Biochemical and hematological changes following the 120-km open-water marathon swim

Data on physiological effects and potential risks of a ultraendurance swimming are scarce. This report presents the unique case of a 61-year old athlete who completed a non-stop open-water 120-km ultramarathon swim on the Warta River, Poland. Pre-swimming examinations revealed favorable conditions (blood pressure, 110/70 mmHg; rest heart rate, 54 beats/minute, ejection fraction, 60%, 20.2 metabolic equivalents in a maximal exercise test). The swimming time and distance covered were 27 h 33 min and 120 km, respectively. Blood samples for hematological and biochemical parameters were collected 30 min, 4 hrs, 10 hrs and 8 days after the swim. The body temperature of the swimmer was 36.7°C before and 35.1°C after the swim. The hematological parameters remained within the reference range in the postexercise period except for leucocytes (17.5 and 10.6 x G/l noted 30 minutes and 4 hours after the swim, respectively). Serum urea, aspartate aminotransferase and C-reactive protein increased above the reference range reaching 11.3 mmol/l, 1054 nmol/l/s and 25.9 mg/l, respectively. Symptomatic hyponatremia was not observed. Although the results demonstrate that an experienced athlete is able to complete an ultra-marathon swim without negative health consequences, further studies addressing the potential risks of marathon swimming are required.

Evaluation of the Heart Function of Swimmers Subjected to Exhaustive Repetitive Endurance Efforts During a 500-km Relay

Aim: Knowledge of the human body’s ability to adapt to repeated endurance efforts during swimming is limited. We echocardiographically assessed the impact of an exhausting and repetitive swimming effort on cardiac activity.Materials: Fourteen well-trained amateur swimmers (8 female swimmers aged 16–43 years and 6 male swimmers aged 13–67 years old) participated in an ultramarathon relay. Over 5 days, swimmers swam 500 km in the Warta River (in 5-km intervals). Each swimmer swam seven intervals, each within 44:46 to 60:02 min. Objective difficulties included low water temperatures, strong winds, rain, and night conditions.Methods: Transthoracic echocardiography (TTE) was performed three times: at baseline (the day before exertion), at peak effort, and during recovery (48 h after the event). The heart rate (HR) of each swimmer was monitored.Results: Swimmers completed the ultramarathon relay within approximately 91 h. The average HR value at the end of each interval was 91% HRmax. TTE test results showed no significant changes indicative of deterioration of myocardial function at peak effort or after 48 h. Significant increases in left ventricular (LV) ejection fraction, LV fractional shortening (LVFS), LV myocardial systolic velocity, and right ventricular (RV) fractional area changes observed on day 2 after swimming were compared to baseline values and peak effort values. No significant changes in diastolic heart function were observed.Conclusion: Echocardiography assessment indicated that prolonged intense swimming does not affect LV or RV function. Supercompensation of the post-event RV function and increased global LV systolic function demonstrated ventricular interaction after prolonged intense swimming

Ten-year changes in the prevalence and socio-demographic determinants of physical activity among polish adults aged 20 to 74 years : results of the national multicenter health surveys WOBASZ (2003-2005) and WOBASZ II (2013-2014)

INTRODUCTION:The aim of the study was to estimate ten-year changes in physical activity (PA) patterns and sociodemographic determinants among adult residents of Poland. METHODS:The study comprised two independent samples of randomly selected adults aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2003-2005; n = 14572) and WOBASZ II (2013-2014; n = 5694). In both surveys the measurements were performed by six academic centers in all 16 voivodships of Poland (108 measurement points in each survey). Sociodemographic data were collected by an interviewer-administered questionnaire in both surveys. Physical activity was assessed in three domains: leisure-time, occupational and commuting physical activity. RESULTS:Leisure-time PA changed substantially between the surveys (p<0.001). The prevalence of subjects being active on most days of week fell in both genders in the years 2003-2014 (37.4% vs 27.3% in men); 32.7% vs 28.3% in women. None or occasional activity increased from 49.6% to 56.8% in men, while remained stable in women (55.2% vs 54.9%). In both WOBASZ surveys the likelihood of physical inactivity was higher in less educated individuals, smokers and those living in large agglomerations (p<0.01). No significant changes were observed in occupational activity in men between the surveys, while in women percentage of sedentary work increased from 43.4% to % 49.4% (p<0.01). Commuting PA decreased significantly in both genders (p<0.001). About 79.3% of men and 71.3% of women reported no active commuting in the WOBASZ II survey. CONCLUSIONS:The observed unfavourable changes in PA emphasize the need for novel intervention concepts in order to reverse this direction. Further detailed monitoring of PA patterns in Poland is of particular importance

