News Category: General

For a person intent on staying in shape, it seems there’s always something new to isolate and tone: the abdominals, the quadriceps, the biceps. A new study suggests that we may also want to tone the parasympathetic nervous system. This part of the nervous system runs many functions in the body, including the beat of the heart.

Scientists can indirectly check heart health by measuring the difference–or variability–in heart rate with each breath of air. A lower variability is associated with common heart problems like coronary artery disease, congestive heart failure, and angina. Moderate amounts of aerobic exercise appear to improve the tone of the parasympathetic nervous system, thereby increasing heart rate variability.
 
This study looked at how different amounts of exercise affect heart rate variability. Thirty seven men between the ages of 25 and 49 volunteered. They were asked how much they exercised, and then placed in a low, moderate, or highly active group depending on their answers. Activity levels were based on calories burned in a week doing aerobic exercise, since aerobic activities relate best to heart rate variability. 

The low (sedentary) group spent less than 1,000 calories per week during aerobic exercise. Moderate equaled 1,000 to 2,000 calories per week, and high indicated over 2,000 calories per week. The high-level group tended to be endurance-trained athletes such as swimmers, triathletes, long distance runners, and martial artists. Participants took part in a 10-minute test every day for five days. This test was used to judge the men’s existing  level of heart rate variability. Their heart rates were monitored while they matched their breathing to the beat of a metronome set at 10 breaths per minute.

The results showed that heart rate variability was better in both the high and moderate exercise groups when compared with the low-activity group. Yet no marked difference appeared between the high and moderate exercisers. It was no surprise that resting heart rate was lower in both the moderate and high exercisers compared to those in the low-activity group.

If you are hoping for improved heart health, at least a moderate level of exercise seems to be the key. In this study, aerobically active men showed better heart rate variability, which was likely due to good parasympathetic tone. It didn’t seem to make a difference whether the exercisers were trained athletes or moderate exercisers. Toning up the parasympathetic nervous system may make a difference in heart health.

The great thing about exercise is it helps burn calories. An added bonus is that certain forms of exercise allow the body to keep burning fat even after the exercise is done. This is because the energy that was used during the exercise has to be replenished. To do this the body burns extra fat calories. This is called “excess postexercise oxygen consumption.” Some research shows that fat keeps burning for an hour after exercise while another study shows the calorie-burning effects last until the next day.

The intensity of the workout seems to affect this more than the length of the workout. Intense exercise that includes stops and starts during the workout leads to more fat burned afterward.

The authors of this study focused on resistance training (weight lifting), since it is an exercise that involves stopping and starting. Past studies of this type have mainly been done on men. These authors wanted to see whether the calorie-burning trends were the same in women, whose intensity during weight lifting would generally be lower than that of men.

The study included twelve women who were regular lifters. Participants performed three sets of 10 repetitions, completing a circuit of nine different resistance exercises. Their workouts totaled 45 minutes of high-intensity lifting with 60 second rest intervals. Before and after-exercise calorie-burning measures were taken.

The results showed that energy use stayed high for up to 60 minutes after exercise. After 90 minutes, there wasn’t much additional calorie burning, but the calories being burned tended to be from fat. The body attempts to replace sugars used during exercise, so it turns to fat calories to restock energy stores.

Compared to the amount of energy burned at rest, exercise burned 79 percent more fat. The authors insist that further studies are needed to see how these figures actually impact changes in body fat and weight control.

We’ve heard it a million times: Exercise is great for your health. People who exercise regularly have more energy, fewer weight problems, and less chance of developing diabetes, heart disease, and even some types of cancer. So what’s stopping some people?

People often cite lack of time or an injury as the reason they don’t exercise. In this study, almost half of the people over 60 replied that a past injury was the culprit that kept them from exercising. Since this is the age that many of these health problems start to show up, it makes sense to figure out how to keep people active with exercise.

