Thesis (PhD (Biomedical Sciences. Medical Physiology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background: There has been a dramatic increase in the use of dietary creatine supplementation among sports men and women, and by clinicians as a therapeutic agent in muscular and neurological diseases. The effects of creatine have been studied extensively in skeletal muscle, but knowledge of its myocardial effects is limited. Objectives: To investigate the effects of dietary creatine supplementation with and without exercise on 1) basal cardiac function, 2) susceptibility to ischaemia/reperfusion injury and 3) myocardial protein expression and phosphorylation and 4) mitochondrial oxidative function. Methods: Male Wistar rats were randomly divided into control or creatine supplemented groups. Half of each group was exercise trained by swimming for a period of 8 weeks, 5 days per week. At the end of the 8 weeks the open field test was performed and blood corticosterone levels were measured by RIA to determine whether the swim training protocol had any effects on stress levels of the rats. Afterwards hearts were excised and either freeze-clamped for biochemical and molecular analysis or perfused on the isolated heart perfusion system to assess function and tolerance to ischaemia and reperfusion. Five series of experiments were performed: (i) Mechanical function was documented before and after 20 minutes global ischaemia using the work heart model, (ii) A H2O filled balloon connected to a pressure transducer was inserted into the left ventricle to measure LVDP and ischaemic contracture in the Langendorff model, (iii) The left coronary artery was ligated for 35 minutes and infarct size determined after 30 minutes of reperfusion by conventional TTC staining methods. (iv) Mitochondrial oxidative capacity was quantified. (v) High pressure liquid chromatography (HPLC) and Western Blot analysis were performed on blood and heart tissue for determination of high energy phosphates and protein expression and phosphorylation. Results: Neither the behavioural studies nor the corticosterone levels showed any evidence of stress in the groups investigated. Hearts from creatine supplemented sedentary (33.5 ± 4.5%), creatine supplemented exercised rats (18.22 ± 6.2%) as well as control exercised rats (26.1 ± 5.9%) had poorer aortic output recoveries than the sedentary control group (55.9 ± 4.35% p < 0.01) and there was also greater ischaemic contracture in the creatine supplemented exercised group compared to the sedentary control group (10.4 ± 4.23 mmHg vs 31.63 ± 4.74 mmHg). There were no differences in either infarct size or in mitochondrial oxygen consumption between the groups. HPLC analysis revealed elevated phosphocreatine content (44.51 ±14.65 vs 8.19 ±4.93 nmol/gram wet weight, p < 0.05) as well as elevated ATP levels (781.1 ±58.82 vs 482.1 ±75.86 nmol/gram wet weight, p<0.05) in blood from creatine supplemented vs control sedentary rats. These high energy phosphate elevations were not evident in heart tissue and creatine tranporter expression was not altered by creatine supplementation. GLUT4 and phosphorylated AMPK and PKB/Akt were all significantly higher in the creatine supplemented exercised hearts compared to the control sedentary hearts. Conclusion: This study suggests that creatine supplementation has no effects on basal cardiac function but reduces myocardial tolerance to ischaemia in hearts from exercise trained animals by increasing the ischaemic contracture and decreasing reperfusion aortic output. Exercise training alone also significantly decreased aortic output recovery. However, the exact mechanisms for these adverse myocardial effects are unknown and need further investigation. / AFRIKAANSE OPSOMMING: Agtergrond: Die gebruik van kreatien as dieetaanvulling het in die afgelope