Epidemiology of physical activity in adult Polish population in the second decade of the 21st century. Results of the NATPOL 2011 study

Objectives: The aim of the study was to assess physical activity (PA) level in a representative sample of Polish adults.Materials and Methods: A cross-sectional analysis was performed among 2413 randomly selected individuals (51.5% women) aged 18-79 years, who participated in the Nationwide Study of Occurrence of Risk Factors of Cardiovascular Diseases NATPOL 2011 (March-July 2011). The study procedures consisted of a questionnaire as well as of anthropometric, blood pressure and biochemical measurements. Leisure-time, occupational and commuting PA were assessed by the use of a questionnaire interview. Results: About 48.2% of adults do exercise for at least 30 minutes on most days of a week. About 11% of the respondents declare a sedentary lifestyle. About 26.5% of working population report hard physical work, while sedentary work is reported by 47.6% of the employed participants. Active commuting is declared by 27.3% of working/studying population. About 47.2%, 36.6%, and 15.3% spend 30 min per day, respectively, on this kind of PA. Conclusions: PA level of more than half of Polish adults is still not satisfactory. Promotion of an active lifestyle should concern mainly leisure-time and commuting PA with paying special attention to substantial differences in various socio-demographic groups

Prevalence of Non-Functional Ovearreaching and Overtraining Syndromes in Athletes

Wstęp. Zaburzenie równowagi pomiędzy obciążeniem treningowym a regeneracją organizmu prowadzi do rozwinięcia Zespołu niefunkcjonalnego przemęczenia (NFO) lub Zespołu przetrenowania (OTS) i pogorszenia wyniku sportowego. Celem badania jest określenie częstości występowania tych zespołów w grupie sportowców. Materiał i metody. Przebadano 111 mężczyzn w wieku 18-35 lat trenujących min. 2 lata: biegi długie, kolarstwo, triathlon, trójbój siłowy, crossfit, kulturystykę, podnoszenie ciężarów. Przeprowadzono badanie lekarskie z wywiadem sportowym. Oceniano wydolność fizyczną tlenową – badanie ergospirometryczne (CPET) na bieżni mechanicznej oraz wydolność beztlenową podczas testu Wingate na cykloergometrze. Wykluczono stany zapalne, zaburzenia hematologiczne i metaboliczne. Dokonano pomiarów antropometrycznych. Poziom przemęczenia oraz motywację do treningu oceniano kwestionariuszem Oceny profilu nastrojów- POMS (Profile of Mood State)- wyniki odniesiono do wartości referencyjnych. Materiał poddano analizie w programie Statistica v. 13.0. Wyniki. Na podstawie wyników POMS i zmian w wydolności fizycznej wyodrębniono grupę 26 (23,4%) osób z cechami zespołu NFO/OTS. Byli to sportowcy ze średnim stażem treningowym 73 miesiące trenujący: biegi długie, crossfit i kulturystykę, startujący w zawodach częściej niż 20 razy w roku. Obserwowano istotne statystycznie różnice u sportowców z cechami zespołów NFO/OTS w ocenie nastroju POMS: wartości wyższe w subskalach: napięcie/niepokój, depresja, zmęczenie oraz niższe w subskali krzepkość/aktywność. Obserwowano mniejsze wartości wydolności fizycznej tlenowej i beztlenowej w tej grupie, jednak bez istotności statystycznej. Ilość snu, czas trwania i liczba treningów nie wpływały na wyniki badań. Wnioski. Wystąpienie NFO/OTS dotyczy blisko 25% sportowców różnych dyscyplin sportowych, o średnim stażu treningowym ok. 73 miesiące, startujących w zawodach średnio 20 razy w roku. Kwestionariusz oceny nastrojów POMS okazał się przydatnym narzędziem do diagnostyki tych zespołów.Background. Imbalance between training load and body recovery leads to the development of the non-functional overreaching syndrome (NFO) or overtraining syndrome (OTS) and deterioration of athlete’s performance. The aim of the study was to determine the prevalence of these syndromes in a sample of athletes. Material and methods. 111 males aged 18-35 years, training long distance running, cycling, triathlon, powerlifting, crossfit, bodybuilding and weightlifting minimum 2 years. The medical assessment was combined with history taking on athletic career and performance. Aerobic capacity was assessed by means of ergospirometry – cardiopulmonary exercise test (CPET) on a mechanical treadmill and anaerobic capacity was measured using Wingate test on a cycle ergometer. The patients with inflammatory conditions, hematological disorders and metabolic disorders were excluded. Anthropometric measurements were taken. Overreaching level and motivation for training were assessed using Profile of Mood State (POMS) questionnaire. The results were next compared with the reference values. Statistical analysis was performed using Statistica program, v.13.0. Results. Based on POMS results and the changes in physical capacity a group of 26 participants was selected (23.4%) with NFO/OTS syndrome symptoms. These were athletes training long distance running, crossfit and bodybuilding within 73 months and those who started in competitions more often than 20 times a year. Statistically significant differences were noted in athletes with NFO/OTS syndromes in mood assessment using POMS questionnaire. Higher values were noted in the following subscales: tension/anxiety, depression and fatigue while lower values were obtained in vigor/ activity subscale. Lower yet statistically insignificant values corresponding to physical anaerobic and anaerobic activity were observed in this group. The amount of sleep and the number of training sessions had no effect on the results. Conclusions. NFO/OTS syndromes are developed in nearly 25% of athletes involved in various sport disciplines, training within about 73 months and starting in competitions 20 times a year on average. POMS questionnaire turned out a useful tool in diagnosing these syndromes

