ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00001

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS

ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00002

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS

摘要:

SummaryResults of heart transplantation as therapy for end-stage cardiac diseases are encouraging not only because of actuarial survival curves but also because of the recovered quality of life for the heart transplant recipient.Although heart transplantation drastically improves the physical capacity of the patients, heart recipients still have a reduced maximal aerobic capacity compared to healthy people.Altered resting and exercise haemodynamics, due to cardiac denervation, are a common finding after orthotopic heart transplantation: increases in heart rate and stroke volume at exercise are first linked with the augmented venous return and later with the increased plasmatic noradrenaline level. Maximal heart rate and stroke volume are both reduced when compared to innervated heart. Reduced cardiac output response to exercise therefore results in early anaerobic metabolism, acidosis, hyperventilation and diminished physical capacity.In spite of an altered ventilatory adaptation to exercise, characterised by hyperpnoea in most transplant patients, ventilation is not the limiting factor for exercise in heart recipients without associated obstructive pulmonary disease.Endurance training restores lean tissue, decreases submaximal minute ventilation, increases peak work output, maximal ventilation and peak heart rate.Guidelines for prescribing exercise are not yet standardised due to the limited number of studies on a sufficient cohort of heart recipients. Nevertheless, recommendations similar to those used for persons with coronary heart disease, with modifications due to the denervated heart, seem to be used.The cardiocirculatory and pulmonary capacity of heart transplant recipients allow them to undertake endurance sports activities such as walking, jogging, cycling and swimming, and these should be encouraged.

ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00003

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS

摘要:

SummaryMany endurance athletes and coaches fear a decrement in physical conditioning and performance if training is reduced for several days or longer. This is largely unfounded. Maximal exercise measures (V̇O2max, maximal heart rate, maximal speed or workload) are maintained for 10 to 28 days with reductions in weekly training volume of up to 70 to 80%. Blood measures (creatine kinase, haemoglobin, haematocrit, blood volume) change positively or are maintained with 5 to 21 days of reduced training, as are glycogen storage and muscle oxidative capacities. Submaximal exercise measures (economy, heart rate, postexercise lactate) and muscular power are maintained or improved with a 70 to 90% reduction in weekly volume over 6 to 21 days, provided that exercise frequency is reduced by no more than 20%. Athletic performance is improved or maintained with a 60 to 90% reduction in weekly training volume during a 6 to 21 day reduced training period, primarily due to an enhanced ability to exert muscular power. These findings suggest that endurance athletes should not refrain from reduced training prior to competition in an effort to improve performance, or for recovery from periods of intense training, injury, or staleness.

ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00004

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS

摘要:

SummaryLumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat.Factors predisposing the young athlete to back injury include the growth spurt, abrupt increases in training intensity or frequency, improper technique, unsuitable sports equipment, and leg-length inequality. Poor strength of the back extensor and abdominal musculature, and inflexibility of the lumbar spine, hamstrings and hip flexor muscles may contribute to chronic low back pain.Excessive lifting and twisting may produce sprains and strains, the most common cause of low back pain in adolescents. Blows to the spine may create contusions or fractures. Fractures in adolescents from severe trauma include compression fracture, comminuted fracture, fracture of the growth plate at the vertebral end plate, lumbar transverse process fracture, and a fracture of the spinous process. Athletes who participate in sports involving repeated and forceful hyperextension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis. The large sacroiliac joint is also prone to irritation. The signs and symptoms of disc herniation in adolescents may be more subtle than in adults. Disorders simulating athletic injury include tumours and inflammatory connective tissue disease. Often, however, a specific diagnosis cannot be made in the young athlete with a low back injury due to the lack of pain localisation and the anatomic complexity of the lumbar spine.A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques. Diagnostic tests may be considered, though, for the adolescent athlete whose back pain is severe, was caused by acute trauma, or fails to improve with conservative therapy after several weeks. Radiographs, bone scanning, computed tomography, and magnetic resonance imaging may help identify, or exclude serious pathology.Fortunately, the majority of cases of low back pain in adolescents respond to conservative therapy. Immediate treatment of an acute injury, such as a sprain or strain, includes cryotherapy, electrogalvanic stimulation, anti-inflammatory medications and gentle exercises. Prolonged bed rest should be avoided since atrophy may occur rapidly. Strong analgesics are also usually contraindicated, except for sleep, since they mask pain and may allow overvigorous activity.Early strengthening exercises include the Williams flexion exercises and/or McKenzie extension exercises. Both exercise motions may often be prescribed. Athletes with an acute disc herniation, however, should only perform extension exercises initially. Athletes with spondylolysis, spondylolisthesis and facet joint irritation should initially be limited to flexion exercises.Brief sessions of walking, pool walking or jogging, and upright cycling may be started when tolerated to maintain aerobic conditioning. The proper timing for an athlete to return to activity depends on the demonstration of functional skills necessary to perform a specific sport. The final component of a young athletes’ back rehabilitation programme includes a long term stretching, and back and abdominal strengthening programme.

ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00005

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS

摘要:

Summary‘Functional rehabilitation’ is an embellishment of the traditional concepts of rehabilitation which are motion and strength. Functional rehabilitation incorporates the concepts of agility, proprioception, and finally the confidence of the individual when performing whatever task he or she wishes to undertake. The determinants of rehabilitation include the patient, the type of injury the knee has sustained as well as its surgical treatment, and how innovative the director of rehabilitation is.The principles of rehabilitation include joint motion and stability as well as muscular endurance and strength. These should be considered during the immobilisation phase, the surgical and postsurgical phase, and continued through the early healing, late healing and final healing stages. The rehabilitation director must advance activity to levels of ever increasing complexity. Various modalities of rehabilitation such as bracing, passive motion machines and muscle stimulation units should be added in an effort to achieve a painless course. This course is progressive as long as errors of rehabilitation are avoided, including overtraining and too rapid a progression resulting in injury or reinjury.Realistic goals must be firmly established in the mind of the patient and the director at the outset. Determinants of rehabilitation are a guide to the reality of reaching a functional level.The functional activity programme depends upon knee stability, successful completion of lesser activities and healing of the injury or the surgery. Progressing from less difficult to more difficult activities before the patient is ready usually results in an injury or reinjury. Therefore, constant assessment of the performance level of the patient must be made before advancing to more demanding activities.Conservative and surgical treatment programmes for functional rehabilitation are essentially the same except for the time factors involved. The times of completion of different levels of activity are generally longer in the surgical programme. Time alone is not the signal for advancement from one programme to another. Attention should be paid to range of motion, strength, fluidity of performance of functional activities as well as functional testing.

ISSN:0112-1642    

DOI:10.2165/00007256-199112060-00006

出版商:Springer International Publishing    

年代:2012

数据来源: ADIS