To jog or to stride: A comparison between two standardised running tests to monitor neuromuscular status in team sport athletes

This study investigated: 1) monitoring post-match neuromuscular fatigue (NMF) status in rugby union players using two submaximal running tests (SRT); and 2) the sensitivity of each SRT to locomotor variables obtained during match-play. Twenty-three male rugby players (age: 21.0 ± 1.3 years; height: 185.2 ± 6.1 cm; body mass; 97.3 ± 10.3 kg) were monitored across one season (n = 71 player-match and 159 fatigue-players-testing observations). Two different SRTs (SRT-jog [5-minute shuttle run protocol] and SRT-stride [a repeat stride effort protocol]) were used to characterise post-match NMF, with measures taken two days prior to match day (baseline), on MD + 1, and MD + 2. Linear mixed models (±90% CIs) were used to explore differences between measures and match-play locomotor variables. SRT-jog presented a meaningful increase following MD + 1 (ES: 0.63 [0.37 to 0.89]). SRT-Stride showed small increases at MD + 1 (ES: 0.24 [0.02 to 0.49]) and MD + 2 (ES: 0.33 [0.07 to 0.59]) suggesting a potential impairment in running mechanics. SRT-stride was significantly associated with total distance (ES: 0.41 [-0.01 to 0.83]) and collisions (ES: 0.58 [0.18 to 0.99]). While both tests presented small to moderate changes post-match, only the SRT-stride was related to match locomotor variables. Therefore, the SRT-stride may be a more sensitive monitoring tool for monitoring NMF in rugby union players.

Quantifying Trunk Impact Dynamics and Workload with Inertial Sensors in Goalball Players

The aim of this study was to quantify trunk impact dynamics in goalball players using inertial sensors and evaluate the goalball players' workloads, focusing on changes between the first and second halves of a match to enhance understanding of the demands experienced throughout the game. Utilizing inertial technology, trunk impacts during goalball gameplay were analyzed to provide a holistic insight into how these impacts influence athletes' dynamic stress loads, which refers to the physical demands placed on the body during dynamic movements. Six goalball players were recruited to wear an accelerometer during a whole goalball game to quantify trunk impacts. The results showed a higher number of total impacts and a higher number of impacts at higher levels during the first half, compared to a higher percentage of impacts at a low impact level in the second half. These results suggest that the intensity of gameplay is related to the number of impacts sustained, with players experiencing significantly more impacts, particularly at very low, low, and very high impact levels, in the first half compared to the second half. This decline in impacts aligns with the reduction in game intensity as the match progressed, as indicated by a lower heart rate and a trend towards a lower dynamic stress load in the second half. Future research could explore targeted training interventions aimed at optimizing workload and performance in goalball players.

Energy expenditure of international female rugby union players during a major international tournament: a doubly labelled water study

The purpose of this study was to quantify the total energy expenditure (TEE) of international female rugby union players. Fifteen players were assessed over 14 days throughout an international multi-game tournament, which represented two consecutive one-match microcycles. Resting metabolic rate (RMR) and TEE were assessed by indirect calorimetry and doubly labelled water, respectively. Physical activity level (PAL) was estimated (TEE:RMR). Mean RMR, TEE, and PAL were 6.60 ± 0.93 MJ·day-1 (1578 ± 223 kcal·day-1), 13.51 ± 2.28 MJ·day-1 (3229 ± 545 kcal·day-1), and 2.0 ± 0.3 AU, respectively. There was no difference in TEE (13.74 ± 2.31 (3284 ± 554 kcal·day-1) vs. 13.92 ± 2.10 MJ·day-1 (3327 ± 502 kcal·day-1); p = 0.754), or PAL (2.06 ± 0.26 AU vs. 2.09 ± 0.23 AU; p = 0.735) across microcycles, despite substantial decreases in training load (total distance: -8088 m, collisions: -20 n, training duration: -252 min). After correcting for body composition, there was no difference in TEE (13.80 ± 1.74 (3298 ± 416 adj. kcal·day-1) vs. 13.16 ± 1.97 (3145 ± 471 adj. kcal·day-1) adj. MJ·day-1, p = 0.190), RMR (6.49 ± 0.81 (1551 ± 194 adj. kcal·day-1) vs. 6.73 ± 0.83 (1609 ± 198 adj. kcal·day-1) adj. MJ·day-1, p = 0.633) or PAL (2.15 ± 0.14 vs. 1.87 ± 0.26 AU, p = 0.090) between forwards and backs. For an injured participant (n = 1), TEE reduced by 1.7 MJ·day-1 (-401 kcal·day-1) from pre-injury. For participants with illness (n = 3), TEE was similar to pre-illness (+0.49 MJ·day-1 (+117 kcal·day-1)). The energy requirements of international female rugby players were consistent across one-match microcycles. Forwards and backs had similar adjusted energy requirements. These findings are critical to inform the dietary guidance provided to female rugby players.

