Clinical and biochemical characteristics of high-intensity functional training (HIFT) and overtraining syndrome: findings from the EROS study (The EROS-HIFT)

Comparison between Measured and Predicted Resting Metabolic Rate Equations in Cross-Training Practitioners

This study aimed to investigate the resting metabolic rate (RMR) in cross-training practitioners (advanced and novice) using indirect calorimetry (IC) and compare it with predictive equations proposed in the scientific literature.

METHODS

A cross-sectional and comparative study analyzed 65 volunteers, both sexes, practicing cross-training (CT). Anthropometry and body composition were assessed, and RMR was measured by IC (FitMate PRO®), bioimpedance (BIA-InBody 570®), and six predictive equations. Data normality was tested by the Kolgomorov-Smirnov test and expressed as mean ± standard deviation with 95% confidence intervals (CI), chi-square test was performed to verify ergogenic resources, and a Bland-Altman plot (B&A) was made to quantify the agreement between two quantitative measurements. One-way ANOVA was applied to body composition parameters, two-way ANOVA with Bonferroni post hoc was used to compare the RMR between groups, and two-way ANCOVA was used to analyze the adjusted RMR for body and skeletal muscle mass. The effect size was determined using Cohen's d considering the values adjusted by ANCOVA. If a statistical difference was found, post hoc Bonferroni was applied. The significance level was p < 0.05 for all tests.

RESULTS

The main results indicated that men showed a higher RMR than women, and the most discrepant equations were Cunningham, Tinsley (b), and Johnstone compared to IC. Tinsley's (a) equation indicated greater precision in measuring the RMR in CM overestimated it by only 1.9%, and BIA and the Harris-Benedict in CW overestimated RMR by only 0.1% and 3.4%, respectively.

CONCLUSIONS

The BIA and Harris-Benedict equation could be used reliably to measure the RMR of females, while Tinsley (a) is the most reliable method to measure the RMR of males when measuring with IC is unavailable. By knowing which RMR equations are closest to the gold standard, these professionals can prescribe a more assertive diet, training, or ergogenic resources. An assertive prescription increases performance and can reduce possible deleterious effects, maximizing physical sports performance.

Physical Activity and Cortisol Regulation: A Meta-Analysis

Physical activity participation is associated with effective stress coping, indicated by decreases in both physiological stress reactivity and perceived stress. Quantifying the effect of physical activity on the diurnal regulation of one key physiological stress indicator, the stress hormone, cortisol, across studies may demonstrate the extent to which physical activity participation is associated with diurnal HPA axis regulation. We meta-analyzed studies examining relations between physical activity participation and indices of HPA axis regulation: the diurnal cortisol slope and the cortisol awakening response. We also examined moderators of the relation. The analysis revealed a small, non-zero negative averaged correlation between physical activity and the diurnal cortisol slope (r = -0.043, 95% CI [-0.080, -0.004]). Examination of sample sociodemographic differences, study design characteristics, cortisol measurement methods, and physical activity variables as moderators revealed few effects on the relation between physical activity and diurnal cortisol slope. We did not observe lower levels of variability in the mean cortisol awakening response at higher levels of physical activity participation, and moderator analyses showed little evidence of reductions in heterogeneity for this effect. We found some evidence of systematic publication bias. Findings suggest higher physical activity is associated with a steeper diurnal cortisol slope. However, the cortisol awakening response did not differ by physical activity level. Future studies testing the physical activity and cortisol regulation association should use standardized physical activity measures, follow guidelines for better quality cortisol sampling collection and analysis, and test relations in large-scale empirical studies to confirm the direction and causality of the effect.

Prevalence of dietary supplement consumption among CrossFit practitioners

Purpose

We aimed to verify the prevalence of dietary supplements among CrossFit practitioners (CFPs), considering gender and training status. Still, we aimed to determine the type, reasons, and associated factors of dietary supplement utilization among CFPs.

Methods

This is a cross-sectional, exploratory, and descriptive study with the snowball sampling method. Data were collected through online questionnaires using the Google Forms® tool. We included CFPs aged 18-64 years, from Aug 1, 2020, to Sept 31, 2020. The questionnaire contained questions to assess the prevalence, type, and reasons for supplement use; also, we assessed information about sociodemographic variables and the prevalence of the main chronic morbidities. To analyze aspects of eating behavior and sleep-related parameters, we applied the three-factor eating questionnaire (TFEQ)-R21 and the Pittsburgh Sleep Quality Index questionnaire (PSQI), respectively.

Results

We assessed one hundred twelve (n = 112; 57 men; 55 women) CFPs (28.9 ± 7.64 years old; body mass index (BMI), 25.5 ± 4.83 kg/m2). Eighty-seven (50 men; 37 women; 28.2 ± 6.66 years old; BMI, 25.4 ± 4.55 kg/m2) reported using dietary supplements. Whey protein was the most used supplement (n = 70), followed by creatine (n = 54). Cognitive restraint (a dimension of eating behavior) score was higher in supplement users than in non-users (51.7 ± 18.6 vs. 42.6 ± 20.5; p = 0.040). Sleep-related parameters did not differ between supplement users and non-users. The most associated factors to supplement use were sex (being man; OR, 7.99; p = 0.007), sleep quality (poor; OR, 5.27; p = 0.045), CrossFit level (as prescribed (RX); OR, 4.51; p = 0.031), and cognitive restraint (OR, 1.03; p = 0.029).

