Numerous studies on serum enzymes derived from skeletal muscle, such as CH, AST, LDH, are also being reported in the field of sports medicine. In this article, I would like to summarize the findings on “physical exercise and serum enzymes” studied up to the present. Secondly, I will evaluate the usefulness and limits as indicators of condition and muscle fatigue in athletes. The amount of change and time course of Ch, AST, LDH and myoglobin responses were markedly different in 5-km, marathon and triathalon races, and in trained and untrained subjects. Trained subjects showed peaks of these enzymes one day after endurance running, and untrained subjects had a typical biphasic variation after endurance running. The typical change in untrained subjects might reflect a series of different histopathological changes, including muscle damage, repair and regeneration of muscles. In participants of women's marathon races, higher ranking prize winners showed lower levels before and lower increases in Ch activity after the mice than the other participants. higher serum CIA activity above 300 mU/ml accompanied by increases in serum myosin light chain I (MLC I) concentration (above 2.5 ng/ml) without increases in troponin T and CN-MIA were observed during marathon, triathalon, 100-km and 250 km ultra marathon races. The athletes who showed a higher serum CK activity above 500 mU/ml at the pre-race stage felt subjective fatigue and sonic dropped out from the race. Normal persons who had a lower Ch activity below 40.50 mU/ml indi cated lower levels of serum HDL-C and physical fitness (VO₂max) . On the contrary, persons who showed a higher CR level of 100-200 mU/ml or more had higher levels of IIDL-C and VO₂max.
Measurement of serum CK activity might provide useful information for checking health and physical fitness levels in normal persons, and also the physical and subjective conditions of athletes.

Maximal oxygen uptake (VO₂max) is an important determinant of health-related physical fitness. In 2006, the Japan Ministry of Health, Labour and Welfare (JMHLW) officially declared a standard reference value and reference interval of VO₂max. However, these values were established on the basis of a systematic review of reports published in Western countries and were not based on actual VO₂max data of the Japanese population. Therefore, we conducted a study entitled “The study on a minimum zone of VO₂max as one of the determinants of health-related physical fitness in Japan” from 2004 to 2006 as a project of the Japanese Society of Physical Fitness and Sports Medicine (JSPFSM). In addition, we collected published VO₂max data of the Japanese population from the JSPEFM website. In the present study, we attempted to determine the reference interval of VO₂max with regard to age, gender, and different methods of exercise. Further, we established a cut-off value of VO₂max for determining metabolic syndrome (MS).1. Reference interval of VO₂maxFor both men and women, 325 and 364 values for the treadmill exercise, and 1175 and 2178 values for the cycle ergometer exercise, respectively, were collected. This data revealed a balanced distribution of VO₂max with regard to age. Data that satisfied the VO₂max criterion were used for the analysis. These data were regressed to age on gender and methods of exercise. The percentage of VO₂max was calculated using the following equation: %VO₂max = measured VO₂max × 100/age-estimated VO₂max. The iterative truncation method was used to calculate the reference interval of VO₂max (70%∼130% VO₂max) from the crude data of %VO₂max, and then converted to actual VO₂max. Thus, the reference interval of VO₂max for healthy Japanese was determined with regard to age, gender, and different methods of exercise.2. Cut-off value of VO₂max for determining MSUsing the VO₂max data of subjects with body mass index (BMI) of ≧25kg/m² and ≧2 MS risk factors, and the data of subjects with normal BMI without any risk factors, we calculated sensitivity and specificity. The cut-off value was determined using the receiver operating characteristic curve. This cut-off value was defined as the critical value of VO₂max that should be maintained to avoid MS and remain healthy.

