The well-documented pattern of elevated serum enzyme activity (ESEA) data after a single bout of unaccustomed exercise can very easily be modeled using a biexponential curve. However, the changed pattern of ESEA after a second exercise bout, or after a period of conditioning or during repetitive training, demonstrates that exercise-induced adaptations have been taking place. The mechanism for this is unclear. One plausible explanatory hypothesis is that within the pool of muscle fibers, some fibers are stress susceptible or weak, and the pool becomes diminished as a result of damage induced by earlier exercise. Repair of the muscle damage takes place during the period after exercise but may be incomplete at the time of a subsequent exercise bout, in which case ESEA amplitude is reduced. Frequently repeated bouts may lead to chronic ESEA. These ideas are developed, both mathematically and graphically, by means of a compartment model approach. In so doing, the model explains documented patterns of ESEA response to single and multiple exercise bouts, both closely and widely spaced. Predictions are possible using the model, in particular the previously unreported baseline overshoot (reduction below resting levels) in serum enzyme activity occurring beyond 82 h after very severe exercise. Some directions for experimentation to test the validity of the model are suggested.

American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC.