Anja Carlsohn

Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes.

Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0u2009±u20091.9 years; 160u2009±u200913u2009cm; 50u2009±u200914u2009kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (Pu2009≤u20090.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (Pu2009≤u20090.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.

Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years.

Background Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1–12 years. Methods A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0±2.9yr; 1.23±0.19m; 26.6±10.6kg; BMI: 17.1±2.4kg/m2) were included for (complete case) data analysis. Children were categorized to normal-weight (≥3rd and <90th percentile; n = 6458), overweight (≥90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid- and hindfoot. Data was analyzed descriptively (mean ± SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12yrs (post-hoc Tukey Kramer/Dunnett’s C; α = 0.05). Results Mean walking velocity was 0.95 ± 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p<0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight. Conclusion Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.

Tendon adaptation to sport-specific loading in adolescent athletes

Tendon adaptation due to mechanical loading is controversially discussed. However, data concerning the development of tendon thickness in adolescent athletes is sparse. The purpose of this study was to examine possible differences in Achilles (AT) and patellar tendon (PT) thickness in adolescent athletes while considering age, gender and sport-specific loading. In 500 adolescent competitive athletes of 16 different sports and 40 recreational controls both ATs and PTs were sonographically measured. Subjects were divided into 2 age groups (<u200913; ≥u200913 years) and 6 sport type categories (ball, combat, and water sports, combined disciplines, cycling, controls). In addition, 3 risk groups (low, moderate, high) were created according to the athletes risk of developing tendinopathy. AT and PT thickness did not significantly differ between age groups (AT/PT:<13: 5.4±0.7u2009mm/3.6±0.5u2009mm;≥13: 5.3±0.7u2009mm/3.6±0.5u2009mm). In both age groups males presented higher tendon thickness than females (p<0.001). AT thickness was highest in ball sports/cyclists and lowest in controls (p≤0.002). PT thickness was greatest in water sports and lowest in controls (p=0.02). High risk athletes presented slightly higher AT thickness compared to the low risk group (p=0.03). Increased AT and PT thickness in certain sport types compared to controls supports the hypothesis of structural tendon adaptation due to sport-specific loading.

Reliability and day-to-day variability of peak fat oxidation during treadmill ergometry

BackgroundExercising at intensities where fat oxidation rates are high has been shown to induce metabolic benefits in recreational and health-oriented sportsmen. The exercise intensity (Fatpeak) eliciting peak fat oxidation rates is therefore of particular interest when aiming to prescribe exercise for the purpose of fat oxidation and related metabolic effects. Although running and walking are feasible and popular among the target population, no reliable protocols are available to assess Fatpeak as well as its actual velocity (VPFO) during treadmill ergometry. Our purpose was therefore, to assess the reliability and day-to-day variability of VPFO and Fatpeak during treadmill ergometry running.MethodsSixteen recreational athletes (fu2009=u20097, mu2009=u20099; 25u2009±u20093 y; 1.76u2009±u20090.09xa0m; 68.3u2009±u200913.7xa0kg; 23.1u2009±u20092.9xa0kg/m2) performed 2 different running protocols on 3 different days with standardized nutrition the day before testing. At day 1, peak oxygen uptake (VO2peak) and the velocities at the aerobic threshold (VLT) and respiratory exchange ratio (RER) of 1.00 (VRER) were assessed. At days 2 and 3, subjects ran an identical submaximal incremental test (Fat-peak test) composed of a 10xa0min warm-up (70xa0% VLT) followed by 5 stages of 6xa0min with equal increments (stage 1u2009=u2009VLT, stage 5u2009=u2009VRER). Breath-by-breath gas exchange data was measured continuously and used to determine fat oxidation rates. A third order polynomial function was used to identify VPFO and subsequently Fatpeak. The reproducibility and variability of variables was verified with an intraclass correlation coefficient (ICC), Pearson’s correlation coefficient, coefficient of variation (CV) and the mean differences (bias)u2009±u200995xa0% limits of agreement (LoA).ResultsICC, Pearson’s correlation and CV for VPFO and Fatpeak were 0.98, 0.97, 5.0xa0%; and 0.90, 0.81, 7.0xa0%, respectively. Biasu2009±u200995xa0% LoA was −0.3u2009±u20090.9xa0km/h for VPFO and −2u2009±u20098xa0% of VO2peak for Fatpeak.ConclusionIn summary, relative and absolute reliability indicators for VPFO and Fatpeak were found to be excellent. The observed LoA may now serve as a basis for future training prescriptions, although fat oxidation rates at prolonged exercise bouts at this intensity still need to be investigated.

Ultrasound Applied to Subcutaneous Fat Tissue Measurements in International Elite Canoeists.

