Promotion of physical activity in patients with non-communicable diseases in Luxembourg: a follow-up of the Sport-Sante inventory from 2014.

Regular practice of physical activity (PA) has many health benefits in both healthy individuals and in people with non-communicable diseases (NCDs). In order to disseminate this evidence and to strengthen the promotion of PA in people with NCDs, the Sport-Santé project was created in Luxembourg and officially launched in April 2015. In 2014, a stocktaking of the different organizations offering PA for people with NCDs was realized in order to develop the Sport-Santé project. Different communication tools were used to promote Sport-Santé as well as the aforementioned organizations. The present study aimed to re-evaluate the offers of PA for people with NCDs in Luxembourg one year after the launch of the project. The organizations offering PA for people with NCDs (orthopaedics, obesity and overweight, neurology and rare diseases, oncology and cardiology) were screened in 2014 and in 2016. The number of weekly offered hours of PA for people with NCDs were collected and the participation rate was observed. Participants (192 in 2014 and 196 in 2016) volunteered to answer a survey, which contained questions regarding their age, sex, time since enrolment, travel distance, former and current PA participation, and type of recruitment. Additional items regarding prescription and refund were explored only in 2016. In 2016, more than 55 hours per week of PA were offered for people with NCDs in Luxembourg (≈44 hours per week were identified in 2014). However, this increase was not statistically significant. No difference was observed between 2014 and 2016 regarding the participation rate (2014: 8.9 ± 5.1 participants per hour; 2016: 8.4 ± 5.7 participants per hour). Participants were younger in 2016 than in 2014. The time since enrolment was shorter in 2016 than in 2014. No difference between 2014 and 2016 was observed for travel distance, sex distribution, former and current PA participation, and type of recruitment. Participants were mainly recruited by the healthcare professionals. More than 69 % of the participants would like to receive a medical prescription for the PA. Fifty-two percent of the participants would appreciate a refund of the participation fees by their health insurance. The increasing efforts of Sport-Santé and the organizations offering PA for people with NCDs lead to increase the offer. However, the participation rate remains unchanged. The decrease in age and in time since enrolment observed in 2016 could be explained by the creation of new activities, a larger participant's turnover or high number of withdrawals among long-term participants. Even if participants are mainly recruited by healthcare professionals, this type of recruitment can be attributed to very few idealists. All healthcare professionals should be aware of the offers of Sport-Santé and advise their patients to participate in a PA program. It is now time to advance the idea of prescription of PA as a privileged treatment option and to convince the policymakers to take action against sedentary behaviours in Luxembourg. Nevertheless, this type of promotion is not enough to increase the number of participants and additional strategies must be explored and developed. The best sustainable strategies are always those that approach the problem from different viewpoints.

Association of previous injury and speed with running style and stride-to-stride fluctuations.

Running-related injuries remain problematic among recreational runners. We evaluated the association between having sustained a recent running-related injury and speed, and the strike index (a measure of footstrike pattern, SI) and spatiotemporal parameters of running. Forty-four previously injured and 46 previously uninjured runners underwent treadmill running at 80%, 90%, 100%, 110%, and 120% of their preferred running speed. Participants wore a pressure insole device to measure SI, temporal parameters, and stride length (S(length)) and stride frequency (S(frequency)) over 2-min intervals. Coefficient of variation and detrended fluctuation analysis provided information on stride-to-stride variability and correlative patterns. Linear mixed models were used to compare differences between groups and changes with speed. Previously injured runners displayed significantly higher stride-to-stride correlations of SI than controls (P = 0.046). As speed increased, SI, contact time (T(contact)), stride time (T(stride)), and duty factor (DF) decreased (P < 0.001), whereas flight time (T(flight)), S(length), and S(frequency) increased (P < 0.001). Stride-to-stride variability decreased significantly for SI, T(contact), T(flight), and DF (P ≤ 0.005), as did correlative patterns for T(contact), T(stride), DF, S(length), and S(frequency) (P ≤ 0.044). Previous running-related injury was associated with less stride-to-stride randomness of footstrike pattern. Overall, runners became more pronounced rearfoot strikers as running speed increased.

