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Coronary flow reserve is supranormal in endurance athletes: an adenosine transthoracic echocardiographic study.

OBJECTIVE: To compare coronary flow reserve in endurance athletes and healthy sedentary controls, using adenosine transthoracic echocardiography. METHODS: 29 male endurance athletes (mean (SD) age 27.3 (6.6) years, body mass index (BMI) 22.1 (1.9) kg/m(2)) and 23 male controls (age 27.2 (6.1) years, BMI 23.9 (2.6) kg/m(2)) with no coronary risk factors underwent transthoracic echocardiographic assessment of distal left anterior descending coronary artery (LAD) diameter and flow, both at rest and during intravenous adenosine infusion (140 microg/kg/min). RESULTS: Distal LAD diameter and flow were adequately assessed in 19 controls (83%) and 26 athletes (90%). Distal LAD diameter in athletes (2.04 (0.25) mm) was not significantly greater than in sedentary controls (1.97 (0.27) mm). Per cent increase in LAD diameter following 400 microg sublingual nitrate was greater in the athletes than in the controls, at 14.1 (7. 2)% v 8.8 (5.7)% (p < 0.01). Left ventricular mass index in athletes exceeded that of controls, at 130 (19) v 98 (14) g/m(2) (p < 0.01). Resting flow among the athletes (10.6 (3.1) ml/min; 4.4 (1.2) ml/min/100 g left ventricular mass) was less than in the controls (14.3 (3.6) ml/min; 8.2 (2.2) ml/min/100 g left ventricular mass) (both p < 0.01). Hyperaemic flow among the athletes (61.9 (17.8) ml/min) exceeded that of the controls (51.1 (14.6) ml/min; p = 0.02), but not when corrected for left ventricular mass (25.9 (5.6) v 28.5 (7.4) ml/min/100 g left ventricular mass; NS). Coronary flow reserve was therefore substantially greater in the athletes than in the controls, at 5.9 (1.0) v 3.7 (0.7) (p < 0.01). CONCLUSIONS: Coronary flow reserve in endurance athletes is supranormal and endothelium independent vasodilatation is enhanced. Myocardial hypertrophy per se does not necessarily impair coronary flow reserve. Adenosine transthoracic echocardiography is a promising technique for the investigation of coronary flow reserve.

Adenosine↗

Physiological upper limits of ventricular cavity size in highly trained adolescent athletes.

OBJECTIVES: To define physiological upper limits of left ventricular (LV) cavity size in trained adolescent athletes. DESIGN: Cross sectional echocardiographic study. SETTING: British national sports training grounds and Olympic Medical Institute. SUBJECTS: 900 elite adolescent athletes (77% boys) aged 15.7 (1.2) years participating in ball, racket, and endurance sports and 250 healthy controls matched for age, sex, and size. MAIN OUTCOME MEASURES: LV end diastolic cavity size. RESULTS: Compared with controls, athletes had a larger LV cavity (50.8 (3.7) v 47.9 (3.5) mm), a difference of 6%. The LV cavity was > 54 mm in 18% athletes, whereas none of the controls had an LV cavity > 54 mm. The LV cavity exceeded predicted sizes in 117 (13%) athletes. Among the athletes with LV dilatation, 78% were boys, LV size ranged from 52-60 mm, and left atrial diameter and LV wall thickness were enlarged. Systolic and diastolic function were normal. None of the athletes in the study had an LV cavity size > 60 mm. LV cavity size correlated with age, sex, heart rate, and body surface area. CONCLUSION: Highly trained junior athletes usually have only modest increases in LV cavity size. A proportion of trained adolescent athletes have LV cavity size exceeding predicted values but, in absolute terms, LV cavity rarely exceeds 60 mm as in patients with dilated cardiomyopathy. In highly trained adolescent athletes with an LV cavity size > 60 mm and any impairment of systolic or diastolic function, the diagnosis of dilated cardiomyopathy should be considered.

