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Exercise associated beef airtight (EAMC) can be authentic as “a painful, automatic abbreviating of ashen beef that occurs during or anon afterwards exercise.”1 Numerous studies accept authentic the serum electrolyte changes that action with adeptness exercise.2–6 Serum electrolyte and aqueous disturbances accept been associated with the development of beef cramps in assertive analytic conditions.7–13 It is accordingly generally affected that EAMC is additionally acquired by aqueous imbalances, in authentic dehydration, and serum electrolyte abnormalities.14–17 This acceptance is common,15,16,18–20 admitting the actuality that actual few studies accept advised the affiliation amid changes in serum electrolyte concentrations and the development of EAMC. There are no able-bodied conducted studies that accept authentic a affiliation amid aridity and beef airtight in athletes.

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A -to-be abstraction of chase runners showed no affiliation amid EAMC and claret aggregate changes or changes in serum sodium, potassium, calcium, phosphate, bicarbonate, urea, or creatinine concentrations.21 Two limitations of this abstraction were that serum magnesium concentrations were not bent and that serum electrolyte concentrations were not authentic in the accretion aeon afterwards the race. If aberrant serum electrolyte concentrations acknowledgment to accustomed during recovery, and this correlates with analytic accretion from EAMC, it would abutment the antecedent that aberrant serum electrolyte concentrations are accompanying to EAMC.

Magnesium has been apparent to comedy an important role in beef and assumption function.22,23 Magnesium is additionally generally promoted, mostly by the industry, as the best important electrolyte supplement for preventing ashen beef airtight in athletes. Thus any abstraction analytical the affiliation amid EAMC and changes in serum electrolyte concentrations should accommodate altitude of serum magnesium.

The affiliation amid serum electrolytes, dehydration, and EAMC has been appear in two added case series. There was no affiliation amid EAMC and serum potassium concentrations in cyclists who cycled for amid two and a bisected and bristles hours, and no affiliation amid aridity (per cent anatomy weight loss) and amoral beef abbreviating in 44 triathletes.24,25 Baby accountable numbers and the abridgement of any ascendancy groups were limitations of those case series.

There is acutely a abridgement of assay documenting the affiliation amid EAMC, dehydration, and serum electrolyte status. The affiliation amid EAMC and aqueous and electrolytes during the accretion appearance from astute airtight afterwards exercise has additionally not been documented. This affiliation is decidedly important to certificate because a alienation amid accretion from EAMC and changes in serum electrolyte concentrations would acerb abutment the antecedent that changes in serum electrolytes are not accompanying to the aetiology of EAMC.

Our aim in this abstraction was accordingly to certificate the affiliation amid the development of EAMC in ultra-distance runners and accessory changes in serum electrolyte concentrations and hydration status.

This -to-be accomplice abstraction was conducted at the Two Oceans Ultra-marathon, a 56 km alley chase captivated annually in Cape Town, South Africa. The acceptance and assay board of the University of Cape Town Medical School accustomed the study.

All runners who registered for the chase were advised abeyant subjects. In a pre-race advertisement attack in the columnist and during allotment for the race, a accomplice of 72 runners was recruited. Forty bristles of these had a history of consistently adversity from EAMC and 27 had no antecedent acquaintance of beef cramping. A approved history of EAMC was authentic as accepting a history of EAMC during at diminutive two of every six afterwards races. Inclusion acceptance were that all capacity should be macho amid the ages of 20 and 60, accept a history of at diminutive two years of alive active as a registered runner, accept no history of medical illness, and accept no history of abiding or contempo alleviative biologic use.

A claimed account was conducted with anniversary agent during pre-race allotment by one of the board (JN). A check was aboriginal administered to the runners to arm-twist claimed details, medical history, and any history of EAMC. A claimed account followed during which the advice in the check was accustomed and all testing procedures were anxiously explained. Written a accord was acquired from anniversary subject.

On chase day, 21 runners from the antecedent subgroup of 45 runners with a history of cramping, who were all allotment of the accomplice of 72 runners, suffered astute EAMC during or aural 60 account of commutual the chase and formed the “cramp” accession (n = 21). Abstracts were calm from 22 of the 27 runners who had no accomplished history of airtight but who were all allotment of the antecedent accomplice of 72 runners. These runners formed the ascendancy accession (n = 22) and they had no accomplished history of EAMC and did not ache any anatomy of beef airtight during or afterwards the race. Twenty nine runners of the aboriginal accomplice of 72 were afar for assorted reasons: 16 bootless to accede with the agreement during the race, nine had abridged claret samples, and four drank cogent amounts of aqueous afterwards commutual the chase but afore accession for actual post-race claret sample collection.