Can parallel use of different running shoes decrease running-related injury risk?

The aim of this study was to determine if runners who use concomitantly different pairs of running shoes are at a lower risk of running-related injury (RRI). Recreational runners (n = 264) participated in this 22-week prospective follow-up and reported all information about their running session characteristics, other sport participation and injuries on a dedicated Internet platform. A RRI was defined as a physical pain or complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day. One-third of the participants (n = 87) experienced at least one RRI during the observation period. The adjusted Cox regression analysis revealed that the parallel use of more than one pair of running shoes was a protective factor [hazard ratio (HR) = 0.614; 95% confidence interval (CI) = 0.389-0.969], while previous injury was a risk factor (HR = 1.722; 95%CI = 1.114-2.661). Additionally, increased mean session distance (km; HR = 0.795; 95%CI = 0.725-0.872) and increased weekly volume of other sports (h/week; HR = 0.848; 95%CI = 0.732-0.982) were associated with lower RRI risk. Multiple shoe use and participation in other sports are strategies potentially leading to a variation of the load applied to the musculoskeletal system. They could be advised to recreational runners to prevent RRI.

Ergometric performance and cardiovascular profile of obesity clinic patients.

BACKGROUND: Aerobic exercise capacity is considered as an independent prognostic factor for cardiovascular disease and mortality. It is usually expressed in maximal oxygen consumption (VO2(max)) or metabolic equivalent (MET) and is measured by spiroergometry or calculated by a regression formula based on maximal performance achieved. Obesity is associated with reduced physical performance and increased cardiovascular mortality. The aim of our study was to describe the ergometric and cardiovascular profile of patients of an obesity clinic, and to compare a direct measure of VO2(max) with an indirect by a regression formula and to. METHOD: 131 consecutive patients of an obesity clinic (95 females, 36 males) aged 16-75 years participated. The VO2(max) was measured by spiro-ergometry on a treadmill and estimated by a regression formula on the basis of the speed and grade of the treadmill. We have determined the relationship between Body mass index (BMI), Waist Circumference (WC) and the parameters VO2(max)/kg, MET, Performance Relative for Age, Heart Rate Recovery one minute after maximal effort (HRR), VO2(max) relative to a theoretical normal body weight (corresponding to a BMI of 25 kg/m2 (VO2(max)Rel25)), blood pressure, at rest and 5 minutes after exercise, Framingham Score and C-reactive protein (CRP). RESULTS: For the different age groups the VO2(max)/kg was below normal values (mean -23.4%). Measured VO2(max) was 15.2% lower than estimated by the regression formula. After adjusting to age and to a theoretical upper-limit normal body weight (corresponding to a BMI of 25 kg/m2) VO2(max)/kg was 5-20% (mean value 15%) higher than the reference values. VO2(max)/kg and HRR were correlated with BMI, WC and Framingham Score. 40% of the patients were already treated for hypertension, 55% had elevated blood pressure measurements at rest and 52% after exercise. CONCLUSIONS: Ergometric stress testing in obese subjects delivers important information that helps to evaluate the cardiovascular risk in this population and to provide individual recommendations for training therapy (e.g. training intensity, heart rate etc). Obese patients show a marked diminution of aerobic exercise capacity. In this population, the use of a standard regression formula to calculate VO2(max) leads to an overestimation of aerobic performance. The even higher than normal VO2(max) related to upper-normal body weight indicates that the reduced physical performance in obese patients is rather due to the overweight than to a pathological loss of muscle mass.

[Promotion of physical activity for secondary prevention in patients with chronic diseases: the situation in the Grand-Duchy of Luxembourg]. / Promotion de l'activité physique comme moyen de prévention secondaire chez des patients atteints de maladies chroniques: état des lieux au Grand-Duché de Luxembourg.

