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Children Exercise Physiology
by
Moch.Yunus
1Moch.Yunus / Exercise Physiology
(EXERCISE PHYSIOLOGY)
2Moch.Yunus / Exercise Physiology
The study of the human body during exercise
Offers ability to study the body out of homeostasis
Exercise Physiology
Stimulus Response
Acut exercise Response
Chronic Exercise Adaptation
HOMEOSTASIS
3Moch.Yunus / Exercise Physiology
Moch.Yunus / Exercise Physiology 4
• Homeostasis,, is the property of a
system in which variables are
regulated so that internal conditions
remain stable and relatively constant.
Examples of homeostasis include the regulation
of temperature and the balance between
acidity and alkalinity (pH). It is a process that
maintains the stability of the human body's
internal environment in response to changes in
external conditions
Children and Adolescents
Exercise Physiology
?????
5Moch.Yunus / Exercise Physiology
OBJECTIVES
Children are not just smaller
versions of adults.
1. GROWTH AND MATURATION
2. PHYSIOLOGICAL DIFFERENCES
3. NUTRITIONAL CONSIDERATIONS
4. PSYCHOLOGICAL CONSIDERATIONS
5.THE IMMATURE MUSCULOSKELETAL SYSTEM
Moch.Yunus / Exercise Physiology 6
OBJECTIVES
6. ACUTE SPORTING INJURIES
7. OVERUSE INJURIES
8. CHRONIC CHILDHOOD ILLNESS
9. ACUTE ILLNESS AND SPORTS PARTICIPATION
10.PRE-PARTICIPATION HEALTH EVALUATION
11. INJURY PREVENTION
7Moch.Yunus / Exercise Physiology
GROWTH AND MATURATION
1) VARIABILITY IN THE PHYSICAL GROWTH OF 6 YEARS
2) PEAK HEIGHT VELOCITY ( PHV )
3) 12 YEAR OLD: SIGNIFICANT DIFFERENT HEIGHT,
MUSCULAR STRENGTH, CARDIOVASCULAR FITNESS
LEVELS
4) NO REASON TO SEGREGATE SEXES UP TO 14 YEARS
OLD
8Moch.Yunus / Exercise Physiology
PHYSIOLOGICAL DIFFERENCES
1. Aerobic Capacity in Children
• VO2max (L/min) peaks around age 17 to 21 in
males, then decreases linearly with age.
• VO2max (L/min) has been shown to peak around
age 12 to 15 in females
– Decrease after age 15 may be due to females tending
to reduce physical activity
• Absolute VO2max (L/min) is lower in children
than adults at similar training levels.
9Moch.Yunus / Exercise Physiology
Aerobic Capacity in Children
• When VO2max is expressed relative to body
weight, there is little difference in aerobic
capacity between adults and children, thus,
additional muscle mass increases maximal
oxygen consumption.
• Relative to body weight, running economy is
lower in children compared to adults.
10Moch.Yunus / Exercise Physiology
Changes in VO2max With Age
Absolute (e.g. L/min)
Relative to body weight
(e.g. ml/kg/min)
11Moch.Yunus / Exercise Physiology
PHYSIOLOGICAL DIFFERENCES
2) ANAEROBIC POWER:
- SIGNIFICANT LOWER IN CHILDREN
( SHORT TERM POWER OUTPUT )
- IMPROVING WITH GROWTH
- IN GIRLS LITTLE CHANGE AFTER 12 YEARS OLD
- CHILDREN: LESS USE OF GLYCOGEN, LESS ABLE TO
REDUCE PH
12Moch.Yunus / Exercise Physiology
Optimal Anaerobic Power Output
13Moch.Yunus / Exercise Physiology
Aerobic and Anaerobic Capacities as a
% of Adult Levels
Adult level
14Moch.Yunus / Exercise Physiology
PHYSIOLOGICAL DIFFERENCES
3) CARDIOVASCULAR SYSTEM:
- CHILDREN: HIGHER MAXIMAL HEART RATE
- LOWER STROKE VOLUME
- LOWER SYSTOLIC BLOOD PRESSURE
- BETTER PERIFERAL BLOOD FLOW
ADJUSTMENT TO SPORT
15Moch.Yunus / Exercise Physiology
HR and SV as a Function of O2
Uptake
16Moch.Yunus / Exercise Physiology
PHYSIOLOGICAL DIFFERENCES
4) RESPIRATORY SYSTEM:
- CHILDREN: SHALLOW BREATHING PATTERN
RESULTING IN LOWER ABSORPTION OF
OXYGEN FROM INSPIRATION
- HIGHER RESPIRATORY FREQUENCY
RESULTING IN GREATER OXYGEN COST IN
RESPIRATION
17Moch.Yunus / Exercise Physiology
PHYSIOLOGICAL DIFFERENCES
5) EXERCISE IN HOT AND COLD ENVIRONMENTS:
CHILDREN VUNERABLE: RATIO OF SURFACE AREA TO
VOLUME 30-40% HIGHER THAN ADULTS RESULTING
IN FASTER INCREASE OR LOOSING BODY HEAT
SWEATING MECHANISM IS FULLY OPERATIVE AFTER
ADOLESCENT GROWTH SPURT - DEHYDRATION
18Moch.Yunus / Exercise Physiology
19
Beginning Training
Sensitive Periods.
