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Inzidenz und Therapie der Depression bei Patienten mit Osteoporose und Rheumatoider Arthritis
(2018)
Dieser Band beschäftigt sich mit den theoretischen Grundlagen und der praktischen Umsetzung von Krafttraining mit Kindern und Jugendlichen. Ausgehend von der Kennzeichnung der körperlichen Situation und der Kraftentwicklung im Kindes- und Jugendalter werden die Effekte von Krafttraining bei Kindern und Jugendlichen aufgezeigt. Hierzu zählen neben Verbesserungen der Kraftausdauer, der Maximal- und Schnellkraft, die Förderung elementarer und sportartspezifischer Fertigkeiten sowie die günstige Beeinflussung gesundheitsrelevanter Faktoren (u.a. Verletzungshäufigkeit, Knochenstatus, kardio-vaskuläre und psycho-soziale Kennwerte).
Im Anschluss werden neuronale und muskuläre Mechanismen zur Erklärung der trainingsbedingten Anpassungen beschrieben. Das Kernstück des Buches bildet die Darstellung und Beschreibung vielfältiger Übungsbeispiele für ein Krafttraining an Maschinen, mit Freihanteln, Zusatzgeräten, dem eigenen Körpergewicht und ein Sprungkrafttraining. Hierbei wurden insbesondere Übungen ausgewählt, die sich für den Einsatz im Schul- und Vereinssport eignen. Dieses Buch dient somit Lehrern, Übungsleitern und Trainern, ein zielgerichtetes Krafttraining mit Kindern und Jugendlichen wirkungsvoll und sicher durchzuführen.
Background: So far, for center comparisons in inpatient cardiac rehabilitation (CR), the objective outcome quality was neglected because of challenges in quantifying the overall success of CR. In this article, a multifactorial benchmark model measuring the individual rehabilitation success is presented.
Methods: In 21 rehabilitation centers, 5 123 patients were consecutively enrolled between 01/2010 and 12/2012 in the prospective multicenter registry EVA-Reha (R) Cardiology. Changes in 13 indicators in the areas cardiovascular risk factors, physical performance and subjective health during rehabilitation were evaluated according to levels of severity. Changes were only rated for patients who needed a medical intervention. Additionally, the changes had to be clinically relevant. Therefore Minimal Important Differences (MID) were predefined. Ratings were combined to a single score, the multiple outcome criterion (MEK).
Results: The MEK was determined for all patients (71.7 +/- 7.4 years, 76.9 % men) and consisted of an average of 5.6 indicators. After risk adjustment for sociodemographic and clinical baseline parameters, MEK was used for center ranking. In addition, individual results of indicators were compared with means of all study sites.
Conclusion: With the method presented here, the outcome quality can be quantified and outcome-based comparisons of providers can be made.
In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability.
The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube.
In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic.
A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years).
Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.
Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.
Back pain is a complex phenomenon that goes beyond a simple medical diagnosis. The aetiology and chronification of back pain can be best described as an interaction between biological, psychological, and social processes. However, to date, multimodal prevention and intervention programs for back pain that target all three aetiological factors have demonstrated limited effectiveness. This lack of supportive evidence for multimodal programmes in the treatment of back pain could be due to the fact that few programs are suitable for long-term and unsupervised use in everyday life. Moreover, in combining the elements from various therapies, little attention has been paid to the mechanisms underlying the synergistic effects of the separate components. In this contribution, we will describe the development of a new multimodal intervention for back pain that set out to address these limitations. To this end, the biological elements of neuromuscular adaptation is supplemented with cognitive behavioral and psychophysiological techniques in an intervention that can be followed at home as well as in clinics, and that is suitable for all grades of pain. The efficacy of this intervention will be tested in a multicentric randomized controlled longitudinal trial (n = 714) at five time points over a period of 6 months. Here we will describe the development and the content of this new intervention.
Mindfulness and acceptance describe the skills necessary to experience emotions and thoughts (e.g., performance-interfering cognitions) consciously and without judging them. This article introduces the mindfulness and acceptance approach and its potential in the context of competitive sports. Definitions as well as research results related to mechanisms of action and differential psychological aspects are given and the efficacy of the approach in the field of clinical psychology is reviewed. The rationale and implementation of the mindfulness-acceptance-commitment approach, an approach adapted for performance enhancement, is illustrated. Finally, evidence from psychotherapy research is presented, and a recommendation for the use of mindfulness and acceptance in the context of competitive sports is given.
