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

Aging

The paper deals with changes of human organism during physiological aging. Initially changes occur in internal organ function, followed by morphological changes of particular organs. The body start showing signs of growing old at the beginning of the fourth decade. Some organs age faster as the kidneys, while others age slower such is the liver. Among the general changes which occur along with aging, body mass increases as a result of fatt tissue increase, but decreases in highly advancing age. Changes of body water also occur and is reduced by about 10–15 % in comparison to middle-aged persons. The human body contains more extracellular than intracellular water and that is why is greater plasma volume with advancing age. The quantity of the connective tissue in heart muscle increases, particularly in the endocardium and the epicardium, while the pigment lipofuscin is deposited in the myocardium. From the beginning of the fourth decade, cardiac output decreases by about 1% yearly, stroke volume decreases for about 0.7%, and peripheral vascular resistence increases for about 1.2% yearly. In the respiratory system, from the fourth decade the number of cilia diminish, alveolar macrophages are less efficient, lung elasticity decreases, sternocostal joints became inelastic, chest expansion is diminished, the speed of expiratory air can be reduced. In the kidneys changes in blood vessels leading to the alteration of nephron function. The number of capillaries dwindles, influencing both glomerular and peritubular parts, the total weight of the kidneys can be reduced, the connective tissue increases as the basalmembrane become thicker. Glomerular capillaries degenerate and are bridging by arterioles. Other internal organs change with advancing age also

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

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

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)