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Purpose Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. Methods Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. Results Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). Conclusions The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. Type of study/level of evidence Therapeutic IV.

Purpose Long-standing scaphoid nonunion preferentially is treated by using a vascularized bone graft because of its superiority in achieving bone healing. In the present study nonunion was repaired using a bone graft raised from the thumb metacarpal and vascularized by the first dorsal metacarpal artery. Methods Twenty-four patients with scaphoid nonunion for longer than 5 years, without ligament injuries and panarthrosis, had surgery. According to the location of the nonunion and presence of dorsal intercalated segment instability deformity, surgery was performed by either a dorsal or palmar approach. The patients had a final clinical and radiographic evaluation 12 months after surgery. Results Complete healing was shown in 21 patients but incomplete healing was observed in the remaining 3 patients. After surgery patients had marked pain relief, with an improved range of motion and grasping strength. Anatomic restoration of carpal angles and scaphoid length was observed. None of the patients required additional surgery. Before surgery 15 patients presented radiographic signs of wrist arthrosis. During surgery, however, cartilage erosion on the proximal pole or on the radius articular surface was not confirmed. Despite the presence of radiographic arthrosis, wrist symptoms, motion, and grasping strength improved after surgery. Conclusions Long-standing scaphoid nonunion, even in the presence of limited arthrosis, can be treated with surgery and healing promoted by a vascularized bone graft. Because of its versatility for use by dorsal or palmar approach and reliability, the first dorsal metacarpal artery vascularized bone graft represents our method of choice.

Background: The regulation of myocardial mass in athletes involves complex interactions between physical stress, cardiac growth factors (GF), and the individual genetic background. Studies suggest the renin-angiotensin-system (RAS) plays a key role in the development of myocardial hypertrophy. Genetic polymorphisms of the RAS, associated with an activation, have been shown to correlate with left ventricular mass (LVM) in athletes. It is not clear whether these polymorphisms influence angiotensin (A) II levels directly or only markers coprecipitating with other factors modifying LVM. Endothelin (ET)-1 acts synergistically to AII in the induction of cardiac hypertrophy. The role of these GF in an athlete's heart is not yet clarified. Objectives: To analyze the correlation of RAS-gene polymorphisms with AII and ET-1 plasma concentrations in high performance athletes. Methods: In 83 male Caucasian, mainly endurance trained, elite athletes, intensity and duration of exercise were assessed by questionnaires; LV...

Background Genetic factors may be important in modifying heart size due to long-term athletic training. The significance of polymorphisms of genes of the renin–angiotensin system in myocardial mass in a population of athletes participating in different disciplines is not known. Methods The angiotensin I-converting enzyme gene insertion/deletion (I/D) polymorphism, angiotensinogen gene M235T polymorphism and angiotensin II type 1 receptor gene A1166C polymorphism were determined in 83 male Caucasian endurance athletes and associated with left ventricular mass. Results No association with left ventricular mass was found for the polymorphisms of angiotensin I-converting enzyme gene I/D, angiotensinogen gene M235T and angiotensin II type 1 gene A1166C when studied separately. However, combined analysis of the angiotensin I-converting enzyme gene I/D polymorphism and angiotensinogen gene M235T polymorphism genotypes suggested an association with left ventricular mass (g m−2) (P = 0·023). Athletes with the angiotensin I-converting enzyme gene DD/angiotensinogen gene TT genotype combination had greater left ventricular mass compared with all other genotype combinations (179·8 ± 26·1 g m−2 vs. 145·2 ± 27·3 g m−2, P = 0·003). Conclusions These results suggest an association of combined angiotensin I-converting enzyme gene I/D polymorphism genotypes, and angiotensinogen gene M235T polymorphism genotypes with left ventricular hypertrophy due to long-term athletic training. A synergistic effect of angiotensin I-converting enzyme gene DD genotype and angiotensinogen gene TT genotype on left ventricular mass in endurance athletes appears to occur.