The regular practice of physical activities has health benefits in healthy subjects (primary prevention) and in patients with non-communicable diseases (secondary prevention). This study aimed to perform a stocktaking of the physical activities programs for patients or individuals at risk in the Grand-Duchy of Luxembourg. The organizations offering therapeutic physical activities (TPA) have been investigated. Eleven groups offering TPA adapted to different non-communicable diseases were characterized by their costs, instructors, participants and potential participants. These groups were divided into five main categories: cardiology, neurology, obesity, oncology, and orthopedics. During on-site meetings, 41 professionals, 192 participants and 34 potential participants have been interviewed during the period September 2013 to April 2014. The results show that about 40 hours of TPA, 17 hours of which in cardiology, are currently proposed every week, except during school holidays. The main TPA are gymnastics, aerobics, swimming, Nordic walking, cycling, and resistance training. The national coverage is quite low, especially for obesity, neurology and orthopedics. The costs is mainly related to the human resources, the gym being often borrowed but rarely available during school holidays. Between 200 and 400 individuals participate in the TPA. The average number of participants per hour is 8.9 (± 5.1), which represents only 50% of the maximal capacity estimated by the instructors (18.0 ± 8.2 participants per hour). The recruitment process is different according to the groups but the medical doctors and the physiotherapists are mainly involved in this process. However, the majority of the potential participants were not aware of the existence of the groups. The existence of these groups is a positive point, since it contributes to compensate for the current lack of concrete action of the public and private authorities. However, the current TPA offer is clearly insufficient. The groups are frail, on the one hand because their future relies exclusively upon the idealism of a few key actors, and on the other hand because the participation rate is low. This low rate is related to a lack of information and to organizational constraints. However, the public health action initiated by these groups should be perpetuated and strengthened with a better structuration and professionalization. Finally, the increase of the number of participants remains the main objective.

Association between preseason functional tests and injuries in youth football: a prospective follow-up.

This prospective cohort study aimed at identifying player-related risk factors for injuries in youth football as determined by extensive preseasonal screening. All male U15-U19 players from a regional football school (season 2007-2008; n = 67) underwent preseason evaluations assessing physical fatigue, emotional stress and injury history (questionnaire), anthropometric variables, general joint laxity (Beighton score), lower limb coordination (functional hop tests), aerobic fitness (shuttle run test), strength of knee extensor and flexor muscles (isokinetic tests), static and dynamic balance (force plate tests), and explosive strength (jump tests on force plate). Football exposure and all football-related injuries (n = 163) were recorded during the entire subsequent season (44 weeks). Total injury incidence was 10.4 injuries/1000 h and was higher in competition than in training [relative risk = 3.3; CI(95%) (2.39; 4.54); P < 0.001]. Lower limb injuries were most frequent (87%). Acute contact injuries represented 37%, while intrinsic (noncontact and chronic) injuries amounted to 63%. Of all the variables tested, only physical fatigue was significantly associated with injury, as revealed by univariate and multivariate analyses. The same result was observed when considering only intrinsic injuries as outcome. A single preseason test session may be of limited interest in the framework of an injury prevention strategy.

Echocardiography of the right ventricle in athlete's heart and hearts of normal size compared to magnetic resonance imaging: which measurements should be applied in athletes?

