that a multidimensional individually tailored intervention, including NPMP based physiotherapy, cognitive behavioural therapy elements, and a rehabilitation plan may reduce inspiratory distress and dysfunctional breathing in athletes with EILO. Trial registration ClinicalTrials.gov Protocol Registration and Results system NCT06033755, date of registration: September12, 2023. Retrospectively registered.

This article explores how athletes experience injuries and performance pressures when striving for an "Olympic dream", and focuses on how ten young women, aged 19-22, understand present and past experiences with injuries. Through a narrative analysis, we found that female players striving to become elite athletes often talk about injuries as something that made them feel invisible in a culture where visibility is key. "Being seen" emerged as a parallel narrative to that of injuries and the elite athlete as the players often looked back with regrets about how young and na & iuml;ve they had been. This holistic take on injuries as a cultural construct is important for any coach to consider when working with young aspiring athletes. We conclude that this process is contingent on social processes and is a matter of when, how, and on what or whose terms young athletes are seen.

Background: In the latest statement for CPET (ERS,2019) 84% of the included studies were based on ergometer cycling protocols while only 16% were based on treadmill protocols. More studies with treadmill protocols are requested. The Glittreprotocol was designed based on a modified Bruce protocol in 1992 for patients with lung disease and has been used in clinical practice since then but has not been validated. Aim: To validate the Glittreprotocol in patients with COPD. Do these patients achieve the criteria for a maximal test when performing a CPET using the Glittreprotocol on a treadmill? Methods: Data from patients who had performed CPET on a treadmill using the Glittreprotocol were retrospectively analyzed. Criteria for a validated test were based on the ERS statement: 1) patients had to achieve one or more of the six criteria for maximum effort (achieved expected VO2peak; HRpeak ≥95% pred.; VEpeak ≥85% of MVV; RER >1,05 or according to age/gender, blood lactate >8mmol.L-1 or according to age/gender, Borg CR10 ≥9); 2) time of the stress phase within 8-12 minutes; 3) whether the Glittreprotocol consisted of recommended phases (rest-stress-recovery). Results: 80 patients with COPD (55% men, age 65(9) years, FEV1%pred 45(17)) were included. 91% of the patients met criteria for maximal effort. The average stress-phase time was 09:24 min. The Glittreprotocol contained phases of rest, stress and recovery. Conclusion: The Glittreprotocol appears to be a valid protocol for maximal CPET in patients with COPD. Patients achieved the criteria for maximum effort, and the criteria were achieved within the recommended time. More prospective studies are needed to fully validate the Glittreprotocol.

Objective The primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of low BMD, to compare the concentration of bone turnover markers, vitamin D and symptoms of low energy availability (LEA) between the groups, and to identify possible associations between BMD and selected variables. Methods Fifteen runners and fifteen controls were included. Assessments included dual-energy X-ray absorptiometry measurement of BMD in the total body, lumbar spine and dual proximal femur. Blood samples included endocrine analyses and circulating bone turnover markers. The risk of LEA was assessed through a questionnaire. Results Runners had higher Z-scores in the dual proximal femur (1.30 (0.20 to 1.80) vs 0.20 (−0.20 to 0.80), p<0.021) and total body (1.70 (1.20 to 2.30) vs 0.90 (0.80 to 1.00), p<0.001). The lumbar spine Z-score was similar between groups (0.10 (−0.70 to 0.60) vs −0.10(−0.50 to 0.50), p=0.983). Three runners had low BMD (Z-score <−1) in the lumbar spine. Vitamin D and bone turnover markers showed no differences between the groups. Forty-seven per cent of the runners were at risk of LEA. Dual proximal femur BMD showed a positive correlation to estradiol and a negative correlation to LEA symptoms in runners. Conclusion Norwegian female elite runners had higher BMD Z-score in the dual proximal femur and total body compared with controls, while no difference was observed in the lumbar spine. The advantages of long-distance running on bone health seem to be site specific, and there is still a need for the prevention of LEA and menstrual disorders in this group.

