Cognitive dietary restraint is associated with stress fractures in women runners

High levels of cognitive dietary restraint (CDR) have been associated with subclinical menstrual cycle irregularities and increased cortisol levels, both of which can affect bone mineral density (BMD). Low BMD has been implicated in stress fracture risk. We assessed CDR in female runners (> or = 20 km/wk) with a recent stress fracture (SF) and with no stress fracture history (NSF). A sample of 79 runners (n = 38 SF, 29 +/- 5 y; n = 41 NSF, 29 +/- 6 y) completed a 3-d food record and questionnaire assessing physical activity, menstrual cycle history, and perceived stress. SF and NSF runners had similar body mass index (21.2 +/- 1.8 vs. 22.0 +/- 2.5 kg/m2), physical activity (35.7 +/- 13.5 vs. 33.4 +/- 1.34 km/wk), perceived stress, and dietary intakes. CDR, however, was higher in SF runners (11.0 +/- 5.4 vs. 8.4 +/- 4.3, P < 0.05). Subclinical menstrual cycle disturbances and increased cortisol levels that are associated with high CDR, might in turn contribute to lowered BMD and increased stress fracture risk.     

Oxidative stress in marathon runners: interest of antioxidant supplementation

We have recently reported that xanthine oxidase is involved in the generation of free radicals in exhaustive exercise. Allopurinol, an inhibitor of xanthine oxidase, prevents it. The aim of the present work was to elucidate the role of exercise-derived reactive oxygen species in the cell signalling pathways involved in the adaptation to exercise in man. We have found that exercise causes an increase in the activity of plasma xanthine oxidase and an activation of NF-kappaB in peripheral blood lymphocytes after marathon running. This activation is dependent on free radical formation in exercise: treatment with allopurinol completely prevents it. In animal models, we previously showed that NF-kappaB activation induced by exhaustive physical exercise leads to an increase in the expression of superoxide dismutase, an enzyme involved in antioxidant defence. We report evidence in man that reactive oxygen species act as signals in exercise as decreasing their formation prevents activation of important signalling pathways which can cause useful adaptations in cells.     

Sacral stress fractures

Stress fractures result from skeletal failure resulting from submaximal repetitive forces over time. Sacral stress fractures may represent an underdiagnosed cause of low back and buttock pain. They occur primarily in two populations, young active persons and elderly osteoporotic women, usually corresponding to fatigue and insufficiency-type fractures, respectively. The clinical presentation of these fractures is similar, but the medical and rehabilitation management of these patient populations differs and is tailored to the specific underlying etiology. In both types of fractures, appropriate conservative measures generally result in good functional outcomes. This paper provides an overview of the anatomical considerations, risk factors, clinical presentations, diagnostic imaging findings, appropriate laboratory studies, medical management, and rehabilitation management of patients with sacral stress fractures.     

Supplementation patterns in marathon runners

The purpose of the present investigation was to study the use of supplements in a large group of endurance runners (no. = 347) who had participated in the 1987 Los Angeles Marathon. Three-day dietary records were analyzed for nutrient content and supplement usage. The runners' supplementation patterns with respect to demographics, dietary quality, training habits, and race performance were investigated. In general, no significant associations were found between supplement use and the aforementioned variables. Use of supplements, especially vitamins C and E, calcium, and zinc, increased with age (p less than .05). Daily use of at least one type of supplement was reported by 29% of the runners; 48% reported use of at least one type of supplement within the 3-day period.     

Nutrition and the incidence of stress fractures in ballet dancers

The effects of nutrition on the incidence of stress fractures among classical ballet dancers were studied. Ten dancers with stress fractures were compared with a group of dancers without stress fractures and a group of nondancing control subjects. Subject pairs were matched for age, weight, and height. Specific nutrient intake and eating patterns were thus isolated to determine if dietary patterns could account for the incidence of stress fractures among these dancers. The majority (80%) of the 10 dancers with recent stress fractures had weights less than 75% of ideal (p less than 0.05) and showed a greater incidence of eating disorders (p less than 0.05). This group also showed a lower fat intake and a higher intake of low-calorie food (p less than 0.05). Menstrual patterns and bone density studies of the wrist, foot, and spine did not differ among the three groups, showing that stress fractures were significantly associated with a more-restrictive diet.     

