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.

Walking with poles (Nordic walking, NW) has become popular. We compared training responses of brisk walking (W) or NW on cardiorespiratory and neuromuscular fitness. We randomized 121 non-obese sedentary women (aged 50-60) to an NW or W group (NWG, WG), to train 40 min four times weekly for 13 weeks. Intensity was based on subjective perception of exertion. Cardiorespiratory performance was assessed in four levels corresponding to 50%, 65%, 80% and 100% of peak VO(2). Fifty-four NWG and 53 WG subjects completed the study. The mean intensity was about 50% of heart rate (HR) reserve. The baseline peak VO(2) was 25.8 (SD 3.9) mL/min/kg. Both groups improved peak VO(2) similarly (NWG 2.5 mL/min/kg, 95% confidence interval (CI) 1.9-3.3; WG 2.6, CI 1.9-3.3). In the submaximal stages while walking with or without poles, HR and lactate decreased after training in both groups, but the changes were not statistically significantly different between the groups. Of the neuromuscular tests after training, the only significant difference between the groups was in the leg strength in the one-leg squat, favoring WG. In conclusion, both training modes improved similarly health-enhancing physical fitness, and they were feasible and safe.

This study evaluated the ability to use the relationship between heart rate (HR) and oxygen uptake (VO2) to estimate energy expenditure during physical activity (AEE). General prediction equations were established based on the individual relations between HR and AEE. Forty-two women, (mean age 38.1 [SD 9.8] years, BMI 23.9 [SD 4.4]), and 45 men (40.3 [SD 9.2] years, BMI 24.7 [SD 2.9]), carried out two incremental tests, one with a cycle ergometer and another on a treadmill. Subjects also performed a 10 minute steady-state exercise, cycling and walking. Respiratory gases were obtained from indirect calorimetry. AEE was calculated from VO2 and carbon dioxide production (VCO2). The predicted AEE was compared with the AEE measured during the steady-state exercise. Using the generalised linear model, two alternative models were found to predict AEE and HR. The first showed a three-way interaction between HR, body weight and gender (p = 0.022) and also between HR age and gender (p=0.083). The second produced a three-way interaction between HR, body weight and gender (p=0.057). For cycling and walking, respectively, the predicted AEE overestimated the actual AEE by 17.7 (SD 23.2)% and 6.2 (SD 19.3)% in the first model and by 17.9 (SD 22.7)% and 6.6 (SD 19.8)% in the second during the steady-state exercise. It was concluded that at least gender and body weight should be included when HR is used to predict AEE.

The results show that simple factorial methods may assess ADEE with small random errors in population with a rather narrow range of physical activity. The accelerometer and HR with the higher FLEX-point have comparable results with smaller bias but larger random error compared with the factorial techniques.