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Concept: Paralympic Games

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Zika virus belongs to the genus Flavivirus of the family Flaviviridae; it is transmitted to humans primarily through the bite of an infected Aedes species mosquito (e.g., Ae. aegypti and Ae. albopictus) (1). Zika virus has been identified as a cause of congenital microcephaly and other serious brain defects (2). As of June 30, 2016, CDC had issued travel notices for 49 countries and U.S. territories across much of the Western hemisphere (3), including Brazil, where the 2016 Olympic and Paralympic Games (Games of the XXXI Olympiad, also known as Rio 2016; Games) will be hosted in Rio de Janeiro in August and September 2016. During the Games, mosquito-borne Zika virus transmission is expected to be low because August and September are winter months in Brazil, when cooler and drier weather typically reduces mosquito populations (4). CDC conducted a risk assessment to predict those countries susceptible to ongoing Zika virus transmission resulting from introduction by a single traveler to the Games. Whereas all countries are at risk for travel-associated importation of Zika virus, CDC estimated that 19 countries currently not reporting Zika outbreaks have the environmental conditions and population susceptibility to sustain mosquito-borne transmission of Zika virus if a case were imported from infection at the Games. For 15 of these 19 countries, travel to Rio de Janeiro during the Games is not estimated to increase substantially the level of risk above that incurred by the usual aviation travel baseline for these countries. The remaining four countries, Chad, Djibouti, Eritrea, and Yemen, are unique in that they do not have a substantial number of travelers to any country with local Zika virus transmission, except for anticipated travel to the Games. These four countries will be represented by a projected, combined total of 19 athletes (plus a projected delegation of about 60 persons), a tiny fraction of the 350,000-500,000 visitors expected at the Games.* Overall travel volume to the Games represents a very small fraction (<0.25%) of the total estimated 2015 travel volume to Zika-affected countries,(†) highlighting the unlikely scenario that Zika importation would be solely attributable to travel to the Games. To prevent Zika virus infection and its complications among athletes and visitors to the Games and importation of Zika virus into countries that could sustain local transmission, pregnant women should not travel to the Games, mosquito bites should be avoided while traveling and for 3 weeks after returning home, and measures should be taken to prevent sexual transmission (Box).

Concepts: Olympic Games, Aedes, Rio de Janeiro, Summer Olympic Games, 2016 Summer Olympics, Paralympic Games, Estádio do Maracanã, 2015

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Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.

Concepts: Medicine, Olympic Games, Management, Philosophy of science, Leadership, Paralympic Games, World Wheelchair and Amputee Games, Special Olympics World Games

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SUMMARY Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.

Concepts: Epidemiology, Olympic Games, London, Summer Olympic Games, Paralympic Games, World Wheelchair and Amputee Games, 2012 Summer Paralympics, Special Olympics World Games

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This case study examined body composition changes of a cerebral palsy (CP) athlete, in the 12 weeks prior to the London 2012 Paralympic Games. The aim was to monitor body composition of an athlete in preparation for the London Paralympic Games as part of the optimisation of performance. Within a 12 week period, body composition assessments were completed alongside an incremental 7×200 m swimming performance test, each separated by 6 weeks. One ISAK trained anthropometrist recorded body mass, sum of 8 skinfold thicknesses (biceps, triceps, subscapular, iliac crest, supraspinale, abdominal, front thigh and medial calf), girths (arm, waist, hips and calf), alongside calculations of mid upper arm muscle circumference (MUAMC). With the athlete’s non-affected side being the left side, additional measurements of arm and calf circumference, bicep and triceps skinfold and MUAMC were also assessed. Sum of 8 skinfolds fluctuated over weeks 1, 6 and 12 with 65.8 mm, 60.7 mm and 63.0 mm respectively. Arm circumference in the dominant left arm increased in the 12 week period 29.7 cm, 29.4 cm and 30.5 cm respectively, with the non-dominant right arm maintaining arm circumference over the same period. Performance in the final 200 m of the incremental performance test improved at each time point. 1.2% improvement in performance was noted between weeks 1 and 6 and a 2.1% improvement between weeks 6 and 12. A total performance improvement of 3.2% was noted from the start to end of the 12 week period. This case study highlights in a CP athlete, performance and body composition changes in the lead into major competition. There was little change in body composition but improvements in performance. This suggests that minimal body fat is not critical in CP swimming performance. However, the athlete maintained muscle mass which may suggest that functional mass is more an indicator of performance and provides a direction for future work.

