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1.  Sudden Cardiac Death in Athletes: Big Trouble, Not So Little Asia 
Asian Journal of Sports Medicine  2011;2(4):275-276.
PMCID: PMC3289219  PMID: 22375249
Sudden Cardiac Death; Physical Examination; Athletes
PMCID: PMC3289206  PMID: 22375229
Sudden Cardiac Death; Athletes; Asia
3.  Sudden Cardiac Death in Young Athletes 
Asian Journal of Sports Medicine  2011;2(2):120-122.
PMCID: PMC3289198  PMID: 22375228
Sudden Cardiac Death; Sudden Cardiac Arrest; Athletes
4.  Vitamin D and Athletic Performance: The Potential Role of Muscle 
Asian Journal of Sports Medicine  2011;2(4):211-219.
Vitamin D deficiency is a worldwide epidemic, with well known impacts on calcium metabolism and bone health, but increasingly recognized associations with chronic health problems such as bowel and colonic cancer, arthritis, diabetes and cardiovascular disease. In recent years in the Sports Medicine literature, there has been an increased focus on the potential impact that inadequate Vitamin D levels may have on athletic performance.
In the early 20th Century, athletes and coaches felt that ultraviolet rays had a positive impact on athletic performance, and while remaining limited, evidence is accumulating to support this view. Muscle structure and function is recognised to play a key role in athletic performance, and both cross-sectional and longitudinal studies allude to a functional role for Vitamin D in muscle. The identification of the Vitamin D receptor in muscle tissue provides a direct pathway for Vitamin D to impact upon Skeletal Muscle structure and function. This review focuses on the current understanding of the action of Vitamin D within skeletal muscle tissue, and the potential impact on performance.
PMCID: PMC3289217  PMID: 22375241
Vitamin D; Sports; Athletic Performance; Exercise; Muscle
5.  Correlations of Handgrip Strength with Selected Hand-Arm-Anthropometric Variables in Indian Inter-university Female Volleyball Players 
Asian Journal of Sports Medicine  2011;2(4):220-226.
The purpose of this study was to estimate the dominant handgrip strength and its correlations with some hand and arm anthropometric variables in 101 randomly selected Indian inter-university female volleyball players aged 18-25 years (mean age 20.52±1.40) from six Indian universities.
Three anthropometric variables, i.e. height, weight, BMI, two hand anthropometric variables, viz. right and left hand width and length, four arm anthropometric variables, i.e. upper arm length, lower arm length, upper extremity length, upper arm circumference and dominant right and non-dominant handgrip strength were measured among Indian inter-university female volleyball players by standard anthropometric techniques.
The findings of the present study indicated that Indian female volleyball players had higher mean values in eleven variables and lesser mean values in two variables than their control counterparts, showing significant differences (P<0.032-0.001) in height (t=2.63), weight (t=8.66), left hand width (t=2.10), left and right hand length (t=9.99 and 10.40 respectively), right upper arm length (t=8.48), right forearm length (t=5.41), dominant (right) and non-dominant (left) handgrip strength (t=9.37 and 6.76 respectively). In female volleyball players, dominant handgrip strength had significantly positive correlations (P=0.01) with all the variables studied.
It may be concluded that dominant handgrip strength had strong positive correlations with all the variables studied in Indian inter-university female volleyball players.
PMCID: PMC3289218  PMID: 22375242
Anthropometry; Grip; Hand Strength; Volleyball; Female
6.  A Pilot Trial on Kinematic Magnetic Resonance Imaging Using a Superconducting, Horizontally Opened, 1.2 T Magnetic Resonance System 
Asian Journal of Sports Medicine  2011;2(4):267-274.
This study was performed to introduce and evaluate the potential of kinematic magnetic resonance imaging (KMRI) using a high-field open-magnet magnetic resonance (MR) system.
We attempted to perform KMRI of healthy volunteers’ lumbar spine and knee in the lateral position and ankle in the supine position utilizing the superconducting, horizontally opened, 1.2 T MR system (OASIS, HITACHI, Tokyo, Japan). For the KMRI of the lumbar spine, the volunteer had to lie on one side while maintaining maximally anteflexed, neutral, and maximally retroflexed positions and remain still for the duration of the acquisition time for each posture. In the same way, KMRI of the knee was performed with the volunteer's knee flexed at 0°, 30°, 60°, 90°, and 120° in the lateral position, and KMRI of the ankle was performed with the volunteer's ankle in maximally dorsiflexed, neutral, and maximally plantarflexed positions while lying in the supine position.
