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Long-term recreational gymnastics, estrogen use, and selected risk factors for osteoporotic fractures.

The purpose of this cross-sectional study was to examine whether long-term participation in recreational gymnastics or folk dancing or estrogen replacement therapy (ERT) is associated with mechanically more competent bones and improved muscular strength and body balance. One hundred and seventeen healthy, female postmenopausal recreational gymnasts (mean age 62.1 [SD 4.7] years) and 116 sedentary controls (mean age 61.5 [4.6] years) were enrolled in the study. Bone mineral content (BMC) of the distal radius, femoral neck, and trochanter were measured with dual-energy X-ray absorptiometry. BMC of the midshaft and distal tibia and trabecular density (TrD) of the distal tibia were measured with peripheral computed quantitative tomography. Maximal isometric strength, muscular power, cardiorespiratory fitness, and body balance of the participants were also assessed. The cardiorespiratory fitness, muscular strength, and dynamic balance of the recreational gymnasts and folk dancers combined were significantly better than those of the controls, the average group difference ranging from 7.5% (95% confidence interval 5.0-9.9%) in dynamic balance to 12.8% (6.6-19. 4%) in dynamic muscular power. ERT was not associated with the fitness indicators, muscular power, or balance, but was significantly associated with the BMC at all the measured bone sites, the mean group difference between estrogen users and nonusers ranging from 6.5% (3.7-9.3%) for the tibial shaft to 11.8% (6.4-17. 0%) for the distal radius. Recreational gymnastics, in turn, was significantly associated with higher BMC at the tibia only, the mean group difference being 3.9% (0.9-6.9%) for the tibial shaft and 7.7% (3.7-11.9%) for the distal tibia. Recreational gymnastics was also associated with higher TrD at the distal tibia (5.2%; 1.2-9.2%), whereas estrogen usage did not show such association. The results indicate that ERT seems especially effective in preventing postmenopausal bone loss, whereas recreational gymnastics and folk dancing improve muscular performance and body balance in addition to increased bone mass and bone size in the tibia. All these factors are essential in prevention of fall-related fractures of the elderly.

Absorptiometry, Photon↗

[Evolution of the physiological profile of gymnasts over the past 40 years. A review of the literature].

Authors illustrate the evolution of the physiological profile of gymnasts over the past 40 years. Gymnasts are demonstrating increased anaerobic power. Maximal power output measured by the Wingate test in high level male gymnasts is currently between 12 and 14 W x kg(-1). Female gymnasts show maximal power between 10 and 12 W x kg(-1). In spite of an increase in the number of training hours, they have a low aerobic aptitude. It is still adequate and sufficient for their practice. Maximal heart rate values measured during gymnastic exercises have mirrored technical and acrobatic demands of increasing difficulty. Currently, exercise heart rates exceed 190 beat x min(-1) as compared to 135 to 151 beat x min(-1) in the seventies. Measurement of higher blood lactate values suggests that anaerobic glycolysis has increased in importance. Glycolytic contributions differ between apparatuses. Data from energy cost studies demonstrate that gymnastics energy demands are greater now than in the seventies.

Adaptation, Physiological↗

Nutritional status and body composition of juvenile elite female gymnasts.

BACKGROUND: The purpose of this study was to examine body composition, dietary intake and energy expenditure in 12 young female elite gymnasts aged 10.1 +/- 0.3 years, doing a physical exercise of 15 hrs x week-1. The results were compared with a control group consisting of nine volunteer school girls age matched doing less than 4 hrs x wk-1 of physical exercise. METHODS: Assessments included dietary intake for 7 days, anthropometric measurements (body weight, height, arm circumference, triceps and subscapular skinfolds, body mass index). Body fat percentage was estimated using the Slaughter equation. Anthropometric measurements and nutritional intake were recorded in autumn. RESULTS: The gymnasts were shorter and had lower body weight compared with controls (p<0.05). Percentage of body fat was significantly lower in gymnasts versus controls (p<0.01). Gymnasts had higher percentage of fat free mass (p<0.01) than the reference group. Daily energy intake met daily energy requirement in both groups. Distribution of energy for both groups was almost identical, with approximately 14% from protein, 48% from carbohydrate, and 37% from fat. The average intakes of polyunsaturated fat were low in the two groups. The main daily intake of most nutrients in both groups were in accordance with recommendations; exceptions were dietary fibre, E and B6 vitamins. CONCLUSIONS: The primary finding of this investigation is that in both groups, the mean daily energy intake met the energy requirement. Thus, the gymnasts did not restrict total energy. The overall nutrient intake of the two groups may appear adequate. Prepubertal gymnasts have higher percentage of fat free mass and daily energy expenditure and dietary intakes, but lower percent body fat than age matched controls.