To fix the problem, researchers sought to learn how a past injury might influence future exercise habits. They surveyed more than 2,000 participants of all ages living in Australia. They asked how active they were and what reasons they had for not exercising more. One of 19 possible barriers listed on the survey was having an injury or disability. Other reasons included lack of time, dislike of physical activity, or fear of injury. Respondents’ body mass was calculated based on their weight and height.

Those who cited injury as the reason they didn’t exercise had two things in common–they were either overweight or over 50. And those who were 60 or older were nearly twice as likely to report an injury than the 50- to 59-year-old group. The results from the overweight group bring up a cart-and-horse kind of question. Did their injuries result because they were overweight, or did they become overweight because their injury kept them from getting back to exercise? More research is needed to be able to answer this question accurately.

People 50 years old and older who are overweight need extra guidance about the importance of exercise and how to work around an injury. Health providers can help these individuals by designing a structured program that includes safe exercise choices and reassurance that even people with injuries can exercise in some fashion. Sometimes the fear of further injury keeps people from resuming activity rather than the injury itself.

Most athletes know that to perform better in a competition, it’s a good idea to start backing off on the intensity of their training a week or so before the event. By cutting back 7 to 21 days before a big heat, they can still gain increased endurance and muscle strength. This method often results in a 2-4% performance improvement. Likewise, working out too hard right up to the event leads to a drop in muscle strength and poorer performance.

Researchers sought to understand more clearly why this happens. To get some answers, they studied the changes that happen inside the muscle fibers of swimmers who tapered their training sessions before a heavy competition.
 
Six highly trained college swimmers volunteered for the study.  Twenty-one days before a major swim competition, they starting easing off on the overall intensity of their workouts. They still pushed hard with interval training, but their total distance during training sessions was a lot less than before.

Researchers measured how hard and fast each swimmer could go while swimming against heavy resistance. The authors also did muscle biopsies of each swimmer’s upper arm muscles before and after the change in training. A muscle biopsy is done by using a needle to take a tiny sample of muscle cells. Ouch! Now you understand why they only had 6 volunteers! The researchers compared the muscle cells using a microscope to see if there were any changes over the
21-day period.
 
Of the two main types of muscle fibers, the microscope showed that only one type was particularly affected. The Type IIa fibers had more power and speed in their spring. These are the muscle cells that give short bursts of energy for high-intensity actions like sprinting and lifting. The microscope also showed that these fibers were bigger across in size after the 21-day training period. Interestingly, these same fibers shrink in size when athletes work too hard right up to the time of competition. With the improved spring and larger size in their Type IIa muscle cells, the swimmers had stronger muscles and performed better.

Another type of muscle cell is the Type I muscle fiber. This cell gives the body endurance to work for longer time periods, such as during a long walk or jog. The Type I fibers seen on microscope showed little change after either intense training or after tapering down on training. Studies like this build a case for swimmers to taper their training programs before they compete. Future research is needed to confirm whether these results are similar for other types of sports.

It’s commonly known that elderly people are at risk of falling and potentially hurting themselves. Lots of different factors can be involved in these falls, including poor vision and medication use. But some of the most important factors are musculoskeletal ones–those having to do with balance and the strength of muscles and bones.

Swiss scientists recently studied this relationship. They wanted to know how closely related musculoskeletal factors were to bone density, and whether both factors could predict an elderly person’s risk of falling.

The study was conducted at two Swiss hospitals with extended-stay geriatric units. One hundred thirty-four patients were given a mobility test, musculoskeletal tests that measured (among other things) strength and reach, and ultrasound on the heel bone to determine bone density. Patients were also asked to report their activity in sports before age 40. The study included 96 women (average age 85.1) and 38 men (average age 81.8), none of whom were able to live independently at the time of the study. Nurses at one of the two hospitals monitored falls among 94 of these patients for 12 months. A fall was considered “unintentionally coming to rest on the ground, floor, or other lower level.”

The researchers found that regular exercise (at least once per week) before age 40 had little impact on the muscle strength of the elderly patients. However, the women who exercised regularly before age 40 had significantly higher bone density. They also fell less frequently, even less than the men in the same category, who had stronger muscles. That’s interesting because strength plays a major role in balance. This led researchers to believe that the women had better posture control.

