Search

Objective To assess the correlation between maternal mobility after cesarean delivery and postoperative morbidity. Methods A prospective study was conducted in a tertiary hospital among patients after cesarean delivery. The women were recruited after surgery and before ambulation. Each participant received an accelerometer and routine instructions for mobilization. The patients were asked to wear the accelerometer constantly. It was collected at discharge. Electronic files were reviewed and patients' outcomes were analyzed. The Mann-Whitney U test was used to compare groups and a receiver operating characteristic curve was calculated for the threshold of number of steps. Results Data were analyzed for 199 patients, among which 107 (54.4%) deliveries were urgent and 90 (45.6%) were elective. The median number of steps was higher for multiparous women compared to nulliparous women (P = 0.035). Patients who developed complications after discharge walked significantly less during their hospitalization compared to those who did not. There was a trend toward increased risk for in-hospitalization complications among patients who walked less while hospitalized. A threshold of more than 9716 steps per hospitalization was found to be associated with fewer post-discharge complications. Conclusion There is a significant correlation between the extent of ambulation after cesarean delivery and fewer postoperative complications.

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

PURPOSE This study aimed to test the hypothesis that aerobic exercise performance is impaired in the midluteal (ML) compared with the midfollicular (MF) phase of the menstrual cycle. METHODS Twelve recreationally active eumenorrheic women (25 ± 6 yr) completed exercise sessions during the MF and the ML phases. Each session consisted of an 8-km cycling time trial that was preceded by 10 min of cycling performed at a constant power below and above gas exchange threshold. Heart rate, ventilation, and oxygen uptake were continuously measured. RPE and ratings of fatigue were assessed during the time trial using visual analog scales. Total mood disturbance was calculated from the POMS questionnaire administered before and 20 min postexercise. RESULTS Salivary progesterone concentration was 578 ± 515 pg·mL-1 higher in ML compared with MF phase (P < 0.01), whereas estradiol concentration did not differ between phases (167 ± 55 vs 206 ± 120 pg·mL-1, P = 0.31). Total mood disturbance before exercise was greater during the ML phase compared with the MF phase (P < 0.01), but this difference was abolished postexercise (P = 0.14). Mean power output was lower during the ML phase (115 ± 29 vs 125 ± 28 W, P < 0.01), which led to a slower time trial in the ML phase (18.3 ± 2.0 min) compared with the MF phase (17.8 ± 1.7 min, P = 0.03). Ratings of fatigue were greater during the ML phase from 2 to 8 km (P ≤ 0.01), whereas no differences in RPE were observed. Heart rate (P = 0.85), minute ventilation (P = 0.53), and oxygen uptake (P = 0.32) did not differ between phases during the time trial. CONCLUSION Aerobic exercise performance is worse in the ML phase compared with the MF phase in recreationally active women, which was accompanied by a more negative mood state preexercise and increased ratings of fatigue.

The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.

Individuals with PWS require marked caloric restriction and daily exercise to prevent morbid obesity. Lower energy expenditure, hypotonia, decreased muscle mass, and cognitive impairment make exercise challenging for this population. Exercise guidelines include resistance training as an important component. Myokine responses to resistance exercise may mediate beneficial metabolic effects. We aimed to determine if young PWS adults can perform a resistance exercise program and to measure myokine responses in PWS versus age- and BMI-matched controls. Each group included 11 participants (7M/4F). Ages and BMI for PWS and controls were 30.7 ± 4.6 versus 30.1 ± 4.3 years and 28.3 ± 4.3 versus 28.2 ± 4.2 kg/m2 , respectively. Glucose, creatine kinase (CK), lactate, and myokines were measured before, after, 30, and 60 min after completing eight resistance exercises. Myokines were assayed using a multiplex myokine panel (Merck Millipore). CK was lower in PWS versus controls (62 ± 16 vs.322 ± 100 U/L, p < .04). Peak lactate was 3.7 ± 0.7 in PWS versus 7.3 ± 0.7 mmol/Lin controls (p < .001). The increase in interleukin-6 was similar in PWS and controls (41 ± 16% and 35 ± 10%, respectively). Pre- and post-exercise levels of the six myokines assayed showed no consistent differences between the PWS and control participants. PWS young adults are capable of performing resistance/strength-building exercise. The lower CK and peak lactate levels in PWS may reflect decreased muscle mass in this population. Further studies are needed to determine optimal exercise regimens and assess the role of myokines incontributing to the metabolic phenotype of PWS.

A 17-year-old elite triathlete presented with recurrent loss of consciousness events. Implantable loop recorder (ILR) documented sinus node asystoles of up to 21 seconds. She underwent cardiac neuromodulation ablation. After ablation, a generalized tonic-clonic seizure (GTCS) occurred, without concomitant asystole on the ILR. Temporal lobe seizures were diagnosed and supported by interictal epileptic activity on electroencephalogram. We assumed that the syncope episodes were ictal asystole (IA) and that the IA terminated the epileptic seizures early after their onset. The cardiac ablation prevented IA, enabling spread of seizure activity and development of GTCS. To the best of our knowledge, this is the first case of IA treated with cardiac ablation, allowing avoidance of cardiac pacing. This case raises the awareness to epileptic seizures as a cause of asystole in athletes, with an elusive and atypical presentation.

