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pulsepulse

Summ

er 2002 Vol. 15 No.1

SM

CA

B

oard of D

irectorsP

residentW

ill McM

illan, BPE, CAT(c)

Past P

residentTim

Takahashi, M Kin, C

AT (c), RK, C

SCS

Vice P

residentD

r. Joel Weaver M

D, C

CFP, C

ASM

TreasurerD

arren Turchansky, CA

SecretaryKoralee Sam

aroden, BPE, PFLC

ASSM

Rep.

Dr. Joel W

eaver MD

, CC

FP, CASM

SPD

Rep.

Martin Trudel, BSc.PT

AA

TAR

ep.Sylvia C

iurysek, BPE, CAT (c)

SSAA

Rep.

Dr. Tish D

oyle-Baker, PH, M

A, BSc

SM

CA

staffE

xecutive Director

Ryan Petersen, BPE

Dir. of P

rograms and Tech Services

Kristine Godziuk, M

A

Special Projects C

oordinatorJennifer H

anon

Accounts

Janice Peters, BCom

(Hons)

Special Projects A

ssistantJana M

cCubbin

Pulse is published three times a year by the Sport

Medicine C

ouncil of Alberta. Our address is:

11759 - Groat Rd.

Edmonton, Alberta, C

anadaT5M

3K6Phone: (780) 415-0812Fax: (780) 422-3093

Website:

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w.sportm

edicinecouncilofalberta.caEm

ail:sm

ca@sportm

edicinecouncilofalberta.ca

Contents copyright 2002 by the SM

CA

. Articles m

ay not be reprint-ed w

ithout permission. T

he opinions expressed herein are those ofthe respective authors and not necessarily those of the SM

CA

.ISSN

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STU

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International: $41.99 Cdn.

Send subscription requests and changes via email to:

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We gratefully acknow

ledge the financial support of Alberta

Com

munity D

evelopment and the A

lberta Sport, Recreation, Parks

and Wildlife Foundation, tow

ard our editorial costs.

I am stepping into the role of President of

the SMC

A on the heels of a job very w

elldone by the Past President, T

im T

akahashi.T

here are many projects on the go, such as

the Japan Exchange and the w

ork beingdone by the C

urriculum C

omm

ittee, that Ilook forw

ard to helping lead to a successfulfinish.

As w

ell, there are future projects that will

come to the SM

CA

by way of our m

ember-

ship or our Executive D

irector or outsidesources that w

ill help the SMC

A continue to

promote safe, active living in A

lberta.I w

ould like to welcom

e Dr. Joel W

eaverto the E

xecutive as the Vice President,

Darren T

urchansky, CA

, as the Treasurer,

and Koralee Sam

aroden as the Secretary.I can be contacted through the office of

the SMC

A in E

dmonton. T

hank you foryour support of the SM

CA

.

Sin

cere

ly,W

ill McM

illan

, CA

T(C)

SM

CA

Pre

side

nt

The Sport M

edicine Council of A

lberta(SM

CA

) would like to w

elcome Jana M

cCubbin

as our Special Projects Assistant.

She completed high school in Prince G

eorge,B

C and m

oved to Edm

onton, AB

in 1998 to go tothe U

niversity of Alberta. Jana is currently com

-pleting her B

achelor of Science in Kinesiology.

Jana plays div.1 soccer for the Phoenix FCteam

. She is an asset to her soccer team as she is

here at the council. Jana’s duties and responsibilities are being

involved in SMC

A’s H

eads Up program

, upgrad-ing our physician and therapist kits, m

arketing,high school equivalencies, and organizing all ourSM

CA

courses. Please help us w

elcome Jana to our staff by

giving her a call and setting up a time to discuss

your programm

ing needs. She can be reached bycalling the SM

CA

office at (780) 415-0812 orem

ail her at jm@

sportmedicinecouncilofalberta.ca.

Message from

the President

New

additionto SM

CA

teamJana M

cCu

bb

in

The S

po

rt Med

icine C

ou

ncil o

f Alb

erta than

ks the

follo

win

g organ

ization

s for th

eir sup

po

rt of o

ur

pro

grams an

d services:

15S

MC

A P

uls

esum

mer 2

002

diabetics must also be under good m

etabolic control beforebeginning or changing a physical activity program

. Some

type II diabetics are on glucose lowering m

edications andthis m

ust be taken into account when planning a program

.A

s always, it is critical that type II diabetics have m

edicaldoctor’s perm

ission to start or change an exercise programespecially since type II diabetics tend to be older and have ahigh incidence of coronary heart disease.

Su

mm

aryT

ype I and II diabetes mellitus is a prevalent disease in

our society but it does not preclude an individual from per-

forming physical activity. R

egular physical activity can bedone safely provided proper guidelines and m

onitoring arefollow

ed. In fact, regular physical activity can provide sig-nificant health benefits to som

eone with D

M that can

improve their quality of life, prolong their lifespan and

reduce the serious health complications that often accom

pa-ny D

M.

Reso

urces:

Handbook for C

anada’s Physical Activity G

uide to Healthy A

ctiveLiving. H

ealth Canada, O

ttawa, O

ntario, K1A

0K9.

ww

w.paguide.com

, 1-888-334-9769.C

anada’s Physical Activity G

uide to Healthy A

ctive Living forO

lder Adults. H

ealth Canada, O

ttawa, O

ntario, K1A

0K9.

ww

w.paguide.com

, 1-888-334-9769.The Fitness Book for People w

ith Diabetes. A

merican D

iabetesA

ssociation.1660 Duke St., A

lexandria, Virginia, 22314, 1994.

101 Tips for Staying Healthy w

ith Diabetes (&

Avoiding

Com

plications). Am

erican Diabetes A

ssociation.1660 Duke St.,

Alexandria, V

irginia, 22314, 1999. D

iabetes Your Com

plete Exercise Guide. The C

ooper Clinic and

Research Institute Fitness Series. N

eil F. Gordon. H

uman

Kinetics Publishers, 475 D

evonshire Road, U

nit 100, Windsor,

Ont., 1993.

The Health Professional’s G

uide to Diabetes and Exercise.

Am

erican Diabetes A

ssociation.1660 Duke St., A

lexandria,V

irginia, 22314, 1995. Exercise in the C

linical Managem

ent of Diabetes. B.N

.C

ampaigne and R

.M. Lam

pman, H

uman K

inetics Publishers, 475D

evonshire Road, U

nit 100, Windsor, O

nt., 1994.Tow

ard Active Living. H

.A. Q

uinney, L. Gauvin, A

.E. Ted Wall.

Hum

an Kinetics Publishers, 475 D

evonshire Road, U

nit 100,W

indsor, Ont., 1994.

1998 Clinical Practice G

uidelines for the Managem

ent ofD

iabetes in Canada. C

anadian Medical A

ssociation Journal,159(8 Suppl.): S1-S29, 1998.Exercise and the Treatm

ent of Type 2 Diabetes M

ellitus. J. G.

Eriksson. Sports Medicine, 27(6): 381-391.

Theme Issue: Physical A

ctivity Interventions. S.N. Blair, J.R

.M

orrow. A

merican Journal of Preventive M

edicine, 15(4): 255-437, 1998).The D

iabetic Athlete. Sheri C

olberg, Ph.D. H

uman K

ineticsPublishers, 475 D

evonshire Road, U

nit 100, Windsor, O

nt., 2000.The R

ecomm

ended Quantity and Q

uality of Exercise forD

eveloping and Maintaining C

ardiorespiratoryand M

uscular Fitness, and Flexibility in Healthy

Adults. M

edicine and Science in Sports andExercise, 30(6): 975-991, 1998.