Conclusion

The CFPs, especially RX and Elite ones, showed a higher prevalence of supplement utilization. Anabolic-related supplements (i.e., whey protein and creatine) were the most used; moreover, several CFPs used supplements not supported by scientific evidence. Cognitive restraint score was higher in supplement users than in non-users. RX level, being men, and poor sleep quality were associated with supplement utilization. These data draw attention to the necessity of nutritional education for CrossFit coaches and athletes. Broader studies are necessary to confirm our findings.

High-Intensity Interval Training Combined with Different Types of Exercises on Cardiac Autonomic Function. An Analytical Cross-Sectional Study in CrossFit® Athletes

It is well established that endurance exercise has positive effects on cardiac autonomic function (CAF). However, there is still a dearth of information about the effects of regular high-intensity interval training combined with different types of exercises (HIITCE) on CAF.

OBJECTIVE

The aim of this study is to compare CAF at rest, its reactivity, and reactivation following maximal exercise testing in HIITCE and endurance athletes.

METHODS

An observational study was conducted with 34 male athletes of HIITCE (i.e., CrossFit^®) [HG: n = 18; 30.6 ± 4.8 years] and endurance athletes (i.e., triathlon) [TG.: n = 16; 32.8 ± 3.6 years]. We analyzed 5 min of frequency-domain indices (TP, LF, HF, LFn, HFn, and LF/HF ratio) of heart rate variability (HRV) in both supine and orthostatic positions and its reactivity after the active orthostatic test. Post-exercise heart rate recovery (HRR) was assessed at 60, 180, and 300 s. Statistical analysis employed a non-parametric test with a p-value set at 5%.

RESULTS

The HG showed reduced HFn and increased LFn modulations at rest (supine). Overall cardiac autonomic modulation (TP) at supine and all indices of HRV at the orthostatic position were similar between groups. Following the orthostatic test, the HG showed low reactivity for all HRV indices compared to TG. After the exercise, HRR does not show a difference between groups at 60 s. However, at 180 and 300 s, an impairment of HRR was observed in HG than in TG.

CONCLUSION

At rest (supine), the HG showed reduced parasympathetic and increased sympathetic modulation, low reactivity after postural change, and impaired HRR compared to TG.

The Addition of High-Load Resistance Exercises to a High-Intensity Functional Training Program Elicits Further Improvements in Body Composition and Strength: A Randomized Trial

The current study aimed to examine the effects of adding specific high-load resistance exercises to a high-intensity functional training (HIFT) program on healthy adults’ physical fitness and body composition. Twenty recreationally active volunteers (30 ± 4 y, 12 females, 8 males) were randomly assigned to either a HIFT-control (HIFT-C, n = 10) or HIFT-power (HIFT-P, n = 10) group and trained three times per week for eight weeks. The HIFT-C protocol included four rounds of an 8-exercise circuit (30:15 s work: rest, 2 min rest after the second round). The exercises used were clean-and-press, box jump, TRX chest press, wall ball throws, burpees, repeated 10 m sprints, sumo squat-and-upright row, and abdominal crunches. The HIFT-P-group replaced TRX chest press with bench press and squat-and-upright row with squat, both at an intensity of 80% 1 RM. Before and after the intervention, participants underwent an evaluation of body composition, cardiorespiratory fitness, vertical jump, 1 RM bench press, and the maximum number of abdominal crunches in 1 min. In both groups, cardiorespiratory fitness, squat jump, countermovement jump, bench press 1 RM, and percent body fat improved significantly after the intervention (p < 0.050), while a trend towards significant time x group interaction was found for bench press 1 RM (p = 0.076), indicating a superiority of HIFT-P over HIFT-C. Muscle mass significantly increased by 3.3% in the HIFT-P group, while abdominal muscle endurance improved by 16.2% in the HIFT-C group (p < 0.050). Short-term HIFT resulted in improvements in whole-body cardiorespiratory and neuromuscular fitness and reduction of body fat. The addition of high-load resistance exercises was well tolerated and resulted in increased muscle mass and upper body maximal strength. HIFT-P programs can be suitable for individuals seeking to enhance muscle mass and physical fitness in a short time.

