Mix'Fit Magazine by Janus de Lange

Series 3 / Volume 2

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Mix’Fit™

8 Seconds ....................... 27 Ÿ Q&A: Viking Power - Quinton “The Irish Poison” Osmers.34

Ÿ Introduction to Ebola ...... 44

Ÿ Coping with Rotator Cuff

Syndrome at the Workplace................ 56

Ÿ The Top 5 Moves For Rock

Hard Abs ....................... 66 Ÿ Endurance & The Cardio Connection ..................... 72

Ÿ The Top 10 Most Extreme

Races ............................ 90 Ÿ How To Establish Your Vo2

Max ............................... 100

Ÿ What is the Paleo Diet ........112

Ÿ Homeopathy...................... 118 Ÿ Avoid The Herbal High ..... 120

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Ÿ Bench Like A Boss .......... 12 Ÿ Snatch That Bastard ....... 18 Ÿ How 2 Avoid Being KO ‘ed in

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won’t lie, our team got a little bored of being a “specialist” or dedicated publication only featuring a particular sport, discipline or activity. So, we quickly decided to mix fitness up a little and cover the entire spectrum of getting in-shape. Admitting, we have a gym, mixed martial arts and cross-fitness pedigree, is the first step to acknowledging we have a problem or is it an addiction? Today, we are Mix’Fitters seeing as fitness is more than just a brand, sport, logo or hobby. Fitness, health and training is a lifestyle developed over many years of staying active, a long term commitment to yourself. Unlike the Merriam Webster’s Collegiate Dictionary that defines “fitness” and being “fit” as the ability to transmit genes and being healthy. We “crazy” people at Mix’Fit Magazine believe fitness to be;

“the commitment to be best possible version of yourself whatever that entails.” Fitness to us, is a state of mind, not a state of training. We are motivated by our mental, spiritual and emotional state. Not by our physical state. When our bodies give up, we ignore the pain and persevere, when we to weak to achieve our 608

goals, we do the impossible. This is our version of fitness, regardless of the level at witch we operate. Essentially fitness to our team is; Ÿ a healthy mental state Ÿ a healthy emotional state Ÿ a healthy spiritual state Ÿ and a healthy physical state. Ironically, for all these factors to operate at optimum capacity an entire collage of factors will need to be addressed but that is what this publication is really about. In this publication we essentially cover our version of our truth, our take on fitness and an opportunity to mix things up the way we and our reader’s want our fitness lifestyles to be. So, what more is there to say about our “little” magazine? Have fun, enjoy reading our hours of work and we sincerely hope you the reader will enjoy our production. Yours in Health & Fitness Janus de Lange Editor-in-Chief: Mix’Fit Magazine

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For years, lifters have struggled to get their bench press up. Why? Because a lot of what they know, or think they know, has been learned from some of the greatest shirt-ed benchers of all time. In other words, geared powerlifters â&#x20AC;&#x201C; those who use special bench press shirts that add safety and ultimately a whole lot of plates to their PRs. Thing is, shirted benching requires a different technique. While a lot of the info coming from geared power-lifters has been great, some of it doesn't transfer over to raw benching. Luckily, I managed to learn how to properly train for a massive raw bench from Dan Green, aka "The Boss." His tips and tricks helped my gym achieve three 500-pound raw benches, many respectable one-and-half-times body-weight benches, and even some doublebodyweight benches. Here are four things he taught me to bring the bench up to boss status.

For years it's been drilled into our heads that we need triceps for a big bench. Bands and chains, boards, and extensions are great, but let's not forget the chest itself. Big arms are awesome but big arms and a big chest are even better. The chest is a much bigger muscle group and it needs to be utilized to its fullest potential.

Every big raw bencher has a barrel chest. The trouble is, it took a long time for me to learn how to feel my chest work again since I'd become so triceps dominant over the years. Doing exercises where you can really spread your chest open at the bottom with your elbows out wide will help teach you to use your chest when you bench. Dumbbell bench presses with the elbows out can help a ton, as well as doing simple old school, widegrip bodybuilding style benches with the feet up. If you aren't used to benching with your feet up, simply start light and work through a pain-free range. Use light to moderate weight for moderate to high reps. No need to go super heavy here. Save that for the competition-style presses with your feet on the ground. As your chest gets stronger, you'll be able to handle more and learn how to bench with your chest again. This is especially important not only for strength, but for a well-balanced physique, too.

Extend Your Range and Time Under Tension Once you learn to engage your chest again, work to increase your time under tension. Extending the press range of motion and adding in pauses are two great ways to do this.

great tool for benching. Most commercial gyms at least have a cambered bar for shrugs, so if it that's your only option, just make sure to use boards or put something on top of your chest so you're only benching from a slight deficit. One to two inches is plenty. You'll feel an incredible stretch in your chest at the bottom. You'll feel an incredible stretch in your chest at the bottom. Start with a closer grip and work out wider as you gain more strength and stability in your shoulders. Again, keep these light and use them as a secondary movement to build your competition bench. Do a slow eccentric and use a slight pause to ensure proper form and safety during the lift. If you don't have access to cambered bars, you can use a close grip on a conventional bar to extend your range of motion. This won't work your chest in the same way, but it'll still give you the added benefit of time under tension as well as build up your arms quite a bit. The last thing you can do to increase the time under tension and build strength out of the bottom is adding in long pauses. Three to five seconds work particularly well for building starting strength. The key is to maintain tension during the pause and don't relax. Your body should be like a slingshot or a bow and arrow.

If you can, use a buffalo bar for this type of training. This bar has a slight camber and is traditionally used to save your shoulders when squatting, but it's also a

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Keep everything tight and explode when you start the press. This will build a powerful start to your bench. When you go back to a regular pause or touch and go, it's going to feel a whole lot easier.

Not every lifter is weak off the chest, which is why it's important to strengthen every part of your bench. Board presses typically work great for the lockout, but doing board presses without boards can add a new twist to help kick-start your gains. Invisible board presses are much more challenging since you can't rest on the board anymore. You have to rely on your muscles to stabilize the weight.

This will build a tremendous amount of reversal strength since it takes a ton of effort to bring the weight to a dead stop and let it float in the air before you have to start it up again. Eric Spoto, one of the greatest benchers of all time with a 722 raw bench, coined these invisible board presses "Spoto" presses. If you ever saw how explosive he is off the chest, then you simply can't argue with his methods.

above and below the point of the pause. This is why Spoto presses work the bottom end as well as mid range. However, you should implement various heights in your training in order to gain strength in all areas. Again, right above the chest and about a two-board height are great places to start. You can utilize these with heavy weight for a few reps or lighter weight for a lot of reps.

You can also pause at different heights depending on your sticking point. For instance, I like invisible two board presses to strengthen the mid range to lockout portion of the lift. Remember, any time you do isometric work, you're strengthening a few degrees

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also include some type of overhead pressing in their training as well. Strong shoulders will give you the foundation for a strong bench as well as aid in the stability of the lift.

The overhead press is one of those supposedly taboo exercises people either love or hate. Some people legitimately don't have the mobility to do it correctly â&#x20AC;&#x201C; at least in the beginning â&#x20AC;&#x201C; but it's certainly something you should try to progress toward doing. The old-time benchers all had great overheads. Many of the best raw benchers of the new age

Shoulder training is so important for a raw bench in the off-season that it deserves its own day. At my facility, the second upper body day has turned into more of a bodybuilding day with an emphasis on shoulders instead of a standard speed bench day, which is what we used to do. We still utilize speed work from time to time, but we do it on the main benching day instead. The rationale is that most people need to work on gaining muscle mass in the upper body before focusing on a speed day.

alternative. And even if you can lift overhead, the incline bench is another great lift to supplement your bench press training. The incline bench puts you directly between a flat bench and an overhead so you really get the best of both worlds. You'll get lots of chest and shoulder work at the same time. If your shoulders are really jacked up, you can also try incline pressing with a neutral grip dumbbell, a special neutral grip bar like the Dead-Squatâ&#x201E;˘ Bar or a strongman log. It's a great exercise to build up the shoulders as well as the arms. When all else fails, even some simple shoulder raises with dumbbells are a great alternative.

If you can't quite get overhead, incline presses are a great

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he full snatch is one of the most complicated movements in all of sports. An athlete has to pull a weight upward with force and speed, then completely reverse his mental keys to explode downward under the still-moving bar. His foot placement, body positioning and lockout have to be precise when he hits the bottom or the bar will crash to the floor. The snatch is the ultimate in athleticism, and the pole vault is the only other movement that’s comparable in terms of concentration and difficulty. In that event, the athlete has to run at full speed and then direct that speed vertically. In the snatch, the conversion is from moving upward bearing a heavy load to moving downward—a more severe shift. To be able to perform a snatch with a maximum poundage is a feat of strength without peer.

natch Your Way to Sporting Success

By definition, a snatch is an exercise where the bar is pulled from the floor to a locked-arms position in one continuous move. The bar does not stop on the way up, and there is no pressing out at the finish. The power snatch is one form of the lift, but the full snatch is used to handle much more weight. In the full snatch, the bar is pulled just high enough to allow the athlete to squat under it and lock it out. If the athlete is quick enough, he need only pull the bar chest high before slipping under it for a successful lift. The split style can also be used, but for the sake of simplicity, I will only focus on the squat style because that is the one used by 99 percent of the athletes who do snatches. The snatch is one of the two contested lifts in the sport of Olympic weightlifting (the clean and jerk is the other), so competitive weight-lifters do lots and lots of snatching out of necessity. Yet full snatches have value for all athletes because they involve so many of the larger muscle groups in a dynamic fashion. In fact, every muscle in the body is activated during the execution of a full snatch, including smaller groups such as the biceps and calves. The snatch is a high-skill movement, so every rep requires absolute concentration on the part of the athlete, which means the nervous system receives much more stimulation than when a static exercise is done. Whenever an athlete masters the technique in the full snatch, he has learned to trigger the necessary form cues instantly, and this skill is transferred to all his other athletic endeavors. In other words, learning how to do a full snatch benefits not only strength but many other athletic attributes, such as flexibility, coordination, foot speed, balance, timing, determination and mental acuity. A

wide range of athletes benefit from doing full snatches, from tennis and basketball players to competitors in all contact sports. Perhaps throwers in track events such as the shot put, hammer, discus and javelin see the most benefits. Performing full snatches teaches them to propel objects much longer and with a more powerful snap at the very end, and the enhanced foot speed, coordination, balance and timing they develop from snatching help, too.

lexibility and Grip

Before learning how to do full snatches, an athlete needs to be able to do two other exercises: overhead squats and power snatches. I’ll start with the power snatch. Even if someone isn’t interested in moving on to full snatches, this is an excellent exercise for building back strength in a rather unique fashion. Power snatches involve the lats to a greater degree because the snatch utilizes the widest grip of any pulling exercise. Back when physique contestants regularly competed in Olympic contests in order to gain athletic points, they did lots of power snatches, which was a legal form of the lift. As a result, they ended up with amazing lat development. The lift also has a very positive effect on the traps and shoulders. This is due to the fact that the bar is pulled so much higher than in any other exercise, bringing into play the wide portion of the traps and the rear deltoids in an entirely different manner. The first step in preparation for power snatches is making sure your shoulders are flexible enough to lock the bar out overhead correctly. Flexibility will also be needed for overhead squats, so time must be spent improving it. Of course, some already possess sufficient shoulder flexibility, especially young people. Females, too, have no problem with tight shoulders. However, those who are older or have been enamored with the bench press generally find they lack the range of motion needed in their shoulders to properly lock out a snatch.

These issues can be rectified unless there is a reason for the tightness, such as an old shoulder or elbow injury. Simply take a stick or towel, hold it overhead with your arms locked and rotate it back and forth until you feel your shoulders loosen a bit. Then bring your grip a bit closer and do it some more. Most Olympic lifters carry a length of clothesline in their gym bags and spend a great deal of time keeping their shoulders very flexible. Some, like Dr.John Gourgott, could hold a length of clothesline over his head with his arms perfectly vertical and rotate it down to his lower back. Obviously, the more you work on making your shoulders more flexible, the better, so stretch them before you train, in between sets while you train and at night while watching TV. You want to be able to hold the bar with a wide grip directly over your head. If you drew a line up from the back of your skull, that’s where the bar would be held. Once you’re able to achieve that much flexibility in your shoulders, you’re ready to power snatch. The immediate question arises: how wide should the grip be? This depends on several factors, such as height, body weight and degree of flexibility in your shoulders. Those with very wide upper bodies often have to grip the bar at the extreme ends of the Olympic bar, but most do not have to go that wide. On Olympic bars, there’s a score on each side six inches in from the collars. Wrap your ring fingers around that score. If, after doing a few reps, you find that isn’t quite right, make the necessary adjustments. Sometimes, a slight half-inch shift makes a world of difference.

Next, learn how to hook-grip the bar. While you can use straps for power snatches, you shouldn’t with full snatches. Straps alter the line of pull ever so slightly, and if you miss a full snatch back over your head, you do not want to be strapped to the bar. The hook grip is simple: just bring your thumbs under the bar and lock them down tightly with your middle and index fingers. Those with chubby fingers can only manage to get their index fingers over their thumbs, but that’s better than nothing. You might be thinking, “Doesn’t the hook grip hurt?” Yes it does, but only until you get used to it, and here’s a tip Olympic lifters use to reduce the pressure on their thumbs: they wrap a 1/2-inch strip of trainer’s tape around the thumb at the joint closest to the palm. Just wrap the tape around two times, because more will cause the tape to bunch up, which makes matters worse. If you start using the hook grip from the very beginning when you’re training with light weight, you’ll quickly get accustomed to it, and in no time you won’t notice it at all.

Your entire back must stay extremely tight throughout the power snatch. The most effective way to ensure that it starts and finishes tight is to lock your shoulder blades together and keep them that way during the movement. Look straight ahead. Make sure the bar is snug against your shins and your frontal deltoids are a bit out in front of the bar. The initial stage of the movement, breaking the bar off the floor, is basically a dead-lift. This must be done in a smooth, controlled fashion. The tendency of most beginners is to jerk the bar upward, using their arms, in hopes of getting a jump-start on the exercise. That doesn’t work at all and usually ends up sending the bar running forward, which spells disaster for the finish. And when the arms are bent prematurely, the back tends to round, once again causing the bar to move too far out front for you to have a successful finish.

he First and Second Pulls

Now you’re ready to do power snatches. Step up to the bar with your shins touching it. To find your ideal foot placement for this or any other pulling exercise, do this: shut your eyes and set your feet as if you were about to do a standing broad jump. That’s your most powerful stance for pulling a weight off the floor. Hook-grip the bar, flatten your back and lower your hips. How low? Again, this starting position is determined by body type to a large degree. Taller athletes can benefit from setting their hips rather high, even high enough to put the back parallel to the floor.However, this only works if the athlete can maintain that position as the bar moves off the floor. Should his hips

elevate during that initial pulling motion, he needs to lower them a bit. Placing the hips slightly below a line parallel to the floor works best for most, but some experimentation may be in order to find the one that suits you.

Instead of thinking about rushing the bar off the floor, try this: get set, tighten all the muscles in your body from your toes to your neck, then imagine you’re pushing your feet down into the floor and squeeze the bar upward with your arms straight and your back extremely flat. When the bar passes mid-thigh, drive your hips forward aggressively and—with your arms still straight—shrug your traps. All the while, the bar must be close to your body. Make sure you don’t punch the bar away from your body when you drive your hips forward. Many athletes pick up this habit. It’s fine until the weights get heavy, but then it knocks the bar out of the correct positioning to finish strongly. After the bar passes your navel, bend your arms explosively and your biceps and brachioradialis will punch the bar upward even higher. The final touch is

to extend high on your toes and elevate the bar a couple more inches. These final inches are often critical to making the lift cleanly. The power snatch is a long pulling motion, so it’s absolutely essential that the bar stays close to your body until it passes your head. If it moves away there’s little you can do to correct the error without taking a step forward, and you don’t want to do that because you will not be able to take a step during the full snatches. It’s also important to learn how to drive your elbows up and out, rather than back at the very conclusion of the pull. Remember, once your elbows rotate backward, you no longer have any upward thrust and have to depend on momentum or pure shoulder strength to fix the bar properly over your head. Conversely, when you keep your elbows up and out, your powerful traps can assist you with the finish.

owering the Bar and Foot Position

The lockout is a coordinated movement that gets better with practice. As the bar climbs past your head, bend your knees slightly and dip under the bar. Don’t just catch the bar overhead—push up against it. This will help you place it exactly where you want it to be and control it more readily. If you find that you’re catching the bar with bent arms, reduce the weight until you’re able to lock it out with your arms straight. This is most important because you’re not going to be able to hold a full snatch with bent arms— at least not any attempt with a heavy poundage. Once the bar is locked out overhead, fix it in that spot atop the imaginary line running from the back of your head. Don’t let it hang too far out front or push it way back over your head.

This might be all right for a light power snatch, but it will not work with heavy weights or with any amount of weight in a full snatch. The bar will just fall to the floor in either case. While holding the bar overhead, extend pressure against it and think about stretching it apart as well. This helps to strengthen the position and will prove to be most valuable as you move on to full snatches. It is most important to lower the bar back to the floor in a controlled fashion. Allowing it to fall to the floor unimpeded is not a good idea. The fast-falling weight will invariable cause the athlete’s back to round excessively and can result in any injury. The bar should be lowered in two steps: first from lockout to waist. Bend your knees and cushion the bar at your waist. Then, with a very flat back, ease the bar to the floor. Think of a power snatch as a whip. The bar will come off the floor deliberately in a perfect line, pick up speed through the middle, and be no more than a blur at the top. In the final pulling position, the athlete should be high on his toes with an erect torso, the bar tucked into the body and the elbows up and out. Some coaches feel it’s best not to move the feet during a power snatch, believing this forces the athlete to pull longer. Others want their lifters to skip-jump at the very end of the pull as this movement is closer to what transpires in a full snatch. I teach my athletes not to move their feet while they’re learning to do power snatches as it’s yet another thing to think about in an already complicated movement. Once they master the lift, they can begin skip-jumping. Power snatches are high-skill movements, so stay with lower reps. A couple of sets of fives will serve as a warm-up,

then just do threes. Add weight as you become more proficient, but make sure your form is always good. If the lift becomes sloppy, lower the weight. You don’t want to build any technique mistakes into this lift because they will carry over to the full snatches.

verhead Squats

Overhead squats are rather easy to do once your shoulders are flexible enough to hold the weight in the proper position. While learning this exercise, simply power-snatch the weight, fix it precisely overhead, then go into a deep squat. You’ll learn rather quickly that this form of squatting is very different from back or front squats. The bar must travel in a tight up-and-down line. If the bar moves too far forward or back, you will not be able to control it and will have to dump the weight. Keep in mind that everyone ends up dropping a bar while learning this movement. It’s no big deal, but make sure you just let the bar go when it’s out of control. That’s why it’s so important to keep your arms locked tightly during the execution of the overhead squats. Should it run out of the correct line, merely push it away from your body. After you power-snatch a weight or have two training mates assist you in getting the bar overhead, move your feet a bit wider so you’ll be able to go into a full squat. Once your feet are set, push up against the bar forcefully while making sure it’s positioned perfectly in a line directly over the back of your head. Then pull yourself down into a deep squat. Don’t lower yourself slowly as this will invariably cause you to lean forward in the middle, and the bar will come tumbling down. When you get to the bottom, sit there for a second or two, staying tight all the while. This long pause will let your feel how a full snatch will feel, and it will also make the bottom position much stronger—a definite plus.

