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Effect of eight weeks' physical training on muscle and connective tissue of the M. vastus lateralis in 69-year-old men and women.

Five one-hour exercise periods a week for 8 weeks included walking-jogging, swimming, gymnastics and ballgames for 26 healthy male and female 69-year-old pensioners. The mean maximal oxygen uptake of the men increased from 28.9 ml-kg-1-min-1 before training to 32.0 ml-kg-1-min-1 after training and for the women from 27.9 to 31.3 ml-kg-1-min-1. Muscle malate dehydrogenase activity was increased while that for lactate dehydrogenase decreased or remained the same. The activity of these enzymes was higher in the male both before and after training when compared with the female. However, the percentage number of slow twitch muscle fibers was nearly the same in both groups. Prolyl hydroxylase activity was increased after training especially in the female subjects. These results show that endurance-type training leads to an enhanced capacity for aerobic metabolism in older subjects and that collagen metabolism in skeletal muscles is affected by physical training.

Aged↗

Improving health-enhancing physical activity in girls' physical education.

This study examined the effectiveness of an intervention to increase levels of moderate-to-vigorous intensity physical activity (MVPA) during girls' physical education lessons. Two Year 7 classes (age 11-12 years) were randomly appointed to control and experimental groups. Both followed the same six-lesson unit of gymnastics with identical lesson objectives. The experimental class teacher included the additional objective of increasing MVPA during each lesson. MVPA was assessed in all six lessons using heart rate (HR) monitoring and systematic observation. After each lesson, students' intrinsic motivation and perceived competence were assessed, and the teachers evaluated whether they had met planned objectives. The experimental group engaged in more MVPA [F(1, 21) = 8.49, P = 0.008 (HR), t8 = -2.35, P = 0.048 (observation)] than the control group and also had most opportunities for skill practice (t8 = -2.81, P = 0.023). Intrinsic motivation and perceived competence levels were similar between the groups for each lesson, and teachers reported that lesson objectives were satisfactorily achieved. This intervention succeeded in increasing MVPA without compromising intrinsic motivation, perceived competence or planned lesson objectives.

Aptitude↗

Elastic activator for treatment of open bite.

This article presents a modified activator for treatment of open bite cases. The intermaxillary acrylic of the lateral occlusal zones is replaced by elastic rubber tubes. By stimulating orthopaedic gymnastics (chewing gum effect), the elastic activator intrudes upper and lower posterior teeth. A noticeable counterclockwise rotation of the mandible was accomplished by a decrease of the gonial angle. Besides the simple fabrication of the device and uncomplicated replacement of the elastic rubber tubes, treatment can be started even in mixed dentition when affixing plates may be difficult.

Acrylic Resins↗

A nested case-control study of the correlates of early menarche.

Age at menarche, an early determinant of breast cancer risk, shows both a downward secular trend and marked differences by socioeconomic status, both presumably the reflection of dietary variations. A cohort study is being conducted in the Quebec City, Canada, area to assess the relation between diet, physical activities, and menarche. In the fall of 1986, 3,022 fifth-grade girls (mean age, 10.7 years) agreed to participate in the study. All of the girls' parents provided information on health, familial, and socioeconomic variables. A 3-day dietary record and a 7-day physical activity recall were provided by 95.8% of the girls. All dietary information was verified with each girl by a dietician. Body weight and height and two skinfold thickness measurements were also recorded for 98% of the subjects. At the beginning of the study, 107 girls had already experienced menarche. In the fall of 1987, letters were sent to the mothers of the remaining 2,915 girls; 2,854 (97.9%) responded. In the preceding year, 352 girls had reached menarche. Of these, 333 (94.6%) had provided baseline dietary data. A case-control analysis was conducted in which these 333 girls were compared with 333 age-matched premenarcheal girls. There was a weak association between energy intake, energy expenditure, and early menarche. Weight, height, skinfold thickness, mother's age at menarche, and participation in a dance, ballet, gymnastics, or figure skating club were also associated with the early onset of menstruation.

Anthropometry↗

The female athlete triad.

The female athlete triad, a syndrome of disordered eating, amenorrhea, and osteoporosis, is now clearly recognized in selected populations of elite athletes. It is often seen in the sports that have an emphasis on "thinness," including gymnastics, figure skating, and ballet. Components of the triad are linked pathophysiologically, leading to significant morbidity and, on occasion, mortality. The disorder is difficult to treat and requires a multidisciplinary approach with intense psychological counseling as the primary focus of attack.

