Monitoring of immunological parameters in adolescent basketball athletes during and after a sports season

Longitudinal Internal Training Load and Exposure in a High-Performance Basketball Academy

ABSTRACT

Lever, JR, Duffield, R, Murray, A, Bartlett, JD, and Fullagar, HHK. Longitudinal internal training load and exposure in a high-performance basketball academy. J Strength Cond Res 38(8): 1464-1471, 2024-This study describes the longitudinal training exposure (session counts) and internal training load (Rating of Perceived Exertion [RPE] and Session Rating of Perceived Exertion [sRPE]) of youth basketball players at a high-performance academy, based on the training year, training term, and playing position. Historical internal training load and training exposure data were collated from 45 male high-performance youth basketball athletes between 2015 and 2019. Data included session duration, RPE, sRPE, training type, and date. Linear mixed models and pairwise comparisons were performed on the weekly means and categorized by training year (year 1, year 2, year 3), term (term 1, term 2, term 3, term 4), and playing position (Backcourt, Frontcourt). Linear mixed models indicate that the individual athlete had the greatest influence on variance in training load and exposure. Significant differences were observed for increased session count, duration, and sRPE ( p < 0.001) in year 2 compared with year 1. These measures also increased within each year whereby term 3 and term 4 ( p < 0.001) were significantly greater than term 1 and term 2. No significant differences were observed between playing position ( p > 0.05). Training exposure and internal training load increase in year 2 from year 1 for high-performance youth basketball academy athletes. Differences between training load and exposure for terms (i.e., training blocks) suggest the phase of season influences training prescription, while playing position has limited effect.

Weekly Fluctuations in, and Associations Between, Salivary Hormone Responses, Load, and Well-Being During the Pre-season in Professional Male Basketball Players

ABSTRACT

Kamarauskas, P, Scanlan, A, Ferioli, D, and Conte, D. Weekly fluctuations in, and associations between, salivary hormone responses, load, and well-being during the pre-season in professional male basketball players. J Strength Cond Res 38(1): 128-135, 2024-This study aimed to (a) quantify weekly fluctuations in hormonal responses (testosterone [T], cortisol [C], and their ratio [T:C]), external (PlayerLoad [PL] and PL·minute-1) and internal (session rating of perceived exertion load [sRPE-load], summated heart rate zones [SHRZs], and percentage of maximal heart rate [%HRmax]) load measures, and well-being measured using a self-reported questionnaire and (b) determine the associations between weekly changes in hormonal responses and load measures with weekly changes in well-being during the pre-season phase in basketball players. Twenty-one professional male basketball players (age: 26.2 ± 4.9 years) were monitored during a 5-week pre-season phase. Linear mixed models were used to determine weekly differences in each variable and associations between weekly changes in hormonal and load variables with weekly changes in well-being. Findings revealed that T (p < 0.001) and T:C (p = 0.002) increased toward the end of the pre-season phase. Moreover, higher (p < 0.05) external (PL·minute-1) and internal (%HRmax) load intensities were evident during the first 3 weeks of the pre-season, with no significant fluctuations in other load variables. Weekly changes in PL and sRPE-load were negatively associated (p < 0.05) with weekly changes in well-being, albeit weak in magnitudes (R2 = 0.061-0.105). These results highlight that a periodized approach was undertaken across the pre-season predominantly predicated on altering weekly load intensities, which coincided with positive hormonal responses toward the end of the pre-season. In addition, weak relationships were evident between weekly changes in hormonal responses and load measures with well-being, emphasizing that a low commonality may be present between these constructs.

The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season

The objective was to determine the associations between several biochemical indicators and the dynamics of concentration change across four physical fitness phases over the period of a competitive season. Furthermore, associations between serum calprotectin and biomarkers of inflammation or muscle injury and physical indicators were examined.

SUBJECTS AND METHODS

Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity.

RESULTS

Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination.

CONCLUSIONS

Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.