Objective: The present study was designed to investigate the integrated effects of the beta-1-selective blocker with vasodilator properties, nebivolol, on systemic haemodynamics, neurohormones and energy metabolism as well as oxygen uptake and exercise performance in physically active patients with moderate essential hypertension (EH). Design and methods: Eighteen physically active patients with moderate EH were included: age: 46.9 ± 2.38 years, weight: 83.9 ± 2.81 kg, blood pressure (BP): 155.8 ± 3.90/102.5 ± 1.86 mm Hg, heart rate: 73.6 ± 2.98 min−1. After a 14-day wash-out period a bicycle spiroergometry until exhaustion (WHO) was performed followed by a 45-min submaximal exercise test on the 2.5 mmol/l lactate-level 48 h later. Before, during and directly after exercise testing blood samples were taken. An identical protocol was repeated after a 6-week treatment period with 5 mg nebivolol/day. Results: Nebivolol treatment resulted in a significant (P < 0.01) decrease in systolic and diastolic BP and heart rate at rest and during maximal and submaximal exercise. Maximal physical work performance, blood lactate and rel. oxygen uptake (rel. VO2) before and after nebivolol treatment at rest and during maximal and submaximal exercise remained unaltered. Free fatty acid, free glycerol, plasma catecholamines, beta-endorphines and atrial natriuretic peptide (ANP) increased before and after treatment during maximal and submaximal exercise but remained unaltered by nebivolol treatment. In contrast, plasma ANP levels at rest were significantly higher in the presence of nebivolol, endothelin-1 levels were unchanged. Conclusions: Nebivolol was effective in the control of BP at rest and during exercise in patients with EH. Furthermore, nebivolol did not negatively affect lipid and carbohydrate metabolism and substrate flow. The explanation for the effects on ANP at rest remain elusive. This pharmacodynamic profile of nebivolol is potentially suitable in physically active patients with EH.

From January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performed and is still in progress. In Germany until 1992 the cardiac rehabilitation was exclusively performed stationary. The objective of the "Cologne model" was to evaluate, whether the transfer of the stationary cardiac rehabilitation programs into the ambulatory setting is achievable without deficits in efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory cardiac rehabilitation programs in Germany. From 1992 to 1994 108 patients (94 men, 14 women; 52.3 +/- 8.0 years old) with coronary artery disease (CAD) which were compatible with the criteria of the "Cologne model" (Table 1) participated in the 4-week ACR. The indications for inclusion into the ACR were in 74 cases a myocardial infarction (MI), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Seven patients discontinued the ACR prematurely, 2 patients because of cardiovascular reasons. Reasons for the preference of the ambulatory over a stationary cardiac rehabilitation program were in 40.6% of the patients refusal of "hospital ambience", in 43.6% familiar or in 12.9% professional reasons. During the 4-week ACR patients participated in a mean of 72.9 +/- 6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4 +/- 28.8 to 129.9 +/- 34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7 +/- 35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stated to be physically active in ambulatory heart groups (AHG) (27.6%) or on their own (49.4%). Three years after ACR the rate of regularly physically active patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly. There was a reduction in the consumption of lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 30.5%. The plasma concentrations of cholesterol decreased from 231 +/- 49.8 to 213.2 +/- 35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6 +/- 39.4 mg%. Three years after ACR the mean cholesterol level was 219.1 +/- 39.3 mg%. In the high risk group (cholesterol at the initial visit > 220 mg%) cholesterol levels were reduced from 266 +/- 44 to 232 +/- 31.9 mg%**. Six and 12 months after ACR they were 239.7 +/- 35.8 mg% and 245.8 +/- 32.6 mg%, respectively, (Tables 6 and 7) and still significantly lower than before ACR, though only 19% of the patients were treated with lipid lowering agents. Three years after ACR cholesterol were 234.6 +/- 37.7 mg%** in the high-risk group. 34.2% of the patients received lipid lowering agents. Mean body weight remained unaltered over the 3-year period. Smoking behavior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes. At the beginning and at the end of ACR 20.8% of the patients still smoked. During the ACR the number of smoked cigarettes was reduced significantly from 32.4 +/- 15.2 to 6.9 +/- 5.2 cigarettes per day. One year after ACR 23% of the patients were smokers, 3 years after ACR the percentage of smokers increased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percentage increased to 73% in the following 6 months. The results demonstrate that it is achievable to transfer the contents of the established stationary cardiac rehabilitation programs into the ambulatory setting without loss of efficiency, safety and overall quality. It is further confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. (ABSTRACT TRUNCATED)

