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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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2
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Ušaj A, Lihteneger Vidmajer J, Lojen S. Recovery after Running an "Everesting" Mountain Ultramarathon. Life (Basel) 2023; 13:1946. [PMID: 37895328 PMCID: PMC10607996 DOI: 10.3390/life13101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Blood markers of muscle microdamage and systemic inflammation do not adequately explain the reduced performance observed over a prolonged recovery after running a mountain ultramarathon. This case study aimed to determine whether the reduced performance after the Everesting mountain ultramarathon can be further assessed by considering cardiorespiratory and metabolic alterations determined via repeated incremental and continuous running tests. A single runner (age: 24 years, BM: 70 kg, BMI: 22, Vo2peak: 74 mL∙min-1∙kg-1) was observed over a preparatory period of two months with a one-month recovery period. The Everesting consisted of nine ascents and descents of 9349 vertical metres completed in 18:22 (h:min). During the first phase of the recovery, enhanced peak creatine kinase (800%) and C-reactive protein (44%) levels explained the decreased performance. In contrast, decreased performance during the second, longer phase was associated with a decreased lactate threshold and Vo2 (21% and 17%, respectively), as well as an increased energetic cost of running (15%) and higher endogenous carbohydrate oxidation rates (87%), lactate concentrations (170%) and respiratory muscle fatigue sensations that remained elevated for up to one month. These alterations may represent characteristics that can explain the second phase of the recovery process after Everesting.
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Affiliation(s)
- Anton Ušaj
- Laboratory of Biodynamics, Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Jon Lihteneger Vidmajer
- Laboratory of Biodynamics, Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Sonja Lojen
- Department of Environmental Sciences, Institute Jožef Stefan, Jamova 39, 1000 Ljubljana, Slovenia;
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3
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Martínez-Noguera FJ, Alcaraz PE, Ortolano-Ríos R, Marín-Pagán C. One Season in Professional Cycling Is Enough to Negatively Affect Bone Health. Nutrients 2023; 15:3632. [PMID: 37630821 PMCID: PMC10458969 DOI: 10.3390/nu15163632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Cycling is a very popular sport worldwide, and several studies have already indicated that cycling at various levels has a negative impact on bone health. This is of concern to both performance and health managers of many cycling teams at different levels because of its economic and social impact. Based on the scientific literature, we hypothesize that a single season at the professional level can negatively affect bone health status. The aim of this study was to assess how professional cycling affects bone health markers after one season. Densitometry was used to measure the bone mineral density (BMD), bone mineral content (BMC), bone area (BA), fat mass (FM), fat-free mass (FFM), T-score and Z-score in professional cyclists after one season. After one season at the professional level, cyclists' BMD decreased significantly in the legs, trunk, ribs and pelvis (p ≤ 0.05). BMC decreased in the arms and spine (p ≤ 0.05). BA decreased significantly in the arms and spine (p ≤ 0.05). In addition, a significant decrease in Z-score (p ≤ 0.05) and a decreasing trend in T-score and total BMD (p = 0.06) were observed. One season of professional cycling is enough to negatively affect bone health status.
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Affiliation(s)
- Francisco Javier Martínez-Noguera
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
| | - Pedro E. Alcaraz
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
| | - Raquel Ortolano-Ríos
- Sports Physiology Department, Faculty of Health Sciences, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain;
| | - Cristian Marín-Pagán
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
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4
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Cupka M, Sedliak M. Hungry runners - low energy availability in male endurance athletes and its impact on performance and testosterone: mini-review. Eur J Transl Myol 2023. [PMID: 37052052 PMCID: PMC10388605 DOI: 10.4081/ejtm.2023.11104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
Low Energy Availability (LEA) arises from the inability to cover energy needs and requirements of training or normal physiological functions. This value differs from the energy balance, which takes into account the total daily energy intake compared to all the energy expended, regardless of the amount of fat-free mass. Insufficient energy consumption affects recovery, adaptation processes, increases the risk of injury or illness, so all of this can negatively affect performance. This mini-review is written on research articles in Pubmed database related to LEA in endurance-trained men and its impact on performance and testosterone. This article also clarifies the prevalence of LEA in male endurance athletes and its correlation to Relative Energy Deficiency in Sports (RED-S). LEA occurs in male endurance athletes and correlates with decreased testosterone levels, decreased bone density and also Resting Metabolic Rate. In endurance-trained men, there is great potential for the negative consequences of low energy availability. It can also be said that there are possibilities for primary screening, so we recommend regular check-ups of blood markers, body structure and keeping not only training but also dietary records, which can increase awareness of an adequate energy balance.
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Affiliation(s)
- Martin Cupka
- Comenius University in Bratislava, Faculty of Physical Education and Sport, Department of Biological and Medical Sciences, Bratislava.
| | - Milan Sedliak
- Comenius University in Bratislava, Faculty of Physical Education and Sport, Department of Biological and Medical Sciences, Bratislava.
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5
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Grzędzicka J, Dąbrowska I, Malin K, Witkowska-Piłaszewicz O. Exercise-related changes in the anabolic index (testosterone to cortisol ratio) and serum amyloid A concentration in endurance and racehorses at different fitness levels. Front Vet Sci 2023; 10:1148990. [PMID: 37138908 PMCID: PMC10150884 DOI: 10.3389/fvets.2023.1148990] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Increased training loads in both human and equine athletes are generally implemented to improve their physical performance. These loads are tolerated only within appropriate training periodization with regard to recovery time. Otherwise, training overload causes failure in the systemic adaptation, which at first leads to overreaching, and progressively to overtraining syndrome (OTS). Exercise endocrinology, and anabolic/catabolic balance as an indicator of athlete performance status and OTS has continued to attract attention. In human medicine, changes in testosterone and cortisol levels, as well as the testosterone to cortisol ratio (T/C; anabolic index), are suggested to be sensitive stress markers. However, there is a lack of research investigating these parameters for use in equine sports medicine. The aim of the study was to investigate the differences in testosterone, cortisol, and T/C in response to a single training session in two types of equine sports: endurance and race, together with serum amyloid A (SAA), the main acute phase response indicator of physical effort, and the overall health status in horses. Two groups of horses were enrolled in the study: endurance (n = 12) and racehorses (n = 32) of different fitness level. Blood samples were obtained before and after the exercise. On average, T increased 2.5 times after the race training in experienced racehorses and dropped in endurance horses regardless the fitness level (p < 0.05). In endurance horses, a decrease in T/C occurred after training in inexperienced horses (p < 0.05). In racehorses, a T/C decrease occurred in the inexperienced group (p < 0.05) and an increase in the experienced (p < 0.01). In conclusion, T/C ratio was found to be a potentially reliable indicator of fitness status especially in racing horses. These findings provide insight into the physiological response of the horses to different types of exercise and the potential use of hormone levels as markers of performance and adaptation.
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Tidmas V, Brazier J, Bottoms L, Muniz D, Desai T, Hawkins J, Sridharan S, Farrington K. Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16887. [PMID: 36554767 PMCID: PMC9779673 DOI: 10.3390/ijerph192416887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Increasingly popular, ultra-endurance participation exposes athletes to extremely high levels of functional and structural damage. Ultra-endurance athletes commonly develop acute kidney injury (AKI) and other pathologies harmful to kidney health. There is strong evidence that non-steroidal anti-inflammatory drugs, common amongst ultra-athletes, is linked to increased risk and severity of AKI and potentially ischaemic renal injury, i.e., acute tubular necrosis. Ultra-endurance participation also increases the risk of exertional rhabdomyolysis, exercise-associated hyponatremia, and gastrointestinal symptoms, interlinked pathologies all with potential to increase the risk of AKI. Hydration and fuelling both also play a role with the development of multiple pathologies and ultimately AKI, highlighting the need for individualised nutritional and hydration plans to promote athlete health. Faster athletes, supplementing nitrates, and being female also increase the risk of developing AKI in this setting. Serum creatinine criteria do not provide the best indicator for AKI for ultra-athletes therefore further investigations are needed to assess the practicality and accuracy of new renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL). The potential of recurring episodes of AKI provide need for further research to assess the longitudinal renal health impact of ultra-participation to provide appropriate advice to athletes, coaches, medical staff, and event organisers.
