Physical exercise and cardiac death due to pneumonia in male teenagers [Iznenadna smrt zbog upalće pluća za vrijeme tjelovježbe u trojice mladića]

From 1998 to 2008 we noticed 3 cardiac deaths in male teenagers aged 18-19 during or after physical exercise. The first was working at the site recreatively, the second was engaged in soccer recreatively and the third was professional soccer player. One felt general tiredness and was exhausted of a heavily physical effort, the other after physical exercise became septic and the third was without symptoms. One died suddenly during physical exercise at the field and two died in the hospital. At the forensic autopsy the first had bilateral bacterial pneumonia, possible high-altitude non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, suprarenal bleeding, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, cerebral contusion with edema, thickenning of the left ventricle 20 mm and hypoplastic ascending aorta. In Croatia the death rate among athletes reached 0.15/ 100,000, in athletes suffered of acute pneumonia 0.28/ 100,000, in others who practice exercise recreatively 0.57/ 100,000 (p = 0.0068), in all males who practice exercise recreatively 0.75/ 100,000 (p = 0.0014). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after bacterial pneumonia depends on disappearing of clinical and X-ray signs of pneumonia, normalization of erythrocite sedimentation rate and of white cell count

A physical exercise and quality of life

Physiological aging of the human organism begins with the onset of the 4th decade of life. The article presents some changes in the organism during the so-called primary aging, as well as those occurring due to secondary aging with diseases in the background. The most frequent diseases in the so-called elderly people are cardio-metabolic X syndrome, consisting of obesity, diabetes or glucose intolerance, with the occurring insulin resistance, hyperliporoteinemia: hyperglyceridemia with low HDL and elevated LDL cholesterol, arterial hypertension, hyperfibrinogenemia and high C-reactive protein concentration in the serum. Along with preventive measures and treatment of these diseases, physical exercise has a prominent place. In the so-called elderly persons it should be regular and frequent: at least 2–3 times a week, although it would be best every day, with adequate intensity: usually moderate and/or modified according to the criteria of physiological age and the degree of health or illness, lasting for at least 15 minutes. Physical exercise in the elderly should be adjusted to age, gender, health and functional capacities, taking into account previous experience with physical exercise or sports activities. Special attention should be paid to physical exercises in elderly persons who have not practiced thempreviously, but want to do it. Priority should be given to activities stimulating functional improvement of the heart function, blood flow, and breathing – general endurance exercises that activate at least 1/7 of all skeletal muscles, about 50 % of possible blood flow, and which last at least 5 minutes. It would be best to perform them daily. Measuring of quality of life due to aging could be expressed by parameters of physical fitness by assessing walking, somatic symptoms and mental state

Does Chronological Age Reduce Working Ability?

Definitions of so-called older age often are based on a chronological age of 65 years and over, although by some authors aging is the process that starts after the 30th year of life. At the beginning occur changes in the organ functions, followed by anatomical changes as well. Some organs age faster, some slower. For example, kidneys decrease for one third, lungs do not change, liver shrinks a little, prostate increases twice. In some cross-sectional studies, muscle mass in men aged 65 is on average 12 kg less than in the so-called middle age, and in women it is approximately 5 kg less. In the heart the amount of connective tissue increases, lipofuscin is deposited in cardiac muscle, the strength of which is decreasing. In the respiratory tract the number of pathways cilia decreases, along with the alveolar surface, muscles involved in breathing change, lung elasticity is also diminished. But, in regard with the previous body capacity, »physiological aging « can be divided into three types of elderly: the »older« elderly have the highest functional capacity of 2–3 MET (MET – metabolic unit, i.e. the oxygen consumption of 3.5 ml/kg body mass in a minute), the »younger« elderly are the persons of older age having maximal functional capacity of 5–7 MET, while the »sport« elderly have the functional capacity of 9–10 MET, disregarding chronological age. The brain weight diminishes for approximately 7% compared to younger age. In temporal gyrus and area striata even 20–40% of cells are being lost, vacuolar and neuroaxonal degeneration occurs, lipofuscin is being accumulated. The brain blood flow, which is in normal conditions 50–60 ml/ min/100 g of tissue, with the increase of biological age decreases to about 40 ml/min/100 g of tissue. However, this usually is not the consequence of biological age but of disease. A chronological age of 65 for the beginning of »elder hood« is a sociopolitical construct developed by social security systems and government organizations to decide an arbitrary age at which benefits should be paid. Thus, it neither a border nor do changes designating old age occurs exactly with that »age border«. The changes in the organism during the so-called aging are individual. So, the functional capacity of an organism, both physical and intellectual, must be evaluated individually, having in mind biological age