Wahrend eines 4wochigen ambulanten Rehabilitationsprogramms wurden 262 KHK-Patienten, 235 Manner und 27 Frauen, Durchschnittsalter 53,6±10,2 Jahre, im Mittel 30,5±2,9 Therapiestunden im Bereich der Bewegungs- und Sporttherapie unterzogen. Inhaltlicher Schwerpunkt war ein dosiertes Ergometertraining 5mal pro Woche. Im Mittel wurden 18,4±1,8 Trainingseinheiten auf dem Ergometer absolviert. Vor und nach der Rehabilitation wurde die Leistungsfahigkeit mittels einer Belastungsuntersuchung auf dem Fahrradergometer uberpruft. Auf jeder Belastungsstufe wurde neben Pulsfrequenz- und Blutdruckmessung auch eine Blutprobe aus dem hyperamisierten Ohrlappchen entnommen fur die Bestimmung der Laktatkonzentration im arterialisierten Blut. Die Bestimmung der Laktatkonzentration bei ansteigender Belastung ermoglicht eine exakte Beurteilung der Ausdauerleistungsfahigkeit und dadurch eine gezielte Intensitatssteuerung wahrend der Therapie. Weiter kann durch die Kontrolle des Laktatwertes der Therapieerfolg objektiv nachgewiesen werden. Die Ergebnisse der Vor- und Nachuntersuchung zeigten eine hochsignifikante Steigerung der maximalen Ergometerleistung von 105,3±32,3 auf 121,9±37,3 Watt. Die relative Leistungsfahigkeit wurde von 1,30±0,39 auf 1,51±0,44 Watt/kg Korpergewicht erhoht. Die mittlere Leistung bei 2,0 mmol/l Laktat im Blut wurde von 72,2±23,5 auf 86,4±25,8 Watt um 19,7%, bei 2,5 mmol/l von 83,5±23,2 auf 97,4±26,4 Watt um, 16,6% und bei 3,0 mmol/l von 93,1±23,0 auf 106,6±26,1 Watt um 14,5% jeweils hochsignifikant gesteigert. Die Herzfrequenz bei der Belastung von 2,0, 2,5 und 3,0 mmol/l Laktat blieb trotz erhohter Wattleistung unverandert. Die Leistung fur definierte Herzfrequenzwerte wurde bei allen definierten Herzfrequenzwerten (85, 90, 95, 100, 105, 110) jeweils hochsignifikant erhoht. Am deutlichsten war die Steigerung bei Herzfrequenz 110/min mit 22,8%.

In 12 moderately trained subjects reduced glutathione (GSH) and oxidized glutathione (GSSG) as well as thiobarbituric acid reactive substances (TBARS) were measured in the blood before and during the first two hours and first two days after a 2.5-h run. The participants covered between 19 and 26 km (20.8 +/- 2.5 km, mean +/- SD). The running speed was between 53 and 82% of the speed at which blood lactate concentration reached 4 mmol/L lactate (67.9 +/- 8.2%, mean +/- SD) assessed during a previously performed treadmill test. Blood samples were collected 1 h before, immediately before, immediately after, 1 and 2 h after, as well as 1 and 2 days after the run. Immediately after exercise GSH was significantly decreased (p < 0.01) and GSSG significantly increased (p < 0.01). In all subjects the ratio of GSH to GSSG showed a marked decline to 18 +/- 4% (mean +/- SD) of the pre-exercise values (p < 0.01). One hour later the mean GSH and GSSG values returned to baseline. However, there were considerable inter-individual differences. In some subjects the GSH/ GSSG ratio overshot the pre-exercise levels, in others the ratio remained low even two hours after exercise. Compared with the pre-exercise values TBARS concentrations did not change significantly at any time point after exercise. The findings suggest that after prolonged exercise in moderately trained subjects a critical shift in the blood glutathione redox status may be reached. The changes observed were generally short-lived, the duration of which may have depended on the relative importance of reactive oxygen species generation by the capillary endothelial cells and neutrophil and eosinophil granulocytes after the end of exercise.

