でなければならない ) でも グリコーゲンは十分に存在するか否か というものだ このプロセスを計算 11 した結果 ほぼすべてのグリコーゲンは1 2 分間で消費されること そして筋肉中のグリコーゲン貯蔵がそのパワー産生に影響を与えることがわかった 解糖により生まれるのは乳酸塩 (Lactate) で

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Download "でなければならない ) でも グリコーゲンは十分に存在するか否か というものだ このプロセスを計算 11 した結果 ほぼすべてのグリコーゲンは1 2 分間で消費されること そして筋肉中のグリコーゲン貯蔵がそのパワー産生に影響を与えることがわかった 解糖により生まれるのは乳酸塩 (Lactate) で"

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1 10 招待講演 1 オランダにおけるスピードスケートの医 科学サポート Gee van Enst オランダスケート連盟 1. オランダのスピードスケートチームでスポーツ内科医を務める 私は2006 年から スポンサーの支援を受けたスピードスケートチームで チームドクター ( 内科医 ) を務めている ヘッドコーチは Jac Orie 氏である 同氏は2 名のトレーナーを雇用しており その他に1 名ウエイトリフティング専門のスタッフを雇用している 医療チームはチームドクターである私 ( 内科医 ) の他に2 名の理学療法士で構成されており 2 年前からはマネージャーもついている 現在 スケートチーム Lotto Jumbo には10 名の選手が所属している Jac Orie 氏が率いるこのチームには 世界大会やオリンピックで金メダルを獲得した選手 (Jannie Romme Marianne Timmer Erben Wennemars Mark Tuitert Stefan Groothuis Sven Cramer) が数多く所属している チームにおける私の仕事は以下の通り : 1. シーズン前のスクリーニングを管理すること 2. 血液検査を実施すること 3. トレーニングキャンプやワールドカップなどの期間中に 診断や治療を行うこと 4. 選手の行動や オーバートレーニングの兆候がないかどうか気を配ること 5. 生理学的な測定を行い トレーニングのアイデアを出すこと またワールドカップ / 世界選手権の期間中は KNSB( オランダスケート連盟 ) のナショナルチームでも職務を行っている 私の仕事は以下の通り : 1. ドーピングコントロールを行うこと 2. トレーニングキャンプやワールドカップなどの期間中に 診断や治療を行うこと 3. 選手の行動に留意すること 4. ナショナルチームの外で 医療上の問題を解決すること 2. 短距離競技の生理学 私たちの生理学的測定の多くは 無酸素的解糖による代謝を伴う 測定の過程において 無酸素的解糖は 酸素が少なすぎることの結果なのか否か という疑問が生まれた 私たちは 短距離競技におけるパワーを測定することからスタートした チームで測定を行った結果 このパワーは60 秒間で約 1,000 ワットだった (30 秒間では1,200ワット ) 有酸素性のパワーは400ワットであることから 600ワット以上は解糖系により生み出されなければならない つまり 解糖系代謝は 酸素が少なすぎることが原因でおこる代償性の反応ではない 大きなパワーを出すためには 有酸素的に産生されるエネルギーよりも 単位時間当たりでより多くのエネルギーが必要となることが原因なのである 大きなパワーはすべての筋線維タイプによって生み出されるが 特に Type IIx 筋線維は大きなパワーを生み出す ( サイズの原理 ) Type IIx 筋線維は大きな運動単位で ミトコンドリアは存在しないか 存在するにしてもごくわずかである Type IIx 筋線維は たとえ酸素 ( 赤血球など ) が豊富に存在する状況でも 酸素を使うことなくパワーを生み出す 結果 ハイパワー出力中 Type IIx 筋線維の代謝は速い解糖に基づく ( これは有酸素的解糖より32~40 倍速い ) 第二の疑問は 解糖が非常に速く行われている状況 ( ミトコンドリアによるパワー産生を上回るペース

