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PurposeTo determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions.MethodsFrom 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (Tcore; ingestible pill) and skin (Tskin; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (% personal best) and did not finish (DNF) were extracted from official results.ResultsPeak Tcore during competition reached 39.6°C±0.6°C (maximum 41.1°C). Tskin decreased from 32.2°C±1.3°C to 31.0°C±1.4°C during the races (p<0.001). Tcore was not related to DNF (25% of starters) or medical events (p≥0.150), whereas Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were (p≤0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9% of athletes) increasing the risk of in-race medical events (71% vs 17%, p<0.001). Athletes (63%) who performed 5–30 days heat acclimation before the competition: ranked better (18±13 vs 28±13, p=0.009), displayed a lower peak Tcore (39.4°C±0.4°C vs 39.8°C±0.7°C, p=0.044) and larger in-race decrease in Tskin (−1.4°C±1.0°C vs −0.9°C±1.2°C, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19% vs 30%, p=0.273) and medical events (19% vs 32%, p=0.179).ConclusionTskin, Tskin rate of decrease and Tcore-to-Tskin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events.

While athletes have high exposures to air pollutants due to their increased breathing rates, sport governing bodies have little guidance to support events scheduling or protect stadium users. A key limitation for this is the lack of hyper-local, high time-resolved air quality data representative of exposures in stadia. This work aimed to evaluate whether air quality sensors can describe ambient air quality in Athletics stadia. Sensing nodes were deployed in 6 stadia in major cities around the globe, monitoring NO2, O3, NO, PM10, PM2.5, PM1, CO, ambient temperature, and relative humidity. Results demonstrated that the interpretation of hourly pollutant patterns, in combination with self-organising maps (SOMs), enabled the interpretation of probable emission sources (e.g., vehicular traffic) and of atmospheric processes (e.g., local vs. regional O formation). The ratios between PM size fractions provided insights into potential emission sources (e.g., local dust re-suspension) which may help design mitigation strategies. The high resolution of the data facilitated identifying optimal periods of the day and year for scheduling athletic trainings and/or competitions. Provided that the necessary data quality checks are applied, sensors can support stadium operators in providing athlete communities with recommendations to minimise exposure and provide guidance for event scheduling.

Several International Federations (IFs) employ specific policies to protect athletes’ health from the danger of heat. Most policies rely on the measurement of thermal indices such as the Wet Bulb Globe Temperature (WBGT) to estimate the risk of heat-related illness. This review summarises the policies implemented by the 32 IFs of the 45 sports included in the Paris 2024 Olympic Games. It provides details into the venue type, measured parameters, used thermal indices, measurement procedures, mitigation strategies and specifies whether the policy is a recommendation or a requirement. Additionally, a categorisation of sports’ heat stress risk is proposed. Among the 15 sports identified as high, very high or extreme risk, one did not have a heat policy, three did not specify any parameter measurement, one relied on water temperature, two on air temperature and relative humidity, seven on WBGT (six measured on-site and one estimated) and one on the Heat Stress Index. However, indices currently used in sports have been developed for soldiers or workers and may not adequately reflect the thermal strain endured by athletes. Notably, they do not account for the athletes’ high metabolic heat production and their level of acclimation. It is, therefore, worthwhile listing the relevance of the thermal indices used by IFs to quantify the risk of heat stress, and in the near future, develop an index adapted to the specific needs of athletes.

