Bone mineral content and levels of gonadotropins and estrogens in amenorrheic running women.

Serum gonadotropin and estrogen levels and their relationship to bone mineral content in exercise-related amenorrhea were studied in 11 amenorrheic women and 24 eumenorrheic women, all of whom were runners. Serum estradiol, LH, FSH, estrone, and testosterone were measured in serial blood samples obtained at 15-min intervals for 4 h. The amenorrheic women had lower estradiol, LH, FSH; and estrone levels as well as a higher estrone-estradiol ratio than did the eumenorrheic women. There was no difference in testosterone levels. The amenorrheic women had lower LH pulse amplitudes, whereas no differences were found in FSH pulse amplitudes. LH and FSH pulse frequencies did not differ between the two groups. Bone mineral content of the lumbar spine was lower in amenorrheic women and was positively correlated with estradiol levels in all women. There was no difference in bone mineral content of the radius. These data suggest that, in exercise-related amenorrhea, low serum LH, FSH, and estrogen levels reflect an alteration in the hypothalamic control of gonadotropin release. Reduced circulating estrogen levels in amenorrheic running women may be a cause of low mineral content of the spine.

Body composition in elderly men: effect of dietary modification during strength training.

OBJECTIVE: To assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men. DESIGN: Randomized controlled trial. INTERVENTION: During 12 weeks of resistance training of knee extensors and flexors, a daily supplement of 560 +/- 16 kcal/day (17% energy from protein, 43% from carbohydrate, 40% from fat) was randomly assigned to six men (S) while five men (U) received no supplement. Food intake, strength, whole body composition, and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks. SETTING: The men were outpatients but lived in a Metabolic Research Unit during the three assessments. PARTICIPANTS: Eleven healthy men aged 61 to 72 years. RESULTS: Densitometry showed no change over time in fat or fat-free mass. However, the S men increased (P less than 0.05) weight, skinfold thickness at six sites, subcutaneous midthigh fat, and creatinine excretion; in all men, changes in these values and in midthigh muscle were proportional to changes in reported energy intake (P less than 0.05). There was midthigh muscle hypertrophy in both groups, but it was greater in S than U (P less than 0.01). Both groups gained strength (P less than 0.001) with no effect of diet. CONCLUSIONS: During physical rehabilitation of the elderly, dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain. These preliminary findings should be confirmed by a larger study with sedentary controls.

Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health.

The longitudinal changes in isokinetic strength of knee and elbow extensors and flexors, muscle mass, physical activity, and health were examined in 120 subjects initially 46 to 78 years old. Sixty-eight women and 52 men were reexamined after 9.7 +/- 1.1 years. The rates of decline in isokinetic strength averaged 14% per decade for knee extensors and 16% per decade for knee flexors in men and women. Women demonstrated slower rates of decline in elbow extensors and flexors (2% per decade) than men (12% per decade). Older subjects demonstrated a greater rate of decline in strength. In men, longitudinal rates of decline of leg muscle strength were approximately 60% greater than estimates from a cross-sectional analysis in the same population. The change in leg strength was directly related to the change in muscle mass in both men and women, and it was inversely related to the change in medication use in men. Physical activity declined yet was not directly associated with strength changes. Although muscle mass changes influenced the magnitude of the strength changes over time, strength declines in spite of muscle mass maintenance or even gain emphasize the need to explore the contribution of other cellular, neural, or metabolic mediators of strength changes.

A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women.

The isokinetic strength of the elbow and knee extensors and flexors was measured in 200 healthy 45- to 78-yr-old men and women to examine the relationship between muscle strength, age, and body composition. Peak torque was measured at 60 and 240 degrees/s in the knee and at 60 and 180 degrees/s in the elbow by use of a Cybex II isokinetic dynamometer. Fat-free mass (FFM) was estimated by hydrostatic weighing in all subjects, and muscle mass (MM) was determined in 141 subjects from urinary creatinine excretion. FFM and MM were significantly lower (P less than 0.001) in the oldest group. Strength of all muscle groups at both testing speeds was significantly (P less than 0.006) lower (range 15.5-26.7%) in the 65- to 78- than in the 45- to 54-yr-old men and women. When strength was adjusted for FFM or MM, the age-related differences were not significant in all muscle groups except the knee extensors tested at 240 degrees/s. Absolute strength of the women ranged from 42.2 to 62.8% that of men. When strength was expressed per kilogram of MM, these gender differences were smaller and/or not present. These data suggest that MM is a major determinant of the age- and gender-related differences in skeletal muscle strength. Furthermore, this finding is, to a large extent, independent of muscle location (upper vs. lower extremities) and function (extension vs. flexion).