Squeeze out of the bottom in a controlled manner. When you try to explode upward, you will almost always drive the bar out of the proper line. Overhead squats must be done deliberately, and everyone finds that after the first difficult session their middle and upper backs get extremely sore from this new method of squatting. Do these for triples. I should note that even if you’re not interested in moving on to full snatches, overhead squats are an excellent way to work all the groups in your shoulders, back, hips and legs in a different manner than any other exercise.

he Drill

Spend a month or six weeks mastering the power snatch and overhead squat, at which point you’ll be ready to learn how to do full snatches. I recommended using the three-step exercise I call the Drill, which I picked up from Morris Weissbrot, the Olympic-lifting coach for the Lost Battalion Weightlifting Club in New York City. I also use the Drill when I’m teaching an athlete how to do full snatches. The exercise consists of a power snatch followed by an overhead squat, a hang snatch plus an overhead squat, then a full snatch. The first segment teaches you to pull long and hard at the top, the second teaches you to move quickly into the bottom position, and the third lets you know just how it feels to do a full snatch. Use a hook grip because a conventional grip will begin to slip after the first or second phase of the Drill. The first step is merely combining the two exercises you’ve already been doing, but with a slight twist. Because your feet need to be wider for the overhead squat than the power snatch, you need to start skip-jumping at the end of the pull.

It will, of course, take practice to learn just how far to skip-jump your feet so they’re in the ideal placement for you to overhead squat. I have my athletes mark where their feet need to land with a piece of chalk until they have that movement down pat. And think about slamming your feet into the floor when you skip-jump. This will provide you will a more solid foundation from which to squat. Stand up and lower the bar to your waist. Take a moment to reset your feet to their strongest pulling position. Now you’re ready for the second phase of the Drill. Make sure your back is tight and flat and your frontal deltoids are out in front of the bar. Lower the bar to mid-thigh, then pull it as high as you can. Your line of pull has to be exactly the same as when you power snatch. Many lean too far backward, letting the bar rest on their thighs, but this will cause the bar to drive you back, and you’ll end up on your butt. Be prepared to fail. No one has ever learned the Drill without being knocked around some. It’s like riding a bike: falling is part of the process. But learn from your mistakes and you’ll come out just fine. Try to fully extend on the hang snatch. That will give you time to jump into the bottom, and if you finish your pull with your torso fully erect, you’ll be able to hit the bottom in that same correct position. The second phase teaches you timing, a critical aspect of the snatch. As soon as you give the bar that final, strong snap, you must move to the bottom position and pull the weight down with you. Some of the top lifters are able to let the bar crash down and still control it. However, they are the exceptions and not the rule. Stretch the bar and exert pressure up against it rather than merely holding it overhead. This second move has to be done in the blinking of any eye. It is the most difficult of the three steps but also the most beneficial. Once you

master the hang snatch, the full snatch is a snap. The pull sequence on the hang snatch has to be perfect: traps, then arms, with the elbows staying up and out with the bar tucked in close. At the end of the pull, you should be high on your toes, just as in a power snatch. From that extended position, you must explode down into a deep squat while simultaneously locking out the bar. Sounds tough? It is, but it’s the key to learning the full movement and has been done by thousands of athletes, so there’s no reason why you can’t do it as well, Stand up and place the bar back on the floor. Reset your feet and make sure your back is flat and the bar is in front of your shoulders, now you’re ready for the final set. If you have learned how to do the hang phase correctly, the last step is rather easy. Pull the bar exactly as if you’re going to power-snatch it. Once you’re fully extended, jump into the deep bottom position. You’ve done a full snatch.

inal Tips

Athletes make the same two mistakes on the hang and full snatches: they fail to extend fully and they do not go into a deep squat. That’s why it’s called the Drill. You must do the threestep exercise over and over until everything falls in place and that third segment is done perfectly. Use a poundage that is demanding enough that it makes you pay close attention and work hard but not so heavy that you are using faulty technique. In some cases, a slightly heavier weight makes the Drill easier to do than a lighter one. If you have followed my advice on learning cleans and taken the time to learn how to snatch, you’re now ready to take part in one of the greatest sports of all: Olympic weightlifting. Don’t be concerned about how much you can lift or whether you’ll win a medal; enter a competition. In a

competition, you will learn from watching others, and the electric atmosphere will inspire you to lift a great deal more than you thought you would. Or less. Either way, you will add to your knowledge bank, and this will help you get stronger and become a better athlete in any sports endeavor. The two quick lifts are great for building functional strength that can be utilized in a wide range of athletic activities, so make them a part of your strength program. About the Author Bill Starr coached at the 1968 Olympics in Mexico City, the 1970 World Olympic Weightlifting Championship in Columbus, Ohio, and the 1975 World Power-lifting Championships in Birmingham, England. He was selected as head coach of the 1969 team that competed in the Tournament of Americas in Mayaguez, Puerto Rico, where the United States won the team title, making him the first active lifter to be head coach of an international Olympic weightlifting team. Starr is the author of the books The Strongest Shall Survive: Strength Training for Football and Defying Gravity, which can be found at The Aasgaard Company Bookstore.

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It's the fight-ender… The deal-breaker… It's the knock-out shot. There's a reason every UFC, Muay Thai, Boxing or other sport-fight is stopped immediately upon a knockout shot. Because once you're knocked out, you're as good as dead. If, by some unfortunate circumstance, you end up in a fight, there's a real danger of getting knocked out, and once you're knocked out, you have literally no defence – you're 100% at the mercy of your attacker(s). For this reason, it's extremely important that you understand the physiology of what gets you knocked out, and learn techniques to defend yourself against a knockout punch at all costs. First we’re going to explain the physiology of your brain and skull, what happens in a “knock-out shot”. This is the “why” of why you get knocked out. Next, we’re share the techniques you can use immediately to avoid getting knocked out.

First, let's clear up some typical misunderstandings. What causes a knock out is NOT a “Tom & Jerry” smack to the head with a mallet or the butt of a gun, like you see in movies & TV, and we’re not basing this on just our lifetime’s of accidentally slamming our head’s into inanimate objects without being knocked out. There's a lot of scientific research that supports the fact that it's NOT a compressing impact that knocks you out.

What actually causes the knock-out (and in severe cases, paralysis or death) is a not a direct impact “whack to the head”. What does it is a sudden rotation of the skull. To get how this works, it's helpful to understand how your brain and cranium are 'designed'. Your brain is similar to Jell-O. In most cases, probably something fruity like strawberry. You could think of your skull as an upside-down bowl (filled with a ball of the previously mentioned strawberry Jell-O). Your brain attaches to the smooth inner surface of your skull in just a few points by connective nerve tissues, veins and arteries. Other than these few small connections, your Jell-Olike brain is only held in place by being the same basic shape as the interior of your skull. Got it? Your brain is an upsidedown-strawberry-Jell-O-bowl. Now, imagine you've got that bowl of JellO in your hands. DON'T EAT IT. (It's your brain). Now as fast as you can, rotate that bowl of Jell-O a quarter turn. What does the Jell-O do (besides be delicious)? Like your brain, Jell-O is soft, flexible and mostly liquid. So when you suddenly spin the bowl, the Jell-O takes a moment to catch up, it sits still as the bowl spins, then its few attachment points are yanked and pull it to try to make it catch up to the bowl. Now, when you do this with Jell-O, no big deal. You may spill some on your lap, but you're used to that. But if we remember that the Jell-O is your BRAIN, we start to see the problem. Remember those few attachment nerves and arteries I mentioned? Well, as your skull rotates, all the

attachments to the brain from the skull get seriously stretched and even torn while the brain stays still for that split-second. Furthermore, if the sudden rotation is fast enough, the brain 'smacks' into the walls of the cranium, essentially bashing your brain against your own skull. If the acceleration is sudden enough, and the damage is severe enough, your brain shuts down to “reboot”. (If it's REALLY bad, like in a car accident, there is no 'reboot. It's more of a “game over”). This is the human equivalent of the “blue screen of death” you get on a computer causing you to be unconscious while your OS attempts to restart. Now that you understand how it works, it is natural to ask “Can I have some Jell-O?” to which we would say you have already been hit in the head a few too many times. It would also be natural to ask “how do I keep this from happening?”

Despite your surprisingly delicate physiology, there are tricks to avoid getting knocked out. You see, it's very hard to knock you out if you are prepared for the punch. Your neck muscles are quite strong, and can prevent this kind of head rotation in many cases. That is IF you see the punch coming.

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There are THREE clear things to develop to keep from being knocked out:

Keeping your head/chin at the right angle The ability of these muscles to resist rotation is greatly affected by the angle at which you hold your chin. If you go into any boxing gym worth it's weight in dirty sweat socks, you are likely to hear someone shouting “chin DOWN!” at sparring boxers. That's because those trapezius muscles have a lot more leverage to hold your head in place when your chin is down. When your chin is up, not only is it a much more viable target, but you've got almost no power to resist the rotation of your head caused by impact. But a strong neck and proper head/chin position is only part of the battle, because that doesn't help you AT ALL if you don't see the punch coming. There's an old saying in boxing: It's the punch you don't see that knocks you out. The reason is simple: if you don't see it, you're not able to tense your neck in time to keep your head from being whipped around. So the next step is to increase the chance that you WILL see the punch coming.

See the punch(es) coming Again, keeping your chin down helps in this regard. The uppercut and hook are the punches that tend to knock people out, as they both strike your chin, pivoting your head at the furthest point from the Atlas (the pivot point of the skull and the neck). Thus, being hit on the chin by a hook or uppercut will rotate your head with the most leverage and as mentioned in the post about punches, the uppercut is very hard to perceive as it travels up your “sagital plane” or midline. An uppercut comes up underneath your chin, so it's hidden by both your chin and your nose. The most deadly combination is being hit by an unseen uppercut, which whips your chin up, and then being hit by an unseen hook to your now very exposed chin, which whips your head around and finishes the job. Keeping your chin down does two things: first, it makes this a harder target to strike, as there's less 'under-chin-area' exposed to hit. Second, it increases your peripheral vision, making it easier to see all around you, and thus to see punches coming. If you don't believe us, check it out. Stand with your head perfectly level and look straight ahead. Now have a friend stand a few feet to your side and have them walk backwards until you can't see them any more out of your peripheral vision. Now, while still looking forward, lower your chin and your gaze, and you'll see them

again. Have them move back further and further until you can't see them. You'll see that you have MUCH wider peripheral vision when your chin is down. This is also important when fighting multiple opponents, as it gives you a better sense of anyone coming up behind you. Finally, you can help build up your support structure with technique 3:

Develop a strong neck The first is a strong neck. Your trapezius muscles do the stabilizing of your head and neck, and developing strong traps will help you have what is called a 'strong chin' in boxing (meaning you're hard to knock out as opposed to a 'glass chin' which means you are knocked unconscious combing your hair). These tricks can go a long way to helping you avoid ever getting knocked out, which ultimately could save your life. These techniques will help protect you, and could even save your life, in the event you end up in a fight with someone who knows how to really throw a punch…

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MIX’FIT CLUB SUPPORT

Mix’Fit /////////////////////////////

At Mix’Fit, the guys believe that society has come a long way since 5000 BC, therefore the approach of sports should shift it’s focus from; Winning vs. Losing to participation and achieving set objectives.

he true purpose of any combat activity, in ancient Greek and Roman philosophy is the act of being victorious over another whether, it be in battle or in a MMA cage. However, the guys at Mix’Fit™ believe, society has come along way since 5000 BC, both in people’s approach to life, evolution, religion, thinking methodology and culture. This conclusion brings them to the new sports of Mix’Fit™, a mixed fitness approach specifically designed to improve the health, and well-ness of the numerous communities that inhabit this place we call “Our World”, minus the actual combat we experience in a mixed martial arts cage. Mix’Fit™ holds many treasures for those with an open mind to seek the true meaning of getting combat ready. Seeing as very few things beats being in fight ready shape with the ability to kick through walls, sporting a six pack and developing you mental and physical conditioning. After some research and spending some time with world class Mix’Fit™ affiliates. Our media team at Mix’Fit™ magazine, came up with the following “TOOLS” to assists future Mix’Fitters™ in the

hybrid/mixed sports called Mix’Fit™. CLUB REGISTRATION For the new sport of Mix’Fit™ to fully develop into the WORLD MIXFIT GAMES™, a series of inter-club, inter-state & intercontinental competitions, the guys at Mix’Fit™ HQ made club registration compulsory. Clubs may register themselves on the www.mixfitmag.co.za website or contact admin@mixfitmag.co.za, directly. The cost for annual club registrations are $1500,00 payable by club owners, to Mix’Fit™ HQ. Ÿ Club owners may consist of

any qualified coach/personal trainer or Mix’Fit™ certified fitness instructor. HOW TO GEAR FOR Mix’Fit™ Mix’Fit™ is all about creating an - inexpensive - alternative to “Traditional” gyms. Ideally we want to build on the Mix’Fit™ tradition by providing an updated guide to outfitting a traditional Dojo and/or Gym, whether it’s a personal garage or basement gym, a portable equipment cache for outdoor workouts, a 5,000-square-foot

Power House performance center, or anything in between. As always, concentrate on value. (If money is no issue for you, then you can stop reading here. Go forth and purchase what you want.) What should I buy? How do I go about it? Why should I buy those particular items? How do various models and brands compare? When do I need to purchase my own stuff? These are more great questions that will have different answers according to your personal preference, time-line, experience, and budget. What you can afford: Visualizing the Mix’Fit™ HOT BOX The first step is to identify a realistic budget. And, if you will be outfitting an affiliate or training groups, you’ll also need to visualize your anticipated class size six months from now. Don’t just come up with a number, though; actually try to imagine yourself training private clients for an hourly rate and what that will look like. What do you need, how much, why, how will the space and workouts be organized, what can be shared, and at what point will you need more based on increased numbers?

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For instance, if you run any of Mix’Fit’s™ benchmark workouts with a group of ten, determine how many of each equipment item you’d need to do that properly. Then determine whether you can afford that much and where you can compromise on equipment without compromising the experience.

The way to break it down, the core of every garage gym contains the following staple items: ŸPull-up bars or stations ŸAdjustable squat stands ŸMen’s and women’s Olympic

barbells

ŸBar collars ŸRubber bumper plates Think also about which items are ŸSmall metal plates must-haves, what you’re willing to ŸRings “make do” with, whether you’ll have ŸMedicine balls time and money later to revisit the ŸDumbbells shopping and purchasing process ŸSmall metal “change” plates to upgrade or add to your inventory, ŸPVC pipe or wooden dowels

and whether you’re open to used or homemade equipment and how much time, expertise, and patience you have for custom fabrication or do-it-yourself projects. A key point is that there isn’t a cookie-cutter approach that will work for everyone. The gear recommendations you’ll find in this article and elsewhere will make a lot more sense if you go in armed with these visualizations and understandings of your needs. What you need: Priority hierarchies Think of the world of Mix’Fit™ equipment as a set of concentric circles, with the innermost circle consisting of the most necessary and useful items, and each larger ring adding the next set of priorities.

1 2 3

Working your way outward, your second ring of essentials comprises the following items: ŸGlute-Ham developers ŸLight training barbells (10, 15, 22,

or 25 pounds) ŸConcept 2 rowers ŸPlyo boxes ŸFlat benches ŸKettlebells ŸJump ropes ŸParallettes ŸClimbing rope ŸRubber flooring ŸRubber stretch bands for assisting body-weight exercises Your third ring contains “premium” items. You might consider seeking out some of these items: ŸPower cages or half racks ŸPlatforms ŸPunching bags ŸParallel bars ŸStall bars ŸBikes (stationary or not)

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Ok , so Quinton, welcome to our magazine, thank you for the interview and tell us quickly?

Mix’Fit: What is this MMA story and how long have you been doing it? Osmers: Well, I’ve been doing MMA for 5 years now. I started at a MMA club, got a couple of certificates and trophies, seen EFC on TV so I decided MMA is worth a try.

Osmers: Umm, well I taught my brother how to do MMA. He is a little young, made some mistakes but he won his last fight after I pushed him hard with training.

Mix’Fit: We hear you might want to do some coaching? Osmers: Well, YES. If I am not busy training, and preparing for a fight I am busy training other people to do MMA. So far, they have learnt allot from me, and they doing just fine.

Mix’Fit: Ok, so Quinton. What is the hardest... Striking, Grappling or Conditioning?

Mix’Fit: So tell us. What is your vision for the next 5 years?

Osmers: Umm, Fitness always stays the hardest! Fitness & Conditioning is always the hardest. I enjoy striking allot. BJJ & Greco-Roman Wrestling, I also enjoy allot, but Fitness & Conditioning is the hardest.

Osmers: Well if I get my EFC branding, I would like to go fight in Europe. I am thinking Ireland. Maybe Dana White will see me and give me an opportunity in UFC.

Mix’Fit: Ok, nice. Now, umm, Quinton tell us quickly. You say you’ve been doing this MMA thing for a while now. Now, what has been your biggest success thus far?

Mix’Fit: Ok, so you make kind of nice photo’s. What dieting tips do you have for our readers?

Osmers: My biggest success is... umm, I always train hard and I am always very prepared for a fight. When I climb in the cage I am fully prepared and I make sure I win.

Mix’Fit: Nice, thank you. Now, Quinton. Tell our readers quickly. We hear your brother also does MMA? Are you the two brothers like in the movie “warrior” or what the whole story?

Osmers: Like what dieting tips?

Mix’Fit: Like any dieting tips that could help our readers get fighting fit? Osmers: Well, I am a fan of coconut oil. So, bake and cook with coconut oil. It doesn’t make you gain to much weight and keeps me oiled up for events.

Mix’Fit: Ok, thank you. Now tell our female readers. Are you married?

Osmers: No, I am not married.

Mix’Fit: So Quinton, I hear you now training at CrossFit HUA? How are things there? Osmers: Thing are great. I haven’t looked back since I started training there. I always thought: “CrossFit wasn’t a tuff sports but I was wrong”. I started off slowly but I am definitely picking up speed. I finished, my last WOD very strong.

Mix’Fit: Now, tell us from who did you learn the most in your striking game? Osmers: Umm, I did learn ok things from Gert Strydom, but honestly I learnt more from the coaches at TKOMMA.

Mix’Fit: Ok, so Gert Strydom? They where you’re striking coaches up to now? Osmers: Yes, but they only taught me boxing stuff, and where simply less MMA orientated.

Mix’Fit: Ok, so tell us who’s working on your ground game? Osmers: I’ve been working with a real Brazilian, at Grazie Barra, Glenhazel. David Agliot, a real black belt. I am back there from next week.

Mix’Fit: Ok so what colour black belt do you have now, ok rephrase: what colour belt do you have now in BJJ?

Osmers: Ok, I don’t have any colour belt. All I know is a have solid BJJ & Greco game and I’ve never lost a fight on the ground.

Mix’Fit: So, tell us? What is your favourite promotion on the amateur circuit in SA? You’ve done Fight Star, AFL. Who is the most fun? Osmers: Well AFL was fun, but Fight-Star is just better.