We could acquire higher quality kinematic MR images than those acquired using low-field MR systems. The spinal canal, intervertebral discs and foramina, and facet joints in lumbar spine KMRI; the ligaments, menisci and patellofemoral joint in knee KMRI; and the tibiotalar articulation and peroneal tendon in ankle KMRI were clearly depicted.
The results of our pilot trial indicated that a superconducting horizontally opened, 1.2 T MR system offers high-quality KMRI images and can be utilized for the kinematic diagnosis and evaluation of sports injuries.
PMCID: PMC3289220  PMID: 22375248
Joint Motion; Magnetic Resonance Imaging; Kinematic; Open MRI; KMRI
7.  Functional Performance Testing in Athletes with Functional Ankle Instability 
Asian Journal of Sports Medicine  2011;2(4):249-258.
To determine if functional performance deficits are present in athletes with functional ankle instability (FAI) compared to healthy athletes using various functional performance tests.
Sixty two athletes (mean age-21.7±1.8years; height-168.2±9.1cm; weight-63.8±11.0kg) participated in this case control study. Athletes were divided into two groups: athletes with FAI (FAI group, n=31) and healthy athletes (Non-FAI group, n=31). The FAI group was further divided into two subgroups: FAI with giving way (FAI-GW), FAI with no giving way (FAI-NGW). Functional performance was assessed with the single-limb hopping test, figure-of-8 hop test, side-hop test, single-limb hurdle test, square hop test and single hop test.
Significant differences (P<0.05) were observed for all the functional performance tests (FPTs) except the single hop test between FAI and Non-FAI groups; between FAI-GW, FAI-NGW and Non-FAI groups. Additionally, the involved limb performed significantly worse (P<0.05) than the contra-lateral uninvolved limb of the FAI-GW group for the above-mentioned FPTs.
Significant functional performance deficits were observed in the FAI group in all tests except single hop test with greater deficits observed in the FAI-GW group. Hence, these tests can be used to determine the presence of FAI. However no deficits were identified for the test involving sagittal plane functional activities suggesting that this test can not be used as a criterion to discriminate individuals with FAI. It was further ascertained that functional performance was not affected by limb dominance.
PMCID: PMC3289221  PMID: 22375246
Joint Instability; Ankle; Athletic Performance; Functional Performance
8.  How Effective Is Sun Salutation in Improving Muscle Strength, General Body Endurance and Body Composition? 
Asian Journal of Sports Medicine  2011;2(4):259-266.
The purpose of the present study was to evaluate effects of regular practice of sun salutation on muscle strength, general body endurance and body composition.
Subjects (49 male and 30 female) performed 24 cycles of sun salutation, 6 days a week for 24 weeks. Upper body muscle strength was determined by 1 repetition maximum (1RM) for bench press and shoulder press technique. Back and leg dynamometry was used to assess strength of back and leg muscles. General body endurance was evaluated by push-up and sit-up tests. Body composition was assessed by noting% body fat by using bioelectric impedance analysis. Perceived intensity of exercise by subjects was noted by Borg scale.
Muscle strength by bench press showed significant increase in male (29.49±9.70 to 36.12±9.09 Kg, P<0.001) and female (10.5±4.42 to 13.16±4.44 Kg, P<0.001) subjects. Strength by shoulder press also increased (males; 22.96±9.57 Kg to 26.53±11.05 Kg, P<0.001, females; 6.83±2.78 to 8.83±3.87, P<0.001). Endurance by push-ups & sit-ups showed similar findings in male (19.0±9.58 to 21.98±8.98, P<0.001 and 24.92±10.41 to 29.84±12.64, P<0.001 respectively) and female (14.66±6.80 to 18.56±6.97 and 13.16±7.75 to 19.23±8.25, P<0.001 respectively) subjects. A significant decrease in body fat percent was observed only in female (27.68±5.46 to 25.76±4.72, P<0.001) but not in male subjects. BMI significantly decreased in both the groups (z=4.37, P<001 and t=5.41, P<0.001 respectively).
