Endurance Athletes Ebook

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Bags, Bells, and Bodyweight Training System

This eBook is designs a program to make you strong and fit in an athletic way, rather than a big and bulky kind of way. This program makes you lean, ripped, and athletic. This gives you a program that makes you actually strong, powerful, and athletic, rather than just looking like you lift. It gives you explosive gains in full body strength and muscle, huge increases in stamina, and a shredded body and mental toughness. This program takes advantage of the three best kinds of bodybuilding equipment: sandbags, kettlebells, and bodyweight workouts. These methods of working out provide much bigger results than a simple pump to your muscles; they actually provide real strength training. In addition, you get 4 free eBooks when you get Bags, Bells, and Bodyweight. You will also get The Sandbag Manual, The Kettlebell Manuel, The Bodyweight Manuel, which all go into more detail about how to use each one to the max. You will also get The Dumbbell Manuel, which shows you what to do if you have no kettlebells. This complete workout system builds whole bodies, not just a few muscles.

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Effect of training on the hormonal response to exercise

Other stressful stimuli, e.g. hypoxia or hypoglycemia is in fact increased in the trained state and it is well known that the secretory capacity of the adrenal medulla is increased by endurance training 'sports adrenal medulla' 62 . Trained individuals display lower insulin concentrations in plasma, during both basal and glucose-stimulated conditions, secondary to a decreased pancreatic insulin secretory rate 32 and an increased peripheral insulin sensitivity 69 . Training augments the lipolytic capacity of the adipocyte, which serves to maintain a sufficient lipolytic rate in a trained individual, in spite of a reduced sympathetic activation during exercise at a given intensity 70 . Endurance training also increases the oxidative capacity of the liver as well as the hepatic capacity for gluconeo-genesis, although the glucose demand during exercise is clearly decreased in the trained state, as discussed above. This decreased demand is sensed by the body and as little as 10 days of...

Muscle fiber plasticity

Furthermore, serum response element 1 of the skeletal a-actin promoter has been identified as part of the mechanotransduction pathway involved in enhancing actin gene transcription, which results in muscle enlargement (Table 1.3.2). Endurance training, on the other hand, increases and decreases the maximal shortening velocity of individual slow and fast fibers, respectively, both changes contributing to improved endurance performance. Expression of several genes is increased with training, and a complex interaction with and between modulators such as nerves, With the use of immunohistochemical and molecular biological techniques for determination of MHC isoforms and thus characterization of fiber types, it has been demonstrated that endurance training can cause a fiber type shift from type IIx to Ila. Although animal studies using long-term low-frequency electrical stimulation of muscle have been able to demonstrate a fiber type shift from II to I, it is more questionable to what...

The effects of physical inactivity and activity on bone mass and bone mineral density in humans

Observational studies can be suggestive as to the effect of different kinds of activities on bone mass. However, the study groups are independent samples and therefore a causal relationship between the different variables of interest cannot be established. In addition, the subjects investigated in these studies are highly selected. Individuals with a high muscle mass (and thereby bone mass) are more prone to engage in activities involving resistance training such as weight-lifting, while individuals with a low muscle mass might preferentially choose to participate in endurance training activities like long-distance running.

Skateboarding Rollerskating And Windsurfing

Co-ordination and muscle strength and should be prescribed to already fit individuals, for example soccer or rugby players, but cannot be recommended for those with poor balance and co-ordination. For example, for those with shin splints or who are recovering from knee surgery, as an alternative to bicycling and running, roller-skating is very efficient endurance training to develop quadriceps muscle strength. For ice-hockey players, roller-skating is a natural way of exercising during pre-season training. Both skateboarding and wind-surfing are excellent balance exercises for different seasons for injured martial arts athletes and gymnasts. All these sports should preferably be performed in controlled environments, with instructors.

Role of physical activity

The effects of exercise training on blood pressure show wide variation in different studies. A recent meta-analysis of 44 randomized controlled trials found that aerobic or endurance exercise on nor-motensive and hypertensive men and women resulted on average 3.4 2.4 mmHg net decrease in systolic and diastolic blood pressure, respectively, adjusted for control observations and for the number of trained participants 83 . The effect depends on the initial blood pressure being greater in hypertensive subjects. Another meta-analysis of 10 randomized controlled trials on the effect of aerobic exercise on blood pressure of normotensive and hypertensive women revealed a 2 1 mmHg decrease in systolic and diastolic blood pressure, respectively 84 . A comparable meta-analysis on the effect of progressive resistance exercise including 11 studies found an average 3 3 mmHg blood pressure decrease 85 . Hagberg et al. 86 reported in their updated review of all studies on the effect of exercise...

Longitudinal perspective

Cient magnitude (and this for older people requires more individual tailoring), then even in very late life, individuals are able to increase their aerobic power through training. For example Seals et al. 60 reported that 12 months of aerobic training in 60-70-year-old subjects resulted in a mean increase of 30 in Vo2max. In 70-79-year-old men and women 26 weeks of endurance training resulted in an increase in Vo2max of 22 27 . Two recent studies on the oldest old suggest that, as with positive adaptations to strength training, even very elderly people may adapt to aerobic-based physical training. Maltbut-Shannan et al. 61 reported a 15 increase in Vo2max in women aged 80-93 years of age following 24 weeks of progressive aerobic training however, no change was observed in the older men. In a second recent study on the oldest old, Puggaard et al. 62 reported a similar increase in Vo2 max of 18 in women, also over the age of 80 years, following 8 months of general training. Hardly any...