Overall, the researchers found a correlation between bone density and muscle strength and mobility. They determined that elderly women might benefit from rehabilitation focused on strength building. Men, in turn, might benefit from rehabilitation focused on improving balance. But the researchers believe that everyone would benefit from life-long physical activity. Women especially might improve bone density and improve fall risk by being athletic in their younger years.

Complex regional pain syndrome type one (CRPS I) is a serious condition that has often eluded doctors’ efforts to solve it. The syndrome involves pain and other factors, such as swelling or blood flow changes in the skin, after an injury. The pain often seems out-of-portion to the medical condition and is not easily explained. No particular treatment has been widely accepted, though many combinations of medicine, physical therapy, and psychological counseling have been used.

One recent case of CRPS I was successfully solved with the help of capsaicin. Capsaicin comes from red hot chili peppers and is applied directly on the skin. It is a common ingredient in pain relievers for osteoarthritis and neuralgia (sharp nerve pain). However, capsaicin has not been studied as a treatment for CRPS I.

The patient was a 26-year-old man who had been run over by a fork-lift truck. His left arm had been amputated, and his left leg suffered a tricky fracture. After three months, the fracture hadn’t healed. The leg was casted, and the patient was told to avoid putting weight on the leg. After being in the cast for six weeks, the patient’s foot and foreleg were swollen, warm to the touch, and painful enough to limit walking. The patient was diagnosed with CRPS I.

Capsaicin (.075 percent) was applied twice per day. The patient was permitted to start gradually putting his foot down with more pressure while he was up and walking. His treatment sessions were closely monitored. If he had too much pain or showed signs of swelling or nerve irritation, he was required to immediately reduce the pressure he was placing on his foot. No other treatments were given for the CRPS I.

After three weeks of these treatments, the man’s pain and swelling were decreased. After six weeks, pain and swelling were gone, and other factors in his condition were improved as well. He was able to leave the hospital.

This result led the doctor on the case to suggest that capsaicin might warrant further study for use against CRPS I. Used for this challenging medical condition, capsaicin may help patients better tolerate physical therapy treatments, lower their pain sensitivity, and keep them from having long-term problems.

In this editorial, the author outlines how osteoporosis is becoming a more commonly recognized condition. As the population ages, osteoporosis and its complications–including vertebral compression fractures (VCF)–are becoming more and more costly to individuals and to our health care system. Direct medical costs of VCFs are estimated to be $13.8 billion annually in the U.S.

The author insists that doctors will need a good method of detecting and aggressively treating osteoporosis in its early stages. The author also suggests the need to get rid of osteoporosis myths: the beliefs that osteoporosis is a concern only for older people, that it can’t be effectively treated, and that VCF is easy to treat.

The author paints a much different picture. He lists the different types of treatments available to treat osteoporosis. He also talks about the problems of managing VCF and the different treatments and surgeries to treat it.

He has much to say about prevention. The best way to prevent osteoporosis and VCF is to develop the highest amount of bone mass in the early years. Bone mass can be improved throughout childhood until the mid-30s. From that point on, it’s all downhill. Inadequate calcium, low levels of exercise, excessive dieting and drinking, and smoking in youth can all lead to less bone mass. The author challenges doctors to make sure their younger patients understand that they need to help develop and protect their bone mass well before they hit old age.

The author also suggests screening men and women who are at risk of developing osteoporosis. For those who show signs of it, a treatment plan should be put in place. In some cases, physical therapy should be started and efforts taken to reduce the patient’s risk of falling down. This is especially true if a person has already suffered a fracture.

The author encourages research on osteoporosis–especially research on how to detect it early, and research on how best to treat VCF. The more we know, the better health providers will be able to deal with the ever-increasing number of osteoporosis cases.

Exercise is good for us in lots of ways. It tones the muscles and improves the function of the heart and lungs. Exercise is also a good treatment for fatigue. It may seem like a contradiction, but regular exercise can relieve fatigue. It is now known that regularly exercising can help relieve fatigue caused by conditions such as depression, multiple sclerosis, and chemotherapy.