The influence of external loads on post-match neuromuscular fatigue in international rugby union: A partial least squares correlational analysis

The aims were to determine the relationship(s) between match-play external load and post-match neuromuscular fatigue as latent constructs, the contribution of the specific measured variables to these latent constructs, and how these differ between forwards and backs in elite rugby union. Forty-one elite male rugby union players (22 forwards and 19 backs) from the same international rugby union team were tested, with data included from the 2020 and 2021 international seasons (11 matches; 146 player appearances). Player's match-play external loads were quantified using microtechnology (for locomotor activities) and video analysis (for collision actions). Neuromuscular fatigue was quantified using countermovement jump tests on force plates which were conducted ~ 24 to 48 hours pre- and post-match. Partial least squares correlation (PLSC) leave one variable out (LOVO) procedure established the relative variable contribution to both external load (X matrix) and neuromuscular fatigue (Y matrix) constructs. Linear mixed-effects models were then constructed to determine the variance explained by the latent scores applied to the variables representing these constructs. For external load, both locomotor and collision variables were identified for the forwards and the backs, although the identified variables differed between groups. For neuromuscular fatigue, jump height was identified as a high contributor for the forwards and the backs, with concentric impulse and reactive strength index high contributors only for the backs. The explained variance between the external load and neuromuscular fatigue latent constructs at the individual player level was 4.4% and 32.2% in the forwards and the backs models, respectively. This discrepancy may be explained by differences in match-play external loads and/or the specificity of the tests to measure indicators of fatigue. These may differ due to, for example, the activities undertaken in the different positional groups.

When to Pull the Trigger: Conceptual Considerations for Approximating Head Acceleration Events Using Instrumented Mouthguards

Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.

Acute Response to Training after Returning from the Off-Season in Elite Rugby League Athletes

The purposes of this study were to quantify the physiological response to the initial two-week preseason period in elite male rugby league (RL) athletes, and to determine if a repeated bout effect (RBE) occurs. Eighteen RL players were monitored for the initial two-week preseason period. Blood samples were collected on days (D)1, D2, D4, D5, D8, D9, D11 and D12 to measure creatine kinase (CK). Neuromuscular power was assessed on D1, D5, D8 and D12. During field-based sessions, the external training load was quantified using global positioning system technology, whilst the internal load was quantified using the training impulse and the session rating of perceived exertion. Resistance-based gym session volume was quantified by total repetitions x weight lifted. Perceived measures of fatigue and muscle soreness were assessed on all training days. Two-way (day x week) repeated measures analysis of variance and Bonferroni's corrected post-hoc tests identified significant changes. There were no significant changes in CK activity (649.2 ± 255.0 vs. 673.8 ± 299.1 µL; p = 0.63) or internal training load measures from week 1 to week 2. External training load measures including total distance (4138.1 ± 198.4 vs. 4525.0 ± 169.2 m; p < 0.001) and repeated high-intensity efforts (12.6 ± 1.8 vs. 17.5 ± 1.8 au; p < 0.001) significantly increased in week 2 compared to week 1. Internal training loads and CK activity did not change in response to an increase in external training loads during the initial preseason. The current results provide support for a 'real world' perspective of the RBE phenomenon that may be more applicable for team sport practitioners.

A Review of the Health-Promoting Properties of Spirulina with a Focus on athletes' Performance and Recovery