aantal jaar dramaties toegeneem onder sportlui, sowel as mediese praktisyns wat dit as ‘n terapeutiese middel vir die behandeling van spier- en neurologiese siektes aanwend. Die effekte van kreatien op skeletspier is reeds deeglik ondersoek, maar inligting aangaande die miokardiale effekte van die preperaat is beperk. Doelwitte: Om die effekte van kreatien dieetaanvulling met of sonder oefening ten opsigte van die volgende aspekte te ondersoek: 1) basislyn miokardiale funksie, 2) vatbaarheid vir iskemie/herperfusie besering, 3) proteïenuitdrukking en -fosforilering in die miokardium en 4) mitochondriale oksidatiewe funksie. Metodes: Manlike Wistar rotte is ewekansig in kontrole of kreatien aanvullings groepe verdeel. Helfte van elke groep is aan oefening in die vorm van swemsessies, vir ‘n periode van 8 weke, 5 dae per week blootgestel. Gedrags- en biochemiese toetse is aangewend om die moontlike effek van die swemprotokol op die rotte se stres vlakke te bepaal. In hierdie verband is die oop area toets gebruik, asook bloed kortikosteroon vlakke gemeet deur radioaktiewe immuunessais. Harte is daarna uit die rotte gedissekteer en gevriesklamp vir biochemiese en molekulêre analise, of geperfuseer op die geïsoleerde werkhart perfusiesisteem om sodoende funksie en weerstand teen iskemie en herperfusie beskadeging te bepaal. Vyf eksperimentele reekse is uitgevoer: (i) Meganiese funksie is noteer voor en na 20 minute globale isgemie in die werkhart model; (ii) ‘n Water gevulde plastiek ballon, gekoppel aan ‘n druk omsetter, is in die linker ventrikel geplaas om sodoende linker ventrikulêre ontwikkelde druk (LVDP), asook iskemiese kontraktuur te meet; (iii) Linker koronêre arterie afbinding is vir ‘n periode van 35 minute toegepas en die infarktgrootte bepaal na 30 minute herperfusie deur gebruik te maak van standaard kleuringsmetodes; (iv) Mitochondriale oksidatiewe kapasiteit is gemeet; (v) Hoë druk vloeistof chromatografie (HPLC) en Western Blot analises is uitgevoer op bloed en hartweefsel vir die bepaling van hoë energie fosfate (HEFe), sowel as proteïenuitdrukking en -fosforilering. Resultate: Beide gedragsstudies en kortikosteroonvlakke het geen teken van stres in die betrokke groepe getoon nie. Die groep blootgestel aan kreatienaanvulling en oefening se harte het na iskemie funksioneel swakker herstel as harte van die onaktiewe kontrole groep (18.22±6.2% vs 55.9±4.35%; p<0.01), asook ‘n groter ikgemiese kontraktuur in vergelyking met die onaktiewe kontrole groep ontwikkel (31.63±4.74 mmHg vs 10.4±4.23 mmHg). Daar was geen verskille in infarktgrootte of mitochondriale suurstofverbruik tussen die verskillende groepe waargeneem nie. HPLC analise het verhoogde fosfokreatien (44.51±14.65 vs 8.19±4.93 nmol/gram nat gewig, p<0.05) en adenosientrifosfaat (ATP) bloedvlakke (781.1±58.82 vs 482.1±75.86 nmol/gram nat gewig, p<0.05) in kreatien aanvullings vergelyk met die kontrole groepe getoon. Daar was egter geen meetbare veranderings in HEF vlakke in hartweefsel nie. Gepaardgaande hiermee het kreatienaanvulling geen effek gehad op die uitdrukking va die kreatien transporter nie. In vergelyking met onaktiewe kontrole harte was GLUT4, en fosforileerde AMPK en PKB/ Akt beduidend hoër in harte van geoefende rotte met kreatienaangevulling. Gevolgtrekking: Hierdie data dui daarop dat kreatienaanvulling geen effek op basislyn miokardiale funksie het nie. Kreatienaanvulling het egter die miokardium se weerstand teen iskemiese skade verlaag in harte van rotte blootgestel aan oefening: iskemiese kontraktuur is verhoog en aorta-uitset tydens herperfusie is verlaag. Die presiese meganismes hierby betrokke is egter onbekend en vereis dus verdere studie. / Division of Medical Physiology (University of Stellenbosch), The National Research Foundation and the Harry Crossley Fund for financial support.

