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Newsletter Medicina Sportiva

 Professor Paula Drosescu MD PhD
Societatea Romana de Medicina Sportiva

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  The realities of modern training, which involves high volumes and intensities for the duration of the athletic effort, have shown that the natural, spontaneous recovery of the organism after an effort is exceeded, exposing the athlete’s body to certain risks that can go as far as the installation of chronic tiredness with polymorph manifestations, which can be very difficult to treat.
  Having this reality as a starting point, we have conceived a method of analyzing the signs of chronic tiredness while still latent. The bottom line of the idea lies in the use of a “diary of self-control”, where we have introduced supplementary data, which we have analyzed in correlation with laboratory samples (immunological testing).
  In the assessment score of recovery after effort, we have included and marked the elements that we can interpret, in case of their modification, as medical signs of the chronic tiredness or over-training syndromes. We present the elements this score is based on in table 1:

Table 1: The assessment score of recovery after effort
The symptoms in viewThe score given
WeightIdeal weight1
Fluctuations of more than 1,5 kg-1
Dynamic vegetative reaction
The vegetative test2
The Dorgo index1
Sleep8-9 hours1
Quality of sleep1
Desire for training1
Means of recoveryBalneotherapeutical1
Alkaline nutrition, liquid intake1

The elements introduced in the calculation of the score have the following justifications:

• The weight of the athletes, as well as that of sedentary people, should not fluctuate more that 0,4 kg in the evening as compared to the one in the morning. The modifications (the deficit or the extra weight) indicate unevenness of anabolism / catabolism, which can be an early symptom of latent illness, or the expression of an imbalance between ingestion of nutriments / loss of energy (in the case of fasting or in hyperthyroidism). For athletes, the problem of ideal weight is permanent, in relation to having and maintaining an optimal body ratio.

• The fluctuation of more than 1,5 kg in weight is considered in sports medicine to be patognomonic for chronic nervous tiredness, being met in the cases of psycho-emotional stress and / or overdosed training.

• The dynamic vegetative reaction is one of the most sensitive tests for latent tiredness, the discharges of catecholamine leading to peripheral vessel constriction with tachycardia in repose state.

• The Dorgo test uses the pulse to highlight the cardiac activities during effort. The modifications of the Dorgo index, in relation to its normal values, have the following explanations: the pulse during the first minute after the warm-up exercise shows if this part of the training was under- or overdosed. P3 (pulse in the third minute) reflects how the body perceives the maximum intensity moments of the training. The pulse at 5 minutes after stopping all physical effort shows the immediate capacity of the cardio-vascular system to go back to its base values.

• Sleep is the main recovery factor after physical/ mental effort. The decrease of the number of hours of sleep in a 24 hour-period is not very common in sports medicine and shows the implication of a psycho-affective component. We can interpret the increase of the number of hours of sleep as a daily overload / overwork situation with an excessive consumption of energy; it can also be described in latent cases of glandular diseases (hypothyroid disease). The quality of sleep ensures the recovery of the body’s structures in its anabolic stage.

• Appetite is an indicator of the metabolism (it is not taken into consideration in diseases such as intestinal parasites, duodenal ulcers, diabetes). With humans, the mechanism of alimentary self-protection doesn’t always work, the caloric share being mostly based on the principle of accepting/rejecting, like/dislike, which may cause deficits in the alimentary principles, especially regarding mineral salts and vitamins. As a reflex reaction to these, hunger can occur in cases of lack of elements / excess through over-saturation (i.e. with lipids).

• The desire for training reflects the capacity of muscles of rebuilding the energy stocks and of loading / saturating with minerals, and also the ratio of removal of the local acid radicals through the circulatory system after training. Local muscular tiredness, slumber, digestive disorders are only some of the factors that can change the athlete’s ability to train.
 The means of recovery can ensure a starting point for later training sessions. They are included in a complex set of measures, which, alone, but with more efficiency in association with each other, can improve the rhythm of reconstruction of the biochemical, enzymatic and hormonal parameters consumed by the physical effort. 

• The problem of hydration after physical effort is widely discussed in the practice of sport medicine. Given the aspects discussed in great detail in specialty manuals (Dragan I. 1982, 1989, 1994) we can only dare to sustain, with our own data, the significance of the hydration before, but more importantly after effort. Greenleaf J.E. (1995) draws attention on the ingestion of at least 250 ml before physical effort and 300-450 ml after effort. The immune depression of natural killer (NK) cells registered by these studies is similar to the one obtained by us and from the physiological point of view, is explicable through the significant increase in the blood’s viscosity due to abundant perspiration, and also through the diminution in the lymphocyte mobilization caused by the blood speed, which itself is also modified by the viscosity.
  The test conceived was applied to a number of 41 subjects: 15 judo sportsmen, 16 athletes and, as control, 10 students from the Faculty of Physical Education and Sports and correlated / linked with the intensity of physical effort during the training of the athletes or the practical activities of the control group.

