The influence of sleep and training load on illness in nationally competitive male Australian Football athletes: A cohort study over one season

Sleep and Sport Performance

SUMMARY

Elite athletes and coaches believe sleep is the most important recovery strategy and widely consider it critical to optimal performance. Despite this perceived importance, there are numerous circumstances that can reduce sleep quantity and quality in athletic populations. Because of the effects of sleep loss on various physical, neurophysiological, and cognitive parameters, such perturbations can have consequences for performance and recovery outcomes. Although peer-reviewed literature examining the interaction between sleep, performance, and recovery in athletes is increasing, understanding of these issues remains equivocal. Perhaps most pertinently, the effect of sleep on sport performance does not align with a one-size-fits-all approach and rather depends on numerous factors such as type of sport, scheduling, time of the season, and the intraindividual requirements for sleep. The relationship between brain plasticity and memory, which in turn can influence learning processes and long-term memory consolidation, suggests that sleep may play an important role in learning new skills and tactics for both elite and developing athletes. The aim of this special issue review was to analyze the evidence of sleep loss on sport performance and recovery, with a specific focus on elite athletes. An assessment of these sleep-compromising situations that elite athletes may face during a typical season and practical considerations for alleviating these issues is also provided to further the understanding for medical professionals, scientists, and applied sporting practitioners alike.

Intensified Olympic Preparation: Sleep and Training-Related Hormonal and Immune Responses in Water Polo

PURPOSE

To investigate whether sleeping activity, hormonal responses, and wellness are altered in elite water polo players during their preparation toward the Tokyo Olympics.

METHODS

Eight elite-level water polo players participated in 3 consecutive training phases: (1) before the commencement of a residential-based conditioning camp (PRE-CAMP; 3 d), (2) residential-based conditioning camp (5 d), and (3) a congested period of training and competition (POST-CAMP; 8 d). Nocturnal sleep was monitored for 14 consecutive days in PRE-CAMP (2 d), CAMP (5 d), and POST-CAMP (7 d). Postawakening salivary cortisol, immunoglobulin-A, and subjective wellness were measured during PRE-CAMP, CAMP, and POST-CAMP, and internal training/match load (ITL) was calculated daily. The averaged values for dependent variables were compared among training phases and analyzed using linear mixed models.

RESULTS

At CAMP compared with PRE-CAMP, ITL was higher (P < .01), and sleep onset and offset were earlier (P < .01). At this period, sleep interruptions and salivary cortisol were higher (P < .01, d = 1.6, d = 1.9, respectively), and subjective wellness was worsened (P < .01, d = 1.3). At POST-CAMP, the reduction of workload was followed by increased sleep efficiency, reduced sleep interruptions, and moderately affected salivary cortisol, yet overall wellness remained unaltered. In POST-CAMP, 2 of the players demonstrated severe symptoms of illness.

CONCLUSIONS

At the highest level of the sport and prior to the Olympics, large increments in workload during a training camp induced meaningful sleep interruptions and salivary cortisol increases, both of which were reversed at POST-CAMP. We suggest that the increased workload alongside the inadequate recovery affects sleep patterns and may increase the risk of infection.

Sleep and Performance in Professional Athletes

Purpose of Review

Sleep is an essential human behavior that plays a key role in proper biopsychosocial development as well as short- and long-term biological, physical, psychological, and cognitive health. Sleep plays a key role in athletic performance, influencing an athlete's ability to train, recover, and perform, as well as their overall wellness. Over the recent decade, the awareness of sleep's import has penetrated just about every professional sport domain. The purpose of the review was to identify and synthesize the literature published within the past 5 years (2018-2022) that relates to sleep and performance in professional athletes. Literature related to nonprofessional, high-level athletes (e.g., collegiate; Olympic) was omitted as well as those associated with non-traditional professional sports (e.g., eSports).

Recent Findings

Results from 38 articles were incorporated into this review, which covered (1) the sleep's role in the training, physical injury prevention and recovery, competitive performance, and mental health of professional athletes, (2) common sleep problems and disorders in professional athletes, and (3) the impact of unique challenges from training, travel, competition, and other factors on sleep health. Additionally, we provide an orientation to utilized strategies and interventions to assist with sleep health in professional athletes, as well as conclude with a commentary on critical steps forward.

Summary

Sleep plays a critically important role in the training, recovery, performance, and overall wellness of professional athletes. Professional athletes are vulnerable to a variety of sleep-related problems and disorders, due to unique factors related to training, travel, and competition, among other factors. Improved, standardized research methodology and partnerships between professional athletes, coaches, teams, and organizations and researchers are necessary to advance the knowledge of sleep and performance in professional athletes, including identifying sport-specific differences and variation across individual characteristics, as well as developing individualizable, dynamic, and appropriate interventions for improving sleep health among professional athletes.