All About Muscle Glycogen

Muscle glycogen is stored carbohydrate in your muscle. Imagine this After you eat and digest a meal, the amount of carbohydrate that you immediately need will get used as fuel, but the rest (up to a point) will be stored in your muscles for future fuel. Athletes in ultra-endurance sports such as soccer, basketball, hockey, and distance running rely on high-octane muscle fuel for energy. In fact, between the grueling practice sessions and vigorous competitions, serious endurance athletes are constantly depleting and restoring their muscle glycogen stores, so they require much more carbohydrate-rich foods than athletes involved in less aerobic activity (golf, archery, and martial arts). What happens if you don't replenish your muscle-glycogen stores Simple If you run out of glycogen, you run out of energy. The amount of muscle fuel you have determines how long you can exercise. As a car needs a full tank of gas before heading out on a long trip, an endurance athlete requires sufficient...

Fueling Your Body During Prolonged Endurance Activity

Some sports are so lengthy they require feedings throughout the event, to help supply your body with glucose when glycogen stores are running low. For example, marathon runners (and other endurance athletes such as soccer players) need to take about 30-60 grams of carbohydrate per hour, which translates into a mere (but important) 120-240 calories. Although it's a minuscule amount, these calories should be spread out over each hour. The simplest method is to drink one of the popular sports drinks during the event. You can hydrate and carbo-hydrate your body at the same time.

Low Ferritin in Nonanemic Athlete

The common belief among coaches and endurance athletes is that a low ferritin level can cause fatigue, poor recovery, and poor performance. The ferritin level generally reflects total body iron, and 82 of female endurance athletes have a low ferritin level (Shaskey and Green, 2000). Many studies have examined whether improvements in performance seen in nonanemic athletes are caused by small increases in Hb level (from a normal to a higher normal Hb level) or by an increase in iron alone (Garza et al., 1997). A review of eight randomized, controlled trials (RCTs) indicates that iron has a positive effect on performance in iron-deficient athletes without anemia, independent of Hb increases (Fogelholm et al., 1992 Friedmann et al., 2001 Hinton et al., 2000 Klingshirn et al., 1992 LaManca and Haymes, 1993 New-house et al., 1989 Rowland et al., 1988 Zhu and Haas, 1998).

Risk factors for the development of eating disorders

The etiology of eating disorders is multifactorial 123,124 . Because of additional stress associated with the athletic environment, however, female elite athletes appear to be more vulnerable to eating disorders than the general female population 111 . Furthermore, recent studies suggest that specific risk factors for the development of eating disorders occur in some sport settings one retrospective study indicated that a sudden increase in training load may induce a caloric deprivation in endurance athletes, which in turn may elicit biologic and social reinforcements leading to the development of eating disorders 108 . However, longitudinal studies with close monitoring of a number of sports-specific factors (volume, type and intensity of training) are needed to answer questions about the role played by different sports in the development of eating

Strengthening and Conditioning

For those who cannot step, strengthening and fitness are potentially important goals to increase endurance for community tasks. For instance, routine wheelchair mobility utilizes 18 of the peak oxygen intake of paraplegic athletes in their mid-20's, approximately 30 less than that used by sedentary paraplegic people their age, whereas sedentary people with paraplegia in their 50s use over 50 of their peak oxygen intake for wheelchair activities. Fitness training can increase reserves for midlife activities.

Determinants of Energetic and Tense Arousal Including Cognitive Mood Interactions

Cortical activity is thus sustained by, and sustains, the wakefulness system and the skeletal musculature. In the operation of the multiple feedback circuits, wakefulness capacity is limited by muscular endurance. As was shown by the course of events in sleep-deprivation experiments the subjects could maintain wakefulness as long as they were able and willing to main

Bilateral Stance On Unstable Surface

The final aspect of rehabilitation regarding neuromuscular control involves enhancing muscular endurance. Proprioceptive and neuromuscular control has been shown to diminish once muscular fatigue occurs.65-67 Exercises such as bicycling, stair climbing, and elliptical machines may be used for long durations to increase endurance as well as high repetition, low weight

Iron Deficiency Anemia

As in the general population, iron deficiency anemia is common in athletes, especially among female athletes. This is typically caused by low intake of dietary iron, but can also be caused by exertional GI or genitourinary bleeding or GI bleeding related to NSAID use. Iron requirements of athletes, particularly endurance athletes, may also be higher than for sedentary individuals (Beard and Tobin, 2000). The diagnosis of iron deficiency anemia is made by a low Hb or Hct level and a low ferritin or iron level. Treatment consists of increasing dietary iron, iron supplementation, and treating the underlying cause if present.

Ergometric testing and blood chemistry in overtraining

The existing findings indicate at least in endurance-trained athletes an impairment of the speed endurance or short-term endurance with impaired anaerobic lactic capacity, which is primarily recognized when reaching the limit of physical exhaustion 47,50,51,55,56 . The maximal blood lactate concentration in these exercises lasting approximately 30 s-30 min is typically reduced in OTS. In a so-called 'stress test' a short-term endurance exercise test on the cycle ergometer performed at the intensity of 110 of the individual anaerobic threshold the exercise duration to exhaustion was significantly decreased by 27 during OTS 50 other authors report a decrease in running time at 18 km h on the treadmill by 29 56 . During incremental graded test procedures, however, the maximal power output and the maximal oxygen uptake are not always decreased in overtrained athletes 47,50,51,57 . The anaerobic alactic performance also seems not to be affected systematically. had usually performed her...

The results of functional restoration

Alaranta in Finland studied 293 patients, aged 30-47 years, with low back pain for more than 6 months. Most had been off work for several months. Their 3-week, inpatient program included an intensive fitness, muscle-strengthening, and endurance exercise program. Patients then continued an exercise program on their own. They had intensive psychosocial training but no specific vocational intervention. The approach and goals of this program were very similar to those of Mayer, even if the detail varied. The control group had the same length of treatment, which was mainly physical therapy, and the authors estimated that the intensity of exercise was about 40-507 . The control group had no psychosocial training.