ObjectivesPelvic floor dysfunction (PFD) symptoms are common among athletes but remain underexplored in youth of both sexes competing in track and field. The primary objective was to assess the prevalence of PFD. Secondary objectives evaluated symptoms impact, awareness of pelvic floor health, related behaviours and gynaecological health in females.MethodsThis observational, cross-sectional study was conducted during the Lima 2024 World Athletics U20 Championships. All athletes were eligible and invited to complete a multilingual, anonymous web-based survey assessing pelvic floor health.ResultsOf the 325 athletes who participated (59.1% females, 40.9% males), 43.7% (n=142) reported PFD symptoms. Prevalence was similar across daily life and athletics activities. Overactive bladder and pelvic pain were the most common conditions. Females had higher PFD rates (n=103, 53.7%) compared with males (n=39, 29.3%). Athletes with athletics-related urinary incontinence (n=42; 12.9%) reported frustration and reduced concentration during performance. Symptomatic athletes had low body mass index and reported more maladaptive pelvic floor-related behaviours than asymptomatic athletes (p<0.05). Menstrual issues and contraceptive use were more frequent among females with PFD (p<0.05). Fewer than 30% (n=95) were aware of pelvic floor health, and 88% (n=286) had never undergone screening. Most did not disclose symptoms (n=111; 78.2%) or seek specialised care (n=135; 95.1%).ConclusionsPFD was prevalent among elite youth athletes, particularly females. These findings highlight the need for proactive strategies, including education, embedding pelvic floor health in medical evaluations and addressing sex-specific needs to optimise athletes’ health throughout their careers.

Introduction World-wide, endurance races, including road races, trail races, cycling events, and triathlons, attract millions of participants each year. While these events promote health, fitness, and exercise, there exists significant risk for morbidity and mortality. The World Academy of Endurance Medicine (WAEM) created the Race Emergency Medicine Course (REMC) to train and certify race organizers and medical directors regarding planning and response for medical emergencies at endurance events. The course includes asynchronous e-learning modules, in person lectures, hands-on simulation sessions, and race-day observation. Methods 599 participants from 20 courses conducted in Europe, Asia, North and South America were surveyed. A 5-point Likert scale was utilized to assess participants’ impressions regarding the format, quality and effectiveness of the course. A paired t-test was utilized to evaluate participants’ self-assessments of their confidence in managing critical siutations both before and after participating in the course. Descriptive statistics were used to evaluate responses to open-ended questions. Results Participants rated the overall REMC 4.7 out of 5. Pre-course e-learning modules were rated 4.4 out of 5 while the lectures, hands-on sessions, and race-day observation activity scored 4.6 out of 5. Overall self-confidence in managing race-related critical situations increased from a mean score of 5.0 to 6.1 on a 7-point scale ( p  < 0.01). 73% of participants indicated that they plan to modify their practice based on what they learned. Conclusion The REMC is a valuable educational tool to promote medical care and safety at endurance events. Key points Mass participation endurance events pose significant medical risks, requiring well-prepared medical teams. Emergency medical response training for endurance events is key to ensure high-quality medical services and proper athletes' care. The proposed training combines e-learning with hands-on workshops and race-day simulations, offering a structured, evidence-based curriculum to enhance emergency preparedness.

PurposeTo characterise hydration, cooling, body mass loss, and core (Tcore) and skin (Tsk) temperatures during World Athletics Championships in hot-humid conditions.MethodsMarathon and race-walk (20 km and 50 km) athletes (n=83, 36 women) completed a pre-race questionnaire. Pre-race and post-race body weight (n=74), Tcore (n=56) and Tsk (n=49; thermography) were measured.ResultsMost athletes (93%) had a pre-planned drinking strategy (electrolytes (83%), carbohydrates (81%)) while ice slurry was less common (11%; p<0.001). More men than women relied on electrolytes and carbohydrates (91%–93% vs 67%–72%, p≤0.029). Drinking strategies were based on personal experience (91%) rather than external sources (p<0.001). Most athletes (80%) planned pre-cooling (ice vests (53%), cold towels (45%), neck collars (21%) and ice slurry (21%)) and/or mid-cooling (93%; head/face dousing (65%) and cold water ingestion (52%)). Menthol usage was negligible (1%–2%). Pre-race Tcore was lower in athletes using ice vests (37.5°C±0.4°C vs 37.8°C±0.3°C, p=0.024). Tcore (pre-race 37.7°C±0.3°C, post-race 39.6°C±0.6°C) was independent of event, ranking or performance (p≥0.225). Pre-race Tsk was correlated with faster race completion (r=0.32, p=0.046) and was higher in non-finishers (did not finish (DNF); 33.8°C±0.9°C vs 32.6°C±1.4°C, p=0.017). Body mass loss was higher in men than women (−2.8±1.5% vs −1.3±1.6%, p<0.001), although not associated with performance.ConclusionMost athletes’ hydration strategies were pre-planned based on personal experience. Ice vests were the most adopted pre-cooling strategy and the only one minimising Tcore, suggesting that event organisers should be cognisant of logistics (ie, freezers). Dehydration was moderate and unrelated to performance. Pre-race Tsk was related to performance and DNF, suggesting that Tsk modulation should be incorporated into pre-race strategies.

