Low Back Pain Perceptions and Coping Strategies in Pre-Professional Dancers: A Qualitative Study.

AIMS: Low back pain (LBP) is a common health problem in pre-professional dancers which could hamper the dancers' professional career. However, pre-professional dancers are not often studied, although they may have their own pain perceptions and coping strategies towards LBP. Considering the biopsychosocial nature of LBP, it is important to increase the understanding of these perceptions and coping strategies. The aim of this qualitative research study was to explore the dancers' perceptions about LBP and their coping strategies when they suffered from LBP. METHODS: Eighteen pre-professional dancers with and without LBP from different dance schools in Belgium were included in this study. Participants were invited for an in-depth online video interview. These in-depth interviews were based on a topic list. Afterwards, the interview transcripts were analyzed thematically. RESULTS: Two primary themes emerged from the data: 1) perceptions of LBP and 2) coping strategies which dancers applied when they suffered from LBP. The perceptions about LBP were related to two different themes: "it's all about the body" and "it's all about the psychosocial and contextual factors." In addition, the coping strategies were divided into "active coping strategies" and "passive coping strategies," whereas the most popular coping strategies were stretching exercises and passive coping strategies such as massages or heating cream. CONCLUSION: Although LBP has clearly been shown to be a biopsychosocial phenomenon, this qualitative study showed that dancers mainly considered biomedical factors as contributing factors to LBP. Additionally, instead of relying on coping strategies aimed at directly improving pain or trying to treat LBP on the basis of a single-cause diagnosis, it is important to consider the biopsychosocial origin of LBP in the management plans.

Perspective: Towards Personalised Metabolic Coaching in Cancer.

Although cancer survivorship has improved over the last decades, numbers of cancer incidence and prevalence are rising. Evidence is growing that lifestyle factors, such as physical activity, a healthy weight management and -diet, play an important role in first- and second line preventive strategies. When implementing a healthy lifestyle, the maintenance of the energy balance should be taken into account. The energy equilibrium is achieved when the energy intake (Ei) for one day is equal to the total daily energy expenditure (TEE). The latter is, among others, made up of the resting energy expenditure, its largest contributor (60-80% of TEE), and can be assessed by indirect calorimetry (i.e. the gold standard). The resting energy expenditure reflects the individual's minimal caloric need in 24h to support basal functions. In cancer patients, energy imbalances, expressed as a positive (Ei > TEE) or negative (Ei & TEE) energy balance, may occur and are characterised by weight gain or -loss respectively. As a corollary, shifts in fatmass and fatfree mass are reported. Adequate nutritional follow-up is necessary in order to meet the energy needs, since both positive and negative energy balances are known to have deteriorating effects on cancer prognosis and mortality. In the clinical setting, predictive formulas (e.g. Harris-Benedict equation) are often used to estimate the caloric need. However, both under- and overfeeding are reported when using equations. Therefore, we advise to use indirect calorimetry in the standard assessment of a patient's energy need in order to provide adequate metabolic coaching and -follow up.

Effect of different head and neck positions on behaviour, heart rate variability and cortisol levels in lunged Royal Dutch Sport horses.

Different head-and-neck positions (HNPs) are discussed in relation to potential welfare issues. To evaluate the effect on welfare, seven Royal Dutch Sport horses were studied in five predetermined HNPs: (1) unrestrained (HNP1); (2) neck raised, bridge of nose around the vertical (HNP2); (3) neck lowered and considerably flexed, bridge of nose pointing towards the chest (HNP4); (4) neck raised and extended, bridge of nose in front of the vertical (HNP5), and (5) neck lowered and flexed, bridge of nose pointing towards the carpus (HNP7). A standardised exercise test (SET) of 34 min consisted of trot, canter and walk. Behaviour was recorded with a pre-defined ethogram and R-R intervals measured using telemetry. Cortisol concentrations were taken at the start, 5 and 30 min after the SET. Behaviour around the SET was scored separately. Conflict behaviours increased significantly during HNP2 when compared with HNP1, HNP4 and HNP7 during the SET, and there was significant negative anticipation before HNP2 and HNP7. The heart rate variability (HRV) frequency domain for HNP2 showed a significantly increased low frequency peak (LFpeak) compared with other HNPs, and there was a decrease in very low frequency (VLF%) compared with HNP1. HNP4 showed a significant increase in LF% and decrease in VLF% compared with HNP1. Saliva cortisol concentrations were significantly increased in HNP2 at 5 and 30 min after exercise. Increased conflict behaviour was mostly observed in HNP2, but there was a raised HRV suggesting a sympathetic shift in HNP2 and HNP4, and increased cortisol concentrations during HNP2 indicated a stress response.