Right ventricular (RV) pathologic hypertrophy and cardiomyopathy have been reported to be related to ventricular arrhythmias and sudden cardiac death in athletes. However, it is unclear which echocardiographic measurements reflect RV dimensions in athlete's heart (AH) correctly. We aimed to compare two-dimensional echocardiography of the RV in AH and normal hearts to magnetic resonance imaging (MRI), and derive recommendations for RV echocardiography in athletes. Twenty-three healthy male endurance athletes with AH (A; 28+/-4 yrs) and 26 healthy untrained males (C; 26+/-4 yrs) matched for body-dimensions were examined. In recommended echocardiographic parasternal and 4-chamber views, three enddiastolic RV free wall-thicknesses (T1,T5,T9) and RV diameters were determined (M-mode enddiastolic diameter [RV-EDD]; longitudinal [RV-LAX], sagittal, outflow-tract and tricuspid valve anulus diameters). MRI determined RV enddiastolic volumes (RV-EDV) and masses (RVM) in A and C were: 162+/-29 vs. 136+/-15 ml and 76+/-10 vs. 59+/-13 g (p<0.001). Significant correlations between RV-EDV and RV-EDD (r=0.49; p=0.001) as well as RV-LAX (r=0.38; p=0.01), and RVM and T5 (r=0.52; p=0.01) were found. For RV echocardiography, significant differences between A and C were documented for RV-EDD (medians [quartiles]: A: 26 mm [24/29 mm]; C: 22 mm [21/27 mm]; p=0.04; measurable in 49/49 subjects), and in the parasternal short axis view for T5 (A: 6.0 mm [5.4/7.8 mm]; C: 5.0 mm [4.5/5.2 mm]; p=0.04; measurable in 22/49). In conclusion, two-dimensional echocardiographic RV measurements offer only a limited potential to reflect true RV dimensions. Only RV-EDD may differentiate between normal hearts and exercise related RV adaptations in AH, and is the only recommendable parameter to be measured in athletes routinely. In unclear cases additional methods should be used to examine the RV in athletes.

Analysis of sex-specific injury patterns and risk factors in young high-level athletes.

This study analyzed sex-specific injury patterns and risk factors in young athletes (n=256) from 12 sport disciplines practicing at the national or the international level in the Grand-Duchy of Luxembourg. Injury occurrence as a result of sport practice was analyzed retrospectively over the year 2006 using a standardized self-administered questionnaire. Overall incidence was not different between girls and boys (1.20 and 1.21 injuries/1000 athlete-hours, respectively), but in the context of team sport competition girls tended to be at a greater risk (rate ratio 2.05, P=0.053). Girls had a higher proportion of injuries in the ankle/foot region compared with boys (34.8% vs 16.8%). No sex-related differences were found regarding injury severity. Multivariate logistic regression (controlling for age and practice volume) revealed that girls' team sports were associated with a greater injury risk compared with individual sports [odds ratio (OR) of 4.76], while in boys this was observed for racket sports (OR=3.31). Furthermore, physical or emotional stress tended to be a specific risk factor in girls. There was a tendency for injury outside sports to be coupled to a higher injury risk in girls and boys. Consideration of sex-specific injury patterns and risk factors could be of importance for effective injury prevention.

Recovery training in cyclists: ergometric, hormonal and psychometric findings.

This randomized cross-over study aimed at comparing the recovery effect of 4 days of low-intensity, discipline-specific training of 1 vs 3 h daily. Eleven athletes completed two periods of 13 days intensive cycling training (IT), followed by a recovery period consisting of 4 days of low-intensity cycling for either 1 or 3 h each day. Before IT, after IT and after the recovery period, subjects were tested in the laboratory: venous blood sampling, "profile of mood states" (POMS), graded cycling test and a 30-min time trial (TT). Maximal heart rates and lactate concentrations decreased significantly after IT. Peak power output, maximal heart rates and maximal lactate concentrations changed significantly different during the recovery periods. Whereas these parameters were similar to pre-training values after 1-h daily active recovery, 3-h recovery training (REC) led to further decreases. Power output during TT was neither affected by IT nor by both recovery periods. TT-induced increases in cortisol, adrenocorticotropic hormone and prolactin were reduced only after 3-h REC. Total POMS and subscores fatigue and vigor changed significantly different during the recovery periods, a return to pre-training levels after 1 h active recovery and a further deterioration after 3 h REC. It is concluded that low-intensity training of a 1-h duration each day is more appropriate for recovery after an IT period than 3 h.

Volume vs. intensity in the training of competitive swimmers.