Determinants of flexibility

Unquestionably people exhibit differences in musculoskeletal flexibility. A component of a person's existing flexibility may be inherited, a sport-specific adaptation (loading history) or achieved by flexibility training. Previous investigations on human flexibility have measured maximal joint range of motion, but not the passive properties of the muscle-tendon unit. At the same time, it has been shown that tolerance to tensile load plays an important role in short-term and long-term gains in flexibility (see above) rather than the passive properties of the muscle. To address whether tolerance also contributed to differences in flexibility endurance athletes were classified as tight (inflexible) and normal based on a simple toe-touch test. It was observed that both passive properties (stiffness) of the hamstring muscle group and stretch tolerance explained the difference in flexibility 119 . That is, 'tight' athletes had a muscle-tendon unit with greater stiffness than athletes with...

Medial tibial stress syndrome

Pain at the medial and posterior aspect of the distal leg is called 'medial tibial syndrome' or 'medial tibial stress syndrome' 9,10 . This is caused by overuse and is seen especially in endurance athletes as runners, triathlonists, cross-country skiers, orienteers and joggers. It is seen also in athletes participating in jumping sports, such as basketball, volleyball and other indoor ball games.

Pathomechanism and hormonal dysregulation in overtraining

Fig. 2.1.5 Impaired maximal exercise-induced increase of adrenocorticotrophic hormone (ACTH), growth hormone (GH) (P < 0.01), cortisol and insulin (P < o. i) after exhaustive short-endurance cycle ergometer test with an intensity of iio of the individual anaerobic threshold ('stress test') in 15 endurance athletes (means and SD) 6i . Fig. 2.1.5 Impaired maximal exercise-induced increase of adrenocorticotrophic hormone (ACTH), growth hormone (GH) (P < 0.01), cortisol and insulin (P < o. i) after exhaustive short-endurance cycle ergometer test with an intensity of iio of the individual anaerobic threshold ('stress test') in 15 endurance athletes (means and SD) 6i .

Epidemiology of exercise health and aging

In another well-controlled study, Sarna et al. 8 examined the life expectancy of the athletes representing Finland in international competitions during 1920-65. The athletes were compared with a reference cohort of healthy men matched on age and area of residence. The mean life expectancy of long-distance runners and cross-country skiers was more than 5 years longer than that of the referents (Fig. 3.3.2). The increased life expectancy of the endurance athletes was mainly explained by decreased cardiovascular mortality (odds ratio 0.49 compared to referents). No differences between the groups were observed for maximum lifespan. The authors concluded that the active and healthy lifestyle adopted by the athletes prevented the premature deaths rather than extended the possibly genetically determined maximum lifespan. Fig. 3.3.2 Survival curves with mean life expectancies in endurance athletes and referents adjusted by occupational group. The figure also shows examples of population...

Stress Fractures of the Femoral Neck

Fatigue fractures are most often seen in young athletes, especially those involved in running and jumping, and are seen in endurance athletes such as military recruits. These are fractures that occur when normal bone is subjected to abnormal forces. Risk factors for fatigue stress fractures are female gender and low femoral bone mineral density scores. Fatigue fractures are the focus of this section.

Physical activity and low back pain

Postures as well as reduced muscle strength in back, abdominal and thigh muscles, reduced endurance in back muscles, hypermobility in the lumbar column and hypomobility of hip joints are commonly listed, activity-related risk factors for low back pain 52 . The theoretical rationale for the role of physical activity (PA) in the causation or prevention of low back pain includes the following ideas (i) PA can induce acute and repetitive subclinical or more severe injuries in the back structures (ii) higher strength of the muscles of the back and trunk could protect the back from injury or minimize the effects of injurious events (iii) higher endurance of the trunk muscles helps to maintain motor control due to less fatigue in various tasks thus decreasing the risk of high loading of spine structures or occurrence of malfunctions and consequently development of injury (iv) better flexibility may decrease the risk of injury especially during lifting and bending activities (v) good motor...

RS Williams and P Rosenberg

A recent experiment to promote gain of function of CaMK revealed a previously unexpected link to the gene encoding PGC-1, which was discovered as a coactivator of PPARy target genes and found to promote mitochondrial biogenesis in brown adipose tissue. Many, if not all, nuclear genes encoding mitochondrial proteins are induced by the action of PGC-1, which appears to function as a master regulator of this large class of proteins (Puigserver et al. 1999 Wu et al. 1999). Forced expression of a constitutively active form of CaMKIV in skeletal muscles produced a variety of phenotypes, including mild hypertrophy, a shift in myosin isotype from fast to slower forms, and a prominent increase in the fractional volume of mitochondria within the myofibers. These effects closely resemble the morphological and biochemical remodeling responses evoked by endurance exercise, and muscles isolated from CaMKIV transgenic mice exhibited resistance to fatigue during repeated stimulation, a prominent...

Chronic obstructive lung disease

One large well-conducted prospective study demonstrated that short-term low-dose androgen therapy (nandrolone decanoate) augmented the effects of nutritional supplementation in patients with moderate to severe chronic airways disease (Schols et al. 1995). From 233 consecutive patients with stable, moderate to severe and bronchodilator-unresponsive pulmonary disease admitted to an intensive pulmonary rehabilitation program, 217 were randomised into three groups. These were to receive eight weeks of treatment with (a) placebo injections, (b) a nutritional supplement (one high fat, high calorie drink daily) plus placebo injections or (c) a nutritional supplement plus androgen injections (nandrolone decanoate 50 mg men, 25 mg women ) with intramuscular injections given fortnightly. Participants were also stratified according to the degree ofbaseline muscle depletion (body weight < 90 and or lean mass < 67 ideal ornot) at entry. During the study all patients...

