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PubMed1978

Exertion injuries in adolescent athletes.

A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases.

Adolescent↗
PubMed1978

Iliotibial tract friction syndrome in athletes--an uncommon exertion syndrome on the lateral side of the knee.

An uncommon exertion pain on the lateral side of the knee is described in 88 patients, in four of whom it was bilateral. The disorder is a result of the friction of the iliotibial tract over the lateral femoral epicondyle. The syndrome is the iliotibial tract friction syndrome of ITFS. All the patients in the material were active athletes or middle-aged joggers in regular training. The cases were seen over four years and four months. The mean age of them was approximately 25 years, and there were only nine women in the series. Th pain appeared usually after running and was localised on the outer femoral condyle, and often radiated downwards along the iliotibial tract. Conservative treatment and changes in training habits cured most cases. The disorder has not often been described in the literature, and seems to appear only in physically very active people, such as athletes or military recruits.

Adolescent↗
PubMed1981

Exertion injuries in female athletes.

Because sports injuries in men form most of the available statistics, the reportage of injuries in female athletes is sparse. We describe exertion injuries and disorders in 281 women athletes, all of which hampered athletic training or performances. Sixty per cent of the injuries occurred to girls ages between 12-19 years, and about forty-eight per cent were track and field athletes. The most common sites of injury were the ankle, foot, heel and leg. Osteochondritic disorders were the most typical injuries in the series, and the chronic medical tibial syndrome was the injury that needed surgical treatment most frequently. Overuse injuries seem to differ very little from each other in the events included in this survey.

Adolescent↗
PubMed2004

Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study.

OBJECTIVE: To investigate in a military setting the potential role of intrinsic biomechanical and anthropometric risk factors for, and the incidence of, exertional medial tibial pain (EMTP). METHODS: A prospective clinical outcome study in a cohort of 122 men and 36 women at the Australian Defence Force Academy. Each cadet underwent measurements of seven intrinsic variables: hip range of motion, leg length discrepancy, lean calf girth, maximum ankle dorsiflexion range, foot type, rear foot alignment, and tibial alignment. Test-retest reliability was undertaken on each variable. A physician recorded any cadet presenting with diagnostic criteria of EMTP. Records were analysed at 12 months for EMTP presentation and for military fitness test results. RESULTS: 23 cadets (12 men, 11 women) met the criteria for EMTP after 12 months, with a cross gender (F/M) odds ratio of 3.1. In men, both internal and external range of hip motion was greater in those with EMTP: left internal (12 degrees, p = 0.000), right internal (8 degrees, p = 0.014), left external (8 degrees, p = 0.042), right external (9 degrees, p = 0.026). Lean calf girth was lower by 4.2% for the right leg (p = 0.040) but by only 2.9% for the left leg (p = 0.141). No intrinsic risk factor was associated with EMTP in women. EMTP was the major cause for non-completion of the run component of the ADFA fitness test in both men and women. CONCLUSIONS: Greater internal and external hip range of motion and lower lean calf girth were associated with EMTP in male military cadets. Women had high rates of injury, although no intrinsic factor was identified. Reasons for this sex difference need to be identified.

Adolescent↗
PubMed1991

Effect of pre-exercise protein ingestion upon VO2, R and perceived exertion during treadmill running.

The study investigated the effect of pre-exercise protein ingestion upon the oxygen consumption (VO2), respiratory exchange ratio (R) and perceived exertion (PE) of athletes during treadmill running at intensities of approximately 60, 80, 90 and 100% of their VO2max. Seventeen female athletes aged between 17 and 22 years participated in the study. Subjects completed six assessment sessions, each being preceded by one of the following dietary regimens: a protein solution ingested 3h before assessment (P3), a protein solution ingested 1 h before assessment (P1) and the ingestion of water 1-3 h before assessment (B). The subjects' VO2, R and PE were measured at all exercise intensities using standardized procedures. The results showed that P1 produced significantly higher values for VO2 (P less than 0.05) at all exercise intensities and was associated with an increased PE (P less than 0.01). The findings could have implications for athletes when considering the composition of their pre-exercise meal, especially if performing in activities which require the participants to exercise close to or at their VO2max.

Adolescent↗
PubMed1992

Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy.