Web Sites:

ww

w.diabetes.org A

merican D

iabetesA

ssociation.w

ww

.paguide.com C

anada’s Physical Activity

Guide.

ww

w.diabetes.ca C

anadian Diabetes

Association.

ww

w.gssiw

eb.com G

atorade Sports ScienceInstitute.w

ww

.cflri.ca Canadian Fitness and Lifestyle

Research Institute.

ww

w.csep.ca C

anadian Society for ExercisePhysiology. The H

ealth vs. Fitness Benefitschart is on this site.w

ww

.afn.ca Assem

bly of First Nations w

ebsite w

ith a variety of health information.

Reprinted w

ith permission from

theU

niversity of Alberta Provincial Fitness

Unit’s “Fitness Inform

er.”

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14S

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A P

uls

esum

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002

overloads after a period of 3 to 4 weeks at each stage to allow

forphysiological adaptations to develop. T

his will also allow

time to

adjust nutrition and insulin practices to maintain good m

etabolic con-trol before, during and after a physical activity. C

ontinue until thedesired health or fitness response is obtained and be sure to includeproper w

arm-ups and cool-dow

nsas w

ell as stretching with all pro-

grams.

Physical activity programs for

type I diabetics are not without

their risks. The tim

e of day that atype I diabetic exercises is anim

portant consideration.Perform

ing physical activity inthe evening is not recom

mended

because of the potential occur-rence of hypoglycem

ia that couldoccur w

hile sleeping due to theelevation in post exercise m

eta-bolic rate for several hours aftercertain types of physical activi-ties. A

s well, the type I diabetic

should avoid exercising duringthe peak action of the type ofinsulin that they are taking. Atype I diabetic should also avoidinjecting insulin in a body sitenear the exercising m

uscle.Furtherm

ore, very high intensityexercise and heavy w

eight train-ing are often not recom

mended

due to the risk of vascular dam-

age especially in long term type I

diabetics that may have vascular com

plications such as retinopathy(dam

age to the blood vessels of the eye), neuropathy (disease ofperipheral nerves) or hypertension. A

lso, physical activity involvingeccentric (lengthening) m

uscle contractions such as unaccustomed

exercise, downhill w

alking/jogging or heavy strength training may

cause a disruption of muscle m

embranes that m

ay impair glucose

uptake. Type I diabetics should alw

ays carry insulin, a source of glu-cose and a w

ater bottle during and after physical activity.

Ph

ysical Activity P

rescriptio

n

for Typ

e II Diab

etics.Physical activity should be a prim

ary therapy of individuals with

type II DM

as it plays a major role in glycem

ic control in these indi-viduals. O

ver 80 % of type II diabetics at tim

e of diagnosis are inac-tive and overw

eight. In fact, these two factors alone are strong pre-

dictors for the development of type II diabetes. Furtherm

ore, many

type II diabetics can manage their blood glucose w

ith good nutritionand physical activity practicesproving that lifestyle factors play alarge role in type II D

M. A

s statedbefore, any physical activity pro-gram

should follow the established

training principles. Since many

type II diabetics are overweight

and inactive, beginning a lifestyletype physical activity programsuch as outlined in the C

anadianPhysical A

ctivity Guide (C

PAG

) isa great starting point. T

his type ofprogram

recomm

ends performing

a variety of physical activities inshort blocks of tim

e (10 to 15 min-

utes) at a low to m

oderate intensityso that an accum

ulation of 60 min-

utes of activities are achieved on adaily basis. T

he physical activitiesshould involve com

ponents ofstretching, aerobic endurance andm

uscular strength and endurance.In fact, the C

PAG

is a great pre-scription for anyone w

ith any typeof diabetes. T

his is because thereis m

uch lower risk of developing

hypoglycemia w

ith short exercisebouts spread throughout the day and there is also a low

er risk ofhyperglycem

ia since the intensity prescription is low to m

oderate. Italso requires less stressful nutritional and m

edication (insulin) plan-ning w

ith the short (10 to 15 minute) activity bouts.

Similar risks of participating in physical activity program

s as out-lined for type I diabetics also exist w

ith type II diabetics. Type II

From page 13

Diabetes

Test your knowledge

True o

r False?1. Type II diabetics m

ay require insulin injections to assist with

controlling blood glucose.2 Type I diabetes is only diagnosed only at a young age.3 H

ypoglycemia refers to a low

er that normal blood glucose

level.4 Physical activity only produces a decrease in blood glucoselevels.5 A

ll type I diabetics are insulin dependent.6 M

ost forms of physical activity can be perform

ed safely intype I and II diabetics provided proper guidelines are follow

ed. 7 The tim

e of day is an important consideration w

hen prescrib-ing physical activity to som

eone with diabetes.

8 High intensity and volum

es of exercise or heavy resistancetraining is not recom

mended for any diabetic especially if any

complications are apparent.

9 Physical activity can be safely performed in a type I diabetic

during the time w

hen insulin injection is at its peak response.10 M

ost individuals with diabetes m

ellitus improve their

glycemic control.

Answ

ers1T, 2F, 3T, 4F ,5T, 6T, 7T, 8T, 9F, 10T

SM

CA

M

EM

BE

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AP

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IC

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OR

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ail:smca@

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By: D

r. P.K. D

oyle-Baker/ C

linical ExercisePhysiologist and A

ssociate Professor, U of C

algary

The w

omen’s ice hockey program

is the fastestgrow

ing segment of C

anadian hockey mem

bershipin C

anada. An International Ice H

ockey Federationsurvey published in 1996 show

ed that between 1988-89

and 1994-95 wom

en’s hockey experienced an overallgrow

th rate of 265 percent (1). In recognition of this trend,w

omen’s ice hockey becam

e a medal event for the first tim

ein the 1998 W

inter Olym

pics (2). How

ever, with this

increased participation comes an increase in sports related

injuries. W

e can be certain that injuries and injury patterns occur infem

ale hockey, however w

e have no indication if these injurypatterns or rates of injury are identical in m

ale and female

players because of the lack of published data available. When

we review

ed the literature in 1995 we did not find any pub-

lished studies on female ice hockey injuries and since then at

least three have been completed (3,4,5).

We need to m

indful that there are a number of differences

between the tw

o games, i.e. m

ale and female, that m

ay contributeto different types of injuries. T

hese include: rules (e.g. female

hockey has a no intentional contact rule; mandatory full face m

askrule), level and intensity of gam

es played, duration of the periods(e.g. som

e females play three, 10 m

inute periods), and type of equip-m

ent (e.g. only recently has equipment been specifically designed for

females).

Another one of the differences betw

een male and fem

ale hockeyinjuries that hasn’t been studied m

ay lie in the psychology or thesociology of the participating athlete. For exam

ple, a gender attributem

ight be the way young girls are socialized to avoid overt com

peti-tion (6). A

n in-depth profile, however, by T

heberge in 1997 demon-

strates that competitive senior fem

ale teams portray the im

age thatfem

ales like competition (7). T

eam m

embers w

ere described as con-veying a sense of initiative, or being pow

erful, and fearless.T

heberge (1997) quotes one female athlete as saying “I w

ill never letanother person physically overpow

er me.”

Recently, D

ryden et al. (2000) published a study on personal riskfactors (8). Players w

ere asked to assess on a 10 point scale, howm

uch the possibility of getting injured acted as a barrier to continu-ing to play. E

ighty percent of the players rated injuries either as nobarrier or a low

barrier (0-3 on the scale), while 19.7 %

rankedinjuries as a m

oderate to high barrier (4-10). It may be that fem

ale

athletes treat their injuries differently than their male

counterparts; they rationalize that seriousness of the injury is notenough to prevent them

from playing.

It is my experience from

working w

ith the wom

en’s national teamfor a few

years that female players often shrug off their injuries.