Women of reproductive age experience regular physical changes in their bodies due to hormonal alterations during the course of their ovulatory menstrual cycles, as well as during pregnancy and with the administration of oral contraceptive pills. The variations in endogenous and exogenous levels of estrogen and progesterone have the potential to affect sports performance through several possible mechanisms: changes in energy/fuel sources; effects on various components of physical fitness, body temperature control, and fluid retention; psychological changes; and finally, changes in the risks of certain injuries. Existing studies in this important area have used many different methodologies to assess and characterize both menstrual cycle phase and aspects of physical fitness and sport performance. Based on the evidence to date, it can be recommended that athletes and coaches monitor each female athlete’s individual responses to these potential periodic perturbations in physical performance during training and competition. Oral contraceptives can also have some independent effects depending on the formulation used. In certain cases, it may be advantageous to utilize these medications to manipulate the menstrual cycle around important competitions.

In 2014, the International Olympic Committee (IOC) published a consensus statement entitled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)”. The syndrome of RED-S refers to: “impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.”

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.

Background By 2020, the World Health Organization predicts that two-thirds of all diseases worldwide will be the result of lifestyle choices. Physicians often do not counsel patients about healthy behaviors, and lack of training has been identified as one of the barriers. Between 2010 and 2014, Hebrew University developed and implemented a 58-h Lifestyle Medicine curriculum spanning five of the 6 years of medical school. Content includes nutrition, exercise, smoking cessation, and behavior change, as well as health coaching practice with friends/relatives (preclinical years) and patients (clinical years). This report describes this development and diffusion process, and it also presents findings related to the level of acceptance of this student-initiated Lifestyle Medicine (LM) curriculum. Methods Students completed an online semi-structured questionnaire after the first coaching session (coaching questionnaire) and the last coaching session (follow-up questionnaire). Results Nine hundred and twenty-three students completed the coaching questionnaire (296 practices were with patients, 627 with friends /relatives); and 784 students completed the follow-up questionnaire (208 practices were with patients, 576 with friends /relatives). They reported overall that health coaching domains included smoking cessation (263 students), nutrition (79), and exercise (117); 464 students reported on combined topics. Students consistently described a high acceptance of the curriculum and their active role in coaching. Further, most students reported that they were eager to address their own health behaviors. Conclusions We described the development and acceptance of a student-initiated comprehensive LM curriculum. Students perceived LM as an important component of physicians’ professional role and were ready to explore it both as coaches and in their personal lives. Thus, medical school deans might consider developing similar initiatives in order to position medical schools as key players within a preventive strategy in healthcare policy.

Background: Individuals with PWS require marked caloric restriction and daily exercise to prevent morbid obesity. Lower energy expenditure compared to BMI-matched controls along with hypotonia, decreased muscle mass, and cognitive impairment make exercise particularly challenging for this population. Exercise guidelines include resistance training as an important component. Myokine responses to resistance exercise may have beneficial metabolic effects. Objectives: Determine if young PWS adults can perform a resistance exercise program. Evaluate myokine responses to acute resistance exercise in young adults with PWS and compare responses with age and BMI-matched controls. Methods: Each study group included 11 participants (7M/4F). Mean±SD ages were 30.7±4.6 and 30.1±4.3 years for PWS and controls (NS). BMI values were 28.3±4.3 and 28.2±4.2 kg/m2 for PWS and controls, respectively (NS). Blood samples for glucose, creatine kinase (CK), lactate, hemoglobin A1c (HbA1C) and myokines were obtained before performing a program of eight resistance exercises lasting 45-60 minutes. Additional blood samples were drawn immediately after, and 30 and 60 minutes after completing the exercises. Myokines were assayed using a multiplex myokine panel (Merck Millipore). Paired t-test was used for comparing results for PWS vs controls. The unpaired t-test was used for comparing peak laboratory values with basal levels. Results: Basal levels (mean±SEM) of glucose, hemoglobin A1c, and lactate were similar for PWS and controls but CK was lower in PWS vs controls (62±16 vs 322±100 U/L, p

Introduction Stress fractures (SFs) occur when microdamage caused by repetitive mechanical load exceeds the biological load-bearing capacity of the bone. The study objective was to test whether a vest specifically designed and manufactured for female recruits, compared with the standard vest used on a regular basis by Border Police recruits, would reduce the incidence of SF in female Border Police recruits. Data based on reports of military personnel show that women are more likely to sustain SFs. Methods A follow-up of 240 female Border Police infantry recruits, divided into two trial groups, was conducted from 2007 to 2009. Two different vests were evaluated—the standard special unit fighting vest, which was conventionally used by both men and women during basic training, and the new fighting vest, specially design for female body shape. Results No significant difference was noted in the number of SFs between the two groups which may be attributed to increased weight of the new vest. There was a lower incidence of long bone SFs which may have been due to the superior vest design. The female Border Police Infantry recruits expressed great satisfaction with the new vest. Conclusions Increased effort should be invested to further reduce the weight of female combat gear, alongside efforts to improve fit and comfort.

