Competitive Season of Triathlon Does not Alter Bone Metabolism and Bone Mineral Status in Male Triathletes

Changes of bone turnover markers and testosterone in Japanese male endurance runners: a pilot study

INTRODUCTION

The bone metabolism of male endurance runners during a competitive season has been little studied. Furthermore, Japanese runners have a special competitive season. This study aimed to investigate the change of bone turnover markers (BTMs) and other hormones in Japanese male endurance runners.

MATERIALS AND METHODS

We investigated biochemical markers, bone formation and resorption markers and sex hormones, body composition using dual-energy X-ray absorptiometry (DXA), and training volume during a competitive season. 11 (age: 24.0 ± 4.3 years) Japanese male endurance runners were analyzed in this study. They participated in all measurements three times a year: the baseline (BL), the post-track period (PT), and the road race period (RR).

RESULTS

Fat mass (FM) and percentage of body fat (% body fat) at RR (p = 0.009, p = 0.009) were lower than at BL. Specific bone alkaline phosphatase (BAP) decreased at PT (p = 0.004) and RR (p = 0.004) compared with BL. However, the bone resorption marker did not change. Free testosterone at PT (p = 0.032) was lower than BL. There was no correlation with blood variables and body composition or training volume.

CONCLUSION

BAP and testosterone in Japanese male endurance runners decreased during the competitive season. However, there was no correlation between blood variables and training volume.

Nutritional Considerations for the Vegan Athlete

Accepting a continued rise in the prevalence of vegan-type diets in the general population is also likely to occur in athletic populations, it is of importance to assess the potential impact on athletic performance, adaptation, and recovery. Nutritional consideration for the athlete requires optimization of energy, macronutrient, and micronutrient intakes, and potentially the judicious selection of dietary supplements, all specified to meet the individual athlete's training and performance goals. The purpose of this review is to assess whether adopting a vegan diet is likely to impinge on such optimal nutrition and, where so, consider evidence based yet practical and pragmatic nutritional recommendations. Current evidence does not support that a vegan-type diet will enhance performance, adaptation, or recovery in athletes, but equally suggests that an athlete can follow a (more) vegan diet without detriment. A clear caveat, however, is that vegan diets consumed spontaneously may induce suboptimal intakes of key nutrients, most notably quantity and/or quality of dietary protein and specific micronutrients (eg, iron, calcium, vitamin B12, and vitamin D). As such, optimal vegan sports nutrition requires (more) careful consideration, evaluation, and planning. Individual/seasonal goals, training modalities, athlete type, and sensory/cultural/ethical preferences, among other factors, should all be considered when planning and adopting a vegan diet.

Monitoring the Changing Patterns in Perceived Learning Effort, Stress, and Sleep Quality during the Sports Training Period in Elite Collegiate Triathletes: A Preliminary Research

Background: Few studies have examined the mental profiles and academic status of collegiate triathletes during training/competitive periods. We evaluated the changes in sleep quality, physical fatigue, emotional state, and academic stress among collegiate triathletes across training periods. Methods: Thirteen collegiate triathletes (19−26 years old) were recruited in this study. Mood state, sleep quality, degree of daytime sleepiness, subjective fatigue, and academic learning states were measured during the following five training periods: before national competitions for 3 months (3M-Pre Comp), 2 months (2M-Pre Comp), 1 month (1M-Pre Comp), 2 weeks (2wk-Pre Comp), and national competition (Comp) according to their academic/training schedule. Results: The academic stress index in 1M-Pre Comp (Final exam) was significantly higher than that in 3M-Pre Comp in these triathletes. No markedly significant differences were observed in overall mood state, sleep quality, individual degree of sleepiness, and fatigue among these five periods. However, the profiles mood state scale (POMS)-fatigue and -anger were lower in 2wk-Pre Comp than that in 1M-Pre com. The POMS-tension score in Comp was significantly higher than that in 3M-Pre Comp and 2M-Pre Comp. POMS-depression in Comp was lower than that in 1M-Pre Comp. Conclusion: We found that training volume was highest one month before a competition, and the academic stress is greatest during their final term exam period (1M-Pre Comp). After comprehensive assessment through analyzing POMS, PSQI, ESS, and personal fatigue (CIS), we found that the collegiate triathletes exhibited healthy emotional and sleep states (PSQI score < 5) across each training period, and our results suggest that these elite collegiate triathletes had proficient self-discipline, time management, and mental adjustment skills.

Associations between bio-motor ability, endocrine markers and hand-specific anthropometrics in elite female futsal players: a pilot study

BACKGROUND

The second-to-fourth digit ratio (2D:4D) has been calculated for individual athletes and sports, but it has not been investigated in futsal performance. Therefore, the aim of this study was to investigate any relationships between 2D:4D of the dominant and non-dominant hands and physical capacity performances, selected functional variables and hormone concentrations in elite female futsal players.

METHODS

Twenty-four elite female futsal players were measured for 2D:4D in the dominant (2D:4D_D) and non-dominant (2D:4D_ND) hand. The futsal specific performance test (FSPT), hand-grip strength (HGS) and aerobic power were also assessed. In addition, selected circulatory hormones were measured (estradiol, cortisol, growth hormone and insulin like growth factor-1). Pearson's correlation test was used to identify correlational relationships.

