Posts Tagged ‘cardiorespiratory fitness’


The whole town and his wife seems to be using whey protein.

Whey protein isolate – everybody knows – works; you know it works. It is the best protein for improving body composition (reducing fat while improving lean mass)! Or is it really?!

Whey protein isolate may be the best protein for you in most instances, that may not be the case always! Depending on your fitness goal, whey protein concentrate (and, even casein!) can sometime give whey isolate a run for its money. How is that?!

Well, read on to find out!

However, before we get into the nitty-gritty of which type of whey will best serve your purpose, let us get to know a bit more about why you should supplement with whey, in the first place.

Why should I take whey supplements?

Resistance training causes increase in muscle mass. This is due to increased muscle protein synthesis (MPS) that resistance training induces (Hulmi et al., 2009; Hakkinen et al., 2001; Hulmi et al., 2007). However, intense workouts alone are not enough to keep packing on lean muscle mass; you have to ‘stay anabolic’ most of the time to be able to keep that MPS working for you.

Without complicating matters, here’s a look at how resistance training increases lean muscle mass: a resistance training session causes muscle protein breakdown. This is then followed by repair of the damaged muscle tissue so that the muscles come out stronger the next time you hit the weights. For the muscles to get stronger, however, proteins ingestion (over and above normal needs) is crucial. Needless to say, the process of repair will suffer if you aren’t loading up on proteins.

That resistance training combined with protein supplementation causes muscle hypertrophy is well-documented (Moore et al., 2009; Hulmi et al., 2009; Cribb, Williams, Carey, & Hayes, 2006).  Ingestion of a whey protein supplement either immediately before or after a training session is – considered by some – to be the best for this purpose; also whey increases muscle protein turnover like no other protein. Furthermore, whey protein seems to work equally well in women as well (Josse, Tang, Tarnopolsky, & Phillips, 2010).

Another benefit of supplementing with whey is, improved post-workout recovery  This is likely due to the ‘anti-catabolic’ action of essential amino acids (Bird, Tarpenning, & Marino, 2006; Hoffman et al., 2010; Etheridge, Philp, & Watt, 2008).

What is Whey Protein?

You most likely know that whey is one of the 2 milk proteins – the other being casein. Casein is the more abundant of the two and it is casein that gives milk that white colour. In commercially available cow’s milk, 20% of protein is whey while the rest of it is casein (Hulmi, Lockwood, & Stout, 2010; Ha & Zemel, 2003; Etzel, 2004; Krissansen, 2007).

Whey is produced in large amounts as a by-product in the cheese industry. However, this whey has loads of fat, milk sugar (lactose) and salts in it and is not suitable for improving body composition.

During the process of whey purification, whey concentrate and isolate are produced sequentially. During the initial steps, larger molecules are separated out resulting in formation of whey concentrate. These larger molecules are proteins, lactose, immunoglobulins, amongst other less important ones. To produce whey isolate, cheese whey is passed through an ultrafiltration process (ion exchange or other methods). The ultra membrane filters fat, milk sugar (lactose), salts and other unwanted ingredients leaving behind a pure form of whey (Barile et al., 2009).

Hydrolysates, on the other hand, are formulations where large protein molecules are broken down into smaller fragments. The hypothesis is that this might further increase the rate of absorption of whey. However, this might not be totally true and hydrolysates may not offer much of an advantage over isolates or concentrates.

Types of Whey Protein

Whey is available commercially as either isolate or concentrate. ‘So, what’s the difference between them and which one should I be using’, you might want to ask?

The main difference between the two is the quality and the amount of protein content – isolate is purer and thus will contain almost 100% protein (well, 90-94% to be precise) while whey concentrate will contain protein ranging from 70-85%.

‘Well, that settles it – I am going with whey isolate!’, you might say. Hang on, not so fast! There is more to it than just protein content.

Comparing Whey Isolate and Whey Concentrate

Since whey isolate is higher in protein content, has a better amino acid ratio and thus bioavailability, it is absorbed into your system way quicker than whey concentrate (or any other protein, for that matter). That makes whey isolate the ideal post-exercise anabolic drink (Hulmi et al., 2009). Some researchers have suggested taking whey protein isolate before workouts as well in addition to your routine post-workout shake for maximum benefits (Esmark et al., 2001; Cribb & Hayes, 2006). Quicker absorption will mean almost instantaneous rise in blood amino acids which are then taken up by ‘hungry muscles’.

Having said that, the need for immediate post-workout protein supplementation in now being increasingly questioned (more below).

High protein content and higher quality of protein, however, that does not clinch the deal in favour of whey isolate. Concentrate has something up its sleeve that will make sit up and take notice!