It is hypothesized that vitamin D insufficiency in athletes might negatively affect sport performance. The objective of this study was to examine the effect of vitamin D3 supplementation on physical performance of adolescent swimmers with vitamin D insufficiency. Fifty-three adolescent competitive swimmers with vitamin D insufficiency (serum 25-hydroxyvitamin-D concentrations (25(OH)D)3 or placebo for 12 weeks. Swimming performance at several speeds, arm-grip strength, and one-legged balance, were measured before and after supplementation. The age-adjusted changes in performance variables during the study were compared between groups. 25(OH) D concentrations at study end were significantly higher in the vitamin group compared with the placebo group (29.6 ± 6.5ng/ml vs. 20.3 ± 4.2ng/ml, p < .001), yet only 48% of the vitamin group became vitamin D sufficient with this dosing. No between-group differences were found in the changes of the performance variables tested. No significant differences in performance were found between participants that became vitamin D sufficient, and those who did not. No significant correlation was found between the change in serum 25(OH)D and ageadjusted balance, strength or swimming performance at study end. Vitamin D3 supplementation that raised serum 25(OH)D concentrations by a mean of 9.3ng/ml above placebo in adolescent swimmers with vitamin D insufficiency, did not improve physical performance more than placebo.

Aim This study examined the effects of physical activity on the fitness, body composition and mental health of children after cancer or bone marrow transplantation. Methods We focused on 22 children aged from seven to 14 years who had received chemotherapy and/or bone marrow transplantation in our medical centre. Ten children took part in a six-month exercise programme, and 12 children who did not exercise formed the control group. At baseline and at the end of the trial, we measured aerobic fitness, body composition, bone density and assessed the child's mood and quality of life. We pooled all participants together post hoc to compare changes in fitness with the various study outcomes. Results We found no differences between groups in changes in fitness, body composition or mental health indices. Significant correlations were found between changes in aerobic fitness and changes in lean body mass (r = 0.74, p = 0.002), bone mineral content (r = 0.57, p = 0.026) and femoral neck bone mineral density (r = 0.59, p = 0.027) in all participants. Conclusion Group-based exercise training did not improve aerobic fitness in children after cancer or bone marrow transplantation. However, changes in fitness throughout the study period were associated with changes in body composition and bone health in all participants.

Mother and Child Health Clinics have provided preventive health services in Israel for nearly a century. The Public Health Nurses Promote Healthy Lifestyles Program was developed to assist families in adopting healthy behaviors. The program ran in the Jerusalem District from 2009 to 2011. After piloting, 175 public health nurses received training and interventions took place in 45 clinics serving parents of 167 213 infant and toddlers per year. When evaluation is completed, our hope is to incorporate the program into Mother and Child Health Clinic services regularly provided nationwide, thereby becoming an integral part of the initiative, Healthy Israel 2020.

The purpose of this study was to compare the effects of two bariatric procedures on abdominal lipid partitioning and metabolic response.Fifty-one patients (RYGB 31(11 M/20 F); (SG) 20(8 M/12 F)) who met the criteria of metabolic syndrome before the operation were followed following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Visceral and subcutaneous abdominal fat depots were assessed by CT before, 6 months, and 12 months following the operation.Patients undergoing both procedures did not differ in baseline body mass index (BMI) (42.84 ± 4.65 vs. 41.70 ± 4.68 kg/m(2)) or abdominal lipid depots. BMI at 12 months post-op was similar (29.44 ± 3.35 vs 30.86 ± 4.31 kg/m(2) for RYGB and SG, respectively). Both procedures led to a significant reduction in visceral and subcutaneous fat at 6 months (p 0.001 for both). The visceral-to-subcutaneous fat ratio was comparable at 6 months vs. baseline yet was lower at 12 months vs. baseline for both procedures (p 0.01). In patients who lost the diagnosis of metabolic syndrome, baseline visceral/subcutaneous fat was the only predictor of recovery (p 0.005). No difference was detected between procedures in dynamics of abdominal fat depots or remission of cardiovascular risk factors.RYGB and SG induce a similar effect on abdominal fat mobilization. The metabolic effects in individual patients are mostly determined by their baseline abdominal lipid partitioning.

