Non-local muscle fatigue is mediated at spinal and supraspinal levels.

The objective was to measure the corticospinal excitability and motoneuron responsiveness of the right and left Biceps Brachii (BB), and left Abductor Digiti Minimi (ADM) muscles in response to submaximal isotonic fatiguing contractions performed by the right BB muscle. With the familiarization session, ten young moderately active male subjects came to the lab on seven occasions. Three sets of 3 min seated elbow curls at 25% of one-repetition maximum (1RM) separated by a 1-min rest performed by the right BB muscle were used as the fatiguing protocol. The motor evoked potential (MEP), cervicomedullary motor evoked potential (CMEP), and compound muscle action potential (Mmax) of the right BB muscle (baseline and after each set of the fatiguing task), the left BB and ADM muscles (baseline, post-fatigue, post-10, and post-20 min) were measured. MEP and CMEP were then normalized to Mmax for statistical analysis. The results showed that in the right BB muscle, there was a significant reduction in the MEP after performing the fatiguing task (p= 0.03), while no significant effect of time was seen in the CMEP (p= 0.07). In the left BB muscle, the MEP significantly decreased from pre-fatigue to post-fatigue (p= 0.01) and post-10 (p= 0.001), while there was a significant decline in the CMEP post-fatigue (p= 0.03). In the left ADM muscle, MEP significantly decreased post-fatigue (p= 0.03) and no changes were seen in the CMEP (p= 0.12). These results not only confirm the incidence of non-local muscle fatigue (NLMF) in response to performing submaximal isotonic fatiguing contractions but also as a new finding, imply that both spinal and supraspinal modulations account for the NLMF response.

Interictal levels of calcitonin gene related peptide in gingival crevicular fluid of chronic migraine patients.

Calcitonin gene related peptide (CGRP) is a mediator of neurogenic inflammation playing a major role in the pathogenesis of migraine. Increases in serum CGRP have been detected previously in migraineurs and a return to baseline values regarded as successful treatment. As gingival crevicular fluid is known to originate from the serum, the aim of this study is to measure the CGRP content of gingival crevicular fluid (GCF) in chronic migraine patients and to determine whether there is a correlation between serum and GCF values of CGRP. For this study, 24 female individuals suffering from chronic migraine with aura were age-matched with 15 healthy individuals. Serum and GCF samples were obtained from both groups and enzyme linked immunosorbent assay performed to measure CGRP concentration. The level of CGRP in the serum and GCF of chronic migraine patients was 41 ± 16 pg/mL and 0.25 ± 0.09 pg/µg respectively while in healthy individuals CGRP levels were 29 ± 8 pg/mL and 0.19 ± 0.07 pg/µg. The correlation between CGRP levels of the GCF and serum was 0.88 for migraineurs and 0.81 in the controls. Only a weak positive relationship was observed between age and CGRP levels in both groups. CGRP levels were higher in migraineurs compared with controls both in serum and GCF. Furthermore there is a strong correlation between CGRP levels of the serum and GCF. The results of this study suggest that CGRP levels of GCF have potential diagnostic purposes in patients with chronic migraine.

Three-Dimensional Porous Gelapin-Simvastatin Scaffolds Promoted Bone Defect Healing in Rabbits.

Treatment of large bone defects (LBDs) is technically demanding. Tissue engineering is an option. A bioactive graft may be produced by combining tissue scaffolds and healing promotive factors in order to accelerate bone repair. We investigated the role of Simvastatin (Sim)-embedded porous Gelapin (Gel) scaffold on experimental bone healing. At first, the effectiveness of different concentrations of Gel and Sim powders was investigated in an experimentally induced femoral hole model in rabbits (n = 6) for 30 days. Then bone bioactive grafts were produced by combination of the effective concentrations of Gel, Sim, and Genipin. The bioimplants were subcutaneously tested in a rabbit model (n = 9) to determine their biocompatibility and biodegradability for 10-30 days. Finally, a large radial bone defect model was produced in rabbits (n = 20), and the bioimplants were inserted in the defects. The untreated and autograft-treated bone defects were served as controls. The animals were euthanized after 30 and 60 days of bone injury. The bone samples were evaluated by radiography, three-dimensional CT scan, bone densitometry, histopathology, and nano-indentation. At a concentration of 5 mg/hole, Sim closed the femoral bone holes after 30 days, while in the defect, autograft, and Gel groups, the holes were open. Both the Gel and Gel-Sim scaffolds were biocompatible and biodegradable. Subcutaneously, the Gel-Sim scaffold was replaced with the newly regenerated ectopic bone after 30 days. After implantation of the Gel-Sim scaffold in the radial bone defects, the scaffold was completely replaced with new woven bone after 30 days which was then matured and remodeled into a cortical bone after 60 days. Sixty days after bone injury, the Gel-Sim-treated defects had significantly higher bone volume, matrix mineralization, elastic modulus, and contact hardness when compared to the controls. The Gel-Sim scaffold may be a suitable option in managing LBDs.

Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities?

BACKGROUND: Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and effect of training courses on related joint instabilities. MATERIALS AND METHODS: In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. RESULTS: The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1%) and 6 (2.6%) for discrimination of two groups (P = 0.03). There was no significant difference between two groups in case of shoulder dislocation anyway. CONCLUSION: Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial.

Introduction Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis. Methods In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month's post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test. Results A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2 ± 7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months post-intervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales. Discussion The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.

Effects of postural and cognitive difficulty levels on the standing of healthy young males on an unstable platform.

Standing on an unstable platform requires continuous effort of the neuro­musculoskeletal system. The aim of the present study is to evaluate the ability to remain standing on an unstable platform at different levels of postural and cognitive difficulty. Healthy young males stood in the sagittal plane on an unstable platform supported by a pair of springs with modifiable stiffness. The balance test also assessed different levels of vision and cognitive function. Linear and nonlinear metrics of standing, based on motion captured kinematic data, were assessed to analyze the stability of standing. Results showed that vision plays a significant role in maintaining balance in terms of linear metrics. Elimination of visual feedback changed the direction of body sway and increased standing instability. Placement of low stiffness springs led to unstable standing. The cognitive dual task, however, had no effect on the stability metrics and merely could be revealed in the simplest test condition. Standing on an unstable platform was closely related to visual feedback and decreasing the spring stiffness significantly reduced stability. The roles of cognitive involvement were subdued by increasing the postural difficulty in standing on an unstable platform.

THE DIFFERENCE BETWEEN MU SUPPRESSION AND NURSES' EMPATHY WITH THE DIFFERENCE OF THREE YEARS OF WORK EXPERIENCE.

BACKGROUND: Nurse's empathy is one of the major parameters to improve the quality of provided health care known for the patient and it has a significant effect on reducing physical and psychological symptoms in patients. However, it has shown that over time and by increasing the background of nurses, their empathy is reducing. However, there is no research to investigate the Mu Suppression that is an indicator of the performance of mirror neurons that is a basis of empathy sense in the brain. So, the aim of this study is to investigate the difference between reported empathy and Mu suppression among nurses with three years of work background. METHODS: So, a total of 39 male nurse were chosen by available sampling that 15 of them has about 3 years working experience more than other's 15 people, Data collection tool was empathy questionnaire of Jefferson's health professionals. Mirror neurons' activation was investigated by Mu suppression. So, EEG was recorded in three situations including: 1) watching a video of a motionless hand, 2) watching a video of a hand that is opening and closing and 3) moving their own hand. RESULTS: The results of MANOVA analysis indicated that although Mu suppression among nurses with more background is less, but this difference is not significant. Also, there is no significant difference between the reported empathy scores by nurses among two groups. CONCLUSIONS: These results indicate that three years of work experience don't have an effect on empathy reduction.

Association of Nurses' Self-Reported Empathy and Mu Suppression with Patients' Satisfaction.

INTRODUCTION: The aim of this study is to explore the association between mu suppression and self-reported empathy in nurses with patients' satisfaction. METHODS: For this correlational study, 30 male nurses, as well as 30 patients took care by these nurses during the week before data gathering, were selected via accessible and random sampling method, respectively. The tools included Jefferson's Scale of Empathy-health professionals, and patient's satisfaction scale of La Monica-Oberst. Activation of Mirror Neurons System (MNS) was investigated by mu suppression. For this purpose, electroencephalography (EEG) was recorded in three phases: 1) Watching the video of a non-moving hand, 2) Watching the video of a hand being open and closed, and 3) Opening and closing one-self's hand. EEG recordings were analyzed using Matlab R 2014a software. Data were analyzed by Pearson's correlation coefficients and multiple regression analyses. RESULTS: There was no significant correlation between mu suppression in nurses with nurses' self-reported empathy and patients' satisfaction, however, a significant correlation was found between nurses' self-reported empathy and patients' satisfaction. Regression analysis outcomes showed that nurses' self-reported empathy could predict 18.5% (nearly one fifth) of patients' satisfaction variance while mu suppression did not forecast patients' satisfaction significantly. CONCLUSION: These findings suggested that mu rhythm was a good biomarker neither for nurses' self-reported empathy nor for patients' satisfaction. In addition, it was manifested that patients' satisfaction, at least partly, depended on skills that nurses could learn, since showing empathy is highly learnable.

Magnetic resonance imaging investigations of position of conus medullaris in adolescent idiopathic scoliosis as a peripheral neuropathy.

Adolescent idiopathic scoliosis (AIS) is a structural 3-dimensional deformity the spine, which is occurring between 10 years of age and skeletal maturity and it mostly affects prepuberbal girls. The etiology of AIS remains unknown and seems should be multifactorial. According to the theories, there could be a shorter spinal cord or a higher location of the conus medullaris and disproportionate growth in neuro-osseous system. This study wants to investigate the position of the conus medullaris in AIS patients with a large curve magnitude in comparison with healthy adolescents. 94 AIS patients consisting of 25 males and 69 females between 11 and 25 years old, based on physical examination and standing posteroanterior roentgenography of the total spine with a Cobb angle more than 40 degrees was chosen. The main curve magnitude of every AIS patient was measured by the Cobb method. Apex of deformity was determined based on SRS definition. Patients' deformity were calcified based on Lenke classification. Magnetic resonance imaging examinations of the total spine were performed in the AIS group, by means of a 1.5-T magnetic resonance imaging system. The position of conus medullaris was defined according to the method by saffiudin et al and was assessed based on the age, sex, type of deformity, severity of deformity, kyphosis, lordosis, flexibility, apical vertebra, stable vertebra. The mean age of patients were 16.34 with 6.77 of conus medullaris position in mean, which was lower one-third of L1. Our study showed no significant correlation between the position of conus medullaris with age, weight, preoperative curve, flexibility, types of deformity based on Lenke classification and degree of kyphosis and lordisis. In conclusion, there is the same mean and the distribution of the conus medullaris locations for AIS patients and normal populations.

Venous insufficiency after prolonged standing: Is joint hypermobility an important risk factor?

BACKGROUND: Varicose veins are extremely common disease which is due to elevated superficial venous pressures. We aimed to know that if joint hypermobility causes the venous insufficiency following the prolonged standing. MATERIALS AND METHODS: This prospective cohort study conducted on the soldiers of training periods in a military base of Iran Army in Isfahan in 2013. The active-duty soldiers were first examined by a physician and their Beighton scores (BSs) were obtained. At the onset of the training period, the presence of chronic venous insufficiency was clinically evaluated according to the C class of clinical, etiological, anatomical, and pathological classification. After 3 months, soldiers with and without joint hypermobility were reexamined for manifestations of venous insufficiency based on clinical examination. RESULTS: Of 718 soldiers, 211 subjects were diagnosed for joint hypermobility syndrome (29.3%). The mean BS was significantly higher in hypermobility soldiers (5.5 ± 1.5) than the healthy ones (1.2 ± 1.1). Before the training period, the prevalence of spider and varicose veins in soldiers with joint hypermobility was significantly higher than healthy subjects (P > 0.001). After the training period, the prevalence of venous insufficiency significantly increased in soldiers with joint hypermobility (P > 0.001) while there was no significant difference in healthy group before and after the period of training (P = 0.25). CONCLUSION: Hypermobility could be considered as a risk factor for the development of venous insufficiency, so it seems necessary to evaluate the population who need to be standing for a long time for evidence of joint hypermobility.

Evaluation of the Relationship Between Musculoskeletal Discomforts and Occupational Stressors Among Nurses.

BACKGROUND: Stress in nurses may increase the prevalence of musculoskeletal discomforts. AIM: The aim of this study was to determine the prevalence of musculoskeletal discomforts and job stress among nurses and to investigate the association between musculoskeletal discomforts and occupational stressors. MATERIALS AND METHODS: In this cross-sectional study, 144 nurses in one of the main referral hospitals of Tehran-Iran were randomly selected and studied. Data were collected by HSE job stress questionnaire and The Cornell Musculoskeletal Discomfort Questionnaire through interviews with nurses in their workplace. RESULTS: Most reported musculoskeletal discomforts localized in the neck, back, knee and shoulder and the minimal discomforts were in wrist and elbow. On the other hand, stressors such as demand, changes in workplace, control and responsibilities had significant effect on increasing musculoskeletal discomforts of organs such as neck, shoulders and back (P < 0.001). CONCLUSION: There was a significant association between stressors such as demand, control, responsibilities and changes in workplace and reported musculoskeletal disorders, especially in neck, shoulders and back. It is suggested to use defined programs for management and control of stressors to control occupational stress in nurses. Moreover, prevention of musculoskeletal discomforts due to their high prevalence in the study population is important.

