Menstrual dysfunction and bone health in female athletes

Female athletes are generally considered to be at Iow risk of osteoporosis because of the skeletal loading associated with sports participation. Sites that are exposed to long-term high-impact loading are consistently reported to be higher than the same sites in their sedentary peers. However, weight-bearing exercise does not always ensure that athletes will have high bone-mineral density, as the hormonal environment, dietary factors, and loading history all influence bone-mineral density, In particular, menstrual dysfunction, which can occur with intense training or disordered eating, is a significant risk factor for Iow bone-mineral density. Exercise history before menstrual dysfunction is likely to offer some protection for Iow bone-mineral density, particularly at the hip, Resumption of menses is unlikely to restore bone-mineral density to levels reported in eumenorrheic athletes or even sedentary peers, Athletes at risk of amenorrhea should be identified and their training loads and energy intakes monitored to ensure normal menstrual function, Athletes who remain amenorrheic should be counseled about the possible negative effects of amenorrhea and monitored for bone loss. Early intervention is recommended for amenorrheic athletes with Iow bone-mineral density.

Thermoregulation in young athletes exercising in hot environments.

Children are less efficient thermoregulators than are adults. During exercise, sweat evaporation is the most important physiological means of cooling the body. The sweat response in children, however, is less efficient than in adults, so children dissipate less heat though evaporative sweating and more through convection (the loss of heat through the skin) plus radiation. Children and adolescents with high levels of body fat and heavy builds are more susceptible to heat stress because they dissipate body heat less efficiently. Maintaining adequate hydration is crucial for preventing heat stress, Although water is often described as the best choice of fluid, studies on voluntary drinking habits and flavor preferences in children and adolescents suggest that greater consumption occurs when sports drinks are offered instead of water. Although a child's sweat contains less sodium and chloride than an adult's does, there appears to be no evidence that a child's performance improves when given beverages more diluted than those currently recommended for adults, More information is necessary to identify the optimal electrolyte and carbohydrate content of sports drinks for young athletes.

Inadvertent doping through supplement use by athletes: assessment and management of the risk in Australia

Many athletes report using a wide range of special sports foods and supplements. In the present study of 77 elite Australian swimmers, 99% of those surveyed reported the use of these special preparations, with 94% of swimmers reporting the use of non-food supplements. The most popular dietary supplements were vitamin or mineral supplements (used by 94% of the group), herbal preparations (61%), and creatine (31%). Eighty-seven percent of swimmers reported using a sports drink or other energy-providing sports food. In total, 207 different products were reported in this survey. Sports supplements, particularly supplements presented as pills or other non-food form, are poorly regulated in most countries, with little assurance of quality control. The risk of an inadvertent "positive doping test" through the use of sports supplements or sports foods is a small but real problem facing athletes who compete in events governed by anti-doping rules. The elite swimmers in this survey reported that information about the "doping safety" of supplements was important and should be funded by supplement manufacturers. Although it is challenging to provide such information, we suggest a model to provide an accredited testing program suitable for the Australian situation, with targeted athlete education about the "sports safety" of sports supplements and foods.

Exercise dependence and elite athletes: perceptions of coaches of elite athletes.

Exercise dependence (EXD) is a psychological condition associated with physical, emotional, social and performance consequences. Despite growing awareness of the prevalence of EXD within the athletic population, the symptoms or dimensions that comprise the condition largely remain unclear. The aim of the present study was to examine the perceptions of coaches relating to the symptoms or dimensions that define EXD among athletes. Participants were 90 coaches of elite athletes employed by the Australian Institute of Sport and State Institutes of Sport in Australia. Coaches completed an EXD checklist and a separate checklist of characteristics of committed exercisers. Both checklists contained 31 dimensions. The results supported a constellation of cognitive, emotional, behavioral, physical, social and performance dimensions. The results are discussed in terms of the consequences of EXD for elite athletes. Implications for coaches and teammates of elite athletes who experience EXD are also highlighted.

Neovascularization and pain in abnormal patellar tendons of active jumping athletes

Objective: The aim of this study was to investigate tendon pain in abnormal patellar tendons with and without neovascularization.

Study design: Comparative design.

Setting: Multidisciplinary tendon study group at a competitive volleyball venue.

Participants: One hundred eleven volleyball players volunteered to participate in the study.