This study was designed to test how well a “dose” of exercise helped combat fatigue in women undergoing chemotherapy for breast cancer. The researchers wanted to know if exercise decreased fatigue on the same day, if the effects of exercise added up over time, and how much exercise was best for decreasing fatigue.

Sixty-one women took part in an eight-week aerobic exercise program. The women were instructed never to exercise to the point that it made their pain or fatigue worse. The women logged details about their exercise and fatigue in a journal. The women also wore a meter to determine how much energy they put out in their exercise sessions.

The women were assessed at the beginning and end of the study on fatigue levels and how far they could walk in 12 minutes. By the end of the study, 61% of the women could walk an average of 15% further in the 12-minute walk test. These women tended to have exercised more frequently and for longer periods during the eight weeks. More importantly, researchers found that exercising during the day lessened fatigue from 14% to 35% during that same day. In general, the longer a woman exercised, the less fatigue she felt on that day. The only exception to this was when exercise sessions went over 60 minutes. Then the benefits reversed, and the women began to feel increased fatigue.

The energizing effects of exercise only seemed to help on the day people exercised. The benefits didn’t carry over very much to the next day. Exercising every day seemed to have the best effects on fatigue levels. In other words, it took a moderate dose of exercise each day to help keep fatigue away.

Based on these results, the researchers suggest that doctors help patients find a way to exercise throughout their chemotherapy treatments. More research is suggested on the best and most realistic way for chemo patients to fight fatigue with exercise.

The diet and exercise habits of more than 10,000 people were analyzed in this study. Researchers also analyzed the fitness of subjects’ heart and lungs. The idea was to get some basic information on the way diet, exercise, and heart and lung fitness are related.

Subjects were tested on a treadmill to gauge their fitness level. Of the women, 61% were rated as having a high level of fitness, 30% a moderate level, and 9% a low level. Of the men, 59% were in the high level, 31% moderate, and 10% low. (This may very well be a higher level of fitness than in our population as a whole. People who chose to take part in the study tended to be white, well educated, and well off.)

Subjects also answered questions about their lifestyle and health, and they filled out extensive food diaries for three days. Researchers analyzed the food diaries to find the number of calories subjects ate, in addition to the nutritional content of the food and the number of calories from fat, saturated fat, protein, and fiber.

The results show that the highly fit subjects tended to eat according to diet guidelines–lower amounts of fat, little saturated fat, and higher amounts of fiber, vitamins, and minerals. Highly fit subjects were also less likely to smoke and had lower amounts of body fat.

This is hardly shocking news. But this study is part of a larger research project comparing relationships between diet, exercise, and fitness. These results are a piece of the puzzle. When they put the puzzle together, researchers hope to have a more complete understanding of the way diet and exercise together affect our health and fitness.

Athletes work to strengthen muscles that help them in their sports. Yet little attention is paid to the muscles that control breathing. Breathing seems as natural as blinking, and it doesn’t really seem to matter how we do it. But breathing muscles actually play an important role in athletic performance. Whether you’re a casual jogger or super-competitive triathlete, here’s something that might interest you.

Fourteen competitive rowers were placed into either a training or placebo group. All were given an inspiratory muscle trainer and instructed to use it for 11 weeks. This device creates resistance when you breathe in but allows you to breathe out with no resistance. The training group had the resistance set at 50%. They used the device twice a day for 30 breaths. The placebo group had the resistance set at 15%, which is a level that does not affect training. They used the device once a day for 60 breaths. Subjects were given a bogus explanation of the test, and they didn’t know which group they were in.

After 11 weeks, all the rowers were tested. Researchers looked at measures including lung capacity, rowing performance, and blood testing. The training group “kicked butt.” They improved their inspiratory muscle strength by over 40%. The placebo group showed only a 5% improvement. And get this: the training group also shaved 36 seconds off a 5000 meter rowing trial, compared to 11 seconds for the placebo group.