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Affiliation(s)
- Victoria Tidmas
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Jon Brazier
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Lindsay Bottoms
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Daniel Muniz
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Terun Desai
- Department of Psychology, Sport, and Geography, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Sivakumar Sridharan
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, De Havilland Campus, University of Hertfordshire, Hatfield AL10 9EU, UK
- Renal Unit, Lister Hospital, East and North Herts Trust, Stevenage SG1 4AB, UK
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Borchers J, Merle CL, Schöneborn DD, Lyko LR, Thouet T, Wolfarth B, Kottmann T, Scheibenbogen C, Zimmer J, Diederich S, Bauer K, Sack U, Schmalz G, Ziebolz D, Wüstenfeld J. Salivary Diagnostic for Monitoring Strenuous Exercise-A Pilot Study in a Cohort of Male Ultramarathon Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16110. [PMID: 36498185 PMCID: PMC9737684 DOI: 10.3390/ijerph192316110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Intense physical stress, such as that in ultramarathon running, affects the immune system. For monitoring in sports medicine, non-invasive methods, e.g., salivary analysis, are of interest. This pilot cohort study aimed to assess changes in salivary parameters in response to an ultramarathon. The results were compared to blood parameters. Male, healthy finishers (n = 9, mean age: 48 ± 8.8 years, mean height: 1.8 ± 0.1 m, mean weight: 72.5 ± 7.2 kg, mean BMI: 23.5 ± 1.9 kg/cm²) of a 160 km ultramarathon were included. Saliva and blood samples were collected at three time points: T1 (baseline), T2 (shortly after the ultramarathon) and T3 (after recovery). In saliva, cortisol, testosterone, IL-1β, IL-6, IL-8, IL-10, TNF-α, albumin, IgA, α-amylase, aMMP-8, and neopterin were assessed via ELISA. In blood, cortisol, testosterone, IL-1β, IL-6, IL-8, IL-10, TNF-α, blood cell counts, procalcitonin, CRP, osmolality, albumin, and α-amylase were analyzed. The statistical evaluation comprised longitudinal testing and cross-sectional testing between saliva and blood using ratios of T2 and T3 to baseline values. Various parameters in saliva and blood changed in response to the ultramarathon. Comparing blood and saliva, the longitudinal changes of testosterone (p = 0.02) and α-amylase (p = 0.03) differed significantly. Despite the limitations of the study, it underlines that saliva is an interesting option for comprehensive monitoring in sports medicine and necessitates further studies.
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Affiliation(s)
- Josephin Borchers
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Cordula Leonie Merle
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | | | - Lea Ronja Lyko
- Department of Sports Medicine, Charité University Medicine, 10115 Berlin, Germany
| | - Thomas Thouet
- Department of Sports Medicine, Charité University Medicine, 10115 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité University Medicine, 10115 Berlin, Germany
- Department of Sports Medicine, Institute for Applied Scientific Training, 04109 Leipzig, Germany
- Institute of Sports Science, Humboldt University, 10115 Berlin, Germany
| | | | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité University Medicine, 13353 Berlin, Germany
| | - Jeannot Zimmer
- SYNLAB Medizinisches Versorgungszentrum Berlin GmbH, 10828 Berlin, Germany
| | | | - Katrin Bauer
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich Sack
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Jan Wüstenfeld
- Department of Sports Medicine, Charité University Medicine, 10115 Berlin, Germany
- Department of Sports Medicine, Institute for Applied Scientific Training, 04109 Leipzig, Germany
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8
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Le Goff C, Gergelé L, Seidel L, Cavalier E, Kaux JF. Mountain Ultra-Marathon (UTMB) Impact on Usual and Emerging Cardiac Biomarkers. Front Cardiovasc Med 2022; 9:856223. [PMID: 35402558 PMCID: PMC8987719 DOI: 10.3389/fcvm.2022.856223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
The number of participants in ultra-marathons is increasing. However, the data regarding the impact of this type of exercise on the cardiovascular system are contradictory. In our study, 28 ultra-trail runners were enrolled. Blood samples were collected at three time points: immediately before, immediately after, and 7 days after the ultra-marathon. Different biomarkers were measured. Immediately after the race, the blood concentrations of the different cardiac and inflammatory biomarkers increased significantly. Interestingly, some biomarkers remained high even after 7 days of recovery.
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Affiliation(s)
- Caroline Le Goff
- Department of Clinical Chemistry, University Hospital of Liege and University of Liège, Liège, Belgium
- *Correspondence: Caroline Le Goff
| | - Laurent Gergelé
- Department of Intensive Care, Intensive Unit Care, University Hospital of Saint Etienne, University of Lyon, Lyon, France
| | - Laurence Seidel
- Biostatistics Department, University Hospital of Liege, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University Hospital of Liege and University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Sports and Rehabilitation Sciences, University of Liège, Liège, Belgium
- Physical Medicine and Sport Traumatology Department, SportS2, IOC Research Centre for Prevention of Injury and Protection of Athlete Health FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University Hospital of Liège, Liège, Belgium
- Jean-François Kaux
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9
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Moris JM, Olendorff SA, Zajac CM, Fernandez Del Valle M, Webb BL, Zuercher J, Smith BK, Tucker KR, Guilford BL. Collegiate Male Athletes Exhibit Conditions of the Male Athlete Triad. Appl Physiol Nutr Metab 2021; 47:328-336. [PMID: 34807739 DOI: 10.1139/apnm-2021-0512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The primary purpose of this study was to determine prevalence of the Male Athlete Triad (MAT) conditions: low energy availability (EA), low bone mineral density (BMD), and low testosterone in male collegiate athletes from different sports. Participants included 44 collegiate male athletes (age, 20.4 ± 0.2 yr; BMI, 25.3 ± 1.3 kg/m2) from seven sports (cross country, soccer, basketball, wrestling, track, golf, and baseball). Resting metabolic rate, three-day food intake, seven-day exercise energy expenditure, body composition, and reproductive and metabolic hormones were assessed. Of the total participants, 15% had low EA, 0% had low BMD, 28% had low total testosterone (TT), and 80% had low calculated free testosterone (cFT). There were no significant correlations between EA, BMD, TT, and cFT. Insulin and sex hormone binding globulin (SHBG) were below and on the upper end of the reference range for healthy male adults, respectively. Insulin was negatively correlated with total (r = -0.330, p = 0.043) and lumbar spine BMD z-scores (r = -0.413, p = 0.010). Low TT and low cFT were the most prevalent MAT conditions among all athletes. Further research should investigate the relationship between insulin and SHBG and the role of these hormones in the MAT. Novelty Bullets • Assessment of energy availability alone is not sufficient to identify physiological disturbances in collegiate male athletes. • Low total and/or free testosterone may be present in some collegiate male athletes, regardless of BMD status. • Low insulin and high SHBG concentration may portray the presence of conditions of the MAT in male collegiate athletes.
