Background: Downhill running involves eccentric contractions of the gluteal, quadriceps, hamstring and calf muscles and the lengthening of muscle fibres as they contract. Several studies have demonstrated that this type of prolonged eccentrically biased exercise induces tissue damage and subsequent enhancement of an inflammatory response. Traumeel® S (Heel GmbH, Baden-Baden, Germany) is a homeopathic-complex used to treat trauma and inflammatory processes that is sold as an over the counter remedy in pharmacies. Although the antiinflammatory and analgesic effects of Traumeel® S have been demonstrated in selected clinical trials as well as in in vitro experimental models, little is known of its scientific mechanisms of action. Aim: The aim of this study was to establish whether administration of Traumeel® S five days before and three days after a 90-minute downhill treadmill run at 75% V02 peak significantly changes systemic markers of the inflammatory response. These are to include blood-borne concentrations of Cortisol and examples of selected T-helperrcell cytokines, T-helper2-cell cytokines, chemokines and pro-inflammatory cytokines during the three days following the 90-minute downhill run. Method: This study was designed as a double-blinded, placebo-controlled clinical trial in which matched subjects were randomised to Traumeel (TRAU) and Placebo (PLAC) pairs and exposed to two 90-minute downhill running trials. Twenty subjects (12 men, 8 women) aged between 20 and 50 years, fully complied with all inclusion criteria set for the study. Following baseline laboratory and field testing, they were matched according to gender, body mass index (BMI), training age, training status, peak running performance and foot-strike patterns and randomized into TRAU and PLAC groups. One Traumeel® S tablet was ingested three times per day for five days prior to and three days following a 90-minute downhill run on a treadmill at a -6% gradient and at a speed eliciting 75% V02 peak on a level gradient. Blood samples were obtained immediately before the 90-minute trial (PRE), immediately after the trial (IPE) and 24 hours (24 PE), 48 hours (48 PE) and 72 hours (72 PE) following the trial. Each subject was also requested to complete a training record prior to the trial and keep a record of the daily symptoms of delayed onset muscle soreness (DOMS) both at rest (general pain) and while walking (daily living). Full blood counts, serum creatine kinase (CK) and Cortisol concentrations were determined using standard haematological laboratory procedures. A sandwich ELISA was used to determine plasma interleukin-6 (IL-6) concentrations. A commercial bead-array kit was used to conduct flow cytometric analysis of Interleukin-8 (IL-8), Interleukin-10 (IL-10), Tumour Necrosis Factor alpha (TNFa), and Interleukin-12p70 (IL-12p70) concentrations. Results: Paired student Mests indicate that the mean ± SEM of the two groups was not significantly different (p < 0.05) in terms of age, BMI, percentage body fat, training age, foot strike patterns, running performance, FVC, FEV1; baseline heart rate and blood pressure, RERmax, V02 peak, VEmax, or training status. Although the TRAU group completed the 90-minute downhill running trial at a significantly faster speed (13.3 ± 2.1 vs. 12.8 ±0.3 km.hr; p = 0.02) and covered a greater distance (20.1 ± 0.3 vs. 19.34 ± 0.4; p = 0.03), mean and maximum heart rate and RPE did not differ between trials in the TRAU and PLAC groups. The downhill running protocol resulted in significant increases in neutrophil counts and creatine kinase, Cortisol, IL-6, IL-8 and IL-10 concentrations in the circulation (n = 20; p < 0.001). When comparing the TRAU (n = 10) and PLAC (n = 10) groups, blood neutrophil counts, creatine kinase, Cortisol, and IL-6 concentrations over the 5 time points and PRE, IPE and 24 PE plasma TNF, IL-8, EL-10 and EL-12p70 concentrations did not differ significantly (p > 0.05). Blood creatine kinase was, however, significantly higher in the TRAU group at 24PE (p < 0.05). The post-trial DOMS scores reported by the TRAU group over the 3-day post-exercise recovery period were also significantly lower in the TRAU group at 24PE (p = 0.03). Conclusion: Despite a faster running speed and higher post trial CK concentration in the TRAU group following the 90-minute downhill run, statistically significant differences in circulating stress hormone, and cytokine concentrations (IL-6, IL-8, IL-10, TNFa and IL-12p70) between the TRAU and PLAC groups, were not identified. Delayed onset muscle soreness was also significantly lower in the TRAU group at 24 hours post trial (p = 0.03). While these findings would support attenuation of the post-exercise inflammatory response by Traumeel® S, further work is required to verify this possibility. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2008.