Fish meal (FM) and fish oil (FO) have traditionally been central in aquaculture feed formulation but the finite global supply situation limiting future use along with issues of contaminant levels in these feed ingredients have become critical issues. The objectives of the present study were to investigate alternative feed ingredients as substitutes for both FM and FO in feeds for Atlantic salmon (Salmo salar) to ensure optimal growth, feed efficiency and health of the fish as well as maintaining the nutritional quality of the fish product to the human consumer, especially the levels of n-3 highly unsaturated fatty acid (HUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in the flesh. The results of the present study revealed that there were no negative effects on growth performance, feed utilisation and apparent digestibility in Atlantic salmon when FO was substituted with vegetable oil (VO) but these parameters were affected when FM was replaced with alternative protein sources from plants and animals at high levels, despite dietary supplementation with crystalline amino acids and lecithin. Reduction in feed intake was a factor affecting growth retardation when FM inclusion decreased. However, replacing FM with alternative plant and animal proteins along with partial replacement of FO had no major effect on nutritional quality, particularly n-3 HUFA content of salmon tissues. Replacing Northern FO with decontaminated FO or blends of southern hemisphere FO and VOs strategies to reduce POP contaminants and retain high nutritional values in flesh were very successful. Dietary treatments and genetic origin of fish both had effects on tissue compositions and gene expression. All fish groups (strain/family), consist of CAL, LEAN and FAT strains, fed a diet containing VO showed significant differential expression of lipid metabolism-related genes compared to fish fed a FO diet with LEAN strain appearing to adapt to VO inclusion better than FAT strain. This thesis has demonstrated dual replacement of FM and FO with alternative raw materials in salmon feeds without a major negative impact on nutritional quality.

Contexte. Les produits de santé naturels (PSN) suscitent de plus en plus d’intérêt au sein de la population. Les professionnels de la santé, dont les nutritionnistes, doivent être à l’affût de cette tendance afin de conseiller les utilisateurs et de limiter les risques liés à leur utilisation. Objectif. Explorer l’expérience, les perceptions et les besoins de formation des nutritionnistes du Québec à l’égard des PSN. Méthodes. Un sondage électronique a été envoyé à tous les membres de l’Ordre professionnel des diététistes du Québec via Fluid Survey. Les questions visaient à identifier les expériences, les attitudes à l’égard des PSN et de leur clientèle qui en consomme, les sources d’informations utilisées dans leurs consultations et d’identifier les besoins de formations en relation avec les PSN. Résultats. Au total, 295 nutritionnistes ont complété le questionnaire. Parmi ceux-ci, 93 % ont déjà reçu des questions portant sur les PSN. Environ 91 % ont déclaré consommer ou avoir déjà consommé un PSN et, au moins 94 % ont affirmé avoir recommandé un PSN. Aussi, 95 % de l’échantillon désiraient davantage d’informations sur les PSN. Enfin, ils ont une perception positive quant à leur rôle dans ce dossier, puisque 77 % de l’échantillon ont indiqué que le nutritionniste devrait être une source d’informations sur les PSN. Conclusion. Les grands constats de notre étude révèlent que le rôle des nutritionnistes du Québec en relation avec les PSN n’est pas clairement défini. Ils ont besoin de formation sur les PSN afin d’être outillés pour conseiller la population et, ainsi, leur ouvrir un nouveau champ d’expertise. / Background. Natural Health Products (NHPs) are becoming an increasing interest within the population. Health professionals, including nutritionists, must keep up to date with this trend in order to properly advise users and limit the risks associated with their use. Objective. Explore Quebec’s nutritionist’s experiences, perceptions and their training needs about NHPs. Methods. An electronic survey was administered to members of the Professional Order of Dietitians of Quebec through Fluid Survey. The 21 questions were designed to identify personal experiences, attitudes towards NHPs and towards their clientele that consume them, identify which sources of information they rely on and their training needs. Results. A total of 295 nutritionists completed the questionnaire. Among these, 93 % have already received questions on NHPs. Approximately 91 % of nutritionists admitted using or having used NHPs and at least 94 % said they recommended them. Also, 95 % of the sample would like to receive more information on NHPs. Finally, they have a positive perception as to their role regarding this subject, since 77 % indicated that the nutritionist should be a reliable source of information for NHPs. Conclusion. The major findings of our study are that Quebec’s nutritionists’ roles related to NHPs are not clearly defined. They need training on NHPs in order to be able to advise the population and, thus, form a new field of expertise for nutritionists.