Upper respiratory tract infections

Number of URTI symptoms have been reported in the days following strenuous exercise (e.g. a marathon race) 29-32 , whereas moderate training has been claimed to reduce the number of symptoms 33,34 . It has been suggested that a 'J'-shaped curve best describes the relationship between the intensity of physical activity, ranging from a sedentary lifestyle to the activity of the high-performance endurance athlete (along the x-axis) and the sensitivity to upper respiratory tract infections (Fig. 4.2.6). The finding of an increased frequency of infections following intense exercise may be causally linked to the postexercise impairment of immune function.

Treatment of overtraining syndrome

The first treatment of overreaching is rest and the removal of external stressors. After several days, however, regenerative to shorter extensive endurance training sessions are suitable, which should not exceed the maximal exercise intensity achievable without an increase of blood lactate (aerobic lactate threshold). It is strongly recommended that the training modalities are varied by including other sports in order to prevent training monotony. Coordinative and pure speed sessions (very short high intensity with long periods of rest) can be allowed as soon as the athlete is able to exercise at an adequate level. It is only after a normal and stable exercise tolerance has been restored, which in OTS takes weeks to in the worst cases even months, that the training intensity should reach and finally exceed the range of anaerobic threshold over a longer period of time (intensive endurance, intensive intervals and speed endurance training sessions). Effective treatment of OTS by...

The respiratory muscles

The actions of the respiratory muscles differ expiratory flow is mainly dependent on the elastic recoil of the respiratory system with only a minor contribution from expiratory muscle contraction until very high expiratory flows are recruited. Expiratory muscle contraction mainly acts to reduce end-expiratory lung volume and thus recruit the inspiratory recoil of the thorax and increase the precontraction length of the inspiratory muscles in this way, they tend to 'unload' the inspiratory muscles 114 . The latter have to generate inspiratory flow against the lung recoil pressure, and thus carry the major responsibility for ventilatory work. Inspiratory muscle training mainly accompanies other aspects of endurance training, but resistive training is known to improve inspiratory muscle strength and endurance 115 . These considerations have important implications in aging athletes in whom there is the normal decline in lung elasticity end-expiratory lung volume cannot be reduced to the...

Peripheral vascular adaptations

Well et al. 73 found a near 30 greater reduction in forearm vascular resistance to an endothelium-dependent stimulus in endurance athletes as compared to sedentary subjects. This reduction was directly related to maximal aerobic power. In endurance-trained older people a significantly greater EDD, as compared with age-matched sedentary subjects, has also been observed 74 . Additionally, Rinder etal. 75 found that abnormal EDD discovered in older, otherwise healthy individuals could be improved with long-term endurance training. They also noted a significant and reasonably good correlation between maximal aerobic power and EDD. The mechanisms behind the enhanced endothelial function associated with physical training may involve exercise-induced increases in shear stress and pulsatile flow. According to Niebaur and Cooke 76 chronic increases in blood flow induced by training may exert their effect on EDD by modulating the expression of endothelial cell nitric oxide synthase (NOS). It...

Myocardial vascularization and perfusion

In a comparison of the cross-sectional area of proximal coronary arteries from endurance-trained and sedentary humans it has been suggested that coronary vascular volume may be increased by training 31 . It remains unresolved whether in humans endurance training increases coronary vascular dimensions beyond the vascular proliferation that accompanies normal training-induced cardiac hypertrophy. On the basis of studies in rats, endurance training has been shown to increase myocardial capillary density expressed as capillary fiber ratio 32 . However, in larger animals, there is little evidence for increased capillary proliferation per fiber, nor is there evidence for proli Commensurate with the reduction in myocardial work and O2 consumption at rest and during submaximal exercise after endurance training, coronary blood flow per unit myocardial mass is reduced 33 . However, studies in animals have shown that endurance training can increase maximal coronary perfusion per unit mass of the...

Maximal aerobic power

In elite athletes from endurance sports values for maximal aerobic power (V02 ) of > 6.5 L min or > 90 mL min kg body weight are frequently obtained. These extremely high values are primarily due to a large maximal cardiac output (Qmax). Values of more than 40 L min have been measured 8 . Since the arteriovenous oxygen difference (a-v 02diff) during maximal exercise in these well-trained athletes does not differ from that in less trained individuals but is somewhat larger than in untrained individuals, the main cause for the high Qm and, thus, V02 in the well-trained athlete is the large stroke volume (SV) values exceeding 200 mL during maximal exercise are reported 8 . markers of the peripheral energy turnover such as enzyme activity 130,131 . Furthermore, endurance training may increase and inactivity reduces mitochondria enzyme concentrations considerably without any or only minor changes in V02max 132,133 .

Left ventricular and right ventricular cavity dimension and wall thickness

The heart muscle responds to physical training depending on the type of exercise performed. With pure endurance training LV cavity dimensions and LV wall dimensions increase similarly with a mainly unchanged ratio between wall thickness and LV end-diastolic dimension. In contrast athletes training in strength sports, such as weight-lifting and wrestling, have high values for wall thickness relative to cavity dimension. In combined dynamic and static sports (for example cycling and rowing) a combination of this is seen with both increased LV cavity dimensions and relatively more increased wall thickness. In a study of 1309 Italian athletes (including 25 women) 14 had a LV cavity > 60 mm, which was used as an arbitrary cut-off value for upper limit of normal LV size. The major determinants of a large cavity dimension were greater body surface area and participation in endurance sports. The few athletes with > 60 mm LV cavities had normal left ventricular systolic function and no...

