Browsing by Subject "Sports Medicine"
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- ItemOpen AccessAchilles tendon ultrasound findings in triathletes before and after the ironman triathlon(2006) Schwabe, Karen; Schwellnus, MartinThe aim of this prospective cohort study therefoew was to assess the morphological and blood flow changes in the Achille tendons of triathletes competing in the 2006 South African Ironman Triathlon.
- ItemOpen AccessThe association of the AVPR2 gene with serum sodium and water imbalances during an Ironman Triathlon(2007) Ah Kun, Maresa; Collins, MalcolmIt is well documented that participation in ultra-endurance events such as the Ironman Triathlon, can be associated with the development of post-race water and sodium imbalances in athletes. Variants within genes that encode for proteins that regulate thirst have been shown to be associated with weight changes during participation in an Ironman Triathlon. Recent evidence of mutations within the arginine vasopressin 2 receptor (AVPR2) gene, which encodes a constitutively active receptor in the collecting tubules of the kidney, resulted in increased water reabsorption and hyponatraemia in two unrelated male infants. This suggests that serum imbalances and hydration status in individuals participating in an endurance event may also be, in part, controlled by variants withink the AVPR2 gene. The aim of this study was to investigate whether polymorphisms within the AVPR2 gene are associated with exercise-associated serum sodium and/or water imbalances in triathletes who particpated in the 2006 South African Ironman Triathlon.
- ItemOpen AccessClinical and immunological factors associated with post-race upper respiratory tract symptoms (URTS) in Ironman triathletes(2007) Baxter, PeterUltra-endurance events, in particular Ironman Triathlons, are physically very demanding for the competitors. There is a large body of evidence showing the Upper Respitory Tract Symptoms (URTS) are very common in athletes in the 2-week period after such an event. However, there is no definitive explanation as t the exact cause of mechanism for the development of post-race URTS. The aims of this study were: (1) to determine the incidence of post-race URTS in triathletes competing in an Ironman Triathlon; (2) to identify clinical and immunological factors that are associated with the development of post-race URTS in these triathletes. In this prospective cohort study, 99 triathletes entering the 2006 South African Ironman Triathlon were recruited as subjects. All the subjects completed a validated questionnaire in the one to three days before the race (during registration). The questionnaire contrained sections on demographics, training history and previous performances, common general medical conditions that they may have experienced, and a detailed section pertaining to respiratory tracgt symptoms (RTS) and allergies. At registration, each subject had a blood sample taken for analysis of cytokines representing mainly a TH1 response (IL-2, and IL-12) (cell mediated immunity) and a TH2 response (IL-4, IL-6, IL-10) (humoral immunity), as well as a saliva sample (for salivary α-amylase, cortisol and IgA concentrations). Collection of blood and saliva samples was repeated immediately post-race. Data regarding race performance was collected within one week after completion of the race.
- ItemOpen AccessA comparison of two treatment protocols in the management of exercise-associated postural hypotension (EAPH) : a randomised clinical trial(2007) Anley, Cameron; Schwellnus, Martin; Noakes, Tim; Collins, MalcolmThe aim of this study was to compare which of the two commonly used treatment protocols for Exercise Associated Postural Hypotension (EAPH) (Trendelenburg with oral fluids ad libitum or intravenous fluids) result in quicker recovery and earlier discharge from the medical facility.
- ItemOpen AccessThe effect of musculoskeletal injury on endogenous nandrolone metabolism(2003) Kohler, R M N; Lambert, M IBibliography: leaves 55-66.