Catecholamines Are the Key Trigger of COVID-19 mRNA Vaccine-Induced Myocarditis: A Compelling Hypothesis Supported by Epidemiological, Anatomopathological, Molecular, and Physiological Findings

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine-induced myocarditis is a rare but well-documented complication in young males. The increased incidence of sudden death among athletes following vaccination has been reported and requires further investigation. Whether the risk of myocarditis, a known major cause of sudden death in young male athletes, also increases after coronavirus disease 2019 (COVID-19) infection is unknown. The severity and implications of these critical adverse effects require a thorough analysis to elucidate their key triggering mechanisms. The present review aimed to evaluate whether there is a justification to hypothesize that catecholamines in a "hypercatecholaminergic" state are the key trigger of SARS-CoV-2 mRNA vaccine-induced myocarditis and related outcomes and whether similar risks are also present following COVID-19 infection. A thorough, structured scoping review of the literature was performed to build the hypothesis through three pillars: detection of myocarditis risk, potential alterations and abnormalities identified after SARS-CoV-2 mRNA vaccination or COVID-19 infection and consequent events, and physiological characteristics of the most affected population. The following terms were searched in indexed and non-indexed peer review articles and recent preprints (<12 months): agent, "SARS-CoV-2" or "COVID-19"; event, "myocarditis" or "sudden death(s)" or "myocarditis+sudden death(s)" or "cardiac event(s)"; underlying cause, "mRNA" or "spike protein" or "infection" or "vaccine"; proposed trigger, "catecholamine(s)" or "adrenaline" or "epinephrine" or "noradrenaline" or "norepinephrine" or "testosterone"; and affected population, "young male(s)" or "athlete(s)." The rationale and data that supported the hypothesis were as follows: SARS-CoV-2 mRNA vaccine-induced myocarditis primarily affected young males, while the risk was not observed following COVID-19 infection; independent autopsies or biopsies of patients who presented post-SARS-CoV-2 mRNA vaccine myocarditis in different geographical regions enabled the conclusion that a primary hypercatecholaminergic state was the key trigger of these events; SARS-CoV-2 mRNA was densely present, and SARS-CoV-2 spike protein was progressively produced in adrenal medulla chromaffin cells, which are responsible for catecholamine production; the dihydroxyphenylalanine decarboxylase enzyme that converts dopamine into noradrenaline was overexpressed in the presence of SARS-CoV-2 mRNA, leading to enhanced noradrenaline activity; catecholamine responses were physiologically higher in young adults and males than in other populations; catecholamine responses and resting catecholamine production were higher in male athletes than in non-athletes; catecholamine responses to stress and its sensitivity were enhanced in the presence of androgens; and catecholamine expressions in young male athletes were already high at baseline, were higher following vaccination, and were higher than those in non-vaccinated athletes. The epidemiological, autopsy, molecular, and physiological findings unanimously and strongly suggest that a hypercatecholaminergic state is the critical trigger of the rare cases of myocarditis due to components from SARS-CoV-2, potentially increasing sudden deaths among elite male athletes.

The Athlete's Paradox: Adaptable Depression

We proposed that an athlete's depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term "Adaptable Depression (AD)" to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in "Adaptable Depression" in athletes and to establish a better understanding of the depressive tipping point.

Effects of High-Intensity Resistance Training on Physical Fitness, Hormonal and Antioxidant Factors: A Randomized Controlled Study Conducted on Young Adult Male Soccer Players

Purpose: The aim of this study was to test the effects of high-intensity resistance training (HIRT) intervention on the physical fitness, hormonal and antioxidant factors of adult male soccer players. Methods: A randomized controlled study design was implemented. Eighteen soccer players (age: 20.3 ± 0.66 years; stature: 174.0 ± 6.01 cm; body mass: 69.1 ± 6.4 kg; body mass index: 22.8 ± 1.6 kg/m2) voluntarily participated in this study. Players were assessed before and after an intervention lasting 8 weeks, with three training sessions a week. Assessments of physical fitness included the Yo-Yo intermittent recovery test level 1 (YYIRT1), 10-, 20-, and 30 m sprint time (ST), running-based anaerobic sprint test (RAST) and change-of-direction time (COD). Hormonal tests included cortisol, testosterone and growth hormone (GH), whereas the antioxidant assessment included superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione (GSH). Results: Between-group analysis revealed no significant differences at baseline, whereas it revealed that HIRT presented significant better results than the control group on YYIRT (p = 0.032), 10 m ST (p = 0.041), 20 m ST (p = 0.040), 30 m ST (p = 0.044), RAST (p = 0.013), and COD (p = 0.031) after the intervention period. The within group analysis revealed that the HIRT group significantly improved the YYIRT1 (p < 0.001), VO2max (p < 0.001), 10 m ST (p < 0.001), 20 m ST (p = 0.006), 30 m ST (p < 0.001), RAST (p < 0.001) and COD (p < 0.001). Moreover, HIRT group significantly reduced the cortisol (p < 0.001) and MDA (p = 0.021), whereas it significantly increased the GH (p < 0.001), testosterone (p < 0.001), SOD (p = 0.009) and GSH (p = 0.005). Conclusions: The HIRT is effective for improving physical fitness, revealing significant better adaptations than controls. Moreover, hormonal and antioxidant adaptations are also confirmed after HIRT intervention.

Overtraining Syndrome Symptoms and Diagnosis in Athletes: Where Is the Research? A Systematic Review

CONTEXT

To understand overtraining syndrome (OTS), it is important to detail the physiological and psychological changes that occur in athletes.

OBJECTIVES

To systematically establish and detail the physiological and psychological changes that occur as a result of OTS in athletes.