STRENGHT TRAINING AND INFLUENCING FACTORS Objectives: The aim of this thesis is to form, apply and find the influence of created workout regarding body composition changes. Methods: In this work we used bioimpedance analysis, antropomotorical measurements of muscle mass and diagnostics of previous physical experience. Results: Considering the following measurement we found out significant changes in fat mass and muscle mass ratio as well as increase of muscle mass in upper extremities. Keyowords: muscle strenght, adaptation, muscle hypertrophy, fat loss, dietary supplements, training programme

Doping has become a more common phenomenon in society. Doping often occur in gyms and the typical user is a young male who somehow has been involved in sports. The use of dietary supplements increases as well, studies in Sweden has shown that 61 percent of the males and 41 percent of the females who exercise at gyms use dietary supplements. The usage of dietary supplements is not entirely risk-free since it has been shown that the supplements may be contaminated with unknown substances and there is no consistent research on the effects of dietary supplements. The aim of this study was to study sports high school students’ use of and attitudes towards doping and dietary supplements, and also study if the usage and attitudes differ between boys and girls. The study is based on a questionnaire performed among students at a sports high school. The results showed that the majority of the students (79,4%) had used dietary supplements at some point, significant gender differences were observed that showed that boys use dietary supplements more frequently than girls. The attitudes towards doping were negative in general and the majority of the students believe that dietary supplements can be damaging (90,1%) at the same time the majority also believe that dietary supplements can have a positive effect (86,3%). The results can be explained by means of Theory of reasoned action, a theory that explains how attitudes can affect behaviors. Due to ethical reasons no results are shown about usage of doping. / Dopning har blivit ett mer vanligt förekommande fenomen i samhället. Dopning förekommer ofta på gym och den typiske brukaren är en ung man som har någon form av idrottsbakgrund. Samtidigt ökar bruket av kosttillskott och undersökningar i Sverige har visat att 61 procent av männen och 41 procent av kvinnorna som tränar på gym använder kosttillskott. Användningen av kosttillskott är inte riskfri eftersom tillskotten kan vara kontaminerade med främmande substanser samtidigt som forskningen gällande effekter är motsägande. Syftet med studien var att studera idrottsgymnasieelevers användning av och attityder till dopning och kosttillskott, samt om användning och attityder skiljer sig mellan pojkar och flickor. Studien baseras på en enkätstudie bland elever på ett idrottsgymnasium. Studiens resultat visade att majoriteten av eleverna (79,4 %) någon gång har brukat kosttillskott, signifikanta könsskillnader påvisades där pojkar använder kosttillskott oftare än flickor. Attityderna till dopning var generellt negativa och majoriteten av eleverna upplever att det kan finnas kosttillskott som kan vara skadliga (90,1 %), samtidigt som majoriteten tror att kosttillskott kan ha positiv effekt (86,3 %). Resultaten kan förklaras med hjälp av Theory of reasoned action, en teori som förklarar hur attityder kan påverka beteenden. På grund av etiska skäl redovisas inte något resultat rörande användning av dopningspreparat.