Strength conditioning in older men: skeletal muscle hypertrophy and improved function.

The effects of strength conditioning on skeletal muscle function and mass were determined in older men. Twelve healthy untrained volunteers (age range 60-72 yr) participated in a 12-wk strength training program (8 repetitions/set; 3 sets/day; 3 days/wk) at 80% of the one repetition maximum (1 RM) for extensors and flexors of both knee joints. They were evaluated before the program and after 6 and 12 wk of training. Weekly measurements of 1 RM showed a progressive increase in strength in extensors and flexors. By 12 wk extensor and flexor strength had increased 107.4 (P less than 0.0001) and 226.7% (P less than 0.0001), respectively. Isokinetic peak torque of extensors and flexors measured on a Cybex II dynamometer increased 10.0 and 18.5% (P less than 0.05) at 60 degrees/s and 16.7 and 14.7% (P less than 0.05) at 240 degrees/s. The torque-velocity relationship showed an upward displacement of the curve at the end of training, mainly in the slow-velocity high-torque region. Midthigh composition from computerized tomographic scans showed an increase (P less than 0.01) in total thigh area (4.8%), total muscle area (11.4%), and quadriceps area (9.3%). Biopsies of the vastus lateralis muscle revealed similar increases (P less than 0.001) in type I fiber area (33.5%) and type II fiber area (27.6%). Daily excretion of urinary 3-methyl-L-histidine increased with training (P less than 0.05) by an average 40.8%. Strength gains in older men were associated with significant muscle hypertrophy and an increase in myofibrillar protein turnover.

Dietary protein requirements and body protein metabolism in endurance-trained men.

The effects of regular submaximal exercise on dietary protein requirements, whole body protein turnover, and urinary 3-methylhistidine were determined in six young (26.8 +/- 1.2 yr) and six middle-aged (52.0 +/- 1.9 yr) endurance-trained men. They consumed 0.6, 0.9, or 1.2 g.kg-1.day-1 of high-quality protein over three separate 10-day periods, while maintaining training and constant body weight. Nitrogen measurements in diet, urine, and stool and estimated sweat and miscellaneous nitrogen losses showed that they were all in negative nitrogen balance at a protein intake of 0.6 g.kg-1.day-1. The estimated protein requirement was 0.94 +/- 0.05 g.kg-1.day-1 for the 12 men, with no effect of age. Whole body protein turnover, using [15N]glycine as a tracer, and 3-methylhistidine excretion were not different in the two groups, despite lower physical activity of the middle-aged men. Protein intake affected whole body protein flux and synthesis but not 3-methylhistidine excretion. These data show that habitual endurance exercise was associated with dietary protein needs greater than the current Recommended Dietary Allowance of 0.8 g.kg-1.day-1. However, whole body protein turnover and 3-methylhistidine excretion were not different from values reported for sedentary men.

Drink composition, voluntary drinking, and fluid balance in exercising, trained, heat-acclimatized boys.

This study examined the effects of beverage composition on the voluntary drinking pattern, body fluid balance, and thermoregulation of heat-acclimatized trained boys exercising intermittently in outdoor conditions (wet bulb globe temperature 30.4 +/- 1.0 degreesC). Twelve boys (age 13.4 +/- 0.4 yr) performed two 3-h sessions, each consisting of four 20-min cycling bouts at 60% maximal aerobic power alternating with 25-min rest. One of two beverages was assigned: unflavored water (W) or flavored water plus 6% carbohydrate and 18 mmol/l Na (CNa). Drinking was ad libitum. Total intake was higher (P < 0.05) during CNa (1,943 +/- 190 g) compared with W (1,470 +/- 143 g). Euhydration was maintained with CNa (+0.18% body wt), but a mild dehydration resulted with W (-0.94% body wt; P < 0.05). Sweat loss, much higher than previously published for children of similar age, was similar between conditions (CNa = 1,644.7 +/- 117.5; W = 1,750.2 +/- 152.7 g). The increase in rectal temperature (CNa = 0.86 +/- 0.3; W = 0.76 +/- 0.1 degreesC), heart rate, and all perceptual variables did not differ between conditions. In conclusion, a flavored carbohydrate-electrolyte drink prevents voluntary dehydration in trained heat-acclimatized boys exercising in a tropical climate despite their large sweat losses. Because hydration changes were minor, the thermoregulatory strain observed was similar between conditions.

Strength training and determinants of VO2max in older men.

The effects of strength training on maximal aerobic power (VO2max) and some of its determinants were studied in 12 healthy older men (60-72 yr). They underwent 12 wk of strength conditioning of extensors and flexors of each knee with eight repetitions per set, three sets per session, and three sessions per week at 80% of the one repetition maximum (1 RM). Left knee extensors showed a 107% increase in 1 RM, a 10% increase in isokinetic strength at 60 degrees/s, and a 23% increase in total work performed during 25 contractions on an isokinetic dynamometer. Strength measurements of the untrained left elbow extensors showed no change. Leg cycle ergometer VO2max per unit fat-free mass increased by an average 1.9 ml (P = 0.034) whereas arm cycle VO2max was unchanged. Pulmonary function, hemoglobin concentration, erythrocyte volume, plasma volume, and total blood volume did not change. Biopsies of the vastus lateralis showed a 28% increase in mean fiber area, no change in fiber type distribution, a 15% increase in capillaries per fiber, and a 38% increase in citrate synthase activity. The data suggest that the small increase in leg cycle VO2max in older men may be due to adaptations in oxidative capacity and increased mass of the strength-trained muscles.

Enhanced protein breakdown after eccentric exercise in young and older men.

The effects of eccentric exercise on whole body protein metabolism were compared in five young untrained [age 24 +/- 1 yr, maximal O2 uptake (VO2max) = 49 +/- 6 ml.kg-1.min-1] and five older untrained men (age 61 +/- 1 yr, VO2max = 34 +/- 2 ml.kg-1.min-1). They performed 45 min of eccentric exercise on a cycle ergometer at a power output equivalent to 80% VO2max (182 +/- 18 W). Beginning 5 days before exercise and continuing for at least 10 days after exercise, they consumed a eucaloric diet providing 1.5 g.kg-1.day-1 of protein. Leucine metabolism in the fed state was measured before, immediately after, and 10 days after exercise, with intravenous L-[1-13C]leucine as a tracer (0.115 mumol.kg-1.min-1). Leucine flux increased 9% immediately after exercise (P less than 0.011) and remained elevated 10 days later, with no effect of age. Leucine oxidation increased 19% immediately after exercise and remained 15% above baseline 10 days after exercise (P less than 0.0001), with no effect of age. In the young men, urinary excretion of 3-methylhistidine per gram of creatinine did not increase until 10 days postexercise (P less than 0.05), but in the older men, it increased 5 days after exercise and remained high through 10 days postexercise (P less than 0.05), averaging 37% higher than in the young men. These data suggest that eccentric exercise produces a similar increase in whole body protein breakdown in older and young men, but myofibrillar proteolysis may contribute more to whole body protein breakdown in the older group.

Eccentric exercise-induced muscle damage impairs muscle glycogen repletion.