Anthropometry↗

Gymnast's wrist.

The wrist is a frequent site of symptoms and injury in the gymnast, both acute and chronic. The chronic injuries are due to repetitive loading of the musculoskeletal system, and their incidence rises as participation and level of competition rises. More attention needs to be directed toward prevention, but many of these injuries seem to be inherent to the sport as it transforms the upper extremities into weight-bearing limbs. Evaluation and recognition of wrist injuries in the gymnast will allow appropriate management for these patients; however, the compulsive and intense nature of many gymnasts can lead to recurrent or new injury and continued wrist symptoms. Much more sophisticated and detailed examination of the gymnast's wrist should be done before onset of training, before increase of intensity of training, before competition, and with the onset of any symptoms, including observed guarding. In addition, pretraining and annual follow-up wrist radiographs should be considered for the skeletally immature gymnast. Follow-up evaluation after skeletal maturity and retirement from active participation is needed to elucidate the long-term effect of gymnastics on the wrist.

Chronic Disease↗

Gymnastics safety for the physician.

For purposes of referral, it would be wise for the physician who frequently sees gymnasts as patients to own a copy of the U.S.G.S.A. Safety Manual. All safety standards are thoroughly explained and diagrammed. Through the employment of the physician's expertise and the coaches' and gymnasts' cooperation, a reduction in both the frequency and the severity of gymnastics injuries will occur. I firmly believe that gymnastics is already a safe sport. The injury survey previously referred to verifies this. I have, however, learned that through the ongoing support and cooperation of a sports medicine practitioner who has taken the time to acquaint himself with gymnastics, gymnasts will benefit in immeasurable ways.

Equipment Safety↗

Height, body composition, biological maturation and training in relation to socio-economic status in girl gymnasts, swimmers, and controls.

This study examined the height, body composition, prevalence of obesity, biological maturation and training in relation to socio-economic status of 78 female gymnasts (age 138 +/- 18 months), 52 girl swimmers (age 134 +/- 24 months) and 116 control girls (age 131 +/- 21 months). The female gymnasts are shorter and lighter than girl swimmers. They are also shorter than control girls comparing the growth percentiles. The weight to height ratio (w/h) and the Quetelet index are the same for the groups. The female gymnasts have less fat, and a later biological maturation than girl swimmers and controls. The socio-economic status of girl swimmers is lower than that of the control group. Nevertheless the girl swimmers are taller and they have the same biological maturation as the controls. The girl swimmers are even more matured than the gymnasts. The gymnasts have the same socio-economic status as the controls, but they are shorter and less matured. Therefore, in the investigated groups no positive relationship between height and socio-economic status exists. Nor is a low socio-economic status accompanied by a late biological maturation or a higher prevalence of obesity. Training did not correlate with socio-economic status in gymnasts or controls, only in the swimming group a weak correlation was found.

Adolescent↗

Bone mineral density and dietary intake of female college gymnasts.

The purposes of this study were to determine bone mineral density (BMD) of female college gymnasts (N = 26) and age- (+/- 1.0 yr), height- (+/- 5.1 cm), and weight- (+/- 2.3 kg) matched controls (N = 26) using dual energy x-ray absorptiometry and to examine the relationship of physical activity, diet, menstrual history, and BMD in these athletes. Energy expenditure, dietary intake and menstruation were assessed using standardized questionnaires. The BMD of the gymnasts were significantly (all P < 0.0001) higher than controls for the lumbar spine (L1-4), total proximal femur, femoral neck, Ward's triangle, and whole body. Mean calcium and kcal intakes for both groups were lower than the Recommended Dietary Allowances, and gymnasts had significantly lower kcal intakes than controls (P < 0.05). More gymnasts than controls (59% vs 24%) reported that their menstrual cycle had been interrupted at some point since menarche (P < 0.02). The major finding of this investigation is that the BMD of gymnasts were higher than matched controls despite the fact that gymnasts as a group had inadequate dietary calcium and a higher propensity to have an interruption of their menstrual cycle.

Absorptiometry, Photon↗

Gymnasts, distance runners, anorexics body composition and menstrual status.