Ryzyko metaboliczne u mężczyzn z chorobą niedokrwienną serca a uczestnictwo w ambulatoryjnej kompleksowej rehabilitacji kardiologicznej

Background: With a growing population of patients with ischaemic heart disease (IHD), the number of interventional cardiology and cardiac surgery procedures is also increasing. This is particularly the case for patients with multivessel coronary disease who are treated with percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG). A considerable part of the IHD population are subjects with metabolic syndrome (MetS) who participate in comprehensive cardiac rehabilitation (CCR) programs as a part of secondary prevention of cardiovascular disease. Aim: To evaluate prospectively conventional risk factors within MetS, including uric acid (UA) level, in men with IHD after PCI or CABG who participated in ambulatory CCR. Methods: The study included 90 adult men (mean age 59.1 ± 7.31 years) with IHD after PCI (n = 63, 70%) or CABG (n = 27, 30%) referred for ambulatory CCR on average 30–60 days after an acute coronary syndrome. All subjects were examined twice 2 months apart — at the referral for CCR and after completion of CCR. MetS was diagnosed based on the measurement of systolic and diastolic blood pressure, waist circumference (WC), and high-density lipoprotein cholesterol, triglyceride (TG), and fasting blood glucose levels. In all subjects, UA level was also measured and the waist-to-hip ratio (WHR) and body mass index (BMI) were calculated. Following clinical evaluation and exercise test, each patient underwent 24 interval training sessions on a cycle ergometer. The patients received drug therapy including beta-blockers, angiotensin-converting enzyme inhibitors, statins, and acetylsalicylic acid. As a part of CCR, the patients also received education regarding healthy lifestyle changes including physical activity, healthy diet, stress coping techniques, effects of nicotine and alcohol, and effective methods to eliminate these habits. Results: In most subjects, WC, BMI and WHR did not change significantly after the period of 2 months of CCR, and WC and BMI increased in the CABG subgroup (p = 0.00003 and p = 0.0178, respectively). Irrespective of the type of cardiac intervention, significant increases in exercise capacity and physical effort tolerance were observed after 2 months of CCR (p &lt; 0.00001). TG level increased in all participants (p = 0.0514) and in the PCI subgroup (p = 0.0489). Systolic blood pressure decreased in all participants (p = 0.0216) and in the PCI subgroup (p = 0.0043). Mean UA level also decreased in all patients regardless of the type of cardiac intervention. Overall, the proportion of patients with the diagnosis of MetS did not change significantly after 2 months of CCR (36% vs. 31%, p &gt; 0.05). However, the rate of MetS decreased in the PCI subgroup (from 46% to 29%, p = 0.043) and increased in the CABG subgroup (from 11% do 37%, p = 0.0562). Conclusions: The effect of participation in CCR on the metabolic risk in men with IHD varies depending on the type of earlier cardiac intervention. The metabolic risk decreased in patients treated with PCI, while it increased in those treated with CABG. In order to reduce the metabolic risk, particularly in CABG patients, a CCR program requires intensification of the patient support including educational activities regarding diet and weight reduction as well as individually prescribed physical activity.Wstęp: Ustawicznie zwiększającej się populacji osób z chorobą niedokrwienną serca (IHD) towarzyszy progresja liczby zabiegów z zakresu kardiologii interwencyjnej i zabiegów kardiochirurgicznych. W szczególności dotyczy to osób z wielonaczyniową postacią choroby wieńcowej po protezowaniu naczyń wieńcowych (PCI) i po wszczepieniu pomostów aortalno-wieńcowych (CABG). Duży odsetek pacjentów z IHD stanowią osoby z zespołem metabolicznym (MetS) biorące udział w programie kompleksowej rehabilitacji kardiologicznej (CCR) obejmującej wielopłaszczyznowe działania interwencyjne wchodzące w skład prewencji wtórnej chorób sercowo-naczyniowych. Cel: Celem badania była prospektywna obserwacja klasycznych wskaźników składających się na MetS poszerzona o stężenie kwasu moczowego (UA), u mężczyzn z IHD po PCI lub po CABG poddawanych ambulatoryjnej CCR. Metody: Badaniem objęto 90 dorosłych mężczyzn (średnia wieku 59,1 ± 7,31 roku) z IHD zakwalifikowanych do programu ambulatoryjnej CCR. W obserwacji uczestniczyło 63 (70%) mężczyzn po PCI i 27 (30%) mężczyzn po CABG, średnio 30–60 dni po ostrym incydencie sercowym. Wszyscy uczestnicy byli badani 2-krotnie w odstępie 2 miesięcy — w czasie kwalifikacji i po ukończeniu programu. MetS zdiagnozowano, oceniając skurczowe (SBP) i rozkurczowe ciśnienie tętnicze, obwód talii (WC) oraz stężenia cholesterolu frakcji HDL, triglicerydów (TG) i glukozy na czczo. U wszystkich uczestników określono również stężenie UA, wyliczono wskaźnik talia-biodra (WHR) i wskaźnik masy ciała (BMI). Po kwalifikacji klinicznej i próbie wysiłkowej u każdego z badanych mężczyzn przeprowadzono 24 treningi interwałowe na ergometrze rowerowym. Chorzy przyjmowali w tym samym czasie środki farmakologiczne, głownie: beta-adrenolityki, inhibitory konwertazy angiotensyny, statyny i kwas acetylosalicylowy. Istotny element programu CCR stanowiła edukacja zdrowotna uczestników dotycząca prozdrowotnej modyfikacji stylu życia, z uwzględnieniem aktywności fizycznej, racjonalnego żywienia, technik radzenia sobie ze stresem, wpływu nikotyny i alkoholu na organizm człowieka oraz metod wykorzystywanych do skutecznej walki z tymi uzależnieniami. Wyniki: Po okresie 2-miesięcznej CCR wartości WC, BMI i WHR nie uległy istotnej redukcji u większości badanych mężczyzn, a w podgrupie poddanej CABG odnotowano zwiększenie WC i BMI (odpowiednio p = 0,00003 i p = 0,0178). Bez względu na rodzaj zastosowanej interwencji kardiologicznej zaobserwowano istotny wzrost wydolności fizycznej i poprawę tolerancji wysiłku fizycznego po 2-miesięcznej CCR (p &lt; 0,00001). Po tym czasie zanotowano wzrost stężenia TG u wszystkich badanych (p = 0,0514) oraz w podgrupie poddanej PCI (p = 0,0489). Analiza wartości SBP dostarczyła informacji o istotnym obniżeniu tego parametru po 2-miesięcznej CCR wśród wszystkich badanych (p = 0,0216). Podobny kierunek zmian w zakresie SBP odnotowano w podgrupie poddanej PCI (p = 0,0043). Bez względu na charakter zastosowanej interwencji kardiologicznej zaobserwowano istotne statystycznie obniżenie średniego stężenia UA u wszystkich badanych mężczyzn. W wyniku stosowania 2-miesięcznej CCR częstość diagnozy MetS w całej badanej grupie nie uległa istotnej statystycznie zmianie (36% vs. 31%; p &gt; 0,05). Natomiast w podgrupie poddanej PCI stwierdzono znamienną redukcję liczby rozpoznań MetS (46% vs. 29%; p = 0,043), a w podgrupie po CABG wzrost liczby rozpoznań MetS (11% vs. 37%, p = 0,0562). Wnioski: Wpływ udziału w CCR na ryzyko metaboliczne u mężczyzn z IHD jest rożny i zależny od wcześniej zastosowanej interwencji kardiologicznej. U mężczyzn po PCI ryzyko metaboliczne obniżyło się, a u mężczyzn po CABG ryzyko to wzrosło. W celu zmniejszenia ryzyka metabolicznego, zwłaszcza wśród mężczyzn po CABG, program CCR wymaga zintensyfikowania wsparcia działaniami edukacyjnymi dotyczącymi sposobu żywienia i redukcji masy ciała oraz regularnej, indywidualnie zalecanej aktywności fizycznej

Long-term effect of different physical activity levels on subclinical atherosclerosis in middle-aged men: a 25-year prospective study.