O Brasil é o segundo país no mundo em número de academias de ginástica, contando atualmente com cerca de 30 mil unidades. Apesar da transição no modelo de gestão e filosofia das academias do fitness para o wellness, muitas ainda propagam em seus ambientes o culto ao corpo magro e atlético, dietas sem fundamentação nutricional e consumo descontrolado de suplementos. Crescem as evidências de que uma parcela significativa dos frequentadores de academias desenvolve um comprometimento exacerbado à prática de exercícios físicos, gerando até uma dependência patológica. O objetivo foi determinar a associação entre dependência de exercício físico (DEF), consumo de suplementos e insatisfação da imagem corporal em frequentadores de academias. Para tanto foi empregada a Escala de Comprometimento com Exercício Físico (CEF) em uma amostra de 227 frequentadores, maiores de 19 anos, de ambos os sexo em três academias. Foi realizada entrevista individual com emprego de anamnese nutricional para determinar o perfil de consumo suplementar, avaliação antropométrica, da imagem corporal, do compromisso ao exercício físico assim como de participação na academia. A frequência de DEF nas academias foi de 66% e sendo que as chances estimadas deste ser consumidor de suplementos de 4,53. Os indivíduos dependentes de exercício físico são jovens, com maior chance de pertencer ao sexo masculino, frequentar a academia > 5 vezes por semana, consumir mais de um tipo de suplemento e praticar musculação. A frequência de insatisfação com a imagem corporal foi alta tanto entre homens (50,9%) como mulheres (78,4%). / Brazil is the second country in number of gym clubs, currently with about 30 thousand units. Despite the transition in the managing model and philosophy of gym clubs from fitness to wellness, many still disseminate the cult of a lean and athletic body, diets without nutritional basis, and uncontrolled consumption of supplements. We have growing evidence that a significant number of individuals going to gym clubs develop an exacerbated commitment to the practice of physical exercises, yielding even pathological dependence. The main goal of our work is to determine the association between exercise dependence (ED), supplements consumption, and dissatisfaction with body image between users of gym clubs. For this purpose we employed the Commitment Exercise Scale (CES) in a sample of 227 gym club users, over 19 years old, from both sexes, in three gym clubs. We used nutritional assesment to determine the profile of supplements consumption, and recorded anthropometrical and exercise engagement data. Frequency of ED in gym clubs was estimated to be 66% with odds ratio of 4.53 favoring supplements consumption. Dependent individuals are on average young, most probably males, attending the gym club more than 5 times a week, consumers of more than on type of supplement, and practitioners of body building. Frequency of body image dissatisfaction is high both between men (50.9%) and women (78.4%).

L'objectif de ces travaux a été de démontrer l'intérêt d'appliquer la Résonance Magnétique Nucléaire (RMN) à des problématiques analytiques dans le domaine des produits de santé. Deux axes principaux ont été abordés. Le premier cible principalement les compléments alimentaires adultérés. Les études ont été menées par RMN à haut champ. Diverses expériences de RMN mono et bidimensionnelles ont permis de mettre en évidence la présence illicite, dans des compléments alimentaires déclarés comme naturels, de médicaments à visée érectile et/ou de leurs analogues structuraux. Ces substances actives peuvent induire, à l'insu du consommateur, des risques importants pour sa santé. De plus, des analyses menées par RMN 1H et 13C ont permis de révéler des cas d'adultération de compléments alimentaires pour sportifs par des substances considérées comme dopantes par la règlementation en vigueur. Le second axe a été mené en explorant les potentialités de la RMN à bas champ pour l'analyse de médicaments. Cette technique, moins onéreuse et plus adaptée à des analyses de routine que la RMN à haut champ, s'est avérée très efficace pour mettre en évidence des cas de médicaments falsifiés par de simples expériences RMN 1H monodimensionnelles. Des expériences bidimensionnelles de diffusion (DOSY : Diffusion Ordered SpectroscopY), qui permettent d'obtenir la séparation virtuelle des constituants d'un mélange complexe, ont été mises au point et appliquées, pour la première fois, à la dé-formulation d'un médicament. / The purpose of this research was to demonstrate the interest of Nuclear Magnetic Resonance (NMR) to deal with analytical issues in the field of health products. The studies focused on two main axes. The first one targeted adulterated dietary supplements and the studies were conducted with high-field NMR. Various mono and bidimensional experiments revealed the illegal presence in dietary supplements claimed as natural, of erectile drugs and/or their structural analogues. These active substances can induce, without the consumer's knowledge, significant risks to his health. Moreover, analyses conducted with 1H and 13C NMR, highlighted cases of adulteration of dietary supplements for exercise and athletic performance with doping substances. The second axis explored the potential of low-field NMR for drug analysis. This technique, which is less expensive and more suitable for routine analyses than high-field NMR, has proved very effective in detecting cases of falsified medicines by simple one-dimensional 1H NMR experiments. Two-dimensional diffusion experiments (DOSY: Diffusion Ordered Spectroscopy), which provide virtual separation of the constituents of a complex mixture, were developed and applied for the first time to the de-formulation of a drug.