RESULTS

Total test-time and performance time (total time + penalty time) for the FSPT showed a significant correlation with 2D:4D_D (r = 0.53, p = 0.005 and r = 0.55, p = 0.003, respectively). HGS_ND also displayed a significant correlation with the 2D:4D_D (r = 0.59, p = 0.002). Aerobic power and time spent running on the treadmill also showed a significant relationship with 2D:4D_ND (both, r = 0.54, p = 0.006). Cortisol showed a significant correlation with 2D:4D_D (- 0.58, p = 0.003) and 2D:4D_ND(- 0.52, p = 0.008).

CONCLUSIONS

The measurement of 2D:4D ratio could be an important factor in determining potential performance attributes and talent identification of elite female futsal players. Further studies are needed in this area to further examine the results presented here.

Association Between Endocrine Markers, Accumulated Workload, and Fitness Parameters During a Season in Elite Young Soccer Players

The purpose of this study was to analyze differences between endocrine markers in soccer players, based on playing positions, and correlations between endocrine markers (testosterone, cortisol, growth hormone, and insulin-like growth factor-1), with accumulated workload training and fitness parameters [maximal oxygen uptake (VO2max), countermovement jump (CMJ), and isometric maximal strength (1-RM) of the knee for hamstring (ISH) and quadriceps (ISQ) muscles] during early-, mid-, and end-seasons. Twenty-four elite soccer players under 17 participated in this study. The results showed that there was no difference between levels of the endocrine markers among the different positions of the players. Significant correlations were observed between endocrines parameters and fitness performance (ISQ, ISH, VO2max, and CMJ). Regression analysis showed that 1-RM and VO2max were the best predictors of endocrine markers. These findings demonstrated that the activity profiles of youth soccer players were not influenced by endocrine markers. Also, it may be assumed that endocrines levels can be used to better explain the physical capacities of this population. Finally, endocrines markers may help to predict changes in 1-RM and VO2max.

The Bone Metabolic Response to Exercise and Nutrition

Bone (re)modeling markers can help determine how the bone responds to different types, intensities, and durations of exercise. They also might help predict those at risk of bone injury. We synthesized evidence on the acute and chronic bone metabolic responses to exercise, along with how nutritional factors can moderate this response. Recommendations to optimize future research efforts are made.

The effects of a 226-km ironman triathlon race on bone turnover in amateur male triathletes

BACKGROUND

The purpose of this study was to investigate the effects of an Ironman-distance triathlon on bone metabolism.

METHODS

Nine recreational male triathletes (39.7±8.2 years old) were voluntarily recruited before a 226-km Ironman triathlon race. Baseline blood samples were collected >1 hour before race. Serial post-race blood sampling time points included immediately (0hr), 1 hour (1hr), 1 day (d), 3 d, and 5 d after the Ironman race.

RESULTS

Serum muscle damage markers, serum myoglobin, creatine kinase (CK) and lactate dehydrogenase (LDH) revealed significant post-race peak values immediately, 1hr and 1d after the race, respectively. Except for the marginally higher serum CK and myoglobin at 5d (P=0.01~0.05), all post-race serum levels of muscle damage markers were significantly higher than baseline levels (P<0.01). Serum phosphorus values were significantly higher immediately (0hr) after the Ironman race. Serum osteocalcin, an index specific to bone formation, showed a significant decrease at time points 0hr and 1hr, but a significant increase 1 day after (P<0.01) and a marginal increase 3 and 5 days after (P=0.01~0.05) the race. No difference was shown in type I collagen C-telopeptide (CTX-1), a bone resorption marker. Pearson's correlation between serum osteocalcin and CTX-1 was done at each time point, and significant correlation was shown on the 5th d after the race (r=0.591, P<0.05).

CONCLUSIONS

An Ironman-distance contest induces a bone-formative-favoring turnover during the post-race period for amateur male triathletes.

The time course and mechanisms of change in biomarkers of joint metabolism in response to acute exercise and chronic training in physiologic and pathological conditions

PURPOSE

The benefits of exercise across the lifespan and for a wide spectrum of health and diseases are well known. However, there remains less clarity as to the effects of both acute and chronic exercise on joint health. Serum biomarkers of joint metabolism are sensitive to change and have the potential to differentiate between normal and adverse adaptations to acute and chronic load. Therefore, the primary objective of this review is to evaluate how serum biomarkers can inform our understanding of how exercise affects joint metabolism.

METHODS

A comprehensive literature search was completed to identify joint biomarkers previously used to investigate acute and chronic exercise training.

RESULTS

Identified biomarkers included those related to joint cartilage, bone, synovium, synovial fluid, and inflammation. However, current research has largely focused on the response of serum cartilage oligomeric matrix protein (COMP) to acute loading in healthy young individuals. Studies demonstrate how acute loading transiently increases serum COMP (i.e., cartilage metabolism), which is mostly dependent on the duration of exercise. This response does not appear to be associated with any lasting deleterious changes, cartilage degradation, or osteoarthritis.

CONCLUSION

Several promising biomarkers for assessing joint metabolism exist and may in future enhance our understanding of the physiological response to acute and chronic exercise. Defining 'normal' and 'abnormal' biomarker responses to exercise and methodological standardisation would greatly improve the potential of research in this area to understand mechanisms and inform practice.

