Acute and chronic effects of high-intensity interval and moderate-intensity continuous exercise on heart rate and its variability after recent myocardial infarction: A randomized controlled trial.

BACKGROUND: Resting heart rate (HR) and HR variability (HRV) are known to predict mortality in patients after myocardial infarction (MI). OBJECTIVE: We assessed acute and chronic effects of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise (MICE) on HR and HRV in individuals after acute ST-segment elevation MI (STEMI). METHODS: Participants within 7 weeks after MI were randomly assigned to HIIT or MICE groups for a 9-week intervention. HR and the power spectrum of HRV were measured pre- and post-intervention by using orthostatic challenge and during sleep to assess chronic effects. Sleep measurements were performed at night after HIIT, MICE or no training to assess acute effects. Mixed models assessed time*group interaction for differences in chronic and acute effects, adjusted for beta-blocker dose and number of training sessions. RESULTS: Overall, 34 of 37 and 35 of 36 participants in the HIIT and MICE groups completed the study. We found a trend for an acute increase in HR of 2.5 bpm (4%, P=0.023) during sleep after HIIT. We found a trend for a chronic decrease in HR during supine and standing position as well as during sleep in the MICE group but a trend for an increase in HR during supine and standing position in the HIIT group. Low- and high-frequency power (LF, HF) of the standing segment increased from pre- to post-intervention in the MICE group but decreased in the HIIT group (group*time interaction P=0.005 and P=0.026, respectively). CONCLUSION: HR during sleep tended to be increased acutely during the night after HIIT but not after MICE as compared with controls. Chronic effects on resting HR, HF and LF tended to be more beneficial after MICE than HIIT in individuals with recent STEMI.

Response of peripheral arterial pulse wave velocity to acute exercise in patients after recent myocardial infarction and healthy controls.

BACKGROUND: Many studies found increased central arterial stiffness and poor endothelial function in patients with coronary artery disease (CAD). Acute exercise has been shown to decrease peripheral pulse wave velocity (pPWV) in young healthy volunteers. We hypothesized the response to acute exercise to be diminished in CAD patients compared to healthy young (HY) and age-matched (HAM) controls. METHODS: In 21 patients after recent myocardial infarction (CAD), 11 HAM and 10 HY pPWV was measured by applanation tonometry at the proximal femoral artery and the posterior tibial artery at rest and from 5 to 15 min after cessation of exhaustive exercise. Heart rate (HR) and blood pressure (BP) were monitored continuously. Resting central PWV (cPWV) was measured between the carotid and femoral arteries. Resting values and reponses to acute exercise were compared between the three groups and predictors for pPWV response were sought. RESULTS: The response in pPWV to acute exercise seen in HY (lowering in pPWV by 17%) was absent in both CAD and HAM. Resting pPWV was not statistically different between the three groups, while cPWV was comparable in CAD and HAM but 17% lower in HY. Predictors for response in pPWV to exercise were age (Spearman r = 0.48), cPWV (r = 0.34) and response in diastolic BP (r = 0.32). CONCLUSION: The response in pPWV to acute exercise observed in HY was absent in CAD and HAM. In dilated peripheral arteries, PWV may reflect stiffness of passive vessel structures, which are likely to increase with age in healthy persons and CAD alike.

Inter-observer agreement in athletes ECG interpretation using the recent international recommendations for ECG interpretation in athletes among observers with different levels of expertise.

INTRODUCTION: International criteria for the interpretation of the athlete's electrocardiogram (ECG) have been proposed. We aimed to evaluate the inter-observer agreement among observers with different levels of expertise. METHODS: Consecutive ECGs of Swiss elite athletes (≥14 years), recorded during routine pre-participation screening between 2013 and 2016 at the Swiss Federal Institute of Sports were analysed. A medical student (A), a cardiology fellow (B) and an electrophysiologist (C) interpreted the ECG's independently according to the most recent criteria. The frequencies and percentages for each observer were calculated. An inter-observer reliability analysis using Cohen Kappa (κ) statistics was used to determine consistency among observers. RESULTS: A total of 287 ECGs (64.1% males) were analysed. Mean age of the athletes was 20.4±4.9 years. The prevalence of abnormal ECG findings was 1.4%. Both, normal and borderline findings in athletes showed moderate to good agreement between all observers. κ scores for abnormal findings resulted in excellent agreement (κ 0.855 in observer A vs C and B vs C to κ 1.000 in observer A vs B). Overall agreement ranged from moderate (κ 0.539; 0.419-0.685 95% CI) between observer B vs C to good agreement (κ 0.720; 0.681-0.821 95% CI) between observer A vs B. CONCLUSIONS: Our cohort of elite athletes had a low prevalence of abnormal ECGs. Agreement in abnormal ECG findings with the use of the recently published International recommendations for ECG interpretation in athletes among observers with different levels of expertise was excellent. ECG interpretation resulted in moderate to good overall agreement.