Adolescent↗

Evolving management of pectus excavatum based on a single institutional experience of 664 patients.

Most pediatricians and family physicians believe that children with pectus excavatum require surgery only for cosmetic indications and then only in teenagers. We believe pectus excavatum should be repaired in childhood (1) to relieve structural compression of the chest and allow normal growth of the thorax; (2) to prevent pulmonary and cardiac dysfunction in teenagers and adults; and (3) to obviate the cosmetic impact that may cause a child to avoid sports and gymnastics. Preoperative CT scans now help select those children who need repair to prevent progressive deformities. Pulmonary function studies during vigorous exercise can document respiratory dysfunction in teenagers. These features are reversible if repair is completed before the pubertal growth spurt. The ideal age for repair is 4 to 6 years, which permits enough emotional maturity for a positive hospital experience and avoids later psychological effects. Repair at an earlier age has no operative advantages. Our operative technique consists of the removal of three to four overgrown costal cartilages, repositioning of the sternum with a transverse osteotomy, and internal support using the child's lowest normal ribs, avoiding any prosthetic support. To prevent recurrence in teenagers, we add a temporary bar beneath the sternum to prevent depression of the sternum from the weight of the chest-wall muscle mass. Six hundred sixty-four patients have been followed for 1 to 40 years; 95% have excellent long-term results and only 5% have mild to moderate recurrences. Our current techniques of patient selection and surgery will be presented.

Adolescent↗

Beneficial effect of etidronate on bone loss after cessation of exercise in postmenopausal osteoporotic women.

OBJECTIVES: To determine whether etidronate could prevent or restore bone loss after cessation of exercise in postmenopausal osteoporotic women. DESIGN: Thirty-five postmenopausal osteoporotic women were studied. Exercise consisted of daily brisk walking and gymnastic training. The changes in the lumbar bone mineral density measured by dual energy x-ray absorptiometry were assessed. RESULTS: One or two years of exercise increased the bone mineral density from the baseline. One year of cessation of exercise after 1 yr of exercise resulted in the loss of the bone mineral density gained through exercise. Two years of cyclical etidronate treatment from year 2 sustained the bone mineral density during 2 yr of cessation of exercise in the preventative etidronate treatment group and completely restored the loss of bone mineral density after 1 yr of cessation of exercise in the therapeutic etidronate treatment group. CONCLUSIONS: Cyclical etidronate treatment, when exercise is discontinued, seems to be beneficial for the prevention or restoration of bone loss after cessation of exercise in postmenopausal osteoporotic women. Although the present study has a small sample size, the results may be interesting, especially because they raise additional questions that could stimulate further research.

Absorptiometry, Photon↗

Chronic wrist pain.

Nonarticular chronic wrist pain continues to be a challenging subject in which interest and knowledge are increasing. Although many more excellent articles could have been included in this review, an attempt is made to discuss papers that have impact on the recognition, diagnosis, and treatment of various wrist problems. Developments in diagnostic algorithms and refinements in the use of imaging and arthroscopic tools are reviewed. Arthroscopy provides exciting direct visual information and therapeutic opportunities for triangular fibrocartilage complex disruptions and lunatotriquetral ligament pathology. A new carpal instability analysis system is proposed to allow better comparison of results reported in the literature. Comprehensive evaluation and treatment of the rheumatoid wrist are revisited. The effectiveness of operative treatment for midcarpal instability and distal radioulnar joint osteoarthritis continues to be assessed. Sports-related chronic wrist injuries from golf, trampolining, and gymnastics, as well as newer recreational activities such as in-line skating, are rapidly gaining the recognition they deserve.

Algorithms↗

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Athletic Injuries↗

Low-back pain in adolescent athletes.