AIM: To evaluate pulmonary function in childhood cancer survivors (CCS) compared to age and sex-matched controls. Methods: In this multicenter European cross-sectional study (Norway, Switzerland), 157 CCS and 113 controls (age range 9-18 years) performed spirometry and whole-body plethysmography, and measured lung diffusion capacity, according to guidelines. Multi-level linear statistical models were used to compare CCS and controls. Predicted values were according to Global Lung Initiative. Results: Mean age was 13.4±2.6 years. The most common cancer diagnoses were leukemia (50%), brain tumors (11%) and lymphoma (10%). The majority (78%) of CCS had received chemotherapy with anthracyclines. Tabulated preliminary data showing differences between CCS and controls (95% CI): Conclusion: Pulmonary function was well preserved in CCS despite significant differences between CCS and controls. There was no evidence of diffusion limitation induced by treatment toxicity.

Introduction This systematic review with meta-analysis investigates the effect of glucocorticoids on maximal and submaximal performance in healthy subjects. Methods We searched for randomised controlled trials investigating the effect of glucocorticoids on physical performance in Web of Science, Scopus, Medline, Embase and SportDiscus in March 2021. Risk of bias was assessed with the revised Cochrane Collaboration Risk of Bias Tool (RoB2). Data from random effect models are presented as standardized difference in mean (SDM) with 95% confidence interval. We included 15 studies comprising 175 subjects. Results Two studies had high risk of bias. Glucocorticoids had a small positive effect on maximal physical performance compared to placebo (SDM 0.300, 95% CI 0.080 to 0.520) and the SDM for the 13 included comparisons was not heterogeneous ( I 2 = 35%, p = 0.099). Meta regression found no difference in the effect of acute treatment vs. prolonged treatment or oral ingestion vs. inhalation ( p > 0.124). In stratified analysis prolonged treatment (SDM 0.428, 95% CI 0.148 to 0.709) and oral ingestion (SDM 0.361, 95% CI 0.124 to 0.598) improved physical performance. Glucocorticoids improved aerobic performance (SDM 0.371, 95% CI 0.173 to 0.569) but not anaerobic performance ( p = 0.135). Glucocorticoids did not change energy expenditure during submaximal performance (SDM 0.0.225 95% CI −0.771 to 0.112). Discussion This study indicates that glucocorticoids improves maximal performance and aerobic performance. Glucocorticoids did not affect the energy expenditure during submaximal performance. The conclusions are based on relatively few subjects leading to limited statistical power and uncertain estimates. Still, these results are consistent and should be of interest to WADA and anyone concerned about fair play. Systematic Review Registration Open Science Framework 2021-04-29 ( https://osf.io/fc29t/ ).

In general, aerobic exercise has a positive impact on the vascular system, but the syndrome of relative energy-deficiency in sports (RED-S) makes this impact less clear for the athlete. The present cross-sectional controlled study aimed to investigate the vascular function in female elite long-distance runners, compared to inactive women. Sixteen female elite long-distance runners and seventeen healthy controls were recruited. Assessments of vascular function and morphology included endothelial function, evaluated by flow-mediated dilatation (FMD), vascular stiffness, evaluated with pulse wave velocity (PWV), carotid artery reactivity (CAR %), and carotid intima-media thickness (cIMT). Blood samples included hormone analyses, metabolic parameters, lipids, and biomarkers reflecting endothelial activation. RED-S risk was assessed through the low energy availability in female questionnaire (LEAF-Q), and body composition was measured by dual-energy X-ray absorptiometry (DXA). We found no significant differences in brachial FMD, PWV, CAR %, cIMT, or biomarkers reflecting endothelial activation between the two groups. Forty-four percent of the runners had a LEAF-Q score consistent with being at risk of RED-S. Runners showed significantly higher HDL-cholesterol and insulin sensitivity compared to controls. In conclusion, Norwegian female elite runners had an as good vascular function and morphology as inactive women of the same age.