A few countries permit women to serve in combat roles, but their long term performance in these positions has not been reported. The incidences of overuse injuries and attrition of 85 male and 235 female recruits in a light infantry brigade was followed in a three-year prospective study. Females were shorter (162 cm, CI 161–163 cm) than males (174 cm, CI 173–176), had more body fat (18.9 kg, CI 18.2–19.6 kg) than males (12.6 kg, 11.3–13.8 kg), had lowerV˙O2max (36.8 mL·min−1·kg−1, CI 35.8–37.78 mL·min−1·kg−1) than males (50.48 mL·min−1·kg−1, CI 48.4 to 52.48 mL·min−1·kg−1), had more stress fractures (21.0%, 95% CI 16.2–26.5%) than males (2.3%, CI 0.3–8.2%), and had more anterior knee pain (41.2%, CI 34.9–47.7%) than males (24.7%, CI 16.0–35.2%). Three-year attrition was 28% CI 22–34% for females and 37% CI 26–48% for males. The females in this study successfully served as light infantry soldiers. Their lower fitness and high incidence of overuse injuries might impede service as regular infantry soldiers.

Objective To assess the association between demographic and lifestyle parameters and perceived severity of the climacteric syndrome in perimenopausal women. Study design A cross-sectional study of 151 healthy women aged 45–55 years who attended the University Medical Center affiliated menopause clinics. The analysis was based on self completion of the Greene climacteric score, consisting of psychological, somatic/physical, sexual and vasomotor subscores. The Greene total score and subscores were the main outcomes of the study. Results Of all demographic, anthropometric and lifestyle parameters recorded, the correlates with reduced total Greene score were high-order maternity and regular physical exercise. Mothers of 3 or more children reported significantly lower total Greene score (18 ± 12.8 vs. 22.1 ± 8.1) (p = 0.01) as well as lower psychological subscore (8.7 ± 6.8 vs. 11.5 ± 5.4) (p = 0.01). Regular physical activity was also associated with significantly lower total Greene score (17.0 ± 11.0 vs. 22.6 ± 11.3) (p = 0.01) and specifically lower psychological subscore (9.5 ± 6.6 vs. 12.8 ± 7.7) (p = 0.03) and sexual subscore (1.1 ± 0.99 vs. 1.61 ± 1.05) (p = 0.03). Linear regression models showed that regular exercise was the lifestyle parameter most significantly correlated with a lower total Greene score (p = 0.006) independent of menopausal status. Of particular note, regular exercise was significantly correlated with lower psychological (p = 0.006) and physical subscores (p = 0.06). Moreover, the higher the frequency of exercise (both aerobic and non aerobic), the lower the severity of the climacteric symptoms reported, yet the vasomotor and sexual subscores remained unchanged. Conclusions Regular exercise of at least 3 times a week was the most significant lifestyle parameter to be associated with the severity of climacteric symptoms.

The objective of this study was to assess the impact of a pilot nutrition intervention program on knowledge, attitudes, and behaviors of female combat soldiers in basic training serving in the Israeli army and to determine changes in nutrient intake. Seventy recruits participated in the intervention. Anthropometric measurements and food frequency questionnaires were completed at 3 time points: at enlistment, at 2 months, and at 4 months. Additional questionnaires to assess nutrition knowledge, attitudes, and behaviors were administered preintervention and postintervention. Baseline results indicated that intakes of calcium, vitamin E, and vitamin D were below recommended levels. After 2 months (8 weeks), suboptimal consumption of many nutrients was observed. At this time point, a nutrition education program was initiated and activities were carried out for the final 2 months of basic training. Following completion of the intervention, a marked improvement in nutrient intake was reported, accompanied by significant changes in attitudes toward healthy eating and increased nutrition knowledge. One-year follow-up evaluation indicated that approximately 20% of participants had made long-term dietary changes. In conclusion, nutrition education increased knowledge, modified attitudes, and led to dietary changes in female recruits. Programs of this type should be considered for implementation in the military.

To evaluate the effect of the extremes of long term high and low physical activities on musculoskeletal heath in middle age, a historical cohort study was performed. The MRI knee and back findings of 25 randomly selected subjects who were inducted into the armed forces in 1983 and served at least 3 years as elite infantry soldiers were compared 25 years later, with 20 randomly selected subjects who were deferred from army service for full time religious studies at the same time. Both cohorts were from the same common genome. The two primary outcome measures were degenerative lumbar disc disease evaluated by the Pfirrmann score and degenerative knee changes evaluated by the WORMS score. At the 25-year follow up, the mean Pfirrmann score (8.6) for the L1 to S1 level of the elite infantry group was significantly higher than that of the sedentary group (6.7), (P=0.003). There was no statistically significant difference between the WORMS knee scores between the two cohorts (P=0.7). In spite of the much greater musculoskeletal loading history of the elite infantry cohort, only their lumbar spines but not their knees showed increased degenerative changes at middle age by MRI criteria.