From our observations we conclude that sun salutation can be an ideal exercise to keep oneself in optimum level of fitness.
PMCID: PMC3289222  PMID: 22375247
Yoga; Sun Salutation; Muscle Strength; Body Fat; Endurance
9.  The Attenuation of Strike Acceleration with the Use of Safety Equipment in Tae Kwon Do 
Asian Journal of Sports Medicine  2011;2(4):235-240.
The objectives of this study include: (1) Determination of the attenuation of strike acceleration that Tae Kwon Do sparring safety pads provide from kicks from Olympic style TKD fighters, (2) The sex and weight differentiation in acceleration achieved within the thorax model with the roundhouse kicks.
This prospective, observational study utilized 15 Olympic style fighters from an “elite” team kicking a water core heavy bag thorax model with roundhouse kicks. The model was fitted with a tri-axial accelerometer (GCDC, model X250-2) to measure g acceleration from strikes to the bag. The bag was kicked in three, 10 kick phases by all subjects: kicks without padding; kicks with hogu on heavy bag, and kicks with hogu and instep guards on feet. The g acceleration readings were recorded in all phases.
Kolmogorov-Smirnov failed for all variables. There were 8 female subjects: median age 14 years, median weight 53.4 kg and 7 male subjects: median age 17 years, median weight 70.45 kg. The ANOVA on ranks of the acceleration from kicks against the bag achieved significance, P=0.001. Spearman rank order correlation between the weights of players and acceleration of strike against the hogu without and with insteps pads was significant, P=0.035/r=0.54 and P=0.018/r=0.59, respectively.
Heavier and male subjects tend to produce more force in strikes. Protective chest guard reduces acceleration to the thorax model, but the utility of instep guards is questionable.
PMCID: PMC3289223  PMID: 22375244
Martial arts; Injury; Safety Equipment; Acceleration; Kick
10.  The Offensive Efficiency of the High-Level Handball Players of the Front and the Rear Lines 
Asian Journal of Sports Medicine  2011;2(4):241-248.
The aim of this study was to investigat the offensive efficiency of the professional handball players forming the front and rear lines.
Our investigation was carried out on four matches (final, semi-finals and classifying match) at the 19th male Handball World Championship “Tunisia 2005”. Finalist teams were Tunisia, France, Croatia, and Spain. Matches were recorded using 5 digital camcorders (SONY, DCL, and TRV 130E). Number of passes and the length of the attacks were determined by software “STUDIO 9”. Speed of the ball at the different shootings was calculated by REGAVI software, version 2.57, 2004. Work was dissociated according to 2 variables namely axes and lines.
Players of lateral axes (A4) and front basis (L1) were shorter and thinner than those of the central axis (A3) and rear basis (L2). No differences were observed between lines and axes in age. The analysis of the total shootings to the goal shows that the players of lines and axes present very close values in each team, excepting the Croatian L2 compared to the Tunisian L2. Players of the rear Croatian basis present also a number of attacks concluded by a non-successfully cadred shooting greater than all other groups. In the Spanish group, a significant difference among number of passes concluded by a non-successfully cadred shooting between lines, and front basis vs central axis was noted. No significant difference was found between lines and axes in the Croatian team. Regarding the velocity of shooting, excepting the Croatian team, no differences were found between lines and axes of the other teams. No differences were also noted in the attack duration between lines and axes in Croatian and Tunisian teams. In the Spanish team, duration of attacks concluded by a cadred shooting was most important when finished by an L2 or an A3 player.
The present results demonstrate that finalist teams were found to be clearly characterized by L2 and A3 players taller and weightier than those of L1 and A4. Organized attack was generally concluded by shooting done by an L2 or an A4 player and the shooting velocity did not significantly determine the offensive efficiency.
PMCID: PMC3289224  PMID: 22375245
Offensive Efficiency; Handball; Lines; Axes
11.  Effect of Eccentric Isotonic Quadriceps Muscle Exercises on Patellofemoral Pain Syndrome: An Exploratory Pilot Study 
Asian Journal of Sports Medicine  2011;2(4):227-234.
There is a decrease in quadriceps muscle strength in subjects with patellofemoral pain syndrome. Various types of strengthening exercises of the quadriceps are done as part of its management, but the effect of isotonic eccentric quadriceps muscle exercises on patellofemoral pain syndrome has not been studied. Hence the aim of this exploratory pilot study was to evaluate the effect of eccentric quadriceps training in patients with patellofemoral pain.
