Sudden death due to recreational exercise in physicians

In a period from 1982-2002 we noticed five dead among Croatian male physicians aged 34 to 67, during or after recreational physical exercise: swimming, soccer, tennis and jogging. Three of them who were autopsied, have been non-smokers and without previous symptoms. In all coronary heart disease was found. The left descending anterior artery was stenotic in one and occluded in two, with myocardial scars in one. An acute myocardial infarction was found in none of them, and in two-left ventricular hypertrophy 15 and 18 mm. We could not find a recent medical record in those physicians including a clinical finding and other findings. Two physicians who were not been autopsied, had possible an alcohol cardiomyopathy. Both of them were smokers. In Croatia about 7% of the whole population are engaged in recreational physical exercise. In a period of twenty years (1982-2002) we noticed 43 sudden and unexpected deaths during or immediately after physical exercise: it reached 43/6,300,000 sudden death in Croatia in twenty years or 2.15/315,000 yearly among persons engaged in physical exercise. In Croatia there are 4,957 male physicians-specialists, and a rate of sudden cardiac death during or immediately after physical exercise in this group reached 5/99,140 in 20 years or 1/19,828 every four years. A medical check up before recreational physical exercise is essential including a clinical examination, a serum concentration of risk factors and other risk factors, an electrocardiogram at rest, a stress test and echocardiography in clinical indication, as are medical controls over persons taking exercise. This study shows that medical evaluation is important because of the underlying problems such as sudden death during exercise. In non-trained persons and in the elderly a physical exercise should be recommended of a gradually intensity, which could not exceed 6 METs.     

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).     

Physical activity and sudden cardiac death in elders--a Croatian study

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).     

Unexpected sudden death due to recreational swimming and diving in men in Croatia in a 14-year period

The article deals with 17 sudden deaths which occurred during recreational swimming and diving in men in Croatia in a 14-year period: from January 1, 1998 to December 31, 2011. The sample is taken out from the total number of 61 sudden deaths in men during or immediately after sport or recreational exercise. Included are also sudden deaths of 8 foreigners spending holidays at the Croatian Adriatic Coast. In all of them forensic medicine autopsy was done. Thirteen males from Croatia died during recreational swimming. Three of them were aged 15-29 yrs: one had signs of hypertrophic cardiomyopathy, the second suffered from chronic myopericarditis with left ventricular aneurysm, and the third had cardiomegaly and blood alcohol level of 1.7 per thousand. Five were aged 30-64 yrs: four of them have suffered from coronary atherosclerosis and left ventricular hypertrophy of 15-18-18-22 mm, and one with left ventricular hypertrophy drowned suddenly, probably because of malignant ventricular arrhythmia. The fifth suffered stroke and drowned. Five elderly men, aged 65-85 yrs, have suffered from coronary atherosclerosis, myocardial fibrosis or myocardial scars, and three of them had left ventricular hypertrophy of 19 mm. Four males died during recreational diving. One aged 26yrs drowned, at autopsy he had left ventricular hypertrophy of 17 mm. Three males were middle-aged: two had coronary atherosclerosis, two of them had a severe degree of coronary atherosclerosis and one had coronary atherosclerosis of medium degree but with myocardial fibrosis and left ventricular hypertrophy of 18 mm. Seven male foreigners died, five of them during swimming: two aged 30-64 and two aged 65-85. They all have had coronary atherosclerosis: one of them had an acute myocardial infarction of the posterior wall, and one hypertrophic cardiomyopathy as well. One middle-aged and one elderly man died during diving, and both had an acute myocardial infarction of the posterior wall. One elderly foreign woman died during swimming, she had coronary atherosclerosis and a myocardial scar. In Croatia, death rate during both swimming and diving in men aged 15-29 years amounted to 0.63/1,000.000 (p=1.0000); in those aged 30-64 it reached 0.56/1,000.000 (p=0.3698), and in those aged 65-85 it was 1.41/1,000.000 (p=0.1849). The death rate during swimming in men aged 15-29 amounted to 1.47/1,000.000 (p=0.9864), in men aged 30-64 it reached 0.35/1,000.000 (p=0.2245), and in those aged 65-85 it was 1.41/1,000.000 (the difference is significant, p=0.0472). The death rate during diving in men aged 15-29 was 0.16/1,000.000, and in men aged 30-64 the observed rate was 0.21/1,000.000 (p=1.0000).     

