Showing papers in "Sports Medicine in 1996"

Circadian variation in sports performance.

Abstract: Chronobiology is the science concerned with investigations of time-dependent changes in physiological variables. Circadian rhythms refer to variations that recur every 24 hours. Many physiological circadian rhythms at rest are endogenously controlled, and persist when an individual is isolated from environmental fluctuations. Unlike physiological variables, human performance cannot be monitored continuously in order to describe circadian rhythmicity. Experimental studies of the effect of circadian rhythms on performance need to be carefully designed in order to control for serial fatigue effects and to minimise disturbances in sleep. The detection of rhythmicity in performance variables is also highly influenced by the degree of test-retest repeatability of the measuring equipment. The majority of components of sports performance, e.g. flexibility, muscle strength, short term high power output, vary with time of day in a sinusoidal manner and peak in the early evening close to the daily maximum in body temperature. Psychological tests of short term memory, heart rate-based tests of physical fitness, and prolonged submaximal exercise performance carried out in hot conditions show peak times in the morning. Heart rate-based tests of work capacity appear to peak in the morning because the heart rate responses to exercise are minimal at this time of day. Post-lunch declines are evident with performance variables such as muscle strength, especially if measured frequently enough and sequentially within a 24-hour period to cause fatigue in individuals. More research work is needed to ascertain whether performance in tasks demanding fine motor control varies with time of day. Metabolic and respiratory rhythms are flattened when exercise becomes strenuous whilst the body temperature rhythm persists during maximal exercise. Higher work-rates are selected spontaneously in the early evening. At present, it is not known whether time of day influences the responses of a set training regimen (one in which the training stimulus does not vary with time of day) for endurance, strength, or the learning of motor skills. The normal circadian rhythms can be desynchronised following a flight across several time zones or a transfer to nocturnal work shifts. Although athletes show all the symptoms of 'jet lag' (increased fatigue, disturbed sleep and circadian rhythms), more research work is needed to identify the effects of transmeridian travel on the actual performances of elite sports competitors. Such investigations would need to be chronobiological, i.e. monitor performance at several times on several post-flight days, and take into account direction of travel, time of day of competition and the various performance components involved in a particular sport. Shiftwork interferes with participation in competitive sport, although there may be greater opportunities for shiftworkers to train in the hours of daylight for individual sports such as cycling and swimming. Studies should be conducted to ascertain whether shiftwork-mediated rhythm disturbances affect sports performance. Individual differences in performance rhythms are small but significant. Circadian rhythms are larger in amplitude in physically fit individuals than sedentary individuals. Athletes over 50 years of age tend to be higher in 'morningness', habitually scheduling relatively more training in the morning and selecting relatively higher work-rates during exercise compared with young athletes. These differences should be recognised by practitioners concerned with organising the habitual regimens of athletes.

Biomechanics of Overhand Throwing with Implications for Injuries

Abstract: Proper throwing mechanics may enable an athlete to achieve maximum performance with minimum chance of injury. While quantifiable differences do exist in proper mechanics for various sports, certain similarities are found in all overhand throws. One essential property is the utilisation of a kinetic chain to generate and transfer energy from the larger body parts to the smaller, more injury-prone upper extremity. This kinetic chain in throwing includes the following sequence of motions: stride, pelvis rotation, upper torso rotation, elbow extension, shoulder internal rotation and wrist flexion. As each joint rotates forward, the subsequent joint completes its rotation back into a cocked position, allowing the connecting segments and musculature to be stretched and eccentrically loaded. Most notable is the external rotation of the shoulder, which reaches a maximum value of approximately 180 degrees. This biomechanical measurement is a combination of true glenohumeral rotation, trunk hyperextension and scapulothoracic motion. Near the time of maximum shoulder external rotation (ERmax), shoulder and elbow musculature eccentrically contract to produce shoulder internal rotation torque and elbow varus torque. Both the shoulder and the elbow are susceptible to injury at this position. At ball release, significant energy and momentum have been transferred to the ball and throwing arm. After ball release, a kinetic chain is used to decelerate the rapidly moving arm with the entire body. Shoulder and elbow muscles produce large compressive forces to resist joint distraction. Both joints are susceptible to injury during arm deceleration.

