Hypogonadism and anemia in an athlete.

We report the case of a highly trained endurance athlete (22-year-old) who developed anemia (Hb 9.5 mg/dl) over a period of 6 months. Iron deficient or haemolytic anemia, as well as chronic loss of blood, were excluded. Further, laboratory analyses revealed that this athlete exhibited very low levels of testosterone due to a partial hypogonadotropic hypogonadism. Following testosterone supplementation, red blood cell indices improved. Although hypogonadotropic hypogonadism is well known to be associated with reduced hematopoesis, it rarely causes anemia in athletes. This should be considered as a possible cause for anemia. Extreme training, unbalanced nutrition or the combination of both, have been shown to be causally involved in the development of secondary hypogonadotropic hypogonadism.

Changes in blood lactate concentrations during different treadmill exercise test protocols.

AIM: The purpose of this study was to compare the blood-lactate and heart rate response of three treadmill tests and to define a conversion algorithm. METHODS: Subjects included 19 long-distance runners. The first two tests had increments of 2 km/h every 3 (test3m) or 5 minutes (test5m). The third test (testFm) consisted of four consecutive 2000m-runs. The calculated individual-anaerobic-threshold (IAT) from test3m was defined as speed at the third step of testFm, speed-increments between the four steps were 0.25 m/s. RESULTS: Lactate threshold (LT) did not show significant differences. Speed at IAT in test3m (15.09|*plusmn*|2.29 km/h) was significantly higher than in test5m (14.74|*plusmn*|2.22 km/h), heart rates were nearly identical. Speed and heart rate at 2 mmol/L showed no significant differences. At lactate concentrations of 3 and 4 mmol/L, running-speeds in test3m were significantly higher than in test5m and testFm. Heart rate were the same in test3m and test5m but significantly higher in testFm. CONCLUSION: Taking test3m as basis for determining endurance-performance, an adjustment of test5m can be made by adding 1.8 mmol/l instead of 1.5 mmol/l to the LT to derive the IAT. TestFm shows similar results as test5m, however, standardization is difficult due to variable increment durations.

Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study.

BACKGROUND AND OBJECTIVES: Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence-based to date. HYPOTHESIS: Polyurethane foam orthoses adapted to a participant's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners. DESIGN: Prospective, randomised, controlled clinical trial. INTERVENTION: 51 patients with running injuries were treated with custom-made, semirigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment. MAIN OUTCOME MEASURES: Evaluation was made by the validated pain questionnaire Subjective Pain Experience Scale, the pain disability index and a comfort index in the orthoses group (ICI). RESULTS: There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index (mean difference 3.2; 95% CI 0.9 to 5.5) and the Subjective Pain Experience Scale (6.6; 2.6 to 10.6). The patients with orthoses reported a rising wearing comfort (pre-treatment ICI 69/100; post-treatment ICI 83/100) that was most pronounced in the first 4 weeks (ICI 80.4/100). CONCLUSION: Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners.

The psychosocial situation of obese children: Psychological factors and quality of life.

The psychosocial situation of obese children at the beginning of the Freiburg Intervention Trial for Obese Children (FITOC) program influences the course and outcome of intervention therapy. At the beginning of FITOC, mothers of 30 children (12 ♂ age 10.5 ± 1.4, 18 ♀; 10.2 ± 1.3) rated the psychopathological symptoms using the Child Behavior Checklist (CBCL) and the quality of life of their children (Inventar zur Erfassung der Lebensqualität [ILK]). 46.6% of mothers rated their children to be disturbed (normal population group, 2% disturbed). There was no correlation between the body mass index of the child and the CBCL score. On the ILK, the obese children themselves selected "good" while the mother's view of their childrens' quality of life varied around "poor". The stress on the mother increased with the degree of the child's obesity and number of critical life events (p = 0.030). The CBCL and the ILK at the beginning of treatment serve as a good screening instrument for psychopathology and distress in children with obesity.

Physical activity throughout life reduces the atherosclerotic wall process in the carotid artery.