Sudden death due to physical exercise in the elderly

Physical exercise has a beneficial effect to the humans. Sudden death in healthy persons engaged in physical exercise is extremely rare since healthy heart is protected from complications. The records of five elderly men who died during or immediately after exercise in the period between 1988-2001 in our region have been given, out of 23 men (and no one woman) aged 14-68 who died due to physical exercise in that time. They have been engaged in tennis, jogging and swimming recreatively. In all of them coronary heart disease has been found by the forensic autopsy. Only one has had arterial hypertension, symptoms of chest pain few years before accident and acute myocardial infarction has been found. The other four have been without symptoms. In three of them myocardial scars have been found of past myocardial infarctions. In all of them the thickness of the left ventricle wall was 15 mm or more (from 15 to 25 mm). It seems that the thickness of the wall of the left ventricle increases cardiovascular risk in persons without symptoms. In Croatia about 7% of the whole population are engaged in recreation. In this population 13% are elderly: 40,950. The reported five deaths due to recreational physical exercise in the elderly reached 1/114,660 persons every three years, or 1/573,300 persons during fourteen years.     

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.     

Accuracy in a volleyball service test in rested and physical exertion conditions in elite and near-elite adolescent players

Volleyball coaches use skill tests to assess the skill level of their players and to predict the players' future success. In a typical volleyball skill test, the players are asked to perform the skill after a rest period. The purpose of this study was to assess a volleyball service test performed not only under a rested condition but also immediately following physical exertion. Twenty-six male adolescent volleyball players (15 elite players of a coherent team [team A; mean age = 16.4 years] and 11 near-elite players of a high school team [team B; mean age = 16.3 years]) performed a service test in a rested condition and following physical exertion. The physical exertion consisted of a block at the net followed by a dig at the 3-m line, both performed twice, and again a block at the net. The players performed 10 consecutive serves under the rested condition and 5 sets of 2 consecutive serves under the physical exertion condition. The points for each serve were allotted according to predesignated target areas. The data analyses indicated no differences between the teams in service performances. No differences between the players' service scores in rested and physical exertion conditions were found. A high correlation (r = 0.97) was obtained between the total score of the test and the number of successful 7-point serves. A moderate correlation (r = 0.69) was found for the 7-point serves score following exercise. It was concluded that the number of serves hit successfully at the 7-point areas can be used by coaches as the total score of the test. In addition, the number of successful 7-point serves performed after physical exertion can provide coaches with relevant information on their players' serving skill level.     

Ratings of perceived exertion and muscle activity during the bench press exercise in recreational and novice lifters

This study examined ratings of perceived exertion (RPE) and electromyography (EMG) during resistance exercise in recreational and novice lifters. Fourteen novice (age = 21.5 +/- 1.5 years) and 14 recreationally trained (age = 21.9 +/- 2.2 years) women volunteered to perform the bench press exercise at 60 and 80% of their 1 repetition maximum (1RM). RPE and EMG were measured during both intensities. Statistical analyses revealed that active muscle RPE increased as resistance exercise intensity increased from 60% 1RM to 80% 1RM (12.32 +/- 1.81 vs. 15.14 +/- 1.74). Integrated EMG also increased as resistance exercise intensity increased from 60% 1RM to 80% 1RM (in the pectoralis major; 98.62 +/- 17.54 vs. 127.98 +/- 29.02). No significant differences in RPE or EMG were found between novice and recreational lifters. These results indicate that RPE is related to the relative exercise intensity lifted as well as muscle activity during resistance exercise for both recreational and novice lifters. These results support the use of RPE as a method of resistance exercise intensity estimation for both types of lifters.     

Subacute sclerosing panencephalitis--the continuing threat

Clinical, epidemiological and laboratory findings of four patients with subacute sclerosing panencephalitis (SSPE), diagnosed in Croatia in 2002, were examined. Patient age at disease onset ranged from 5-11 years. All patients were vaccinated regularly with MMR-vaccine. Two patients had a history of measles infection at the age of six and seven months, respectively. In the other two patients, the disease started immediately after the varicella infection. Complement fixing antibody titre to the measles virus (MV) ranged from 1:1024 to 1:65536 in serum, and from 1:16 to 1:128 in cerebrospinal fluid (CSF). In CSF, no antibodies to varicella-zoster virus were found. Brain tissue samples were obtained at autopsy from two patients. In one patient, electron microscopy demonstrated intranuclear viral inclusions (MV nucleocapsids). MV antigen was detected in brain imprints using IFA in both of them. Viral RNA was found in brain tissue samples only, while plasma, serum and CSF were negative. Nucleotide sequence analysis showed that the viruses detected in brain tissue belong to the wild-type MV D6 genotype.     

