Eccentric hamstring strength in elite track and field athletes on the British Athletics world class performance program.

OBJECTIVES: This novel study aims to provide unique data on eccentric hamstring strength in elite track and field athletes. DESIGN: Clinical measurement, cross-sectional study. SETTING: Across two British Athletics performance centres. PARTICIPANTS: 44 elite British track and field athletes. MAIN OUTCOME MEASURES: Eccentric hamstring force and torque were evaluated using the Nordbord device. Injury history and demographic data was collected to assess whether differences between gender, event group, limb symmetry and previous injury history were present. RESULTS: Average peak force for males and females was 418.38N and 318.54N. Relative to body weight there were no gender differences (Male 5.21N.kg-1, Female 4.99N.kg-1) (p = 0.62). The right limb was significantly stronger in long sprint (400m athletes) (p = 0.00018) (d = 0.56). No differences in relative force or torque were observed between previously injured and non-injured limbs. CONCLUSIONS: This study provides unique data in elite track and field athletes. Relative force per kilogram should be used when comparing male and female athletes. Unlike other studies, we found no difference in eccentric strength between previously injured and non-injured limbs. The novel finding of increased eccentric strength demonstrated in the right limb in 400m sprinters may be due to the asymmetric demands of bend running and may be considered normal.

Determinants of olympic fencing performance and implications for strength and conditioning training.

Fencing is one of only a few sports that have featured at every modern Olympic games. Despite this, there is still much the sport science team does not know regarding competition demands and athlete physical characteristics. This review aims to undertake an analysis of the current literature to identify what is known, and questions that must be answered to optimize athlete support in this context. In summary, fencing is an explosive sport requiring energy production predominately from anaerobic sources. Lunging and change-of-direction speed seem vital to performance, and strength and power qualities underpin this. In the elimination rounds, fencers are likely to accumulate high levels of blood lactate, and so high-intensity interval training is recommended to reduce the intolerance to and the accumulation of hydrogen ions. Injury data report the hamstrings as a muscle group that should be strengthened and address imbalances caused by continuous fencing in an asymmetrical stance.

Aceptación y barreras para el inicio y la intensificación del tratamiento con insulina / Patient acceptance and barriers to the initiation and intensification of insulin therapy

La importancia del buen control metabólico en la prevención de las complicaciones crónicas de la diabetes quedó claramente probada para la diabetes tanto tipo 1 como tipo 2, en los estudios publicados en la década de los noventa. Asimismo, está bien establecido que la insulina es el fármaco más efectivo en la reducción de la glucemia. Sin embargo, existe una reticencia, que afecta tanto a pacientes como a los profesionales sanitarios, médicos especialistas, generalistas y educadores en diabetes, a iniciar la insulinización, que se traduce en una prolongación del mal control metabólico del paciente, con el consiguiente aumento de riesgo de desarrollar complicaciones de la diabetes. Las barreras a la insulinización pueden analizarse desde el punto de vista del paciente o del profesional sanitario, y en diversos aspectos son comunes a ambos. Entre los factores que dificultan la insulinización desde la perspectiva del paciente, cabe citar la ansiedad o incluso la fobia a la inyección, la complejidad del tratamiento con insulina, la culpabilización del paciente por considerar la insulinización como un fracaso en el control de la diabetes, la percepción de que la insulinización indica un agravamiento de la enfermedad y la consideración de que el uso de insulina implica una limitación en su estilo de vida, lo que supone la pérdida de calidad de vida o la posibilidad de sentirse estigmatizado socialmente. Por su parte, una porción significativa de profesionales sanitarios parecen mantener dudas acerca de la eficacia de la insulina en los pacientes con diabetes tipo 2, perciben el tratamiento con insulina como más complejo para el paciente (lo que dificulta el cumplimiento) y también para el propio profesional, que podría carecer del tiempo preciso para instruir al paciente. Finalmente, los efectos secundarios más importantes del tratamiento con insulina, así como el aumento de las hipoglucemias y de peso corporal suponen una preocupación tanto para el paciente como para el profesional sanitario. Muchas de las preocupaciones de los pacientes se superan con una información adecuada, la educación diabetológica y, finalmente, con la práctica. Asimismo, los avances técnicos en aspectos como sistemas de inyección, nuevos tipos de insulina o las nuevas formas de administración, como la insulina inhalada, reducen la dificultad para iniciar o intensificar el tratamiento con insulina (AU)

The importance of tight metabolic control in the prevention of the chronic complications of both type 1 and type 2 diabetes was clearly demonstrated in studies published in the 1990s. Likewise, it is well established that insulin is the most effective drug in reducing glycemia. However, there is a reluctance among both patients and health professionals – general practitioners, specialists, and educators in diabetes –to begin insulin therapy, which translates into a prolongation of poor metabolic control with a consequent increase in the risk of developing the complications of diabetes. The barriers to insulin therapy can be analyzed from the point of view of the patient or the health professional and several aspects are common to both. Among the factors that hamper the use of insulin therapy from the patient’s perspective are anxiety or eveninjection phobia, the complexity of insulin therapy, blaming patients by considering insulin therapy as a failure of diabetic control, the perception that insulin therapy indicates a worsening of the disease, and the belief that insulin use imposes a limitation on lifestyle, representing a lower quality of life or the possibility of social stigma. For their part, a significant percentage of health professionals still have doubts about the effectiveness of insulin therapy in patients with type 2 diabetes, perceive insulin therapy as more complex for the patient, thus hampering compliance, and also as more complex for professionals, who lack the time necessary to instruct the patient. Finally, the most important adverse effects of insulin therapy, an increase in hypoglycemic episodes and body weight, are a cause of concern both to patients and to health professionals. Patients’ concerns can usually be overcome with adequate information, education, and practice. Likewise, technical advances in aspects such as injection systems, new types of insulin, and new forms of administration such as inhaled insulin, reduce the difficulty of initiating or intensifying insulin therapy (AU)