When using Borg's 6-20 scale during pregnancy, ratings of perceived exertion (RPE) did not significantly correlate with exercise heart rates (HR) (P greater than 0.05). The HR predicted from RPE significantly (P less than 0.05) underestimated the exercise HR in the second trimester during walking (Group 1: mean difference 16 beats min-1, n = 11), aerobics classes (Group 4: mean 15 beats min-1, n = 48) and circuit training (Group 3: mean 18 beats min-1, n = 24); and in the third trimester during cycling (Group 2: mean 16 beats min-1, n = 12) and aerobics classes (Group 5: mean 11 beats min-1, n = 29). Maximal individual HR under-estimations were large for each physical activity during pregnancy, with values up to 54 beats min-1. Consequently, exercise intensity should not be monitored solely with RPE during pregnancy.

Exercise Test↗
PubMed1995

Rating of perceived exertion and heart rate relative to ventilatory threshold in women.

Forty women took part in a study designed to investigate self-selected exercise intensity relative to ventilatory threshold during circuit weight training (CWT) and exercise-to-music (ETM) sessions. Subjects were assigned to one of two groups which were beginners (B) or habitual exercisers (HE) on the basis of their exercise habits. All subjects first underwent a laboratory cycle ergometer test involving a continuous incremental exercise protocol from which ventilatory threshold (VT) was determined using piecewise linear regression analysis. This point was expressed in terms of heart rate (VTHR) and rating of perceived exertion (VTRPE). These points were then compared with those determined during exercise training sessions (TRAHR and TRARPE respectively). The results showed that mean(s.d.) TRARPE (13.5(1.1) was not significantly different to mean(s.d.) VTRPE (12.8(0.5); P > 0.05) but that mean(s.d.) VTHR (134.8(13.5) beats min-1) and TRAHR (154.9(12.0) beats min-1) were different (P < 0.05). Beginners trained at a significantly higher percentage above VTHR than habitual exercisers (118(3.1) versus 111(2.8)% P < 0.05). During CWT the mean(s.d.) TRAHR for beginners (143.2(7.6) beats min-1) was significantly lower than that for habitual exercisers (152.5(10.1) beats min-1; P < 0.05), but not different during ETM (P < 0.05). When these TRAHR values were expressed relative to an estimated maximum heart rate (EMHR) they represented 86.5% in ETM and 80.5% in CWT which were different (P < 0.05). These results suggest that regardless of habitual exercise level and training mode, these women selected a common intensity of effort that was compatible with the described RPE.

Adolescent↗
PubMed1999

Reliability of ratings of perceived exertion during progressive treadmill exercise.

OBJECTIVE: To assess the test-retest reliability (repeatability) of Borg's 6-20 rating of perceived exertion (RPE) scale using a more appropriate statistical technique than has been employed in previous investigations. The RPE scale is used widely in exercise science and sports medicine to monitor and/or prescribe levels of exercise intensity. The "95% limits of agreement" technique has recently been advocated as a better means of assessing within-subject (trial to trial) agreement than traditional indicators such as Pearson and intraclass correlation coefficients. METHODS: Sixteen male athletes (mean (SD) age 23.6 (5.1) years) completed two identical multistage (incremental) treadmill running protocols over a period of two to five days. RPEs were requested and recorded during the final 15 seconds of each three minute stage. All subjects successfully completed at least four stages in each trial, allowing the reliability of RPE responses to be examined at each stage. RESULTS: The 95% limits of agreement (bias +/- 1.96 x SDdiff) were found to widen as exercise intensity increased: 0.88 (2.02) RPE units (stage 1), 0.25 (2.53) RPE units (stage 2), -0.13 (2.86) RPE units (stage 3), and -0.13 (2.94) RPE units (stage 4). Pearson correlations (0.81, 0.72, 0.65, and 0.60) and intraclass correlations (0.82, 0.80, 0.77, and 0.75) decreased as exercise intensity increased. CONCLUSIONS: These findings question the test-retest reliability of the RPE scale when used to monitor subjective estimates of exercise intensity in progressive (or graded) exercise tests.

Adolescent↗
PubMed2000

Ratings of perceived exertion in braille: validity and reliability in production mode.