Physical Exercise and Cardiac Death Due to Pneumonia in Male Teenagers

From 1998 to 2008 we noticed 3 cardiac deaths in male teenagers aged 18–19 during or after physical exercise. The first was working at the site recreatively, the second was engaged in soccer recreativelyand the third was professional soccer player. One felt general tiredness and was exhausted of a heavily physical effort, the other after physical exercise became septic and the third was without symptoms. One died suddenly during physical exercise at the field and two died in the hospital. At the forensic autopsy the first had bilateral bacterial pneumonia, possible high-altitude non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, suprarenal bleeding, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, cerebral contusion with edema, thickenning of the left ventricle 20 mm and hypoplastic ascending aorta. In Croatia the death rate among athletes reached 0.15/100 000, in athletes suffered of acute pneumonia 0.28/100 000, in others who practice exercise recreatively 0.57/100 000 (p=0.0068), in all males who practice exercise recreatively 0.75/100 000 (p=0.0014). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after bacterial pneumonia depends on dissapearing of clinical and X-ray signs of pneumonia, normalization of erythrocite sedimentation rate and of white cell count

Physical activity and sudden cardiac death in elders - a Croatian study [Rekreacijska tjelovježba i nagla kardijalna smrt u osoba starije dobi u Hrvatskoj]

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs)

Arrhythmogenic Right Ventricular Dysplasia and Sudden Cardiac Death in Croatians, Young Athletes in 25 Years

The paper deals with the sudden cardiac death during training in male athletes in Croatia. The data are a part of a retrospective study dealing with 67 sudden death due to physical activity in men in Croatia during 25 years: from January 1, 1986 to December 31, 2010. Two of them suddenly died during training due to malignant ventricular arrhythmia because of the arrhythmogenic right ventricular dysplasia. First was a short trails runner aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second was a soccer player aged 13, with no any previous physical discomfort, who suddenly collapsed and died during training. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of arrhythmogenic right ventricular dysplasia reached 0.07/ 100.000 yearly (p=0.00000), in all young athletes suffered of heart diseases reached 0.19/100 000 (p=0.00005), and in the total male population aged 15–40 engaged in sports and recreational physical exercise: 0.71/100.0000 (p=0.00001)

Hypertrophic Cardiomyopathy and Sudden Cardiac Death Due to Physical Exercise in Croatia in a 27-Year Period

The paper deals with the sudden cardiac death during physical exercise in males in Croatia. The data are a part of a retrospective study dealing with 69 sudden death due to physical activity in men in Croatia during 27 years: from January 1, 1984 to December 31, 2010. Three of them suddenly died during training and two of them died during recreational physical exercise, probably because of malignant ventricular arrhythmia due to hyperthrophic cardiomyopathy. One had an obstructive form of hypertrophic cardiomyopathy with i.v. septum of 40 mm and four had a non-obstructive forms of hyperthrophic cardiomyopathy with left ventricular wall of 18–20–22–25 mm. First athlete was a short trails runner, aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second athlete was a soccer player aged 18, with no any previous physical discomfort, who suddenly collapsed and died during training. The third aged 15, was a school boy, basketball player, with no any previous physical discomfort, who collapsed and died during training. Two aged 25 and 34, were with no physical discomfort during exercise and died suddenly during recreational soccer games. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of hyperthropic cardiomyopathy reached 0.06/100 000 yearly (p=0.00000) in 27 years, in teenagers 0.26/100 000 (p= 0.00226), in teenagers suffered of hypertrophic cardiomyopathy reached 0.10/100 000 (p=0.00000), in all young athletes suffered of other heart diseases reached 0.19/100 000 (p=0.00005), and in the total male population aged 15 or more, engaged in sports and recreational physical exercise: 0.71/100.0000 (p=0.00001)

Sport zu treiben oder nicht während Akuterinfektionen von oberen Atemwegen?

