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Dawn T. Gulick and Iris F. Kimura

Muscle soreness, a familiar phenomenon to most athletes, has been differentiated into “acute” and “delayed onset.” The etiology of acute muscle soreness has been attributed to ischemia and the accumulation of metabolic by-products. However, the etiology of delayed onset muscle soreness (DOMS) is not so clear. Six theories have been proposed: lactic acid, muscle spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories. The treatment of DOMS has also been investigated. Studies in which anti-inflammatory medications have been administered have yielded varying results based on the dosage and the time of administration. Submaximal concentric exercise may alleviate soreness but does not restore muscle function. Neither cryotherapy nor stretching abates the symptoms of DOMS. Transcutaneous electrical stimulation has been shown to decrease soreness and increase range of motion, but the effect on the recovery of muscle function is unknown. Therefore, the treatment of DOMS remains an enigma.

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Neal R. Glaviano, Noelle M. Selkow, Ethan Saliba, Jay Hertel and Susan Saliba

Context:

Iontophoresis is a method of administering medications transcutaneously using galvanic current. Dose is the product of current amplitude and treatment duration. It is assumed that higher doses of iontophoresis are more effective in delivering medication, yet research supporting this claim is insufficient.

Objective:

To compare high-dose lidocaine iontophoresis (80 mA-min), standard-dose lidocaine iontophoresis (40 mA-min), and 2 sham treatments indirectly by measuring skin anesthesia.

Design:

Double-blind crossover study.

Setting:

Research laboratory.

Participants:

15 healthy volunteers (10 women, 5 men: age 24.06 ± 2 y, height 169.7 ± 8.3 cm, weight 72.5 ± 14.2 kg).

Intervention:

Four treatments were counterbalanced and applied on the anterior forearm: 2 true interventions (40 and 80 mA-min) and 2 sham interventions separated by at least 24 h. The true-intervention doses were applied at a current of 2 mA with 2.5 ml 2% lidocaine HCL for 20 and 40 min. The sham treatments were 2.5 ml of lidocaine without galvanic current (intensity = 0 mA, 40 min) and 2.5 ml of saline solution (galvanic current of 2 mA for 40 min).

Main Outcome Measures:

Semmes-Weinstein monofilament scores were taken preintervention and postintervention (at 0, 20, 40, and 60 min) to measure skin anesthesia.

Results:

A significant interaction between treatment and time (F = 4.137, P < .01) was identified. The 40-mA-min dose produced greater anesthesia than the lidocaine and saline shams at all times. The 80-mA-min dose produced greater anesthesia than saline sham at all times. There was a significant difference noted, with 40 mA-min over 80 mA-min, at the 20-min posttest, but there were no other significant differences between the 40- and 80-mA-min doses at 0, 40, or 60 min posttreatment or between the 2 sham treatments at any time.

Conclusions:

The 40-mA-min treatment was just as effective as the 80-mA-min treatment, suggesting that shorter treatments may be more time efficient for clinicians and patients.

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Heather Fahsl and Shannon David

During the fall preseason of 2013, a 19-year-old Division I linebacker (body mass = 104 kg; height = 189 cm) attending a college football camp developed severe throat pain, quickly followed by night sweats, fever, nausea, vomiting, shortness of breath, and generalized body weakness. The athletic trainer believed that the athlete had a cold. Because symptoms did not improve, the athlete was referred to several physicians with different specialties and underwent standard testing. The ears, nose, and throat (ENT) physician recognized the signs and symptoms of Lemierre’s syndrome based on a previous case seen only once in his career. A computed tomography (CT) scan confirmed the presence of a peritonsillar abscess and thrombosis of the left internal jugular vein, which justified further investigation for this rare syndrome. A positive blood culture for Fusobacterium necrophorum confirmed the diagnosis of Lemierre’s syndrome. Several antibiotics and anticoagulation medications were prescribed and the athlete was closely monitored. After two months, he was cleared to play football.