Previous studies suggest that ET-1 plays a role in induction of coronary artery disease (CAD). It was shown that secretion of endothelin-1 (ET-1) by the vascular endothelium is enhanced in atherosclerotic alterations and may be antagonized by EDRF. The objective of the present study was to investigate the effects of ergometric exercise on plasma ET-1 concentrations, and the potential modulatory role of LDL cholesterol, and the effects of an orally administered nitrate, PETN, in patients with CAD. Ten men with CAD and 10 healthy men underwent bicycle ergometry according to the WHO-standards. Venous blood samples for determination of ET-1 concentrations were drawn directly before and 5 min after ergometric exercise. Patients were randomized and treated for 72 h in a crossover design either with placebo or pentaerithrityltetranitrate (PETN). After 72 h the identical ergometric protocol was repeated. Basal plasma levels of ET-1 were 6.1 +/- 0.7 pg/ml (patients) and 5.5 +/- 0.6 pg/ml (controls) (n.s.). After ergometric exercise ET-1 plasma concentrations rose significantly (7.3 +/- 0.9 pg/ml; p < 0.05) in the patient group under placebo treatment, whereas they remained constant (5.5 +/- 0.7 pg/ml) with PETN treatment. ET-1 levels remained unaffected by ergometric exercise in healthy controls. Mean LDL cholesterol plasma levels in patients with CAD were 156 +/- 8 mg% and 152 +/- 7 mg% in healthy controls. In the patient group there was a significant (p < 0.002) positive correlation between the exercise-induced increase in ET-1 and the LDL cholesterol plasma concentrations (r = 0.85). Blood pressure and heart rate were not modified by PETN treatment. In patients with CAD bicycle ergometry induced an increase in ET-1 plasma concentrations. The positive correlation with the LDL cholesterol plasma levels indicates that LDL cholesterol is involved in regulation of ET-1 secretion in vivo. PETN therapy completely abolished the exercise-induced increase in ET-1 plasma levels. This may result from local hemodynamic effects of the nitrate; hypothetically a nitrate-induced rise in the local NO concentrations can be considered. The clinical implications of these findings remain elusive. However, the findings of the present study are in accordance with the beneficial clinical effects of nitrates in patients with CAD.

We investigated the effects of the angiotensin-converting enzyme (ACE) inhibitor trandolapril (2 mg/o.d.) on the physical work capacity (PWC), the received perception of exertion (RPE), as well as parameters determining physical performance (i.e., energy metabolism, lactate production, and oxygen uptake) in well-trained, healthy subjects. Twenty male sports students underwent a bicycle spiroergometry until exhaustion to determine maximum work load, maximum oxygen uptake, lactate threshold, and parameters of energy metabolism. The identical protocol was repeated after a 14-day treatment period with 2 mg of trandolapril o.d. or placebo. Treatment with the ACE inhibitor did not significantly alter maximum PWC, RPE, 4.0 mmol/L lactate threshold, heart rate, maximum oxygen uptake, plasma levels of total cholesterol, triglycerides, free fatty acids, glucose, insulin, cortisol, and human growth hormone. In the presence of the ACE inhibitor, the exercise-induced increase in systolic blood pressure was moderately (n.s.) blunted (204 +/- 7 versus 192 +/- 7 mm Hg). Treatment with the ACE inhibitor did not impair physical performance and RPE. This favorable profile of action was accompanied by no alterations in maximum oxygen uptake and parameters of energy metabolism at all levels of exercise intensity. Therefore, it may be concluded that antihypertensive treatment with an ACE inhibitor should be primarily considered in physically active patients.

