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Manuscript submitted to editorial office

Abdominal Circumference, Body Fat Percent, and VO2 Max


in Pilgrims of HST Regency

Journal: International Journal of Sports Medicine

Manuscript ID IJSM-02-2019-7449-tt

Manuscript Type: Training & Testing


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Key word: Vo2max, Pilgrim, Exercise

ABSTRACT
Maximum oxygen capacity (VO2 max) is the maximum volume of oxygen
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that the body processes when carrying out intensive activities. VO2 max
units is milliliters per minute per kilogram of body weight. Factors that
determine VO2 max include age, gender, heart lung function, aerobic
muscle metabolism, exercise, genetics, multivitamins, and nutritional
ee

status such as BMI, abdominal circumference, and percent body fat. The
study is an analytic descriptive. The number of samples is 50 people.
Selected using purposive sampling technique. The VO2 max
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measurement is done by Rockport test. Data analysis uses frequency


distribution. The results showed that the majority of the research
Abstract:
subjects were 26-45 years old (33%), female (40%), normal BMI (32%),
central obesity (44%), normal body fat percent (28%). Data on
ev

abdominal circumference relationships and body fat percent with VO2


max were analyzed using the chi square test with a confidence level of
95%, p = 0.04 and p = 0.013. The conclusions of this study were that
the majority of Hulu Sungai Tengah pilgrims who had VO2 max enough.
iew

There is a significant relationship between abdominal circumference and


body fat percent with VO2 max.

Keywords: pilgrims, VO2 max, age, gender, BMI, abdominal


circumference, body fat percent.

Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Page 1 of 11 Manuscript submitted to editorial office

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7 Abdominal Circumference, Body Fat Percent, and VO2 Max in
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Pilgrims of Hulu Sungai Tengah Regency
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11 Authors
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13
Huldani1, Asnawati1, Diana Auliadina2, Fedia Riska Amilia2, Novita Nuarti2,
14 Rahma Jayanti2
15
16
17
Affiliations
18 1 Department of Physiology, University of Lambung Mangkurat, Banjarmasin,
19 Indonesia
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2 Student of Medicine, Faculty of Medicine, University of Lambung Mangkurat,
21
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22 Banjarmasin, Indonesia
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24
ABSTRACT
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25
26 Maximum oxygen capacity (VO2 max) is the maximum volume of oxygen that the
27 body processes when carrying out intensive activities. VO2 max units is milliliters
28 per minute per kilogram of body weight. Factors that determine VO2 max include
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29 age, gender, heart lung function, aerobic muscle metabolism, exercise, genetics,
30 multivitamins, and nutritional status such as BMI, abdominal circumference, and
31
percent body fat. The study is an analytic descriptive. The number of samples is 50
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32
33 people. Selected using purposive sampling technique. The VO2 max measurement
34 is done by Rockport test. Data analysis uses frequency distribution. The results
35 showed that the majority of the research subjects were 26-45 years old (33%),
ev

36 female (40%), normal BMI (32%), central obesity (44%), normal body fat percent
37 (28%). Data on abdominal circumference relationships and body fat percent with
38
iew

VO2 max were analyzed using the chi square test with a confidence level of 95%, p
39
40
= 0.04 and p = 0.013. The conclusions of this study were that the majority of Hulu
41 Sungai Tengah pilgrims who had VO2 max enough. There is a significant
42 relationship between abdominal circumference and body fat percent with VO2 max.
43
44 Keywords: pilgrims, VO2 max, age, gender, BMI, abdominal circumference, body
45
46 fat percent.
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Manuscript submitted to editorial office Page 2 of 11

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INTRODUCTION decrease because someone tends to
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11 Indonesia is a country whose choose to work, besides the decrease
12 population is predominantly Muslim, in heart contraction and capacity total,
13 the Hajj activity which is 70% in the and heart muscle mass also affects.4,5
14 form of physical activity and the
15 VO2 max of men and women
remaining 30% is non-physical
16 is different, the difference in VO2 max
spiritual worship, and the majority of
17 is not apparent at a young age and is
18 pilgrims range from young adults to
most evident during adulthood or
19 old age. As it is known that the cells
middle age. The difference between
20 of the body begin to degenerate
21
VO2 max male and female is related
function which result in a decrease in
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22 to differences in body composition


the endurance of the lung heart,
23 and size because the physiological
flexibility, muscle strength, muscle
24 bodies of men and women are
endurance. So that it requires a good
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25 different. In addition to the body