Adolescent↗

Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing "athlete's heart" from hypertrophic cardiomyopathy.

OBJECTIVE: In some athletes with a substantial increase in left ventricular wall thickness, it may be difficult to distinguish with certainty physiological hypertrophy due to athletic training from hypertrophic cardiomyopathy. The purpose of the present investigation was to determine whether assessment of left ventricular filling could differentiate between these two conditions. DESIGN: Doppler echocardiography was used to obtain transmitral flow velocity waveforms from which indices of left ventricular diastolic filling were measured. Normal values were from 35 previously studied control subjects. SETTING: Athletes were selected mostly from the Institute of Sports Science (Rome, Italy), and patients with hypertrophic cardiomyopathy were studied at the National Institutes of Health (Bethesda, Maryland). PARTICIPANTS: The athlete group comprised 16 young competitive athletes with an increase in left ventricular wall thickness (range 13-16 mm; mean 14). For comparison, 12 symptom free patients with non-obstructive hypertrophic cardiomyopathy were selected because their ages and degree of hypertrophy were similar to those of the athletes. RESULTS: In the athlete group, values for deceleration of flow velocity in early diastole, peak early and late diastolic flow velocities, and their ratio were not significantly different from those obtained in untrained normal subjects; furthermore, Doppler diastolic indices were normal in each of the 16 athletes. Conversely, in patients with hypertrophic cardiomyopathy, mean values for Doppler diastolic indices were significantly different from both normal subjects and athletics (p = 0.01 to 0.003), and one or more indices were abnormal in 10 (83%) of the 12 patients. CONCLUSIONS: Doppler echocardiographic indices of left ventricular filling may aid in distinguishing between pronounced physiological hypertrophy due to athletic training and pathological hypertrophy associated with hypertrophic cardiomyopathy.

Adaptation, Physiological↗

Mid-expiratory flow versus FEV1 measurements in the diagnosis of exercise induced asthma in elite athletes.

BACKGROUND: A fall in FEV(1) of > or =10% following bronchoprovocation (eucapnic voluntary hyperventilation (EVH) or exercise) is regarded as the gold standard criterion for diagnosing exercise induced asthma (EIA) in athletes. Previous studies have suggested that mid-expiratory flow (FEF(50)) might be used to supplement FEV(1) to improve the sensitivity and specificity of the diagnosis. A study was undertaken to investigate the response of FEF(50) following EVH or exercise challenges in elite athletes as an adjunct to FEV(1). METHODS: Sixty six male (36 asthmatic, 30 non-asthmatic) and 50 female (24 asthmatic, 26 non-asthmatic) elite athletes volunteered for the study. Maximal voluntary flow-volume loops were measured before and 3, 5, 10, and 15 minutes after stopping EVH or exercise. A fall in FEV(1) of > or =10% and a fall in FEF(50) of > or =26% were used as the cut off criteria for identification of EIA. RESULTS: There was a strong correlation between DeltaFEV(1) and DeltaFEF(50) following bronchoprovocation (r = 0.94, p = 0.000). Sixty athletes had a fall in FEV(1) of > or =10% leading to the diagnosis of EIA. Using the FEF(50) criterion alone led to 21 (35%) of these asthmatic athletes receiving a false negative diagnosis. The lowest fall in FEF(50) in an athlete with a > or =10% fall in FEV(1) was 14.3%. Reducing the FEF(50) criteria to > or =14% led to 13 athletes receiving a false positive diagnosis. Only one athlete had a fall in FEF(50) of > or =26% in the absence of a fall in FEV(1) of > or =10% (DeltaFEV(1) = 8.9%). CONCLUSION: The inclusion of FEF(50) in the diagnosis of EIA in elite athletes reduces the sensitivity and does not enhance the sensitivity or specificity of the diagnosis. The use of FEF(50) alone is insufficiently sensitive to diagnose EIA reliably in elite athletes.

Adult↗

A physiological comparison of young and older endurance athletes.

Sixteen highly trained masters endurance athletes, 59 +/- 6 yr, were compared with 16 young athletes, with whom they were matched on the basis of their training regimens, and with 18 untrained middle-aged men. On echocardiographic evaluation, both groups of athletes had a significantly greater left ventricular volume and mass than the untrained men; their were no significant differences in percent fiber shortening or velocity of fiber shortening among the three groups. Maximum O2 uptake (VO2max) averaged 15% less in the masters than in the young athletes (58.7 vs. 69 ml.kg-1.min-1). When expressed in terms of lean body mass to correct for differences in body fat content, VO2max of the masters athletes was about 60% higher than that of the middle-aged untrained men. Maximum heart rate was 14% lower in the masters athletes than in the young athletes (169 vs. 197 beats/min). The O2 pulse during maximum exercise (i.e., VO2max/heart rate at VO2max) was identical in the masters and young athletes. This finding suggests that the major factor responsible for the lower VO2max of the masters athletes, compared with the young athletes, is their slower heart rate.

Adolescent↗

Cardiovascular disease in athletes.

As a physician, coach, or trainer, we see athletes as healthy, physically fit, and able to tolerate extremes of physical endurance. It seems improbable that such athletes may have, on occasion, underlying life-threatening cardiovascular abnormalities. Regular physical activity promulgates cardiovascular fitness and lowers the risk of cardiac disease. However, under intense physical exertion and with a substrate of significant cardiac disease--whether congenital or acquired--athletes may succumb to sudden cardiac death. The deaths of high-profile athletes receive much attention through the national news media, but there are also deaths of other athletes. With repetitive, intense physical exercise, the heart undergoes functional and morphologic changes. Knowledge of those changes may help one identify cardiovascular abnormalities that can cause sudden death from the heart known as an "athlete's heart." This article will review cardiovascular diseases that may limit an athlete's participation in sports and that may put an athlete at risk for sudden cardiac death. It also reviews the extent and limitations of the cardiovascular preparticipation screening examination. Team physicians, coaches, and trainers must understand the process of evaluation of a symptomatic athlete that may indicate significant cardiac abnormalities. Finally, guidelines to determine eligibility of athletes with cardiovascular disease to return to sports will be reviewed.

Cardiovascular Diseases↗

Mechanisms of enhanced insulin sensitivity in endurance-trained athletes: effects on blood flow and differential expression of GLUT 4 in skeletal muscles.

Exercise is associated with increased insulin sensitivity. To better understand mechanisms that could be responsible for this association, we studied seven controls and seven endurance-trained athletes. A 600 mU/m2.min hyperinsulinemic euglycemic glucose clamp with the limb balance technique assessed insulin sensitivity as whole body glucose uptake (WBGU) and leg glucose uptake (LGU). Indirect calorimetry and hemodynamic measurements, such as leg blood flow (LBF) and cardiac output, were performed at baseline and maximal insulin stimulation. The content of the glucose transporter GLUT 4 and muscle fiber type were evaluated in three muscle groups: vastus lateralis, gastrocnemius, and biceps. Athletes exhibited 35% higher WBGU and 30% higher LGU than controls. Basal LBF (liters per min) was higher in athletes, but the difference was not statistically significant. After insulin stimulation, LBF was 31% higher in athletes than controls (P = 0.05). Indirect calorimetry revealed that athletes had a 44% higher rate of nonoxidative glucose metabolism than controls (P = 0.01). GLUT 4 levels in vastus were 90% (P < 0.05) greater in athletes, whereas smaller differences were noted between athletes and controls in biceps and gastrocnemius. Importantly, the vastus lateralis GLUT 4 content was correlated with WBGU (r = 0.60; P < 0.05) and LGU (r = 0.62; P < 0.05). Relative numbers of oxidative fibers were increased in vastus from athletes and were positively correlated with maximal oxygen consumption (VO2 max), but GLUT 4 content could not be correlated with oxidative fiber content in individual controls or athletes. We conclude that in humans 1) endurance training enhances insulin's ability to increase LBF; 2) GLUT 4 is differentially expressed as a function of muscle group and is up-regulated by exercise in a muscle-specific manner; 3) in vastus lateralis, GLUT 4 levels are well correlated with insulin-stimulated rates of both WBGU and LGU; and 4) GLUT 4 content and in vivo insulin sensitivity do not vary as a function of fiber type composition. Thus, blood flow and GLUT 4 expression in muscle are important mechanisms that mediate greater insulin sensitivity in athletes.