Diet and bone status in amenorrheic runners

Our purpose was to determine the relationship of diet, exercise, and amenorrhea with bone mineral status in trained young women. Bone mineral density of the lumbar spine was significantly lower in amenorrheic compared to normally menstruating runners. Circulating estradiol was also significantly lower. No significant differences between the two groups were found in body composition, maximum aerobic power, or amount of training per week. A 3-day dietary record showed that the amenorrheic women reported a significantly lower daily energy intake, but no difference in the calcium intake. Protein intake was less than the US Recommended Dietary Allowance in 82% of amenorrheic women and 35% of eumenorrheic women. Abnormal eating behaviors may be associated with the development of amenorrhea. Our results show that when weight-bearing exercise and a low energy intake are associated with amenorrhea, the accretion of a large bone mass in young trained women is not favored.     

Menstrual dysfunction among habitual runners

The association of menstrual dysfunction and weekly running mileage was investigated in a group of habitual women runners, categorized into high mileage runners (30 or more miles/week) and low mileage runners. Both mileage groups reported menstrual changes and weight loss since starting to run. Menstrual irregularities (35 or more days between cycles) were reported more often among the high mileage women than among the low mileage women (p = 0.001). However, after controlling for cycle irregularity before starting a running program, the effect of mileage was no longer statistically significant. While these results suggest that pre-running menstrual irregularity is more important than higher doses of weekly mileage, further investigations are needed to assess the role of potentially confounding factors such as stress, diet, and other lifestyle changes that may occur with increased exercise.     

Internal fixation for stress fractures of the ankylosed spine.

Three cases of stress fractures affecting the rigid spine of ankylosing spondylitis are reported. Even without the typical destructive features of the Romanus lesion, symptoms may be very prolonged and disabling and the diagnosis difficult. Internal fixation produces immediate pain relief and rapid fracture union.     

腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤的疗效

目的探讨腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗腓骨远端骨折合并下胫腓韧带损伤的疗效。方法对20例腓骨远端骨折合并下胫腓韧带损伤患者采用腓骨解剖型钢板联合可吸收拉力螺钉内固定治疗。结果患者术后骨折愈合时间为13~16周,根据改良Baird和Jackson的主、客观和X线评价：优17例,良3例,其优良率为100%。而且伤口均一期愈合,无一例感染,无局部不良反应。结论腓骨解剖型钢板联合可吸收拉力螺钉内固定是治疗腓骨远端骨折合并下胫腓韧带损伤的有效方法。     

Postrace morbidity among runners.

We examined two general measures of morbidity, musculoskeletal problems and respiratory symptoms, among participants of a 42 km race. We compared the morbidity experience of these participants to runners racing shorter distance events (5 km and 10 km) on the same day. Male marathon runners were almost twice as likely (and female marathon runners four times as likely) to report a lower extremity musculoskeletal problem in the month after the race as nonmarathon runners. Although adjusting for other factors did not change the crude odds ratio for either men or women, logistic regression results indicated that the strongest factor associated with lower extremity musculoskeletal problems in the month after the marathon was the report of a musculoskeletal problem in the year before the marathon. Neither male nor female marathon runners reported an excess of respiratory symptoms compared to those who ran shorter distances. However, a report of respiratory symptoms in the month before the race was statistically associated with respiratory symptoms in the month after the race. These results suggest that runners who have had lower extremity musculoskeletal problems in the year before, or those who have recently experienced respiratory symptoms, should use caution when preparing for and recovering from racing events.     

