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Muscle metabolism in track athletes, using 31P magnetic resonance spectroscopy.

We tested whether preferred running event in track athletes would correlate with the initial rate of phosphocreatine (PCr) resynthesis following submaximal exercise. PCr recovery was measured in the calf muscles of 16 male track athletes and 7 male control subjects following 5 min of repeated plantar flexion against resistance. Pi, PCr, and pH were measured using phosphorus magnetic resonance spectroscopy (31P MRS) with an 8-cm surface coil in a 1.8-T magnet. During exercise, work levels were gradually increased to deplete PCr to 50-60% of the initial value. No drop in pH was seen in any of the subjects during this exercise. The areas of the PCr peaks following exercise were fit to monoexponential curves. Two or three tests were performed on each subject and the results averaged. Athletes were divided into three groups based on their primary event: sprinters running 400 m or less, middle-distance athletes running 400-1500 m, and long-distance athletes running farther than 1500 m. The maximal rates of PCr resynthesis (mmol.min-1.kg-1 muscle weight) were 64.8 +/- 8.6, for long-distance runners; 41.4 +/- 11, for middle-distance runners; 32.0 +/- 7.0, for sprinters; and 38.6 +/- 10, for controls (mean +/- SE). The faster PCr recovery rates seen in long-distance runners compared with sprinters indicate greater oxidative capacity, which is consistent with the known differences between athletes in these events.

Adolescent↗

Myocardial blood flow, oxygen consumption, and fatty acid uptake in endurance athletes during insulin stimulation.

We have previously demonstrated reduced myocardial glucose uptake rates in hearts of endurance athletes, which could be due to increased use of alternative fuels or reduced energy demands. In the present study myocardial blood flow, oxygen consumption, and free fatty acid uptake were measured with [(15)O]H(2)O, [(15)O]O(2), [(18)F]FTHA, and positron emission tomography (PET) in 9 endurance athletes and 11 sedentary men during euglycemic hyperinsulinemia. Compared with sedentary men, athletes had 33% lower myocardial blood flow, 27% lower oxygen consumption, and 20% lower estimated myocardial work per gram of tissue. Myocardial fatty acid uptake rates were not significantly different in endurance athletes (0.83 +/- 0.29) and sedentary men (1.0 +/- 0.31 micromol. 100 g(-1). min(-1), P = 0.232). In conclusion, myocardial blood flow and oxygen consumption per unit mass of myocardium are reduced at rest in endurance athletes. This can be explained by reduced energy requirements per gram of tissue due to anatomic and physiological changes of the athlete's heart.

Adult↗

Skeletal muscle enzymes and fiber composition in male and female track athletes.

Muscle samples were obtained from the gastrocnemius of 17 female and 23 male track athletes, 10 untrained women, and 11 untrained men. Portions of the specimen were analyzed for total phosphorylase, lactic dehydrogenase (LDH), and succinate dehydrogenase (SDH) activities. Sections of the muscle were stained for myosin adenosine triphosphatase, NADH2 tetrazolium reductase, and alpha-glycerophosphate dehydrogenase. Maximal oxygen uptake (VO2max) was measured on a treadmill for 23 of the volunteers (6 female athletes, 11 male athletes, 10 untrained women, and 6 untrained men). These measurements confirm earlier reports which suggest that the athlete's preference for strength, speed, and/or endurance events is in part a matter of genetic endowment. Aside from differences in fiber composition and enzymes among middle-distance runners, the only distinction between the sexes was the larger fiber areas of the male athletes. SDH activity was found to correlate 0.79 with VO2max, while muscle LDH appeared to be a function of muscle fiber composition. While sprint- and endurance-trained athletes are characterized by distinct fiber compositions and enzyme activities, participants in strength events (e.g., shot-put) have relatively low muscle enzyme activities and a variety of fiber compositions.

Adenosine Triphosphatases↗

Respiratory drives and exercise in menstrual cycles of athletic and nonathletic women.