- ItemOpen AccessThe effects of an ultra-endurance event on heart rate variability and cognitive performance during induced stress in Ironman triathletes(2009) Joubert, Ilse; Derman, WayneThe effects of long-term participation in ultra-endurance exercise on the cardiovascular system have recently been the subject of much interest. It is well known that HRV, a marker of autonomic activity, is enhanced with long-term aerobic exercise training. However, after acute exercise, HRV is reduced, but recovers over time depending on the intensity of the prior bout of exercise. A limitation of previous research is that exercise bouts of only up to 120 minutes have been studied. A modified Stroop Task is a laboratory stressor to assess executive cognitive function by means of reaction time and accuracy. The resting HRV is directly related to these prefrontal neural functions, but the effect of an altered HRV on cognitive function has never been investigated. We determined the effects of an ultra duration (10 – 15 hours) exercise event on parameters of HRV and cognitive function during a Modified Stroop Task, 60 – 200 minutes after the 2007 South African Ironman Triathlon event (3,6km swim; 180 Km cycle; 42,2 Km run). 1 Female and 13 male competing triathletes (IRON; ages 33.7±7.9) and 7 control subjects (CON; 2 female and 5 males aged 42 ±4.5) completed a Modified Stroop Task before and after the event. The individual HRV parameters, heart rate (HR), respiratory frequency (RF), reaction time (RT) and % of mistakes made were recorded via the Biopac MP150WSW System (Goletta, California, USA). Data was transformed by auto regressive analyses (Biomedical signal analysis group, University of Kuopio, Finland) into LF (0.04 - 0.15 Hz) and HF (0.15 - 0.5 Hz) components. Additional calculations included %LF and %HF as well as the central or peak frequencies in both the LF and HF bands.
- ItemOpen AccessEffects of exercise training on left ventricular function and exercise capacity in patients with coronary artery disease and varying degrees of left ventricular dysfunction(1999) Digenio, Andres G; Noakes, Timothy DThe medical profession has increased its acceptance of the benefits of exercise training for patients with uncomplicated coronary artery disease. Access to more modem technology and better management of this condition has led to an increase in the number of patients surviving acute coronary episodes . Some of these patients may have developed chronic asymptomatic left ventricular dysfunction and/or residual myocardial ischaemia, and could become potential candidates for cardiac rehabilitation if exercise training could induce physiological benefits without further deteriorating their condition. Over the last 10 years, several patients at moderate to high risk of future cardiovascular events because of the presence of left ventricular dysfunction and/or myocardial ischaemia have been accepted for cardiac rehabilitation at the Johannesburg Cardiac Rehabilitation Center. The purpose of the study was to evaluate the effects of exercise training on left ventricular function and exercise capacity in patients with coronary artery disease and varying degrees of left ventricular dysfunction and/or myocardial ischaemia attending the Johannesburg Cardiac Rehabilitation Center.
- ItemOpen AccessThe effects of water ingestion on high intensity cycling performance in a moderate ambient temperature(1994) Robinson, Tracy Anne; Hawley, John; Dennis, SteveEight endurance~trained cyclists rode as far as possible in 1 h on a stationary cyclesimulator in a moderate environment (20°C, 60% relative humidity, 3 m/s wind speed) while randomly receiving either no fluid (NF) or attempting to replace their ~1.7 l sweat loss measured in a previous 1 h familiarisation performance ride at ~85% of peak oxygen uptake (VO₂ peak) with artificially sweetened, coloured water (F). During F the cyclists drank 1.49 ± 0.14 1 (values are mean± SEM), of which 0.27 ± 0.08 1 remained in the stomach at the end of exercise and 0.20 ± 0.05 1 was urinated after the trial. Thus, only 1.02 ± 0.12 l of the ingested fluid was available to replace sweat losses during the 1 h performance ride. That fluid decreased the average heart rate from 166 ± 3 to 157 ± 5 beats/min (P < 0.0001) and reduced the final serum [Na+] and osmolalities from 143 ± 0.6 to 139 ± 0.6 mEq/1 (P < 0.005) and from 294 ± 1.7 to 290 ± 1.9 mOsm/1 (P = 0.05), respectively. Fluid ingestion did not attenuate rises in plasma anti diuretic hormone and angiotensin concentrations, or decrease the ~-15% falls in estimated plasma volume in the F and NF trials. Nor did fluid ingestion significantly effect the ~1.7 l/h sweat rates, the rises in rectal temperature (~36.6° to 38.3°C) or the ratings of perceived exertion in the two trials. Ingestion of ~1.5 l of fluid produced an uncomfortable stomach fullness and reduced the distance covered in 1 h from 43.1 ± 0. 7 to 42.3 ± 0.6 km (P<0.05). Thus, trying to replace > 1.0 l/h sweat losses during high-intensity, short duration exercise in a moderate environment does not induce beneficial physiological effects, and may impair exercise performance.