The present study aimed at comparing a high-volume, low-intensity vs. low-volume, high-intensity swim training. In a randomized cross-over design, 10 competitive swimmers performed two different 4-week training periods, each followed by an identical taper week. One training period was characterized by a high-training volume (HVT) whereas high-intensity training was prevalent during the other program (HIT). Before, after two and four weeks and after the taper week subjects performed psychometric and performance testing: profile of mood states (POMS), incremental swimming test (determination of individual anaerobic threshold, IAT), 100 m and 400 m. A small significant increase in IAT was observed after taper periods compared to pre-training (+ 0.01 m/s; p = 0.01). Maximal 100-m and 400-m times were not significantly affected by training. The POMS subscore of "vigor" decreased slightly after both training periods (p = 0.06). None of the investigated parameters showed a significant interaction between test-time and training type (p > 0.13). Nearly all (83 %) subjects swam personal best times during the 3 months after each training cycle. It is concluded that, for a period of 4 weeks, high-training volumes have no advantage compared to high-intensity training of lower volume.

Cardiac tissue Doppler in steroid users.

Anabolic steroids cause a variety of side effects, among them a slight concentric left ventricular hypertrophy. The objective of the present study was to clarify if they also induce alterations in left ventricular function. 14 male body builders with substantial intake of anabolic steroids (users) were examined by standard echocardiography and cardiac tissue Doppler imaging. They were compared to 11 steroid-free strength athletes (non-users) and 15 sedentary control subjects. Users showed an increased left ventricular muscle mass index. The ratio of peak transmitral blood flow velocities during early diastolic filling and atrial contraction did not differ between groups (users: 1.4 +/- 0.3; non-users: 1.7 +/- 0.5; controls: 1.4 +/- 0.4). In contrast an analogous tissue Doppler parameter, the ratio of myocardial velocities during early and late ventricular filling in the basal septum, was significantly lower in users (1.2 +/- 0.4) when compared to non-users (1.6 +/- 0.5) or controls (1.6 +/- 0.6). The velocity gradient during myocardial E-wave in the posterior wall showed significantly lower values in users (3.8 +/- 1.3 1/s) as compared to controls (5.8 +/- 2.5 1/s). There were no differences in systolic function. Summarizing strength athletes abusing anabolic steroids show negative alterations in diastolic function.

Effectiveness of low-intensity endurance training.

Recent studies point to the preventive efficacy of low-intensity endurance training in terms of cardiovascular risk factor modification and mortality reduction. In addition, it is frequently recommended as a means of stimulating fat metabolism. It was the intention of this study to clarify if endurance training effectiveness remains unimpaired when exercise intensity is reduced by a certain amount from "moderate" to "low", but total energy expenditure held constant. For this purpose, 39 healthy untrained subjects (44 +/- 7 yrs, 82 +/- 19 kg; 173 +/- 9 cm) were stratified for endurance capacity and sex and randomly assigned to 3 groups: "moderate intensity" (MOD, n = 13, 5 sessions per week, 30 min each, intensity 90 % of the anaerobic threshold [baseline lactate + 1.5 mmol/l]), "low intensity" (LOW, n = 13, 5 sessions per week, intensity 15 bpm below MOD, duration proportionally longer to arrive at the same total energy output as MOD), and control (CO, n = 13, no training). Training was conducted over 12 weeks and each session monitored by means of portable heart rate (HR) recorders. Identical treadmill protocols prior to and after the training program served for exercise prescription and documentation of endurance effects. VO (2max) improved similarly in both training groups (MOD + 1.5 ml x min (-1) x kg (-1); LOW + 1.7 ml x min (-1) x kg (-1); p = 0.97 between groups). Compared with CO (- 1.0 ml x min (-1) x kg (-1)) this effect was significant for LOW (p < 0.01) whereas there was only a tendency for MOD (p = 0.07). However, objective criteria (HR (max), maximal blood lactate) indicated that a different degree of effort was responsible for this finding. In comparison with CO (mean decrease of 3 bpm), average HR during incremental exercise decreased significantly by 9 bpm (MOD, p < 0.05 vs. CO) and 6 bpm (LOW, p = 0.26), respectively. However, there was no significant difference between MOD and LOW (p = 0.60), but for changes in oxygen uptake at the anaerobic threshold (VO (2AT)) it was observed that MOD was significantly more effective than CO (p = 0.048) and LOW (p = 0.04). It is concluded that within a middle-aged population of healthy untrained subjects, endurance training effectiveness might be slightly impaired when the training heart rate is chosen 15 bpm lower as compared to moderate intensity, but the total energy output held equal.