METHODS

Databases were searched for studies that were (1) original investigations; (2) English, full-text articles; (3) published in peer-reviewed journals; (4) investigations into adult humans and provided (5) objective evidence that detailed changes in performance from prior to the onset of OTS diagnosis and that performance was suppressed for more than 4 weeks and (6) objective evidence of psychological symptoms.

RESULTS

Zero studies provided objective evidence of detailed changes in performance from prior to the onset of OTS diagnosis and demonstrated suppressed performance for more than 4 weeks accompanied by changes in psychological symptoms.

CONCLUSIONS

All studies failed to provide evidence of changes in performance and mood from "healthy" to an overtrained state with evidence of prolonged suppression of performance. While OTS may be observed in the field, little data is available describing how physiological and psychological symptoms manifest. This stems from vague terminology, difficulties in monitoring for prolonged periods of time, and the need for prospective testing. Real-world settings may facilitate the collection of such data, but the ideal testing battery that can easily be conducted on a regular basis does not yet exist. Consequently, it must be concluded that an evidence base of sufficient scientific quality for understanding OTS in athletes is lacking.

Time-course effects of functional fitness sessions performed at different intensities on the metabolic, hormonal, and BDNF responses in trained men

Background

To investigate the time-course effects of a self-regulated training session (performed at an rating perceived exertion of 6/10), all-out session, and a control session on the metabolic, hormonal, and brain derived neurotrophic factor (BDNF) responses in Functional-Fitness (FFT) participants.

Methods

In a randomized, crossover fashion, eight healthy males (age 28.1 ± 5.4 years old; body mass 77.2 ± 4.4 kg; VO_2max: 52.6 ± 4.6 mL.(kg.min)⁻¹; 2000 m rowing test 7.35 ± 0.18 min; 1RM back squat 135.6 ± 21.9 kg) performed a FFT session under two different conditions: all-out, or with the intensity controlled to elicit an rating perceived exertion (RPE) of 6 in the Borg 10-point scale (RPE6). A control session (no exercise) was also completed. Metabolic (lactate and creatine kinase), hormonal (testosterone and cortisol), and BDNF responses were assessed pre, post-0 h, 1 h, 2 h and 24 h after the sessions.

Results

Creatine kinase concentrations were significantly higher (p ≤ 0.05) after 24 h for both training sessions. Total and free testosterone concentrations were lower post-2 h for all-out when compared to the RPE6 session (p ≤ 0.05). Serum cortisol concentration increased post-0 h (p = 0.011) for RPE6 and post-0 h (p = 0.003) and post-1 h (p = 0.030) for all-out session when comparing to baseline concentrations. BDNF was significantly higher (p = 0.002) post-0 h only for the all-out session when compared to baseline. A positive correlation between blood lactate concentrations and BDNF (r = 0.51; p = 0.01) was found for both effort interventions.

Conclusions

A single FFT session when performed in all-out format acutely increases the concentrations of serum BDNF. However, physiological stress markers show that the all-out session requires a longer recovery period when compared to the RPE6 protocol. These findings can be helpful to coaches and practitioners design FFT session.

Prevalence of Urinary Incontinence in CrossFit Practitioners before and during the COVID-19 Quarantine and its Relationship with Training Level: An Observational Study

OBJECTIVE

 To compare the prevalence of urinary incontinence (UI) before and during the COVID-19 quarantine in CrossFit women and their relationship with training level.

METHODS

 A cross-sectional study was performed among 197 women practicing CrossFit. The inclusion criteria were nulliparous women, between 18 and 45 years old, who had trained, before quarantine, in accredited gyms. The exclusion criteria were not following the COVID-19 prevention protocols and having UI on other occasions than just sport. An online questionnaire was emailed containing questions about frequency, duration, and intensity of training and data related to the COVID-19 pandemic. The participants were invited to answer whether they were infected with COVID-19 and what treatment/recommendation they have followed. Whether UI stopped among participants, they were asked about the possible reasons why this happened. The training intensity was categorized as "the same," "decreased" or "increased."

RESULTS

 The mean age of the participants was 32 years old and most (98.5%) could practice CrossFit during the pandemic. There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%), were the most performed. Urinary incontinence was reported by 32% of the participants before the COVID-19 pandemic, and by only 14% of them during the pandemic (odds ratio [OR] = 0.32 [0.19-0.53]; p < 0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing doubleunder exercise.

CONCLUSION

 The reduction in the intensity of CrossFit training during the COVID-19 quarantine decreased the prevalence of UI among female athletes.

Exercise load monitoring: integrated approaches to advance the individualisation of exercise oncology

Whether slowing disease progression or combatting the ills of advancing age, the extensive utility of exercise training has contributed to the outright declaration by the American College of Sports Medicine that 'exercise is medicine'. Consistent with general framework of adaptation, the advantages of exercise training are indiscriminate-benefitting even the most susceptible clinical populations. Still, the benefit of exercise training presupposes healthy adaptation wherein progressive overload matches sufficient recovery. Indeed, a difference exists between healthy adaptation and non-functional over-reaching (ie, when internal/external load exceeds recovery capacity)-a difference that may be blurred by cancer treatment and/or comorbidity. Recent advances in smartwatches make them ideally suited to non-invasively monitor the physiological stresses to exercise training. Resolving whether individuals are successfully adapting to exercise training via load monitoring bears clinical and practical relevance. While behaviour-change research aims to identify positive constructs of exercise adherence, further attention is needed to uncover how to optimise exercise prescription among cancer populations. Herein, we briefly discuss the constituents of exercise load monitoring, present examples of internal and external load and consider how such practices can be applied to cancer populations.