The aim of this study was to evaluate the effects of M. elsdenii (Me) dosing on dairy heifer performance. A secondary set of data (feed intake, heifers birth weights, age and Weight at insemination, and first lactation milk performance) of heifers (dosed and not dosed with Me) was obtained from the dairy herd of the Agricultural Research Council – Animal Production. Data were arranged in a complete randomised design and analysed as repeated measures. Milk, pre-weaning starter and metabolised energy intake did not differ between the control and the Me groups. Post-weaning starter feed intake was higher (p=0.03) for Me fed heifers than control heifers. The post-weaning metabolisable energy intake was also higher (p=0.03) for heifer fed Me than control heifers. The average daily weight gain of heifers dosed with Me was higher during the pre-weaning period (0.66 kg/day; p=0.04) and after weaning (1.12 kg/day; p=0.03) compared to control (0.60 and 0.65 kg/day, respectively). At 42 and 70 days old, the BW of Me-heifers was greater (75.8 ± 2.6 and 91.2 ± 4.6 kg) than control heifers (61.9 ± 2.6 and 77.2 ± 4.6 kg) (p<0.05). There was no difference (P>0.05) in BW at insemination, number of insemination and milk yield between the two groups of cows (p>0.05). Early feeding of Me to heifers in the present study positively affect heifer growth during and early after milk feeding period, confirming previous report. Animal weight at puberty and the subsequent milk production were not influenced by feeding Me. It is possible that Me did not survive long after weaning to continue to express its influence on animal performance. / Agriculture and  Animal Health / M. Sc. (Agriculture)

This thesis investigated lifestyle characteristics including cigarette smoking, alcohol consumption, dietary supplements intake, physical activity, and urinary incontinence status for Japanese patients with chronic obstructive pulmonary disease (COPD). Field studies were conducted in the middle of Japan. The study was conducted using a cross-sectional survey and all patients were recruited from the outpatient departments of six hospitals in three districts/prefectures, namely, Aichi, Gifu, and Kyoto. Three hundred referred COPD patients diagnosed by respiratory physicians were recruited in 2006. Inclusion criteria were (i) aged between 50 and 75 years; and (ii) had COPD as the primary functionally limiting illness which was diagnosed within the past four years. Diagnosis of COPD was confirmed by spirometry with FEV1/FVC < 70%, where FEV1 = forced expiratory volume in one second and FVC = forced vital capacity. A structured questionnaire was administered to collect information on lifestyle characteristics. All interviews, averaging 40 minutes, took place in the hospital outpatient departments. Clinical characteristics, height, weight and presence of any co-morbidity (e.g. diabetes, hypertension, cardiovascular disease), were retrieved from medical records. / A total of 278 eligible participants (244 men and 34 women) were available for analysis. The majority were men (88%) with mean age 66.5 (SD 6.7) years and mean body mass index (BMI) 21.9 (SD 3.6). Most of them were married (84%), had high school or below education (80%) and retired (55%). In relation to cigarette smoking, 62 (53 male and 9 female) participants (22.5%) were current smokers of whom the great majority (89%) smoked daily. Only six (2.1%) participants were never smokers. The prevalence of smoking by time from diagnosis was: 24.5% (< 1 year), 20.6% (1-2 years), and 18.9% (2-4 years). Continuous smoking was inversely associated with age (odds ratio (OR) = 0.94, 95% confidence interval (CI) 0.90-0.98), BMI (OR = 0.88, 95% CI 0.80-0.97) and disease severity vii (OR = 0.29, 95% CI 0.12-0.74 for severe COPD and OR = 0.29, 95% CI 0.09-0.92 for very severe COPD). For alcohol consumption, 158 (150 male and 8 female) patients (56.8%) drank alcohol regularly on at least a monthly basis, the majority of them (73.4%) being daily drinkers. Beer was the most preferred alcoholic beverage drank (30.9%). Alcohol