Subcutaneous adipose tissue (SAT) measurements with ultrasound have recently been introduced to assess body fat in elite athletes. However, appropriate protocols and data on various groups of athletes are missing. We investigated intra-rater reliability of SAT measurements using ultrasound in elite canoe athletes. 25 international level canoeists (18 male, 7 female; 23±4u2009years; 81±11u2009kg; 1.83±0.09u2009m; 20±3 training h/wk) were measured on 2 consecutive days. SAT was assessed with B-mode ultrasound at 8 sites (ISAK): triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, front thigh, medial calf, and quantified using image analysis software. Data was analyzed descriptively (mean±SD, [range]). Coefficient of variation (CV%), intraclass correlation coefficient (ICC, 2.1) and absolute (LoA) and ratio limits of agreement (RLoA) were calculated for day-to-day reliability. Mean sum of SAT thickness was 30.0±19.4u2009mm [8.0, 80.1u2009mm], with 3.9±1.8u2009mm [1.2u2009mm subscapular, 8.0u2009mm abdominal] for individual sites. CV for the sum of sites was 4.7%, ICC 0.99, LoA 1.7±3.6u2009mm, RLoA 0.940 (u2009*u2009 /÷1.155). Measuring SAT with ultrasound has proved to have excellent day-to-day reliability in elite canoe athletes. Recommendations for standardization of the method will further increase accuracy and reproducibility.

Ernährungsverhalten von Gesundheits- und Krankenpflegern im Nachtdienst

ZusammenfassungHintergrundSchicht- und Nachtarbeit beeinflussen das Ernährungsverhalten. Dies kann zur Entstehung von ernährungsmitbedingten Erkrankungen führen. Dennoch liegen für Gesundheits- und Krankenpfleger, als größte von Schichtarbeit betroffene Berufsgruppe, im Gesundheitswesen bisher kaum Daten vor. Ziel ist es daher, das Ernährungsverhaltens von Gesundheits- und Krankenpflegern (GKP) während des Nachtdienstes zu erfassen.MethodeDas Ernährungsverhalten von 19xa0GKP wurde mithilfe eines „doubly labelled water“ validierten, offenen 3‑Tage-Ernährungsprotokolls erfasst. Die ermittelte tägliche Zufuhr verschiedener Lebensmittelgruppen wurde mit den gesundheitsförderlichen Orientierungswerten verglichen.ErgebnisseGKP weisen Defizite bei der Umsetzung der Ernährungsempfehlungen auf. Dies betrifft insbesondere den zu geringen Konsum von Gemüse (1,43u202f±u20090,88 Portionen [P]/Tag), Obst (1,54u202f±u20091,21u202fP/Tag) und Getreideprodukten (2,36u202f±u20090,93u202fP/Tag).DiskussionHinsichtlich des Lebensmittelverzehrs wurden keine Unterschiede zwischen den GKP und der deutschen Bevölkerung erfasst. Stattdessen wurden während der Schichtarbeit eine Umverteilung der Mahlzeiten von Tag zu Nacht, ungewöhnliche und unregelmäßige Essenszeiten sowie ein geringer Verzehr warmer Mahlzeiten beobachtet. Aufgrund dieser Defizite sollten gesundheitsförderliche Maßnahmen auf Verhaltens- und Verhältnisebene in den Klinikalltag integriert werden.AbstractBackgroundShift and night work affect nutritional behaviour. This can promote non-communicable diseases. Until now, few studies analysing the nutritional behaviour of nurses are available, even though this is the largest occupational group affected by shift work in health care. Therefore, the objective of this work is to investigate the nutritional behaviour of nurses working night shifts.MethodThe dietary intake of 19xa0nurses was assessed using axa0doubly labelled water validated, open 3xa0day-dietary record and the recommendations for food intake.ResultsThe results indicate that nurses working night shifts show similar nutritional shortcomings compared to the general German population. Especially the intake of vegetables (1.43u202f±u20090.88 servings/day), fruits (1.54u202f±u20091.21u202fservings/day) and cereals (2.36u202f±u20090.93u202fservings/day) is not sufficient.ConclusionsIn addition, we observed axa0redistribution of meals from day to night, unusual and irregular mealtimes as well as axa0low consumption of warm meals during night shifts. Therefore, health-promoting interventions at the behavioural and environmental levels should be integrated into the daily routine in hospitals.

Vegetable consumption among university students: Relationship between vegetable intake, knowledge of recommended vegetable servings and self-assessed achievement of vegetable intake recommendations:

Objectives: To investigate the relationship between vegetable intake, knowledge of recommended vegetable servings and self-assessed achievement of vegetable intake recommendations. Design and setting: Cross-sectional nutritional study in a university setting. Method: Students answered a set of standardised questions. Vegetable intake was assessed using a food frequency questionnaire (FFQ). Knowledge of recommended vegetable servings was determined by asking how many servings of vegetables should be part of the daily diet. Self-assessed achievement of vegetable recommendation was operationalised using the behavioural stages of the Health Action Process Approach (HAPA). Results: Mean vegetable intake was 176 ± 165 g/day for women and 179 ± 153 g/day for men. Overall, 7.3% of women and 9.8% of men achieved the recommended vegetable intake. Recommended vegetable servings were correctly identified by 68.5% of women and 47.1% of men. About 34.1% of women and 23.5% of men believed they could achieve the recommended intake of vegetables. However, of these, only 18.7% and 33.3% actually achieved the recommended intake. These students did not differ with respect to their knowledge of recommended vegetable servings from those who stated they achieved the recommended intake but in fact did not. Conclusion: Our study identified a potential target group who did not know that their vegetable intake was below the recommended level. It may be concluded that students have difficulty correctly estimating amounts of vegetables. From a health promotion perspective, this creates the need for the practice-oriented communication of dietary recommendations.