[Back to school physical education despite rheumatism : Development and testing of a sport scientific-based physical education certification]. / Zurück in den Schulsport trotz Rheuma : Entwicklung und Überprüfung einer sportwissenschaftlich basierten Schulsportbescheinigung.

BACKGROUND: Taking part in physical education is an important element of social participation for children with chronic diseases. Nevertheless, children suffering from rheumatism mostly receive recommendations to stop sport activities either completely or partially, without underlying scientific guidelines. OBJECTIVE: The aim was the development of an IT-tool based on scientific data in order to create individualized recommendations for sport activities plus verification of its practical feasibility. MATERIAL AND METHODS: An interdisciplinary group of experts developed and approved a prototype of the rheumatism and sports compass (Rheuma und Sport Kompass, RSK) based on the literature and own experience. They considered individual health factors and biomechanics of sports functions. The prototype was tested, revised and reconsidered in an interim evaluation. The resulting RSKv1 was evaluated in a clinical observation phase with 61 patients. The results were subsequently incorporated into the final version of RSK during an interdisciplinary decision-making process. This was verified in a feasibility study with a follow-up survey of rheumatic patients with a RSK partial participation certification for physical education including: clinical assessment during 8 lessons of physical education and after 8 lessons of physical education. Teachers rated the RSK online after 8 lessons. The evaluation was descriptive and differences in mean values were tested. RESULTS AND DISCUSSION: In this study 50 patients and 31 teachers were evaluated. The affliction of pain decreased in terms of frequency, amount and duration after physical education with RSK. No worsening in health was reported after participation in sports. The teachers rated the RSK as understandable, practicable and they felt confident to allow the patients to participate in classes. The RSK was rated significantly better than a standard certification text. With the RSK, patients can be advised to safely take part in physical education.

Oxygen consumption of gastrocnemius medialis muscle during submaximal voluntary isometric contractions with and without preceding stretch.

After an active muscle stretch, maintaining a certain amount of force in the following isometric phase is accompanied by less muscle activation compared to an isometric contraction without preceding active stretch at the corresponding muscle length. This reduced muscle activation might be related to reduced metabolic costs, such as the oxidative metabolism. Hence, the aim of this study was to clarify if mechanisms associated with stretch-induced activation reduction (AR) also influence oxygen consumption of voluntary activated human muscles after active stretch. Plantarflexion torque of 20 subjects was measured during 1) purely isometric and 2) active stretch contractions (26°, 60°/s), at a submaximal torque level of 30% MVC. Oxygen consumption (m[Formula: see text]O2) of gastrocnemius medialis (GM) was estimated by near-infrared spectroscopy while applying arterial occlusion. Since the overall group did not show AR at GM after active stretch (p > 0.19), a subgroup was defined (n = 10) showing AR of 13.0 ± 10.3% (p = 0.00). However, for both purely isometric and active contractions m[Formula: see text]O2 was the same (p = 0.32). Therefore, AR triggered by active stretch did not affect m[Formula: see text]O2 of active human muscle.

Mid-term Functional Outcome and Return to Sports after Proximal Hamstring Tendon Repair.

Proximal hamstring tendon ruptures are commonly associated with a significant loss of function, and operative treatment is recommended in active patients. The objective was to evaluate objective/subjective functional results and return to sports following proximal hamstring tendon repair in the mid-term follow-up. 16 repairs of proximal hamstring ruptures were performed in 15 patients (9 males, 6 females). The average age at the time of injury was 47 years (range, 21-66). All patients were clinically examined at a mean follow-up of 56 months (range, 24-112 months). Validated patient-oriented assessment scores focussing on sports activity including the Lysholm Score, Tegner Activity Score, UCLA Activity Score, adapted WOMAC Score, and the VAS were evaluated as well as the return to sports. Isokinetic strength of both legs was tested using a rotational dynamometer. The Lysholm, Tegner, UCLA Activity Score and the adapted WOMAC demonstrated predominantly a return to a preinjury activity level at follow-up. Functional measurements of the operated leg showed similar results to the uninjured leg in knee extension and flexion strength (p>0.094). In return to sports, no signficant (p>0.05) differences concerning types or frequency were noted. The surgical repair of proximal hamstring tendon ruptures leads to constantly good functional results in the mid-term follow-up, where patients demonstrate similar isokinetic results in the healthy leg.

[May eccentric training be effective in the conservative treatment of chronic supraspinatus tendinopathies? A review of the current literature]. / Kann exzentrisches Training in der konservativen Therapie von chronischen Supraspinatus-Tendinopathien effektiv sein? Eine Übersicht zur aktuellen Literatur.