Functional adaptations

In addition to structural adaptations, endurance training produces functional improvements in cardiac performance during exercise 25 . Most notable is a more rapid early and peak ventricular filling rate during diastole. An enlarged blood volume, together with greater ventricular compliance and distensibility, and a faster and more complete ventricular relaxation are important factors allowing stroke volume to increase even at high heart rates during exercise 9,26 . Improved myocardial relaxation allows for a more rapid lowering of ventricular pressure, optimizing the left atrial ventricular pressure gradient for enhanced filling 27 . At the same time, the cardiac output is distributed more selectively to activated regions of skeletal muscle, from where the muscle pump facilitates venous return. As a result of an enlarged end-diastolic volume, left ventricular systolic performance is improved mainly by way of the Frank-Starling mechanism 28 . During submaximal exercise, myocardial...

Energy sources during exercise in the trained state

The source of the increased fat usage during exercise in endurance-trained subjects has been debated, however, since the plasma levels of free fatty acids during exercise are often lower than in untrained individuals 50 . This is likely to be secondary to the lower sympathoadrenal activation after training 5i which, unopposed, would lead to decreased lipolysis of not only adipose tissue, but also intramuscular triglycerides. When male subjects exercised at the same absolute intensity (64 of the pretraining Vo2max) before and after a i2-week programme of endurance training, plasma free fatty acid and glycerol concentrations were found to be lower in the trained than in the untrained state 42 . In spite of this, the respiratory exchange ratio was reduced after training, indicating a greater reliance on fat oxidation. Muscle triglyceride utilization was found to be twice as great and muscle glycogen utilization to be 40 lower after, as opposed to before, training. It was concluded that...

Energy density vs nutrient density

The energy density of a diet refers to the amount of energy per weight or volume, while the nutrient density refers to the amount of nutrient in relation to energy, i.e. g 10 MJ. Foods rich in fat and sugar have a high energy density, while their nutrient density is low. Persons with a high energy turnover, i.e. endurance athletes, may however cover their nutrient needs even on a diet with low nutrient density if they are in energy balance, while a low nutrient density may be detrimental in low-energy consumers. There are few examples, if any, where athletes consuming a normal diet in amounts relevant to cover their energy needs develop any objective signs of nutrient deficiency.

Effects of increased physical activity on collagen in skeletal muscle

The specific activities of PH and GGT, as well as Hyp concentration, are known to be greater in the antigrav-ity soleus muscle than in the dorsiflexor tibialis anterior which is not tonically active 26,41 . Skeletal muscle is known to respond to increased loading caused by endurance training 14,28,42 , acute exercise 24 (Fig. 1.6.3b) or experimental compensatory hypertrophy 30,43 by increased collagen synthesis and or accumulation in the muscle. Strenuous exercise, especially acute weight-bearing exercise that contains eccentric components, is known to cause muscle dam

Classical reference

Endurance exercise causes a loss of water, electrolytes and glycogen. Replacement of these is essential to avoid fatigue and impaired performance. This requires a functioning gastrointestinal (GI) tract and many athletes find it difficult to ingest enough to adequately replenish that which is lost. There are many factors that govern the rate of gastric emptying (GE) in the resting state. However, limited data existed regarding the effects of exercise on GE and results had been conflicting. In a landmark study Fordtran and Saltin performed one of the earliest and most rigorous evaluations of the effects of exercise on upper gastrointestinal function.

Cardiovascular adaptation Cardiac output

Maximal aerobic power (V02 ) is a classic measure of the capacity to perform endurance exercise, and may be described physiologically as the product of cardiac output and the extraction of O2 by muscle. For almost a century it has been recognized that a linear relationship exists between maximal oxygen uptake and cardiac output, and this relationship is also observed in other species 1-3 . It is estimated that 70-85 of the interindividual difference in V02 is Fig. 1.1.2 Relationship between increases in cardiac output and maximal oxygen uptake in heart failure patients (circles), healthy males after 20 days' bedrest (squares), the same subjects before bedrest (inverted triangle), the same subjects after endurance training (upright triangle), and endurance athletes (diamonds). attributable to the level of maximal cardiac output 4 . Looked at another way, during whole body exercise, only 6o-8o of maximal mitochondrial respiratory capacity is exploited because of the limits of O2...

Ancient and modern drug use

Century when sport became more organized and sophisticated, reflecting the industrialization and urbanization of society drugs included strychnine, nitroglycerine, opium, alcohol, coca leaves and caffeine. The majority of stories were related to cycling and other endurance sports. The events leading to a banning of drugs in sports are listed in Table 2.5.2.

Adaptability of older people to exercise Crosssectional perspective

Weight-lifting) over the previous 6 years and compared them with non-active men of a similar age and a group of young men who were also non-trained. They reported that among the older subjects the size and strength of the knee extensor muscles was greatest in those older men who had been strength training and that their strength values were actually similar to those of the non-trained young men (Fig. 3.3.6). In a similar study Sipila et al. 45 studied 82 Finnish master athletes and confirmed that this (as well as other major muscle groups) group was stronger in weight lifters when compared with non-trained and endurance-trained individuals. In addition, Harridge et al. 46 reported that although having a high level of aerobic power (35.6-46.8 mL kg min in those aged 70-76 years), lifelong orienteering athletes of up to 95 years of age were no stronger than those of non-active individuals. These data suggest that for the maintenance of muscle strength, exercise which involves high...

Prevention of cardiovascular disease

Common sense would suggest that active children should be less obese than inactive children since the former expend more energy compared with the latter. It may thus seem surprising that several studies have failed to document an effect of enhanced PA on body fatness of non-obese children. In the SPARK project, fourth- to fifth-grade USA students were taught physical education by either physical education specialists or trained classroom teachers over 2 years 16 . These groups were compared with children attending ordinary physical education classes. Although the intervention groups spent significantly more time per week being physically active (40 min and 33 min) compared with the control group (18 min), there was no difference among groups in calf or triceps skinfolds at the end of the 2-year intervention 16 . Likewise, no effect of 3 hours of additional physical education per week was observed on triceps skinfold and body mass index in the Odense schoolchild study 17 . In contrast...