Biomechanics and Running Economy

Abstract: Running economy, which has traditionally been measured as the oxygen cost of running at a given velocity, has been accepted as the physiological criterion for 'efficient' performance and has been identified as a critical element of overall distance running performance. There is an intuitive link between running mechanics and energy cost of running, but research to date has not established a clear mechanical profile of an economic runner. It appears that through training, individuals are able to integrate and accommodate their own unique combination of dimensions and mechanical characteristics so that they arrive at a running motion which is most economical for them. Information in the literature suggests that biomechanical factors are likely to contribute to better economy in any runner. A variety of anthropometric dimensions could influence biomechanical effectiveness. These include: average or slightly smaller than average height for men and slightly greater than average height for women; high ponderal index and ectomorphic or ectomesomorphic physique; low percentage body fat; leg morphology which distributes mass closer to the hip joint; narrow pelvis and smaller than average feet. Gait patterns, kinematics and the kinetics of running may also be related to running economy. These factors include: stride length which is freely chosen over considerable running time; low vertical oscillation of body centre of mass; more acute knee angle during swing; less range of motion but greater angular velocity of plantar flexion during toe-off; arm motion of smaller amplitude; low peak ground reaction forces; faster rotation of shoulders in the transverse plane; greater angular excursion of the hips and shoulders about the polar axis in the transverse plane; and effective exploitation of stored elastic energy. Other factors which may improve running economy are: lightweight but well-cushioned shoes; more comprehensive training history; and the running surface of intermediate compliance. At the developmental level, this information might be useful in identifying athletes with favourable characteristics for economical distance running. At higher levels of competition, it is likely that 'natural selection' tends to eliminate athletes who failed to either inherit or develop characteristics which favour economy.

Significance of the Velocity at V̇O2max and Time to Exhaustion at this Velocity

Abstract: In 1923, Hill and Lupton pointed out that for Hill himself, ‘the rate of oxygen intake due to exercise increases as speed increases, reaching a maximum for the speeds beyond about 256 m/min. At this particular speed, for which no further increases in O2 intake can occur, the heart, lungs, circulation, and the diffusion of oxygen to the active muscle-fibres have attained their maximum activity. At higher speeds the requirement of the body for oxygen is far higher but cannot be satisfied, and the oxygen debt continuously increases’.

Exercise testing and prescription : Practical recommendations for the sedentary

Abstract: A sedentary lifestyle is prevalent in most industrialised societies. Persuasive evidence allows us to demonstrate that a physically active lifestyle protects against the development and progression of many chronic diseases. The assessment of sedentary individuals for the purpose of exercise testing and or exercise prescription should always culminate in the determination of the relative risk of the individual for traumatic events which may be precipitated by participation in moderate physical activity. Sedentary individuals may be categorised in a low to high risk stratification as apparently healthy (Class I), higher risk (Class II), or known coronary heart disease and/or symptomatic of chronic disease (Class III). An expanded role for allied health professionals, such as a clinical exercise physiologist, may enhance and extend the services of physicians and nurses as they relate to exercise testing, exercise prescription and preventative healthcare in general. Risk stratification will determine the type of exercise test, the exercise prescription and the exercise environment (low to high levels of supervision). The exercise prescription may include a determination of mode, duration, frequency, intensity, and progression of activity. Although target heart rate remains one of the most effective instruments for monitoring exercise intensity, the rate of perceived exertion should be incorporated especially in the titration of exercise prescriptions for those on beta-blockade therapy. Finally the benefits of an exercise programme, derived from a foundation of proper assessment, are numerous and include improvements in cardiovascular fitness, body composition, blood lipid profile and retention of essential muscle mass during the course of the life-cycle. A considerable public health benefit will result if sedentary individuals become regularly more physically active.

The role of antioxidant vitamins and enzymes in the prevention of exercise-induced muscle damage.

Abstract: A growing amount of evidence indicates that free radicals play an important role as mediators of skeletal muscle damage and inflammation after strenuous exercise. It has been postulated that the generation of oxygen free radicals is increased during exercise as a result of increases in mitochondrial oxygen consumption and electron transport flux, inducing lipid peroxidation. The literature suggests that dietary antioxidants are able to detoxify the peroxides produced during exercise, which could otherwise result in lipid peroxidation, and that they are capable of scavenging peroxyl radicals and therefore may prevent muscle damage. Endogenous antioxidant enzymes also play a protective role in the process of lipid peroxidation. The studies reviewed (rodent and human) show significant increases of malondialdehyde (a product of lipid peroxidation) after exercise to exhaustion, and also favourable changes in plasma antioxidant levels and in antioxidant enzyme activity. In trained individuals and trained rats, the antioxidant enzyme activity increases markedly. In this way, the increased oxidative stress induced by exercise is compromised by increased antioxidant activity, preventing lipid peroxidation. Human studies have shown that dietary supplementation with antioxidant vitamins has favourable effects on lipid peroxidation after exercise. Although several points of discussion still exist, the question whether antioxidant vitamins and antioxidant enzymes play a protective role in exercise-induced muscle damage can be answered affirmatively. The human studies reviewed indicate that antioxidant vitamin supplementation can be recommended to individuals performing regular heavy exercise. Moreover, trained individuals have an advantage compared with untrained individuals, as training results in increased activity of several major antioxidant enzymes and overall antioxidant status. However, future studies are needed in order to be able to give more specific information and recommendations on this topic.