As stated earlier, in comparison to isolate, whey protein concentrate will contain lesser amount of protein (in the range of 70-85%). However, somewhat similar to casein, whey protein concentrate will get absorbed slowly – this helps you stay anabolic for longer! Slower absorption also helps with absorption of other important nutrients from food like calcium. Not a lot of people know this but calcium plays an important role in causing fat loss (in addition to keeping your bones healthy)! Add to that the added benefit of appetite suppression for longer and casein suddenly become an important tool for your fat-loss goals or intermittent-fasting health journey…

Furthermore, whey protein concentrate is loaded with immunoglobulins – this helps boost your immune system and therefore may be beneficial in dealing with the intense stresses of training (especially if you happen to overtrain!).

Whey Isolate


    • pure; contains 90-94% protein!
    • purity means that it is great for gaining / maintaining lean mass while getting ripped (ideal when nearing competition or a photo shoot)
    • contains all essential amino acids in the best possible ratios
    • bioavailability for humans is best amongst all proteins – meaning, of the amount ingested, more is likely to be absorbed. For instance, in a scoop containing 25 g of whey isolate, almost all of the protein in there, will be going into your muscle
    • lightening fast absorption; ideal post-exercise drink – helps you get into the anabolic mode almost immediately


    • pricier than whey protein concentrate – to ensure purity, the commercial production of whey necessitates use of complex filtration procedure, hence the price
    • although whey isolate will help recovery after workouts, it loses out to whey concentrate in some respects. This is so because immune boosting constituents of milk protein like alpha – lactoglobulins and lactoferrins are removed during the purification process

Whey Concentrate


    • lot cheaper than whey isolate
    • has a slower absorption rate than whey protein isolates; thus ensures a steady state of elevated amino acids in the blood and helps you stay anabolic for longer. This also reduces the need for frequent dosing
    • slower absorption helps with absorption of other important minerals like calcium and reducing blood glucose and lipid levels
    • induces appetite suppression which may help longer fasting interval, thereby improving body composition and metabolic disease parameters
    • contains immune boosting complexes (alpha – lactoglobulins and lactoferrins) which help post-exercise muscle recovery
    • helps fight diseases – for instance, chronic hepatitis C (Elattar et al., 2010)


    • some amount of fat will be present so not ideally suited during times when keeping body fat% down is desirable
    • if you have any degree of intolerance to milk and dairy products, you might want to forget using whey concentrate on account of its lactose content – which is missing from the more purer whey isolate


In conclusion, isolate and concentrate are equally good – however, your circumstances – price, training goals and lactose intolerance – should tip the scales in favour of one or the other.

Recent developments

  1. More recently, the presence of a post-workout anabolic window (of opportunity) is being increasing questioned. ‘Not only is nutrient timing research open to question in terms of applicability, but recent evidence has directly challenged the classical view of the relevance of post-exercise nutritional intake with respect to anabolism’ (Aragon and Schoenfeld, 2013). The amount and quality of protein that you consume throughout the day is, now, thought to be more important than immediate post-workout whey ingestion.
  2. BCAAs (branched-chain amino acids – leucine, isoleucine and valine) may be overrated and ‘data do not seem to support a benefit to BCCA supplementation during periods of caloric restriction’ (Dieter BP, Schoenfeld BJ and Aragon AA, 2016).

Reference List

Aragon AA, Schoenfeld BJ (2013). Nutrient timing revisited: is there a post-exercise anabolic window? Journal of the International Society of Sports Nutrition. 2013;10:5 /1550-2783-10-5.

Barile, D., Tao, N., Lebrilla, C. B., Coisson, J. D., Arlorio, M., & German, J. B. (2009). Permeate from cheese whey ultrafiltration is a source of milk oligosaccharides. Int Dairy J, 19, 524-530.

Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2006). Liquid carbohydrate/essential amino acid ingestion during a short-term bout of resistance exercise suppresses myofibrillar protein degradation. Metabolism, 55, 570-577.

Cribb, P. J. & Hayes, A. (2006). Effects of supplement timing and resistance exercise on skeletal muscle hypertrophy. Med Sci.Sports Exerc., 38, 1918-1925.

Cribb, P. J., Williams, A. D., Carey, M. F., & Hayes, A. (2006). The effect of whey isolate and resistance training on strength, body composition, and plasma glutamine. Int J Sport Nutr.Exerc.Metab, 16, 494-509.

Dieter BP, Schoenfeld BJ, Aragon AA.(2016). The data do not seem to support a benefit to BCAA supplementation during periods of caloric restriction. Journal of the International Society of Sports Nutrition;13:21. doi:10.1186/s12970-016-0128-9.

Elattar, G., Saleh, Z., El-Shebini, S., Farrag, A., Zoheiry, M., Hassanein, A. et al. (2010). The use of whey protein concentrate in management of chronic hepatitis C virus – a pilot study. Arch.Med Sci., 6, 748-755.

Esmarck, B., Andersen, J. L., Olsen, S., Richter, E. A., Mizuno, M., & Kjaer, M. (2001). Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol, 535, 301-311.

Etheridge, T., Philp, A., & Watt, P. W. (2008). A single protein meal increases recovery of muscle function following an acute eccentric exercise bout. Appl.Physiol Nutr.Metab, 33, 483-488.

Etzel, M. R. (2004). Manufacture and use of dairy protein fractions. J Nutr., 134, 996S-1002S.