Endurance events are estimated to generate over US$3 billion/year in the USA alone.3 Taking the example of road running, 17.6 million people registered for road running events in the USA in 2019.4 Endurance sports, thanks to the competition format, allow elite and amateur athletes to compete together, attracting large crowds of participants (e.g. Henley Royal Regatta, Vasaloppet, Gran Fondos, International Triathlon Union World Championship Grand Final). [...]the cessation of endurance events represents a huge societal loss. [...]endurance events planners and stakeholders were added as an advisory working group, to provide perspective and support to the medical task force. The tool provides a macroscopic, multisport perspective taking into consideration local health and safety regulations, the individual event’s characteristics and the local community needs.

Purpose International Sports Federations (IF) are global governing bodies for each respective sport and their main duties are to organize international competitions, regulate and promote their sport. Despite their objective of promoting sports participation, their activity mostly focused on competitive/elite sports so far. International competitions not only represent the epitome of each sport but could also be used as an opportunity to improve the health of those living in the hosting city or the staff working for the local organising committee (LOC). The purpose of this pilot project was to measure the benefits of active commuting (AC) and leisure time physical activity (LTPA) of the staff involved in the World Athletics Championships Oregon22 during the two weeks of competition. Project description World Athletics partnered with StravaMetro□ to measure AC between official accommodation and competition venues, as well as the staff LTPA, during the Championships. Before the event, World Athletics staff was briefed on the project purposes and given information on AC options available in Eugene (pedestrian and cycling paths, bike rental). Staff members were encouraged to record their AC and LTPA through the Strava App. During the 2 weeks, a total of 18,656 walking/running trips (both AC and LTPA) were recorded in Eugene. This represents a 225.4% increase compared to the same period of the previous year. Furthermore, 2690 cycling commuting trips were recorded, representing a 143% increase. Conclusions This pilot project demonstrates that IF can efficiently use their main events to promote AC and LTPA to their staff and the workforce involved. Encouraging AC, improves the health of those active, reduces traffic related air pollution, road traffic, and transportation costs for the LOC. An upscaled approach adopted in the early phase of the event planning, involving spectators would amplify observed results and their health-related benefits. The post analysis by StravaMetro□ of the walking and cycling routes used by staff and spectators can also allow the host city to better define and create protected routes which represent a tangible legacy. These objectives require a strong collaboration between the IF, LOC, city government and the national institutions promoting AC and HEPA.

Elite athletes will compete in extreme heat more frequently as global land and sea temperatures increase, alongside more intense, frequent and longer duration heatwaves. Best practices to protect athlete health and performance during competition include heat acclimation/acclimatisation [(HA); i.e., long-term pre-competition preparation] complemented by pre-planned and practised cooling and hydration strategies (i.e., short-term interventions immediately before or during competition). This review explores elite athletes’ current behaviours and practices when preparing for competition in the heat and assesses the level of knowledge that has been exhibited by athletes and their practitioners in this space. Recommendations for future research, discussions of current best practices, and methods to improve translation of research into practice are provided. Available research focuses on small samples of elite endurance athletes during a selection of World Championship/Olympic/Paralympic events (~6% of competing athletes). While generally an increase in the adoption of evidence-based HA is seen chronologically from 2015 onwards, universal adoption is not seen. HA adoption is lowest in those who live/train in cold/temperate environments with cost and access to facilities/equipment being the most commonly reported barriers. Further research is required across the sporting landscape to fully characterise elite athlete behaviours and practices in these spaces. International federations and national governing bodies should continue their efforts to educate athletes and focus on regularly updated and reinvigorated release of evidence-based guidelines (in multiple germane languages) for competing in the heat, to increase the adoption of HA and other heat related best practice.