• Max strength : 12-14(f) 14-16(m)
• explosive strength : 10-12(f) 12-14(m)
• Strength Endurance : 12-14(f) 14-16(m)
• Aerobic Endurance : 8-10 (f & m)
Anaerobic Endurance : 12-14(f) 14-16(m)
• Speed of Reaction : 8-10 (f & m)
• Maximal Speed : 10-12(f) 12-14(m)
• Coordination : 5-8 (f & m)
Moch.Yunus / Exercise Physiology
20Moch.Yunus / Exercise Physiology
NUTRITIONAL CONSIDERATIONS
1) ADOLESCENT GROWTH SPURT
2) IRREGULAR EATING HABITS (SNACKS,
MISSING LUNCH ETC )
3) CALCIUM, FOLIC ACID, ZINC, IRON,VITAMINS
A,B6,C
4) DIETARY MANIPULATION, EATING DISORDERS
21Moch.Yunus / Exercise Physiology
PSYCHOLOGICAL CONSIDERATIONS
1) CHILDHOOD PLAY IMPORTANT FOR SPORT: ( FIRST 7
YEARS OF LIFE)
- BALANCE AND CO-ORDINATION
- PROPREOCEPTION ( POSITION SENSE )
2) REWARDS OF PHYSICAL ACTIVITY
SELF ESTEEM AND ADMIRATION
3) SPORTS VERSUS PLAY ( AFTER 6 YEARS OLD ) GROUP
GAMES, RULES OF GAMES, GOAL GAMES
PREPARATION AND FEELINGS OF GAME SPORTS
22Moch.Yunus / Exercise Physiology
THE IMMATURE MUSCULOSKELETAL
SYSTEM
• 1) PRESENCE OF GROWTH CARTILAGE IN SKELETON
• A) ARTICULAR SURFACES
• B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS
• 2) EFFECTS OF EXERCISE:
• INTENSIVE PROGRAMMES LEAD TO BONY DEFORMATION
• HEAVY PHYSICAL TRAINING LEADS TO LONGER PREPUBERTAL
STATE IN GIRLS
• SPECIAL INTENSIVE TRAINING LEADS TO STRENGTH
IMBALANCE: SHOULDER
23Moch.Yunus / Exercise Physiology
THE IMMATURE MUSCULOSKELETAL
SYSTEM
• 3) FACTORS ASSOCIATED WITH INCIDENCE OF
SPORT INJURIES
• EPIDEMIOLOGY: 3 INJURIES PER 100 CHILDREN
PER YEAR
• 0.69 SERIOUS INJURIES PER YEAR
• PEAK FOR BOYS: 14 YEARS OLD
• GIRLS: 15 YEARS OLD
24Moch.Yunus / Exercise Physiology
THE IMMATURE MUSCULOSKELETAL
SYSTEM
• INCOMPLETE RECOVERY FROM INJURY: 30%
• FOUL OR ILLEGAL PLAY: 13%
• OVERUSE INJURIES: 50%
• - COMPETITION 35% OF INJURIES
• - RUGBY LEAGUE 32%,SOCCER, RUGBY UNION 11%,
MARTIAL ARTS, HORSE RIDING 2% SAFEST
• SPRAIN ANKLE 45%. 30% MEDICAL ATTENTION, 11%
HOSPITALIZED, 12% LONG TERM DYSFUNCTION
25Moch.Yunus / Exercise Physiology
ACUTE SPORTING INJURIES
• 1) HEAD AND NECK : VERY RARE BELOW 11 YRS
• 1-5% OF ALL SPORT INJURIES SERIOUS CNS DAMAGE
• 2) DIAPHYSEAL FRACTURES
• 3) GROWTH PLATE INJURY: SALTER-HARRIS
CLASSIFICATION
• 4) AVULSION FRACTURE OF ACL
• 5) AVULSION FRACTURE MUSCLE GROUPS
• 6) SUFE: 30% SUDDENLY, 70% GRADUAL
26Moch.Yunus / Exercise Physiology
OVERUSE INJURIES
• 1) OSTEOCHONDROSES
• 2) STRESS FRACTURES: SUDDEN INCREASE IN
TRAINING INTENSITY
• X-RAYS OR BONE SCANS