- ItemOpen AccessThe end of season electroencephalographic and neuropsychological status of a team of secondary school rugby players : a comparison between very mild traumatic brain injury and a sedentary control group(2004) Dijkstra, Hendrick Paulus; Schwellnus, MartinAlthough the incidence and consequences of mild traumatic brain injury (MTBI) in secondary school rugby has been well documented, little is known about the incidence and consequences of repetitive sub concussive injuries - the so called very mild traumatic brain injuries (vMTBI). The aim of this study was to compare the end of season neuropsychological and electroencephalographic (EEG) status as well as the academic performance of players in a secondary school rugby team who, during the course of the season sustained only repetitive vMTBI to those players who sustained MTBI and a sedentary control group.
- ItemOpen AccessThe epidemiology of injuries in professional rugby union in South Africa(2001) Holtzhausen, Louis Johannes; Schwellnus, Martin PThe first aim of this study was therefore to review the available literature on the epidem iology of injuries in professional rugby. The second aim was to collect data on medical profiles, previous injuries, use of protective gear, medication and nutritional supplements in South African professional rugby players. Thirdly, the incidence, nature and circumstances surrounding injuries in a cohort of professional South African rugby players were documented. The data collected was compared with available literature.
- ItemOpen AccessThe epidemiology of injuries in South African high school soccer players(1998) Ramathesele, Jonas Ramorwesi; Schwellnus, Martin PThe aim of the study was to document the epidemiology of injuries sustained by South African high school soccer players. Subjects for the study were selected from all the high schools (n = 10) in Tembisa (Gauteng, South Africa). A cohort of 227 high school soccer players, representing all the players in the Tembisa schools, was followed over one playing season. All practice and match hours were recorded and specific injury report forms were completed by all the coaches. All injured players were then referred to the principal investigator (JR) for detailed examination to document injuries. Factors such as pre-season training, warm-up, stretching, playing surface, environmental factors, and the use of protective equipment were also recorded. In this study, 63% of all the players sustained an injury during the season (seasonal incidence). The overall incidence of injuries was 9.04/1000 hours of play. The incidence in matches was 274 times higher than in practice. More than half (57%) of the injuries were classified as moderate. The highest incidence of injury per player position was in goalkeepers (13.7/1000 hours play). The lower extremity accounted for most injuries (88.8%), principally the ankle (42.4%) and the knee (27.1%). The most common type of injury was a ligamentous sprain (68%), followed by musculotendinous strains (15.8%). There were only two joint dislocations, and no fractures. All the participants in this study played on gravel pitches and on no occasion was a first-aid kit available. The majority of players were not aware of appropriate stretching, warm-up, and strapping techniques to prevent injuries. None of the players engaged in any form of pre-season training. In two of the schools (20%) the soccer coaches had formal training with coaching certification. Although the injury rate in high school soccer players in this study is only slightly higher than that reported · by others, it is clear that scientifically based measures of injury prevention (pre-season training, warm-up, stretching, and strapping) need to be implemented in these schools. In addition, proper sports and first-aid facilities should be provided, and coaches should receive formal continuous training.
- ItemOpen AccessExercise induced bronchospasm and chlorine in swimming pools(2004) Williams, ArthurThe purpose of this thesis was firstly to review the possible relationship between chlorine in swimming pool water and exercise induced bronchospasm, and secondly to assess whether chlorine exposure during swimming provokes EIB in well-trained swimmers with and without a history of EIB.
- ItemOpen AccessExercise-associated muscle cramping (EAMC) in Ironman triathletes(2006) Drew, Nichola; Schwellnus, Martin; Collins, MalcolmExercise-associated muscle cramping (EAMC) is a common condition of spontaneous, painful skeletal muscle spasms that occur in exercising muscles during exercise or in the immediate post-exercise period. There is a high prevalence in endurance athletes, including ultra-distance triathletes. The exact cause for this condition has not been defined but various hypotheses have been proposed. Over the last decade the ""fatigue hypothesis"" has received most of the support in the scientific literature. Evidence from animal experiments, clinical studies on endurance athletes and situational information, suggest that neuromuscular fatigue may precede the increased neuromuscular excitability leading to EAMC. The objective of this research study was to identify factors associated with EAMC in endurance triathletes in an attempt to further elucidate the aetiology. Triathletes competing in the 2006 South African lronman triathlon were recruited as subjects in a prospective cohort study. A total of 44 triathletes made up the cramping group and 166 the non-cramping group. A detailed questionnaire, including information on training, personal best performances and a cramping history was completed by both groups of triathletes. Full clinical data was also collected from both groups. This included pre-and post race body weights, and pre- and post-race serum electrolyte concentrations. The main findings of the study were that the two independent risk factors for EAMC in these triathletes were a faster overall race time (and cycling time), and a past history of cramping (in the last 10 races). Results showed that EAMC was correlated with faster overall and cycle section times. The athletes who had experienced cramps in this event not only achieved taster race times but also predicted faster times, despite similarly matched preparation and performance histories as those who did not cramp. A higher intensity of racing would thus be required by these athletes, predisposing them to premature fatigue. The results thus agree with the ""fatigue hypothesis"" as an aetiological mechanism for EAMC. This study also showed no correlation between EAMC and changes in hydration status or changes in serum electrolyte concentration. This study thus adds to the evidence against disturbances in hydration and electrolyte balance as causes for cramping in exercise and further focuses attention on neuromuscular fatigue as a possible primary factor.