The present study was conducted to investigate the effect of acid-base disturbance on blood lactate concentration (bLA) and OBLA (Onset of Blood Lactate Accumulation) during an incremental bicycle test.
Nine healthy male subjects underwent the incremental test at 60 min after the oral administration of NH₄Cl (acidotic-treatment ; Acid), NaHCO₃ (alkalotic-treatment ; Alk) and NaCI (control ; Cont) at 1.87 mM⋅kg^-1body weight. Exercise was started at a load of 80W, which was subsequently increased by 10W every minute until exhaustion. During exercise, O²intake (VO²), ventilatory volume (VE) and heart rate (HR) were monitored continuously. Venous blood samples were obtained before administration and every 2 min during exercise.
No change could be detected in resting VO₂, VE and HR following oral administration of NH₄Cl, NaHCO₃and/or NaCl. At 60 min after oral administration venous blood pH (_vpH) and bicarbonate ion concentration (_v [HCO₃^-] ) were significantly lower in Acid (7.265±0.033; p <0.001, 23.6±1.8 mM⋅1^-1; p<0.01) ; and significantly higher in Alk (7.370±0.045 ; p<0.01, 29.7±1.6 mM⋅1^-1; p<0.01) compared to Cont (7.318±0.041, 26.6±2.1 mM⋅1^-1) . Changes in VO₂, VE and HR during exercise were essentially the same in all cases. No differences were observed in exercise time. During exercise, vpH and_v [HCO₃^-] gradually decreased, but remained significantly lower in Acid and higher in Alk compared to Cont. Blood lactate concentration (bLA) increased during exercise. Peak values were observed at exhaustion, but it was lower in Acid (8.03±1.18mM⋅1^-1) and higher in Alk (10.73±1.48) compared to Cont (9.49±1.79) in all subjects. The Onset of Blood Lactate Accumulation (OBLA) was determined for each subject. OBLA was significantly higher in Acid (71.9±9.1%VO₂max) than Cont (62.5±9.9%VO₂max) and Alk (62.2±8.0%VO₂max) .
Changes in acid-base balance were found to cause differences in bLA responses to the same exercise load and possibly change OBLA. Care must be taken when using OBLA or LT as an index of aerobic capacity in some patients with acid-bace disorders; hemodialitic, obese or diabetic patient.

This study tried to establish both critical and desirable levels of health-related physical fitness (HRPF) including muscle strength (relative grip strength), flexibility and estimated VO₂max. Subjects were 3102 males aged 20 to 59 years. Four batteries of health index score (HIS-A-D) were made based on health examinations and lifestyle habits. Subjects who had 0 to 1 points were defined as healthy individuals, and subjects who had more than 3 or 4 points were defined as unhealthy. Receiver-operating characteristic (ROC) curves were drawn by HRPF test in each battery of HIS. The HIS-B was selected as the most valid battery of HIS. Sensitivity, specificity and the Youden index were calculated using cut-off values which were mean values of each HRPF test measurement in each group who had 0, 1, 2, 3 and>4 points in HIS-B. The critical levels were defined the highest specificity and/or Youden index in each HRPF test. There were seen in groups having > 4 points. The desirable levels were defined as the HRPF test levels in healthy individuals who had 0 to 1 points in HIS-B. The critical and desirable levels of VO₂max were 41.8 and 50.2 at 20y, 40.9 and 46.2 at 30y, 40.0 and 46.2 at 40y, and 37.8 and 45.5 ml/kg/min at 50y, respectively. The levels of other HRPF test were also calculated in the present study. Exercise guidance after health check-ups should be done to attain desirable levels rather than to just maintain critical levels of HRPF.

The purpose of the present study was to investigate a useful exercise protocol and method of evaluation for determining the gas exchange threshold (VO₂GET) and correlation coefficient between VO₂GET and maximal oxygen uptake (VO₂max), which is an index of aerobic capacity. Five healthy male volunteers (age: 25.6 ± 2.0 yrs; height: 172.9±4.0 cm; weight: 69.5±6.6 kg) performed exercise tests 82 times. Each volunteer randomly conducted a RAMP exercise (1 W⋅3 sec^-1), STEP-1 exercise (20W⋅min^-1) and STEP-2 exercise (40W⋅2 min^-1), respectively, at least 4 to 8 rotations. The gas exchange parameters (VE, VO₂and VCO₂) for incremental exhaustive cycle ergometer exercise were measured using a“breath-by-breath”method. Three different methods of evaluation- (VE/VO₂and VE/VCO₂) exchange (M-1), V-slope method (M-2), and M-1 & M-2 (M-3) -were attempted to determine VO₂GET. The VO₂GET values, determined by three different methods (M-1, -2 and -3) of evaluation, were classified as‘easy’ (J-A) and‘difficult’ (J-B) in all tests. Reproducibility of VO₂max and VO₂GET were assessed using the coefficient of variation (CV) and correlation coefficients (r) between VO₂max and VO₂GET.
The results are summarized as follows:
1) The means of the reproducibility of VO₂max were determined among the 5 subjects by us ing RAMP, 4.8% (n=25), STEP-1, 3.1% (n=28) and STEP-2, 2.9% (n=29) exercise tests; STEP-2 exercise test values (CV) were lower than the others. There was no significant difference in the means of VO₂max among the 5 subjects according to the RAMP and two STEP exercise tests (Two-way ANOVA) .
2) The best reproducibility value of VO₂GET among the 5 subjects was determined using RAMP exercise tests with the V-slope method (M-2) and evaluations were classified as easy (J-A) . The value (CV) was 2.8%. There was no significant difference in the VO₂GET values (M-1 (J-A, -B), M-2 (J-A, -B) and M-3) (Two-way ANOVA) and their means among the 5 subjects concerning RAMP and two STEP exercise tests (Two-way ANOVA) .
3) The best correlation coefficient (r) value between VO₂max and VO₂GET was obtained using RAMP exercise tests with M-2 (J-A) (r=0.976, n=20) .
The present results indicate that the most useful exercise protocol and method of evaluation for determining VO₂GET is the RAMP exercise test with the V-slope method.