Introduction: The prevalence of obesity in South Africa and throughout the world is increasing. Obesity is related to hypertension, atherosclerosis, diabetes, dyslipidemia and other sub-clinical conditions. Aim: To establish the prevalence of obesity and related risk factors among nurses in a public health hospital in KwaZulu-Natal. Methods: The design entailed a cross-sectional survey among 250 randomly selected nurses (22-64 years) working in King Edward Hospital (KZN). Obesity was measured using anthropometric and derived parameters of stature, body mass, body mass index (BMI) and waist to hip ratios (WHR). Related risks were determined using a screening questionnaire. Results: The mean body mass and BMI observed was 84.42 ± 17.49 kg and 32.60± 6.34 kg/m2, respectively with 76.10% of the sample being overweight or obese (64.80%; BMI~30). The mean waist circumference (93.01±12.73 cm) fell into the high risk category. A large proportion (30.4%) reported experiencing lower back pain. A significant crude odds ratio (OR) was found between obesity and the risk for lower back pain with an OR of 2.53 (CI 1.12 - 5.71). An increased but insignificant risk was observed in obese individuals for hypertension (OR 1.85: CI 0.63 - 5.40). Stressed individuals (PSS> 13) had an increased but insignificant risk for obesity (OR 1.78: CI 0.70 - 4.50) but a significantly increased risk for lower back pain (OR 8.59: CI 2.00-36.85; p:S0.05). Only 79 of the 250 nurses (31.6%) from our sample reported doing vigorous exercises on a regular basis and the nature of their exercise programs did not protect against the risk of obesity (OR 2.18: CI 1.03-4.60; p:S0.05). Discussion and Conclusion: A high prevalence of obesity and related risk factors among this population of nurses in a public hospital, and potentially in the nursing occupation at large, should be addressed within the context of employee wellbeing. The need for education on appropriate diet and exercise programming in order to prevent hypokinesis and associated diseases of lifestyle is evident. Key words: Nurses, Body Mass Index, Obesity, Low Back Pain, Hypertension, Stress, Hypokinesis / Thesis (M.Sport Sc.)-University of KwaZulu-Natal, Durban, 2010.

Background: The homeopathic preparation, Traumeel S, has been used as a valuable alternative to conventional non-steroidal anti-inflammatory drugs (NSAIDS) for over 30 years. This antihomotoxic, anti-phlogistic drug has been widely used by sportsmen and women in the treatment of lesions and inflammatory processes which result from exercise-induced skeletal muscle microtrauma. Although numerous randomised, double-blind placebo-controlled trials have confirmed the efficacy of Traumeel S as an anti-inflammatory agent, there are few in vivo studies which have specifically investigated the mechanism by which Traumeel S is effective in reducing inflammatory response to exercise-induced muscle cell damage. Aim: To establish whether the administration of Traumeel S during the five days before participation and three days following participation, significantly attenuates the systemic markers of the inflammatory response, following a 90-minute downhill running trial. Method: Twenty-four healthy athletes (14 men and 10 women), aged 20-50 years, were recruited for this study. Following baseline laboratory testing and familiarisation with the treadmill as well as a field test, subjects were matched according to gender, BMI, training age, training status, peak performance and foot strike patterns and randomised into Traumeel (TRS) and Control (PLAC) groups in a placebo-controlled, double-blind design. One Traumeel S or Placebo tablet was ingested three times per day for five days prior to and three days following a 90-minute exercise trial on a downhill (-6% gradient) at 75% V02 max- Blood samples were collected prior to the 90-minute trial (PRE), immediately after the trial (IPE) and 24 hours (24 PE), 48 hours (48 PE) and 72 hours (72 PE) following the trial. Each subject was also requested to complete a training record prior to the trial and keep a record of the daily symptoms of delayed onset muscle soreness (DOMS) both at rest (general pain) and during walking (daily living). Full blood counts (FBC), serum creatine kinase (CK), lactate dehydrogenase (LDH) and Cortisol concentrations were measured using standard haematological laboratory procedures and serum C-Reactive Protein (CRP) was determined by immunoturbidimetric assay. Sandwich ELISA's were used to determine myeloperoxidase (MPO) and plasma interleukin-6 (IL-6) concentrations. All results obtained were adjusted for