Ha, E. & Zemel, M. B. (2003). Functional properties of whey, whey components, and essential amino acids: mechanisms underlying health benefits for active people (review). J Nutr.Biochem., 14, 251-258.

Hakkinen, K., Pakarinen, A., Kraemer, W. J., Hakkinen, A., Valkeinen, H., & Alen, M. (2001). Selective muscle hypertrophy, changes in EMG and force, and serum hormones during strength training in older women. J Appl.Physiol, 91, 569-580.

Hoffman, J. R., Ratamess, N. A., Tranchina, C. P., Rashti, S. L., Kang, J., & Faigenbaum, A. D. (2010). Effect of a proprietary protein supplement on recovery indices following resistance exercise in strength/power athletes. Amino.Acids, 38, 771-778.

Hulmi, J. J., Ahtiainen, J. P., Kaasalainen, T., Pollanen, E., Hakkinen, K., Alen, M. et al. (2007). Postexercise myostatin and activin IIb mRNA levels: effects of strength training. Med Sci.Sports Exerc., 39, 289-297.

Hulmi, J. J., Kovanen, V., Selanne, H., Kraemer, W. J., Hakkinen, K., & Mero, A. A. (2009). Acute and long-term effects of resistance exercise with or without protein ingestion on muscle hypertrophy and gene expression. Amino.Acids, 37, 297-308.

Hulmi, J. J., Lockwood, C. M., & Stout, J. R. (2010). Effect of protein/essential amino acids and resistance training on skeletal muscle hypertrophy: A case for whey protein. Nutr.Metab (Lond), 7, 51.

Josse, A. R., Tang, J. E., Tarnopolsky, M. A., & Phillips, S. M. (2010). Body composition and strength changes in women with milk and resistance exercise. Med Sci.Sports Exerc., 42, 1122-1130.

Krissansen, G. W. (2007). Emerging health properties of whey proteins and their clinical implications. J Am Coll.Nutr., 26, 713S-723S.

Moore, D. R., Tang, J. E., Burd, N. A., Rerecich, T., Tarnopolsky, M. A., & Phillips, S. M. (2009). Differential stimulation of myofibrillar and sarcoplasmic protein synthesis with protein ingestion at rest and after resistance exercise. J Physiol, 587, 897-904.


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For many-a-years, ‘treadmill-users’ in gyms – especially women – have been subjected to immense ridicule by those that swear by the resistance training method as the only way of training – there’s been an ever increasing tendency to criticise people using the treadmill or indulging in aerobic activities. The advent of CrossFit (and the Concept 2 Rower) hasn’t helped matter since CrossFitters have also jumped into the fray as the ‘treadmill bashers’.

The basis of the criticism springs from the thinking that lifting weights is far better than aerobic training when it comes to losing fat. Although much of the evidence for such thinking is anecdotal, the proof for the idea that ‘weight-training’ is far better than aerobic training – like treadmill runs – is flimsy to say the least. Yet, all ‘knowledgeable fitness experts’ seems to agree unanimously that weight training is far better than treadmill running for fat loss! Read my blog here on why I think resistance training may not be a great fat loss as is usually made out.

Notwithstanding what bodybuilders of CrossFitters might suggest, runners have always maintained that running (as in long-distance running) continues to be the best darn way to lose fat! Having said that, I have always maintained that running does come at a risk (of injuries); this is how I feel about long-distance running! However, this blog post is more about the fact that treadmill running seems to be a great fat loss strategy and yet, it seems to have copped a lot of unwarranted heat.

Argument(s) for Resistance Training

Lifting weights – also called resistance training (RT) – increases muscle mass and tone. This increase in muscle mass – since muscle is the most metabolically active tissue in the body – translates into more calories burned throughout the course of the day, even when resting, they say.

In short, resistance training bumps up your metabolic rate. This, they believe, is in contrast to aerobic training (AT) where you’d burn calories only when you exercise but nothing much after!

Not surprisingly, most ‘knowledgeable’ fitness experts – thinking along these lines – suggest RT over AT for burning fat.

Well, it just may be that  fitness gurus may have been wrong and those’ women on treadmills’ may have been right all along – if a new study, published in the American Journal of Physiology – Endocrinology and Metabolism is to be believed (Lee et al., 2013).

Evidence in Favour of Aerobic Training 

Researchers from the University of Pittsburgh, Pennsylvania, conducted a study comparing resistance training with aerobic training in young women (Lee et al., 2013). The results were astonishing (for most!) – to say the least! Apparently, not only is AT better than RT at reducing body fat % but it also wins hands down when it comes to:

    • improving cardiorespiratory fitness,
    • improving insulin sensitivity,
    • reducing visceral adipose tissue (fat surrounding organs),
    • reducing abdominal fat, and
    • reducing inter-muscular fat (fat within muscle)

Other studies have also supported the idea that aerobic training may be better at reducing visceral and abdominal fat, not to mention, the overall body fat%.