Myopericarditis and sudden cardiac death due to physical exercise in male athletes

In the period 1998-, we registered four sudden and unexpected cardiac deaths in male athletes due to myopericarditis during or after physical exercise. Three of them were professional soccer players and the fourth was engaged in swimming. One aged 29, had symptoms of tiredness, heart enlargement and left ventricular premature beats during training. Three of them, aged 17-18-18, were without symptoms. Three died during training and the fourth died in the hospital after head trauma at training. In the first one, aged 29, forensic autopsy showed chronic myopericarditis, thickening of the left ventricular wall of 15 mm and enlargement of the whole heart. The second one, aged 17, had subacute diffuse myopericarditis, suppurative tonsillitis and narrowed ascending aorta. The third, aged 18, had chronic myopericarditis and cardiac aneurysm of the left ventricle. The fourth, aged 18, had fibrinous pericarditis, thickening of the left ventricle 20 mm, hypoplastic ascending aorta, bilateral bronchopneumonia and cerebral contusion with edema. In Croatia, death rate among athletes, including all its causes, reached 0.15/100,000, in athletes suffering from myopericarditis it was 0.34/100,000, in others who practice exercise recreatively it amounted to 0.57/100,000 (p=0.0068), and in all males who practice exercise it measured 0.75/100,000 (p=0.0014). Physical exercise has to be contraindicated in cases of myopericarditis for at least six months from the onset of the illness.     

Effect of alcohol on perceived exertion in relation to heart rate and blood lactate

The purpose of the study was to determine whether the perception of exertion is affected by alcohol during physical performance and whether altered self-rating of exertion is the result of an altered perception per se or of an altered physical capacity to perform work. Ten healthy men participated. Each subject was his own control and received an alcohol dose corresponding to 1 g.kg-1 body mass in 40% solution in the experimental session. The exercise test was performed on a cycle ergometer with an initial intensity of 50 W which was increased stepwise by 50 W at 4-min intervals up to near-maximal. The rating of perceived exertion (RPE) did not differ between alcohol and control sessions. Alcohol induced a significant increase in heart rate during exercise at 50 W (delta x = 8 beats.min-1) and at 100 W (delta x = 10 beats.min-1), while the change at higher intensities was insignificant. The systolic blood pressure and the blood lactate concentration were not significantly changed by alcohol. It is concluded that a moderate dose of alcohol does not alter RPE during physical exercise either per se or secondarily to an altered physical capacity to perform work.     

Comparison between Nintendo Wii Fit aerobics and traditional aerobic exercise in sedentary young adults

Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit "Free Run" program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min(-1)) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min(-1)). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit "Free Run" with a self-selected intensity. We concluded that Nintendo Wii Fit "Free Run" may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.     

Longevity of men capable of prolonged vigorous physical exercise: a 32 year follow up of 2259 participants in the Dutch eleven cities ice skating tour.

OBJECTIVE--To compare the long term survival of a group of athletes taking prolonged vigorous physical exercise to that of the general population. DESIGN--Follow up of a cohort of participants in the Dutch eleven cities ice skating tour (a race and recreational tour) over a distance of 200 kilometers. SETTING--Data on participation from the organising committee and data on mortality from all municipalities in The Netherlands. SUBJECTS--2259 Male athletes. MAIN OUTCOME MEASURES--Comparison of all cause mortality in male participants in the tour with that in the general population of The Netherlands. RESULTS--The standardised mortality ratio for all participants during 32 years of follow up was 0.76 (95% confidence interval 0.68 to 0.85), and 0.90 (0.48 to 1.44) for participants in the race, and 0.72 (0.60 to 0.86) for participants in the recreational tour who finished within the time limit. CONCLUSIONS--The capacity for prolonged and vigorous physical exercise, particularly if the exercise is recreational, is a strong indicator of longevity.     