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Affiliation(s)
- Jose M Moris
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
| | - Samantha A Olendorff
- Southern Illinois University Edwardsville, 33140, Chemistry, Edwardsville, Illinois, United States;
| | - Chelsie M Zajac
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
| | - Maria Fernandez Del Valle
- Southern Illinois University Edwardsville, 33140, Applied Health, Vadalabene Center, Campus box 1126, VC 2626, Edwardsville, Illinois, United States, 62026-1001;
| | - Benjamin L Webb
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
| | - Jennifer Zuercher
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
| | - Bryan K Smith
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
| | - Kevin R Tucker
- Southern Illinois University Edwardsville, 33140, Chemistry, Edwardsville, Illinois, United States;
| | - Brianne L Guilford
- Southern Illinois University Edwardsville, 33140, Applied Health, Edwardsville, Illinois, United States;
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10
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Partyka A, Waśkiewicz Z. The Consequences of Training and Competition to the Musculoskeletal System in Ultramarathon Runners: A Narrative Review. Front Physiol 2021; 12:738665. [PMID: 34630159 PMCID: PMC8497806 DOI: 10.3389/fphys.2021.738665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
Ultramarathons are becoming increasingly popular every year, leading to more and more publications focusing on athletes of these endurance events. This paper summarizes the current state of knowledge on the effects of ultramarathons on the motor system. Various studies have attempted to answer questions about negative and positive effects on the musculoskeletal system, common injuries, optimal strategies, and regeneration. Considering the increasing number of ultramarathon athletes, the discoveries may have practical applications for a multitude of experts in the field of sports medicine, as well as for the athletes themselves. Acute locomotor system changes in runners as assessed by locomotor biomarkers are reversible and may be asymptomatic or painful. Injuries suffered by runners largely allow them to finish the competition and are usually overlooked. Regeneration, including regular massage and the use of supporting techniques, allows for faster convalescence. This publication is meant to be a source of knowledge for people associated with this discipline.
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Affiliation(s)
| | - Zbigniew Waśkiewicz
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.,Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, Moscow, Russia
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11
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Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Med 2021; 52:725-740. [PMID: 34542868 PMCID: PMC8450723 DOI: 10.1007/s40279-021-01561-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.
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12
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Le Goff C, Kaux JF, Dulgheru R, Seidel L, Pincemail J, Cavalier E, Melon P. The impact of an ultra-trail on the dynamic of cardiac, inflammatory, renal and oxidative stress biological markers correlated with electrocardiogram and echocardiogram. Acta Cardiol 2021; 76:739-747. [PMID: 32539581 DOI: 10.1080/00015385.2020.1778871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The aim of this study was to describe the effects of a 64.2 km ultra-trail on the biomarkers of muscle damage, inflammation and oxidative stress, and compare the results observed with an ECG and an echocardiogram, both performed before and after the race.Thirty-three ultra-trail volunteers (45.8 ± 8.7 years old) were enrolled in our study. Three blood tests were drawn from each runner, one just before (TPRE), one just after (TPOST) and the last 3 h after the end of the race (TPOST3h).All the markers increased. The maximum concentrations observed were at TPOST3h and were significant (p < 0.001) for creatine kinase, creatine kinase isoform MB, high-sensitivity C-reactive protein, uric acid and for the ratio of reduced glutathione to oxidised glutathione. However, in the case of myoglobin, high-sensitive troponin T, N-terminal pro-brain natriuretic peptide, oxidised glutathione, myeloperoxidase, cystatin C and creatinine, the most significant increases were at TPOST (p < 0.001). Modifications were observed in the medical imaging using echocardiography such as reduction of left ventricule end-sytolic and diastolic volumes and left ventricular global longitudinal strain. ECG showed electrical criteria for left ventricular hypertrophy and incomplete right bundle branch block after the race.Endurance races cause significant physiological stress to the body that can be measured by the increase of different biomarkers. From a laboratory perspective, it is important to take into account the possible exercise performed previous to the testing to avoid a misinterpretation of the results. From a training perspective, due to these increases in biomarkers, it is recommended that runners wait at least 72 h after an ultra-trail before subsequent training. In addition a transient impairment of ventricular function due to dehydration were observed.
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Affiliation(s)
- C. Le Goff
- Clinical Chemistry Department, University and University Hospital of Liège, Liège, Belgium
| | - J-F. Kaux
- Physical Medicine and Sports Traumatology Department, SportS2, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - R. Dulgheru
- Department of Cardiology, University and University Hospital of Liège, Liège, Belgium
| | - L. Seidel
- Biostatistic Department, University Hosptial of Liège, Liège, Belgium
| | | | - E. Cavalier
- Clinical Chemistry Department, University and University Hospital of Liège, Liège, Belgium
| | - P. Melon
- Department of Cardiology, University and University Hospital of Liège, Liège, Belgium
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13
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Kopp C. Relatives Energiedefizit im Sport (RED-S). GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Nattiv A, De Souza MJ, Koltun KJ, Misra M, Kussman A, Williams NI, Barrack MT, Kraus E, Joy E, Fredericson M. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clin J Sport Med 2021; 31:335-348. [PMID: 34091537 DOI: 10.1097/jsm.0000000000000946] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
ABSTRACT The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.
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Affiliation(s)
- Aurelia Nattiv
- Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Mary Jane De Souza
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Kristen J Koltun
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrea Kussman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Nancy I Williams
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California; and
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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15
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Lunetti P, Capobianco L, Zara V, Ferramosca A. Physical Activity and Male Reproductive Function: A New Role for Gamete Mitochondria. Exerc Sport Sci Rev 2021; 49:99-106. [PMID: 33720911 DOI: 10.1249/jes.0000000000000245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies demonstrated that some types of physical exercise might affect male reproductive potential, even though the potential mechanisms involved in the modulation of sperm quality remain poorly understood. Therefore, we propose a new role for gamete mitochondria as a key hub that coordinates molecular events related to the effects induced by physical exercise.
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Affiliation(s)
- Paola Lunetti
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
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16
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Dipla K, Kraemer RR, Constantini NW, Hackney AC. Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females. Hormones (Athens) 2021; 20:35-47. [PMID: 32557402 DOI: 10.1007/s42000-020-00214-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.
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Affiliation(s)
- Konstantina Dipla
- Department of Sports Science, Exercise Physiology and Biochemistry Laboratory, Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert R Kraemer
- Department of Kinesiology and Health Studies, Exercise Physiology Laboratory, Southeastern Louisiana University, Hammond, LA, USA.
| | - Naama W Constantini
- Heidi Rotberg Sport Medicine Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
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17
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Gajda R, Samełko A, Czuba M, Piotrowska-Nowak A, Tońska K, Żekanowski C, Klisiewicz A, Drygas W, Gębska-Kuczerowska A, Gajda J, Knechtle B, Adamczyk JG. To Be a Champion of the 24-h Ultramarathon Race. If Not the Heart ... Mosaic Theory? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052371. [PMID: 33804352 PMCID: PMC7957735 DOI: 10.3390/ijerph18052371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
This comprehensive case analysis aimed to identify the features enabling a runner to achieve championship in 24-h ultramarathon (UM) races. A 36-year-old, multiple medalist of the World Championships in 24-h running, was assessed before, one and 10 days after a 24-h run. Results of his extensive laboratory and cardiological diagnostics with transthoracic echocardiography (TTE) and a one-time cardiopulmonary exercise test (CPET) were analyzed. After 12 h of running (approximately 130 km), the athlete experienced an increasing pain in the right knee. His baseline clinical data were within the normal range. High physical efficiency in CPET (VO2max 63 mL/kg/min) was similar to the average achieved by other ultramarathoners who had significantly worse results. Thus, we also performed genetic tests and assessed his psychological profile, body composition, and markers of physical and mental stress (serotonin, cortisol, epinephrine, prolactin, testosterone, and luteinizing hormone). The athlete had a mtDNA haplogroup H (HV0a1 subgroup, belonging to the HV cluster), characteristic of athletes with the highest endurance. Psychological studies have shown high and very high intensity of the properties of individual scales of the tools used mental resilience (62–100% depending on the scale), openness to experience (10th sten), coherence (10th sten), positive perfectionism (100%) and overall hope for success score (10th sten). The athlete himself considers the commitment and mental support of his team to be a significant factor of his success. Body composition assessment (%fat 13.9) and the level of stress markers were unremarkable. The tested athlete showed a number of features of the champions of ultramarathon runs, such as: inborn predispositions, mental traits, level of training, and resistance to pain. However, none of these features are reserved exclusively for “champions”. Team support’s participation cannot be underestimated. The factors that guarantee the success of this elite 24-h UM runner go far beyond physiological and psychological explanations. Further studies are needed to identify individual elements of the putative “mosaic theory of being a champion”.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center in Pułtusk, 06-100 Pułtusk, Poland;
- Correspondence: ; Tel.: +48-604286030
| | - Aleksandra Samełko
- Department of Pedagogy and Psychology of Physical Culture, Faculty of Physical Education, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka St. 34, 00-968 Warsaw, Poland;
| | - Miłosz Czuba
- Department of Applied and Clinical Physiology, Collegium Medicum University of Zielona Gora, 28 Zyty St., 65-417 Zielona Gora, Poland;
- Department of Kinesiology, Institute of Sport, 2 Trylogii St., 01-982 Warsaw, Poland
| | - Agnieszka Piotrowska-Nowak
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a Street, 02-106 Warsaw, Poland; (A.P.-N.); (K.T.)
| | - Katarzyna Tońska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Pawinskiego 5a Street, 02-106 Warsaw, Poland; (A.P.-N.); (K.T.)
| | - Cezary Żekanowski
- Laboratory of Neurogenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, ul. Pawinskiego 5, 02-106 Warszawa, Poland;
| | - Anna Klisiewicz
- The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland; (A.K.); (W.D.)
| | - Wojciech Drygas
- The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland; (A.K.); (W.D.)