Effect of platelet-rich plasma on the healing of cutaneous defects exposed to acute to chronic wounds: a clinico-histopathologic study in rabbits.

BACKGROUND: Platelet-rich plasma (PRP) contains numerous growth factors to promote wound healing and angiogenesis. The aim of this study was to gain further information about the benefits of platelet-rich-plasma for healing cutaneous acute to chronic wounds. METHODS: A total of 30 New Zealand albino rabbits (n = 15/group) were randomly assigned to two experimental groups: control group, and PRP group. Bilateral resection defects measuring 3 cm were surgically created on the dorsolateral of the cutaneous in animals and the defects were randomly divided into two mentioned groups. Wound area, neovascularization, size and epithelialization were compared on days 7, 14 and 21 post-wounding. Histopathological analyses were conducted on 15 specimens from each group after sacrifice by the cellular aspects of the regeneration of the tissue. RESULTS: Our results were indicated that the wound area of PRP was smaller than that in the non-treated group on days 7, 14 and 21. Furthermore, a significant decrease of the wound size was observed in PRP groups that were significantly greater than that in the control group. A significant increase of the mean vascular density was noted in the PRP treated groups compared to the control groups at day 14 and especially day 21. This results indicated that PRP treated group' enhanced angiogenesis at the wound beds as compared to no treatment group. CONCLUSION: These results could be useful for researchers in the growing fields of tissue repair and experimental wound healing. Further studies will be essential to determine the role of PRP in clinical practice.

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).

INTRODUCTION: Knee osteoarthritis (OA) is the most common articular disease. Different methods are used to alleviate the symptoms of patients with knee OA, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP) as a complex of growth factors. Due to the high incidence of OA and its consequences, we decided to study the long-term effect of intraarticular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA. METHOD: This non-placebo-controlled randomized clinical trial involved 160 patients affected by knee OA, grade 1-4 of Kellgren-Lawrence scale. In the PRP group (n = 87), two intra-articular injections at 4-week interval were applied, and in the HA group (n = 73), three doses of intra-articular injection at 1-week interval were applied. All patients were prospectively evaluated before and at 12 months after the treatment by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and SF-36 questionnaires. The results were analyzed using SPSS 16.1 software (RCT code: IRCT2014012113442N5). RESULTS: At the 12-month follow-up, WOMAC pain score and bodily pain significantly improved in both groups; however, better results were determined in the PRP group compared to the HA group (P < 0.001). Other WOMAC and SF-36 parameters improved only in the PRP group. More improvement (but not statistically significant) was achieved in patients with grade 2 OA in both the groups. CONCLUSION: This study suggests that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment.

Military exercises, knee and ankle joint position sense, and injury in male conscripts: a pilot study.

CONTEXT: The high incidence of lower limb injuries associated with physical exercises in military conscripts suggests that fatigue may be a risk factor for injuries. Researchers have hypothesized that lower limb injuries may be related to altered ankle and knee joint position sense (JPS) due to fatigue. OBJECTIVE: To evaluate if military exercises could alter JPS and to examine the possible relation of JPS to future lower extremity injuries in military service. DESIGN: Cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 50 male conscripts (age = 21.4 ± 2.3 years, height = 174.5 ± 6.4 cm, mass = 73.1 ± 6.3 kg) from a unique military base were recruited randomly. main outcome measure(s): Participants performed 8 weeks of physical activities at the beginning of a military course. In the first part of the study, we instructed participants to recognize predetermined positions before and after military exercises so we could examine the effects of military exercise on JPS. The averages of the absolute error and the variable error of 3 trials were recorded. We collected data on the frequency of lower extremity injuries over 8 weeks. Next, the participants were divided into 2 groups: injured and uninjured. Separate 2 × 2 × 2 (group-by-time-by-joint) mixed-model analyses of variance were used to determine main effects and interactions of these factors for each JPS measure. In the second part of the study, we examined whether the effects of fatigue on JPS were related to the development of injury during an 8-week training program. We calculated Hedges effect sizes for JPS changes postexercise in each group and compared change scores between groups. RESULTS: We found group-by-time interactions for all JPS variables (F range = 2.86-4.05, P < .01). All participants showed increases in JPS errors postexercise (P < .01), but the injured group had greater changes for all the variables (P < .01). CONCLUSIONS: Military conscripts who sustained lower extremity injuries during an 8-week military exercise program had greater loss of JPS acuity than conscripts who did not sustain injuries. The changes in JPS found after 1 bout of exercise may have predictive ability for future musculoskeletal injuries.

