Kathryn H. Myburgh

Low Bone Density Is an Etiologic Factor for Stress Fractures in Athletes

OBJECTIVE To determine whether low bone density and other risk factors for osteoporosis are associated with stress fractures in athletes. DESIGN Case-control study. SETTING Institutional sports injury clinic with primary and secondary care. PARTICIPANTS Twenty-five athletes (nineteen women) with scintigraphically confirmed stress fractures matched for sex, age, weight, height, and exercise history with 25 control athletes with no history of bone injury. MEASUREMENTS AND MAIN RESULTS Bone mineral density measured by dual-energy x-ray absorptiometry was significantly lower in athletes with fractures than in control athletes: In the spine, bone mineral density was 1.01 +/- 0.14 g/cm2 in athletes with fractures and 1.11 +/- 0.13 g/cm2 in control athletes (P = 0.02). In the femoral neck, it was 0.84 +/- 0.09 g/cm2 in athletes with fractures and 0.90 +/- 0.11 g/cm2 in control athletes (P = 0.005). It was also significantly lower in the Ward triangle (P = 0.01) and the greater trochanter (P = 0.01). Eight athletes with fractures and no control athletes had less than 90% of predicted age-related spine density (P = 0.01), and three athletes with fractures had bone mineral densities that were 2 SDs or more below this predicted level. More athletes with fractures than control athletes had current menstrual irregularity (amenorrhea or oligomenorrhea) (P less than 0.005). Fewer athletes with fractures were using oral contraceptives (P less than 0.05). Seven-day diet records indicated similar energy and nutrient intakes, except athletes with fractures had lower calcium intakes (697 +/- 242 mg/d compared with 832 +/- 309 mg/d; P = 0.02). Dairy product intake was lower in athletes with fractures since leaving high school (P less than 0.05). The incidence of a family history of osteoporosis was similar in both groups. CONCLUSIONS In athletes with similar training habits, those with stress fractures are more likely to have lower bone density, lower dietary calcium intake, current menstrual irregularity, and lower oral contraceptive use.

Peak treadmill running velocity during the VO2 max test predicts running performance

Twenty specialist marathon runners and 23 specialist ultra-marathon runners underwent maximal exercise testing to determine the relative value of maximum oxygen consumption (VO2max), peak treadmill running velocity, running velocity at the lactate turnpoint, VO2 at 16 km h-1, % VO2max at 16 km h-1, and running time in other races, for predicting performance in races of 10-90 km. Race time at 10 or 21.1 km was the best predictor of performance at 42.2 km in specialist marathon runners and at 42.2 and 90 km in specialist ultra-marathon runners (r = 0.91-0.97). Peak treadmill running velocity was the best laboratory-measured predictor of performance (r = -0.88(-)-0.94) at all distances in ultra-marathon specialists and at all distances except 42.2 km in marathon specialists. Other predictive variables were running velocity at the lactate turnpoint (r = -0.80(-)-0.92); % VO2max at 16 km h-1 (r = 0.76-0.90) and VO2max (r = 0.55(-)-0.86). Peak blood lactate concentrations (r = 0.68-0.71) and VO2 at 16 km h-1 (r = 0.10-0.61) were less good predictors. These data indicate: (i) that in groups of trained long distance runners, the physiological factors that determine success in races of 10-90 km are the same; thus there may not be variables that predict success uniquely in either 10 km, marathon or ultra-marathon runners, and (ii) that peak treadmill running velocity is at least as good a predictor of running performance as is the lactate turnpoint. Factors that determine the peak treadmill running velocity are not known but are not likely to be related to maximum rates of muscle oxygen utilization.

Skeletal muscle buffering capacity and endurance performance after high-intensity interval training by well-trained cyclists

Abstract Skeletal muscle buffering capacity (βm), enzyme activities and exercise performance were measured before and after 4 weeks of high-intensity, sub maximal␣interval training (HIT) undertaken by six well-trained competitive cyclists [mean maximal oxygen consumption (O2max) = 66.2 ml · kg−1 · min−1]. HIT replaced a portion of habitual endurance training and consisted of six sessions, each of six to eight repetitions of 5 min duration at 80% of peak sustained power output (PPO) separated by 1 min of recovery. βm increased from 206.6 (17.9) to 240.4 (34.1) μmol H+ · g muscle dw−1 · pH−1 after HIT (P = 0.05). PPO, time to fatigue at 150% PPO (TF150) and 40-km cycle time trial performance (TT40) all significantly improved after HIT (P < 0.05). In contrast, there was no change in the activity of either phosphofructokinase or citrate synthase. In addition, βm correlated significantly with TT40 performance before HIT (r = −0.82, P < 0.05) and the relationship between change in βm and change in TT40 was close to significance (r = −0.74). βm did not correlate with TF150. These results indicate that βm may be an important determinant of relatively short-duration (< 60 min) endurance cycling activity and responds positively to just six sessions of high-intensity, submaximal interval training.

