218 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
- Supervised exercise through a rehabilitation program
is warranted if patient has significant disease. Most
can graduate to independent exercise within 6 weeks
(Mink, 1997). - Independent exercise goal should be to exercise 3 days
a week at 60 to 80% of maximal heart rate for 20 to
30 min. Type of exercise will vary based on patient’s
ability and comorbidities. Stationary cycling is useful
initially as many patients are unsteady on their feet
and arm ergometry can be used for those with lower
extremity limitations. These goals may take months to
reach, if at all. Start with several minutes of exercise
and progress at a rate appropriate for the individual
(Mink, 1997).
•Exercise aids can include supplemental oxygen and
medications. Bronchodilators and anticholinergics
are the mainstay of pharmacologic therapy in COPD
and should be used aggressively. Mucolytics can
assist with excessive secretions. Inhaled corticos-
teroids can also assist in decreasing airway inflam-
mation. Oral corticosteroids are reserved for more
severe cases, and theophylline remains a controversial
therapy. - Bronchopulmonary toilet and pursed lip breathing are
two other mechanical techniques that can aid COPD
patients in achieving activity goals. - Careful attention to preventive health care such as
influenza and polyvalent pneumococcal immuniza-
tions can help COPD patients avoid setbacks in their
exercise programs and enhance overall well-being.
CYSTIC FIBROSIS
- Cystic fibrosis(CF) is an autosomal recessive disorder
that affects multiple organ systems, including the pul-
monary, gastrointestinal, reproductive, and skeletal
systems as well as the sweat glands. Chronic pul-
monary disease is the leading cause of morbidity and
mortality as the thick mucus found with CF leads to
infection as well as inhibits pulmonary function.
Aerobic exercise has been shown to aid in the clear-
ance of secretions and improve quality of life in
patients with CF. - Diagnosis of CF is made by an abnormal sweat chlo-
ride test. Prenatal screening is now available and
should be offered to couples at higher risk, particu-
larly those of Northern European descent. Pulmonary
function tests are similar to an asthmatic, but also
demonstrate a decreased forced vital capacity(FVC). - Management of CF is dependent on the extent of dis-
ease. A goal of preventing recurrent respiratory infec-
tions is attempted through chest physiotherapy,
bronchodilators, and antibiotics. Corticosteroids,
oxygen, recombinant deoxyribonuclease I, and possibly
lung transplantation in advanced cases may also be
warranted.
•Exercise can augment mobilization of secretions
when combined with chest physiotherapy (Thomas,
Cook, and Brooks, 1995). A study also demonstrated
less loss of FVC compared to controls (Schneiderman-
Walker et al, 2000). In mild forms of CF, athletes
should be allowed to participate as their pulmonary
function allows. Moderate to severe cases of CF
benefit from more formal rehabilitation programs
where the need for supplemental oxygen can be
tracked.- All athletes with CF need to be counseled on safe
exercise in the heat, as they are subject to increased
sodium and chloride losses in their sweat when com-
pared to those without CF.
RESPIRATORY INFECTIONS- Respiratory tract infections are one of the most
common medical problems encountered in the care of
athletes (Hanley, 1976). Upper respiratory tract infec-
tions (URIs) comprise the majority of these infec-
tions. - Immune function affects avoidance and occurrence of
URIs. Studies demonstrate moderate exercise can pro-
tect against URIs, while intense exercise can decrease
immunity and increase the risk of URIs (Smith and
MacKnight, 1998; Nieman, 1994). - Prevention of URIs can be augmented through avoid-
ance of overtraining, adequate sleep, proper nutrition,
and limiting stress. Influenza vaccination of athletes
in winter sports should be considered.
•Treatment of URIs is primarily symptomatic. Nasal
ipratropium bromide and oral/topical decongestants
can be helpful short-term. Caution must be exercised
with antihistamines in athletes as they can impair tem-
perature regulation and cause sedation. Inhaled beta-
agonists can help with URI-associated coughs.
Antibiotics are only indicated if progression to a sec-
ondary bacterial infection occurs. Zinc and vitamin C
may reduce the duration of URI symptoms (Hemila,
1994; Mossad et al, 1996). - Athletes with a common cold can continue to partici-
pate to a lesser degree provided no fever is present.
Care should be taken to increase hydration and cease
activity if constitutional symptoms occur, such as
fever, myalgias, productive cough, vomiting, or diar-
rhea. - Progression to diseases such as pneumonia and com-
plicated bronchitis warrant up to 10–14 days of rest
before resuming full activity.