changes in plasma volume as calculated from the red blood cell indices. Results: Mean ± SD characteristics of the gender-matched subjects in the experimental (TRS) and placebo-control (PLAC) groups did not differ significantly in terms of BMI, age, % body fat, FVC, FEVi, training age and status, foot strike pattern or peak running performance, maximal Heart Rate, VE, V02peak> RER, RPE during the maximal exercise test (p > 0.05). This indicated that the randomised pairs were well matched. The 90-minute downhill running protocol resulted in significant elevations in total circulating white blood cell count (WBC), neutrophil, CK, LDH, Cortisol, CPR, MPO and IL-6 concentrations (p < 0.001). When comparing the TRS and PLAC groups, mean ± SD total and differential WBC count, neutrophil count, CK, LDH, Cortisol, CPR, MPO and IL-6 concentrations did not differ (p > 0.05) over the 5 time points. At 24 PE, MPO concentrations were significantly higher in the TRS group than in the PLAC group (p = 0.03). The lower mean ± SD post-trial DOMS scores reported by the TRS group were not significantly different from those reported by the PLAC group (p > 0.05). Conclusion: Although the findings of this study did not identify differences in circulating CK, LDH, Cortisol, CPR and IL-6 concentrations between the TRS and PLAC groups, the elevated MPO concentration at 24 PE did provide preliminary novel evidence of enhanced activation of neutrophil oxidative burst activity following exercise-induced muscle damage which is hypothesized to accelerate the recovery process. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2008.

Introduction The physiological effects of single and multiday road running races have been studied extensively and include the occurrence of rhabdomyolysis, reflected by significantly increased urinary myoglobin (uMb), as well as increased concentrations of serum creatine phosphokinase (CPK), high sensitivity C-reactive protein (hsCRP), cortisol and cardiac troponin-T (cTnT), dehydration and compromised renal function. Furthermore, in hyperthermic athletes, a positive relationship has been noted between hyperthermia, muscle damage, dehydration and pacing. The physiological effects of a multiday trail run of similar duration to single day road races, however, are unknown. The side-effects of the use of statin medication for hypercholesterolaemia include muscle fatigue, cramping and increased muscle damage. These have been found to be aggravated in endurance athletes and it has been reported that females, especially when being medicated from a young age, are more susceptible to these side-effects. Objectives 1. To investigate the effect of a three-day trail run on systemic and urinary markers of muscle damage and inflammation in recreational runners and to establish the association of dehydration and hyperthermia with these markers. 2. To observe the effect of the three day trail run on systemic and urinary markers of muscle damage and inflammation on an additional hypercholesterolaemic female athlete using statin medication in combination with a lipid uptake inhibitor. Method Firstly, an observational cohort study was conducted on 19 recreational male (n=6) and female (n=13) athletes during a 95km trail run over three days. Pre-and post-stage and 24 and 72 h post-race concentrations of serum CPK, hsCRP, cortisol, cTnT, and osmolality (sOsm) as well as uMb, changes in body mass, delayed onset muscle soreness (DOMS) and thigh circumference (TC) were measured. Continuous recordings of heart rate (HR) and intestinal temperature (Tintest ) were made throughout each stage. In addition, a case report is included on one trained female endurance athlete currently being treated for familial hypercholesterolaemia with 20 mg Aspavor and 10 mg Ezetrol daily and not included in the above cohort, to investigate the degree of muscle damage and inflammation she experienced as a result of participation in the three-day event. Results: Heart rate ranged between 77 and 83% age-predicted-maximum (APmax) and Tintest between 36.1 and 40.2 ºC during the three stages. Significant rises in mean serum CPK, hsCRP, sOsm and blood neutrophil count reached peak concentrations of 1 488U/L, 8.91mg/l, 298mosm/L and 10.21 10^9/L (p≤0.001), respectively. No evidence of elevations in uMb and cTnT were detected. The stage-induced increments in DOMS correlated positively with CPK, r=0.71; 95% CI [0.62, 0.78]. TC decreased significantly post S1post and S2post (p≤0.05) and a maximum mean body mass loss of 3.09% (±1.04%) occurred during S2. There was no significant difference between nonsteroidal