The good old hockey game
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* Eric Alan Cohen

Atwal and coauthors are to be congratulated for their study of the cardiovascular effects of adult recreational hockey.1 I could not help but notice, however, that the ubiquitous problem of ringers entered into their study.

For those who do not play adult hockey, a ringer is an ineligible (usually by virtue of age) but generally very skilled player. Unlike Little League baseball, where players (or their parents) may understate their age, in adult hockey the problem tends to be the opposite.

I was therefore somewhat bemused to notice that although the authors listed age greater than 35 years as an inclusion criteria, at least 15 of 113 study subjects were between 24 and 35 years (see Fig. 1). After reading the paper, one realizes that part of the value of an underage ringer is his higher maximum heart rate. Nonetheless, it is ironic that it appears to be just as difficult to keep some under-age adults out of an age- restricted study as it is to keep them off an age-restricted team. I'm sure Atwal and colleagues would find a sympathetic ear among convenors of adult hockey across the country. 

**Eric Alan Cohen** Cardiologist Sunnybrook & Women's College Health Sciences Centre University of Toronto Toronto, Ont.

## Reference

1.  1. Atwal S, Porter J, MacDonald P. Cardiovascular effects of strenuous exercise in adult recreational hockey: the Hockey Heart Study. CMAJ 2002; 166 (3):303-7. 
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjYvMy8zMDMiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTY2LzkvMTEzMS4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)