Theberge (1997) states that fem

ale athletes normalize the presence of

pain in their lives through strategies of denial and ‘disrespect’ orindignation tow

ard painful injuries. Frequent bruises, sore joints,m

uscle pulls, foot problems, and cuts are referred to as “m

inor stuff”and “you just w

arm up and play.” T

hese types of injuries are regard-ed as som

ething that “just happens” in hockey and should not affectyour gam

e. For example, in 1997 during a training cam

p before theT

hree Nations C

up, it was discovered that a player had a broken

wrist. She apparently had broken it three w

eeks prior to camp, but

she didn’t identify the pain with the severity of the injury.

In 1997, we prospectively, investigated the incidence, nature, and

causes of female ice hockey injuries in the province of A

lberta dur-ing a four-m

onth period of the hockey season. We w

ere able toaccess 30 players, w

ith an age range of 15-30 years from the follow

-

Crash course

Crash course

3S

MC

A P

uls

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002

Continued on page 4

Profiling injury rates in female hockey

Profiling injury rates in female hockey

ing participating teams: A

lberta Wom

en’s AA

A M

idget hockeyleague, A

lberta Senior Wom

en’s League, C

IAU

, and the Olym

picO

val High Perform

ance program. Som

e of these teams had m

embers

of the 1998 Olym

pic team participating.A

ssessment of the player’s

risk factors was by w

ay of a Female H

ealth Hockey Q

uestionnairethat w

as voluntarily completed at the start of the season.

Docum

entation of injuries by team occurred through the T

herapist(C

AT

A) or Physician.

The injury report form

used, was a m

odified version of theC

anadian Intercollegiate SportsInjury R

egistry (CISIR

) (9).Investigated V

ariables of theInjury R

egistry are listed inT

able 1. A reportable injury

was any brain concussion caus-

ing cessation of the athlete’sparticipation for physicalobservation before return toplay, dental injury requiringprofessional attention,injury/illness causing cessationof an athlete’s custom

ary par-ticipation throughout the partic-ipation day, follow

ing day ofonset, or injury/illness requir-ing substantive professionalattention before the athlete’sreturn to participation (10).

We assessed three out-

comes. 1) E

xposure rate, was defined as the num

ber of hours of playin practice and in a gam

e. 2) Injury rate was expressed in person-

units using 1000 player-games and 1000 player-practice hours to

determine the injury incidence during gam

es and practices by posi-tion. 3) Frequency rate w

as expressed using descriptive statistics tom

easure the variables identified in Table 1.

A total of 595 full participation hours w

ere recorded for 30 ath-letes during a 4 m

onth. Seventy-six player-hours were lost due to

injury of which 16.5%

resulted in players participating in less than50%

of the scheduled practice or game. T

he incidence rate of missed

participation due to injury was 20.4%

. Of the injuries, 29.2%

were

due to illegal play and 58.3% resulted in players not returning to play

for at least one practice or game.

Overall, the low

er extremity w

as the injury site most often report-

ed and similar to D

ryden et al (1998) study of female recreational

players; sprain or strain was the m

ost comm

on diagnosis. The overall

distribution was: 5 knee, 3 concussions, 2 thighs, 2 shoulders, and 2

necks. W

e were not able to identify any trends related to the type of

injury sustained, player position or zone where injury occurred on

the ice (9). How

ever, many of injuries w

ere due to: 1) player to play-er contact either in a gam

e or practice and 2) player implem

ent con-tact from

the puck, net, or board. Less than one-third of the injuries

were due to illegal play suggesting that the contact w

as not intention-al. In sum

mary, injuries in

female hockey do occur w

hichm

ay result in missing m

ore thanone participation. T

his can beexpected since the gam

e offem

ale ice hockey is played at ahigh speed and players w

illundoubtedly m

ake contact with

one another. 0verall the inci-dence rate of injury is very low(4) and therefore suggests thatthe gam

e of female ice hockey

is a safe sport for females to

play at the intermediate to elite

level (8). How

ever, as more and

more fem

ales play the game the

incidence and severity of injurym

ay change, therefore ongoingresearch w

ill be required toidentify areas to focus on for injury prevention

Referen

cesA

very, J. & Stevens, J. (1997). Too M

any Men O

n The Ice. PolestarB

ook Publishers, BC

. Pp. 19.

Longman J. (1997, A

pr. 7). Wom

en’s hockey: no fights, justskating. N

ew York Tim

es:A1.

Brust JD

, Leonard BJ, Pheley A

, et al. (1992). Children’s ice

hockey injuries. Am

J Dis C

hild:146(6):741-7.

Dryden, D

. M., Francescutti, L. H

., Row

e, B. H

., Spence, J. C.,

& Voaklander, D

C. (2000b). Epidem

iology of wom

en’s recre-ational ice hockey injuries. M

edicine and Science in Sportsand Exercise, 32, 1378-1383.

Doyle-B

aker, PK., Fagan, C

D. &

Meeuw

isse, WH

. (1999,June). Investigation A

nd Analysis O

f Female Ice H

ockeyInjuries. M

edicine & Science In Sports &

Exercise, 31:5S,309.

William

s, M. (1995). W

omen’s hockey: heating up the equity

debate. Canadian W

omen’s Studies, 15(4):78-81

Theberge, N. (1997). It’s part of the gam

e: physicality andthe production of gender in w

omen’s hockey. G

ender andSociety, 11: 69-87.

Dryden, D

. M., Francescutti, L. H

., Row

e, B. H

., Spence, J. C.,

& Voaklander, D

C. (2000a). Personal risk factors associated

with injury am

ong female recreational ice hockey players.

Journal of Science and Medicine in Sport, 3 (2): 140-149.

Meeuw

isse, WH

. (1994). Devlopm

ent, implem

entation andvalidation of the C

anadian Intercollegiate Sports InjuryR

egistry. PhD D

issertation, University of C

algary.

Pelletier, R.L., M

ontelpare, W.J. &

Stark, R.M

. (1993).Intercollegiate ice hockey injuries. A

merican Journal of

Sports Medicine, 21(1): 78-81.

4S

MC

A P

uls

esum

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002

CoronationPhysiotherapy

•Authorized providers

ofWCB and CRP

• CARF accredited• Open Saturday

Leig

h G

arv

ie,

MSc.PT,BSc.(PT),Dip (Level III) Sport Physical Therapist,

Part A Manual Therapist

•Served on the SMCA board ofdirectors for 10 years

• Past president ofthe SMCA

• 7-time m

ember ofCanadian Olym

pic and Pan Am m

edical teams

Acupuncture • M

assage Therapy • Manual Therapy •

Exercise P

rograms • TM

J Disorders

#142 - 1

4315 - 1

18 A

ve.E

dm

onto

nP

hone:(7

80) 4

51-6

263

Fax:(7

80) 4

51-6

264

Treatment for orthopedics, m

otor-vehicle and sports-related injuries

Caro

lyn W

oute

rs,

BSc.(PT) Medical Acupuncture

Anil B

ham

bhani,

BSc,BSc.(PT) Acupuncture Student

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e L

eung,

BSc.(PT),Acupuncture Student

Ric

k F

earo

n,

RMT

Bob R

eid

,RM

T

Injury rates in w

omen’s hockey

From page 3

Specific variables of the injury registry

1. severity of injury 2. player position 3. period of play 4. practice, gam

e, training, or other forms of physical activity,

5. injury due to trauma or overuse

6. localization of injury on the body 7. type of injury 8. exact m

echanism of injury

9. competition level

10. veteran or rookie player status 11. recurrent injuries, and 12. circum

stance of injury during game (i.e. pow

er play).

13S

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during pregnancy but this should begin to resolve itself postpartum.

