Sports and Exercise Medicine for the Pharmacist

Sports and Exercise Medicine for the

PharmacistEric J. Jarvi, Ph.D.

Associate Dean and ProfessorHusson University School of Pharmacy

Sports Exercise and Medicine for the Pharmacist (Fall 2012 MPA)

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Increased sympathetic stimulation

Contraction of muscles around vessels

Dilation of resistant vessels in muscles

Physiological Effects of Exercise on Cardiac Output


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Flow at rest versus during exercise

Mechanisms for increased blood flow

Physiological Effects of Exercise on Muscle Blood Flow


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Oxygen uptake by pulmonary blood

Regulation of respiration

Physiological Effects of Exercise on Oxygen Demand


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Physiological Effects of Exercise on Metabolic Rate

Muscle 100 x more heat than at rest In well trained athlete body heat can • ↑50 x for a few seconds• ↑ 20 x for few minutes

Metabolic rate ↑ 2000 x Basal metabolic rate (70 kg):• Bed = 1650 calories• Eating = 1850 calories• Sitting = 2000 calories• Exercise = (170-100 calories/hour)


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Physiological Effects of Exercise on Blood Glucose

http://www.elmhurst.edu/~chm/vchembook/604glycogenesis.html


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Exercise ↑ body temperature as results of three factors: metabolic rate, environmental conditions, body temperature

Net water = [liquid/food consumed + metabolism] – [respiratoryloss + GIloss + renalloss + sweatloss]

Hypohydration versus euhydration versus hyperhydration

Physiological Effects of Exercise on Hydration


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Carbohydrate recommendationsProtein recommendationsFat recommendationsDehydrationGoals (pre-exercise, during

exercise, post-exercise)

Sports Nutrition(ADA Position Paper “Nutrition and Athletic

Performance”)


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By location• Lower extremities at greatest risk• Upper extremities – greatest risk not age but

specific skill demands• Central body

Sports Injuries


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By injury type• Overuse• Strains (1st degree, 2nd degree, 3rd degree)• Contusion/hematoma• Sprains• Fractures• Dislocations• Fractures• Concussions (grade 1, grade 2, grade 3)

Sports Injuries

RX561.05 - Soft Tissue Injuries 11

“HS Sports-Related Injury Surveillance Study” 2009-2010






http://www.iaaf.org/mm/document/imported/42032.pdf


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Stage 1 – acute inflammatory process lasting up to 72 hours

Stage 2 – regeneration and repair lasting 48 hours to 6 weeks

Stage 3 – remodeling phase lasting 3 weeks to 12 months

Stages of Sports Injury Rehabilitation


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Rest, Ice, Compression, ElevationMovement , Ice, Compression, Elevation

Heat therapyStrapping/bracing

Non-drug Treatment of Injuries


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NSAIDOpiate analgesicsCorticosteroid injections Local anesthetics

Drug Treatment of Injuries


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Skeletal-muscle relaxantsTopical rubifacientsCapsicumDrugs for bruising

Drug Treatment of Soft Tissue Injuries


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Abrasions/cuts Stress Blisters Bruises Soft tissue injuries Cramps Pain

CAMS Treatment of Soft Tissue Injuries


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Physical activity guidelines (2008)• Avoid inactivity• Some better than none• Any activity provides some benefit

Metabolic equivalent units (MET) Cardiometabolic exercise (CME) - General

health and gradual weight loss = 150 points/day or ~1000 points/week

Exercise Guidelines


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CME TableSource: Excerpted from Tables 4.2 in Simon HB. The No Sweat Exercise Plan.

Lose Weight, Get Healthy, and Live Longer. New York: McGraw-Hill; 2006. Activity Pace Duration CME Points

Daily Activities Carpentry Moderate 30 minutes 100Cleaning Heavy 30 minutes 150Digging in yard Moderate 30 minutes 190Mowing lawn Pushing hand mower 30 minutes 200

Pushing power mower 30 minutes 145Raking lawn Moderate 30 minutes 130Stair climbing Moderate, upstairs 10 minutes 100

Moderate, downstairs 10 minutes 30Washing car by hand Moderate 30 minutes 100

Recreational Activities Aerobic dance Moderate 30 minutes 200Biking Moderate 30 minutes 250Golfing Pulling clubs 30 minutes 145Jogging 12 minutes/mile 30 minutes 200Rope jumping Moderate 15 minutes 200Skiing Downhill or water 30 minutes 200

