ABC | Volume 113, Nº3, September 2019

Special Article Oliveira Filho et al. Paralympics – addendum to the update on the guidelines for sport and exercise cardiology of the SBC and the SBMEE Arq Bras Cardiol. 2019; 113(3):339-344 1. Webborn N, Van de Vliet P. Paralympic medicine. Lancet. 2012;380(9836):65-71. 2. Thompson WR. The paralympic winter athlete. Clin J Sports Med. 2012 ; 22(1):1-2 3. McNamee MJ. Paralympism, Paralympic values and disability sport: a conceptual and ethical critique. Disabil Rehabil. 2017;39(2):201-9. 4. Burkett B. Paralympic Sports Medicine - Current evidence in winter sport: considerations in the development of equipment standards for paralympic athletes. Clin J Sports Med. 2012;22(1):46-50. 5. Wolbring G. Therapeutic bodily assistive devices and paralympic athlete expectations in winter sport. Clin J Sports Med. 2012;22(1):51-7. 6. GastaldiL,PastorelliS,Frassinelli S. A biomechanicalapproach toparalympic cross-country sit-ski racing. Clin J Sports Med. 2012;22(1):58-64. 7. Martin, Jeffrey. Mental preparation for the 2014Winter Paralympic Games. Clin J Sports Med. 2012;22(1):70-3. 8. Oliveira Filho JA. O Atleta paraolímpico. In: Ghorayeb N, Dioguardi GS. Tratado de cardiologia do exercício e do esporte. São Paulo: Atheneu; 2007. 9. Vital R, Silva Hesojy GP. As lesões traumato-ortopédicas. In: MelloMT (ed). Avaliação clínica e da aptidão física dos atletas paraolimpícos brasileiros: conceitos, métodos, resultados. São Paulo: Atheneu; 2004. 10. Khalili MA. Quantitative sports and functional classification (QSFC) for disabled people with spasticity. Br J Sports Med. 2004;38(3):310-3. 11. Oliveira Filho JA, Silva AC, Lira Filho E, Luna Filho B, Covre SH, Lauro FA, et al. Coração de Atleta emDesportistas Deficientes de Elite. Arq Bras Cardiol. 1997;69(6):385-8. 12. Leitão MB. Perfil eletrocardiográfico dos atletas integrantes da equipe brasileira dos XI Jogos Paraolímpicos de Sydney 2000. Rev BrasMed Esporte. 2002;8(3): 102-6. 13. Oliveira Filho JA, Luna Filho B, Covre SH, Lira Filho E, Regazzini M, Greco J, et al. Signal averaged electrocardiogram in top deficient athletes. Arq Bras Cardiol. 1999;72(6):687-92. 14. Oliveira JA, Salvetti XM, Lira EB, MelloMT, Silva AC, Luna B. Athlete’s heart, oxygenuptakeandmorphologic findings inparalympicathletes. Int JCardiol. 2007;121(1):100-1. 15. Oliveira Filho JA, Monteiro MB, Salles AF, Campos Filho O. Paralímpicos judiocas e coração de atleta. Rev DERC. 2015;21(1):15. 16. Shapiro DR, Malone LA. Quality of life and psychological affect related to sport participation in children and youth athletes with physical disabilities: A parent and athlete perspective. Disabil Health J. 2016;9(3):385-91. 17. Silva AC, Torres FC. Ergoespirometria em atletas paraolímpicos brasileiros. Rev Bras Med Esporte. 2002;8(3):107-16. References Table 4 – Recommendations for attending Paralympic athletes (class of recommendation: I, level of evidence: C) 1. All Paralympic athletes should undergo evaluation, regardless of age, sex, and associated disability. 2. Pre-participation evaluation should include male and female children, adolescents, adults, and elderly athletes, and it should be the sole responsibility of the attending physician. 3. Re-evaluation frequency should be at the discretion of the attending physician, in accordance with each case’s characteristics; the primary aim of re-evaluation frequency should be safe athletic practice. 4. Evaluations should follow the protocol of the International Paralympic Committee, and they should by specific for each athletic activity and individualized for each athlete. 5. Clinical and cardiological evaluations should be coordinated and carried out by physicians; physical education instructors, physical therapists, physiologists, nutritionists, and psychologists should participate in evaluation, and the integration of physicians and other healthcare professionals is of great value. 6. Clinical evaluation should include all parts and systems of the organism, and it should be performed by a multi-professional team involving diverse medical specialties. 7. Cardiovascular evaluation follows the same general eligibility criteria for athletes without disabilities. 8. Pharmacological prescriptions should always be guided by the WADA’s latest policies, which are periodically updated. WADA: World Anti-Doping Agency competition. 28 For the purpose of obtaining rapid elevations in blood pressure, some athletes who use wheelchairs might induce a state of autonomic dysreflexia, a reflex which occurs in the lower part of the body. 29 Boosting leads to an increase in circulating catecholamines, blood pressure, and heart rate, and it leads to a 9.7% improvement in racing time for 7% to 10% of athletes. 30 The practice of boosting, however, exposes athletes to serious risks during competitions, and it is officially banned by the International Paralympic Committee. 30 In order to obtain a rapid increase in blood pressure athletes who use wheelchairs have been reported to provoke a state of autonomic dysreflexia by exposing the lower part of the body to painful stimuli, which include keeping one’s bladder full, tying belts or straps around one’s legs, sitting on pointed objects, sitting on one’s own scrotum, closing one’s catheter tube in order to fill the bladder, bending one’s feet in the wheelchair, and provoking the fracture of toes. 29 Only Paralympic athletes with high-level spinal cord injuries may experience episodes of autonomic dysreflexia. 31 During medical care, special attention should be paid to musculoskeletal injuries, which accounted for 44.6% of 2,590 accreditedmedical encounters. 32 Considering anymusculoskeletal complaint which led athletes to seek medical attention, the occurrence of sports injuries during theWinter Paralympic Games was 9.4% in2002, 8.4% in2006, and24% in2010. This proportion was similar in men (22.8%) and women (26.6%). 33 343