Bioelectrical impedance vector analysis (BIVA) in renal transplant recipients during an unsupervised physical exercise program.

BACKGROUND: Muscle weakness, incorrect body water distribution and reduced exercise tolerance are the main characteristics found in renal transplant recipients after surgical treatment. Regular physical supervised exercise programs, at moderate intensity, have been promoted to contrast these aspects, while few data are available for long-term unsupervised mixed exercise plans. Bioelectrical impedance vector analysis (BIVA) provides a semi-quantitative evaluation of body cell mass and body water. This study aims to approach the role of the BIVA analysis in the follow-up of Renal Transplant Group (RTG) and analyze the impact of unsupervised exercise program. METHODS: Thirteen male RTG and ten healthy subjects, adherent to a tailored exercise program, at moderate intensity and prescribed in an unsupervised way, have been followed up for one year. Every six months all the subjects have been submitted to the ergometric test, echocardiographic exam and an analysis of body composition by bioimpedance. They were compared to a healthy control group (HG). RESULTS: A significant reduction of the BMI was observed at the end of the study in the RTG group (T0 24.8±3.2, T12 24.2±3.2 kg/m2; P<0.05). BIVA has shown a lower right quadrant for RTG. All echocardiographic parameters were in a normal range, and no differences were found over time. CONCLUSIONS: Unsupervised tailored and mixed exercise intervention reduces some cardiovascular risks factors. However, it does not modify the frailty of RTG. BIVA analysis seems to have appropriate sensitivity to highlight this aspect.

Physical activity in solid organ transplant recipients: preliminary results of the Italian project.

BACKGROUND/AIMS: The role of physical activity in transplanted patients is often underestimated. We discuss the Italian National Transplant Centre experience, which started in 2008 studying transplanted patients involved in sports activities. The study was then developed through a model of cooperation between surgeons, sports physicians and exercise specialists. METHODS: A multicentre study was realized in 120 transplanted patients of which 60 treated with supervised physical activity (three sessions/week of aerobic and strengthening exercises) and 60 controls. We present the results of the first 26 patients (16 males, 10 females; 47.8 ± 10.0 years; 21 kidney, 5 liver transplanted; time from transplant 2.3 ± 1.4 years) who completed 12 months of supervised physical activity. RESULTS: Data showed an increase of peak aerobic power (t=4.535; P<0.01) and maximum workload (t=4.665; P<0.01) in the incremental cycling test. Maximum strength of knee extensors (t=2.933; P<0.05) and elbow flexors (t=2.450; P<0.05), and the power of lower limb (t=2.303; P<0.05) significantly increases. Health Related Quality of Life showed a significant improvement. Serum creatinine (1.4 ± 0.5 vs 1.3 ± 0.4 mg/dL) and proteinuria (0.10 ± 0.14 vs 0.08 ± 0.08 gr/dL) were stable. CONCLUSION: These preliminary results confirm the positive effects of supervised physical exercise. It can be considered as an input to promote other detailed exercise protocols.

The science of fencing: implications for performance and injury prevention.

In this review we analyse the data from the literature on fencing with the aim of creating a psychobiological and multi-factorial model of fencing performance. Fencing is an open-skilled combat sport that was admitted to the first modern Olympic Games in Athens (1896). It is mainly practised indoors, with three different weapons: the foil, the sabre and the épée, each contested with different rules. A fencing international tournament may last between 9 and 11 hours. Bouts represent only 18% of total competition time, with an effective fight time of between 17 and 48 minutes. The physical demands of fencing competitions are high, involving the aerobic and anaerobic alactic and lactic metabolisms, and are also affected by age, sex, level of training and technical and tactical models utilized in relation to the adversary. The anthropometrical characteristics of fencers show a typical asymmetry of the limbs as a result of the practice of an asymmetrical sport activity. Fencing produces typical functional asymmetries that emphasize the very high level of specific function, strength and control required in this sport. Moreover, the physical demands of fencing are closely linked to the perceptual and psychological ones, and all are subjected to a continuous succession of changes during the bouts based on the behaviour of the opponent. For this reason it is difficult to identify a significant relationship between any one physiological characteristic and performance, and performance is more likely to be influenced by perceptual and neuro-physiological characteristics. Fencers need to anticipate the opponent and to mask their true intentions with a game of feints and counter-feints, which must be supported by an adequate psycho-physical condition to prevent central and peripheral fatigue. Fencing is not particularly dangerous; however, there is a fine line between a fatal lesion and a simple wound from a broken blade. The suggestions for injury prevention fall into three primary areas: (i) actions that can be taken by participants; (ii) improvements in equipment and facilities; and (iii) administration of fencing competitions. As in every other sport, the prevention of accidents must be accomplished at various levels and above all must involve the institutions that are responsible for safety in sports.

Return to official Italian First Division soccer games within 90 days after anterior cruciate ligament reconstruction: a case report.

STUDY DESIGN: Case report. BACKGROUND: To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. CASE DESCRIPTION: The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. OUTCOMES: The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. DISCUSSION: This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises.

Energy cost of walking and running at extreme uphill and downhill slopes.

The costs of walking (Cw) and running (Cr) were measured on 10 runners on a treadmill inclined between -0.45 to +0.45 at different speeds. The minimum Cw was 1.64 +/- 0.50 J. kg(-1). m(-1) at a 1.0 +/- 0.3 m/s speed on the level. It increased on positive slopes, attained 17.33 +/- 1.11 J. kg(-1). m(-1) at +0.45, and was reduced to 0.81 +/- 0.37 J. kg(-1). m(-1) at -0.10. At steeper slopes, it increased to reach 3.46 +/- 0.95 J. kg(-1). m(-1) at -0.45. Cr was 3.40 +/- 0.24 J. kg(-1). m(-1) on the level, independent of speed. It increased on positive slopes, attained 18.93 +/- 1.74 J. kg(-1). m(-1) at +0.45, and was reduced to 1.73 +/- 0.36 J. kg(-1). m(-1) at -0.20. At steeper slopes, it increased to reach 3.92 +/- 0.81 J. kg(-1). m(-1) at -0.45. The mechanical efficiencies of walking and running above +0.15 and below -0.15 attained those of concentric and eccentric muscular contraction, respectively. The optimum gradients for mountain paths approximated 0.20-0.30 for both gaits. Downhill, Cr was some 40% lower than reported in the literature for sedentary subjects. The estimated maximum running speeds on positive gradients corresponded to those adopted in uphill races; on negative gradients they were well above those attained in downhill competitions.