Spielberger's (1972) Trait-State-Anxiety theory distinguishes between anxiety as a trait (A-trait) - involving a stable characteristic of a person to react with anxiety in response to varying situations and anxiety as a state (A-state), a situation-dependent reaction to a stimulus perceived as threatening. Using a general instead of a sport-specific measure, a previous study provided only mixed support for core predictions of the theory as related to sports (Schwenkmezger, 1985). With the aid of enhanced instruments and statistical methods, we tested these predictions again. The multidimensional and competition-specific assessment of anxiety results in support for the assumption of a stable A-trait and a fluctuating A-state, whereby the A-trait not only predicts the intensity of A-states but also the A-state variability. The repeated assessment of A-states prior to two competitions reveals a rather low relative consistency (i.e., interindividual differences across measurements were only moderately stable). Especially this latter finding suggests that, in order to gain a full understanding of the experience of competitive anxiety in athletes, sport psychologists should not only assess competitive A-traits, but also repeatedly measure competitive A-states.
Since the legend of the ancient Marathon run, the risk of endurance exercise-induced cardiovascular damage or sudden cardiac death is discussed. In recent studies, the exercise-induced increases in cardiac biomarkers in endurance athletes as well as acute alterations in cardiac function and cardiovascular abnormalities have been reported. As elevations of the cardiac biomarkers troponin and BM) have been observed frequently for the vast majority of athletes after Marathon runs or strenuous exercise bouts followed by a decrease within a short period, a physiological reaction rather than a pathologicial cause is presumed. Also a transient decrease of cardiac function demonstrated by newer echocardiographic techniques (tissue Doppler or speckle tracking imaging, 3D echocardiography) after strenuous exercise often termed "cardiac fatigue" should not be considered necessarily as pathologic, as cardiac function also depends on hemodynamic load and heart rate. Furthermore, exercise-induced changes in cardiac function did not correlate with exercise-induced increases in cardiac biomarkers in most studies. The functional cardiac alterations can also be detected by magnetic resonance imaging (MRI) after Marathon runs. However, no signs of acute or chronic myocardial damage have been demonstrated in MRI studies in cardiovascular healthy athletes after running a Marathon, although especially in older athletes undetected cardiovascular diseases such as coronary artery disease or myocardial necrosis or fibrosis can be present. hi conclusion, according to recent studies. there seems to be a lack of evidence to support endurance exercise-induced cardiac damage in the healthy heart which is adapted tostrenous exercise by regular endurance training. Nevertheless, as running a Marathon results in a high cardiac load, a sufficient endurance training period as well as a preparticipation or regular medical screening to exclude relevant congenital or aquired cardiovascular diseases is recommended from a sports cardiology perspective to exclude relevant congenital or acquired cardiovascular diseases
According to the results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) published in 2009, only 5% to 8% of the 15-17-year-old adolescents reach the current recommendations on health-enhancing physical activity This result (besides others in the survey) rests on data measured with the 25-item physical activity questionnaire for children and adolescents (MoMo-AFB). The present study compares two different methods of assessing physical activity with the purpose of testing the validity of the MoMo-AFB self-report. First, we measured the physical activity status of 73 15 to 18-year-old pupils (32 boys and 41 girls) over seven days via objective accelerometry (ActiGraph GT1M), then the pupils completed the MoMo-AFB for the same (previous) period. Results show that using the MoMo-AFB leads to higher levels of self-reported physical activity than measuring it with accelerometers. Furthermore, only the MoMo-AFB subscale MVPA (moderate-to-vigorous physical activity), that uses two single items to decide whether the health-enhancing physical activity recommendation is reached or failed, corresponds statistically significantly with the accelerometry data. For all other subscales (e.g. school- or leisure time activity), we found no agreement. Further research, first of all on the measurement quality of the MoMo-AFB but also on the physical (in)activity status of children and adolescents, is needed.
Quality management of sport psychology care in competitive sports - (no) effect without acceptance?!
