Hematologic Disorders in the Athlete

Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners

OBJECTIVE

To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD).

DESIGN

Multiyear cross-sectional study.

SETTING

One hundred-mile ultramarathon.

PARTICIPANTS

Competing runners were recruited in 2018 and 2019.

ASSESSMENT OF RISK FACTORS

Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only).

MAIN OUTCOME MEASURE

A Triad Cumulative Risk Assessment Score was calculated for each participant.

RESULTS

One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk.

CONCLUSIONS

Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.

Protective Effect of a Cocoa-Enriched Diet on Oxidative Stress Induced by Intensive Acute Exercise in Rats

Intensive acute exercise can induce oxidative stress, leading to muscle damage and immune function impairment. Cocoa diet could prevent this oxidative stress and its consequences on immunity. Our aim was to assess the effect of a cocoa-enriched diet on the reactive oxygen species (ROS) production by peritoneal macrophages, blood immunoglobulin (Ig) levels, leukocyte counts, and the physical performance of rats submitted to an intensive acute exercise, as well as to elucidate the involvement of cocoa fiber in such effects. For this purpose, Wistar rats were fed either a standard diet, i.e., a diet containing 10% cocoa (C10), or a diet containing 5% cocoa fiber (CF) for 25 days. Then, half of the rats of each diet ran on a treadmill until exhaustion, and 16 h later, the samples were obtained. Both C10 and CF diets significantly prevented the increase in ROS production. However, neither the cocoa diet or the cocoa fiber-enriched diet prevented the decrease in serum IgG induced by acute exercise. Therefore, although the cocoa-enriched diet was able to prevent the excessive oxidative stress induced by intensive exercise, this was not enough to avoid the immune function impairment due to exercise.

Different Waters for Different Performances: Can We Imagine Sport-Related Natural Mineral Spring Waters?

Preserving the hydration status means to balance daily fluids and salt losses with gains, where the losses depend on several physiological and environmental factors. Especially for athletes, these losses could be relevant and negatively influence the performance: therefore, their hydro-saline status must be preserved with personalized pre- and rehydration plans all along the performance period. Scientific literature in this field is mainly dedicated to artificial sport drinks. Different territories in most world areas are rich in drinking natural mineral spring waters with saline compositions that reflect their geological origin and that are used for human health (often under medical prescription). However, scarce scientific attention has been dedicated to the use of these waters for athletes. We therefore reviewed the existing literature from the innovative viewpoint of matching spring water mineral compositions with different athletic performances and their hydro-saline requirements.

Hematological and Running Performance Modification of Trained Athletes after Reverse vs. Block Training Periodization

The aim of the present study was to analyze the effect of block (BP) and a reverse training periodization (RP) in the hematological and running performance of amateur trained athletes. Modifications in hematological, aerobic, and anaerobic running performance and countermovement jump before and after twelve weeks of BP vs. RP training programs were analyzed in 16 trained athletes (eight males: 40.0 ± 6.2 years; 179.2 ± 12.8 cm; 73.8 ± 12.2 kg; and eight females: 34.2 ± 4.1 years; 163.4 ± 9.6 cm; 57.0 ± 11.0 kg). A significant decrease in heart rate (HR) at ventilatory threshold (VT1) (p = 0.031; ES = 1.40) was observed in RP without changes in BP. In addition, RP increased significantly VO₂max (p = 0.004; ES = 0.47), speed at VO₂max (p = 0.001; ES = 1.07), HR at VT2 (p < 0.001; ES = 1.32) and VT1 (p = 0.046; ES = 0.57), while BP improved VO₂max (p = 0.004; ES = 0.51), speed at VO₂max (p = 0.016; ES = 0.92), and HR at VT2 (p = 0.023; ES = 0.78). In addition, only RP increased anaerobic performance in a running-based anaerobic sprint test (RAST) (mean sprint: p = 0.009; ES = 0.40, best sprint: p = 0.019; ES = 0.30 and total time: p = 0.009; ES = 0.40). Moreover, both types of training periodization proposed in this study maintained hematological values and efficiently improved jump performance (p = 0.044; ES = 0.6) in RP and p = 0.001; ES = 0.75 in BP). Therefore, twelve weeks of either RP or BP is an effective strategy to increase jump and aerobic running performance maintaining hematological values, but only RP increases anaerobic running performance.