Adult↗

Nutritional and endocrine-metabolic aberrations in amenorrheic athletes.

Growing evidence suggests that menstrual disturbances in female athletes are related to the metabolic cost of high levels of energy expenditure without compensatory increases in dietary intake. However, the linkage(s) between nutritional deficits and reproductive impairments as a result of slowing of LH pulsatility has not been defined. This study was directed to simultaneously characterize nutritional intake, insulin sensitivity (by rapid iv glucose tolerance test), and 24-h dynamics of insulin/glucose, cortisol, somatotropic [GH/GH-binding protein (GHBP)/insulin-like growth factor I (IGF-I)/IGF-binding proteins (IGFBPs)], and LH axes in highly trained athletes with (cycling athletes; CA) and without (amenorrheic athletes; AA) menstrual cyclicity and in age- and body mass index-matched cycling sedentary controls (CS; n = 8/group). Although daily caloric intake did not differ among the three groups, athletes (CA and AA) consumed less fat and protein than CS. However, the restriction of fat was 50% greater (P < 0.01) in AA than CA and was accompanied by increased carbohydrate (P < 0.05) and fiber (P < 0.01) intake. Athletes, independent of menstrual status, had increased (P < 0.05) insulin sensitivity and reduced insulin levels during the feeding phase of the day. Hypoinsulinemia was more pronounced in AA (P < 0.05) than CA, extending throughout the day, and was accompanied by reduced glucose increments in response to meals (P < 0.05), not seen in CA. Levels of the insulin-dependent IGFBP-1 were markedly elevated (P < 0.001) throughout the diurnal pattern in AA, whereas in CA, a modest elevation (P < 0.001) of IGFBP-1 levels occurred only during the feeding portion of the day. IGFBP-1 levels for the three groups related inversely to 24-h insulin (r = -0.63) and directly to 24-h cortisol (r = 0.69) levels. A 70-80% augmentation (P < 0.001) of 24-h mean GH levels was seen in both groups of athletes, but with distinct pulsatile features. Although pulse amplitude was increased 60% in CA with no change in pulse number, AA displayed more frequent (P < 0.001) pulses, with an elevated (P < 0.01) baseline between pulses. The distorted pattern of GH pulses seen in AA was associated with a 35% decrease in GHBP levels, not seen in CA. Although levels of IGF-I and IGFBP-3 did not differ in either CA or AA, the 2- to 4-fold higher levels of IGFBP-1 in AA than in CA and CS resulted in a 3-fold reduced ratio of IGF-I/IGFBP-1 in AA, which may decrease the bioactivity and hypoglycemic effect of IGF-I. LH pulse frequency was progressively attenuated in the athletes, with a greater (P < 0.001) slowing in AA than CA, unaccompanied by alterations in pulse amplitude or 24-h levels. LH pulse frequency was related positively with insulin (r = 0.65) levels and the ratio of IGF-I/IGFBP-1 (r = 0.69), and negatively with cortisol (r = -0.70) and IGFBP-1 (r = -0.75) concentrations. Stepwise regression analysis suggested that negative influences associated with hypercortisolemia and elevated IGFBP-1 levels predominate in determining GnRH/LH pulsatile activity in these athletes. In sum, although neuroendocrine-metabolic adaptations to the energy cost of exercise training were evident in both groups of athletes, AA displayed alterations distinct from their cycling counterparts, with evidence of a hypometabolic state, including decreased basal body temperature and reduced levels of plasma glucose and serum GHBP, a decrease in the ratio of IGF-I/IGFBP-1, accelerated GH pulse frequency, and elevated interpulse GH levels. Thus, in AA, increased insulin sensitivity, decreased circulating insulin, and a reduced hypoglycemic effect of IGF-I together with elevated GH and cortisol concentrations may comprise a cascade of glucoregulatory adaptations to repartition metabolic fuels for conservation of protein. (ABSTRACT TRUNCATED)