Researchers feel that improved tidal volume was part of the reason for the improvements in the training group. Tidal volume is the amount of air inhaled and exhaled. Tidal volume increased significantly in the training group. In comparison, the placebo group breathed much faster, which can be a sign of respiratory muscle fatigue. This research puts a whole new spin on the phrase “sucking air.”

For many people, getting going in the morning requires caffeine. Coffee and other forms of caffeine, such as tea and cola, are a necessary part of the day for all kinds of people. But there is a lot of debate about whether caffeine actually helps or hurts our best efforts.

Athletes in particular want to know how caffeine affects their performance. Several studies have shown that caffeine helps athletes in endurance sports. For sports that require short bursts of energy, studies so far are inconclusive. Caffeine use led to more fatigue in some studies and better peak performance in others.

This study of 16 sprinters doesn’t exactly answer the caffeine question. A couple days before the test, the sprinters stopped all caffeine. They didn’t eat in the three hours before the test. An hour before the exercise test, the sprinters were given either caffeine or a placebo, without knowing which. They then did 10 sprints. This same test was repeated three times over a week.

The results showed a slight improvement in sprinting times with caffeine–but the improvement was so slight that it wasn’t felt to have any practical significance. The authors felt that the response to caffeine really depends on the individual. Some sprinters consistently did better on caffeine, and some consistently did worse. Until the role of caffeine in energy-burst sports is better understood, it looks like athletes need to pay attention to the effect caffeine has on their own performance.

A major concern for elderly people is avoiding falls that could break bones or cause other injuries. About 30% of people over age 65 suffer a fall at some point, and half of those people fall more than once. Good physical conditioning, strong muscles, and flexibility can help people avoid falls. But most exercise programs are too fast and furious for older people.

That’s where Tai Chi Chuan comes in. Also called “Chinese shadow boxing,” this ancient form of exercises uses slow, steady movements. Tai Chi involves a series of graceful movements linked together. The body constantly but slowly shifts from foot to foot with a low center of gravity. Tai Chi emphasizes deep breathing and concentration.

This study in Taiwan compared the balancing abilities of two groups of people. One group had practiced Tai Chi every day for at least 30 minutes. They had been practicing Tai Chi for two to 35 years. The control group did not do Tai Chi. People in both groups were over age 65 and were active and fit. Researchers measured subjects’ ability to balance for 20 seconds under increasingly difficult conditions. Subjects stood on a platform that swayed and were given increasingly confusing visual feedback or had to balance with their eyes closed. (Vision helps us compensate for lack of balance.) Subjects also did tests that involved shifting from foot to foot in specific patterns at different speeds.

Results showed no difference between the two groups in the simpler balancing tests. However, the Tai Chi groups had much better results in the more difficult tests. The researchers compared people in the Tai Chi group who had done the exercises for at least three years with the people who had done the exercises for less than three years. Both groups did about equally well on the tests. This means it’s never too late for older people to improve their coordination and balance, especially when they take it slow and steady.

Our hearts age just like the rest of our bodies. Older hearts generally have less ability to pump hard and fast. Yet older veteran athletes have been shown to maintain strong heart function.

This study tested the hearts of 10 life-long athletes. Their average age was 73, and all of them took part in intense exercise from three to seven hours each week. Researchers took echocardiograms (heart ultrasounds) of the athletes. Special blood tests were done while resting and during increasingly difficult exercise. These tests measured the action of the left ventricle, the main pumping chamber of the heart. Researchers also tracked the athletes’ blood pressure and heart rate.

The athletes’ heart tests were compared to a control group. The control group was made up of 12 healthy nonathletes or moderately active people with an average age of 75. The control group did the same tests as the athletes.

As expected, the athletes could do much more intense exercise–about 50% more intense–than the control group. The echocardiograms showed that particular parts of the athletes’ ventricle walls were thicker than in the control group. Even at rest, the athletes had better efficiency with each heart beat. The amount of blood pumped at rest was same, but during exercise, the athletes’ hearts could pump way more blood.

