Sports and Exercise Medicine
for the Pharmacist
Eric J. Jarvi, Ph.D.
Associate Dean and Professor
Husson University School of Pharmacy
Physiological Effects of Exercise on
Cardiac Output
 Increased sympathetic stimulation
 Contraction of muscles around vessels
 Dilation of resistant vessels in muscles
Sports Exercise and Medicine for the Pharmacist (Fall 2012 MPA)
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Physiological Effects of Exercise on
Muscle Blood Flow
 Flow at rest versus during exercise
 Mechanisms for increased blood flow
Sports Exercise and Medicine for the Pharmacist (Fall 2012 MPA)
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Physiological Effects of Exercise on
Oxygen Demand
 Oxygen uptake by pulmonary blood
 Regulation of respiration
Sports Exercise and Medicine for the Pharmacist (Fall 2012 MPA)
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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):
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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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Physiological Effects of Exercise on
Hydration
 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
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Sports Nutrition
(ADA Position Paper “Nutrition and Athletic
Performance”)
 Carbohydrate recommendations
 Protein recommendations
 Fat recommendations
 Dehydration
 Goals (pre-exercise, during exercise,
post-exercise)
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Sports Injuries
 By location
• Lower extremities at greatest risk
• Upper extremities – greatest risk not age but specific
skill demands
• Central body
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Sports Injuries
 By injury type
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Overuse
Strains (1st degree, 2nd degree, 3rd degree)
Contusion/hematoma
Sprains
Fractures
Dislocations
Fractures
Concussions (grade 1, grade 2, grade 3)
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“HS Sports-Related Injury
Surveillance Study” 2009-2010
RX561.05 - Soft Tissue Injuries
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“HS Sports-Related Injury
Surveillance Study” 2009-2010
RX561.05 - Soft Tissue Injuries
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“HS Sports-Related Injury
Surveillance Study” 2009-2010
RX561.05 - Soft Tissue Injuries
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http://www.iaaf.org/mm/document/imported/42032.pdf
RX561.05 - Soft Tissue Injuries
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Stages of Sports Injury Rehabilitation
 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
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Non-drug Treatment of Injuries
 Rest, Ice, Compression, Elevation
 Movement , Ice, Compression, Elevation
 Heat therapy
 Strapping/bracing
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Drug Treatment of Injuries
 NSAID
 Opiate analgesics
 Corticosteroid injections
 Local anesthetics
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Drug Treatment of Soft Tissue
Injuries
 Skeletal-muscle relaxants
 Topical rubifacients
 Capsicum
 Drugs for bruising
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CAMS Treatment of Soft Tissue
Injuries
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Abrasions/cuts
Stress
Blisters
Bruises
Soft tissue injuries
Cramps
Pain
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Exercise Guidelines
 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
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CME Table
Source: 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
100
Cleaning
Heavy
30 minutes
150
Digging in yard
Moderate
30 minutes
190
Mowing lawn
Pushing hand mower
30 minutes
200
Pushing power mower
30 minutes
145
Raking lawn
Moderate
30 minutes
130
Stair climbing
Moderate, upstairs
10 minutes
100
Moderate, downstairs
10 minutes
30
Moderate
30 minutes
100
Washing car by hand
Recreational Activities
Aerobic dance
Moderate
30 minutes
200
Biking
Moderate
30 minutes
250
Golfing
Pulling clubs
30 minutes
145
Jogging
12 minutes/mile
30 minutes
200
Rope jumping
Moderate
15 minutes
200
Skiing
Downhill or water
30 minutes
200
Cross-country
30 minutes
315
Swimming
Moderate
30 minutes
230
Tennis
Doubles
30 minutes
160
Singles
30 minutes
200
2130 minutes
125
Walking
Moderate
Sports Exercise
and Medicine for the Pharmacist
(Fall 2012 MPA)
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 fatigue
Improved glycemic control and clearance
of post-prandial lipids
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Doping
 History goes back to ancient Egypt
 First laws governing doping in 1963
 Prohibited substances
Stimulants
b2 agonists
Narcotic analgesics
Anti-estrogenic agents
Cannabinoids
Masking agents
Anabolic agents
Glucocorticosteroids
Peptide hormones/analogs
 Prohibited methods
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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)
 Caffeine is on the watch list of doping of International
Olympic Committee (IOC)
 Maximum permissible urinary concentration by World AntiDoping 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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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)
 Caffeine is on the watch list of doping of International
Olympic Committee (IOC)
 Maximum permissible urinary concentration by World AntiDoping 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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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)
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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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
 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
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Special Case #1 – Adolescent Athlete
 Injury types and patterns differ from adult because of
skill level, conditioning and musculoskeletal
differences
 Common causes of injury
 Chronic injuries
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Special Case #2 – Female Athlete
(Female Athlete Triad)
 First described at the 1993 meeting of the American
College of Sports Medicine (ACSM)
 Components: eating disordered, menstrual disorder,
and osteoporosis
 Pathophysiology:
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Reduced energy availability
Menstrual dysfunction
Impaired bone health
Endothelial dysfunction
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Special Case #3 – Older Athlete
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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
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References
 “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
Sports Exercise and Medicine for the Pharmacist (Fall 2012 MPA)
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