Amino acid profile during exercise and training in Standardbreds.

The objective of this study is to assess the influence of acute exercise, training and intensified training on the plasma amino acid profile. In a 32-week longitudinal study using 10 Standardbred horses, training was divided into four phases, including a phase of intensified training for five horses. At the end of each phase, a standardized exercise test, SET, was performed. Plasma amino acid concentrations before and after each SET were measured. Training significantly reduced mean plasma aspartic acid concentration, whereas exercise significantly increased the plasma concentrations of alanine, taurine, methionine, leucine, tyrosine and phenylalanine and reduced the plasma concentrations of glycine, ornithine, glutamine, citrulline and serine. Normally and intensified trained horses differed not significantly. It is concluded that amino acids should not be regarded as limiting training performance in Standardbreds except for aspartic acid which is the most likely candidate for supplementation.

Overtrained horses alter their resting pulsatile growth hormone secretion.

The influence of intensified and reduced training on nocturnal growth hormone (GH) secretion and elimination dynamics was studied in young (1.5 yr) Standardbred geldings to detect potential markers indicative for early overtraining. Ten horses trained on a treadmill for 32 wk in age-, breed-, and gender-matched fixed pairs. Training was divided into four phases (4, 18, 6, and 4 wk, respectively): 1) habituation to high-speed treadmill trotting, 2) normal training, in which speed and duration of training sessions were gradually increased, 3) in this phase, the horses were divided into 2 groups: control (C) and intensified trained (IT) group. In IT, training intensity, duration, and frequency were further increased, whereas in control these remained unaltered, and 4) reduced training (RT). At the end of phases 2, 3, and 4, blood was sampled overnight every 5 min for 8 h for assessment of GH secretory dynamics using pulse detection, deconvolution analysis, and approximate entropy (ApEn). Intensified training induced overtraining (performance decreased by 19% compared with C), which was associated with an increase in concentration peaks number (3.6 vs. 2.0, respectively), a smaller peak secretion pattern with a prolonged half-life (15.2 vs. 7.3 min, respectively), and an increased ApEn (0.89 vs. 0.49, respectively). RT did not lead to full recovery for the overtrained horses. The increased irregularity of nocturnal GH pulsatility pattern is indicative of a loss of coordinated control of GH regulation. Longer phases of somatostatin withdrawal are hypothesized to be the underlying mechanism for the observed changes in GH pulsatility pattern.

Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life.

The short-term beneficial effects of physical rehabilitation programmes after cancer treatment have been described. However, little is known regarding the long-term effects. The purpose of this study was to investigate the long-term effects of high-intensity resistance training compared with traditional recovery. A total of 68 cancer survivors who completed an 18-week resistance training programme were followed for 1 year. During the 1-year follow-up, 19 patients dropped out (14 due to recurrence of cancer). The remaining 49 patients of the intervention group were compared with a group of 22 patients treated with chemotherapy in the same period but not participating in any rehabilitation programme. Outcome measures were muscle strength, cardiopulmonary function, fatigue, and health-related quality of life. One year after completion of the rehabilitation programme, the outcome measures in the intervention group were still at the same level as immediately after rehabilitation. Muscle strength at 1 year was significantly higher in patients who completed the resistance training programme than in the comparison group. High-intensity resistance training has persistent effects on muscle strength, cardiopulmonary function, quality of life, and fatigue. Rehabilitation programmes for patients treated with chemotherapy with a curative intention should include high-intensity resistance training in their programme.

Unexplained underperformance syndrome in sport horses: classification, potential causes and recognition.