Exercise Immunology Applied to Pediatric Sport and the Importance of Monitoring Stages of Puberty and Biological Maturation

CONTEXT

Exercise immunology is aimed at understanding how exercise sessions can affect the immune system in athletic subjects of different age groups. The objective of the current study was to discuss in which stage of biological maturation (BM) young athletes may be more vulnerable in relation to the immune system, and whether there is a BM range in which it is safer to perform sports training with strenuous exercise loads.

EVIDENCE ACQUISITION

Evidence from scientific research from several scientific disciplines (eg, immunology, sport immunology, pediatrics, sports medicine, human development) was gathered to holistically examine the main particularities of exercise immunology as applied to pediatric sport.

STUDY DESIGN

Narrative review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

In pediatric patients, lymphoid tissue expands during puberty and involutes after puberty until it returns to pre-expansion values. This suggests that there is a specific period in which the immune system may be stronger, which may provide opportunities for strenuous exercise in pediatric athletes. However, the chronological period when puberty occurs will be determined by BM, which is the rate at which the biological systems of the human body improves. This may affect the period of lymphoid tissue expansion and, consequently, the behavior of the immune system in pediatric subjects of the same age category.

CONCLUSION

During puberty, there is a significant increase in the proinflammatory profile; to compensate for this, there is an expansion of lymphoid tissue that may favor the efficiency of the immune system. The period in which puberty is reached may vary according to the stages of BM. Therefore, in exercise immunology applied to pediatric sports, in addition to external and internal training loads, it is necessary to consider BM and puberty, which have been shown to be safer biomarkers than chronological age for determining immune system behavior in pediatric athletes.

STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT)

Evidence B level 3.

Acute and chronic effects of physical exercise on IgA and IgG levels and susceptibility to upper respiratory tract infections: a systematic review and meta-analysis

This systematic review and meta-analysis aimed at evaluating acute and chronic effects of physical exercise on IgA and IgG levels, as well as its relationship with the susceptibility to develop upper respiratory tract infections (URTI). This systematic review and meta-analysis was conducted and reported in accordance with PRISMA statement. A systematic search of PubMed, Web of Science, and EMBASE was performed in July 2020. This systematic review and meta-analysis included studies in which participants performed acute exercise or chronic physical training and were subjected to analyses of URTI incidence and concentrations of IgA and IgG. The selected studies for systematic review were divided into the following three groups: (I) trials that evaluated the effects of acute exercise in sedentary subjects, (II) trials that evaluated the effects of acute exercise in athletes/trained individuals, and (III) trials that evaluated the effects of chronic physical training on the incidence of URTI, as well as on the levels of IgA and IgG. Acute exercise increases the IgA levels in trained subjects but does not affect its levels in untrained subjects. Such increase in IgA levels induced by acute exercise is greater in trained individual that performed ultramarathon. On the other hand, chronic physical training reduces IgA levels in both trained and untrained subjects, does not change IgA levels in non-military subjects, besides from not affecting IgG levels. The present systematic review and meta-analysis indicates that acute exercise positively influences IgA levels in trained individuals, being this effect pronounced when a strenuous exercise such as ultramarathon is executed. Chronic physical training, in turn, does not affect IgG levels.

Vitamin D in Basketball Players: Current Evidence and Future Directions

CONTEXT

Despite growing interest in quantifying and correcting vitamin D inadequacy in basketball players, a critical synthesis of these data is yet to be performed to overcome the low generalizability of findings from individual studies.

OBJECTIVE

To provide a comprehensive analysis of data in basketball pertaining to (1) the prevalence of vitamin D inadequacy; (2) the effects of vitamin D supplementation on 25-hydroxyvitamin D [25(OH)D] concentration (and its association with body composition), bone health, and performance; and (3) crucial aspects that warrant further investigation.

DATA SOURCES

PubMed, MEDLINE, ERIC, Google Scholar, SCIndex, and ScienceDirect databases were searched.

STUDY SELECTION

After screening, 15 studies were included in the systematic review and meta-analysis.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

The prevalence of vitamin D inadequacy, serum 25(OH)D, body composition, stress fractures, and physical performance were extracted.