Use of Blood Lactate Measurements for Prediction of Exercise Performance and for Control of Training Recommendations for Long-Distance Running

Abstract: Time over a distance, i.e. speed, is the reference for performance for all events whose rules are based on locomotion in different mechanical constraints. A certain power output has to be maintained during a distance or over time. The energy requirements and metabolic support for optimal performance are functions of the length of the race and the intensity at which it is completed. However, despite the complexity of the regulation of lactate metabolism, blood lactate measurements can be used by coaches for prediction of exercise performance. The anaerobic threshold, commonly defined as the exercise intensity, speed or fraction of maximal oxygen uptake (VO2max) at a fixed blood lactate level or at a maximal lactate steady-state (MLSS), has been accepted as a measure of the endurance. The blood lactate threshold, expressed as a fraction of the velocity associated with VO2max, depends on the relationship between velocity and oxygen uptake (VO2). The measurement of the post-competition blood lactate in short events (lasting 1 to 2 minutes) has been found to be related to the performance in events (400 to 800m in running). Blood lactate levels can be used to assist with determining training exercise intensity. However, to interpret the training effect on the blood lactate profile, the athlete’s nutritional state and exercise protocol have also to be controlled. Moreover, improvement of fractional utilisation of VO2max at the MLSS has to be considered among all discriminating factors of the performance, such as the velocity associated with VO2max.

The Use of Isometric Tests of Muscular Function in Athletic Assessment

Abstract: Isometric assessment of muscular function is a popular form of testing which has been used in exercise science for over 40 years. It typically involves a maximal voluntary contraction performed at a specified joint angle against an unyielding resistance which is in series with a strain gauge, cable tensiometer, force platform or similar device whose transducer measures the applied force. Often both the maximum force and the rate of force development are recorded. These tests have generally shown high reliability in both single and multi-joint test protocols, although the maximum force is typically more reliable than rate of force development. This review outlines the reliability of isometric assessment and discusses a number of methodological considerations designed to enhance reliability and validity, including standardisation procedures, type of instructions, muscular pre-tension, testing position and joint angle. Currently, there appears to be considerable controversy as to the external validity of isometric assessment, particularly the ability of the tests to monitor changes in dynamic performance and their relationship to such performances. Indeed, a number of studies have recently shown that dynamic assessment modalities (isokinetic and isoinertial) are superior in terms of their relationship to dynamic performance and ability to discriminate between athletes of various performance levels compared with isometric assessment. This article reviews the use of isometric assessment in exercise science and consequently outlines a number of neural, mechanical and methodological factors which may have contributed to the contrasting research, and which may limit the ability of isometric assessment to relate to dynamic movement. Because of the large neural and mechanical differences between isometric and dynamic muscular actions, athletic assessment, which is dynamic in its nature, is generally most appropriately accomplished using dynamic muscular assessment methods, and in most instances isometric testing should be avoided.

The effects of acute and chronic exercise on sleep. A meta-analytic review.

Abstract: Studies attempting to ascertain the effects of acute and chronic exercise on measures of sleep have yielded conflicting results and interpretations. Methodological differences among studies may explain this lack of consensus; however, small sample sizes and subsequently low statistical power may also have contributed. In an attempt to resolve these issues, this review used meta-analytical techniques to: (a) re-examine the effects of exercise on sleep; and (b) examine possible moderators of these effects. Studies meeting the selection criteria were included in the analysis. Analyses of moderating factors were performed for stage 4 sleep and rapid eye movement (REM) sleep. The results indicated that acute and chronic exercise increased slow wave sleep (SWS) and total sleep time but decreased sleep onset latency and REM sleep. Moderating variables influencing the magnitude and direction of these effects were related to characteristics of the individual (e.g. sex, age, fitness level) and the exercise (e.g. time of day exercise was completed, type of exercise, exercise duration). Mechanisms which have been suggested to explain the relationship between exercise and sleep are discussed and directions for further research are provided.