Pacing pattern and physiological responses to a 5-minute maximal exercise bout

The purpose of this study was to describe the pacing strategy of experienced cyclists in a 5-minute maximal exercise bout and to describe selected physiological responses associated with this effort. Six experienced and well-trained competitive cyclists (five males, one female) with a mean (+/-SD) age, height, and mass of 27.0 +/- 4.77 years, 174.7 +/- 8.57 cm, and 71.0 +/- 6.45 kg, performed a 5-minute maximal exercise bout in a laboratory on a racing cycle. Subjects were free to determine their work rate throughout. During exercise, data were collected for work rate, heart rate (HR), [latin capital V with dot above]O2, electromyography of the rectus femoris and vastus lateralis, oxygen saturation, and rating of perceived exertion. All six subjects selected a pacing strategy characterized by a surge in work rate in the first minute followed by a gradual decline until the last minute, when a sprint to the end occurred. Values for HR, respiratory exchange ratio, and blood lactate concentration (182.8 +/- 2.8 bpm, 1.08 +/- 0.07, and 15.5 +/- 2.1 mmol x L-1, respectively) indicated that [latin capital V with dot above]O2 (3.6 +/- 0.4 L x min-1) was close to or at maximum from minutes 2 to 5. Oxygen saturation dropped continuously across time, reaching <94% in the last minute, and rating of perceived exertion was 19.5 +/- 0.8. Electromyographic activity of the rectus femoris and vastus lateralis was not significantly related to work rate during the bout (p > 0.05). It is concluded that work rate or pace is uneven in an all-out, 5-minute exercise bout in experienced cyclists, yet the physiological responses are near maximal in minutes 2-5. Cyclists seem to pace themselves in a common pattern in short-term stochastic exercise bouts. The possible benefits of including some stochastic exercise in the training programs of athletes might be worthy of examination.     

The serum levels of growth factors: PDGF, TGF-beta and VEGF are increased after strenuous physical exercise.

Strenuous physical exercise induces muscle fibers damage and non-specific inflammatory response. Activated by inflammatory process cells may serve as the source of wide spectrum of inflammatory mediators and growth factors. Namely Platelet Derived Growth Factor (PDGF), Transforming Growth Factor-beta (TGF-beta) and Vascular Endothelial Growth Factor (VEGF) could be released. The aim of present study was to assess the impact of physical exercise on growth factors generation in healthy young people. 14 young sportsmen were enrolled into the study. They performed strenuous physical exercise. Blood samples were drawn before, immediately after, and 2 hours after the exercise bout. Serum PDGF, TGF-beta and VEGF concentrations were measured using commercially available ELISA kit based on immunoenzimatic method. Serum level of PDGF increased significantly from 1.7 ng/ml before to 4.64 ng/ml (2.73-fold) immediately after, and to 3.3 ng/ml (1.94-fold) 2 hours after exertion. Serum level of TGF-beta increased significantly from 20.58 ng/ml before to 55.37 ng/ml (2.7-fold) immediately after, and to 40.03 ng/ml (1.95-fold) 2 hours after exertion. Serum level of VEGF increased significantly from 91.83 pg/ml before to 165.61 pg/ml (1.8-fold) immediately after the exercise. Two hours after the exertion serum level of VEGF was 137.22 pg/ml, what is 1.49-fold above the basal level; however not being significantly different. In summery, observed increased level of growth factors could be involved in the process of adaptation of human organism to physical training. In addition, in the context of the role of inflammation in the pathogenesis of various diseases, our results point to the potentially deleterious effect of strenuous physical exercise.     

Low-dose caffeine administered in chewing gum does not enhance cycling to exhaustion