Main Outcome Measures: Subjects' patellar tendons were imaged with ultrasound, with and without Doppler. Tendons that were imaging abnormal were categorized according the presence of tendon neovascularization. Subjects completed 3 pain scales that examined function (Victorian Institute of Sport Assessment score, 100-point maximum), pain with tendon load (decline squat, visual analogue scale, 100-mm maximum), and maximum pain for the previous week (visual analogue scale, 100-mm maximum). A 1-tailed Mann-Whitney U test compared pain scores in abnormal tendons without neovascularization to abnormal tendons with neovascularization.

Results: Functional scores were lower (Victorian Institute of Sport score, median, 78; P = 0.045) and pain scores under tendon load were greater (decline squat pain, median, 19; P = 0.048) in subjects with abnormal tendons with neovascularization than subjects with abnormal tendons without neovascularization (Victorian Institute of Sport Assessment score, median, 87; decline squat pain, median, 0).

Conclusions: This study indicates that the presence of neovascularization in abnormal patellar tendons is associated with greater tendon pain compared with abnormal tendons without neovascularization in active jumping athletes.

Vascularity and pain in the patellar tendon of adult jumping athletes : a 5 month longitudinal study

Background: This study investigated changes in tendon vascularity in 102 (67 men and 35 women) volleyball players over a 6 month competitive season.

Methods: Athletes were examined with both grey scale ultrasound and standardised colour Doppler settings. Vessel length and pain were measured each month on five separate occasions. Vascular tendons were divided into (i) those that were vascular on all occasions (persistent vascularity) and (ii) those that were vascular on more than two but less than five occasions (intermittent vascularity).

Results: A total of 41 of the 133 abnormal tendons were vascular on two or more occasions. Of these, 16 had persistent vascularity and 25 had intermittent vascularity. There was no significant difference in the prevalence of vascularity between men and women. None of the tendons had a pattern of vascularity over the season that could be clearly interpreted as the onset or resolution of vascularity. Subjects with changes in both tendons were more likely to have persistent vascularity (p = 0.045). Vessels were longer in tendons with persistent vascularity (p<0.000) and pain was significantly greater (p = 0.043) than in tendons with intermittent vascularity. Tendons with intermittent vascularity had similar pain scores on all days, whether or not they had detectable blood flow.

Sports training, science and class among British amateur athletes in the mid to late nineteenth century

Organised amateur sports emerged in the second half of the nineteenth century. This paper, an exercise in historical sociology, analyses how a new system of sports training was devised by the amateurs to meet their particular needs. The data comes from contemporary British training manuals and the analysis is informed by the theories of Bourdieu and Foucault. That amateurs came from the higher social classes was highly
significant: it meant that they could not adopt existing training practices because these were associated with plebeian professional athletes. For amateurs to have followed the preparation of the professionals would have placed their bodies under the control of a social inferior and promoted a somatic shape more in keeping with the lower than with
the higher social orders. Mirroring the social distance between them, amateurs came to stridently reject professional training practices. Instead, they devised new training techniques which were justified through recourse to contemporary bio-medical knowledge. It is argued that amateur training originated for social reasons, with the proponents’ class positions and social capital facilitating the evocation of scientific knowledge as a legitimating ideology.

Muscle Na+ -K+ -ATPase activity and isoform adaptions to intense interval exercise and training in well-trained athletes

The Na⁺-K⁺-ATPase enzyme is vital in skeletal muscle function. We investigated the effects of acute high-intensity interval exercise, before and following high-intensity training (HIT), on muscle Na⁺-K⁺-ATPase maximal activity, content, and isoform mRNA expression and protein abundance. Twelve endurance-trained athletes were tested at baseline, pretrain, and after 3 wk of HIT (posttrain), which comprised seven sessions of 8 x 5-min interval cycling at 80% peak power output. Vastus lateralis muscle was biopsied at rest (baseline) and both at rest and immediately postexercise during the first (pretrain) and seventh (posttrain) training sessions. Muscle was analyzed for Na⁺-K⁺-ATPase maximal activity (3-O-MFPase), content ([³H]ouabain binding), isoform mRNA expression (RT-PCR), and protein abundance (Western blotting). All baseline-to-pretrain measures were stable. Pretrain, acute exercise decreased 3-O-MFPase activity [12.7% (SD 5.1), P < 0.05], increased α₁, α₂, and α₃ mRNA expression (1.4-, 2.8-, and 3.4-fold, respectively, P < 0.05) with unchanged ß-isoform mRNA or protein abundance of any isoform. In resting muscle, HIT increased (P < 0.05) 3-O-MFPase activity by 5.5% (SD 2.9), and α₃ and ß₃ mRNA expression by 3.0- and 0.5-fold, respectively, with unchanged Na+-K+-ATPase content or isoform protein abundance. Posttrain, the acute exercise induced decline in 3-O-MFPase activity and increase in α₁ and α₃ mRNA each persisted (P < 0.05); the postexercise 3-O-MFPase activity was also higher after HIT (P < 0.05). Thus HIT augmented Na⁺-K⁺-ATPase maximal activity despite unchanged total content and isoform protein abundance. Elevated Na⁺-K⁺-ATPase activity postexercise may contribute to reduced fatigue after training. The Na⁺-K⁺-ATPase mRNA response to interval exercise of increased α - but not ß-mRNA was largely preserved posttrain, suggesting a functional role of α mRNA upregulation.