Mix’Fit: Why? Osmers: You get seen by allot more influential persons, they treat you more professionally. They have stronger competition and they simply closer to home.

Mix’Fit: Quinton tell us what we don’t know about you? What your favourite food? Osmers: My favourite food is Sushi / Fish and salads.

Mix’Fit: Ok, so of you don’t do MMA what do you keep yourself busy with? What do you do for entertainment? Osmers: Well. I like to watch DVD’s. I like to fish and go camping. I also like going to the beach. I like Play station.

Mix’Fit: We hear you’ve got kids? What are their names and how old are they?

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Osmers: I’ve got 3 kids. My youngest is a boy, his name is David and he is one year old. I have a daughter of two years old, her name is Angelique and my other daughter is 4, her name is Angelina.

Mix’Fit: Ok, besides for my dog barking now. (Everybody Laughs) So, you think EFC stays the top promotion in Africa? Osmers: In Africa, yes, definitely. I could even say the top promotion in the Southern Hemisphere!

Rally, an event where 3-4 people die every year? Osmers: I think MMA is very dangerous, but you can compare fighters with rally drivers. MMA fighters are either smart or unlucky. Rally drivers are less smart. But, MMA is dangerous no matter what media says. Personally, MMA is more dangerous because you never hear how fighter got injured post-event in all cases, unless it’s a career ender.

Mix’Fit: So EFC is the promotion to fight for if you live south of the equator?

Mix’Fit: What do you think of purse fees?

Osmers: Yes, for sure.

Osmers: Purse Fees? As in?

Mix’Fit: Ok, so tell us about this “Fighting Irish” thing of yours?

Mix’Fit: As in, are fighters paid enough in Africa?

Osmers: Umm, well my dad is 100% Irish. That’s where the Irish blood comes from. That’s why I am so tuff, why I last long and why this fighting thing is in my “blood-line”. I’ve had plenty injuries and I’ve never looked back or looking to retire... I simply keep going forward.

Osmers: I’ve never been paid for fighting but I hear EFC pays best in Africa.

Mix’Fit: Ok, so will you retire one day as a fighter? Osmers: Retire?

Mix’Fit: Ok, while we’re on the subject of injuries. What is the biggest injury, you’ve ever sustained, doing MMA. Osmers: I don’t go public with my injuries, normally something I keep for myself. But, yes, I’ve had a couple of surgeries.

Mix’Fit: Ok, so thus far we had one fighter die in EFC, umm. How dangerous do you think MMA is compared to the Dakar

Mix’Fit: As in Financially? Osmers: Well, eventually I want to retire and open up my own dojo, grow the sports by coaching a new generation.

Mix’Fit: Ok, so what will you call your dojo? Osmers: Umm, I will call it Vikings MMA.

Mix’Fit: Ok, so if Dana White had to read this interview. What would you have to say to the guy? Osmers: Umm, if he had to read this interview. Umm, what would he say? The only reason Dana White would read this interview would be to ask me to fight in UFC, and I’ll obviously answer yes!

Mix’Fit: So, what do you have to say to Cairo at EFC? Osmers: When I am I seeing a fight contract?

Mix’Fit: You have anything to say to your fight fans? Osmers: Ja, thank you for the social media comments, motivation and support.

Mix’Fit: Who are your sponsors? Osmers: CrossFit HUA (Training), Resurrect MMA (Clothing), TKOMMA (Training)

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iloviridae is the only known virus family about which we have such profound ignorance. We do not even understand the maintenance strategies employed in nature by the agents, and we know much less about the resulting diseases, their pathogenesis, and detailed virology. The information gathered during control efforts directed toward recent epidemics has provided considerable fundamental information about filoviruses. A number of colleagues, both in the laboratory and in the field, agreed to prepare reports reflecting recent research, thus permitting this supplement to the Journal of Infectious Diseases, which provides a single source for substantial new, peer reviewed information. We have somewhat arbitrarily divided the supplement into the categories of clinical observations; epidemiology and surveillance; ecology and natural history; virology and pathogenesis; experimental therapy; control, response, prevention; and conclusions. "Ebola," however, is not just one Ebola: There are 4 distinguishable subtypes, whose phylogenetic tree is shown on page 48 of this article. Because the subtypes, which may even be different virus 44

species, have differing properties, we have grouped the papers by the subtype discussed within each subject area.

arburg, the First Known Filovirus

Biomedical science first encountered the virus family Filoviridae when Marburg virus appeared in 1967. At that time, commercial laboratory workers with a severe and unusual disease were admitted to a hospital in Marburg, Germany. The attending physician recognized the distinctive clinical picture as additional cases appeared, and an investigation led to the isolation and identification of the immediate source of the virus as green monkeys imported from Africa for use in research and vaccine production. The monkeys, some of which had been shipped to Frankfurt, Germany, and Belgrade, Yugoslavia, were euthanatized, and the epidemic was contained with only 31 human cases and one generation of secondary transmission to health care workers and family members. Nevertheless, the bizarre morphology of the virions, the 23% human mortality, and the failure to identify the natural history of the virus left fear among many who were

concerned with the role of viruses in human economy. Quarantine procedures were put in place in many countries to prevent the recurrence of disease introduced by imported monkeys, and tests were instituted to exclude Marburg virus from vaccine substrates. Fortunately, there have been only three detected recurrences of Marburg virus, all in humans traveling in rural Africa, and none of these has led to extensive transmission. This brief history of Marburg virus presages the very similar course of events with Ebola virus.

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bola, the Second Known Filovirus

Humans Meet Ebola Virus in Africa, 1976 In the late 1970s, the international community was again startled, this time by the discovery of Ebola virus as the causative agent of major outbreaks of hemorrhagic fever in the Democratic Republic of the Congo (DRC) and Sudan. International scientific teams that arrived to deal with these highly virulent epidemics found that transmission had largely ceased; however, they could reconstruct considerable data from the survivors. Medical facilities had been closed because of the high death toll among the staff, thus eliminating major centers for dissemination of infection through the use of unsterilized needles and syringes and the lack of barrier-nursing techniques. In contrast, patients in the affected villages were segregated through traditional methods of quarantine, a step that controlled the situation outside the clinics. Much of the information concerning these outbreaks has been previously summarized. The international alarm and research efforts that arose in response to these outbreaks quickly dwindled when the only convincing evidence that Ebola virus infections were continuing among humans consisted of a small outbreak in the Sudan in 1979 and 1 case in Tandala, DRC, in 1977. Ebola Virus Visits the United States: The Virus Family Grows In 1989, Ebola surprised us once more when it appeared in monkeys imported into a Reston, Virginia, primate facility outside of Washington, DC. Epidemics in cynomolgus monkeys (Macaca fascicularis) occurred in this facility and others through 1992 and recurred in 1996, as reported in this supplement. Epidemiologic studies that were conducted in connection with both epidemics successfully 46

traced the virus introductions to one Philippine exporter but failed to detect the actual source of the virus. Attempts to work in the remote areas where the monkeys were captured have been too dangerous due to political instability. We do know that this virus strain (EBO-R) has an apparent Asian origin and lesser pathogenicity than other Ebola subtypes for both macaques and humans, but we are still not certain of its real origin. Nevertheless, current quarantine procedures for imported primates and vaccine requirements have protected the public. The control of these introduced virus outbreaks in 1989 andchimpanzeeinbrid the 1990s stimulated laboratory studies to improve diagnosis of nonhuman primate infections. However, the materials necessary to definitively confirm the utility of these techniques for humans were lacking. The African Ebola Epidemics of 1994–1996 After Ebola hemorrhagic fever (EHF) appeared in Africa in 1976–1979, it was not seen again until 1994. Was it gone during those 15 years? In one sense, certainly not—it was circulating in its natural reservoir. Was the virus causing sporadic human infections that remained undetected because the patients never contaminated hospitals to produce the savage nosocomial epidemics that brought Ebola virus to medical attention? During 1981–1985, Ebola virus surveillance was carried out concurrently with intensified efforts to understand monkeypox. This surveillance may have identified several cases and estimated the seroprevalence among the population; however, the findings are subject to caveats because of problems with the validity of laboratory tests. Serosurveillance in 1995 also suggested that human infections may have occurred from time to time. During 1994–1996, no less than five independent active sites of Ebola virus transmission were identified: Côte d'Ivoire in 1994; DRC in 1995; and Gabon in 1994, 1995, and 1996. The previously known Zaire

subtype of Ebola virus (EBO-Z) and the newly discovered Côte d'Ivoire subtype (EBO-CI) were both involved, and as in previous African Ebola virus transmissions, the sites were in or near tropical forests, such as along riverine forests. Whether this hiatus after 1976–1979, which was followed by renewed human transmission, reflects actual Ebola virus activity or rather publicity combined with fortuitous entry of the virus into medical facilities (leading to recognition) is unknown; we believe the renewed quiescence of reported Ebola activity since 1996 argues for the former. EBO-CI was discovered when ethologists in the Taï forest of Côte d'Ivoire noted that members of a chimpanzee troupe began to experience an unusually high mortality. One of the study group scientists became infected and was transferred to Basel, Switzerland, for definitive care. The clinical information derived from her hospitalization provides the beststudied clinical case of any Ebola virus infection. Furthermore, the circulation of virus in the well-defined region of the Taï forest reserve provides an excellent opportunity to study the Ebola reservoir question. Reports of the clinical case, the epidemiology in chimpanzees, and the pathogenesis in chimpanzees are in this supplement. EBO-Z was also circulating in Gabon, and at least 3 separate outbreaks in humans and nonhuman primates occurred. Thus, Gabon may well provide another site where the search for risk factors of human infection and the natural reservoir could be carried out. Notable among the epidemics were features such as the important role of a dead, naturally infected chimpanzee in bridging the virus to humans, the rapid control of human transmission when barrier-nursing measures were instituted and the continued circulation of virus without these precautions, and the deep forest exposures of index cases.

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BO-Z, Kikwit, DRC, 1995

The description of the large African EHF outbreaks in 1976 was largely based on retrospective information, so the Kikwit epidemic provided a better opportunity for more detailed investigations while the epidemic was in progress. Other differences were also present. For example, in 1995, the press and tabloid response in Kikwit was extraordinary and unanticipated. The last weeks of this epidemic took place in an unprecedented atmosphere of legitimate news reporting and tabloid exploitation. Largely because of the popular success of Richard Preston's book, The Hot Zone , there was tremendous public interest in both the information and misinformation that was generated by the media. Fortunately, careful mainstream journalists were accurate in carrying the best scientific information, and the World Health Organization (WHO) became a highly capable center for the dissemination of reliable facts about the epidemic. Large donations flowed into WHO and directly to the DRC; however, there were difficulties with the disbursement of relief supplies and resources, acquisition of appropriate types of materials, and triage of the contributions. Clinical disease The clinical syndrome seen among patients in Kikwit resembled that seen in 1976, but bleeding was less common and other significant findings were identified, as reported by Bwaka et al. Unfortunately, circumstances did not permit as close an evaluation as would have been desirable. It was possible, however, to make observations on eye complications, pregnancy, late sequelae, and an unusual case with mucormycosis complicating Ebola. As the epidemic progressed, mortality progressively declined from virtually 100% to 69%. There is no known therapy for EHF. Late in the epidemic, this fact motivated a clinical experience with 48

bood transfusions from survivors. Although no contemporaneous controls are available for comparison, only 1 of the 8 treated patients died. Comparison with the bulk of patients in the outbreak, taking into account the patient's age and sex, the day of treatment, and the stage of the epidemic, did not suggest any real benefit to the therapy. In addition, virologic analysis of the incomplete specimen set that was available did not lend support for efficacy. Nevertheless, it is useful to consider what was present in the transfused blood that might have been helpful. It is questionable whether antibodies would have had much effect (see below), but the activated allogeneic lymphocytes and the added volume of platelets, erythrocytes, and plasma were probably beneficial. If therapeutic studies are undertaken in patients in the future, it will be important to have randomized control serial laboratory samples and some consideration given to the potential immunostimulatory effects of allogeneic lymphocytes. We assume that filoviruses, like other viruses causing hemorrhagic fevers, can latently or chronically infect their natural reservoir hosts. Primates seem to be susceptible hosts, and nonhuman primates may even provide a frequent link to humans. They are unlikely, however, to be the true reservoir hosts, given the high pathogenicity of filoviruses for African monkeys, macaques, chimpanzees, and perhaps great apes. Furthermore, a direct search for chronic, persistent, or latent infection in monkeys was unsuccessful. Marburg virus has been cultured from secretions or immunologically privileged sites 1–3 months after acute disease. In the 1995 Ebola outbreak in Kikwit, late transmission of disease was not detected in follow-up of contacts of several survivors. There was, however, evidence for Ebola virus RNA shed in semen and vaginal secretions for months, although it was not possible to isolate virus. The only testicle examined from a fatal case showed clear-cut viral invasion. Patients with persistent arthritis also had higher anti-Ebola IgG ELISA titers, suggesting increased or prolonged antigenic stimulation. Thus, although the question is not settled, persistence of virus or viral antigen or

genomes for weeks into convalescence seems common, but long-term infection is apparently not likely. IgG and IgM ELISAs were used to evaluate the possibility of subclinical infections among family contacts, contacts of convalescent patients, medical staff, and local residents, and evidence suggested that a very low level of subclinical transmission occurred during the outbreak. Of interest, there was an appreciable seroprevalence among the residents of Kikwit and those of surrounding villages, which was thought to represent temporally distant infections. Epidemiology and surveillance The presence of the international teams allied with several organizations from the DRC during the end of the epidemic provided an opportunity for several studies to better define the transmission of Ebola virus among humans. Details of transmission in households showed the important role of close contact and exposure to body fluids, particularly to care givers, who suffered the major burden of secondary infections. Touching cadavers at funerals was also an independent risk factor for disease and may well be related to the extensive skin involvement of Ebola virus, as discovered by Zaki et al. There is considerable misunderstanding concerning the potential for aerosol transmission of filoviruses. The data on formal aerosol experiments leave no doubt that Ebola and Marburg viruses are stable and infectious in smallparticle aerosols, and experience of transmission between experimental animals in the laboratory supports this.

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Indeed, during the 1989–1990 epizootic of the Reston subtype of Ebola, there was circumstantial evidence of airborne spread of the virus, and supporting observations included suggestive epidemiology in patterns of spread within rooms and between rooms in the quarantine facility, high concentrations of virus in nasal and oropharyngeal secretions, and ultra-structural visualization of abundant virus particles in alveoli. However, this is far from saying that Ebola viruses are transmitted in the clinical setting by small-particle aerosols generated from an index patient. Indeed patients without any direct exposure to a known EHF case were carefully sought but uncommonly found. The conclusion is that if this mode of spread occurred, it was very minor. What then were the major routes of transmission? Nonhuman primate studies found conjunctival and oral routes of infection to be possible. It seems likely that the increased risk from late-stage patients reflects increased virus excretion as the disease progresses, similar to that seen in monkey models. Thus, mucousmembrane exposure, pharyngeal contamination during swallowing, inoculation via small skin breaks, or even infection from swallowed infectious material may all contribute to virus transmission. Ecology and natural history The epidemic also provided an opportunity to search for the elusive reservoir of Ebola virus in connection with an acute outbreak. It is not widely appreciated that there is only one reported study of any search for the reservoir. Many ecologic investigations have been made in connection with other viruses; it is not known if the methods used would have detected Ebola virus, although EBO-Z is lethal in the most commonly used assay system, the suckling mouse. Certainly, antibodies were not sought. In Kikwit, investigators were faced with multiple dilemmas, particularly timing and selection strategy. The first problem was that the outbreak began in 49

January during the rainy season, but because of the delay in recognition and other factors, no research effort was mounted until several months later during the dry season. At that time, there was no guarantee that the virus would still be present in its natural habitat. Several international teams began the search as soon as possible and made a broad general collection. The implicated index case was a charcoal maker who lived in the city of Kikwit. He rode his bicycle through the savanna to an area of secondary forest, where he had exposure to tree-top, ground-level, and burrowing species of plants and animals. To complicate matters, he also had a small agricultural plot near a primary forest in a clearing near a stream. A decision was made to throw a wide net and capture arthropods and vertebrates from several biotopes, recognizing that the diversity of tropical species would be a limiting factor. Unfortunately, no evidence of Ebola or antibodies reactive with the virus were found in vertebrates, and Ebola genomes were not amplified from the extensive arthropod collections. Another group (R. Swanepoel and colleagues) from the National Institute of Virology in Sandringhan, South Africa, returned to the area during the following rainy season and made selective collections to extend the available information (unpublished). The interpretation of these studies was augmented by the results of work done during 1979–1980 in connection with the monkeypox surveillance program. A second problem was the choice of how to select the species sampled. There are several hypotheses concerning the most likely reservoirs for filoviruses, but each of these involves implicit assumptions about the nature of the reservoir. It was known in 1995 that arthropod cells and arthropods themselves were not readily infected with filoviruses, and these observations have been extended; however, one must ask if the correct arthropod has been tested. Virology and pathogenesis Ksiazek et al. provide thewithEBOZ.The first opportunity to examine more

than anecdotally the clinical virology of Ebola virus. The most important finding was that acutely ill patients are intensely viremic and that ELISA determination of viral antigens in serum provides a sensitive and specific way to quickly screen large numbers of suspect human samples. Virus isolation and reverse transcriptase—polymerase chain reaction are useful in a few instances as well. These results closely parallel those found in Ebola (Reston subtype) virus studies in naturally infected monkeys. Antibodies appear as patients recover; this provides an illuminating contrast to hantavirus diseases, in which the onset of the detectable immune response coincides with the development of serious disease . There is no more contentious issue in Ebola virology than the measurement of simple IgG antibodies to assess past infection. Since 1976, indirect fluorescent antibody tests have been used for acute diagnosis and seroepidemiology, but their limitations were recognized early on. During the Reston epidemics, the situation became more difficult. Monkeys with no likelihood of Ebola infection had positive titers, the titers could rise from negative to high levels, such as 1:256 in an animal under observation, and application of Western blots failed to resolve the problem. The virus is not readily neutralized by convalescent sera, and no hemagglutinin has been detected, eliminating two of the common confirmatory tests. An ELISA test appears to eliminate the falsepositive results widely seen in normal monkeys and shows positive reactions with every monkey serum from a confirmed infection and with sera obtained from a small number of human Ebola survivors available at the time of test development. This outbreak provided an opportunity to apply the test to humans with acute infection. The use of the test in such sera was satisfactory and provides an improved measure of Ebola antibodies, but more experience is indicated.

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During acute disease, there was mRNA evidence of activation of multiple cytokines. These cytokines have been implicated in the pathogenesis of several forms of shock and cause specific defects in vascular permeability in filovirus infections studied in vitro. Another interesting finding in acute-phase infections of humans and nonhuman primates was the presence of a circulating soluble glycoprotein, which shares ∼300 amino acids with the viral glycoprotein that is produced through transcriptional editing of the same gene. It has been speculated that this protein may serve as some form of immunologic decoy, preventing an effective immune response. There are several other possible immunosuppressive mechanisms, including the extensive necrosis of spleen and lymph nodes from fatal human and nonhuman primate cases. Extensive infection and co-localized necrosis were found in parenchymal cells, macrophages, and endothelial cells of many organs. The virologic and pathologic findings are important for the way we think about therapy of patients infected with EBOZ. The pathogenetic hurdle is the extensive nature of infection with a cytopathic virus and the lack of an effective immune response. In fact, the infection and related necrotic lesions are so widespread in fatal cases that it seems unlikely that supportive care will have much impact on survival unless some form of antiviral or immunologic therapy can be instituted relatively early in disease. The extensive cytokine activation explains some features of the disease, and it may well be that disseminated intravascular coagulation occurs on the severely affected endothelial cell surfaces, as seen in some animal models, but these are not the driving forces behind the fatal disease process. Treatment of these phenomena as well as traditional supportive care may be useful in some cases but should not distract research energies from antiviral drugs, effective passive antibody, or other forms of therapy designed to modify the

underlying problem.

efficacy.

