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PubMed1998

Sudden death in athletes: an update.

The athlete projects the ultimate image of well-being in the health status spectrum. Nevertheless, exercise-related sudden cardiac death (SCD) is an uncommon, yet tragic, occurrence. Exercise-related SCD is defined by symptoms that arise within 1 hour of participation in sport. The major mechanisms involved in exercise-related SCD are related to haemodynamic and electrophysiological changes brought about by exercise in the susceptible individual. Fatal arrhythmia seems to be the most common mechanism of death. Between 1 and 5 cases of SCD per 1 million athletes occur annually. In young athletes (<35 years old), the majority of these cases are caused by defined and hereditary cardiovascular disorders. Among other aetiologies, hypertrophic cardiomyopathy and coronary artery anomalies are most common in this group. In older athletes (>35 years old), sudden death is usually associated with atherosclerotic cardiac disease. A problem for identifying athletes at risk for SCD is that the athlete's heart undergoes adaptive changes in response to regular physical exercise. Alterations in cardiac function influence the physical examination, the electrocardiogram and the echocardiogram. Because of these characteristic 'abnormalities' of the athlete's heart, it is often difficult to distinguish physiological adaptations from pathophysiological processes. Although studies and observations have helped to clarify the cardiovascular pathology responsible for SCD in young, apparently healthy individuals, effective methods for preventing SCD and identifying and screening athletes at risk remain elusive. Problems with routine comprehensive screening of athletes include the limitations inherent in the predictive value of available diagnostic procedures and the cost of testing large populations. The variation from normal cardiac physiology found within the athletic population and the rarity of SCD in athletes means that elaborate screening to determine individuals at risk is neither practical nor cost effective. A thorough assessment of pertinent family and medical histories, cardiac auscultation of young athletes, evaluation of exercise-induced symptoms and education of older athletes to the symptoms of cardiac ischaemia are all essential to primary prevention of SCD in the athletic population. Until reliable methods can accurately identify those athletes at risk for SCD, broad recommendations are available to help guide the management and participation in sports of athletes with cardiovascular disease.

Adaptation, Physiological↗
PubMed2005

Prevalence of Disordered-Eating Behaviors in Undergraduate Female Collegiate Athletes and Nonathletes.

Context: As the number of female college students participating in athletics has grown dramatically in the last few decades, sports medicine health care providers have become more aware of the unique health concerns of athletic women. These concerns include disordered eating, amenorrhea, and osteoporosis: the female athlete triad. Disordered eating appears to be central in the triad, and the literature has conflicting data regarding the influence of athletic participation on disordered-eating behaviors.Objective: To compare disordered-eating symptoms between collegiate athletes (in lean and non-lean sports) and nonathletes.Design: A volunteer, cross-sectional cohort study of female students during the 2002-2003 academic year.Setting: A National Collegiate Athletic Association Division I institution.Patients or Other Participants: Undergraduate females, including 84 collegiate athletes and 62 nonathletes.Main Outcome Measure(s): Symptoms associated with disordered eating were assessed using the Eating Disorders Inventory-2, a self-report measure of 91 items, and self-reported weight and menstrual function.Results: The athletes had significantly lower scores in body dissatisfaction (P = .01) and ineffectiveness (P = .002). No difference in mean body weight was noted between the 2 groups, but the nonathlete group had a significantly lower desired body weight (P = .004). Lean-sport athletes had a higher score on body dissatisfaction (P = .008) and lower actual (P = .024) and desired body weight (P = .002) than non-lean-sport athletes. A total of 7.1% of the collegiate athletes and 12.9% of the nonathletes were classified as having a high risk for disordered eating. Within the athlete sample, the high-risk group included 2.9% of the non-lean-sport athletes and 25% of the lean-sport athletes.Conclusions: In our study, female athletes did not exhibit more disordered-eating symptoms than women who did not participate in collegiate sports. However, our data suggest that lean-sport athletes are at greater risk for disordered eating than athletes in non-lean sports.

Journal Article↗
PubMed1998

Cancer detection: the educational role of the athletic trainer.