The Effectiveness of Resistance Training in Children: A Meta-analysis

Abstract: Many recent studies have reported that resistance training can be effective in producing strength gains among prepubescents. These studies appear to refute the early claims of ineffectiveness of resistance training in children. A meta-analysis procedure combines the results of individual empirical studies and estimates a standardised effect, termed effect size. This effect size is based on the scores of the control and experimental groups before and after training. It defines the difference between the gain of the experimental and control groups, divided by the standard deviation of the pooled variances of both groups. A literature search revealed 28 studies which described a resistance training programme for girls and boys under the age of 12 and 13 years, respectively. Presumably, these children were pre- or early-pubescents. However, only 9 of these studies provided the necessary data to calculate the effect size and could be included in the analysis. The majority of the studies showed a gain in strength between 13 and 30%. The overall mean effect size was found to be 0.57. This signifies that following training, the average child in the resistance training group was above 71.6% of the children in the control group. The effectiveness of resistance training can be influenced by factors such as age and maturation, gender, as well as the frequency, duration and intensity of the training programme. The studies included in the analysis examined participants of varying ages and did not demonstrate a clear influence of age. Most studies examined only boys or a mixed group of boys and girls. Therefore, the influence of gender on the effectiveness of resistance training in prepubescents cannot yet be determined. Nevertheless, in the few studies where boys and girls were examined separately, no difference was found in the effect of resistance training between genders. It appears that a training frequency of twice per week is sufficient to induce strength gains in children. However, the minimal, or for that matter optimal, duration and intensity are not clear. Some of the weaknesses observed in the reviewed studies include: (i) the lack of control for a possible learning effect; (ii) non-randomisation into the training and control groups; (iii) no report of adherence rate; (iv) a reliance on boys as study participants; and (v) too little information on the type, volume and intensity of training. Future studies should take these weaknesses into consideration.

The Utility of Isokinetic Dynamometry in the Assessment of Human Muscle Function

Abstract: Isokinetic dynamometry has become a favoured method for the assessment of dynamic muscle function in both clinical research and sports environments. Several indices, such as peak torque, are used in the literature to characterise individual, group or larger population performance via these sophisticated data acquisition systems. Research suggests that there are several competing demands on the design of the measurement protocol which may affect the measurement of isokinetic strength and subsequent suitability of data for meaningful evaluation and interpretation. There is a need to increase measurement rigour, reliability and sensitivity to a level which is commensurate with the intended application, via more elaborate multiple-trial protocols. However, this may be confounded by logistical and financial constraints or reduced individual compliance. The net effect of the interaction of such demands may be considered to be the utility of the isokinetic dynamometry protocol. Of the factors which impinge on utility, those which relate to reliability afford the most control by the test administrator. Research data suggest that in many measurement applications, the reliability and sensitivity associated with all frequently-used indices of isokinetic leg strength which are estimated via single-trial protocols, are not sufficient to differentiate either performance change within the same individual or between individuals within a homogeneous group. While such limitation may be addressed by the use of protocols based on 3 to 4 inter-day trials for the index of peak torque, other indices which demonstrate reduced reliability, for example the composite index of the ratio of knee flexion to extension peak torque, may require many more replicates to achieve the same level of sensitivity. Here, the measurement utility of the index may not be sufficient to justify its proper deployment.

Effects of Exercise on Blood Coagulation, Fibrinolysis and Platelet Aggregation

Abstract: Disturbances of the haemostatic balance may result in thrombosis or bleeding tendency. There have been abundant reports on the effects of exercise on blood haemostasis, but the results reported have been conflicting and difficult to interpret. This review outlines and critically evaluates the relevant literature on the effects of short term exercise and physical training on the 3 systems of blood haemostasis i.e. blood coagulation, fibrinolysis and platelet aggregation. Short term exercise is usually associated with a significant shortening of activated partial thromboplastin time (APTT) and a marked increase in factor VIII (FVIII). The rise in FVIII is directly related to exercise intensity and the individuals' training status. Exercise also induces a significant increase in blood fibrinolysis which is dependent on exercise intensity, duration and training condition. The rise in blood fibrinolysis is mainly due to an increase in tissue-type plasminogen activator (t-PA) and a decrease in its main inhibitor plasminogen activator inhibitor (PAI-1) which are released from the endothelial cells of the vessel wall. Platelet count increases in exercise and this is probably due to a fresh release of platelets from the spleen, bone marrow and lungs. Studies on the effects of exercise on platelet aggregation and markers of platelet activation have produced conflicting results, and the exact effects of exercise remain as yet undetermined. It is suggested that short term exercise activates blood coagulation and enhances blood fibrinolysis and the delicate balance between clot formation and clot dissolution is maintained in normal populations. No valid conclusion could be reached regarding the actual effects of physical training on blood coagulation, fibrinolysis and platelet aggregation. This is undoubtedly due to variations in training programmes employed, populations studied, and the analytical methods used.

The emerging role of glutamine as an indicator of exercise stress and overtraining

Abstract: Glutamine is an amino acid essential for many important homeostatic functions and for the optimal functioning of a number of tissues in the body, particularly the immune system and the gut. However, during various catabolic states, such as infection, surgery, trauma and acidosis, glutamine homeostasis is placed under stress, and glutamine reserves, particularly in the skeletal muscle, are depleted. With regard to glutamine metabolism, exercise stress may be viewed in a similar light to other catabolic stresses. Plasma glutamine responses to both prolonged and high intensity exercise are characterised by increased levels during exercise followed by significant decreases during the post-exercise recovery period, with several hours of recovery required for restoration of pre-exercise levels, depending on the intensity and duration of exercise. If recovery between exercise bouts is inadequate, the acute effects of exercise on plasma glutamine level may be cumulative, since overload training has been shown to result in low plasma glutamine levels requiring prolonged recovery. Athletes suffering from the overtraining syndrome (OTS) appear to maintain low plasma glutamine levels for months or years. All these observations have important implications for organ functions in these athletes, particularly with regard to the gut and the cells of the immune system, which may be adversely affected. In conclusion, if methodological issues are carefully considered, plasma glutamine level may be useful as an indicator of an overtrained state.