Spirulina species are photosynthetic and filamentous bacteria, commonly called 'blue-green microalgae'. Spirulina has a high nutrient content. It contains 60-70% protein with all essential amino acids present, and is rich in several vitamins, minerals, and bioactive compounds. Spirulina is also rich in essential fatty acids, and antioxidants. This rich nutritional content provides to Spirulina several health benefits including antioxidant, anti-inflammatory, immunomodulation, and insulin-sensitizing properties as well as positive effects in various diseases which could be also interesting for athletes. This paper mainly aims to review the interest and effects of Spirulina supplementation in athletes at rest, and in relation to exercise/training. Spirulina's biochemical composition, health properties/effects in humans, and effects in athletes including nutritional status, body composition, physical performance and intense exercise-related disorders were discussed in this review. Literature data showed that Spirulina seems to have positive effects on body composition especially in overweight and obese subjects which could not be the case in other pathologies and athletes. Spirulina appears to be also effective in improving aerobic fitness especially in untrained and moderately trained subjects. Results reported in the literature suggest that Spirulina may improve strength and power performance despite the minor or no significant effects in highly trained subjects. Most studies have shown that Spirulina improves antioxidant status, prevents and accelerates the recovery of exercise-induced lipid peroxidation, muscle damage and inflammation in trained and untrained subjects. Taken together, the results from these studies are encouraging and may demonstrate the potential benefits of Spirulina supplementation in athletes despite methodological differences.

Low-Volume High-Intensity Interval Training Sessions With Different Work-Recovery Durations and Muscle Damage in Trained Men

Purpose: This study compared the effect of low-volume high-intensity training (LV-HIIT) sessions with different work-recovery durations on muscle damage markers.Methods: Twenty-four trained adult males (22.3 ± 2.9 years; 24.6 ± 2.7 kg∙m-2) performed two LV-HIIT sessions (10 x 60 s and 20 x 30 s at 100% of maximal aerobic speed on treadmill (Vmax) interspersed with equal time passive recovery, respectively) in a randomized, counter-balanced order, separated by a 1-week interval. Delayed onset muscle soreness (DOMS) and countermovement vertical jump height (CVJH) performance were assessed before, and 24-h and 48-h post sessions.Results: Pressure-pain threshold (PPT), pressure-pain tolerance (PPTol) and perceived pain intensity (PPI) using pressure algometry assessed DOMS in the rectus rectus femoris, biceps femoris and gastroctemius. A non-significant session by time interaction for PPT, PPTol and PPI in all muscles analyzed was observed (all P > 0.260). Additionally, a non-significant session by time interaction was observed for CVJH performance (P = 0.836).Conclusion: LV-HIIT sessions with different work-recovery durations elicited non-significant changes on muscle damage markers following 24- and 48-h in trained males.

Defining and quantifying fatigue in the rugby codes

The rugby codes (i.e., rugby union, rugby league, rugby sevens [termed 'rugby']) are team-sports that impose multiple complex physical, perceptual, and technical demands on players which leads to substantial player fatigue post-match. In the post-match period, fatigue manifests through multiple domains and negatively influences recovery. There is, however, currently no definition of fatigue contextualised to the unique characteristics of rugby (e.g., locomotor and collision loads). Similarly, the methods and metrics which practitioners consider when quantifying the components of post-match fatigue and subsequent recovery are not known. The aims of this study were to develop a definition of fatigue in rugby, to determine agreement with this common definition of fatigue, and to outline which methods and metrics are considered important and feasible to implement to quantify post-match fatigue. Subject matter experts (SME) undertook a two-round online Delphi questionnaire (round one; n = 42, round two; n = 23). SME responses in round one were analysed to derive a definition of fatigue, which after discussion and agreement by the investigators, obtained 96% agreement in round two. The SME agreed that fatigue in rugby refers to a reduction in performance-related task ability which is underpinned by time-dependent negative changes within and between cognitive, neuromuscular, perceptual, physiological, emotional, and technical/tactical domains. Further, there were 33 items in the neuromuscular performance, cardio-autonomic, or self-report domains achieved consensus for importance and/or feasibility to implement. Highly rated methods and metrics included countermovement jump force/power (neuromuscular performance), heart rate variability (cardio-autonomic measures), and soreness, mood, stress, and sleep quality (self-reported assessments). A monitoring system including highly-rated fatigue monitoring objective and subjective methods and metrics in rugby is presented. Practical recommendations of objective and subjective measures, and broader considerations for testing and analysing the resulting data in relation to monitoring fatigue are provided.