OBJECTIVE: We found in an earlier study that while 26% of athletic trainers had worked with athletes with cancer, only 8% had taught their athletes self-examination procedures. In an attempt to examine why athletic trainers do not teach their athletes self-examination procedures, we investigated athletic trainers' knowledge of breast and testicular cancer risk factors and detection techniques. DESIGN AND SETTING: One hundred researcher-developed questionnaires were distributed at the 1994 National Athletic Trainers' Association Annual Meeting. SUBJECTS: Sixty-nine certified athletic trainers with an average age of 32 years. Seventy-two percent held master's degrees. MEASUREMENTS: SPSS-X was used to analyze the results of the study, and chi-square tests were used to compare the athletic trainers' responses by gender. RESULTS: Over 91% of the athletic trainers had never been taught about either breast or testicular self-examination in their athletic training education. Nearly half of the respondents did not know any of the nine breast cancer risk factors, although females reported significantly more knowledge of risk factors than males. Ninety-one percent of athletic trainers knew none of the four testicular risk factors, although male respondents reported significantly more knowledge of testicular cancer risk factors than females. On a Likert scale, 46% rated breast cancer and 41% rated testicular cancer as being "of little concern" to athletic trainers. CONCLUSIONS: Cancer risk factors and detection techniques should be taught in the athletic training curriculum. As advocates for health and wellness, athletic trainers should then teach this information to their athletes.

Journal Article↗
PubMedDate not supplied

Athletes' view of the preparticipation physical examination. Attitudes toward certain health screening questions.

OBJECTIVES: To determine the value student-athletes place on the preparticipation physical examination (PPE) in ensuring safe participation and to determine whether these athletes would accept a station-based PPE that emphasizes health-related issues. DESIGN: Survey. SETTING: Athletic departments of 2 small southeastern colleges. PARTICIPANTS: Population of student-athletes enrolled in these colleges. MAIN OUTCOME MEASURES: Athletes' views on the necessity of the PPE to ensure safe participation in athletics, willingness to pay a fee for the currently free examination, appropriateness of the PPE as a setting for counseling by physicians regarding age-specific health screening issues, and PPE as the only routine health maintenance contact with a physician during the year. RESULTS: A majority of athletes (66%) believed they could safely participate in athletics and avoid severe injuries or death and minor injuries without undergoing a PPE. Most athletes believed the PPE prevents or helps to prevent both major (89%) and minor (76%) injuries. Male and female respondents would not be uncomfortable with a physician or other health care provider asking questions regarding health-related issues. However, many athletes (especially women) believed that the PPE is not a place for specific questions (questions related to sexual activity and health, eating disorders, smoking, and personal and family use of alcohol). CONCLUSIONS: Most student-athletes do not see a value of the PPE in regard to safe athletic participation; most athletes believe that the PPE prevents or helps to prevent injuries when there is no clear evidence to support this assumption; and athletes are receptive to most preventive health screening, but do not feel comfortable with certain issues being raised (i.e., gynecologic health, eating disorders, and alcohol and nicotine use). With specific modifications aimed toward the needs and comfort level of the student-athlete, the PPE may provide an opportunity to present health-related education and counseling by means of unique and innovative materials to a group of adolescents and young adults.

Adolescent↗
PubMed2002

Asthma screening of high school athletes: identifying the undiagnosed and poorly controlled.

BACKGROUND: It is believed that there are many high school-age athletes who have undiagnosed asthma or exercise-induced asthma (EIA). The screening of these athletes for EIA will allow them to be identified and treated. OBJECTIVES: 1) To obtain reliable peak expiratory flow rate (PEFR) measurements and administer questionnaires to high school-age athletes to evaluate their asthma risk. 2) To identify high-risk athletes for having EIA or asthma by a free run challenge test. 3) To evaluate whether an athlete's present asthma control is adequate. 4) To evaluate these tools for their value as screening tools for asthma or EIA. METHODS: Eight hundred one student athletes from 10 suburban Pittsburgh schools were screened for more than 18 months for asthma as part of their preparticipation sports physicals. The screening included all athletes from all high school sports. The athletes were given a brief questionnaire, had PEFR measured, and then participated in a free running exercise challenge. RESULTS: Forty-six of 801 athletes had asthma or EIA, Of the remaining 755 athletes, 49 athletes were identified as having undiagnosed asthma. In the previously unrecognized athletes with EIA, the positive and negative predictive value of the questionnaire was 42% and 97%, respectively. Eighty-five percent (39 of 46) of the known asthmatic athletes, using their recommended medication, failed their free running test by a >15% drop of their PEFR. CONCLUSIONS: The free running test is a good test for identifying and assessing the athlete with EIA. The PEFR meter is not a good screening tool for EIA in the high school athlete. A questionnaire may be a good negative screening tool, but further development is needed before it can be used for widespread screening.

Adolescent↗
PubMed1988

Iron deficiency in female athletes: its prevalence and impact on performance.