Bicuspid aortic valve: evaluation of the ability to participate in competitive sports: case reports of two soccer players.

UNLABELLED: Two competitive soccer players aged 23 and 17 years with known bicuspid aortic valve presented for sports-medical pre-participation screening. Both athletes were well trained and had a maximal oxygen uptake of 61 and 60 ml/min/kg, respectively. Echocardiography of the first athlete revealed an eccentric hypertrophy of the left ventricle (end-diastolic diameter 58-59 mm, septal and posterior myocardial wall thickness 12-13 mm) with good systolic and diastolic function and a functional bicuspid aortic valve with mild regurgitation. In the second athlete, echocardiography showed a bicuspid aortic valve with moderate regurgitation and a relative stenosis, a hypertrophied left ventricle (end-diastolic diameter 62-63 mm, myocardial wall thickness 13-16 mm) and dilation of the ascending aorta of 46 mm, which was confirmed by magnetic resonance imaging. According to international guidelines, the first athlete was allowed to participate in competitive soccer. Nevertheless, regular cardiologic examinations in intervals of 6 months were recommended. In the second case, the athlete was not allowed to take part in competitive sports due to the extended ecstasy of the ascending aorta and the concomitant risk of an aortic rupture. In addition, the left ventricular hypertrophy has to be considered as pathologic. Therefore, the athlete was only allowed to exercise in recreational sports with low and easily controllable intensities. CONCLUSION: In athletes with bicuspid aortic valve, besides the evaluation of the aortic valve, physiologic adaptations of the heart have to be differentiated from pathological changes. Furthermore, the aorta deserves special attention, because in the case of a (probably genetically determined) dilated ascending aorta, an elevated risk for aortic rupture is present during intensive and competitive exercise. A general judgement in athletes with bicuspid aortic valves on their ability to participate in competitive sports is, therefore, not possible.

Cardiocirculatory and metabolic responses at different walking intensities.

OBJECTIVES: Although walking is a common physical activity, scientifically based training guidelines using standardised tests have not been established. Therefore this explorative study investigated the cardiovascular and metabolic load resulting from different walking intensities derived from maximal velocity (Vmax) during an incremental treadmill walking test. METHODS: Oxygen uptake, heart rate (HR), blood concentrations of lactate and catecholamines, and rating of perceived exertion were recorded in 16 recreational athletes (mean (SD) age 53 (9) years) during three 30 minute walking trials at 70%, 80%, and 90% of Vmax (V70, V80, and V90) attained during an incremental treadmill walking test. RESULTS: Mean (SD) oxygen uptake was 18.2 (2.3), 22.3 (3.1), and 29.3 (5.0) ml/min/kg at V70, V80, and V90 respectively (p<0.001). V70 led to a mean HR of 110 (9) beats/min (66% HRmax), V80 to 124 (9) beats/min (75% HRmax), and V90 to 152 (13) beats/min (93% HRmax) (p<0.001). Mean (SD) lactate concentrations were 1.1 (0.2), 1.8 (0.6), and 3.9 (2.0) mmol/l at V70, V80, and V90 respectively (p<0.001). There were no significant differences between catecholamine concentrations at the different intensities. Rating of perceived exertion was 10 (2) at V70, 12 (2) at V80, and 15 (2) at V90. Twelve subjects reported muscular complaints during exercise at V90 but not at V70 and V80. CONCLUSIONS: Intensity and heart rate prescriptions for walking training can be derived from an incremental treadmill walking test. The cardiovascular and metabolic reactions observed suggest that V80 is the most efficient workload for training in recreational athletes. Further studies are needed to confirm these findings.