Eccentric training (ET) has been shown to be an effective conservative treatment option for chronic patellar and Achilles tendinopathies. As part of the four-muscle-tendon-complex of the rotator cuff, the supraspinatus is involved most commonly in shoulder disorders. Histopathologic alterations of the supraspinatus tendon are comparable to findings in lower extremity tendinopathies. Hence, the question arises whether the concept of eccentric training can be successfully transferred to the upper extremity. Yet, no randomised controlled trials have been published to support this theory. This problem emerges from the fact that the supraspinatus is part of a complex functional unit. Consequently, surrounding soft tissues are frequently concomitantly affected. The inherent etiology and genesis of pathologic alterations in the supraspinatus tendon and its influence on shoulder disorders is not clear to date. However, the apparent success of ET in managing tendinopathies of the lower extremity urges further scientific work for developing evidence-based guidelines for the conservative treatment of tendinopathies in the shoulder region. Taking into account this lack of data as well as the anatomical and functional constraints, the aim of this work is to review the current state of the literature.

Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations.

Juvenile idiopathic arthritis (JIA) patients (n = 36) with symmetrical polyarticular joint involvement of the lower extremities and healthy controls (n = 20) were compared concerning differences in kinematic, kinetic, and spatio-temporal parameters with 3D gait analysis. The aims of this study were to quantify the differences in gait between JIA patients and healthy controls and to provide data for more detailed sport activities recommendations. JIA-patients showed reduced walking speed and step length, strongly anterior tilted pelvis, reduced maximum hip extension, reduced knee extension during single support phase and reduced plantar flexion in push off. Additionally the roll-off procedure of the foot was slightly decelerated. The reduced push off motion in the ankle was confirmed by lower peaks in ankle moment and power. The gait of JIA-patients can be explained as a crouch-like gait with hyperflexion in hip and knee joints and less plantar flexion in the ankle. A preventive mobility workout would be recommendable to reduce these restrictions in the future. Advisable are sports with emphasis on extension in hip, knee, and ankle plantar flexion.

Workload demands in mountain bike racing.

This study aims at describing the workload demands during mountain bike races using direct power measurements, and to compare these data to power output and physiological findings from laboratory exercise tests. Power output (P, Watt) from 11 national team cyclists (9 male, 2 female) was registered continuously during 15 races using mobile crank dynamometers (SRM System). To evaluate the intensity of racing, incremental exercise tests with determination of P at aerobic and anaerobic thresholds (AT, IAT) and at exhaustion (MAX) were performed. Intensity zones were determined (zone 1 < AT; AT < zone 2 < IAT; IAT < zone 3 < MAX; zone 4 > MAX) and time spent during racing in these zones was calculated. Based on power output measurements P during racing was 246 +/- 12 W (male) and 193 +/- 1 W (female). P showed high variation throughout the race. In contrast heart rate (HR) was relatively stable during racing (male 177 +/- 6 bpm, female 172 +/- 7 bpm). 39 +/- 6 % of race time were spent in zone 1, 19 +/- 6 % in zone 2, 20 +/- 3 % in zone 3 and 22 +/- 6 % in zone 4. MTB races are characterized by a high oscillation in P with permanently elevated HR. A highly developed aerobic and anaerobic system is needed to sustain the high variation in workload.

Influence of different types of exercise on the expression of haem oxygenase-1 in leukocytes.

Haem-oxygenase-1 (HO-1) is an antioxidant stress protein that is mainly induced by reactive oxygen species, inflammatory cytokines and hyperthermia. We assessed the influence of different types of exercise on HO-1 expression in leukocytes of the peripheral blood in three groups of male participants: a short exhaustive run above the lactate steady state (n = 15), eccentric exercise (n = 12) and an intensive endurance run (half-marathon, n = 12). Blood samples were taken at rest and up to 24 h after exercise. Blood lactate concentration after exercise was 9.0 +/- 2.1, 3.8 +/- 1.6 and 5.1 +/- 2.2 mmol x l(-1) (mean +/- s) for the exhaustive run, eccentric exercise and half-marathon groups, respectively (P < 0.05). Creatine kinase concentration was highest 24 h after exercise: 133 +/- 91, 231 +/- 139 and 289 +/- 221 U x l(-1) for the exhaustive run, eccentric exercise and half-marathon groups, respectively (P < 0.05). The maximal increase in leukocyte counts after exercise was 11.5 +/- 19.2, 6.2 +/- 1.4 and 14.7 +/- 2.1 x 10(9) x l(-1). There was no change in HO-1 as a result of the short exhaustive run or the eccentric exercise, whereas the half-marathon had a significant stimulatory effect on HO-1-expression in lymphocytes, monocytes and granulocytes (P < 0.001) using flow cytometry analyses. In conclusion, eccentric exercise alone or short-term heavy exercise are not sufficient to stimulate the antioxidative stress protein HO-1 in peripheral leukocytes