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Anita Gębska-Kuczerowska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland;
| | - Jacek Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center in Pułtusk, 06-100 Pułtusk, Poland;
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Jakub Grzegorz Adamczyk
- Department of Theory of Sport, Faculty of Physical Education, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka St. 34, 00-968 Warsaw, Poland;
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18
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Morawin B, Kasperska A, Zembron-Lacny A. The Impact of Professional Sports Activity on GH-IGF-I Axis in Relation to Testosterone Level. Am J Mens Health 2021; 14:1557988319900829. [PMID: 32102608 PMCID: PMC7047237 DOI: 10.1177/1557988319900829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study was designed to investigate whether sports-induced elevation of testosterone level impacts on the growth hormone/insulin-like growth factor-I (GH-IGF-I) axis and body composition, especially skeletal muscle mass. The study included 12 male wrestlers aged 21.1 ± 1.7 years and 10 male nonathletes aged 21.1 ± 1.2 years. Anthropometric and biochemical measurements in the group of nonathlete men were carried out once, while for wrestlers they were carried out twice, that is, on the 1st and 14th days of the training camp. The levels of resting free testosterone (fT), cortisol (C), and human growth hormone (hGH) were significantly higher in the athletes than in nonathletes. A 2-week sports training induced a significant reduction in fT, IGF-I, and IGF binding protein-3 (IGFBP-3) levels and a rise in C level. Increased C level and reduced fT level in the athletes’ blood caused a rise in C/fT from the level of 39.95 ± 4.97 nmol/L to 59.73 ± 10.09 nmol/L (p < .05). A negative correlation was demonstrated between C/fT ratio and IGF-I level (r = −0.474, p < .05), which may indicate an inhibitory impact of high C level and low fT concentration on IGF-I release in response to sports training. Sports activity induces significant changes in the C/fT ratio that can impact on the secretion of GH and IGF-I from the liver and finally on the fat-free body mass. The quantification of GH-IGF-I axis in relation to testosterone level could be a useful diagnostic tool in biochemical assessment of the regenerative ability of skeletal muscle or provide evidence of the early stages of muscle functional overload.
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Affiliation(s)
- Barbara Morawin
- Department of Applied and Clinical Physiology, Faculty of Medicine and Health Sciences, University of Zielona Góra, Poland
| | - Anna Kasperska
- Department of Physiology, Faculty of Physical Education, Gorzów Wlkp
| | - Agnieszka Zembron-Lacny
- Department of Applied and Clinical Physiology, Faculty of Medicine and Health Sciences, University of Zielona Góra, Poland
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19
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Coker MS, Ladd K, Murphy CJ, Ruby BC, Shriver TC, Schoeller DA, Newcomer BR, Bateman T, Bartlett L, Coker RH. Alaska backcountry expeditionary hunting promotes rapid improvements in metabolic biomarkers in healthy males and females. Physiol Rep 2021; 9:e14682. [PMID: 33369890 PMCID: PMC7769173 DOI: 10.14814/phy2.14682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/23/2020] [Accepted: 11/14/2020] [Indexed: 12/16/2022] Open
Abstract
We have previously reported negative energy balance and health benefits during an Alaska backcountry expeditionary hunting (ABEH) immersion in two males. The purpose of our present study was to increase the number of participants, include females, and evaluate macronutrient intake and serum lipids. Four men (age: 46 ± 6 year, BMI: 26 ± 1 kg/m2 ) and three women (age: 46 ± 11 year, BMI: 25 ± 3 kg/m2 ) were recruited. Doubly labeled water methodology and dietary recall were utilized to assess energy expenditure and energy intake, respectively. Data were collected during pre- and post-ABEH visits. Body composition was measured using dual-energy x-ray absorptiometry and the cross-sectional area of skeletal muscle in the upper leg (XT), and intrahepatic lipid (IHL) was determined using magnetic resonance imaging and/or spectroscopy (MRI/MRS). Blood parameters were measured by LabCorp. Paired T-tests were used for statistical analysis. Data are reported as mean ± SD and considered significant at p < 0.05. Total energy intake was 7.7 ± 3.4 MJ/day and total energy expenditure was 17.4 ± 2.6 MJ/day, resulting in a negative energy balance of -9.7 ± 3.4 MJ/day. Protein intake(grams)/body weight(kilograms)/day was 1.0 ± 0.4. There were reductions in body weight (Δ-1.5 ± 0.7 kg), BMI (Δ-0.3 ± 0.2 kg/m2 ), fat mass (Δ-1.7 ± 0.9 kg), and IHL (Δ-0.3 ± 0.3% water peak). There were no changes in lean tissue mass (Δ0.6 ± 1.4 kg) or XT (Δ-1.3 ± 3.3 cm2 ). There were significant reductions in total cholesterol (Δ-44 ± 35 mg/dl), LDL-cholesterol (Δ-25 ± 14 mg/dl), VLDL-cholesterol (Δ-7 ± 7 mg/dl), and triglycerides (Δ-35 ± 33 mg/dl). The ABEH immersion resulted in considerable negative energy balance and provided comprehensive benefits in metabolic health without any reduction in skeletal muscle.
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Affiliation(s)
- Melynda S. Coker
- Department of Natural Resources and EnvironmentUniversity of Alaska FairbanksFairbanksAKUSA
| | - Kaylee Ladd
- Department of Biology and WildlifeUniversity of Alaska FairbanksFairbanksAKUSA
| | - Carl J. Murphy
- Institute of Arctic BiologyUniversity of Alaska FairbanksFairbanksAKUSA
| | - Brent C. Ruby
- Montana Center for Work Physiology and Exercise MetabolismUniversity of MontanaMissoulaMTUSA
| | - Timothy C. Shriver
- Isotope Ratio Core LaboratoryUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Dale A. Schoeller
- Isotope Ratio Core LaboratoryUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Bradley R. Newcomer
- Department of Physics and Honors CollegeJames Madison UniversityHarrisonburgVAUSA
| | | | | | - Robert H. Coker
- Department of Biology and WildlifeUniversity of Alaska FairbanksFairbanksAKUSA
- Institute of Arctic BiologyUniversity of Alaska FairbanksFairbanksAKUSA
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20
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Roca E, Nescolarde L, Brotons D, Bayes-Genis A, Roche E. Macronutrient and mineral intake effects on racing time and cardiovascular health in non-elite marathon runners. Nutrition 2020; 78:110806. [DOI: 10.1016/j.nut.2020.110806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
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21
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Martínez-Navarro I, Sanchez-Gómez JM, Aparicio I, Priego-Quesada JI, Pérez-Soriano P, Collado E, Hernando B, Hernando C. Effect of mountain ultramarathon distance competition on biochemical variables, respiratory and lower-limb fatigue. PLoS One 2020; 15:e0238846. [PMID: 32915883 PMCID: PMC7485829 DOI: 10.1371/journal.pone.0238846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
The study aimed at assessing the acute physiological effects of running a 65-km vs a 107-km mountain ultramarathon. Nineteen athletes (15 males and 4 females) from the shorter race and forty three athletes (26 males and 17 females) from the longer race were enrolled. Body weight, respiratory and lower limb strength were assessed before and after the race. Blood samples were obtained before, after and 24-h post-race. Body weight loss did not differ between races. A decrease in squat jump height (p<0.01; d = 1.4), forced vital capacity (p<0.01; d = 0.5), forced expiratory volume in 1 s (p<0.01; d = 0.6), peak inspiratory flow (p<0.01; d = 0.6) and maximal inspiratory pressure (p<0.01; d = 0.8) was observed after the longer race; while, after the shorter race only maximal inspiratory pressure declined (p<0.01; d = 0.5). Greater post-race concentrations of creatine kinase (p<0.01; d = 0.9) and C-reactive protein (p<0.01; d = 2.3) were observed following the longer race, while high-sensitivity cardiac troponin was higher after the shorter race (p<0.01; d = 0.3). Sodium decreased post-competition only after the shorter race (p = 0.02; d = 0.6), while creatinine increased only following the longer race (p<0.01; d = 1.5). In both groups, glomerular filtration rate declined at post-race (longer race: p<0.01, d = 2.1; shorter race: p = 0.01, d = 1.4) and returned to baseline values at 24 h post-race. In summary, expiratory and lower-limb fatigue, and muscle damage and inflammatory response were greater following the longer race; while a higher release of cardiac troponins was observed after the shorter race. The alteration and restoration of renal function was similar after either race.