The paper deals with the problem of acute viral infections of the upper respiratory tract in sport and recreational exercise. Regarding these infections, important factors are biological age and the previous health status – the existence of one or more chronic diseases, particularly respiratory and cardiovascular ones. Described are virus types, ways of their transmission, disease course and possible complications. Special attention is paid to influenza. The risk of the upper respiratory tract diseases is increased during intensive endurance training sessions, marathon and ultramarathon races, as well as in the cases of overtraining and chronic fatigue. Cited are changes in the individual components in the immune system, which happen in intensive long-lasting high volume training, and which are related to neuroendocrinologic changes. Recommendations for the prevention of increased risk of upper respiratory tract infections are listed. The duration of a certain viral disease is particularly stressed, as well as which circumstances condition the restart of training.Akutne bolesti dišnih putova vrlo su učestale (više od 65% svih infekcija) i najčešći su uzročnik pobolijevanja i razlog nesposobnosti za rad i tjelovježbu pučanstva, napose u kasnu jesen i u zimskim mjesecima, odnosno u vremenima znatnih promjena temperature okoliša. Akutne se bolesti dišnih putova šire kapljičnom infekcijom, tj. kontaktom s respiratornim sekretima druge osobe koji sadrže virus. Inkubacija je kratka. Razvoju bolesti, napose epidemijama, pogoduju klimatski uvjeti: hladni mjeseci s visokom vlagom u zraku, boravak u jako napučenom prostoru, gustoća, brzina i intenzitet prometa bolesnika, napose u fazi inkubacije i dr. Virus može u dišni sustav dospjeti aerosolom, direktnim i indirektnim kontaktom koji uključuje kontaminirani objekt. Potencijal za širenje infekcije od osobe oboljele od respiratorne infekcije znatan je najmanje 8 dana, a virusi se mogu stvarati i tijekom 2-3 tjedna. Brojni virusi i njihovi brojni serotipovi uzročnici su infekcija gornjih dišnih putova. Rhinovirusi, kojih ima više od 100 serotipova, odgovorni su za oko 40% infekcija tzv. obične prehlade, s dobro definiranom prevalencijom, napose u jesenjim i proljetnim mjesecima, ali se prehlade mogu javljati i tijekom zimskih mjeseci. Coronavirusi su druga skupina uzročnika tzv. obične prehlade tijekom kasne jeseni, u zimskim i ranoproljetnim mjesecima. Najčešći su uzročnici zimske prehlade. Coxackievirusi i echovirusi uzročnici su infekcija gornjeg dišnog sustava, a potonji mogu biti uzročnicima akutne upale mišića srca (akutnog miokarditisa). Do toga mogu dovesti i adenovirusi, respiratorni sincicijski virus, virus influence, virus parainfluence, Epstein-Barrov virus (koji uzrokuje infektivnu mononukleozu). Imunost je po preboljeloj akutnoj infekciji gornjih dišnih putova kratka pa odrasla osoba preboli 1-6 takvih infekcija godišnje. Gripa (influenca) se pojavljuje u epidemijama, ali i u pandemijama, zbog čega je treba napose izdvojiti. Uzrokovana je virusom influence. Prenosi se kapljičnom infekcijom s čovjeka na čovjeka. Vrijeme inkubacije je 1-3 dana. Započinje naglo s općim simptomima. Lokalni simptomi nisu napose izraženi. Često protječe poput obične prehlade, no tijek može biti i napose težak s razvojem brojnih komplikacija pred kraj bolesti, kao što su bakterijske superinfekcije, ali i s razvojem upale pluća kao i akutnog miokarditisa s kardiogenim šokom i smrtnim ishodom. Osobe koje se bave tjelovježbom u periodima intenzivnih treninga češće obolijevaju od infekcija gornjeg dišnog sustava, poput obične prehlade. No osobe koje se bave rekreacijskom tjelovježbom od tih bolesti obolijevaju rjeđe nego tjelesno neaktivno pučanstvo. Funkcija imunološkog sustava se mijenja pod utjecajem dugotrajnog treninga velikog volumena. Događaju se sljedeće promjene: neutrofilija i limfocitopenija, što je uvjetovano povišenom koncentracijom katekolamina u plazmi, kao i hormona rasta i kortizola; povećanje granulocitne i monocitne fagocitoze, ali sniženje neutrofilne fagocitoze u sluznici nosa; smanjenje granulocitne oksidativne aktivnosti; smanjenje učinkovitosti mukocilijarnog sustava nosa; smanjenje citotoksične aktivnosti “stanica prirodnih ubojica”; smanjenje limfocitne proliferacije inducirane mitogenom (što je mjera funkcije T-limfocita); smanjenje odgovora kasne preosjetljivosti; porast koncentracije proupalnih i protuupalnih citokina; smanjenje proizvodnje citokina ex vivo u