Dietary Intakes of Elite Male Professional Rugby Union Players in Catered and Non-Catered Environments

In professional rugby union, it is common for players to switch between catered and non-catered dietary environments throughout a season. However, little is known about the difference in dietary intake between these two settings. Twelve elite male professional rugby union players (28.3 ± 2.9 y, 188.9 ± 9.5 cm, 104.1 ± 13.3 kg) from the New Zealand Super Rugby Championship completed seven-day photographic food diaries with two-way communication during two seven-day competition weeks in both catered and non-catered environments. While no significant differences were observed in relative carbohydrate intake, mean seven-day absolute energy intakes (5210 ± 674 vs. 4341 ± 654 kcal·day^-1), relative protein (2.8 ± 0.3 vs. 2.3 ± 0.3 g·kgBM·day^-1) and relative fat (2.1 ± 0.3 vs. 1.5 ± 0.3 g·kgBM·day^-1) intakes were significantly higher in the catered compared to the non-catered environment (respectively) among forwards (n = 6). Backs (n = 6) presented non-significantly higher energy and macronutrient intakes within a catered compared to a non-catered environment. More similar dietary intakes were observed among backs regardless of the catering environment. Forwards may require more support and/or attention when transitioning between catered and non-catered environments to ensure that recommended dietary intakes are being achieved.

Spirulina supplementation prevents exercise-induced lipid peroxidation, inflammation and skeletal muscle damage in elite rugby players

BACKGROUND

The present study aimed to examine the effects of spirulina supplementation on pro/antioxidant status, inflammation and skeletal muscle damage markers immediately and 24 h after exhaustive exercise in elite rugby players.

METHODS

Seventeen elite male Rugby Union players were randomly assigned to a spirulina (SPI: n = 9) or placebo (PLA: n = 8) group in a double-blind design. Subjects were supplemented with Spirulina platensis (5.7 g day^-1 ) or placebo (isoproteic and caloric) for 7 weeks. At baseline and after 7 weeks of supplementation, blood samples were obtained before (T0), immediately after (T1) and 24 h after (T2) exhaustive exercise. The Yoyo Intermittent Recovery Test Level 2 was used as an exhaustive exercise to induce oxidative stress (OS), inflammation and skeletal muscle damage. The studied parameters included pro/antioxidant status markers (superoxide dismutase, glutathione peroxidase, reduced glutathione/glutathione disulphide ratio, oxidised low-density lipoprotein and F2α-isoprostanes [F2-Isop]), inflammation markers (myeloperoxidase and C-reactive protein [CRP]) and skeletal muscle damage markers (lactate dehydrogenase and creatine kinase [CK]).

RESULTS

Our results showed that F2-Isop, CRP and CK levels significantly increased at T1 only in the PLA group (p < 0.05, p < 0.05 and p < 0.001, respectively) with no change in the SPI group, which reflects the effect of spirulina to prevent lipid peroxidation, inflammation and skeletal muscle damage induced by exhaustive exercise. Moreover, spirulina supplementation accelerated the return to baseline values given that F2-Isop, CRP and CK levels at T2 were significantly lower than at T0 in the SPI group (p < 0.05, p < 0.01 and p < 0.001, respectively).

CONCLUSIONS

Based on the markers used in the present study, our results show that spirulina supplementation potentially prevents exercise-induced lipid peroxidation, inflammation and skeletal muscle damage, and may also accelerate the recovery of some of these markers. Based on our findings, we recommend spirulina supplementation especially for those athletes who do not achieve the recommended antioxidant dietary intake and who perform a high training load aiming to reduce the magnitude of OS, inflammation and skeletal muscle damage, which could help to reduce performance losses and accelerate recovery after training/competitions throughout the season.

Ice slurry ingestion improves physical performance during high-intensity intermittent exercise in a hot environment

Ice slurry ingestion enhances exercise performance by lowering the core body temperature. However, an operational issue related to this ingestion is the requirement for a high intake of 7.5 g·kg^-1 to produce the desired effects. We investigated the effects of the intake of low amounts of ice slurry at −2°C on the tympanic temperature and exercise performance during repeated high-intensity intermittent exercises in a hot environment. This study was a randomized, crossover study, with a 6-day washout period. Twelve university rugby union players performed two 30-min sessions of high-intensity intermittent exercises separated by a 15-min half-time break on a cycle ergometer in a hot environment (28.8°C ± 0.1°C, 49.5% ± 0.6% relative humidity). The participants ingested 450 g of −2°C-ice slurry (ICE), or a 30°C-beverage (CON) having the same composition as ICE, or 30°C-water (WAT) during the half-time break. The tympanic temperature and skin temperature were measured as the physiological data, and the peak power and mean power as the exercise performance data. The tympanic temperature at the half-time break and beginning of the 2^nd session was significantly lower in the ICE group as compared with the CON and WAT groups. The skin temperature at the half-time break was significantly lower in the ICE group as compared with the WAT group. While the peak power and mean power during the 2^nd session were significantly greater in the ICE group as compared with the CON and WAT groups. Our findings suggest that even the intake of lower amounts, as compared with those used in previous studies, of low-temperature ice slurry can reduce the body temperature and improve the peak power. These results suggest that intake of low-temperature ice slurry as a strategy for internal body cooling is useful for improving endurance exercise performance in hot environments.