The need for an alternative method to determine intravascular volumes

It is well described that numerous environmental factors, including exercise, modulate plasma volume (PV). These modulations prove problematic when a number of haematological markers are measured as a concentration in blood plasma. A primary example is haemoglobin concentration ([Hb]), a marker of erythropoiesis commonly used within medicine and also used to detect blood doping. Natural changes in PV can confound [Hb] values when a volume change is detected rather than a true change in haemoglobin mass (Hb_mass) (e.g. volume expansion resulting in a [Hb] decrease and pseudo-anemia vs. Hb_mass decline resulting in anaemia). Currently, there is no simple solution to correct for PV shifts, and this has proven problematic when monitoring volumetric health markers in clinical and anti-doping settings. This narrative review explores the influence that PV shifts have on volumetric biomarkers, such as [Hb]. The progressive expansion in PV observed during multi-day endurance events will be summarised, and the observed impact PV variance has on concentration-based markers will be quantified. From this, the need for alternative methods to correct [Hb] for volume fluctuations is highlighted. Available methods for calculating intravascular volumes are then discussed, with a focus on a recently developed approach using a panel of 'volume descriptive' biomarkers from a standard blood test. Finally, the practical applications of this novel PV blood test within both anti-doping and clinical settings will be examined.

The prevalence of anemia in Japanese Universiade athletes, detected with longitudinal preparticipation medical examinations

Background

No reports have evaluated the long-term trends of the prevalence of anemia in Universiade athletes using preparticipation medical examinations (PPMEs). We aimed to investigate the prevalence of anemia among Japanese Universiade athletes, using longitudinal PPMEs.

Methods

In this retrospective, observational study, athletes with published data from official reports of the Japanese delegation of the summer Universiade games between 1977 and 2011 were included, as were similar-aged nonathletes with published health data, extracted from official national reports from the Japanese Ministry of Health, Labour and Welfare. PPME data and national health survey data included blood tests for anemia and the age of each participant. We compared the anemia prevalence in both groups using an unpaired t test.

Results

Anemia prevalence among Universiade athletes decreased by 11.6% over the study period (13.3% in 1977 to 1.7% in 2011). Moreover, anemia prevalence between 1991 and 2011 in the total Universiade athlete population was significantly lower than that in the nonathletic population (mean ± standard deviation: 5.2 ± 2.9% vs 9.8 ± 1.5%, respectively; P = .025). In female Universiade athletes, anemia prevalence between 1977 and 1981 was higher than that in the nonathletic populations (48.1% vs 19.7%, respectively). However, in 2003, this value was lower than that in nonathletic female populations (8.5% vs 19.8%, respectively).

Conclusions

A decrease in anemia prevalence in Japanese Universiade athletes was revealed with longitudinal PPMEs. Hematological parameters should be evaluated longitudinally in athletes to provide continuous performance support throughout the athlete's career.

Comparison of immunohematological profile between endurance- and power-oriented elite athletes

There is general perception that elite athletes are highly susceptible to changes in immunohematological profile. The objective of this study was to compare immunohematological parameters of elite athletes of different aerobic and muscular strength sports and analyze changes over 2 months. Sixteen judoists and 14 swimmers were evaluated 2 months before (M1) and immediately prior to competition (M2). Hemogram and lymphocytes subpopulations were assessed with automatic counter and flow cytometry, respectively. Judoists had higher neutrophils and lower monocytes and eosinophils percentages than swimmers at M1 and M2. At M2 judoists had lower red blood cells (RBC), hemoglobin, and hematocrit than swimmers. At M2 judoists' hematocrit and CD16 decreased while swimmers' hemoglobin and hematocrit increased. In conclusion, neither sports characteristics nor intense training seem to displace the athletes' immunohematological profile out of the clinical range, despite the possibility of occurrence of microlesions that may stimulate production of leukocytes and reduction of RBC in judoists.