Kanehiro Takaki, the founder of The Jikei University School of Medicine suggested that a nutritional factor was important for preventing beri-beri, which was a common disease in the Meiji era in Japan and Southeast Asia. He improved the rations fed to crews of the Imperial Japanese Navy to include wheat and meat. The rations he devised effectively prevented beri-beri. Some 30 years later, vitamin B₁ was discovered, and a deficiency of vitamin B₁ was found to be the cause of beri-beri. Takaki believed that nutrition and exercise were important for keeping our bodies fit. He often gave lectures on how people could keep fit to prevent diseases. Thus, his activities are considered to be the beginning of preventive medicine in Japan. The contributions of Takaki to the physical fitness of the Japanese people have been continued by the graduates of The Jikei University School of Medicine. Some of the graduates became professors of The Jikei University School of Medicine and Tokyo University of Education (now, Tsukuba University). Thus, both universities have the common basis and tradition for research and education in the fields of physical fitness and sports medicine, and have collaborated with each other in these fields. In this article, we provide a brief overview of the history of the development of research regarding physical fitness and sports medicine in Japan. We discuss the contribution of various persons including our graduates, to the health and physical fitness of the Japanese people.

The purpose of the present study was to assess the effect of commercial sports beverage intake after a thermal exposure on water-electrolytes balance.
Nine healthy male volunteers with a mean age of 26.4 years, not heat acclimated, participated in a control experiment where no fluid was given (C experiment) . Five of them were given 500ml isotonic sports beverage containing Na⁺, K⁺, Cl^-and glucose (S. B experiment) and/or 500 ml tap water (Wa experiment) immediately after sauna exposure. The nude subjects were exposed to a sauna with 65 to 70°C (r. h. 50 to 60%) for 30 min.
Serum protein, electrolytes (Na⁺, K⁺, Cl^-), creatinine, plasma aldosterone (Ald), and catecholamines concentrations and excretions of electrolytes and aldosterone into urine were measured before, and 3, 30, 60, and 120 min after the sauna. Serum and urinary osmolalities, blood pressure, rectal temperature (Tr), heart rate, oxygen consumption and weight loss were also measured.
Body weight loss ranged from 50 to 750g. Serum protein, electrolytes and Ald concentrations increased significantly after the sauna. The enhanced levels of these variables and the depression of urine volume, urinary Na⁺excretion were maintained throughout the 2h recovery period in C experiment. Hydration associated with a reduced concentration of serum protein and electrolytes was observed at 30 min in S. B, at 60 min in Wa, and a dehydration occured again at 120 min both in S. B and Wa. A peak of urine volume was observed at 60 min in S. B and at 120 min in Wa during recovery. Free water clearance (C_H2O) was -0.98 ml/min/100 ml GFR (Ccr) prior to the exposure. With no fluid administration after the sauna, an excess in negative water balance remained throughout the 2 h recovery. But C_H2Ochanged from negative to positive at 60 and 120 min after sports beverage and/or water loadings.
A significant elevation of % TRNa (0.33 to 1.14%) was maintained after the sauna in both C and Wa experiment. Plasma Aid concentration and excretion of Aid in urine after the exposure were higher in both C and Wa than in S. B experiment. The increased Tr did not return to the initial level throughout the recovery. No significant differences were observed among the three experiments in heart rate and blood pressure as well as Tr.
The data indicate that salt deficit due to the sauna exposure was attenuated, but not prevented, by sports beverage intake, although the Aid secretion was alleviated. It is suggested that an over loading of sports beverage or water (i. e. 500 ml VS 50 to 750 g weight loss) leads to a marked and prompt water-diuresis, and to another dehydration. The increase of Tr as well as a partly salt deficit can be related to the rises in Ald secretion still observed at 2 h recovery.