- ItemOpen AccessImmediate post catastrophic injury management in rugby union. Does it have an effect on outcomes?(2017) Suter, Jason Alexander; Lambert, Michael I; Brown, James CraigBackground: Rugby union ('rugby') has a high injury risk. These Injuries range from having minor consequences to catastrophic injuries with major life changing consequences. In South Africa, previous research indicated that the risk of catastrophic injury was high and that the immediate management was sub-optimal, worsening the injury outcome. In response, the South African Rugby Union launched the BokSmart nationwide injury prevention programme in 2008. Through education - mainly of coaches and referees - this programme aims to improve the prevention and management of catastrophic injuries. Moreover, the programme began administering a standardised questionnaire for all catastrophically injured players to assess the prevention and management of these injuries. Objectives: To assess whether factors in the immediate pre- and post-injury management of catastrophic injuries in rugby were associated with their outcome. In addition, as part of the BokSmart programme in Rugby in South Africa, there were modules developed as part of the education material delivered to referees and coaches in their workshops that deal specifically with safety in the playing environment, and the correct management of catastrophic injuries. We assessed whether these protocols within the modules were implemented. Design: A prospective, cohort study conducted on all catastrophic injuries in rugby collected through a standardised questionnaire by BokSmart between 2008 - 2014. Methods: Secondary analyses were performed on the information collected on all rugby-related catastrophic injuries in BokSmart's serious injury database. Injury outcomes were split into 'permanent' (permanently disabling and fatal) and 'non-permanent' (full recovery/ "near miss"). Immediate post injury management factors as well as protective equipment and ethnicity were analysed for their association with injury outcome using a Fisher's exact test. Results: There were 87 catastrophic injuries recorded between 2008 and 2014. Acute spinal cord injuries (ASCI) made up most of the catastrophic injuries (n=69) with traumatic brain injuries (TBI) the second most common (n = 11 injuries). There were 7 cardiac events. Black African players were associated with a 2.4 times higher proportion of permanent outcome that the injured White players (p=0.001). There was no association between any protective equipment or injury management (including optimal immobilization, time and method of transport taken to hospital) and ASCI outcome (non-permanent vs. permanent) Conclusions: Neither immediate post-injury management, nor the wearing of protective equipment was associated with catastrophic injury outcome in these South African rugby-related injuries. This might indicate that the initial injury is more important in determining the outcome than the post-injury management and associated secondary metabolic cascade, as proposed by some experts in this area. Moreover, that ethnicity was associated with ASCI outcome in this study is indicative of the wider problems in South Africa; not only specific to rugby. It is recommended that BokSmart continue to focus their programme in low socioeconomic areas that play rugby in South Africa.