Is lactic acidosis a cause of exercise induced hyperventilation at the respiratory compensation point?

OBJECTIVES: The respiratory compensation point (RCP) marks the onset of hyperventilation ("respiratory compensation") during incremental exercise. Its physiological meaning has not yet been definitely determined, but the most common explanation is a failure of the body's buffering mechanisms which leads to metabolic (lactic) acidosis. It was intended to test this experimentally. METHODS: During a first ramp-like exercise test on a cycle ergometer, RCP (range: 2.51-3.73 l x min(-1) oxygen uptake) was determined from gas exchange measurements in five healthy subjects (age 26-42; body mass index (BMI) 20.7-23.9 kg x m(-2); Vo(2peak) 51.3-62.1 ml x min(-1) x kg(-1)). On the basis of simultaneous determinations of blood pH and base excess, the necessary amount of bicarbonate to completely buffer the metabolic acidosis was calculated. This quantity was administered intravenously in small doses during a second, otherwise identical, exercise test. RESULTS: In each subject sufficient compensation for the acidosis, that is, a pH value constantly above 7.37, was attained during the second test. A delay but no disappearance of the hyperventilation was present in all participants when compared with the first test. RCP occurred on average at a significantly (p = 0.043) higher oxygen uptake (+0.15 l x min(-1)) compared with the first test. CONCLUSIONS: For the first time it was directly demonstrated that exercise induced lactic acidosis is causally involved in the hyperventilation which starts at RCP. However, it does not represent the only additional stimulus of ventilation during intense exercise. Muscle afferents and other sensory inputs from exercising muscles are alternative triggering mechanisms.

Are the cardiac effects of anabolic steroid abuse in strength athletes reversible?

OBJECTIVE: To investigate the reversibility of adverse cardiovascular effects after chronic abuse of anabolic androgenic steroids (AAS) in athletes. METHODS: Doppler echocardiography and cycle ergometry including measurements of blood pressure at rest and during exercise were undertaken in 32 bodybuilders or powerlifters, including 15 athletes who had not been taking AAS for at least 12 months (ex-users) and 17 currently abusing AAS (users), as well as in 15 anabolic-free weightlifters. RESULTS: Systolic blood pressure was higher in users (mean (SD) 140 (10) mm Hg) than in ex-users (130 (5) mm Hg) (p < 0.05) or weightlifters (125 (10) mm Hg; p < 0.001). Left ventricular muscle mass related to fat-free body mass and the ratio of mean left ventricular wall thickness to internal diameter were not significantly higher in users (3.32 (0.48) g/kg and 42.1 (4.4)%) than in ex-users (3.16 (0.53) g/kg and 40.3 (3.8)%), but were lower in weightlifters (2.43 (0.26) g/kg and 36.5 (4.0)%; p < 0.001). Left ventricular wall thickness related to fat-free body mass was also lower in weightlifters, but did not differ between users and ex-users. Left ventricular wall thickness was correlated with a point score estimating AAS abuse in users (r = 0.49, p < 0.05). In all groups, systolic left ventricular function was within the normal range. The maximum late transmitral Doppler flow velocity (Amax) was higher in users (61 (12) cm/s) and ex-users (60 (12) cm/s) than in weightlifters (50 (9) cm/s; p < 0.05 and p = 0.054). CONCLUSIONS: Several years after discontinuation of anabolic steroid abuse, strength athletes still show a slight concentric left ventricular hypertrophy in comparison with AAS-free strength athletes.

Sport specific performance diagnosis in rowing: an incremental graded exercise test in coxless pairs.

