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McArdle disease (Glycogen storage disease type V) is a myopathy caused by an inherited deficit of muscle glycogen phosphorylase (PYGM). Since glycogen is an important fuel for muscular activity, people with McArdle's disease experience exercise intolerance. Dynamic or static vigorous exercise may lead to rhabdomyolysis, myoglobinuria and renal failure. Although exercise intolerance appears early in childhood, most people with McArdle's disease are diagnosed in the second or third decade of life. People with McArdle's disease tend to avoid exercise, despite its clear beneficial effects on health. As with many chronic diseases, medically supervised exercise with proper nutrition is possible, important, and beneficial to people with McArdle's disease.

Ergogenic aids (from the Greek, ergon, meaning work) are ingested to enhance energy utilization in athletes. In recent years there has been an increase in youth participating in competitive sports and, as a consequence, a concomitant increase in the usage of performance enhancing substances. Ergogenic aid usage could influence, or its efficiency could be influenced, during this period of rapid growth and sexual maturation, and by the marked hormonal fluctuations. Ephedra alkaloids; pain relief medications, diuretics, anabolic steroids and protein hormones are among the ergogenic aids used by young athletes. While there is no scientific evidence to support the usage of these agents for enhancing performance in children and adolescents, using supra-physiological doses may be associated with undesired side effects.

In recent years there have been changes in the patterns of pediatric physical activity. Most children are now less physically active, and this fact leads to the emergence of childhood obesity and its complications. On the other hand, there is an increase in the number of children and adolescents participating in organized competitive sports. These changes have led to an increased number of children and adolescents seeking emergency evaluation and treatment due to sports-related injuries. Approximately one third of overall injuries in childhood and adolescence are sports-related injuries. Head, neck and chest injuries are among the most important sports-related injuries. In addition, sports participation could lead to severe injury and, rarely, even death in children with underlying heart diseases. Other conditions that may endanger children engaged in sports are related to heat illness or allergic reactions. This article reviews these sports-related emergencies, their diagnosis, treatment and ways of prevention.

Since levels of physical activity markedly affect body composition, sedentary lifestyles in children are a major cause of the current epidemic of childhood obesity and its accompanying co-morbidities. School-based physical education is considered an important means for increasing physical activity in children and is believed to contribute a substantial proportion of the physical activity recommended for health purposes.To evaluate, using direct observation, the level of physical activity during physical education classes in middle-school age children in Israel.Twenty non-obese healthy children (10 male, 10 female) participated in the study and their level of physical activity during physical education class was assessed using the System for Observing Fitness Instruction time (SOFIT) method for direct observation.During the 45-minute physical education class 5.3+/-0.94 minutes were found not to include any activity. Students had 18.4+/- 1.2 minutes of moderate to vigorous physical activity (MVPA, walking plus running, 39%). Male students had significantly more MVPA minutes than female students (22.03+/- 1.64 vs. 14.76 +/-1.04 minutes respectively, p0.002). The average time spent in vigorous activity (more intense than jogging) was 6.2+/-0.8 minutes. Females had significantly less minutes of vigorous activity compared to males (4.54+/-0.51 vs. 7.89+/-1.34 minutes, respectively, p0.03). Six male students (60% of the male students) and none of the female students (0%) were at least moderately active = 50% of the physical education class time.Our results demonstrate that physical education classes in middle schools may not achieve the recommended levels of physical activity. In our struggle to reduce childhood obesity and promote health, improving physical education classes is of essence.

In contrast to the effect of exercise training on the menstrual cycle in female athletes, the effect of physical activity on the male reproductive system is described far less extensively in the scientific literature. The male reproductive system consists of the hypothalamic-pituitary unit and the testes. The testes are responsible for the production of sperm and androgens, mainly testosterone. Androgens are responsible for the development of secondary male characteristics, muscle and bone growth, production of red blood cells, sex drive and other behavioral aspects. The effect of physical activity on the male reproductive axis depends on the intensity and duration of the activity, the fitness level of the individual, and his nutritional status. A single bout of short and intensive aerobic and anaerobic exercise usually increases serum testosterone level. Prolonged moderate to intense exercise (2 hours) leads to an initial increase followed by a decline to or below the baseline levels. Exercise training frequently results in a decrease of serum testosterone, and may rarely be associated with reduced libido, sperm production and fertility. In addition, the reduced testosterone levels may attenuate the exercise-associated muscle hypertrophy, reduce the repair of muscle damage, reduce post exercise muscle rehabilitation and may play an important role in the development of over-training syndrome. Other consequences include decreased bone density and a possible effect on mood and behavior. Surprisingly, even in the medically well-supervised elite athletes, changes in testosterone levels and their effects on performance and health are rarely evaluated.

The inflammatory process in torticollis involves the cervical muscles, nerves, and/or the vertebral synovia causing painful and abnormal head position. Most cases of acute acquired non-traumatic torticollis are of benign etiology, but some patients may suffer from a serious disease requiring thorough investigation and hospitalization.To describe the epidemiology, clinical features and the etiology of acute acquired non-traumatic torticollis in our center.A retrospective chart review of 45 hospitalized children in the Sapir Medical Center over a 10 year period.We studied 45 children; 23 girls and 22 boys. Their mean age was 6 years (range 6 months to 16 years). All patients reported marked neck pain as their main complaint. Local infection was the most frequent etiology, and 33 (73%) patients were hospitalized during the fall-winter season. Twenty six patients underwent x-ray imaging, and of these, ten (38%) had pathology. The main findings were some degree of atlanto-axial subluxation, and widening of the prevertebral space. Treatment included analgesic and antibiotics for suspected bacterial infections. Two patients required surgical drainage. Cervical neck traction was performed on 15 patients. Mean admission time was 4.1 days and was shorter in the pediatric department compared to the ENT and orthopedic departments.Careful clinical and radiological evaluation for the wide spectrum of clinical entities should be done. Local infections of the respiratory tract are the most common etiology. Conservative treatment usually leads to complete resolution in a short time.