Ten patients with scaphoid non-unions which had been present for longer than 2 years were treated using a vascularised bone graft harvested from the thumb and pedicled on the first dorsal metacarpal artery. Bone harvesting and grafting were performed by a single palmar approach. Concomitant cancellous bone graft was not used. Bone healing was confirmed by CT scans in nine of the ten patients. Persistence of the non-union was observed in one patient who was the oldest in this series, had the longest standing non-union and was a heavy smoker. Twelve months after surgery, nine of the ten patients had significant pain relief with an improved range of motion and grip strength.

Eosinophil cationic protein (ECP) has been shown to be a marker of eosinophil granulocyte activation. In 10 healthy young subjects the plasma concentrations of ECP were measured before and after a graded maximal bicycle exercise test. The analyses were carried out 30 min before and immediately before exercise, immediately after exercise and 20 and 45 min later. The post-exercise values were corrected for plasma volume changes which were calculated from hematocrit and hemoglobin values. Immediately post-exercise the ECP increased significantly (p < 0.01) from 1.25 +/- 0.28 at rest to 2.40 +/- 0.59 micrograms/l. Twenty and 45 min later the values normalized and significant differences from the pre-exercise values could no longer be measured. The results provide strong evidence for an activation of eosinophil granulocytes after a short maximal exercise.

An intense physical exercise induces an inflammatory reaction as demonstrated by the delayed increase in blood of acute phase proteins and among them of C-reactive protein (CRP). There is also evidence for a diminished acute phase reaction due to regular exercise suggesting a suppression of the inflammatory response through training. With this background CRP was measured by a sensitive enzyme immunoassay under resting conditions before and after 9 months of training in 14 subjects preparing for a marathon with the aim of studying the effect of training on the base-line CRP concentration. The mean distance run per week increased significantly from 31 +/- 9 km at the beginning to 53 +/- 15 km after 8 months of training (p < 0.01). The aerobic capacity rose significantly after training as demonstrated by the increase of running velocity during a maximal treadmill test from 3.82 +/- 0.29 m/s pre-training to 4.17 +/- 0.17 m/s post-training at a blood lactate concentration of 4 mmol/L (p < 0.01). In 10 of 12 runners base-line CRP was diminished after training in spite of a continuous increase of training intensity. The CRP median fell from 1.19 mg/L before to 0.82 mg/L after training (p < 0.05). Since intense physical exercise is known to be associated with an inflammatory reaction of muscles and tendons, the CRP decrease was unexpected. In 2 subjects the CRP concentration rose markedly because of a borrelia infection and a knee injury, respectively. These values were caused by a pathological condition and were not considered for the statistical evaluation. In 10 non-training control subjects the CRP median did not change significantly during the same 9 months period. The decrease of the CRP base-line concentration after training suggests that intensive regular exercise has a systemic anti-inflammatory effect. This is of particular interest with regard to several recent reports confering on the concentration of CRP in plasma a predictive value for the risk of cardiac infarction, venous thrombosis or stroke.

The aim of this study was to investigate hypothalamic-pituitary-adrenal (HPAA) and -gonadal (HPGA) axis responses to post-exercise (30 min at 65% VO2max) combined corticotrophin, luteinizing hormone and thyrotrophin releasing hormone challenge (0.7 microg/ kg body mass) in elderly distance runners (DR; age: 68.9+/-4.2 year) and sedentary individuals (SI; age: 69.1+/-2.6 year). Plasma cortisol, growth hormone, prolactin, luteinizing hormone, follicle stimulating hormone and total testosterone (T) concentrations pre- and post-exercise as well as in response to stimulation did not differ between DR and SI. Plasma adrenocorticotropic hormone returned to pre-exercise level in DR 60 min and in SI 90 min post-stimulation. Free T was lower in DR at all time points. Our results do not support the notion of altered releasing hormone-stimulable HPAA and HPGA synthesis-secretion capacity in elderly males after endurance training.