May Young Elite Cyclists Have Less Efficient Bone Metabolism?

The purpose of this work was to describe changes in metabolic activity in the bones of young male competitive cyclists (CYC) as compared with age-matched controls (CON) over a one-year period of study. Eight adolescent male cyclists aged between fourteen and twenty, and eight age-matched controls participated in this longitudinal study. Serum osteocalcin (OC), amino-terminal propeptide of type I procollagen (PINP), beta-isomerized C-telopeptides (β-CTx) and plasma 25 hydroxyvitamin D [25(OH)D], were investigated by an electrogenerated chemiluminescence immunoassay. Analysis of variance revealed no significant differences in formation and resorption markers between cyclists and controls. Within the groups, both CYC and CON showed decreased OC at -30% and -24%, respectively, and PINP where the figures were -28% and -30% respectively (all p < 0.05). However, only the CYC group showed a decrease in [25(OH)D], lower by 11% (p < 0.05). The similarity in the concentrations of markers in cyclists and controls seems to indicate that cycling does not modify the process of bone remodeling. The decrease in vitamin D in cyclists might be detrimental to their future bone health.

Endocrinology and Pediatric Exercise Science-The Year That Was 2017

The Pediatric Exercise Science "Year That Was" section aims to highlight the most important (to the author's opinion) manuscripts that were published in 2017 in the field of endocrinology and pediatric exercise science. This year's selection includes studies showing that 1) in pubertal swimmers, there is a decrease in insulin-like growth factor-1 (IGF-I) and IGF-binding protein-3 (IGFBP-3) during intense training (a catabolic-type hormonal response) with an anabolic "rebound" characterized by a significant increase of these growth factors during training tapering down. Moreover, it was shown that changes of IGF-I and IGFBP-3 paralleled changes in peak and average force but not with endurance properties, showing decreases during intense training and increases during tapering; 2) a meta-analysis showing that growth hormone administration elicits significant changes in body composition and possible limited effect on anaerobic performance but does not increase either muscle strength or aerobic exercise capacity in healthy, young subjects; and 3) short-term exercise intervention can prevent the development of polycystic ovary syndrome in a dose-dependent manner in letrozole-induced polycystic ovary syndrome rat model with high-intensity exercise being most effective. The implication of these studies to the pediatric population, their importance, and the new research avenues that were opened by these studies is emphasized.

Seasonal Variations of Bone Metabolism and Bone Mineral Density in Collegiate Alpine Skiers

Sato, T, Sakuraba, K, Tsuchiya, Y, Maruyama, S, and Ochi, E. Seasonal variations of bone metabolism and bone mineral density in collegiate alpine skiers. J Strength Cond Res 32(5): 1448-1454, 2018-This study investigated the seasonal variations in bone metabolism, mineral density, and physical characteristics in collegiate alpine skiers. Twelve male subjects (20.6 ± 1.5 years) were evaluated for body composition, bone mineral density (BMD), serum levels of osteocalcin (OC), bone alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b), parathormone, and 25-hydroxy vitamin D. We also measured the knee extensor and flexor strength, maximal power, and vertical jump. Measurements were conducted in the preseason period (T1), competitive period (T2), end-of-season period (T3), and resting period (T4). The percentage of body fat significantly increased from T1 to T2-T4 (p < 0.05), but lean body mass significantly decreased from T1 to T2-T4 (p < 0.05). Although BMD increased at T2 (0.9%) and T3 (0.8%), as compared with that at T1 (p < 0.05), BAP and OC decreased at T2 and T3, as compared with that at T1 (p < 0.05). Tartrate-resistant acid phosphatase 5b significantly increased from T1 to T2 (p < 0.05). We concluded that it is important to monitor bone metabolism markers and BMD of male alpine skiers throughout the season.

Seasonal DXA-measured body composition changes in professional male soccer players

This work investigated changes in body composition of professional soccer players attending an Italian Serie A club across the competitive season; it is original insofar as body composition was assessed at multiple time points across the season using the accurate three-compartment model provided by Dual-Energy X-Ray Absorptiometry (DXA). Thirty-one players (4 goalkeepers, 13 defenders, 8 midfielders, 6 forwards) underwent DXA and anthropometry at pre-, mid- and end-season. One operator measured whole body and regional body composition (fat mass, FM; fat-free soft tissue mass, FFSTM; mineral mass). Two players were excluded from analysis due to serious injury. Data were analysed with repeated measures ANOVA; factors were season time point and playing position. Results showed that whole-body FM and %FM significantly (P < 0.001) decrease at mid-season (-11.9%; -1.3%, respectively) and end-season (-8.3%; -0.8%, respectively) whereas FFSTM significantly (P < 0.001) increase at mid-season (+1.3%) and end-season (+1.5%). Limited, but significant changes took place in bone mineral content. Some regional (upper and lower limbs, trunk) differences in the pattern of body composition changes across the season were also found. Changes were similar for all playing positions. It was concluded that professional soccer players undergo changes in their FM, FFSTM, and mineral mass across the season with some regional variations, irrespective of the playing position. Changes are mostly positive at mid-season, possibly due to difference in training between the first and second phase of the season.

The impact of triathlon training and racing on athletes' general health

Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries 'causing cessation or reduction of training or seeking of medical aid' are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9-2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.