• NAVICULAR, PARS-INTERARTICULARIS, FEMORAL
NECK
• 3) MALALIGNMENT SYNDROMES:
• TARSAL COALITIONS ( PERONEI TENDINITIS )
27Moch.Yunus / Exercise Physiology
OVERUSE INJURIES
• 1) OSTEOCHONDROSES:
• “ SELF-LIMITED,IDIOPATHIC, DEVELOPEMENTAL
DISORDERS OF PRIMARY OR SECONDARY
OSSIFICATION CENTRES”
• - TRACTION OSTEOCHONDRITIS (APOPHYSITIS ):
OSGOOD-SCHLATTERS, SINDING-LARSEN-
JOHANSSON, SEVERS
28Moch.Yunus / Exercise Physiology
OVERUSE INJURIES
• 1) OSTEOCHONDROSES:
• - ARTICULAR SUBCHONDRAL ( CRUSHING )
• PERTHES DISEASE (FEMORAL HEAD)
• KIEBOCKS DISEASE ( LUNATE )
• KOHLERS DISEASE ( NAVICULAR )
• FREIBERGS DISEASE ( 2ND METAT.)
• ARTICULAR CHONDRAL (SPLITTING)
• OSTEOCHONDRITIS DISSECANS (
FEMUR,CAPITELUM,TALAR)
• PHYSEAL: SCHEURMANNS (THORACIC SPINE )
• BLOUNTS ( TIBIA )
29Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• 1) ASTHMA: EXERCISE INDUCED
BRONCHSPASM ( EIB)
• EXERCISE INDUCED ASTHMA ( EIA )
• 2) DIABETES: INCREASED FATIGUE,
ABNORMAL THIRST, FREQ.URINARY,WEIGHT
LOSS
• 3) EPILEPSY ( PETIT MAL, TEMPORAL LOBE,
GRAND MAL )
30Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• 4) CYSTIC FIBROSIS ( GENERAL EXOCRCINE
GLAND DYSFUNCTION )
• CHRONIC RECURRENT SINUS AND
RESPIRATORY TRACT INFECTIONS
• DIGESTIVE TRACT DISORDERS AND
MALNUTRITION
• SWIMMING OF PARTICULAR BENEFIT IN
BRONCHOSPASM HYGIENE
31Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• 5) HYPERTENSION:
• (?) CAUSES, PRIMARY OR SECONDARY
• SPORTS BENEFICIAL FOR PRIMARY
HYPERTENSION
• AVOIDANCE IN PRIMARY ISOMETRIC
ACTIVITIES: WEIGHT LIFTING, WRESTLING,
ICE-SKATING
32Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• 6) HEART DISEASE: CONGENITAL HEART DISEASE IN
5/1000 SCHOOL AGED CHILDREN. RHEUMATIC
HEART DISEASE 1/1000, VALVULAR DAMAGE
• CARDIOMYOPATHY, MYOPATHY, HEREDITARY
SYNDROME 0.8/1000
• RHYTHM SIGNIFICANT DISORDER 0.7/1000
• CONGENITAL CORONARY ANOMALIES 2/100.000
CHILDREN
33Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• 6) HEART DISEASE
• - CARDIAC CONDITIONS ASSOCIATED COMMONLY
WITH SUDDEN DEATH IN SPORT ACTIVITIES
• AORTIC STENOSIS, TETRALOGY OF FALLOT,
HYPERTROPHIC CARDIOMYOPATHY, PULMONARY
HYPERTENSION, MYOCARDITIS
34Moch.Yunus / Exercise Physiology
CHRONIC CHILDHOOD ILLNESS
• - CARDIAC CONDITIONS ASSOCIATED WITH
SUDDEN DEATH IN YOUNG ATHLETES:
• HYPERTROPHIC CARDIOMYOPATHY,
ABERRANT LEFT CORONARY ARTERY, AORTIC
DISSECTION ( MARFANS SYNDROME )
CORONARY ARTERY DISEASE
35Moch.Yunus / Exercise Physiology
ACUTE ILLNESS AND SPORT