26 physical condition in order to be able
composition the difference in VO2
27 to carry out all the series of activities
max is also due to the different
28 in the Hajj properly and become a hajj
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29
hemoglobin concentrations of men
mabrur. To be able to achieve good
30 and women. The composition of the
physical condition means that you
31 female body is more fat than muscle
must have good physical fitness.1
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32 compared to men which causes


33 Physical fitness has 4 basic
women has smaller VO2 max. The
34 components, namely endurance of the male hemoglobin concentration is
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heart and lungs (cardiopulmonary), also higher than women. The


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37 strength and endurance of muscles, hemoglobin concentration is closely
38 flexibility and body composition. linked to the binding of oxygen that
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39 Fitness for heart and lung endurance the body needs for the process of
40 burning energy, so that men can
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is defined as the maximum capacity
optimally produce energy.6
42 for breathing oxygen or abbreviated Nutritional status can be
43 as VO2 max. Factors that determine
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assessed based on body mass index,
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VO2 max include age, gender, heart abdominal circumference and body
46 lung function, aerobic muscle fat percent. BMI is obtained by
47 metabolism, exercise, genetics, dividing body weight (kg) by the
48 square of height (m). Body weight
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multivitamins, and nutritional status
tends to be inversely proportional to
50 such as BMI, abdominal
maximum oxygen capacity. This
51 circumference, and percent body
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means that the greater the weight (kg),
fat.2,3 the lower the maximum oxygen
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54 The peak age of the endurance capacity. Being overweight is
55 of the heart and lungs is in the age of associated with an increase the
56 amount of fat tissue. The abdominal
20-30 years old, then it will decrease.
57 circumference is the amount of length
58 This is because the more a person
around a person's body parallel to the
59 ages, the various sports activities will
60

Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Page 3 of 11 Manuscript submitted to editorial office

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7 navel. The abdominal circumference multivitamins one day before the
8 is generally used as a measure of study was held, had no history of
9 central obesity. Central obesity is chronic heart and lung disease, mild
10 defined as excess fat in the body to moderate physical activity, and
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accompanied by a partial buildup of cooperative.
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fat in the visceral part of the stomach. Physical test
14 Central obesity is considered a risk Before measuring VO2 max, data
15 factor associated with several chronic collection and informed consent were
16 diseases.7,8,9 carried out. Informed consent
17 The lifestyle of people who included the approval of the research
18 prefer to eat fast food compared to subjects to take measurements of VO2
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more nutritious home-made foods max. The measurement of VO2 max
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21 causes high rates of obesity.10 Body uses the rockport method by means of
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22 fat percent is related to obesity the study subjects warming up and


23 because it is a constituent component stretching the muscles first in the
24 of the body besides bone mass, form of walking slowly 5-10 minutes,
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25 muscle mass, and body water content. then walking fast constantly along the
26 describes the condition of the weight 1.6 km track. Travel time (in minutes
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or fat mass that is in a person's body and seconds) is measured using a
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29 in general, both subcutaneous fat and stopwatch and the results are matched
30 visceral fat (fat contained in organs). with the available VO2 max tables.
31 At fitness centers, before starting an Calculation of body mass index by
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32 exercise program, it is usually done measuring height and weight. Height


33 checking body composition, one measurement is carried out with the
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component of which is body fat subject standing against the wall and
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percent. below the measuring instrument, the
37 measuring instrument is pulled up to
38 Method the top of the head, the number seen
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39 Study design above that is indicated by the