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Daniel Jolley, Brian Dawson, Shane K. Maloney, James White, Carmel Goodman and Peter Peeling

This study investigated the influence of dehydration on urinary levels of pseudoephedrine (PSE) after prolonged repeated effort activity. Fourteen athletes performed a simulated team game circuit (STGC) outdoors over 120 min under three different hydration protocols: hydrated (HYD), dehydrated (DHY) and dehydrated + postexercise fluid bolus (BOL). In all trials, a 60 mg dose of PSE was administered 30 min before trial and at half time of the STGC. Urinary PSE levels were measured before drug administration and at 90 min postexercise. In addition, body mass (BM) changes and urinary specific gravity (USG), osmolality (OSM), creatinine (Cr), and pH values were recorded. No differences in PSE levels were found 90 min postexercise between conditions (HYD: 208.5 ± 116.5; DHY: 238.9 ± 93.5; BOL: 195.6 ± 107.3 μg·ml−1), although large variations were seen within and between participants across conditions (range: 33–475 μg·ml−1: ICC r = .03–0.16, p > .05). There were no differences between conditions in USG, OSM, pH or PSE/Cr ratio. In conclusion, hydration status did not influence urinary PSE levels after prolonged repeated effort activity, with ~70% of samples greater than the WADA limit (>150 μg.ml−1), and ~30% under. Due to the unpredictability of urinary PSE values, athletes should avoid taking any medications containing PSE during competition.

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Andrew M. Johnson, Philip A. Vernon, Quincy J. Almeida, Linda L. Grantier and Mandar S. Jog

The effect of a precue on improving movement initiation (i.e., reaction time; RT) is well understood, whereas its influence on movement execution (i.e., movement time; MT) has rarely been examined. The current study investigated the influence of a directional precue (i.e., left vs. right) on the RT and MT of simple and discrete bi-directional movements in a large sample of Parkinson's disease patients and healthy control participants. Both patients and controls were tested twice, with testing sessions separated by 2 hours. Patients were tested first following an overnight levodopa withdrawal and again after they had taken their medication. Both patients and controls demonstrated a significant RT improvement when information was provided in advance. MT in both healthy participants and medicated patients was, however, slower with the provision of advance information, while unmedicated patients showed no significant MT effects. These results suggest that while the basal ganglia may not be involved in motor program selection, they may dynamically modulate movement execution.

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Astrid Steinbrecher, Eva Erber, Andrew Grandinetti, Claudio Nigg, Laurence N. Kolonel and Gertraud Maskarinec

Background:

Physical inactivity is an established risk factor for diabetes; however, little is known about this association across ethnic groups with different diabetes risk. Therefore, we evaluated the association between physical activity and diabetes and potential effect modification by ethnicity in the Hawaii component of the Multiethnic Cohort.

Methods:

Participants, aged 45 to 75 years, were enrolled by completing a questionnaire on demographics, diet, and self-reported weekly hours of strenuous sports, vigorous work, and moderate activity. Among the 74,913 participants (39% Caucasian, 14% Native Hawaiian, 47% Japanese American), 8561 incident diabetes cases were identified by self-report, a medication questionnaire, and through health plan linkages. Cox regression was applied to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) while adjusting for known confounders.

Results:

Engaging in strenuous sports was inversely related to diabetes risk with HRs (4+ hours/week vs. never) of 0.67 (95%CI: 0.57–0.79) in women and 0.80 (95%CI: 0.72–0.88) in men. In stratified analyses, the inverse association was consistent across ethnic groups. The inverse association of vigorous work with diabetes was limited to men, while beneficial effects of moderate activity were observed only in Caucasians.

Conclusions:

These findings support a role of high-intensity physical activity and ethnic-specific guidelines in diabetes prevention.

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Anita T. Cote, Angela M. Devlin and Constadina Panagiotopoulos

Second-generation antipsychotic (SGA) medications, used to treat youth for a wide-range of mental health conditions, are associated with excessive weight gain and other comorbidities, placing these individuals at high risk for cardiovascular disease. Little is known about the effect of physical activity (PA) on cardiovascular risk in these children. Anthropometrics, fasting blood sample and self-report PA were obtained in 386 children diagnosed with mental health conditions (6–18 y). PA was classified as below (<60 min/day) or meets (>60 min/day) current recommended guidelines for daily PA in children. SGA-treated (n = 166) and SGA-naive (n = 220) were compared in the analysis. The SGA-treated children had higher (p < .05) BMI z-score, waist-to-height ratio, fasting glucose, and LDL-cholesterol than SGA-nai’ve children. Waist circumference, waist-to-height ratio, HDL cholesterol, fasting insulin, and HOMA-IR were significantly different by PA status. After adjusting for SGA-treatment duration, sex, age, and ethnicity, higher PA was associated with lower insulin resistance (HOMA-IR) in SGA-treated (mean, 95% CI; below vs. meets: 2.10 [1.84, 2.37] vs. 1.59 [1.37, 1.81], p = .046) but not in SGA-naive (1.70 [1.47, 1.94] vs 1.55 [1.35, 1.75], p = .707) children. Upon initial screening, SGA-treated children that reported meeting the minimal recommendations for daily PA displayed lower measures of adiposity and improved insulin resistance.