Picture 1: Recovery score for judo
Picture 1: Recovery score for judo
Picture 2: Recovery score for athletics
Picture 2: Recovery score for athletics

Legend: the abscissa shows the intensity of physical effort; the ordinate shows the score (number of points) obtained by each athlete. R2= 0,7884 for judo, R2= 0,7575 for athletics; p < 0,05.
Picture 3: Recovery score for the control group
Picture 3:
Recovery score for the control group
Legend: the abscissa shows the intensity of physical effort; the ordinate shows the score (number of points) obtained by each athlete.
R2= 0,6319; p< 0,05

  The evolution of the curves representing the recovery score in pictures 1, 2, 3 demonstrates that on a subjective level we can see a reflection of the symptomatic modifications discussed in the recovery score. All three curves have one element in common: as the intensity of the physical effort grows, the marks received for the recovery score decrease. In the analyzed cases, the decrease in the number of points has been registered on account of: the quality of sleep, that of the dynamic vegetative reaction as an expression for tiredness, lack of alkaline nutrients after effort, insufficient liquid intake – not necessarily after effort, but in 24 hours, or the association of all these factors.
  The data obtained for this score have rendered obvious another aspect – which we were in fact anticipating: a diet determined not by rational principles, but mostly by preference (only in 5 of the analyzed cases a precarious financial situation required it). Thus, we have found a lack of iron in alimentation (a preference for fried food), which the laboratory data subsequently confirmed: the average value of hemoglobin was 13,5%, the average of hematocrit was 36,57% (both at the inferior physiological threshold accepted for athletes). Apart from the proven significance in the creation of hemoglobin and implicitly in the transport of blood gases, it seems that ionic iron plays an important part in the modulation of the cytotoxic function of natural killer cells, having the capacity to stimulate the cytotoxic natural killer activity (Gray A.B. 1993).
  The data obtained in the questionnaire also showed that the alimentary ratio was ensured at least in what concerned proteins. However, those of vegetal origin predominated, which makes us wonder about the quality of the structures of the body, and indirectly about that of immunological structures as well. Pederson B.K. (1994) and Phillips S.M. (1996) draw attention onto this very aspect, indicating protein supplement not as alimentary substitutes, but in order to ensure the quality of amino acids that the body will use.
   We can conclude that the approach of the state of health and of recovery can be achieved through this recovery score as an indirect, latent reflection of the nonspecific defense capacity. We consider this is a simple, easily applicable method, but extremely useful in conducting the athletic training.  

1.Dr\gan I [i col., Medicina Sportiv\ aplicat\, Ed. Editis, Bucure[ti, 1994
2.Drosescu Paula: Structuri morfologice ale aparatului cardiovascular implicate `n antrenamentul sportiv- tez\ de doctorat, 2000
3.Gray AB; Telford RD; Weidemann MJ: The effect of intense interval exercise on iron status parameters in trained men. Med Sci Sports Exerc, 25: 7, 1993 Jul, 778-82;
4.Greenleaf JE; Jackson CG; Lawless D CD4+/CD8+ T-lymphocyte ratio: effects of rehydration before exercise in dehydrated men. Med Sci Sports Exerc, 27: 2, 1995 Feb, 194-9;
5.Pedersen BK; Kappel M; Klokker M; Nielsen HB; Secher NH The immune system during exposure to extreme physiologic conditions. J Sports Med, 15 Suppl 3:1994 Oct, S116-21
6.Peters C; Lötzerich H; Niemeir B; Schüle K; Uhlenbruck G Exercise, cancer and the immune response of monocytes. Anticancer Res, 15: 1, 1995 Jan-Feb, 175-9.
7.Phillips, S. M., H. J. Green, M. A. Tarnapolsky, G. J. F. Heigenhauser, R. E. Hill, and S. M. Grant. Effects of training duration on substrate turnover and oxidation during exercise. J. Appl. Physiol. 81: 2182-2191, 1996.

Professor Paula Drosescu, MD. PhD
Faculty of Physical Education and Sports
“Al. I. Cuza” University Iasi
December 10, 2009
Medical Cabinet Alternative Iasi
Associate Certified Coach ICF

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