Pre-race acceptance was conducted on the morning of the race. All runners were advised at diminutive 75 account afore the alpha of the chase (0600 hours). Anatomy accession was abstinent in abounding chase accoutrements (running shorts, vest, and shoes). An cyberbanking calibration (Soehnle, Germany) was acclimated for all anatomy accession measurements. The calibration was calibrated afore acceptance sessions. Capacity were instructed not to alcohol any fluids or absorb any aliment amid the acceptance action and the alpha of the race.

Pre-race claret samples were calm from all capacity in the 75 account afore the alpha of the race. Claret samples were taken from the antecubital veins, with capacity in the built-in position. All the claret samples were acutely coded and stored for afterwards analysis. Claret samples were analysed for haemoglobin concentration, arranged corpuscle volume, claret proteins, serum sodium, serum potassium, serum absolute calcium, serum absolute magnesium, serum osmolality, and claret glucose.

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The temperature on chase day ranged from 14.3°C to 23.8°C, with a about clamminess of 47%.

All capacity appear to the medical covering aural bristles account of commutual the chase and afore bubbler any aqueous or elimination their bladder. On accession at the medical tent, claret samples were anon calm from all the subjects. These samples were analysed for haemoglobin concentration, arranged corpuscle volume, claret proteins, serum sodium, serum potassium, serum absolute calcium, serum absolute magnesium, serum osmolality, and claret glucose. Thereafter capacity were advised in abounding chase accoutrements (running shorts, vest, and shoes) as afore the race. Capacity were requested to acknowledgment 60 account afterwards for a echo claret sample and an account to access chase ache history. Runners were accustomed to absorb liquids ad libitum in this 60 minute post-race period.

A additional post-race claret sample was calm from capacity at 60 account afterwards the race. This claret sample was analysed for serum sodium, serum potassium, serum absolute calcium, serum absolute magnesium, serum osmolality, and claret glucose.

All capacity were requested to adviser beef ache cachet during the race. These abstracts were authentic at the 60 minute post-race interview. The afterward abstracts were calm from the EAMC group: beef groups that cramped, the chase ambit back cramps started, the continuance of airtight bouts, the ceremony of airtight bouts, airtight severity, and abating factors for an astute cramp.

Muscle groups were listed as quadriceps, hamstrings, gastrocnemius, and other. Chase ambit was listed as beneath than 28 km, 28 to 42 km, or added than 42 km. Landmarks accustomed to all Two Oceans chase runners were acclimated to analyze these distances that chronicle to the aboriginal half, the third quarter, and the aftermost division of the race, respectively. Continuance of EAMC was recorded as abiding for beneath than 30 seconds, 30 to 120 seconds, and added than 120 seconds. Ceremony of EAMC referred to the cardinal of echo episodes of the beef ache afterwards the aboriginal episode. This was quantified as one to two recurrences, three to four recurrences, or added than four recurrences until achievement of the race.

Cramp severity was quantified according to the time the agent was affected to stop or run boring and the adeptness to abide active afterwards. Any airtight area the agent could abide active or walking aural bristles account was classified as mild. Airtight that appropriate the agent to stop for 10 to 15 account but with resumption of walking or active was classified as moderate, and airtight that appropriate endlessly for added than 15 account with disability to resume a adequate walking or active clip was classified as severe. Abating factors included addition the airtight muscle, massaging the airtight muscle, and slowing of active pace.

Discharge acceptance were that capacity had to be pain-free, able to airing freely, and accept suffered no airtight action for 30 minutes.

A centrifuge and two ample acknowledgment boxes abounding with ice were set up in a area of the medical covering for actual alertness and accumulator of claret samples. Serum was acquired for sodium, potassium, calcium, magnesium, and osmolality analysis. Claret for glucose assay was acquired in tubes absolute potassium oxalate/sodium fluoride. Claret for haemoglobin and arranged corpuscle aggregate assay was acquired in tubes absolute K3 EDTA 15%. Aliquots of accomplished claret were removed from the amethyst top vacutainers and kept for afterwards assay of arranged corpuscle aggregate and haemoglobin. The of the vacutainer was kept on ice until centrifugation at 2500 rpm for 10 minutes. This break of serum was aural 45 account of accepting the claret sample.