Heart rate

A distinct cardiovascular adaptation to endurance training is a lowering of the heart rate at rest and during submaximal exercise. Maximal heart rate is unchanged or in some cases may be slightly reduced. The lowering of resting and submaximal heart rate is mediated by alterations in the autonomic nervous system, and by changes in the intrinsic automaticity of the sinus node and right atrial myocytes 41,42 . The mechanisms underlying the training-induced increase in vagal tone are thought to be greater activation of the cardiac baroreceptors in response to the enlargement of blood volume and ventricular filling 28,52 , as well as changes in opioid 53 and dopaminergic modulation of parasympathetic activity 54 . It is not fully resolved whether a lowering of intrinsic heart rate is a true adaptation to endurance training, but it appears that an intensive and lengthy training period may be necessary for this adaptation 55 . Primates with larger hearts have lower intrinsic heart rates and...

Management

Supervised exercise programs should be considered for patients at high risk for falls exercise can reduce the physical risk factors (Rose, 2008). Specifically, programs that focus on two of three exercise components (strengthening, balance training, and aerobic endurance training) for a minimum of 12 weeks have shown the most benefit (Costello and Edelstein, 2008). Finally, home hazard evaluation and intervention is an essential component in the assessment of falls in elderly

Strength Training

Muscle strength and endurance training can be controlled movement (machines), semi-controlled (cross wires) or free weights (dumb-bells or body weight). The choice of training method depends on the athlete's aims and training background and the character of the injury. Free weights are more difficult to control than fixed movement training machines but add more stress to muscle and joint control. Complex muscle groups are more effectively trained using free weights, while isolated muscle groups may be efficiently trained using machines. Training with lighter resistance and more repetitions will improve muscle strength and endurance. This type of training predominantly uses slow-twitch fibres but, if performed at higher speeds, fast-twitch fibres will be used. Muscular endurance is defined as the ability to perform dynamic muscular work, with constant generation of power, over a limited time. If using resistance training to achieve this effect in a specific muscle group, more than 15...

Physical Therapy

Physical therapy sessions are prescribed for children with ASDs to enhance their physical abilities. Impairments of movement can interfere with develop-mentally appropriate functioning. Some children with ASDs can have low muscle tone, as well as poor posture, balance, and coordination. Physical therapy sessions can treat these impairments by providing passive, active, resistive, or aerobic exercise as well as training in functional and developmental skills. Physical therapists implement procedures to increase endurance, motor control, and motor planning. They incorporate therapeutic exercises along with equipment such as weights, exercise balls, and BAPS boards (balance boards) to increase muscle strength and endurance and to facilitate body awareness and coordination. Aquatic, aerobic, and breathing exercises can also be part of your child's treatment. Physical therapy sessions are typically one-on-one and last 45 minutes. They can be administered in the therapist's office or in...

The Starchy Carbs

Generally speaking, breads, grains, and other starchy foods contain approximately 15 grams (give or take a few) of carbohydrate per serving (1 slice bread, Vz cup pasta, 1 serving of cereal). These foods receive top billing for endurance athletes simply because it's easy to eat multiple servings in one sitting. For instance, a pasta entree can easily total five grain servings, and because one pasta serving contains about 20 grams of carb, five servings supplies a whopping 100 grams of carbohydrate. Clearly, this is the reasoning behind marathon runners packing in the pasta before the lengthy 26-mile run.

Treatment of EIB

The healthy athlete and to prevent the occurrence of EIB in the asthmatic athlete. Prolonged endurance exercise should be avoided in the summer during periods and in areas with high pollen counts, and in the winter at temperatures lower than 15 C. The same applies to exercise in areas with air pollution or other airway irritants, irrespective of the time of year. Moreover, strenuous exercise should not be commenced for at least 7 days after recovery from a recent upper respiratory tract infection. Athletes should be given a clear message that it is better to rest and stay in bed than to recommence training too early after such infections. Lastly, the use of heat-moisture exchange devices should be encouraged during training sessions to minimize heat and water loss from the airways. Inspiration of air at 15 C and 50 relative humidity results in a loss to the environment of 25 mL water and 35 kcal L of minute ventilation. The loss of heat and water can be considerable, especially in...

Metatarsalgia

Conservative management is the mainstay of treatment. Initially, this involves relative rest and the use of NSAIDs. Metatarsal pads may also help relieve pressure from the metatarsal heads. Appropriate footwear with good arch supports is essential to treat and prevent symptom recurrence. Orthotics can be prescribed to correct excessive foot pronation. Rehabilitation also involves an individualized stretching and strengthening program to address improper biomechanics. Inclusion of sports-specific exercises and endurance training should gradually be incorporated.

Physical exercise

Despite their athletic appearance male athletes have lower androgen levels than untrained men in a resting state. The results of comparative studies suggest significantly lower free and total testosterone concentrations in chronically (several years) endurance-trained runners, weight lifters, rowers, cyclists, and swimmers (Arce and De Souza 1993 Arce et al. 1993 Hackney 2000 Hackney et al. 1988 Wheeler etal. 1984 1991). In these studies, testosterone concentrations of trained subjects were only 60-85 of the age-matched untrained men. It should be noted that these low testosterone levels are typically not outside the clinical norm, but at the very low end of this range. Acute effects ofsubmaximal, prolonged (> 60 min) exercise in marathon runners or cross-country skiers resemble hormonal changes found in endurance-trained men during resting state. After a 42-km marathon run or cross-country skiing over a distance of 75 km a highly significant decline in testosterone concentrations...