Adolescent↗

Bronchial hyperresponsiveness, airway inflammation, and airflow limitation in endurance athletes.

BACKGROUND: Whereas a high prevalence of bronchial abnormalities has been reported in endurance athletes, its underlying mechanisms and consequences during exercise are still unclear. STUDY OBJECTIVES: The purpose of this study was to assess the following: (1) bronchial responsiveness to methacholine and to exercise; (2) airway inflammation; and (3) airflow limitation during intense exercise in endurance athletes with respiratory symptoms. DESIGN: Cross-sectional observational study. SETTING: Lung function and exercise laboratory at a university hospital. PATIENTS AND MEASUREMENTS: Thirty-nine endurance athletes and 13 sedentary control subjects were explored for the following: (1) self-reported respiratory symptoms; (2) bronchial hyperresponsiveness (BHR) to methacholine and exercise; (3) airflow limitation during intense exercise; and (4) bronchial inflammation using induced sputum and nitric oxide (NO) exhalation. RESULTS: Fifteen athletes (38%) showed BHR to methacholine and/or exercise in association with bronchial eosinophilia (mean [+/- SD] eosinophil count, 4.1 +/- 8.5% vs 0.3 +/- 0.9% vs 0%, respectively), higher NO concentrations (19 +/- 10 vs 14 +/- 4 vs 13 +/- 4 parts per billion, respectively), a higher prevalence of atopy, and more exercise-induced symptoms compared with non-hyperresponsive athletes and control subjects (p < 0.05). Furthermore, airflow limitation during intense exercise was observed in eight athletes, among whom five had BHR. Athletes with airflow limitation reported more symptoms and had FEV1, FEV1/FVC ratio, and forced expiratory flow at midexpiratory phase values of 14%, 9%, and 29%, respectively, lower compared with those of nonlimited athletes (p < 0.05). CONCLUSION: BHR in endurance athletes was associated with the criteria of eosinophilic airway inflammation and atopy, whereas airflow limitation during exercise was primarily a consequence of decreased resting spirometric values. Both BHR and bronchial obstruction at rest with subsequent expiratory flow limitation during exercise may promote respiratory symptoms during exercise in athletes.

Adult↗

Eating disorders in female athletes.

Eating disorders can lead to death. The prevalence of subclinical and eating disorders is high among female athletes, and the prevalence of eating disorders is higher among female athletes than nonathletes. Athletes competing in sports where leanness or a specific bodyweight is considered important are more prone to develop eating disorders than athletes competing in sports where these factors are considered less important. It appears necessary to examine true eating disorders, the subclinical disorders and the range of behaviours and attitudes associated with eating disturbances in athletes, to learn how these clinical and subclinical disorders are related. Because of methodological weaknesses in the existing studies, including deficient description of the populations studied and the methods of data collection, the best instrument or interview method is not known. Therefore, more research on athletes and eating disorders is needed. Suggestions of the possible sport specific risk factors associated with the development of eating disorders in athletes exist, but large scale longitudinal studies are needed to learn more about risk factors and the aetiology of eating disorders in athletes at different competitive levels and within different sports. Further studies are required on the short and long term effects of eating disorders on athletes' health and athletic performance.

Feeding and Eating Disorders↗

Athletes and rape: is there a connection?