RESULTS

The pooled prevalence of vitamin D inadequacy for 527 basketball players in 14 studies was 77% (P < 0.001; 95% CI, 0.70-0.84). Supplementation with 4000 IU/d and 4000 IU/wk (absolute mean difference [AMD]: 25.39 nmol/L; P < 0.001; 95% CI, 13.44-37.33), as well as 10,000 IU/d (AMD: 100.01; P < 0.001; 95% CI, 70.39-129.63) vitamin D restored 25(OH)D to normal concentrations. Body composition data revealed inverse correlations between changes in serum 25(OH)D (from pre- to postsupplementation) and body fat (r = -0.80; very large). Data concerning positive impacts of vitamin D supplementation on bone health and physical performance remain sparse.

CONCLUSION

The high proportion of vitamin D inadequacy underscores the need to screen for serum 25(OH)D in basketball players. Although supplementation restored vitamin D sufficiency, the beneficial effects on bone health and physical performance remain sparse. Adiposity can modulate 25(OH)D response to supplementation.

Mental fatigue increases across a 16-week pre-season in elite female athletes

OBJECTIVES

To examine potential changes in mental and physical fatigue across an elite netball pre-season training phase and relationships between mental fatigue, physical fatigue, salivary cortisol (sCort) and alpha-amylase (sAA).

DESIGN

Observational with repeated measures.

METHODS

Across a 16-week pre-season, 10 elite female netballers (25.3 ± 3.7y) rated their physical fatigue, mental fatigue and readiness to perform on 100-mm visual analogue scales, and provided salivary samples for sCort and sAA analyses.

RESULTS

Linear mixed model analyses revealed elevated (p < 0.05) ratings of mental fatigue for weeks 12, 14 and 15 v 1; 12, 14 and 15 v 4 and 14 v 7. Higher (p < 0.05) ratings of physical fatigue were reported on weeks 6, 10, 11 and 12-16 compared to week 4; and 10 and 13 compared to week 7. Moderate and large ES differences were found between multiple weeks. Mental and physical fatigue demonstrated a shared variance of 14.3% (r = 0.38, p < 0.001) and an inverse relationship was observed between mental fatigue and readiness to perform (r = -0.50; p < 0.001). Changes in sCort nor sAA were not related to changes in mental or physical fatigue.

CONCLUSIONS

Mental fatigue fluctuated across the 16-week pre-season phase with elevated ratings observed in the later weeks. Whilst value remains in identifying subjective tools to assess mental fatigue; salivary biomarkers do not appear to be a suitable objective indicator of mental fatigue in the applied sporting environment. Practitioners should work to identify and manage mental fatigue with the same level of importance given to the periodisation of physical fatigue.

Acute Effects of Training Loads on Muscle Damage Markers and Performance in Semi-elite and Elite Athletes: A Systematic Review and Meta-analysis

BACKGROUND

The relationship between exercise-induced muscle damage (EIMD) indicators and acute training loads (TL) is yet to be reviewed extensively in semi-elite and elite athlete populations.

OBJECTIVES

The objectives of this systematic review and meta-analysis were threefold: (1) to evaluate studies of EIMD following the initial period of the preseason in semi-elite and elite athletes: (2) to examine acute physiological and performance responses across two periods of the season with similar TL; and (3) to examine acute physiological and performance responses to acute changes in TL during the season.

METHODS

The CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science databases were systematically searched for studies that investigated: (1) semi-elite or elite athletes in team or individual sports following a periodised training programme; and (2) measured acute responses to training. Studies were excluded if: (1) conducted in animals; (2) non-English language; or (3) a conference abstract, review or case report. The Kmet Quality Scoring of Quantitative Studies tool was used for study appraisal.

SYNTHESIS METHODS

Data were quantitatively analysed by generating forest plots to report test statistics for statistical significance and inter-trial heterogeneity.

