The 2012 University of Cape Town Faculty of Health Sciences centenary debate “Cholesterol is not an important risk factor for heart disease, and the current dietary recommendations do more harm than good”

Our human ancestors thrived on a diet high in fat and protein of animal or fish origin for at least 2.5 million years. Foods with a high-energy content and nutritional density were required for the development of the large, energy-expensive human brain. A reduction in human height and deterioration in our health followed the introduction of agriculture 2 000-12 000 years ago. In 1977, the United States Department of Agriculture (USDA) introduced novel dietary guidelines based on an untested hypothesis of Keys that dietary fat, especially of animal origin, increases the blood cholesterol concentration, “clogging” the coronary arteries and causing heart attacks, i.e. the diet-heart hypothesis

Spinal cord injuries in South African Rugby Union (1980 - 2007)

Objectives and design. To address an apparent increase in thenumber of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby.Methods. We identified 264 rugby-related SCIs. A structuredquestionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died.Results. SCIs increased in number in the 1980s and in 2006.Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance.Conclusion. A register of all rugby-related SCIs in South Africais essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation

Peripheral arterial disease and intermittent claudication: Efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home

Objective. To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD).Design. 30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to ‘walk as much as possible at home’ (CONT). Before and after intervention groupsperformed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2) , heart rate and perceived pain were measured.Results. MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9±79% v. 7.0±19.8% v. 7.3±46%; CER v. UBST v. CONT p=0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4±20 v. –6.2±15 v. –1.0±21%; CER v. UBST v. CONT p=0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37±47% v. 27±71% v. –30±29%; CER v. UBST v. CONT p=0.03), and perceived pain decreased in the CER group compared with the UBST group (–24±39% v. 27±48%; CER v. UBST p=0.01).Conclusion. CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of managemen

Factors predicting walking intolerance in patients with peripheral arterial disease(PAD) and intermittent claudication

Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. Subjects. Thirty-one patients diagnosed with PAD were included in the study. Outcome measures. During a GTT, peak oxygen consumption (VO2peak), peak minute ventilation (VEpeak), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Anklebrachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. Results. Peak venous lactate concentrations did not correlate significantly with either PFWD (r=–0.08; p=0.3) or MWD (r=–0.03; p=0.4). Resting ABI did not correlate with either MWD (r=0.09; p=0.64) or PFWD (r=–0.19; p=0.29). Subjects terminated exercise at significantly (

Acute renal failure in four Comrades Marathon runners ingesting the same electrolyte supplement: Coincidence or causation?

Objectives. To evaluate common factors associated with the development of acute renal failure (ARF) in Comrades Marathon runners.Methods. This was a retrospective case series of 4 runners hospitalised post-race with ARF in the 89 km 2010 Comrades Marathon. The outcome measures were incidence of analgesic use, levels of creatine  phosphokinase (CPK) and degree of electrolyte supplementation (sodium, potassium, calcium and magnesium).Results. The prevalence of ARF was 1/4 125 runners. They presented with rhabdomyolysis (mean admission CPK of 36 294 IU) and hyponatraemia (mean admission blood sodium level of 133 mEq/l). All had ingested an analgesic during the run (3 ingested a non-steroidal anti-inflammatory  drug) and the same readily available anti-cramp electrolyte supplement.  The average amount of supplemental sodium (452 mg), potassium (393 mg), calcium (330 mg) and magnesium (154 mg) ingested via this  particular electrolyte supplement before and during the run did not exceedthe recommended upper limits of daily intake. Three of the runners were Comrades Marathon novices.Conclusions. There is a continuing need to clarify the specific cluster variants that cause ARF in Comrades Marathon runners, as the risk factors appear to have evolved since the first case was described over 40 years ago.S Afr Med J 2011;101:876-878

Avoid adding insult to injury – correct management of sick female endurance athletes

Objectives. To evaluate the efficacy of Ringer’s lactate, isotonic saline and hypertonic saline on the clinical and biochemical recovery of athletes with exercise-associated hyponatraemic encephalopathy caused by fluid overload.Methods. We retrospectively reviewed serial blood sodium concentrations (Na+) and qualitative signs of recovery and time to recovery in two healthy menstruant females hospitalised with dilutional exercise-associated hyponatraemic encephalopathy after withdrawal from the 2011 Comrades Marathon (89 km) and Argus Cycle Tour (109 km).Results. Improvements in blood Na+ did not occur with intravenous administration of Ringer’s lactate solution, but did occur with administration of isotonic and hypertonic saline. Qualitative improvements in mental status were not quantitatively related to the biochemical value of blood Na+ or subsequent return to normonatraemia.Conclusions. Hyponatraemia should be suspected in all female athletes presenting to the medical area of endurance races with vomiting, altered mental status and a history of high fluid intake. If a diagnosis of exercise-associated hyponatraemia with cerebral encephalopathy is confirmed, the treatment of choice is administration of an intravenous bolus of hypertonic saline. Administration of Ringer’s lactate should be discouraged, as this does not correct Na+ and appears to delay recovery

