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Lifestyle in general and particularly health enhancing physical activity is known to be an important component in the prevention and therapy of type 2 diabetes mellitus.To gain substantial health benefits a minimum of 150 min of moderate or vigorous intense aerobic physical activity and muscle strengthening activities per week are needed. Additionally, inactivity should be recognised as health hazard and prolonged episodes of sitting should be avoided.Exercise in particular is not only useful in improving glycaemia by lowering insulin resistance and positively affect insulin secretion, but to reduce cardiovascular risk. The positive effect of training correlates directly with the amount of fitness gained and lasts only as long as the fitness level is sustained. The effect of exercise is independent of age and gender. It is reversible and reproducible.Supervised exercise classes are well known to be attractive for adults to reach a sufficient level of health enhancing physical activity. The potential of regional, standardised exercise programmes could have been shown, although existing barriers to entry must be reduced. To tackle this public health challenge and based on the large evidence of exercise referral and prescription the Austrian Diabetes Associations aims to implement the position of a "physical activity adviser" in multi-professional diabetes care.

Tissue flossing is a technique used to improve range of motion, performance and regeneration, and to reduce pain, oedema and injury risks.To analyse if tissue flossing is an effective therapeutic modality to improve regeneration after strength endurance exercises and to reduce delayed-onset muscle soreness (DOMS).42 active, healthy female and male subjects were randomly assigned to either the control (n = 21) or the tissue flossing group (n = 21). All subjects followed the same testing protocol. On the leg press, participants performed as many one-legged repetitions as possible with 65 % of their one-repetition maximum (1 RM) at measurement point one (M1). Between M1 and M2, all subjects performed a strength endurance program until they were fully exhausted (three times as many repetitions as possible with 65 % of their 1 RM, one-legged on the leg press). At M2 (immediately after the strength-endurance-to-exhausting program), M3 (30 minutes after the strength-endurance-to-exhausting program) and M4 (60 minutes after the strength-endurance-to-exhausting program), the participants performed as many repetitions as possible with 65 % of their 1 RM on the leg press. Between M2 and M3, the tissue flossing group received three flossing treatments lasting two minutes each as a regeneration tool. Each subject completed the numeric rating scale (NRS) (0 - 10) and the "Likert muscle scale" 12 h, 24 h, 36 h, 48 h, 60 h and 72 h post M4.There were no significant effects over all four measurement points in favour of the tissue flossing group compared with the control group. No effects were found for the "Likert muscle scale". There was merely a significant effect on the NRS after 36 h (p = 0.044) in favour of the tissue flossing group.Tissue flossing neither improves nor delays regeneration after strength endurance intervals. Tissue flossing has no effect on DOMS reduction.Flossing ist eine Behandlungsmethode um die Beweglichkeit, Leistungsfähigkeit und Regeneration zu verbessern sowie um Schmerzen, Ödeme und Verletzungsrisiken zu reduzieren. ZIEL: Welche Auswirkungen hat Flossing auf die Regenerationsfähigkeit nach Kraftausdauer-Belastungen und den wahrgenommenen Muskelkaterschmerz?42 aktive, gesunde weibliche und männliche Probanden wurden randomisiert in eine Kontrollgruppe (n = 21) und Flossinggruppe (n = 21) eingeteilt. Für alle Probanden galt der gleiche Ablauf des Testprozedere: Am Mess-Zeitpunkt 1 (M1) absolvierte jeder Teilnehmer an der Beinpresse einbeinig so viele Wiederholungen wie möglich mit 65 % des Ein-Wiederholungs-Maximums (1 RM). Zwischen M1 und M2 wurde ein Ermüdungsprotokoll (3* so viele Wiederholungen wie möglich mit 65 % des 1 RM einbeinig an der Beinpresse) durchgeführt. Zum Zeitpunkt M2 (sofort nach dem Ermüdungsprogramm), M3 (30 Minuten nach dem Ermüdungsprogramm) und M4 (60 Minuten nach dem Ermüdungsprogramm) wurden erneut die maximalen Wiederholungen mit 65 % des 1 RM erfasst. Zwischen M2 und M3 erhielten die Probanden der Flossinggruppe eine dreimalige Anwendung mit dem Flossingband als Regenerationsmaßnahme für je zwei Minuten. 12 h, 24 h, 36 h, 48 h, 60 h und 72 h nach der letzten Messung wurde jeweils der Muskelkaterschmerz mit der numerischen Ratingskala (NRS) (0 – 10) und „Likert-Muscle-Scale“ erfasst.Über alle vier Mess-Zeitpunkte zeigte sich kein signifikanter Effekt zugunsten der Flossinggruppe im Vergleich zur Kontrollgruppe. Die „Likert-Muscle-Scale“ ergab kein signifikantes Ergebnis. Lediglich nach 36 h zeigten sich niedrigere NRS-Werte in der Flossinggruppe im Vergleich zur Kontrollgruppe (p = 0,044).Flossing beeinflusst die Regenerationsfähigkeit nach Kraftausdauer-Belastungen weder positiv noch negativ. Flossing hat keinen Effekt auf die Schmerzwahrnehmung bei Muskelkater.