BACKGROUND: Good cardiorespiratory fitness has been associated with a reduced risk for clinical events of atherosclerotic vascular diseases. It is still unclear how this relates to a slower progression of the early atherosclerosis wall process. METHOD: Using a dynamic model, we generated new parameters for describing the pathologic wall process in the carotid artery, based on an automatic layer detection system. In this study, we scrutinised the influence of two ultrasonographic parameters, intima-media thickness (IMT) and roughness, by comparing two groups: a healthy inactive group (PIP) (mean (SD) age 64.37 (5.10) years; n = 50) and a healthy lifelong physically active group (PA) (mean (SD) age 64.48 (3.45) years; n = 51). All subjects underwent a blood test, spiroergometry, echocardiography and carotid ultrasound examination. RESULTS: There was a significant difference in the well known risk factors for cardiovascular disease (for example, high density lipoprotein cholesterol, triglyceride) between groups. PIP compared to PA had a significantly higher roughness (PIP 0.073 (0.015) vs PA 0.065 (0.0156); p<0.01). No significantly higher IMT was found for PIP (PIP 0.89 (0.18) vs PA 0.90 (0.22); p = 0.63) compared to PA. In this cross sectional study of middle aged men, Vo(2)max was inversely associated with carotid atherosclerotic parameters. CONCLUSION: In this study, good cardiorespiratory fitness was associated with an increase of the proven risk factors and a reduction of atherosclerosis in the common carotid artery. Roughness seems to be significantly more sensitive than IMT for characterising the changes of the arterial wall. We suggest measuring roughness in addition to IMT to gain additional information about the atherosclerotic wall.

Haemoglobin mass in cyclists during stage racing.

Haemoglobin mass is a main determinant of maximal oxygen uptake. Blood doping aims at increasing this variable. Limits for haematocrit and haemoglobin concentration are used as indicators of blood doping. However, these variables are measures of concentration, do not represent total haemoglobin mass and are altered by vascular volumes shifts. Direct estimation of haemoglobin mass could improve blood tests. It is unknown if physical exercise alters haemoglobin mass. The purpose of this study was to investigate the reaction of haemoglobin mass and other vascular compartments to heavy exercise in athletes. Haemoglobin mass and vascular compartments were evaluated using the optimised CO rebreathing method in 7 elite cyclists during a stage race. Simultaneously, haemoglobin concentration and haematocrit were analysed. Haemoglobin mass (pre-race 958 +/- 123 g, end race 948 +/- 106 g) and red cell volume did not change significantly over the study period, while plasma volume and blood volume tended to increase. Haematocrit (pre-race 44.1 +/- 2.5 %, end race 40.9 +/- 1.59 %) and haemoglobin concentration (pre race 15.8 +/- 0.9 g/dl, end race 14.7 +/- 0.7 g/dl) decreased. During the study, a plasma volume expansion as adaptation to prolonged exercise occurred. Haemoglobin concentration and haematocrit decreased accordingly, whereas haemoglobin mass remained stable. Haemoglobin mass might therefore be a suitable screening tool for blood manipulations.

Cadence-power-relationship during decisive mountain ascents at the Tour de France.

The aim of the study was to report the relationship between cadence and power developed by professional cyclists during high mountain ascents of the Tour de France. From the 10 cyclists (30 +/- 4 years, 178 +/- 8 cm, 69 +/- 6 kg) involved in the study, 108 ascents were recorded and analyzed using a mobile power measurement device (SRM Training Systems, Jülich, Germany). Based on topographic characteristics, the ascents were categorized into 1st and Hors Category (HC) climbs. During the ascents of the 1st Category climbs, power output averaged 312 +/- 43 W (4.5 +/- 0.6 W/kg) with a mean cadence of 73 +/- 6 rpm and a mean duration of 37 : 41 +/- 16 : 16 min. Power output averaged 294 +/- 36 W (4.3 +/- 0.6 W/kg) at a mean cadence of 70 +/- 6 rpm during 57 : 40 +/- 10 : 32 min on HC climbs. The maximal mean power for long durations (1800 s) showed a mean power output of 327 W and 346 W for the 1st and HC climbs, respectively. The evaluation of the cadence-power output and the distance per pedaling cycle-power output relationship shows that high power outputs are mainly yielded by higher pedaling cadences and higher gears.

Sequential based analysis of Intima-Media Thickness (IMT) in common carotid artery studies.