Changes in volumetric BMD of radius and tibia upon antidepressant drug administration in young depressive patients.

OBJECTIVES: To determine longitudinal changes in trabecular volumetric BMD (vBMD) at tibia and radius in young depressive patients under antidepressants using pQCT. METHODS: PQCT data on 26 patients (22 females, 4 males) on serotonin re-uptake inhibitors (SSRI), and 14 patients (12 females, 2 males) on non-SSRI (10 SNRI, 4 TCA) were obtained at 4% and 66% of radius and tibia at baseline and at 12-month. Depression was assessed by Beck Depression Inventory (BDI) at baseline and follow-up. Wilcoxon tests were performed to find longitudinal changes in bone parameters within each group, Mann-Whitney tests to detect differences between groups. RESULTS: The two groups were comparable with regard to age, height and BDI. None of the measured bone parameters changed in the SSRI group. In the non-SSRI group trabecular vBMD increased slightly but significantly from baseline to follow-up at radius and tibia (p<0.03). Between group differences were significant for trabecular BMD at the radius. BDI decreased significantly in both groups by the same amount. CONCLUSIONS: Bone properties were found to be stable over 12 months under therapy with SSRIs. Whether SNRI and TCA indeed increase trabecular vBMD need to be shown in larger cohort.

Contralateral comparison of bone geometry, BMD and muscle function in the lower leg and forearm after stroke.

OBJECTIVE: The aim of the study was to investigate the side-to-side differences of the upper and lower limbs in chronic stroke patients by means of peripheral quantitative computed tomography (pQCT). METHODS: Twenty-three subjects (12 males and 11 females) who had previously suffered a stroke were recruited. Bone parameters and muscle cross-sectional areas were measured by pQCT in the forearm and the lower leg on the paretic and non-paretic side. Muscle function tests included hand grip dynamometry and sit-to-stand on force plates. RESULTS: Relative side-to-side differences in bone parameters at the radius were twice to three times the relative differences at the tibia. At the forearm the muscle-bone relationship was stronger on the non-paretic than the paretic side, while at the lower leg the muscle-bone relationship was similar on both sides. CONCLUSIONS: Side-to-side differences in bone parameters were much smaller than differences between individuals, and bone mass deficits on the paretic side were greater at the radius than at the tibia. Therapies to restore muscle force and function, which may also help to decrease the risk of falls, are recommended.

Comparison of pQCT parameters between ulna and radius in retired elite gymnasts: the skeletal benefits associated with long-term gymnastics are bone- and site-specific.

OBJECTIVES: To compare the skeletal benefits associated with gymnastics between ulna and radius. METHODS: 19 retired artistic gymnasts, aged 18-36 years, were compared to 24 sedentary women. Bone mineral content (BMC), total and cortical bone area (ToA, CoA), trabecular and cortical volumetric density (TrD, CoD) and cortical thickness (CoTh) were measured by pQCT at the 4% and 66% forearm. RESULTS: At the 4% site, BMC and ToA were more than twice greater at the radius than ulna whereas at the 66% site, BMC, ToA, CoA, CoTh and SSIpol were 20 to 51% greater at the ulna than radius in both groups (p<0.0001). At the 4% site, the skeletal benefits in BMC of the retired gymnasts over the non-gymnasts were 1.9 times greater at the radius than ulna (p<0.001), with enlarged bone size at the distal radius only. In contrast, the skeletal benefits at the 66% site were twice greater at the ulna than radius for BMC and CoA (p<0.01). CONCLUSION: Whereas the skeletal benefits associated with long-term gymnastics were greater at the radius than ulna in the distal forearm, the reverse was found in the proximal forearm, suggesting both bones should be analysed when investigating forearm strength.