Storage of serum samples was done at −20°C in able-bodied closed tubes until analysis. This accumulator was accomplished aural 90 account of claret sampling. The claret samples were stored at the Physiology Laboratories at the University of Cape Town (UCT) Medical School. All analyses were completed aural 10 canicule afterwards collection. All samples were analysed in alike with acceptable standards and accidental intervals amid samples.

Serum sodium and serum potassium determinations were done application ion careful electrodes on an ionised sodium/potassium analyser (KNA1, Radiometer, Copenhagen, Denmark). Serum absolute calcium and absolute magnesium concentrations were bent application diminutive assimilation spectrophotometry (Varian AA 1275 alternation diminutive assimilation spectrophotometer, Varian Techtron, Musgrave, Australia). The serum samples were adulterated 1:40 with 0.1% lanthanum chloride solution. The wavelengths of assurance were 422.7 nm for calcium and 285.2 nm for magnesium. Serum osmolality determinations were done application an automatic osmometer (Osmette A, Precision Systems, Newton, Massachusetts, USA). Authentic affliction was taken to ensure with accumulator of samples afore altitude of serum osmolality. Accumulator may aftereffect in baptize evaporation, causing an absurdity of measurement. All samples were stored in paraffin wax closed Eppendorf tubes until assay could be undertaken. Claret glucose determinations were done on fluoride/oxalated claret application an automatic glucose analyser (Beckman Glucose Analyzer 2, Beckman Instruments, Brea, California, USA). This glucose analyser was based aloft an enzymatic glucose oxidase technique. Serum protein determinations were done on the serum samples application the accustomed Biuret method.

Haemoglobin determinations were done on accomplished claret samples application the accustomed cyanmethaemoglobin address (Drabkins solution) for haemoglobin estimation. Arranged corpuscle aggregate determinations were agitated out in alike application a microhaematocrit centrifuge.

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Two methods were acclimated to actuate changes in hydration cachet of runners in this study. The aboriginal affected changes in pre-race and post-race anatomy accession measurements. The afterward blueprint was acclimated to account the allotment change in anatomy weight afterwards the race: [pre-race weight−post-race weight]/pre-race weight×100. The admeasurement of anatomy weight accident was acclimated as an basis of dehydration.23,26

The additional adjustment to appraise hydration cachet acclimated the blueprint that is activated to haematological abstracts to account the changes in claret volume, claret volume, and red corpuscle aggregate that occurred during the race.27 The changes were affected by applying the Dill and Costill blueprint to the haematological data.27

Statistical assay of the abstracts was conducted at the Medical Assay Council in Cape Town application SAS arrangement software on a Sunsperc 10 Server computer (SAS Institute Inc, SAS/STAT User’s Guide, adaptation 6, 4th ed; Cary, North Carolina: SAS Institute Inc, 1989). Abstracts were analysed application both parametric and non-parametric statistics. Area abstracts were skewed, non-parametric statistics were used. The Wilcoxon two sample analysis was acclimated for comparisons amid groups and aural groups. The Tukey-type assorted allegory post-hoc analysis was acclimated to actuate area the differences amid the groups lay. The Wilcoxon assurance rank analysis was acclimated to analysis for aural accession differences. Acceptation was accustomed at the 0.05 level.

The boilerplate age (years), weight (kg), and finishing time (minutes) from the ache and ascendancy groups are presented in table 1. There were no cogent differences amid the two groups for any of these variables.

 Age, weight, and finishing time for the ache and ascendancy groups

The analytic characteristics and chase history of beef airtight in the ache accession are presented in table 2. The best accustomed beef groups appear by the ache accession were hamstring (48%) and quadriceps (38%). All the runners (100%) appear airtight in the closing bisected of the race, with best (67%) advertisement airtight anon afterwards the race. Best cramps (62%) reportedly lasted best than 30 abnormal and best runners (71%) appear three or added airtight episodes. Best cramps (57%) were abstinent to astringent in acuteness and were best adequate by slowing the active clip (76%) or acquiescent addition (52%).

 Clinical characteristics and chase history of beef airtight in the airtight accession (n = 21)

The pre-race, actual post-race, and 60 minute post-race after-effects for serum sodium, potassium, absolute calcium, and absolute magnesium concentrations (mmol/l), serum osmolality (mmol/kg), claret glucose assimilation (mmol/l), claret proteins (g/l), arranged corpuscle aggregate (%), and haemoglobin (g/dl) from the ache and ascendancy groups are accustomed in table 3.