The prevalence of iron deficiency and its impact on performance have not been adequately investigated in non-endurance athletes. This study evaluated these factors in 100 female intercollegiate athletes in various sports, and in 66 non-athletes. All subjects had determinations of hemoglobin, ferritin, and transferrin saturation. Athletes reported on diet, menses, and symptoms. Athletes and coaches described mood and performance. Iron-deficient athletes were treated with iron; others received placebo. The same data were collected at season's end. Initially 31/100 (31%) athletes had iron deficiency (ferritin less than 12 ng.ml-1; transferrin saturation less than 16%, or both) compared to 30/66 (45.5%) controls (not statistically significant). Compared to normal athletes, iron-deficient athletes did not have more symptoms of iron deficiency or differences in mood state, but they considered their performance to be worse (P less than 0.05). Their total iron intakes were similar, as were menstrual blood losses. At re-evaluation, 7/45 (15.6%) initially normal athletes were iron-deficient; 14/22 (63.6%) initially iron-deficient athletes were normal. Athletes receiving an iron supplement and their coaches did not report a greater improvement in performance or mood than athletes receiving a placebo. Female college athletes frequently had iron deficiency that could be successfully treated during the season, while some untreated normal athletes became iron-deficient. Iron deficiency and its treatment had no significant impact on symptoms or mood, but affected subjective assessment of performance.

Administration, Oral↗
PubMed1993

Nutritional practices of elite athletes. Practical recommendations.

The nutritional intake of elite athletes is a critical determinant of their athletic performance and ability to compete both physically and mentally. However, their demanding training and travel schedules in addition to a possible lack of nutritional knowledge may prohibit them from maintaining an optimal dietary intake. Sound scientific data about the nutritional habits of elite athletes are limited and, therefore, it is not clear as to whether elite athletes are following nutritional recommendations and maintaining nutritionally sound diets. This review takes a comprehensive look at 22 recent dietary intake studies, including 50 groups of elite athletes. The time period for food record collection ranged from 3 to 7 days except for 2 studies which collected records for 21 and 22 days. Energy intakes of > 50 kcal/kg/day for male athletes who train for > 90 min/day and 45 to 50 kcal/kg/day for female athletes training for > 90 min/day are recommended. Bodyweight should be monitored frequently as a check on calorie intake. With a sufficient calorie intake (1.2 to 2.0 kg/kg/day) protein supplementation is not necessary. Ingested carbohydrate stored as glycogen serves as the primary fuel for muscle performance. Athletes in training should consume 70% of total calories as carbohydrate. Athletes on low energy diets (< 2200 kcal/day) should have a diet of < 25% fat, and athletes with large energy needs should consume 30% fat in their diet. In general, fat intakes should be reduced and carbohydrate intakes increased. Athletes should also restrict alcohol intake during training and competition periods. Athletes with low calorie intakes should consume foods with high contents of iron, calcium, magnesium, zinc and vitamin B12. Athletes with high calorie intakes should consume foods that are naturally high in or fortified with B-group vitamins. Fluid, electrolyte and energy supplementation is desirable to support circulatory, metabolic and thermoregulatory functions. There is no special food that will help elite athletes perform better; the most important aspect of the diet of elite athletes is that it follows the basic guidelines for healthy eating.

Adult↗
PubMed2002

Dietary recommendations and athletic menstrual dysfunction.

Exercise-induced or athletic menstrual dysfunction (amenorrhoea, oligomenorrhoea, anovulation, luteal phase deficiency, delayed menarche) is more common in active women and can significantly affect health and sport performance. Although athletic amenorrhoea represents the most extreme form of menstrual dysfunction, other forms can also result in suppressed estrogen levels and affect bone health and fertility. A number of factors, such as energy balance, exercise intensity and training practices, bodyweight and composition, disordered eating behaviours, and physical and emotional stress levels, may contribute to the development of athletic menstrual dysfunction. There also appears to be a high degree of individual variation with respect to the susceptibility of the reproductive axis to exercise and diet-related stresses. The dietary issues of the female athlete with athletic menstrual dysfunction are similar to those of her eumenorrhoeic counterpart. The most common nutrition issues in active women are poor energy intake and/or poor food selection, which can lead to poor intakes of protein, carbohydrate and essential fatty acids. The most common micronutrients to be low are the bone-building nutrients, especially calcium, the B vitamins, iron and zinc. If energy drain is the primary contributing factor to athletic menstrual dysfunction, improved energy balance will improve overall nutritional status and may reverse the menstrual dysfunction, thus returning the athlete to normal reproductive function. Because bone health can be compromised in female athletes with menstrual dysfunction, intakes of bone-building nutrients are especially important. Iron and zinc are typically low in the diets of female athletes if meat products are avoided. Adequate intake of the B vitamins is also important to ensure adequate energy production and the building and repair of muscle tissue. This review briefly discusses the various factors that may affect athletic menstrual dysfunction and two of the proposed mechanisms: the energy-drain and exercise-intensity hypotheses. Because energy drain can be a primary contributor to athletic menstrual dysfunction, recommendations for energy and the macro- and micronutrients are reviewed. Methods for helping the female athlete to reverse athletic menstrual dysfunction are discussed. The health consequences of trying to restrict energy intake too dramatically while training are also reviewed, as is the importance of screening athletes for disordered eating. Vitamins and minerals of greatest concern for the female athlete are addressed and recommendations for intake are given.