2 でなければならない ) でも グリコーゲンは十分に存在するか否か というものだ このプロセスを計算 11 した結果 ほぼすべてのグリコーゲンは1 2 分間で消費されること そして筋肉中のグリコーゲン貯蔵がそのパワー産生に影響を与えることがわかった 解糖により生まれるのは乳酸塩 (Lactate) ではなく乳酸 (Lactic Acid) である これは解糖に伴い 乳酸塩 (20mmol/L 以上 ) だけでなく酸 ( 水素イオン ) も同量生産されていることを意味している 乳酸濃度を下げる第一の可能性は 乳酸をピルビン酸へと酸化し どこか体内あるいは筋肉 (Type I 筋線維 ) 内のミトコンドリアでピルビン酸を有酸素性代謝で用いること あるいはコリ回路を用いて 肝臓内でのグリコーゲンへの変換することがあげられる 第二の方法は 緩衝により酸性度を下げることである さまざまな緩衝システム ( タンパク質 ヘモグロビン ミオグロビンなど ) が同時に働くが 水素イオンの緩衝において最も重要なのは 重炭酸塩 -pco2システム( 比率 ) である pco2を速やかに低下させるためには 心拍出量 換気量を素早く増加させなくてはならない これらによって 乳酸緩衝能 - つまり筋内の酸性度 (ph) をいくらかコントロールすることが可能になる この段階後 緩衝能は降下し 代謝性アシドーシスが引き起こされると考えられる 高い酸性度やその他の要因は 解糖系の利用能を低下させる 標高の高さやその他の要因は 重炭酸塩 -pco2システムに影響を与える 1,000 1,500メートルのスピードスケート選手が大きなパワーを発揮するためには 下記の身体能力が必要となる 分間の高いパワー出力 2. 平均以上の Type IIx 筋線維組成 3. 高いグリコーゲン貯蔵 4. 速い解糖系亢進 (32-40 倍速い ) 5. クレブス回路を介した高いピルビン酸処理能力を有する ( 有酸素性代謝能力の高い )Type I 筋線維組成 6. 高い緩衝能 ( ヘモグロビン 重炭酸イオン ) 7. 高い二酸化炭素排出量

3 12 Special Lecture 1 Medical-Scientific support for Dutch speed skaters Gee van Enst Sports medicine staff of KNSB 1. sports physician in Dutch speed skating Since 2006 I am the team-physician of a sponsored speed-skating team. Head coach is Jac Orie. He has two trainers and an other especially for weight lifting. The medical team consists of two physiotherapists and me. Since two years we have a manager. The skating team Lotto Jumbo has now 10 athletes. Jac Orie has had a lot of World- and Olympic gold medal champions in his team: Jannie Romme, Marianne Timmer, Erben Wennemars, Mark Tuitert, Stefan Groothuis, Sven Cramer. My job for the team consists of: 1.looking for pre-seasonal screening; 2.blood-tests 3.diagnostic and therapeutic work during training-camps and during World Cups etc. 4.looking for the behavior of the athletes and overtraining symptoms 5.physiologic measurements and training ideas. I am also working for the national team of the KNSB (Netherlands skating Federation) during world cups / championships. My task for them is: 1.doping controle, 2.diagnostic and therapeutic work during training-camps and during World Cups etc. 3.looking for the behavior of the athletes 4.medical problem solution outside the national team 2. physiology of sprinting A lot of our physiologic measurements had to do with anaerobic glycolysis. Doing this the question rose if anaerobic glycolysis is the consequence of too few oxygen or not. We started from the power in sprinting. In our team this power is around 1000 Watt during 60seconds (1200 W in 30seconds). With an aerobic power of 400Watt more than 600W must be produced by glycolysis, not because there is to few oxygen but because high power needs more energy per time(s) than aerobic can produced. The high power is produced by all the muscle type fibers but especially by the type IIx fibers (size principle). Type IIx are big motor units without or with just a few mitochondria. Type IIx fibers produce power without oxygen even if there is a lot of oxygen like erythrocytes. The conclusion is that during high power output the fast twitch IIx fibers metabolism is based on fast glycolysis (32-40 times faster than the glycolysis for aerobic metabolism). The second question was if there is enough glycogen when the glycolysis is going very fast (must faster than power can be made by mitochondria). After counting this process the result is that nearly all the glycogen is used in 1-2 minute and that the glycogen reserve in the muscles can influence the power.