PARTICIPATION
• 1) INFECTIONS MONONUCLEOSIS
• ( GLANDULAR FEVER )
• - SELF-LIMITED ACUTE VIRAL ILLNESS
• - 90% INFECTED BY 30 YEAR OLDS
• - PEAK IS 15-25 YEARS OLD
• - EPSTEIN-BARR VIRUS (EBV)
• - DIAGNOSIS FROM POSITIVE HETEROPHILE
ANTIBODY TEST (MONOSPOT)
36Moch.Yunus / Exercise Physiology
ACUTE ILLNESS AND SPORT
PARTICIPATION
• - ENLARGED SPLEEN 40-60%, RUPTURE 0.1 –
0.2%
• - 4 WEEKS ABSENCE, SYMPTOMS CAN LAST UP
TO 6 MONTHS
• 2) OTHER ACUTE ILLNESSES:
HAEM.STREPTOCOCCUS, MYCOPLASMA
PNEUMONIA, SIMPLE HERPES, TINEA PEDIS
37Moch.Yunus / Exercise Physiology
PRE-PARTICIPATION HEALTH
EVALUATION
• HISTORY TAKING, PHYSICAL EXAMINATION,
INVESTIGATIONS, ANTHROPOMETRIC
MEASUREMENT
• - CONDITIONS REQUIRING FURTHER EVALUATION
AND POSSIBLE DISQUALIFICATION FROM SPORT:
• 1) UNRESOLVED ORGANIC HEART DISEASE
• 2) SUSTAINED HYPERTENSION WITH EXERCISE
38Moch.Yunus / Exercise Physiology
PRE-PARTICIPATION HEALTH
EVALUATION
• 3) LOSS OF CONCIOUSNESS WITH EXERCISE
• 4) SERIOUS CNS TRAUMA OR SURGERY
• 5) HISTORY OF RECURRENT CNS SYMPTOMS (
SEIZURE ETC )
• 6) PERSISTENT HEAT INTOLERANCE
• 7) INTRACTABLE ORTHOPAEDIC PROBLEMS
39Moch.Yunus / Exercise Physiology
PRE-PARTICIPATION HEALTH
EVALUATION
• 8) SINGLE ORGAN
• 9) HAEMORRHAGIC DISSORDERS
• 10) CHRONIC INFECTIONS
• 11) CHRONIC DEBILITATING ILLNESS
• 12) ENLARGED ABDOMINAL VISCERA
• 13) OBVIOUS PHYSICAL IMMATURITY
40Moch.Yunus / Exercise Physiology
INJURY PREVENTION
• 1) FACTORS CONTRIBUTING TO SPORT INJURIES
• - LACK OF COACHING EDUCATION
• - INADEQUATE PREPARTICIPATION PHYSICAL EXAMS
• - HAZARDOUS PLAYING FIELDS
• - CONDITIONING AND TRAINING ERRORS
• - EQUIPMENT – LACK, IMPROPER, POORLY FITTED
41Moch.Yunus / Exercise Physiology
INJURY PREVENTION
• - PLAYING WHILE INJURED OR OVERTIRED
• - GROUPING TEAMS BY AGE NOT SIZE
• - POOR NUTRITION
• - RULES AND OFFICIALS
• - IMPROPER TECHNIQUE
• - INADEQUATE SUPERVISION
• - PSYCHOLOGICAL STRESS
• - WEATHER CONDITIONS
42Moch.Yunus / Exercise Physiology
INJURY PREVENTION
• PREVENTION STRATEGIES:
• - GENERAL FITNESS – TRAINING
• - RANGE OF SPORT ACTIVITIES
• - TRAINING WELL BEFORE SEASON
• - ALLOW CHILDREN TO CONTROL INTENSITY OF
ACTIVITIES
• - MODIFY RULES OF ADULT GAMES
• - LESS EMPHASIS ON WINNING
43Moch.Yunus / Exercise Physiology
INJURY PREVENTION
• - OPPONENTS TO BE MATCHED IN AGE,
HEIGHT, WEIGHT, MATURITY
• - STRICT SUPERVISION
• - NO MORE THAN A 10% INCREASE PER WEEK
IN TRAINING
• - WARM-UP AND COOL-DOWN TIME
• - PRE-PARTICIPATION EXAMS.