Dry Needling Produces Mild Injuries Irrespective to Muscle Stiffness and Tension in Ex Vivo Mice Muscles

Numerous studies have suggested that the myofascial trigger points are responsible for most of the myofascial pain syndrome, so it seems reasonable that its destruction is a good therapeutic solution. The effectiveness of dry needling (DN) has been confirmed in muscles with myofascial trigger points, hypertonicity, and spasticity. The objective of this study is to analyze the need of repetitive punctures on muscles in different situations. The levator auris longus (LAL) muscle and gastrocnemius muscle from adult male Swiss mice were dissected and maintained alive, while being submerged in an oxygenated Ringer’s solution. DN was evaluated under four animal models, mimicking the human condition: normal healthy muscles, muscle fibers with contraction knots, muscles submerged in a depolarizing Ringer solution (KCl-CaCl2), and muscles submerged in Ringer solution with formalin. Thereafter, samples were evaluated with optical microscopy (LAL) and scanning electron microscopy (gastrocnemius). Healthy muscles allowed the penetration of needles between fibers with minimal injuries. In muscles with contraction knots, the needle separated many muscle fibers, and several others were injured, while blood vessels and intramuscular nerves were mostly not injured. Muscles submerged in a depolarizing solution inducing sustained contraction showed more injured muscular fibers and several muscle fibers separated by the needle. Finally, the muscles submerged in Ringer solution with formalin showed a few number of injured muscular fibers and abundant muscle fibers separated by the needle. Scanning electron microscopy images confirm the optical analyses. In summary, dry needling is a technique that causes mild injury irrespective of the muscle tone.

Impact and workload are dominating on-field data monitoring techniques to track health and well-being of team-sports athletes

Participation in sports has become an essential part of healthy living in today's world. However, injuries can often occur during sports participation. With advancements in sensor technology and data analytics, many sports have turned to technology-aided, data-driven, on-field monitoring techniques to help prevent injuries and plan better player management. This review searched three databases, Web of Science, IEEE, and PubMed, for peer-reviewed articles on on-field data monitoring techniques that are aimed at improving the health and well-being of team-sports athletes. It was found that most on-field data monitoring methods can be categorized as either player workload tracking or physical impact monitoring. Many studies covered during this review attempted to establish correlations between captured physical and physiological data, as well as injury risk. In these studies, workloads are frequently tracked to optimize training and prevent overtraining in addition to overuse injuries, while impacts are most often tracked to detect and investigate traumatic injuries. This review found that current sports monitoring practices often suffer from a lack of standard metrics and definitions. Furthermore, existing data-analysis models are created on data that are limited in both size and diversity. These issues need to be addressed to create ecologically valid approaches in the future.

The Effect of Rugby Union Match Play on Sleep Patterns and Subsequent Impact on Postmatch Fatigue Responses

PURPOSE

Sleep is recognized as an important recovery strategy, yet little is known regarding its impact on postmatch fatigue. The aims of this study were to (1) describe sleep and postmatch fatigue, (2) understand how sleep is affected by contextual and match factors, and (3) assess how changes in sleep can affect postmatch fatigue.

METHODS

Twenty-three male rugby union players were monitored across 1 season (N = 71 player-match observations). Actigraphy was used during preseason to establish baseline sleep quality and quantity. Sleep was then measured 1 and 2 days after each match day (MD + 1 and MD + 2). Global positioning systems, notational analysis, and rating of perceived exertion represented external and internal load from matches. Subjective wellness and a standardized run were used to characterize postmatch fatigue 2 days prior (baseline) and at MD + 1 and MD + 2. Linear mixed models established the magnitude of change (effect size [ES]) between baseline, MD + 1, and MD + 2 for sleep and postmatch fatigue. Stepwise forward selection analysis ascertained the effect of match load on sleep and the effect of sleep on postmatch fatigue. Each analysis was combined with magnitude-based decisions.

RESULTS

Sleep characteristics and neuromuscular and perceptual postmatch fatigue were negatively affected at MD + 1 and MD + 2 (ES = small to very large). Kickoff and travel time had the greatest effect on sleep (ES = small). Wellness and soreness were influenced by sleep (fall-asleep time and fragmentation index) and collisions, respectively (ES = small).