Experimental therapy

Control, response, and prevention

Fortunately, there are examples of provocative new findings that may provide therapy for filovirus infections. Simple convalescent serum has generally had low neutralizing capacity in vitro and has not conferred protection on passive transfer. Nevertheless, hightitered hyperimmune horse anti-Ebola serum has been produced and been found protective in baboons challenged with Ebola virus. This product has been confirmed to be efficacious in guinea pigs, but it is not as useful in rhesus monkeys or the mouse model of Ebola virus infection. The production of human monoclonal antibodies against Ebola virus surface protein from mRNA extracted from bone marrow of Kikwit survivors raises the possibility that an improved, standardized, safe, and replenishable source of therapeutic antibodies could be developed. Although there is no obvious role for an Ebola virus vaccine today, there are promising efforts toward experimental filovirus vaccines. It is important to continue these studies to be sure we have the technology to produce a vaccine should it be needed and to elucidate mechanisms of protection to help us in the search for effective immunotherapeutic agents. Antiviral drugs also show promise in experimental infections. The thrust of the effort is a collaborative approach among the US Army Medical Research Institute of Infectious Diseases (Fort Detrick, Frederick, MD), the National Institute of Allergy and Infectious Diseases (National Institutes of Health, Bethesda, MD), and other partners to identify drugs efficacious against viruses such as respiratory syncytial virus (RSV), another negative-sense, singlestranded RNA virus with some similarities to Ebola. The expense of preclinical and early clinical work would be justified by the potential commercial use of the drug against RSV, while the efficacy against Ebola virus would provide an alternate model to demonstrate broad-spectrum preclinical

The epidemic in Kikwit posed certain serious problems. The medical infrastructure was poor to begin with and suffered greatly from the epidemic. Hospitals were closed, and 30% of the physicians and 10% of the nurses contracted EHF. The city, with a population of >250,000, had no regular transportation, a paucity of vehicles, no newspaper or radio station, and no reliable electric power. Because of fear and of stigmatization, new cases were cared for at home and often in secrecy. It became urgent to rehabilitate the medical infrastructure and to convince patients to come to the hospital, where they could be isolated and their families could be observed. This contrasts with the 1976 outbreaks, which occurred in villages where leaders enforced quarantine in local houses. This action, combined with the collapse of the medical care system, effectively ended the epidemics. The importance of the medical care facility in amplifying the spread of Ebola virus is emphasized by the fact that only the hospitals in Kikwit and Mosango, DRC, had extensive transmission: ∼7% of patients left for small villages, and no transmission was noted there. We do not know if Ebola virus transmission would have continued indefinitely, burrowed into the mass of people in the city, if measures to begin hospital use had not succeeded. In any case, the infection of health care workers ended with the arrival of proper patient-isolation supplies and training in barrier-nursing techniques. The coordination of medical logistics and plans for rational triage of the patients were key in the effort.

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ince the age of 5, after watching to many Bruce Lee movies, I’ve always wondered. What would it take to become a professional martial artist? Well, after only 6 months of ball breaking work, a couple of ZAR’s, a little opportunity costs and 16 years operating as a personal trainer in Morningside, Sandton. We finally achieved one for the childhood bucket list and became a fully fledged EFC worldwide Pro Fighter. Now, although my “in the cage performance” was less than admirable. I can safely say;

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The lesson is obvious: The hospital is the link that must be strengthened. This will require both money and training, but the improvements will be useful in preventing many other infections, including those with hepatitis C and human immunodeficiency viruses. How this might occur without marked economic and cultural changes is not clear; despite intensive training, health care workers in Kikwit abandoned most of the improvements in medical hygiene within 3 months of the end of the epidemic, due in part to a lack of supplies and a reversion to previous practices. Unfortunately, the massive aid that comes with emergencies does not continue in reduced form to help prevent future emergencies. Surveillance is also a problem. The case definition that was adopted was accurate in the epidemic setting, but it would be much less so in sporadic infections or at the beginning of an epidemic. The finding of copious amounts of Ebola virus antigen in skin opened the way to confirm cases by taking simple skin biopsies, which could be placed in formalin and analyzed later by immunohistochemistry. This obviates the need for cold chain or special precautions while processing or shipping infectious material. One could argue that Ebola diagnostics should be placed at many sites in the potentially endemic areas, but this may be unrealistic given the small number of expected cases and the economics. Such tests could be devised on the basis of antigen detection on paper strips, but the logistics of production, distribution, quality control, and shelflife considerations are formidable. It would seem that laboratory capability for diagnosing common diseases, such as shigellosis or typhoid, would be much more practical as a first step. This would also make it easier to sort out which patients to suspect for Ebola virus infection, remembering that the initial diagnosis of the epidemic in Kikwit was bloody diarrhea until clinicians suspected otherwise weeks later. Thus, the algorithm proposed by Lloyd et al. calls for early recognition of suspect cases by the clinician and then 54

institution of simple, inexpensive barrier-nursing precautions. If a patient dies, as the majority of humans infected with EBO-Z do, a skin biopsy is obtained and sent for analysis. Today, the Centers for Disease Control and Prevention is the main site for analysis, but as demand builds, the technology can be transferred to regional centers. The delay in definitive diagnosis is not the problem one might anticipate. The protocol calls for barrier nursing to begin at once, thus decreasing the chance of spread. In the Kikwit outbreak, almost 5 months passed from the beginning of the outbreak until the first samples were obtained. The ability to obtain a skin sample safely and without cold chain problems should encourage more use of this technique and may well give an earlier warning. Information for the Future What information is needed to deal with Ebola virus? The major questions are tied to important issues in biology. For example, how will we be able to elucidate the natural reservoir without intensive studies of the many animals resident in the tropical forest? Do we really have a viable hypothesis as to the true reservoir? Certainly we would put bats high on our list of suspects, but should we do this to the exclusion of other species ? Very little is known about the virology of Ebola. For example, this agent has less than a dozen genes, compared with the expansive genomes of poxviruses or herpesviruses. How does it accomplish its task of natural maintenance and also cause disease in humans? The virus appears to be relatively refractory to the antiviral effects of interferon, but the mechanism is unknown. Recent studies have shown that the virus inhibits gene induction by interferons and double-stranded RNA in endothelial cells, effects that could be relevant to pathogenesis. We have no structural studies of the virus that could yield information on the function of some of the unmapped genes. Additional knowledge of the three-dimensional structure of the virus and its proteins could be helpful in

designing inhibitors of the fusion process and of the polymerase. The clinical description of the disease is still incomplete, due in part to the lack of infrastructure during epidemics and the difficult and dangerous circumstances. For example, does pancreatitis contribute to the demise of patients ? What are the variations in clinical pathology findings? Much additional work on the virology and immunology remains. Finally, we need a pre-planned response team that is already integrated, prepared to execute selected functions, and equipped. This team may have to wait 20 years for the next epidemic; however, its chance to respond may come much sooner. Information for Now Most of the known information on filoviruses can be found in Marburg Virus Disease , Ebola Virus Haemorrhagic Fever , and this supplement. Marburg and Ebola Viruses has just been published and contains, but is not limited to, particularly good summaries of recent work on the molecular biology of filoviruses. Much of the Russian literature has never been properly surveyed and synthesized in the English language. This supplement contains reviews of Russian work on antibody therapy and pathogenesis , and other information on pathogenesis and vaccine immunology is available.

cknowledgments.

We gratefully acknowledge the work of the many field and laboratory investigators who contributed their original findings to manuscripts included in this supplement, especially to those who delayed publication so that their work might be shared in this compendium of recent research. We also recognize the many other dedicated individuals not included in the author lines who participated in many different ways in the international responses to the Kikwit and other outbreaks, especially those whose lives were lost while assisting in the epidemic responses and caring for the sick or dead. Finally, we thank the editorial board and the staff of the Journal of Infectious Diseases, especially Donna Mirkes and Claudia Chesley, for their

Rehabilitation

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At The Office

n developed countries, managing rotator cuff syndrome in the workplace presents significant challenges for health care providers and industry employers. Rotator cuff syndrome can substantially affect a person’s health and functioning with pain and/or weakness often restricting a person’s ability to carry out their daily activities and to work. Rotator cuff syndrome frequently results in lost productivity and significant financial costs for industry and employers. It is therefore imperative that appropriate evidence-based management of rotator cuff syndrome is adopted to minimise negative outcomes for individuals, their families and the workplace.

Background Rotator cuff syndrome can affect a person’s quality of life. If left untreated, shoulder problems and pain can lead to significant disability, limitations in activity and restrict participation in major life areas such as work and employment, education, community, social and civic life. Rotator cuff syndrome in the workplace presents a number of significant challenges for clinicians and employers. These challenges include: clinical classification / diagnosis, determination of the contribution of physical and psychological working conditions to the development of rotator cuff syndrome and the design of appropriate treatment and prevention programs. Recovery from rotator cuff syndrome can be slow with the potential for recurrence of shoulder

pain201, 202. During recovery from rotator cuff syndrome there will typically be a limited period of time where some activities and participation in home, work and community are restricted. Management of rotator cuff syndrome requires the skilled assessment of each individual person’s health status, circumstances and perspectives to help determine the treatments that are relevant and appropriate to that person.

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Red Flags for Rotator Cuff Syndrome

Signs and Symptoms of Inﬂammatory Arthropathy

Signiﬁcant Trauma

Signs and Symptoms Indicating Referral from a Remote Site or System (chest pain, ischaemic heart disease, shortage of breath, progressive neuromuscular deﬁcit)

Unexplained Swelling/Deformity (skin changes, erythema)

Signs and Symptoms of a Large Rotator Cuff Tear (loss of strength unrelated to pain, presence of bruising in the absence of trauma)

Concurrent or Suspected Malignancy ( 1º or 2º)

Systemic Symptoms (fevers, night sweats, weight loss)

Urgent laboratory\ Investigations, imaging as appropriate and onwards referral

Figure 1: Red Flags for Rotator Cuff Syndrome

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Definition

Incidence and Prevalence

The rotator cuff is comprised of four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) and serves as a dynamic stabiliser of the humerus (see Figure). Rotator cuff syndrome can be acute or chronic in nature. Injury to the rotator cuff may arise from a single traumatic event (e.g. fall or direct impact trauma), an acute overload incident or develop gradually from degenerative processes. The research suggests that the diagnoses of SIS, subacromial bursitis, rotator cuff tendonitis and rotator cuff tears (partial- or full-thickness) arise from tendon degeneration and/or the repetitive or excessive contact of the rotator cuff tendons with other anatomic structures in the shoulder, and usually result in functional loss and disability. In degenerative rotator cuff syndrome, it is possible for the underlying processes to be occurring over time with limited or no symptoms, but an incident (such as a posture which uses the end of range motion of the shoulder or sudden increase in load upon the tendon) can precipitate pain from the degenerative tendon.

Shoulder pain is the third most common musculoskeletal complaint reported to general practitioners in primary care settings200, 202. In developed countries, approximately 1% of the adult population is expected to visit a general practitioner annually for shoulder pain and the incidence of reported shoulder complaint is 19.0 per 1000 patients per year36. It has been estimated that 65–70% of all shoulder pain is due to rotator cuff complaints. On the basis of these figures approximately 13.3 per 1,000 patients per year present to GPs with a rotator cuff syndrome. In Australia, a recent analysis of workrelated shoulder injuries presenting to GPs was conducted by the Australian Institute for Health and Welfare (2008/9). Approximately 13% of all shoulder problems presenting to GPs are considered work-related. Occupations which have a higher incidence of reported rotator cuff syndrome include athletes (especially throwing and swimming), heavy labourers and workers who use their arm repetitively in the horizontal position or above204. Various occupations, such as construction workers, carpenters, slaughterhouse workers, fish and meat processing workers, sewing machine operators and industrial workers have all been noted to have elevated levels of shoulder pain relative to sedentary controls.

Prognosis Approximately 50% of new episodes of shoulder pain resolve in eight to twelve weeks, but as many as 40% of cases persist for longer than one year36, 202, 212 and recurrence rates are high201. In a 2003 study of Danish workers with shoulder tendonitis, Bonde et al. identified average symptom duration of 10 months or less, with 25% of workers continuing to experience symptoms at 22 months.

Recurrence of symptoms has been reported to occur in 40–50% of people. Some authors postulate that symptoms may return as partial rotator cuff tears progress to fullthickness tears. Poor prognosis is associated with increasing age, female sex, severe or recurrent symptoms at presentation and associated neck pain. A favourable prognosis is associated with mild trauma or overuse before onset of pain, early presentation and acute onset.

Rotator Cuff Syndrome Recommendations Recommendation 1: Diagnosis of rotator cuff syndrome requires a thorough history-taking which should include the following factors and consideration of their implications: age, occupation and sports participation, medical history, mechanism of injury, pain symptoms, weakness and/or loss of range of motion (body function impairments), activity limitations and social situation. Recommendation 2: Assessment of rotator cuff syndrome requires physical examination which should include the following: direct observation of the shoulder and scapula; assessment of active and passive range of motion; resisted (isometric) strength testing; and evaluation of the cervical and thoracic spine (as indicated). It may also include administration of other clinical tests dependent upon the experience and preference of the clinician. Recommendation 3: The clinician must exclude ‘red flags’ in the diagnosis of rotator cuff syndrome. ‘Red flags’ are signs and symptoms which suggest serious pathology.

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Recommendation 4: The clinician should take note of ‘yellow flags’ discussed or identified during history-taking. ‘Yellow flags’ are contextual factors such as personal, psychosocial or environmental factors that could impact on recovery and/or RTW following injury. Recommendation 5: X-rays and imaging are not indicated in the first four to six weeks for an injured worker presenting with suspected rotator cuff syndrome in the absence of ‘red flags’. Recommendation 6: Clinicians will educate injured workers with suspected rotator cuff syndrome on the limitations of imaging and the risks of ionising radiation exposure. Recommendation 7: In established rotator cuff syndrome, maintaining activity within the limits of pain and function should be recommended. Its reported benefits include: earlier RTW; decreased pain, swelling and stiffness; and greater preserved joint range of motion.

Recommendation 8: Clinicians should use a shared decision making process with the injured worker to develop a management plan. Recommendation 9: Clinicians should use and document appropriate outcome measures at baseline and at other stages during the recovery process to measure change in the injured worker’s impairments, activity limitations and/or participation restrictions. Recommendation 10: Health care providers should consider any additional issues, potential disadvantages or need for additional resources (such as an interpreter) for the injured worker and their family if the injured worker identifies as foreign, or is from a culturally and linguistically diverse or non-English speaking background. Recommendation 11: Injured workers should be prescribed paracetamol as the initial choice for mild to moderate pain.

Recommendation 13: To reduce pain and swelling following acute rotator cuff syndrome, injured workers may intermittently apply cold within the first 48 hours. Recommendation 14: From 48 hours post-injury, injured workers may intermittently apply either heat or cold for short periods for pain relief. Recommendations 15: There must be early contact between the injured worker, workplace and health care provider. Recommendation 16: A specific and realistic goal for the RTW of the injured worker, with appropriate time frames, should be established early with outcomes measured and progress monitored. Recommendation 17: The RTW program must involve consultation and engagement with a team which includes the injured worker, relevant health care providers and the workplace.

Recommendation 12: Injured workers with acute shoulder pain may be prescribed NSAIDs (either oral or topical) for pain relief. NSAIDs can be prescribed alone or in conjunction with paracetamol.

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First Presentation – Shoulder Pain

Thorough History and Physical Examination Recommendations 1 - 6

Yellow Flags

Red Flags

Yes

Onwards referral as appropriate (Figure 1)

Yes

Factors identiﬁed which may inﬂuence recovery and/or RTW (Appendix 1)

Onwards referral as appropriate

Initial Diagnosis of Rotator Cuff Syndrome

Development of Management Plan Including activity and work participation Recommendations 7 - 10

Initial Treatment

Paracetamol For mild to moderate pain and/or NSAIDs

Heat/Cold

RTW Program

Prescribed exercise and/or manual therapy and/or acupuncture

Recommendations 11, 12

Recommendations 13, 14

Recommendations 15 - 20

Recommendations 21 - 24

Injured Worker to be Reviewed by their Clinician in Two Weeks Earlier if no response to treatment or adverse treatment side effects Recommendation 25

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Recommendation 18: The RTW program should include a workplace assessment and job analysis matching worker capabilities and possible workplace accommodations. Recommendation 19: The RTW program, where possible, should be workplace-based. Improved outcomes occur if rehabilitation processes take place within the workplace. Recommendation 20: When planning a RTW program, a graded RTW should be considered and adjusted following review of objectively measured outcomes.

Initial Management Recommendation 21: Injured workers should be initially treated with exercise prescribed and reviewed by a suitably qualified health care provider. There is no evidence of adverse impacts for prescribed exercise programs for patients with rotator cuff syndrome. Recommendation 22: Manual therapy may be combined with prescribed exercise by a suitably qualified health care provider*, for additional benefit for patients with rotator cuff syndrome. Recommendation 23: Clinicians may consider acupuncture in conjunction with exercise; both modalities should be provided by suitably qualified health care providers. Recommendation 24: The evidence suggests that therapeutic ultrasound does not enhance outcomes compared to exercise alone. The health care provider should refrain from using ultrasound for either pain reduction and/ or increased function for injured workers with subacromial impingement

syndrome (SAIS).

Review Recommendation 25: Injured workers with suspected rotator cuff syndrome should be reviewed by their clinician within two weeks of initial consultation, with the proviso that the injured worker can contact their clinician earlier if they have had no response to their prescribed treatment, or if they have experienced treatment side effects. Recommendation 26: Injured workers with suspected rotator cuff syndrome who have experienced significant activity restriction and pain for four to six weeks following initiation of an active, non-surgical treatment program and have had no response to the treatment program should be referred for MRI and plain film X-ray. Recommendation 27: In the absence of access to MRI or for those with contraindications for MRI, refer injured workers with suspected rotator cuff syndrome for ultrasound and plain film X-ray. Ultrasound performed by a skilled clinician provides equivalent diagnostic accuracy to MRI for rotator cuff tears (partial- or full-thickness). Recommendation 28: For pain reduction in injured workers with persistent pain or who fail to progress following initiation of an active, non-surgical treatment program, the clinician may consider subacromial corticosteroid injection combined with local anaesthetic. Recommendation 29: Injured workers should be educated regarding the possible risks and benefits of corticosteroid injections. Recommendation 30: Subacromial corticosteroid injections should only be administered by suitably trained and experienced clinicians.

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Recommendation 31: If pain and/or function have not improved following two corticosteroid injections, additional injections should not be used.