Diagnosing Overtraining Syndrome: A Scoping Review

Context:

Overtraining syndrome (OTS) is a condition characterized by a long-term performance decrement, which occurs after a persisting imbalance between training-related and nontraining-related load and recovery. Because of the lack of a gold standard diagnostic test, OTS remains a diagnosis of exclusion.

Objective:

To systematically review and map biomarkers and tools reported in the literature as potentially diagnostic for OTS.

Data Sources:

PubMed, Web of Science, and SPORTDiscus were searched from database inception to February 4, 2021, and results screened for eligibility. Backward and forward citation tracking on eligible records were used to complement results of database searching.

Study Selection:

Studies including athletes with a likely OTS diagnosis, as defined by the European College of Sport Science and the American College of Sports Medicine, and reporting at least 1 biomarker or tool potentially diagnostic for OTS were deemed eligible.

Study Design:

Scoping review following the guidelines of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR).

Level of Evidence:

Level 4.

Data Extraction:

Athletes’ population, criteria used to diagnose OTS, potentially diagnostic biomarkers and tools, as well as miscellaneous study characteristics were extracted.

Results:

The search yielded 5561 results, of which 39 met the eligibility criteria. Three diagnostic scores, namely the EROS-CLINICAL, EROS-SIMPLIFIED, and EROS-COMPLETE scores (EROS = Endocrine and Metabolic Responses on Overtraining Syndrome study), were identified. Additionally, basal hormone, neurotransmitter and other metabolite levels, hormonal responses to stimuli, psychological questionnaires, exercise tests, heart rate variability, electroencephalography, immunological and redox parameters, muscle structure, and body composition were reported as potentially diagnostic for OTS.

Conclusion:

Specific hormones, neurotransmitters, and metabolites, as well as psychological, electrocardiographic, electroencephalographic, and immunological patterns were identified as potentially diagnostic for OTS, reflecting its multisystemic nature. As exemplified by the EROS scores, combinations of these variables may be required to diagnose OTS. These scores must now be validated in larger samples and within female athletes.

Metabolomic signatures in elite cyclists: differential characterization of a seeming normal endocrine status regarding three serum hormones

INTRODUCTION

Serum phenotyping of elite cyclists regarding cortisol, IGF1 and testosterone is a way to detect endocrine disruptions possibly explained by exercise overload, non-balanced diet or by doping. This latter disruption-driven approach is supported by fundamental physiology although without any evidence of any metabolic markers.

OBJECTIVES

Serum samples were distributed through Low, High or Normal endocrine classes according to hormone concentration. A ¹H NMR metabolomic study of 655 serum obtained in the context of the longitudinal medical follow-up of 253 subjects was performed to discriminate the three classes for every endocrine phenotype.

METHODS

An original processing algorithm was built which combined a partial-least squares-based orthogonal correction of metabolomic signals and a shrinkage discriminant analysis (SDA) to get satisfying classifications. An extended validation procedure was used to plan in larger size cohorts a minimal size to get a global prediction rate (GPR), i.e. the product of the three class prediction rates, higher than 99.9%.

RESULTS

Considering the 200 most SDA-informative variables, a sigmoidal fitting of the GPR gave estimates of a minimal sample size to 929, 2346 and 1408 for cortisol, IGF1 and testosterone, respectively. Analysis of outliers from cortisol and testosterone Normal classes outside the 97.5%-confidence limit of score prediction revealed possibly (i) an inadequate protein intake for outliers or (ii) an intake of dietary ergogenics, glycine or glutamine, which might explain the significant presence of heterogeneous metabolic profiles in a supposedly normal cyclists subgroup.

CONCLUSION

In a next validation metabolomics study of a so-sized cohort, anthropological, clinical and dietary metadata should be recorded in priority at the blood collection time to confirm these functional hypotheses.

Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities

The symptom similarities between training-overload (with or without an Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic-pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA). In this narrative review we wish to showcase that many of the negative outcomes of training-overload (with, or without an OTS diagnosis) may be primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO availability. Accordingly, we undertook an analysis of training-overload/OTS type studies that have also collected and analyzed for energy intake (EI), CHO, exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) that met our criteria showed indications of an EA decrease or difference between two cohorts within a given study (n = 14 studies) or CHO availability decrease (n = 4 studies) during the training-overload/OTS period, resulting in both training-overload/OTS and RED-S symptom outcomes compared to control conditions. Furthermore, we demonstrate significantly similar symptom overlaps across much of the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) literature. It is important to note that the prevention of under-recovery is multi-factorial, but many aspects are based around EA and CHO availability. Herein we have demonstrated that OTS and RED-S have many shared pathways, symptoms, and diagnostic complexities. Substantial attention is required to increase the knowledge and awareness of RED-S, and to enhance the diagnostic accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude LEA/RED-S from OTS diagnoses.