BACKGROUND AND OBJECTIVE Previous studies have suggested that endothelin (ET)-1 with its marked vasoconstrictive potency may play a role in the induction of coronary artery spasms. Furthermore, it was demonstrated using in-vitro vessel preparations that the secretion of ET-1 by the vascular endothelium is enhanced in the presence of atherosclerotic alterations. The objective of the present study was to investigate a) the effects of ergometric exercise on ET-1 plasma concentrations in 10 patients with coronary artery disease (CAD) as compared to an age and sex matched control group and b) the modulatory role of the orally administered organic nitrate, pentaerithrityltetranitrat (PETN), in patients with CAD. PATIENTS AND METHODS 10 male patients with CAD confirmed by coronarography and 10 male healthy controls underwent a bicycle ergometry according to the WHO-standards upt to 125 watts. Venous blood samples for determination of ANP and ET-1 plasma concentrations were drawn in supine position directly before and 5 min after ergometric exercise. Subsequently, patients were randomized and treated for 3 days in a crossover design either with placebo or PETN (150 mg b.i.d.). RESULTS Basal plasma levels of ET-1 were 6.1 +/- 0.7 pg/ml (patients) and 5.5 +/- 0.6 pg/ml (controls), resp. (n.s.). After ergometric exercise ET-1 plasma concentrations rose significantly (7.3 +/- 0.9 pg/ml; p < 0.05) in the placebo-treated patient group, whereas they remained constant (5.5 +/- 0.7 pg/ml) in the PETN-treated patient group. Blood pressure and heart rate were not modified by the PETN-treatment. ET-1 plasma levels remained unaffected by ergometric exercise in controls. DISCUSSION In contrast to healthy controls ergometric exercise induced an increase in ET-1 plasma concentrations in patients with CAD that may be potentially harmful by promoting coronary vasospasms. The almost complete blunting of the ET-1-increase in the presence of PETN-therapy may result from local-hemodynamic effects of the organic nitrate; it may be hypothesized that the nitrate-induced rise in local NO-concentrations counteracts ET-secretion. The findings of the present study are in accordance with the beneficial clinical effects of organic nitrates in patients with CAD.

Wahrend fruher der Sport vor allem eine Domane des jungen, gesunden und fitten Menschen war, treiben heute immer mehr altere Menschen, bei denen bereits gesundheitliche Vorschadigungen vorliegen konnen, Sport. Daruber hinaus wird der Sport zunehmend auch als Behandlungsmoglichkeit vor allem bei chronischen Krankheiten angeboten. Der alte Glaubenssatz, der Kranke gehort ins Bett, trifft heute bestenfalls noch bei akuten schweren Erkrankungen zu, beispielsweise bei hohem Fieber oder einem frischen Herzinfarkt. Bei fast allen chronischen Krankheitszustanden ist Bewegung in irgendeiner Form sinnvoll. Wer etwa ein akutes Gelenkrheuma hat, mit schweren schmerzhaften Schwellungen der Gelenke, sollte sich moglichst ruhig verhalten. Bei chronischem Rheuma ist Bewegung dagegen gunstig, um die Gelenke beweglich zu halten und die Muskulatur zu kraftigen. Ahnliche Uberlegungen gelten fast bei allen Erkrankungen, auch solcher von inneren Organen.

Sport ist - wer wuste dies nicht - keineswegs nur mit positiven Auswirkungen verbunden. Mancher, der durch Sport gesund werden will, erreicht das Gegenteil. Die Frage, ob Sport gesund ist oder nicht, wird wohl ein ewiges Stammtischthema bleiben. Dabei ist es ja eigentlich ganz einfach: Wie bei jedem Medikament kommt es auch bei der Droge Sport auf die Dosis an. Dies hat schon der mittelalterliche Arzt Paracelsus treffend formuliert: Wahrend Heilmittel in zu geringen Mengen nichts nutzen, kann in unvernunftig grosen Mengen alles zum Gift werden, selbst mit Wasser kann man sich notfalls umbringen. Dies gilt auch fur den Sport: Wahrend zu schwache Reize ohne Trainingswirkungen bleiben und Reize im optimalen Trainingsbereich zu gesundheitlich positiven Anpassungen fuhren, entstehen als Ergebnisse von ubertriebenen Reizen Uberlastungen und Verletzungen. Diese sind dann das Resultat eines unvernunftig betriebenen Sports.