Persisting severe pyayin and/or restriction of activity for more than 4–6 weeks post injury

Investigation Review red and yellow ﬂags Review management and RTW plan

Recommendation 32: Clinicians should refer for specialist opinion if an injured worker experiences significant activity limitation and participation restrictions and/or persistent pain following engagement in an active, non-surgical treatment program for three months. Surgery

Red ﬂags present

Red ﬂags not present

Yellow Flags Present Onwards referral as appropriate (Appendix 1)

Continue non-surgical treatment

Onwards referral as appropriate (Figure 1)

MRI and plain ﬁlm X-ray (ultrasound and plain ﬁlm X-ray in the absence of MRI)

Recommendation 33: On review, clinicians should refer injured workers for surgical opinion if there is a symptomatic, established small or medium, fullthickness rotator cuff tear.

Recommendations 26, 27

Recommendation 34: Clinicians should refer injured workers for surgical opinion if there is a symptomatic, full-thickness rotator cuff tear greater than 3 centimetres.

Full-thickness Tear

Non-full Thickness Tear (no pathology except rotator cuff syndrome)

Surgical opinion

Subacromial steroid injection

Recommendations 33–35

Recommendations 28–31

Pain and/or limitation of activity longer than 3 months

Recommendation 35: The clinician should be aware of factors that may influence prognosis post-rotator cuff surgery

Specialist opinion

Recommendation 32

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™

eveloping a strategic and measurable means of managing and assessing a fitness client, athlete or even your own progress is ultimately any coach or manager’s goal. Years where spent doing body-fat percentages assessments determining body composition when athletes all have three things in common: 1. Peak physical conditioning 2. Measurable performance levels 3. Lower body-fat% Maybe it does take a scientist to figure out body composition analysis is merely one scientific approach to establish; my fitness client or athlete is in peak physical condition, compared to the world best? Method of testing at Mix’Fit™ clubs may vary and there are numerous test available on-line, such as the 12 Minute Cooper Test to determine cardiovascular endurance. All you going to need is a scientific approach, ultimately giving you a score out of a maximum of 10.(See chart) Obviously, the goal of the chart is to identify possible strengths and weaknesses of the test subject. The chart is an excellent tool in establishing areas of conditioning which need more attention in training as well as an individualistic approach in coaching test subjects according to their specific needs. The simple reality remains individuals with set objectives will need to be managed, directed. Maximizing time and resources to develop a competitive advantage is exactly what sports is about.

Its worth mentioning. The Mix’Fit™ athlete assessment chart was developed and refined by Mix’Fit™ for elite athletes, exclusively. It was used by TKOMMA™ in preparation of 15 Mixed Martial Art events resulting in 15 consecutive victories for our Mix’Fit™ sponsored athletes. The conclusions of our little Mix’Fit™ experiment was: The Mix’Fit™ athlete assessment chart works for coaches, athletes and for getting measurable results. It’s also the only coaching aid of it’s kind in the world, fully endorsed by professional fighters, TKOMMA™ and Mix’Fit™. So, feel free to download a pdf. template and use it in the future.

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™ TM

Current 6 Week Goal Current Averadge

Junior / Civilian Amateur Pro-Am Professional Champion

PERFORMANCE SCORES Average Agility Power Strength Static Flex Dynamic Flex M. Endure Cardio Speed

Test 1

Test 2

OVERALL AVERAGE FITNESS: ______ DATE: ____________ FIGHT DATE: ____________ Test 3

Test 4

Test 5

Conditioning

BOOTCAMP PROGRAM

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abdominal area compared to women (who can often be relatively fat and still have abs showing), so well-defined abs are one sign of being in top condition-lean, hard, and strong.

In most sports, the abdominals play an extremely important role when it comes to the visible impression your physique makes on an observer. The abs are, in fact, the visual center of the body. If you superimpose an X on the body with the terminal points being the shoulders and the feet, the two lines cross at the abdominals, and this is where the eyes are inevitably drawn. Men carry a disproportionate number of fat cells in the 66

A small waist tends to make both your chest and your thighs appear larger, more impressive, and more aesthetic. The traditional V-shaped torso is as important as sheer mass when it comes to creating a quality, championship physique.

The rectus abdominis, a long muscle extending along the length of the ventral aspect of the abdomen. It originates in the area of the pubis and inserts into the cartilage of the fifth, sixth, and

seventh ribs. BASIC FUNCTION: To flex the spinal column and to draw the sternum toward the pelvis The external obliques (obliquus externus abdominis), muscles at each side of the torso attached to the lower eight ribs and inserting at the side of the pelvis BASIC FUNCTION: T:o flex and rotate the spinal column. The intercostals, two thin planes of muscular and tendon fibers occupying the spaces between the ribs. BASIC FUNCTION: To lift the ribs and draw them together

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Nigerian Kick-Boxing Champion & EFC worldwide Professional: Raymond Ahana

Image Courtesy: J&MDL Photography

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Since most of the top athletes today, regardless of discipline, are massively marketed for their achievements, the most important goal of abdominal training has become definition. This involves two things: Ÿ training and developing the abdominal's. Ÿ reducing body fat sufficiently to reveal the muscularity underneath. Spot reduction refers to training a specific muscle in order to bum off fat in that particular area. According to this idea, to develop abdominal definition, you do a lot of ab training, lots of high reps, and bum away the fat that is obscuring the development of the abdominal muscles. Unfortunately, this doesn't work. When the body is in caloric deficit and begins metabolizing fat for energy, it doesn't go to an area where the muscles are doing a lot of work in order to get additional energy resources. The body has a genetically programmed pattern by which it determines from what adipose cells to access stored fat energy. Exercise does bum calories, of course, but the abdominal's are such relatively small muscles that no matter how much ab training you do you won't metabolize nearly the energy you would by simply going for a walk for the same amount of time. But this is not to say that training a given area like the abs doesn't increase definition. As I said, the abdominal's get a hard workout when you do heavy exercises, but what they don't get is quality 68

training-that is, isolation, full-rangeof-movement exercise’s. Movements that do this bring out the full shape and separation of the abdominal's instead of just making them bigger So although training the abs like this doesn't do a lot to reduce the fat around the waistline, it does create very well defined muscles that are revealed once you are able to reduce your body fat sufficiently by means of diet and aerobic exercise.

When the abdominal muscles contract, a very simple thing happens: They pull the rib cage and the pelvis toward each other in a short, "crunching" motion. No matter what kind of abdominal exercise you do, if it is really a primary ab movement this is what happens. In the past, before the physiology of abdominal training was well understood, athletes used to do alot of "conventional" abdominal exercises such as SitUps and Leg Raises. Unfortunately, those are not primary abdominal exercises but instead work the iliopsoas musclesthe hip flexors. The hip flexors arise from the lower back, go across the top of the pelvis, and attach to the upper thigh. When you raise your leg, you use the hip flexors. When you hook your feet under a support and lift your torso up in a conventional Sit- Up, you are also using the iliopsoas muscles. Try this experiment: Stand up, hold on to something for support, and lift one leg up in front of you while putting one hand on your abdominal's. You'll feel a pull at the

top of the thigh but it will also be obvious that the abdominal’s are not involved in lifting the leg. The abdominal’s attach to the pelvis, not the leg, so they have nothing to do with raising the leg up in the air. The same thing is true of a Sit-Up or Slant-Board Sit-Up. This exercise is really the reverse of a Leg Raise. Instead of keeping the torso steady and lifting the leg, you are keeping the legs steady and lifting the torso and the same muscles are being used, the hip flexor’s. When you do any of these exercises, the primary role of the abdominal’s is as stabilizers. They keep the torso locked and steady. But this is directly opposite of what you want to achieve in your abspecific training because the role of the abs, as I have pointed out, is simply to draw the rib cage and pelvis together-to crunch them together in a very short movement which involves the back curling forward. The back doesn't bend much doing a Sit-Up, while it curls a lot doing a Crunch. That is the secret to full-range, quality isolation training of the abdominal's.

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Nigerian Kick-Boxing Champion & EFC worldwide Professional: Raymond Ahana

Image Courtesy: J&MDL Photography

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CRUNCHES PURPOSE OF EXERCISE: Emphasizes upper abs.

ROMAN CHAIRS PURPOSE OF EXERCISE: Emphasizes upper abs. EXECUTION(1:) Sit on the Roman Chair bench, hook your feet under the support, and fold your arms in front of you. (2) Keeping your stomach tucked in, lower yourself back to approximately a 70-degree angle, but not all the way back so your torso is parallel to the floor. Raise and curl your torso forward as far as possible, feeling the abdominals crunch together in a full contraction. I like to rest the front of the Roman Chair bench on a block of some sort to create an incline and increase the intensity of the exercise. You can introduce variable resistance into this exercise by starting out with the front of the bench raised and then, when you are getting tired, lower it to the floor and continue with your set.

EXECUTION:(1) Lie on your back on the floor. Hook your legs across a bench in front of you. You can put your hands behind your neck or keep them in front of you, whichever you prefer. (2) Curl your shoulders and trunk upward toward your knees, rounding your back. Don't try to lift your entire back up off the floor, just roll forward and crunch your rib cage toward your pelvis. At the top of the movement, deliberately give an extra squeeze of the abs tp achieve total contraction, then release and lower your shoulders back to the starting position. This is not a movement you do quickly. Do each rep deliberately and under control. You can vary the angle of stress on your abdominals by raising your foot position. Instead of putting your legs across a bench, try lying on the floor and placing the soles of your feet against a wall at whatever height feels most comfortable.

HANGING REVERSE CRUNCHES PURPOSE OF EXERCISE: Emphasizes lower abs. EXECUTION: This is another version of Reverse Crunches, only you do it hanging by your hands from a bar or resting on your forearms on a Hanging Leg Raise bench instead of lying on a bench. (1) Get into the hanging position and bring your knees up to the level of your abdomen. (2) From this starting position, raise your knees up as far as possible toward your head, rounding your back and rolling yourself upward into a ball. At the top of the movement, hold and crunch the ab muscles together for full contraction, then lower your knees to the starting position with the knees pulled up. Again, don't lower your legs beyond this starting point. A lot of people (because of the mass of their legs) can't really do Hanging Reverse Crunches. An easier variation is to lie head upward on a slant-board. This gives you more resistance than Reverse Crunches on a flat bench, but you can dial in the amount of resistance you want by the angle at which you set the slant-board.

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CABLE CRUNCHES

MACHINE CRUNCHES

PURPOSE OF EXERCISE: For upper and lower abs.

EXECUTION: This is an exercise you used to see much more in the "old days" than you do today, but it's an effective one. (1) Attach a rope to an overhead pulley. Kneel down and grasp the rope with both hands. (2) Holding the rope in front of your forehead, bend and curl downward, rounding your back, bringing your head to your knees and feeling the abdominals crunch together. Hold the peak contraction at the bottom, then release and come back up to the starting position. Make sure the effort involved is made with the abs. Don't pull down with the arms.

EXECUTION: A great many athletes feel that machines are unnecessary when it comes to ab training. But others swear by some of the ab training equipment currently available. Personal Trainers, for example, often have their clients use Crunch machines. In all cases, however, concentrate on feeling the rib cage and the pelvis squeeze together as the abdominals contract. If you can't achieve this feeling, the piece of equipment you are using may not be suited to your individual needs.

Nigerian Kick-Boxing Champion & EFC worldwide Professional: Raymond Ahana Image Courtesy: J&MDL Photography

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Images Courtesy: IRONMAN P/R

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here is ample evidence that being physically fit reduces the risk of heart disease, stroke, metabolic syndrome, osteoporosis, hypertension, diabetes, prostate cancer, breast cancer, colon cancer, depression, anxiety, and many other conditions. There is also evidence that physically fit people live longer than do sedentary people. It is also clear that the only way to become and remain physically fit is by being physically active. The question is, "How much physical activity is required to be considered fit, and is there such a thing as overdoing the physical fitness"? How Much is Enough? Ten years ago researchers at the Royal Free Hospital School of Medicine in London, England reported that middle-aged men who regularly engaged in light to moderate physical activity experienced a 40-50% lower mortality than did those who were largely inactive. Researchers at Harvard Medical School found that women who walked for at least one hour a week at a moderate pace had a 50% lower risk of developing coronary artery disease than did those who did not walk regularly. The pace of walking (exercise intensity) was found to be less important than the time spent in walking, and increasing pace or walking time (beyond 1.5 hours/week) did not provide added protection.[2] Clearly, regular exercise is important, but how much is required and what are the optimum ways of getting it? An expert panel endorsed by the American Heart Association and the American College of Sports Medicine recommends that all healthy adults aged 18 to 65 years engage in at least 30 minutes of moderate-intensity aerobic physical activity on 5 days each week, or vigorous-intensity aerobic activity for a minimum of 20 minutes on 3 days of the week. Combinations of moderate and vigorous exercise are also acceptable and the 30 minutes of moderate physical activity can be met, for example, by 3 individual bouts of 10 73

minutes each. The panel emphasizes that physical exercise over and above the recommend minimum can be expected to lead to reduced premature mortality and further health improvements, particularly in regard to cardiovascular health. The panel also recommends activities that maintain and increase muscular strength for a minimum of 2 days each week. Such activities would include stair climbing, weight training, and weight-bearing calisthenics. The intensity of physical exercise is usually expressed in terms of energy expenditure which, in turn, is expressed in metabolic equivalents (MET). One MET represents an individual's energy expenditure while sitting quietly for 1 minute (equivalent to about 1.2 kilo-calories /minute for a person weighing 160 lbs). Moderate activity is associated with a MET equivalent of 3-6 METs per minute, while vigorous exercise is associated with METs greater than 6. METs for some common activities are given below: • Walking at 3 mph (5.0 km/h) 3.3 MET • Walking at very brisk pace of 4 mph (6.4 km/h) 5.0 MET • Bicycling on flat surface at 10-12 mph (16-19 km/h) 6.0 MET • Bicycling fast at 14-16 mph (22-26 km/h) 10.0 MET • Golfing (walking and pulling clubs) 4.3 MET • Swimming (leisurely) 6.0 MET • Swimming (moderate to hard) 8.011.0 MET • Hiking at moderate pace with light or no pack 7.0 MET • Hiking at steep grades and heavy pack 7.5-9.0 MET • Jogging at 5 mph (8 km/h) 8.0 MET • Cross-country skiing (slow) 7.0 MET • Cross-country skiing (fast) 9.0 MET • Competitive soccer 10.0 M Thus, 30 minutes of walking at 3.0 mph would accumulate 99 METs (3.3x30) and jogging for 20 minutes at 5 mph would accumulate 160 METs (8x20). The panel suggests a

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minimum weekly MET accumulation of 450 to 750 METs be achieved through specific physical exercise. The panel makes the interesting observation that exercise is relatively ineffective in achieving weight loss, but that a very much increased level of activity is required to maintain a weight loss achieved by other means. They also acknowledge that the risk of musculoskeletal injury increases substantially with increased physical activity and can affect as many as 55% of people involved in jogging programs and US Army basic training. The risk of cardiac arrest and heart attack also increases during vigorous physical exercise, especially among infrequent exercisers. Nevertheless, the panel concludes that, in the case of healthy individuals, the benefits of regular moderate to vigorous physical activity far outweighs the risks. They also suggest that healthy men and women do not need to consult with a physician or other healthcare provider prior to embarking on a regular exercise program. However, those with cardiovascular disease, diabetes, or other chronic diseases should clearly do so. I an accompanying article Miriam Nelson of Tufts University and other members of a separate panel outline physical activity recommendations for

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those above the age of 65 years and adults aged 50-64 years with clinically significant chronic disease conditions or functional limitations. The recommendations are identical to those discussed above, except that the definition of moderate and vigorous exercise is tailored to the individual's basic fitness level rather than given as specific MET targets.[4] How Much is Too Much? So, regular exercise is clearly a good thing, but like all good things it can be overdone. British researchers followed 20 veteran athletes for 12 years and concluded that high intensity lifelong endurance exercise is associated with altered cardiac structure and function, especially the development of left ventricular hypertrophy (thickening of the muscles of the left ventricle) and profound bradycardia. Two of the athletes ended up having to have a pacemaker implanted. NOTE: Endurance exercise is usually defined as vigorous exercise for more than 45 minutes per session. Swedish sports medicine experts found that elderly men with a lifelong history of regular, very strenuous exercise were more likely to suffer from complex ventricular arrhythmias than were men who had been only moderately physically active.

A recent study involving 134 former Swiss professional cyclists concluded that these former athletes were more likely to suffer from sinus node disease and atrial fibrillation and flutter than were an age-matched group of golfers. The two groups were examined at age 66 years, which for the cyclists was an average of 38 years from their last professional race (Tour de Suisse). The Swiss researchers also observed that ventricular tachycardias were more common in the cyclists than in the golfers (15% vs 3%). They conclude that, "The elderly athlete may not be as healthy as believed." In 1998 Jouko Karjalainen and colleagues at the University of Helsinki reported that the prevalence of lone atrial fibrillation in a group of elite orienteers was 6 times higher than in a control group of less active men (5.3% vs 0.9%). The first afib episode among the orienteers occurred at a mean age of 52 years after an average training history of 36 years. Although the orienteers were more likely to develop lone atrial fibrillation, they were significantly less likely to develop heart disease (2.7% vs 7.5% in control group) and experienced lower mortality during

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the observation period (1.7% vs 8.5% in control group). The Finnish researchers conclude that vigorous, long-term endurance exercise is associated with atrial fibrillation in healthy, middle-aged men despite protecting against coronary heart disease and premature death. They speculate that the increased risk for afib is related to enhanced vagal tone, atrial enlargement, and left ventricular hypertrophy. Medical researchers at the University of Barcelona have found that men who engage in vigorous physical exercise of many years have an increased risk of developing lone (vagal) atrial fibrillation. A review of the records of 1160 patients seen at an outpatient arrhythmia clinic revealed that the incidence of lone AF among long-term exercisers was 60% as compared to only 15% in the general population of Catalonia. The same group of researchers also concluded that lone afib was about 3 times more prevalent among men who reported former and current sport practice than among men who did not. They observed a particularly strong correlation for men who reported more than 1500 hours of lifetime sports activities. More recent research by the Spanish group confirmed the strong association between LAF risk and accumulated moderate and heavy physical activity. Those with a lifetime accumulated moderate plus heavy physical activity of more than 9300 hours had 15 times the prevalence of LAF than did those with less than 2100 hours accumulated. More than 564 hours of accumulated heavy, vigorous physical activity was associated with a 7 times increased prevalence of LAF. The researchers speculate that the negative effects of moderate and particularly vigorous physical activity may be related to the chronic volume and pressure overload caused by the increased activity. They conclude, "The fact that physical activity is a

risk factor for AF does not argue against exercise as a way of preventing coronary artery disease. It only offers a word of caution suggesting that the benefits obtained by physical activity, if excessively intense and over a great many hours, may be counteracted by the risk of AF." The evidence that heavy, sustained physical exercise is associated with an increased risk of lone atrial fibrillation is indeed substantial. The only study disputing this connection is the one carried out by Antonio Pelliccia and colleagues at the National Institute of Sports Medicine in Rome. These researchers found no difference in the prevalence of atrial fibrillation in a group of competitive athletes as compared to the general population. However, the average age of this group of athletes (24 years) was substantially lower than the average age in the studies discussed earlier, so the results are not comparable, especially since it is well known that the incidence of afib increases with age, and that the average age at diagnosis is about 48 years for lone afibbers. Why would long-term, vigorous endurance exercise increase the risk of developing atrial fibrillation? Longterm endurance training profoundly affects the body's physiology. Among other things it significantly reduces the heart rate and testosterone levels. It is also known that, while exercise in the short-term increases adrenergic tone, its long-term effect is an increase in vagal tone. Vigorous, long-term endurance exercise has also been associated with an increased risk of inflammation. Greek researchers observed that participants in a 36-hour long distance run experienced a 152-fold increase in C-reactive protein (CRP) levels and an 8000-fold increase in the level of interleukin-6 (IL-6), another important marker of systemic inflammation. They conclude that the increases in the