The rupture of the pectoralis major tendon is an uncommon pathological condition that is reported in literature to prevail among athletes, although also case reports and case series of nursing home residents or workers can be found, as well as traumatic lesions. Among athletes, pectoralis major tendon ruptures have shown a significant increase in incidence over the last years. This may be due to the higher number of individuals taking part in high-impact sports and weight-lifting. In the recent literature, there are only few recommendations to rely on conservative treatment alone. Especially in athletes, numerous case reports and series give the recommendation for an early surgical intervention. Comparing the results of the two treatment plans, there is some evidence for a superior outcome after surgical repair with better cosmesis, better functional results, better recovery of muscle power and return to sports compared to the conservative treatment. In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes. In all other cases, especially in the elderly, conservative treatment remains an important option.

Despite significant improvements in the surgical therapy of acute aortic dissection (AAD), mortality rates in the initial phase remain unacceptably high. Early diagnosis and therapy are essential to improving prognosis in these patients. A prerequisite of prompt and correct diagnosis is"thinking of it". Delayed or incorrect diagnosis can often have catastrophic results.The reported acute chest and back pain of a tearing, stabbing nature combined with the physiognomy of Marfan syndrome often arouse the clinical suspicion of AAD, prompting immediate imaging of the thoracic aorta and therapy. For less clear cases, additional hints drawn from the patient history and special findings from the medical examination are presented schematically in a diagnostic pathway. As an innovative form of diagnosis, preventive echocardiographic screening in high risk groups is discussed.To heighten awareness of AAD and the importance of its correct diagnosis, the poster campaign "Thinking of it can save lives" has been initiated. The poster depicts AAD schematically, indicates Marfan syndrome as a risk factor for AAD in young people and illustrates a CT scan as the most frequently performed imaging technique with high sensitivity and specificity.

A 49-year-old male athlete sustained a complete rupture of the pectoralis major muscle while bench pressing. The inferior and the superior border of the clavicular lamina and the sternal lamina were fixed with mattress sutures. After that transosseous reinsertion via drill holes (no suture anchors). The lateral rim of both tendons was fixed with Mason-Allen sutures. Final adaption of the distal tendon stump above the reinserted tendon (doubling). Postoperative immobilisation for 3 weeks in Gilchrists sling was followed by active-assistive step-by-step mobilisation. A speedy rehabilitation was planned after 6 weeks, but at this time the patient was doing strength training, swimming, pull-ups and press-ups at his own responsibility. Normal mobility and previous sports activity were achieved in spite of the early and extremely high stress. We assume that the very strong and secure reinsertion technique with 4 mattress sutures, Mason-Allen sutures and doubling of the tendon close to the foot print region may be the reason for the good result in spite of the massive and early loading.

While the compartment syndrome after traumatic injury is a well-known entity and well recognised, an exercise-induced acute compartment syndrome is seldom and often missed. Delayed diagnosis and treatment can result in a poor outcome such as loss of function or limb. Early recognition and prompt fasciotomy are necessary. We would like to present the case of an exertional compartment syndrome of the tibialis anterior space after weight-lifting which was complicated by an acute pressure-induced palsy of the common peroneal nerve due to a self applied knee-support-bandage. A thorough case history provided the clue to understand the resulting pathology. This case shows again the necessity of good medical assistance for athletes in leisure-time sport activities.