Upper respiratory tract symptom risk in elite field hockey players during a dry run for the Tokyo Olympics

ABSTRACTThe primary aim of this study was to examine if biomarker and/or self-reported data could predict upper respiratory tract symptom (URTS) risk in elite field hockey players. The secondary aim was to investigate the effect of the additional stressor 'repeated heat exposure' on measures of thermoregulation and immunity. A prospective cohort repeated measures study design was used to collect URTS, household illness, self-reported wellness, biomarker and thermoregulatory data from elite male field hockey players (n = 19), during an 8-week training and competition period that simulated the preparatory and competition phases of the 2020 Tokyo Olympics. Heat response testing (HRT) was performed at the beginning of the study period, following heat acclimation (HA) and following an intensified competition period (ICP) played in hot and humid conditions (27-37°C and 53-80% relative humidity). Univariate frailty analysis demonstrated that illness in players' households (Hazard ratio (HR: 4.90; p < 0.001)) and self-reported stress (HR: 0.63; p = 0.043) predicted players' risk for URTS. Additionally, low baseline resting salivary secretory immunoglobulin A (SIgA) concentration predicted players' "potential" URTS risk (p = 0.021). The additional stressor "repeated heat exposure" was found to facilitate partial thermoregulatory adaptation without attenuating resting immune functions. In conclusion, lifestyle and behavioural factors (i.e. household illness and stress) influenced players risk for URTS more so than sport-related stressors. Furthermore, repeated heat exposure did not appear to compromise players resting immunity. To assess athletes' risk for URTS, baseline screening of SIgA concentration and regular monitoring of self-reported lifestyle and behavioural data are recommended.

Various Workload Models and the Preseason Are Associated With Injuries in Professional Female Cyclists

PURPOSE

To determine if workload and seasonal periods (preseason vs in season) are associated with the incidence of injuries and illnesses in female professional cyclists.

METHODS

Session rating of perceived exertion was used to quantify internal workload and was collected from 15 professional female cyclists, from 33 athlete seasons. One week (acute) workload, 4 weeks (chronic) workload, and 3 acute:chronic workload models were analyzed. Two workload models are based on moving averages of the ratios, the acute:chronic workload ratio (ACWR), and the ACWR uncoupled (ACWRuncoup). The difference between both is the chronic load; in ACWR, the acute load is part of the chronic load, and in ACWRuncoup, the acute and chronic load are uncoupled. The third workload model is based on exponentially weighted moving averages of the ratios. In addition, the athlete season is divided into the preseason and in season.

RESULTS

Generalized estimating equations analysis was used to assess the associations between the workload ratios and the occurrence of injuries and illnesses. High values of acute workload (P = .048), ACWR (P = .02), ACWRuncoup (P = .02), exponentially weighted moving averages of the ratios (P = .01), and the in season (P = .0001) are significantly associated with the occurrence of injury. No significant associations were found between the workload models, the seasonal periods, and the occurrence of illnesses.

CONCLUSIONS

These findings suggest the importance of monitoring workload and workload ratios in female professional cyclists to lower the risk of injuries and therefore improve their performances. Furthermore, these results indicate that, in the preseason, additional stressors occur, which could lead to an increased risk of injuries.

Evolution of Physical Demands of Australian Football League Matches from 2005 to 2017: A Systematic Review and Meta-Regression

BACKGROUND

There is extensive research investigating the match demands of players in the Australian Football League (AFL).

OBJECTIVE

This systematic literature review and meta-regression sought to analyse the evolution of in-game demands in AFL matches from 2005 to 2017, focusing on the relationship between volume and intensity.

METHODS

A systematic search of Ovid MEDLINE, Embase, Emcare, Scopus, SPORTDiscus, and Cochrane Library databases was conducted. Included studies examined the physical demands of AFL matches utilising global positioning system (GPS) technology. Meta-regression analysed the shift in reported volume (total distance and total match time) and intensity (metres per minute [m.min^-1], sprint duration and acceleration) metrics for overall changes, across quarters and positional groups (forwards, nomadics and defenders) from 2005 to 2017 inclusive and for each year between 2005 and 2007, 2007 and 2010, 2010 and 2012, and 2012 and 2015/2017 breakpoints.

RESULTS

Distance (p = 0.094), m.min^-1 (p = 0.494), match time (p = 0.591), time over 18 km·h^-1 (p = 0.271), and number of accelerations greater than 4 km·h^-1 (p = 0.498) and 10 km·h^-1 (p = 0.335) in 1 s did not change from 2005 to 2017. From 2005 to 2007 volume decreased (- 6.10 min of match time; p = 0.010) and intensity increased (6.8 m.min^-1 increase; p = 0.023). Volume and intensity increased from 2007 to 2010, evidenced by increases in total distance (302 m; p = 0.039), time over 18 km·h^-1 (0.31 min; p = 0.005), and number of accelerations greater than 4 km·h^-1 (41.1; p = 0.004) and 10 km·h^-1 (3.6; p = 0.005) in 1 s. From 2010 to 2012, intensity decreased, evidenced by reductions in metres per minute (- 4.3; p = 0.022), time over 18 km·h^-1 (- 0.93 min; p < 0.001), and number of accelerations greater than 4 km·h^-1 (- 104.4; p < 0.001) and 10 km·h^-1 (- 8.3; p < 0.001) in 1 s, whilst volume stabilised with no changes in distance (p = 0.068) and match time (p = 0.443). From 2012 to 2015/2017 volume remained stable and intensity increased with time over 18 km·h^-1 (0.27 min; p = 0.008) and number of accelerations greater than 4 km·h^-1 (31.6; p = 0.016) in 1 s increasing.