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the inflammation markers noted, "amount to a potent systemic inflammatory response". Finally, there is ample evidence that long-term endurance training tends to increase the size of the left atrium and is also likely to lead to left ventricular hypertrophy. Taken together, all these effects of vigorous, long-term endurance training is likely to combine to form a potent breeding ground for the development of atrial fibrillation. It would seem logical that continuing vigorous endurance training after experiencing a first afib episode would be a poor choice. Several studies have found a convincing association between inflammation and afib. There is also evidence that vigorous endurance sports such as participating in marathons can result in a very pronounced systemic inflammation. Andrea Frustaci and colleagues at the Catholic University of Rome have found that inflammation of the heart lining (myocarditis) is an almost universal feature among lone afibbers. Further exercise will fan an inflammation and Swedish sports medicine experts are adamant that exercise should be avoided when myocarditis is suspected. Does Detraining Help Prevent AF? Does refraining from heavy exercise actually work for lone afibbers? Says the late Professor Philippe Coumel,

"It is known that in welltrained people suffering from vagal AF, the first step of therapy should be deconditioning by discontinuing high-level training. It may be sufficient to bring about an improvement in the patient and it is often a necessary adjuvant to facilitate pharmacological therapy." 76

In the same paper Dr. Coumel also makes the following statement of interest to vagal afibbers,

"Not only are betablockers ineffective, [for vagal afibbers] but they usually make patients worse and inhibit the efficacy of antiarrhythmics." British researchers support Dr. Coumel's observation about the beneficial effects of detraining. They report the case of a 53-year-old athlete whose symptoms of palpitations, ectopics, and atrial tachycardia completely resolved after detraining. Spanish researchers report that detraining for 2-4 weeks results in an increase in heart rate and adrenergic tone – both changes beneficial in regards to vagallyinduced afib. At least one member of our afib group has found that forgoing exercise one week out of every four significantly reduced his frequency of episodes. Of course, abruptly ceasing all exercise may carry with it a whole new set of problems, so a gradual approach is definitely in order. This might be worth experimenting with if you are a vagal afibber. There is some evidence that patients who have been ablated for right atrial flutter are more likely (81% increased risk) to develop atrial fibrillation postablation if they have a history of active engagement in endurance sports. Those continuing endurance sports after their ablation are also more likely (68% increased risk) to develop post-ablation AF. The Belgian researchers reporting these findings conclude that there is a 10% and 11% increased risk of developing AF per weekly hour of sport performed pre- and post-ablation for flutter. Several ablated afibbers who resumed their pre-ablation training

schedule too early have reported a relapse and required a second ablation to achieve a final cure. There is now evidence that repeat ablations may be the norm rather than the exception for competitive athletes with afib. Italian researchers found it took an average of 2.3 PVIs to prevent afib recurrences in athletes who had been disqualified from competition due to their afib. Somewhat paradoxically, actions that may promote afib in vagal afibbers may also help to terminate an episode already in progress. About 27% of male vagal afibbers reported (in LAF Survey 14) that they were able to terminate an afib episode by exercise. This finding is supported by a case history involving a 45-year-old physician with vagally-mediated, paroxysmal AF. The patient was able to convert to normal sinus rhythm by exercising for 20 minutes on a cross-country ski machine (pulse rate of 170 bpm).

Conclusion So, is exercise good or bad? There is no question that the overall benefits of a regular, moderate exercise program far outweigh any possible adverse effects. However, when it comes to long-term, vigorous endurance exercise, the benefit/risk ratio is less clear. Such exercise can lead to undesirable cardiac modifications and an increased risk of developing atrial fibrillation. In those who already experience vagally-mediated afib, refraining from such exercises, or substantially cutting back may prove highly beneficial.

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BOOTCAMP PROGRAM by Joe Vennare

ough Mudder Boot Camp is a high-intensity circuit series designed to torch every part of your body.

Each exercise is a timed station designed to challenge your heart, lungs, and muscles, as well as prepare you for specific Tough Mudder obstacles. Boot Camp will set you

on the path to becoming a sculpted, rugged, gritty Mudder. At the Tough Mudder level, you should strive to complete this Boot Camp three times per week and work out on three additional days with further cardio training (or repeat this Boot Camp if it’s your jam).

Photos courtesy of Touth Mudder PR

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OVERVIEW Here is the general structure of the Tough Mudder Boot Camp:

5 minute warm up

1 CIRCUIT = 10 MIN. 2 MIN CARDIO 1 MIN OBSTACLE

MUddERLING

MAYBE MUddER

3 CIRCUITS

TOUGH MUddER

4 CIRCUITS

5 CIRCUITS

2 MIN CARDIO 1 MIN OBSTACLE 2 MIN CARDIO 1 MIN OBSTACLE

5 minute COOL DOWN

1 MIN REST

GET READY Time: 60 minutes Recommended Equiptment: • Towel • Pull-up Bar • Dumbbell/Weight/Kettlebell • Box/Bench • Bosu/Medicine Ball

Advancing Levels: Once you’ve mastered this Boot Camp you are ready to tackle Tough Mudder! Take rest as needed for your ﬁtness level. We recommend one minute of rest per circuit, though you may need to build up to this level. Please consult your doctor or physician for any additional concerns.

If you do not have the equipment or resources to complete one of the obstacles above, look on toughmudder.com/tough-mudder-boot-camp-training for alternative exercises.

info@toughmudder.com toughtmudder

www.toughmudder.com @toughmudder

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WARM UP: 5 MIN One minute for each exercise: (1) running; (2) grapevine, alternate sides; (3) side shu翿?e, alternate sides; (4) high knees; (5) butt kicks.

CIRCUIT 1: 10 MIN Follow our recommended sequence or build your own.

TIME

WORKOUT

DESCRIPTION

2 min

You Don’t Know Jacks

As fun as they were in elementary school, jumping jacks are awesome for the cardio portions of your training. Only now, bring your arms to your shoulders (not your hips) to isolate your delts and then bring them all the way back up. Push yourself. Jump until your shoulders sizzle.

Shoulder Jumping Jacks

1 min

Everest Push Ups

2 min

Mud Skippers Jump Rope

1 min

Hold Your Wood Tough Squats

2 min

All-Around Strength Burpees

1 min

Everest Slippery Mountain Climbers

1 min

Hands flat on the ground, square your shoulders, and make sure your hips are in-line with your back. Your body should be razor straight as you lower your chest to the ground. Add even more intensity to the exercise by performing explosive push ups and clapping mid-air. See yourself going all-out on that wall until it comes a-tumblin’ down. HOORAH. If a jump rope workout is good enough for Rocky, it’s good enough for you. Start with the standard jump by pushing off the ground evenly, with both feet. Work up to the running jump rope and then double jumps. Stand with your feet hip distance apart with your toes, knees and hips in a straight line. Pull your belly button towards your spine and contract your abdominal muscles. Slowly lower your body, as though you are sitting in a chair, until your butt is in line with your knees. You should have your back straight, knees behind your toes and weight on your heels. Take the Maybe Mudder to the next level: squat with a heavier weight and press the weight over your head as you return to the standing position. Now, go faster. To master the burpee, begin in a squat position with hands on the floor in front of you. Kick your feet back to a push-up position. Immediately return your feet to the squat position. Leap up as high as you can from the squat position. Repeat, moving as fast as possible and maintain a fast pace. To kick it up a notch, begin adding a push-up as you hit the ground. Find a wooden floor or flat surface and place your feet on two washcloths or a folded hand towel. Assume a high plank position and pull BOTH legs in towards your chest at the same time and then push them back out to resume the plank position. Repeat and build up speed.

Rest

CIRCUIT 2: 10 MIN TIME 2 min

WORKOUT

DESCRIPTION

Stability

Try this hip stability exercise: stand with your feet shoulder-width apart and balance your weight on your right foot. Then pick up your left foot and loop it behind you toward the right leg, tracing a D-shape with your toes. Bring your left arm to your right foot. Now push with your right leg and transfer your weight to your left leg while bringing your right leg behind your left. Bring your right arm to left foot. Continue skating, gaining speed and distance between each skate.

Skates

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1 min

Start lying on your back, holding a kettlebell, dumbbell, or rock above one shoulder. Then simply stand up, using your free arm to help you, while keeping the weight above you at all times. Keep the arm fully extended as you lie back down and repeat. Switch sides halfway through. Add more weight and go faster.

Hangin’ Tough Turkish Get Ups

2 min

Ski jump exercises give you overall stability. Stand with your feet together straddling a crack in the sidewalk or folded towel on the ﬂoor. Bend your knees and jump to the right as far as you can. Land with soft knees and immediately jump laterally to the left. Repeat.

Glacier Ski Jumps Ski Jumps

1 min

Stand with your legs straight and your hands flat on the floor. Depending on your flexibility you’ll probably need to begin with your hands a couple of feet in front of you. Keeping your legs completely straight, walk your hands forward as far as possible. Concentrate on keeping your stomach tight, with your navel pulled in toward your pelvis. Then take small steps to walk your feet forward to your hands, ending in the starting position. Repeat. Faster.

Cage Crawl Crawl Outs

2 min

Ladder to Hell Climbers Standing Mountain Climbers

1 min

Hangin’ Tough Side Planks

1 min

From a standing position, reach your left hand as high as you can, while driving your right knee up and out. Then pull down your left hand and reach high with your right, while simultaneously dropping your right foot and driving your left knee up and out. Start in a low plank position: lie face-down and prop yourself up on your forearms. Slowly drop your right hip down to the ground with your core engaged. Switch to the left side and repeat until you feel the burn. Once you’ve mastered low plank dips, take it up to high plank. Keep both arms fully extended so that your body forms a T-shape. Start to lower your hips and pull them back up. Switch sides halfway.

Rest

CIRCUIT 3: 10 MIN TIME 2 min

1 min

WORKOUT

DESCRIPTION

Log Jammin’ High Knees

Get through Log Jammin’ with this high knees exercise. Stand in place with your feet hip-width apart. Drive your right knee to your chest and quickly back down, immediately repeating the action with your left knee. Hold your arms out at shoulder length and keep alternating knees as quickly as you can.

Funky Monkey

Take the overhand pull up and kick it up a notch. Pitch slightly to the right or left between each pull up to get comfortable with the movement. Now you’re swingin’.

Pull Ups

2 min

1 min

Quick Feet

Stand with your legs hip-width apart, and start running in place on your toes. Increase your speed so it feels like you’re digging into the ground. Every 20 seconds drop quickly to the ground and jump back up to resume Quick Feet.

Twinkle Toes

Stand atop a small medicine ball with both legs. Slowly lower your bum towards the ground to complete a full squat. Make sure your knees are behind your toes.

Rapid Fire

Balance Series

2 min

1 min

Tire Run

You can prepare for Tired Yet with or without tires. Start by standing on one leg, then shift your weight to the opposite leg. Continue alternating. Keep your butt down, knees high and the pace fast.

Kiss of Mud

Move from low to high plank and keep alternating between the two as quickly as you can.

Tired Yet?

Plank Series

1 min

Rest

info@toughmudder.com toughtmudder

www.toughmudder.com @toughmudder

+27-823-516-988

admin@nutrifit.co.za nutrifit

@nutrifit

www.nutrifit.co.za

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CIRCUIT 4: 10 MIN TIME 2 min

WORKOUT

DESCRIPTION

Running Man

We know running in a straight line is boring, but our course is 10-12 miles and you'll need to prepare with some running. The best way to break the monotony is to add in speed work and obstacles––climb that tree, scale the picnic bench, chase dogs. Whatever it takes.

Running, Plus Obstacles

1 min

Dong Dangler Tricep Dips

2 min

Swamp Stomps Hand-to-Toe Kicks

1 min

Mud Mile Lunges

2 min

Island Hopping Leap Frogs

1 min

Balls to the Wall

Get in between two chairs, bars, or if at a gym, a dip machine. Grab each bar or handle with each arm and lower yourself slowly and with control, then push back up. If this is easy, then try exploding off the bar and lifting yourself completely away from your support. Standing upright, contract your core and lift one leg off the ground directly in front of you while simultaneously bringing your opposite hand down to touch your toe. Your hand and toe should meet at a 90 degree angle from your body. Alternate sides. Stand with your feet and knees together, hands on your hips. Take a large step with your right foot to the right side and lunge toward the ﬂoor. Make sure your right knee does not extend past your toes and keep your left leg straight. Place a towel under your lunging foot. It’s the MUD mile, Mudders, you’ll be sliding. Push off through your right foot to return to the start. Alternate sides. Keep working with the towel side lunge and add weights if you don’t feel the burn. Focus on your leap frog form. Begin by lowering yourself into a low squatting position. Place your feet slightly wider than hip-width apart, bend your knees and lower your bum toward the ground. Continue lowering until your knees are as close to a 90-degree angle as possible. Stay in this position as you jump forward. As you leap, keep your head, neck, shoulders and arms relaxed. When the burn hits remember you’ll need to leap 3-5 feet or you’ll ﬁnd yourself submerged in muddy water. Find a rope (or tie one to a tree) and start climbing.

Towel Pull Ups

1 min

Rest

CIRCUIT 5: 10 MIN TIME 2 min

1 min

WORKOUT

DESCRIPTION

King Of the Mountain Mountain Climbers

Start in a high plank position and descend into a push-up. As you lower bring your right knee to your right elbow. Return to high plank and repeat on the left side. Alternate sides and work up to mountain climbing speed.

Island Hopping

Stand in front of a bench, chair, or box and using both legs jump onto the object. Make sure to maintain a neutral spine and explode from a squatting position.

Bench Jumps

2 min

1 min

Ski Jumps

Funky Monkey

Take the overhand pull up and kick it up a notch. Pitch slightly to the right or left between each pull up to get comfortable with the movement. Now you’re swingin’.

Glacier Ski Jumps

Pull Ups

2 min

Mud Skippers Jump Rope

1 min

Everest Slippery Mountain Climbers

1 min

Rest

If a jump rope workout is good enough for Rocky, it’s good enough for you. Start with the standard jump by pushing off the ground evenly, with both feet. Work up to the running jump rope and then double jumps. Find a wooden ﬂoor or ﬂat surface and place your feet on two washcloths or a folded hand towel. Assume a high plank position and pull BOTH legs in towards your chest at the same time and then push them back out to resume the plank position. Repeat and build up speed.

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By Ed Drakich

TRAINING FLOOR CONSTRUCTION

The following guidelines will assist you in the proper construction of a Mix'Fit™ FIT-PIT™ (indoor or outdoor training floor). Proper construction will ensure ideal training conditions, superior longevity and low maintenance requirements.

It is best to select a site that allows the training floor(s) to have a North/South orientation in order to reduce glare from the sun (The sun rises in the east and sets in the west). Another important consideration is the area around the periphery of the training floor, which should be free of large rooted and/or overhanging trees. There should be a clearance height of at least 7m above the training surface.

The Mix'Fit™ FIT-PIT™ is an ideal training surface for: Ÿ Mix’Fit™ Beach Functional Fitness Training Ÿ Mix’Fit™ Beach Martial Arts Training Ÿ Mix’Fit™ Beach Volley Ball Sessions Ÿ Mix’Fit™ Beach Aerobics Classes Ÿ Mix’Fit™ Beach Dancing Classes Ÿ Mix’Fit™ Beach Soccer Sessions Ÿ Mix’Fit™ Beach Touch Rugby Sessions Ÿ Mix’Fit™ Beach Yoga Classes Ÿ Mix’Fit™ Beach Meditation Classes

A. Drainage Drainage of the training floor under the sand must be considered and can be accomplished by both grading the earth properly and installing a surface below the sand to promote drainage. The training floor should be excavated an additional 30cm (Below the sand depth of 30cm to 40cm) to allow for the installation of drainage pipe on the standard slant (14 degrees). The drainage point should lead away from the training floor at the lowest point; be aware of the natural surrounding slope so that you do not The basic requirements necessary for building a trap water with your inclined viewing sides. Mix'Fit™ FIT-PIT™ training floor include: Depending on the soil quality of the subsurface you might need to place layer of gravel over the Ÿ While the actual training floor size is 8m X drainage pipes to enhance drainage. A good idea 16m (home use) and 9m X 18m (commercial is to place a semi-permeable cover, such as a use), an area at least 14m x 24m should be plastic landscaping mesh or some other artificial excavated to a sand depth of between 30cm small-hole mesh, over the gravel to prevent the and 40cm (more if a gravel layer and/or drainage pipes are needed under the sand to sand from washing through.* assist in drainage) *NOTE: If you have soil with good drainage and Ÿ Permeable sand/soil or sand/gravel liner (filter cloth) 160,000 kg (160 tons) to 200,000 no rocks you could get away without the drainage system but we would still recommend kg (200 tons) of sand are required per using the semi-permeable sand/soil liner. Mix'Fit™ FIT-PIT™ training floor

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B. Sand Sand selection is probably the most important factor in training floor construction and any sand that is used should incorporate these specifications: ŸWashed - The sand should be double washed, and free of silt and clay in order to prevent compaction ŸParticle Size - The size of the sand particles should be between .5 and 1 mm to allow for proper drainage and maximum safety. ŸParticle Shape - A sub angular shape will resist compaction and assist in drainage. ŸColour - Tan colored sand absorbs less heat with minimal glare. ŸSource - A granite based sand (noncalcareous - no calcium or limestone) sand remains stable under all weather conditions and is unaffected by acid rain. The sand boundary should be a minimum of 14m X 24m, thus allowing for a sand perimeter around the actual training floor. For commercial applications the outer training floor dimensions should be 18m X 26m. The general guideline is that the area should be clear of any obstructions for 3m to 4m on all sides of the training floor. You should be careful to pad any item that would seem to be a hazard. There should also be a beam or boundary around the perimeter of the training floor to act as a container for the sand, which should be soft and contoured in order to eliminate possible injuries.

OTHER SYSTEMS A. Poles Poles for permanent equipment fixtures can be either wood or pipe. The minimum suggested metal pole thickness is 4” to 5" (10cm to 12.5cm) in diameter, galvanized and thick walled steel pipe, while 6" (15cm) diameter pressure treated wood poles (Or 6” x 6” square pressure treated wood) are also acceptable. Poles should always be padded to prevent injury. Standards should be 4m long, with 3m above the training floor's sand surface and an additional 1m imbedded into the ground using a concrete footing. These should be placed 2.0m to 3.5m apart; any less and there will not be room for individual training space. Permanent equipment systems should be free-standing (not use any support wires/straps). Portable equipments systems are also very popular and can be purchased at most specialty shops and sporting good stores. B. Boundary Lines Boundary lines are made of 1/4" rope or 2” (5cm) ribbon and tied to the four corners with buried anchors. A bungee training floor should be attached to each corner and connected to a buried wood or plastic anchor disk (without sharp edges). The bungee will provide the tension necessary to keep the boundaries in place while giving the flexibility to reduce to chance of injury should a Mix'Fitter catch their foot under the line.