Novel Markers of Recovery From Overtraining Syndrome: The EROS-LONGITUDINAL Study

PURPOSES

Overtraining syndrome (OTS) is an unexplained underperformance syndrome triggered by excessive training, insufficient caloric intake, inadequate sleep, and excessive cognitive and social demands. Investigation of the recovery process from OTS has not been reported to date. The objective was to unveil novel markers and biochemical and clinical behaviors during the restoration process of OTS.

METHODS

This was a 12-week interventional protocol in 12 athletes affected by OTS, including increase of caloric intake, transitory interruption of training, improvement of sleep quality, and management of stress, followed by the assessment of 50 parameters including basal and hormonal responses to an insulin tolerance test and nonhormonal biochemical markers, and body metabolism and composition.

RESULTS

Early cortisol (P = .023), late ACTH (adrenocorticotrophic hormone) (P = .024), and early and late growth hormone (P = .005 and P = .038, respectively) responses, basal testosterone (P = .038), testosterone:estradiol ratio (P = .0005), insulinlike growth factor 1 (P = .004), cortisol awakening response (P = .001), and free thyronine (P = .069) increased, while basal estradiol (P = .033), nocturnal urinary catecholamines (P = .038), and creatine kinase (P = .071) reduced. Conversely, markers of body metabolism and composition had slight nonsignificant improvements.

CONCLUSION

After a 12-week intervention, athletes affected by actual OTS disclosed a mix of non-, partial, and full recovery processes, demonstrating that remission of OTS is as complex as its occurrence.

Acute leucocyte, muscle damage, and stress marker responses to high-intensity functional training

BACKGROUND

High-intensity functional training (HIFT) has become more popular, and the number of practitioners has increased; however, it remains unclear whether perturbations in the immune parameters occur, even after one single bout. Our aim was to examine acute leucocyte, muscle damage, and stress marker responses following a single 'Cindy' workout session, and compare the results between novice and experienced participants.

MATERIAL AND METHODS

Twenty-three HIFT practitioners (age 31.0 ± 1.0 years) completed the 'Cindy' workout. They were categorized as novice (3-8 months of experience; n = 10) and experienced (≥18 months; n = 13). White blood cell (WBC) count, plasma creatine kinase (CK) activity, blood cortisol level, and lactate concentration were measured. Blood analysis was performed before (pre-ex), immediately after (post-ex), 30 min after (post-30 min), and 24 h after (post-24 h) a single 'Cindy' workout session.

RESULTS

WBC count was higher post-ex (6.8 to 11.8x103/μL) and returned to baseline values within post-30 min (p<0.01). Neutrophil (3.3 to 4.5x103/μL) and lymphocyte levels (2.8 to 5.9x103/μL) were higher post-ex and returned to baseline values after post-24 h, yet lymphocytopoenia (2.2x103/μL) was observed at post-30 min (p<0.01). CK increased post-ex (174.9 to 226.7 U.L-1) and remained elevated post-24 h. Cortisol (14.7 to 17.0 μg/dL) and lactate (1.9 to 13.5 mmol.l-1) responses increased post-ex, but only the lactate level was reduced at post-30 min (p<0.01). The experienced participants had higher WBC, lymphocyte, and cortisol concentrations post-ex than the novice ones (p<0.01).

CONCLUSIONS

A single HIFT session elicited significant acute perturbations in WBC count, stress markers, and muscle tissue, which is like other similar regimens. Importantly, the experienced participants showed greater lymphocyte and cortisol responses than the novice ones.

Characterization of Hormonal, Metabolic, and Inflammatory Responses in CrossFit® Training: A Systematic Review

Background: CrossFit® training is a high-intensity functional training program that aims to increase physical functional performance through biochemical responses, i.e., hormonal, metabolic, and inflammatory responses. Most hormonal, metabolic, and inflammatory changes induced by CrossFit® training have been reported in isolated clinical studies. The purpose of this review was to systematically explore the existing literature on characterization of hormonal, metabolic, and inflammatory responses resulting from CrossFit® training. Methods: A systematic search of the literature was conducted in PubMed, Web of Science and Scopus from August 2019 to October 2019. Studies were selected through critical review of the content. Using specific keywords, 623 articles were found, of which 597 were excluded for ineligibility, and 25 were eligible. The papers were separated according to subject area: hormonal (n = 8), metabolic (n = 19), and inflammatory (n = 6) changes. All were published between 2015 and 2019. Results: This review reveals potential effects of CrossFit® training on hormonal, metabolic, and inflammatory responses. However, studies had low levels of evidence and reliability due to methodological limitations. Conclusion: In summary, the results showed a greater volume and intensity of workouts accentuate the responses, that are of paramount importance for improving understanding of the effects of CrossFit® training and serve as a basis for prescribing future exercise protocols.