OBJECTIVES: (a) To assess the validity and reliability of producing and reproducing a given exercise intensity during cycle ergometry using a braille version of Borg's standard 6-20 rating of perceived exertion (RPE) scale, and (b) to determine whether the exercise responses of blind participants, at a given produced RPE, were similar to those reported in recognised guidelines for sighted subjects. METHODS: Ten healthy registered blind volunteer participants (four women, six men; mean (SD) age 23.2 (9.0) years) performed an initial graded exercise cycle test to determine maximal heart rate (HRMAx) and maximal oxygen uptake (VO2MAX). Three trials of three exercise bouts at RPEs 9, 11, and 13 were then performed in random order on three separate days of the same week, with expired air and heart rate measured continuously. Each exercise bout was followed by 10 minutes of rest. The validity of the scale as a means of producing different exercise intensities was assessed using a two factor (RPE x trial) repeated measures analysis of variance. Intertrial reliability was assessed using intraclass correlation coefficients (ICC) and the bias +/-95% limits of agreement (95%LoA) procedure. RESULTS: Participants reported no difficulty in using the braille RPE scale. When asked to produce exercise intensities equating to RPE 9, 11, and 13, they elicited mean %VO2MAX values of 47%, 53%, and 63% respectively. Analysis of variance showed no significant differences in either %HRMAx or %VO2MAX between trials at each of the three RPEs, but there was a significant difference (p<0.001) in both %HRMAx and %VO2MAX between the three RPE levels. All pairwise comparisons of the three different RPEs were significantly different (p<0.016). The ICC between the second and third trial for %HRMAx was significant (p <0.05) for all three RPEs. Similarly for %VO2MAX, the ICC was significant for RPE 9 and 11 but not 13. The 95%LoA decreased for both %HRMAx and %VO2MAX with each successive trial. CONCLUSIONS: Blind participants were successful in using a braille RPE scale to differentiate exercise intensity on a cycle ergometer. In every trial at RPE 13, all participants achieved %HRMAX and %VO2MAX levels, which fell within the recommendedrange for developing cardiorespiratory fitness. Using %HRMAx as a judge of intertrial reliability, the participants were able to repeat similar exercise intensities after two trials at each of the three RPEs (9, 11,13). The same was true for RPE 9 and 11, when %VO2MAX was used as a judge, but further trials were required to achieve similar reliability at RPE 13. A braille RPE scale can be used by healthy blind people during cycle ergometry, with similar effect to the visual analogue scale recommended for use in healthy sighted people.

Adult↗
PubMed1990

Effects of ultrasound, shortwaves, and physical exertion on pregnancy outcome in physiotherapists.

STUDY OBJECTIVE: The aim of the study was to investigate whether occupational exposure among physiotherapists is associated with spontaneous abortion or congenital malformation in the offspring. DESIGN: The study was a retrospective nested case-control study, where the pregnancy outcome data were based on the medical registers. SETTING: All registered physiotherapists in Finland who had become pregnant during the study period were included in the study. SUBJECTS: Cases were defined as women who had been treated for spontaneous abortion during 1973-1983 or had delivered a malformed child during 1973-1982. One pregnancy per woman was randomly selected for the study. Three age matched (+/- 18 months) controls were selected for each abortion case and five for each malformation case. The final study population was 204 cases and 483 controls in the spontaneous abortion study, and 46 cases and 187 controls in the congenital malformation study. MEASUREMENTS AND MAIN RESULTS: Exposure information was collected by mailed questionnaires from 1329 women. The response rate was 92% in the spontaneous abortion study, and 89% in the congenital malformation study. Heavy lifting (including patient transfers) was associated significantly with spontaneous abortion. Exposure to ultrasound and shortwaves showed about threefold odds ratios for spontaneous abortions occurring after the 10th week of gestation but in analysis where potential confounding variables were controlled, neither reached statistical significance. Deep heat therapies together, and shortwaves alone, were associated significantly with congenital malformations, but the increase was found in the lower exposure category only. From the potential confounding variables, previous abortion (spontaneous or induced) was associated significantly with spontaneous abortion, and febrile disease in early pregnancy was associated with congenital malformation. CONCLUSION: Physical exertion during early pregnancy seems to be a risk factor for spontaneous abortion. The findings raise suspicion of the potential harmful effect of shortwaves and ultrasound on the pregnancy, but no firm conclusion can be drawn on the bases of these results alone.

Abortion, Spontaneous↗
PubMed1988

Ca2+-ATPase deficiency in a patient with an exertional muscle pain syndrome.

31P Magnetic resonance spectroscopy studies were carried out in vivo on skeletal muscle of a patient with verapamil-responsive, chronic, progressive post-exertional muscle pain. A sister suffered from a similar complaint. The results showed that the muscle: (1) decreased its high energy phosphate content more rapidly than normal during exercise, indicating either increased utilisation or decreased production of ATP; (2) acidified more rapidly than normal during exercise suggesting an increased glycolytic rate; (3) continued in some studies to acidify markedly during the first minute after exercise, indicating that glycolysis remained active into the recovery period; (4) had phosphocreatine and ADP recovery rates consistent with normal rates of oxidative phosphorylation. On the basis of these results, it was proposed that the patient suffers from a defect in Ca2+ handling in the muscle. Subsequently, direct measurement of Ca2+-ATPase activity in the sarcoplasmic reticulum fraction from a muscle biopsy sample showed that the activity of this enzyme was reduced by about 90%.