When inadequate training stress is applied and recovery time is insufficient, performance reduction and chronic maladaptation occurs. Known as overtraining syndrome (OTS), this complex condition afflicts horses in top training. The name of the syndrome implies causation and it is necessary to differentiate it from over-reaching, a term used in horses that, after suffering a loss of performance without an obvious clinical reason, recover their performance within 1 or 2 weeks. The term OTS should be used for horses in heavy training losing performance without an obvious clinical reason and which is sustained for > 2 weeks. Despite considerable scientific investigations, the underlying mechanisms are still poorly understood and there are no objective biomarkers for OTS. An imbalance between training and recovery seems to be the primary cause of this dysfunction. However, other factors such as transport, feeding, subclinical disease and general management may play a role. There is now sufficient evidence that red cell hypervolaemia is not a mechanism for the OTS in horses. A dysfunction of the hypothalamo-pituitary-adrenocortical axis is momentarily the only mechanism that may be related to the development of this syndrome. In the absence of a scoring system to assess the psychological status of horses, the most effective method for diagnosis is the thorough assessment of the history and presenting complaint (length of unexplained performance deficit, weight loss despite adequate feed intake, concurrence of unspecific subclinical problems, unsuccessful treatments and changes of behaviour). Standardised exercise tests are suggested to provide a way to detect subtle changes in hormonal responses in the individual, which may make an important contribution to the detection of early overtraining. But further longitudinal studies are needed to clarify mechanism(s) underlying OTS and to establish the potential for the use of a physiological test as a predictive tool of this disorder.

Four weeks' corticosteroid inhalation does not augment maximal power output in endurance athletes.

OBJECTIVE: To assess possible ergogenic properties of corticosteroid administration. DESIGN: A balanced, double-blind, placebo-controlled design was used. PARTICIPANTS: 28 well-trained cyclists and rowers. INTERVENTION: 4 weeks' daily inhalation of 800 microg budesonide or placebo. MAIN OUTCOME MEASUREMENTS: The subjects performed three incremental cycle ergometer tests until exhaustion, before and after 2 and 4 weeks of placebo or budesonide administration, to measure maximal power output (W(max)). Once a week they filled in a profile of mood state (POMS) questionnaire. RESULTS: There was no significant difference in W(max) between the placebo (376 (SD 25) W) and the corticosteroid group (375 (36) W) during the preintervention test, and there were no significant changes in either group after 2 and 4 weeks of intervention. No effect of the intervention on mood state was found. CONCLUSION: 4 weeks of corticosteroid or placebo inhalation in healthy, well-trained athletes did not affect maximal power output or mood state. Hence no ergogenic properties of 4 weeks' corticosteroid administration could be demonstrated, which corroborates previous studies of short-term corticosteroid administration.

Hormonal responses to acute exercise, training and overtraining. A review with emphasis on the horse.

Overtraining is an imbalance between training and recovery leading to symptoms associated with a neuroendocrine dysbalance called the overtraining syndrome, a disease characterized by behavioral, emotional and physical symptoms similar with depression. Although the prevalence of overtraining is high in human and equine athletes, at present no sensitive and specific test is available to prevent or diagnose overtraining. Nowadays, it is believed that combination of different (hormonal) parameters appear to be the best indicators of overtraining. Therefore, this review provides a summary of previous literature examining the response of the hypothalamic-pituitary-adrenal (HPA) axis and the growth hormone-insulin-like growth factor-I (GH-IGF-I) axis to acute and chronic exercise as well as overtraining in humans and horses. The exercise induced hormonal responses seem to be equal for the equine as well as the human athlete, which makes comparisons possible. Repeated bouts of exercise are suggested to provide a way to detect subtle changes in hormonal responses in the individual athlete, which may make them an important tool in detecting early overtraining. This should be combined with corticotropin releasing hormone (CRH) stimulation tests and basal ACTH and GH pulsatility determination. Further research is needed to establish the correct training intensity and rest period for the exercise test in equines.

The effect of long-term exercise on glucose metabolism and peripheral insulin sensitivity in standardbred horses.