Physical and Physiological Factors Associated with Success in the Triathlon

Abstract: The physiological demands of sequential exercise in swimming, cycling and running are unique and require the triathlete to develop physical and physiological characteristics that are a blend of those seen in endurance swimming, cycling and running specialists. Elite triathletes are generally tall, of average to light weight and have low levels of body fat, a physique which provides the advantages of large leverage and an optimal power to surface area or weight ratio. Triathletes have high maximum oxygen uptake (VO2max) values, but VO2max may be on average marginally lower than values previously observed in endurance specialists. Although VO2max is a predictor of performance in triathletes of mixed abilities, it cannot be used to predict performance within homogenous groups of elite performers. Nevertheless, elite triathletes have significantly higher VO2max values than sub-elite triathletes and high VO2max levels are required for success in triathlons. The ability of the triathlete to exercise at a lower percentage of VO2max for a given submaximal workload may be especially important to triathlon success. This is influenced not only by VO2max itself, but also by anaerobic threshold and economy of movement. Anaerobic threshold, as indicated by either ventilatory threshold or lactate threshold, improves with triathlon training and when measured in the appropriate exercise mode has been related to swim, cycle and run performance in the triathlon. Economy of movement in swimming, cycling and running is also related to triathlon performance, and swimming economy in particular appears to be an area where triathletes could make large improvements. Future research should utilise experimental methodologies to investigate triathlon physiology, in particular, the influence of sequential exercise in different exercise modes on physiological function and examine the influence of different training interventions on triathlon physiology and performance.

Benefits of aerobic exercise after stroke.

Abstract: The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (VO2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

Psychological and behavioural effects of endogenous testosterone and anabolic-androgenic steroids. An update.

Abstract: Endogenous testosterone levels have been linked to aggressive behaviour in both animals and humans. Studies administering moderate doses of exogenous testosterone for contraceptive and clinical purposes reveal essentially no adverse effects on male sexual and aggressive behaviour. However, investigations and case reports of athletes, usually involving higher doses, demonstrate an association between anabolic-androgenic steroid use and affective and psychotic syndromes and psychological dependence. Efforts to study the psychological and behavioural effects of anabolic-androgenic steroids are complicated by a variety of methodological limitations. Only 3 prospective, blinded studies demonstrating aggression or adverse overt behaviour resulting from anabolic-androgenic steroid use have been reported. With estimates of over 1 million past or current users in the US, an extremely small percentage of individuals using anabolic-androgenic steroids appear to experience mental disturbances severe enough to result in clinical treatment and medical case reports. Even among those so affected, the roles of previous psychiatric history, genetic susceptibility to addictions or mental disorders, environmental and peer influences, and individual expectations remain unclear.

Biomechanical Factors Critical for Performance in the Men’s Javelin Throw

Abstract: In the men’s javelin event the athlete throws an 800g implement into a 40° sector. The objective is to throw as far as possible. Compared with most other throwing implements, the javelin is relatively aerodynamic. Even so, the most important release parameter is still the release speed. Maximising this parameter gives the athlete the best chance of attaining success in the event.

The use of ratings of perceived exertion for exercise prescription in patients receiving beta-blocker therapy.