INTRODUCTION: Carotid Intima-Media Thickness (IMT) is used widely to assess an individual's risk of myocardial infarction and stroke. Although significant associations have been showed, IMT as used in major studies does not improve prediction of cardiovascular events much compared to traditional risk factors. Therefore, a new approach to IMT-measurements is sought-after by examining the wall structure continuously throughout several heart cycles. MATERIALS AND METHODS: Computerized single-image analysis (IA) and sequential analysis (SA) were used to assess latter's capability in predicting risk of cardiovascular disease and to compare both. Healthy subjects (mean+/-S.D., age 46.1+/-5.6 years, n=490) were compared with subjects suffering from confirmed coronary artery disease (CAD) (mean+/-S.D., age 47.3+/-6.2 years, n=51). RESULTS: SA could differentiate between both groups better then single IA, especially when looking at the maximal and mean IMT-values (SA<-->IA, p<0.01<-->p<0.05). The area under the curve (AUC) for maximal and mean IMT was greater for sequences then for single images as well. DISCUSSION: Due to our findings sequential analysis can offer an extensive and complete examination of the carotid wall with a maximal reduction of bias. Commonly used IA may disguise vascular conditions and therefore the patient's risk, since IMT-values, as proven with SA, seems to usually be higher. Therefore, the need for further studies arises, examining if and to what extend common IMT-studies underestimate differences between groups.

Computer-based quantification of the mean Achilles tendon thickness in ultrasound images: effect of tendinosis.

BACKGROUND: B-mode measurement of the sagital diameter of the Achilles tendon based on a manual tracing (MT) procedure is partly dependent on the subjectivity of the reader. The aim of this study is to establish a standardised automatic procedure to differentiate between normal and chronically degenerated tendons. For this comparison, the tracing results of the tendon boundaries of an automatic identification (AI) process, already established with the detection of intima-media thickness, are compared with computer-assisted MT. METHODS: The detection of the tendon boundaries was performed in 115 ultrasound images including the cranial border of the calcaneal tuberosity. The measured section (starting point 4 cm away from the anterior boundary of the calcaneal tuberosity) amounted to 3 cm, and was divided into three sub-segments (1 cm each). Intra- and inter-reader/observer variability for mean and maximum Achilles tendon thickness (ATT) with AI and MT were evaluated. A normal group and a group with clinically diagnosed chronic tendon degeneration had mean and maximum ATT readings compared. RESULTS: Using MT, the intra- and inter-reader variability was 3.0% and 6.8%, respectively, using AI the variability was 1.6% and 3.9%, respectively. Mean and maximum ATT were measured systematically lower by AI compared to MT in all regions by 0.4 mm. The AI procedure was most accurate in the second segment. The mean ATT and maximum ATT were correctly detected in 93.9% and 96.6% of the images. CONCLUSION: The AI procedure detected the ATT with a high level of precision in all three segments. The most robust measurement was reached in the second segment. It eliminates most of the inter-/intra-reader variability in ATT measurement using MT. We suggest this new method could be a new gold standard for quantification of chronic disorder in Achilles tendons.

Power Output during the Tour de France.

The aim of this study was to evaluate the demands of riding a "Grand Tour" by monitoring both heart rate and power output in 15 professional cyclists. SRM power output profiles (SRM Trainingsystem, Jülich, Germany) were collected during 148 mass start stages during the 2005 Tour de France and analyzed to establish average power, heart rate (HR) and cadence produced in different terrain categories (flat [FLT]; semi-mountainous [SMT]; mountainous [MT]). The maximal mean power (MMP) for progressively longer durations was quantified. Average HR was similar between FLT (133 +/- 10 bpm) and SMT (134 +/- 8 bpm) but higher during MT (140 +/- 3 bpm). Average power output revealed a similar trend (FLT 218 +/- 21 W [3.1 +/- 0.3 W/kg], SMT 228 +/- 22 W [3.3 +/- 0.3 W/kg], and MT 234 +/- 13 W [3.3 +/- 0.2 W/kg]). Cadence during MT was approximately 6 - 7 rpm lower (81 +/- 15 rpm) compared to FLT or SMT. During MT stages, the MMP for 1800 sec. was highest (394 W vs. 342 W) but the MMP 15 was lower (836 W vs. 895 W) compared to FLT. The data document comprehensively the power output demands during the Tour de France.

Motor abilities and aerobic fitness of obese children.