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ith South-Africa hosting 4 of the world's most difficult races, one can only come to the conclusion that South-Africans are “tough”. Therefor let's celebrate our toughness by looking at the world's Top 10 most difficult races as judged by the editorial team of Top Sports, as featured on DSTV Africa.

10 Cape Epic 09 Red Bull 400 08 Badwater Ultra Marathon 07 IronMan 70.3 06 IronMan Full

05 Comrades Marathon 04 Iditarod Trail Invitational 03 Tough Mudder 02 Tour de France 01 Marathon Des Sables

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ape Epic

The Absa Cape Epic is a UCI sanctioned event, riders earn points towards world rankings. Over and above this, there are additional regulations that make the Untamed African race an unforgettable experience that attracts riders from around the world. The two-minute rule This is the x-factor that makes the Absa Cape Epic different to any other race: it’s a team race. Team members have to stick together at all times. If riders are caught more than two minutes away from their partner at any stage of the race they will receive a time penalty and may face disqualification. No towing Towing is the practice of attaching two riders bikes together with an elastic cord so that the stronger rider can pull the weaker rider. This is far too dangerous to do on the Absa Cape Epic, but a good teammate sits up front so that his or her partner can slipstream.

The Prologue and Grand Finale are broadcast LIVE on SuperSport. Daily highlights are also broadcast each evening of the race so be sure to check Dish Magazine or the interactive DSTV Guide for viewing times and channels. Visit www.cape-epic.com from 15 March 2015

ed Bull 400

Even if you're not a professional athlete, completing a 400-meter race doesn't sound like that big of a challenge, right? But what if that relatively short distance had to be covered up the steepest ski jumping hill in Europe? That certainly complicates things a bit, doesn't it? The Red Bull 400 uphill race is the brainchild of former world-class sprinter

Andreas Berger. After seeing the ski jumping hill in Kulm, Austria, he got the idea to use the venue for the world's most extreme 400-meter track and field event. Berger and his wife were the first to run up to the very top, and decided it was difficult enough but still doable. The first ever edition of the Red Bull 400 took place in 2011, and every year since then hundreds of athletes, both male and female have signed up to push their muscles to the limit in “the hardest 400 meters in the world”. Kulm is one of the steepest slopes on Earth, with an average gradient of about 45% and an angle of ascent of 37 degrees in its toughest sections. The difference in altitude from the bottom to the top is 180 meters, but it's not just the vertical climb runners have to worry about. The grass-covered lower part of the track is very slippery, and spike or crampon footwear is not allowed, while the second stage takes place on smooth concrete, forcing participants to change their approach.

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The Badwater course covers three mountain pass ascents for a total of over 17,000’ (5,800m) of cumulative vertical ascent and 12,700’ (4450m) of cumulative descent. The finish line at Whitney Portal is the trail head to the Mt. Whitney summit, the highest point in the contiguous United States.

adwater Ultra Marathon

A true “challenge of the champions,” this legendary race pits up to 100 of the world’s toughest athletes from 24 countries and 24 American states—runners, triathlete’s, adventure racers, and mountaineers—against one another and the elements. Held at the hottest time of the year and traversing the most epic terrain imaginable, the Badwater 135 is the most demanding and extreme running race offered anywhere on the planet. The Badwater 135 covers 135 miles (217km) non-stop from Lone Pine, CA to the summit of Horseshoe Meadows (elev. 10,000 feet / 3048m), then crosses the Owens Valley to a 5,500 foot dirt road ascent to the authentic western ghost town of Cerro Gordo. Next follows a trek to the entrance to Darwin and then the final dramatic ascent to the end of the highest paved point on Mt. Whitney, CA at 8,360’ (2530m).

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ronMan 70.3

When IRONMAN 70.3 was launched in 2006, there were 17 events worldwide. That figure grew to 22 in 2007 and in 2008, athletes had a total of 29 races that served as qualifiers for the 2008 Foster Grant IRONMAN 70.3 World Championship, Presented by Ford. Due to overwhelming demand, the 2009 Event Series grew to include 34 events. The global IRONMAN 70.3 Series has expanded significantly over the past three years to now include more than 70 IRONMAN 70.3 events worldwide. In 2011, the IRONMAN 70.3 World

Championship moved to Lake Las Vegas in Henderson, Nev., located near the Las Vegas Strip. Starting in 2014, the IRONMAN 70.3 World Championship will rotate globally on an annual basis. The accomplishment of crossing an IRONMAN 70.3 finish line, coupled with the variety of unique and beautiful venues at which the events are held, makes for truly unforgettable experiences. Whether athletes race just one or several IRONMAN 70.3 events each year, they all embody spirit, passion and determination. The 2015 IRONMAN 70.3 World Championship will be help in Zell am See-Kaprun, SalzburgerLand, Austria and the 2016 IRONMAN 70.3 World Championship will move to Mooloolaba, Queensland, Australia.

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ronMan

While stationed near San Diego in the mid-1970s, John Collins and wife, Judy, participated in multi-sport workouts designed to break up the monotony of constant run training. During an awards banquet in 1977 for a Hawai`i running race, a lively discussion about the creation of a major endurance event in Hawai’i occurred. To challenge athletes who had already seen success at a local biathlon (swim/run), the first “Hawai`i an IRONMAN Triathlon” was born.

omrades Marathon

The Comrades Marathon is an ultramarathon of approximately 89 km (approx. 56 miles)[1] which is run annually in the KwaZulu-Natal Province of South Africa between the cities of Durban and Pietermaritzburg. It is the world's largest and oldest ultra-marathon race. The direction of the race alternates each year between the "up" run (87 km) starting from Durban and the "down" run (89 km) starting from Pietermaritzburg.

As the conversation continued, Collins began playing with the idea of combining the three toughest endurance races on the island into one race. He decided to issue a challenge. He proposed combining the 2.4-mile Waikiki Roughwater Swim with 112 miles of the AroundO’ahu Bike Race (originally a twoday event and 114 miles), followed by a 26.2-mile run on the same course as the Honolulu Marathon. The event was unveiled at the Waikiki Swim Club Awards Banquet in late 1977. ”The gun will go off about 7 a.m., the clock will keep running and whoever finishes first we’ll call the IRONMAN,” Collins recalls. By any measure, the IRONMAN presents the ultimate test of body, mind and spirit for professional and amateur athletes. It centers on the dedication, courage and perseverance exhibited by athletes who demonstrate the IRONMAN mantra that ”ANYTHING IS POSSIBLE®.”

average age of finishers have increased substantially. Runners over the age of 20 qualify when they are able to complete an officially recognised marathon (42.2 km) in under five hours. During the event an athlete must also reach five cut-off points in specified times to complete the race. The spirit of the Comrades Marathon is said to be embodied by attributes of camaraderie, selflessness, dedication, perseverance and ubuntu.

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ditarod Trail Invitational

The Iditarod Trail Invitational follows the historic Iditarod Trail. The famous sled dog route runs 1000 miles through frozen Alaska every winter since 1973 in memory of those brave individuals who brought the important serum to Nome in 1925 during a diphterie outbreak. Today it is a thin white line in the snow that only exists for about two months during the Iditarod Sled Dog Race and the Iditarod Trail Invitational races and crosses swamps, lakes, rivers and frozen tundra, mountain passes, across roadless wilderness in Alaska. The field is capped at 18,000 runners, and entrants hail from more than 60 countries. In every event since 1988, over 10,000 runners have reached the finish within the allowed 11 or 12 hours. With increased participation since the 1980s, the average finish times for both genders, and the

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03 T

ough Mudder

Tough Mudder is an endurance event series in which participants attempt 10–12-mile-long (16–19 km) militarystyle obstacle courses. It was designed and created by two British Harvard Business School post graduates and tests mental as well as physical strength. The obstacles often play on common human fears, such as fire, water, electricity and heights. The main principle of the Tough Mudder revolves around teamwork. The Tough Mudder organization values camaraderie throughout the course, designing obstacles that encourage group participation. Participants must commit to helping others complete the course, putting teammates before themselves, and overcoming fears. An average 78% of entrants successfully complete the course. The first Tough Mudder challenge was held in the United States in 2010.[4] To date, more than 1.3 million people worldwide have participated in Tough Mudder events.

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our de France

The Tour de France (French pronunciation: [tuʁ də fʁɑs̃ ]) is an annual multiple stage bicycle race primarily held in France, while also occasionally making passes through nearby countries. The race was first organized in 1903 to increase paper sales for the magazine L'Auto; it is currently run by the Amaury Sport Organisation. The race has been held annually since its first edition in 1903 except for when it was stopped for the two World Wars. As the Tour gained prominence and popularity the race was lengthened and its reach began to extend around the globe. Participation expanded from a primarily French field, as riders from all over the world began to participate in the race each year. The Tour is a UCI World Tour event, which means that the teams that compete in the race are mostly UCI ProTeams, with the exception of the teams that the organizers invite.

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arathon Des Sables

The Marathon des Sables (MdS, Marathon of the Sands, or Sahara Marathon) is a six-day, 251 km (156 mi) ultra-marathon, which is the equivalent of six regular marathons. The longest single stage (2009) is 91 km (57 mi) long. This multi-day race is held every year in southern Morocco, in the Sahara Desert. It is considered the toughest foot race on Earth. The first event of the Marathon started in 1986.

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Mix’Fit™

itness expects recognize cardiorespiratory endurance as the primary component of physical fitness because its improvement enhances energy output, promotes longer life, and positively influences the development of strength, muscle endurance, flexibility and body composition. Each year, we are becoming more sedentary. Currently, three out of four Americans do not get enough physical activity to maintain a healthy lifestyle. Is it a coincidence that diabetes rates are skyrocketing or that obesity is at an all-time high? America is gaining 200 million pounds per year. Yankee Stadium used to seat 67,000 people – until 1976 when it was renovated with seats that we 4” wider to accommodate the growth of the rear 100

ends of the fans! Now Yankee Stadium seats only 57,000! There are many ways to measure one’s level of physical activity. One of the simplest, most meaningful measures can be obtained by looking at how much time it takes you to walk one mile.

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he main purpose of this lab is to determine your level of cardiorespiratory endurance. This will be done through walking a mile very briskly and recording your time and 10-sec heart rate. Maximal Oxygen Consumption reflects the fitness level of the cardiovascular and respiratory systems. A good score reflects an energy level that can add greatly to a person’s quality of life. Measured in milliliters of oxygen per kilogram of body weight per minute, an oxygen consumption level of about 43ml/kg/min for young men and about 36ml/kg/min for young women would place a person in the upper 50th percentile and is a worthy goal. Maximal Oxygen Consumption (Vo2max) is the body’s ability to transport and use oxygen while removing carbon dioxide. Walk a Mile Procedure 1. Walk the measured 1.0-mile course AS FAST AS POSSIBLE. Walk with an energy efficient arm-swing. Pace well with good, relaxing breathing. 2. Record you total walking time: ________minutes and ________seconds. 3. Immediately take your pulse for 10 seconds at the carotid or radial artery and record: _____ 4. Multiply your pulse by 6 to obtain your exercise HR (bpm). _______ X 6 = ______bpm 5. Convert your time from min:sec to min:fractions of a min by dividing the seconds by 60. (ie: if walking time is 13:20, then 20 sec/60 sec = .33 min, yielding a total of 13.33 min) Total Walking Time in Minutes: ____________ Using the information above, use the following formula to estimate your

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VO2 max in ml/kg/min. VO2 max = 88.768 – (0.0957 x Wt) + (8.892 x G) – (1.4537 x Tt) – (0.1194 x HR) Where Wt = body weight (lbs), G = gender (0 = female, 1 = male), Tt = total time to walk one mile (min:fraction of min), and HR = 60 second heart rate at the end of the test.

xplanation of Lactate Threshold and Vo2max

Lactate Threshold (or anaerobic threshold) When increasing running pace or workload there is a point at which lactic acid begins to accumulate. This is a crucial workload, as lactic acid can inhibit muscle contraction and energy production and cause pain and a burning sensation. The point (heart rate or running pace) at which lactic acid begins to accumulate is called the Lactate Threshold. This measurement is also sometimes called the anaerobic threshold or onset of blood lactic acid. The lactate threshold measurement is very valuable as it is one of the more sensitive indicators of fitness level. For example, if training is ineffective the lactate threshold will be reached at a relatively low running speed; with more effective training the threshold will be achieved at a higher speed. Elite athletes reach the lactate threshold at a much higher running speed than sub-elites. The threshold is, once again, a function of effective training and also genetics. Many scientific studies indicate that the lactate threshold is one of the best predictors of distance running performance.

Mixâ&#x20AC;&#x2122;Fitâ&#x201E;˘ The lactate threshold is also very valuable relative to training and competition. Training at the threshold has been found to improve performance and the capacity of the aerobic system. Interval training and "overdistance" training should thus consider the running speed at which the lactate threshold is attained. The lactate threshold is one of the more important measurements that will be obtained during testing of an endurance athlete. The lactate threshold for most males is between 165 and 180 beats per minute, with females being slightly higher, at about 175 to 185 beats per minute. Of all the measurements obtained during testing, the speed and heart rate at which the lactate threshold is obtained are probably the most important to remember when planning training. The lactate threshold can also be 'roughly' estimated by graphing VO2 (l/min) on the x-axis against Ve (l/min) on the y-axis and 'looking' for the ventilation breaking point. Which would generally be 2/3 of the way up the graph. The most accurate way would be to take blood lactates throughout the VO2max test, but if this is not available this graphing technique can work quite well. For comparison purpose, in competitive regional and national level distance runners, the lactate threshold is reached at speeds of 6:00 to 5:00 pace per mile. A higher speed at the threshold is desirable. The threshold represents a point where the accumulation of metabolites detrimental to performance may begin; thus, a faster threshold speed indicates that the athlete may perform at this speed for a fairly long period of time (possibly up to a marathon) without experiencing undue fatigue. However, when speed or workload exceeds the threshold, the accumulation of lactic acid and depletion of muscle fuels can lead to more rapid fatigue and a slowing of

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pace. The lactate threshold is perhaps the best and most sensitive indicator of distance running performance. An individual who reaches the threshold at a speed of 10 mph (16.1 km/hr) would most likely defeat an individual who reaches the threshold at any lower running speed. It is thus desirable to increase the speed at which the threshold is obtained; this can be accomplished by methods outlined below. 1) Training at speeds/heart rates near or at the threshold. The above information has provided you with the approximate speed and heart rate at which the lactate threshold is achieved. Of the two, training at this given heart rate is probably the most effective method for monitoring training intensity relative to the threshold. This knowledge may greatly improve training effectiveness as training near or at the threshold provides a very effective stimulus for improving factors associated with endurance performance. For example, it was found that when highly-trained distance runners added a weekly 20 min run at the lactate threshold the speed at which the threshold was reached increased after 14 weeks of such training (Sjodin et al., Eur. J. Appl. Physiol. 49:45, 1982). This research also demonstrated that the addition of this single weekly run significantly improved many of the enzymes, which produce energy in muscle. Thus, steady-state training (i.e., longer distance, continuous runs) at the lactate threshold will improve the metabolic capacity of skeletal muscle even in well-trained athletes. It was also found that the addition of the 20 min run improved running economy. Thus, relatively long-duration runs (15-30 min) at the speed or heart rate of the lactate threshold should be considered when designing an effective endurance-training program. The "theory" behind these

adaptations is that at a speed greater than the lactate threshold, lactate acid begins to accumulate in the muscle. The accumulation of lactate then results in a slower running speed and/or shortens the length of the workout where a high speed is attained. By keeping training intensity at the lactate threshold, the muscle and cardiovascular system can be optimally stressed for a relatively long period of time. In other words, the lactate threshold appears to be the "red line" of training intensity; going above this workload results in fatigue, while going below it does not adequately stress the systems involved. It is this "stress" on the cardiovascular and muscular systems, which provides the stimulus for positive adaptations to occur. Such adaptations then lead to enhanced endurance performance. 2) Interval work. Relatively high-intensity, short rest period interval work has also been found to improve the lactate threshold. Cycles of 2-3 minutes of work with 1-2 minutes of rest have been found to reduce lactate accumulation during exercise. As with VO2max, the principal is that skeletal muscle and the heart adapt when the level of exercise is close or above VO2max. Unfortunately, this is quite intense exercise, which cannot be maintained for a long period of time (5-15 minutes) due to the accumulation of lactic acid. The lactic acid diffuses out of the skeletal muscle by allowing a "recovery" period of walking or slow running between intense work bouts. Intervals thus allow a high workload to be maintained over a longer time period which results in maximal adaptations. With shorter, intense intervals, the stress is even greater.

/////////////////////////////////////////////////////////////////////////////////////// Mixâ&#x20AC;&#x2122;Fitâ&#x201E;˘ The endurance athlete and coach should thus not shy away from the performance of relatively "sprint" type work with an active recovery between each bout. Such work has been found to increase the lactate threshold, which is a very sensitive and accurate indicator of performance potential in endurance events. Knowledge about the lactate threshold can also help in designing workloads/heart rates for various types of training. General recommendations are listed below (from Coen et al., Int. J. Sports Med., 12:519-524, 1991). Implementation of these guidelines may help prevent overtraining and staleness and also provide a maximal stimulus to the muscle and cardiorespiratory systems for development. Please keep in mind that these recommendations are based upon treadmill data under room conditions; different environmental conditions (i.e., heat) and terrain (hills) can alter the relationship. 1) Over-distance runs and "easy" or recovery days should be performed at 80 to 90% of the lactate threshold. 2) Intensive, continuous distance runs (15-30 min duration) can be performed at approximately 100% of the lactate threshold, as discussed above. No more than one of these workouts should be performed per week. 3) Longer interval work (i.e., 8001000 m repeats) should be performed at approximately 110120% of the lactate threshold. 4) For shorter, intense interval work the lactate threshold is usually not considered. Keep in mind that such work, although commonly considered "anaerobic" can maximally stimulate the aerobic systems if adequate sets are performed with rest between the sets.

This discussion has emphasized the importance of the lactate threshold to the endurance athlete. A key question for the coach/athlete is how to monitor if the threshold is changing over the course of a month or years over training. Unfortunately, measuring the lactate threshold can only be effectively performed in a laboratory setting. However, the design of my research is to find out possible means of estimating the lactate threshold without having to use the laboratory setting. In the next few months I will have a better idea of which of these estimation formulas most accurately estimated the lactate threshold. I will be glad to share that information with you at that time.

o2max (maximal aerobic power)

Maximal oxygen consumption, also known as VO2max, has long been considered the "gold-standard" for determining cardiorespiratory fitness level. Your VO2max value is dependent upon several factors: 1) the ability of your muscle to use oxygen to produce energy 2) the ability of your lungs, heart, and circulatory system to transport oxygen to the muscle 3) your body composition, which is the amount of fat and muscle you have. The measurement of VO2max is important, as in many athletic events a large amount of the energy needed to perform the exercise is produced through the use of oxygen. For example, it is estimated that approximately 25% of total energy comes from oxygen in short events which last 40 to 60 seconds. In events lasting 100 to 120 seconds about 50% of energy comes from oxygen and in events lasting 3-4

minutes about 65% of the energy comes from oxygen. Longer events such as distance running require greater than 90-95% of their energy from aerobic sources. A high VO2max is indicative of an enhanced ability of the aerobic systems to provide this energy to the working muscle. Thus a measurement of the capacity of the aerobic system to produce energy is vital to assessing athletic performance. Successful athletes which participate in sports lasting more than 1 minute generally possess a higher VO2max then sedentary individuals or those in more short-duration, high-intensity oriented sports such as weightlifting or sprinting. Vo2max value is measured 'relatively' in the units of ml/kg/min or 'absolutely' in l/min. The VO2max value in ml/kg/min is adjusted for your body weight while the value in l/min is your absolute maximal oxygen consumption. In many sports, such as running, the commonly used value is ml/kg/min, since the mass of the body must be moved against gravity. Absolute VO2max is more appropriate for non-weight supported events such as swimming and cycling. Maximal oxygen consumption is determined by training and genetic endowment; the contribution of each is not known. VO2max can indicate the potential of an athlete for participation in enduranceoriented events. VO2max can also help determine if a specific training program is efficient in developing the aerobic system. How does your VO2max compare to values in other athletes? Keep in mind that any one variable that is being measured as part of your evaluation does not predict athletic performance. However, there are ranges of VO2max for many different sporting endeavours.