In this 3-yr longitudinal study we investigated the occurrence of low-back pain and anatomic changes in the low back in relation to loading and injuries among 98 adolescents: 33 nonathletes (16 boys, 17 girls), 34 boy athletes (17 ice hockey, 17 soccer players), and 31 girl athletes (17 figure skaters, 14 gymnasts). During the 3-yr follow-up, low-back pain lasting longer than 1 wk was reported by 29 (45%; 95% CI, 32%-57%) athletes and by 6 (18%; 95% CI, 7%-35%) nonathletes (P = 0.0099). Acute back injury was reported by 17 of 19 subjects who also reported low-back pain (89%; 95% CI, 67%-99%) and by 2 of 63 of those without prolonged low-back pain (3%; 95% CI, 0%-11%) (P < 0.0001). Among 43 girls participating in baseline and follow-up MRI examinations of the lumbar spine, new MRI abnormalities were found in 6 of 8 reporting acute back injury (75%; 95% CI, 35%-97%) and in 8 of the remaining 35 girls (23%; 95% CI 10% to 40%) (P = 0.018). In conclusion, excessive loading that involves a risk for acute low-back injuries during the growth spurt is harmful to the lower back.

Adolescent↗

Training of rowers before world championships.

In rowing, static and dynamic work of approximately 70% of the body's muscle mass is involved for 5.5 to 8 min at an average power of 450 to 550 W. In high load training phases before World Championships, training volume reaches 190 min.d-1, of which between 55 and 65% is performed as rowing, and the rest is nonspecific training like gymnastics and stretching and semispecific training like power training. Rowing training is mainly performed as endurance training, rowing 120 to 150 km or 12 h.wk-1. Rowing at higher intensities is performed between 4 and 10% of the total rowed time. The increase in training volume during the last years of about 20% was mainly reached by increasing nonspecific and semispecific training. The critical borderline to long-term overtraining in adapted athletes seems to be 2 to 3 wk of intensified prolonged training of about 3 h.d-1. Sufficient regeneration is required to avoid overtraining syndrome. The training principles of cross training, alternating hard and easy training days, and rest days reduce the risk of an overtraining syndrome in rowers.

Adult↗

Bacterial osteitis pubis in a weight lifter without invasive trauma.

Osteitis pubis is a well-known complication of invasive procedures about the pelvis which is caused by a bacterial infection. It is also now known that osteitis pubis in athletes is an inflammatory disorder rather than infectious as previously thought. It occurs in athletes who place significant repetitive stresses across the symphysis in such activities as running, race walking, gymnastics, soccer, rugby, basketball, and tennis. This case report, however, describes a weight lifter who developed a bacterially caused osteitis pubis without any invasive trauma. He was evaluated thoroughly and no other focus of infection was found. He was treated conservatively with intravenous antibiotics and physical therapy. At 3 months follow-up he had returned to his usual fitness activities without limitations. Although most osteitis pubis in athletes is inflammatory in nature, health care providers must keep an index of suspicion that an infectious etiology is possible in this population even without invasive trauma.

Cumulative Trauma Disorders↗

Growth, dietary intake, and trace element status in pubescent athletes and schoolchildren.

PURPOSE: To examine interactions between club-level sports training, dietary intake, and nutritional status during puberty. METHODS: A 2-yr prospective study was undertaken with 64 boys (40 ice hockey players, 24 controls) and 71 girls (28 gymnasts, figure skaters, and runners, 43 controls). The boys' age in the beginning of the study was 12-13 yr, whereas the girls were 11-12 yr. The following variables were measured in the beginning, and after 1 and 2 yr: physical activity level (record), dietary intake (record), blood hemoglobin concentration, serum ferritin, zinc and copper concentration, anthropometric indices (height, weight, skinfolds, upper arm muscle girth), and biological maturation (self-report). RESULTS AND CONCLUSIONS: The changes in the anthropometric variables throughout the study period were not different between the athletes and controls (P = 0.09). The athlete boys had higher mean energy, iron and zinc intakes, and higher mean serum zinc concentration than the controls (P < or = 0.003). The athlete and control girls' dietary intakes and biochemical indices of trace element status were not different from each other (P < or = 0.13). Moreover, sports participation was not associated with the longitudinal changes in trace element status (P > or = 0.08). These data suggest that club-level sports training does not affect growth, maturation or nutritional status during puberty.

Adolescent↗

Reciprocal strength ratio in shoulder abduction/adduction in sports and daily living.

