Pre-competition cardiac screening in professional handball players - setting up at the EHF European Handball Championship 2010 in Austria

Zusammenfassung: In vielen Sportarten wird ein regelmäßiges, richtliniengetreues kardiales Screening zur Verhinderung des plötzlichen Herztods noch immer nicht gewährleistet. Wir nahmen die Handball Europameisterschaften, welche 2010 in Wien und weiteren Städten in Österreich stattfanden, zum Anlass, die aktuelle Situation bei Toplevel-Handballern zu untersuchen: Ein standardisierter Fragebogen wurde vor dem Turnier an alle qualifizierten Teams und Spieler versandt. Eine Rücklaufrate von 42,7 % kann zum Schluss führen, dass das Problem des plötzlichen Herztods bei den Spielern und Verantwortlichen unterschätzt wird. Die überwiegende Mehrzahl der Spieler (82 %) wurde gemäß der Auswertung der Fragebögen korrekt, entsprechend der aktuellen Screening-Richtlinien untersucht. In gut der Hälfte der Teams wurde das Screening jedoch "inhomogen" durchgeführt. 5 Spieler (4,1 %) wurden zumindest nicht innerhalb der letzten Jahre untersucht, bei 1 Spieler (0,8 %) wurde kein EKG durchgeführt. Während 69 % der Handballer ihr erstes Screening erst nach dem Alter von 18 Jahren durchliefen, wurden 16 Spieler (13,1 %) gar niemals zuvor einer kardialen Vorsorgeuntersuchung unterzogen. Schließlich identifizierten wir aufgrund der Fragebögen 17 Athleten (13,9 %) mit einer hoch suspekten Anamnese, wovon 2 Athleten (1,6 %) niemals zuvor kardiologisch abgeklärt wurde

A 12-Month Lifestyle Intervention Program Improves Body Composition and Reduces the Prevalence of Prediabetes in Obese Patients

Background: The present study investigated the effects of a 12-month interdisciplinary standardized lifestyle program addressing physical activity and changes in dietary and lifestyle behavior in 2,227 obese prediabetic participants. Methods: Measures of obesity (BMI, waist circumference), cardiopulmonary fitness, and metabolic parameters were determined before and after the intervention period. Results: From the 2,227 participants who were initially prediabetic, 839 participants (-37.7%) did no longer show the criteria of prediabetes after the intervention and had normal HbA1c levels. Conclusion: The clinical effects are substantial, and it is likely that the applied intense and multidisciplinary lifestyle interventions could reduce the risk of developing diabetes and the prevalence of a full-blown metabolic syndrome in obese and prediabetic patients

Lactate distribution in red blood cells and plasma after a high intensity running exercise in aerobically trained and untrained subjects

Introduction: To determine endurance capacity and to give specific training recommendations, blood lactate (LA) concentrations are frequently used in performance diagnostics. In blood, LA is stored in red blood cells (RBC) and in plasma. Higher LA uptake by RBC might lead to delayed muscle fatigue since RBC serve as a dilution space for LA and more LA can be taken up by plasma which is released from the working muscle. Therefore, the aim of this study was to investigate the distribution of lactate in plasma and RBC in aerobically well-trained athletes (AA) in comparison to an untrained control group (CG). Materials and Methods: 13 AA and 13 CG participated in this study and conducted a high intensive treadmill test consisting of 2x4 minutes of running at 95% of the maximal running velocity with an active break of 4 minutes. Venous blood was drawn before and after the test. LA was measured in whole blood, plasma and RBC. Further, the ratio (LARatio) was calculated using the following formula: LA of RBC / LA of plasma. Results: AA exhibit significantly higher values in VO2peak and maximum running velocity. After the running test, LA in whole blood, RBC and plasma is increased significantly in both groups. No interaction effect (group X time point) was observed in any parameter. Values of LARatio did not show any significant differences. Conclusion: This study showed that the LA distribution in RBC and plasma after a high intensity running test is very similar in well trained endurance athletes and in untrained control subjects. Hence, LA uptake by RBC cannot or only in part be seen as a contributor to aerobic athletic performance

Pre-competition cardiac screening in professional handball players - setting up at the EHF European Handball Championship 2010 in Austria

In many sports, regular cardiac screening for exercise-associated sudden cardiac death is still not provided. To set up the current situation in top-skilled handball players qualified for the 2010 European Handball Championship in Austria, a standardised questionnaire was sent to every team. The fact that only 42.7% of the players returned the questionnaire may lead to the conclusion that the awareness of the problem is quite low. However, 82% of these players have been screened according to current recommendations. Half of the teams were screened inhomogeneously: 5 players (4.1%) have not been screened within the last years, 1 athlete (0.8%) was screened without an ECG. While 69% of the athletes got their first screening only after the age of 18, 16 players (13.1%) never went through a specific screening ever. We identified 17 athletes (13.9%) with a highly suspicious history, 2 of them (1.6%) never underwent a medical screening at all