REASONS FOR PERFORMING STUDY: To study the possible long-term effect of improved glucose tolerance in horses after long-term training, as the impact of exercise training on glucose metabolism is still unclear in the equine species. It is not known whether there is a direct long-term effect of training or if the measurable effect on glucose metabolism is the residual effect of the last exercise session. OBJECTIVES: To determine the chronic effect on glucose metabolism and peripheral insulin sensitivity of long-term training in horses by use of the euglycaemic hyperinsulinaemic clamp technique. METHODS: Eleven Standardbred horses were acclimatised to running on the high-speed treadmill for 4 weeks (Phase 1) followed by training for 18 weeks with an alternating endurance (approximately 60% HRmax) high intensity training programme (approximately 80% HRmax) (Phase 2). Training frequency was 4 days/week. At the end of Phase 1, a euglycaemic hyperinsulinaemic clamp was performed 72 h after the last bout of exercise in all horses. At the end of Phase 2, the horses were clamped 24 h or 72 h after the last bout of exercise. RESULTS: Glucose metabolism rate did not change significantly after 18 weeks of training, measured 72 h after the last exercise bout (0.018 +/- 0.009 and 0.022 +/- 0.006 mmol/kg bwt/min, respectively). Peripheral insulin sensitivity also did not change significantly following training (7.6 +/- 5.7 x 10(-6) and 8.0 +/- 3.1 x 10(-6), respectively). The same measurements 24 h after the last bout of exercise showed no significant differences. CONCLUSIONS: Results indicated that long-term training in Standardbreds neither changed glucose metabolism or insulin sensitivity 72 h after the last bout of exercise. POTENTIAL RELEVANCE: The fact that the beneficial effect of increased insulin sensitivity after acute exercise diminishes quickly in horses and no long-term effects on insulin sensitivity after chronic exercise have as yet been found in horses, implies that exercise should be performed on a regular basis in horses to retain the beneficial effect of improved insulin sensitivity.

Physiological, biochemical and psychological markers of strenuous training-induced fatigue.

The purpose of the study was to investigate whether severe fatigue, possibly leading to overreaching, could be diagnosed at an early stage by a combination of parameters. Seven well-trained male subjects (age [mean +/- SD]: 25.3 +/- 4.7 yr; body mass: 76 +/- 6.6 kg; VO2max: 61.1 +/- 7 ml.kg(-1).min(-1)) increased their training load by doubling their training volume and increasing the intensity by 15 % over a period of two weeks. Before and after this intensified training period subjects underwent a series of tests including a maximal incremental cycle ergometer test (Wmax) with continuous ventilatory measurements and blood lactate values, time trial, basal blood parameter tests (red and white blood profile), hormones [growth hormone (GH), insulin-like growth factor 1(IGF-1), adreno-corticotropic hormone (ACTH), cortisol], neuro-endocrine stress test [short insulin tolerance test (SITT), combined anterior pituitary test (CAPT) and exercise], a shortened Profile of Mood State (POMS), the estimated rate of perceived exertion (RPE) and a cognitive reaction time test. The intensified training period resulted in a significant increase of the training load (p <0.01), training monotony (p <0.01) and training strain (p <0.01). The RPE during training increased significantly (p <0.01) during the intensified training period. Total mood score obtained from the POMS tended to increase (p=0.06), reflecting an increase in worse mood state. A novel finding was that reaction times increased significantly, indicating that overreaching might adversely affect speed of information processing by the brain, especially for the most difficult conditions. After the intensified training period, neither changes in exercise-induced plasma hormone values, nor SITT values were observed. During the CAPT only cortisol showed a significant decrease after the intensified training period. Hemoglobin showed a significant decrease after the intensified training period whereas hematocrit, red blood cell count (RBC) and MCV tended to decrease. The intensified training had no effect on physical performance (Wmax or time trial), maximal blood lactate, maximal heart rate and white blood cell profile. The most sensitive parameters for detecting overreaching are reaction time performance (indicative for cognitive brain functioning), RPE and to a lesser extend the shortened POMS. This strongly suggests, that central fatigue precedes peripheral fatigue. All other systems,including the neuro-endocrine, are more robust and react most likely at a later stage in exhaustive training periods.

[Treatment of stroke by reducing the body temperature; 'Paracetamol (acetaminophen) in stroke' (PAIS): start of a clinical trial]. / Behandeling van een beroerte door verlaging van de lichaamstemperatuur; 'paracetamol (acetaminophen) in stroke' (PAIS): start van een klinische trial.