Adult↗
PubMed1993

Exertional rhabdomyolysis in a patient with calcium adenosine triphosphatase deficiency.

A patient with exertional rhabdomyolysis and continuously elevated serum creatine kinase (CK) was investigated. The known causes of recurrent attacks of rhabdomyolysis were ruled out by appropriate histochemical and biochemical investigations. During ischaemic exercise tests an abnormal K(+)-efflux from exercising muscles was observed. The patient was found to have a deficiency of muscular Ca(2+)-ATPase. Dantrolene sodium therapy gave relief of muscle symptoms and improved the exercise tolerance. Both the CK level and the K(+)-efflux in ischaemic forearm testing became normal on this therapy.

Adult↗
PubMed2001

Analysis of stimuli triggering attacks of paroxysmal dystonia induced by exertion.

In a patient with a familial form of paroxysmal exertion induced dyskinesia (PED), the efficacy of different stimuli and manoeuvres in triggering dystonic attacks in the arm was studied. As a new approach, transcranial magnetic stimulation (TMS) of the motor cortex was used to trigger motor paroxysms and to monitor cortical excitability during attacks. Motor paroxysms could be provoked by muscle vibration, passive movements, TMS, magnetic stimulation of the brachial plexus, and electrical nerve stimulation. Sham stimulation over the motor cortex and thermal and tactile cutaneous stimuli were ineffective in triggering attacks. It is concluded that dystonic attacks are triggered by proprioceptive afferents rather than cutaneous stimuli or the descending motor command itself. Outside the attacks, motor cortical excitatory and inhibitory neuronal mechanisms as assessed by TMS (response threshold and amplitudes, duration of the contralateral and ipsilateral silent period, corticocortical inhibition, and facilitation) were normal, which underlines the paroxysmal character of the disorder.

Adult↗
PubMed1998

Exertional dyspnoea in patients with airway obstruction, with and without CO2 retention.

BACKGROUND: Dyspnoea is a common and disabling symptom in patients with cardiopulmonary disease. Unfortunately the mechanisms that produce dyspnoea are still poorly understood. The relationship between dyspnoea and the load on the ventilatory muscles, chemical drive, and ventilatory indices was therefore assessed in patients with obstructive pulmonary disease during an incremental exercise test. METHODS: Fifty patients with a wide range of obstructive pulmonary disease (mean forced expiratory volume in one second (FEV1) 66.1 (28.8)% predicted) performed an incremental cycle ergometer test. A subdivision was made between subjects with CO2 retention (delta PaCO2 > or = 0, n = 22) and subjects without CO2 retention (delta PaCO2 < 0, n = 28) during exercise. During the test dyspnoea (Borg score), oesophageal pressures (mechanical load on the ventilatory muscles (time tension index (TTI), blood gas tensions, and minute ventilation were measured. Correlations for changes in mechanical and chemical factors with changes in dyspnoea score were calculated to assess relevant factors. An analysis of covariance was used to examine whether there was a relationship between dyspnoea score and each of these factors and whether this relationship was different between the subgroups with and without CO2 retention. Multiple regression analysis was used to assess the independent effect of each parameter on dyspnoea sensation. Furthermore, the amplitude of pleural pressure swing ((Pi + Pe)act) generated at maximal work load (Ptot, an indication of the load on all respiratory muscles) was calculated. Analysis of covariance was used to assess whether there was a relationship between tidal volume (VT) and Ptot and whether this relationship was different between the groups (slopes are an expression of the length-tension inappropriateness, LTI). RESULTS: In the total group and the group without CO2 retention a significant correlation between dyspnoea and the increase in the inspiratory time tension index (TTIi) was present. In the group with CO2 retention a significant correlation was seen between dyspnoea and delta PaCO2. The factors delta PaO2, delta VE%MVV and delta (VT/Ti) showed a correlation with a p value of < or = 0.10 both in the total group and in those without CO2 retention. In an analysis of covariance the relationship between dyspnoea score and delta PaCO2 appeared to be significantly different between the two subgroups, being more pronounced in the group with CO2 retention. No other relationships with change in dyspnoea score were found. There was no significant relationship between VT and Ptot in the total group nor in the two subgroups, indicating some length-tension inappropriateness in both groups. CONCLUSIONS: In patients with distinctive pulmonary disease who are normocapnic or hypocapnic the mechanical load (delta TTIi) and length-tension inappropriateness (LTI) on ventilatory muscles seem to be the main determinant of exertional dyspnoea. As soon as hypercapnia occurs, this seems to override all other inputs for dyspnoea.