The present study builds upon previous research examining variables related to sexual assault. Previous studies have linked sexual aggression with attitudes toward rape as well as hostility toward women. Recent high-profile cases involving athletes and sexual assault have raised questions about the link with athletes. In fact, recent research has suggested that athletes may be more prone to commit rape; however, no study has examined competitiveness. This characteristic, associated with athletes, may predict sexual aggression and help assess why rape is reportedly perpetrated by athletes significantly more frequently than by nonathletes. It may be that individuals with high competitiveness may be more likely to be involved in sexual assaults. Scores on Competitiveness in 104 college men were significantly correlated with reported sexual aggression and athletic participation; however, there was no significant difference between athletes and nonathletes on aggressive sexual behavior. These findings suggest that characteristics of athletes rather than athletic participation alone must be considered further in examining the presumed link between athletes and sexual assault.

Adolescent↗

Physiologic left ventricular cavity dilatation in elite athletes.

BACKGROUND: Absolute left ventricular cavity dimension may be substantially increased in some highly trained athletes. This raises questions about the differential diagnosis between athlete's heart and dilated cardiomyopathy as well as possible disqualification from competitive sports. OBJECTIVE: To evaluate the morphologic characteristics and physiologic limits of left ventricular cavity enlargement associated with intensive, long-term athletic conditioning. DESIGN: Evaluation of left ventricular cavity dimension in a large sample of highly trained athletes. SETTING: Institute of Sports Science, Rome, Italy. PARTICIPANTS: 1309 elite Italian athletes (957 men and 352 women), 13 to 59 years of age (mean, 24 years), participating in 38 different sports. MEASUREMENTS: Echocardiographic assessment of left ventricular cavity dimension and multivariate statistical analysis of the determinants. RESULTS: Left ventricular end-diastolic cavity dimensions varied widely (38 to 66 mm [mean, 48 mm] in women and 43 to 70 mm [mean, 55 mm] in men) and was within generally accepted normal limits for most participants (< or = 54 mm in 725 athletes [55%]). According to an arbitrary clinical cut-point of 60 mm, the left ventricular cavity was substantially enlarged in 185 participants (14%). These athletes had global left ventricular systolic function within normal limits and no regional wall-motion abnormalities; participants remained free of cardiac symptoms and impaired performance over 1 to 12 years (mean, 4.7 years). The major determinants of cavity dimension were greater body surface area and participation in certain endurance sports (cycling, cross-country skiing, and canoeing). CONCLUSIONS: In a sample of highly trained athletes, left ventricular cavity dimension varied widely but was strikingly increased to a degree compatible with primary dilated cardiomyopathy in almost 15% of participants. In the absence of systolic dysfunction, this cavity dilatation is most likely an extreme physiologic adaptation to intensive athletic conditioning. The long-term consequences and significance of this marked left ventricular remodeling of the athlete's heart is not known.

Adolescent↗

Creatine supplementation in Wisconsin high school athletes.

BACKGROUND: Creatine is a nutritional supplement used to enhance athletic performance in collegiate and professional athletes. There is increasing evidence that high school athletes are using creatine as well. The objective of this study was to describe patterns of creatine supplementation as well as the behaviors and beliefs associated with creatine use in high school athletes. METHODS: 4011 high school student-athletes from 37 public high schools in Wisconsin took part in a cross-sectional, multi-site, anonymous, descriptive survey. Measurements included self-reported patterns of creatine use. RESULTS: 16.7% of the athletes (25.3% males, 3.9% females) reported using creatine. Creatine use was lowest in the 9th grade (8.4%) and highest in the 12th grade (24.6%). The percentage of participants in each sport who used creatine varied considerably from 1.3% (female cross country) to 30.1% (football). Increased strength was the most likely perceived benefit of creatine supplementation, while dehydration was cited most often as a perceived risk of creatine use. Users were encouraged to take creatine most often by their friends while their parents discouraged its use. CONCLUSION: Despite the lack of research regarding the efficacy or safety of creatine supplementation in high school athletes, creatine was used by 25% of males and 4% of female high school athletes in Wisconsin. High school athletes who use creatine may not be aware of the risks and benefits associated with creatine supplementation. Primary care providers and sports medicine professionals need to educate athletes, coaches and parents about the creatine use as a performance enhancing supplement.