To investigate the influence of the midluteal and midfollicular phases of the menstrual cycle on exercise performance and ventilatory drives, we studied six outstanding female athletes, six controls with normal menstrual cycles, and six outstanding athletes who were amenorrheic. In all menstruating subjects resting minute ventilation (Ve) and mouth occlusion pressures (P0.1) were higher in the luteal phase (p less than k0.0001 and p less than 0.02, respectively),. Hypoxic (expressed as the hyperbolic shape parameter A) and hypercapnic (expressed as S, deltaVE/delta PAco2) ventilatory responses were increase in the luteal phase (p less than 0.01). The athletes had lower A values during the luteal phase than the nonathletes (p less than 0.001). Maximal exercise response, expressed either as total exercise time or maximum O2 consumption or CO2 production (VO2 max or Vco2 max) was decreased during the luteal phase but was significantly different at a p less than 0.05 level only among the nonathletes. Ventilatory equivalent (VE/VO2) during progressive exercise on a bicycle ergometer was significantly increased during the luteal phase. The amenorrheic athletes showed no changes between the two test periods. The luteal phase of the menstrual cycle induced increases in ventilatory drives and exercise ventilation in both athletes and controls, but the athletes, in contrast to controls, demonstrated no significant decrease in exercise performance in the luteal phase.

Adolescent↗

Effect of exercise on left ventricular diastolic filling in athletes and nonathletes.

To evaluate the effect of exercise on left ventricular diastolic filling, the following were measured at rest and during exercise in 14 control subjects and 15 athletes, using digitized M-mode echocardiography: the peak early diastolic lengthening rate of the left ventricular dimension and the filling volume and the filling fraction during the first 0.10 s of diastole. During ergometer exercise performed at a level that increased the heart rate to 100 beats/min, there were significant increases in the peak normalized lengthening rate of the left ventricular dimension (control subjects, 4.2 +/- 1.3 vs. 6.1 +/- 1.1 s-1, mean +/- SD, P less than 0.001; athletes, 5.3 +/- 0.9 vs. 7.4 +/- 1.1 s-1, P less than 0.001), filling volume (control subjects, 15 +/- 12 vs. 33 +/- 10 ml, P less than 0.001; athletes, 21 +/- 12 vs. 63 +/- 18 ml, P less than 0.001), and filling fraction (control subjects, 21 +/- 14 vs. 42 +/- 17%, P less than 0.005; athletes, 21 +/- 13 vs. 54 +/- 12%, P less than 0.01). The peak lengthening rate of the left ventricular dimension, the filling volume, and the filling fraction were significantly greater in athletes than in control subjects during exercise (P less than 0.005, P less than 0.001, and P less than 0.05, respectively). Augmented early diastolic filling may be a mechanism to provide adequate filling for the ventricle at high heart rates produced by exercise, especially in athletes.

Adolescent↗

Left ventricular mass, geometry, and filling in endurance athletes: association with exercise blood pressure.

We studied whether left ventricular (LV) mass and concentricity [relative myocardial volume (RMV)] are associated with exercise blood pressure (BP) in athletes. LV structure and filling were evaluated by Doppler echocardiography and BP in maximal bicycle ergometry and isometric handgrip tests on 32 male endurance athletes and 15 age-matched controls. Indexed LV mass was 145 +/- 14 (SD) g/m in athletes and 93 +/- 20 g/m in controls. Mass was not associated with BP at rest or in low-grade exercise, but with heavier exercise loads this association strengthened in athletes, being maximal at peak exercise (r = 0.65 for mass and 0.58 for indexed mass; P < 0.001). Multivariate analysis indicated that BP at peak exercise accounted for 34% and the amount of training for an additional 11% of the variance in indexed LV mass. RMV was 21% larger in athletes. Only the increase in systolic BP during handgrip explained significantly (19%) the variance in RMV. LV filling velocities were not associated with mass, RMV, or BP. We conclude that in endurance athletes LV mass is associated with BP in heavy dynamic exercise and LV concentricity with BP response in static exercise.