Body Weight↗
PubMed2004

Effects of exercise on lipid metabolism and musculoskeletal fitness in female athletes.

AIM: This study investigated the effects of intense training on lipid metabolism, bone metabolism and bone mineral density (BMD) in female athletes. METHODS: Sixty-six female subjects participated in this study, age ranging from 18 to 55 years. The sample group included thirty-six athletic subjects and the control group comprised thirty non-athletic individuals. Five athletes competed with national level (5/36) and nine non-athletic subjects (9/30) were postmenopausal women. The assessment items included body composition, radius BMD, calcaneus BMD, lung function, muscular endurance, renal and liver function, bone marker assay and hormone status. All data were analysed, using SPSS 10.0 software, and were presented as mean rank statistical difference, using the Kurskal-Wallis (K-W) test. After that the non-parameter statistics were used. Either K value or P value below 0.05 was considered significant. RESULTS: Urine deoxypyridinoline/creatinine (Dpd/Cre) levels increased significantly (5.93+/-2.31 vs 6.85+/-1.43, K<0.01), sit-reach (29.30+/-9.48 cm vs 41.31+/-9.43 cm, K<0.001, P<0.001), 1 minute sit-ups with bended knees (1 min sit-ups) (17.60+/-9.34 count vs 30.00+/-10.38 count, K<0.001, P<0.001), and vertical jump (25.27+/-6.63 cm vs 34.69+/-7.99 cm, K<0.001, P<0.001) improved significantly in the athletes group. The athletes group also had a significantly increased level of estriol (E(3)) (0.14+/-0.13 pg/mL vs 0.07+/-0.04 pg/mL, K<0.01, P<0.01), radius BMD (1.37+/-0.49 gm/cm(2) vs 1.19+/-0.40 gm/cm(2), K<0.05) and calcaneus BMD (0.57+/-0.17 gm/cm(2) vs -0.20+/-0.17 gm/cm(2), K<0.01, P<0.05) compared with those of the controls. The high density lipoprotein (HDL) (65.00+/-14.02 mg/dL vs 52.26+/-4.84 mg/dL, K<0.05, P<0.05) was significantly lower in postmenopausal inactive athletes (5/36) than premenopausal active athletes (31/36). On the other hand, low-density lipoprotein (LDL) (98.35+/-23.84 mg/dL vs 131.00+/-21.63 mg/dL, K<0.05, P<0.01), cholesterol (CHO) (164.03+/-27.01 mg/dL vs 193.00+/-23.48 mg/dL, K<0.05, P<0.05), triglyceride (TG) (63.00+/-26.39 mg/dL vs 147.00+/- 87.21 mg/dL, K<0.01), body fat % (BF%) (28.16+/-4.90% vs 34.84+/-4.44%, K<0.05, P<0.001) and body mass index (BMI) (21.98+/-2.98 kg/m(2) vs 26.42+/-5.01 kg/m(2), K<0.05, P<0.001) were significantly higher in postmenopausal inactive athletes (5/36) than premenopausal active athletes (31/36). TG (90.22+/-39.82 mg/dL vs 147.00+/-87.21 mg/dL), CHO (186.44+/-24.90 mg/dL vs 193.00+/-23.48 mg/dL) were higher, but the HDL was significantly lower (62.18+/-10.68 mg/dL vs 52.26+/-4.84 mg/dL, P<0.05) in postmenopausal athletes (5/36) group than in postmenopausal control group (9/30). CONCLUSION: Postmenopausal athletes (5/36) who no longer took competing exercises had reduced levels of physical activity, faced increased risk of cardiovascular disease compared to active athletes (31/36) and the postmenopausal controls (9/30). We may thus concluded that long term exercise effectively improves musculoskeletal fitness and prevents BMD loss in female athletes.