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Affiliation(s)
- Ignacio Martínez-Navarro
- Physical Education and Sports Department, University of Valencia, Valencia, Spain
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain
| | - Juan Miguel Sanchez-Gómez
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain
- University Clinical Hospital of Valencia, Valencia, Spain
| | - Inma Aparicio
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
- AITEX (Textil Research Institute), Alcoy, Spain
| | - Jose Ignacio Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - Pedro Pérez-Soriano
- Research Group in Sports Biomechanics (GIBD), Physical Education and Sports Department, University of Valencia, Valencia, Spain
| | - Eladio Collado
- Faculty of Health Sciences, Jaume I University, Castellon, Spain
| | | | - Carlos Hernando
- Sport Service, Jaume I University, Castellon, Spain
- Department of Education and Specific Didactics, Jaume I University, Castellon, Spain
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22
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Rojas-Valverde D, Sánchez-Ureña B, Crowe J, Timón R, Olcina GJ. Exertional rhabdomyolysis and acute kidney injury in endurance sports: A systematic review. Eur J Sport Sci 2020; 21:261-274. [PMID: 32202487 DOI: 10.1080/17461391.2020.1746837] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The increase of wide-spread participation in endurance events in sports such as open water swimming, cycling, running and triathlons, has given rise to a concern about potential implications for renal function and kidney health. This study aimed to delve into the findings on exertional rhabdomyolysis (ER) and acute kidney injury (AKI) in endurance sports, emphasizing the diagnostic criteria used, physical and environmental contextual conditions in which ER and AKI are reported. Following PRISMA guidelines for systematic reviews and meta-analysis, topic related studies were searched digital sources (from 2009 to 2020). Studies with biomarkers of ER and AKI reported in endurance or ultra-endurance events were included. A total of 43 publications (sample = 813) were extracted, and 345 (43.5%) individuals were diagnosed with ER (creatinine kinase > 5000 UI/L) and 130 (16.39%) with ER + AKI (creatinine ≥ 1.88 mg/dL). Out of the total cases of ER + AKI, 96.92% were in ultra-endurance runners. There were inconsistences between studies in diagnosis criteria for ER and AKI, which represented a difficulty in the interpretation of the data. Increased levels of muscle and kidney injury immediately after endurance events were reported, but after 5.86 days these levels usually returned to baseline. There is a lack of knowledge around the potential of repeated ER and AKI predisposing to long-term chronic kidney disease. More accurate markers for subclinical and functional AKI diagnosis are needed in the analysis of kidney health after endurance events. ER and AKI are serious clinical problems with significant morbidity. Further research may be in order to help define future prevention strategies.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica.,Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Braulio Sánchez-Ureña
- Programa de Ciencias del Ejercicio y la Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Instituto Regional de Estudios Toxicológicos, Universidad Nacional, Heredia, Costa Rica
| | - Rafael Timón
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Guillermo J Olcina
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
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23
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De Souza MJ, Koltun KJ, Williams NI. The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes. Sports Med 2019; 49:125-137. [PMID: 31696452 PMCID: PMC6901401 DOI: 10.1007/s40279-019-01217-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.
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Affiliation(s)
- Mary Jane De Souza
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kristen J. Koltun
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Nancy I. Williams
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
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24
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Merritt EK, Nieman DC, Toone BR, Groen A, Pugachev A. Proteomic Markers of Non-functional Overreaching During the Race Across America (RAAM): A Case Study. Front Physiol 2019; 10:1410. [PMID: 31798466 PMCID: PMC6874140 DOI: 10.3389/fphys.2019.01410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 11/13/2022] Open
Abstract
In a previous study, proteomics procedures identified blood proteins as potential overreaching and overtraining biomarkers, and a targeted proteomics panel of 21 proteins was developed.
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Affiliation(s)
- Edward K Merritt
- Department of Kinesiology, Southwestern University, Georgetown, TX, United States
| | - David C Nieman
- North Carolina Research Campus, Appalachian State University, Kannapolis, NC, United States
| | - Brian R Toone
- Department of Mathematics and Computer Science, Samford University, Homewood, AL, United States
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Kaufman JM, Lapauw B, Mahmoud A, T'Sjoen G, Huhtaniemi IT. Aging and the Male Reproductive System. Endocr Rev 2019; 40:906-972. [PMID: 30888401 DOI: 10.1210/er.2018-00178] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/27/2018] [Indexed: 12/21/2022]
Abstract
This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ahmed Mahmoud
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Ilpo Tapani Huhtaniemi
- Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.,Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland
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Hohl R, Nazário de Rezende F, Millet GY, Ribeiro da Mota G, Marocolo M. Blood cardiac biomarkers responses are associated with 24 h ultramarathon performance. Heliyon 2019; 5:e01913. [PMID: 31338451 PMCID: PMC6607063 DOI: 10.1016/j.heliyon.2019.e01913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/22/2019] [Accepted: 06/03/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose Clinical significance of cardiac biomarkers response in ultra-endurance runners are not completely elucidated because events vary in distance/duration and competitors modulate running intensity according to individual running capacity. The aim of this study was to examine the relationship between self-selected exercise intensity with cardiac biomarkers comparing experienced (EXP, N = 11) and novice (NOV, N = 14) runners able to finish a 24h ultramarathon (24UM) with significant differences in performance. Methods Cardiac biomarkers (i.e. CKMB/totalCK, cTnT and NT-proBNP), inflammatory markers (i.e. leukocytes and CRP) and cortisol were analyzed before and after a 24UM. Results EXP finished the race with significant (p < 0.05) longer distance than NOV (158.8 ± 15.8 vs 116.8 ± 10.3 Km). Two-way mixed ANOVA showed significant time × performance level interaction with greater increase of cTnT (F(1,23) = 6.18, p = 0.021), NT-proBNP (F(1,23) = 9.27, p = 0.006) and cortisol (F(1, 23) = 5.13, p = 0.03) in the EXP group. CKMB/totalCK (F(1, 23) = 71.90, p < 0.0001) decreased while leukocytes (F(1, 23) = 100.06, p < 0.0001) and CRP (F(1, 23) = 93.37, p < 0.0001) increased in both groups (main effect of time). Correlations were found between 24UM distance and cortisol (r = 0.58; p = 0.002), CKMB (r = 0.47; p = 0.017), cTnT (r = 0.44; p = 0.027) or NT-proBNP (r = 0.56; p = 0.003). Cortisol and NT-proBNP were also significantly correlated (r = 0.51; p = 0.01). Conclusions Although there is no clear evidence of cardiac risk when comparing cardiac biomarkers levels with clinical cut-off values, cardiac biomarkers are associated with running performance and pituitary-adrenocortical system response. In EXP runners, higher levels of cardiac biomarkers and cortisol suggest a more hemodynamically challenged heart during prolonged endurance exercise.