Concepts: Muscle, Adipose tissue, Olympic Games, Biceps brachii muscle, Human anatomy, Paralympic Games, 2012 Summer Paralympics, International Paralympic Committee

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The use of technological aids to improve sport performance (‘techno doping’) and inclusion of Paralympic athletes in Olympic events are matters of ongoing debate. Recently, a long jumper with a below the knee amputation (BKA) achieved jump distances similar to world-class athletes without amputations, using a carbon fibre running-specific prosthesis (RSP). We show that athletes with BKA utilize a different, more effective take-off technique in the long jump, which provided the best athlete with BKA a performance advantage of at least 0.13 m compared to non-amputee athletes. A maximum speed constraint imposed by the use of RSPs would indicate a performance disadvantage for the long jump. We found slower maximum sprinting speeds in athletes with BKA, but did not find a difference in the overall vertical force from both legs of athletes with BKA compared to non-amputees. Slower speeds might originate from intrinsically lower sprinting abilities of athletes with BKA or from more complex adaptions in sprinting mechanics due to the biomechanical and morphological differences induced by RSPs. Our results suggest that due to different movement strategies, athletes with and without BKA should likely compete in separate categories for the long jump.

Concepts: Olympic Games, Difference, Amputation, Prosthesis, Speed, Paralympic Games, Carl Lewis, Jumpers

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The laboratory anti-doping services during XXII Winter Olympic and XI Paralympic Games in Sochi in 2014 were provided by a satellite laboratory facility. In total, 2134 urine and 479 blood samples were analyzed during Olympic Games (OG), and 403 urine and 108 blood samples-during Paralympic Games (PG). The number of erythropoietin tests requested in urine was 946 and 166 at the OG and PG, respectively. Several adverse analytical findings have been reported including pseudoephedrine (1), methylhexaneamine (4), trimetazidine (1), dehydrochloromethyltestosterone (1), clostebol (1), and a designer stimulant N-ethyl-1-phenylbutan-2-amine (1.).

Concepts: Olympic Games, Russia, Winter Olympic Games, Summer Olympic Games, Paralympic Games, World Wheelchair and Amputee Games, Special Olympics, 2014 Winter Olympics

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In the International Blind Sports Federation (IBSA) judo Sports Classes B1, B2, and B3 compete against each other within weight- and gender-specific categories. B1 athletes are totally blind, whereas B2 and B3 are partially sighted.

Concepts: Myopia, Visual impairment, Blindness, Low vision, Vision loss, Paralympic Games, British B class submarine, Judo

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As public health experts work to contain the outbreak of Zika virus in South America and minimize the devastating prenatal complications, the international sports community prepares for the 2016 Summer Olympic and Paralympic Games in Rio de Janeiro, Brazil. Athletes have publicly expressed concern regarding the health risks of competition in Zika-endemic areas.(33) Ensuring the safety of the athletes during training and competition is the primary role of the team physician. Special consideration is needed for sports teams preparing for travel to areas affected by Zika virus.

Concepts: Olympic Games, Brazil, São Paulo, South America, Rio de Janeiro, Summer Olympic Games, 2016 Summer Olympics, Paralympic Games

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London 2012 is the first Olympic and Paralympic Games to explicitly try and develop socioeconomic legacies for which success indicators are specified - the highest profile of which was to deliver a health legacy by getting two million more people more active by 2012. This editorial highlights how specialists in Sport and Exercise Medicine can contribute towards increasing physical activity participation in the UK, as well as how the National Centre for Sport and Exercise Medicine might be a useful vehicle for delivering an Olympic health legacy. Key challenges are also discussed such as acquisition of funding to support new physical activity initiatives, appropriate allocation of resources, and how to assess the impact of legacy initiatives.

Concepts: United Kingdom, Olympic Games, Weight loss, London, Summer Olympic Games, Paralympic Games, World Wheelchair and Amputee Games, Special Olympics World Games