44Moch.Yunus / Exercise Physiology

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Children Exercise Physiology

  • 2. (EXERCISE PHYSIOLOGY) 2Moch.Yunus / Exercise Physiology The study of the human body during exercise Offers ability to study the body out of homeostasis
  • 3. Exercise Physiology Stimulus Response Acut exercise Response Chronic Exercise Adaptation HOMEOSTASIS 3Moch.Yunus / Exercise Physiology
  • 4. Moch.Yunus / Exercise Physiology 4 • Homeostasis,, is the property of a system in which variables are regulated so that internal conditions remain stable and relatively constant. Examples of homeostasis include the regulation of temperature and the balance between acidity and alkalinity (pH). It is a process that maintains the stability of the human body's internal environment in response to changes in external conditions
  • 5. Children and Adolescents Exercise Physiology ????? 5Moch.Yunus / Exercise Physiology
  • 6. OBJECTIVES Children are not just smaller versions of adults. 1. GROWTH AND MATURATION 2. PHYSIOLOGICAL DIFFERENCES 3. NUTRITIONAL CONSIDERATIONS 4. PSYCHOLOGICAL CONSIDERATIONS 5.THE IMMATURE MUSCULOSKELETAL SYSTEM Moch.Yunus / Exercise Physiology 6
  • 7. OBJECTIVES 6. ACUTE SPORTING INJURIES 7. OVERUSE INJURIES 8. CHRONIC CHILDHOOD ILLNESS 9. ACUTE ILLNESS AND SPORTS PARTICIPATION 10.PRE-PARTICIPATION HEALTH EVALUATION 11. INJURY PREVENTION 7Moch.Yunus / Exercise Physiology
  • 8. GROWTH AND MATURATION 1) VARIABILITY IN THE PHYSICAL GROWTH OF 6 YEARS 2) PEAK HEIGHT VELOCITY ( PHV ) 3) 12 YEAR OLD: SIGNIFICANT DIFFERENT HEIGHT, MUSCULAR STRENGTH, CARDIOVASCULAR FITNESS LEVELS 4) NO REASON TO SEGREGATE SEXES UP TO 14 YEARS OLD 8Moch.Yunus / Exercise Physiology
  • 9. PHYSIOLOGICAL DIFFERENCES 1. Aerobic Capacity in Children • VO2max (L/min) peaks around age 17 to 21 in males, then decreases linearly with age. • VO2max (L/min) has been shown to peak around age 12 to 15 in females – Decrease after age 15 may be due to females tending to reduce physical activity • Absolute VO2max (L/min) is lower in children than adults at similar training levels. 9Moch.Yunus / Exercise Physiology
  • 10. Aerobic Capacity in Children • When VO2max is expressed relative to body weight, there is little difference in aerobic capacity between adults and children, thus, additional muscle mass increases maximal oxygen consumption. • Relative to body weight, running economy is lower in children compared to adults. 10Moch.Yunus / Exercise Physiology
  • 11. Changes in VO2max With Age Absolute (e.g. L/min) Relative to body weight (e.g. ml/kg/min) 11Moch.Yunus / Exercise Physiology
  • 12. PHYSIOLOGICAL DIFFERENCES 2) ANAEROBIC POWER: - SIGNIFICANT LOWER IN CHILDREN ( SHORT TERM POWER OUTPUT ) - IMPROVING WITH GROWTH - IN GIRLS LITTLE CHANGE AFTER 12 YEARS OLD - CHILDREN: LESS USE OF GLYCOGEN, LESS ABLE TO REDUCE PH 12Moch.Yunus / Exercise Physiology