Cross-country 30 minutes 315Swimming Moderate 30 minutes 230Tennis Doubles 30 minutes 160

Singles 30 minutes 200Walking Moderate 30 minutes 125


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Aerobic Exercise versus Resistance Exercise

AET RET

Improves CV reserve Increased muscle/bone mass/strength

Increased skeletal muscle adaptation

Improved psychological well being

Decrease age-related accumulate of central body fat

Decreased cognitive decline

Trained older individuals sustain maximum exercise load with less CV stress and muscle fatigueImproved glycemic control and clearance of post-prandial lipids


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History goes back to ancient Egypt First laws governing doping in 1963 Prohibited substances

Prohibited methods

Doping

Stimulants b2 agonistsNarcotic analgesics Anti-estrogenic agentsCannabinoids Masking agentsAnabolic agents GlucocorticosteroidsPeptide hormones/analogs


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Caffeine is on the watch list of doping of International Olympic Committee (IOC)

Maximum permissible urinary concentration by World Anti-Doping Agency (WADA) is 12 µg/ml.

31 (17 male and 14 female) healthy university students with sedentary lifestyle (mean weight 63.0±2.9 kg, height 166.80±9.84 and age 24±2.25) reporting caffeine intake of ≤200 mg/week participated in the study

the dosage of caffeine tested was 5 mg/kg BW

Performance Enhancement“Effects of caffeine ingestion on strength and endurance performance of normal

young adults” Sharma Archna, Sandhu S Jaspal, Doping Journal (2012): 7(2)


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Caffeine is on the watch list of doping of International Olympic Committee (IOC)

Maximum permissible urinary concentration by World Anti-Doping Agency (WADA) is 12 µg/ml.

31 (17 male and 14 female) healthy university students with sedentary lifestyle (mean weight 63.0±2.9 kg, height 166.80±9.84 and age 24±2.25) reporting caffeine intake of ≤200 mg/week participated in the study

the dosage of caffeine tested was 5 mg/kg BW




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Distribution of Mean values of Peak Force with 5 mg/kg BW Caffeine

Distribution of Mean values of Average Force with 5 mg/kg BW Caffeine*

Distribution of Mean values of Fatigue index with 5 mg/kg BW Caffeine*

Distribution of Mean values of Time to Exhaustion with 5 mg/kg BW Caffeine

Distribution of Mean values of Urinary Caffeine concentration following 5 mg/kg BW Caffeine ingestion


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Study: n = 40,795 walkers The ant-idiabetic, antihypertensive and LDL

cholesterol-lower medication use may be reduced by walking, function of• Walking distance• Longest walk• Walking intensity

Exercise Effects in Chronic Drug Use“Reduced Diabetic, Hypertensive and Cholesterol Medication Use With Walking” Paul. T.

Williams, Medicine and Science in Sports Exercise (2008): 40(3): 433-443


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Injury types and patterns differ from adult because of skill level, conditioning and musculoskeletal differences

Common causes of injury Chronic injuries

Special Case #1 – Adolescent Athlete


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First described at the 1993 meeting of the American College of Sports Medicine (ACSM)

Components: eating disordered, menstrual disorder, and osteoporosis

Pathophysiology: Reduced energy availability Menstrual dysfunction Impaired bone health Endothelial dysfunction

Special Case #2 – Female Athlete(Female Athlete Triad)


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Injury as barrier to exercise Age associated muscle atrophy and loss of

strength Bone loss Connective tissue changes Intrinsic factors contributing to injury Extrinsic factors contributing to injury

Special Case #3 – Older Athlete


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“Sports and Exercise Medicine for Pharmacists” Steven B. Kayne, Pharmaceutical Press (2006)

Simon HB. The No Sweat Exercise Plan. Lose Weight, Get Healthy, and Live Longer. New York: McGraw-Hill; (2006)

“Effects of caffeine ingestion on strength and endurance performance of normal young adults” Sharma Archna, Sandhu S Jaspal, Doping Journal (2012): 7(2)

“Reduced Diabetic, Hypertensive and Cholesterol Medication Use With Walking” Paul. T. Williams, Medicine and Science in Sports Exercise (2008): 40(3): 433-443

References

Sports and Exercise Medicine for the Pharmacist

Documents

exercise medicine

anaerobic exercise

restduring exercise

oxygen demandsports

metabolic ratesports

cardiac outputsports

pharmacist sports

rate of respiration