Adolescent↗
PubMed2003

A study of the effects on the ovarian cycle of athletic training in different sports.

AIM: The purpose of this research was to investigate the effects of sports training on the ovarian cycle of athletes of various disciplines, and of non-athletes, their participation and their performance in competition as well as the appearance of symptoms of discomfort pre and during the duration of menstruation. METHODS: Athletes from the disciplines of basketball, track athletics, gymnastics, swimming, synchronized swimming and water polo as well as non-athletes took part in this research. All the participants, both athletes and non-athletes were selected and completed a specially designed questionnaire. RESULTS: The results of the research showed that there are no significant differences in the menarche to the duration of the ovarian cycle and to the duration of the menstrual flow. Also, the involvement in different athletic disciplines appears to affect to different degrees the regularity of the cycle although this does not prevent the athlete from participating in training and in competition. The effects are sometimes beneficial to their performance and sometimes they could have a negative effect on their performance. Regarding the symptoms and the discomforts which occasionally appeared pre and during the duration of menstruation e.g. headache symptoms, these appear to be greatly decreased in the athletes of swimming, synchronized swimming and water polo and perhaps this is a result of the beneficial effects of the water. The percentage for abdominal pain appeared decreased for certain disciplines (such as swimming) or stable both pre and during the duration of menstruation. Concerning the pain in the thoracicolumbar region, the percentages were different for every sport: a noticeable decrease was recorded for the athletes of swimming, gymnasts, synchronized swimming, water polo, track athletes and the non-athletes, but with an increase for the basketball players. For the symptoms of weakness and fatigue, the percentages were increased for all the athletic disciplines as well as for the non-athletic during the duration of menstruation compared with pre menstruation, although for the percentages for symptoms of nervousness, the picture was different, that is, the percentages appeared decreased during the duration of menstruation. CONCLUSION: In conclusion, where problems appear in the function of the ovarian cycle, the assistance of a specialist gynaecologist is considered essential when we are sure that these problems are not caused by training, malnutrition or psychological factors.

Adolescent↗
PubMedDate not supplied

Peer-assisted learning in the athletic training clinical setting.

CONTEXT: Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education in order to provide evidence for its current use or as a pedagogic tool. OBJECTIVE: To describe the prevalence of PAL in athletic training clinical education and to identify students' perceptions of PAL. DESIGN: Descriptive. SETTING: "The Athletic Training Student Seminar" at the National Athletic Trainers' Association 2002 Annual Meeting and Clinical Symposia. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 138 entry-level male and female athletic training students. MAIN OUTCOME MEASURE(S): Students' perceptions regarding the prevalence and benefits of and preferences for PAL were measured using the Athletic Training Peer-Assisted Learning Assessment Survey. The Survey is a self-report tool with 4 items regarding the prevalence of PAL and 7 items regarding perceived benefits and preferences. RESULTS: A total of 66% of participants practiced a moderate to large amount of their clinical skills with other athletic training students. Sixty percent of students reported feeling less anxious when performing clinical skills on patients in front of other athletic training students than in front of their clinical instructors. Chi-square analysis revealed that 91% of students enrolled in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs learned a minimal to small amount of clinical skills from their peers compared with 65% of students in Joint Review Committee on Educational Programs in Athletic Training-candidacy schools (chi2(3) = 14.57, P < .01). Multiple analysis of variance revealed significant interactions between sex and academic level on several items regarding benefits and preferences. CONCLUSIONS: According to athletic training students, PAL is occurring in the athletic training clinical setting. Entry-level students are utilizing their peers as resources for practicing clinical skills and report benefiting from the collaboration. Educators should consider deliberately integrating PAL into athletic training education programs to enhance student learning and collaboration.

Journal Article↗
PubMed2002

Dermatologic disorders of the athlete.

The most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete. Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger's nipples and mogul's palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer's itch or seabather's eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete's nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete's sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.

Anaphylaxis↗
PubMed2000

Marked ventricular repolarization abnormalities in highly trained athletes' electrocardiograms: clinical and prognostic implications.