Relationship between indices of adiposity obtained by peripheral quantitative computed tomography and dual-energy X-ray absorptiometry in pre-pubertal children.

BACKGROUND/AIM: The study investigated the relationship between indices of adiposity measured by peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) in pre-pubertal children. SUBJECTS AND METHODS: DXA-derived per cent body fat (%BF) was measured in 284 boys and 288 girls, aged 7-10 years. Cross-sections of the forearm (n=427) and lower leg (n=560) were obtained by pQCT to measure total cross-sectional area of the limb (Total CSA), Muscle CSA, Fat CSA, %Fat CSA (Fat CSA/Total CSAx100) and muscle density. RESULTS: Peripheral QCT-derived %Fat CSA in the forearm and lower leg correlated strongly with DXA-derived %BF (r=0.83-0.89, p<0.01) in both boys and girls. However, forearm and lower leg %Fat CSA were higher than whole body %BF by 5% and 10%, respectively. A better prediction of whole-body %BF was achieved by including %Fat CSA, muscle density and height into a hierarchical regression model. Using sex-specific regression equations, 87.7% of the boys and 83.7% of the girls had a predicted %BF within 3% units of the %BF obtained by DXA. CONCLUSION: In pre-pubertal children, pQCT measures of adiposity are strongly associated with whole-body per cent body fat. This reproducible method could be an alternative technique to estimate body composition in this population.

History of amenorrhoea compromises some of the exercise-induced benefits in cortical and trabecular bone in the peripheral and axial skeleton: a study in retired elite gymnasts.

BACKGROUND: Female gymnasts frequently present with overt signs of hypoestrogenism, such as late menarche or menstrual dysfunction. The objective was to investigate the impact of history of amenorrhoea on the exercise-induced skeletal benefits in bone geometry and volumetric density in retired elite gymnasts. SUBJECTS AND METHODS: 24 retired artistic gymnasts, aged 17-36 years, who had been training for at least 15 h/week at the peak of their career and had been retired for 3-18 years were recruited. They had not been engaged in more than 2 h/week of regular physical activity since retirement. Former gymnasts who reported history of amenorrhoea ('AME', n=12: either primary or secondary amenorrhoea) were compared with former gymnasts ('NO-AME', n=12) and controls ('C', n=26) who did not report history of amenorrhoea. Bone mineral content (BMC), total bone area (ToA) and total volumetric density (ToD) were measured by pQCT at the radius and tibia (4% and 66%). Trabecular volumetric density (TrD) and bone strength index (BSI) were measured at the 4% sites. Cortical area (CoA), cortical thickness (CoTh), medullary area (MedA), cortical volumetric density (CoD), stress-strain index (SSI) and muscle and fat area were measured at the 66% sites. Spinal BMC, areal BMD and bone mineral apparent density (BMAD) were measured by DXA. RESULTS: Menarcheal age was delayed in AME when compared to NO-AME (16.4+/-0.5 years vs. 13.3+/-0.4 years, p<0.001). No differences were detected between AME and C for height-adjusted spinal BMC, aBMD and BMAD, TrD and BSI at the distal radius and tibia, CoA at the proximal radius, whereas these parameters were greater in NO-AME than C (p<0.05-0.005). AME had lower TrD and BSI at the distal radius, and lower spinal BMAD than NO-AME (p<0.05) but they had greater ToA at the distal radius (p<0.05). CONCLUSION: Greater spinal BMC, aBMD and BMAD as well as trabecular volumetric density and bone strength in the peripheral skeleton were found in former gymnasts without a history of menstrual dysfunction but not in those who reported either primary or secondary amenorrhoea. History of amenorrhoea may have compromised some of the skeletal benefits associated with high-impact gymnastics training.

A randomised controlled trial of spinal manipulative therapy in acute low back pain.