Adult↗

Electrical and mechanical H(max)-to-M(max) ratio in power- and endurance-trained athletes.

The aim of this study was to compare the mechanical and electromyographic (EMG) characteristics of soleus motor units activated during maximal H reflex and direct M response among subjects with different histories of physical activity. Power-trained athletes produced stronger twitches, with a higher rate of twitch tension buildup and relaxation, than their endurance counterparts for both maximal H-reflex and maximal M-wave responses. The maximal H-reflex-to-maximal M-wave ratios for both force output (twitch) and EMG wave amplitude were significantly lower in power-trained than endurance-trained athletes. However, power-trained athletes exhibited a significantly greater twitch-to-EMG ratio for the reflexly activated motor units with respect to the entire motor pool, whereas endurance-trained athletes had comparable twitch-to-EMG ratios for both reflexly and directly activated units. Power training increases the force output of the whole ensemble of the motor units, thereby compensating for the lower efficacy of the reflex transmission between Ia spindle afferent input and soleus alpha-motoneuron. On the other hand, the lower level of force evoked by the reflexly activated units in endurance-trained athletes is associated with a greater motor pool reflex excitability. Therefore, endurance-trained athletes produce the necessary force by recruitment of more slow-twitch units than do other subjects for comparable levels of force and type of task.

Adult↗

Left ventricular wall thickening does occur in elite power athletes with or without anabolic steroid Use.

Reports on the occurrence of left ventricular wall thickening in resistance-trained athletes have rejected the possibility for this physiological adaptation to occur without concomitant anabolic steroid abuse. Others have concluded short bursts of arterial hypertension that occur with maximal weight lifting are not sufficient to induce left ventricular wall thickening, and left ventricular wall thickness >/=13 mm should not be found in pure resistance-trained athletes. Therefore, we examined 4 elite resistance-trained athletes by two-dimensional echocardiography. In addition, we retrospectively examined the individual left ventricular dimensions of 13 bodybuilders from our previous echocardiographic studies. All 4 elite resistance-trained athletes had left ventricular wall thicknesses beyond 13 mm. One of the elite bodybuilders has the largest left ventricular wall thickness (16 mm) ever reported in a power athlete. Retrospectively, 43% of the drug-free bodybuilders and 100% of the steroid users had left ventricular wall thickness beyond the normal range of 11 mm. In addition, 1 drug-free subject and 3 steroid users were beyond the critical mark of 13 mm. No subjects demonstrated diastolic dysfunction. In contrast to previous reports, we have demonstrated that left ventricular wall thicknesses >/=13 mm can be found routinely in elite resistance-trained athletes. The use of anabolic steroids concomitant with intensive resistance exercise does appear to augment left ventricular size without dysfunction. Anabolic steroids may accelerate left ventricular wall thickening indirectly by increasing strength, thus augmenting the pressor response.

Adult↗

B-type natriuretic peptide is related to left ventricular mass in hypertensive patients but not in athletes.

A positive correlation has been previously documented between B-type natriuretic peptide (BNP) levels and left ventricular mass index (LVMI) in hypertensive patients. We evaluated 8 cycling athletes, 8 healthy age-matched controls; 17 hypertensive patients and 7 age-matched controls. LVMI was significantly higher in athletes and hypertensive patients than in their controls. Plasma levels of BNP in hypertensive patients were significantly higher than in athletes and their age-matched controls. No significant difference was found between athletes and their controls. Cycling athletes had significantly larger LVMI than hypertensive patients and controls, without elevated BNP levels. These results suggest that BNP levels are elevated in patients with increased LVM due to hypertension but not in physiologically increased LVM. Whether elevated BNP levels in athletes is a sign of structural heart disease merits further investigation.

Adult↗

The protein polymorphism of haptoglobin in Korean elite athletes.