OBJECTIVE: We sought to study the functional, clinical and prognostic implications of marked repolarization abnormalities (MRA) sometimes seen in athletes' electrocardiograms (ECGs). BACKGROUND: The clinical meaning of ECG MRA in athletes is unknown. No relationship has been drawn between either training intensity or any particular type of sport and MRA. Athletes are usually symptom free and do not show any decrease in their physical performance. It is as yet unclear whether MRA may have a negative effect on the performance of such athletes in competitive sports. METHODS: We studied 26 athletes with MRA (negative T waves > or =2 mm in three or more ECG leads at rest). No athletes presented clinical symptoms of cardiac disease or decrease in their physical performance. Clinical and physical examinations, ECG at rest, exercise test and echocardiographic and antimyosin studies were performed in all athletes. Rest/exercise myocardial perfusion single-photon emission computed tomography studies were performed in 17 athletes. The follow-up ranged from 4 to 20 years (mean 6.7 years). RESULTS: Four athletes were excluded due to hypertrophic cardiomyopathy. Echocardiographic studies showed right and left normal ventricular dimensions for highly conditioned athletes. In the exercise test, heart rate was 166 +/- 12.4 beats/min, and exercise tolerance was 15.2 +/- 2.7 metabolic equivalents of the task. All athletes had ECG at rest simulating myocardial ischemia or "pseudoischemia" with a tendency to normalize during exercise. Myocardial perfusion studies were normal in the studied athletes. Antimyosin studies showed mild and diffuse myocardial radiotracer uptake in 15 athletes (68%). No adverse clinical events were observed in the follow-up. CONCLUSIONS: These results suggest that MRA have no clinical or pathological implications in athletes and should, therefore, not preclude physical training or participation in sporting events.

Action Potentials↗
PubMedDate not supplied

Age at menarche in athletes and their mothers and sisters.

Retrospective ages at menarche were obtained from 109 university athletes and their mothers, and from 77 sisters of the athletes. The athletes were participants in seven sports. Mean age (+/- SD) at menarche of the 109 athletes was identical with that of the total sample of 338 athletes from which they were drawn, 13.8 +/- 1.5 years. Mean age at menarche in the mothers was 13.4 +/- 1.7 years. When mothers were grouped as having been athletes (n = 52) or non-athletes (n = 57), menarcheal ages were, respectively, 13.7 +/- 1.8 years and 13.2 +/- 1.5 years. The mother-daughter correlation for age at menarche was 0.25. Corresponding correlations between athletes and mothers who were athletes and between athletes and mothers who were not athletes were 0.24 and 0.22, respectively. Ages at menarche in athletes who had sisters (n = 62) and their sisters (n = 77) were 14.0 +/- 1.4 and 13.6 +/- 1.6 years, respectively. The intraclass sister-sister correlation was 0.44. Familial resemblance in age at menarche in athletes, their mothers and sisters, is identical with that in the general population, and suggests that later menarche commonly observed in athletes is to a large extent familial.

Adolescent↗
PubMed1997

Lifestyles and health risks of collegiate athletes: a multi-center study.

OBJECTIVE: To determine whether college athletes are at greater risk for maladaptive lifestyle and health-risk behaviors than their nonathletic peers and to identify high risk taking groups by gender, sport, and other identifiers. DESIGN: Multicenter, cross-sectional study. SETTING: Seven major geographically represented collegiate institutions in the United States. PARTICIPANTS: A total of 2,298 college athletes and 683 randomized nonathlete controls completed a confidential survey questionnaire between the summer of 1993 and winter of 1994, assessing lifestyle and health-risk behaviors over the previous 12 months. MAIN OUTCOME MEASURES: Self-reports of lifestyle behaviors and health risks in the following areas: motor-vehicle safety, substance abuse, sexually transmitted diseases and contraception, mental health, cancer prevention, nutrition, exercise and general preventive health issues. RESULTS: Athletes demonstrated significantly higher risk-taking behaviors (p < 0.05) than their nonathlete peers in the following areas: less likely always to use seatbelts; less likely always to use helmets with motorcycles, mopeds, and bicycles; more often drive as a passenger with a driver under the influence of alcohol or drugs; greater quantity and frequency of alcoholic beverages; greater frequency of smokeless tobacco and anabolic steroid use; less-safe sex; greater number of sexual partners; less contraceptive use; and more involvement in physical fights. Female athletes reported a higher prevalence of irregular menses, amenorrhea, and stress fractures compared with female nonathletes. Male athletes had more risk-taking behaviors than did female athletes (p < 0.05), and athletes in contact sports demonstrated more risk-taking behaviors than did athletes in noncontact sports (p < 0.05). Athletes with one risk-taking behavior were likely to have multiple risk-taking behaviors (p < 0.05). CONCLUSIONS: College athletes appear to be at higher risk than their nonathletic peers for certain maladaptive lifestyle behaviors. Athlete subgroups at highest risk include male athletes and athletes participating in contact sports. Athletes at risk for one high-risk behavior demonstrated an increased risk for multiple risk-taking behaviors. Preventive health interventions deserve further study to determine strategies for risk reduction in high-risk groups.