Nutrient intake of marathon runners

Three-day food records from a large group of marathon runners (291 men, 56 women) were analyzed and compared to various standards of dietary quality. Intake by the runners exceeded two-thirds of the Recommended Dietary Allowance for all nutrients except vitamin D and zinc in female runners. Energy and nutrient intake levels in the marathon runners were higher than those of the general U.S. population except for total fat, vitamin B-12, and zinc in both men and women and sodium in men. In general, runners consumed better diets than the general population. However, both caloric intake and percent energy as carbohydrate were lower than recommended for individuals engaging in endurance exercise. The need for professional help in planning high-carbohydrate diets for runners is indicated. Increasing amounts of training were not associated with significant increases in nutrient densities across three activity categories within this group of runners. However, more than 75% of the runners perceived their diets to be much improved after they began regular training (men 8.2 +/- 0.3 years of running experience, women 6.7 +/- 0.6). Together, these data suggest that regular moderate-to-heavy endurance exercise is associated with a better quantity and quality of nutrient intake than that found in the general population, which may in part be related to the adoption of such exercise by previously sedentary individuals.     

Consultant work patterns. Blade runners

An analysis of the work of 182 consultant orthopaedic surgeons in two English regions found they averaged seven hours a week operating. A fifth were working below the minimum operating hours recommended by the British Orthopaedic Association. Orthopaedic teams are now seeing fewer outpatients and inpatients than 10 years ago, despite a 50 per cent increase in the number of consultants. The current situation raises serious concerns about appropriate use of specialists' time and operating theatres. Trusts should not appoint any more consultant orthopaedic surgeons until those they have operate for a minimum of eight hours a week.     

Nutrition and diets for endurance runners

The average runner does not require a special diet except to maintain a desired weight. Individuals wishing to lose weight by running must run more than 9 miles a week for as much as a year to achieve weight loss. The muscle glycogen content is a limiting factor in the stamina required to run regularly for more than one and half hours. The levels necessary for endurance running can be achieved and maintained by a daily carbohydrate intake of 500 g a day. During marathon runs it is essential to drink water at regular intervals along with some glucose.     

Intestinal permeability in runners in the 1996 Chicago marathon

Abdominal cramping, nausea, diarrhea, and GI bleeding are often reported in long-distance runners. This study set out to determine the effects of prolonged (2-4 hrs) exercise and NSAID ingestion on gastric and intestinal permeability during the first 5 hrs following the 1996 Chicago Marathon. Thirty-four healthy volunteers (20 M, 14 F; ages 30-50) completed the race and ingested the test solution (5 g sucrose, 5 g lactulose, 2 g rhamnose, in 40 ml water) within 10-15 min. The urinary excretion ratio of lactulose/rhamnose was used to assess small intestine permeability; sucrose excretion was used to evaluate gastric impairment. There were no significant differences for mean training mileage, postrace rectal temperature, and percent dehydration between runners who ingested NSAIDs and those who did not. In all, 75% of subjects reported aspirin or ibuprofen ingestion before or during the race. Runners who ingested ibuprofen had significant elevations in urinary lactulose excretion and lactulose/rhamnose ratio, whereas those who ingested aspirin or who did not ingest either NSAID had no significant differences in urinary excretion of lactulose, rhamnose, sucrose, or lactulose/rhamnose ratio compared to resting controls. Thirteen of the 26 NSAID users and 4 of the 8 non-users reported GI symptoms. It is concluded that (a) ibuprofen but not aspirin ingestion during prolonged exercise may increase gastrointestinal permeability and lead to GI symptoms, and (b) prolonged exercise alone can produce GI symptoms.     

Getting injured runners back on track

With more people running--and incurring lower extremity injuries--than ever before, you'll have many occasions to use this handy diagnostic and treatment guide.     

Nutritional survey of highly trained women runners

Mean daily intakes from 3-day dietary records for calories, energy-providing nutrients, and selected minerals were calculated for 51 highly trained women runners. Selected blood constituents relating to mineral status were also measured. Intakes of calcium, magnesium, iron, and copper were above the amounts recommended by the National Research Council whereas zinc intake was below the recommended dietary allowances (RDA). Caloric intakes, although above the RDA for sedentary women, appeared low for women running 10 miles/day. Concentrations of serum ferritin and plasma zinc were indicative of marginal iron and zinc status in many of the women. Whether the nutrient content of the diets consumed by these women is adequate relative to energy output or whether training lowers nutrient requirements by enhancing metabolic efficiency will require further investigation.