Effects of cardiovascular single pill combinations compared with identical multi-pill therapies on healthcare cost and utilization in Germany

Aim: This study assessed whether a single pill combination (SPC) is associated with lower direct healthcare costs. Materials & methods: Anonymized claims data of patients ≥18 years treated with drugs for cardiovascular (CV)-related diseases either as a single pill combination or multi-pill combination (followup to 1 year) were evaluated. After propensity score matching, 59,336 out of 1,369,840 patients were analyzed. Results: In all cohorts, patients receiving a single pill combination had a lower frequency of general practitioner and specialist visits. The patients also had a significantly lower ratio of all-cause hospitalization days and number of CV-related prescriptions as well as all-cause prescriptions (with one exception) compared with those receiving a multi-pill combination. Conclusion: Direct CV-related costs were significantly lower in four out of seven comparisons, with a trend toward lower costs in the other three comparisons

Prediabetes conversion to Normoglycemia is superior adding a low-carbohydrate and energy deficit formula diet to lifestyle intervention - a 12-month subanalysis of the ACOORH trial

Lifestyle interventions have been shown to reverse hyperglycemia to normoglycemia. However, these effects are not long-lasting and are accompanied with high dropout rates. As formula diets have been shown to be simple in usage and effective in improving glycemic control, we hypothesised that adding a low-carbohydrate and energy deficit formula diet to a low-intensity lifestyle intervention is superior in reversing prediabetes compared with lifestyle intervention alone. In this predefined subanalysis of an international, multicenter randomised controlled trial (Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (ID DRKS00006811)), 141 persons with prediabetes were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 45) or a lifestyle intervention group accompanied with a formula diet (INT, n = 96). Both groups were equipped with telemonitoring devices. INT received a low-carbohydrate formula diet substituting three meals/day (~1200 kcal/day) within the first week, two meals/day during week 2–4, and one meal/day during week 5–26 (1300–1500 kcal/day). Follow-up was performed after 52 weeks and 105 participants (75%, INT: n = 74; CON: n = 31) finished the 26-week intervention phase. Follow-up data after 52 weeks were available from 93 participants (66%, INT: n = 65; CON: n = 28). Compared with CON, significantly more INT participants converted to normoglycemia after 52 weeks (50% vs. 31%; p 0.05). The risk reduction led to a number-needed-to-treat of 5.3 for INT. Lifestyle intervention with a low-carbohydrate formula diet reduces prediabetes prevalence stronger than lifestyle intervention alone and is effective for type 2 diabetes prevention

Exhaustive exercise alters thinking times in a Tower of London task in a time-dependent manner

Purpose: In contrast to other aspects of executive functions, acute exercise-induced alterations in planning are poorly investigated. While only few studies report improved planning performances after exercise, even less is known about their time course after exhaustive exercise. Methods: One hundred and nineteen healthy adults performed the Tower of London (ToL) task at baseline, followed by a graded exercise test (GXT). Participants were subsequently randomized into one of four groups (immediately, 30, 60, and 90 min after the GXT) to repeat the ToL. Main outcomes of the ToL were planning (number of tasks completed in the minimum number of moves), solutions (correct responses independent of the given number of moves) as well as thinking times (time between presentation of each problem and first action) for tasks with varying difficulty (four-, five,- and six-move problems). Blood lactate levels were analyzed as a potential mediator. Results: No effect of exercise on planning could be detected. In contrast to complex problem conditions, median thinking times deteriorated significantly in the immediately after GXT tested group in less challenging problem conditions (four-move problems: p = 0.001, F = 5.933, df = 3; five-move problems: p = 0.005, F = 4.548, df = 3). Decreased lactate elimination rates were associated with impaired median thinking times across all groups ΔMTT4-6 (p = 0.001, r = −0.309), ΔMTT4 (p < 0.001, r = −0.367), and ΔMTT5 (p = 0.001, r = −0.290). Conclusion: These results suggest that planning does not improve within 90 min after exhaustive exercise. In line with previous research, revealing a negative impact of exhaustive exercise on memory and attention, our study extends this knowledge of exercise-induced alterations in cognitive functioning as thinking times as subcomponents of planning are negatively affected immediately after exercise. This is further associated with peripheral lactate levels

High-protein, low-glycaemic meal replacement decreases fasting insulin and inflammation markers — a 12-month subanalysis of the ACOORH trial