Overreaching and overtraining in strength sports and resistance training: A scoping review

To date, little is known about overreaching (OR) and the overtraining syndrome (OTS) in strength sports and resistance training (RT) populations. However, the available literature may elucidate the occurrence of both conditions in these populations. A scoping review was conducted. SPORTDiscus, Scopus and Web of Science were searched in a robust and systematic manner, with relevant articles analysed. 1170 records were retrieved during an initial search, with a total of 47 included in the review. Two broad themes were identified during data extraction: 1) overreaching in strength sports; 2) overreaching and overtraining syndrome in RT. Short-term periods of OR achieved with either high-volume or high-intensity RT can elicit functional OR (FOR) but there is also evidence that chronic high-volume and/or intensity RT can lead to non-functional overreaching (NFOR). There is minimal evidence to suggest that true OTS has occurred in strength sports or RT based on the studies entered during this review. More research is needed to develop robust guiding principles for practitioners. Additionally, due to the heterogeneous nature of the existing literature, future research would benefit from the development of practical tools to identify and diagnose the transition from FOR to NFOR, and subsequently OTS in strength athletes and RT populations.

ABBREVIATIONS

RT: Resistance training; OR: Overreaching; FOR: Functional overreaching; NFOR: Non-functional overreaching; OTS: Overtraining syndrome; WP: Weightlifting performance.

High-Intensity Functional Training Improves Cardiorespiratory Fitness and Neuromuscular Performance Without Inflammation or Muscle Damage

Posnakidis, G, Aphamis, G, Giannaki, CD, Mougios, V, Aristotelous, P, Samoutis, G, and Bogdanis, GC. High-intensity functional training improves cardiorespiratory fitness and neuromuscular performance without inflammation or muscle damage. J Strength Cond Res XX(X): 000-000, 2020-We examined the effects of high-intensity functional training (HIFT) on cardiorespiratory and neuromuscular performance, as well as on inflammatory and muscle damage markers. Thirteen physically active healthy volunteers (aged 28.3 ± 3.8 years, 5 men and 8 women) underwent 8 weeks of a group HIFT program performed 3 times per week. Each session consisted of 4 rounds of a 9-exercise circuit (30-second exercise and 15-second recovery). During the first and last weeks of training, venous blood was sampled daily to monitor changes in serum C-reactive protein (CRP) and creatine kinase (CK). After 8 weeks of HIFT, body fat decreased by 0.64 ± 1.01 kg (p = 0.041), maximal oxygen uptake improved by 1.9 ± 2.2 ml·kg·min (p = 0.009), countermovement jump by 2.6 ± 1.5 cm (p = 0.001), bench press 1-repetition maximum (1RM) by 4.5 ± 3.8 kg (p = 0.001), maximum number of bench press repetitions at 65% 1RM by 4 ± 5 repetitions (p = 0.03), and abdominal muscle endurance by 6 ± 4 repetitions (p < 0.001). In both week 1 and week 8 of training, CK increased mildly in the morning after the first session of the week (main effect for day, p = 0.008), whereas no significant changes were observed in CRP (p = 0.31). During week 8, CK on all days was ∼32% lower compared with week 1 (160 vs. 235 U·L; main effect of week 1 vs. week 8, p = 0.027), whereas CRP remained unchanged (p = 0.225). This HIFT program was effective in improving cardiorespiratory and neuromuscular physical fitness without causing significant inflammation or muscle damage in physically active subjects.

Eating, Sleep, and Social Patterns as Independent Predictors of Clinical, Metabolic, and Biochemical Behaviors Among Elite Male Athletes: The EROS-PREDICTORS Study

Objectives: Physiological hormonal adaptions in athletes and pathological changes that occur in overtraining syndrome among athletes are unclear. The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study evaluated 117 markers and unveiled novel hormonal and metabolic beneficial adaptive processes in athletes. The objective of the present study was to uncover which modifiable factors predict the behaviors of clinical and biochemical parameters and to understand their mechanisms and outcomes using the parameters evaluated in the EROS study. Methods: We used multivariate linear regression with 39 participants to analyze five independent variables-the modifiable parameters (caloric, carbohydrate, and protein intake, and sleep quality and duration of concurrent cognitive activity) on 37 dependent variables-that were elected among the parameters evaluated in the EROS study. Results: Carbohydrate intake predicted quick hormonal responses to stress and improved explosive responses during exercise. Protein intake predicted improved body composition and metabolism and caloric intake, regardless of the proportion of macronutrients, predicted muscle recovery, and alertness in the morning. Sleep quality predicted improved mood and excessive concurrent cognitive effort in athletes under intense training predicted impaired metabolism and libido. Conclusions: The results support the premise that eating, sleep, and social patterns modulate metabolic and hormonal function, clinical behaviors, and performance status of male athletes, and should be monitored continuously and actively to avoid dysfunctions.

Novel causes and consequences of overtraining syndrome: the EROS-DISRUPTORS study

Background

Hormonal physiology in athletes, dysfunctional paths leading to overtraining syndrome (OTS), and clinical and biochemical behaviors that are independently modified by the presence of OTS remain unclear. Although multiple markers of OTS have recently been identified, the independent influence of OTS on hormones and metabolism have not been assessed. Hence, the objective of the present study was to uncover the previously unrecognized independent predictors of OTS and understand how OTS independently modifies the behaviors of clinical and biochemical parameters.