Die Diskussion um den gesundheitlichen Wert des Sports orientiert sich uberwiegend an dem »wichtigsten Mitglied« unserer Gesellschaft, dem eigentlichen »Leistungstrager«, dem Mann in den mittleren Lebensjahren. Er ist in besonderer Art und Weise vom Herzinfarkt bedroht. Er verursacht die grosten Kosten, wenn er krank wird und vorzeitig Rente benotigt. Aus diesem Grund wird als besonders gesund im allgemeinen die Ausdauerbelastung, das Joggen, hervorgehoben. Dies fuhrt dazu, das gewissermasen alle zum Zwangsjoggen verpflichtet werden, vom Kind bis zur Grosmutter! Die Bewegungsbedurfnisse, die aus Freude am Sport oder im Interesse der Gesundheitserhaltung entstehen, stellen sich fur einzelne Lebensabschnitte und fur beide Geschlechter aber sehr unterschiedlich dar. Zwar gibt es keine rein »mannliche« oder rein »weibliche« Sportart, keine typischen Alters- oder Kindersportarten. Trotzdem lassen sich fur bestimmte Lebensphasen bestimmte Schwerpunkte herausarbeiten.

Die Belastung beim Sport wird ganz entscheidend auch von den Bedingungen bestimmt, unter denen er durchgefuhrt wird. Ein Langlauf ist unter Normalbedingungen im Regelfall gesund, der gleiche Langlauf bei schwul-warmer Witterung kann zu einem Herz-Kreislauf-Versagen fuhren. Ein Skilanglauf bei -20 °C stellt eine wesentlich hohere Kreislaufbelastung dar als bei 0°. In der Offentlichkeit werden besonders mogliche Einflusse von Umweltschadstoffen diskutiert. Die wichtigsten Gesichtspunkte zum Sport unter verschiedenen Umweltbedingungen sollen daher im folgenden erortert werden.

Wer gesund Sport treiben will, mus kein Experte fur Sport und Sportmedizin sein, aber einige theoretische Grundkenntnisse sind sicher hilfreich. Vielleicht macht es sogar mehr Spas, gesund Sport zu treiben, wenn man weis, was man warum tut. Auch wer vernunftig Auto fahren will, mus nicht unbedingt sein Auto auseinandernehmen und wieder zusammenbauen konnen, einiges uber die Funktionsweise eines Autos sollte er jedoch wissen (Abb. 1). Nun wissen in unserer automobilen Gesellschaft die meisten Leute uber ihr Auto viel besser Bescheid als uber sich selbst. Und hier liegt sicher eines unserer Hauptprobleme im gesundheitlichen Bereich. Gesundheit oder gar Krankheit, das ist etwas Geheimnisvolles, und wie es mit dem eigenen Korper bestellt ist, mochte man vielleicht gar nicht so genau wissen. Womoglich kommt sonst heraus, das man gar nicht so gesund ist, wie man glaubt!

Dieses Buch richtet sich an alle, die gesund Sport treiben wollen. Das heist: Es richtet sich an denjenigen, der durch Sport Krankheiten verhindern will, ohne durch den Sport krank zu werden. Und es richtet sich an denjenigen, der schon regelmasig Sport treibt und fragt, wie er dies aus gesundheitlicher Sicht am besten tun sollte und wie er seine Leistungsfahigkeit steigern kann, ohne dabei durch allzu intensives und unvernunftiges Training krank zu werden. Hier gibt es viele Fragen, die Sie vielleicht schon immer Ihrem Hausarzt stellen wollten—wozu Sie aber in der uberfullten Sprechstunde nie gekommen sind. Das Buch richtet sich aber auch an denjenigen, der bisher nie uber die Moglichkeit nachgedacht hat, seine Gesundheit durch Sport zu verbessern, der Sport vielleicht fur etwas gehalten hat, das nur in der Sportschau betrieben wird, fur den Normalburger aber unerreichbar oder sogar gefahrlich ist. Dies gilt nicht nur fur Gesunde, sondern auch fur diejenigen, bei denen moglicherweise bereits Krankheiten vorhanden sind.