- ItemOpen AccessInjuries and illnesses in athletes with spinal cord injury during the 2012 London Summer Paralympic Games(2018) Swart, Thomas FrederickBackground: The Summer Paralympics have grown from participation of a mere 16 athletes at the 1948 Stoke-Mandeville Games, to a large multi-code event of 4176 athletes competing in 20 different sporting codes at the 2012 London Summer Paralympic Games. Unlike able-bodied athletes, Paralympic athletes represent a heterogenous group of people with a varied degree of physical-, mental- and physiological impairment. Despite the growth in the Paralympic sport, limited research exists describing injury and illness in Paralympic athletes. For athletes with impairment to perform optimally and not to jeopardise their health, studies should identify and eventually address risk factors for both injury and illness. Aim: The main aim of this study was to determine the incidence and nature of illnesses and injuries in a cohort of athletes with spinal cord injury (SCI) during the 3-day pre-competition and 11-day competition period at the 2012 London Summer Paralympic Games. This knowledge could provide an initial framework for future research regarding injury- and illness prevention strategies in athletes with SCI. Methods: This study was a component of the large prospective cohort study which was conducted over the 14-day period of the London 2012 Summer Paralympic Games, coordinated by the Medical Committee of the International Paralympic Committee (IPC). The data were collected at the London 2012 Summer Paralympic Games during the 3-day pre-competition and 11-day competition periods. Three data sources were used. Firstly, the IPC provided a comprehensive athlete database that contains accreditation number, country code, sports code (20 sports), gender and age. The second data source was the medical encounters of staff that provided care to their own teams. At the London 2012 Summer Paralympic Games, a novel system (WEB-IIS) was used to collect data via desktop computer interface, tablet or smart phone. The third data source was from an electronic medical data capture system (EMDCS) (ATOS, France) where the medical staff of the Local Organizing Committee of the London Summer Paralympic Games (LOCOG) were requested to enter all medical encounters, at both the Paralympic Village polyclinic and at the sports venues wherever the athlete reported for care. A standardized form was used for this purpose. After comparing all the data, a total of 3009 athletes, of which 709 were athletes with SCI formed part of this study. The Incidence Rate (IR) for illnesses and injuries in athletes with SCI was calculated as the number of illnesses and injuries per 1000 athlete days and was compared to a group of all other Paralympic athletes with injury and illness (who had other impairments). Results: There were significantly more upper limb injuries in athletes with SCI (p=0.0001), with an IR of 6.4 injuries / 1000 athlete days (95% CI 4.6 - 8.9). The IR for all the other athletes were 4.4 injuries / 1000 athlete days (95% CI 3.4 - 5.8). For lower limb injuries, the IR for athletes with SCI was significantly lower (p=0.0001) at 1.4 injuries / 1000 athlete days (95% CI 0.8 -2.5) compared to an average IR of 4.2 injuries / 1000 athlete days (95% CI 3.3-5.4) for all other athletes participating at the 2012 London Paralympic Games. Athletes with SCI had a significantly higher IR for illness than the group of all other athletes (p=0.0004). The IR for illness in athletes with SCI was 15.4 illnesses / 1000 athlete days (95% CI 11.8-20.1), whereas the average for all other athletes were 11.0 illnesses / 1000 athlete days (95% CI 8.7-14.1). The IR for skin- and genito-urinary illness were significantly greater in athletes with SCI (p=0.0001), with an IR of 3.9 illnesses / 1000 athlete days (95% CI 2.5-6.2) for skin illness and 2.3 /1000 athlete days (95% CI 1.8-4.6) for genito-urinary illness. The IR in skin illness for all other athletes were 1.8 illnesses / 1000 athlete days (95% CI 1.1-2.7) and genito-urinary illness, were 0.5 illnesses / 1000 athlete days (95% CI 0.3-0.8). Summary: The results of this study present an insight into injuries and illnesses in athletes with SCI. Athletes with SCI injury have a greater incidence rate of upper limb injuries and a lower incidence of lower limb injuries, than other Paralympic athletes. Total-, skin- and genito-urinary illnesses were also significantly greater in athletes with SCI compared to other Paralympic athletes. For clinicians caring for athletes with SCI, the results indicate that more attention should be given to the prevention of upper limb injuries and specifically skin- and genito-urinary illnesses.