Twenty patients (12 female and 8 male, mean ages, 27.50 +/- 6.6 years) with patellofemoral pain syndrome were treated. The eccentric training of the quadriceps was given using a Baltimore Therapeutic Equipment (BTE) Primus machine. The main outcome measures used were percentage time on target as shown by the BTE primus machine, SF-36 Health questionnaire and patellofemoral pain severity scale. Statistical analysis was performed using SPSS 13.
All the outcome measures showed significant improvements (P<0.05). Percentage time on target improved with a mean difference of 23.6, the SF-36 questionnaire showed an improvement in physical component score, mental component score and bodily pain with a mean difference of 10.9, 2.6 and 29.2 respectively and pain score when taken using patellofemoral severity scale also improved with a mean difference of 3.4.
Isotonic eccentric training of quadriceps muscles was found to be effective in reducing pain and improving the functional status of patients with patellofemoral pain syndrome and can be suggested as part of the treatment.
PMCID: PMC3289225  PMID: 22375243
Quadriceps Muscle; Patellofemoral Pain Syndrome; Isotonic Contraction; Eccentric Exercises; Muscle Strength
12.  Effect of Ramadan Fasting on Body Water Status Markers after a Rugby Sevens Match 
Asian Journal of Sports Medicine  2011;2(3):186-194.
To evaluate the effect of Ramadan fasting on body water status markers of rugby players at basal condition and following a simulation of rugby sevens match.
Twelve recreational rugby sevens players played three matches: one day before Ramadan (before Ramadan), at the end of the first week of Ramadan (Beg-R) and at the end of Ramadan (End-R). Before and immediately after each match, body weight was determined and blood samples were taken for the measurement of body water status markers. Total body water was measured with an impedancemeter only before matches.
At rest, an increase in hematocrit (+4.4%, P=0.03), hemoglobin (+3.4%, P=0.01) and plasma osmolarity (+2.8%, P<0.001) was noticed at End-R compared to before Ramadan. Total body water measured before Ramadan did not differ significantly from that of Ramadan. After the match, values of hematocrit and plasma osmolarity increased significantly at End-R (+1.4%, P=0.02; +3.1%, P<0.001 respectively) compared to before Ramadan. Although, hemoglobin measured after matches occurring during Ramadan did not differ from those of before Ramadan. In response to matches, the change of percentage of body water status markers did not differ during each period of the investigation.
The present results show that Ramadan fasting induces dehydration at basal conditions. Also, rugby sevens match played during Ramadan did not exacerbate the magnitude of responses to matches of blood and body water status markers.
PMCID: PMC3289207  PMID: 22375238
Intermittent Exercise; Dehydration; Total Body Water; Islamic Fasting
13.  Subjective Perception of Sports Performance, Training, Sleep and Dietary Patterns of Malaysian Junior Muslim Athletes during Ramadan Intermittent Fasting 
Asian Journal of Sports Medicine  2011;2(3):167-176.
To examine the subjective perception of daily acute fasting on sports performance, training, sleep and dietary patterns of Muslim athletes during the Ramadan month.
Seven hundred and thirty-four (411 male and 323 female) Malaysian Junior-level Muslim athletes (mean age 16.3 ± 2.6 y) participated in the survey which was designed to establish the personal perception of their sport performance, sleep pattern, food and fluid intake during Ramadan fasting. The survey was conducted during and immediately after the month of Ramadan in 2009.
Twenty-four percent of the athletes perceived that there was an adverse effect of the Ramadan fast on their sporting performance and 29.3% reported that quality of training during Ramadan was also negatively influenced. Majority (48.2%) of the athletes stated that Ramadan fasting did not affect their normal sleep pattern but 66.6% of them complained of sleepiness during the daytime. Half of the athletes (41.4%) maintained the caloric intake during Ramadan as they normally would with the majority of them (76.2%) reporting that they consumed more fluids during Ramadan.
Overall, Malaysian Junior-level Muslim athletes showed diverse views in their perception of changes in their training, sleep and dietary patterns during Ramadan fast. These individual differences probably indicate differences in the athletes’ adaptability and coping strategies during fasting and training in Ramadan.