OBJECTIVE: To determine whether treatment with spinal manipulative therapy (SMT) administered in addition to standard care is associated with clinically relevant early reductions in pain and analgesic consumption. METHODS: 104 patients with acute low back pain were randomly assigned to SMT in addition to standard care (n = 52) or standard care alone (n = 52). Standard care consisted of general advice and paracetamol, diclofenac or dihydrocodeine as required. Other analgesic drugs or non-pharmacological treatments were not allowed. Primary outcomes were pain intensity assessed on the 11-point box scale (BS-11) and analgesic use based on diclofenac equivalence doses during days 1-14. An extended follow-up was performed at 6 months. RESULTS: Pain reductions were similar in experimental and control groups, with the lower limit of the 95% CI excluding a relevant benefit of SMT (difference 0.5 on the BS-11, 95% CI -0.2 to 1.2, p = 0.13). Analgesic consumptions were also similar (difference -18 mg diclofenac equivalents, 95% CI -43 mg to 7 mg, p = 0.17), with small initial differences diminishing over time. There were no differences between groups in any of the secondary outcomes and stratified analyses provided no evidence for potential benefits of SMT in specific patient groups. The extended follow-up showed similar patterns. CONCLUSIONS: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain.

Interaction between playing golf and HRT on vertebral bone properties in post-menopausal women measured by QCT.

UNLABELLED: We investigated the effect of playing regular golf and HRT on lumbar and thoracic vertebral bone parameters (measured by QCT) in 72 post-menopausal women. The main finding of this study was that there was positive interaction between golf and HRT on vertebral body CSA and BMC at the thoracic 12 and lumbar 2 vertebra but not the third and seventh thoracic vertebras. INTRODUCTION: Identifying specific exercises that load the spine sufficiently to be osteogenic is an important component of primary osteoporosis prevention. The aim of this study was to determine if in postmenopausal women regular participation in golf resulted in greater paravertebral muscle mass and improved vertebral bone strength. METHODS: Forty-seven postmenopausal women who played golf regularly were compared to 25 controls. Bone parameters at the mid-vertebral body were determined by QCT at spinal levels T3, T7, T12 and L2 (cross-sectional area (CSA), total volumetric BMD (vBMD), trabecular vBMD of the central 50% of total CSA, BMC and cortical rim thickness). At T7 and L2, CSA of trunk muscles was determined. RESULTS: There was a positive interaction between golf and HRT for vertebral CSA and BMC at T12 and L2, but not at T3 or T7 (p ranging < 0.02 to 0.07). Current HRT use was associated with a 10-15% greater total and trabecular vBMD at all measured vertebral levels. Paravertebral muscle CSA did not differ between groups. Vertebral CSA was the bone parameter significantly related to muscle CSA. CONCLUSION: These findings provide preliminary evidence that playing golf may improve lower spine bone strength in postmenopausal women who are using HRT.

The effect of exercise and nutrition on the mechanostat.

In this review, we discuss the effect of increased and decreased loading and nutrition deficiency on muscle and bone mass and strength (and bone length and architecture) independently and combined. Both exercise and nutrition are integral components of the mechanostat model but both have distinctly different roles. Mechanical strain imparted by muscle action is responsible for the development of the external size and shape of the bone and subsequently the bone strength. In contrast, immobilization during growth results in reduced growth in bone length and a loss of bone strength due to large losses in bone mass (a result of endosteal resorption in cortical bone and trabecular thinning) and changes in geometry (bone shafts do not develop their characteristic shape but rather develop a rounded default shape). The use of surrogate measures for peak muscle forces acting on bone (muscle strength, size, or mass) limits our ability to confirm a cause-and-effect relationship between peak muscle force acting on bone and changes in bone strength. However, the examples presented in this review support the notion that under adequate nutrition, exercise has the potential to increase peak muscle forces acting on bone and thus can lead to a proportional increase in bone strength. In contrast, nutrition alone does not influence muscle or bone in a dose-dependent manner. Muscle and bone are only influenced when there is nutritional deficiency--and in this case the effect is profound. Similar to immobilization, the immediate effect of malnutrition is a reduction in longitudinal growth. More specifically, protein and energy malnutrition results in massive bone loss due to endosteal resorption in cortical bone and trabecular thinning. Unlike loading however, there is indirect evidence that severe malnutrition when associated with menstrual dysfunction can shift the mechanostat set point upward, thus leading to less bone accrual for a given amount of bone strain.

Influence of chronic supplementation of arginine aspartate in endurance athletes on performance and substrate metabolism - a randomized, double-blind, placebo-controlled study.

