The role of depression in early psychological rehabilitation in patients with CHD

Afin de mieux comprendre comment les sportifs de haut niveau perçoivent les tests visant à évaluer leurs performances physiques, qu'ils passent régulièrement durant leur pratique sportive, une enquête a été menée par autoquestionnaire auprès de 150 athlètes lorrains de haut niveau. Les questionnaires, comprenant 15 items, sont adressés et recueillis par correspondance. Le taux de retour est de 0,72. Un formulaire incomplet est exclu. La population étudiée consiste en 107 sujets, moyenne d'âge : 22,4 ± 5,3 ans, composée de 69 hommes et de 38 femmes. En moyenne, en 1995, chaque athlète a effectué 1,5 test d'évaluation de la performance, mais 27 % n'en ont pas bénéficié du tout. Ce sont significativement les plus jeunes qui passent ces tests (âge moyen : 20,4 ans; p < 0,01 ). Les structures d'accueil sont principalement le Creps (28,4 % des cas), le terrain (14,7 %) et le cabinet médical privé (12,8 %). L'objectif majeur de ces tests, cité par 46 % des athlètes, est la mesure de la consommation maximale d'oxygène et la détermination des seuils lactiques. Selon 50 % d'entre eux, ces épreuves n'ont eu aucune influence sur leur pratique sportive, surtout pour les plus âgés (p < 0,05) et ceux qui ont passé moins de deux tests dans l'année (p < 0,001). Neuf entretiens ont permis d'expliciter ce jugement, et ont abouti notamment aux conclusions suivantes : 1 ) les résultats obtenus lors de ces tests étaient ininterprétables ou non transposables au terrain; 2) malgré sa demande, l'athlète n'a pas obtenu, de la part de son encadrement ou de l'équipe médicale responsable de la passation des tests, d'explications susceptibles de le convaincre de l'intérêt des tests. Ces résultats interrogent sur l'utilité réelle des tests d'évaluation pour les athlètes de haut niveau ou, au minimum, sur la façon dont les responsables leur en présentent l'utilité.Objective: every day in France, hundreds of athletes undergo exercise testing, performed by physicians to evaluate their physical ability. For physicians and coaches, there is usually no doubt these tests are necessary for program training and, therefore, for performance improvement. The present survey documents high-level athletes' impressions of exercise testing. Experimental design: prospective study by a mailed self-reporting 15-item questionnaire, completed in nine interviews. Setting: elite athletes of the Lorraine region (eastern France). Participants: 150 French athletes, who all gave informed consent, and were involved in national or international level events. Response rate obtained was 72%. One questionnaire was omitted because of inappropriate responses on items designed to assess validity. Subject population consisted of 107 normal, healthy, elite athletes, ranging in age from 16 to 31 years (mean±SD, 22.4±5.3 years), including 69 males and 38 females. Sixty-four were students, 33 followed a trade and ten were unemployed. Measures: knowledge and impressions of exercise testing, based upon the athletes' own experience. Data analysis: questionnaires were coded and computeed. The data were analysed and compared by χ2 and analysis of variance. Statistical significant was accepted at P < 0.05. Results: in 1995, each athlete performed a mean of 1.5 tests (from zero to eight). Twenty-seven percent of the athletes reported having had no test at all. There is a significant difference between age (P < 0.01): young athletes (mean age: 20.4 year old) performed more than two tests, where older (mean age: 24.0 year old) athletes performed less than two (no difference between gender). The description they gave from the tests is rather poor. According to them, two main ergometers were used: cycle ergometer (43% of all answers) and travelling band (32%). The main purpose of the tests was maximum oxygen consumption measurement (quoted by 46% of all athletes), with maximum heart rate and blood lactate concentration. For many athletes, (50%) the tests they underwent had no influence on their practice, mainly due to: 1) inappropriate exercise testing with regard to sport practiced by the athlete; 2) uninterpretable data (or could not be used in training); 3) athlete not convinced the test was necessary; 4) unexperienced coach planned training without biological data. Statistical analysis shows a difference: older athletes (mean age: 22.3. P < 0.05) or those who performed less than two tests (P < 0.001) reported more frequently this point of view (no difference between gender). Ninety-six percents of all the subjects estimated that a physician has a part to play in an athletic team, mainly to help athletes enhance their physical performance (56% of all answers). Conclusions: challenges for the future: 1) better educate sports physicians, coaches and athletes about exercise testing; 2) physicians, who prescribe and/or who realise exercise testing, should provide more information to coaches and athletes concerning the practical aspects of tests (ie, data use), and therefore to the interest of exercise testing.