OBJECTIVE: To investigate protein polymorphism of the haptoglobin (Hp) and the relationship between Hp phenotypes and anthropometric or biochemical parameters in elite Korean male athletes. MATERIALS AND METHODS: Serum samples were collected from 120 Korean male elite athletes. The Hp phenotypes were determined by polyacrylamide gel electrophoresis, followed by peroxidase staining. Then anthropometric or biochemical measurements were made: body composition, blood pressures, ventilatory responses, cholesterol (total, LDL cholesterol and HDL cholesterol), triglyceride, apolipoprotein A1, lipoprotein (a), creatine phosphokinase and lactate dehydrogenase. RESULTS: The gene frequencies of the Hp1-1, Hp2-1 and Hp2-2 phenotypes in Korean male athletes were 12, 37 and 51%, respectively; this polymorphism was significantly associated with the VO(2max) index in the athletes. An excess of the Hp1 allele was also observed in marathon runners compared with the other sporting activities, although it did not have any statistical significance. CONCLUSION: Hp polymorphism exists in elite Korean male athletes and Hp phenotype may be a useful marker for endurance performance in these male athletes.

Adult↗

Augmented cardiopulmonary baroreflex control of forearm vascular resistance in young athletes.

The aim of this study was to examine the effect of exercise training on reflex control of vascular resistance in human males. Forearm vascular responses to lower body negative pressure (LBNP) at -10 and -40 mm Hg were compared between highly trained young athletes (21.5 +/- 0.5 years old, n = 14) and age-matched nonathletes (20.7 +/- 0.5 years old, n = 16). Resting heart rate was lower in athletes than in nonathletes. Resting blood pressure, central venous pressure, forearm blood flow, and forearm vascular resistance were not different between the two groups. The magnitude of reflex forearm vasoconstriction in response to LBNP at -10 mm Hg, which decreased central venous pressure but did not alter blood pressure or heart rate, was greater in athletes than in nonathletes. The slope of the regression line relating changes in central venous pressure and forearm vascular resistance was steeper in athletes than in nonathletes. Vasoconstrictive responses to intraarterially administered norepinephrine and angiotensin II did not differ between athletes and nonathletes. These results suggest that the tonic inhibitory influence of the cardiopulmonary receptors is augmented in athletes. This augmentation may contribute to some of cardiovascular and endocrine adaptations that occur with exercise training.

Adult↗

Airway hyperresponsiveness in elite athletes.

It has been suggested that high-level training could contribute to the development of airway hyperresponsiveness (AHR), but the comparative effects of different sports on airway function remains to be determined. We evaluated 150 nonsmoking volunteers 18 to 55 yr of age; 100 athletes divided into four subgroups of 25 subjects each according to the predominant estimated hydrocaloric characteristic of ambient air inhaled during training: dry air (DA), cold air (CA), humid air (HA) and a mixture of dry and humid air (MA), and 50 sedentary subjects. Each subject had a respiratory questionnaire, a methacholine challenge, allergy skin-prick tests, and heart rate variability recording for evaluation of parasympathetic tone. The athletes had a 49% prevalence of AHR (PC(20) < 16 mg/ml), with a mean PC(20) of 16.9 mg/ml, compared with 28% (PC(20): 35.4) in sedentary subjects (p = 0.009). The prevalence (%) of AHR and mean PC(20) (mg/ml) varied as followed in the four subgroups of athletes: DA: 32% and 30.9; CA: 52% and 15.8; HA: 76% and 7.3; and MA: 32% and 21.5 (p = 0.002). The estimated parasympathetic tone was higher in athletes (p < 0.001), but this parameter showed only a weak correlation with PC(20) (r = -0.17, p = 0.04). This study has shown a significantly higher prevalence of AHR in athletes than in the control group because of the higher prevalence in the CA and HA groups. Parasympathetic activity may act as modulator of airway responsiveness, but the increased prevalence of AHR in our athlete population may be related to the type and possibly the content of inhaled air during training.

Adolescent↗

When food becomes a drug: nonanabolic nutritional supplement use in athletes.