PMCID: PMC3289208  PMID: 22375236
Subjective Perception; Ramadan Fasting; Sleep Patterns; Dietary Intake; Training
14.  Effect of Acute Maximal Exercise on Circulating Levels of Interleukin-12 during Ramadan Fasting 
Asian Journal of Sports Medicine  2011;2(3):154-160.
The purpose of this study was to examine the effects of Ramadan fasting on circulating levels of interleukin-12 (IL-12) after a brief maximal exercise.
Nine subjects performed a Wingate test on three different occasions: (i) the first week of Ramadan (1WR), (ii) the fourth week of Ramadan (4WR), and (iii) three weeks after Ramadan (AR). Blood samples were taken before, immediately and 60 min after the exercise. Plasma concentrations of IL-12 were measured using enzyme-linked immunosorbent assay. Variance analysis revealed no significant effect of Ramadan on Ppeak and Pmean during the three testing periods.
Considering the effect of Ramadan on plasma concentrations of IL-12, analysis of the variance revealed a significant Ramadan effect (F(2, 16)=66.27; P < 0.001) as well as a significant time effect (F(2, 16)= 120.66; P < 0.001). However, no significant (Ramadan × time) of test interaction (F(4, 32)=2.40; P>0.05). For all measures, IL-12 levels were lower during 1WR and 4WR in comparison with AR (P < 0.05). Considering the exercise effects, IL-12 levels measured immediately after the exercise were significantly higher than those measured before and at 60 minutes after the exercise (P < 0.001).
These results suggest that an acute intense exercise-induced IL-12 response is modified by daytime fasting and modifications in sleep schedule during Ramadan.
PMCID: PMC3289209  PMID: 22375234
Ramadan; Wingate Test; Interleukin-12; Immunity; Sleep Deprivation
15.  Effects of Fasting During Ramadan Month on Cognitive Function in Muslim Athletes 
Asian Journal of Sports Medicine  2011;2(3):145-153.
Our study aimed to profile the effect of fasting during the Ramadan month on cognitive function in a group of healthy Muslim athletes.
Eighteen male athletes underwent computerized neuropsychological testing during (fasting) and after (non-fasting) Ramadan. Diet was standardized, and tests were performed at 0900h and 1600h to characterize potential time-of-day (TOD) interactions. Psychomotor function (processing speed), vigilance (visual attention), visual learning and memory, working memory (executive function), verbal learning and memory were examined. Capillary glucose, body temperature, urine specific gravity, and sleep volume were also recorded.
Fasting effects were observed for psychomotor function (Cohen's d=1.3, P=0.01) and vigilance (d=0.6, P=0.004), with improved performance at 0900h during fasting; verbal learning and memory was poorer at 1600h (d=-0.8, P=0.03). A TOD effect was present for psychomotor function (d=-0.4, P<0.001), visual learning (d=-0.5, P=0.04), verbal learning and memory (d=-1.3, P=0.001), with poorer performances at 1600h. There was no significant fasting effect on visual learning and working memory.
Our results show that the effect of fasting on cognition is heterogeneous and domain-specific. Performance in functions requiring sustained rapid responses was better in the morning, declining in the late afternoon, whereas performance in non-speed dependent accuracy measures was more resilient.
PMCID: PMC3289210  PMID: 22375233
Psychomotor Function; Cognition; Ramadan Fasting; Memory
16.  Effect of Ramadan Fasting on Body Composition and Physical Performance in Female Athletes 
Asian Journal of Sports Medicine  2011;2(3):161-166.
The aim of this study was to determine the effect of Ramadan fasting on body composition, calorie intake and physical performance in young female athletes undertaking training sessions during Ramadan.
Twelve voluntary female athletes (15-27 years old) were assigned to the research. A prospective study was conducted to investigate the athletes on four different occasions: one week before Ramadan (T1), the second (T2) and fourth (T3) weeks of Ramadan, and two weeks after the end of Ramadan (T4). Food intake, body composition and physical performance (agility, balance and explosive leg power) were investigated on each occasion. Further, Physical performance was assessed by agility, vertical jump and balance tests.