SummaryObjective Osteocalcin is a bone-related protein, recently found to correlate with body mass index (BMI), waist circumference, fat percentage and metabolic syndrome in adults. The aim of this study was to determine the relationship between osteocalcin and BMI in adolescence, a time of significant bone accrual, while considering possible confounders related to bone and body composition. Methods We analyzed data from 160 female adolescents (mean age 15.1 ± 0.7 years), which were divided into tertiles by osteocalcin levels. Across these three groups, we examined the differences in BMI with relation to age, total daily energy intake, calcium intake, physical activity (PA), total body bone mineral density, parathyroid hormone (PTH), 25(OH)-vitamin D, bone alkaline phosphatase and body fat percentage. Results Mean BMI values differed significantly between participants in the three osteocalcin tertiles, including after adjustment for age, PA, PTH, energy and calcium intakes. Post-hoc analysis revealed that girls in the highest osteocalcin tertile, had a significantly lower BMI than those in the two lower ones (19.3 ± 2.2 vs. 20.6 ± 3.0 and 20.7 ± 2.9 kg m−2, respectively, P = 0.018). There was no significant difference in energy and calcium intakes, bone mineral density, 25(OH)-vitamin D levels and PTH between study groups. Conclusions In female adolescents, BMI is inversely related to osteocalcin, even after consideration of several factors that may affect bone and fat mass. As bone mineral density, 25(OH)D and PTH did not differ between groups, it is possible that the relation between osteocalcin and BMI could be unrelated to bone tissue itself.

Summary There is much discussion on what an athlete should be eating , but much less reference to drinking . Dehydration might decrease both aerobic and cognitive/mental performance. Overhydration might also impair physical ability, and pose a risk for exercise-associated hyponatremia. Athletes and coaches should anticipate possible fluid losses in prolonged events, and calculate appropriate drinking amounts to maintain euhydration. Body weight changes during similar events or training can be used to determine the amount of fluids to be ingested. Another important adjunct to sports nutrition is the wide range of sports dietary supplements. Such supplements are expected to enhance sport performance, by assisting either weight control, physical and mental performance (e.g. power, speed, endurance, agility), and recovery. Very few dietary supplements have been proven to possess clinically relevant effectiveness, and others are dangerous and illegal. It should be remembered that dietary supplements are not a substitute for a poor diet, that most are not produced or marketed by homogenous standards, that they are not under tight supervision, and that many are marketed without any proof of efficacy. Persons that are very active, whether professionally or recreationally, could benefit from consulting with sport dietitians in order to verify proper nutrition, hydration, and supplement use.

It was previously demonstrated that drinking water significantly elevates the resting energy expenditure (REE) in adults, and that low water intake is associated with obesity and lesser success in weight reduction. This study addressed the potential of water drinking to increase the REE in children, as an additional tool for weight management.To examine the effect of drinking water on the REE of overweight children.A total of 21 overweight, otherwise-healthy children (age 9.9±1.4 years, 11 males) drank 10 ml kg(-1) cold water (4 °C). REE was measured before and after water ingestion, for 66 min. The main outcome measure was the change in mean REE from baseline values.Immediately after drinking water, there was a transient decrease in REE, from a baseline value of 3.32±1.15 kilojoule (kJ) per min to 2.56±0.66 kJ per min at minute 3 (P=0.005). A subsequent rise in REE was then observed, which was significantly higher than baseline after 24 min (3.89±0.78 kJ/min (P=0.021)), and at most time points thereafter. Maximal mean REE values were seen at 57 min after water drinking (4.16±1.43 kJ per min (P=0.004)), which were 25% higher than baseline. REE was significantly correlated with age, height, weight and fat-free mass; the correlations with maximal REE values after water drinking were stronger than with baseline REE values.This study demonstrated an increase of up to 25% in REE following the drinking of 10 ml kg(-1) of cold water in overweight children, lasting for over 40 min. Consuming the recommended daily amount of water for children could result in an energy expenditure equivalent to an additional weight loss of about 1.2 kg per year. These findings reinforce the concept of water-induced REE elevation shown in adults, suggesting that water drinking could assist overweight children in weight loss or maintenance, and may warrant emphasis in dietary guidelines against the obesity epidemic.

OBJECTIVE Bariatric surgery is gaining acceptance as an efficient treatment modality for obese patients. Mechanistic explanations regarding the effects of bariatric surgery on body composition and fat distribution are still limited. RESEARCH DESIGN AND METHODS Intra-abdominal and subcutaneous fat depots were evaluated using computed tomography in 27 obese patients prior to and 6 months following bariatric surgery. Associations with anthropometric and clinical changes were evaluated. RESULTS Excess weight loss 6 months following surgery was 47% in male and 42.6% in female subjects. Visceral fat and subcutaneous fat were reduced by 35% and 32%, respectively, in both sexes, thus the visceral-to-subcutaneous fat ratio remained stable. The strongest relation between absolute and relative changes in visceral and subcutaneous fat was demonstrated for the excess weight loss following the operations (r ∼0.6–0.7), and these relations were strengthened further following adjustments for sex, baseline BMI, and fat mass. Changes in waist circumference and fat mass had no relation to changes in abdominal fat depots. All participants met the criteria of the metabolic syndrome at baseline, and 18 lost the diagnosis on follow-up. A lower baseline visceral-to-subcutaneous fat ratio (0.43 ± 0.15 vs. 0.61 ± 0.21, P = 0.02) was associated with clinical resolution of metabolic syndrome parameters. CONCLUSIONS The ratio between visceral and subcutaneous abdominal fat remains fairly constant 6 months following bariatric procedures regardless of sex, procedure performed, or presence of metabolic complications. A lower baseline visceral-to-abdominal fat ratio is associated with improvement in metabolic parameters.