odgovoru na mitogene i endotoksin; smanjenje koncentracije imunoglobulina A (IgA) u sluznici nosa i u slini. Te promjene upućuju na blago smanjenje imunološke funkcije, prolazno nakon ponovljenog kroničnog iscrpljujućeg napora. Čii se da su mnoge nabrojene imunološke promjene rezultat neuroendokrinoloških promjena: porast razine hormona, broja hormonskih receptora, kao i receptorske osjetjivosti. Za sada nije dovoljno poznat prag opterećenja ispod odnosno iznad kojega tjelovježba štiti, odnosno djeluje nepovoljno. Osoba koja se bavi vrhunskim sportom, koja se, dakle, podvrgava dugotrajnim treninzima visokog intenziteta, da bi se zaštitila od povećane opasnosti obolijevanja od infekcija gornjeg dišnog sustava, treba: svesti stres svakodnevnog življenja na najmanju mjeru (psihološki stres poznati je modulator imunološke funkcije); koristiti dobro uravnoteženu prehranu s osobitom pozornosti na dostatan unos ugljikohidrata prije, za vrijeme i nakon dugotrajne intenzivne aktivnosti; primjereno unositi vitamine, napose askorbinsku kiselinu (C-vitamin), minerale, glutamine (neesencijalna aminokiselina, čime se može smanjiti stopa proliferacije limfocita); izbjegavati nagli gubitak tjelesne mase; izbjegavati kronični umor i priječiti stanje pretreniranosti; priječiti samoinokulaciju virusa dodirom sluznice nosa i oka; izbjegavati susrete s bolesnim osobama i boravak u napučenom prostoru prije velikih natjecanja; osiguravati dobar redoviti odmor i oporavak tijekom trenažnih ciklusa, kao i kvalitetan i redovit san prije natjecanja; prije zimskih mjeseci (listopad) cijepiti se protiv influence. U slučaju obolijevanja od obične prehlade, a bez znakova sustavne bolesti, sportaš se može uključiti u trening nekoliko dana nakon prestanka simptoma. Umjereno vježbanje u običnoj prehladi obično nije kontraindicirano. Ako se radi o preboljeloj gripi srednje teške kliničke slike, a koja pro-tječe bez komplikacija, tek nakon 7 dana po prestanku simptoma može se ocjenjivati kada ponovno započeti sa sportskim ili rekreacijskim treningom. Ako se radi o komplikacijama, kao što je upala pluća, nastavak tjelovježbe može se ocjenjivati tek 14 dana nakon nestanka kliničkih simptoma bolesti, po nestanku infiltrata na plućima, normalizaciji bijele krvne slike te normalizaciji sedimentacije eritrocita u prvom satu. U slučajevima obolijevanja od akutnog miokarditisa, vraćanje aktivnostima tjelovježbe može se razmatrati najranije nakon 6 mjeseci, što ovisi o brojnim kliničkim i laboratorijskim parametrima. Niz komplikacija može biti povezan s akutnim infekcijama gornjih dišnih putova. Iako iznimno rijetke, smrtne su komplikacije u mladih, prethodno zdravih osoba, podvrgnutih iscrpljujućem treningu tijekom akutne virusne bolesti gornjih dišnih putova opisane u svijetu i u nas. Zaključno se može reći da treba znati prepoznati virusne bolesti gornjih dišnih putova, njihov tijek i možebitne komplikacije. To je važno i zbog odlučivanja o tome kada nakon takve bolesti sportaš ili vježbač može nastaviti s kompetitivnom ili rekreacijskom tjelovježbom, a što treba uvijek pojedinačno ocjenjivati. Tu ocjenu treba donijeti liječnik specijalist u suradnji s kineziologom.Diese Arbeit befasst sich mit dem Problem akuter Virusinfektionen von oberen Atemwegen während sportiver Betätigung oder während Erholungsübungen. In Bezug auf diese Infektionen sind die Faktoren wie, zum Beispiel, das biologische Alter und der vorherige Gesundheitsstatus – das heißt, das Vorhandensein einer oder mehrerer chronischen Krankheiten, insbesondere der Atemwege- und Herz-Kreislauferkrankungen, vongroßer Bedeutung. Verschiedene Virustypen, die Art und Weise ihrer Übertragung, der Erkrankungsverlauf und mögliche Komplikationen wurden beschrieben. Der Influenza wurde besonderer Nachdruck verliehen. Das Risiko der Erkrankung oberer Atemwege nimmt während intensiven Ausdauertrainings, des Marathons und der Ultramarathonläufe zu, sowie in Fällen von Übertrainiertheit und chronischer Erschöpfung. Die Veränderungen von individuellen Komponenten des Immunsystems wurden angeführt, die im Lauf intensiven, langwierigen und hohen Trainingsumfangs zustande kommen und die mit neuroendokrinologischen Veränderungen zu tun haben. Außerdem wurden die Empfehlungen zur Vorbeugung gegen den erhöhten Erkrankungsrisiko der oberen Atemwegeinfektionen angeführt. Große Bedeutung wurde der Dauer einer bestimmen Viruserkrankung beigemessen, genauso wie den Umständen, die den Wiederbeginn des Trainings beeinflussen