  • 13. Optimal Anaerobic Power Output 13Moch.Yunus / Exercise Physiology
  • 14. Aerobic and Anaerobic Capacities as a % of Adult Levels Adult level 14Moch.Yunus / Exercise Physiology
  • 15. PHYSIOLOGICAL DIFFERENCES 3) CARDIOVASCULAR SYSTEM: - CHILDREN: HIGHER MAXIMAL HEART RATE - LOWER STROKE VOLUME - LOWER SYSTOLIC BLOOD PRESSURE - BETTER PERIFERAL BLOOD FLOW ADJUSTMENT TO SPORT 15Moch.Yunus / Exercise Physiology
  • 16. HR and SV as a Function of O2 Uptake 16Moch.Yunus / Exercise Physiology
  • 17. PHYSIOLOGICAL DIFFERENCES 4) RESPIRATORY SYSTEM: - CHILDREN: SHALLOW BREATHING PATTERN RESULTING IN LOWER ABSORPTION OF OXYGEN FROM INSPIRATION - HIGHER RESPIRATORY FREQUENCY RESULTING IN GREATER OXYGEN COST IN RESPIRATION 17Moch.Yunus / Exercise Physiology
  • 18. PHYSIOLOGICAL DIFFERENCES 5) EXERCISE IN HOT AND COLD ENVIRONMENTS: CHILDREN VUNERABLE: RATIO OF SURFACE AREA TO VOLUME 30-40% HIGHER THAN ADULTS RESULTING IN FASTER INCREASE OR LOOSING BODY HEAT SWEATING MECHANISM IS FULLY OPERATIVE AFTER ADOLESCENT GROWTH SPURT - DEHYDRATION 18Moch.Yunus / Exercise Physiology
  • 19. 19 Beginning Training Sensitive Periods. • Max strength : 12-14(f) 14-16(m) • explosive strength : 10-12(f) 12-14(m) • Strength Endurance : 12-14(f) 14-16(m) • Aerobic Endurance : 8-10 (f & m) Anaerobic Endurance : 12-14(f) 14-16(m) • Speed of Reaction : 8-10 (f & m) • Maximal Speed : 10-12(f) 12-14(m) • Coordination : 5-8 (f & m) Moch.Yunus / Exercise Physiology
  • 21. NUTRITIONAL CONSIDERATIONS 1) ADOLESCENT GROWTH SPURT 2) IRREGULAR EATING HABITS (SNACKS, MISSING LUNCH ETC ) 3) CALCIUM, FOLIC ACID, ZINC, IRON,VITAMINS A,B6,C 4) DIETARY MANIPULATION, EATING DISORDERS 21Moch.Yunus / Exercise Physiology
  • 22. PSYCHOLOGICAL CONSIDERATIONS 1) CHILDHOOD PLAY IMPORTANT FOR SPORT: ( FIRST 7 YEARS OF LIFE) - BALANCE AND CO-ORDINATION - PROPREOCEPTION ( POSITION SENSE ) 2) REWARDS OF PHYSICAL ACTIVITY SELF ESTEEM AND ADMIRATION 3) SPORTS VERSUS PLAY ( AFTER 6 YEARS OLD ) GROUP GAMES, RULES OF GAMES, GOAL GAMES PREPARATION AND FEELINGS OF GAME SPORTS 22Moch.Yunus / Exercise Physiology
  • 23. THE IMMATURE MUSCULOSKELETAL SYSTEM • 1) PRESENCE OF GROWTH CARTILAGE IN SKELETON • A) ARTICULAR SURFACES • B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS • 2) EFFECTS OF EXERCISE: • INTENSIVE PROGRAMMES LEAD TO BONY DEFORMATION • HEAVY PHYSICAL TRAINING LEADS TO LONGER PREPUBERTAL STATE IN GIRLS • SPECIAL INTENSIVE TRAINING LEADS TO STRENGTH IMBALANCE: SHOULDER 23Moch.Yunus / Exercise Physiology
  • 24. THE IMMATURE MUSCULOSKELETAL SYSTEM • 3) FACTORS ASSOCIATED WITH INCIDENCE OF SPORT INJURIES • EPIDEMIOLOGY: 3 INJURIES PER 100 CHILDREN PER YEAR • 0.69 SERIOUS INJURIES PER YEAR • PEAK FOR BOYS: 14 YEARS OLD • GIRLS: 15 YEARS OLD 24Moch.Yunus / Exercise Physiology