(2011)
In the past decade quality management (QM) has grown to be one of the most important topics in the area of applied sport psychology. There we discuss structures, processes, and results concerning QM, considering the QM model of the European Foundation of Quality Management (EFQM). In terms of results, quality can be defined in three areas: the coaching process itself (e. g., satisfaction and well-being of coach and client), psychological skills (e. g., efficacy of techniques used by the client), and health, personality, as well as sport performance (e. g., client's motor behavior in training and competition). Measures and processes to improve and ensure quality in these three areas are discussed as being dependent on four types of determinants: associated institutions, sport psychologists (i.e., individual competence and valence of tasks), coaching character, and socio-economic factors. As key processes of QM in this complex structure, both orientation to stakeholders and communication about quality and QM measures are identified.
High class students in the universities, the rest in the other institutions of higher education
(2011)
In Germany, different types of university-level institutions are available for tertiary education: traditional universities (Universitaten) and-since the 1970s-universities of applied science (Fachhochschulen) as well as universities of cooperative education (Berufsakademien). The present study investigates differences in key areas related to students' academic choices and success: do students at different types of university differ significantly in terms of cognitive performance, personality or social background? We compared N = 1.230 students at traditional universities, universities of applied science, and universities of cooperative education (Baden-Wurttemberg Cooperative State University) on the basis of a large scale longitudinal study in the German federal state of Baden-Wurttemberg. Students of the different university types differed significantly in all three key areas (cognitive performance, personality, and social background) within the fields of technical sciences and economics. We determine the relative importance of these key areas for differences between university types and we discuss the implications of our findings.
Efforts to break the link between the school type attended and the qualification awarded are seen an important step in the modernization of Germany's tracked secondary school system. However, it remains disputed whether these efforts have reduced social disparities or in fact increased them. This study examined the transition from lower secondary education in academic- and intermediate-track schools to upper secondary education in general and vocational gymnasium schools in the state of Baden-Wurttemberg. When indicators of parental social background and school-leaving qualifications were controlled, the opening of upper secondary education was found to be associated with a decrease in the social selectivity of upper secondary education for intermediate-track students. At the same time, for those intermediate-track students who were entitled to enter upper secondary education, social background had predictive effects on the transition decision; however, the overall size of these effects was low.
This paper investigates the role of ability profiles and profiles of vocational interests at the transition from "Realschule" (lower secondary level) into the academic and vocational oriented "Gymnasium" (upper secondary track) school. Based on Guttman's (1954) radex model of cognitive and academic abilities as well as Holland's (1997) circumplex model of vocational interests, we developed statistical models for assessing individual differences in intraindividual profiles. The empirical results underscore the validity of our profile approach. Particularly (1) profiles derived on basis of test scores, grades, and interests were associated with all educational choices under consideration, and (2) decisions for different gymnasia types were systematically and meaningfully associated with individual profile parameters. In addition (3) criterion correlations of interest and ability measures could be explained by individual profile parameters.
Objective: How do patients with severe aphasia perform in the clock test? Methods:Ten patients with severe aphasia performed the clock test in two modes: copy a given clock (copy condition) and set a clock by drawing the clock hands, where a given digital display (11:10) should be transformed into an analogue display (time setting condition). Results: Not a single patient with severe aphasia was able to master any mode of the clock test. Both copy and time conditions were severely impaired by executive, conceptual, motoric visuospatial and apraxic disorders - impairments of language system were only one of numerous influencing factors. Conclusions and clinical relevance:The clock test measures and requires for its execution so many different cognitive, motoric and perceptual functions that it cannot adequately differentiate between patients with severe aphasia and other severe brain damage.
The initial interview is important for psychological counseling regarding the acquisition of diagnostic information and in terms of establishing a professional counseling relationship. In applied sports psychology there so far exist no clear guidelines to structure this process. To improve the quality of sports psychological consultations, the present study introduces and evaluates a semi-structured guideline for an initial interview in which the content and form of the consultation are determined, the concerns of the client are systematically explored, and the objectives of the collaboration and the further process are defined. Eleven sport psychology trainees participated in our study and conducted initial interviews with actors. One interview was conducted by using the initial interview guide and the other interview was created individually by each sport psychology trainee based on his own expertise. The results showed that the quality of the interview process (i.e., formal requirements, use of open questions) as well as the satisfaction of the consultant with the interview was significantly higher when following the guideline. No differences were found regarding the quality of the consultation findings and the satisfaction of the athletes with the interview. The results are discussed with respect to their theoretical and practical implications.