anti-inflammatory drug (NSAID) users and non-users in terms of serum CPK, hsCRP, cortisol, post race DOMS scores, running times, TC or sOsm (p>0.05). The post-pre change in sOsm during each stage correlated inversely with the changes in % body mass, r = -0.36, 95% CI [-0.57,-0.094] and the pooled data examining the relationship between the change of sOsm and change in serum CPK for the three stages (n=57), revealed an insignificant positive correlation (r= 0.034, 95% CI [-0.228, 0.291]. The maximum Tintest ranged between 38.3 º C and 40.2 º C and only exceeded 40º C in two of the 12 athletes monitored. The relationship between the change in Tintest and serum CPK was insignificant (p>0.05) for the 11 individuals from whom complete sets of data were available (r= 0.24, 95% CI [-0.42, 0.734]. In the hypercholesterolaemic athlete, the maximum serum CPK (665U/L), hsCRP (1.9mg/Ll) and cortisol (845nmol/L) concentrations corresponded with undetected uMb despite a maximum body mass loss of 4.5% Conclusion: Three consecutive days of 95km trail running resulted in low markers of muscle damage and inflammation, when compared to results obtained in previous single day road races of similar duration despite the maintenance of a heart rate above 77% APmax, Tintest rising above 39o C and mean body mass decrement of >2.0%. The unchanged concentrations of serum cTnT and uMb confirmed the low values of the markers of muscle damage and inflammation. An insignificant positive correlation between muscle damage and dehydration was noted. Furthermore the daily use of 0.4 mg/kg Atorvastatin in combination with 10mg Ezetrol did not result in the subject experiencing subjective myalgia, cramps, fatigue or increased markers of muscle damage following her participation in the trail run. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2012.

Introduction: Respiratory tract symptoms (RTS), common in athletes during heavy training and after events, result in impaired readiness for events and race times. Since the 1980’s exercise immunologists have investigated the aetiological factors surrounding the development of exercise induced RTS in order to develop effective preventative strategies. A number of theories have been put forward and explored, such as increased susceptibility to infection, ‘run-away’ inflammatory response and reactivation of prior viral infection. It has been suggested that the mechanisms producing exercise induced inflammation could potentiate allergic responses in sensitized individuals and recently allergic response has been proposed as a potential contributor to exercise induced RTS. Certainly allergic reactions can produce a range of respiratory symptoms; however the relationship between allergic sensitization, allergic reaction and the incidence of post-exercise RTS has not been well defined. Objectives: The primary objective of this study was to document the incidence of RTS for two weeks before and two weeks after a three-day trail run and relate these to the general systemic and salivary immunological profile as well as atopic status of the participants. The secondary objective was to validate the use of the Phadiatop® assay as a predictor of allergy-associated post-race RTS in trail runners. Study Design and Methods: The study formed part of a larger, descriptive field study examining the physiological responses of trail runners during the Three Cranes Challenge, a multi-day 95 km event divided into three stages, in Karkloof, KwaZulu-Natal. Outcome measures examined included self- reported RTS over a 31 day period (pre, during and post race), as well as pre-race Phadiatop® status, salivary IgA (sIgA) concentrations and changes in concentrations of serum IgE (sIgE), cortisol, high sensitivity C-Reactive Protein (hs-CRP) and differential leukocyte counts. The haematological and salivary parameters were obtained at 8 time points before, during and after the event. A convenience sample of 22 individuals was used and two separate analyses were conducted on the data. The inclusion criteria of the first analysis were met by 14 participants. In this analysis, the incidence of RTS was related to each participant’s general immunological profile. Sixteen of the subjects met the inclusion criteria for the second analysis, in which their Phadiatop® status was related to their sIgE and blood eosinophil and basophil concentrations in order to establish the validity of the Phadiatop® assay in predicting the development of allergy–associated postexercise RTS in trail runners. Results: In the first analysis, 78.6 % (n=11) of subjects met the criteria for positive