Sports-related carotid artery dissection are very rare and were described in different kinds of sports. We report on a 45-year old man who suffered bilateral brain infarctions caused by bilateral extracranial internal carotid artery dissection after excessive weight lifting in a gym. As possible trigger factors for the dissections we assumed the abrupt extension of the neck during weight lifting and the frequent Valsalva manoeuvers with massive rise in the pressure in the carotid artery system. The patient underwent angioplasty and stenting of the stenosis of right carotid artery, the primarily occluded left carotid artery recanalized spontaneously. Secondary prevention was established by platelet aggregation inhibitors. The patient recovered completely. The pathogenesis of sports-related dissections is multifactorial. In addition to sporting activities hereditary or acquired structural aberrations in the arterial walls could be discussed. Acute focal neurological symptoms after sport should always focus on carotid or vertebral artery dissection.

Resistance training induces differenciated adaptions. Depending on the applied method, neural or anabolic adaptions may dominate. Neural adaptions already reveal in the early stage of a training program, since force improvements can be seen even without muscle hypertrophy. During this phase, upcoming adaptions on myofibrilliar protein level are initiated on mRNA level. These adaptations may be described mainly as an increase of myofibrillar proteins and fibre type transformation, respectively. The article describes adaptations against specific methods of resistance training like maximum power, speed strength and strength endurance and shortly discusses the therapeutic use of resistance training.

The patellofemoral joint is stressed strongly during weight training. There are different individual preconditions that influence the stress distribution. Forces on tendons and cartilage are a function of angle and exercise. The most common disorders are tendinopathies and cartilage damage. Patellofemoral malalignment, high loads and overuse, uncontrolled exercises and steroids represent risk factors for injuries. Individual training concepts with controlled exercises that reduce peak loads are desirable. There is a wide scope of therapeutic options ranging from antiphlogistic therapy to the reconstruction of tendons and cartilage.

Power lifting injuries most often involve shoulder injuries with an injury rate of 0.57 to 0.71/1000 hours of power lifting. Wrist injuries are less common in power lifters with 0.05/1000 hours exposure vs. 0.23/1000 h in elite weight lifting men. Often, two contributing factors causing wrist injuries are encountered: a) loss of balance causing the barbell to drift back behind the head of the power lifter, which hyperextends the wrist and b) the maximal weight. We report on an elite power lifting athlete preparing for the World Masters Bench press championships suffering two months of persisting pain during bench press exercise and rest in the snuff-box area following a loss of balance of the bar-bell during bench press with 280 kg load. Following prolonged presentation 2 months after the initial injury with training in the meantime, CT-scan was performed revealing a C-type scaphoid fracture. Surgery was performed as Herbert screw fixation and bone grafting according to the technique of Matti-Russe, followed by an immobilisation of twelve weeks with a plaster. We recommended ending the athletes' power lifting career, however he further exercised with the plaster with consecutive re-operation 3months later and 2nd Matti-Russe and Herbert screw re-do. One year later he became national champion with 240 kg bench pressing. Given the limited scaphoid blood supply and the high complication rate especially among C-type scaphoid fractures, a surgical procedure with bone grafting, Herbert screw fixation and sufficient plaster immobilisation is advocated in scaphoid fractures in elite athletes.

A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups.A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used.Aerobic exercise training is strongly recommended (grade A) and the temporary use of whole body hyperthermia, balneotherapy and spa therapy is recommended (grade B).The significance which can be assigned to most of the studies on the various procedures for therapy is restricted due to short study duration (mean 6-12 weeks) and small sample sizes.