There was a significant main effect for time for body composition indices. A significant decrease was observed in weight (P=0.01) and body mass index (BMI) (P=0.01) in T2 compared with T1, further decrease in weight (P<0.001) and BMI (P<0.001) was observed in T3 compared to T1. Calorie intake decreased significantly in T3 compared with T1 (P=0.008), and increased significantly in T4 compared with T3 (P=0.04). There was a significant main effect for time for agility performance (P=0.03), but no significant main effect for time was observed for vertical jumping (P=0.1) and balance performance (P=0.3).
This study has found that Ramadan fasting could affect the body composition, but not physical performance in female athletes during Ramadan.
PMCID: PMC3289211  PMID: 22375235
Body Composition; Female Athletes; Performance; Ramadan Fasting
17.  Temporal Patterns of Subjective Experiences and Self-Regulation during Ramadan Fasting among Elite Archers: A Qualitative Analysis 
Asian Journal of Sports Medicine  2011;2(3):195-204.
Some major competitions (e.g. London Olympics, 2012) are scheduled during the Ramadan fasting month. Little attention has been given to explore the archers’ performance related subjective experiences with a qualitative method. Therefore, this study addressed individual archers’ subjective experiences within the framework of self-regulation during Ramadan.
Eleven elite Malaysian Muslim fasting archers volunteered to participate in the study. Grounded theory was the qualitative approach used to examine the subjective experiences of athletes during Ramadan. Interviews were conducted and inductive content analysis was adopted to identify the temporal patterns of self-regulation of subjective experiences across the fasting period.
Inductive content analysis identified (a) physical, (b) mental,(c) emotional, (d) behavioral, and (e) spiritual experiences. Overall patterns revealed that experiences associated with physical, emotional, behavioral, and spiritual dimensions dominated in the first phase of fasting, while the mental dimension surfaced increasingly in the latter phase of fasting.
The trend showed changes in the patterns of experiences among the major domains across the temporal dimension. Athletes reported increased subjective experiences in mental factors toward the latter half of the fasting period. Practitioners should emphasize on mental aspects of training, as these appear to be salient in archery performance.
PMCID: PMC3289212  PMID: 22375239
Self Regulation; Qualitative Research; Ramadan Fasting; Subjective Experiences
18.  The Effect of Ramadan Fasting on Physical Performances, Mood State and Perceived Exertion in Young Footballers 
Asian Journal of Sports Medicine  2011;2(3):177-185.
This study was designed to assess the effects of Ramadan fasting on the profile of mood state and perceived exertion in young soccer players and aerobic and anaerobic performances during the Yo-Yo, repeated sprint ability (RSA) and the Wingate tests.
Twenty junior male soccer players completed the Yo-Yo, the RSA, and the Wingate tests on three different occasions: one-week before Ramadan (BR), the second week (SWR) and the fourth week (ER) of Ramadan. The total distance (TD) covered and the estimated maximal aerobic velocity (MAV) during the Yo-Yo test were recorded. During the RSA test, peak power (PP) during each sprint, the percentage of decrement of PP (PD) and total work (Wtotal) were calculated. During the Wingate test, peak (Ppeak) and mean (Pmean) powers and fatigue index (FI) were recorded.
TD and MAV (P=0.01) during the Yo-Yo test and PP (P=0.01, P=0.004, P=0.001, P=0.01, P=0.03 for sprints 1, 2, 3, 4, and 5, respectively) and Wtotal (P=0.02) during the RSA test were significantly higher during BR than ER. Furthermore, muscle fatigue during the RSA test increased significantly from BR to ER (P=0.01). Ppeak and Pmean during the Wingate test decreased significantly from BR to SWR and ER (P<0.0005). FI was higher during SWR (P=0.001) and ER (P<0.0005) than BR. In addition, rating of perceived exertion scores and fatigue estimated by the profile of mood state questionnaire were higher during Ramadan in comparison with BR.
The present study suggests that both aerobic and anaerobic performances during the Yo-Yo, the RSA and the Wingate tests were affected by Ramadan fasting in young soccer players.
PMCID: PMC3289213  PMID: 22375237
Ramadan Fasting; Fatigue; Aerobic Exercise; Anaerobic Exercise; Footballers
19.  Ramadan and Its Effect on Fuel Selection during Exercise and Following Exercise Training 
Asian Journal of Sports Medicine  2011;2(3):127-133.