Reciprocal regulation of calcium-/phosphate-regulating hormones in cyclists during the Giro d'Italia 3-week stage race

Calcium and phosphate are essential for cell functions, and their serum concentrations result from the balance between intestinal absorption, bony storage, and urinary excretion. Fibroblast growth factor 23 (FGF23), expressed by osteocytes and osteoblasts, acts in the kidney, leading to hypophosphatemia and low 1,25-dihydroxycholecalciferol synthesis, but suppresses parathyroid function. The aim of this study was to explore the effects of a high-energy demanding cycling race on this bone-kidney-parathyroid axis. We studied nine cyclists during the 2011 Giro d'Italia stage race. Pre-analytical and analytical phases followed academic and anti-doping recommendations. Serum parathyroid hormone (PTH), 25(OH)D, total calcium, inorganic phosphorus, and plasma FGF23 were measured on days -1, 12, and 22 and corrected for changes in plasma volume. Dietary calcium and phosphorus, anthropometric parameters (height, weight, and body mass index) and indexes of metabolic effort (net energy expenditure, power output) were recorded. Dietary calcium and phosphorus intakes were kept at the same levels throughout the race. Twenty-five (OH)D, PTH, and calcium concentrations remained stable. FGF23 increased 50% with a positive correlation with the indexes of metabolic effort and, consequently, phosphorous decreased, although only in the first half. The strong metabolic effort acts on the bone-kidney-parathyroid system, and the rise in FGF23 plasma concentration might be aimed at maintaining calcium and phosphorus homeostasis.

A cross-sectional study of osteocalcin and body fat measures among obese adolescents

Osteocalcin (OCN), a marker of osteoblast activity, has been implicated in the regulation of energy metabolism by the skeleton and thus may affect body fat measures.

OBJECTIVE

To examine the relationships of OCN to body fat measures and whether they vary according to markers of energy and vitamin D metabolism.

DESIGN AND METHODS

Data were obtained from 58 obese adolescents aged 13-17.9 years (38 females, 8 black or African-American). Total fat mass (FM) [dual X-ray absorptiometry (DXA)] and visceral adipose tissue (VAT) [computerized axial tomography (CT)] were calculated. Blood tests included leptin, OCN, 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), thyroid function tests, and triglycerides. Markers of glucose metabolism were obtained from fasting and OGTT samples.

RESULTS AND CONCLUSIONS

Adolescents with 25(OH)D <20 ng mL(-1) were considered deficient (n = 17/58); none had high PTH (PTH ≥ 65 pg mL(-1) ). OCN was associated with lower VAT (-84.27 ± 33.89 mm(2) ) and BMI (-0.10 ± 0.05 kg m(-2) ), not FM (P = 0.597) in a core model including age, sex, race, geographic latitude, summer, height z-score, and tanner stage. Adding 25(OH)D deficiency and PTH attenuated the inverse association of OCN to VAT. There was a significant interaction of OCN and 25(OH)D deficiency on FM (0.37 ± 0.18 kg, P = 0.041) and BMI (0.28 ± 0.10 kg m(-2) , P = 0.007) in this adjusted model, which was further explained by leptin. Adding A1C to the core model modified the relationship of OCN to VAT (-93.08 ± 35.05 mm(2) , P = 0.011), which was further explained by HOMA-IR. In summary, these findings provide initial evidence for a relationship between OCN and body fat measures that is dependent on energy metabolism and vitamin D status among obese adolescents.

Bone and energy metabolism parameters in professional cyclists during the Giro d'Italia 3-weeks stage race

Cycling is a not weight-bearing activity and is known to induce bone resorption. Stage races are really strenuous endurance performances affecting the energy homeostasis. The recently highlighted link, in the co-regulation of bone and energy metabolism, demonstrates a central role for the equilibrium between carboxylated and undercarboxylated forms of osteocalcin. Aim of this study was to understand the acute physiological responses to a cycling stage race in terms of bone turnover and energy metabolism and the possible co-regulative mechanisms underlying their relationship. We studied nine professional cyclists engaged in 2011 Giro d'Italia stage race. Pre-analytical and analytical phases tightly followed academic and anti-doping authority's recommendations. Bone and energy metabolism markers (bone alkaline phosphatase, tartrate-resistant acid phosphatase 5b, total and undercarboxylated osteocalcin, leptin and adiponectin) and related hormones (cortisol and testosterone) were measured, by Sandwich Enzyme Immunoassays, at days -1 (pre-race), 12 and 22 during the race. The power output and the energy expenditure (mean and accumulated) were derived and correlated with the biochemical indexes. During the race, bone metabolism showed that an unbalance in behalf of resorption, which is enhanced, occurred along with a relative increase in the concentration of the undercarboxylated form of osteocalcin that was indirectly related to the enhanced energy expenditure, through adipokines modifications, with leptin decrease (high energy consumption) and adiponectin increase (optimization of energy expenditure). The exertion due to heavy effort induced a decrease of cortisol, while testosterone levels resulted unchanged. In conclusion, during a 3-weeks stage race, bone metabolism is pushed towards resorption. A possible relationship between the bone and the energy metabolisms is suggested by the relative correlations among absolute and relative concentrations trends of undercarboxylated OC, adipokines concentrations, BMI, fat mass (%), power output and the derived energy expenditure.