Intra- and interrater variability of sonographic investigations of patella and achilles tendons
(2012)
Background: Clinical examinations of tendon disorders routinely include ultrasound examinations, despite the fact that availability of data concerning validity criteria of these measurements are limited. The present study therefore aims to evaluate the reliability of measurements of Achilles- and Patella tendon diameter and in the detection of structural adaptations.
Materials and Methods: In 14 healthy, recreationally active subjects both asymptomatic Achilles (AT) and patella tendons (PT) were measured twice by two examiners in a test-retest design. Besides the detection of anteroposterior (a.p.-) and mediolateral (m.l.-) diameters, areas of hypoechogenicity and neovascularisation were registered. Data were analysed descriptively with calculation of test-retest variability (TRV), intraclass-correlation coefficient (ICC) and Bland and Altman's plots with bias and 95% limits of agreement (LOA).
Results: Intra- and interrater differences of AT- and PT-a.p.-diameter varied from 0.2 - 1.2 mm, those of AT- and PT-m.l-diameter from 0.7-5.1 mm. Areas of hypoechogenicity were visible in 24% of the tendons, while 15% showed neovascularisations. Intrarater AT-a.p.-diameters showed sparse deviations (TRV 4.5-7.4%; ICC 0.60-0.84; bias -0.05-0.07 mm; LOA-0.6-0.5 to -1.1 - 1.0 mm), while interrater AT- and PT-m.l.-diameters were highly variable (TRV 13.7-19.7%; ICC 0.11-0.20; bias -1.4-4.3 mm; LOA-5.5-2.7 to -10.5 - 1.9 mm).
Conclusion: Our results suggest that the measurement of AT- and PT-a.p.-diameters is a reliable parameter. In contrast, reproducibility of AT- and PT-m.l.-diameters is questionable. The study corroborates the presence of hypoechogenicity and neovascularisation in asymptomatic tendons.
Background: Several equipment interventions like optimizing seat position or optimizing shoe/insole/pedal interface are suggested to reduce overuse injury in cycling. Data analyzing clinical or biomechanical effects of those interventions is sparse. Foot orthoses out of carbon fiber are one possibility to alter the interface between foot and pedal. The aim of this study was therefore to analyze plantar pressure distribution in carbon fiber foot orthoses in comparison to standard insoles of commercially available cycling shoes. Materials and Methods: 11 pain-free triathletes (Age: 29 +/- 9, 1.77 +/- 0.04 m, 68 5 kg) were tested on a cycle ergometer at 60 and 90 rotations per minute (rpm) at workloads of 200 and 300 Watts. Subjects wore in randomized order a cycling shoe with its standard insole (control condition CO) or the shoe with carbon fiber foot orthoses (Condition CA). Mean peak pressure out of 30 movement cycles were extracted for the total foot and specific foot regions (rear, mid, fore foot (medial, central, lateral) and toe region). Three-factor ANOVAs (factor foot orthoses, rpm, workload) for repeated measures (alpha = 0.05) were used to analyze the main question of a foot orthoses effect on peak in-shoe plantar pressure. Results: Peak pressures in the total foot were in a range of 70-75 kPa for 200 Watts (W) (300 W: 85-110 kPa). The carbon fiber foot orthoses reduced peak pressures by -4,1% compared to the standard insole (p = 0,10). In the foot regions rear(-16,6%, p<0.001), mid (-20,0%, p<0.001) and fore foot (-5.9%, p < 0.03)CA reduced peak pressure compared to CO. In the toe region, peak pressure was higher in CA (+16,2%) compared to CO (p<0,001). The lateral fore foot showed higher peak pressures in CA (+34%) and CO (+59%) compared to medial and central fore foot. Conclusion: Carbon fiber can serve as a suitable material for foot orthoses manufacturing in cycling. Plantar pressures do not increase due to the stiffness of the carbon. Individual customization may have the potential to reduce peak pressure in certain foot areas.
Dietary records are often biased, especially those of overweight individuals. The purpose of the study was to investigate underreporting among persons of normal weight with a very high energy intake (El).
The total energy expenditure (TEE) of 16 elite athletes (BMI 24 +/- 2 kg/m(2)) and 17 controls (BMI 23 3 kg/m2) was measured using the doubly-labeled water technique (DLW, 14d). El was estimated using 2 x 3-day dietary records. Underreporters were identified by BLACK'S cut-off (El:TEE < 0.76). 44% of athletes (El: 3584 824 kcal/d; TEE: 4621 1460 kcal/d) and 29% of controls (El: 2552 680 kcal/d; TEE: 3151 822 kcal/d) were identified as underreporters. TEE explains 52% of underreporting. In summary, a high energy intake seems to strongly predict underreporting. Prevalence and magnitude of underreporting increase with increasing energy intake.