    • A study published in Dec, 2012 reported that while AT and combined AT/RT exercise programs caused more fat loss than RT alone, AT/RT and RT resulted in increased lean mass. However, although requiring a double time commitment over AT alone, a combined AT/RT exercise program, the authors observed, did not result in ‘significantly more fat loss over AT alone’ (Willis et al., 2012)
    • Another study published in the American Journal of Physiology – Endocrinology and Metabolism concluded that aerobic training caused significant reductions in body fat (including subcutaneous abdominal fat), visceral and liver fat, plasma liver enzymes, alanine aminotransferase (enzyme reflecting the amount of liver damage) and HOMA (Homeostasis Model Assessment – a measure of the level of your steady state beta cell function (%B) and insulin sensitivity (%S)). Resistance training, on the other hand, failed to significantly affect these variable. Also, AT was found to be more effective that RT at reducing abdominal as well as body fat (Slentz et al., 2011)

Aerobic Training and Metabolic Disease

An interesting observation is that aerobic training seems to be better than resistance training in reducing the risk of metabolic syndrome (obesity, diabetes, cardiovascular conditions and what-have-yous). Researchers from the Duke University Medical Center showed that the results of a combination of AT and RT exercise regimen – although more effective at reducing the risk of metabolic disease than RT alone – were not significantly different from AT alone (Bateman et al., 2011). This effectively suggests  that the RT component may be contributing very little to the disease prevention effect of an AT-RT exercise program

Why Women prefer Treadmills?

As if the results of the studies mentioned above weren’t shocking enough, here’s something that is even more thought-provoking – something that might answer your question of why women tend to favor treadmills over free-weights!

It appears that aerobic training is more effective in (overweight and obese) women than in men (Lee et al., 2013). Furthermore, there is some evidence to suggest that women enjoy AT more than RT (Lee et al., 2012)the opposite seems to be true with young men – they seem to enjoy RT more (now come on, do we even need any proof of that?!).

My hunch is that is that women find aerobic training more enjoyable because it is more effective for them! Not surprisingly then – call it nature or the subconscious minds at work – there seems to be a very valid reason why you see more women heading to the treadmill rather than the ‘free-weights section’!


It is likely that treadmill runs may be more effective than resistance training – especially in overweight women – for reducing body fat and preventing metabolic diseases. Also,

    • RT contributes very little (if at all) to fat-loss
    • RT contributes very little towards (metabolic) disease prevention
    • the above seem to be the job of the  good old aerobic training

Furthermore, as opposed to popular belief, a combination of aerobic and resistance training does not seems to afford any more benefits over aerobic training alone when losing body fat is your prime goal. So, out goes the almost ancient ‘fitness program’ of alternate days of weight training and cardio.

I reckon – in light of recent research findings – women are advised to get as much cardio under their belt as they can. After all, Jane Fonda did manage to get into top shape without too much of lifting, didn’t she?! So, if you feel like it, don’t let anyone stop you from jumping on to the treadmill, girls!


It appears that for overweight or obese individuals – especially women – aerobic training may still be the best way to go, not only to reduce body fat but also to reduce the risk of metabolic diseases as well.

Although, it can be argued here that studies cited have shortcomings (and a well-qualified researcher will likely, blow the results of these studies to smithereens), it has to be acknowledged these studies do have the potential to make us think twice.The question that begs to be answered is ‘what if we were wrong about our fat-loss strategies and indeed, about our obsession with resistance training and what if those women on treadmill were right all along?!

Until such a time that someone comes up with concrete proof about resistance training being so damn good that we can totally do away with aerobic training, let’s us keep our minds open. AND, let’s also stop ridiculing (or even downright laughing at) those women who hit the treadmill every single time!


Bateman, L. A., Slentz, C. A., Willis, L. H., Shields, A. T., Piner, L. W., Bales, C. W. et al. (2011). Comparison of aerobic versus resistance exercise training effects on metabolic syndrome (from the Studies of a Targeted Risk Reduction Intervention Through Defined Exercise – STRRIDE-AT/RT). Am J Cardiol, 108, 838-844.

Lee, S., Bacha, F., Hannon, T., Kuk, J. L., Boesch, C., & Arslanian, S. (2012). Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial. Diabetes, 61, 2787-2795.

Lee, S., Deldin, A. R., White, D., Kim, Y., Libman, I., Rivera-Vega, M. et al. (2013). Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol.Metab, 305, E1222-E1229.

Slentz, C. A., Bateman, L. A., Willis, L. H., Shields, A. T., Tanner, C. J., Piner, L. W. et al. (2011). Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Am J Physiol Endocrinol.Metab, 301, E1033-E1039.

Willis, L. H., Slentz, C. A., Bateman, L. A., Shields, A. T., Piner, L. W., Bales, C. W. et al. (2012). Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. J Appl.Physiol (1985.), 113, 1831-1837.