Hematological and biochemical markers of iron status in a male, young, physically active population

The aim of this study was to establish reference intervals (RIs) for the hemogram and iron status biomarkers in a physically active population. The study population included male volunteers (n = 150) with an average age of 19 ± 1 years who had participated in a regular and controlled exercise program for four months. Blood samples were collected to determine hematological parameters using a Sysmex XE-5000 analyzer (Sysmex, Kobe, Japan). Iron, total iron-binding capacity (TIBC), transferrin saturation and ferritin, and high-sensitivity C-reactive protein (CRP) concentrations in serum samples were measured using commercial kits (Roche Diagnostics, GmbH, Mannheim, Germany) and a Roche/Hitachi 902 analyzer. The RIs were established using the RefVal program 4.1b. The leucocyte count, TIBC, and CRP and ferritin concentrations exhibited higher RIs compared with those in a nonphysically active population. Thirty volunteers (outliers) were removed from the reference population due to blood abnormalities. Among the outliers, 46% exhibited higher CRP concentrations and lower concentrations of iron and reticulocyte hemoglobin compared with the nonphysically active population (P < 0.001). Our results showed that it is important to establish RIs for certain laboratory parameters in a physically active population, especially for tests related to the inflammatory response and iron metabolism.

Comparison of the hematological profile of elite road cyclists during the 2010 and 2012 GiroBio ten-day stage races and relationships with final ranking

Cycling stage races are strenuous endurance events during which exercise-induced variations in hematological parameters are consistently observed. However, specific literature on such changes is scarce and published data have been derived from small samples of athletes. The aims of this study were: (1) to determine the hematological response to middle-term strenuous endurance; and (2) to determine whether a relationship exists between the athlete-specific hematological profile and final placement in a cycling stage race. The study population was male professional cyclists (n = 253) competing in the 2010 (n = 144) and 2012 (n = 109) GiroBio 10-day stage races. Blood draws taken before the start of the race, at mid-race, and at end-race were performed in strict compliance with academic and anti-doping pre-analytical warnings. Blood chemistry included white blood cell, red blood cell, hemoglobin concentration, hematocrit, mean corpuscular volume (MCV), mean hemoglobin content (MCH), mean corpuscular hemoglobin content (MCHC), platelets, and reticulocyte relative and absolute counts. Compared to baseline values, erythrocyte, hemoglobin, hematocrit, MCHC, platelet and reticulocyte counts were all consistently lower at mid-race, but returned to normal by race-end, while leukocytes were increased in the final phase. MCV increased during both events. MCH increased in the first part to then return to baseline in the 2012 race. The calculated OFF-score consistently decreased in the first half of the race before increasing, but remained lower than the baseline value. The trends of variation in hematological parameters were substantially similar in both events. There was an inverse, albeit weak, relationship between placement and erythrocyte, platelet, hemoglobin, hematocrit and OFF-score values in the 2010, but not in the 2012 race. In conclusion, the data confirm that, in this large series of elite road cyclists, the strenuous effort a rider sustains during a stage race induces appreciable changes in the hematological profile.

Reticulocytes in sports medicine: an update

Reticulocytes are young red blood cells which develop from erythroblasts and circulate in the bloodstream for about 1-4 days before maturing into erythrocytes. With the introduction of reticulocyte count in equations and statistical models for detecting suspected blood doping, its application to sports medicine has attracted growing interest in reticulocyte behavior during training and competition seasons in athletes and experimental blood doping treatment in healthy volunteers. An update on recent publications is therefore needed to improve the interpretation of reticulocyte analysis and its variability in sportsmen. Reticulocyte count constitutes a robust parameter during the preanalytical phase, but cell stability can be assured only if blood samples are kept at constantly cold temperatures (4 degrees C) and test results will differ depending on the blood analyzer system used. Marked intraindividual variability is the principal finding to be evaluated when exercise-induced changes are observed or illicit procedures suspected. Furthermore, reticulocyte variability is greater than that of other hematological parameters such as hemoglobin or hematocrit. Ideally, any variation should be interpreted against long-term time series for the individual athlete: values obtained from large athlete cohorts ought to be used only for extrapolating outliers that deserve further examination. Reticulocyte distribution in athletes is similar to that found in the general population, and a gender effect in some sports disciplines or selected athlete groups may be seen. Reticulocyte variability is strongly influenced by seasonal factors linked to training and competition schedules and by the type of sports discipline. Published experimental data have confirmed the high sensitivity of reticulocyte analysis in identifying abnormal bone marrow stimulation by either erythropoietin administration or blood withdrawal and reinfusion.

Haematological changes in elite kayakers during a training season

This study monitored haematological markers in response to training load in elite kayakers during a training season. The sample comprised eight elite kayakers aged 22 ± 4.2 years with a 77.2 ± 6.7 kg body mass and a 177.5 ± 5.6 cm stature. The initial [Formula: see text]O(2max) was 61.2 ± 5.5 mL·kg(-1)·min(-1). The control group consisted of six healthy males, aged 18.6 ± 1.1 years, with an 81.3 ± 13.8 kg body mass and a 171.9 ± 4.5 cm stature. Blood samples were collected at the beginning of the training season after an off-training period of six weeks (t(0)), at the 11th week after the application of high training volumes (t(1)), at the 26th week after an intense training cycle (t(2)), and at the 31st week at the end of a tapering phase (t(3)). Differences between time points were detected using ANOVA and the Bonferroni post hoc test. Significant changes were found after the intense training cycle (t(2)), lymphocytes decreased while haemoglobin, mean corpuscular volume, mean corposcular haemoglobin, mean concentration of corpuscular hemoglobin concentration, platelets distribution width, and red blood cell distribution width values increased when compared with baseline values. At t(3), a reduction in monocyte numbers and an increase in mean platelet volume compared with baseline values were seen. By reducing the volume and intensity of training, many variables returned to values close to those at baseline. Although many athletes had accumulated responses over time due to training, they still suffered transient changes that appear to be influenced by training load. Haemorheology monitoring may help detect health risks, especially during times of intensified training.

Blood doping and its detection

Hemoglobin mass is a key factor for maximal exercise capacity. Some athletes apply prohibited techniques and substances with intent to increase hemoglobin mass and physical performance, and this is often difficult to prove directly. Autologous red blood cell transfusion cannot be traced on reinfusion, and also recombinant erythropoietic proteins are detectable only within a certain timeframe. Novel erythropoietic substances, such as mimetics of erythropoietin (Epo) and activators of the Epo gene, may soon enter the sports scene. In addition, Epo gene transfer maneuvers are imaginable. Effective since December 2009, the World Anti-Doping Agency has therefore implemented “Athlete Biologic Passport Operating Guidelines,” which are based on the monitoring of several parameters for mature red blood cells and reticulocytes. Blood doping may be assumed, when these parameters change in a nonphysiologic way. Hematologists should be familiar with blood doping practices as they may play an important role in evaluating blood profiles of athletes with respect to manipulations, as contrasted with the established diagnosis of clinical disorders and genetic variations.

Seasonal variations of haematological parameters in athletes

The influence of training and competition workloads is crucial for evaluation of longitudinal haematological data in athletes. There are only a few papers on the variation of haematological parameters during long-lasting periods and, especially, during an entire competitive season. We summarized that some haematological parameters can be influenced by long-term training and competition periods. Haemoglobin (Hb) and haematocrit (Ht) are decreased during the more intense periods of training, throughout the season. In different sport disciplines, the decline of Hb ranges from 3 to 8% during the competition season, while the range of reticulocytes (Ret%) varies from 5 to 21%. Reticulocytes are also decreased after long periods of training and competitions, but their variation is not necessarily associated with that of Hb. The qualitative variations (trend of modifications) of haematological parameters are roughly independent of the sport discipline, but quantitatively (amount of modifications) dependent on sport discipline. The modifications are more evident in cycling, running, swimming than they are in football and rugby. The variations of haematological parameters within the same sport discipline are qualitatively concordant and quantitatively different among separate but consecutive competitive seasons. These findings are described in aerobic and team sports sportsmen. The definition of reliable reference ranges in sportsmen would only be possible by following the best laboratory practices. For antidoping purposes more studies investigating haematological modifications during the season are advisable.

Iron deficiency in women and its potential impact on military effectiveness

Iron deficiency is recognized as a significant health concern for women of childbearing age in the civilian population. In the military, most women are of childbearing age. Not only do they carry the normal risks for developing iron deficiency, but they also have the added threats of possible decreased choices of food high in iron content, increased physical activity, and weight loss. This can put these women at risk for decreased energy efficiency and impaired cognitive performance. This article describes the pathophysiology of iron deficiency and iron deficiency anemia, the consequences of each, and the need to routinely screen military women for iron depletion.