intake appeared to be positively associated with the habit of adding soy sauce to foods, whereas dyspnoea of patients posed significant limitations for them to drink alcoholic beverages. / Also, female patients tended to have lower alcohol consumption levels than male patients. Regarding dietary supplements, 117 (101 male and 16 female) participants (42.1%) were dietary supplement users, but the prevalence for female patients (47.1%) was higher than male patients (41.4%). Younger patients (≤ 60 years) and those with severe COPD had relatively low proportion of users (27.3% and 28.9%, respectively). Dietary supplementation was found to be affected by age (p = 0.04), COPD severity (p = 0.03) and presence of co-morbidity (p = 0.03). Older patients over 60 years were more likely to take dietary supplements (OR = 2.44, 95% CI 1.03-5.80), whereas severe COPD patients (OR = 0.41, 95% CI 0.18-0.95) and those with a co-morbidity (OR = 0.54, 95% CI 0.32-0.94) tended not to use. With respect to physical activity of COPD patients, 198 (175 male and 23 female) of them (77%) participated in physical activities on at least weekly basis, but only 22% and 4% engaged in moderate and vigorous activities, respectively. Over 2/3 of them walked at least weekly. Regression analysis showed that perceived life-long physical activity involvement appeared to be positively associated with total physical activity, whereas patients with very severe COPD tended to have significantly lower total physical activity levels. / Besides COPD severity, both age and smoking exhibited a negative impact on walking. It is evident that walking activities decreased among very severe patients, current smokers and those in advanced age. The prevalence of urinary incontinence was 12.6% (10% for men and 32% for women). The most common occurrence of urine loss was before reaching the toilet (54%) followed by coughing/sneezing (23%). While urge incontinence was reported viii by 63% of male incontinent patients, 82% of female incontinent patients experienced stress incontinence. Incontinence was more likely among female patients (OR = 8.7, 95% CI 3.2-23.4) and older patients over 70 years (OR = 2.3, 95% CI 1.0-5.2). COPD severity was also found to be a significant factor (p = 0.007), with very severe patients at slightly higher risk of urinary incontinence (OR = 1.1, 95% CI 0.3-3.5) than mild COPD patients, though the relationship appeared not to be linear across the severity classifications. It is alarming to find mild and moderate COPD patients continue to smoke. The implementation of a co-ordinated tobacco control program immediately post diagnosis is needed for the effective pulmonary rehabilitation of COPD patients. The high alcohol consumption by COPD patients is also alarming. Alcohol control programs targeting male patients should be promoted during pulmonary rehabilitation in order to minimise the harm due to excessive drinking. Dietary supplements are popular for patients with COPD especially among older patients. / The findings are important to clinical trials and experimental interventions advocating nutritional supplementation therapy for pulmonary rehabilitation. Patients with COPD had lower physical activity levels than the general elderly population. Older patients with very severe COPD and those who currently smoke should be targeted for intervention and encouraged to increase their participation in physical activity so as to maintain their health and well being. The high prevalence yet underreporting of urinary incontinence suggested that education and regular assessment are needed after COPD diagnosis. Appropriate exercise and treatment tailored for the specific type of incontinence incurred should be incorporated within the rehabilitation program of COPD patients. To maintain a healthy lifestyle and to achieve optimal outcomes during the pulmonary rehabilitation of COPD patients, the identified factors should be taken into consideration and health awareness programs should be promoted in conjunction with respiratory physicians and allied health professionals.