Metabolic markers in sports medicine

Physical exercise induces adaptations in metabolism considered beneficial for health. Athletic performance is linked to adaptations, training, and correct nutrition in individuals with genetic traits that can facilitate such adaptations. Intense and continuous exercise, training, and competitions, however, can induce changes in the serum concentrations of numerous laboratory parameters. When these modifications, especially elevated laboratory levels, result outside the reference range, further examinations are ordered or participation in training and competition is discontinued or sports practice loses its appeal. In order to correctly interpret commonly used laboratory data, laboratory professionals and sport physicians need to know the behavior of laboratory parameters during and after practice and competition. We reviewed the literature on liver, kidney, muscle, heart, energy, and bone parameters in athletes with a view to increase the knowledge about clinical chemistry applied to sport and to stimulate studies in this field. In liver metabolism, the interpretation of serum aminotransferases concentration in athletes should consider the release of aspartate aminotransferase (AST) from muscle and of alanine aminotransferase (ALT) mainly from the liver, when bilirubin can be elevated because of continuous hemolysis, which is typical of exercise. Muscle metabolism parameters such as creatine kinase (CK) are typically increased after exercise. This parameter can be used to interpret the physiological release of CK from muscle, its altered release due to rhabdomyolysis, or incomplete recovery due to overreaching or trauma. Cardiac markers are released during exercise, and especially endurance training. Increases in these markers should not simply be interpreted as a signal of cardiac damage or wall stress but rather as a sign of regulation of myocardial adaptation. Renal function can be followed in athletes by measuring serum creatinine concentration, but it should be interpreted considering the athlete's body-mass index (BMI) and phase of the competitive season; use of cystatin C could be a reliable alternative to creatinine. Exercise and training induce adaptations in glucose metabolism which improve glucose utilization in athletes and are beneficial for reducing insulin insensitivity in nonathletes. Glucose metabolism differs slightly for different sports disciplines, as revealed in laboratory levels. Sport activities induce a blood lipid profile superior to that of sedentary subjects. There are few reports for a definitive conclusion, however. The differences between athletes and sedentary subjects are mainly due to high-density lipoprotein cholesterol (HDLC) concentrations in physically active individuals, although some differences among sport disciplines exist. The effect of sports on serum and urinary markers for bone metabolism is not univocal; further studies are needed to establish the real and effective influence of sport on bone turnover and especially to establish its beneficial effect.

A Systematic Review of Bone Health in Cyclists

Context:

Low bone mineral density (BMD) is a serious public health problem. Osteoporotic fractures are associated with low bone mass, occurring frequently in the hip and spine. Previous studies have demonstrated a positive relationship between BMD and weightbearing exercise but not a similar positive relationship with nonweightbearing exercise. There is concern that cycling, a weight-supported sport, does not benefit bone health.

Objective:

To systematically review the evidence suggesting that cyclists have impaired bone health at the femoral neck and lumbar spine.

Data Sources:

Articles in PubMed, Cochrane Library, and CINAHL were identified in December 2009 What is the start date for the search?based on the following terms and combinations: bicycling, bone density, cyclist.

Study Selection:

Thirteen studies satisfied inclusion criteria: 2 prospective studies (level of evidence 2b) and 11 cross-sectional studies (level of evidence 2c).

Data Extraction:

Data included sample size, demographics, description of cycling and control criteria, and BMD (g/cm²) at the lumbar spine, femoral neck, and hip.

Results:

Two prospective studies showed a decrease in femoral neck, total hip, or lumbar spine BMD in cyclists over the study period. Four cross-sectional studies compared cyclists with sedentary controls, and 3 found cyclists’ lumbar spine and femoral neck BMD similar to that of controls, whereas 1 found cyclists’ BMD to be lower than that of controls. Seven cross-sectional studies compared cyclists with active controls: 2 found no differences in femoral neck and lumbar spine BMD between cyclists and controls; 4 found that cyclists had lower lumbar spine BMD than did active controls, including runners; and 1 reported a trend toward lower lumbar spine BMD in cyclists versus controls.

Conclusions:

There is concerning but inconsistent, limited-quality disease-oriented evidence—primarily from cross-sectional data—indicating that cyclists may be at risk for low bone mass, particularly at the lumbar spine. Additional longitudinal controlled intervention trials are needed.

Effects of physical activity on bone remodeling

Physical exercise is recommended to improve bone mass in growing children and decrease bone loss in elderly men and women. However, the specific mechanisms by which exercise influences bone metabolism are still not thoroughly understood. The effect of physical activity on the skeleton is generally evaluated by dual-energy x-ray absorptiometry, which measures bone mineral density. However, a relatively long period is needed to detect even a minor variation in bone mineral density with this technique, limiting its usefulness. Bone biochemical markers that reflect the cellular activities of bone formation and resorption are thus also useful tools, both to monitor the acute effects of exercise on bone remodeling and to investigate the mechanisms of exercise-induced changes in bone mass. This article describes the effects of physical activity on bone remodeling in various types of population. The comparison of sedentary individuals and athletes with many years of high-volume sports practice, for example, has clarified some of the long-term effects of exercise. Moreover, the acute variation in bone cell activities after brief exercise or a training program is here examined. The interpretation of results is difficult, however, because of the many parameters, such as age, that are involved. The various populations are therefore categorized to reflect the biological factors implicated in the modulation of bone marker response during exercise.

