Medical Problems of the Athlete

  • Jeffrey L. Tanji


Medical conditions among athletes and physically active individuals encompass a broad spectrum of problems commonly seen by the family physician. The diagnosis, management, and attitudinal approach to these patients might reasonably be assumed to be the same as for any other patient, but in fact it is not always the case. Some medical conditions are improved with exercise, others may be exacerbated by certain types of activity. For some patients the interaction of medication and physical activity may require a tailor-made design for the intensity, duration, and frequency of exercise. The focus of this chapter is to examine the medical problems of asthma, the athlete’s heart, hypertension, diabetes mellitus, anemia and other blood disorders, gastrointestinal disorders, fluid and electrolyte management, and pregnancy associated with exercise.


Physical Activity Physical Fitness Endurance Athlete Fluid Replacement Heat Stroke 
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  1. 1.
    Harris SS, Caspersen CJ, DeFriese GH, Estes EH. Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting: report for the U.S. Preventive Services Task Force. JAMA 1989;262:3590–8.Google Scholar
  2. 2.
    Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987;8:253–87.PubMedCrossRefGoogle Scholar
  3. 3.
    US Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; The President’s Council on Physical Fitness and Sports, Physical Activity and Health. A report of the Surgeon General. Atlanta: CDC, 1996.Google Scholar
  4. 4.
    American College of Sports Medicine. Guidelines for exercise testing and prescription. 5th ed. Baltimore: Williams & Wilkins, 1995.Google Scholar
  5. 5.
    Paffenbarger RS Jr, Hyde RT, Wang AL, Hsieh CC. Physical activity, all-cause mortality and longevity of college alumni. N Engl J Med 1986;314:605–13.PubMedCrossRefGoogle Scholar
  6. 6.
    Leon AS, Connett J, Jacobs DR Jr, Rauraman R. Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA 1987;258:2388–95.PubMedCrossRefGoogle Scholar
  7. 7.
    Ekelund RS, Haskell WL, Johnson JL, et al. Physical fitness as a predictor of cardiovascular mortality in North American men. N Engl J Med 1986;314:605–13.CrossRefGoogle Scholar
  8. 8.
    Blair SN, Kohl HW, Paffenbarger RS Jr, et al. Physical fitness and all-cause mortality. JAMA 1989;262:2395–401.PubMedCrossRefGoogle Scholar
  9. 9.
    Tanji JL. Sports safety. In: Hudson TW, editor. Clinical preventive medicine. Boston: Little, Brown, 1988:251–9.Google Scholar
  10. 10.
    US Department of Health and Human Services. The national children and youth fitness study. J Phys Educ Recreat Dance 1985;1(6) :44–90.Google Scholar
  11. 11.
    Tanji JL. The preparticipation physical examination for sports. Am Fam Physician 1990;42:397–402.PubMedGoogle Scholar
  12. 12.
    Paffenbarger RS Jr, Hale WE. Work activity and coronary heart mortality. N Engl J Med 1975;292:545–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Paffenbarger RS Jr, Laughlin ME, Gima AS, Black RA. Work activity of longshoremen as related to death from coronary heart disease and stroke. N Engl J Med 1970;282:1109–14.PubMedCrossRefGoogle Scholar
  14. 14.
    McCarthy P. Wheezing or breezing through exercise-induced asthma. Phys Sports Med 1989;17(7):125–30.Google Scholar
  15. 15.
    Varray AL, Mercier JG, Terral CM, et al. Individualized aerobic and high intensity training for asthmatic children in an exercise readaptation program: is training always helpful for better adaptation to exercise? Chest 1991;99:579–86.PubMedCrossRefGoogle Scholar
  16. 16.
    McFadden ER Jr. Exercise performance in the asthmatic. Am Rev Respir Dis 1984;129:584–7.Google Scholar
  17. 17.
    Nickerson BG, Bautista DB, Maney MA, et al. Distance running improves fitness in asthmatic children without pulmonary complications or changes in exercise-induced bronchospasm. Pediatrics 1983;71:147–52.PubMedGoogle Scholar
  18. 18.
    Clark CJ, Cochrane LM. Assessment of work performance in asthma for determination of cardiorespiratory fitness and training capacity. Thorax 1988;43:745–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Haas F, Pineda M, Axen K, et al. Effects of physical fitness on respiratory airflow in exercising asthmatic people. Med Sci Sports Exerc 1985;17:585–92.PubMedGoogle Scholar
  20. 20.
    Ludwick SK, Jones JW, Jones TK, et al. Normalization of cardiopulmonary endurance in severely asthmatic children after bicycle ergometry therapy. J Pediatr 1986;109:446–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Ahmed T. Role of heparin for exercise induced asthma. In: Proceedings of American Medical Society for Sports Medicine Annual Meeting. Orlando, AMSSM, 1996:35–46.Google Scholar