The aim of the present study was to develop and validate an incremental graded exercise test performed in the rowing boat(coxless pair) in order to give specific performance evaluation data. Furthermore, an attempt was made to transfer these data to training recommendations. Thirty-four female rowers of national and international level performed a 4 x 6 min incremental graded exercise test GXT(boat) in coxless pairs on a lake (6 km, no wind, no waves). The boat velocity on the water (V; measured by a speedometer PACE COACH) was increased continuously from 3.55 m x s-I to 4.03 m x s-1. The individual anaerobic threshold(IAT) was determined by means of the lactate (LA) kinetics during and after exercise. Within 28 days all subjects performed arowing ergometry test GXT(ergo); Gjessing rowing ergometer: 40 watts increments every 3 min) as well as 70 min of constant endurance training in the boat in moderate velocity (ET; n- 10 pairs because of changing weather conditions). Results for V/LAIHR at IAT are: GXT(boat): 3.84+/- 0.10 m x s-1/2.44 +/- 0.66 mmol x 1-1/172 + 11 min(-1); GXT(ergo): 206+/-10 watts/2.53 +0.40 mmol x 1-171 +/- 10 min-' (means+/-SD). The Spearman rank order test showed significant correlations for HR (p < 0.001) and the mean performances of the coxless pairs (p < 0.05). A'5 % lower V during ET lead to a 10% lower HR and a 30% lower LA compared to the values at IAT. In conclusion, both a performance specific evaluation and velocity oriented control of training are possible by means of a 4 x 6 min incremental graded exercise test in coxlesspairs. However, this test on the water requires almost perfect weather conditions. The HR recommendations based on GXT (ergo) were confirmed during GXT(boat).

[Left ventricular mass in endurance-athletes with athlete's heart and untrained subjects--comparison between different echocardiographic methods and MRI]. / Vergleich echokardiographischer Methoden zur linksventrikulären Muskelmassenbestimmung mit der MRT bei Ausdauerathleten mit Sportherz und Untrainierten.

UNLABELLED: The echocardiographic determination of left ventricular mass (LVM) and volume is of importance for the interpretation of cardiac adaptations and risk-stratification. In pathologically hypertrophied hearts, conventional one- and two-dimensional echocardiographic methods tend to overestimate LVM. For the athlete's heart, a comparison between different echocardiographic methods and magnetic resonance imaging (MRI) has not been performed so far. 23 healthy male endurance-athletes (28+/-4 yr) with athlete's heart (A) and 26 healthy untrained males (U; 26+/-4 yr) were examined by MRI and the following echocardiographic methods: ASE-Cube (ASE), Devereux (DEV), Troy (TRO), Teichholz (TEI), Reichek (REI) and Dickhuth (DIC). Indexed LVM were: MRI: 107+/-6 g/m(2) (A), 79+/-7 g/m(2) (U); ASE: 170+/-20 g/m(2) (A), 119+/-14 g/m(2) (U); DEV: 134+/-16 g/m(2) (A), 95+/-11 g/m(2) (U); TRO: 134+/-16 g/m(2) (A), 92+/-12 g/m(2) (U); TEI: 115+/-10 g/m(2) (A), 91+/-8 g/m(2) (U); REI: 114+/-14 g/m(2) (A), 89+/-11 g/m(2) (U); DIC: 110+/-14 g/m(2) (A); 80+/-9 g/m(2) (U). In A and U, LVM is significantly overestimated by ASE, DEV, TRO, TEI, and REI compared to MRI (p<0.05), but not by DIC. Although coefficients of correlation were similar, only DIC revealed acceptable limits of agreement (ASE: +20 to +172 g; DEV: -13 to +93 g; TRO: -18 to +92 g; TEI: -17 to +53 g; REI: -25 to +57 g; DIC: -37 to +45 g). Depending on the used method, LVM upper limits range between 93 (MRT) and 146 g/m(2) (ASE) in U, and 119 (MRT) and 209 g/m(2) (ASE) in A. CONCLUSION: Compared to MRI, DIC is the most accurate conventional echocardiographic method to determine LVM in U and A. For a correct interpretation of LVM, differences of the echocardiographic methods have to be considered.