  • 25. THE IMMATURE MUSCULOSKELETAL SYSTEM • INCOMPLETE RECOVERY FROM INJURY: 30% • FOUL OR ILLEGAL PLAY: 13% • OVERUSE INJURIES: 50% • - COMPETITION 35% OF INJURIES • - RUGBY LEAGUE 32%,SOCCER, RUGBY UNION 11%, MARTIAL ARTS, HORSE RIDING 2% SAFEST • SPRAIN ANKLE 45%. 30% MEDICAL ATTENTION, 11% HOSPITALIZED, 12% LONG TERM DYSFUNCTION 25Moch.Yunus / Exercise Physiology
  • 26. ACUTE SPORTING INJURIES • 1) HEAD AND NECK : VERY RARE BELOW 11 YRS • 1-5% OF ALL SPORT INJURIES SERIOUS CNS DAMAGE • 2) DIAPHYSEAL FRACTURES • 3) GROWTH PLATE INJURY: SALTER-HARRIS CLASSIFICATION • 4) AVULSION FRACTURE OF ACL • 5) AVULSION FRACTURE MUSCLE GROUPS • 6) SUFE: 30% SUDDENLY, 70% GRADUAL 26Moch.Yunus / Exercise Physiology
  • 27. OVERUSE INJURIES • 1) OSTEOCHONDROSES • 2) STRESS FRACTURES: SUDDEN INCREASE IN TRAINING INTENSITY • X-RAYS OR BONE SCANS • NAVICULAR, PARS-INTERARTICULARIS, FEMORAL NECK • 3) MALALIGNMENT SYNDROMES: • TARSAL COALITIONS ( PERONEI TENDINITIS ) 27Moch.Yunus / Exercise Physiology
  • 28. OVERUSE INJURIES • 1) OSTEOCHONDROSES: • “ SELF-LIMITED,IDIOPATHIC, DEVELOPEMENTAL DISORDERS OF PRIMARY OR SECONDARY OSSIFICATION CENTRES” • - TRACTION OSTEOCHONDRITIS (APOPHYSITIS ): OSGOOD-SCHLATTERS, SINDING-LARSEN- JOHANSSON, SEVERS 28Moch.Yunus / Exercise Physiology
  • 29. OVERUSE INJURIES • 1) OSTEOCHONDROSES: • - ARTICULAR SUBCHONDRAL ( CRUSHING ) • PERTHES DISEASE (FEMORAL HEAD) • KIEBOCKS DISEASE ( LUNATE ) • KOHLERS DISEASE ( NAVICULAR ) • FREIBERGS DISEASE ( 2ND METAT.) • ARTICULAR CHONDRAL (SPLITTING) • OSTEOCHONDRITIS DISSECANS ( FEMUR,CAPITELUM,TALAR) • PHYSEAL: SCHEURMANNS (THORACIC SPINE ) • BLOUNTS ( TIBIA ) 29Moch.Yunus / Exercise Physiology
  • 30. CHRONIC CHILDHOOD ILLNESS • 1) ASTHMA: EXERCISE INDUCED BRONCHSPASM ( EIB) • EXERCISE INDUCED ASTHMA ( EIA ) • 2) DIABETES: INCREASED FATIGUE, ABNORMAL THIRST, FREQ.URINARY,WEIGHT LOSS • 3) EPILEPSY ( PETIT MAL, TEMPORAL LOBE, GRAND MAL ) 30Moch.Yunus / Exercise Physiology
  • 31. CHRONIC CHILDHOOD ILLNESS • 4) CYSTIC FIBROSIS ( GENERAL EXOCRCINE GLAND DYSFUNCTION ) • CHRONIC RECURRENT SINUS AND RESPIRATORY TRACT INFECTIONS • DIGESTIVE TRACT DISORDERS AND MALNUTRITION • SWIMMING OF PARTICULAR BENEFIT IN BRONCHOSPASM HYGIENE 31Moch.Yunus / Exercise Physiology
  • 32. CHRONIC CHILDHOOD ILLNESS • 5) HYPERTENSION: • (?) CAUSES, PRIMARY OR SECONDARY • SPORTS BENEFICIAL FOR PRIMARY HYPERTENSION • AVOIDANCE IN PRIMARY ISOMETRIC ACTIVITIES: WEIGHT LIFTING, WRESTLING, ICE-SKATING 32Moch.Yunus / Exercise Physiology
  • 33. CHRONIC CHILDHOOD ILLNESS • 6) HEART DISEASE: CONGENITAL HEART DISEASE IN 5/1000 SCHOOL AGED CHILDREN. RHEUMATIC HEART DISEASE 1/1000, VALVULAR DAMAGE • CARDIOMYOPATHY, MYOPATHY, HEREDITARY SYNDROME 0.8/1000 • RHYTHM SIGNIFICANT DISORDER 0.7/1000 • CONGENITAL CORONARY ANOMALIES 2/100.000 CHILDREN 33Moch.Yunus / Exercise Physiology
  • 34. CHRONIC CHILDHOOD ILLNESS • 6) HEART DISEASE • - CARDIAC CONDITIONS ASSOCIATED COMMONLY WITH SUDDEN DEATH IN SPORT ACTIVITIES • AORTIC STENOSIS, TETRALOGY OF FALLOT, HYPERTROPHIC CARDIOMYOPATHY, PULMONARY HYPERTENSION, MYOCARDITIS 34Moch.Yunus / Exercise Physiology