Apitherapy

Proponents claim that bee and other insect venom can treat chronic pain, rheumatoid arthritis, multiple sclerosis, lower back pain, migraines, and some dermatologic conditions. Bee pollen consumed internally is also claimed to increases one's energy, endurance, and overall performance. Although practitioner and client testimonials praise bee-product therapies, no studies document the ability of bee products to cure any ailment or to increase endurance or energy.

Stress

Earliest studies investigated young military trainees in extremely stressful situations during combat training (Kreuz et al. 1972 Rose et al. 1969) and observed a significant decline of testosterone levels under psychologic and somatic stress. Twenty years later, Opstad (1992) studied Norwegian military cadets during five days of training involving strenuous exercise and almost total deprivation of food and sleep. They confirmed the previous findings of significantly decreased testosterone levels. Opstad attributed the hormonal response to extreme endurance training, sleep deficit and psychic stress (cf. Christiansen et al. 1984 Cortes-Gallegos et al. 1983 Guezennec et al. 1994 Singer and Zumoff 1992). In a similar study design, Bernton et al. (1995) investigated young male soldiers during eight weeks. They lived under extreme psychosomatic stress with long exposure to rough environments, caloric deprivation, four hours of sleep per week and psychologic stressors including constant...

Heat Illness

With the increasing popularity of endurance and ultraendurance competitions (marathons, ultra-marathons, and triathlons), our understanding of exercise-associated collapse (EAC) falls into question. No longer can an athlete who collapses during endurance competitions, in heat-related conditions, be simply diagnosed as a casualty of heat-related exertion. The mechanisms of collapse can be very different when comparing this new endurance athlete and the classic high school or collegiate competitor. Treatment of athletic populations that exercise in heat-related conditions requires medical personnel to have a thorough understanding of thermoregulatory physiology, dehydration in athletics, populations at risk of heat illness,

Frostbite

Frostbite is a localized lesion of the skin, predominantly of the periphery, caused by the direct effects of cold exposure. Enough heat is lost from the area that ice crystals are allowed to form in the tissues.29 Most commonly affected are the feet and lower extremities, accounting for 57 of injuries. Also common are injuries of the hands (46 ) and exposed areas of the face such as the nose, ears, and cheeks (17 ).30 Historically, frostbite has had its highest prevalence during military campaigns. Today, those most at risk are mountain climbers and cold-weather endurance athletes.29

Caffeine

Caffeine is perhaps the most popular stimulant used by the general population. Prior to the U.S. Food and Drug Administration ban on products containing ephedrine, products combining caffeine and ephedrine were among the most purchased dietary supplements and weight-control compounds. Accordingly, much of the research into the ergogenic properties of caffeine actually studies combinations of caffeine and ephedrine. With regard to caffeine alone, caffeine is thought to be most beneficial for performance in endurance events, perhaps to enable the kick at the end of such an event.102 The metaanalysis of Doherty and Smith103 demonstrated caffeine's ergogenic benefits, primarily in studies of endurance exercise and time-to-exhaustion measurements.

The protein debate

In athletic physiology the question as to whether there is a special need for protein in athletes is an ongoing matter of controversy. Critical analyses of the background data, however, show that there are a lot of conflicting opinions. When discussing protein needs, we must be certain that the studies performed have not been influenced by problems with energy deficiency, i.e. that the energy needs are not met 5 . This is of special concern in athletes with a high energy turnover as the body gives priority to covering its energy needs even when protein turnover is increased. Although it has essentially been the strength athletes that have been engaged in the discussions regarding increased protein needs of athletes, it seems, rather, that protein requirement is in fact a problem of endurance athletes. An increased demand may be due to essentially three reasons. First, it is obvious that training leads to increased muscle mass, which may increase the protein requirement. Secondly, hard...

Summary

The pumping capacity of the heart is a critical determinant of endurance performance. The increased maximal cardiac output following endurance training results from a larger cardiac stroke volume, whereas maximal heart rate is unchanged or even slightly reduced. The higher stroke volume is due to enlargement of cardiac chamber size and to expansion of total blood volume. Plasma volume increases usually after a few days of training while the expansion of erythro-cyte volume takes a longer time. Functional improvements in cardiac performance include a more rapid early and peak ventricular filling rate during diastole. The enlarged blood volume, together with greater ventricular compliance and disten-sibility, and a faster and more complete ventricular relaxation allow stroke volume to increase even at high heart rates. At the same time, the cardiac output is distributed more selectively to activated regions of skeletal muscle, from where the muscle pump facilitates venous return....

Protein metabolism

Both resistance and endurance exercise have profound effects on postexercise protein metabolism 41 . Although there are conflicting results in the literature, most likely as a consequence of methodologic differences and limitations, it appears that exercise increases both protein degradation and synthesis. Obviously, for muscle growth or repair, there must be a positive net

Protein

Protein is also metabolized during exercise, although to a lesser degree than carbohydrate and fat as long as the athlete is in energy balance. Furthermore, sufficient carbohydrate stores and carbohydrate administration during exercise have a sparing effect on protein utilization. It is recommended that an endurance athlete should consume 1.2-1.5 g protein kg body weight day, while strength-training athletes should

Heat injury

Heat exhaustion is usually the result of fluid loss from the vascular system with accompanying cardiovascular disturbances, such as reductions in skin and splanchnic blood flow and a tendency for a fall in blood pressure. Of note is the fact that the environmental temperature is not necessarily very high in conditions where an endurance athlete performing at high metabolic rates becomes heat exhausted. The upper critical temperature for a good marathon runner may be as low as 20 C (see Fig. 2.3.4). The treatment for heat exhaustion is to put the patient in a supine position, cool him or her, and supply ample water to drink. The heat exhaustion may develop into heat stroke, a potentially fatal syndrome, involving high core temperature, often but not always ceased sweating, unconsciousness, neurologic disorders, metabolic disturbances, cardiovascular failure with low blood pressure and weak pulse. This condition calls for immediate hospitalization and treatment with intravenous infusion...

