D.C. Janse van Rensburg

Heart Rate Variability Assessment of the Effect of Physical Training on Autonomic Cardiac Control

Background: The effect of exercise interventions on autonomic nervous system (ANS) control of the heart by heart rate variability (HRV) is often investigated in just one position. It was hypothesized that results of exercise‐induced changes on ANS are dependent on body position and that it is possible to distinguish between exercise induced changes in vagal and sympathetic influence by taking measurements in different body positions.

Sports injuries in adults: overview of clinical examination and management

Abstract A wide variety of anatomical structures can be involved in a sports injury. To return to play as soon as possible is of utmost importance to an athlete, and in order to achieve this, a correct, all-inclusive diagnosis, a well-focused treatment plan, and a management plan that strives to offer protection are essential. This article aims to give an overview of acute and overuse (chronic) sports injuries in adults, the approach to an accurate diagnosis and the management strategies that are available. A literature review was conducted of scientific journals, text and internet material, including a Medline and PubMed search. Literature was selected for its in-depth data and well-researched information. Key search terms included “acute and overuse injuries”, as well as “sports injuries diagnosis and management” to address current and relevant scientific data on the examination and management of sports injuries in adults. The literature review indicated that sports injuries (both acute and overuse) are increasing in number due to the growing interest in physical activity and sport, as well as the enhanced intensity of training programmes. Adults are vulnerable to both types of sports injuries, and the age of occurrence of overuse injuries varies in competitive and non-competitive athletes. The importance of making an accurate diagnosis cannot be overemphasised. To assist the clinician in making an accurate diagnosis, a comprehensive history, physical examination and appropriate special investigations are mandatory. Familiarity with the demands of the athletes sport may also prove useful. The approach to the management of acute and overuse injuries differs, with the emphasis in acute injuries being on treating the effect (torn, broken, displaced) and in chronic injuries on treating the cause (intrinsic or extrinsic). There have been numerous advances in the management of sports injuries, however further research is still warranted in this area. Follow-up articles will focus more in-depth on specifics with regard to clinical examination, special investigations and management options.

Iliopsoas haematoma in a rugby player

Traumatic iliopsoas haematoma is a serious complication of haemorrhage disorders rarely seen in young healthy athletes. It is mostly described in patients on anticoagulant therapy and commonly associated with various degrees of femoral nerve palsy. A 22-year-old male rugby player presented with severe onset of pain in the lower back, right hip flexor/pelvic area following a tackle during a rugby match. Magnetic resonance imaging identified a distinct, hyperechoic heterogeneous mass within the right iliopsoas muscle, confirming a diagnosis of iliopsoas haematoma. The case resolved completely after conservative medical treatment in addition to a period of rest and intense active physical therapy. This case study reports the rare diagnosis of an uncomplicated iliopsoas haematoma following a sports injury in a young athlete.

Cardiovascular and autonomic response induced by a 20-week military training programme in young healthy South African males

Background. Studies investigating the relationship between exercise and haemodynamic regulation conducted in older caucasian and black African populations suggest that lifestyle modification is effective in the management of numerous disease processes. There are few longterm studies in young healthy populations and even less is known about the influence of habitual exercise on autonomic and haemodynamic variables in young black African subjects. Objective. To investigate the benefit of prolonged exercise on cardiovascular and haemodynamic variables in young healthy black African males. Methods. Fifty-five healthy male volunteers between 18 and 22 years of age participated in this prospective 20-week medium- to highintensity exercise intervention study with a self-control design. The Finometer Pro (Finapres Medical Systems, the Netherlands) was used for non-invasive data sampling of a number of cardiovascular and autonomic variables. Results were generated by computer algorithm and were analysed using non-parametric Wilcoxon signed rank tests. Results. Significant (p 0.05). Conclusion. The measured changes suggest a favourable response to exercise and imply that habitual exercise may be an important lifestyle modification for reducing the risk of cardiovascular disease in young black African males.

Primary spontaneous pneumothorax in a recreational athlete

Primary spontaneous pneumothorax (PSP) is relatively uncommon in the athletic population. Because of the subtle nature of the symptoms, the diagnosis is easily missed, which can lead to unnecessary prolonged discomfort and recovery time for the athlete. ere is currently a lack of evidence in the literature concerning treatment and return-to-play protocols referring specically to PSP within the athletic community. is case report highlights the predisposing and important factors in the history of a 34-year-old recreational male athlete who developed PSP. According to the knowledge of the authors, this report of PSP in a recreational athlete is the rst of its kind described in South Africa. Owing to the possibility of life-threatening complications, it is important for sports physicians to be familiar with the important points in the history and to be made aware of the predisposing factors that may lead to PSP.