Epidemiologic studies have demonstrated that essential hypertension is frequently coassociated with a reduced glucose tolerance, hyperinsulinemia, and dyslipidemia, a combination that dramatically increases the risk of coronary artery disease. 1–3 To provide for the significant increase in the fuel and oxygen requirements of the working skeletal muscle, the performance of dynamic exercise is accompanied by major, potentially beneficial, metabolic adjustments. In this context enhancement of insulin sensitivity and lipolysis and an increase in cellular glucose and free fatty acid (FFA) utilization are of importance, resulting in marked reductions in plasma insulin, glucose, and triglyceride levels in the presence of elevated plasma high-density lipoprotein (HDL) cholesterol concentrations. 4–6 Based on these observations, dynamic physical exercise has been recognized as a useful treatment, alone and in combination with drug medication, for essential hypertension and other cardiovascular risk factors. 7 With respect to pharmacotherapy of essential hypertension, it is evident that the full benefit is only achievable if (1) no negative effects on glucose and lipid metabolism related to rest and physical exercise are induced, and (2) physical performance is not impaired in quality and quantity. The present studies were performed to determine the effects of the angiotensin-converting enzyme (ACE) inhibitor trandolapril 9 on maximum work capacity and also the received perception of exertion (RPE) estimated by the Borg scale on lipid and carbohydrate metabolism during aerobic physical exercise.

Selbstverstandlich konnen beim Sporttreibenden auf allen Ebenen — beim Leistungssportler, Breitensportler sowie beim Patienten, der sich im Rahmen der kardialen Rehabilitation belastet — Rhythmusstorungen auftreten, die in ihrer Entstehung vom Sport vollig unabhangig sind, die aber moglicherweise durch korperliche Belastung ausgelost werden und besondere Gefahrenmomente mit sich bringen konnen. Im Gegensatz zu den bradykarden Erregungsbildungs- und -leitungsstorungen, die als Folge der Vagotonie beim Trainierten entstehen, sind diese Rhythmusvarianten vor allem der Gruppierung der sog. aktiven Heterotopien oder tachykarden Rhythmusstorungen zuzurechnen.

Rhythmusgefahrdete Patienten sollten sportliche Belastungsformen unterlassen, die bei ihnen Rhythmusstorungen auslosen konnen. Hierbei kann es sich im Einzelfall um ganz individuelle Auslosefaktoren handeln, haufig mechanische Faktoren wie plotzliche Drehbewegungen, Presdruck etc. Eine besondere Aufmerksamkeit erfahrt im Zusammenhang von Sport und Rhythmusstorungen das Schwimmen. Durch die Besonderheiten des Schwimmens, die flache Lagerung im Wasser, das erhohte Blutangebot und den uber den Vagus vermittelten Tauchreflex, konnen gerade beim Schwimmen vermehrt gefahrliche Arrhythmien ausgelost werden. An den plotzlichen „Badetod“, also den plotzlichen Tod des scheinbar gesunden Schwimmers, ausgelost durch ein Kammerflimmern, sei erinnert. Rhythmusgefahrdeten Patienten sollte ferner von sportlichen Belastungen abgeraten werden, die sie in Situationen bringen konnen, in denen sie sich bei einer akuten Arrhythmie nicht mehr alleine helfen konnen, wie Tauchen, alpines Bergsteigen, Motor- und Segelfliegen etc.

Korperliches Training, speziell Ausdauertraining, fuhrt zu Veranderungen am Herzen des Athleten, die mit dem Begriff des „Sportherzens“ umrissen werden (s. Abb. 1).