40 This study uses a analytic descriptive measuring line is the subject's height.
41 method to describe VO2 max and the Measurements of body weight were
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factors that influence it and to know carried out by means of subjects being
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44 the relationship between abdominal asked to rise above the weighing
45 circumference and body fat percent instrument with the position of the
46 with VO2 max in pilgrims. The study feet right in the middle of the
47 was conducted at the Hulu Sungai weighing device but not covering the
48 Tengah District Health Office in reading window, calmness, and the
49 May-June 2018. head not looking down, the numbers
50
51
on the weigher will appear and wait
52 Participants until the numbers do not change.
53 The population of this study included Measurement of abdominal
54 all prospective pilgrims of Hulu circumference is performed on
55 Sungai Tengah regency 2018. Of the subjects with a standing position and
56 319 pilgrims there were 50 people breathing normally (normal
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who met inclusion criteria that are expiration) using a measuring tape.
58
59
physical health, did not take stamina Examination is done by feeling the
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
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7 last rib of the subject to set the entering the identity of the research
8 measurement point of the lower edge subjects such as age, gender and
9 of the rib cage. Next, the end point of height. Then the research subjects put
10 the pelvis, and the midpoint of their feet on the sensor until the
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measurement are between the last rib measurement results appear.
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point and the end point of the hip
14 bone. Measurements of the abdominal Result
15 circumference are taken from the Result
16 midpoint and then parallel The characteristics of the study
17 horizontally around the waist and subjects consisted of age, gender,
18 abdomen back towards the midpoint. body mass index, abdominal
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Measuring body fat percent using circumference and body fat percent.
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21 carada scan body fat gauge by
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22 Table 1. The characteristic study subject


23 Characteristic n %
24 Age (years)
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25 1. 26-45 19 38
26 2. 46-65 31 62
27 Gander
28 1. Men 19 38
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29 2. Women 31 62
30 BMI
31 1. Underweight 2 4
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32 2. Normal 24 48
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3. Overweight 9 18
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4. Obesity 15 30
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36
Abdominal circumference
37 1. Normal 16 32
38 2. Obesity 34 68
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39 Persen Lemak Tubuh


40 1. Normal 13 26
41 2. Obesity 37 74
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43 Table 2. VO2 max distribution of pilgrims
44 VO2 maks n %
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46
Low fit 12 24
47 Moderate fit 31 62
48 High fit 7 14
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50 Table 2 shows that the majority of
51 prospective pilgrims have enough
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VO2 max.
54 Tabel 3. VO2 max distribution of pilgrims based on age
55 VO2 maks
56 Age (years) Low fit Moderate fit High fit
57 n % n % n %
58 26-45 6 12 12 24 1 2
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
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7 46-65 1 2 19 38 11 22
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9 Based on Firman's research on of the heart, lung and blood vessels.
10 Nganjuk district soccer athletes in The decrease in the average VO2 max
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2016 stated that the risk of physical per year is 0.46 ml / kg / minute for
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13 fitness of athletes aged 18-35 years men, and 0.54 ml / kg / minute for
14 had physical fitness 42 times higher women. So, at the age of 55 years VO2
15 than athletes aged over 45 years. The max is 27% lower than the age of 25
16 difference in VO2 max between adult years. In addition, heart muscle mass
17 and elderly in the study subjects was factors, and decreased heart
18 caused by a decrease in the function contractions also have an effect.13,14
19
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21 Table 4. VO2 max distribution of pilgrims based on gender
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22 VO2 maks
23 Gender Low fit Moderate fit High fit
24 n % n % n %
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25 Men 4 8 11 22 4 8
26 Women 8 16 20 40 3 6
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28
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29 Differences in male and is one of them also because of the


30 female maximal VO2 are related to different hemoglobin levels of men
31 differences in body size and body and women. Higher hemoglobin
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32 composition because the levels in men than women cause


33 physiological bodies of men and differences in blood transport
34 women are different. The capacity which causes men to get far
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composition of the female body is more oxygen during the training
37 more fat than muscle compared to process so that their aerobic capacity
38 men which causes women to have is better, due to lower oxygen
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39 smaller VO2 max. The difference transport and greater percentage of