The impact of iron deficiency is considerable when enhanced physical fitness is required. Female military recruits represent a unique population faced with intense physical and cognitive demands. Purpose: To examine the prevalence of iron deficiency and the impact of dietary habits among female recruits in the Israel Defense Forces (IDF). Methods: 348 recruits completed the study (188 female combatants, 58 male combatants, 92 non-combat females). Dietary intake was assessed using a Food Frequency Questionnaire (FFQ). Blood samples were collected for CBC, iron indices and vitamin B12. The common definitions for anemia and iron store deficiency were used as follows: Hemoglobin (Hgb) < 12gr/dl for females and Results: The prevalence of iron deficiency and iron deficiency anemia was 29.8% and 12.8%, respectively, among female combatants. Similar data were found among non-combat females (27.2% and 17.4% respectively) as compared to 5.2% and 0%, among males. No significant difference in iron or total calorie intake was detected between subjects with iron deficiency (with or without anemia) when compared to subjects with normal iron status in the same study group. Plant sources constituted 85% of dietary iron source for females, in comparison to 73% for males. Conclusions: A high prevalence of iron deficiency was found among female recruits. Coupled with the iron loss during menstruation, inadequate iron intake may have a permissive role for iron deficiency in female recruits, and is an important issue facing females in the military.

PURPOSE: To develop a new prediction model for stress fractures (SF) in female recruits during basic training (BT) to identify risk factors and to try to prevent orthopedic injuries. METHODS: Measurements and data collection were taken from three companies of gender-integrated recruited units before the BT program (a total of 227 females and 83 males). Measurements included anthropometric variables, blood samples for hematology profile and markers for bone metabolism, fitness tests, bone quality (peripheral quantitative computed tomography), nutritional and activity habits, psychological assessment, and medical evaluation. SF were diagnosed during BT by bone scintigraphy and/or magnetic resonance imaging. RESULTS: All collected measurements were used to construct a new prediction model for the 27 and 192 female soldiers found with and without stress fracture, respectively. There were no SF in the male soldiers. The model successfully predicts 76.5% of the female soldiers with and without stress fractures (SF) as follows:PSF = -13.98 + 0.079 Ht - 0.014 Fe + 0.464 BUR - 0.105 BMI + 0.035 Ferritin,where PSF is the SF prediction according to the log odds(SF); odds(SF) is the ratio between probability of SF existence and nonexistence; Ht is the height (cm); BUR is a subjective assessment of burnout on a scale of 1 to 7; Fe is the iron blood level (microg x dL); ferritin is the iron storage level (ng x mL); and BMI is the body mass index (kg x m). CONCLUSION: A young female recruited to an integrated light combat unit is at risk for stress fracture if she is tall, lean, feels"burnout,"has iron deficiency, and is at the high end of the normal ferritin range. However, further evaluation is required in different populations, conditions, and training programs to evaluate these results. Language: en

Weight-bearing, high-impact exercise, as opposed to nonimpact exercise, has been demonstrated to increase bone mineral density. This was traditionally demonstrated with dual energy X-ray absorptiometry. Our objective was to assess the differences in bone properties, using quantitative ultrasound (QUS, Sunlight Omnisense, Sunlight Medical, Ltd., Tel Aviv, Israel), in male athletes involved in a weight-bearing, impact sport (soccer, SC) or a nonimpact sport (swimming and water polo, AQ), compared with nonathletic control (C) males. A total of 266 boys and men, aged 8 - 23 years, were divided into children (11.1 +/- 1.0 years; 34 SC, 34 AQ, 25 C), adolescents (14.7 +/- 1.2 years; 32 SC, 31 AQ, 31 C), and young adults (19.8 +/- 1.1 years; 31 SC, 24 AQ, 24 C) . Training experience varied between 1.5 years in the children to 15 years in the adults. Bone speed of sound (SOS) was measured bilaterally at the distal radius and the mid-tibia. Body fat was significantly lower in athletes compared with C. AQ were generally heavier and had a higher fat-free mass compared with SC and C, with no significant differences in height between groups. Radial SOS increased with age, but no differences were observed between activity groups or between the dominant (D) and nondominant (ND) arm. Tibial SOS also increased with age. In the children and adolescents, no differences were observed between activity groups. However, among adults, both SC and AQ had higher tibial SOS compared with C. These differences were mainly explained by differences in fat-free mass. Among young adults but not among children and adolescent males, both soccer and aquatic sports appear to be associated with higher bone SOS in the lower, but not the upper, extremities. Further studies are needed to assess possible sport-specific mechanisms which affect bone properties and to determine the minimal cumulative effect which is needed to influence bone properties.