Type I diabetes is often called insulin dependent diabetes m

ellitus(ID

DM

) and is caused by a destruction of the insulin secreting betacells of the pancreas. T

his can occur due to an autoimm

une responsein w

hich specific imm

une cells attack and destroy the beta cells dis-abling them

from m

aking insulin. How

ever, environmental factors

(viruses and toxins) may also be involved. T

he bottom line is that

type I diabetics require insulin injections to balance blood glucoselevels. T

ype I diabetes is usually diagnosed early in life but it canoccur at any age. T

his is why it is no longer referred to as “juvenile-

onset” diabetes. About 10%

of individuals with D

M are type I.

Type II diabetes is often term

ed non-insulin dependent diabetesm

ellitus (NID

DM

), however; insulin injections have been used as a

therapy for some type II diabetics. T

ype II diabetes is characterizedby chronically elevated blood glucose levels but for different reasonsthan type I diabetics. T

ype II diabetics may produce enough insulin

and/or maybe even have a higher than norm

al level, but the problemis that they are often resistant to it or do not respond properly to theaction of insulin. T

his is the primary reason for w

hy glucose remains

elevated in the blood. How

ever, some type II diabetics m

ay alsohave a beta cell dysfunction that reduces insulin secretion. T

ype IID

M has also been called adult-onset diabetes but once again, it can

occur at any age. Statistics are starting to reveal that the age at which

type II diabetes has been diagnosed is getting younger.A

pproximately 90%

of individualsw

ith DM

have type II. Type II dia-

betes is associated with chronically

poor eating habits, unhealthylifestyles and inactive living.

Diagn

osis an

d Treatm

ent

of D

MB

lood glucose is one of the most

finely regulated substances in thehum

an body. This is the prim

aryreason w

hy so many negative

health outcomes are associated

with im

pairment in glucose control.

Symptom

s of DM

include unusualfatigue, excessive thirst and urination, frequent infections, slow

heal-ing processes, fluctuations in appetite and m

ood swings. If these are

apparent, it is most im

portant to contact a medical doctor for proper

diagnosis and to begin a treatment strategy. M

ost medical centers

have or have access to a diabetes education program that includes a

2 to 4 day program of learning about dealing w

ith DM

. Information

with regard to m

edication, nutrition, physical activity, blood glucosem

onitoring and foot care are discussed. As w

ell, other associatedm

edical examinations are often conducted such as eye exam

s and areprovided in such program

. Participation in such programs m

ay be thebest thing a new

ly diagnosed diabetic can do for their health.D

iagnosis of DM

is usually made on a variety of obtained infor-

mation, the m

ost important of w

hich includes blood glucose testing.T

his can be a fasted blood glucose measurem

ent, intermittent blood

glucose measurem

ent made throughout the day and/or an oral glu-

cose tolerance test. A variety of strategies are required to treat dia-

betes but the general treatment procedure is to return blood glucose

levels to as close to normal as possible, try to reduce the fluctuation

in these levels as much as possible and to avoid diabetic com

plica-tions. T

his is accomplished through a variety of m

eans that includepharm

aceutical interventions to provide a balance of the rightam

ount and type of insulin to a type I diabetic or prescribing a par-ticular pharm

aceutical agent to enhance sensitivity to insulin in atype II diabetic. T

he goals of treatment for D

M should be to keep

blood sugar as close to normal as possible, to feel w

ell, avoid com-

plications and age well. T

here is currently no cure for DM

but it canbe m

anaged with a proper balance of m

edication, nutrition and phys-ical activity. H

owever, there is exciting research being conducted

that is working tow

ards a cure especially with islet cell transplanta-

tion.

Ph

ysical Activity an

d D

M.

Physical activity provides a means for m

etabolic control of sub-strates (carbohydrate, fats and protein) used by the body as a fuel forcellular m

etabolism. D

epending on the intensity and duration of thephysical activity, blood glucose can be used as a fuel for m

uscular

contractions. In low to m

oderate intensity and volume of physical

activity, blood glucose levels will drop (hypoglycem

ia) if not proper-ly regulated. R

egulation occurs through a combination of glucose

absorption from the gut as a result of ingested carbohydrate or by an

increased release of glucose from the liver. Physical activity has long

been used to assist in controlling blood glucose in individuals with

DM

and avoid the development of com

plications. Physical activity isknow

n to produce physiological and psychological benefits in any-one that adheres to a regular program

. It is also important to note

that just because an individual has DM

, it does not preclude themfrom

any level of physical activity provided they are otherwise

healthy and in good metabolic control. T

here are many cases of even

elite and professional level athletes including marathoners that are

type I diabetics!T

he most im

portant benefit of physical activity to a person with

DM

is an improvem

ent in blood glucose control through anenhanced insulin sensitivity and a reduction in the risk of com

plica-tions. E

xercise can enhance the action of insulin and in fact, muscle

contractions alone can stimulate the uptake of glucose to a certain

degree, even in the absence of adequate insulin. How

ever, caution isadvised in interpretation of this latter suggestion as physical activitycan also cause an elevation of blood glucose due to an enhanced glu-cose release from

the liver when insulin is deficient. T

his is becauseinsulin counter-regulatory horm

ones such as glucagon, cate-cholam

ines and cortisol are elevat-ed during certain physical activitiesand if left unopposed, they w

illstim

ulate the release of glucoseinto the blood that cannot efficient-ly enter the w

orking muscle.

Conversely, if too m

uch insulin ispresent and/or not enough stores ofglucose are available in the body,physical activity m

ay severelyreduce blood glucose levels andhypoglycem

ia may occur.

It is therefore very important

that a person with D

M plan proper

nutrition and medication strategies

to prepare for and control blood glucose before, during and afterphysical activity. A

long with this, all diabetics should be trained in

the use of personal glucose monitors and practice self-m

onitoring ona regular basis before, during and after physical activity.Furtherm

ore, all diabetics should carry with them

any necessary sup-plies (glucose tablets or gels, insulin, etc.) that they m

ay need in caseof a hypo or hyperglycem

ic event as a result of physical activity andthis should be their responsibility.

Ph

ysical Activity P

rescriptio

n fo

r Type I D

iabetics

Individuals with type I D

M should consult their physician before

beginning a physical activity program or m

aking significant changesto their program

s. The goals should be to assist w

ith effective meta-

bolic control of blood glucose, avoid hypo- and hyperglycemia and

to induce adaptations that will avoid diabetic com

plications, most

importantly of w

hich would be to reduce the developm

ent of cardio-vascular disease. A

lthough regular physical activity may not im

proveglycem

ic control in all type I diabetics, many of these individuals do

benefit and most indicators suggest that an im

provement in the quali-

ty of life can occur. As stated earlier, there are m

any examples of

athletes that train for and complete even m

arathons with type I dia-

betes. Thus, good m

etabolic control is possible even with high vol-

umes of physical activity. It also im

portant to note that all the same

physical activity training principles and guidelines that are comm

on-ly used for achieving fitness and health changes equally apply indeveloping a program

for an individual with type I diabetes or any-

one with D

M for that m

atter. T

ype I diabetics must learn their ow

n glycemic response to the

types of physical activities they do by monitoring blood glucose and

recording the type, amount and tim

ing of meals and insulin. It is of

utmost im

portance that good metabolic control be w

ell establishedbefore em

barking on any type of physical activity. As w

ith anyphysical activity program

, begin slowly and add sm

all progressive

Exercise can enhance the actionof insulin and in fact, m

uscle con-tractions alone can stim

ulate theuptake of glucose to a certaindegree, even in the absence ofadequate insulin.