40 between VO2 max between men and body fat then women tend to show
41 women apart from body composition lower VO2 max values than men.15,16
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44 Table 5. VO2 max distribution of pilgrims based on BMI
45 VO2 maks
46 BMI Low fit Moderate fit High fit
47 n % n % n %
48 Underweight 0 0 2 4 0 0
49 Normal 4 8 16 32 4 8
50 Overweight 1 2 6 12 2 4
51 Obesity 8 16 6 12 1 2
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54 The VO2 max level in obese people is the body. Excess fat tissue will inhibit
55 always lower than the normal BMI the function of the cardio respiration
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because obese individuals will find it system to take enough oxygen.
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58 harder to move which will result in an Excessive amount of body fat
59 increase in the amount of fat tissue in provides a burden that does not
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Manuscript submitted to editorial office Page 6 of 11

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7 benefit and inhibits heart function, type I muscle fiber which has the
8 especially when on the move. In effect of reducing oxygen
9 17
obese people there is an increase in absorption.
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11 type II muscle fiber and a decrease in
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13 Table 6. VO2 max distribution of pilgrims based on abdominal circumference
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VO2 maks
15 Abdominal
16 Low fit Moderate fit High fit
circumference
17 n % N % n %
18 Normal 2 4 9 18 5 10
19 Obesity 10 20 22 44 2 4
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The greater the waist hip ratio, the producer of bio-active substances
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23 lower the level of VO2 max. This is called adipokines namely leptin
24 related to more fat tissue not only as a which can affect the cardiovascular
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25 place to store triglycerides, but as a system.18


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27 Table 7. VO2 max distribution of pilgrims based on body fat percent
28
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VO2 maks
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30 Body fat percent Low fit Moderate fit High fit
31 n % N % n %
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32 Normal 2 4 6 12 5 10
33 Obesity 10 20 25 50 2 4
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Based on table 7 shows the research have low cardiorespiratory


36 11
37 subjects with percent of normal body endurance.
38 fat and VO2 max which is less or less According to Chatterjee et al, the
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39 than the study subjects who have percentage of excessive body fat will
40 have an impact on decreasing cardiac
41 percent of obesity body fat. Based on
output while doing activities. The
42 Susilo's research, people who have
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excessive amount of fat tissue will
percent of normal body fat will have a cause narrowing of the arteries and
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45 high cardiorespiratory endurance and peripheral resistance. As a result, the
46 conversely people who have a pumped blood becomes less so that
47 percentage of obesity body fat will the maximum oxygen capacity also
48 decreases and causes a decrease in
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cardiovascular ability.19
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51 Table 8. The relationship between VO2 max with abdominal circumference of
52 pilgrims
53 VO2 maks
54 Abdominal Total
Low fit Moderate fit High fit
55 circumference
56 n % n % n % n % p Value
57 Normal 2 4 9 18 5 10 16 100 0,04
58 Obesity 10 20 22 44 2 4 34 100
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
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7 Based on the statistical test and VO2 max to Makassar
8 obtained p = 0.04 this states that there Polytechnic Physiotherapy students
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is a significant relationship between (p = 0.002). In students, central
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11 abdominal circumference and VO2 obesity is generally caused due to
12 max. The results of this study are in obesity in childhood which persists
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line with Nurlim's research in 2012 into adolescence. Incorrect eating
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15 Physiotherapy students at patterns and low physical activity in
16 Hasanuddin University medical childhood cause obesity in
17 school, stating that there was a adolescence. If this condition persists,
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19 significant relationship between it will increase the risk of obesity in
20 abdominal circumference and VO2 advanced adulthood, where there is a
21 max (p = 0.002) .20 The 2012 Ramba decrease in metabolism and
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22 21
23 study showed a significant disposition of fat tissue.
24 relationship between central obesity
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Table 9. The relationship between VO2 max with body fat percent of pilgrims
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28 VO2 maks
Total
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29 Body fat percent Low fit Moderate fit High fit