Mix’Fit™

VO2max values of some athletes (ml/kg/min): Ÿ Steve Prefontaine, middle

Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ

distance runner, American record holder 84.4 Lance Armstrong, Tour de France Cycling Champion 83.8 Alberto Salazar, world record holder, marathon 78.0 Bill Rodger, world class marathoner 78.0 Grete Waitz, world class female distance runner 73.5 Frank Shorter, Gold Medalist, Munich Olympic Marathon 71.3 World Class male long-distance runners 78.7 World Class female long- and middle-distance runners 65.6 World Class male marathon runners 74.1 Elite middle-distance and male distance runners 76.9 Good national class male distance runners 69.2

It is evident from the above information that a high VO2max (greater than 68-70 ml/kg/min in men and 60-65 ml/kg/min in women) must be attained for international success in many athletic events involving endurance, such as distance running. However, there is very little "separation" between VO2max

values in terms of performance; for example an athlete with a VO2max of 70 will not always run faster than an athlete with a VO2max of 68. Thus, for your athletic event, you should optimally be in the ranges listed in the presented tables and figures. Generally, a nationally competitive male distance or middle-distance runner will have a VO2max of approximately 70 ml/kg/min or greater; a nationally competitive female distance runner will have a VO2max greater than 65 ml/kg/min. To increase VO2max many factors must be considered by the coach and athlete.

here are four considerations when attempting to improve maximal oxygen uptake.

1) Training. One way to improve maximal oxygen consumption is by stressing the aerobic system. Thus, workouts must overload the heart and skeletal muscle. This can be accomplished by performing repeated intense work bouts (intervals or repeats) lasting > 2 min in duration. Maximal stress is induced by the performance of interval work (i.e., exercise lasting 2-4 minutes or longer) with minimal rest (i.e., 30 sec to 1 minute) between sets.

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/////////////////////////////////////////////////////////////////////////////////////// Mixâ&#x20AC;&#x2122;Fitâ&#x201E;˘ The combination of high intensity and a high amount of total work then stimulates the cardiorespiratory and muscle systems to adapt which increases VO2max. The "magic" combination of work and rest which will induce optimal improvement is, however, specific to the athlete and must be discerned by the athlete and coach. It is generally accepted that the incorporation of interval work into a training program or a modification of existing interval work is the most effective way to improve aerobic capacity. However, any type of training which stresses the aerobic systems can improve VO2max, although to a lesser degree. For example, the incorporation of endurance work may increase VO2max if an athlete has a low endurance base. However, interval work must ultimately be performed to attain the highest values for a given individual. 2) Genetics. Each athlete has a "ceiling" for VO2max due to his/her genetic makeup. If training is already optimal, i.e., there are sufficient, regular, and well-planned interval workouts, it is virtually impossible to increase VO2max any further. This should be kept in mind, as obviously not all individuals can become world-class athletes due to genetic limitations. Thus an alteration in training may not increase aerobic capacity, particularly if the training program is already optimal. On the other hand, individuals with a high VO2max and low training volume may be genetically predisposed toward endurance events. 3) Body composition. A high VO2max is associated with a minimal amount of body fat. Adipose

tissue (body fat) is essentially dead weight during exercise and leads to a lower oxygen consumption relative to body mass. Since body fat (adipose tissue) does not utilize oxygen, increased body fat reduces the oxidative energy available to move each kg of body weight during exercise. Examine the normative values for body fat outlined in this report; if body fat content is too high then a loss of fat may benefit the athlete. However, most competitive athletes already possess a minimal amount of body fat; thus weight loss is not recommended as a means of increasing aerobic potential for many competitive athletes. To the contrary, an extremely low amount of body fat may actually impede performance. Again, communication between the coach and athlete should be performed prior to implementing any possible weight gain/weight loss program. 4) Event Specificity. (your VO2max is sufficient for your athletic event) If your VO2max is within the ranges published for your athletic event, then you may have maximally trained the aerobic system. This would most likely be the case if you have been training intensely for a prolonged period of time and have been incorporating the proper amount of interval and endurance work. It is possible that VO2max may change slightly with subtle alterations in training; however, this may only be determined by repeated laboratory tests over time. In summary, VO2max is a good indicator of fitness level and may change with training. However, if training is already optimal then genetic factors may limit the VO2max obtained. This test must thus be interpreted in relation to your training and performance potential.

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Quick & Simple Paleo Meals

Pork Chop with Applesauce and Roasted Tomatoes

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Quick & Simple Paleo Meals

Chili Shrimp Cocktail with Arugula Artichoke Salad

Paleo Recipe Book

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4 salmon filets

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salt and pepper to taste

8 slices of prosciutto ¼ cup Dijon mustard

PREPARATION

1 2 3

Preheat oven to 375 F.

Place filets on baking sheet and cook for approximately 15 minutes.

INGREDIENTS

•

8 cups fresh bok choy, chopped

• •

1 tbsp olive oil

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2 tbsp soy sauce (optional)

•

salt and pepper to taste

2 cloves garlic, minced

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Sprinkle the salmon with salt and pepper. Spread mustard on top of each filet and then tightly wrap the salmon in prosciutto. You may find you need more or less prosciutto depending on the size of the filets.

PREPARATION

Heat oil in a large skillet over medium heat. Add garlic and allow it to cook for approximately 1 minute.

Add bok choy to the skillet and pour in soy sauce. Cook for 3 to 5 minutes, until the greens have wilted.

Toss in salt and pepper prior to serving.

Quick & Simple Paleo Meals

Salmon Prosciuto Wrap with Garlic Bok Choy

INGREDIENTS

s a full system of medicine, homeopathy is much more recent in its development. It owes it modern origins to Samuel Hahnemann, a German physician, who formulated homeopathic theories in the late eighteen century, although the principles were almost certainly known for hundreds of years before. Essentially, symptoms are seen not as negative effects of illness but as the attempts of the person to resist disease. Hahnemann tested a treatment for malaria on him-self by taking many doses of quinine; after some time he induced malaria-like symptoms, and came to the conclusion that quinine worked precisely because it created these reactions in a healthy person; it mimicked and supported our own healing responses. This led to the principle of “like curing like”, and hundreds of homeopathic remedies have since been tested by giving them to healthy people and recording the responses. These “remedy pictures” are then applied to see which one fits the symptoms of an ill person. The other major point of difference between

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homeopathic and conventional medicine is that when a remedy has been identified as being appropriate to encourage the individuals self-healing mechanism, it is then prescribed in minute amounts.

The personality of the patient is a significant factor in choosing a remedy. Paradoxically, the more dilute the remedy, the more effectively it works. A homeopathic practitioner may well use Hahnemann had found that by diluting his a much diluted remedy, to address an remedies in a special way he was able to imbalance in our basic constitution, if get a quicker effect, and he understood there is a very clear picture that matches these dilutions to work on a more subtle the individual. level than simply obtaining a physical reaction. For self-help treatment chose either the 6c or 30c potencies. For mild problems try One of the common scales for measuring taking the 6c dilution (normally remedies the dilutions is the centesimal scale – that are available as tables or pills, with the is, diluting the remedy in the ratio of container they come in) 3 times a day for 1:100. For a liquid this means one part of up to 5 days. In more acute conditions, the remedy is mixed with 99 parts of a take a 3oc dilution in the same way. dilution, usually either alcohol or water. In the short-term, really acute conditions This is called a 1c dilution; this is then you can take up to 6 doses of either shaken in a special way, or succussed, and potency at 3-hourly intervals. Continuing one part of this is added to 99 parts of the to take the remedies for longer, however, diluents to make a 2c dilution, and so on. may result in aggravation of symptoms, as As you can see, levels of extreme dilution you “prove” the remedy in the same way are quickly reached, and so the remedy that Hahnemann did. cannot be said to be acting physically in a conventional way, and indeed an If any doubt, in any case there is no important part of the “remedy picture” is response within this time, always see a the emotional reactions that are produced. professional homeopath or physician.

Doreen , A retired SAP Officer, has dedicated her life to protecting abandoned, raped and abused children. She has dedicated her funds and time to protect children who may not have anywhere else to go. Her and her husband have dedicated their lives to raise these children through religion and dignity.

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anything from non-perishable food, toiletries,toys, educational goods and gas dontaions.

There are children of all ages welcomed into this home.

Image Courtesy: COSMOPOLITAN MAGAZINE

he first time 28-yearold events manager Andrea* took magic mushrooms was at a New Year’s party. ‘It was great. I felt as uninhibited as a child and I had mild hallucinations,’ she says. But the second time she took ‘shrooms’ she felt frightened for most of the duration of their effect. ‘I had somehow wandered away from my friends and couldn’t find them again. Suddenly I was overwhelmed with fear and a profound sense of aloneness. It was horrible and took ages to wear off,’ she says.

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Stories such as Andrea’s are common among young women who’ve dabbled with ‘herbal highs’ to heighten their party or clubbing experiences. But even stories of unpleasant effects haven’t generally led people to regard such drugs as ‘serious’, and certainly not as potentially lethal. That changed when two teenagers in the UK, Nicholas Smith, 19, and Louis Wainwright, 18, recently died after taking mephedrone, known as MCAT or meow-meow – then a legal drug there – after drinking all night. Mephedrone is a synthetic form of cathinone, the active ingredient found in khat ( catha edulis), a plant indigenous to East Africa that is traditionally chewed or brewed into

tea. Because it’s in a concentrated form – either in pills, capsules or white powder – the effects of mephedr one are stronger than those of khat. Such was the brouhaha that ensued after the deaths of Smith and Wainwright that mephedrone was banned in the UK in April. (But already manufacturers have concocted a new formula to skirt the law. Called ‘subcoca dragon’, it produces a similar high to that of mephedr one.) After the deaths, several people came forward to describe the frightening experiences they’d had with mephedrone – a drug they’d assumed was benign because it was legal. Amy Crown, 23, a waitress from London, told Grazia magazine she’d taken the drug in powder form while out drinking with her friends. ‘Within 10 minutes my heart started beating faster but instead of feeling a buzz, I felt on edge. I thought a drink might calm my nerves and dull the paranoia, but after a vodka I felt sick and disorientated.’ Crown said she then collapsed, ‘shivering violently’, before lapsing into unconsciousness and waking up in hospital a few hours later. ‘Mephedrone is a stimulant, so like cocaine it gives you a high – you feel excited, talkative and alert – but it can also bring on nausea, nosebleeds and hallucinations,’ says Carol du Toit, director of the South African National Council on Alcoholism and Drug Dependence in Durban.

LEGAL ISN ’T ALWAYS LEKKER Although khat – along with marijuana, magic mushrooms and laboratorysynthesised narcotics – is illegal in South Africa, mephedrone is not listed as an illegal drug. Some of it has made its way here, says Du Toit, having been ordered by South Africans via UK websites that offer to send the drug for about R114 a gram, plus postage. Other plants that yield mindaltering chemicals – such as salvia divinorum (diviner’s sage), trichocereus

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pachanoi (San Pedro cactus), lophophora williamsii (peyote cactus) and sceletium tortuosum (‘Bushman’s ecstasy’) – are also not prohibited in terms of South Africa’s Drugs and Drug Trafficking Act, so buying and possessing these are not illegal. Adding to the sense that these are not ‘serious drugs’ is the fact that many of them can be bought online using a credit card – which means you don’t even need to know who your drug merchant is. An unbranded package arrives by post – simple. But the reality is that some of these drugs can be just as dangerous as their illegal counterparts, and addictive too.

PARTY PACKS One risk particular to herbal highs is that, because they are assumed not to be harmful, people tend to take more than their bodies can cope with. At a recent rave in Worcester in the Western Cape, says Cape Town writer and veteran raver Mario d’Offizi, ‘a surprising number of people lined the medic tents, having a bad trip – probably from having taken too much’. Du Toit says one of the more common legal highs locally is from sceletium tortuosum , also known as ‘Bushman’s ecstasy’, ‘African ecstasy’, ‘herbal ecstasy’, kanna and kougoed . It’s a herb indigenous to South Africa and has long been used as a moodenhancer by the San. ‘It can be smoked in powder form or taken in tablets,’ says D’Offizi. It is available online and from various health shops around the country. For 30 capsules of 100mg each, you’ll pay about R80. The problem with using it as a party drug is that it needs to be taken in large quantities to create a ‘high’ – and that can, as one UK blogger records, make you ‘anxious and jittery, unable to concentrate’. An overdose, according to the website www.drugsafetysite.com , can result in ‘delirium and loss of consciousness’.

THE FULL M IN TY Salvia divinorum is a drug derived from the mint plant and was originally used by Mexican shamans to achieve altered states of consciousness. It is chewed or smoked – popularly with marijuana, says D’Offizi – and is said to be hallucinogenic for up to five minutes, but not always pleasantly so. A blogger on www.drugs-forum.com who took too much describes his experience with salvia as ‘a trip through hell’. Andrea says she’s always been ‘too scared’ to try it. ‘I’ve heard it messes with your brain, like the flowers of the malpit plant, which a friend of mine took once – she ended up screaming at a dressing gown for hours and had to be hospitalised.’ Again, salvia is easily accessible in South Africa online – with five grams of leaves selling for only R50 or so.

SHROOM AH! Magic mushrooms or ‘shrooms’ are also grown here, either cultivated or wild. They are typically dried and sold in a ‘bankie’ (small plastic bag). They are taken raw or powdered, and are sometimes mixed into tea. Psilocybin mushrooms contain psychoactive alkaloids, the effects of which can be powerful and are sometimes likened to those of LSD. On a ‘bad’ mushroom trip, you can experience paranoia, hallucinations, anxiety, nausea and diarrhoea that can last for three to six hours. ‘I fell into a terrifying trance. I saw geometric shapes and patterns moving towards me and 4

felt totally out of control,’ says Carol*, 30, a copywriter from Johannesburg.

UPS AN D DOWN S Dozens of other concoctions, not all herbal-based, are sold as ‘legal highs’ in tubs of pills, among them so-called ‘funk pills’, which contain benzylpiperazine (BZP), a stimulant that has proved to be extremely euphoric for some, but very unpleasant for others, in some cases for as long as 12 hours. It’s been banned in some countries but can still be ordered online. Common on the South African rave scene for some time was a pill called Midnite Flight, which contained the stimulant ephedrine along with a number of complex vitamins, and was ‘extremely powerful’, says Steve Blues, co-founder of the local clubbing website www.mrspencer.com . Similar pills, with names such as Red Heart, Ice Diamonds, Charge and Push, have come and gone, and Blues says he has seen some of their adverse effects at work. ‘People end up as twitching, dysfunctional lumps,’ he says. But Merle Jacobs, founder of PlaySafe (formerly known as RaveSafe) and also a veteran of the rave scene, says bad reactions from these pills are usually due to people popping more than they should. ‘You will always get people who abuse these things, who’ll just put three in their mouth and swallow, but in my experience they are by far the minority,’ she says.

TRIP A DVISER Du Toit cautions that just because something is ‘natural’ doesn’t mean

Herbal lows MARIJUANA New research shows this weed can double the likelihood of psychotic episodes.

it’s good for you. ‘Natural in source it may be, but so is poison ivy and strychnine. Look at what marijuana does, and it’s also a natural substance,’ she says. Scientists from the Queensland Brain Institute in Australia recently found that young people who smoke dagga for six years or more are twice as likely to have psychotic episodes, hallucinations or delusions as people who have never used the drug, she says. Like marijuana, other herbal drugs can be psychologically addictive, says Du Toit. She also points out that, because herbal concoctions don’t have to be registered with the Medicines Control Board, you can never be sure of their effects. Peddlers of these drugs are doing it to make money, she adds, so the drugs are often surreptitiously cut with other substances, just as synthetic drugs are. ‘The point is, you never know exactly what you’re taking when it comes to unregulated drugs, and if you’re drinking or taking other drugs, which is commonly the case, you don’t know how these substances will interact with each other. Everybody processes these things differently,’ she says. Also, some people have an unknown predisposition to psychosis or a heart condition that it takes just one druginduced trip to trigger, she warns. ‘Mephedrone and most of the other herbal highs are stimulants, which increase your heart rate. If you have a weak heart to begin with, it’s very dangerous indeed. This may well have been the scenario in the UK mephedrone tragedies,’ she says.

RUSSIAN ROULETTE Although South African rehab centres – which counsel about 10 000 patients at any one time – have not reported cases of patients seeking help for addiction to mephedrone or other herbal drugs, they are well aware of the threat these substances present, says Andreas Plüddemann of the Medical Research Council’s Alcohol & Drug Abuse Research Unit. Pam Goodman of Tharagay House addictions-treatment facility in Cape Town says, ‘Just because we’re not seeing such cases at centres doesn’t mean these drugs aren’t out there, being used in a game of Russian roulette with willing participants who don’t appreciate the risks they’re taking.’ ¨ * NAME HAS BEEN CHANGED

BAD-TRIP TIP S If a friend is having a ‘bad trip’ on drugs, what can you do to help her? ■ If she is feeling ill or anxious after taking a drug, legal or illegal, act immediately. Take her somewher e quiet and try to keep her calm. ■ Try to keep her cool; stay with her. ■ If she collapses, turn her on her side. Check that there is nothing in her mouth and that her airway is clear. ■ If you suspect an overdose, call an ambulance immediately. Tell the paramedics exactly what she took. ■ If she stops breathing or you think her heart has stopped, perform CPR (cardiopulmonary resuscitation) if you know how. ■ Do not let her drive, especially if the drug she has taken causes sensory changes (as magic mushrooms do).

SPIRITUAL OR DANGEROUS? WE SAY YOUR BEST BET IS GETTING HIGH … ON LIFE!

MEPHEDRONE This synthetic form of an ingredient in the East African plant khat has been banned in the UK after causing two deaths.

SALVIA DIVINORUM Derived from the mint plant, it was first used in spiritual rituals by Mexican shamans.

SCELETIUM TORTUOSUM Overdosing on this mood-enhancer can cause delirium.

MUSHROOMS Traditionally used by shamans, there are almost 200 types of ‘shrooms’ that have hallucinogenic effects.

www.mixfitmag.co.za The safest natural high is still endorphins. Release them with the workouts from our Fitness section.

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