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Physical exercise, per se, does not cause cardiovascular death. Does it, then, unmask a cardiac condition to cause a ‘heart attack’ which otherwise would not have occurred had the person not been exercising or playing sport? 
That is the question for the sports medicine community to answer!
The recent death of a young Italian footballer, Piermario Morosini has brought back into focus the mystery surrounding ‘sudden death’. For decades now, sports medicine has been struggling to find answers to the what causes sudden death in sports. 
Elite athletes are fine specimen of fitness and human health, revered and idolized by society – what causes sudden death in these super-fit individuals is an enigma. Some researchers are of the opinion that exercise, can, under some circumstances and in some individuals,  unmask conditions which can lead to cardiovascular complications. These researchers are of the opinion that these conditions likely to cause death on the field can be diagnosed and hence there is enough ethical ground to ban these individuals from competitive sports.
And, there-in lies one of the biggest ongoing debates in sports medicine.
So, What Exactly is Sudden Death?

Sudden death in sport (SD) – better known as sudden cardiovascular death – is death that occurs due to cardiovascular complications within an hour of onset of symptoms in a fit individual participating in, usually, an elite level sport.

Cardiac anomalies contribute to 93% of all sudden deaths in sport. SD apparently occurs in a person without previously recognized predisposing cardiovascular conditions. In some instances, pre-existing symptoms may already have been present, but the time and mode of death are unexpected.

Of the cardiovascular causes of deaths in athletes, 80% have been identified to be either due to hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy.

This definition of SD excludes deaths occurring due to cerebrovascular, respiratory, traumatic and drug-related causes (responsible for the remainder of 7% of deaths in sport.

Another significant cause of death, especially in contact sports, is commotio cordis which is briefly described below.

Incidence of SD

The incidence of SD is estimated to be about one death in 1 in 1,00,000 per year with an average of 300 deaths per year, but the incidence could be higher according to some European studies. An Italian study suggested an incidence of 1.6 – 2.3 per 1,00,000 athletes per year (2.1 per 1, 00,000 per year due to cardiovascular causes in athletes). This clearly suggests that the incidence could be much higher than previous studies suggest.

Symptomatology of SD

most cases of SD are asymptomatic; in a small % of cases, symptoms do occur prior to  SD;

these are:

i.     angina (chest pain)

ii.    dyspnoea (breathlessness)

iii.   palpitations (awareness of one’s heart beating)

iv.   presyncope or syncope (lightheadedness or fainting)

What causes SD?

Enumerated below are some of the causes of death in sports

Cardiovascular and allied causes

i. Hypertrophic Cardiomyopathy (HCM): non-obstructive, obstructive, ischemic, etc

ii. Valvular disease: Aortic stenosis, Mitral Valve Prolapse

iii. Coronary artery disease

iv. Congenital anomalies of coronary arteries

v. Idiopathic concentric left ventricular hypertrophy (LVH)

vi. Aortic rupture

vii. Right ventricular dysplasia (ARVC)

viii. Myocarditis: viral, sarcoidosis, amyloidosis

ix. Arrhythmias and conduction defects – including paroxysmal atrial fibrillation and others

x. Congenital heart disease: Marfan’s, WPW syndrome

xi. Pulmonary embolisation

Read more about what triggers atrial fibrillation


i. QT interval prolonging: cisapride, domperidone, chlorpromazine, haloperidol, pimozide, erythromycin and clarithomycin

ii. Adrenergics: epinephrine, ephedrine, cocaine, etc

iii. Performance enhancing: erythropoietin (hyperviscosity & thrombogenesis)

iv. Anabolics

Commotio cordis (CC)

Sudden impact on the chest from front-on (precordium), during a vulnerable period of the cardiac cycle can cause ventricular fibrillation and death without any visible injury to the sternum or ribs. This kind of event is mostly seen in contact sports.

Age Considerations in Aetiology of SD

In general, in athletes > 35 years of age, atherosclerotic coronary arterial disease is the leading cause while in those under 35, it is often caused by HCM (hypertrophic cardiomyopathy), a silent cardiac condition which gets unmasked during high-intensity exercise or performance.

Geographic Considerations in Aetiology of SD

In the US, HCM is the major cause of SD. In Europe, on the other hand, cardiac arrhythmia and abnormal cardiac arterial anatomy is supposed to be the leading cause. In Asia, on the contrary, (the Philippines, Thailand and Japan), Brugada Syndrome seems to be a major cause of sudden death. However, this relates to cardiac arrest occurring during sleep or at rest in men less than 50 years in age and not related to a sporting performance.

An interesting statistic is that in the US, 50% of sports-related sudden death occurred in athletes of Afro-American origin.

Diagnosis of SD

Diagnosis of SD can be reached based upon the presence of the following findings in an athlete:


a.Double apical impulse with each ventricular contraction

b.Carotid jerky double pulsation, called pulses bisferiens

c.Ejection systolic murmur

Laboratory Investigations

a. ECG: suggestive of LVH, in addition, there is ST segment depression, gross T wave inversions, pathologic Q waves, and suggestion of LBBB, left axis deviation

b. 2D Echocardiography: to measure the thickness of the Left ventricular wall, and the anatomical variations of the Mitral valve

c. Angio–CT

d. MRI

e. Doppler Study: to access the blood flow through the chambers

f. Ambulatory Holter monitoring and Invasive Cardiac catheterization: to assess the pressure gradient between the LV and the ascending aorta, in normal heart there being no such difference


The underlying mechanism of sudden cardiovascular death, more often than not, is ventricular fibrillation; hence, as such it can be treated with defibrillation.