Five healthy untrained young male subjects were studied before, immediately after, and 10 days after a 45-min bout of eccentric exercise on a cycle ergometer (201 W). The subjects were sedentary at all other times and consumed a eucaloric meat-free diet. Needle biopsies of the vastus lateralis muscle were examined for intracellular damage and glycogen content. Immediately after exercise, muscle samples showed myofibrillar tearing and edema. At 10 days, there was myofibrillar necrosis, inflammatory cell infiltration, and no evidence of myofibrillar regeneration. Glycogen utilization during the exercise bout was 33 mmol glycosyl units/kg muscle, consistent with the metabolic intensity of 44% of maximal O2 uptake; however, the significant glycogen use by type II fibers contrasted with concentric exercise performed at this intensity. At 10 days after exercise, muscle glycogen was still depleted, in both type I and II fibers. It is possible that the alterations in muscle ultrastructures were related to the lack of repletion of muscle glycogen. Damage produced by eccentric exercise was more persistent than previously reported, indicating that more than 10 days may be necessary for recovery of muscle ultrastructure and carbohydrate reserves.

Metabolic changes following eccentric exercise in trained and untrained men.

The effects of one 45-min bout of high-intensity eccentric exercise (250 W) were studied in four male runners and five untrained men. Plasma creatine kinase (CK) activity in these runners was higher (P less than 0.001) than in the untrained men before exercise and peaked at 207 IU/ml 1 day after exercise, whereas in untrained men the maximum was 2,143 IU/ml 5 days after exercise. Plasma interleukin-1 (IL-1) in the trained men was also higher (P less than 0.001) than in the untrained men before exercise but did not significantly increase after exercise. In the untrained men, IL-1 was significantly elevated 3 h after exercise (P less than 0.001). In the untrained group only, 24-h urines were collected before and after exercise while the men consumed a meat-free diet. Urinary 3-methylhistidine/creatinine in the untrained group rose significantly from 127 mumol/g before exercise to 180 mumol/g 10 days after exercise. The results suggest that in untrained men eccentric exercise leads to a metabolic response indicative of delayed muscle damage. Regularly performed long distance running was associated with chronically elevated plasma IL-1 levels and serum CK activities without acute increases after an eccentric exercise bout.

Peripheral effects of endurance training in young and old subjects.

The effects of 12 wk of endurance training at 70% peak O2 consumption (VO2) were studied in 10 elderly (65.1 +/- 2.9 yr) and 10 young (23.6 +/- 1.8 yr) healthy men and women. Training had no effect on weight or body composition in either group. The elderly had more adipose tissue and less muscle mass than the young. Initial peak VO2 was lower in the elderly, but the absolute increase of 5.5-6.0 ml.kg-1.min-1 after training was similar for both groups. Muscle biopsies taken at rest showed that, before training, muscle glycogen stores were 61% higher in the young. Before training, glycogen utilization per joule during submaximal exercise was higher in the elderly. Glycogen stores and muscle O2 consumption increased significantly in response to training in the elderly only. After training, the proportion of energy derived from whole body carbohydrate oxidation during submaximal exercise declined in the young only. The absolute changes that training produced in peak VO2 were similar in both age groups, but the 128% increase in muscle oxidative capacity was greater in the elderly, suggesting that peripheral factors play an important role in the response of the elderly to endurance exercise.

Aging of skeletal muscle: a 12-yr longitudinal study.

The present study examines age-related changes in skeletal muscle size and function after 12 yr. Twelve healthy sedentary men were studied in 1985-86 (T1) and nine (initial mean age 65.4 +/- 4.2 yr) were reevaluated in 1997-98 (T2). Isokinetic muscle strength of the knee and elbow extensors and flexors showed losses (P < 0.05) ranging from 20 to 30% at slow and fast angular velocities. Computerized tomography (n = 7) showed reductions (P < 0.05) in the cross-sectional area (CSA) of the thigh (12.5%), all thigh muscles (14.7%), quadriceps femoris muscle (16.1%), and flexor muscles (14. 9%). Analysis of covariance showed that strength at T1 and changes in CSA were independent predictors of strength at T2. Muscle biopsies taken from vastus lateralis muscles (n = 6) showed a reduction in percentage of type I fibers (T1 = 60% vs. T2 = 42%) with no change in mean area in either fiber type. The capillary-to-fiber ratio was significantly lower at T2 (1.39 vs. 1. 08; P = 0.043). Our observations suggest that a quantitative loss in muscle CSA is a major contributor to the decrease in muscle strength seen with advancing age and, together with muscle strength at T1, accounts for 90% of the variability in strength at T2.