Abstract: The ratings of perceived exertion (RPE) scale has received widespread acceptance for gaining a subjective estimate of work intensity and as a means of monitoring and regulating exercise intensity across a variety of populations. The original premise for the use of the scale was its high correlation with heart rate (HR). Although individual correlations between HR and RPE in individuals on beta-blocker therapy are probably as high as in untreated individuals, there is evidence to suggest that the RPE response is mediated at a given work rate, particularly at higher absolute work rates. The variation in the RPE response appears to be mediated by the type of beta-blocker therapy administered. In the interests of safety it is necessary for the exercise specialist to develop at least a basic understanding of the mechanism and effects of beta-blocker therapy as they relate to exercise prescription. beta-Blocking drugs cause a decrease in HR and cardiac output at rest and during exercise, a decrease in myocardial contractility and a decrease in coronary and muscle blood flow. These effects can initiate premature fatigue and apprehension in the exercising patient. In the light of these responses, the RPE scale provides important information and may be used to increase the accuracy of monitoring and the prescription of exercise intensity in the cardiac population. While results regarding the use and accuracy of the scale during beta-blocker treatment are equivocal, this appears to be due mainly to variations in dosage of the drug, the mode, intensity and duration of exercise and the health status of the individuals used. Overall, the RPE scale appears to be an appropriate monitoring tool, particularly when it is used after a learning period. It is concluded that nonselective beta-blockade therapy increases RPE, particularly localised RPE. This could be attributed to a decreased blood flow and oxygen delivery to the muscle and altered glycolytic metabolism, which increases local muscle fatigue. There is no evidence to suggest a decrease in the total level of oxygen consumption at given work rates. However, as beta-blocker therapy reduces the maximal oxygen consumption (VO2max) attainable, this serves to increase the exercise intensity at all work rates. Thus, for a given absolute work rate, the RPE response is higher. However, when the work rate is expressed as a proportion of the VO2max attainable during beta-blockade, the differences in RPE are minimised or disappear. Although the evidence is not conclusive, it appears that cardioselective beta-blocker therapy does not have such profound effects on the RPE response, compared with nonselective beta-blocker therapy, when this is expressed as a proportion of VO2max. However, localised RPE tends to be higher for nonselective beta-blocker therapy. Thus, the evidence indicates that RPE can be used to estimate exercise intensity, provided the specific effects of the type of beta-blocker therapy on local and central fatigue (and local and central RPE) are taken into account. Studies which have examined the effects of an endurance training programme during beta-blocker therapy have shown that RPE are decreased at given work rates after training. This has been observed for cardioselective and nonselective beta-blocker therapy, and local and central RPE. There is also some evidence to suggest that the RPE can be used as the controlling variable to regulate the exercise response. Patients on cardioselective beta-blocker therapy produce similar exercise intensities to other cardiac patients who are not receiving beta-blocker treatment.

Effects of Exercise Training on Abdominal Obesity and Related Metabolic Complications

Abstract: Excessive deposition of visceral adipose tissue is known to predispose to cardiovascular diseases. Considerable epidemiological and experimental evidence suggests that many physiological factors are involved in the aetiology of premature atherosclerosis associated with visceral obesity. Insulin resistance is frequently associated with abdominal obesity, and probably plays an important role in the pathophysiology of hypertriglyceridaemia, low levels of plasma high-density lipoprotein (HDL)-cholesterol, hypertension and reduced fibrinolytic activity. Exercise training may counteract the aberrant metabolic profile associated with abdominal obesity both directly and as a consequence of body fat loss. Exercise may increase insulin sensitivity, favourably alter the plasma lipoprotein profile and improve fibrinolytic activity. Changes in the activity of insulin-sensitive glucose transporters and of skeletal muscle lipoprotein lipase are some of the possible explanations for the increased insulin sensitivity and improved blood lipid profile associated with regular exercise. This review presents physical training as a relevant nonpharmacological tool in the treatment of abdominal obesity and associated metabolic disorders. The impact of regular exercise on the different aspects of the insulin resistance syndrome is discussed. The roles of gender, age and the state of insulin resistance on the metabolic effect of physical training are also considered.

Evaluation of body composition. Current issues.

Abstract: In the selection of body composition field methods and prediction equations, exercise and health practitioners must consider their clients' demographics. Factors, such as age, gender, level of adiposity, physical activity and ethnicity influence the choice of method and equation. Also, it is important to evaluate the relative worth of prediction equations in terms of the criterion method used to derive reference measures of body composition for equation development. Given that hydrodensitometry, hydrometry and dual-energy x-ray absorptiometry are subject to measurement error and violation of basic assumptions underlying their use, none of these should be considered as a 'gold standard' method for in vivo body composition assessment. Reference methods, based on whole-body, 2-component body composition models, are limited, particularly for individuals whose fat-free body (FFB) density and hydration differ from values assumed for 2-component models. Use of field method prediction equations developed from 2-component model (Siri equation) reference measures of body composition will systematically underestimate relative body fatness of American Indian women, Black men and women, and Hispanic women because the average FFB density of these ethnic groups exceeds the assumed value (1.1 g/ml). Thus, some researchers have developed prediction equations based on multicomponent model estimates of body composition that take into account interindividual variability in the water, mineral, and protein content of the FFB. One multicomponent model approach adjusts body density (measured via hydrodensitometry) for total body water (measured by hydrometry) and/or total body mineral estimated from bone mineral (measured via dual-energy x-ray absorptiometry). Skinfold (SKF), bioelectrical impedance analysis (BIA), and near-infrared interactance (NIR) are 3 body composition methods used in clinical settings. Unfortunately, the overwhelming majority of field method prediction equations have been developed and cross-validated for White populations and are based on 2-component model reference measures. Because ethnicity may affect the composition of the FFB and regional fat distribution, race-specific prediction equations may need to be developed for some ethnic groups. To date, race-specific SKF (American Indian women, Black men, and Asian adults), BIA (American Indian women and Asian adults), and NIR (American Indian women and White women) equations have been developed. However, these equations need to be cross-validated on additional samples from these ethnic groups. In summary, research strongly suggests that multicomponent models need to be used in order to quantify differences in FFB composition due to ethnicity so that accurate SKF, BIA, and NIR prediction equations can be developed. Assessment of body composition in vivo may be enhanced by using advanced technologies such as dual-energy x-ray absorptiometry and hydrometry to refine hydrodensitometry. Practitioners should carefully select and use only those prediction equations that have been developed and cross-validated for specific ethnic groups. Additional research is needed to test the accuracy and applicability of previously published prediction equations for the American Indian, Asian, Black, and Hispanic populations.