diagnosis of upper respiratory symptoms (URS) during the two week post-race period. In four subjects (36.4 %), URS appeared to be of inflammatory origin, but these were not linked to systemic markers of an allergic response. Of the URS positive subjects, six (54.5 %) presented with markers of infection, three (27.3 %) with markers of a de novo infection and three (27.3%) with a profile suggestive of reactivation of previous infection. Of those presenting with markers of infection 66.7 % (n=4) had concomitantly elevated levels of IgE suggestive of allergic response. There was, however, no evidence of isolated allergic reaction independent of other causes amongst the symptomatic subjects. In the second analysis, 75% (n=12) of runners presented with post-race RTS and seven of these were Phadiatop® positive. In four of the Phadiatop® positive RTS subjects, symptoms appeared to be of allergic origin. Although total IgE concentrations were significantly higher (p< 0.01) in Phadiatop® positive group, there was no significant difference between the eosinophil and basophil concentrations or post-race RTS of the positive and negative groups (p>0.05). Of the four subjects who did not develop RTS, three were Phadiatop® positive. Conclusion: Respiratory tract symptoms in trail runners have a multi-factorial aetiology. A link between concurrent markers of an allergic response and infection is common in symptomatic trail runners. The Phadiatop® assay does not accurately predict the incidence of allergic postexercise RTS in trail runners. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Westville, 2012.

The heart rate achieved with maximal upper limb exercise is quoted as being on average thirteen beats per minute lower than when performing maximal leg exercise. Many canoeists use heart rate monitors during training and seek advice on setting their heart rate training zones. Existing guidelines are based on lower limb-derived heart rates, which may not be appropriate. As canoeists use predominantly their upper limbs during canoeing, it was hypothesized that as their upper limbs are trained, they may achieve heart rates and oxygen consumption similar to those achieved with lower limb exercise. The purpose of this investigation was to compare the relationship between heart rate and oxygen consumption when exercising on either a kayak ergometer or treadmill. Fifteen volunteer canoeists, who compete regularly, were recruited by convenience, purposive sampling and randomly allocated to a V02max test using open circuit spirometry, on either a kayak ergometer or treadmill. They returned within 5 to 7 days for a V02max test on the other apparatus. Their heart rates were also measured during these activities. The heart rate oxygen consumption relationship for upper and lower limb exercise was then analysed. Maximum heart rate was on average only 6 beats per minute lower with upper limb exercise, with some subjects achieving the same or very similar HRmax; the median difference in heart rate maximum was only 4 beats per minute. Although the response of heart rate and oxygen consumption to kayaking and running was similar at any given workload, the heart rate on the kayak was about 8 beats per minute higher at any submaximal workload. V02max. on the kayak was lower than on the treadmill. At any metabolic equivalent, the tidal volume was lower on the kayak and there was a lower respiratory rate on the treadmill. At any tidal volume, the metabolic equivalent was lower on the kayak ergometer. The minute volume on the kayak was higher than on the treadmill, for all but the highest intensities of exercise. Using the leg heart rate max to determine the training zones, a slightly higher (negligible) percentage of arm V0max is achieved at any given percentage heart rate. Kayakers who train regularly, appear to be able to attain similar maximum heart rates with upper and lower limb exercise, but a lower V02max when exercising with their arms. The heart rate oxygen consumption response is the same for upper and lower body exercise; and a reduced HRmax and increased heart rate at any sub maximal workload do not appear to apply to canoeists. It is therefore concluded that heart rate training zones based on leg HRmax are suitable for kayak training. This study has helped distinguish the difference between the heart rates of the upper and lower limbs at any given oxygen consumption in canoeists. The benefits of performing this study have also been to provide better advice to canoeists on how to train using heart rate monitors. / Thesis (M.Med.Sc.)-University of Natal, Durban, 2003.