- ItemOpen AccessInnovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects(2021) Evans, Robert William; Albertus, Yumna; West, Sacha; Derman, WayneA spinal cord injury (SCI) is life-altering, resulting in neurological deficits and a multitude of secondary complications. South Africa holds one of the highest traumatic SCI incidence rates in the world, where the social need for SCI prevention and rehabilitation is immense. Robotic locomotor training (RLT) is a novel rehabilitation technique that may improve health and wellbeing after SCI. A systematic review was conducted across 27 studies and 308 participants to explore the systemic effects of RLT. This review demonstrated that RLT shows promise as a tool for improving neurological rehabilitation outcomes; providing individuals with a SCI the ability to walk safely while improving their walking performance, as well as potentially improving cardiovascular outcomes and psychosocial factors. However, the studies reviewed were non-controlled with small, heterogenous sample sizes. Further high-powered, randomised controlled trials, with homogenous samples, are required to investigate these effects. If widespread adoption of these new technologies is to occur, sound evidence demonstrating efficacy and long-term cost saving is required. This dissertation aimed to explore some of these under-researched areas in a sample of sixteen persons with incomplete tetraplegia. Areas of focus included, 1) rehabilitation feasibility, adherence, and research challenges in an under-resourced environment 2) cardiovascular functioning and adaptation to a rehabilitation programme, and 3) psychological well-being. We implemented two interventions, robotic locomotor training (RLT) and activity-based training (ABT), over a 24-week pilot randomised control trial. Adherence to the interventions was high (93.9 ± 6.2%). Challenges to the study's feasibility included: ethical approval, medical clearance, transport and limited human/financial resources. Cardiovascular parameters demonstrated that efficiency of exoskeleton walking improved during the intervention. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress, with standing heart rate at 24-weeks being significantly lower in the RLT group (75.1 ± 15.0 beats/min) compared to the ABT group (95.6 ± 12.6 beats/min). Standing and RLT had similar effects on the parasympathetic nervous system, whilst both interventions were limited in their effect on brachial and ankle blood pressure. Despite experiencing past trauma, participants possessed psychological resources including resilience, self-efficacy and post-traumatic growth which contributed to high perceptions of quality of life. The use of an exoskeleton may have had a greater positive impact on subjective psychological well-being. Expectations of participants entering the study centred around regaining the ability to walk again, despite past experiences and medical advice suggesting otherwise. Hope aids in buffering against negative emotions, however, a thin line exists between supporting high expectations and confronting unrealistic hope. Initial high expectations of recovery decreased and became more realistic during the intervention. This dissertation demonstrates potential physiological and psychological benefits that RLT provides. Despite this potential, barriers exist in the use of RLT in low- and middle-income countries such as South Africa, primarily due to a lack of financial and human resources. The development of lower-cost exoskeletons would lessen the burden of conducting large-scale trials and increase the likelihood of adopting these innovative rehabilitation tools into current standard of care practices.
- ItemOpen AccessLeft ventricular function after ultra-distance triathlon : response is dependent on the cardiac loading conditions(2003) Hassan, Muhammad Yusuf; Noakes, TimothyThe purpose of this thesis is to establish if there is any evidence to support the hypothesis that altered ventricular loading conditions after the cessation of exercise may cause "cardiac fatigue". The studies that have shown post-exercise "cardiac fatigue" have not controlled for either preload or afterload or both, before and after exercise. These studies may rather have identified the effects of alterations in peripheral vascular function on left ventricular function after prolonged exercise. The research study in this thesis is to evaluate if the loading conditions of the heart affect the echocardiographic measurements after exercise that may be misinterpreted as "cardiac fatigue". Echocardiography as a tool of cardiac evaluation cannot be done during exercise because of the technical difficulty of doing a cardiac ultrasound on a human being in motion. The studies that have investigated post exercise "cardiac fatigue" have therefore measured cardiac function after exercise and retrospectively assumed that the cardiac dysfunction was present during exercise since the cardiac demands are at their peak during exercise. However, the post exercise period may be associated with altered loading conditions that may cause changes in the echocardiographic measurements that are similar to cardiac abnormalities.