CONCLUSION

Sleep quality and quantity were affected independently of the match load (ie, running activity) sustained, and changes in sleep marginally affected postmatch fatigue.

From skeletal muscle damage and regeneration to the hypertrophy induced by exercise: What is the role of different macrophages subsets?

Macrophages are one of the top players when considering immune cells involved with tissue homeostasis. Recently, increasing evidence has demonstrated that these macrophages could also present two major subsets during tissue healing; proliferative macrophages (M1-like), which are responsible for increasing myogenic cell proliferation, and restorative macrophages (M2-like), which are accountable for the end of the mature muscle myogenesis. The participation and characterization of these macrophage subsets is critical during myogenesis, not only to understand the inflammatory role of macrophages during muscle recovery but also to create supportive strategies that can improve mass muscle maintenance. Indeed, most of our knowledge about macrophage subsets comes from skeletal muscle damage protocols, and we still do not know how these subsets can contribute to skeletal muscle adaptation. This narrative review aims to collect and discuss studies demonstrating the involvement of different macrophage subsets during the skeletal muscle damage/regeneration process, showcasing an essential role of these macrophage subsets during muscle adaptation induced by acute and chronic exercise programs.

Quantifying Fatigue in the Rugby Codes: The Interplay Between Collision Characteristics and Neuromuscular Performance, Biochemical Measures, and Self-Reported Assessments of Fatigue

Locomotor and collision actions that rugby players complete during match-play often lead to substantial fatigue, and in turn, delays in recovery. The methods used to quantify post-match fatigue and recovery can be categorised as subjective and objective, with match-related collision characteristics thought to have a primary role in modulating these recovery measures. The aim of this review was to (1) evaluate how post-match recovery has been quantified in the rugby football codes (i.e., rugby league, rugby union, and rugby sevens), (2) to explore the time-course of commonly used measures of fatigue post-match, and (3) to investigate the relationships between game-related collisions and fatigue metrics. The available evidence suggests that upper-, and lower-body neuromuscular performance are negatively affected, and biomarkers of muscular damage and inflammation increase in the hours and days following match-play, with the largest differences being at 12–36 h post-match. The magnitude of such responses varies within and between neuromuscular performance (Δ ≤ 36%, n = 13 studies) and tissue biomarker (Δ ≤ 585%, n = 18 studies) measures, but nevertheless appears strongly related to collision frequency and intensity. Likewise, the increase in perceived soreness in the hours and days post-match strongly correlate to collision characteristics across the rugby football codes. Within these findings, there are specific differences in positional groups and recovery trajectories between the codes which relate to athlete characteristics, and/or locomotor and collision characteristics. Finally, based on these findings, we offer a conceptual model of fatigue which details the multidimensional latent structure of the load to fatigue relationship contextualised to rugby. Research to date has been limited to univariate associations to explore relationships between collision characteristics and recovery, and multivariate methods are necessary and recommended to account for the latent structures of match-play external load and post-match fatigue constructs. Practitioners should be aware of the typical time windows of fatigue recovery and utilise both subjective and objective metrics to holistically quantify post-match recovery in rugby.

"Fuel for the Damage Induced": Untargeted Metabolomics in Elite Rugby Union Match Play

The metabolic perturbations caused by competitive rugby are not well characterized. Our aim is to utilize untargeted metabolomics to develop appropriate interventions, based on the metabolic fluctuations that occur in response to this collision-based team sport. Seven members of an English Premiership rugby squad consented to provide blood, urine, and saliva samples daily, over a competitive week including gameday (GD), with physical demands and dietary intake also recorded. Sample collection, processing and statistical analysis were performed in accordance with best practice set out by the metabolomics standards initiative employing 700 MHz NMR spectroscopy. Univariate and multivariate statistical analysis were employed to reveal the acute energy needs of this high intensity sport are met via glycolysis, the TCA cycle and gluconeogenesis. The recovery period after cessation of match play and prior to training recommencing sees a re-entry to gluconeogenesis, coupled with markers of oxidative stress, structural protein degradation, and reduced fatty acid metabolism. This novel insight leads us to propose that effective recovery from muscle damaging collisions is dependent upon the availability of glucose. An adjustment in the periodisation of carbohydrate to increase GD+1 provision may prevent the oxidation of amino acids which may also be crucial to allay markers of structural tissue degradation. Should we expand the ‘Fuel for the work required’ paradigm in collision-based team sports to include ‘Fuel for the damage induced’?