The Early Prevention of Metabolic Syndrome by Physical Exercise

The article deals with physical exercise in the early prevention of metabolic syndrome, which is one of the most frequent diseases today. Sedentary life style of modern man, surrounded by sophisticated technological achievements, supersedes the time spent in motion in all age groups, from the earliest childhood. The growing number of well substantiated studies has yielded results connecting such kind of life with greater incidence of many chronic diseases and low functional capability of an organism. Metabolic syndrome (MS) is a complex process and one of the most important groups of diseases, presenting a major health problem in developing countries. MS is an increasing risk for coronary heart disease, stroke and peripheral angiopathy. MS comprises overweight and abdominal (intraperitoneal) apple shape obesity, insulin resistance or glucose intolerance (type 2 diabetes mellitus – some persons are genetically predisposed to insulin resistance), hypertriglyceridemia with low HDL and high LDL cholesterol, accompanied by arterial hypertension. The prevention of metabolic syndrome should start as early as possible. Regarding physical activity, the period of childhood and adolescence is very important from the aspects of public health. However, intervention exercise programs should not be limited to younger age groups, but must encompass all age groups within population

Suppurative Tonsillitis and Sudden Cardiac Death Due to Physical Training in a Young Soccer Player

A teenager aged 17 was a professional soccer player, and was without symptoms. He died suddenly during physical exercise at the field. All reanimation efforts were unsuccessfull. At the forensic autopsy he had suppurative bacterial tonsillitis, subacute diffuse myopericarditis and narrowing of the ascending aorta of 10 mm. In Croatia the death rate among athletes reached 0,15/100 000, in athletes suffered of acute respiratory tract infections 0,34/100 000, in males who practice exercise recreatively 0,75/100 000 (p=0.0014), in school children 1,0/100 000 (p=0.0010). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after suppurative-bacterial tonsillitis depends on disappearing of clinical signs, normalization of erythrocite sedimentation rate; of white cell count and serum level of C-reactive protein. Physical exercise is contraindicated in patients suffering of myopericarditis for at least 6 months. When to start exercise depends on disappearing of subjective symptoms and normalization of clinical and laboratory findings