In most combat sports and martial arts, athletes compete within weight categories. Disordered eating behaviors and intentional pre-competition rapid weight loss are commonly seen in this population, attributed to weight categorization. We examined if height categories can be used as an alternative to weight categories for competition, in order to protect the health of athletes. Height and weight of 169 child and adolescent competitive karate athletes were measured. Participants were divided into eleven hypothetical weight categories of 5 kg increments, and eleven hypothetical height categories of 5 cm increments. We calculated the coefficient of variation of height and weight by each division method. We also calculated how many participants fit into corresponding categories of both height and weight, and how many would shift a category if divided by height. There was a high correlation between height and weight (r = 0.91, p We conclude that dividing young karate athletes by height categories significantly reduced the range of heights of competitors within the category. Such categorization would not cause athletes to compete against much heavier opponents in most cases. Using height categories as a means to reduce eating disorders in combat sports should be further examined.

In April 2014, the International Olympic Committee (IOC) published a Consensus Statement in this journal entitled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)”.1 In reference to that Consensus Statement, Professor Mary Jane De Souza and colleagues published an editorial (July 2014).2 The editorial below expands on the original Consensus Statement and comments on the 2014 Editorial by Professor Mary Jane De Souza and colleagues. Albert Einstein said: “The important thing is to never stop questioning.” A group of 11 IOC authors have called attention, as others in the past,3 ,4 to a problem that is wider and more complex than originally identified when the term ‘Female Athlete Triad’ (Triad or FAT) was first coined in 1992. Just as knowledge evolves, so too should ideas and constructs on how to address it. Given the evolution of science since 1992, and to more accurately describe the clinical syndrome originally known as the Female Athlete Triad, the IOC introduced a more comprehensive, broader term: Relative Energy Deficiency in Sport. The syndrome of RED-S refers to impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. Our April 2014 Consensus statement identifies the aetiological factor underpinning the syndrome as: an energy deficiency relative to the balance between dietary energy intake and the energy expenditure required to support homeostasis, health and the activities of daily living, growth and sporting activities. We reaffirm the principle that the IOC Consensus Statement highlights about energy deficiency/low energy availability among exercising people. De Souza and colleagues’ editorial criticises the use of the word ‘balance,’ suggesting that the IOC authors have confused the terms energy availability and energy balance. We used the term …

Background The long term implications of elite infantry service on cardiovascular health and cortical bone width at middle age has not been studied. The purpose of this study was to compare the cardiovascular health and cortical bone thickness of former elite infantry soldiers at middle life with a sedentary population of religious scholars using seven factors associated with cardiovascular risk and QCT tibial cross sections 8 cm above the ankle joint. Results Torah scholars had a higher 5 year risk for a fatal or non fatal cardiovascular event (p = 0.008) than former elite infantry soldiers. The former elite infantry soldiers had wider tibia cortices than Torah scholar (p = 0.003). Conclusions This study shows that former elite infantry soldiers who performed strenuous physical activity during their military service and continued physical activity in their subsequent life, had stronger tibias based on increased cortical width and a modest decrease in cardiovascular risk at middle life compared to sedentary Torah scholars.

In April 2014, the International Olympic Committee (IOC) published a Consensus Statement in the British Journal of Sports Medicine (BJSM) entitled “Beyond the Female Athlete Triad – Relative Energy Deficiency in Sport (RED-S)”. To assist sports medicine professionals working in clinical sports medicine with the practical screening and management of the RED-S athlete, the IOC authors have developed a Clinical Assessment Tool – the RED-S CAT . It is well known that the utility of scientific knowledge is limited at a practical level and that implementing effective interventions in the real life sport setting are challenging. As in all areas of medicine, there is now attention in sports medicine to the growing field of knowledge …

The female sex steroid hormones estrogen and progesterone have potential effects on exercise capacity and performance through numerous mechanisms, such as substrate metabolism, cardiorespiratory function, thermoregulation, psychologic factors, and injuries. Consequently, hormone level changes may theoretically lead to either improved or decreased performance at various times throughout the menstrual cycle. Numerous methodological issues and a paucity of studies have precluded evidence-based conclusions in almost every area of research in this field. In addition, there appears to be a great degree of inter- and intraindividual variability in these hormonal responses. Using oral contraceptives may be advantageous for female athletes who are negatively affected by their menstrual cycle, as they may provide a stable yet controllable hormonal milieu for training and competition.