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Affiliation(s)
- Rodrigo Hohl
- Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Guillaume Y Millet
- Univ Lyon, UJM-Saint-Etienne, LIBM, EA 7424, F-42023, Saint-Etienne, France.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Gustavo Ribeiro da Mota
- Human Performance and Sport Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Moacir Marocolo
- Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Evidence of the Exercise-Hypogonadal Male Condition at the 2011 Kona Ironman World Championships. Int J Sports Physiol Perform 2019; 14:170-175. [DOI: 10.1123/ijspp.2017-0476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hooper DR, Tenforde AS, Hackney AC. Treating exercise-associated low testosterone and its related symptoms. PHYSICIAN SPORTSMED 2018; 46:427-434. [PMID: 30063407 DOI: 10.1080/00913847.2018.1507234] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Exercise-Hypogonadal Male Condition (EHMC) has been described to occur in athletes who experience low serum testosterone and associated symptoms. While high volumes of endurance exercise can lead to reduced testosterone concentrations in men, similar changes may occur in other sports including anerobic and power sports such as American football, and weight class sports such as wrestling. A reduced testosterone concentration alone does not necessarily warrant treatment, but when it is accompanied by symptoms of hypogonadism, such as fatigue, sexual dysfunction, and/or low bone mineral density (BMD), an athlete's performance and/or health may suffer. While pharmacological treatments such as testosterone or clomiphene citrate have been shown to be effective in treating hypogonadism, these options are not available to athletes competing in sports governed by the World Anti-Doping Agency. We recommend treatment of EHMC in athletes should include nutritional intervention and modification of training. Recognizing EHMC's existence in male athletes is important to optimize their health.
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Affiliation(s)
- David R Hooper
- a Department of Kinesiology , Jacksonville University , Jacksonville , FL , USA
| | - Adam S Tenforde
- b Department of Physical Medicine and Rehabilitation , Harvard Medical School , Cambridge , MA , USA
| | - Anthony C Hackney
- c Department of Exercise & Sport Science and Department of Nutrition , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA
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Belli T, Macedo DV, de Araújo GG, Dos Reis IGM, Scariot PPM, Lazarim FL, Nunes LAS, Brenzikofer R, Gobatto CA. Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury. Front Physiol 2018; 9:1368. [PMID: 30349484 PMCID: PMC6186806 DOI: 10.3389/fphys.2018.01368] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study aimed to investigate changes in muscle damage during the course of a 217-km mountain ultramarathon (MUM). In an integrative perspective, inflammatory response and renal function were also studied. Methods: Six male ultra-runners were tested four times: pre-race, at 84 km, at 177 km, and immediately after the race. Blood samples were analyzed for serum muscle enzymes, acute-phase protein, cortisol, and renal function biomarkers. Results: Serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) increased significantly throughout the race (P < 0.001, P < 0.001; P = 0.002, respectively), and effect size (ES) denoted a large magnitude of muscle damage. These enzymes increased from pre-race (132 ± 18, 371 ± 66, and 28 ± 3 U/L, respectively) to 84 km (30, 1.8, and 3.9-fold, respectively); further increased from 84 to 177 km (4.6, 2.9, and 6.1-fold, respectively), followed by a stable phase until the finish line. Regarding the inflammatory response, significant differences were found for C-reactive protein (CRP) (P < 0.001) and cortisol (P < 0.001). CRP increased from pre-race (0.9 ± 0.3 mg/L) to 177 km (243-fold), cortisol increased from pre-race (257 ± 30 mmol/L) to the 84 km (2.9-fold), and both remained augmented until the finish line. Significant changes were observed for creatinine (P = 0.03), urea (P = 0.001), and glomerular filtration rate (GFR) (P < 0.001), and ES confirmed a moderate magnitude of changes in renal function biomarkers. Creatinine and urea increased, and GFR decreased from pre-race (1.00 ± 0.03 mg/dL, 33 ± 6 mg/dL, and 89 ± 5 ml/min/1.73 m2, respectively) to 84 km (1.3, 3.5, and 0.7-fold, respectively), followed by a plateau phase until the finish line. Conclusion: This study shows evidence that muscle damage biomarkers presented early peak levels and they were followed by a plateau phase during the last segment of a 217-km MUM. The acute-phase response had a similar change of muscle damage. In addition, our data showed that our volunteers meet the risk criteria for acute kidney injury from 84 km until they finished the race, without demonstrating any clinical symptomatology.
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Affiliation(s)
- Taisa Belli
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Denise Vaz Macedo
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Gustavo Gomes de Araújo
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | | | - Pedro Paulo Menezes Scariot
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
| | - Fernanda Lorenzi Lazarim
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - Lázaro Alessandro Soares Nunes
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, Brazil
| | - René Brenzikofer
- Laboratory of Instrumentation for Biomechanics (LIB), Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Claudio Alexandre Gobatto
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, Brazil
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Baradaran N, Awad M, Gaither TW, Fergus KB, Ndoye M, Cedars BE, Balakrishnan AS, Eisenberg ML, Sanford T, Breyer BN. The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study. BJU Int 2018; 124:336-341. [DOI: 10.1111/bju.14396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Nima Baradaran
- Department of Urology; University of California San Francisco; San Francisco CA USA
| | - Mohannad Awad
- Department of Surgery; King Abdulaziz University; Rabigh Saudi Arabia
| | - Thomas W. Gaither
- Department of Urology; University of California San Francisco; San Francisco CA USA
| | | | - Medina Ndoye
- Department of Urology; University of California San Francisco; San Francisco CA USA
| | - Benjamin E. Cedars
- Department of Urology; University of California San Francisco; San Francisco CA USA
| | | | - Michael L. Eisenberg
- Department of Urology; Stanford University School of Medicine; San Francisco CA USA
| | - Tom Sanford
- Department of Urology; University of California San Francisco; San Francisco CA USA
| | - Benjamin N. Breyer
- Department of Urology; University of California San Francisco; San Francisco CA USA
- Department of Biostatistics and Epidemiology; University of California San Francisco; San Francisco CA USA
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Knechtle B, Nikolaidis PT. Physiology and Pathophysiology in Ultra-Marathon Running. Front Physiol 2018; 9:634. [PMID: 29910741 PMCID: PMC5992463 DOI: 10.3389/fphys.2018.00634] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
In this overview, we summarize the findings of the literature with regards to physiology and pathophysiology of ultra-marathon running. The number of ultra-marathon races and the number of official finishers considerably increased in the last decades especially due to the increased number of female and age-group runners. A typical ultra-marathoner is male, married, well-educated, and ~45 years old. Female ultra-marathoners account for ~20% of the total number of finishers. Ultra-marathoners are older and have a larger weekly training volume, but run more slowly during training compared to marathoners. Previous experience (e.g., number of finishes in ultra-marathon races and personal best marathon time) is the most important predictor variable for a successful ultra-marathon performance followed by specific anthropometric (e.g., low body mass index, BMI, and low body fat) and training (e.g., high volume and running speed during training) characteristics. Women are slower than men, but the sex difference in performance decreased in recent years to ~10–20% depending upon the length of the ultra-marathon. The fastest ultra-marathon race times are generally achieved at the age of 35–45 years or older for both women and men, and the age of peak performance increases with increasing race distance or duration. An ultra-marathon leads to an energy deficit resulting in a reduction of both body fat and skeletal muscle mass. An ultra-marathon in combination with other risk factors, such as extreme weather conditions (either heat or cold) or the country where the race is held, can lead to exercise-associated hyponatremia. An ultra-marathon can also lead to changes in biomarkers indicating a pathological process in specific organs or organ systems such as skeletal muscles, heart, liver, kidney, immune and endocrine system. These changes are usually temporary, depending on intensity and duration of the performance, and usually normalize after the race. In longer ultra-marathons, ~50–60% of the participants experience musculoskeletal problems. The most common injuries in ultra-marathoners involve the lower limb, such as the ankle and the knee. An ultra-marathon can lead to an increase in creatine-kinase to values of 100,000–200,000 U/l depending upon the fitness level of the athlete and the length of the race. Furthermore, an ultra-marathon can lead to changes in the heart as shown by changes in cardiac biomarkers, electro- and echocardiography. Ultra-marathoners often suffer from digestive problems and gastrointestinal bleeding after an ultra-marathon is not uncommon. Liver enzymes can also considerably increase during an ultra-marathon. An ultra-marathon often leads to a temporary reduction in renal function. Ultra-marathoners often suffer from upper respiratory infections after an ultra-marathon. Considering the increased number of participants in ultra-marathons, the findings of the present review would have practical applications for a large number of sports scientists and sports medicine practitioners working in this field.