Continued on page 14

12S

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A P

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002

By G

ord

on

J. Bell, P

hD

Diabetes m

ellitus (DM

) is a chronic disease of carbohydratem

etabolism com

monly due to an absence or reduction of insulin

production, secretion or due to a cellular insensitivity to circulat-ing insulin. T

he name diabetes m

eans “to flow through” based on the fact

that frequent drinking and urination are often symptom

s. Mellitus m

eans“sw

eet as honey” referring to the excessive levels of glucose in the urine.T

hus, DM

is characterized by a chronic elevation of blood glucose levels.If untreated or not w

ell controlled, DM

complications can lead to blind-

ness, kidney disease, nerve disease, amputation, stroke and cardiovascular

disease as well as others. In fact, people w

ith DM

have at least a four-foldgreater risk of developing cardiovascular disease than non-diabetics..

The incidence of D

M in C

anada is at least 5 % of the population but

this value could grow to as high as 10%

if undiagnosed cases were identi-

fied. Greater than 10 %

of Canadians over the age of 65 have D

M.

Tw

enty-two percent of individuals w

ith a spinal cord injury have type IID

M and 56 %

of this population have abnormal glucose m

etabolism. T

heincidence of type II diabetes in C

anadian Aboriginals is 3.3 tim

es higherthan the C

anadian average for men and 5.3 tim

es higher for wom

en.Furtherm

ore, there is an increase in reports of the incidence of type II dia-betes in 12 to 19 year olds. T

hese statistics suggest that DM

is prevalentin our society, is a serious health concern and is a consum

er of a signifi-cant num

ber of our health care dollars.

Types o

f DM

There are tw

o main categories of D

M: type I and type II. T

here isalso a third type term

ed gestational diabetes that sometim

es occurs

AN

TI

CI

PA

TI

ON

AN

TI

CI

PA

TI

ON

Sw

ee

tS

we

et

Physical activity can help you regulate diabetes

5S

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The Sport M

edicine Council of A

lberta bids a fond farewell to

one of its most dedicated boosters: B

arb Marriage. It has been

a pleasure having her on our Board of D

irectors for the lastseven years. H

er input and enthusiasm have helped strengthen the

entire organization..B

arb received her BSc in nutrition at the U

niversity of Guelph in

1978. In 1987 received her MSc at the U

niversity of Alberta and is

presently working on her PhD

. She has been a dietician for most of

her life and involved in Sport Nutrition for the past 15 years. B

arb’sinterest in sport started in high school and undergraduate years play-ing varsity basketball and she is now

an active long distance runner.O

n a personal note, Barb has been m

arried to Ron Stoyko for 13

wonderful years and thanks him

for being so tolerant and supportive.In 1987, B

arb became involved w

ith the Sport Medicine C

ouncilof A

lberta. Through the SM

CA

she got the Sport Nutrition group

started, they helped arrange meetings, speakers/w

riters bureau andsupported the Sport N

utritionists. Barb, w

ith the help of her sportnutrition colleagues, developed a 4-hour w

orkshop and sport nutri-tion m

anual through the Sport Medicine C

ouncil of Alberta. She has

her Master C

ourse Conductor L

evel 4 Coaching and w

as President ofSport N

utrition Advisory C

ouncil (SNA

C) from

1994 to 1998. Being

involved on the SMC

A B

oard of Directors B

arb did many lectures,

individual counseling and workshops to dieticians, coaches and ath-

letes at the provincial, national and recreational level. T

he professional teams she w

orked with are the C

FL E

dmonton

Eskim

os from 1992-1996 and N

HL

Edm

onton Oilers H

ockey Club

from 1999-2001. E

ventually, becoming president of SM

CA

in 2000. D

uring her time on the SM

CA

Board B

arb has found working

with great staff and volunteers plus developing the Sport N

utritionm

anual was very rew

arding. She attributes many of her accom

plish-m

ents and connections in sport nutrition to her relationship with the

SMC

A. A

special mem

ory she would like to take w

ith her has beenthe chance to go to Japan (H

okkaido) in August of 2001 as a repre-

sentative for the SMC

A on an exchange w

ith Alberta B

aseball. Itw

as an experience of a lifetime that she w

ill always rem

ember and

cherish.

When asked w

hat she sees in the future for SMC

A B

arb smiled

and said, “SM

CA

is the best kept secret.” She sees SMC

A continuing to do

what they are good at: educating people and providing services. H

eradvice for anyone beginning a career in sport m

edicine is that thecontacts and people one m

eets are vital.In N

ovember of this year B

arb will m

ove to Colum

bus, Ohio. H

erposition w

ill be Research Scientist w

ith Metabolic D

iseases. Who

knows…

..she may even becom

e in involved with the N

HL

’s Blue

Jackets. SMC

A w

ould like to wish B

arb all the best in her futureendeavors and thank her for all her hard w

ork and dedication. We

will all m

iss you.

Barb

ara Marriage, M

Sc, R

D/S

N

SMC

A’s loss

is Colum

bus’s gain; Past president headed for O

hio

Mo

ving o

nM

ovin

g on

All C

anad

ian S

po

rt157 Springbank Place S.W

.C

algary, AB

T3H 3S5

Website: allcanadiansport.ca

Ermin

eskin

Ph

ysicalTh

erapy

3032A-106 St.

Edmonton, A

BT6J 5M

5Phone: (780) 438-0001Em

ail:m

ailto:eptrent@pow

ersurfr.com

St. Law

rence S

teel & W

ireC

o. Ltd

.425 H

erbert St., Box 550G

ananoque, ON

K7G

2V1Phone: (613) 382-3565Em

ail: stlawrel@

resonet.comS

turgeo

n V

alley Ath

leticC

lub

205A C

arnegie Drive

St. Albert, A

BPhone: (780) 460-9999Em

ail: mailto:svac@

telusplanet.net

Ph

ysical Therap

y Sp

ort

Med

icine C

linic

Garrison M

edical Clinic

Box 10500 Stn. ForcesEdm

onton, AB

T5J 4J5Phone: (780) 973-4011Em

ail: bickford.dh@forces.ca

Thanks for your helpTh

e Sp

ort M

edicin

e Co

un

cil of A

lberta th

anks its co

rpo

rate m

emb

ers. Their su

pp

ort stren

gthen

s us.

6S

MC

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By D

r. Tom

Grah

am/ Sport M

edicine and Science Council

of Saskatchewan C

onsultant

The T

AIS instrum

ent helps identify our attentional strengths in com-

petition and those attentional areas with room

for improvem

ent. Inaddition, the T

AIS provides inform

ation on how w

e prefer to becoached, the pre-com

petitive environment w

e prefer to prepare in and soon. T

he information provides a solid basis for any m

ental skills interven-tion that follow

s.T

he nice thing about instruments like this is that w

e get to describe our-selves. N

o one comes in and says “I think this is w

hat you need to work

on.” We describe our ow

n strengths and limitations. T

hen, we w

ork on thelim

itations. T

his sort of profiling is available through the Sport Medicine and

Science Council of Saskatchew

an. For your information, SM

SCS has

applied a charge as the scoring of these instruments is labour intensive.

The follow

ing are TA

IS profile examples from

the sports of volleyball.U

niversity Volleyball Player (Position: Setter)

X describes his broad external focus as high (B

ET

=90th %ile). T

hisscore indicates an aw

are, perceptive setter who notices a lot in his environ-

ment. Specifically, X

will take in a great deal of useful inform

ation fromthe oppositions’ front row

. He w

ill use his time betw

een plays, scan theopposition and determ

ine the weaker blockers w

ho are up there. Likew

ise,he w

ill scan his own offensive w

eapons and have a good feel for what he

has at his disposal. X’s O

ET

or overload external score (20th %ile) indi-

cates simply that there is no external overload under conditions of high

competitive arousal. In other w

ords, X is just as likely to access this broad

external information in big m

atches (e.g. CW

UA

A playoffs, C

IAU

’s) ashe is in an exhibition m

atch when less is on the line. H

e probably keepshis head on in these situations and continues to use the tim

e between plays

constructively.Sim

ilarly, X reports his broad internal focus as strong (B

IT=95th %

ile).If the broad internal score is highest, you m

ight be described as analytical,good at problem

solving etc. From a setting perspective, this m

eans that Xis probably excellent at taking broad external inform

ation (their front row,

his own hitters), determ

ining the best matchup and calling plays that iso-

late that matchup. In short, he w

ill be very good at looking at the situationand generating plays that, he feels,gives his hitters their best chance tosucceed. X

’s OIT

or overloadinternal score (40th %

ile), indicatesthat, again, this problem

solvingcapability is present under condi-tions of high com

petitive arousal.N

o problem here.