Effect of six weeks of dura disc and mini-trampoline balance training on postural sway in athletes with functional ankle instability

Lateral ankle sprain (LAS) is one of the most common injuries incurred during sporting activities, and effective rehabilitation programs for this condition are challenging to develop. The purpose of this research was to compare the effect of 6 weeks of balance training on either a mini-trampoline or a dura disc on postural sway and to determine if the mini-trampoline or the dura disc is more effective in improving postural sway. Twenty subjects (11 men, 9 women) with a mean age of 25.4 ± 4.2 years were randomly allocated into a control group, a dura disc training (DT) group, or a mini-trampoline (MT) group. Subjects completed 6 weeks of balance training. Postural sway was measured by subjects performing a single limb stance on a force plate. The disbursement of the center of pressure was obtained from the force plate in the medial-lateral and the anterior-posterior sway path and was subsequently used for pretest and posttest analysis. After the 6-week training intervention, there was a significant (p < 0.05) difference in postural sway between pre- and posttesting for both the MT (pretest = 56.8 ± 20.5 mm, posttest = 33.3 ± 8.5 mm) and DT (pretest = 41.3 ± 2.6 mm, posttest = 27.2 ± 4.8 mm) groups. There was no significant (p > 0.05) difference detected for improvements between the MT and DT groups. These results indicate that not only is the mini-trampoline an effective tool for improving balance after LAS, but it is equally as effective as the dura disc.

Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper

Expansion of the extracellular matrix is a prominent but poorly characterized feature of tendinosis. The present study aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. We obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel thickness and density were determined using computer-assisted image analysis. Markers for smooth muscle actin, endothelial cells (CD31) and proliferating cells (Ki67) were examined immunohistochemically. Western blot analysis and immunohistochemical staining revealed elevated versican content in the proximal patellar tendon of tendinosis patients (P=0.042). Versican content was enriched in regions of fibrocartilage metaplasia and fibroblast proliferation, as well as in the perivascular matrix of proliferating microvessels and within the media and intima of arterioles. Microvessel density was higher in tendinosis tissue compared with control tissue. Versican deposition is a prominent feature of patellar tendinosis. Because this molecule is not only a component of normal fibrocartilagenous matrices but also implicated in a variety of soft tissue pathologies, future studies should further detail both pathological and adaptive roles of versican in tendons.

Chronic intermittent hypoxia and incremental cycling exercise independently depress muscle in vitro maximal Na+-K+-ATPase activity in well-trained athletes

Athletes commonly attempt to enhance performance by training in normoxia but sleeping in hypoxia [live high and train low (LHTL)]. However, chronic hypoxia reduces muscle Na⁺-K⁺-ATPase content, whereas fatiguing contractions reduce Na⁺-K⁺-ATPase activity, which each may impair performance. We examined whether LHTL and intense exercise would decrease muscle Na⁺-K⁺-ATPase activity and whether these effects would be additive and sufficient to impair performance or plasma K⁺ regulation. Thirteen subjects were randomly assigned to two fitness-matched groups, LHTL (n = 6) or control (Con, n = 7). LHTL slept at simulated moderate altitude (3,000 m, inspired O₂ fraction = 15.48%) for 23 nights and lived and trained by day under normoxic conditions in Canberra (altitude ~600 m). Con lived, trained, and slept in normoxia. A standardized incremental exercise test was conducted before and after LHTL. A vastus lateralis muscle biopsy was taken at rest and after exercise, before and after LHTL or Con, and analyzed for maximal Na⁺-K⁺-ATPase activity [K⁺-stimulated 3-O-methylfluorescein phosphatase (3-O-MFPase)] and Na⁺-K⁺-ATPase content ([³H]ouabain binding sites). 3-O-MFPase activity was decreased by –2.9 ± 2.6% in LHTL (P < 0.05) and was depressed immediately after exercise (P < 0.05) similarly in Con and LHTL (–13.0 ± 3.2 and –11.8 ± 1.5%, respectively). Plasma K⁺ concentration during exercise was unchanged by LHTL; [3H]ouabain binding was unchanged with LHTL or exercise. Peak oxygen consumption was reduced in LHTL (P < 0.05) but not in Con, whereas exercise work was unchanged in either group. Thus LHTL had a minor effect on, and incremental exercise reduced, Na⁺-K⁺-ATPase activity. However, the small LHTL-induced depression of 3-O-MFPase activity was insufficient to adversely affect either K⁺ regulation or total work performed.