Fasting induces short-term physiological adaptations which spare the body's remaining carbohydrate stores and mobilize lipid stores to provide a substitute fuel for many tissues and organs, especially skeletal muscle. Rodent studies show that regular occurrence of fasting then refeeding, stimulates adaptations in muscle which make the animal better placed to withstand a further period of fasting by possessing a better ability to oxidise lipid.
This review explores the research describing these adaptations, with an emphasis on Ramadan, a human model of repeated fasting/refeeding. Separately, a single bout of endurance exercise places similar metabolic stress on the body as fasting since the exercising muscle must reduce its use of carbohydrate and utilize lipid more readily as exercise progresses. Not surprisingly therefore, adaptations in muscle to repeated bouts of endurance exercise (endurance training) are similar to those seen with repeated fasting/refeeding. Superimposing the stressors of repeated fasting/refeeding and exercise training, and subsequent adaptations to the muscle and exercise response, are examined by describing the published research which has investigated the situation where athletes continue their training whilst participating in Ramadan.
PMCID: PMC3289214  PMID: 22375231
Endurance Training; Metabolism; Carbohydrate; Lipid; Skeletal Muscle
20.  Investigating Two Different Training Time Frames during Ramadan Fasting 
Asian Journal of Sports Medicine  2011;2(3):205-210.
Muslim athletes may continue training and competing while they are fasting. There is a concern about negative effects of fasting on sports performance. This study aimed to investigate the influence of two training time frames on athletes’ body composition and performance during Ramadan fasting.
An observational study was conducted and thirty four male volunteer athletes from different sports including volleyball, karate, taekwondo and football were assigned in two groups. The first group included 14 elite athletes who during Ramadan voluntarily participated in training sessions at 1 hour before Iftar (BI) and the second group of 20 elite athletes who during Ramadan participated in training sessions at 3 hours after Iftar (AI). Testing was performed one week before; in the first and fourth weeks of Ramadan and one week after Ramadan. Weights, heights and skinfold thickness were assessed at each time point and body mass index was calculated. Each player was assessed for agility and explosive strength as well.
The mean weight and body mass index of both groups decreased significantly during Ramadan (P<0.001). Performance variables were not negatively affected by fasting in BI or AI group athletes.
Weight reduction might come with either BI or AI training schedules in Ramadan. Daytime or evening training did not inversely affect the agility and power performances in a group of elite athletes during Ramadan fasting.
PMCID: PMC3289215  PMID: 22375240
Ramadan Fasting; Athletes; Training time frame; Athletic Performance; Sports
21.  Effects of Ramadan Fasting on Biochemical and Anthropometric Parameters in Physically Active Men 
Asian Journal of Sports Medicine  2011;2(3):134-144.
The aim of this study was to assess the effects of Ramadan fasting on several biochemical and anthropometric parameters in physically active men by comparing fasters and nonfasters before, during, and after Ramadan.
Eighteen physically active men (10 fasters and 8 nonfasters) participated in this study. Subjects visited the laboratory for a total of four sessions on the following occasions: three days before Ramadan (Bef-R), the 15th day of Ramadan (Mid-R), the 29th day of Ramadan (End-R), and 21 days after Ramadan (Post-R). During each session, subjects underwent anthropometric measurements, completed a dietary questionnaire and provided a fasting blood sample.
Body weight and body fat percentage decreased in fasters by 1.9% (P<0.001) and 6.2% (P=0.003), respectively, but increased in nonfasters by 2.2% (P<0.001) and 10.2% (P=0.001), respectively, from Bef-R to End-R. Fasters’ hematocrit and hemoglobin increased by 5.3% (P<0.001) and 6.3% (P=0.01), respectively, from Bef-R to End-R, while neither of these parameters changed in nonfasters. Fasters experienced an increase in the following parameters from Bef-R to End-R: urea (8.7%; P<0.001), creatinine (7.5%; P<0.001), uric acid (12.7%; P<0.001), serum sodium (1.9%; P<0.001), serum chloride (2.6%; P<0.001) and high-density lipoprotein cholesterol (27.3%; P<0.001). Of these parameters, only creatinine increased (4.4%; P=0.01) in nonfasters.