Non-traumatic injury profile of amateur cyclists

Background. Non-traumatic bicycle injuries are common. However, research available on non-traumatic injuries in amateur cyclists is more than a decade old, and most of the research on this topic has been done in Europe and America on professional cyclists in multi-day cycling events. An understanding of the common injuries may lead to appropriate prevention intervention. Objective. To determine the incidence of overuse injuries in amateur cyclists preparing for participation in a 1-day cycle challenge. Methods. A questionnaire was emailed to participants of the 2012 Momentum 94.7 Cycle Challenge, which amateur participants ≥18 years old were invited to complete. Data on demographics, training habits and the participants’ injury profile in the preceding year were collected. Results. Of the 3 300 respondents, 75% were male and 59% were between 30 and 50 years old. Non-traumatic injury, pain or neurological symptoms were reported by 88% of the respondents. The percentages of all respondents who experienced problems in the following anatomical areas were as follows: neck 34%, back 41%, hand/wrist 41%, buttock/perineum 41%, hip 7%, knee 33% and foot/ankle 24%. Knee pain was responsible for the need to stop training for the largest percentage of respondents. Neurological complaints were common in respondents who experienced neck, back, hand/wrist, buttock/perineum and foot/ankle problems. Conclusion. Non-traumatic injuries in amateur cyclists are common, with back, hand/wrist and buttock/perineal symptoms the most frequent problems. Knee problems caused the greatest need to stop training and seek medical help.

The correlation between the health-related fitness of healthy participants measured at home as opposed to fitness measured by sport scientists in a laboratory

Background: Fitness is defined in the health context as a state of good health or physical condition, primarily as a result of exercise and proper nutrition. Conventional methods of measuring fitness are expensive, time consuming and require specialised methods. There is a need for noninvasive, fast methods of assessing health-related fitness and activity in athlete and non-athlete populations. The aim of this study was to establish any correlation between participants’ self-assessed health-related fitness (HRF) index and the HRF index determined by sports scientists, as well as the laboratory-assessed HRF index and maximum oxygen uptake (VO2max) determined by sports scientists via direct methods in a laboratory, and finally, to determine any potential correlation between an activity-recall questionnaire (Kasari) and VO2max. Method: The participants consisted of 169 male and female volunteers between the ages of 18 and 55 years, taking neither supplements nor medication. The University of Pretoria’s HRF index protocol was first carried out by participants on their own at home, and then in the laboratory under the supervision of sport scientists. The complete datasets of 150 participants were statistically analysed to establish correlations. Results: The results indicated highly significant and substantial correlations (ρ = 0.696, p < 0.001) between the participants’ self-assessed HRF index and measurements by the sports scientists. There were moderate correlations between the laboratory-assessed HRF index and the direct VO2max (ρ = 0.512, p < 0.005), as well as the indirect VO2max (ρ = 0.588; p < 0.001). A significant correlation was found between the self-assessed HRF index and the indirect VO2max (ρ = 0.454; p < 0.001). The Kasari questionnaire correlated only weakly with the indirect VO2max (ρ = 0.278, p < 0.002) and not at all with the direct VO2max (ρ = 0.072, p < 0.731). Conclusion: Indications are that this test protocol may be conducted at home by individuals, without supervision, to determine exercise ability or fitness, or to monitor changes in physical fitness, thereby limiting expenses and costs.

Revisiting the importance of childhood activity

Abstract Formalised exercise programmes for children and adolescents are becoming increasingly important. There has been a drastic increase in documented childhood morbidity and mortality relating to poor nutrition and low activity levels in recent years. Regular physical activity decreases the risk of chronic disease and is also a fundamental component in the management of illnesses. Recommendations for the paediatric population remain insufficient and ill-defined. This article revisits the risks of physical inactivity in childhood and provides the latest recommendations for exercise prescription in the paediatric population. Inactive children have a higher risk of developing chronic diseases, such as obesity, type 2 diabetes, high blood cholesterol and hypertension. Other undesirable consequences include orthopaedic problems, cardiovascular disease and various psychological complications. Both aerobic and resistance training should be incorporated into paediatric exercise programmes. The recommended guidelines for childhood activity are 60 minutes of moderate-intensity exercise every day of the week. This article highlights the importance of formalised paediatric exercise programmes in disease prevention and health promotion. A healthy and happy adolescent population ultimately contributes to an adult population with a low risk of ill health.

Exercise prescription in the management of rheumatoid arthritis

Abstract Background: Over the last few years, the types of exercises prescribed for patients with rheumatoid arthritis (RA) have changed. There is also increasing knowledge on the physical status and physical activity levels of these patients. This article aims to give an overview of the physical status, physical activity levels and appropriate exercise prescription for patients with RA. Method: A literature search was conducted of scientific journals and text, including Medline and PubMed (1980–2012). Literature was selected for its in-depth data and well researched information. Key search terms included “RA and exercise therapy”, as well as “physical activity levels and physical status of patients with RA”. Results: The literature indicated that RA has a major impact on physical and psychological health. Over the past decade, there has been growing evidence of the health benefits of physical activity for patients with RA. Despite this evidence, patients with RA are less physically active than the general population. The types of exercises prescribed for patients with RA have changed from the traditionally prescribed isometric and range-of-motion exercises. However, proper choice and appropriate utilisation of exercise is essential in order to provide a therapeutic effect. Conclusion: Although pharmacological interventions have largely improved RA management, exercise therapy remains an important part of treatment. Despite the known benefits of physical activity and exercise, patients with RA are less physically active than the general population.

Acute corticosteroid-induced rhabdomyolysis in a golf player

Acute corticosteroid-induced rhabdomyolysis is a rare, but potentially life-threatening, condition that deserves the attention of medical professionals and sport scientists. Early diagnosis is vital in minimising the secondary damage caused by rhabdomyolysis. This case of rhabdomyolysis highlights the severity of symptoms and the importance of decisive treatment. Clinicians should be familiar with the most common symptoms of acute corticosteroid-induced rhabdomyolysis to enable early diagnosis and efficient management of this condition.