Obesity is considered to be epidemic worldwide. Stopping further progression interdisciplinary, outpatient intervention therapy programs for obese children have become increasingly important. FITOC (Freiburg Intervention Trial for Obese Children) consists of a combination of organized sports, behavioral therapy and nutritional advice. The effectiveness of the therapy is determined on the basis of anthropometrical and physical performance data. The purpose of this report is to give a differentiated view of the motor abilities of obese children and to describe changes in the course of the therapy program FITOC. Data were collected on n = 49 obese children (BMI > 97th percentile) aged 8 - 12 in a pretest at the beginning and posttest at the end of the intensive phase of the therapy. These data were compared with an age-matched German reference group. Besides the General Sports-Motor Test (Allgemeiner Sportmotorischer Test [AST]), the BMI-SDS values, the body fat mass (FM %) and the aerobic capacity (Watt/kg body weight) were recorded. In the pretest, the running exercise results and the aerobic capacity checked ranged significantly below the values of the reference group. The performance in the coordinative tests of the AST was differentiated. The medicine-ball toss was significantly above average of the reference group. In the posttest, the BMI-SDS values and the body fat mass (% FM) decreased (p < 0.001) and the aerobic capacity improved (p < 0.001). Performance in all motor abilities tests improved and the difference between the strength of the obese children and the strength of the reference group decreased. This study demonstrates that in obese children weight-bearing activities are below average but not all motor abilities.

External iliac artery occlusion in a young female cyclist.

After 8 years of high performance training in mountain biking, a top female athlete, aged 23, first complained of diffuse, exercise-induced pain in both thighs. Over a period of the next 4 years, a slight but continuous reduction in her performance was observed, despite having maintained her training regime during the first 2 years. Gradually, pain increased, at last occurring even when she climbed a few stairs. This led to a clinical, echo-Doppler, MR-angiographic and DS-angiographic examination, which showed a complete occlusion of the right iliac external artery with good collateralisation. The left external iliac artery evidenced only small intravascular lesions. Surgical treatment (endarterectomy plus patch angioplasty) eliminated the pain completely. Except for a lipoprotein (a) of 114 mg/dL, no other significant risk factors were found. The influence of a genetic (heterocygotic) low APC-ratio of 1.6 and free protein S of 53% is unclear. This is a typical case of a delayed diagnosis in an athlete. A complete occlusion of an external iliac artery is extremely seldom in young in female athletes. With no indication of a general atherosclerotic or inflammatory process nor congenital abnormalities, an exercise-induced, chronic traumatisation may have caused this pathological condition.

Determining anaerobic capacity using treadmill ergometry.

The determination of anaerobic capacity (AC) using treadmill ergometry is problematic from a methodological, as well as a technical standpoint. In this study, a procedure from Monod and Scherrer was modified to examine whether realistic magnitudes of AC could be determined using three subject groups with different levels of anaerobic training. The subject groups consisted of 10 untrained (UT), 10 aerobic-trained runners (AeT), and 10 anaerobic-trained 400-meter sprinters (AnT). In two separate test series, first the VO2max was determined and second the so-called individual anaerobic threshold (IAT) was used to determine the aerobic power for all subjects. Then all subjects completed a series of sprints with increasing speeds above the VO2max, from which the work output from each test was calculated. Through linear regression, the point of intersection of the regression line with the y-axis was defined as global AC. The results show typically higher VO2max and IAT for AeT (62.2 ml x kg(-1) x min(-1), 14.7 km x h(-1)) compared to UT (53.2 ml x kg(-1) x min(-1); 11.2 km x h(-1)) and AnT (56.7 ml x kg(-1) x min(-1); 11.8 km x h(-1)). AC was significantly higher in AnT (4.1 +/- 0.58 kJ) compared to AeT (1.8 +/- 0.65 kJ) and UT (3.2 +/- 0.68 kJ). The determined absolute values of AC are considerably lower than of comparable examinations using bicycle ergometry. One reason for such an underestimation of AC could be that the horizontal work done during exercise on a treadmill was not taken into enough consideration. Another explanation is that the magnitude of the calculated AC values shows a dependency on the duration of each sprint test. In addition, the critical velocity for all subjects was found to be higher than for IAT, which consequently leads to an underestimation of AC. Moreover, the absolute level of the AC values appears to depend on the endurance of the comparison groups. It can then be concluded that the applied procedure allows for a differentiation amongst a variously trained collective, but does not allow a correct absolute determination of the AC.

[Sports medicine in Germany]. / Sportmedizin in Deutschland.

Sports medicine covers many different aspects, ranging from clinical specialties, such as internal medicine, orthopedics or pediatrics to physiology and sports sciences. The requirements for sports medicine evolve mainly from exercise physiology (elite, leisure and health oriented physical activity), orthopedics and traumatology as well as from preventive and rehabilitative issues. In the new German curriculum, sports medicine is defined as a subspecialty. Historically, sports medicine in Germany has a federal structure with a governing body (Deutsche Gesellschaft für Sportmedizin und Prävention). Due to these facts, University Departments of Sports Medicine (which vary greatly in size and performance) are either attached to Medical or non-Medical Faculties, such as Sports Sciences. In medical schools, sports medicine can be selected as an elective subject. However, the main part of teaching sports medicine is covered by Sports Science Faculties. In an international context, the strength of German sports medicine is its clinical orientation and close cooperation with the sport itself, especially high-performance sports. In the future, like in the Anglo- American countries, sports medicine in Germany will play a major role in health prevention and rehabilitation.