Abstract: Lifestyle interventions, including meal replacement, are effective in the prevention and treatment of type-2-diabetes and overweight. Since insulin is the key weight regulator, we hypothesised that addition of meal replacement to a lifestyle intervention reduces insulin levels more effective than lifestyle intervention alone. In the international, multicenter randomised-controlled ACOORH-trial (Almased-Concept-against-Overweight-and-Obesity-and-Related-Health-Risk) overweight or obese persons with criteria of metabolic syndrome (n=463) were randomised into two groups. Both groups received nutritional advice focussing on carbohydrate restriction and telemonitoring devices. The intervention group substituted all three main meals/day in week 1, two meals/day in week 2–4, and one meal/day in week 5–26 with a protein-rich, low-glycaemic meal replacement. Data were collected at baseline, after 1, 3, 6 and 12 months. All datasets providing insulin data (n=446) were included in this predefined subanalysis. Significantly stronger reductions of insulin (-3.3±8.7μU/ml vs. -1.6±9.8μU/ml), weight (-6.1±5.kg vs. -3.2±4.6kg) and inflammation markers were observed in the intervention group. Insulin reduction correlated with weight reduction and strongest weight loss (-7.6±4.9kg) was observed in those participants with insulin decrease >2μU/ml. These results underline the potential of meal replacement-based lifestyle interventions in diabetes prevention, and measurement of insulin may serve as an indicator for adherence to carbohydrate restriction

Effects of a protein-rich, low-glycaemic meal replacement on changes in dietary intake and body weight following a weight-management intervention—the ACOORH trial

Although meal replacement can lead to weight reduction, there is uncertainty whether this dietary approach implemented into a lifestyle programme can improve long-term dietary intake. In this subanalysis of the Almased Concept against Overweight and Obesity and Related Health Risk (ACOORH) study (n = 463), participants with metabolic risk factors were randomly assigned to either a meal replacement-based lifestyle intervention group (INT) or a lifestyle intervention control group (CON). This subanalysis relies only on data of participants (n = 119) who returned correctly completed dietary records at baseline, and after 12 and 52 weeks. Both groups were not matched for nutrient composition at baseline. These data were further stratified by sex and also associated with weight change. INT showed a higher increase in protein intake related to the daily energy intake after 12 weeks (+6.37% [4.69; 8.04] vs. +2.48% [0.73; 4.23], p 0.001) of intervention compared to CON. Fat and carbohydrate intake related to the daily energy intake were more strongly reduced in the INT compared to CON (both p 0.01). After sex stratification, particularly INT-women increased their total protein intake after 12 (INT: +12.7 g vs. CON: −5.1 g, p = 0.021) and 52 weeks (INT: +5.7 g vs. CON: −16.4 g, p = 0.002) compared to CON. Protein intake was negatively associated with weight change (r = −0.421; p 0.001) after 12 weeks. The results indicate that a protein-rich dietary strategy with a meal replacement can improve long-term nutritional intake, and was associated with weight loss

Early and strong leptin reduction is predictive for long-term weight loss during high-protein, low-glycaemic meal replacement: a subanalysis of the randomised-controlled ACOORH trial

Lifestyle interventions including meal replacement are suitable for prevention and treatment of obesity and type-2-diabetes. Since leptin is involved in weight regulation, we hypothesised that a meal replacement-based lifestyle intervention would reduce leptin levels more effectively than lifestyle intervention alone. In the international, multicentre, randomised-controlled ACOORH-trial (Almased-Concept-against-Overweight-and-Obesity-and-Related- Health-Risk), overweight or obese participants with metabolic syndrome criteria ( = 463) were randomised into two groups and received telemonitoring devices and nutritional advice. The intervention group additionally used a protein-rich, low-glycaemic meal replacement. Data were collected at baseline, after 1, 3, 6, and 12 months. All datasets providing leptin data ( = 427) were included in this predefined subanalysis. Serum leptin levels significantly correlated with sex, body mass index, weight, and fat mass at baseline ( &lt; 0.0001). Stronger leptin reduction has been observed in the intervention compared to the control group with the lowest levels after 1 month of intervention (estimated treatment difference -3.4 µg/L [1.4; 5.4] for females; -2.2 µg/L [1.2; 3.3] for males; &lt; 0.001 each) and was predictive for stronger reduction of body weight and fat mass ( &lt; 0.001 each) over 12 months. Strongest weight loss was observed after 6 months (-5.9 ± 5.1 kg in females of the intervention group vs. -2.9 ± 4.9 kg in the control group ( &lt; 0.0001); -6.8 ± 5.3 kg vs. -4.1 ± 4.4 kg ( = 0.003) in males) and in those participants with combined leptin and insulin decrease. A meal replacement-based lifestyle intervention effectively reduces leptin which is predictive for long-term weight loss