  • 35. CHRONIC CHILDHOOD ILLNESS • - CARDIAC CONDITIONS ASSOCIATED WITH SUDDEN DEATH IN YOUNG ATHLETES: • HYPERTROPHIC CARDIOMYOPATHY, ABERRANT LEFT CORONARY ARTERY, AORTIC DISSECTION ( MARFANS SYNDROME ) CORONARY ARTERY DISEASE 35Moch.Yunus / Exercise Physiology
  • 36. ACUTE ILLNESS AND SPORT PARTICIPATION • 1) INFECTIONS MONONUCLEOSIS • ( GLANDULAR FEVER ) • - SELF-LIMITED ACUTE VIRAL ILLNESS • - 90% INFECTED BY 30 YEAR OLDS • - PEAK IS 15-25 YEARS OLD • - EPSTEIN-BARR VIRUS (EBV) • - DIAGNOSIS FROM POSITIVE HETEROPHILE ANTIBODY TEST (MONOSPOT) 36Moch.Yunus / Exercise Physiology
  • 37. ACUTE ILLNESS AND SPORT PARTICIPATION • - ENLARGED SPLEEN 40-60%, RUPTURE 0.1 – 0.2% • - 4 WEEKS ABSENCE, SYMPTOMS CAN LAST UP TO 6 MONTHS • 2) OTHER ACUTE ILLNESSES: HAEM.STREPTOCOCCUS, MYCOPLASMA PNEUMONIA, SIMPLE HERPES, TINEA PEDIS 37Moch.Yunus / Exercise Physiology
  • 38. PRE-PARTICIPATION HEALTH EVALUATION • HISTORY TAKING, PHYSICAL EXAMINATION, INVESTIGATIONS, ANTHROPOMETRIC MEASUREMENT • - CONDITIONS REQUIRING FURTHER EVALUATION AND POSSIBLE DISQUALIFICATION FROM SPORT: • 1) UNRESOLVED ORGANIC HEART DISEASE • 2) SUSTAINED HYPERTENSION WITH EXERCISE 38Moch.Yunus / Exercise Physiology
  • 39. PRE-PARTICIPATION HEALTH EVALUATION • 3) LOSS OF CONCIOUSNESS WITH EXERCISE • 4) SERIOUS CNS TRAUMA OR SURGERY • 5) HISTORY OF RECURRENT CNS SYMPTOMS ( SEIZURE ETC ) • 6) PERSISTENT HEAT INTOLERANCE • 7) INTRACTABLE ORTHOPAEDIC PROBLEMS 39Moch.Yunus / Exercise Physiology
  • 40. PRE-PARTICIPATION HEALTH EVALUATION • 8) SINGLE ORGAN • 9) HAEMORRHAGIC DISSORDERS • 10) CHRONIC INFECTIONS • 11) CHRONIC DEBILITATING ILLNESS • 12) ENLARGED ABDOMINAL VISCERA • 13) OBVIOUS PHYSICAL IMMATURITY 40Moch.Yunus / Exercise Physiology
  • 41. INJURY PREVENTION • 1) FACTORS CONTRIBUTING TO SPORT INJURIES • - LACK OF COACHING EDUCATION • - INADEQUATE PREPARTICIPATION PHYSICAL EXAMS • - HAZARDOUS PLAYING FIELDS • - CONDITIONING AND TRAINING ERRORS • - EQUIPMENT – LACK, IMPROPER, POORLY FITTED 41Moch.Yunus / Exercise Physiology
  • 42. INJURY PREVENTION • - PLAYING WHILE INJURED OR OVERTIRED • - GROUPING TEAMS BY AGE NOT SIZE • - POOR NUTRITION • - RULES AND OFFICIALS • - IMPROPER TECHNIQUE • - INADEQUATE SUPERVISION • - PSYCHOLOGICAL STRESS • - WEATHER CONDITIONS 42Moch.Yunus / Exercise Physiology
  • 43. INJURY PREVENTION • PREVENTION STRATEGIES: • - GENERAL FITNESS – TRAINING • - RANGE OF SPORT ACTIVITIES • - TRAINING WELL BEFORE SEASON • - ALLOW CHILDREN TO CONTROL INTENSITY OF ACTIVITIES • - MODIFY RULES OF ADULT GAMES • - LESS EMPHASIS ON WINNING 43Moch.Yunus / Exercise Physiology
  • 44. INJURY PREVENTION • - OPPONENTS TO BE MATCHED IN AGE, HEIGHT, WEIGHT, MATURITY • - STRICT SUPERVISION • - NO MORE THAN A 10% INCREASE PER WEEK IN TRAINING • - WARM-UP AND COOL-DOWN TIME • - PRE-PARTICIPATION EXAMS. 44Moch.Yunus / Exercise Physiology