Post exercise lymphocytopenia is a well documented phenomenon. Studies have reported exercise induced DNA damage in leucocytes and have postulated a possible link to apoptosis. Five subjects of differing fitness levels underwent a ramped treadmill test to exhaustion. Venous sampling was undertaken before, immediately post exercise, and 24 and 48 hours after exercise. Single cell gel electrophoresis showed evidence of single strand DNA breaks (as evidenced by an increase in tail moment measurements using the comet assay) in 100% oflymphocytes immediately after exercise, and in the 24 hour and 48 hour post exercise samples. Flowcytometric analysis oflymphocytes revealed a minimal amount of both apoptosis and necrosis at all time intervals. Lymphocyte apoptosis has again been demonstrated after exercise, however the percentage of apoptosis was a maximum of 4.8% at 24 hours. These findings may in part account for the exercise induced lymphocytopenia and reduced immunity demonstrated by numerous previous other studies. / Thesis (M.Med.Sc.)-University of Natal, Durban, 2001.

Apoptosis (programmed cell death) and exercise immunology have been the focus of research for the past five years. Trained athletes are particularly susceptible to a wide variety of viral and bacterial infections and this has been related to oxidative damage which is a mediator of apoptosis. Apoptosis, a normal physiological mechanism has also been implicated in the pathogenesis of a wide-variety of diseases. To date, the link between apoptosis and exercise has not been shown by established methods or ultrastructurally. The objective of the study was t.o determine the effects of a single bout of high intensity exercise on lymphocyte DNA and antioxidant status in trained athletes. The study was carried out in two phases. In the first phase, 11 trained athletes were subjected to a treadmill run to exhaustion using a ramp protocol to determine their maximum oxygen uptake (V02 max). Fifteen millimetres of blood was collected before exercise, immediately after exercise, 24 hours and 48 hours after exercise. Whole blood (4 ul) was used in the determination of DNA damage in lymphocytes using the single cell gel electrophoresis (SCGE) assay. The remaining blood was centrifuged and used for the following: Vitamin C concentration was determined by the 2,4 dinitrophenylhydrazine method, vitamin E concentration was determined by the High Pressure Liquid Chromatography (HPLC) method and lipid peroxides were determined by the measurement ofhydroperoxides. In the second phase, 3 trained athletes who had participated in phase 1, were subjected to a V02 max. test. Blood samples (10 ml) were collected before and immediately after exercise, 24 hours and 48 hours later. Lymphocytes were isolated using Histopaque 1077. An in situ cell death detection kit, Fluorescein was used for the detection and quantification of apoptosis in lymphocytes at a single cell level, based on labelling of DNA strand breaks. Analysis was carried out using flow cytometry. Lymphocytes were also prepared for Transmission Electron Microscopy (TEM) using conventional techniques. The results showed that immediately after exercise there was a non-significant decrease in vitamin C concentrations (p=o, 16), and a non-significant increase in vitamin E (p=0,82) and lipid peroxide concentrations (p=0,21). There was no significant difference in all 3 levels over the 48 hour period, when compared to the pre-exercise values. The SCGE assay revealed that the immediate post exercise samples showed DNA damage in lymphocytes of all subjects as evidenced by fluorescent strands of DNA outside the cell while DNA damage was observed in only one subsequent sample. In the pre-exercise samples, DNA was visualised as a central core, whereas in all samples taken after exercise, DNA was located at the periphery or confined to one pole of the cell. The pattern of DNA distribution seen in the SCGE assay over the 48 hour period were characteristic features of apoptosis. Flow cytometric analysis showed an increase in apoptosis in lymphocytes immediately after exercise with a further increase after 24 hours. After 48 hours the numbers decreased to control levels. TEM showed that majority of cells were normal before exercise while other lymphocytes were smaller with indented nuclei. Immediately after exercise the lymphocytes displayed features of indented nuclei and microsegregation, cell shrinkage, swelling of the endoplasmic reticulum, mitochondria and Golgi. These changes persisted after 24 hours but were not observed after 48 hours when most of the cells showed normal morphology. The ultrastructural changes observed were also characteristic features of apoptosis. These results suggest that high intensity exercise may cause an increase in apoptosis as evidenced by DNA damage in the SCGE assay and fully supported by the results achieved during flow cytometry and by the ultrastructural changes observed. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1998.