The use of nonanabolic nutritional supplements for the sake of improving athletic performance is common, and the types of supplements used can have significant implications for the medical care of athletes. This review will address the most common and most controversial nonanabolic nutritional supplements, including recommendations regarding their use. Many supplements are marketed and promoted based on various theoretical benefits, often derived from limited animal studies, without any basis for recommending their human use. Physicians are trained to not recommend a nutritional supplement unless it is known to be effective, whereas athletes are oriented toward trying any supplement or ergogenic aid as long as it is safe, with the hope that it may be effective. The built-in error in most study designs is larger than the difference between winning and not qualifying at elite levels of competition, such that research may not always answer the questions raised by athletes. An honest discussion of the limitations of most supplements, and acknowledgment that some supplements may work some of the time in some athletes, may lead the physician to be more credible and useful to athletes in providing medical care and guidance that support their desire to improve their performance.

Amino Acids, Branched-Chain↗

Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity.

PURPOSE: The purpose of this study was to evaluate the results in selected high-risk patients who underwent arthroscopic stabilization of shoulders with recurrent anterior instability. HYPOTHESIS: Arthroscopic stabilization using suture anchors is useful for athletes younger than 25 years or for contact athletes without a large bone loss of glenohumeral articulation. STUDY DESIGN: Prospective cohort study. METHODS: The study group comprised 55 patients, with a mean follow-up of 42 months (range, 25-72 months). Thirty-two patients had recurrent dislocations, 14 had recurrent subluxations, and 9 had recurrent subluxations after a single dislocation. Rowe score, range of motion, recurrence, and sports activities were evaluated. RESULTS: Mean Rowe score improved from 30.1 to 92.3 points; 45 scores (82%) were excellent, 5 (9%) good, 1 fair (2%), and 4 (7%) poor. Patients had lost a mean of 4 degrees of external rotation in adduction. Four (7%) had recurrence. The recurrence rate in contact athletes (9.5%, 2 of 21) was not statistically different from that in noncontact athletes (6%, 2 of 34). Forty-four (80%) returned at the same levels. The complete return rate in overhead-throwing athletes (68%, 17 of 25) was lower than that in nonoverhead athletes (90%, 27 of 30) (P = .0423). Five patients had unsatisfactory results. CONCLUSION: Arthroscopic stabilization is a reliable procedure in selected high-risk patients.

Adolescent↗

Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review.

BACKGROUND: Female collegiate athletes have been reported to have a higher rate of anterior cruciate ligament injury compared to male collegiate athletes. This finding has spawned a branch of research focused on understanding and preventing this injury pattern. PURPOSE: To determine if the trends reported in 1994 have continued. STUDY TYPE: Descriptive epidemiology study. METHODS: The National Collegiate Athletic Association Injury Surveillance System database was reviewed for all data relating to men's and women's basketball and soccer anterior cruciate ligament injuries for 1990 to 2002. RESULTS: No significant difference was seen in basketball comparing frequency of contact versus noncontact injuries between men (70.1%) and women (75.7%). Male basketball players sustained 37 contact injuries and 78 noncontact injuries. Female basketball players sustained 100 contact injuries and 305 noncontact injuries. In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and noncontact injuries (chi2=4.1, P<.05). Male soccer players sustained 72 contact injuries and 66 noncontact injuries. Female soccer players sustained 115 contact injuries and 161 noncontact injuries. The magnitude of the difference in injury rates between male and female basketball players (0.32-0.21, P=.93) remained constant, whereas the magnitude of the difference in the rate of injuries between male and female soccer players (0.16-0.21, P=.08) widened. Comparing injury within gender by sport, soccer players consistently sustained more anterior cruciate ligament injuries than did basketball players. The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P=.002). The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P=.04). The rates for all anterior cruciate ligament injuries for women were statistically significantly higher (P<.01) than the rates for all anterior cruciate ligament injuries for men, regardless of the sport. In soccer, the rate of all anterior cruciate ligament injuries across the 13 years for male soccer players significantly decreased (P=.02), whereas it remained constant for female players. CONCLUSIONS: In this sample, the rate of anterior cruciate ligament injury, regardless of mechanism of injury, continues to be significantly higher for female collegiate athletes than for male collegiate athletes in both soccer and basketball. CLINICAL RELEVANCE: Despite vast attention to the discrepancy between anterior cruciate ligament injury rates between men and women, these differences continue to exist in collegiate basketball and soccer players. Also demonstrated is that although the rate of injury for women is higher than for men, the actual rate of injury remains low and should not be a deterrent to participation in sports.