Methods

In a total of 39 athletes (OTS-affected athletes (OTS) = 14 and healthy athletes (ATL) = 25), we performed two clusters of statistical analyses using the full data of the Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study, in a total of 117 markers. We first used logistic regression to analyze five modifiable parameters (carbohydrate, protein, and overall caloric intake, sleep quality, and concurrent cognitive effort) as potential additional independent risk factors for OTS, and OTS as the outcome. We then used multivariate linear regression to analyze OTS as the independent variable and 38 dependent variables. Training patterns were found to be similar between OTS and ATL, and therefore excessive training was not a risk, and consequently not a predictor, for OTS.

Results

Each of the three dietary patterns (daily carbohydrate, daily protein, and daily overall calorie intake) were found to be the independent triggers of OTS, while sleeping, social, and training characteristics depended on other factors to induce OTS. Once triggered, OTS independently induced multiple changes, including reductions of cortisol, late growth hormone and adrenocorticotropic hormone responses to stimulations, testosterone-to-estradiol ratio, neutrophils, neutrophil-to-lymphocyte ratio, vigor levels, hydration status, and muscle mass, while increase of tension levels and visceral fat.

Conclusions

OTS can be independently triggered by eating patterns, regardless of training patterns, while the occurrence of OTS reduced late hormonal responses and the testosterone-to-estradiol ratio, worsened mood, and affected the immunology panel. These novel findings may explain underperformance, which is the key characteristic of OTS.

Gender Differences in Chronic Hormonal and Immunological Responses to CrossFit®

This study was designed to analyze the chronical responses of the hormonal and immune systems after a CrossFit^® training period of six months as well as to compare these results between genders. Twenty-nine CrossFit^® practitioners (35.3 ± 10.4 years, 175.0 ± 9.2 cm, 79.5 ± 16.4 kg) with a minimum CrossFit^® experience of six months were recruited, and hormonal and immune responses were verified every two months during training. The training was conducted in five consecutive days during the week, followed by two resting days. Testosterone (T) values were significantly higher at the last measurement time (T6 = 346.0 ± 299.7 pg·mL^-1) than at all the other times (p < 0.002) and were higher in men than in women (p < 0.001). Cortisol (C) levels were lower at all times compared to the initial level before training, and differences were observed between men and women, with men having a lower value (T0: p = 0.028; T2: p = 0.013; T4: p = 0.002; and T6: p = 0.002). The TC ratio in women was lower at all times (p < 0.0001) than in men. Significant effects on CD8 levels at different times (F_(3.81) = 7.287; p = 0.002; η_p² = 0.213) and between genders (F_(1.27) = 4.282; p = 0.048; η_p² = 0.137), and no differences in CD4 levels were observed. CrossFit^® training changed the serum and basal levels of testosterone and cortisol in men (with an increase in testosterone and a decrease in cortisol).

Inter-correlations Among Clinical, Metabolic, and Biochemical Parameters and Their Predictive Value in Healthy and Overtrained Male Athletes: The EROS-CORRELATIONS Study

Objectives: The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study identified multiple hormonal and metabolic conditioning processes in athletes, and underlying mechanisms and biomarkers of overtraining syndrome (OTS). The present study's objective was to reveal independent predictors and linear correlations among the parameters evaluated in the EROS study to predict clinical, metabolic, and biochemical behaviors in healthy and OTS-affected male athletes. Methods: We used multivariate linear regression and linear correlation to analyze possible combinations of the 38 parameters evaluated in the EROS study that revealed significant differences between healthy and OTS-affected athletes. Results: The testosterone-to-estradiol (T:E) ratio predicted the measured-to-predicted basal metabolic rate (BMR) ratio; the T:E ratio and total testosterone level were inversely predicted by fat mass and estradiol was not predicted by any of the non-modifiable parameters. Early and late growth hormone, cortisol, and prolactin responses to an insulin tolerance test (ITT) were strongly correlated. Hormonal responses to the ITT were positively correlated with fat oxidation, predicted-to-measured BMR ratio, muscle mass, and vigor, and inversely correlated with fat mass and fatigue. Salivary cortisol 30 min after awakening and the T:E ratio were inversely correlated with fatigue. Tension was inversely correlated with libido and directly correlated with body fat. The predicted-to-measured BMR ratio was correlated with muscle mass and body water, while fat oxidation was directly correlated with muscle mass and inversely correlated with fat mass. Muscle mass was directly correlated with body water, and extracellular water was directly correlated with body fat and inversely correlated with body water and muscle mass. Conclusions: Hypothalamic-pituitary responses to stimulation were diffuse and indistinguishable between the different axes. A late hormonal response to stimulation, increased cortisol after awakening, and the T:E ratio were correlated with vigor and fatigue. The T:E ratio was also correlated with body metabolism and composition, testosterone was predicted by fat mass, and estradiol predicted anger. Hydration status was inversely correlated with edema, and inter-correlations were found among fat oxidation, hydration, and body fat.