- ItemOpen AccessOsteoarthritis and ultra-distance marathon running(1999) Leaver, Roy; Schwellnus, Martin POsteoarthritis (OA) is the most common degenerative joint disease. The impact loading on the articular cartilage of the large weight bearing joints (hip, knee, and ankle joints) during distance running might be a potential precipitating factor in OA. The aim of this case-control study was to investigate the relationship between total accumulated running volume and OA in the weightbearing joints. In this study, OA was defined as pain and/or stiffness and/or swelling in the weight-bearing and non-weight-bearing joints (wrists and fingers). The subjects for this study were selected from previous and current runners of the Two Oceans Ultra-marathon (56 km) in Cape Town (South Africa). The database (1356) consisted of all the runners who participated in this race between 1970 and 1983. From this data-base a random group of male runners (n =128) were divided into six 10-year age groups of runners (18 and 79 years). There was a random sample of 25 runners in five of these groups and three in the 70-79 year age group. Runners were age matched with a random sample of past pupils (n=204) of a school who were in their final year between 1923 and 1994. This was the control group. A questionnaire to diagnose OA was designed and validated with a sensitivity of 92% and a specificity of 71 %. The questionnaire was posted to the runners and controls. Incentive prizes were offered to improve the response rate, which was 59%. Completed information was obtained from 76 ultra-distance marathon runners (response rate 59%) and 114 controls (response rate 56%). In the control group there was a group who participated in running. This group was combined with the runners who were then divided into three groups according to their total running volume which was calculated by the following formula; years involved in running x months/year running x 4 x hours/week running. The subjects were thus divided into four groups: 1) controls (non-runners) (n=60), 2) low volume runners (n=43), 3) medium volume runners (n=43), and 4) high volume runners (n=44). Of these, 22 low volume runners, 7 medium runners, and 7 high volume runners stopped running. The prevalence (%) of OA in all groups was compared. The mean age of the control group was significantly higher than the three running groups. The mean height and weight of the medium volume group was significantly higher than the other groups. There was no significant difference in the BMI in each group. The frequency of professional and retired people was significantly higher in the control and each running group. A significantly greater percentage of controls had a history of admission to hospital. There were more controls on long-term medication, compared to runners. A significant number of injuries to the weight-bearing joints (specifically the knee joint) occurred in all groups, due to other sports (p =0.007). There were no significant differences in symptoms suggestive of OA in all groups when not adjusting for age and previous injuries. However, when assessing the odds ratio to determine the risk for OA in the weight-bearing joints, adjusting for age and previous injuries, the low volume group had the highest risk to develop OA (O.R. = 3.2, 95% C.I. = 1.0-10.3); the medium group had the second highest risk (O.R. = 1.7, 95% C.I. = 0.6- 4.8) and the high-volume group (O.R. = 1.1, 95% C.I. = 0.4-3.1) and control groups (O.R. = 1.0) had equally the lowest risk to develop OA. This study confirmed that distance running is unlikely to be a predisposing factor in the development of OA in the weight-bearing joints, even at high running volumes commonly seen in ultra-distance running.
- ItemOpen AccessPsychological correlates of injury, illness and performance in Ironman triathletes(2008) Hugo, Daniel; Derman, Wayne; Collins, MalcolmBackground: The association of psychological factors with athletic performance and proneness to injury and illness has been widely recognised as an integral part of athletic preparation, treatment and rehabilitation. The exact nature of this association is still not clear, but it can be hypothesised that better mental health leads to better performance, less injuries and illness and more rapid recovery. Psychological distress is a strong predictor of injury, illness and poor performance, but inherent personality traits have failed to show a constant association with these parameters. Advances in validated psychometric instruments of personality and resilience show promise in their application to further the understanding of the psyche in athletes. Objective: The aim of this study was to evaluate the predictive value of personality traits (novelty seeking, harm avoidance and reward dependence), resilience and general psychological distress in terms of injury, illness and performance in a group of triathletes competing in the 2007 lronman Triathlon. Methods: For this descriptive cross-sectional study, 166 entrants in the 2007 lronman Triathlon were recruited. Each subject completed a detailed, previously validated set of questionnaires during registration prior to the event. Contained in the questionnaire were sections on general demographic information, detailed previous and current medical conditions and injuries, and psychometric instruments (TPQ - a measure of personality, CD-RISC - a measure of resilience, K10). After the event, the official overall finishing times, as well as the split times for the swimming, cycling and running legs, were obtained from the race organisers. Results: Higher NS and RD scores were predictors for faster predicted performance times and higher psychological distress scores was a predictor for slower actual times (r=0.160, P=0.053) and particularly predicted slower cycling times (r=0.026, P=0.002). Higher K10 scores significantly predicted the presence of flu-like symptoms (P=0.019) and higher HA scores significantly predicted nervous system symptoms during exercise (P=0.035). Higher RD scores predicted the absence of nervous system symptoms (P=0.075). Higher K10 scores (P=0.093) and HA scores (P=0.070) were associated with medication use prior to and during the event. Higher resilience scores predicted the occurrence of exercise associated collapse (P=0.081) and absence of EAMC (P=0.075). Higher HA scores predicted GIT symptoms during exercise (P=0.091 ). Higher reward dependence predicted the presence of tendon / ligament injuries (P=0.039) and genital injuries were associated with lower resilience (P=0.098) and higher HA scores (P=0.065). Conclusion: Generally, the results showed only a few consistent findings in terms of identifying predictors, although interesting correlations and trends were observed. Studies on different athletic populations and on a larger scale are needed. Physicians should be aware of the cardinal importance of mental well-being, as this is as vital in the preventative and curative management of the injured, ill or poor performing athlete as optimal physical conditioning.