Freiburg Intervention Trial for Obese Children (FITOC): results of a clinical observation study.

BACKGROUND: The Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary, outpatient program for obese children consisting of regular physical exercise and comprehensive dietary and behavioral education. Parental involvement is required. The study is designed as a longitudinal, nonrandomized clinical observation study. An 8-month intensive phase preceded a follow-up phase of 1 y or longer. METHODS: Data were collected from 31 groups comprising 496 children (267 girls, 229 boys), with an average age of 10.5 y. Body height and weight, fasting total-cholesterol (CH), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and physical performance were measured initially and after 8.5 months. A group of n = 35 obese children (16 girls, 19 boys) who did not take part in this intervention program served as controls. RESULTS: After the intensive intervention phase, body mass index (BMI, kg/m2) as well as BMI deviation scores (BMI-SDS) decreased in both sexes (P<0.001). In the controls, BMI increased (P<0.001) and BMI-SDS remained constant. Whereas CH was only significantly lower (P<0.01) in boys after 8.5 months, LDL-C decreased significantly in both sexes. HDL-C tended to increase in both sexes (not significant). The controls showed no significant changes in CH, LDL-C and HDL-C. The fitness levels (W/kg body weight) improved in the intervention group (P<0.001), but not in the control group. CONCLUSIONS: The results indicate that obese children can be successfully treated in such an intervention program. BMI-SDS and risk factors decreased and physical performance improved. To maintain therapeutical success, we highly recommended that these children enroll in community-based exercise programs in order to help them maintain a more active lifestyle after the follow-up phase.

[Current views on the importance of physical activity]. / Fett abbauen--Muskeln stählen: Gewichtskontrolle ist nicht nur FdH.

To improve the individual health profile and to solve the growing overweight problem, a long-term change in the lifestyle to one which includes an energetically balanced combination of diet and activity is essential. Physical activity and the muscles involved are the primary means by which body composition and energy turnover are regulated. A state of imbalance has decisive consequences on the development of atherogenic and inflammatory risk factors. Additionally, the aging process is significantly influenced by the long-term retention or loss of muscle mass. The Deutsche Gesellschaft für Sportmedizin und Prävention (German Society for Sports Medicine and Prevention, a registered association) offers within the concept of a therapeutic lifestyle change, an educational program for overweight adults (M.O.B.I.L.I.S.).

[Current views on the prevention of ailments of the musculoskeletal system through muscle strengthening programs]. / Prävention von Beschwerden des Stütz- und Bewegungsapparates. Schicken Sie lhre Senioren zum Krafttraining!

Because of an increasingly older population structure and the enhanced relevance of body composition, the prevention of problems arising from the musculoskeletal system has become of central importance. Strengthening and muscle-building training have been proven to be useful even for older people. The training is focused on the types of movement and exertion that frequently occur in the "activities of daily living." In addition, a purely hypertrophic training for building muscle mass must be differentiated from a more sensorimotor oriented training with situational employment of the muscles for optimizing motor control and coordination. There are no contraindications for strength training when the program is adapted to the individual. The rate of injury is small, even for people at low performance levels.

[Physical activity and dyslipoproteinemia]. / Triglyzeride sinken, HDL-Wert steigt, LDL-Cholesterin formiert sich neu. Wenn Adipöse loslaufen, kommt auch ihr Lipidprofil in Bewegung.

The positive influence of regular physical activity on lipoprotein metabolism and, hence, on the risks for atherogenesis has been documented in controlled studies. Although the levels of total and LDL cholesterol (LDL) usually change only slightly through physical activity, there is a clear change in the LDL composition with a reduction in the atherogenic small dense LDL particle. An activity-induced increase for HDL cholesterol (HDL) between 4 and 29% and a reduction in the triglyceride (TG) level between 4 and 37% are described. To achieve this, it is necessary to increase energy consumption by 1000-1200 kcal/week and to attain an energy consumption of ca. 2500 (> 2000) kcal/week, optimum ca. 3500 kcal/week.