Adolescent↗

Auscultation of the Chest and Abdomen by Athletic Trainers.

OBJECTIVE: To present a practical overview of the methods and techniques of auscultation of the chest and abdomen for use during the physical examination of athletes. Our intent is to provide information on this clinical technique to assist athletic trainers in recognizing and referring athletes presenting with potentially serious internal organ conditions. BACKGROUND: Use of the stethoscope is a clinical skill increasingly necessary for athletic trainers. Given the expanding breadth of both the assessment techniques used by athletic trainers and the populations they care for and the fact that clinical instruction guidelines have changed in the newly adopted National Athletic Trainers' Association Educational Competencies, our goal is to provide a framework upon which future instruction can be based. DESCRIPTION: This review covers the use of a stethoscope for auscultation of the chest and abdomen. Auscultation of the heart is covered first, followed by techniques for auscultating the breath sounds. Lastly, auscultation of the abdomen describes techniques for listening for bowel sounds and arterial bruits. CLINICAL ADVANTAGES: During the assessment of injuries to and illnesses of athletes, knowledge of auscultatory techniques is valuable and of increasing importance to athletic trainers. Athletic trainers who do not know how to perform auscultation may fail to recognize, and therefore fail to refer for further evaluation, athletes with potentially serious pathologic conditions.

Journal Article↗

Features of Posttraumatic Distress Among Adolescent Athletes.

OBJECTIVE: To examine features of posttraumatic distress related to sport injury among healthy and injured adolescent athletes. DESIGN AND SETTING: Healthy athletes with and without a prior injury history were screened before their competitive season, and injured and matched control athletes were surveyed at 1 week postinjury. SUBJECTS: We screened 283 athletes during the preseason and categorized them by injury history (n = 43) and no injury history (n = 240) groups. Twenty-four athletes (12 injured, 12 matched uninjured controls) were included in the postinjury analysis. MEASUREMENTS: The Impact of Events Scale, a 15-item self-report questionnaire, was used to measure athletes' frequency of experiencing intrusive thoughts and engaging in avoidance behavior regarding athletic injury. RESULTS: Athletes with a recent injury history exhibited a greater frequency of intrusive thoughts and avoidance behavior than did those without a recent injury history. Although postinjury findings did not reach statistical significance, injured athletes' scores increased by 35% to 49% from preinjury to postinjury, whereas only minimal changes (<1%) occurred in the control group. CONCLUSIONS: Younger athletes may be particularly sensitive to injury-related stimuli, which may result in heightened injury-related distress.

Journal Article↗

Athletic Training Students Initiate Behaviors Less Frequently When Supervised by Novice Clinical Instructors.

OBJECTIVE: To identify and compare clinical-instruction behaviors based on the experience level of the instructor. DESIGN AND SETTING: Systematic observation, employing the Clinical Instruction Analysis Tool-Athletic Training II was used to identify clinical instructors', athletic training students', and athletes' behaviors. SUBJECTS: Thirty clinical instructors (19 men, 11 women, mean age = 31.7 +/- 10.4 years) with novice, intermediate, and advanced experience volunteered to participate. MEASUREMENTS: We summarized data into contribution and target categories. Frequency data of the categories were analyzed across experiential level of the clinical instructor. RESULTS: Differences among clinical instructors' experience levels existed in the frequency of athletic training student behaviors (chi(2)(2) = 9.6, P =.008). Post hoc comparisons identified differences in the frequency of athletic training student-initiated behaviors when novice clinical instructors were compared with intermediate (F(2,27) = 5.52, P =.023) and advanced (F(2,27) = 5.52, P =.026) instructors. No significant differences were seen between the clinical instructors' experience levels and total clinical instructors' contribution, total athletes' contribution, silent observation, clinical instructors' use of questions, clinical instructors' use of skill feedback, clinical instructors' use of screening and evaluation techniques, and athletic training students' use of screening and evaluative techniques. CONCLUSIONS: Certified athletic trainers in their initial year of instructor experience appear to lack the requisite clinical-instruction knowledge, skills, and abilities to facilitate athletic training student behavior in a clinical setting. Program directors and clinical coordinators should assign instructors' responsibilities to certified athletic trainers who have more experience or demonstrate the ability to foster student interaction.