The intake of arginine aspartate has been shown to increase anabolic hormones like human growth hormone (hGH) and glucagon. The aim of our study was to investigate whether daily intake of two different dosages of arginine asparate during four weeks affects selected parameters of overtraining syndrome like performance, metabolic and endocrine parameters. Thirty male endurance-trained athletes were included in a randomized, double-blind, placebo-controlled study and divided into three groups. During four weeks, they ingested either arginine aspartate with a high concentration (H) of 5.7 g arginine and 8.7 g aspartate, with a low concentration (L) of 2.8 g arginine and 2.2 g aspartate or placebo (P).VO(2)peak and time to exhaustion were determined on a cycling ergometer in an incremental exercise test before and after supplementation. Before and after each incremental exercise test, concentrations of hGH, glucagon, testosterone, cortisol, ferritine, lactate, and urea were measured. Compared to placebo, no significant differences on endurance performance (VO(2)peak, time to exhaustion), endocrine (concentration of hGH, glucagon, cortisol, and testosterone) and metabolic parameters (concentration of lactate, ferritine, and urea) were found after chronic arginine aspartate supplementation. The chronic intake of arginine asparate during four weeks by male endurance athletes showed independent of dosage no influence on performance, selected metabolic or endocrine parameters. Consequently, there seems to be no apparent reason why the supplementation of arginine aspartate should be an effective ergogenic aid. The practice of using arginine aspartate as potential ergogenics should be critically reevaluated. Further investigations with higher dosage and extended supplementation periods should be performed.

Assessment of anthropometric, systemic, and lifestyle factors influencing bone status in the legs of spinal cord injured individuals.

The aim of the present study was to assess the influence of muscle spasms, systemic or lifestyle factors on bone mass and geometry of the femur and the tibia in people with long-standing spinal cord injury (SCI). Fifty-four motor complete SCI people with paralysis duration of between 5 and 50 years were included in the study. Spasticity was measured by means of the Ashworth scale. Distal epiphyses and mid shafts of the femur, tibia, and radius were measured by peripheral quantitative computed tomography. From the epiphyseal scans, trabecular and total bone mineral density (BMDtrab and BMDtot) were calculated, and from the shaft scans, cortical BMD (BMDcort), total and cortical cross-sectional area (CSAtot and CSAcort), and muscle cross-sectional areas (CSAmus) were determined. Personal characteristics, anthropometric, as well as life-style factors, were assessed by means of a questionnaire. A Spearman correlation matrix was produced with measured data. Correlation coefficients exceeding 0.3 were tested for significance by performing linear regression for parametric data and ANOVA for non-parametric data. Subjects with higher spasticity scores had significantly larger CSAmus in the upper and lower leg. Both spasticity and CSAmus were found to be significantly related to BMDtrab and BMDtot of the distal epiphysis of the femur and to CSAcort of the femoral shaft. In the lower leg, bone parameters of the tibia were found to be strongly related to corresponding bone parameters of the radius, which suggests a systemic origin. No significant relationships were found between bone parameters and any of the life-style factors. The extent of bone loss caused by disuse of the lower extremities in people with long-standing SCI is influenced by systemic factors. Additionally, spasticity has a positive effect on bone parameters of the femur.

Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals.

The aim of the present study was to describe bone loss of the separate compartments of trabecular and cortical bone, as well as changes in bone geometry of a large number of spinal cord injured (SCI) individuals. Eighty-nine motor complete spinal cord injured men (24 tetraplegics and 65 paraplegics) with a duration of paralysis of between 2 months and 50 years were included in the study. Distal epiphyses and midshafts of the femur, tibia, and radius were measured by peripheral quantitative computed tomography. The same measurements were performed in a reference group of 21 healthy able-bodied men of the same age range. In the femur and tibia, bone mass, total and trabecular bone mineral density (BMDtot and BMDtrab, respectively) of the epiphyses, as well as bone mass and cortical cross-sectional area of the diaphyses, showed an exponential decrease with time after injury in the spinal cord injured subjects. The decreasing bone parameters reached new steady states after 3-8 years, depending on the parameter. Bone mass loss in the epiphyses was approximately 50% in the femur and 60% in the tibia, while the shafts lost only approximately 35% in the femur and 25% in the tibia. In the epiphyses, bone mass was lost by reducing BMD, while in the shaft bone mass was lost by reducing cortical wall thickness, a process achieved by endosteal resorption advancing at a rate of about 0.25 mm/year within the first 5-7 years after injury. Except for a slight transient decrease in cortical BMD of the femoral and tibial shaft during the first 5 years after the spinal cord lesion, cortical BMD of the spinal cord injured subjects was found to be at reference values. Bone parameters of the radial epiphysis in paraplegic subjects showed no deficits compared to the reference group. Furthermore, a trend for an increased radial shaft diameter suggests periosteal apposition as a consequence of increased loading of the arms.