 Values for pre-race, actual post-race, and 60 minute post-race serum sodium, potassium, absolute calcium, and absolute magnesium concentrations, serum osmolality, claret glucose concentration, claret proteins, arranged corpuscle volume, and haemoglobin after-effects for the ache and ascendancy groups, bidding as beggarly (SD) and boilerplate (1st and 3rd quartiles)

There were no cogent differences amid ache and ascendancy groups for pre-race, actual post-race, and 60 minute post-race serum potassium and calcium concentrations, osmolality, claret glucose, claret proteins, arranged corpuscle volume, or haemoglobin results. The actual post-race serum sodium assimilation was lower (p = 0.004) in the ache accession (139.8 (3.1) mmol/l) than in the ascendancy accession (142.3 (2.1) mmol/l). The actual post-race serum magnesium assimilation was college (p = 0.03) in the ache accession (0.73 (0.1) mmol/l) than in the ascendancy accession (0.67 (0.1) mmol/l).

The boilerplate per cent change in anatomy weight, claret volume, claret volume, and red corpuscle aggregate amid actual post-race and pre-race from both the ache and ascendancy groups are apparent in table 4. There was no cogent aberration amid the two groups for any of these variables.

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 Per cent change (pre-race to post-race) in anatomy weight, claret volume, claret volume, and red corpuscle aggregate during the chase for the ache and ascendancy groups

The two capital allegation of this abstraction were first, that there is no affiliation amid any clinically cogent changes in serum concentrations of sodium, potassium, absolute calcium, and absolute magnesium and the development of EAMC in ultra-distance runners afore or anon afterwards a race, or during the aeon of analytic accretion from EAMC; and second, that there is additionally no affiliation amid the changes in hydration cachet (measured by changes in anatomy weight, claret volume, claret volume, or red corpuscle volume) and the development of EAMC in ultra-distance runners during or anon afterwards a race. The after-effects of our abstraction additionally appearance that there is no affiliation amid the development of EAMC in ultra-distance runners and changes in serum osmolality, claret glucose concentration, and the assimilation of claret proteins afore and afterwards a race.

The affiliation amid ashen beef airtight and disturbances of serum electrolyte concentrations has been able-bodied authentic in a array of medical conditions. These accommodate claret aggregate abbreviating and extracellular hypo-osmolality in patients ability haemodialysis, astringent aridity afterwards sweating, airsickness or diarrhoea, hyponatraemia associated with accomplished anatomy alkali depletion, hypokalaemia and hyperkalaemia, hypocalcaemia, and added afresh hypomagnesaemia.9–12,28 In best instances, the accepted apparatus for the development of ashen beef airtight is accompanying to alterations in neuromuscular affect which can be induced by disturbances in serum electrolyte concentrations. Clinically, patients with these abnormalities present with added generalised neuromuscular excitability, which can advance to generalised ashen beef cramping.

Numerous studies accept apparent that disturbances in serum electrolyte concentrations and hydration cachet can action afterward ultra-distance running.2–4,6 It is accordingly frequently affected that there is a affiliation amid changes in serum electrolyte concentrations, hydration status, and the development of EAMC in ambit runners.15,16,18–20

In the present study, serum electrolyte concentrations and hydration cachet were not associated with the analytic affection of EAMC. Baby but statistically cogent differences in serum sodium and magnesium concentrations amid the airtight and ascendancy groups in the actual post-race aeon in the present abstraction are too baby to be of analytic significance. Furthermore, the abatement in serum sodium assimilation afterward the chase in the ache accession is apparently accompanying to an added aqueous assimilation during the chase in this group.29 Although bubbler patterns were not abstinent directly, added bubbler in the ache accession is acceptable because of the able-bodied publicised acceptance that airtight is acquired by dehydration. The serum electrolyte concentrations empiric in this abstraction are additionally agnate to those appear by others, and best chiefly are too baby to be of any analytic significance.21,24,25

This abstraction was not advised to admeasurement aqueous antithesis in the runners; accordingly absolute abstracts on the blazon and volumes of aqueous ingested during the race, as able-bodied a specific losses (sweat, urine, faeces) during the race, are not presented. However, authentic and constant abstracts on the hydration cachet anon afterwards the chase (body weight changes, changes in claret volume, changes in claret volume) announce that runners with EAMC were beneath dehydrated than non-cramping runners at the time of presentation. The per cent abatement in anatomy weight (pre- to post-race) was beneath in the ache accession (2.9%) than in the ascendancy accession (3.6%).

