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There are positive health effects of exercise performed at regular intervals also in high volume exercisers. However, at present there is no exact definition of the optimal dose or the maximal safe dose of exercise, nor can the level of exercise to induce increased risk of harmful effects be defined. People who often exercise with a high volume and intensity should therefore individually consider the health-related effects and possible risks of their training as well as the physical or psychological warning signals.

To determine CYP2C19 and CYP2D6 activity in patients with multiple sclerosis (MS) before and during interferon (IFN)-beta treatment.CYP2C19 and CYP2D6 activities were assessed using the probe drugs mephenytoin and debrisoquine, respectively. Urinary mephenytoin (S/R) and debrisoquine (debrisoquine/hydroxy-debrisoquine) metabolic ratios (MR) were determined in 10 otherwise healthy Caucasian multiple sclerosis (MS) patients in the initial stage of the disease, prior to and 1 month after commencing treatment with IFN-beta (Avonex, Rebif or Betaferon). In addition, CYP2C19*2, CYP2C19*3, CYP2D6*3, CYP2D6*4, and CYP2D6*5 genotyping was performed.There was no significant difference in the (S)/(R) mephenytoin ratio (mean difference 0.04; 95% CI -0.03, 0.11) or the debrisoquine MR (mean difference 0.29; 95% CI -0.44, 1.02) before and during regular IFN-beta treatment in extensive metabolizers (EM) (P = 0.5 and P = 0.4 for the respective probe drugs; n = 9 subjects). There were also no differences between the different IFN-beta treatments (P = 0.6 for the (S)/(R) mephenytoin ratio and P = 0.7 for the debrisoquine MR; anova; n = 10).IFN-beta treatment did not affect the activity of CYP2C19 or CYP2D6. The results suggest that it is safe to administer CYP2C19 or CYP2D6 substrates, without dose adjustment, to patients treated with IFN-beta.

No generally accepted definition of osteoarthritis exists. Traditionally, the diagnosis is obtained by radiographic examination but different definitions are used for different purposes. Since no causal treatment exists, treatment is aiming at reducing symptoms and improving function. The correlation between radiographic features of osteoarthritis and symptoms is poor. Thus, it is recommended that in the early and moderate stages the diagnosis osteoarthritis be obtained through clinical examination. Radiographs should be obtained when other serious pathologies are suspected or when operative procedures are being discussed.

There is no causal treatment for osteoarthritis. Instead treatment is aimed at decreasing pain and improving function. The base of osteoarthritis treatment is education and exercise. Exercise, both aerobic exercise and muscular strength training, have positive effects on pain and function. The minimum recommendations of exercise are equivalent to the recommendations of physical activity to obtain or maintain a good general health. Acupuncture is a safe and effective treatment for osteoarthritis pain. However, function is not automatically improved when pain is relieved.