We conclude that Ramadan fasting lowers body weight and body fat percentage and can elevate high-density lipoprotein cholesterol in physically active men. However, practicing aerobic exercise during a hot and humid Ramadan month can induce a state of dehydration marked by an increase in some renal function markers and serum electrolytes.
PMCID: PMC3289216  PMID: 22375232
Islamic Fasting; Aerobic Exercise; Dehydration; Body Composition; Lipids Profile
22.  How to Diagnose Exercise Induced Asthma? 
Exercise induced asthma (EIA) is a transient increase in airway resistance after intensive exercise and can be measured as a decline in forced expiratory volume in one second (FEV1). The condition is due to increased training load and inhalation of cold and dry air. Several studies have shown that eucapnic voluntary hyperpnea challenge test (EVH test) is a very sensitive and specific diagnostic method. EVH test develops EIA by hyperventilation of dry gas and the test achieves the same airway obstruction as training in cold and dry air. The test is better than the previously used methacholine challenge test.
PMCID: PMC3289196  PMID: 22375220
Bronchospasm; Asthma Exercise-Induced; Diagnosis; Athletes; Exercise
23.  Diagnostic Value of Bioelectrical Impedance Analysis versus Body Mass Index for Detection of Obesity among Students 
Obesity is a common nutritional problem in both developed and developing countries. The aim of this study was to determine the prevalence of overweightness and obesity using both bioelectrical impedance analysis (BIA) and body mass index (BMI).
In this cross-sectional study, 288 healthy college students were selected. Socio-economic status questionnaires were completed and subjects’ anthropometric features were measured by a trained nurse. BMI was calculated and body fat mass (BFM) and body fat percent (BF%) were obtained using BIA method by hand-to-hand Omron BF-500 set.
Mean age of the subjects was 21.1±1.7 years. Based on BMI, 2.6% of males and 2.2% of females were obese while 15.7% and 9.6% were diagnosed to be overweight respectively. The correlation between BMI values and BFM were 0.883 and 0.908 in males and females respectively (P<0.001). Furthermore, BF% had a significant correlation with BMI in both males and females (P<0.001).
Our survey demonstrated a lower prevalence of obesity and overweightness in college students compared with Iranian general population, especially in females. Additionally, BIA method was shown to be closely correlated with and as much valuable as BMI in regard to detection of obesity.
PMCID: PMC3289197  PMID: 22375221
Body Mass Index; Bioelectrical Impedance; Obesity; Students; Body Fat
24.  Sudden Cardiac Death in Athletes: Is Universal ECG Screening Plausible? 
Asian Journal of Sports Medicine  2011;2(2):117-119.
PMCID: PMC3289199  PMID: 22375227
Sudden Cardiac Death; Physical Examination; Athletes
25.  The Persian, Last 7-day, Long form of the International Physical Activity Questionnaire: Translation and Validation Study 
Asian Journal of Sports Medicine  2011;2(2):106-116.
To translate long form, interview-administered International Physical Activity Questionnaire (IPAQ) from English to Persian and evaluate its validity, reliability and reproducibility.
A forward-backward translation procedure was followed to develop the Persian version of the IPAQ. A total of 218 respondents (53.7% women, aged 22–76 yr) completed the Persian version in Tehran, Iran. To examine the test–retest reliability, 48 healthy volunteers completed the IPAQ twice during a 7-day period.. The PA indicators derived from the IPAQ were assessed for reliability and were compared with aerobic fitness and body mass index (BMI) for construct validity.
In general, the questionnaire was received well and all domains met the minimum reliability standards (intra-class correlation [ICC]>0.7), except for Leisure-time physical activity (PA). Aerobic fitness showed a weak positive correlation with all of the PA results derived from the IPAQ. A significant correlation was observed between the IPAQ data for total PA and both aerobic fitness (r=0.33, P<0.001) and BMI (r=0.26, P<0.001). Performing a known group comparison analysis, the results indicated that the questionnaire was discriminated well between the subgroups of the study samples expected to be different in their physical activity.
The Persian version of the long form, interview-administered IPAQ had an acceptable reliability and validity for assessing total PA in our Iranian sample of individuals. It may be a useful instrument for generating internationally comparable data on PA.
PMCID: PMC3289200  PMID: 22375226
Metabolic equivalent; Physical Activity; Questionnaire; Reliability and Validity; IPAQ

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