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.

Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature

ABSTRACT

This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Inside the Belly of a Beast: Individualizing Nutrition for Young, Professional Male Rugby League Players: A Review

Professional rugby league (RL) football is a contact sport involving repeated collisions and high-intensity efforts; both training and competition involve high energy expenditure. The present review summarizes and critiques the available literature relating the physiological demands of RL to nutritional requirements and considers potential ergogenic supplements that could improve players' physical capacity, health, and recovery during the preparatory and competition phases of a season. Although there may not be enough data to provide RL-specific recommendations, the available data suggest that players may require approximately 6-8 g·kg-1·day-1 carbohydrate, 1.6-2.6 g·kg-1·day-1 protein, and 0.7-2.2 g·kg-1·day-1 fat, provided that the latter also falls within 20-35% of total energy intake. Competition nutrition should maximize glycogen availability by consuming 1-4 g/kg carbohydrate (∼80-320 g) plus 0.25 g/kg (∼20-30 g) protein, 1-4 hr preexercise for 80-120 kg players. Carbohydrate intakes of approximately 80-180 g (1.0-1.5 g/kg) plus 20-67 g protein (0.25-0.55 g/kg) 0-2 hr postexercise will optimize glycogen resynthesis and muscle protein synthesis. Supplements that potentially improve performance, recovery, and adaptation include low to moderate dosages of caffeine (3-6 mg/kg) and ∼300 mg polyphenols consumed ∼1 hr preexercise, creatine monohydrate "loading" (0.3 g·kg-1·day-1) and/or maintenance (3-5 g/day), and beta-alanine (65-80 mg·kg-1·day-1). Future research should quantify energy expenditures in young, professional male RL players before constructing recommendations.

Quantifying the Collision Dose in Rugby League: A Systematic Review, Meta-analysis, and Critical Analysis

BACKGROUND

Collisions (i.e. tackles, ball carries, and collisions) in the rugby league have the potential to increase injury risk, delay recovery, and influence individual and team performance. Understanding the collision demands of the rugby league may enable practitioners to optimise player health, recovery, and performance.

OBJECTIVE

The aim of this review was to (1) characterise the dose of collisions experienced within senior male rugby league match-play and training, (2) systematically and critically evaluate the methods used to describe the relative and absolute frequency and intensity of collisions, and (3) provide recommendations on collision monitoring.

METHODS

A systematic search of electronic databases (PubMed, SPORTDiscus, Scopus, and Web of Science) using keywords was undertaken. A meta-analysis provided a pooled mean of collision frequency or intensity metrics on comparable data sets from at least two studies.

RESULTS

Forty-three articles addressing the absolute (n) or relative collision frequency (n min^-1) or intensity of senior male rugby league collisions were included. Meta-analysis of video-based studies identified that forwards completed approximately twice the number of tackles per game than backs (n = 24.6 vs 12.8), whilst ball carry frequency remained similar between backs and forwards (n = 11.4 vs 11.2). Variable findings were observed at the subgroup level with a limited number of studies suggesting wide-running forwards, outside backs, and hit-up forwards complete similar ball carries whilst tackling frequency differed. For microtechnology, at the team level, players complete an average of 32.7 collisions per match. Limited data suggested hit-up and wide-running forwards complete the most collisions per match, when compared to adjustables and outside backs. Relative to playing time, forwards (n min^-1 = 0.44) complete a far greater frequency of collision than backs (n min^-1 = 0.16), with data suggesting hit-up forwards undertake more than adjustables, and outside backs. Studies investigating g force intensity zones utilised five unique intensity schemes with zones ranging from 2-3 g to 13-16 g. Given the disparity between device setups and zone classification systems between studies, further analyses were inappropriate. It is recommended that practitioners independently validate microtechnology against video to establish criterion validity.

CONCLUSIONS

Video- and microtechnology-based methods have been utilised to quantify collisions in the rugby league with differential collision profiles observed between forward and back positional groups, and their distinct subgroups. The ball carry demands of forwards and backs were similar, whilst tackle demands were greater for forwards than backs. Microtechnology has been used inconsistently to quantify collision frequency and intensity. Despite widespread popularity, a number of the microtechnology devices have yet to be appropriately validated. Limitations exist in using microtechnology to quantify collision intensity, including the lack of consistency and limited validation. Future directions include application of machine learning approaches to differentiate types of collisions in microtechnology datasets.