X’s profile suggests that his

narrow attentional focus is, by far,

the most lim

ited (NA

R=40th

%ile). T

his indicates that undercertain circum

stances, X m

ay havetrouble narrow

ing his focus of attention to priority cues only. A danger

with high B

IT, low

NA

R setters is that they m

ay generate a number of

plays for each rotation and run them all. A

high NA

R setter w

ill identifythe tw

o BE

ST plays and run these repeatedly until the opposition stops

them. In other w

ords, they can reduce their focus of attention to priority

cues only. X m

ay benefit from looking at different m

atchup situations well

in advance of his Friday match, identify a lim

ited number of priority plays

for each, then mentally rehearse this pairing. H

aving only two priorities to

concentrate on rather than everything hem

ight run will keep his attention narrow

-ly focused and uncluttered com

e game

time.X

’s information processing (90th

%ile) is high and com

pletely in line with

his broad external and broad internalstrengths. C

learly, X’s tendency is to reg-

ulate to these and run with them

. His

challenge, since a lot of info is beingprocessed, is to narrow

his attention topriorities only. X

can do some give and

take work w

ith coaches to establish what

these priorities might be in each situation. H

e will be m

ore comm

itted tow

hat these priorities are if he has a hand in establishing them.

X’s need for control (C

ON

=98th %ile) and self-esteem

(SES=99th

%ile) scores are both very high. T

his is indicative of a self-reliant athletew

ho is confident in his ability as a player. Something to guard against,

Test of Attentional and

Interpersonal Style (TA

IS) Profiles —

second in a two part series

Pay

atte

ntio

nP

ay

atte

ntio

nIt m

akes a difference in sp

ortIt m

akes a difference in sp

ort

adults were of norm

al weight w

hen they were children.

Su

pp

ortin

g Active Livin

g, Health

y Eating, an

dB

od

y Image am

on

g Ch

ildren

and

Ad

olescen

ts1. S

cho

ols

Provide opportunities and teach skills for:� appreciating healthy eating (e.g., learning about m

aking healthysnacks and beverages, and drinks and the essential com

ponents instudents’ ow

n diets);� involvem

ent in activities (e.g., biking, tennis, cross-country ski-ing, inline skating, and sw

imm

ing);� building healthy self-esteem

and the ability to reject unattainable-unrealistic ideals of beauty (e.g., teach children about the unrealis-tic “vital statistics” of B

arbie (if she were full size) and the under-

weight m

odels comm

only used in the media);

� lobbying for healthy alternatives to snacks, drinks, and treats in

schools and for daily physical education;� encouraging life-long enjoym

ent of food, healthy eating, andnon-com

petitive physical activities;� building confidence by keeping school a safe haven from

thestigm

a associated with fatness;

� developing strong physical activity and healthy eating program

sw

ith well trained physical activity teachers (e.g., physical education

specialists and comm

unity nutritionists);� participating in unstructured play;

� involving fam

ilies.2. P

arents

Be a role m

odel:� com

mit to healthy eating in your fam

ily (e.g., satisfy your hungerw

ith healthy foods and have structured meal patterns and avoid con-

tinual snacking);� com

mit to active living w

ithin your family (e.g., w

alk wherever

possible and avoid using your car, always take the stairs, and lim

itT

V/videos);

� foster positive body im

age in your children (remem

ber that yourw

ords and actions are a role model for your children, e.g., do you go

on constant diets and/or make prejudicial com

ments about body

size?);� choose active fam

ily outings (e.g., biking, hiking, skiing, walking

the dog, and packing healthy snacks/ picnics rather than relying onfast foods);� lim

it TV

watching and other sedentary activities;

� point out unrealistic aspects of ultra-slim

ideals of beauty;� encourage children to play outdoors (research show

s that outdoorgam

es are far more active than indoor gam

es).3. C

om

mu

nities

Com

munities can prom

ote active living by:� advocating for food outlets that provide healthy snacks;

� lobbying for safe, accessible w

alk-ing/biking paths, and parks;� advocating for keeping the com

-m

unity environment safe from

preju-dice against fatness;� m

aking healthy foods and drinksavailable at com

munity events;

� providing a w

ide range of afford-able, accessible recreation facilities;� rejecting local advertising that

sends unhealthy body-image m

es-sages to the young.

References available on request or

from the A

lberta Centre for A

ctiveL

iving web site (w

ww

.centre4active-living.ca/)..

This article is reprinted w

ith per-m

ission from W

ellSpring, a publica-tion of the A

lberta Centre for A

ctiveL

iving. You can find other issues of

WellSpring on the C

entre’s web site

at ww

w.centre4activeliving.ca.

11S

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Mary A

. T. Flynn

/ PhD, RD

, PHN

utr (Coordinator,

Nutrition and A

ctive Living), and Kerri S

taden

/ BSc(H

omeEc), BC

om, RD

(Nutrition Specialist) H

ealth Promotion

and Disease Prevention, H

ealthy Com

munities, C

algary Health

Region

Ho

w S

eriou

s Is this C

risis?

We are seeing dram

atic increases in fatness levels world-

wide. T

he spiraling increase in diseases associated with

obesity, such as diabetes and heart disease, are the most

critical—m

any experts now describe this situation as epidem

ic. O

besity is notoriously difficult to treat. Am

ong those who do lose

weight, regain is very com

mon. M

any people gain put back addition-al pounds in this yo-yo process, w

hich research indicates may actual-

ly harm long-term

health. T

hus, attention has focused on obesity prevention, recognizingthat strategic targeting of children and adolescents represents thebest hope of effectively turning the tide.

A recent report outlined a dram

atic increase in the number of

overweight C

anadian children aged seven to 13 between 1981

and 1996. As m

any as a third of girls and almost half (42%

) of boysare overw

eight (Trem

blay M. S. &

Willm

s, J.D. 2000). Secular

trends in the body mass index of C

anadian children. Canadian

Medical A

ssociation Journal;163:1429-33(Trem

blay & W

illms,

2000)). . The seriousness of this situation is evident in the m

any sig-nificant health risks associated w

ith being overweight during the

growing years.

Wh

y Is this a P

rob

lem?

The first aspect of the problem

is the widespread abhorrence of

fatness. Although overw

eight adult wom

en are the most stigm

atizedgroup, prejudice is also strong against overw

eight adult males, ado-

lescents, and children. Research has show

n that even six-year-oldsare intensely aw

are of the cruel ridicule that most overw

eight chil-dren have to face every day. In fact, psychosocial issues are oftendescribed as the m

ost significant effect on the health of overweight

children and adolescents. Fad slimm

ing behaviours among children

and adolescents can lead to growth failure and delayed puberty.

Young girls, especially, risk developing disordered eating behav-

iours, such as frantic dieting and purging. eating disorder develop-m

ent. The harm

ful pressure to be slim is clearly dem

onstrated in theincreasing num

ber of teenage girls who becom

e regular smokers in

order to control their weight.