A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

Ruptures of the pectoralis major muscle should be treated operatively due to the expected loss of strength following conservative treatment. Minimal-invasive surgery technique using suture anchors can lead to perfect anatomical refixation of the muscle. We report mid-term clinical results.We present clinical results of a comparative study concerning ruptures of the pectoralis major muscle. Between 2001 and 2006 a total number of 9 patients were treated operatively using suture anchors. The surgical procedure is described. A control group (n = 4) consisted of patients being treated conservatively in 1999 und 2000. For evaluation of results Bak's score was used.The mean follow-up-time was six months. We found 4 very good and 4 good results, only one patient showed a satisfying result. Among the patients who had followed the conservative treatment regime only one had a good outcome while three patients remained in a satisfying condition. All type-1-ruptures according to Roller showed postoperatively nearly equal strength conditions for both sides.The operative treatment of acute ruptures of the pectoralis major muscle in active people and athletes leads to better results concerning restoration of strength than conservative or delayed treatment. The surgical technique depends upon the type of rupture which has to be determined intraoperatively. The use of suture anchors aiming for intraosseous fixation helps to avoid intraoperative complications and leads to stable conditions with nearly full restoration of strength.

Despite intensive information on possible side effects and complications of performance-enhancing substances in sports, the use of AAS (anabolic androgen steroids) is far common. Particularly in sports like bodybuilding or weight lifting AAS are used for setting up muscle mass and increasing muscle power. We present the case of a 27 year old bodybuilder, who was transferred due to suspected malignant expansion of the upper limb to a department of orthopaedic surgery, not knowing that the patient had injected AAS. At biopsy the tumor was found to be an abscess formation, that had to be treated surgically with curettage. The microbiological analysis detected an infection with Pseudomonas fluorescens and Erwinia species. Erwinia species are associated with plants, Pseudomonas fluorescens is found in feces, sewage and soil. It is obvious, that the infection is caused by an inappropriate injection of AAS or by the contamination of the injected substances.

Therapeutic exercise programs have become an obligatory component in the modern treatment of many internal and orthopaedic conditions. In the field of psychiatry, the interaction of physical fitness and mental well-being has been increasingly recognized. In the meanwhile, solid evidence has emerged that regular exercise is associated with therapeutic effects in psychiatric patients suffering from depressive and possibly other psychiatric disorders. The present article reviews the relevant literature and summarizes neurobiological effects of exercise which might play a role in the effectiveness of therapeutic exercise. For instance, there is experimental evidence, that regular exercise induces a downregulation of central 5-HT(2C) receptors which play an important role in the pathogenesis of anxiety and depression. The production of brain-derived neurotrophic factor (BDNF)is stimulated in several brain regions. In conclusion, practical aspects and motivational factors have to be regarded in order to successfully establish exercise programs in the treatment of psychiatric disorders.

Type 2 diabetes does not represent inescapable fate, but is an avoidable disease, when the main prophylactic approach targets the central problem of insulin resistance. This means daily physical exercise, the reduction of the glycemic load in the diet and--provided there are no contraindications--certainly a daily glass of wine.

Because of an increasingly older population structure and the enhanced relevance of body composition, the prevention of problems arising from the musculoskeletal system has become of central importance. Strengthening and muscle-building training have been proven to be useful even for older people. The training is focused on the types of movement and exertion that frequently occur in the "activities of daily living." In addition, a purely hypertrophic training for building muscle mass must be differentiated from a more sensorimotor oriented training with situational employment of the muscles for optimizing motor control and coordination. There are no contraindications for strength training when the program is adapted to the individual. The rate of injury is small, even for people at low performance levels.

Affective disorders and impulsivity are quite common when using anabolic substances, in this case-study one of the rather rare cases of a psychotic disorder following the abuse of androgenic steroids is described. A 30-year old formerly healthy white male was admitted as inpatient to psychiatric hospital showing symptoms of anxiety and paranoid ideation. In the last 1.5 years he had consumed androgenic steroids, directly before the onset of the first psychotic symptoms 8 weeks before admission he had received an i.m.-injection of nandrolone. Under therapy with neuroleptics the patient recovered completely within 2 months.