RESULTS

Of the included studies (n = 32), athletes experienced greater creatine kinase (CK) concentrations (Z = 4.99, p < 0.00001, I² = 74%), inflammatory factors and other indirect measures of muscle damage in the initial phase of the preseason period compared to the off-season; there were no changes in CK (Z = 1.43, p = 0.15, I² = 74%) across two time points of similar TL; and there were concurrent increases in CK with increases in TL (Z = 4.26, p < 0.0001, I² = 36%) and vice versa (Z = 4.33, p < 0.0001, I² = 79%).The qualitative analysis identified that the response of inflammatory factors and other indirect measures of muscle damage to changes in load were inconclusive.

LIMITATIONS

This review included varying age, sex, sports and competition levels. The group level meta-analysis failed to identify within-athlete or position-specific differences across time.

CONCLUSION

Blood biomarkers of EIMD may not differ across periods of similar TL, however can be considered a sensitive monitoring tool for assessing responses following acute TL changes in semi-elite and elite athletes.

Redox Homeostasis and Inflammation Responses to Training in Adolescent Athletes: a Systematic Review and Meta-analysis

Background

Several studies have highlighted the substantial role of the athlete’s redox and inflammation status during the training process. However, many factors such as differences in testing protocols, assays, sample sizes, and fitness levels of the population are affecting findings and the understanding regarding how exercise affects related biomarkers in adolescent athletes.

Objectives

To search redox homeostasis variables’ and inflammatory mediators’ responses in juvenile athletes following short- or long-term training periods and examine the effect size of those variations to training paradigms.

Methods

A PRISMA-compliant systematic review and meta-analysis were conducted. The entire content of PubMed (MEDLINE), Scopus, and Science Direct were systematically searched until December 2019. Studies with outcomes including (1) a group of adolescent athletes from any individual or team sport, (2) the assessment of redox and/or inflammatory markers after a short- (training session or performance testing) or longer training period, and (3) variables measured in blood were retained. The literature search initially identified 346 potentially relevant records, of which 36 studies met the inclusion criteria for the qualitative synthesis. From those articles, 27 were included in the quantitative analysis (meta-analysis) as their results could be converted into common units.

Results

Following a short training session or performance test, an extremely large increase in protein carbonyls (PC) (ES 4.164; 95% CI 1.716 to 6.613; Z = 3.333, p = 0.001), a large increase in thiobarbituric acid reactive substances (TBARS) (ES 1.317; 95% CI 0.522 to 2.112; Z = 3.247, p = 0.001), a large decrease in glutathione (GSH) (ES − 1.701; 95% CI − 2.698 to − 0.705; Z = − 3.347, p = 0.001), and a moderate increase of total antioxidant capacity (TAC) level (ES 1.057; 95% CI − 0.044 to 2.158; Z = 1.882, p = 0.060) were observed. Following more extended training periods, GSH showed moderate increases (ES 1.131; 95% CI 0.350 to 1.913; Z = 2.839, p = 0.005) while TBARS displayed a small decrease (ES 0.568; 95% CI − 0.062 to 1.197; Z = 1.768, p = 0.077). Regarding cytokines, a very large and large increase were observed in IL-6 (ES 2.291; 95% CI 1.082 to 3.501; Z = 3.713, p = 0.000) and IL-1 receptor antagonist (ra) (ES 1.599; 95% CI 0.347 to 2.851; Z = 2.503, p = 0.012), respectively, following short-duration training modalities in juvenile athletes.

Conclusions

The results showed significant alterations in oxidative stress and cytokine levels after acute exercise, ranging from moderate to extremely large. In contrast, the variations after chronic exercise ranged from trivial to moderate. However, the observed publication bias and high heterogeneity in specific meta-analysis advocate the need for further exploration and consistency when we deal with the assessed variables to ascertain the implications of structured training regimes on measured variables in order to develop guidelines for training, nutritional advice, and wellbeing in young athletes.

