Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientifi c evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/ or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.

BackgroundImmersion pulmonary edema is potentially a catastrophic condition; however, the pathophysiological mechanisms are ill-defined. This study assessed the individual and combined effects of exertion and negative pressure breathing on the cardiovascular system during the development of pulmonary edema in SCUBA divers.MethodsSixteen male professional SCUBA divers performed four SCUBA dives in a freshwater pool at 1 m depth while breathing air at either a positive or negative pressure both at rest or with exercise. Echocardiography and lung ultrasound were used to assess the cardiovascular changes and lung comet score (a measure of interstitial pulmonary edema).ResultsThe ultrasound lung comet score was 0 following both the dives at rest regardless of breathing pressure. Following exercise, the mean comet score rose to 4.2 with positive pressure breathing and increased to 15.1 with negative pressure breathing. The development of interstitial pulmonary edema was significantly related to inferior vena cava diameter, right atrial area, tricuspid annular plane systolic excursion, right ventricular fractional area change, and pulmonary artery pressure. Exercise combined with negative pressure breathing induced the greatest changes in these cardiovascular indices and lung comet score.ConclusionsA diver using negative pressure breathing while exercising is at greatest risk of developing interstitial pulmonary edema. The development of immersion pulmonary edema is closely related to hemodynamic changes in the right but not the left ventricle. Our findings have important implications for divers and understanding the mechanisms of pulmonary edema in other clinical settings.

The effect of peripheral arterial disease on exercise intolerance in COPD seems to be considerable. Therefore, COPD patients participating in a pulmonary rehabilitation programme should profit from a systematic search for arterial disease. Arterial dysfunction has to be taken into account in the multidisciplinary treatment of these patients.

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The aim of this study was to evaluate the energy demands of sailing the new Neilpryde RS:X Ò Olympic windsurf board. Ten skilled male subjects performed an exhaustive incremental treadmill test to determine their maximal physiological parameters. Thereafter, four tests were performed in a randomised order using two wind conditions, light [2-4 ms -1 (4-8 knots)] and strong: [9-11 ms -1 (16-22 knots)]. Oxygen consumption ( _ VO 2 ; ml min -1 kg -1 ), blood lactate concentration ([la] b , mmol l -1 ), and time spent pumping (% total time) were recorded during 10 min of up-wind leg and during 6 min of down-wind leg.The results indicate that sailing on RS:X is associated with a high level of energy demand using both aerobic and anaerobic pathways whatever the wind conditions. During the down-wind leg, _ VO 2 (ml min -1 kg -1 ), [la] b (mmol l -1 ), and time spent pumping (% total time) values for the light and strong wind conditions were 56.5 ± 5.9 versus 55.5 ± 3.6; 10.2 ± 1.5 versus 9.6 ± 2.3, and 69 ± 5 versus 64 ± 2%, respectively. In contrast, during up-wind leg the same parameters for light and strong wind were 53.9 ± 4.5 versus 40.4 ± 7.2; 9.7 ± 2.8 versus 5.0 ± 2.7 and 66 ± 3 versus 37 ± 8%, respectively. During the up-wind leg with strong wind conditions, less time was spent pumping (p < 0.05), mean oxygen consumption values were close to 60% _ VO 2 max ; and post-exercise blood lactate was less than 50% maximal lactate concentration. These results could be related to the time spent in pumping action, involving whole body activity. When sailing with the RS:X board, the physiological demand seems to be higher than with the previous official Olympic windsurf board [Mistral One Design Ò (MOD)]. This difference could be mainly attributed to the specific biomechanical constraints induced by each board characteristic.