Bone metabolism markers in sports medicine

Bone mass can be viewed as the net product of two counteracting metabolic processes, bone formation and bone resorption, which allow the skeleton to carry out its principal functions: mechanical support of the body, calcium dynamic deposition and haemopoiesis. Besides radiological methods, several blood and urinary molecules have been identified as markers of bone metabolic activity for estimating the rates and direction of the biological activities governing bone turnover. The advantages for the use of bone metabolism markers are that they are potentially less dangerous than radiological determinations, are more sensitive to changes in bone metabolism than radiological methods and are easily collected and analysed. The disadvantages are that they have high biological variability. Physical exercise is a known source of bone turnover and is recommended for preventing osteoporosis and bone metabolism problems. There are numerous experiments on bone metabolism markers after acute exercise, but not after long-term training and during or after a whole competition season. Moreover, few studies on bone metabolism markers have evaluated their performance in elite and top-level athletes, who have a higher bone turnover than sedentary individuals. Despite discrepant results among studies, most have shown that short exercise is insufficient for modifying serum concentrations of bone metabolism markers. Marker variations are more evident after several hours or days after exercise, bone formation markers are more sensitive than bone resorption markers, and stimulation of osteoblast and/or osteoclast functions is exercise dependent but the response is not immediate. The response depends on the type of exercise; the markers seem to be less sensitive to resistance exercise and the intensity of exercise is not discriminate. Comparisons between trained subjects and untrained controls have demonstrated the influence of exercise on bone turnover. During training, carboxy-terminal collagen cross-links (CTx), a bone resorption marker, was shown to be less sensitive than amino-terminal cross-linking telopeptide of type I collagen (NTx) and urinary pyridinolines, which were sensitive to anaerobic exercise. Whereas, the bone formation markers, bone alkaline phosphatase (BAP) and osteocalcin (OC) changed after 1 month and 2 months of an exercise programme, respectively. After 2 months, while BAP normalized, it was found to be sensitive to aerobic exercise and OC was found to be sensitive to anaerobic exercise. After prolonged training and competition, bone formation markers are found to change in sedentary subjects enrolled in a physical activity programme. Professional athletes show changes in bone formation markers depending on programme intensity, whereas bone resorption appears to stabilize. Crucial for long-term training, are the characteristics of exercise (e.g. weight-bearing, impact).

Bone metabolism markers in sports medicine

Bone mass can be viewed as the net product of two counteracting metabolic processes, bone formation and bone resorption, which allow the skeleton to carry out its principal functions: mechanical support of the body, calcium dynamic deposition and haemopoiesis. Besides radiological methods, several blood and urinary molecules have been identified as markers of bone metabolic activity for estimating the rates and direction of the biological activities governing bone turnover. The advantages for the use of bone metabolism markers are that they are potentially less dangerous than radiological determinations, are more sensitive to changes in bone metabolism than radiological methods and are easily collected and analysed. The disadvantages are that they have high biological variability. Physical exercise is a known source of bone turnover and is recommended for preventing osteoporosis and bone metabolism problems. There are numerous experiments on bone metabolism markers after acute exercise, but not after long-term training and during or after a whole competition season. Moreover, few studies on bone metabolism markers have evaluated their performance in elite and top-level athletes, who have a higher bone turnover than sedentary individuals. Despite discrepant results among studies, most have shown that short exercise is insufficient for modifying serum concentrations of bone metabolism markers. Marker variations are more evident after several hours or days after exercise, bone formation markers are more sensitive than bone resorption markers, and stimulation of osteoblast and/or osteoclast functions is exercise dependent but the response is not immediate. The response depends on the type of exercise; the markers seem to be less sensitive to resistance exercise and the intensity of exercise is not discriminate. Comparisons between trained subjects and untrained controls have demonstrated the influence of exercise on bone turnover. During training, carboxy-terminal collagen cross-links (CTx), a bone resorption marker, was shown to be less sensitive than amino-terminal cross-linking telopeptide of type I collagen (NTx) and urinary pyridinolines, which were sensitive to anaerobic exercise. Whereas, the bone formation markers, bone alkaline phosphatase (BAP) and osteocalcin (OC) changed after 1 month and 2 months of an exercise programme, respectively. After 2 months, while BAP normalized, it was found to be sensitive to aerobic exercise and OC was found to be sensitive to anaerobic exercise. After prolonged training and competition, bone formation markers are found to change in sedentary subjects enrolled in a physical activity programme. Professional athletes show changes in bone formation markers depending on programme intensity, whereas bone resorption appears to stabilize. Crucial for long-term training, are the characteristics of exercise (e.g. weight-bearing, impact).