Psychological Impact of Injuries in Athletes

Abstract: Although research on the psychological impact of injury is in its infancy, this article reviews relevant literature focusing on post-injury emotional response, self-esteem, and the effect of mood disturbance on rehabilitation from sport injury. Injury is often accompanied by depression, tension, anger and low self-esteem, particularly in competitive, seriously injured athletes. Mood disturbance seems to relate to the athlete’s perceived progress in rehabilitation and has been shown to negatively relate to attendance at rehabilitation sessions.

Anterior Cruciate Ligament Injury Rehabilitation in Athletes Biomechanical Considerations

Abstract: Postoperative rehabilitation is a major factor in the success of an anterior cruciate ligament (ACL) reconstruction procedure. Clinical investigations of patients after ACL reconstruction have shown that immobilisation of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the articular, ligamentous, and musculature structures that surround the knee. Early joint motion is beneficial for; reducing pain, capsular contractions, articular cartilage, and for minimising scar formation that limit joint motion. These findings, combined with graft materials that have biomechanical properties similar to the normal ACL, and adequate fixation strength, have led many to recommend aggressive rehabilitation programmes that involve contraction of the dominant quadriceps muscles. Recently, a prospective, randomised study of rehabilitation following ACL reconstruction has presented evidence that a closed kinetic chain exercise programme (foot fixed against a resistance) results in anterior-posterior knee laxity values that are similar to the contralateral normal knee. Also, open kinetic chain exercises (foot not fixed against a resistance) result in increased anterior-posterior knee laxity compared with the normal knee. Criteria must be observed because the relationship between rehabilitation exercises and the healing response of an ACL graft is unknown at present. Biomechanical studies of healing ACL grafts performed in animals have shown that the graft requires a long time to revascularise and heal, and that the biomechanical behaviour of the graft never returns to normal. Functional knee braces provide a protective strain-shielding effect on the ACL when anterior shear loads and internal torques are applied to the knee in the non-weight-bearing condition. However, the strain shielding effect of functional braces decrease as the magnitude of anterior shear and internal torque applied to the knee increase. Future studies should strive to determine the actual loads transmitted across the knee and ACL graft strain during various rehabilitation exercises and relate these to the healing response of the knee and graft.

Control of skeletal muscle blood flow during dynamic exercise: contribution of endothelium-derived nitric oxide.

Abstract: Traditional explanations for the hyperaemia which accompanies exercise have invoked the ‘metabolic theory’ of vasodilation, whereby contractile activity in the active muscle gives rise to metabolic by-products which dilate vessels bathed in interstitial fluid. Whilst metabolites with vasodilator properties have been identified, this theory does not adequately explain the magnitude of hyperaemia observed in active skeletal muscle, principally because large increases in flow are dependent on dilation of ‘feed’ arteries which lie outside the tissue parenchyma and are not subjected to changes in the interstitial milieu.

Theories and techniques for promoting physical activity behaviours

Abstract: The primary goal of this article is to review theoretical models utilised in designing physical activity interventions for healthy adults. Physical activity offers numerous benefits for improved physical and psychological health. However, the majority of the population is sedentary and therefore at increased risk for morbidity and mortality. Many techniques have been developed for intervening with physical activity behaviours, some of which are based on theoretical models. While some of these models show more promise than others, no model is sufficient to thoroughly explain exercise behaviours or how to best intervene. In the final section, recommendations for future research are presented, and promising areas of development in physical activity interventions are discussed. This is not an exhaustive review of theoretical models but rather focuses on models most commonly applied to physical activity.