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Jim Taylor and Shel Taylor

This article addresses the essential role that pain plays in the rehabilitation of sports injury. It will describe important information and approaches that applied sport psychologists can use to more effectively manage pain in injured athletes. The article includes a brief discussion of the most accepted theories of pain. Types of pain that injured athletes may experience and how they can learn to discriminate between them will be discussed. The article will also consider how pain can be a useful tool as information about injured athletes’ current status in recovery and the need to modify their rehabilitation regimens. The value of measuring pain will be examined with emphasis on determining a simple and easy means of assessing pain. Next, the article will examine why nonpharmacological pain management may be a useful adjunct to pharmacological pain control. Then, a brief description of the most commonly used pain medications and a detailed description of common nonpharmacological pain-management strategies will be furnished. A discussion of how nonpharmacological pain management can be incorporated into the traditional rehabilitation process will be offered. Finally, the article will describe the role that sport psychologists can play in the management of sport injury-related pain. The objective of this article is to provide applied practitioners with the knowledge and tools necessary to assist injured athletes in mitigating the pain they will experience during recovery as a means of facilitating their rehabilitation and return to sport.

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Andrea T. White, C. Steven Fehlauer, Rita Hanover, Stephen C. Johnson and Robert E. Dustman

Older individuals arc more likely than younger adults to exhibit symptoms of exercise intolerance at high work rates. The risks of maximal exercise in older adults increase proportionally as the number of health difficulties increase. In this study, the effects of health status, age, and gender on older adults’ ability to attain V̇O2max are examined. Sedentary volunteers (60 women, 45 men), mean age 67 ± 5 years (range 57-78 years), participated in graded maximal exercise tests on a combined arm and leg cycle ergometer. Subjects were classified into three groups based on test termination reason: attainment of V̇O2max (MAX), symptom-limited (SX), or EKG-limited (EKG). Sixty percent of men and 40% of women were classified as MAX, while 48% of women and 27% of men were characterized as SX. Thirteen percent of men and 12% of women had EKG-limited exercise tests. Those in the EKG group reported significantly more diagnoses than subjects in the MAX group (2.7 vs. 1.4. p < .05). The number of medications reported and age of the subjects did not differ across test termination categories.

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Eduardo Federighi Baisi Chagas, Mariana Rotta Bonfim, Bruna Camilo Turi, Nair Cristina Margarida Brondino and Henrique Luiz Monteiro

Background:

Declines in ovarian function in postmenopausal women may contribute to increase inflammatory cytokines, which can lead to chronic diseases. However, studies have shown that exercise interventions are important to manage inflammatory conditions. Thus, the objective of this study was to analyze the effect of exercise intervention on inflammatory markers among obese and postmenopausal women.

Methods:

70 women composed the sample (Exercise group [EG; n = 35] and nonexercise group [nEG; n = 35]). IL-6, TNF-α, and IL-10 were the inflammatory markers analyzed. Exercise program was 20 weeks long and consisted of aerobic and neuromuscular training. Data about chronic diseases, medication use, dietary intake, body composition and biochemical variables were collected.

Results:

EG showed significant reductions in body mass index, waist circumference and body fat percentage, as well as increased lean body mass. EG showed significant reductions in TNF-α and significant interaction between group and intervention time. Reductions in IL-10 were identified only in nEG. Substantial effect of exercise intervention was observed with increased ratio of IL-10/IL-6 and IL-10/TNF-α.

Conclusions:

Combination of aerobic exercise and resistance training was effective in reducing inflammation. Thus, implementation and maintenance of similar exercise programs can contribute to reduce chronic inflammation among obese postmenopausal women.