Ten top class female distance runners, ten female anorexics and twenty female gymnasts of a similar age were compared for height, mass, %fat, fat mass, lean body mass, age of menarche and incidence of amenorrhoea. The mean age of the distance runners, anorexics, and gymnasts was 13.6 years, 14.7 years, and 13.3 years respectively. In comparison to normal data on females of a similar age they were shorter, lighter, had lower fat masses, and %fat, and the gymnasts and anorexics had lower lean body masses. However, the gymnasts and runners had higher lean body masses compared with the anorexic group. There were no significant differences in body composition by hydrostatic weighing but of these three groups the anorexics tended to have the highest total skinfold, %fat and fat masses. Only 20% of the gymnasts, 40% of the runners and 70% of the anorexics had started menstruating compared with 95% of girls of a similar age. Of the girls in our study who had started menstruating one gymnast, (25% of sub-group) two runners (50% of sub-group) and seven anorexics (100% of sub-group) had developed secondary amenorrhoea. The low body masses, low fat masses, delayed menarche and secondary amenorrhoea in athletes are discussed in relation to low caloric intake, stress, hormone levels, high training loads and genetic factors. Our data demonstrating no significant differences in body composition variables between the three groups of young girls, support the main contention that this type of physique may arise through different mechanisms leading to a common outcome, but without a proven causal link between anorexia and athletic performance.

Adolescent↗

Injury in Australian female competitive gymnasts: A psychological perspective.

A nationwide sample of 162 Australian elite and non-elite competitive female gymnasts was administered a questionnaire to collect personal and training data, as well as information about injuries sustained in the previous 12 months. In addition, to assess the role of psychological variables in injury, the subjects were requested to complete measures of life stress, competitive anxiety, self-esteem, and locus of control. The sample reported 321 injuries, a rate of 1.98 injuries per gymnast (2.36 for the elite gymnasts and 1.83 for the non-elite gymnasts). It was found that for the overall sample and for the non-elite gymnasts, life stress was a significant predictor of injury. For the elite gymnasts, a more internal locus of control significantly predicted injury. The findings indicate the importance of the sports physiotherapist's awareness of the role of stress both as a predisposing factor to injury and also as a variable that should be considered during the rehabilitation process.

Journal Article↗

Ground Reaction Forces Among Gymnasts and Recreational Athletes in Drop Landings.

OBJECTIVE: To compare vertical ground reaction forces among gymnasts and recreational athletes during drop landings from 30-, 60-, and 90-cm heights. DESIGN AND SETTING: Two subject groups, intercollegiate gymnasts and college-aged recreational athletes, participated in this study. Subjects completed 10 landing trials onto a force platform at each height. SUBJECTS: Ten female competitive gymnasts (height = 1.57 +/- 0.02 m, mass = 55.4 +/- 7.3 kg) and 10 female recreational athletes (height = 1.63 +/- 0.06 m, mass = 59.6 +/- 4.9 kg) volunteered for this study. MEASUREMENTS: Measurements of first peak-force magnitude (F1), time to F1 (T1), impulse to F1, second peak-force magnitude (F2), time to F2 (T2), and impulse to F2 were compiled to describe the ground reaction force profile for each trial at 30-, 60-, and 90-cm platform heights. A 2 x 3 (group x height) mixed-factors analysis of variance was calculated for each of the 6 variables. RESULTS: The group-by-height interaction was significant for F1, F2, and impulse to F2. Tukey post hoc analyses revealed significantly higher values for the gymnasts than for the recreational athletes at 60- and 90-cm heights for F1 and F2 magnitudes. Differences between groups for T1, T2, impulse to F1, and impulse to F2 were not statistically significant at any height. CONCLUSIONS: Drop landings performed by female gymnasts at 60- and 90-cm heights exhibited higher vertical ground reaction forces than drop landings performed by female recreational athletes. High ground reaction forces experienced by gymnasts during landings may contribute to the incidence of lower extremity injuries.

Journal Article↗

A comparison of anterior knee laxity in female intercollegiate gymnasts to a normal population.

Increased joint laxity may predispose an individual to ligamentous injury. Female gymnasts have a high incidence of ligamentous injury, including the anterior cruciate ligament (ACL). Previous authors have found a relationship between ACL disruption and preexisting ligament laxity. The purpose of this study was to compare anterior knee laxity in the knees of female intercollegiate gymnasts with those of a normal female population. A secondary purpose was to measure genu recurvatum and assess the relationship between it and anterior laxity in the knee. We tested 30 gymnasts and 30 control subjects having no history of ACL injury with the KT-1000 knee arthrometer. The quadriceps active, 133 N (30 lb) anterior drawer, and manual maximum tests were performed on the subjects' right knees along with goniometer measurements. Using a two-way analysis of variance (ANOVA) with repeating measures, we detected a significant increase in anterior laxity when comparing the 133 N to the manual maximum test, but no significant difference between gymnasts and nongymnasts. We concluded that gymnasts, as a group, are not abnormally lax when compared to an active population of similar age. Future comparison of the longitudinal data of those who incur ACL injury during their gymnastics careers may show whether individuals with increased laxity have increased risk of ligamentous injury.