Swimming training increases the post-yield energy of bone in young male rats

The purpose of this study is to investigate the effects of non-weight-bearing exercise on growing bone. Male Wistar rats (7 week-old) were assigned to one baseline control group, one control group and two swimming training groups, which were trained with 2 and 4% body-weight mass added, respectively. After an 8-week training period, three groups showed significant development compared to the baseline control group. Among the three 15-week-old groups, swimming-trained rats were lower in body weight (BW), densitometry and size-related measurements. In femoral biomechanical testing, swimming training groups were significantly lower in yield moment and ultimate moment, which may be due to a significantly lower long bone cross-sectional moment of inertia. However, the two swimming groups were higher in post-yield energy absorption and displacement. Further, in estimated tissue-level biomaterial properties, no differences were shown in yield stress, strain or toughness among the three groups. Using BW as a covariate, results of ANCOVA showed no differences in size-related parameters among the three groups, and some parameters were even higher in the two swimming groups. Regarding Pearson's correlation, size-related parameters correlated well to BW and whole bone strength but not to tissue post-yield behaviors. In conclusion, when compared to age-matched control group, swimming rats showed lower bone strength and lower yield energy absolutely at the structural level, but similar yield stress and yield toughness at the tissue level. Moreover, swimming training benefited growing bone in post-yield behaviors. Further studies should investigate the parameters that contribute to this exercise-induced post-yield behavior.

Effect of physical activity on calcium homeostasis and calciotropic hormones: a review

Physical exercise has frequently been shown to improve bone mass, especially at load-bearing bone sites. It is widely acknowledged that the anabolic effects of exercise on bone tissue are related to the application of mechanical constraints, but part of the osteogenic response may be due to other factors. In particular, various hormonal parameters that are modified by training, such as insulin-like growth factor-1 and sexual hormones, may modulate the bone response. In contrast, little is known about the involvement of calciotropic hormones in the adaptation mechanism of bone tissue. These hormones, which include parathyroid hormone, vitamin D metabolites, and calcitonin, are highly implicated in the regulation of both bone remodeling and calcium homeostasis. In addition to their direct action on bone cell activity, these hormones act on various target tissues such as kidney and intestine. This article describes the acute and long-term effects of exercise on both calcium homeostasis and calciotropic hormones in various populations. It clearly shows that exercise modifies calcium homeostasis and calciotropic hormone levels and that the variations in response are modulated by parameters related to exercise, including duration and intensity, as well as by individual characteristics such as age, sex, and training status.

Exercise and the preservation of bone health

Exercise is generally accepted as having favorable effects on bone health and, subsequently, a reduction in fracture risk. In the absence of large randomized controlled trials of the potential benefits of exercise on fracture risk, support for this belief comes from cross-sectional studies and interventional studies using surrogate endpoints such as bone mineral density and falls. In this review, we discuss the characteristics of exercise programs that provide an osteogenic stimulus. The goals and benefits of exercise on bone across the age spectrum are discussed. Where there is a paucity of human data, animal studies examining the roles of variables such as exercise intensity, frequency, duration, and mode in shaping the response of bone to exercise are discussed. The effects of disuse and the limited response of bone to remobilization are described. The rapid and dramatic decrease in bone mineral density observed in the early period after heart or lung transplantation is discussed, as are the available data on the benefits of exercise on bone in this population. For cardiopulmonary rehabilitation programs to improve bone health, they should include not just weight-supported activities (eg, cycling) but also weight-bearing activities (eg, walking, resistance exercise). Although the optimal exercise routine for bone health is unknown, components of an osteogenic program are discussed.

Bone mineral density of young boy soccer players at different pubertal stages: relationships with hormonal concentration

OBJECTIVES

To examine the effects of soccer in relation with the hormonal concentration, on the bone mass of young Tunisian players at different pubertal stages.

METHODS

Two groups of 152 young boys (age: 13.3+/-0.9 years) participated in this study: (1) 91 soccer players, and (2) 61 non-athletic boys used as control subjects. The bone mineral density (BMD) and the bone mineral content (BMC) were measured by dual-energy X-ray absorptiometry (DXA). Pubertal stages were assessed, and serum concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), growth hormone (GH) and the total testosterone were measured.

RESULTS

The BMD and BMC for whole body, lumbar spine, femoral neck, pelvis and lower limbs were higher in soccer players than in controls (p<0.001). In early puberty, the soccer players also exhibited significantly greater BMD and BMC in the whole body and in weight-bearing bones compared with the controls (p<0.001). However, there was no intersubject variability due to puberty in either BMD or BMC. The pubescent soccer players had significantly higher hormonal concentrations of IGF-1 and IGFBP-3 than their counterpart controls (p<0.05). Moreover, the whole body BMD was significantly (p<0.001) correlated with GH, IGF-1 and IGFBP-3 but not with the testosterone concentrations.

CONCLUSION

The soccer participation of boys is generally associated with the improvement of their bone mass which is mainly marked at early and late puberty. The relationships between somatotropic axis hormones and BMD of the players may be linked to the parallel development of these two parameters during puberty.

BMD decreases over the course of a year in competitive male cyclists

Male cyclists have been found to have low BMD in cross-sectional studies. Changes in BMD values over 1 yr of training and competition were studied in 14 male cyclists. BMD decreased significantly at the total hip, neck, trochanter, and shaft regions but not the lumbar spine. This first prospective study of cyclists showed a decrease in BMD over the course of 1 yr.

INTRODUCTION

Cross-sectional studies have shown that some endurance athletes, and cyclists in particular, have low BMD. Whether vigorous cycle training is causally related with low BMD remains unknown.