PURPOSE: Functionally, the shoulder is considered a ball joint, whereby high mobility is attended by low stability. Therefore, muscular balance is decisive for stability. Altered strength ratios are frequently described as "muscular dysbalances" and considered one of the causes of shoulder pathologies, whereby objective quantification is difficult. METHODS: In order to quantify physiological muscle balance, the strength ratio of shoulder abduction/adduction (AB/AD) was determined in 166 untrained men (UM) concentrically at 60 degrees.s-1 (LIDO-Active). The influence on this norm of one-sided (25 high-performance (TPH), 18 leisure tennis players (TPL)) and two-sided athletic exercise (32 gymnasts (GY)), altered daily exercise (11 paraplegics with paralysis time < 4 months (PP), 11 paraplegics with paralysis time > 2 yr (PU)), and a combination of altered daily exercise and athletic activity (16 trained paraplegics (PT)) was examined (ANOVA, alpha = 0.05). RESULTS: Determination of the AB/AD quotient in UM was 0.82. Shoulder stress in sports led to a decrease in quotients compared with UM because of a relatively increased torque in AD (P < 0.01). At the beginning of a paraplegia, the quotient of AB/AD is elevated (P < 0.05). This altered ratio decreases with duration of paralysis (PU) and athletic activity (PT). CONCLUSION: With increased shoulder stress, the altered strength ratios reflect specific requirements of the performance attained. However, the importance of muscular dysbalances for the onset of shoulder complaints must be considered more important than their influence on athletic performance capacity.

Activities of Daily Living↗

Management of athletic injuries of the cervical spine and spinal cord.

Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Review of long-term results in supportive treatment of facial paralysis.

We have reviewed approximately 150 patients who were treated with supportive measures for facial paralysis. We found that in the patient's view an adequate result requires establishment of a proper lip sphincter--either by restoring muscular tone, or by creating an anatomical framework to which can be added either a motor unit or stabilization to aid the opposite intact muscle. We also found lasting value from dampening contralateral spasticity, and from the use of such ancillary procedures as the face lift, the brow lift, and the creation of a nasolabial fold. It is important for the physician to help the patient acquire a tranquil face during speech and emotion by persevering in mirror training and mimetic gymnastics.

Dermatologic Surgical Procedures↗

Anthropometric characteristics, passive hip flexion, and spinal mobility in relation to back pain in athletes.

Anthropometric characteristics, passive hip flexion, and spinal mobility were examined and back pain was registered in 116 top Swedish male athletes representing four different sports (wrestling, gymnastics, soccer, tennis). Differences in stature, body weight, passive hip flexion, mobility of the spine in forward flexion, and asymmetry of the back were found when each group of athletes was compared with the rest of the athletes. These differences could be explained by a natural selection of individuals with the physical constitution required for the sport concerned, but they may also be a long-term effect of training. A small sacral inclination, defined as the sacrohorizontal angle, correlated significantly with back pain.

Adolescent↗

A study of functional spinal motion in women after instrumentation and fusion for deformity or trauma.

STUDY DESIGN: Photographs were used to measure the residual spine motion in 71 women who had undergone spine fusion and instrumentation for spinal deformity or trauma. OBJECTIVES: To accurately define the ability of the patient to flex, extend, and bend to the right and left, thus providing the surgeon some accurate information rather than speculation regarding spinal motion. METHODS: The 71 patients had undergone spine fusion with instrumentation for scoliosis, kyphosis, or spine trauma. The average age of the patient at surgery was 22 years, ranging from 11 years to 62 years. The average time since surgery was 6 years, ranging from 1 year to 32 years. Each patient had six views photographed: flexion, extension, right and left side bending from the front, and right and left side bending from the back. Each photograph was measured independently by two research assistants. A total of 852 photographs were analyzed. RESULTS: The average degree of right side bending was 22 degrees, that of left side bending was 23 degrees, that of flexion was 111 degrees, and that of extension was 30 degrees. For the 59 patients who underwent fusion of seven levels or more and who were fused down to T12, L1, L2, L3, or L4, there was no correlation of the range of motion with the lowermost level of fusion, except in patients with fusion to L4 who had significantly less motion. Flexion was primarily a function of hamstring tightness and was best in those who exercised regularly (aerobics, gymnastics, ballet), regardless of the number of levels fused or the lowermost level of fusion. CONCLUSION: Typical spine fusions for deformity produce a moderate loss of functional motion, except in patients who undergo fusion to L4 who lose much more. The technique of analysis was found to be highly accurate and reproducible.

Adolescent↗