Calcium supplementation and 4-week exercise on blood parameters of athletes at rest and exhaustion

In the present study, experiments were designed to investigate if supplementation with calcium during 4 weeks had an effect on blood parameters in sedentary male athletes at rest and exhaustion. Thirty healthy subjects of ages ranging from 18 to 22 years were included in the study. The subjects were separated into three groups, as follows: Group 1 consisted sedentary athletes receiving 35 mg/kg/day calcium gluconate. Group 2 included subjects equally supplemented with calcium training 90 min/day for 5 days/week. Group 3 were subject to the same exercise regime but did not receive calcium supplements. Blood parameters were determined in the experimental subjects at rest and after exhaustion. The leukocyte count (WBC) of athletes in groups 2 and 3 were significantly higher at exhaustion (p < 0.05). There were no significant differences in the WBC of the two supplemented groups. The erythrocyte count (RBC) was increased in the supplemented athletes after training (p < 0.05), but hemoglobin, hematocrit, and thrombocyte levels remained unchanged. The mean corpuscular volume increased in the calcium-supplemented group at rest (p < 0.05). These results suggest that calcium supplementation only causes increases in white and red blood cell counts in athletes after exhaustion while other hematological parameters remain unchanged.

Reticulocytes in sports medicine

Reticulocytes are the transitional cells from erythroblasts to mature erythrocytes. Reticulocytes are present in blood for a period of 1-4 days and can be recognized by staining with supravital dyes, such as new methylene blue, or fluorescent markers, which couple residual nucleic acid molecules, a hallmark of the immature forms of erythrocytes. Although reticulocytes could be counted through a microscope (there is a standard of International Committee for Standardisation in Haematology for manual counting), this method is reported to be time consuming, inaccurate and imprecise. The integration of the reticulocyte count in automated haematology systems allowed the widespread use of these parameters, although the lack of calibration material and different markers, technologies and software used in automated systems could engender discrepancies among data obtained from different analytical systems.The importance of reticulocytes in sports medicine derives from their sensitivity, the highest among haematology parameters, in identifying the bone marrow stimulation, especially when recombinant human erythropoietin is fraudulently used. Automated systems are also able to supply information on volume, density and the haemoglobin content of reticulocytes. Some of the related parameters are also used in algorithms for identifying abnormal stimulation of bone marrow as reticulocytes haematocrit. The pre-analytical variability of reticulocytes (transportation, storage, biological variability) should be taken into account in sports medicine also. Reticulocytes remain stable for almost 24 hours at 4 degrees C from blood drawing, they are affected by transportation, and biological variability is not high in general. It could be remarked, however, that the intra-individual variability is high when compared with other haematological parameters such as haemoglobin and haematocrit. The intervals of data reported in athletes are very similar to reference intervals characterizing the general population.The reticulocyte count shows some modifications after training and during the competition season. The variability induced by exercise cannot be overlooked since the so-called haematological passport, a personal athlete's document in which haemoglobin and other parameters are registered, may be introduced by sports federations. Exposure to naturally high altitude and 'living high-training low' programmes determined contentious results on reticulocytes. Simulated high altitude induced by intermittent hypobaric hypoxia does not modify reticulocytes, despite an increase in erythropoietin serum concentration. The variability among athletes competing in different sport disciplines is apparently limited. The knowledge of the behaviour of reticulocytes in training and competitions is crucial for defining their role in an antidoping control context. It is important for sport physicians and clinical pathologists to know the reticulocyte variability in the general population and in athletes, the pre-analytical warnings, the different methodologies for counting reticulocytes and the derived parameters automatically available, and, finally, the possible influence of training, competitions, type of sport and altitude.

Medical conditions affecting sports participation

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate to the child's condition. This report updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.

Indicators of iron status in elite soccer players during the sports season

The main aim of the study was to investigate the changes of hematologic status in elite soccer players throughout a competitive season. Study was conducted with 35 male professional soccer players and the measurements were collected at the start of the conditioning period, at the start of the season, in the mid-season and at the end of the season. Blood was drawn from an antecubital vein for a complete blood count, serum iron, and transferrin and ferritin levels. We found significantly higher hematocrit at preseason assessment as compared with other sampling periods (P < 0.05). No other differences were found between any of the hematologic variables during the study. The lowest hemoglobin level, mean corpuscular volume (MCV), serum iron, ferritin and transferrin encountered in the study were Hb of 11.2 g/dl, MCV of 77.9 fl, serum iron of 34 microg/dl, ferritin of 15.1 microg/l, transferrin of 224 microg/dl in a 20-year-old soccer player at the start of the season. The variability of the iron status indicators in elite soccer players seems to be stable and poorly related to training phase during sports season.

Hemoglobin concentrations in 358 apparently healthy 80-year-old Danish men and women. Should the reference interval be adjusted for age?