Trial Registration

PROSPERO CRD42020152105

Exercise: A Protective Measure or an "Open Window" for COVID-19? A Mini Review

The coronavirus disease 2019 (COVID-19) has spread to at least 115 countries and caused an alarming number of deaths. The current outbreak has lead authorities from many countries to adopt several protective measures, including lockdown and social distancing. Although being a reasonable measure to counteract the COVID-19 contamination, the restrictive measures have limited individual's ability to perform exercise outdoors or in gyms and similar facilities, thus raising the risks for chronic health conditions related to a sedentary lifestyle. The recent exercise recommendations to counteract the potential deleterious effects of COVID-19-related lockdown have not fully addressed resistance exercise interventions as potential home-based exercise strategies. Additionally, the following questions have been constantly raised: (1) Is training status capable of protecting an individual from COVID-19 infection?; and (2) Can a single endurance or resistance exercise session acutely increase the risks for COVID-19 infection? Therefore, the current mini review aimed to focus on these two concerns, as well as to discuss the potential use of practical blood flow restriction and no load resistance training as possible resistance exercise strategies that could be performed during the current COVID-19 pandemic.

The Cellular Composition of the Innate and Adaptive Immune System Is Changed in Blood in Response to Long-Term Swimming Training

Competitive swimming requires high training load cycles including consecutive sessions with little recovery in between which may contribute to the onset of fatigue and eventually illness. We aimed to investigate immune changes over a 7-month swimming season. Fifty-four national and international level swimmers (25 females, 29 males), ranging from 13 to 20 years of age, were evaluated at rest at: M1 (beginning of the season), M2 (after the 1st macrocycle’s main competition), M3 (highest training load phase of the 2nd macrocycle) and M4 (after the 2nd macrocycle’s main competition) and grouped according to sex, competitive age-groups, or pubertal Tanner stages. Hemogram and the lymphocytes subsets were assessed by automatic cell counting and by flow cytometry, respectively. Self-reported Upper Respiratory Symptoms (URS) and training load were quantified. Although the values remained within the normal range reference, at M2, CD8⁺ decreased (M1 = 703 ± 245 vs. M2 = 665 ± 278 cell μL⁻¹; p = 0.032) and total lymphocytes (TL, M1 = 2831 ± 734 vs. M2 = 2417 ± 714 cell μL⁻¹; p = 0.007), CD3⁺ (M1 = 1974 ± 581 vs. M2 = 1672 ± 603 cell μL⁻¹; p = 0.003), and CD4⁺ (M1 = 1102 ± 353 vs. M2 = 929 ± 329 cell μL⁻¹; p = 0.002) decreased in youth. At M3, CD8⁺ remained below baseline (M3 = 622 ± 245 cell μL⁻¹; p = 0.008), eosinophils (M1 = 0.30 ± 0.04 vs. M3 = 0.25 ± 0.03 10⁹ L^–1; p = 0.003) and CD16⁺56⁺ (M1 = 403 ± 184 vs. M3 = 339 ± 135 cell μL⁻¹; p = 0.019) decreased, and TL, CD3⁺, and CD4⁺ recovered in youth. At M4, CD19⁺ were elevated (M1 = 403 ± 170 vs. M4 = 473 ± 151 cell μL⁻¹; p = 0.022), CD16⁺56⁺ continued to decrease (M4 = 284 ± 131 cell μL⁻¹; p < 0.001), eosinophils remained below baseline (M4 = 0.29 ± 0.05 10⁹ L^–1; p = 0.002) and CD8⁺ recovered; monocytes were also decreased in male seniors (M1 = 0.77 ± 0.22 vs. M4 = 0.57 ± 0.16 10⁹ L^–1; p = 0.031). The heaviest training load and higher frequency of URS episodes happened at M3. The swimming season induced a cumulative effect toward a decrease of the number of innate immune cells, while acquired immunity appeared to be more affected at the most intense period, recovering after tapering. Younger athletes were more susceptible at the beginning of the training season than older ones.

A Review of Countermovement and Squat Jump Testing Methods in the Context of Public Health Examination in Adolescence: Reliability and Feasibility of Current Testing Procedures

BACKGROUND

In the context of a public health physical fitness (PF) examination in adolescence, a countermovement jump (CMJ) and a squat jump (SJ) are two vertical jump (VJ) tests widely used to evaluate lower limb muscle strength and power, respectively. The main criticism of both the CMJ and SJ test is the lack of test standardization. Therefore, the objectives of this review are: (a) to gather information about both jumps; (b) to investigate whether it is possible to identify common procedures referred to in the CMJ and SJ technical execution, and (c) to design standard operating procedures (SOPs) to promote CMJ and SJ standardization in an adolescent population aged 12-18 years.