Analysis of Variance↗
PubMed2004

Prevalence and demographic characteristics of exertional rhabdomyolysis in horses in Australia.

The proportion of the horses, of both sexes and of different ages, breeds and levels of activity, owned by a stratified random sample of Australian owners, which had suffered one or more episodes of exertional rhabdomyolysis during the previous 12 months was determined. The proportion in the general population was 1.9 per cent, and horses which exercised were significantly more likely to have experienced the condition than horses which did not. There were significant differences between the sexes and between certain breeds and activity groups in the proportions of horses affected.

Animals↗
PubMed1998

Ratings of perceived exertion to determine intensity during outdoor running.

A paucity of data exists related to the usefulness of Ratings of Perceived Exertion (RPE) to set exercise intensity in non-laboratory settings. The purpose of this study was to determine if RPE could be used on an outdoor track to generate blood lactate and heart rate (HR) responses similar to those obtained on a treadmill (tm) run. Nine experienced runners (6 males, 3 females; VO2peak = 56.2 +/- 6.7 ml.kg-1.min-1) completed a horizontal, incremental tm test. HR, RPE, and lactate were measured for each stage. Subsequently, subjects ran for 30 min on an outdoor track at the RPE corresponding with 2.5 mM lactate during the tm run. Repeated measures ANOVA compared lactate and HR values at 2.5 mM lactate on the tm run and values obtained during the track run. Lactate during the track run was significantly higher (p < .05) than 2.5 mM throughout the 30 min (6.9 +/- 2.9, 6.3 +/- 2.9, and 5.8 +/- 3.0 mM at 10, 20, and 30 min, respectively). HR at 2.5 mM lactate during the tm run (173 +/- 6.1 bpm) was significantly lower (p < .05) than at min 10 and 20 of the track run (182.6 +/- 9.3 and 182.9 +/- 8.0 bpm, respectively) but not different from min 30 (181.3 +/- 10.6 bpm). In summary, it is difficult to generate specific physiological responses using RPE.

Adult↗
PubMed1991

Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging.

Eccentric muscular actions involve the forced lengthening or stretching of muscles and tend to produce exertional injuries. This study used magnetic resonance (MR) imaging to serially evaluate muscles in five healthy, untrained subjects who performed exhaustive biceps exercise by doing isolated eccentric and concentric actions with a dumbbell. Symptoms were assessed, and T2-weighted images of the arms were obtained before exercise and 1, 3, 5, 10, 25, 40, 50, 60, and 80 days after exercise. Statistically significant increases in T2 relaxation times indicative of muscle injury occurred on each day of MR imaging evaluation in muscles performing eccentric actions, peaking on day 3 in two subjects; day 5, two subjects; and day 10, one subject. The pattern and extent of the abnormalities on MR images were variable. Pain, soreness, and joint stiffness were present on days 1, 3, and 5 in muscles that performed eccentric actions. MR imaging showed subclinical abnormalities that lasted as long as 75 days after the disappearance of symptoms (two subjects). Muscles that performed concentric actions had no changes in T2 relaxation times and were asymptomatic throughout the study.

Adult↗
PubMed1992

Relationship between ammonia, heart rate, and exertion in McArdle's disease.

We studied plasma ammonia and exercise tolerance in six patients with McArdle's disease (myophosphorylase deficiency, type V glycogenosis) during incremental cycle ergometry. Tests were performed either in the postabsorptive state or after supplementation with branched-chain amino and 2-oxoacids and glucose. Glucose and branched-chain 2-oxoacid combined increased total work performed from control 49 +/- 22 to 80 +/- 36 kJ (P less than 0.05). Glucose alone also improved total work performed from 49 +/- 22 to 64 +/- 33 kJ (P less than 0.05). Branched-chain 2-oxoacids alone had a variable effect, and branched-chain amino acids were of no benefit. Correlations between plasma ammonia and heart rate for individual patients were r = 0.99, P less than 0.01; r = 0.95, P less than 0.01; r = 0.84, P less than 0.01; r = 0.76, P less than 0.01; r = 0.73, P less than 0.01; and r = 0.63, P less than 0.05 and between ammonia and perceived exertion for all patients combined was r = 0.70, P less than 0.0001. In two patients, correlation of ammonia with heart rate at a power output of 60 W was r = 0.91, P less than 0.001 and at 40 W was r = 0.77, P less than 0.001. We conclude that ammonia is either a mediator or a marker of the metabolic events leading to fatigue.

Adolescent↗