The authors attribute the athletes’ heart health to better function of the left ventricle. Apparently in older athletes, the left ventricle compensates for some of the power that the heart has lost with age.

Despite the effects of aging, the athletes had heart function as good as that of sedentary young men. Clearly, life-long training had significantly slowed down the heart’s decline. So if you want to keep your heart in shape, pump up your heart health with regular exercise. This study suggests that exercising regularly can help your heart keep pumping efficiently well into your 70s.

It is well known that athletes tend to have greater bone mineral density (BMD) than couch potatoes, as well as better muscle mass and strength. That’s why exercise is recommended to combat the loss of bone mass that can lead to osteoporosis. Other factors–especially genetics, hormones, and nutrition–also contribute to bone mineral density. But exercise can play a vital role in helping people build and maintain strong bones.

But which type of exercise is best for building bone? Medical professionals and researchers aren’t exactly sure how or why exercise stimulates bone building. It is known that weightbearing activities, such as aerobics classes and weight lifting, are better at increasing BMD than nonweightbearing exercise, such as swimming or bicycling. Recent studies have also suggested that runners tend to have lower BMD.

These researchers studied four groups of young men to measure how different kinds of exercise affect BMD and muscle mass in the arms and legs. Three of the groups consisted of highly competitive athletes. One group was made up of judo athletes, one of karate, and one of water polo players. All athletes exercised at least three hours a day, six days a week. The control group was made up of nonathletes. Researchers measured all the men’s BMD and muscle mass using special X-ray technology.

As expected, all the athletes had significantly higher BMD and muscle mass than the control group. The judo athletes had higher BMD than the other groups. This supports the idea that weightbearing sports build bone better, because judo is an especially high-intensity weightbearing activity. On the other hand, the water polo players had the highest muscle mass. But their increased muscle mass did not correspond to higher BMD. This supports the idea that muscle building alone does not build stronger bones. It also suggests that nonweightbearing exercises are not as optimal for building bone density as weightbearing ones. The researchers also noted higher BMD in areas of the skeleton that were subjected to higher exercise loads.

This study is far from the last word on weightbearing exercise and BMD. The authors note that many factors may have influenced BMD on this small group of athletes, including physical activity as a child, amount of different minerals and vitamins in the diet, and metabolism. They suggest further research on these and other variables. But based on what we know now, bone health is affected by some activities more than others.

If you’ve ever broken a bone, you know how long it takes to heal. All that time hauling around a cast, sore arm pits from the crutches, not to mention the itching in places you can’t scratch! But bones are amazingly resilient. Most people are back to new in six to eight weeks. Unfortunately, healing doesn’t always go smoothly. Some peoples’ bones simply don’t heal after a fracture. Sometimes surgery speeds the healing, but even that may not help.

Well, there’s great news for both the normal healers and nonhealers–ultrasound. This study showed that only 20 minutes a day of ultrasound waves directed at the fracture site reduced healing time by 40%. The ultrasound even helped mend fractures that hadn’t healed with surgery and even several years of healing time.

These authors reviewed research done over the past few decades on the effect of ultrasound on fractures. Some of the studies showed dramatic results. For example, one study compared two groups of 33 people. One group received daily ultrasound. The control group got phony treatments. (Neither group knew who was getting the real thing). In the control group, 36% failed to heal well, compared to only 6% of the ultrasound group.

Even more impressive was the response of fractures that simply would not heal (also called non-union fractures). The researchers found several studies of non-unions where the average fracture had happened two to three years before. Some of these fractures had not healed despite two or more surgeries. Then daily ultrasound was added to their treatments for three to five months. The healing rate went from 0% to an amazing 85% to 93%.

Often factors such as older age, cigarette smoking, obesity, and use of steroids or anti-inflammatory drugs (such as aspirin or ibuprofen) can slow healing of a fracture. But ultrasound even appeared to cancel out these factors. Healing rates were no longer delayed even with these higher risk factors.