Analysis of Variance↗

Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention.

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The gender gap in anterior cruciate ligament injury, combined with evidence that the underpinnings of this serious health problem are neuromuscular in nature, leads to the development of neuromuscular interventions designed to prevent injury. A systematic review of the published literature yielded 6 published interventions targeted toward anterior cruciate ligament injury prevention in female athletes. Four of 6 significantly reduced knee injury incidence, and 3 of 6 significantly reduced anterior cruciate ligament injury incidence in female athletes. A meta-analysis of these 6 studies demonstrates a significant effect of neuromuscular training programs on anterior cruciate ligament injury incidence in female athletes (test for overall effect, Z = 4.31, P < .0001). Examination of the similarities and differences between the training regimens gives insight into the development of more effective and efficient interventions. The purpose of this "Current Concepts" review is to highlight the relative effectiveness of these interventions in reducing anterior cruciate ligament injury rates and to evaluate the common training components between the training studies. In addition, the level of rigor of these interventions, the costs and the difficulty of implementation, the compliance with these interventions, and the performance benefits are discussed. This review summarizes conclusions based on evidence from the common components of the various interventions to discuss their potential to reduce anterior cruciate ligament injury risk and assess their potential for combined use in more effective and efficient intervention protocols.

Adolescent↗

Osteoid osteoma of the femoral neck in the young athlete.

The purpose of this paper is to present a progressive diagnostic and management program for osteoid osteoma of the femoral neck in the young athlete. Five young athletes with hip pain secondary to osteoid osteoma are presented. The average age of the patients was 15 years old, with an average followup of 4 years. Radioisotope bone scans, computed axial tomograms, and linear tomograms were valuable diagnostic aids. All five athletes were treated with a limited excisional biopsy via an anterior approach to the femoral neck. Associated treatment modalities, such as bone grafting, internal fixation, and cast immobilization, were not necessary. There were no major complications. The five young athletes returned to sports at an average of 4 months postoperatively. Osteoid osteoma of the femoral neck should be included in the differential diagnosis of hip pain in young athletes. A limited excisional biopsy provided a rapid return to sports for the young athlete without the potential morbidity associated with internal fixation, bone grafting, and cast immobilization.

Adolescent↗

Exercise performance of collegiate rodeo athletes.

In this study we examined the physical, hematologic, and exercise response of 20 male and 10 female athletes of the National Intercollegiate Rodeo Association, Central Rocky Mountain Region. Male subjects were grouped by roughstock, steer wrestling, and roping events. Female athletes were grouped separately. Maximal aerobic capacity, pulmonary ventilation, respiratory exchange ratio, energy expenditure, maximal heart rate, blood pressure, treadmill time, pre- and postexercise lactate, percent body fat, lean body mass, blood chemistry, serum lipids, and reaction/movement time were analyzed by event. No significant differences (P greater than 0.05) were found in any of these categories between male events. Mean resting blood chemistry parameters of rodeo athletes were within normal ranges. Steer wrestling athletes possessed greater body size and lean body mass than other groups. When analyzing body composition, blood pressure, and total cholesterol:high-density lipoprotein (HDL) cholesterol ratios, results indicate average to low risk for coronary heart disease. When compared to other intermittent-activity sport athletes, college rodeo athletes appear to have similar aerobic capacities, but possess lower lean body mass and greater percent body fat.

Adult↗