Low-dose caffeine administered in chewing gum does not enhance cycling to exhaustion. The purpose of the current investigation was to examine the effect of low-dose caffeine (CAF) administered in chewing gum at 3 different time points during submaximal cycling exercise to exhaustion. Eight college-aged (26 ± 4 years), physically active (45.5 ± 5.7 ml·kg(-1)·min(-1)) volunteers participated in 4 experimental trials. Two pieces of caffeinated chewing gum (100 mg per piece, total quantity of 200 mg) were administered in a double-blind manner at 1 of 3 time points (-35, -5, and +15 minutes) with placebo at the other 2 points and at all 3 points in the control trial. The participants cycled at 85% of maximal oxygen consumption until volitional fatigue and time to exhaustion (TTE) were recorded in minutes. Venous blood samples were obtained at -40, -10, and immediately postexercise and analyzed for serum-free fatty acid and plasma catecholamine concentrations. Oxygen consumption, respiratory exchange ratio, heart rate, glucose, lactate, ratings of perceived exertion, and perceived leg pain measures were obtained at baseline and every 10 minutes during cycling. The results showed that there were no significant differences between the trials for any of the parameters measured including TTE. These findings suggest that low-dose CAF administered in chewing gum has no effect on TTE during cycling in recreational athletes and is, therefore, not recommended.     

Attitudes to Exercise and Diabetes in Young People with Type 1 Diabetes Mellitus: A Qualitative Analysis

AimsTo investigate young people’s attitudes to, and understanding of, physical activity on glycaemic control in Type 1 Diabetes Mellitus.MethodsFour focus groups with 11–14 and 15–16 year olds were conducted with twelve young people with Type 1 Diabetes, from within a larger study investigating physical activity and fitness. Qualitative analysis of the focus group data was performed using Interpretative Phenomenological Analysis.ResultsFour superordinate themes were identified: Benefits of Exercise, Knowledge and Understanding, Information and Training and “You can do anything”. Young people felt that exercising helped them to manage their diabetes and had a beneficial psychological and physical impact on their bodies. They reported a lack of knowledge and understanding about diabetes among school staff and other young people. The overwhelming sense from young people was that although diabetes impacts upon their lives, with preparation, physical activity can take place as normal.ConclusionsWhilst young people had an awareness of the physical and psychological benefits of exercise in managing their diabetes, they experienced difficulties at school. Professional support and discussions with young people, giving tailored strategies for managing Type 1 Diabetes during exercise are needed. Healthcare teams should ensure that the support and educational needs of school staff are met. Providing more opportunities to empower young people to take on the responsibility for their Type 1 Diabetes care is merited. Young people felt diabetes did not stop them from participating in activities; it is simply a part of them that needs managing throughout life.     

Screening for hearing loss in childhood: a study of national practice.

A questionnaire survey of all health districts in England and Wales was carried out at the end of 1984 to document screening programmes for identifying hearing loss in childhood. The response rate was 81.3%. All districts performed distraction testing, all but nine aiming at doing so at 7-9 months of age. All districts tested children''s hearing at school, generally before 7 years of age. The number of times that children were screened both before school and at school varied considerably, from one to six times before school and one to six times at school. Few districts collected information that would allow them to make judgments about the efficiency of effectiveness of their screening programmes.     

Recreational Physical Activity as an Independent Predictor of Multivariable Cardiovascular Disease Risk

The role of physical activity in preventing CVD has been highlighted by Professor Jerry Morris in the 1950’s. We report outcome of a 15-year prospective study with the aim to identify whether physical activity showed cardiovascular benefit independent of common risk factors and of central obesity. Baseline data of 8662 subjects, with no previous history of heart disease, diabetes or stroke, were obtained from an age- and gender- stratified sample of adults in Australian capital cities and were linked with the National Death Index to determine the causes of death of 610 subjects who had died to 31 December 2004. The study consisted of 4175 males (age 42.3±13.1 years) and 4487 females (age 42.8±13.2 years). Fasting serum lipid levels, systolic and diastolic blood pressure and smoking habits at baseline were recorded. The Framingham Risk Scores of 15-year mortality due to CHD and CVD were calculated using established equations. Subjects were also asked if they engaged in vigorous exercise, less vigorous exercise or walk for recreation and exercise in the past 2 weeks. Subjects in the high recreational physical activity category were 0.16 (0.06–0.43; p<0.001) and 0.12 (0.03–0.48; p = 0.003) times as likely as subjects in the low category for CVD and CHD mortality respectively. After adjusting for both the Framingham Risk Score and central obesity (Waist circumference to Hip circumference Ratio), those in the high recreational physical activity group were 0.35 (0.13–0.98) times less likely compared to the low category for CVD mortality. Recreational physical activity independently predicted reduced cardiovascular mortality over fifteen years. A public health focus on increased physical activity and preventing obesity is required to reduce the risk of CVD and CHD.