Fiber types

Furthermore, a certain fiber type (e.g. type I) from human musculature displays similar contractile patterns independent of the anatomic position (Table 1.3.3). This indicates that the characteristics of a human muscle are dependent on the relative contribution of the different fiber types rather than on variations in characteristics within a certain muscle fiber type. Although this thight correlation exists for isolated muscle fibers it cannot be extrapolated to whole muscle. However, use of the muscle plays a major role. It has been shown that the specific tension of the muscle fiber is reduced after, say, 42 days of bedrest. Surprisingly, a reduction in specific tension has also been demonstrated after monotonous use of the muscle at a low intensity, as occurs in extreme endurance training.

Erythropoietin rhEPO

The development of erythropoietin in recombinant form to use in patients with anemia has led to it totally replacing blood doping as the doping choice in endurance athletes. It has been demonstrated in both untrained and well-trained athletes with normal hematocrit and hemoglobin values that rhEPO can increase hemoglobin concentration, endurance performance, maximal aerobic power and arterial pressure during exercise 12-14 . Improvements by rhEPO administration are similar to those seen previously with blood transfusion, and it is thus likely that improvements in real sports performance are equally as good as those achieved by blood transfusion (see also Classical reference). It has been documented that performance in cross-country skiing and 10-km running has been shown to be increased by 3-5 up to 5 10 days after blood transfusion. More recently it has been shown in monkeys that genetic engineering was able to produce erythropoietin in muscle and that hematocrit rose. Unfortunately,...

Cerebral palsy

Ing fatigue, and therefore the spasticity can fluctuate, which may imply large fluctuations in the economy of motion. This may have a major impact on performance in endurance sports such as distance running and swimming. For years this particular issue has been debated in sport for the disabled when different disability groups compete together. At the present time it is difficult to substantiate the problem and find solutions acceptable to all involved.

Case study 411

A 70-year-old man with a lifelong history of strenuous training underwent cardiovascular testing in a study of veteran male athletes. He had no symptoms. ECG showed signs of an old myocardial infarction. Echocardiography showed a dilated left ventricle with regional hypokinesia of the LV wall and reduced LV function. Nuclear angiography showed decreased left ventricular function both at rest and during exercise. Myocardial scintigraphy revealed a large perfusion abnormality. Despite these findings he cycled on an ergometer cycle with gradual increase of workload of 20 W min to 180 W. Running on a treadmill his pulmonary oxygen uptake was 39 mL kg min which is higher than in healthy 70-75-year-old controls. This suggests that the endurance training compensated for the deteriorating effect of the myocardial infarction via both central and peripheral mechanisms.

Cardiac structure

The increase in maximal cardiac output (Qmax) following endurance training results from a larger cardiac stroke volume (SV), whereas maximal heart rate (HRmax) is unchanged or even slightly reduced. While heart size is a function of total body size as well as genetic factors, the higher SV achieved by endurance training is attributed to enlargement of cardiac chamber size and to expansion of total blood volume 12 . On the basis of cross-sectional studies in both female and male endurance-trained athletes, total heart volume is generally 15-25 larger than sedentary size-matched controls, with morphologic differences seen in both the ventricles and the atria 13 . Chamber enlargement is also observed in endurance-trained paraplegics compared to sedentary matched controls 14 . There is a close relationship between cardiac volume and physical performance 12 . However, the cardiac hypertrophy is dependent on the type of sport carried out. There are two main types of myocardial hypertrophy....

Blood pressure

There is general agreement that endurance training elicits small reductions in resting blood pressure 56,57 . In addition, long-term exercise training has the beneficial effect of preventing the normal age-related increase in blood pressure. A pressure-lowering effect of endurance training has been shown to occur within 6 days after initiating an exercise The reduction in resting diastolic blood pressure with training is significantly related to the increase in exercise capacity, which suggests that high-intensity training may be important. Attention is currently focused on determining the effectiveness of various training regimens which induce both reductions in resting blood pressure and significant improvements in functional capacity. During exercise at a given submaximal load, blood pressure and vascular resistance are reduced after endurance training. This adaptation is associated with reduced sympathetic activation and lower circulating catecholamines. At high exercise...

Athletes heart

It is now over 100 years since Henschen described the physiologic adaptation of the heart to physical training and distinguished this from cardiac enlargement due to heart disease i . However there still exist confusion and misconcepts regarding so-called athlete's heart. The term 'athlete's heart' is commonly used for the increased left ventricular dimensions seen in trained athletes. The adaptation to intense physical training, especially endurance training, also comprises, however, enlargement of other heart chambers and resting bradycardia.

Arrhythmias

Exercise increases vagal tone and may decrease the need for rate regulation by drugs. When heart rate is well controlled during exercise, the subject may exercise to tolerance. Patients with atrial fibrillation are, however, often treated with anticoagulants and should therefore avoid contact sports. Patients with chronic atrial fibrillation can improve functional capacity through an exercise rehabilitation program 30 . Subjects with atrial fibrillation may compete at high level even in endurance sports as demonstrated by one ori-enteer who, despite a history of atrial fibrillation since youth, competed at national level and at 75 years of age still had an exercise capacity of 240 W or 3.4 W kg on the bicycle and an oxygen uptake of 36mL 02 kg (Jensen-Urstad et al., unpublished data).