Thus, in elite sport, up gradation of sport first aid infrastructure, with routine availability of automated external defibrillators (AEDs) is the need of the hour. Keeping in mind the ABC of resuscitation, the surviving sports person should be transported to a referral health unit for further management and investigations into the causes of the event.

Admission to an ICU for observation or management is usually warranted.


An Overwhelming majority of sports researchers agree on the need for pre-participation screening of athletes. So much so, that it has been made mandatory in the US and Italy. In Australia, it is pre-participation screening is limited to certain sports.

The American Heart Association has laid down recommendations for the screening of athletes. These state that ‘some form of pre-participation cardiovascular screening for high school and collegiate athletes is justifiable and compelling, based on ethical, legal and medical grounds’. Non-invasive testing can enhance the diagnostic potential of the standard history and physical examination; however it is not prudent to carry out routine use of tests as 12-lead ECG, echocardiography, or graded exercise for detection of CV disease in large populations of athletes.

The Lausanne recommendations have also laid down specific guidelines for pre-screening of athletes (Bille et. al). However, guidelines by different bodies have given rise to a lot of debate and confusion. Furthermore, some believe that no single guideline can be considered totally satisfactory.

The result? Failure of implementation of any of these guidelines to screen athletes for cardiovascular anomalies. Athletes, therefore continue to die on the field with an alarming rate of regularity!

In general, a lot of research has been done and a lot written about sudden cardiovascular death related to sport, but thanks to different outcomes of various studies, confusion still prevails about the exact definition of the condition, and indeed, what causes it.

Although, we know of conditions which may predispose to sudden death, we cannot as yet, on the basis of screening tests or procedures available, say for sure what condition(s) will definitely lead to sudden death. Hence, there is a major dilemma surrounding banning athletes from competition.

On the one hand, there is the ethical issue of preventing risks that potentially lead to death, while on the other, there is the thought of banning the athlete when you are not sure if his/her heart condition is indeed a pathological state. One may argue that taking risks is an inherent part of sports, esp. boxing, car racing, etc. And, that is what makes sport exciting. However, it cannot be denied that life-threatening risks in sports are a strict ‘no-no’ and should be discouraged at all costs!


To conclude, exercise or sport may lead to sudden death. The benefits of exercise, however, far outweigh the risks involved.

Even in elite athletes, the risk-benefit ratio is to be taken into consideration when disqualifying him or her from competition. It is of paramount importance to judge whether the left ventricular wall thickness is a measure of physiologic adaptation to exercise or relates to a cardiac pathology.

With a society struggling with the pandemic of obesity and metabolic disease, humanity can ill afford to be discouraged from exercising or participating in sport under any pretext unless irrefutable proof of existence of conditions that will cause death in a person is present.

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Is there a connection between fitness and sexual activity? Would being fat prevent you from being a great bedroom performer? Chances are – YES; you can achieve much greater things by being leaner!

Which bring us to the question – could exercise be prescribed to those who want to improve their bedroom performance?! Shouldn’t functional training – which improves efficiency in carrying out our daily routines – be doing the same for your love life as well? Well, it most definitely should!

Importance of sexual activity in human life

Feeding oneself for survival and indulging in sexual activity for the survival of one’s species are the most basic of all activities for almost all life forms; human beings are no different!

Although even mentioning it, let alone discussing sexual intercourse is still a taboo is most parts of the world, it is an undeniable fact that sexual activity is an integral part of human existence. Thus, it is not at all surprising that striving to be ‘sexually desirable’ by the opposite sex is an inherent part of the human psyche.

Love making and a fit body

Ask a lady about the kind of man she’s looking for and pat comes the answer, ‘he must be good-looking, lean and should make me feel special’.

Well, what the girls really mean (while they may not know it, but the following has been ‘genetically programmed’ in their subconscious minds over generations) is this:

  • good-looking – good genes
  • lean – toned body, low body fat with testosterone tanks overflowing and therefore fit enough to perform ‘the act’ optimally, thereby increasing the chances of conception
  • makes me feel special – the right kind of chemistry which comes down to the right kind of hormones running through his veins and what-have-yous!

Now, if you are one of those who can read between lines, you will realize that all the above mentioned can be improved by exercise. Agreed you can’t do much about your lack of a good genetic make-up but – as any good coach will tell you is that – it shouldn’t stop you from ‘maximizing your potentials’. In my view, almost everyone out there with a poor genetic makeup will surely benefit from regular exercise; no point having awesome genes but sitting on your fat arse, doing nothing!