F wave to height or limb length ratios as rational alternatives for F wave latency in clinical electrodiagnostic medicine.

OBJECTIVE: To delineate the F wave latency/height (F min/He) or F wave latency/limb length (F min/L) ratio as a more useful alternative for the currently reported shortest latency in milliseconds. METHODS: One hundred and sixty-six healthy volunteers, 85 upper limbs and 84 lower limbs entered the study. Minimum F wave latencies were determined in median, ulnar, tibial and peroneal nerves. The F min/He and F min/L ratios of each nerve were calculated. RESULTS: F latencies of all nerves had significant correlation with height and limb length but there was no correlation between either F min/He or F min/L and height in any nerve except for peroneal F min/He (p = 0.04, r = 0.23). CONCLUSIONS: Using the F min/He or F min/L ratios are more accurate than reporting only the F wave minimum latency, since these ratios incorporate corrections for height and/or limb length. This method also eliminates the false positive and negative reports caused by using a single reference table for all heights. SIGNIFICANCE: A unique reference table can be produced using the F min/He or F min/L for all populations and races, so that the comparison between different population samples can be done easily. Also data of different investigations can be pooled together for meta-analysis purposes when a single reference table is used for different samples.

Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy: a randomized clinical trial of efficacy.

OBJECTIVE: To compare local corticosteroid with autologous blood injections for the short-term treatment of lateral elbow tendinopathy. DESIGN: A single blind, randomized clinical trial was performed in an outpatient clinic at a university hospital. Sixty patients aged 27-64 yrs with a new episode of tennis elbow were recruited. Thirty patients were randomized to methylprednisolone and 30 to autologous blood group over 1 yr. Severity of pain within last 24 hrs; limb function; pain and strength in maximum grip; disabilities of the arm, shoulder, and hand quick questionnaire (Quick DASH) scores; modified Nirschl scores; and pressure pain threshold were evaluated before injection and at 4 and 8 wks after injection. We analyzed our data with the chi and t test. RESULTS: Within-group analyses showed better results for autologous blood (all P values <0.001 except for grip strength, P = 0.005). In the corticosteroid group, differences in severity of pain (P = 0.008) and grip strength (P = 0.001) were significant. At 4 wks, between-group analyses showed superiority of autologous blood for severity of pain (P = 0.001), pain in grip (P = 0.002), pressure pain threshold (P = 0.031), and Quick DASH questionnaire score (P = 0.004). There were no significant differences in modified Nirschl score, grip strength, and limb function. At 8 wks, autologous blood was more effective in all the outcomes (all P values <0.001). CONCLUSIONS: Autologous blood was more effective in short term than the corticosteroid injection.

The effects of intensive, long-term treadmill running on reproductive hormones, hypothalamus-pituitary-testis axis, and semen quality: a randomized controlled study.

Effects of intensive exercise on hypothalamus-pituitary-testis (HPT) axis remain controversial. Our aim was to determine the effects of intensive, long-term treadmill running on reproductive hormones, HPT axis, and semen quality. A total of 286 subjects were randomly assigned to moderate-intensity exercise (approximately 60% maximal oxygen uptake (VO(2max)); group 1, n=143) and high-intensity exercise (approximately 80% VO(2max); group 2, n=143) groups. The two groups exercised for 60 weeks in five sessions per week, each session lasting 120 min. This was followed by a 36-week low-intensity exercise recovery period. All subjects underwent routine semen analysis. Blood samples were drawn for the determination of the levels of the following hormones: LH, FSH, prolactin, testosterone (T), free testosterone (fT), inhibin B, and sex hormone-binding globulin (SHBG). The HPT axis was assessed using GnRH and human chorionic gonadotropin tests. After 24 weeks of exercise, the subjects exercising with high intensity demonstrated significantly declined semen parameters compared with those exercising with moderate intensity (P=0.03). Serum T and fT began to decrease, and serum SHBG began to increase at the end of 12 weeks with both moderate- and high-intensity exercises. The serum LH and FSH concentrations decreased below the baseline level at 12 weeks in both groups (P=0.07 in group 1 and 0.03 in group 2). Both groups had blunted LH and FSH responses to GnRH. These parameters improved to their pre-exercise level during the recovery period. Long-term strenuous treadmill exercises (overtraining syndrome) have a deleterious effect on reproduction.