While aerobic endurance training has been a substantial part of international recommendations for cardiac rehabilitation during the last 30 years, there is still a rather reserved attitude of the medical community to resistance exercise in this field. Careful recommendations for resistance exercise in cardiac patients was only published a few years ago. It has been taken for granted that strength exercise elicits a substantial increase in blood pressure and thus imposes, especially in cardiac patients, a risk of potentially fatal cardiovascular complications. Results of the latest studies show that the existing recommended overcaution is not justified. Strength exercise can indeed result in extreme increases of blood pressure, but this is not the case for all loads of this kind. The actual blood pressure response to strength exercise depends on the isometric component, the exercise intensity (load or resistance used), muscle mass activated, the number of repetitions in the set and/or the duration of the contraction as well as involvement of Valsalva maneuver. Intra arterially performed blood pressure measurements during resistance exercise in patients with heart disease showed that strength training carried out at low intensities (40-60% of MVC) and with high numbers of repetitions (15-20) only evokes a moderate increase of blood pressure comparable with blood pressure measures induced by moderate endurance training. If used properly and performed accurately, individually dosed, medically supervised and controlled through experienced sport therapists, a dynamic resistance exercise is-at least for a certain group of patients-not associated with higher risks than an aerobic endurance training and can in addition to endurance training improve muscle force and endurance, have a positive influence on cardiovascular function, metabolism, cardiovascular risk factors as well as psychosocial well-being and overall quality of life. However, with respect to currently available data, resistance exercise cannot be generally recommended for all groups of patients. The appropriate kind and execution of training is highly dependent on current clinical status, cardiac capacity as well as possible accompanying diseases of the patient. Most of the studies carried out up to date included small samples of middle-aged male patients with almost normal levels of aerobic endurance performance and good left ventricular function. Data is missing for risk groups, older patients and women. Therefore, an integration of dynamic resistance exercises in cardiac rehabilitation can only be recommended without hesitation for CHD patients with high physical capacity (good myocardial function, revascularized). Since patients with myocardial ischemia and/or low left ventricular functioning might develop wall motion disturbances and/or dangerous ventricular arrhythmia when performing resistance exercises, prevalence of the following conditions is recommend: moderate to high LV-function, high physical performance (5-6 metabolic equivalents=1.4 watts/kg body weight) in absence of angina pectoris symptoms or ST-depression, by maintained current medication. In the proposed recommendations, a classification of risks for resistance training in cardiac rehabilitation is being made based on current data and is complemented by specific recommendations for particular groups of patients and detailed guidelines for setup and completion of the therapy program.

Chronic abuse of anabolic steroids is widespread. Hypertrophy of skeletal and heart muscle is a well-known effect of chronic anabolic steroid abuse. Structural alterations of blood vessels are new side effects. We report a case of a 32-year-old bodybuilder after long-term use of anabolic steroids who died of cardiac arrest. Coronary angiography and autopsy findings showed especially a hypertrophic heart, structural changes of coronary arteries, intracoronary thrombosis and myocardial infarction, ventricular thrombosis and systemic embolism

Ziel der Arbeit ist, die Computersimulation als Diagnostikmethode beim Gewichtheben zu etablieren, damit der Trainer im Laufe der Saison verschiedene Technikfehler korrigieren und den Trainingsplan für seine Sportler erstellen kann. -Hypothesen:- Wird die für den Athleten individuelle Computersimulation erfolgreich als eine biomechanische Diagnosemethode für das Gewichtheben angewandt?- Welche Beziehung besteht zwischen der Hantelgeschwindigkeit, Körperschwerpunktgeschwindigkeit, dem Hantelgewicht und der Hantelflugbahn sowie der Muskelenergie?- Ist die Effizienz (Beziehung zwischen Muskelenergie und potentieller Energie der Hantel) entscheidend bei der Beurteilung der Technik des Gewichthebers?- Kann Computersimulation sensitiv für intra-individuelle Technikunter-schiede angewendet werden?Methode1. Videoaufnahme von 6 Probanden mit 5 Kameras für die Technik im Reißen.2. Die Filmaufnahmen wurden mit dem APAS-System bearbeitet.3. Anschließend mit dem Programm Human Builder sowie der Software SDS ein Modell für jeden Sportler mit seiner digitalisierten Datei und seinen anthropometrischen Daten erstellt.4. Die durch SDS erhaltenen biomechanischen Variablen wurden mit dem Programm Statistica 5 bearbeitet.Ergebnisse:1. Computersimulation kann als bestimmende Methode für Gewichtheben beim Reißen verwendet werden.2. Darstellung verschiedener signifikanter Korrelationen zwischen ausgesuchten Parametern.3. Durch Computersimulation konnte die Effizienz für jeden Probanden berechnet werden.4. Computersimulation ist eine Methode, die die individuellen Unterschiede zwischen verschiedenen Versuchen mit verschiedenen Leistungen beurteilen kann.