The absence of any relations amid analytic accretion from EAMC and changes in serum electrolyte concentrations in the 60 minute aeon afterwards the chase additionally do not abutment the antecedent that EAMC is associated with alterations in serum electrolyte concentrations. Finally, the analytic account of EAMC is that of localised ashen beef cramping, and this differs essentially from the generalised ashen beef airtight empiric in patients with serum electrolyte changes accessory to systemic disease.9–12,28

The after-effects of our abstraction do not abutment the accustomed hypotheses that EAMC is associated with either changes in serum electrolyte concentrations or changes in hydration cachet afterward ultra-distance running. An another antecedent to explain the aetiology of EAMC charge accordingly be sought.

Schwellnus MP, Derman EW, Noakes TD. Aetiology of ashen beef “cramps” during exercise: a atypical hypothesis. J Sports Sci 1997;15:277–85.

Hiller WD, O’Toole M, Massimino AF, et al. Claret electrolyte and glucose changes during the Hawaiian Ironman triathlon. Med Sci Sports Exerc 1985;17 (suppl) :S219.

Hiller WD, O’Toole ML, Laird RH, et al. Electrolyte and glucose changes in adeptness and ultra-endurance exercise: after-effects and medical implications. Med Sci Sports Exerc 1986;18 (suppl) :S62–3.

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Hiller WD, O’Toole M, Laird RH. Hyponatraemia and ultra marathons [letter]. JAMA1986;11:213–14.

Hiller WD, O’Toole M, Laird RH, et al. Hyponatraemia in triathletes: a -to-be abstraction of 270 athletes in contest from 2 hours to 34 hours duration. Med Sci Sports Exerc 1987;10 (suppl) :S71.

Noakes TD, Norman RJ, Buck RH, et al. The accident of hyponatraemia during abiding ultra adeptness exercise. Med Sci Sports Exerc 1990;22:165–70.

Eaton JM. Is this absolutely a beef cramp? Postgrad Med1989;86:227–32.

Knochel JP. Environmental calefaction illness: an all-embracing review. Arch Intern Med1974;133:841–64.

Knochel JP. Neuromuscular manifestations of electrolyte disorders. Am J Med1982;72:521–35.

Layzer RB, Rowland LP. Cramps. Physiol Med1971;285:31–40.

McGee SR. Beef cramps. Arch Intern Med1990;150:511–18.

Neal CR, Resnikoff E. Analysis of dialysis-related beef cramps with hypertonic dextrose. Arch Intern Med1981;141:171–3.

Shearer S. Aridity and serum electrolyte changes in South African gold miners with calefaction disorders. Am J Indust Med1990;17:225–39.

Eichner ER. Calefaction cramps: alkali is simplest, best able antidote. Sports Med Dig1999;21:88.

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Peterson L, Renstrom P. Sports injuries: their prevalence and treatment. 3rd ed. London: Martin Dunitz, 2001:416.

Eichner ER. Should I run tomorrow? In: Tunstall-Pedoe DS, ed. Chase medicine. London: Royal Society of Anesthetic Press, 2000:323–5.

Maughan RJ. Exercise-induced beef cramp: a -to-be biochemical abstraction in chase runners. J Sports Sci1986;4:31–4.

Casoni I, Guglielmini C, Graziano L, et al. Changes of magnesium concentrations in adeptness athletes. Int J Sports Med 1990;11:234–7.

Willmore JH, Costill DL. Nutrition and comestible ergogenics. Physiology of action and exercise. Lower Mitcham, South Australia: Human Kinetics, 1994:361.

Brouns F, Beckers E, Wagenmakers AJ, et al. Ammonia accession during awful accelerated abiding cycling. Int J Sports Med 1990;11:S78–84.

Kantorowski PG, Hiller WD, Garrett WE, et al. Airtight studies in 2600 adeptness athletes. Med Sci Sports Exerc 1990;22 (suppl 4) :S104.

Maughan RJ. Thermoregulation in chase antagonism at low ambient temperature. Int J Sports Med1985;6:15–19.

Dill DB, Costill DL. Calculation of allotment changes in volumes of blood, plasma, and red beef in dehydration. J Appl Physiol1974;37:247–8.

Milutinovich J, Graefe U, Follette WC, et al. Effect of hypertonic glucose on the able-bodied cramps of haemodialysis. Ann Intern Med 1979;90:926–8.

Speedy DB, Noakes TD, Rogers IR, et al. Hyponatremia in ultradistance triathletes. Med Sci Sports Exerc 1999;31:809–15.

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