METHODS

The review partially adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Due to growing attention in monitoring physical health through field tests in recent years, articles were collected using the PubMed, Web of Science, and Scopus databases from January 2009 to July 2019. Original articles in which CMJ or SJ were used to assess the muscular strength in adolescents were eligible for further analysis. Articles written in English was imposed as a limit.

RESULTS

A total of 117 studies met the inclusion criteria. The description of the CMJ and SJ test procedures was different within the literature, with discrepancies in the jump technique, number of jumps, and measurement devices used.

CONCLUSIONS

A lack of method standardization for both the CMJ and the SJ test was identified. Based on the literature, SOPs for both VJs were proposed. These are useful in the context of public health PF examination in adolescents, as they facilitate an unbiased comparison of jump performance data between published studies.

"N-of-1"-Study: A concept of acute and chronic stress research using the example of ballroom dancing

Athletes often report on heightened stress, higher disease susceptibility, and a deterioration in mood and performance throughout periods of high training load and competitions. This paper presents a single-case study combining different research approaches to monitor the dynamic, idiosyncratic responses to competitive stress in elite sports using the example of professional ballroom dancing. Throughout an 8-month period (313 data points), one international-level female dancer provided data on mood, stress, and fatigue. In parallel, she collected saliva samples for the assessment of cortisol (sCort) and alpha-amylase (sAA). A hair strand was collected every 3 months to examine cumulative cortisol secretion. As expected, perceived stress was related to a reduction in well-being. On a daily basis, sCort predicted lower fatigue. In addition, tournaments resulted in a 3-fold and a 2-fold increase in sCort and sAA, respectively, and there was a pronounced drop in hair cortisol in the aftermath of a surgery-related break from dancing. We confirm competitive ballroom dancing to constitute a major stressor with immediate and prolonged consequences for self-reported well-being and biological stress markers. Single-case studies offer much potential for the observation of complex dynamic associations. In a next step, this approach will also become relevant when evaluating the efficacy of preventive and therapeutic interventions on an individual level.

PARÂMETROS IMUNOLÓGICOS E INFECÇÕES DO TRATO RESPIRATÓRIO SUPERIOR EM ATLETAS DE ESPORTES COLETIVOS

RESUMO Entre atletas e treinadores, existe uma percepção comum de que altas cargas de treinamento e competições, aplicadas de forma crônica, com controle nutricional e/ou períodos de recuperação inadequados, podem reduzir a resistência imunológica, aumentando a predisposição aos episódios de infecções, principalmente infecções do trato respiratório superior (ITRS). Nesse sentido, o presente estudo está centrado em revisar as interações entre os parâmetros imunológicos com a síndrome do sobretreinamento, especificamente em esportes coletivos, considerando a sua natureza intermitente. Assim, foi realizada uma revisão de periódicos nacionais e internacionais relacionados com o tema. As correlações entre exercício, sistema imunológico e suscetibilidade às ITRS têm sido avaliadas principalmente em esportes individuais e de resistência em comparação aos coletivos. As modulações dos leucócitos ao longo da temporada, frente ao efeito somatório das cargas de treinamento e competições, quando analisadas especificamente quanto aos neutrófilos e monócitos, possivelmente se relacionam com os processos de reparo tecidual e incidência de ITRS. As modulações relacionadas com os linfócitos parecem estar relacionadas mais diretamente com a incidência das ITRS. Ademais, o entendimento de todos os marcadores propostos, incluindo os imunológicos em associação com os indicadores de desempenho e controle do treinamento, parece ser um caminho mais promissor para o diagnóstico clínico do estado imunológico do atleta e da prevenção da síndrome do sobretreinamento do que necessariamente a busca por um marcador exclusivo de excesso de treinamento.