Stress fractures. Current concepts of diagnosis and treatment

Abstract: The stress fracture is a common injury seen by healthcare professionals caring for athletes. They have been described in numerous areas of the skeletal system and in multiple sports. However, they are most commonly seen in the lower extremities, with running the reported cause in most cases. Stress fractures result from repetitive, cyclic loading of bone which overwhelms the reparative ability of the skeletal system. Mechanically, three events may lead to stress fractures. First, the applied load can be increased. Secondly, the number of applied stresses can increase. Finally, the surface area over which the load is applied can be decreased. Diagnosis requires thorough clinical evaluation with a high index of suspicion for stress fractures. History must focus on examining the athletes training regimen, especially any changes in distance, running surface and type of shoe. Physical examination varies depending on the location of the stress fracture. Ultrasound is a possible adjunct to the physical examination. Initial plain radiological evaluation may be normal, especially early in the course of a stress fracture. Further radiological evaluation may be necessary to make a definitive diagnosis. Repeating plain radiographs, bone scintigraphy, magnetic resonance imaging and computerised tomography are all possible options. Treatment options begin with rest and cessation of the precipitating activity. This should be 'active rest' in which the athlete continues to exercise depending on the site of the fracture. The athlete should be evaluated from a biomechanical point of view and any abnormalities dealt with prior to rehabilitation. Possible adjuncts to treatment include pneumatic braces and electromagnetic field therapy. There are specific stress fractures that must be considered at-risk for complications of healing. The treatment of these fractures begins with immobilisation and may require surgery pending response to therapy. Stress fractures occur more frequently in female athletes in relation to their male counterparts. There is a demonstrated relationship to eating disorders, amenorrhea and osteoporosis, or the female athlete triad. Thus, stress fractures in the female athlete requires additional investigation into those areas. The diagnosis and treatment of stress fractures is a challenge for the physician caring for the athlete. It requires a high index of suspicion combined with a strong knowledge of the at-risk stress fractures and their complications. Accurate and timely diagnosis is required to prevent possible costly and disabling complications.

Evaluation of shoulder laxity.

Abstract: An understanding of the anatomy and biomechanical features of the glenohumeral joint is necessary when understanding the concept of shoulder laxity. Glenohumeral laxity is a normal feature of shoulder motion, but only when that laxity becomes excessive does instability occur. The clinician must use the history and physical examination to distinguish normal from pathological laxity. Several examination techniques are commonly used to evaluate anterior, posterior, inferior, and multidirectional shoulder laxity. It has become appreciated that subluxation of the shoulder upon physical examination does not necessarily mean that the shoulder is clinically or symptomatically unstable. This paper reviews the current techniques to evaluate shoulder laxity and discusses the interpretation of these examinations as they relate to normal and pathological laxities.

Development of public policy and physical activity initiatives internationally.

Abstract: Epidemiological, pathological, clinical, and experimental studies over the past 40 years convincingly show that physical inactivity and low physical fitness contribute substantially to the major chronic diseases prevalent in industrialised societies. Several industrialised countries around the world report increases in physical activity participation among adults in recent years, but the prevalence of inactivity remains high. These increases in voluntary exercise are at least partially offset by decreasing daily energy demands due to increased mechanisation at home, at work and during leisure-time. In developing countries, physical inactivity is becoming a prevalent lifestyle due to rapid social and economic changes. Clinical interventions and mass appeals to be more physically active are limited in effectiveness against the background of increasingly sedentary lifestyles. Exercise scientists and public health officials need to turn attention to public policy and legislative initiatives to restructure physical and social environments to encourage more physical activity and discourage sedentary habits.

Metabolic Responses and Mechanisms During Water Immersion Running and Exercise

Abstract: The low impact nature of exercise in the water has increased interest in this form of exercise and specifically in water running as a cross-training modality. It is used as a possible preventative and therapeutic modality for rehabilitation. The high impact nature of land running predisposes the runner to stress of the lower limbs and overuse injuries. The need to reduce impact, as well as provide a low impact or non-weight-bearing condition for rehabilitation, has led runners and their coaches to the water. This increased interest by coaches and their athletes, attending sports medicine physicians and rehabilitative professionals has stimulated research into water immersion to the neck (WI) running. Exercise in the water has long been used by rehabilitative professionals with patients who have physically debilitating conditions (i.e. arthritis, musculoskeletal disorders) as it provides a medium for even those with limited mobility to exercise and relax their muscles. Numerous comparative studies into WI running from a metabolic as well as a training perspective have been published. WI has also long been used to simulate weightlessness for the comparative study of cardiorespiratory function and thermoregulation. WI and the associated cephalad shift in blood volume has implications on exercise responses during WI running exercise. In addition, the non-weight-bearing nature of WI running also raises issues of the cross-training benefits of WI running. WI running style and prior familiarity with the activity have been found to have a direct relationship with the comparability of WI to land running. This review presents current research into WI running, training specificity and comparative physiology.

Muscle Glycogen Resynthesis after Short Term, High Intensity Exercise and Resistance Exercise

Abstract: Typical rates of muscle glycogen resynthesis after short term, high intensity exercise (15.1 to 33.6 mmol/kg/h) are much higher than glycogen resynthesis rates following prolonged exercise (≈2 mmol/kg/h), even when optimal amounts of oral carbohydrate are supplied (≈8 mmol/kg/h). Several factors differ during post-exercise recovery from short term, high intensity exercise compared with prolonged exercise. The extremely fast rate of muscle glycogen resynthesis following short term, high intensity exercise may originate from these differences.