The authors cautioned that ultrasound may not be appropriate or effective in all fractures. One study of 32 patients showed no difference between placebo and ultrasound healing. However, the bulk of the evidence showed a significant improvement in healing times. Since ultrasound is so safe, it certainly is worth considering in cases where fracture healing may not occur as planned.

The pain and inflammation of osteoarthritis are almost always treated with a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and ibuprofen are the most common NSAIDs. Recently, the buzz is growing about two new compounds that have been touted to work just as well, or even better, than NSAIDs. These authors reviewed the research on these two compounds, to clarify the science behind the buzz.

Glucosamine and chondroitin sulfate are compounds made in the body. They are thought to help protect cartilage in the joints. Glucosamine and chondroitin sulfate can also be made and given in pill form or by injection. The theory is that these supplements can help protect, or possibly even repair, damaged cartilage. The authors say no one knows exactly how glucosamine and chondroitin sulfate protect cartilage. But laboratory tests do seem to show that they can have positive effects on damaged cartilage.

The authors reviewed clinical trials on humans. Glucosamine and chondroitin sulfate did seem to improve patients’ joint pain, mobility, and ability to do activities. The new compounds may take longer than NSAIDs to kick in. However, the good effects may last longer than the effects of NSAIDs. And glucosamine and chondroitin sulfate have fewer side effects than NSAIDs, which tend to be hard on the guts when taken over time.

This is all good news, but it doesn’t mean that glucosamine and chondroitin sulfate live up to all the buzz. They are hardly cures for osteoarthritis. Also, there are many questions about their long-term safety, correct doses, and purity of the compounds that are currently on drug store shelves. Yet some doctors feel there are enough benefits to encourage their patients to supplement with these compounds. Future research is needed on the long-term benefits of these compounds and their ability to prevent and treat osteoarthritis.

Intense training can create big muscles and improve speed and performance. But heavy training can also stress athletes’ bodies, draining them of the ability to effectively repair themselves or fight off disease. Research has suggested that decreased glutamine, an amino acid formed in the body, might be one reason for impaired immune systems during intense training.

These researchers attempted to understand the way carbohydrates in the diet and intensity of exercise affected glutamine levels in the blood and muscles. They tested five male bike racers during three days of intense exercise on two different diets. One diet regimen provided 45% of the calories from carbohydrates, and the other was 70% carbohydrate. At different times in the study, the athletes’ blood was drawn and their muscles were tested to see how much glutamine was present in the muscles.

The study showed that the high-carbohydrate diet resulted in higher levels of glutamine in the blood throughout the days of intense exercise. Concentrations within the muscles, however, were about the same with each diet. The authors noted a small decrease in muscle glutamine while on the lower carbohydrate diet, although it wasn’t that significant. They suggest that future research should include more subjects to get a better idea of glutamine concentrations in the muscles.

The study also showed that the amount of dietary carbohydrate did not affect levels of glycogen within the muscles. (Glycogen is basically extra carbohydrates stored in the muscles and liver.) Glycogen is needed to help the body form glutamine. The authors feel it is possible that their study’s restriction on eating until two hours after exercise affected this measurement. They also feel it is possible that tissue damage from the intense exercise may have kept the glycogen levels low after exercise.

It appears that a diet higher in carbohydrates reduces the amount of protein taken in by the athlete. The higher carbohydrate diet seems to have had a role in the higher levels of glutamine in the blood. Further research will be needed to help athletes find a diet to maximize their health during periods of intense training.

The web can bring a wealth of information to anyone. This study suggests that, as far as information about back pain is concerned, it can also bring a wealth of misinformation.

This study tracked information on back pain on the Internet over a two-year period. The authors originally identified 74 web sites on back pain by doing a search using the terms “back pain” and “back problems.” The research team included medical and research experts. They focused on analyzing the quality of the site’s information. They did not consider design of web pages or ease of use in their analysis.

So how did the information measure up? Companies produced almost half of the sites, and about 20% were produced by health care providers. A whopping 80% of the sites were focused on advertising. Thirty-nine sites promoted products.