Background Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project “Fitness clubs - a venue for public health?”, we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)]. Methods In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women. Results In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001). Conclusion In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling.

Introduction: Although exercise-induced respiratory symptoms and bronchial hyperresponsiveness (BHR) are prevalent in elite athletes (Fitch, 2012), studies indicate increased lung volumes and high airflow rates in participants of some sports (Rochat, Cote, & Boulet, 2022). Aims and objectives: Examine lung function, BHR and exercise-induced respiratory symptoms in elite athletes across sports. Methods: 30 swimmers, 32 cross-country skiers, 16 speed-skaters, 11 rowers/paddlers, 17 handball players and 23 soccer players completed a validated questionnaire, spirometry and methacholine provocation challenge. Two cut-off levels defined BHR; ≤2µmol and ≤8µmol methacholine causing ≥20% drop in forced expiratory volume in 1 second (FEV1). Results: Mean forced vital capacity (FVC) was highest in swimmers. Mean FEV1 was higher than predicted by the reference equation in swimmers and ball game athletes. Mean forced expiratory flow between 25 and 75% of FVC (FEF25-75), and FEV1/FVC were lower than predicted in all endurance groups. BHR defined by ≤2 and ≤8 µmol methacholine was observed in respectively 50% and 87% of swimmers, 25% and 47% of cross-country skiers, 20% and 53% of speed-skaters, 18% and 36% and of rowers/paddlers, and 0% and 17% of the ball game athletes. Exercise-induced symptoms were common in all groups, most frequent in cross-country skiers (88%), swimmers (83%) and speed-skaters (81%). Conclusion: Elite swimmers and ball game athletes had increased FVC and FEV1, compared to predicted values. FEF25-75 was lower than predicted in all endurance groups. The prevalence of BHR was high across all sports, except the ball game athletes, and many athletes reported symptoms.

Objective:Asthma is a common problem among elite athletes and represents a health risk interfering with the athlete's performance status. This study aimed to evaluate the asthma prevalence among Norwegian summer and winter elite athletes and asthma prevalence across sport categories. We also aimed to examine whether bronchial hyperresponsiveness (BHR), lung function, fraction of exhaled nitric oxide (FENO), and allergy status differed between asthmatic and non-asthmatic elite athletes.Methods:Norwegian athletes qualifying for the Beijing Olympic Summer Games 2008 (n = 80) and the Vancouver Olympic Winter Games 2010 (n = 55) were included. The athletes underwent clinical respiratory examination including lung function measurement, methacholine bronchial challenge for assessment of BHR, FENO, and skin prick testing. Asthma was diagnosed based on respiratory symptoms and clinical examination including objective measurements.Results:Asthma was more prevalent among winter athletes (50%) than summer athletes (20%). Thirty-three (52%) endurance athletes, 3 (6%) team sport athletes, and 7 (33%) technical sport athletes had medically diagnosed asthma. Significantly lower lung function (p < 0.001) and higher prevalence of severe BHR (p < 0.001) were found in asthmatic athletes compared with non-asthmatic athletes.Conclusion:Asthma is common among Norwegian elite athletes, with winter and endurance athletes showing the highest prevalence. Asthmatic athletes were characterized by lower lung function and more severe BHR compared with non-asthmatic counterparts. The high prevalence among winter and endurance athletes demonstrates a need for increased attention to prevent and reduce the prevalence of asthma among those athletes.