Body composition and aerobic capacity in young and middle-aged endurance-trained men.

Aging is associated with increased body fat, decreased muscle mass, lower maximal O2 uptake, and lower energy intake. It has been asserted that these changes are caused in part by decreased activity. In order to determine the effects of aging in men who are habitually active, 6 young men (26.8 +/- 1.2 yr) and 6 middle-aged men (52.0 +/- 1.9 yr) who had been running, cycling, and/or rowing for at least 2 yr were studied in a metabolic ward. The men consumed a diet to maintain constant body weight while keeping to their usual exercise schedule and intensity. Both groups had a similar body mass index and muscle mass, but the middle-aged men had a 77% greater fat mass (P = 0.028). Daily energy requirement was 17% lower in the middle-aged men (P = 0.029) although basal metabolic rate was similar in both groups. Aerobic capacity was 15% lower in the middle-aged men per unit body weight (P = 0.048) but not per unit of lean body mass. The young men exercised for an average 12.3 hr.wk-1 and the middle-aged men for 7.5 hr.wk-1 (P = 0.018). For both young and middle-aged men, weekly hours of exercise were negatively correlated with fat mass, and positively correlated with daily energy requirements and maximal O2 uptake. These findings show that in both young and middle-aged men who habitually exercise aerobically at 65 to 80% maximal O2 uptake, the time spent training was associated with body composition, energy requirements, and aerobic capacity.

The reproducibility of the Bruce protocol exercise test for the determination of aerobic capacity in older women.

The reproducibility of the Bruce exercise test protocol for the determination of maximal aerobic activity was evaluated in sedentary older women. Seventeen women between the ages of 51 and 68 yr performed five maximal graded exercise tests to volitional fatigue on a treadmill. VO2max (mL.kg-1.min-1) values averaged 27.5 +/- 1.1; 28.3 +/- 1.3; 28.4 +/- 1.3; 29.6 +/- 1.5; and 28.2 +/- 1.4 for trials 1-5, respectively, and were not significantly different. Criteria for a plateau in VO2 at the point of exhaustion were met in 21 out of 85 tests (25%). The mean coefficient of variation VO2max for the subjects for the 5 tests was 6.5% (range, 2.0-14%). Pearson's correlation coefficients for the study variables were significant, indicating good agreement between repeated tests (r2: between 0.70 to 0.89). Although there were no significant differences among the mean VO2max values in the 5 trials, 11 subjects had a 1.0 ml.kg-1.min-1 or greater increase in the VO2max from test 1 to test 2, and only 6 subjects had no change or a decrease in VO2max. The mean difference between T2 and T3 was lower (T1 vs T2: 0.8 mL.kg-1.min-1, T2 vs T3: 0.1 mL.kg-1.min-1) indicating slightly better agreement between the second and third set. Estimates of the between and within subject variance revealed a low within subject variance (4.2 (mL.kg-1.min-1)2) compared to the between subject variance (22.1 (mL.kg-1.min-1)2). This study demonstrates that a commonly used exercise testing protocol generates highly reproducible measurements of VO2max in women between 51 and 68 yr. The mean differences between tests and the high level of agreement between repeated tests suggests that a single measurement of VO2max can be performed to assess functional aerobic capacity in this population.

Muscle strength and body composition: associations with bone density in older subjects.

This study investigated the relationship between isokinetic muscle strength and bone density (SPA and DPA) in men and women aged 45-77 yr. Regression models were adjusted for age, weight, smoking status, and calcium supplementation. Elbow extensors (but not flexors) peak torque was correlated with radial density in men (partial r = 0.26, P < 0.05) and women (partial r = 0.24, P < 0.05). Knee flexor (but not extensor) peak torque in women was significantly correlated with spine density (partial r = 0.28, P < 0.05), and muscle mass was significantly correlated with Ward's triangle density (partial r = 0.35, P < 0.05). No associations between knee flexor or extensor muscle strength and spine or femur bone density were observed in men. Fat-free mass (FFM, hydrodensitometry) was associated with all bone density sites in males and females (partial r = 0.30-0.55; P < 0.05). These results demonstrate that 1) significant associations observed between elbow extensor strength and radial bone density in men and women may reflect loading along the longitudinal axis of the radius associated with elbow extensor activity; and 2) significant associations exist between knee flexor muscle strength and lumbar density in women only. Additionally, the associations between FFM and bone density do not necessarily reflect associations between isokinetic muscle strength and bone density.