Journal Article↗

Measured maximal oxygen uptake in a multi-stage shuttle test and treadmill-run test in trained athletes.

AIM: The aims of the study were: i) to compare the measured maximal oxygen uptake (MVO2max) during the 20 m multi-stage shuttle test (MST) with MVO2max during an incremental treadmill-run test (TRT), and ii) to establish the reliability of MVO2max during MST, in trained athletes. METHODS EXPERIMENTAL DESIGN: 8 well-trained endurance-athletes (END) and 8 athletes involved in team games (GAM) performed the MST twice (i.e. MST1 and MST2) and the TRT once, in 3 separate sessions. MEASURES: MVO2maxx attained in the MST and TRT was measured using a portable respiratory analyser (model K4 RQ, Cosmed). RESULTS: MVO2max attained in the MST and TRT were significantly different for the END athletes (4.1+/-0.28 vs 4.45+/-0.31 Lxmin-1, P<0.05) but not for GAM athletes (4.01+/-0.51 vs 4.1+/-0.59 Lxmin-1, P>0.05). The 95% limits of agreement for MVO2max in the MST in Lxmin-1 were -0.67 to 0.27. MVO2max in MST1 and MST2 were not significantly different for END athletes (4.18+/-0.39 vs 4.1+/-0.28 Lxmin-1, P>0.05) and GAM athletes (4.01+/-0.55 vs 4.01+/-0.51 Lxmin-1, P>0.05). Reliability indicators for MVO2max in Lxmin-1 for MST test-retest were: typical error (TE)=0.14, coefficient of variation (CV)=3.5 and intra-class correlation (ICC)=0.90. CONCLUSION: MVO2max in the MST was lower than that measured in the TRT for the END athletes but not for the GAM athletes. Sport-specificity was an important consideration, especially when testing END athletes for VO2max. MVO2max in the MST showed acceptable levels of reproducibility.

Adult↗

An approach to verifying delayed menarche in Japanese female athletes. Analysis by wavelet interpolation method.

AIM: The theory of delayed menarche in female athletes, despite some evidence for such a delay, has not yet been verified. We examined a means to verify this hypothesis by comparing ages at menarche and at peak height velocity (PHV) derived from the wavelet interpolation method (WIM) for female athletes and non-athletes (control group). METHODS: We identified age at maximum peak velocity as the index of the physical maturation rate by WIM. We then conducted a study involving 144 female athletes in their 1st year at University in the Tokai area, all of whom had competed in a national high school sports competition (athlete group). Past school records of these subjects' heights from the 1st grade of elementary to the 3rd year of senior high school (1984-1995) were collected, and ages at menarche were ascertained from questionnaires. A control group of 78 non-athletes was similarly examined. RESULTS: This difference (interval) between age at menarche and age at PHV was 1.62 years (SD=1.25) in the athlete group and 1.08 years (SD=0.74) in the control group. The difference between the 2 groups was statistically significant (P<0.01). This finding provides evidence that menarche in female athletes is delayed in relation to physical maturation rate. CONCLUSIONS: This result alone cannot establish whether athletic training is the only cause of this delay; however, an approach to verifying the hypothesis of delayed menarche in female athletes has been established by this finding.

Adolescent↗