  22. 22.
    Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. N Engl J Med 1985;313:24–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Bryan G, Ward A, Rippe JM. Athletic heart syndrome. Clin Sports Med 1992;11:259–72.PubMedGoogle Scholar
  24. 24.
    Tanji JL. Exercise and the hypertensive athlete. Clin Sports Med 1992;11:291–302.PubMedGoogle Scholar
  25. 25.
    Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. The 5th report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Bethesda: National Institutes of Health, 1993. NIH Publ. 73:1088.Google Scholar
  26. 26.
    Tipton CM. Exercise, training and hypertension: an update. Exerc Sport Sci Rev 1991;19:447–505.PubMedCrossRefGoogle Scholar
  27. 27.
    Kaplan NM. The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989;149:1514–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Tanji JL. Hypertension: how exercise helps. Phys Sports Med 1990;18(7):77–82.Google Scholar
  29. 29.
    MacDougall JD, Tuxen D, Sale DG, et al. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 1985;58:785–90.PubMedGoogle Scholar
  30. 30.
    Tanji JL. Hypertension: the role of medication. Phys Sports Med 1990;18(8):87–91.Google Scholar
  31. 31.
    Reaven GM. Insulin resistance, hyperinsulinemia and hypertriglyceridemia in the etiology and clinical course of hypertension. Am J Med 1991;90 Suppl 2A:7A-7S.CrossRefGoogle Scholar
  32. 32.
    Eichner ER. Runner’s macrocytosis: a clue to foot strike hemolysis. Am J Med 1985;78:321–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Selly GB, Eichner ER. Endurance swimming, intravascular hemolysis, anemia and iron depletion. Am J Med 1986;81:791–4.CrossRefGoogle Scholar
  34. 34.
    Krauss BB, Sinclair JW, Castell DO. Gastroesophageal reflux in runners. Am Intern Med 1990;112:429–33.CrossRefGoogle Scholar
  35. 35.
    Baska RS, Moses FM, Deuster PA. Cimetidine reduces running-associated gastrointestinal bleeding. Dig Dis Sci 1990; 35:956–60.PubMedCrossRefGoogle Scholar
  36. 36.
    Green GA. Gastrointestinal disorders in the athlete. Clin Sports Med 1992;11:453–70.PubMedGoogle Scholar
  37. 37.
    Adolph EF. Physiology of man in the desert. New York: Interscience, 1977.Google Scholar
  38. 38.
    Neufer PD, Young AJ, Sawka MN. Gastric emptying during exercise: effects of heat stress and hypohydration. Eur J Appl Physiol 1989;58:433–9.CrossRefGoogle Scholar
  39. 39.
    Anderson RJ, Reed G, Knochel J. Heatstroke. Adv Intern Med 1983;28:115–41.PubMedGoogle Scholar
  40. 40.
    Weiner JS, Horne GO. A classification of heat illness. BMJ 1958;1:1533–5.CrossRefGoogle Scholar
  41. 41.
    Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev 1974;54:75–159.PubMedGoogle Scholar
  42. 42.
    Gisolfi CV, Duchman SM. Guidelines for optimal replacement beverages for different athletic events. Med Sci Sports Exerc 1992;24:679–87.PubMedGoogle Scholar
  43. 43.
    Costill DL, Sparks KD. Rapid fluid replacement following thermal dehydration. J Appl Physiol 1973;34:299–303.PubMedGoogle Scholar
  44. 44.
    Marbaix O. Le passage pylorique. Cellule 1898;14:249–332.Google Scholar
  45. 45.
    Costill DL, Saltin B. Factors limiting gastric emptying during rest and exercise. J Appl Physiol 1974;37:679–83.PubMedGoogle Scholar
  46. 46.
    Lamb DR, Brodowicz GR. Optimal use of fluids of varying formulations to minimize exercise-induced disturbances in homeostasis. Sports Med 1986;3:247–74.PubMedCrossRefGoogle Scholar
  47. 47.
    Gisolfi CV, Summers RW, Schedl HP. Intestinal absorption of fluids during rest and exercise: fluid homeostasis during exercise. Carmel, IN: Brown & Benchmark, 1990:129–75.Google Scholar
  48. 48.
    ACOG Technical Bulletin. Exercise during pregnancy and the postnatal period. Washington, DC: ACOG, 1985.Google Scholar
  49. 49.
    ACOG Technical Bulletin: Exercise during pregnancy and the postpartum period. Washington, DC: ACOG, 1994.Google Scholar
  50. 50.
    Sternfeld B, Quasenberry CP Jr, Eskenazi B, Newman LA. Exercise in pregnancy and pregnancy outcome. Med Sci Sports Exerc 1995;27:634–40.PubMedGoogle Scholar
  51. 51.
    ACOG. Guidelines for exercise in pregnancy and the postpartum period. ACOG Technical Bulletin #187. Wash. DC. 1994.Google Scholar

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© Springer Science+Business Media New York 1998

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  • Jeffrey L. Tanji

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