We examined the relationship between serum magnesium (sMg) change and urinary Mg (uMg) excretion, lipid metabolism and hormonal responses induced by prolonged physical exercise. Six recreational runners voluntary participated in the study, and their sMg, uMg, serum lipid and circulatory levels of plasma hormones (ACTH, cortisol, ADH, aldosterone) were determined during a 1-week recovery period after a full-marathon race. Immediately after the race, fall of sMg was significant, but recovered to the pre-race level in the next day. Urinary Mg excretion decreased significantly after the race and the tubular reabsorption rate (%TRMg) was elevated for one week. The negative correlation between sMg and %TRMg suggested that a decreased level of sMg enhanced tubular reabsorption of Mg. On the other hand, no correlation was observed between the plasma hormone levels and %TRMg, thus hormonal responses induced by prolonged exercise had less effect on the tubular reabsorption of Mg. Therefore, fall of sMg after the full marathon race may not be a reflection of Mg depletion, but seems to be the result of a Mg shift to other regions (muscle, erythrocytes and adipose cells) from the serum. Increased level of serum FFA after the race suggested enhanced lipolysis, which might be a cause of sMg reduction.

The existing adoptive criterion for VO₂max was created for physically fit subjects who were soldiers and/or sportsmen. However, VO₂max is widely used at present as one of the health-related physical fitness determinants from children to aged persons. It might be appropriate to determine the criterion and the critical values for VO₂max in consideration of age and gender.
The present study attempted to determine the reference range and critical values of the criterion for VO₂max using the iterative truncation method. Voluntary VO₂max was measured in 548 healthy volunteers, aged 8 to 82 years, using a treadmill. The % VO₂max was calculated using the equation of %VO₂max=measured VO₂max × 100 gage-estimated VO₂max. Crude data of %VO₂max was applied to the iterative truncation method, and the reference range of %VO₂max (70-130%VO₂max) was determined. Physiological and biochemical parameters, within the values of 70-130%VO₂max, were converted to a percentage using a similar equation of %VO₂max. The value corresponding to 10% of the lower area of the distribution of each parameter was defined as the critical value, which was the minimum level to adopt as the VO₂max. Taking a single or combined application of the critical value of each parameter, the adoptive ratio of VO₂max was investigated.
The present study indicated that there was no difference between VO₂max selected by the iterative truncation method and that obtained by the existing criterion for VO₂max. The combination of the critical value of HRmax and bLAmax was recommended as a criterion of VO₂max. The reference value, critical value of VO₂max and the critical real value of each parameter were shown as a mean of every 5-year interval with the distinction of gender.

Chronic obstructive pulmonary disease (COPD) causes severe respiratory dysfunction and severely limits patients' daily activities. We report a case of the patient with COPD whose respiratory symptoms were successfully improved by acupuncture. A 70-year-old man visited Meiji University of Oriental Medicine Hospital complaining of dyspnea during exercise on _??_. Despite strictly controlled medication and a regimen of home oxygen therapy (HOT), his general condition continued to worsen. Then a series of acupuncture treatment was started on _??_. The severity of dyspnea of the patient before acupuncture treatment was determined as level V according to Hugh-Jones classification, and spirometry showed severely disturbed respiratory functions (%VC: 63.5%, FEV₁%: 29.4%, PEFR: 84.8 1/min in the morning and 93.5 1/min at night). The basic combination of meridian points for the treatment of the case was LU1 (Zhongfu), CV12 (Zhongwan), CV4 (Guanyuan), LU5 (Chize), and BL13 (Feishu). The acupuncture needles were retained for ten minutes in each session. The single-subject research design (A-B-A method) was applied to detect the specific effect of the acupuncture treatment on the respiratory functions or the symptoms of the subject. “A” and “B” mean “treatment period” and “no treatment period” respectively. After 60 acupuncture treatments during a 14-month period, both the respiratory symptoms and the VAS for dyspnea showed improvement, which were specifically observed during the intervention period. Improvement was also reflected in the level of the Hugh-Jones classification and respiratory function test. It was suggested that acupuncture treatment might be effective for advanced cases of COPD.