Serious physical consequences of obesity (such as - heart prob-lem

s, disorders of the pancreas, and breathing failure when sleeping)

are rare in children and usually only affect the severely obese.H

owever, overw

eight male adolescents can face higher heart disease

death rates in adulthood (some of this risk persists even for boys w

hobecom

e a normal w

eight during adulthood). No such risks are associ-

ated with fatness during fem

ale adolescence. The higher risk for boys

may be due to their natural propensity tow

ards leanness during ado-lescence.

Another m

ajor source of concern is the increase in Type 2 dia-

betes among obese adolescents in genetically at-risk groups (e.g.,g.,

Aboriginal A

boriginal and East Indian population groups adoles-

cents). Type 2 diabetes is associated w

ith obesity and inactivity (this

type of diabetes used to becalled adult-onset diabetesbecause people believedit only affected m

id-dle- aged adults).T

ype 2 diabetes isvery difficult totreat and isassociatedw

ith a highrisk of cardio-vascular dis-ease andother com

pli-cations.

Overw

eightchildren andadolescents alsoexperience high-er blood pres-sure and blood-fat levels. H

owthese riskstranslate intoheart diseaselater largelydepends onw

hether thechildbecom

esan over-w

eightadult.L

ong-termfollow

-up studies also suggest that the overweight children/adoles-

cents of obese parents are most at risk of long-term

obesity.U

nfortunately, the increase in obesity nowadays m

eans that many

more overw

eight Canadian children fall into this risk category.

Wh

at Can

We D

o?

Effective obesity prevention program

s for children and adoles-cents need to prom

ote healthy behaviours in relation to nutrition,active living, and body im

age. A supportive environm

ent will

involve all segments of society, including health professionals,

schools, comm

unity programs, and fam

ilies. E

ven with excellent diet nutritious eating and regular exercise,

some children w

ill always be heavier than others. Fostering life-long

habits in exercise and healthy eating in these children requires partic-ular sensitivity, but yields trem

endous benefits for our future health.W

e need to build these skills during childhood because most obese

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Big

trouble

Big

trouble

Obesity

am

ong c

hild

ren a

nd

adole

scents h

as b

ecom

e a

n e

pid

em

ic

however. H

igh need for control/high self-esteem athletes are som

etimes

difficult to coach. They like to be in control of things and know

they’regood. T

hese athletes must w

ork with coaches as opposed to against them

to develop cooperative strategies. In addition, they must recognize that

gems of w

isdom can com

e from anyw

here (coaches, hitters, even rook-ies). X

describes his decision making (O

BS=75th %

ile) as mid-range. T

hefact that decision m

aking capability is lower than broad external focus,

broad internal focus and information processing indicates that X

may have

a little trouble reducing the waves of inform

ation enough to make consis-

tently good decisions. The key is to take this inform

ation and reduce it topriorities before gam

e time. T

his way, the volum

e of information is sim

-plified and is m

uch easier to access during competition.

X reports that his extroversion score (E

XT

=80th %ile) is higher than

his introversion score (INT

=10th %ile). T

his probaly indicates that, afterX

has done his pre-competitive hom

ework, he m

ay be more com

fortablepreparing in the com

pany of others with extroversion scores like his.

X’s profile suggests that he is w

illing to offer feedback and advice toothers (IE

X or intellectual expression=65th %

ile). His negative affective

expression (NA

E=35th %

ile) and positive affective expression (PAE

=88th%

ile) indicate that the feedback he does offer is mostly positive. H

e isprobably a good leader. Intense, but encouraging.

University V

olleyball Player (Position: Left Side)

This guy has a nice attentional profile. X

describes his broad internalfocus as his attentional strength (B

IT=97th %

ile). If the BIT

score is high-est, you m

ight be described as analytical and good at problem solving.

These individuals focus internally on generating strategies and solutions

and are good at it. Ordinarily, w

ith high broad internal athletes, you worry

a little about a tendency to overanalyze (paralysis by analysis). This occurs

when an athlete gets so analytical that they tie them

selves in knots. X’s

profile, however, suggests that there’s nothing to w

orry about here. His

OIT

or overload internal score (75th %ile) is low

enough to indicatetw

o positives. First, he probably develops strategies to deal with only

what he sees as priorities. T

his keeps his preparation simple, efficient

and uncluttered. If X ever finds him

self overanalyzing and preparingfor everything he expects to see, he should revert back to identifyingpriorities (e.g. the tw

o main plays they run in each rotation) and devel-

op personal strategies to derail those. With less to w

orry about, he’llalw

ays enter matches confident in the sim

ple game plan he’s devel-

oped. Second, X’s O

IT score indicates that his problem

solving andstrategizing w

ill remain effective even under conditions of high com

-petitive arousal. In other w

ords, X’s strategies should be w

ell con-ceived before both exhibition m

atches and competition that carries big

importance (e.g. C

WU

AA

playoffs).X

’s broad external attentional focus is also strong (BE

T=75th %

ile).T

his indicates that X is a reasonably perceptive individual and proba-

bly takes in good information about the other team

. He is likely good at

reading situations and maintaining a broad scope of attention (e.g. w

illlook at their three or four hitters and recognize w

hat their main tenden-

cies are). This provides a good basis for deciding w

hat he should doabout it (the strategies or problem

solving discussed above). Again, X

’sprofile suggests that this broad external focus w

ill remain accessible

even during big matches w

hen he might be a little edgy (B

ET

or over-load external=30th %

ile). A

n important part of X

’s profile is that his narrow attentional focus

is strong (NA

R=84th %

ile). This indicates an athlete w

ho is focusedand probably good at narrow

ing his focus of attention to priority cues.T

his is important as X

takes in a fair amount of broad external info

about his environment. If his narrow

focus wasn’t so strong, he’d likely

attend to a lot of extraneous or unimportant cues about the other team

.In sum

mary, this profile is positive, w

ith all main attentional areas in

the top three 75%.

X’s describes his inform

ation processing (INFP) at the 84th per-

centile. This is com

pletely in line with his narrow

attentional focusscore. T

his indicates that one of X’s pre-com

petitive goals is to reducethe inform

ation he knows about the other team

down to priorities. T

hisis indicative of a very m

ature approach to pre-competitive preparation.

Both X

’s need for control score (CO

N=88th %

ile) and his self-esteem

score (SES=98th %

ile) are high. These scores suggest a self-

reliant athlete who is confident in his ow

n ability. For someone playing

a position with lots of responsibility (passing, hitting, blocking, defense,

serving), this is a positive. What X

might have to guard against is a ten-

dency for high need for control/high self-esteem athletes to be uncoach-

able at times. B

ecause they enjoy being in control and know they’re good,

they sometim

es have difficulty taking advice from authority figures. A

couple of comm

ents. First, X should continue to look for pearls of w

isdomfrom

coaches and teamm

ates. Second, when coaches w

ork with X

to helpdevelop the strategies he’ll take into a m

atch, they should do so coopera-tively. X

will probably be m

ore comm

itted to these strategies if he has am

ajor hand in setting them.

X’s decision m

aking (OB

S=88th %ile) is strong. T

he score is verysim

ilar to his narrow attentional focus score and his inform

ation process-ing score. A

gain, this is clearly an athlete who can reduce the w

aves ofinform

ation coming at him

to priorities he can use.A

long with m

ost of the UB

C team

, X’s extroversion score (E

XT

=98th%

ile) is higher than his introversion score (INT

=16th %ile). T

his indicatesthat, once his personal pre-com

petitive preparation is done, X w

ill proba-bly be m

ore at ease before games around other extroverts. H

e would prob-

ably do well w

ith a roomm

ate on the road who understands that he needs

his quiet time, but has an extroversion score like his ow

n.Finally, X

is apparently not shy about providing advice to himself and

perhaps others (Intellectual expression or IEX

=84th %ile). T

his score isfine as long as X

isn’t playing someone else’s gam

e for him out there. H

isprofile suggests that m

ost of the verbalizations X m

akes are positive(PA

E=90th %

ile) rather than negative (NA

E=35th %

ile). X’s handle on

the other team and his ow

n strengths in problem solving m

ake him a per-

fect candidate to offer simple advice betw

een serves (e.g. watch second

man). T

his said, he should then let the other person figure out how he’s

going to stop the second man.