The Inflammatory Response to Skeletal Muscle Injury

Injury of skeletal muscle, and especially mechanically induced damage such as contusion injury, frequently occurs in contact sports, as well as in accidental contact sports, such as hockey and squash. The large variations with regard to injury severity and affected muscle group, as well as nonspecificity of reported symptoms, complicate research aimed at finding suitable treatments. Therefore, in order to increase the chances of finding a successful treatment, it is important to understand the underlying mechanisms inherent to this type of skeletal muscle injury and the cellular processes involved in muscle healing following a contusion injury.Arguably the most important of these processes is inflammation since it is a consistent and lasting response. The inflammatory response is dependent on two factors, namely the extent of actual physical damage and the degree of muscle vascularization at the time of injury. However, long-term antiinflammatory treatment is not necessarily effective in promoting healing, as indicated by various studies on NSAID treatment. Because of the factors named earlier, human studies on the inflammatory response to contusion injury are limited, but several experimental animal models have been designed to study muscle damage and regeneration.The early recovery phase is characterized by the overlapping processes of inflammation and occurrence of secondary damage. Although neutrophil infiltration has been named as a contributor to the latter, no clear evidence exists to support this claim. Macrophages, although forming part of the inflammatory response, have been shown to have a role in recovery, rather than in exacerbating secondary damage. Several probable roles for this cell type in the second phase of recovery, involving resolution processes, have been identified and include the following: (i) phagocytosis to remove cellular debris; (ii) switching from a pro- to anti-inflammatory phenotype in regenerating muscle; (iii) preventing muscle cells from undergoing apoptosis; (iv) releasing factors to promote muscle precursor cell activation and growth; and (v) secretion of cytokines and growth factors to facilitate vascular and muscle fibre repair. These many different roles suggest that a single treatment with one specific target cell population (e.g. neutrophils, macrophages or satellite cells) may not be equally effective in all phases of the post-injury response.To find the optimal targeted, but time-course-dependent, treatments requires substantial further investigations. However, the techniques currently used to induce mechanical injury vary considerably in terms of invasiveness, tools used to induce injury, muscle group selected for injury and contractile status of the muscle, all of which have an influence on the immune and/or cytokine responses. This makes interpretation of the complex responses more difficult. After our review of the literature, we propose that a standardized non-invasive contusion injury is the ideal model for investigations into the immune responses to mechanical skeletal muscle injury. Despite its suitability as a model, the currently available literature with respect to the inflammatory response to injury using contusion models is largely inadequate.Therefore, it may be premature to investigate highly targeted therapies, which may ultimately prove more effective in decreasing athlete recovery time than current therapies that are either not phase-specific, or not administered in a phase-specific fashion.

Running economy of African and Caucasian distance runners.

PURPOSE Anecdotal evidence suggests an advantageous physiological endowment of the African endurance athlete. Higher fractional utilization of VO2max has been suggested but not measured directly, and investigations of running economy have been inconclusive. The aim of the current study was to measure a) running economy and b) fractional utilization of VO2max, in African and Caucasian 10-km runners of similar body mass. METHODS Eight African and eight Caucasian runners had no significant difference in mean race time (32.8 +/- 2.8, 32.0 +/- 2.5 min, respectively), body mass (61.4 +/- 7.0, 64.9 +/- 3.0 kg), age, body fat, or lean thigh volume. Caucasian runners were 6 cm taller (P < 0.05). Subjects completed a progressive treadmill VO2peak test. On a separate day, subjects completed two 6-min workloads (16.1 km x h(-1) and 10-km race pace) separated by 5 min. RESULTS Mean VO2peak was 13% lower in the Africans (61.9 +/- 6.9, 69.9 +/- 5.4 mL x kg(-1) x min(-1), P = 0.01). At 16.1 km x h(-1), the Africans were 5% more economical (47.3 +/- 3.2, 49.9 +/- 2.4 mL x kg(-1) x min(-1), P < 0.05). This difference increased to 8% (P < 0.01) when standardized per kg(0.66). At race pace, the Africans utilized a higher %VO2peak (92.2 +/- 3.7, 86.0 +/- 4.8%, P < 0.01) and had higher HR (185 +/- 9, 174 +/- 11 b x min(-1), P < 0.05) and plasma [ammonia] (113.2 +/- 51, 60.3 +/- 16.9 micromol x L(-1), P < 0.05). Despite the higher relative workload, the plasma [lactate] was not different (5.2 +/- 2.0, 4.2 +/- 1.7 mmol x L(-1), NS). CONCLUSIONS This study indicates greater running economy and higher fractional utilization of VO2peak in African distance runners. Although not elucidating the origin of these differences, the findings may partially explain the success of African runners at the elite level.

The influence of weekly training distance on fractional utilization of maximum aerobic capacity in marathon and ultramarathon runners

SummaryThis study was designed to examine the interrelationships between performance in endurance running events from 10 to 90 km, training volume 3–5 weeks prior to competition, and the fractional utilization of maximal aerobic capacity (%

Training techniques to improve fatigue resistance and enhance endurance performance

\dot V_{O_{2max} }

Skeletal muscle wasting with disuse atrophy is multi-dimensional: the response and interaction of myonuclei, satellite cells and signaling pathways

) during each of the events. Thirty male subjects underwent horizontal treadmill testing to determine their