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Affiliation(s)
- Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Abstract
Zusammenfassung. Wir stellen die wichtigsten Erkenntnisse zu Organschädigungen durch einen Ultramarathon zusammen. Nach einem Ultramarathon können kardiale Biomarker wie CK, CK-MB, kardiales Troponin I (cTnI) und N-terminales pro-Brain Natriuretic Peptide (NT-pro BNP) erhöht sein. Bis 80 % und mehr der Finisher klagen über Verdauungsprobleme, die einer der Hauptgründe sind, einen Ultramarathon nicht zu finishen. Bis zu 90 % der Läufer, die einen Ultramarathon aufgeben, klagen über Übelkeit. Nach einem Ultramarathon steigen die Leberwerte oft an, schwerwiegende Konsequenzen bleiben meist aus. Risikofaktoren für eine Einschränkung der Nierenfunktion sind eine ausgeprägte Muskelschädigung mit Rhabdomyolyse, Dehydratation, Hypotonie, Hyperurikämie, Hyponatriämie, geringe Wettkampferfahrung sowie die Einnahme von NSARs. Ultraläufer leiden nach einem Ultramarathon oft an Infekten der oberen Atemwege.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich
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Impact of the 24-h ultramarathon race on homocysteine, oxidized low-density lipoprotein, and paraoxonase 1 levels in professional runners. PLoS One 2018; 13:e0192392. [PMID: 29394290 PMCID: PMC5796729 DOI: 10.1371/journal.pone.0192392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 01/23/2018] [Indexed: 12/28/2022] Open
Abstract
The impact of the 24-h ultramarathon race on homocysteine (Hcy) and oxidized low-density lipoprotein (oxLDL) levels, two well-recognized cardiovascular risk factors, has not been deeply investigated. Similarly, no information exists on paraoxonase 1 (PON1), an antioxidant enzyme associated with high-density lipoproteins, which may detoxify oxLDL and Hcy-thiolactone, hence preventing their proatherogenic action. Taking this into account, a competitive 24-h ultramarathon race was organized in Reggio-Emilia (Italy) recruiting professional runners (n = 14) from the Italian Ultramarathon and Trail Association. Blood samples were collected from each participant before, during (14 h), and immediately after (24 h) the competition, thus to monitor the serum changes in Hcy, oxLDL, and PON1 levels, as well as other oxidative stress-related parameters, namely reactive oxygen metabolites (ROM) and total antioxidant capacity (PAT). As a result, a significant PON1 increase was recorded after 14 h of racing that persisted until the end of the performance. The same trend was observed for PAT values, which positively correlated to PON1 levels (R = 0.643, P<0.001). Hcy, oxLDL, and ROM remained almost unchanged throughout the competition. In conclusion, the present study suggested a protective role of PON1 in sustaining the antioxidant defense system and contrasting lipoprotein oxidative modifications over the 24-h race, and did not specifically evidence either Hcy or oxLDL accumulation in such challenging sporting events.
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Belli T, de Macedo DV, Scariot PPM, de Araújo GG, Dos Reis IGM, Lazarim FL, Nunes LAS, Brenzikofer R, Gobatto CA. Glycemic Control and Muscle Damage in 3 Athletes With Type 1 Diabetes During a Successful Performance in a Relay Ultramarathon: A Case Report. Wilderness Environ Med 2017. [PMID: 28629959 DOI: 10.1016/j.wem.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultramarathon races are fairly demanding and impose substantial physiological stress on healthy athletes. These competitions may thus be considerably more challenging for individuals with diabetes. This case study aims to describe glycemic control, muscle damage, inflammation, and renal function in 3 athletes with type 1 diabetes during a successful performance in a relay ultramarathon. The team completed the race in 29 hours and 28 minutes, earning third place. The total distance covered by each athlete was 68.7, 84.5, and 65.1 km. Most blood glucose levels showed that athletes were in a zone where it was safe to exercise (90-250 mg/dL or 5.0-13.9 mmol/L). Creatine kinase, lactate dehydrogenase, and aspartate aminotransferase serum levels increased 1.2- to 50.7-fold prerace to postrace, and were higher than the reference ranges for all the athletes postrace. Blood leukocytes, neutrophils, and serum C-reactive protein (CRP) increased 1.6- to 52-fold prerace to postrace and were higher than the reference ranges for 2 athletes after the race. Serum creatinine increased 1.2-fold prerace to postrace for all the athletes but did not meet the risk criteria for acute kidney injury. In conclusion, our main findings show evidence of satisfactory glycemic control in athletes with type 1 diabetes during a relay ultramarathon. Moreover, elevation of muscle damage and inflammatory biomarkers occurred without affecting renal function and challenging the maintenance of blood glucose among athletes. These findings are novel and provide an initial understanding of the physiological responses in athletes with type 1 diabetes during ultramarathon races.
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Affiliation(s)
- Taisa Belli
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Denise V de Macedo
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - Pedro P M Scariot
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Gustavo G de Araújo
- Sports Science Research Group - Federal University of Alagoas (UFAL), Maceio AL, Brazil (Dr de Araújo)
| | - Ivan G M Dos Reis
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Fernanda L Lazarim
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - Lázaro A S Nunes
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - René Brenzikofer
- Laboratory of Instrumentation for Biomechanics (LIB), Faculty of Physical Education, University of Campinas, Campinas, SP, Brazil (Dr Brenzikofer)
| | - Claudio A Gobatto
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto).
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Hooper DR, Kraemer WJ, Saenz C, Schill KE, Focht BC, Volek JS, Maresh CM. The presence of symptoms of testosterone deficiency in the exercise-hypogonadal male condition and the role of nutrition. Eur J Appl Physiol 2017; 117:1349-1357. [PMID: 28470410 DOI: 10.1007/s00421-017-3623-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE High volumes of aerobic exercise have been associated with reduced testosterone (T), known as the exercise-hypogonadal male condition (EHMC). Although the presence of low T has been identified, few studies have assessed the presence of androgen-deficient symptoms. The purpose of this investigation is to assess men exhibiting EHMC and evaluate their hypothalamic-pituitary-gonadal axis, the presence of hypogonadal symptoms, and also investigate a possible contribution of inadequate nutrition to the condition. METHODS A cross-sectional design compared 9 long-distance runners exhibiting EHMC to 8 non-active controls. Comparisons included serum T, luteinizing hormone (LH), follicle-stimulating hormone, and cortisol, the Aging Male Symptoms (AMS) questionnaire score, bone mineral density (BMD), and a food frequency questionnaire. RESULTS Mean T was significantly reduced in the EHMC group (EHMC 9.2 nmol L-1 vs. CONT 16.2 nmol L-1). The EHMC group demonstrated significantly higher AMS scores (EHMC 27.1 ± 7.3 vs. CONT 19.7 ± 2.5). There were no differences in bone density, although 3 cases of osteopenia were noted for EHMC in the lumbar spine, 1 in the right femur, and 1 in the radius. Energy availability was significantly reduced in EHMC (EHMC 27.2 ± 12.7 vs. CONT 45.4 ± 18.2 kcal d FFM-1). CONCLUSIONS Men exhibiting EHMC do appear to present with symptoms associated with androgen deficiency. For the most part, these symptoms are limited to those reported on the AMS questionnaire, although there are also some cases of clinically low BMD. It is possible that inadequate energy intake is contributing to this condition.