This w

ay, X has given his team

mate the heads up, but is letting him

play his own gam

e.

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Take astepdirection

in the right

Solutions you’ll be comfortable with

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(Elbow D

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ulanda, D.P.M

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&

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By B

arbara M

arriage/ MSc, RD

, Sport Nutritionist

Whether you are a w

eekend jogger or a competitive m

arathoner,nutrition is fundam

ental to your running success. A w

ell-balanceddiet w

ith adequate fluids and plenty of high carbohydrate, low fat

foods that provide energy and replenish fuel and fluids lost during the run isessential. R

unners should pay careful attention to their nutrition needs before,during and after running.W

hy are carb

oh

ydrates

so im

po

rtant fo

r run

ners?

Carbohydrates are the best source of energy for exercising m

uscles. The

greater the intensity and endurance, the greater the need for a carbohydrate-richdiet. C

arbohydrates are necessary to maxim

ize energy stores in the muscle in

the form of glycogen. M

uscle glycogen is an important fuel source for exercise

and runners are unable to maintain endurance and exercise intensity w

henglycogen stores are low

. Fat serves as a major fuel source during endurance

exercise, however, glycogen stores are still im

portant, fueling about 70% of the

activity. Even a trained m

arathon runner at three hours has 10 to 20% of the

energy needs met by glycogen. T

hat is why carbohydrate-containing foods

should comprise at least 60%

of the calories in a runner’s diet.T

he easiest way to ensure adequate dietary carbohydrates is to focus on 2 of

the 4 food groups: The G

rain Products group and the Vegetables and Fruit

group. Foods from these food groups contain large am

ounts of carbohydrateand relatively sm

all amounts of fat. T

here are a few exceptions such as com

-m

ercially made m

uffins, croissants, cake, many types of crackers, avocados and

coconut which are high in fat. Som

e foods high in carbohydrate and low in fat

include breads, cereals, pastas, rice, vegetables, fruit and fruit juices. The m

ini-m

um daily requirem

ent from the G

rain Products food group is 5 servings. The

average athlete should aim for 8 or m

ore servings. The endurance runner w

hotrains strenuously should follow

a high carbohydrate diet and aim for 15 plus

servings from the G

rain Products. The m

inimum

daily requirement from

theV

egetables and Fruit group is 5 or more.

The average athlete should aim

for 8 or more servings. T

he endurance run-ner should strive for 15 or m

ore Vegetables and Fruit servings. T

he number of

servings required will vary from

runner to runner depending on their specificenergy requirem

ents. E

xceptions may be necessary in those runners starting a running program

forw

eight control problems.

Wh

at is best to

eat BEFO

RE ru

nn

ing

and

wh

en sh

ou

ld I eat?

The purpose of eating before exercising is to provide glucose to the m

usclesand enhance endurance by reserving glycogen stores.

Food remaining in the stom

ach during running may cause discom

fort andtherefore foods m

ust be easily digested and leave the stomach quickly to avoid

these problems. Preferences vary but there are som

e general guidelines to fol-low

:

EatEatR

unR

unC

arb

o lo

adin

g b

efo

re, d

urin

gand a

fter y

our ru

n

� C

hoose high carbohydrate, low fat foods that are w

ell tolerated.� L

imit foods high in sim

ple sugar content such as honey, regularsoft drinks and candy bars. T

hese concentrated sweets m

ay promote

the movem

ent of water from

the body tissues into the stomach and

cause cramping and diarrhea.

It is also possible that due to the release of insulin from the inges-

tion of a candy bar or concentrated glucose beverage that blood sugarm

ay drop and give a feeling of fatigue. The results are controversial

and recent research indicates that if the “quick energy source” is con-sum

ed from 0 to 15 m

inutes instead of one hour before the activity,there is little effect on blood glucose.� H

igh protein foods in moderation as they take longer to leave the

stomach.

� Fluids such as w

ater, diluted fruit juice, sports drinks and low fat

milk are recom

mended to prom

ote adequate hydration.� A

llow tim

e to digest.

Sh

ou

ld I eat D

UR

ING

my ru

n?

Carbohydrate feeding during exercise can im

prove performance in

events lasting over 1 hour. Sports drinks with 6 – 10%

carbohydratem

ay be recomm

ended to maintain blood glucose levels as m

uscle andliver glycogen reserves becom

e depleted. Alternatively, the runner

could consume a high carbohydrate solid food (ie, sport bar, low

-fatgranola bar, cookies, fruit etc) as long as they ensure adequate rehy-dration w

ith water. For these “shorter” runs, w

ater is the most criti-

cal determinant of exercise perform

ance and is the nutrient most

often neglected by runners.

Runners lose m

ore races through not drinking enough water than

any other nutritional cause!R

emem

ber…�

For runs lasting less than 1 hour, water is the best replacem

ent.� For intense exercise lasting greater than 60 – 90 m

inutes, dilutedglucose and electrolyte solutions are recom

mended to provide fuel

for working m

uscles.� Sport drinks should be m

ade up of glucose, glucose polymer, and

sucrose solutions providing 6 to 10% glucose.

� D

rinks containing more than 10%

carbohydrate may inhibit fluid

replacement and cause nausea, diarrhea and cram

ps.

Do

es it make a d

ifference

wh

at I eat AFTER

run

nin

g?A

fter a vigorous run, replacing fluid lost in sweat should be a top

priority. Drink frequently until you are rehydrated and do not rely on

thirst. A

llow 2 cups of fluid for each pound lost due to sw

eating. Water,

juices and fruit containing a lot of water are good choices. Juices

and fruits such as waterm

elon, grapes and oranges supply carbohy-drates as w

ell as fluid.T

o replace the glycogen lost from m

uscle after an endurance run,eat or drink high carbohydrate foods or beverages im

mediately after

– ideally within the first 15 m

inutes. Muscle glycogen storage is

higher if carbohydrates are consumed as soon as possible after the

exercise followed by frequent carbohydrate snacks w

ithin the next 2to 4 hours.

Recent research show

s that glycogen storage may be further

enhanced when carbohydrates are com

bined with protein in a 3:1

ratio. Try the follow

ing combinations to replenish glycogen stores

quickly and effectively:Proper nutrition m

ay not make you w

in a race, but poor nutrition-al practices can m

ake you lose a race! Rem

ember rehydrate, refuel

and keep running!

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E-m

ail: za

ki1

96@

ho

me.c

om

Examples of w

hat to eat and when

Type o

f meal

Large

Small

Blend liquid m

eal

Small snack

Time to

wait

3-4 hours

2-4 hours

1-2 hours

< 1 hour

Examp

le1 chicken sandw

ich1 cup vegetable soup1 cup skim

, 1% or 2%

milk

4 fig New

ton cookies1 apple

1 cup Rice K

rispies1 cup skim

, 1% or 2%

milk

banana1 cup orange juice

1 egg1 cup assorted fruit1 cup fruit juice or skim

,1%

or 2% m

ilk1 teaspoon sugar orhoney

1 blueberry muffin

1 cup apple juice

Fluid intake schedule

Ho

w m

uch

?W

hen

?I cup (500 m

l)1 hour before exercising

2/3 to 1/2 cup15- 20 m

inute intervals during exercising

Replenishm

ent combos

Bagel w

ith slice of cheese and 1 glass fruit juice Large bow

l of cereal with low

fat milk and a sliced banana

1 cup low fat yogurt and 1 glass fruit juice