So let’s have a look at how exercise would help you with improving your ‘bedroom performance’ and turning your into a dream lover!

Similarities between exercise and love-making

Since ‘lovemaking’ makes use of the very fitness parameters that typically epitomize short-burst interval training, it can be argued that either of these activities may help in improving performance in the other.

Here are some similarities (that I can think of):

  • Fitness parameters used

It is a well-known fact that sexual activity is akin to exercise – with hearts pounding, blood pressures rising, breathing going haywire, sweating and what-have-you! In a nutshell, you are hitting almost all components of fitness – cardiorespiratory fitness, muscle strength, muscle flexibility, et. al.

Thus, it’s a no brainer that to improve your bedroom performance, you’ve got to improve your fitness.

  • Hormonal response

Testosterone is the major male sex hormone which is instrumental in causing increased libido, improving penile erections and sperm counts. Resistance training, especially squatting, boosts testosterone levels. Research has proved that regular sexual activity – even watching porn material – boosts testosterone secretion many folds over normal! Also, testosterone has prominent anabolic actions: helps pack on lean muscle mass, stimulates metabolism and improves body composition by decreasing body fat.

  • Immune response 

Exercise and regular sexual activity have both been reported to cause increased levels of antibodies – improved serum antibody levels helps fight infections (Brennan and Charnetski, 2000).Studies have shown that those who indulge in sexual activity 2 to 3 times a week exhibited higher levels of IgA antibodies as compared to those who ‘do it’ infrequently (Charnetski and Brennan, 2004).

  • Calories burned

As we all know, exercise is a great way of burning calories over and above those required for your daily chores. Similarly, research supports the view that sexual activity is quite effective at burning calories as well (O’Keefe et al., 2010a;O’Keefe et al., 2011). It might surprise you to know that 30 minutes of intense ‘love making’ can help you burn as much as 200 calories (O’Keefe et al., 2010b) – that’s like running 15 min. on the treadmill!

  • Cardiac Function 

During a sexual act, you are operating intermittently at heart rates of 150 beats per minute and systolic blood pressure of 200 mmHg. This creates cardiovascular dynamics and workloads similar to short-burst interval training.  This ‘heart rate training’ induced by sexual activity can, therefore, act as a great cardiovascular exercise (anaerobic training) and a metabolic-simulator! Conversely, regular exercise sessions of intense cardio interval training combined with weights can help you improve your ‘performance in bed’.

  • Busting stress and improving quality of sleep

Exercise and regular sexual activity, by virtue of secretion of endorphins and suppression of cortisone, improve mood and help fight stress. Prolactin secretion associated with sexual intercourse also causes mood elevation. In addition to these, secretion of oxytocin and the phenomenon of ‘resolution’ – relaxation associated with orgasm – together will put you to a ‘peaceful sleep’.

Furthermore, reduced diastolic blood pressure as a consequence of regular exercise and sexual activity keeps your stress levels reduced throughout the day.

  • Improved muscle tone

By increasing lean mass and decreasing body fat, exercise can help you get the most out of your ‘performances’. Strong pelvic floor musculature is of paramount importance in women as well men for deriving optimal pleasure. Training to produce strong isometric contractions of the pelvic floor can help achieve better erections in males – being able to contract pelvic floor musculature intensely is one of the techniques recommended for treating erectile dysfunction. Furthermore, regular sexual intercourse has also been shown beneficial in preventing prostate cancer.

In women, pelvic floor training can help with urinary incontinence and during pregnancy and childbirth.


To conclude, both – intense, short-burst interval training with resistance exercise thrown in – and regular sexual activity seems to utilize the same mechanisms.  Improving fitness will improve your performance in bed; regular sexual intercourse (and exercise itself) in turn will cause a plethora of health and fitness benefits.

References Cited

Brennan, F. X., and C. J. Charnetski, 2000 Explanatory style and Immunoglobulin A (IgA): Integr.Physiol Behav.Sci., v. 35, no. 4, p. 251-255.

Charnetski, C. J., and F. X. Brennan, 2004 Sexual frequency and salivary immunoglobulin A (IgA): Psychol.Rep., v. 94, no. 3 Pt 1, p. 839-844.

O’Keefe, J. H., R. Vogel, C. J. Lavie, and L. Cordain, 2010a Organic fitness: physical activity consistent with our hunter-gatherer heritage: Phys.Sportsmed., v. 38, no. 4, p. 11-18.

O’Keefe, J. H., R. Vogel, C. J. Lavie, and L. Cordain, 2011 Exercise like a hunter-gatherer: a prescription for organic physical fitness: Prog.Cardiovasc.Dis., v. 53, no. 6, p. 471-479.

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Since its discovery in 1921 by Banting and Best, insulin has never ceased to fascinate. Researchers, medics, diabetics, sports men and women and lay people have all taken a fancy to the way insulin controls our physiology and our lives!