30 n % N % n % n % p Value
31 Normal 2 4 6 12 5 10 13 100 0,013
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Obesity 10 20 25 50 2 4 37 100
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35 Based on statistical tests, it Based on the description obtained in
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36 was found that p = 0.013, this stated this study, it can be concluded that
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38 that there was a significant most of the prospective pilgrims of
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39 relationship between percent body fat Hulu Sungai Tengah regency in 2018
40 and VO2 max. These results are in line are aged 26-45 years (33%), female
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42 with previous research which states sex (40%), normal BMI (32%),
43 that there is a relationship between central obesity ( 44%), percent of
44 physical fitness and body fat in the normal body fat (28%) has enough
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46 gymnastics group (p = 0.02) and non- VO2 max. There was a significant
47 gymnastic groups (p = 0.41)22 and relationship between abdominal
48 there is a strong correlation (r = -0, circumference with VO2 max p = 0.04
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50 75) between percent body fat and VO2 and a significant relationship between
51 max, in this study it was concluded body fat percent with VO2 max p =
52 that an increase in percent body fat 0.013. Pilgrims should prepare their
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was associated with a decrease in physical 1 to 2 years before departure
55 maximal oxygen capacity.23 and the government should hold
56 regular physical training for pilgrims.
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Conclusion
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Manuscript submitted to editorial office Page 8 of 11

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7 Daftar Pustaka 9. Capodaglio P, Castelnuovo G,
8 1. Ningsih IS, Junaidi. Pengaruh Brunani A, Vismara L, Villa
9 latihan senam haji terhadap L, Capodaglio EM.
10 peningkatan daya tahan Functional limitations and
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jantung paru pada calon occupational issues in obesity:
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jamaah haji non resiko tinggi. A review. International
14 Jurnal Fisiologi Indonesia. Journal of Occupational
15 2005; 5(2): 45-9. Safety and Ergonomics. 2010;
16 2. Depkes RI. Petunjuk teknis 16(4): 507-23.
17 pengukuran kebugaran 10. Vinet A, Mandigouz S, Nottin
18 jasmani. Jakarta: Direktorat S. Influence of body
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Jenderal Bina Kesehatan composition, hemoglobin
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21 Masyarakat; 2005. concentration, cardiac size
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22 3. Sugiarto. Hubungan asupan and function of gender


23 energi, protein, dan konsumsi differences in maximal
24 suplemen dengan tingkat
oxygen uptake in prepubertal
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25 kebugaran. Jurnal Media Ilmu


26 children. Chest. 2003; 124:
Keolahragaan Indonesia.
27 1494-9.
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2012; 2: 94-101.
11. Susilo EA. Hubungan
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29 4. Cengiz, Akalan, Robert, A.


30 Robergs, Len, Kravitz. persentase lemak tubuh
31 Prediction of VO2 max from terhadap daya tahan
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32 an individualized submaximal kardiorespi atlet pencak silat


33 cycle ergometer protocol. JEP di klub SMP Negeri 01
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online. 2008; 11(3). Ngunut Tulungagung
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5. Hodges ANH, Sheel AW, [skripsi]. Surabaya: Fakultas
37 Mayo Jr, McKenzien, DC. Ilmu Olahraga Universitas
38 Human lung density is not Negeri Surabaya; 2013.
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39 altered following normoxic 12. Purwati S. Perencanaan menu


40 and hipoxic moderate-
41 untuk penderita kegemukan.
intensity exercise: Jakarta: Penebar Swadaya;
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implications for transient 2001.
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44 edema. J appl physiol. 13. Firman FB. Faktor yang
45 2007;103:111-8. berhubungan dengan
46 6. Katch. Essentials of exercise kebugaran jasmani (VO2
47 physiology. Edition 4. maks) atlet sepakbola.
48 Amerika Serikat: Lippincott;
49 Surabaya : Unair; 2016.
2011. 14. Retnosari D. Hubungan antara
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51
7. Puskesjasrek. Pedoman dan nilai volume oksigen
52 modul pelatihan kesehatan maksimum dengan nilai
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54 olahragawan pelajar. Jakarta: paduan suara mahasiswa
55 Depdiknas; 2000.
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8. Guyton AC, Hall JE. Buku [Karya Tulis Ilmiah]
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Ajar Fisiologi Kedokteran. Makassar: Universitas
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Edisi 11. Jakarta: EGC; 2008. Hasanuddin; 2016.
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7 15. Hoeger, W.W.K, Hoeger, tubuh pada kelompok senam
8 S.A. Principles and labs for dan kelompok tidak senam
9 physical fitness (7th ed). [skripsi]. Bandung: Fakultas
10 USA: Wadsworth. 2010. Kedokteran Universitas Islam
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16. Yunus, F. Ambilan oksigen Bandung; 2015.
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maksimal dan faal paru laki 23. Mondal H, Mishra SP. Effect
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18 17. Setty P, Padmanabha BV, of Clinical and Diagnostic
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Doddamani BR. Correlation Research. 2017; 11(6).17-20.
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Chawla K. Correlation of
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39 Pharmacol. 2005; 49(3): 353-