Zusammenfassung Wir berichten über einen 30-jährigen Bodybuilder, der auf dem Boden regelmäßiger intramuskulärer Selbstinjektionen anabol-androgener Steroide einen glutealen Spritzenabszess ausbildete. Nach Abszessspaltung in Allgemeinanästhesie entwickelte er einen septischen Schock und ein fulminantes “acute respiratory distress syndrome” (ARDS). Anhand der Kasuistik sollen neben Aspekten zur Pathogenese, Differenzialdiag-nose und Therapie insbesondere mögliche immunmodulatorische Mechanismen anaboler Substanzen diskutiert werden, die in diesem Fall den Krankheitsverlauf beeinflusst haben könnten.

A systematic review was performed to evaluate the clinical effects of specific back muscle and non-specific physical fitness training in chronic low back pain.A computer-aided Medline research (19861999) of randomised clinical trials concerning both rehabilitation concepts was conducted. A rating system was used to assess the methodological score of each study. The results were analysed and a final statement for evidence according to three main parameters (back pain, physical capacity, and patients comfort) was postulated.Twelve randomised clinical trials were identified. Nine studies were determined as high-quality trials. For chronic low back pain specific back muscle exercises as well as non-specific fitness training were able to improve the patients' conditions sufficiently. In comparison with passive treatment or no treatment there is strong evidence for pain and physical capacity in both groups, but only a positive influence for patient' comfort in fitness groups. Nevertheless, a confrontation of both concepts in two studies did not reveal any notable differences in all three parameters.Principally, a specific strength training for back rnuscles as well as a non-specific fitness training are comparably effective to rehabilitate chronic low back pain.

The question posed was whether individually adapted, controlled dynamic weight training, in accordance with training principles and methods from sports science, applied for a limited time, can lead to an improvement in the stimulation and release of muscular strength in patients with neuromuscular disorders. The muscles of the pelvic girdle and the lower extremity of 10 patients (5 with dystrophic muscle disease and 5 with neurogenic muscular atrophy) were exercised provisionally for a period of 6 weeks on various weight training machines. The training routine was 3 sessions (TS) per week at an intensity range of 40-60% of the respective best performance for the exercise (One Repetition Maximum; ORM), at 8-12 repetitions/set and 2-4 sets/exercise. Body weight and ORM were determined before, during and after the training period (TP), the different load criteria/TS were documented. It was possible to train the patients in accordance with principles of training known from sports science. Over the entire TP it was possible to increase the load criteria significantly (p0.01). The ORM had increased considerably in all exercises after the TP (p0.01). The changes in strength lay between 11 and 95%. Correlation analyses demonstrated that the percentage changes in strength correlated significantly (p0.01) and positively (r = 0.87) with the training load in terms of quality. No significant changes in development of strength could be ascertained between the two groups of patients (dystrophic versus atrophic). The individually adjusted, controlled dynamic weight training described above, leads to an increase in the stimulation and release of strength and can be conducted according to principles of training science. Applied in clinical rehabilitation, it represents a supplementary form of therapy in the symptomatic treatment of neuromuscular disorders.