Adolescent↗
PubMed2005

Cutaneous community-acquired methicillin-resistant Staphylococcus aureus infection in participants of athletic activities.

OBJECTIVES: Cutaneous community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) has been identified in otherwise healthy individuals either with or without methicillin-resistant S. aureus (MRSA)-associated risk factors who participate in athletic activities. The purpose of this study was to describe the clinical features of CAMRSA skin infection that occurred in university student athletes, evaluate the potential mechanisms for the transmission of MRSA infection of the skin in participants of athletic activities, and review the measures for preventing the spread of cutaneous CAMRSA infection in athletes. METHODS: A retrospective chart review of the student athletes from the University of Houston whose skin lesions were evaluated at the Health Center and grew MRSA was performed. The clinical characteristics and the postulated mechanisms of cutaneous MRSA infection in the athletes were compared with those previously published in reports of CAMRSA skin infection outbreaks in other sports participants. RESULTS: Cutaneous CAMRSA infection occurred in seven student athletes (four women and three men) who were either weight lifters (three students) or members of a varsity sports team: volleyball (two women), basketball (one woman), and football (one man). The MRSA skin infection presented as solitary or multiple, tender, erythematous, fluctuant abscesses with surrounding cellulitis. The lesions were most frequently located in the axillary region (three weight lifters), on the buttocks (two women), or on the thighs (two women). The drainage from all of the skin lesions grew MRSA, which was susceptible to clindamycin, gentamicin, rifampin, trimethoprim/sulfamethoxazole, and vancomycin; five of the isolates were also susceptible to ciprofloxacin and levofloxacin. All of the bacterial strains were resistant to erythromycin, oxacillin, and penicillin. The cutaneous MRSA infections persisted or worsened in the six athletes who were empirically treated for methicillin-sensitive S. aureus at their initial visit. Complete resolution of the skin infection occurred after the abscesses had been drained and the athlete had been treated with systemic antimicrobial therapy for which the bacterial strain was susceptible. CONCLUSIONS: Cutaneous CAMRSA infection typically presents as an abscess, with or without surrounding cellulitis, in otherwise healthy participants of athletic activities who have or do not have MRSA-associated risk factors. Athletes who have MRSA skin infections include weight lifters and team members from competitive sports such as basketball, fencing, football, rugby, volleyball, and wrestling. Bacterial culture of suspected infectious skin lesions should be performed to establish the diagnosis of cutaneous MRSA infection and to determine the antibiotic susceptibility of the bacterial isolate. Treatment of cutaneous MRSA infection involves drainage of the abscess (either spontaneously or after incision) and appropriate systemic antimicrobial therapy. Direct skin-to-skin physical contact with infectious lesions or drainage, skin damage that facilitates the entry of bacteria, and sharing of infected equipment, clothing, or personal items may result in the acquisition and transmission of MRSA infection in participants of athletic activities. Earlier detection and topical treatment of the athlete's skin wounds by their coaches, avoidance of contact with other participants' cutaneous lesions and their drainage, and good personal hygiene are measures that can potentially prevent the spread of cutaneous MRSA infection in participants of athletic activities.

Abscess↗
PubMed1998

Contrasting plasma free amino acid patterns in elite athletes: association with fatigue and infection.