- ItemOpen AccessRespiratory health of the endurance athlete : prevalence of respiratory related conditions/illnesses in endurance athletes(2011) Cloete, Carolette; Schwellnus, Martin; Derman, WayneBackground: Endurance athletes, in particular triathletes and ultra-distance runners, undergo high volumes of intense training in preparation for events. There is recent epidemiological evidence that the respiratory tract is the most common system affected by illness in athletes during tournaments. Respiratory tract symptoms have also been shown to affect endurance athletes particularly in the post- event period. However, the prevalence of respiratory related illnesses including respiratory tract symptoms, asthma, and allergies in the pre-race period has not been well studied in endurance athletes. Objective: The main aims of this dissertation were 1) to review the existing literature focussing on the epidemiology, pathogenesis, possible aetiology and management of respiratory tract symptoms, asthma and allergies in athletes, and 2) to conduct an investigation to determine the pre-event period prevalence (6 weeks and 1 week before an event) and nature of respiratory tract symptoms, asthma and allergies in Ironman triathletes and ultra-distance runners. Methods: In the first part of the dissertation, a review of the literature pertaining to respiratory tract symptoms and illness was undertaken. In the second part of the dissertation, a cross-sectional descriptive study was undertaken in 441 triathletes entering the 2006 and 2007 Ironman Triathlon, and 152 ultra- distance runners in the 2009 Two Oceans Ultra-marathon. In the 1 to 3 days before the race (registration period), participants were requested to complete a validated pre-event medical questionnaire containing sections on demographics, training and previous competition, common medical conditions and detailed sections on respiratory symptoms in the 6 weeks and 1 week period before the race, as well as asthma and allergies experienced. Respiratory symptoms were divided into upper respiratory tract symptoms (URTS), lower respiratory tract symptoms (LRTS) and systemic symptoms (SS). All data obtained regarding these respiratory related illnesses were compared between the triathlete group and the ultra- distance runners. Results: The main findings in the experimental section of the dissertation were that 1) triathletes trained significantly more hours in the 6 weeks and 1 week before an event than ultra-distance runners, 2) the period prevalence (6 weeks before the race) of respiratory tract symptoms was 50% of triathletes and 35% of ultra-distance runners, 3) upper respiratory tract symptoms and particularly nasal symptoms (nasal congestion and rhinorrhoea) were significantly more common in triathletes (21 to 27%) in comparison with ultra-distance runners (12 to 17%), 4) systemic symptoms (especially pyrexia) were significantly more common in ultra-distance runners in the 1 week before an event (9.2 vs. 2.4%), 5) the point prevalence of self-reported asthma was low in both study groups (ultra-distance runners 3.4% and triathletes 8.3%) although symptoms of dry cough, wheezing, shortness of breath and "tight" chest were reported by 25 to 80% of athletes in both study populations, 6) in most cases the diagnosis of asthma was made by means of history taking and a physical examination by a physician, 7) majority of triathletes used beta 2-agonists only as the treatment of choice for asthma symptoms, while ultra-distance runners used combinations of corticosteroids and beta 2-agonist inhalers as first line treatment, 8) allergies were reported by 34% of triathletes and 22.3% of ultra-distance runners, 9) most allergic symptoms in both study groups were confined to the upper respiratory tract with hay fever ranging from 77 to 83% and sinusitis 55 to 64.2%, and 10) the most common medication used for allergies by triathletes and ultra- distance runners, were anti-histamine tablets. Conclusion: There is a high period prevalence of respiratory symptoms in triathletes and ultra-distance runners in the 6 weeks before an endurance event. Triathletes had a significantly higher prevalence of upper respiratory tract symptoms (especially nasal symptoms) in comparison to ultra-distance runners, which might be related to allergies and a higher training volume. There also appears to be a lack in proper diagnostic evaluation of asthma in these endurance athletes with suboptimal and improper treatment of asthma and allergies. Approximately 10% of ultra-distance runners had systemic symptoms in the week before the event, indicating a lack of athlete education on possible risks of exercising with a systemic illness.