Muscle fatigue and muscle injury.

The purpose of this review is to acquaint the reader with the neurobiology of muscle fatigue. Muscle fatigue is a complex, multifactorial process. The authors have covered the chain of events bringing about skeletal muscle contraction and the manner in which fatigue may affect each step. Advances in technology continue to increase understanding of central fatigue. Many excellent studies of peripheral fatigue have been designed to delineate the mechanisms that influence the excitation-contraction coupling, energy supply, and force generation processes. Although much of this work has considered mechanisms in isolation, different mechanisms may be responsible under different conditions. Fatigue is a common complaint among patients with a variety of neuromuscular and metabolic diseases. Armed with an enhanced knowledge of the mechanisms of muscle fatigue, one can more fully recognize the signs and symptoms of metabolic disorders and neuromuscular diseases and use diagnostic testing. The clinician should anticipate the role of muscle fatigue in injury and focus on injury prevention strategies, especially during the restorative phase of rehabilitation. As a clinician-scientist concerned with optimizing patients' and athletes' performance, one must design ways to identify, measure, and treat muscle fatigue. Beyond illustrating what is currently known about muscle fatigue, the authors hope this review inspires the reader to solve problems of great clinical importance to patients and athletes alike.

Patterns of injuries in athletes evaluated in an interdisciplinary clinic.

The pattern of sports injuries appears to be population-specific. The purpose of the present study is to describe 1750 injuries evaluated between April 1988 and April 1994 in our Olympic Training Center Interdisciplinary Sports Injury Clinic. Our patient population included elite and recreational athletes of both sexes between the ages of 7 and 71 years. Males comprised 73% of the patient population and approximately 80% of the injuries corresponded to the 10 to 29 age range. The most frequent sports in males were baseball (21.9%) and basketball (15.9%) and in females were track and field (17.1%) and gymnastics (15.1%). Most injuries (52%) were traumatic in nature, chronic (71.6%), and occurred during training sessions (57.4%). The most commonly affected anatomical areas were the knee (31.2%) and shoulder (15.5%). The most common diagnoses were tendinitis (25.4%), and first degree strains (11.8%) and sprains (9.3%). Finally, treatment strategies included medications (61.0%), physical therapy (48.9%), relative rest (35.7%), and home exercise programs (35.2%). The variety of musculoskeletal disorders seen in combination with the frequent use of conservative treatment confirms the importance of an interdisciplinary approach to sports injuries.

[Morbidity during the XVI Central American and Caribbean Games: Puerto Rican delegation, Mexico 1990]. / Morbilidad durante los XVI Juegos Deportivos Centroamericanos y del Caribe: Delegación de Puerto Rico, México 1990.

The health services offered to the Puerto Rican Delegation during the XVI Central American and Caribbean Sports Games in México in 1990 included: medical, dental and psychological assistance, physical therapy and services on the playing field. From the consultation sheets completed during the Games we obtained information about the use of these services. The 336 members of the Puerto Rico Delegation in the village at México City had 1,838 encounters with the health team. Of these, 991 were medical consults, 55 group therapies, 466 physical therapy sessions and 326 encounters in the sports venues. Among the encounters for medical evaluation the most frequent problems were athletic injuries (318; 32.1%), respiratory problems (240; 24.2%), gastrointestinal conditions (126; 12.7%) and dental services (119; 12.0%). The most frequent athletic injuries were first degree strains (83; 26.1%), tendinitis (56; 17.6%), contusions (42; 13.2%), myositis (40; 12.6%) and first degree sprains (28; 8.8%). The health problems found were diversed and in the majority of cases mild in character, which can be attend by adequately trained on sports health primary health professionals.