Background:It has been found that swimming, a non-impact sport, generally has no effect on bone mineral density.Objectives:To examine bone properties, as measured by quantitative ultrasound, among female swimmers in comparison with control girls and women.Methods:Subjects included 61 swimmers and 71 controls aged 8.5 to 26.5 years. None of the swimmers was at the elite level and none had included resistance training in her schedule. Bone speed of sound (SOS) was measured bilaterally at the distal radius and the mid-tibia.Results:No differences were observed between swimmers and controls in body mass (mean (SD): 49.7 (12.3)v50.7 (12.4) kg, respectively), although swimmers were taller (159 (12)v155 (12) cm) and had lower body fat (18.3 (4.2)%v22.3 (5.4)%). No difference was found in time since menarche (5.2 (4.0) and 4.5 (2.9) years in swimmers and controls, respectively; 21 swimmers and 25 control were premenarcheal). Radial speed of sound (SOS) increased with age but did not differ between swimmers and controls (non-dominant: 3904 (172) and 3889 (165) m/s for swimmers and controls, respectively). Tibial SOS also increased with age and was significantly higher in swimmers than in controls (non-dominant: 3774 (155)v3712 (171) m/s). No differences were found between dominant and non-dominant sides.Conclusions:Swimming appears to be associated with higher bone SOS in the lower but not in the upper extremities. Further studies are needed to assess whether this difference reflects higher habitual activity among the swimmers or swimming specific mechanisms.

Iron depletion, with or without anemia, may have a negative effect on physical and mental performance. Even with current recognition of the problem, its incidence among athletes remains high. Most studies describe iron status in endurance athletes. This study examined the prevalence of iron depletion and anemia among male and female top-level basketball players. Adolescents and adults (N = 103) from 8 national basketball teams were screened for anemia and iron stores status, which included a complete blood count and levels of plasma ferritin, transferrin, and serum iron. Iron depletion, defined by a ferritin level below 20 μg/L, was found among 22% of study participants (15% in males vs. 35% in females, p = .019). Anemia was found among 25% of athletes (18% in males vs. 38% in females, p = .028). Iron deficiency anemia, defined by the presence of anemia, ferritin levels below 12 μg/L, and transferrin saturation below 16%, was found among 7% of players (3% in males vs. 14% in females, p = .043). In summary, a high prevalence of iron depletion, anemia, and iron deficiency anemia was found among basketball players of both genders. We recommend screening ballgame players for blood count and iron store status, and providing nutritional counseling and iron supplementation when necessary.

Observational studies identified associations between vitamin D insufficiency (serum 25(OH)D > 30ng·ml−1) and risk of upper respiratory infection (URI). Swimmers are highly prone to URIs, which might hinder their performance. The aim of this study was to examine if vitamin D3 supplementation reduces URI burden in vitamin D-insufficient swimmers. Fifty-five competitive adolescent swimmers with vitamin D insufficiency were randomized to receive vitamin D3 (2,000IU·d4) or placebo for 12 winter weeks. A URI symptom questionnaire was completed weekly. Serum 25(OH)D concentrations were measured by radio-immunoassay before and after supplementation. We used linear regression to examine the relation between the change in 25(OH)D concentrations during the trial, and the duration and severity of URIs. There were no between-group differences in the frequency, severity, or duration of URIs. Exploratory analyses revealed that in the placebo group only, the change in 25(OH)D concentrations during the trial was highly associated with the duration of URIs (r = −0.90,p > .001), and moderately associated with the severity of URIs (r = −0.65,p = .043). The between-group differences for duration were highly significant. Vitamin D3 supplementation in adolescent swimmers with vitamin D insufficiency did not reduce URI burden. However, larger decreases in serum 25(OH)D concentrations were associated with significantly longer and more severe URI episodes.

Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations.

The purpose of this study was to examine the effect of 2 school years (21 months) of a twice-weekly resistance training program on stature, muscle strength, and self-concept among prepubertal boys. The experimental group (E, n = 27) aged 9.2 ± 0.3 yrs, participated in progressive resistance training, while the control group (C, n = 22) aged 9.4 ± 0.3 yrs, participated in standard physical education classes (as advised by the Ministry of Education). Training sessions included 1–4 sets of 3–6 exercises, with 5–30 repetitions/set. The load ranged between 30% and 70% 1RM. No differences were observed in the gain in body height between groups. Muscle strength increased significantly more in E (e.g., knee extensors: 0.51 ± 0.13 to 0.77 ± 0.16 kg/kg body mass), compared with C (0.34 ± 0.12 to 0.54 ± 0.11 kg/kg body mass). One minor injury was reported throughout the study. Initial scores of self-concept were high in both groups, with no training effect. The results demonstrate that among prepubertal boys, a twice-weekly low-to-moderate-intensity resistance training program over a period of 2 school years (21 months) can result in enhancement in muscle strength with no detrimental effect on growth.

Low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a Boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.