Non-steroidal antiinflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy

The effects of two non-steroidal anti-inflammatory drugs (NSAIDs), meclofenamate and diclofenac, in combination with physiotherapy modalities on the rate of healing of acute hamstring muscle tears were studied in a doubleblind, placebo-controlled trial. Forty-four of the 75 patients with this injury recruited were assessed and randomly allocated to one of three treatment groups: meclofenamate (100 mg 3 times a day), diclofenac (50 mg 3 times a day) and placebo. All patients received the same intensive physiotherapy treatment over the 7-day treatment period. Patient assessments were performed on days 1, 3 and 7 of the 7-day study period and included pain assessment (visual analogue scale), swelling measurement (thigh circumference measurement at the site of the muscle tear) and isokinetic muscle performance testing. Treatment produced a significant improvement in all measurements in all groups, but there was no difference in any measurement between groups. However, when only the more severe injuries were analysed, the reported pain score at day 7 was significantly lower in the placebo group than in either the  eclofenamate group or the diclofenac group (P < 0,05). Hence this study did not find any additive effect on the healing of acute muscle injuries when meclofenamate or diclofenac was added to standard physiotherapeutic modalities. The study therefore does not support the use of NSAIDs in the treatment of acute hamstring muscle injuries.S Afr Med J 1995; 85: 517-52

Preload maintenance protects against a depression in left ventricular systolic, but not diastolic, function immediately after ultraendurance exercise

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright © 2006 BMJ Publishing Group.Objective: To investigate indices of left ventricular (LV) function before and after a 224 km Ironman triathlon, specifically in the presence of unaltered haemodynamic loading. Method: LV loading and function were assessed before and after the race using M mode and Doppler echocardiography in 39 (mean (SD) age 33 (8) years, body mass 77.6 (8.6) kg; 36 male) triathletes in the Trendelenburg position. Specifically left ventricular end diastolic volume (LVEDV) was assessed to estimate preload, and systolic blood pressure to estimate afterload as well as heart rate (HR). Systolic functional indices included ejection fraction (EF) and the end systolic pressure/volume ratio (ESPV), and diastolic functional indices included peak mitral flow velocity in early (E) and atrial (A) filling as well as the ratio E/A. Data obtained before and after the race were compared by t tests, and delta LV functional indices were correlated with delta heart rate. Results: Preload (LVEDV: 143 (34) ml before v 147 (34) ml after) and afterload (systolic blood pressure 121 (13) v 115 (20) mm Hg) were not significantly altered after the race (p>0.05), nor were EF (61 (8)% v 58 (10)%) and ESPV (2.4 (0.9) v 2.1 (0.8) mm Hg/cm3). The diastolic filling ratio E/A was significantly reduced after the race (1.73 (0.25) v 1.54 (0.23); p0.05). Conclusion: When preload and afterload are unaltered after the race, because of the adoption of a unique assessment posture, LV systolic function is not depressed. A depression in LV diastolic function persists which is not explained by an increase in heart rate after the race

An inventory of the South african fitness industry

Objective. The aim of this study was to create an inventory of fitness facilities in South Africa, their location, equipment and services offered, and the demographics, education and training of the staff working in these facilities. Design. A total of 750 facilities were identified, and descriptive data were gathered from 442 facilities (59%) with the use of a questionnaire administered telephonically and via the website of the Sports Science Institute of South Africa. Setting. The study was initiated by the Sports Science Institute, and the results were presented at the 4th Annual Discovery Vitality Fitness Convention on 4 May 2006. Results. Results show that the industry comprises mainly independent facilities (68%). All types of facilities were found to be located mostly within urban areas, and reported providing services to just less than 2% of the South African population. Facilities offer a wide range of equipment and services to their members. Of the fitness-related staff at facilities, the majority were reported to be young (18 - 25 years, 55% of male, and 49% of female staff), and in terms of racial proportions most staff were white (males 40% of total staff and females 33% of total staff).Less than a quarter of fitness-related staff hold university qualifications, and just over 80% of instructors hold qualifications aligned with the National Qualifications Framework. The importance of education and training of staff was emphasised by respondents. Conclusions. This report highlights the widespread value of assessing the fitness industry, particularly within the context of the rise of chronic diseases in South Africa and government initiatives to promote healthy lifestyles. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 93-10

Age-related decrements in cycling and running performance

Objective. This study examined age-related decrements in athletic performance during running and cycling activities. Design. The age group winning times for males aged between 18 and 70 years competing in the 1999 Argus cycle tour (103 km) and 1999 Comrades running marathon (90 km), South Africa's premier endurance cycling and running events respectively, were examined. Main outcome measures. The relationship between speed (cycling and running respectively) and age was calculated using a 4th order polynomial function. The derivative of each of these functions was determined and then the slope of the function corresponding to each age was calculated. Results. The rate of decline in running speed occurred at an earlier age (~ 32 years) during the running race compared with the cycling tour (~ 55 years). Conclusions. These findings establish a trend that there is ‘accelerated' aging during running which can perhaps be attributed to the increased weight-bearing stress on the muscles during running compared with cycling. SA Sports Medicine Vol.16(2) 2004: 8-1