BACKGROUND AND AIMS

In elderly Danes, reference intervals for hemoglobin (Hb) concentrations are derived from younger population groups. The aim was to examine reference intervals for Hb and cut-off limits for anemia by application of criteria for normality to a representative population of 80-year-olds.

METHODS

Participants in this epidemiological health survey cohort were 358 subjects (171 men) 80 years of age. A dietary survey was performed in 232 subjects. Blood samples included Hb, red cell indices, serum ferritin, serum C-reactive protein, renal and hepatic function tests. Normality criteria for Hb were: 1) values in all participants; 2) values in apparently healthy subjects; 3) values in 10-year survivors. Hb was compared with muscle strength, physical performance and diet.

RESULTS

In the entire series, median Hb was 140 g/L, 5-95 percentile 116-160 g/L in men, and 131 g/L, 5-95 percentile 114-147 g/L in women (p<0.001). The prevalence of anemia, as defined by World Health Organization (WHO) criteria, was 18% in men and 17% in women. Apparently healthy iron-replete men (n=129) and women (n=141) had median Hb of 141 g/L and 131 g/L. Median Hb levels were higher in 10-year surviving men (143 g/L) than in deceased men (139 g/L), whereas surviving and deceased women had similar median Hb (131 g/L). Hb and muscle strength were significantly correlated. Subjects with physical performance score >or=20 had a lower frequency of anemia. There was no correlation between Hb and dietary or supplemental iron intake. In men, Hb was correlated to meat consumption.

CONCLUSIONS

WHO decision limits for anemia should not be lowered in 80-year-old subjects. "Optimal" Hb concentrations with respect to survival appear to be at least 140 g/L in men and 131 g/L in women. Further research should evaluate whether not only treating anemia, but also increasing Hb by using erythropoietin and hematinics, may improve functional status and survival in the elderly.

Heat-related illness in athletes

Heat stroke in athletes is entirely preventable. Exertional heat illness is generally the result of increased heat production and impaired dissipation of heat. It should be treated aggressively to avoid life-threatening complications. The continuum of heat illness includes mild disease (heat edema, heat rash, heat cramps, heat syncope), heat exhaustion, and the most severe form, potentially life-threatening heat stroke. Heat exhaustion typically presents with dizziness, malaise, nausea, and vomiting, or excessive fatigue with accompanying mild temperature elevations. The condition can progress to heat stroke without treatment. Heat stroke is the most severe form of heat illness and is characterized by core temperature >104 degrees F with mental status changes. Recognition of an athlete with heat illness in its early stages and initiation of treatment will prevent morbidity and mortality from heat stroke. Risk factors for heat illness include dehydration, obesity, concurrent febrile illness, alcohol consumption, extremes of age, sickle cell trait, and supplement use. Proper education of coaches and athletes, identification of high-risk athletes, concentration on preventative hydration, acclimatization techniques, and appropriate monitoring of athletes for heat-related events are important ways to prevent heat stroke. Treatment of heat illness focuses on rapid cooling. Heat illness is commonly seen by sideline medical staff, especially during the late spring and summer months when temperature and humidity are high. This review presents a comprehensive list of heat illnesses with a focus on sideline treatments and prevention of heat illness for the team medical staff.

Effects of magnesium supplementation on blood parameters of athletes at rest and after exercise

The effects of magnesium supplementation on blood parameters were studied during a period of 4 wk in adult tae-kwon-do athletes at rest and exhaustion. Thirty healthy subjects of ages ranging in age from 18 to 22 yr were included in the study. The subjects were separated into three groups, as follows: Group 1 consisted of subjects who did not train receiving 10 mg/kg/d magnesium. Group 2 included subjects equally supplemented with magnesium and exercising 90-120 min/d for 5 d/wk. Group 3 were subject to the same exercise regime but did not receive magnesium supplements. The leukocyte count (WBC) was significantly higher in groups 1 and 2 than in the subjects who did not receive any supplements (p < 0.05). There were no significant differences in the WBC of the two groups under magnesium supplementation. The erythrocyte, hemoglobin, and trombocyte levels were significantly increased in all groups (p < 0.05), but the hematocrit levels did not show any differences between the groups although they were increased after supplementation and exercise. These results suggest that magnesium supplementation positively influences the performance of training athletes by increasing erythrocyte and hemoglobin levels.