Aim: The aim of this cross-sectional study was to assess the frequency of tendinopathy-typical Doppler sonographic changes in the Achilles tendons of long distance runners and to correlate these findings with anamnestic and anthropometric data of the subjects. Materials and Methods: 1906 Achilles tendons of 953 long distance runners were examined by ultrasound and power Doppler (Toshiba Aplio SSA-770A/80 12 MHz). Ultrasound images (spindle-shaped thickening, hypoechoic/hyperechoic lesions, neovascularizations) were analyzed in relation to the runners' anthropometrical data and history of Achilles tendon complaints. Results: In asymptomatic runners as well as in the overall group, there was a statistically significant correlation between tendon thickness and age, height and weight (CC 0.24 - 0.38, p < 0.001). Runners with current or healed Achilles tendon complaints displayed a statistically significant thickening of the tendons, as well as an increase in hypoechoic lesions and neovascularizations (p < 0.001). While grayscale abnormalities were rarely found in asymptomatic runners (< 10%), neovascularization was detected in 35% of healthy test persons using the high-resolution power Doppler "Advanced Dynamic Flow". Conclusion: Contrary to frequent assumption, neovascularization is often found in tendons of asymptomatic runners, using modern power Doppler equipment. The pathological relevance of single microvessels in asymptomatic tendons must, therefore, be critically discussed.
School can be regarded as a context for a variety of leisure activities. Especially in all-day schools an increasing amount of young adolescents is spending more time in extracurricular activities. Therefore, all-day schools hold the potential to produce an "educational surplus" because it is argued that these activities contribute to the psychosocial development of adolescents. However, prior to the quest for possible developmental outcomes which could be related to extracurricular activities, another fundamental question must be responded to: Which groups of these young people do actually participate in such after-school programs? While analysing the socio-economic structure of participants for different school-organised activities, the article follows this query. For reasons of comparability, two other leisure contexts are examined: Clubs and volunteer associations as organised contexts on the one hand and a variety of informal and unstructured leisure activities on the other hand. The results reveal that extracurricular activities in schools succeed in including socially disadvantaged adolescents. The study is based on a secondary analysis of the German PISA 2000 data set.
Reichsführer-SS Heinrich Himmler maß körperlicher Ertüchtigung und sportlichem Wettbewerb einen hohen Stellenwert zu. Die Angehörigen der SS waren verpflichtet, das SA-Sportabzeichen zu erwerben, um - gemäß der nationalsozialistischen Weltanschauung - eine natürliche Auslese zu erzielen und die Formierung einer elitären Truppe sicherzustellen. Während des "SS-Sportjahres" fanden paramilitärische Übungen statt, in denen sich die Schutzstaffeln auf deutschlandweite Wettbewerbe gegen andere NS-Organisationen vorbereiteten. Doch klafften Anspruch und Realität häufig weit auseinander. Die "Schwarzen Reiter" erwiesen sich hingegen als sportlich äußerst erfolgreich - die Hauptreitschule München versuchte am Vorabend des Zweiten Weltkrieges der Einberufung zu entgehen mit dem Hinweis, dass man sich auf die Olympischen Spiele von 1940 vorbereiten müsse.
In this paper the psychometric quality of the sport-specific Volitional Components Questionnaire (VKS) is examined. After an item analysis, a factor analysis was undertaken resulted in the four factors self optimization, lack of activation, loss of focus, and self impediment. The questionnaire exhibits satisfactory internal consistency (Cronbach's alpha) and retest reliability. In line with theory (Kuhl, 2001), correlations with the general questionnaire VCQ II (Kuhl & Fuhrmann, 1998) and sport-specific action orientation as measured with the HOSP questionnaire (Beckmann, 2003) indcate construct validity. Validity can also be shown by correlations with the external criterion of expert rating by coaches. In addition, the VKS is able to differentiate between athletes who perform well and those who perforin poorly.
Sportpsychologie
(2010)
Volitionale Komponenten im Sport : Fragebogen zur Erfassung volutionaler Komponenten im Sport (VKS)
(2009)
ASuG-Materialien
(1993)