Journal Article↗

Injury incidence and cause in elite gymnasts.

This report describes the incidence, localization, and cause of injuries in Swedish male and female elite gymnasts during 18 active months (three seasons). Thirty-one elite gymnast clubs with all together 437 gymnasts were included in the study, which consisted of a written questionnaire reporting morphometric facts as well as data concerning the injury. There were in total 82 injury reports. The injury incidence was 6.25 per 100 elite gymnasts and season. A majority of the injuries occurred in the lower extremities. The right leg was injured more often than the left. Most of the severe injuries occurred during mounting and dismounting which advocates the need for preventive measures in association with these particular events. Male gymnasts were more prone to sustain severer injuries such as dislocations and fractures. Severe injuries affected the upper extremity in 83%, and the right side was injured more often than the left.

Female↗

Hormonal responses to physical training in high-level peripubertal male gymnasts.

The effects of performing intensive training during growth remains controversial, with claims of negative effects upon growth and maturation purportedly due at least in part to a combination of hormonal disturbances and inappropriate nutrition. We examined the training-related responses of total testosterone (T), insulin-like growth factor-1 (IGF-1), cortisol (C) and diet in 16 peripubertal (pubertal stage <2) male gymnasts [mean (SD) age 10.5 (0.9) years, training 17.2 (5.6) h x week(-1)] and 17 controls [mean (SD) age 9.6 (1.2) years] over a 10-month period. Fasted, resting morning blood samples (0730-0900 hours) were taken from all children on Monday, Wednesday and Friday during a single week towards the end of each of three phases of gymnastics training: routine development (RD), precompetition (PC) and strength conditioning (SC). Serum concentrations of T, C and IGF-1 did not differ between the groups at any time. The ratio between IGF-1 and cortisol was significantly reduced in gymnasts relative to controls during RD and SC training (P<0.05), although no differences were detected for the T:C ratio. Diet did not correlate with any of the hormonal measurements, and no intergroup differences were found for the rate of growth in height. In summary, these results suggest that either the gymnastics training performed by these subjects was not intense enough to alter adrenal function, or that the gymnasts were well adapted to the training. In contrast, the reduction in the anabolic to catabolic balance represented by the IGF-1:C ratio is suggestive of a catabolic state, perhaps resulting from overstrain, insufficient recovery and/or inadequate caloric intake relative to energy output. While physical training during growth may induce a catabolic state, further research is needed to determine the biological significance of this finding, particularly with regard to growth and maturation.

Child↗

Osteochondritis in the female gymnast's elbow.

Ten cases of osteochondritis dissecans of the humeral capitellum are reviewed in seven high-performance female gymnasts, ranging in age from 10 to 17 years old. All but one were evaluated and treated with arthroscopy and/or arthrotomy, with curettage of loose articular margins, drilling of the lesion, and removal of loose bodies. The average length of follow-up is 2.9 years, and includes interview, physical examination, and roentgenographic evaluation. This injury has been previously described in relation to compressive forces across the radiocapitellar joint from repetitive valgus loading in a developing epiphysis. Only one of the athletes, at the time of follow-up, was still in competitive gymnastics. Each has a minimal limitation in range of motion, with crepitus and often catching noted by history and on examination. These cases double the limited literature on this injury in young, female gymnasts. They stimulate concern for the proper and early evaluation and treatment of elbow injuries in this at risk group. Once the bony changes in the capitellum are detected, and pain remains despite conservative management, we have found that symptoms can be improved with surgery, but persist in female gymnasts. Our experience in this more-advanced group is that the return to high-level competitive gymnastics is unlikely.

Adolescent↗

Attentional demand for regulating postural sway: the effect of expertise in gymnastics.