AIM: There is little information on the plasma free amino acid patterns of elite athletes against which fatigue and nutrition can be considered. Therefore the aim was to include analysis of this pattern in the medical screening of elite athletes during both especially intense and light training periods. METHODS: Plasma amino acid analysis was undertaken in three situations. (1) A medical screening service was offered to elite athletes during an intense training period before the 1992 Olympics. Screening included a blood haematological/biochemical profile and a microbial screen in athletes who presented with infection. The athletes were divided into three groups who differed in training fatigue and were considered separately. Group A (21 track and field athletes) had no lasting fatigue; group B (12 judo competitors) reported heavy fatigue at night but recovered overnight to continue training; group C (18 track and field athletes, one rower) had chronic fatigue and had been unable to train normally for at least several weeks. (2) Athletes from each group were further screened during a post-Olympic light training period. (3) Athletes who still had low amino acid levels during the light training period were reanalysed after three weeks of additional protein intake. RESULTS: (1) The pre-Olympics amino acid patterns were as follows. Group A had a normal amino acid pattern (glutamine 554 (25.2) micromol/l, histidine 79 (6.1) micromol/l, total amino acids 2839 (92.1) micromol/l); all results are means (SEM). By comparison, both groups B and C had decreased plasma glutamine (average 33%; p<0.001) with, especially in group B, decreased histidine, glucogenic, ketogenic, and branched chain amino acids (p<0.05 to p<0.001). None in group A, one in group B, but ten athletes in group C presented with infection: all 11 athletes had plasma glutamine levels of less than 450 micromol/l. No intergroup differences in haematological or other blood biochemical parameters, apart from a lower plasma creatine kinase activity in group C than in group B (p<0.05) and a low neutrophil to lymphocyte ratio in the athletes with viral infections (1.2 (0.17)), were found. (2) During post-Olympic light training, group A showed no significant amino acid changes. In contrast, group B recovered normal amino acid levels (glutamine 528 (41.4) micromol/l, histidine 76 (5.3) micromol/l, and total amino acids 2772 (165) micromol/l) (p<0.05 to p<0.001) to give a pattern comparable with that of group A, whereas, in group C, valine and threonine had increased (p<0.05), but glutamine (441 (24.5) micromol/l) and histidine (58 (5.3) micromol/l) remained low. Thus none in group A, two in group B, but ten (53%) in group C still had plasma glutamine levels below 450 micromol/l, including eight of the 11 athletes who had presented with infection. (3) With the additional protein intake, virtually all persisting low glutamine levels increased to above 500 micromol/l. Plasma glutamine rose to 592 (35.1) micromol/l and histidine to 86 (6.0) micromol/l. Total amino acids increased to 2761 (128) micromol/l (p<0.05 to p<0.001) and the amino acid pattern normalised. Six of the ten athletes on this protein intake returned to increased training within the three weeks. CONCLUSION: Analysis of these results provided contrasting plasma amino acid patterns: (a) a normal pattern in those without lasting fatigue; (b) marked but temporary changes in those with acute fatigue; (c) a persistent decrease in plasma amino acids, mainly glutamine, in those with chronic fatigue and infection, for which an inadequate protein intake appeared to be a factor.

Amino Acids↗
PubMed2001

Guidelines for daily carbohydrate intake: do athletes achieve them?

Official dietary guidelines for athletes are unanimous in their recommendation of high carbohydrate (CHO) intakes in routine or training diets. These guidelines have been criticised on the basis of a lack of scientific support for superior training adaptations and performance, and the apparent failure of successful athletes to achieve such dietary practices. Part of the problem rests with the expression of CHO intake guidelines in terms of percentage of dietary energy. It is preferable to provide recommendations for routine CHO intake in grams (relative to the body mass of the athlete) and allow flexibility for the athlete to meet these targets within the context of their energy needs and other dietary goals. CHO intake ranges of 5 to 7 g/kg/day for general training needs and 7 to 10 g/kg/day for the increased needs of endurance athletes are suggested. The limitations of dietary survey techniques should be recognised when assessing the adequacy of the dietary practices of athletes. In particular, the errors caused by under-reporting or undereating during the period of the dietary survey must be taken into account. A review of the current dietary survey literature of athletes shows that a typical male athlete achieves CHO intake within the recommended range (on a g/kg basis). Individual athletes may need nutritional education or dietary counselling to fine-tune their eating habits to meet specific CHO intake targets. Female athletes, particularly endurance athletes, are less likely to achieve these CHO intake guidelines. This is due to chronic or periodic restriction of total energy intake in order to achieve or maintain low levels of body fat. With professional counselling, female athletes may be helped to find a balance between bodyweight control issues and fuel intake goals. Although we look to the top athletes as role models, it is understandable that many do not achieve optimal nutrition practices. The real or apparent failure of these athletes to achieve the daily CHO intakes recommended by sports nutritionists does not necessarily invalidate the benefits of meeting such guidelines. Further longitudinal studies of training adaptation and performance are needed to determine differences in the outcomes of high versus moderate CHO intakes. In the meantime, the recommendations of sports nutritionists are based on plentiful evidence that increased CHO availability enhances endurance and performance during single exercise sessions.

Dietary Carbohydrates↗