Subfebrile temperatures and fever in acute stroke are associated with poor functional outcome. A 1 degree C rise in body temperature may double the risk of a poor outcome in patients who are admitted within 12 hours from the onset of symptoms. Two randomised double-blind clinical trials in patients with acute ischaemic stroke have shown that treatment with a daily dose of 6 g paracetamol results in a small but rapid and potentially worthwhile reduction of 0.3 degree C (95% CI: 0.1-0.5) in body temperature. It has been hypothesized that early antipyretic therapy reduces the risk of death or dependency in patients with acute stroke, even if they are normothermic. For this reason, a multicentre, randomized, double-blind clinical trial comparing high-dose paracetamol with placebo in 2500 patients has been launched. This study has been named 'Paracetamol (acetaminophen) in stroke' (PAIS). The primary outcome is death or dependency at three months. The study protocol is simple, and the amount of data to be gathered is limited. The trial will run for four years.

Timing of the effect of acetaminophen on body temperature in patients with acute ischemic stroke.

The authors assessed the time of onset of the hypothermic effect of acetaminophen in 102 patients with acute ischemic stroke. These patients were randomized to treatment with either 1000 mg of acetaminophen (n = 52) or placebo (n = 50), given six times daily. Treatment with high-dose acetaminophen resulted in a 0.26 degrees C (95% CI 0.07 to 0.46 degrees C) lower mean body temperature than placebo treatment within 4 hours. This effect remained present throughout the next 20 hours. A large phase III trial seems warranted.

Effect of testosterone and endurance training on glycogen metabolism in skeletal muscle of chronic hyperglycaemic female rats.

OBJECTIVES: To investigate in glycolytic and oxidative muscles of trained (nine weeks) and untrained hyperglycaemic female rats the effect of hyperandrogenicity and/or endurance training on energy metabolic properties. METHODS: Glycogen content and activity of muscle enzymes with regulatory functions in glycogen synthesis were examined. RESULTS: Testosterone treatment increased glycogen content of extensor digitorum longus (EDL) and soleus muscles of hyperglycaemic sedentary (18% and 84% respectively) and hyperglycaemic trained (7% and 16% respectively) rats. In both types of muscle of the hyperglycaemic testosterone treated exercised subgroup, less depletion of glycogen was found than in the untreated group (38% and 87% for EDL and soleus respectively). CONCLUSIONS: The mechanisms by which training and/or hyperandrogenism alone or in combination elicits their specific effects are complex. Differences in sex, surgery, levels of hormones administered, and exercise model used may be the main reasons for the observed discrepancies. Conclusions from the results: (a) hyperandrogenism is not a primary cause of the development of insulin resistance; (b) glycogen content of slow and fast twitch muscle is increased by training through increased glycogen synthase activity. The most plausible explanation for differences between different muscle fibre types is the different levels of expression of androgen receptors in these fibres. Hyperandrogenicity therefore acts on energy metabolic variables of hyperglycaemic animals by different mechanisms in glycolytic and oxidative muscle fibres.

Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study.

The data of the present case demonstrate that the abuse of androgenic anabolic steroids (AAS) may lead to serious health effects. Although most clinical attention is usually directed towards peripheral side effects, the most serious central side effect, hypothalamic-pituitary-dysfunction, is often overlooked in severe cases. Although this latter central side-effect usually recovers spontaneously when AAS intake is discontinued, the present case shows that spontaneous recovery does not always take place. We suggest that hypothalamic-pituitary dysfunction should always be considered in the differential diagnosis in athletes seen with typical presentation of anabolic steroid use. In order to regain normal hypothalamic-pituitary function, supraphysiological doses of 200 microg LH-RH should be considered when the physiological challenge test with LH-RH (50 microg) fails to show an acceptable response.

Effects of oral bovine colostrum supplementation on serum insulin-like growth factor-I levels.