As one pathogenetic factor in normal-tension glaucoma an individually elevated sensitivity of lamina cribrosa regarding intraocular pressure fluctuations is postulated. Aim of this study was to evaluate patients with normal-tension glaucoma for the exposure to potential, clinically undetected transient elevations of intraocular tension due to increased intrathoracic and -abdominal pressure.A survey of 64 patients of the "Erlanger Glaucoma registry" with normal-tension glaucoma (NTG) and 64 patients with primary open angle glaucoma (pOAG) as control group were performed with regard to activities respectively diseases causing intrathoracic or -abdominal pressure elevation (1. weight lifting, 2. playing high resistance wind instruments, 3. chronic asthma/cough, 4. obstruction of the urinary system, 5. constipation). Both groups were matched regarding age (median: 61 years), sex (24 male, 40 female), visual field defects (mean defect: NTG 4.4; pOAG 4.7), visual acuity (median 1.0 +/- 0.2) and systemic diseases (diabetes mellitus, hypertension, cardiac disease).Among patients with NTG there were 45% (29/64 patients) with activities respectively diseases causing intrathoracic or intraabdominal pressure elevation in their medical history compared to 11% (7/64) among patients with pOAG. Male patients with normal-tension glaucoma showed with 62% the highest frequency of such activities (among them 4/24 high resistance wind instrument playing, 5/24 urinary system obstructions, 4/24 long time weight lifting). Female patients with normal-tension glaucoma most frequently presented with a history of weight lifting (11/40).Patients with glaucomatous optic nerve atrophy without evident intraocular pressure elevation compared to patients with pOWG more frequently report activities or diseases causing intrathoracic/-abdominal pressure elevation in their medical history. This may suggest an additional pathomechanism in normal-tension glaucoma. Therefore patients may be adviced on these potential risk factors.

The case of long thoracic mononeuropathy associated with sport participation a presented. The diagnosis was confirmed with electromyography. It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Degenerative changes and infections were excluded. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a forable outcome. The 12 month follow-up showed only slight changes in EMG and clinical examination.

How does adjuvant training of strength and endurance influence the muscular, cardial, respiratory, immunological systems, and the quality of life during intrahepatical chemotherapy in a veteran athlete with liver metastasis after resection of a carcinoma of the rectum.A 58-year-old athlete with metastatic carcinoma of the rectum (pT3, N0, M-liver, G2) underwent regional chemotherapy (folinic acid, 5-fluorouracil) via an intrahepatic port system. Six cycles with 5 days each were applied. During the intervals between cycles (14 days), beginning in the 6th postoperative week, a strength and endurance training (duration 13 weeks) was carried out twice weekly with an intensity of 40-60% of the maximum postoperative individual power and endurance (evaluated with weight and treadmill exercise tests and measurement of lactate). Before and after chemotherapy, an echocardiogram, resting and exercise electrocardiogram, lung function, natural killer cells and the gastrointestinal quality of life index (GLQI) was evaluated. After chemotherapy was finished, the effects of training were assumed.Strength increased between 0% and 144%. Endurance improvement was measured on the last comparable submaximal intensity step, expressed by reduction of heart rate and lactate concentration by 10 and 21.5%, respectively, improvement of lung function regarding FEV 1 and FCV by 12.9 and 11.3%, respectively, and VC IN 11.4%. The relative count of natural killer cells increased by 27.2%, and the GLQI improved from 109 points (pathologic) to 129 points (normal).There were positive effects on muscular and cardial mechanisms of adaptation and on illness-related quality of life. Postoperative sports activity during regional chemotherapy is possible.

Excessive body building may be dangerous. To promote athletic performance and to improve physical appearance many of the body builders abuse anabolic-androgenic steroids and other drugs. The abuse of insulin as an anabolic medication in this athletic community was followed by a case of severe hypoglycaemia in a body builder. A 30-year old male presented with cerebral symptoms of hypoglycaemia. Directly before an international competition he tried to stimulate muscle growth by using the hypoglycaemic stimulus to the growth hormone. To achieve this he injected 70 IE of a short-acting insulin subcutaneously, resulting in severe hypoglycaemia. After the initial administration of intravenous glucose by the paramedics, he lost consciousness and showed signs of convulsions. After orotracheal intubation by an emergency physician, despite of ongoing infusion of glucose the blood glucose concentration remained low as measured in the out-of-hospital setting. Finally administration of additional glucose and glucagon in the intensive care unit was able to stabilize the metabolic system. In any case of severe hypoglycaemia, repetitive measurements of blood glucose even in the prehospital setting should be performed to detect the hypoglycaemia especially if athletes are concerned.