MATERIALS AND METHODS

Changes in BMD values over 1 yr of training and competition were studied in 14 male road cyclists, 27-44 yr of age. Subjects were randomized to receive 1500 (500 mg with meals) or 250 mg of supplemental calcium citrate daily. BMD measurements were obtained at pre-, mid-, post-, and off-season time points over 1 yr. Dermal calcium loss during exercise was estimated using a patch collection technique to examine calcium loss as a potential mediator of changes in BMD.

RESULTS

Using paired t-tests, BMD was found to decrease significantly from pre- to off-season at the total hip, neck, shaft, and trochanter regions (relative changes of -1.5 +/- 2.1%, -0.7 +/- 2.1%, -0.9 +/- 2.1%, and -1.0 +/- 1.2%, respectively, all p < 0.05). The 1.0 +/- 1.2% decrease in BMD at the lumbar spine failed to reach statistical significance (p = 0.079). There were no differences in changes in BMD between the calcium supplementation groups. The 2-h dermal calcium loss was estimated at 136.5 +/- 60.5 mg. Higher dermal calcium losses were associated with lower baseline BMD values at the total hip, neck, and shaft (all p < 0.05), but were not significantly associated with changes in BMD.

CONCLUSIONS

This study suggests that high intensity cycle training may adversely affect BMD. Excessive dermal calcium loss during exercise may be a contributing factor, but mechanisms remain to be elucidated.

Alterations in IGF-I affect elderly: role of physical activity

The growth hormone–insulin-like growth factor I (IGF-I) axis is an important physiological regulator muscle for development. Although there is evidence that aging muscle retains the ability to synthesize IGF-I, there is also evidence that aging may be associated with attenuation of the ability of exercise to induce an isoform of IGF-I that promotes satellite cell proliferation. However, it is clear that overexpression of IGF-I in the muscle can protect against age-related sarcopenia. Strength training appears to be the intervention of choice for the prevention and treatment of sarcopenia. IGF-I has been implicated in the loss of the muscle with age, and IGF-I expression levels change as a consequence of strength training in older adults. However, it seems that advancing age, rather than declining serum levels of IGF-I, appears to be a major determinant of life-time changes in body composition in women and men. We concluded that resistive exercise is a significant determinant of muscle mass and function. Elevated levels of IGF-I have been found in physically active compared to sedentary individuals. Recent work suggests that IGF-I as a mediator plays an important role in muscle hypertrophy and angiogenesis, both of which characterize the anabolic adaptation of muscles to exercise.

Bone metabolism in elite male rowers: adaptation to volume-extended training

We examined the effect of 6-month volume-extended training on bone metabolism in elite male rowers. Twelve elite male rowers (20.8+/-3.0 years; 192.9+/-4.7 cm; 91.9+/-5.3 kg; body fat 10.1+/-2.3%; VO2max 6.2+/-0.5 l min(-1)) participated in this study. Bone biochemical markers, hormones, bone mineral content (BMC), and bone mineral density (BMD) were assessed before and after training. Average weekly training volume was significantly higher (P<0.05) during the 6 months of heavy training compared to relative rest (11.6+/-0.4 h week(-1) vs. 16.8+/-0.6 h week(-1)), while intensity remained the same. At the end of training, only arm BMD was significantly increased by 5.7%. Osteocalcin (16.6%), insulin-like growth factor-1 (IGF-1) (20.2%) and the bioavailability IGF-1 index (17.9%) were significantly increased. Before heavy training, relationships were observed between the whole body BMD and growth hormone (r=0.64; P< or =0.02), lumbar spine BMD and 1.25(OH)2 vitamin D (r=0.69; P< or =0.04), arm BMD and testosterone (r=0.59; P< or =0.05), and arm BMD and adiponectin (r=0.59; P< or =0.05). No relationship was found between BMC or BMD and blood biochemical measures 6 months later (r=0.56; P> or =0.05). In addition, osteocalcin was related to IGF-1 (r>0.58; P<0.048) and bioavailability IGF-1 index (r>0.59; P< or =0.055) before and after training. In summary, heavy training had a moderately favorable effect on BMD. Bone tissue at specific skeleton sites is sensitive to changes in training volume even in athletes with already high BMD values. Changes in BMD and bone formation may be caused by changes in specific hormones such as IGF-1 and adiponectin in male athletes.

Effect of training on GH and IGF-1 responses to a submaximal exercise in football players

To study the effects of regular football training on basal and exercise induced levels of growth hormone (GH) and insulin-like growth factor (IGF-1), 13 young football players were investigated by a submaximal exercise at the beginning of the sporting season in October (S1), at the middle of the season in January (S2) and at the end in May (S3). At each session, an exercise test on an ergogycle was performed for 25 min, beginning with an incremental exercise to reach 90% of theoretical maximal heart, which was maintained for the last 10 min of the test. Venous blood samples were collected at rest, at the end of the exercise and at 30 and 60 min during the recovery period. Plasma lactate and glucose concentrations increased during exercise with no difference found between sessions. GH level increased with exercise at each session but the response was significantly higher in S1 than in S2 and S3 (P<0.01). The GH area under the curve decreased significantly all along the football season (P<0.01); the IGF-1 level did not significantly change during exercise nor with training. Basal insulin-like growth factor binding protein-3 (IGFBP3) remained stable during the three sessions. Football training decreased significantly the exercise-stimulated GH levels all along the football season but did not have any significant effect on IGF-1 levels or on basal IGFBP3 levels.