OBJECTIVES: We investigated whether supplementation with 60 g/d of bovine colostrum affects blood levels of insulin-like growth factor-I (IGF-I) and IGF binding protein-3 in relation to doping testing. Nine endurance-trained men ingested 60 g/d of bovine colostrum for 4 wk. METHODS: Blood and urine were sampled before starting supplementation. After 4 wk urine and blood samples were taken after an overnight fast and 2 h after ingestion of the last portion to study possible acute effects. RESULTS: Blood IGF-I levels before supplementation were (mean +/- standard deviation) 31 +/- 13 nM/L, and no acute effects were observed after 4 wk of supplementation (33 +/- 9 nM/L). Levels of IGF-binding protein-3 were 136 +/- 11 nM/L before supplementation and 135 +/- 16 nM/L after 4 wk of supplementation. Two hours after ingestion of the last portion, the level of IGF binding protein-3 was 131 +/- 19 nM/L, which was not different from baseline values. Drug testing in a laboratory accredited by the International Olympic Committee did not show any forbidden substance before or after 4 wk of supplementation. CONCLUSIONS: Daily supplementation with 60 g of bovine colostrum for 4 wk does not change blood IGF-I or IGF binding protein-3 levels and does not elicit positive results on drug tests.

Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial.

BACKGROUND AND PURPOSE: Body temperature is a strong predictor of outcome in acute stroke. However, it is unknown whether antipyretic treatment leads to early and clinically worthwhile reduction of body temperature in patients with acute stroke, especially when they have no fever. The main purpose of this trial was to study whether early treatment of acute ischemic stroke patients with acetaminophen (paracetamol) reduces body temperature. METHODS: Seventy-five patients with acute ischemic stroke confined to the anterior circulation were randomized to treatment with either 500 mg (low dose) or 1000 mg (high dose) acetaminophen or with placebo, administered as suppositories 6 times daily during 5 days. Body temperatures were measured with a rectal electronic thermometer at the start of treatment and after 24 hours and with an infrared tympanic thermometer at 2-hour intervals during the first 24 hours and at 6-hour intervals thereafter. The primary outcome measure was rectal temperature at 24 hours after the start of treatment. RESULTS: Treatment with high-dose acetaminophen resulted in 0.4 degrees C lower body temperatures than placebo treatment at 24 hours (95% CI 0.1 degrees C to 0.7 degrees C). The mean reduction from baseline temperature with high-dose acetaminophen was 0.3 degrees C (95% CI 0 degrees C to 0.6 degrees C) higher than that in placebo-treated patients. Treatment with low-dose acetaminophen did not result in lower body temperatures. After 5 days of treatment, no differences in temperature were found between the placebo and the high- or low-dose acetaminophen groups. CONCLUSIONS: Treatment with a daily dose of 6000 mg acetaminophen may result in a small, but potentially beneficial, decrease in body temperature shortly after ischemic stroke, even in normothermic and subfebrile patients. Further studies should determine whether this effect is reproducible and whether early reduction of body temperature leads to improved outcome.

Nebivolol: a third-generation beta-blocker that augments vascular nitric oxide release: endothelial beta(2)-adrenergic receptor-mediated nitric oxide production.

BACKGROUND: Nebivolol is a beta(1)-selective adrenergic receptor antagonist with proposed nitric oxide (NO)-mediated vasodilating properties in humans. In this study, we explored whether nebivolol indeed induces NO production and, if so, by what mechanism. We hypothesized that not nebivolol itself but rather its metabolites augment NO production. METHODS AND RESULTS: Mouse thoracic aorta segments were bathed in an organ chamber. Administration of nebivolol did not affect NO production. When nebivolol was allowed to metabolize in vivo in mice, addition of plasma of these mice caused a sustained 2-fold increase in NO release. Interestingly, coadministration of a selective beta(2)-adrenergic receptor antagonist (butoxamine) prevented the response. Immunohistochemistry and Western blot analysis demonstrated the presence of beta(2)- but not beta(1)-adrenergic receptors on endothelial cells. In the absence of calcium, metabolized nebivolol failed to increase NO production, suggesting a role for calcium-dependent NO synthase. With digital fluorescence imaging, a rapid and sustained rise in endothelial cytosolic free Ca(2+) concentration was observed after administration of metabolized nebivolol, which also was abrogated by butoxamine pretreatment. CONCLUSIONS: In vivo metabolized nebivolol increases vascular NO production. This phenomenon involves endothelial beta(2)-adrenergic receptor ligation, with a subsequent rise in endothelial free [Ca(2+)](i) and endothelial NO synthase-dependent NO production. This may be an important mechanism underlying the nebivolol-induced, NO-mediated arterial dilation in humans.