4 result of glycolysis is not lactate but lactic acid. This means a lot of lactate (>20mmol/L) but also a lot (the The 13 same amount) of acid (hydrogen ions) is produced. The first possibility to lower the level of lactate acid is by oxidation of lactic acid to pyruvate acid and using the pyruvate acid in mitochondria with oxygen some where else in the muscle (fiber type I) or body or transform it to glycogen in the liver (Cori cycle). The second way is to lower the acid level is by buffering. Different buffer systems (e.g. proteins, Hb, myoglobin) work together but the most important system in buffering hydrogen ions is the bicarbonate-pco2 system (ratio). For a good quality of lowering pco2 you must have a good and fast rising cardiac output (like the Fick equation for VO2) and a good ventilation. By this you can control for some time the isocapnic phase- the acid level (ph). After this fase it will drop and there will be a metabolic acidosis. High acid levels and other factors lower the ability to use the glycolysis. High altitude and other factors have influence on the bicarbonate-pco2 system. For high power output during 1000 and 1500m speed-skaters need : 1.a high power output during 1-2 minutes, 2.more than an average percentage of muscle fiber type IIx, 3.a high glycogen reserve, 4.a fast glycolysis (32-40 times faster), 5.a good quality of type I muscle fibers to reduce the pyruvate acid level via Krebs, 6.a high buffer capacity (Hb, HCO3-) 7.a high VCO2.

5 14 Gee van Enst( 医師 医学博士 ) 1945 年生まれ ボート選手として世界選手権とオリンピックに出場 その他 スピードスケートや自転車 登山などにも取り組む アムステルダムで医学を学び ( ) スポーツ医学の分野で初の専門医学実習生となる ( ) その後アムステルダム大学で スポーツ医学における予防的スクリーニングを学ぶ ( / 医学博士号取得 ) スポーツ医学における医療専門家として 1983 年から1993 年まで国立スポーツ ヘルスケア研究所 ( 科学 [science] 教育 [education] 質 [quality]) に勤める その後依頼を受け ズヴォレ市内の病院 (Isala clinics) でスポーツ医学の診療を開始 2010 年時点で 同病院のスポーツ医学科には5 名のスポーツ内科医と2 名の開業医が勤務している 2010 年に同病院を退職 病院外 時には病院内において バレーボール カヌー ボート 登山 マラソンおよびスピードスケートなどの種目のナショナルチームのために業務を行う モスクワ (1980 年 ) アトランタ(1996 年 ) およびソチ (2014 年 ) の各五輪では五輪チームのスポーツドクターを務める スポーツ医学におけるさまざまな分野 ( 運動性コンパートメント症候群 選手の予防的スクリーニング 心拍数の減少および心臓リズムの異常に高度が及ぼす影響 心臓病患者に高度が及ぼす影響 乳酸塩 シャトルテスト ) を学んだ Gee van Enst, (MD, PhD.) Biography I was born in As an athlete I was rowing on world championships and Olympic games. Beside that I was practicing speed-skating, cycling and mountain climbing. I studied medicine ( ) in Amsterdam. I was the first resident in sports-medicine ( ). Than I did a study ( ) at the university of Amsterdam about preventive screening in sports-medicine (PhD). As a medical specialist in sports-medicine I was working on the National Institute of Sport & Health Care (science, education, quality)from 1983 till Then I was asked to start the first practice in sports-medicine in a hospital (Isala clinics) in Zwolle. In 2010, 5 sports physicians and two practitioners were working on this department of sports-medicine. I retired in 2010 from the hospital. Outside and partly inside my hospital I have worked for national teams in: volleyball, canoeing, rowing, mountain climbing, marathon- and speed-skating. I was sports-physician of the Olympic teams in Moscow (1980), Atlanta (1996) and Sochi (2014). I did studies on different fields in sports-medicine (exercise compartment syndrome, preventive screening of athletes, frequency reduction and heart rhythm irregularity on altitude, heart patients at altitude, lactate, shuttle test).

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