A dual-task paradigm was used to investigate whether the expertise in motor skills requiring a fine postural control can modify the attentional demand necessary for regulating postural sway. Seven expert gymnasts and seven experts in other non-gymnastic sports were asked to respond as rapidly as possible to an unpredictable auditory stimulus while maintaining stable seated and in three upright postures of increasing difficulty: bipedal, unipedal, and unipedal on an unstable support (i.e. a 7 cm thick foam surface). RT values were used as an index of the attentional demand necessary for performing the postural tasks. Results showed that the attentional demand necessary for regulating postural sway increased as the postural task increased in difficulty. Interestingly, this effect was smaller for the gymnasts during unipedal stance. These findings suggest a decreased dependency on attentional processes for regulating postural sway during unipedal stance in gymnasts with respect to non-gymnasts.

Adolescent↗

[Influence of age and physical activity on isokinetic characteristics of hamstring and quadriceps muscles of young gymnasts and soccer players].

OBJECTIVE: The aim of this work is the assessment of age and sport influences on the isokinetic knee muscle characteristics. SUBJECTS AND METHOD: Subjects performed a bilateral knee flexion/extension test on an isokinetic device at 60 and 180 degrees.s(-1) speed in concentric mode. The three parameters studied in this work were the Peak Torque, Average Power and hamstring/quadriceps ratio. Thirty-eight soccer players (16,6 +/- 1.4 years old) and 22 gymnasts (18 +/- 2.8 years old) were tested. The population was separated into three groups : 15 years old, 17 years old, 20 years old. RESULTS: The isokinetic values of soccer players were significantly higher (p < 0.0001) than those of the the gymnasts. The isokinetic values of the oldest soccer players were significantly higher (0.005 < p < 0.05) for hamstrings than those of the younger soccer players. The isokinetic values of the oldest gymnasts were significantly higher (0.005 < p < 0.05) for the quadriceps than those of the younger gymnasts. There were no significant differences between dominant and non dominant limbs in soccer players. CONCLUSION: In the present study, the muscular maturation improves the absolute strength of the older sportsmen in comparison to the younger. Soccer favor most the absolute strength of the inferior member in comparison to the gymnastics.

Adult↗

[Gymnastic school sport injuries--aspects of preventive measures].

INTRODUCTION: Gymnastic school sport injuries account for a significant morbidity and mortality among children and adolescents. Preventive issues may be derived from a thorough in-depth analysis of the pattern and circumstances of gymnastic injuries. METHODS: During a school year among 3993 schools in 43 889 classes with 993 056 pupils 2234 school sport injuries have been reported to the Gemeinde Unfall Versicherung (GUV) Niedersachsen, Germany. RESULTS: Gymnastic sport injuries account for 18 % (403 accidents), which is second after ball sports injuries. Regarding the distribution of the gymnastic disciplines, vault was the major discipline with 34 %, followed by floor exercise (21.3 %), mini- and competition trampoline (16.8 %), and parallel bars (8.2 %). The analysis of the type of injury during vault accidents revealed contusion (31 %) as the predominant injury, followed by sprains (15.4 %), and fractures (15.4 %). Floor exercise injuries distributed among distorsions (26.7 %), contusions (18.6 %), muscle tears (14 %). Back injuries especially of the cervical and thoracic spine, accounted for 40 % of all their injuries. Minor head injuries account for 4.7 % of all floor exercise injuries. Mini-trampoline injuries distribute among contusions (30 %), fractures (22.5 %), distorsions (7.5 %). 21.8 % collisions were noted against a box in comparison to 6.8 % in case of the horse. CONCLUSION: Gymnast injuries account for a significant number of all school sport related injuries. Vault and floor exercise account for the vast majority of all injuries, with alarming high numbers of spine injuries during floor exercise and mini-trampoline. A preservation of a high level of attention during a sport lesson, safety measures including appropriate mats and landing zones are mandatory to reduce injuries. Muscle injuries and ankle sprains can be prevented by a prospective proprioceptive training intervention to be implemented in school sports.

Adolescent↗

A retrospective growth study of female gymnasts and girl swimmers.

The aim of this investigation was to retrospectively evaluate growth patterns of different groups of gymnasts as compared to schoolgirls and girl swimmers from 1 until 11 years of age. The gymnastic groups (recreative, young talented, and older talented gymnasts) were smaller than the groups of girl swimmers and schoolgirls already from a young age on. The differences in body height between the groups of sports participants and schoolgirls in the prepubertal period appeared to be mainly based on the genetic growth regulation and seemed to be largely dependent in the gymnastic groups on inheritance of the mothers' height. Significant differences existed in weight as percentage of normal weight for height between the gymnasts and the swimmers. No relations existed between the standard deviation scores, weight percentage, and socioeconomic status. Contrary to general belief, there was no evidence that physical activity from a young age on directly influences growth until puberty.

Body Height↗