Fat oxidation at different intensities in wheelchair racing.

STUDY DESIGN: Determination of fat oxidation at three different intensities in trained wheelchair athletes on the treadmill. OBJECTIVE: The aim of the study was to assess the level and highest rate of fat oxidation in endurance-trained wheelchair athletes for recommendation on endurance training. SETTING: Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Nine (seven men and two women) endurance-trained wheelchair athletes (VO(2peak) 40.2+/-6.7 ml/kg/min) were studied over 20 min at 55, 65 and 75% VO(2peak) on a treadmill in their own racing wheelchairs in order to find the exercise intensity with the highest absolute fat oxidation. RESULTS: As presumed, total energy expenditure for wheelchair racing was highest at 75% VO(2peak), while absolute fat oxidation was statistically not significantly different at the three tested intensities. Percentage of energy expenditure from fat oxidation decreased with increasing intensity from 31.4% at 55% VO(2peak) to 20.9% at 75% VO(2peak), while percentage from carbohydrate oxidation increased from 68.6% at 55% VO(2peak) to 79.1% at 75% VO(2peak). CONCLUSION: For wheelchair athletes, we recommend training of fat metabolism for endurance exercise at an intensity of 55% VO(2peak), because absolute fat metabolism is not higher at higher intensities but less carbohydrates are used at lower intensity levels. At lower intensities, exercise can be performed over a longer time before the emptied glycogen stores will limit exercise duration. This may apply especially to paraplegic subjects whose active muscle mass is limited in contrast to able-bodied athletes.

Fat oxidation in men and women endurance athletes in running and cycling.

Recent studies showed that the maximal fat oxidation seems to be different in men and women and that it can be influenced by type and intensity of exercise. Nineteen endurance trained male (V.O (2)peak 61.3 +/- 4.4 ml x kg (-1) x min (-1)) and 17 female (V.O (2)peak 52.8 +/- 4.5 ml x kg (-1) x min (-1)) athletes were studied over 30 min at 55, 65 and 75 % V.O (2)peak on a treadmill and a cycling ergometer in order to find the intensity and kind of exercise with the highest absolute fat oxidation. For women, normalised (per body weight) fat oxidation was higher at 75 % V.O (2)peak than at 55 % V.O (2)peak for both running (p = 0.02) and cycling (p = 0.01). Women also oxidised a significantly higher percentage of fat with regard to total energy expenditure than men in running (p = 0.02) and cycling (p = 0.004). Normalised carbohydrate oxidation was significantly higher for men at each tested intensity (p < 0.05) and compared to kind of exercise in men (p = 0.006) and women (p = 0.002) in cycling than in running. Men and women showed a significantly higher normalised fat oxidation for running compared to cycling (p = 0.01). Cycling produced in men (p = 0.06) and women (p = 0.001) significantly more lactate than running. In summary, we found at 75 % V.O (2)peak a higher fat oxidation rate than at 65 % V.O (2)peak and 55 % V.O (2)peak for men and women in cycling and running. This is coincident with lactate threshold in men and women in cycling but not in running, where lactate threshold is higher than 75 % V.O (2)peak.

Effects of different sodium concentrations in replacement fluids during prolonged exercise in women.

