Exercise-Associated Hyponatremia and Hydration Status in 161-Km Ultramarathoners.
Exercise-Associated Hyponatremia and Hydration Status in 161-km Ultramarathoners.
Filed under: Rehab Centers
Med Sci Sports Exerc. 2012 Nov 6;
Hoffman MD, Hew-Butler T, Stuempfle KJ
PURPOSE: This work combines and reanalyzes five years of exercise-associated hyponatremia (EAH) research at 161-km ultramarathons in northern California with primary purposes to define the relationship between post-race blood sodium concentration ([Na]) and change in body weight, examine the interactions among EAH incidence, ambient temperature and hydration state, and explore the effect of hydration status on performance. METHODS: Pre-race and post-race body weight and finish time data were obtained on 887 finishers, and post-race [Na] was also obtained on a subset of 669 finishers. RESULTS: EAH incidence was 15.1% overall (range 4.6- 51.0% by year) and had a significant positive relationship with ambient temperature. Of the runners with EAH, 23.8% were classified as overhydrated (weight change ?0), 40.6% were euhydrated (weight change <0 to -3%), and 35.6% were dehydrated (weight change <-3%) at the finish. There was a weak significant relationship (r=0.17, p<0.0001) between post-race [Na] and change in body weight such that a lower [Na] was more common with increased weight loss. Considering all finishers examined, 18.5% were dehydrated and 34.9% were overhydrated at the finish. There was a weak significant relationship (r=0.092, p=0.006) between change in body weight and performance in that faster runners tended to lose more weight. Top finishers varied in body weight change from ~1% gain to ~6% loss. CONCLUSION: EAH incidence can be high in 161-km ultramarathons in northern California. In this environment, EAH is more common with dehydration than overhydration and is more common in hotter ambient temperature conditions. Because weight loss >3% does not appear to have an adverse effect on performance, excessive sodium supplementation and aggressive fluid ingestion beyond the dictates of thirst are ill-advised.
HubMed – rehab
Acceptability and feasibility of pulmonary rehabilitation for COPD: a community qualitative study.
Filed under: Rehab Centers
Prim Care Respir J. 2012 Nov 7;
Moore L, Hogg L, White P
BACKGROUND: Pulmonary rehabilitation (PR) is second in importance to smoking cessation treatment in the management of chronic obstructive pulmonary disease (COPD). Access to the service is limited and less than half of those referred complete the treatment. AIMS: We assessed the obstacles to participation in PR among COPD patients in a community-based PR programme and associated general practices. METHODS: A qualitative interview study was conducted among COPD patients who completed the PR treatment, those who did not complete or declined treatment, and patients never referred. Participants were invited by letter from their own general practitioners or from the PR service. Views on exercise, disease education, social contact, group activity, accessibility, location, role of referrer, and support for participation were assessed. Data were analysed using the framework approach. RESULTS: Twenty-four patients (28%, 13 male, 12 not referred) were interviewed. The acceptability of PR was the major concern. Feasibility of attending was an issue for some. Perceptions of PR and of exercise were highlighted. How a smoker might be seen, the suitability of group activity, and the views of professionals were influential, as were positive and negative recommendations. The location of the centre was important. Participants’ willingness or reluctance to take on something new was a central element of the decision. Many would welcome the role of experienced patients in introducing the treatment. CONCLUSIONS: For patients who refused referral to PR, had not completed a course, or had yet to be referred, the way the service was introduced was an important determinant of willingness to participate.
HubMed – rehab
Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD.
Filed under: Rehab Centers
Prim Care Respir J. 2012 Nov 7;
Price D, Yawn B, Brusselle G, Rossi A
While the pharmacological management of chronic obstructive pulmonary disease (COPD) has evolved from the drugs used to treat asthma, the treatment models are different and the two diseases require clear differential diagnosis in order to determine the correct therapeutic strategy. In contrast to the almost universal requirement for anti-inflammatory treatment of persistent asthma, the efficacy of inhaled corticosteroids (ICS) is less well established in COPD and their role in treatment is limited. There is some evidence of a preventive effect of ICS on exacerbations in patients with COPD, but there is little evidence for an effect on mortality or lung function decline. As a result, treatment guidelines recommend the use of ICS in patients with severe or very severe disease (forced expiratory volume in 1 second <50% predicted) and repeated exacerbations. Patients with frequent exacerbations - a phenotype that is stable over time - are likely to be less common among those with moderate COPD (many of whom are managed in primary care) than in those with more severe disease. The indiscriminate use of ICS in COPD may expose patients to an unnecessary increase in the risk of side-effects such as pneumonia, osteoporosis, diabetes and cataracts, while wasting healthcare spending and potentially diverting attention from other more appropriate forms of management such as pulmonary rehabilitation and maximal bronchodilator use. Physicians should carefully weigh the likely benefits of ICS use against the potential risk of side-effects and costs in individual patients with COPD. HubMed – rehab
Kenneth Rozenberg Introduces New Facilities – Kenneth Rozenberg, CEO of Centers for Specialty Care Group, is pleased to introduce three new care centers to the nursing home consortium. Nursing home therapy is now available at the Mt. Laurel, Hammonton, and Deptford centers in New Jersey.
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