Interaction of contractile activity and training history on mRNA abundance in skeletal muscle from trained athletes

Skeletal muscle displays enormous plasticity to respond to contractile activity with muscle from strength- (ST) and endurance-trained (ET) athletes representing diverse states of the adaptation continuum. Training adaptation can be viewed as the accumulation of specific proteins. Hence, the altered gene expression that allows for changes in protein concentration is of major importance for any training adaptation. Accordingly, the aim of the present study was to quantify acute subcellular responses in muscle to habitual and unfamiliar exercise. After 24-h diet/exercise control, 13 male subjects (7 ST and 6 ET) performed a random order of either resistance (8 x 5 maximal leg extensions) or endurance exercise (1 h of cycling at 70% peak O2 uptake). Muscle biopsies were taken from vastus lateralis at rest and 3 h after exercise. Gene expression was analyzed using real-time PCR with changes normalized relative to preexercise values. After cycling exercise, peroxisome proliferator-activated receptor- coactivator-1 (ET 8.5-fold, ST 10-fold, P < 0.001), pyruvate dehydrogenase kinase-4 (PDK-4; ET 26-fold, ST 39-fold), vascular endothelial growth factor (VEGF; ET 4.5-fold, ST 4-fold), and muscle atrophy F-box protein (MAFbx) (ET 2-fold, ST 0.4-fold) mRNA increased in both groups, whereas MyoD (3-fold), myogenin (0.9-fold), and myostatin (2-fold) mRNA increased in ET but not in ST (P < 0.05). After resistance exercise PDK-4 (7-fold, P < 0.01) and MyoD (0.7-fold) increased, whereas MAFbx (0.7-fold) and myostatin (0.6-fold) decreased in ET but not in ST. We conclude that prior training history can modify the acute gene responses in skeletal muscle to subsequent exercise.

Energy system contribution during 200- to 1500-m running in highly trained athletes

Purpose: The purpose of the present study was to profile the aerobic and anaerobic energy system contribution during high-speed treadmill exercise that simulated 200-, 400-, 800-, and 1500-m track running events.

Methods: Twenty highly trained athletes (Australian National Standard) participated in the study, specializing in either the 200-m (N = 3), 400-m (N = 6), 800-m (N = 5), or 1500-m (N = 6) event (mean O₂ peak [mL·kg^-1·min^-1] ± SD = 56 ± 2, 59 ± 1, 67 ± 1, and 72 ± 2, respectively). The relative aerobic and anaerobic energy system contribution was calculated using the accumulated oxygen deficit (AOD) method.

Results: The relative contribution of the aerobic energy system to the 200-, 400-, 800-, and 1500-m events was 29 ± 4, 43 ± 1, 66 ± 2, and 84 ± 1% ± SD, respectively. The size of the AOD increased with event duration during the 200-, 400-, and 800-m events (30.4 ± 2.3, 41.3 ± 1.0, and 48.1 ± 4.5 mL·kg^-1, respectively), but no further increase was seen in the 1500-m event (47.1 ± 3.8 mL·kg^-1). The crossover to predominantly aerobic energy system supply occurred between 15 and 30 s for the 400-, 800-, and 1500-m events.

Conclusions: These results suggest that the relative contribution of the aerobic energy system during track running events is considerable and greater than traditionally thought.

Pathology of chronic achilles-tendon injuries in athletes

Overuse tendon conditions have traditionally been considered to result from an inflammatory process and were treated as such. Microscopic examination of abnormal Achilles-tendon tissues, however, reveals a non-inflammatory degenerative process. The histopathology found in surgical specimens in patients with chronic overuse Achilles tendinopathy and those with Achilles-tendon rupture are reviewed. Seminal studies suggest that so-called tendinitis is a rare condition that might occur occasionally in the Achilles tendon in association with a primary tendinosis. These data have clinical implications and require a review of the traditional classification of pathologies seen in tendon conditions, The authors recommend that nomenclature be based on histopathological findings rather than traditional hypothesis.