BACKGROUND: The purpose of the study was to investigate the influence of lifetime physical activity (PA) on selected indices of atherosclerosis in longitudinal observation of middle-aged men. METHODS: The subject of the study was a cohort of 101 men (mean age 59,7 ± 9,0 years), free of cardiovascular symptoms and treatment, participating in follow-up examinations in the years 1985/90-2011/12. Self-report PA was assessed by interviewer-administered Seven-Day PA Recall and Historical PA questionnaire. Subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC) according to Agatston's method using multi-slice computed tomography; the carotid intima-media thickness (IMT) using high-resolution B-mode ultrasound; and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). The participants were initially divided into three groups according to tertiles of exercise-related energy expenditure (EE) in kcal/week at baseline, i.e. <2050 (low-to-moderate; n = 33), 2050-3840 (high; n = 34), >3840 (very high; n = 34). RESULTS: The low-to-moderate, high and very high PA groups were comparable in terms of age and atherosclerosis risk factors at baseline. No linear relationship was found between PA and CAC, IMT and RHI. Men who maintained low-to-moderate (n = 26), high (n = 21) and very high (n = 15) PA level had the mean CAC of 286.1 ± 361.9, 10.7 ± 28.9, and 106.1 ± 278.3 (p<0.001 for low-to moderate vs high; p<0.05 for low-to-moderate vs very high); the mean IMT of 0.751 ± 0.19 mm, 0,641 ± 0.26 mm, and 0.750 ± 0.60 mm (p>0.05); and the mean RHI of 1.69 ± 0.4, 2.00 ± 0.4, and 2.13 ± 0.5 (p for trend = 0.050), respectively. No cases of CAC>400, IMT ≥ 0.9 and RHI<1.67 were noted only among men with maintained high PA level. At final examination men with high and very high PA had more favorable cardiometabolic profile than men with lower PA. CONCLUSIONS: Maintaining regular high PA level through young and middle adulthood may protect against atherosclerosis as measured by CAC, IMT and RHI

Long term regular physical activity as a factor modifying the incidence of subclinical atherosclerosis in occupationally active men

Background: Optimal dose of physical activity in the prevention of atherosclerosis remains unclear. The purpose of the study was to investigate the influence of leisure-time physical activity (LTPA) on selected indices of atherosclerosis in the working-age population of men. Materials and Methods: The study was carried out in a cohort of asymptomatic men participating in follow-up examinations in the Healthy Men Clinic, Medical University of Lodz. Of the 132 men who responded to the invitation to participate in this study, 101 men were eligible for the non-invasive assessment of subclinical atherosclerosis indices. Self-reported PA was assessed by interviewer-administered validated questionnaires. During the latest follow-up subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC), the carotid intima-media thickness (IMT) and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). Results: Preliminary results have been elaborated in the group of 60 men (mean age: 61.3±8.85 years). The participants were predominantly white collar workers with low occupational LTPA. The cohort was divided into 3 groups according to the LTPA level. Both dose and energy expenditure of recreational PA significantly correlated with CA, IMT and RHI in the whole cohort. The majority of men maintained their baseline PA throughout the observation period. Men with the highest LTPA level had significantly lower mean CAC, IMT (p < 0.01), and significantly higher mean RHI (p < 0.05) compared to the least active group. On final examination men with high PA had also the most favorable cardiovascular profile. Conclusions: The preliminary results indicate the protective effect of high LTPA level in the context of subclinical atherosclerosis in men. Med Pr 2013;64(6):785–79

Epidemiology of physical activity in adult Polish population in the second decade of the 21st century. Results of the NATPOL 2011 study

Objectives: The aim of the study was to assess physical activity (PA) level in a representative sample of Polish adults.Materials and Methods: A cross-sectional analysis was performed among 2413 randomly selected individuals (51.5% women) aged 18-79 years, who participated in the Nationwide Study of Occurrence of Risk Factors of Cardiovascular Diseases NATPOL 2011 (March-July 2011). The study procedures consisted of a questionnaire as well as of anthropometric, blood pressure and biochemical measurements. Leisure-time, occupational and commuting PA were assessed by the use of a questionnaire interview. Results: About 48.2% of adults do exercise for at least 30 minutes on most days of a week. About 11% of the respondents declare a sedentary lifestyle. About 26.5% of working population report hard physical work, while sedentary work is reported by 47.6% of the employed participants. Active commuting is declared by 27.3% of working/studying population. About 47.2%, 36.6%, and 15.3% spend 30 min per day, respectively, on this kind of PA. Conclusions: PA level of more than half of Polish adults is still not satisfactory. Promotion of an active lifestyle should concern mainly leisure-time and commuting PA with paying special attention to substantial differences in various socio-demographic groups