During extreme exercise, athletes experience increased inflammation that is similar to the acute phase response. Endurance athletes, distance runners in particular, are also more susceptible to compromised iron stores. This study evaluated inflammation, immune function and iron status in athletes completing a 50K ultramarathon. Twenty-two well-trained distance runners, 11 males and 11 females, were randomized in a double blind manner into--1) those who consumed 300 mg vitamin E and 1000 mg vitamin C (500 mg twice daily) or 2) placebos--for six weeks before and one week following a 50K ultramarathon race. Blood samples were obtained on 13 separate occasions throughout the study: before supplementation, during supplementation, the day before the race, pre-race, mid-race, immediately post-race, 2 hours following the race, and daily for six days following the race. Plasma levels of ascorbic acid and ��-tocopherol were measured by HPLC with electrochemical detection. Inflammatory cytokines, interleukin-6 (IL-6), tumor necrosis factor-�� (TNF-��), and interleukin-1�� (IL-1��) were measured using standard clinical assays. Each subject recorded immune function in an activity log and incidence of illness was tabulated as number of days ill. Ferritin was measured by enzyme immunoassay. Hemoglobin, hematocrit, and total-iron binding capacity (TIBC) and serum total iron were analyzed by standard procedures. Plasma concentrations of ascorbic acid and ��-tocopherol increased significantly in supplemented subjects (p<0.0001). Although the ultramarathon race elicited an inflammatory response, antioxidant supplementation did not alter the responses of IL-6 and TNF-��, which both increased from pre-race to mid-race, post- and post-2 h (Scheffe post-hoc analysis, p<0.0001) and returned to pre-race concentrations by 1 day after the race. Male supplemented subjects had lower IL-1�� concentrations compared to females consuming the supplement or to males consuming the placebo (ANCOVA, gender/time/treatment interaction; p<0.01) at mid-race (p<0.05 females, p<0.005 males), post 1 and 2 days (all p<0.002). Males had significantly higher ferritin levels than the female subjects (ANOVA, p<0.0001); supplementation resulted in lower ferritin concentrations at post-5 days (p<0.02, ANCOVA treatment time interaction, p<0.005). Supplementation did not reduce the days illness among those consuming antioxidants compared to those consuming the placebos. Ferritin not only increases during inflammation, it also is a measure of iron stores. Females had significantly lower levels of iron than the male subjects for each of the iron parameters measured (hemoglobin and hematocrit both p<0.0001, ferritin p<0.001, TIBC p<0.02) excluding serum total iron. The ferritin concentrations measured in the women were indicative of depleted iron stores (<12 ��g/l), and antioxidant supplementation increased hematocrit levels in the female subjects (p<0.05). This investigation indicates that female distance runners need to be aware of an increased susceptibility to iron depletion compared to their male counterparts. Antioxidant supplementation improved hematocrit levels (p<0.05) among female runners and may improve iron status among females with depleted stores. Although other investigations have suggested that antioxidant vitamins decrease exercise induced inflammation, no profound benefit of supplementation was found in this investigation though a response similar to the acute phase response was elicited by the ultramarathon race. Improvements in IL-i and ferritin in response to antioxidant supplementation may indicate that the supplementation was beneficial, but more research is needed to draw definitive conclusions. / Graduation date: 2003