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Affiliation(s)
- David R Hooper
- Department of Health Sciences, Armstrong State University, Savannah, GA, USA.,Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA.
| | - Catherine Saenz
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
| | - Kevin E Schill
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
| | - Brian C Focht
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
| | - Carl M Maresh
- Department of Human Sciences, The Ohio State University, A054 PAES Building, 305 Annie and John Glenn Avenue, Columbus, OH, 43210, USA
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Hoffman MD, Badowski N, Chin J, Stuempfle KJ, Parise CA. Determinants of recovery from a 161-km ultramarathon. J Sports Sci 2016; 35:669-677. [PMID: 27167683 DOI: 10.1080/02640414.2016.1183808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The primary study objective was to identify determinants of short-term recovery from a 161-km ultramarathon. Participants completed 400 m runs at maximum speed before the race and on days 3 and 5 post-race, provided a post-race blood sample for plasma creatine kinase (CK) concentration, and provided lower body muscle pain and soreness ratings (soreness, 10-point scale) and overall muscular fatigue scores (fatigue, 100-point scale) pre-race and for 7 days post-race. Among 72 race finishers, soreness and fatigue had statistically returned to pre-race levels by 5 days post-race; and 400 m times at days 3 and 5 remained 26% (P = 0.001) and 12% (P = 0.01) slower compared with pre-race, respectively. CK best modelled soreness, fatigue and per cent change in post-race 400 m time. Runners with the highest CKs had 1.5 points higher (P < 0.001) soreness and 11.2 points higher (P = 0.006) fatigue than runners with the lowest CKs. For the model of 400 m time, a significant interaction of time with CK (P < 0.001) indicates that higher CKs were linked with a slower rate of return to pre-race 400 m time. Since post-race CK was the main modifiable determinant of recovery following the ultramarathon, appropriate training appears to be the optimal approach to enhance ultramarathon recovery.
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Affiliation(s)
- Martin D Hoffman
- a Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b University of California Davis Medical Center , Sacramento , CA , USA
| | - Natalie Badowski
- c Department of Emergency Medicine , Stanford University School of Medicine , Stanford , CA , USA
| | - Joseph Chin
- d State University of New York Upstate Medical University , Syracuse , NY , USA
| | | | - Carol A Parise
- f Sutter Institute for Medical Research , Sacramento , CA , USA
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Abstract
Study Design Randomized controlled trial. Background Postexercise recovery techniques are widely used, but little research has examined their effectiveness. Objectives To examine the effectiveness of massage and pneumatic compression on recovery from a 161-km ultramarathon. Methods Participants in the 2015 161-km Western States Endurance Run were randomized to a 20-minute postrace intervention of massage, intermittent sequential pneumatic compression, or supine rest. Each subject completed two 400-m runs at maximum speed before the race and on days 3 and 5 after the race, and also provided muscle pain and soreness ratings and overall muscular fatigue scores before and for 7 days after the race. Results Among the 72 runners who finished the race and completed the study, comparison among intervention groups revealed no significant group or interaction effect on 400-m run time, but there was a significant (P<.0001) time effect. Immediately posttreatment, massage resulted in lower muscle pain and soreness ratings compared with the supine-rest control condition (P<.0001), while both massage (P<.0001) and pneumatic compression (P<.01) resulted in lower overall muscular fatigue scores compared with the control group. There were no significant differences between groups in any outcome 1 to 7 days after the race. Conclusion Single 20-minute sessions of postrace massage and intermittent sequential pneumatic compression provide some immediate subjective benefit. There is no evidence, however, that such treatments provide extended subjective or functional benefits of clinical importance. The trial was registered at www.clinicaltrials.gov (NCT02530190). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2016;46(5):320-326. Epub 23 Mar 2016. doi:10.2519/jospt.2016.6455.
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Sollberger S, Ehlert U. How to use and interpret hormone ratios. Psychoneuroendocrinology 2016; 63:385-97. [PMID: 26521052 DOI: 10.1016/j.psyneuen.2015.09.031] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/05/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
Hormone ratios have become increasingly popular throughout the neuroendocrine literature since they offer a straightforward way to simultaneously analyze the effects of two interdependent hormones. However, the analysis of ratios is associated with statistical and interpretational concerns which have not been sufficiently considered in the context of endocrine research. The aim of this article, therefore, is to demonstrate and discuss these issues, and to suggest suitable ways to address them. In a first step, we use exemplary testosterone and cortisol data to illustrate that one major concern of ratios lies in their distribution and inherent asymmetry. As a consequence, results of parametric statistical analyses are affected by the ultimately arbitrary decision of which way around the ratio is computed (i.e., A/B or B/A). We suggest the use of non-parametric methods as well as the log-transformation of hormone ratios as appropriate methods to deal with these statistical problems. However, in a second step, we also discuss the complicated interpretation of ratios, and propose moderation analysis as an alternative and oftentimes more insightful approach to ratio analysis. In conclusion, we suggest that researchers carefully consider which statistical approach is best suited to investigate reciprocal hormone effects. With regard to the hormone ratio method, further research is needed to specify what exactly this index reflects on the biological level and in which cases it is a meaningful variable to analyze.
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Affiliation(s)
- Silja Sollberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.
| | - Ulrike Ehlert
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.
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Hematological and metabolic changes after a 6-day ultramarathon on indoor cycle and treadmill. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chlíbková D, Knechtle B, Rosemann T, Tomášková I, Novotný J, Žákovská A, Uher T. Rhabdomyolysis and exercise-associated hyponatremia in ultra-bikers and ultra-runners. J Int Soc Sports Nutr 2015; 12:29. [PMID: 26113805 PMCID: PMC4480906 DOI: 10.1186/s12970-015-0091-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 01/06/2023] Open
Abstract
Background Exercise-associated hyponatremia (EAH), rhabdomyolysis and renal failure appear to be a unique problem in ultra-endurance racers. Methods We investigated the combined occurrence of EAH and rhabdomyolysis in seven different ultra-endurance races and disciplines (i.e. multi-stage mountain biking, 24-h mountain biking, 24-h ultra-running and 100-km ultra-running). Results Two (15.4 %) ultra-runners (man and woman) from hyponatremic ultra-athletes (n = 13) and four (4 %) ultra-runners (four men) from the normonatremic group (n = 100) showed rhabdomyolysis following elevated blood creatine kinase (CK) levels > 10,000 U/L without the development of renal failure and the necessity of a medical treatment. Post-race creatine kinase, plasma and urine creatinine significantly increased, while plasma [Na+] and creatine clearance decreased in hyponatremic and normonatremic athletes, respectively. The percentage increase of CK was higher in the hyponatremic compared to the normonatremic group (P < 0.05). Post-race CK levels were higher in ultra-runners compared to mountain bikers (P < 0.01), in faster normonatremic (P < 0.05) and older and more experienced hyponatremic ultra-athletes (P < 0.05). In all finishers, pre-race plasma [K+] was related to post-race CK (P < 0.05). Conclusions Hyponatremic ultra-athletes tended to develop exercise-induced rhabdomyolysis more frequently than normonatremic ultra-athletes. Ultra-runners tended to develop rhabdomyolysis more frequently than mountain bikers. We found no association between post-race plasma [Na+] and CK concentration in both hypo- and normonatremic ultra-athletes.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czech Republic
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Ivana Tomášková
- Faculty of Forestry and Wood Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Jan Novotný
- Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Alena Žákovská
- Institute of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Tomáš Uher
- Center for Adult Medicine in Bohunice, University Hospital Brno, Brno, Czech Republic
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