40 7.
41 20. Nurlim I. Hubungan obesitas
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sentral dengan VO2 maks
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45 fakultas kedokteran
46 universitas Hasanuddin tahun
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2012. Makassar: Fakultas
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49 Kedokteran Universitas
50 Hasanuddin; 2012.
51 21. Ramba Y, Hendrik. Hubungan
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54 max mahasiswa fisioterapi
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56 Kesehatan. 2013; 8(2): 41-54.
57 22. Dewi PK. Hubungan
58 kebugaran jasmani dan lemak
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Table 1. The characteristic study subject
6 Characteristic n %
7 Age (years)
8 1. 26-45 19 38
9 2. 46-65 31 62
10 Gander
11 1. Men 19 38
12 2. Women 31 62
13 BMI
14 1. Underweight 2 4
15 2. Normal 24 48
16 3. Overweight 9 18
17 4. Obesity 15 30
18 Abdominal circumference
19 1. Normal 16 32
20
2. Obesity 34 68
21
Persen Lemak Tubuh
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22
23
1. Normal 13 26
24 2. Obesity 37 74
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26 Table 2. VO2 max distribution of pilgrims
27 VO2 maks n %
28 Low fit 12 24
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29
Moderate fit 31 62
30
31 High fit 7 14
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33 Tabel 3. VO2 max distribution of pilgrims based on age
34 VO2 maks
35
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Age (years) Low fit Moderate fit High fit


36
37
n % n % n %
38 26-45 6 12 12 24 1 2
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39 46-65 1 2 19 38 11 22
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41 Table 4. VO2 max distribution of pilgrims based on gender
42 VO2 maks
43
Gender Low fit Moderate fit High fit
44
45 n % n % n %
46 Men 4 8 11 22 4 8
47 Women 8 16 20 40 3 6
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49 Table 5. VO2 max distribution of pilgrims based on BMI
50 VO2 maks
51
BMI Low fit Moderate fit High fit
52
53 n % n % n %
54 Underweight 0 0 2 4 0 0
55 Normal 4 8 16 32 4 8
56 Overweight 1 2 6 12 2 4
57 Obesity 8 16 6 12 1 2
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60

Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html
Page 11 of 11 Manuscript submitted to editorial office

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3 Table 6. VO2 max distribution of pilgrims based on abdominal circumference
4
VO2 maks
5 Abdominal
6 Low fit Moderate fit High fit
circumference
7 n % N % n %
8 Normal 2 4 9 18 5 10
9 Obesity 10 20 22 44 2 4
10
11
12 Table 7. VO2 max distribution of pilgrims based on body fat percent
13 VO2 maks
14 Body fat percent Low fit Moderate fit High fit
15 n % N % n %
16 Normal 2 4 6 12 5 10
17
Obesity 10 20 25 50 2 4
18
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20 Table 8. The relationship between VO2 max with abdominal circumference of pilgrims
21 VO2 maks
Fo

22 Abdominal Total
Low fit Moderate fit High fit
23 circumference
24 n % N % n % n % p Value
rP

25 Normal 2 4 9 18 5 10 16 100 0,04


26 Obesity 10 20 22 44 2 4 34 100
27
28
ee

29 Table 9. The relationship between VO2 max with body fat percent of pilgrims
30 VO2 maks
Total
31 Body fat percent Low fit Moderate fit High fit
rR

32 n % N % n % n % p Value
33 Normal 2 4 6 12 5 10 13 100 0,013
34
Obesity 10 20 25 50 2 4 37 100
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Georg Thieme Verlag KG. P. O. Box 30 11 20, D-70451 Stuttgart, Germany. http://www.thieme.de/fz/sportsmed/index.html

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