The advertising focus is not necessarily bad, as long as the information is factual and useful. However, the researchers rated only nine sites (about 12%) as high quality. Of the remaining sites, 68% were rated fair, and 20% were rated as poor. Only 27 sites (37%) were found to contain information based on cited references. And when it came to recommending the sites to people with back pain, only four sites (5%) were highly recommended by the research team. (Some of the sites were meant for doctors and would not be recommended for patients no matter how high their quality.)

Those ratings were from 1996. Internet information probably improved over the next two years, right? Wrong. Twenty sites were no longer in existence in early 1999, a little over two years after the first review. Of those 20, 13 had been produced or sponsored by nonprofit groups, and none by health care providers. Only 35% of them had focused on advertising. However, none of the 20 sites had been rated as high quality by the research team.

Of the remaining sites, 85% now focused on advertising. Only seven sites were now rated as high quality. Four were recommended for patients with back pain, four for health care providers, and one for the general public.

Clearly, good information on back pain can be found on the Internet. But most web surfers won’t have the medical background to sort out the information they find. The authors conclude that patients need to be aware of the misinformation out there–and that doctors need to help patients sort through the avalanche of information facing patients on the web.

Who are the real experts about recovery from knee and hip replacement surgery? The patients, of course. The authors of this study went to these experts to test two widespread beliefs about recovery from knee and hip replacement. First, it is widely believed in the medical world that results of knee and hip replacement are equally successful. Second, it is commonly believed that patients feel fatigued for at least a month after joint replacement surgeries like these. The “experts” who were interviewed for this study say both these common beliefs are false.

The study included 107 patients who had hip replacement surgery and 53 who had knee replacement surgery. They answered questions about their pain, function, daily activities, and overall quality of life. The patients answered the same set of questions before surgery, several times in the month after surgery, and again six months later.

The authors found that most patients experienced extra fatigue for less than a week after surgery. The authors also found that hip patients recovered more quickly and fully than knee patients. Notably, both groups reported about the same improvement in their overall wellbeing.

Why the differences in what doctors believe and what knee and hip patients experience? According to the authors, part of the problem is that researchers often ask patients whether they’re satisfied with their medical care, rather than asking more detailed questions about mood and general wellbeing. Asking the right questions gives a clearer picture of what patients are truly feeling and how they are getting along.

To compare results between hip and knee patients, the authors suggest that long-term studies should focus on whether knee patients eventually recover to the levels of hip patients. They also conclude that research that lumps hip and knee replacement surgeries into the same category is invalid.

The differences between what doctors believe and what patients experience may not seem like a big deal. But it’s important that patients facing surgery know what to expect in their recovery. By asking the experts–their patients–doctors will be better able to guide their patients who require joint replacement surgery of the hip or knee. And they’ll be able to dispel myths that negatively influence the recovery of their patients.

If you watch the Super Bowl or any other professional football game, you will see players wearing nasal dilators. Nasal dilators are the little strips that stick on the skin over the bridge of the nose. The idea is that they expand the nasal airways, making it easier to breathe. Nasal dilators are sold in drugstores as devices to decrease snoring. Football players and other athletes wear them with the goal of improving their athletic performance.

This study suggests that all nasal dilators really do is look sort of funny. Earlier research has shown that there is less resistance when breathing through the nose while wearing a nasal dilator. But improving athletic performance would require that they actually reduce the amount of work it takes to breathe. But no research has measured whether nasal dilators decrease the work of the breathing muscles–the muscles surrounding the lungs. Until now.

For this study, researchers tested 14 untrained young subjects as they rode an exercise bike. Each subject did two exercise tests. During one test subjects wore nasal dilators; during the other, they wore fake nasal dilators. The resistance on the bike was continuously increased until the subjects couldn’t keep going. The subjects swallowed a special type of balloon, which was placed just above the stomach. The balloon was attached to a machine that measured the efforts of the breathing muscles during exercise. The subjects’ air flow was also measured.

The results showed no real differences in the work of breathing or air flow during exercise. Based on this study, pro football players might as well take off their nasal dilators–or perhaps they could just use them as another spot to sell advertising.