Volumes upon volumes have been written about insulin: its chemical structure, synthesis, modes of action and what have you. However, here are few interesting facts about insulin that I’m pretty sure you’ve never heard of:

Insulin was:

1. the first protein shown to have hormonal action
2. the first protein to be crystallized (Abel, 1926)
3. the first protein to be sequenced (Sanger et al, 1955)
4. the first protein to be synthesized chemically (Du et al, Zahn, Katsoyanis, ca, 1964)
5. the first protein to be synthesized as a large precursor molecule (Steiner et al, 1967)
6. the first protein synthesized for commercial use by DNA recombinant technology

Divine intervention, you reckon?! Maybe, …taking into consideration the immense importance of insulin in present day ‘pandemic of metabolic diseases’. However,  despite these ‘impressive firsts’, the fact remains that even today, compared to other subsequently discovered hormones, very little is known about the mode of action of insulin at the cellular level! How about that?!

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The term VO2 max. stands for maximal oxygen uptake. It is generally accepted as the most sensitive predictor of a person’s cardiorespiratory  or aerobic fitness.

Assessment of cardiorespiratory fitness is important for both the athlete as well as the general population. In athletes for apparent reasons; in general population, VO2 max. can be used to predict subsequent development of cardiovascular disease. Thus, VO2 max. studies can be used for prevention, both primary as well as secondary, of development of cardiovascular sequelae like angina pectoris or myocardial infarction.
Furthermore, since CR fitness has been linked decisively to early deaths from a variety of causes, VO2 max studies in general population assume immense significance.
So what exactly is this VO2 max.? Well, in literal terms, it is the volume (V) of oxygen (O2) during maximum exercise that your body is able to transfer. As we all know, during exercise, your body starts burning calories and these chemical reactions need more oxygen (esp. cardio exercises). Thus, the higher you VO2 max., your body can transport oxygen more effectively during times of intense training and thus you can exercise better and longer at these intense levels. Conversely, if your VO2 max in lower, you will struggle the moment you start stepping out of your comfort zone.
Methods of Assessing VO2 max
VO2 max. can be measured using either maximal or sub maximal exercise testing protocols. Maximum exercise testing involves pushing the subject to the limit of intense physical exercise so much so that immediate medical attention is usually required. Maximal exercise testing is a true reflection of VO2 max. However, for obvious, this method is best avoided, at least in the general population.
Most authorities recommend using the submaximal method to determine values for submaximal loads of exercise intensity and then using regression equations to predict the VO2 max.
Whereas, maximal exercise testing is more sensitive, submaximal exercise testing is safer, esp. when implemented to the population who are not accustomed to training.
Maximal Exercise Testing:
Since maximal exercise testing requires the use of equipment as well as trained individuals and is used only in certain settings, it is considered beyond the scope of this article and will be discussed elsewhere.

Submaximal Exercise Tests

Astrand and Rhyming Step Test
carried out using a 33cm step/ aerobic bench for women and 40cm step for men. It involves stepping up and down the step or bench at the rate of 22.5 per min. ECG and steady state heart rate readings are taken. It would take 25.8 and 29.5 mL/Kg/min. of oxygen uptake for women and men respectively.
Other tests that are popular are the YMCA step test and The Canadian Home Fitness Test. The step tests are popular because of the ease of implementation as well as minimal equipment required. Another major advantage is the minimal cost as well as the fact that large number of subjects can be tested at the same time as The Canadian Home Fitness Test has shown.
3 min. YMCA Step Test 
The basis of this test is to determine how quickly your heart rate returns to normal after a bout of exercise and to extrapolate the information to normative data from previous studies. This test uses a 12 inch aerobic bench. The subject steps onto the bench with a rate of 24 per minute (estimated oxygen uptake of 25.8 mL/Kg/Min.). After 3 min., the subject immediately sits down and the HR is counted for a minute. It is crucial that the HR is counted starting within 5 sec of stopping the exercise. The obtained HR values are then used to compare against established norms.
Treadmill Tests
A minimal of  3 min. treadmill test using 70% of heart rate reserve or and 85% of maximal heart rate as the end point of test is a better predictor of VO2 max than the step tests. Pretty much like in the step tests, achieving a steady state heart rate is imperative to get accurate data. Thus, the need to carry out the test for a minimum of  3min. Variety of treadmill test protocols are used: Bruce Protocol being the most popular of all.
Cycle Ergometer Tests
Astrand-Rhyming Cycle Ergometer Test
is a 6 min. single stage test. The subject should pedal at a rate of 50rpm to achieve a HR between 125 and 170 beats/min. HR should be measure during the 5th and 6th minute of the test. An average of 2 or more HR reading is taken and used to estimate VO2 max from Modified Astrand-Rhyming Normogram.
Other test like Maritz Test uses a multi-stage cycle ergometer test to determine VO2 max.
A plethora of tests for assessing aerobic capacity are available. This, however, makes the choice a bit difficult. A lot depends on the subject, his/her cardiorespiratory status as well as availability of equipment and trained personnel. 
At the end of the day,  designing and implementing a good fitness program, either as a preventive measure for a cardiovascular disease or to achieve fitness goals is equally, if not more important.

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