OBJECTIVE: To investigate the effect of different sodium concentrations in replacement fluids on haematological variables and endurance performance during prolonged exercise. METHODS: Thirteen female endurance athletes completed three four hour runs on a 400 m track. Environmental conditions differed between the three trials: 5.3 degrees C and snow (trial 1), 19.0 degrees C and sunny weather (trial 2), 13.9 degrees C and precipitation (trial 3). They consumed 1 litre of fluid an hour during the trials with randomised intake of fluids: one trial (H) with high sodium concentration (680 mg/l), one trial (L) with low sodium concentration (410 mg/l), and one trial with only water (W). Before and after the trials, subjects were weighed and blood samples were taken for analysis of [Na(+)](plasma), packed cell volume, and mean corpuscular volume. RESULTS: The mean (SD) decrease in [Na(+)](plasma) over the whole trial was significantly (p<0.001) less in trial H (2.5 (2.5) mmol/l) than in trial W (6.2 (2.1) mmol/l). Mild hyponatraemia ([Na(+)](plasma) = 130-135 mmol/l) was observed in only six women (46%) in trial H compared with nine (69%) in trial L, and 12 (92%) in trial W. Two subjects (17%) in trial W developed severe hyponatraemia ([Na(+)](plasma)<130 mmol/l). No significant differences were found in performance or haematological variables with the three different fluids. There was no significant correlation between[Na(+)](plasma) after the run and performance. There was a significant correlation between changes in [Na(+)](plasma) and changes in body weight. CONCLUSIONS: Exercise induced hyponatraemia in women is likely to develop from fluid overload during prolonged exercise. This can be minimised by the use of replacement fluids of high sodium concentration. Sodium replacement of at least 680 mg/h is recommended for women in a state of fluid overload during endurance exercise of four hours. However, higher [Na(+)](plasma) after the run and smaller decreases in [Na(+)](plasma) during the trials were no indication of better performance over four hours.

Effect of electrical stimulation-induced cycling on bone mineral density in spinal cord-injured patients.

BACKGROUND: Bone atrophy in spinal cord-injured people (SCI) is, among other factors, caused by immobilization and is initiated shortly after the injury. The present study measured the effect of an functional electrical stimulation (FES)-cycling intervention on bone mineral density (BMD) of the tibia in recently injured SCI people. METHODS: As soon as possible after the injury (mean 4.5 weeks), para- and tetraplegic patients were recruited into an intervention and control group comparable with regard to gender, age, and lesion level. The intervention consisted of 30-min functional electrical stimulation-cycling three times a week for the duration of their primary rehabilitation (mean = 6 months). Computed tomography (CT) scans of the right tibia diaphysis were taken at the beginning and at the end of the intervention. Bone mineral density of cortical bone was calculated from the CT scans. RESULTS: A total of 38 subjects (19 in each group) were included in the study. Both groups showed a reduction in tibial cortical BMD of 0-10% of initial values within 3-10 months. The mean decrease in BMD was 0.3% (+/- 0.6) per month in the intervention group and 0.7% (+/- 0.8) in the control group. This difference did not reach statistical significance. Decrease of BMD was linearly correlated to initial BMD and age in the pooled data of both groups; subjects who had a high initial BMD and/or were older lost more bone. In neither group was bone loss associated with duration of immobilization nor lesion level. CONCLUSIONS: Functional electrical stimulation-cycling applied shortly after SCI did not significantly attenuate bone loss.

Evaluation of sprint exercise testing protocols in wheelchair athletes.

STUDY DESIGN: Comparison of five different exercise testing protocols with different speeds on a treadmill with seven wheelchair athletes. OBJECTIVE: To determine which speed and duration in an exercise protocol is best to test wheelchair athletes performing sprint races on a track. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Three elite and four junior wheelchair athletes (18.7+/-6.8 years, 52.1+/-9.7 kg and 165.3+/-19.3 cm) performed five different exercise testing protocols at different speeds on a treadmill until exhaustion. Maximal effort treadmill (0.7% incline) testing protocols were performed using three timeframes. The first was focussing on short duration tests (S1 and S2) where incremental increases in velocity (0.42 and 0.1 m.s(-1)) were required from a stationary start. The second were medium duration tests (M1 and M2) where the athlete started at their 200 m and 800 m personal best time (mean velocities) and then had the velocity increased 1 km.h(-1) by every 10 and 60 s respectively. The long duration test (L) started at 14 km.h(-1) and velocity was increased by 2 km.h(-1) every 120 s. Maximal heart rate, maximal concentration of lactate, maximal speed, and maximal duration of the test were measured. RESULTS: The highest concentration of lactate and the highest heart rates were measured in the longest tests. CONCLUSION: During maximal effort testing wheelchair athletes are able to produce higher lactate concentrations when tested for longer duration. Post test lactate assessments provide little information in short duration testing protocols. Sequential lactate assessments post-test may provide additional information on the rate of recovery for middle distance wheelchair athletes and warrants further investigation.