Cardiorespiratory fitness (CRF) in children and adolescents, defined as peak oxygen uptake (V̇O2peak), is generally 7-15 % higher when measured on treadmill, compared to cycle ergometer. However, the difference is less pronounced in certain patient populations. No previous studies have examined the difference in CRF on treadmill and cycle ergometer in children and adolescent childhood cancer survivors (CCS). PURPOSE: To compare CRF on treadmill and cycle ergometer in children and adolescent CCS and in an age and gender-matched control group. METHODS: Sixteen CCS and 12 ostensibly healthy children and adolescents (age 11-18 yrs.) performed a maximal exercise test on a treadmill and a cycle ergometer using a modified Balke- and a modified Godfrey protocol, respectively. The tests were conducted in 2019-2020 with a minimum of 3 days and maximum of 14 days apart. V̇O2peak, peak ventilation and peak respiratory exchange ratio was measured using Oxycon Pro metabolic system using the breath by breath method. Maximal heart rate was measured using Polar V800 Sports watch. Borg scale was used to determine rate of perceived exertion. Wilcoxon singed-rank test was conducted to compare the difference between the groups. RESULTS: Significantly higher V̇O2peak was observed on treadmill versus cycle ergometer for both CSS (median (Mdn) 2.32 L·min− 1, interquartile range (IQR) 0.98 vs. Mdn 2.11 L·min− 1, IQR 1.05, p < 0.05) and the control group (Mdn 2.51 L·min− 1, IQR 1.55 vs. Mdn 2.46 L·min− 1, IQR 1.25, p < 0.05). No meaningful difference was observed for the remaining ventilation parameters, heart rate or Borg scale. The observed difference between the protocols did not vary between CCS and the control group. CONCLUSIONS: The observed difference in CRF between treadmill and cycle ergometer in CCS is comparable to the general population. This suggests that treadmill should be the preferred test modality in CCS to ensure that performance is limited by cardiovascular factors.

BackgroundSurvivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse.ObjectiveThe Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4).MethodsThe PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures.ResultsEthical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published.ConclusionsThe PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation.International Registered Report Identifier (IRRID)DERR1-10.2196/35838

Abstract Background Since cardiorespiratory fitness is an important predictor for all-cause mortality, it is of interest to know if meeting the physical activity (PA) recommendations is associated with higher levels of maximal oxygen uptake (VO2max). We aimed to investigate the association between total PA level given as counts per minute (cpm) and minutes in moderate-to-vigorous PA (MVPA), and VO2max in new fitness club members. Methods A total of 62 men and 63 women (≥ 18 years), defined as healthy (no disease considered to hinder PA) participated in this study. VO2max (mL kg−1 min−1) was measured with a cardiopulmonary exercise (modified Balke protocol), and total PA level was measured with ActiGraph GT1M for seven consecutive days. All participants accumulating ≥ 10 h of activity recordings ≥ 4 days were included in the data analysis. To examine associations between PA level and VO2max, a Pearson correlation and a multiple linear regression analysis adjusted for covariates were used. Results VO2max (mL kg−1 min−1) was 40.5 ± 7.2 in men and 35.1 ± 6.0 in women. Total PA level (cpm) and MVPA (min) were 352.4 ± 123.4 and 260.0 ± 132.6 in men and 361.4 ± 103.8 and 273.2 ± 137.0 in women. Total PA level (men: r = 0.346, p < 0.01, women: r = 0.267 p < 0.01) and MVPA (men: r = 0.359, p = < 0.01, women: r = 0.236, p = 0.03) was associated with VO2max. When adjusting for age and body fat percentage, total PA level and MVPA were no longer associated with VO2max (men: p = 0.11 and p = 0.79, women: p = 0.40 and p = 0.61). In men, age (β = − 0.469 p < 0.01) and body fat percentage (β = − 0.483, p < 0.01) were the strongest predictor for VO2max. For women, body fat percentage was the strongest predictor for VO2max (β = − 0.483, p < 0.01). Conclusions Total PA level and MVPA were associated with VO2max, but the association was low and diminished when adjusted for age and body fat percentage. Body fat percentage (men and women) and age (men) were more strongly associated with VO2max than total PA level and MVPA.

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