CONCLUSIONS

Changes in volume and intensity of AFL match demands are defined by discrete periods from 2007 to 2010 and 2010 to 2012. The interaction of rule and interpretation changes and coaching strategies play a major role in these evolutionary changes. In turn, modified game styles impact player game demands, training, and selection priorities. Standardisation and uniformity of GPS data reporting is recommended due to inconsistencies in the literature.

Predictors of upper respiratory tract symptom risk: Differences between elite rugby union and league players

This study examined possible predictors of upper respiratory tract symptom (URTS) episodes in elite rugby union and league players (n = 51) during intensive pre-season training. Baseline saliva and blood samples were collected in the first week of pre-season training for analysis of salivary secretory immunoglobulin A (SIgA) and cytomegalovirus. Thereafter, SIgA, URTS, internal training load and self-reported wellness data were repeatedly measured throughout a 10-week pre-season training period. Univariate frailty model analysis, which included 502 observations, was performed for each rugby code for the following independent predictor variables: SIgA concentration, internal training load, total wellness, sleep quantity, sleep quality and stress. Rugby union and league players experienced a similar number of URTS episodes; however, predictors of URTS episodes differed between the codes. No biomarkers or self-reported measures significantly predicted URTS risk in rugby union players, while reductions in self-reported total wellness (HR: 0.731, p = 0.004) and sleep quality (HR: 0.345, p = 0.001) predicted increased URTS risk in rugby league players. The findings from this study highlight that factors influencing URTS risk are perhaps sport specific and this may be attributed to different sporting demands and/or different management of players by team-practitioners.

Illness and infection in elite full-contact football-code sports: A systematic review

OBJECTIVES

Full-contact football-code team sports offer a unique environment for illness risk. During training and match-play, players are exposed to high-intensity collisions which may result in skin-on-skin abrasions and transfer of bodily fluids. Understanding the incidence of all illnesses and infections and what impact they cause to time-loss from training and competition is important to improve athlete care within these sports. This review aimed to systematically report, quantify and compare the type, incidence, prevalence and count of illnesses across full-contact football-code team sports.

DESIGN/METHODS

A systematic search of Cochrane Library, MEDLINE, SPORTDiscus, PsycINFO and CINAHL electronic databases was performed from inception to October 2019; keywords relating to illness, athletes and epidemiology were used. Studies were excluded if they did not quantify illness or infection, involve elite athletes, investigate full-contact football-code sports or were review articles.

RESULTS

Twenty-eight studies met the eligibility criteria. Five different football-codes were reported: American football (n=10), Australian rules football (n=3), rugby league (n=2), rugby sevens (n=3) and rugby union (n=9). One multi-sport study included both American football and rugby union. Full-contact football-code athletes are most commonly affected by respiratory system illnesses. There is a distinct lack of consensus of illness monitoring methodology.

CONCLUSIONS

Full-contact football-code team sport athletes are most commonly affected by respiratory system illnesses. Due to various monitoring methodologies, illness incidence could only be compared between studies that used matching incidence exposure measures. High-quality illness surveillance data collection is an essential component to undertake effective and targeted illness prevention in athletes.

Household illness is the strongest predictor of upper respiratory tract symptom risk in elite rugby union players

OBJECTIVES

To identify periods of increased risk for upper respiratory tract symptom (URTS) episodes, and examine whether biomarkers and/or self-reported lifestyle and wellness data can predict URTS risk in elite rugby union players.

DESIGN

Prospective, longitudinal and repeated-measures study.

METHODS

Salivary secretory immunoglobulin A (SIgA), salivary cortisol, URTS, internal training load and self-reported lifestyle and wellness data including household illness, stress, mood, fatigue, muscle soreness and sleep quality were repeatedly measured in elite Southern hemisphere rugby union players (n=28) throughout a season. Univariate frailty model analysis, which included 495 observations, was used to determine predictors of URTS risk.

RESULTS

Surprisingly, the highest incidence of URTS occurred after rest weeks, namely the Christmas break and bye weeks (i.e., no scheduled trainings or matches); whereas URTS risk was reduced during weeks involving international travel (Hazard ratio (HR): 0.43, p<0.001)). Household illness was the strongest predictor of URTS risk; players were almost three-fold more at risk for an URTS episode when illness in the household was present (HR: 2.90, p=0.002). A non-significant, but potentially important trend for an inverse association between SIgA concentration and URTS incidence was also observed (HR: 0.99, p=0.070).

CONCLUSIONS

Rest weeks were identified as periods of increased risk for URTS; while international travel did not appear to increase players risk for URTS. Incidence of household illness and SIgA concentration independently predicted URTS risk, with household illness being the strongest predictor. These findings can assist practitioners monitoring and management of athletes to potentially reduce URTS risk.