Stretching magnitude-dependent inactivation of AKT by ROS led to enhanced p53 mitochondrial translocation and myoblast apoptosis

Previously, we had shown that high magnitude stretch (HMS), rather than low magnitude stretch (LMS), induced significant apoptosis of skeletal muscle C2C12 myoblasts. However, the molecular mechanism remains obscure. In this study, we found that p53 protein accumulated in the nucleus of LMS-loaded cells, whereas it translocated into mitochondria of HMS-loaded cells. Knocking down endogenous p53 by shRNA abrogated HMS-induced apoptosis. Furthermore, we demonstrated that overaccumulation of reactive oxygen species (ROS) during HMS-inactivated AKT that was activated in LMS-treated cells, which accounted for the distinct p53 subcellular localizations under HMS and LMS. Blocking ROS generation by N-acetylcysteine (NAC) or overexpressing constitutively active AKT vector (CA-AKT) inhibited HMS-incurred p53 mitochondrial translocation and promoted its nuclear targeting. Moreover, both NAC and CA-AKT significantly attenuated HMS-induced C2C12 apoptosis. Finally, we found that Ser389 phosphorylation of p53 was a downstream event of ROS-inactivated AKT pathway, which was critical to p53 mitochondrial trafficking during HMS stimuli. Transfecting p53-shRNA C2C12s with the mutant p53 (S389A) that was unable to target p53 to mitochondria underwent significantly lower apoptosis than transfection with wild-type p53. Altogether, our study uncovered that mitochondrial localization of p53, resulting from p53 Ser389 phosphorylation through ROS-inactivated AKT pathway, prompted C2C12 myoblast apoptosis during HMS stimulation.

Adding omega-3 fatty acids to a protein-based supplement during pre-season training results in reduced muscle soreness and the better maintenance of explosive power in professional Rugby Union players

Evidence suggests that omega-3 fatty acid supplementation could reduce muscle soreness and maintain muscle function following eccentric exercise-induced muscle damage. The aim of this applied field study was to investigate the effectiveness of consuming a protein-based supplement containing 1546 mg of omega-3 polyunsaturated fatty acid (PUFA) (551 mg eicosapentaenoic acid (EPA) and 551 mg docosahexaenoic acid (DHA)) twice daily (FO) compared to a protein-based placebo (P) on muscle soreness, countermovement jump (CMJ) performance and psychological well-being in 20 professional Rugby Union players during 5 weeks of pre-season training. Players completed a 5-point-Likert soreness scale with 5 indicating "no soreness" and a questionnaire assessing fatigue, sleep, stress and mood each morning of training, plus they performed CMJ tests once or twice per week. Data were analysed using magnitude-based inferential statistics and are presented as percent beneficial/trivial/harmful. On day 35, there was a likely (% beneficial/trivial/harmful: 94/5/1) moderate (0.75, standardized mean difference (SMD)) beneficial effect of FO vs. P on the change in lower body muscle soreness compared with day 0 (FO: -3.8 ± 21.7%; P: -19.4 ± 11.2%). There was a likely (92/7/0) moderate (SMD: 0.60) beneficial effect of FO vs. P on CMJ performance (change from baseline to day 35, FO: +4.6 ± 5.9%; P: -3.4 ± 8.6%). From day 20, a moderate beneficial effect of FO on fatigue was observed. In terms of practical relevance, the moderate beneficial effect of adding fish oil to a protein-based supplement on muscle soreness translated into the better maintenance of explosive power in elite Rugby Union players during pre-season training.

Collision activity during training increases total energy expenditure measured via doubly labelled water

PURPOSE

Collision sports are characterised by frequent high-intensity collisions that induce substantial muscle damage, potentially increasing the energetic cost of recovery. Therefore, this study investigated the energetic cost of collision-based activity for the first time across any sport.

METHODS

Using a randomised crossover design, six professional young male rugby league players completed two different 5-day pre-season training microcycles. Players completed either a collision (COLL; 20 competitive one-on-one collisions) or non-collision (nCOLL; matched for kinematic demands, excluding collisions) training session on the first day of each microcycle, exactly 7 days apart. All remaining training sessions were matched and did not involve any collision-based activity. Total energy expenditure was measured using doubly labelled water, the literature gold standard.

RESULTS

Collisions resulted in a very likely higher (4.96 ± 0.97 MJ; ES = 0.30 ± 0.07; p = 0.0021) total energy expenditure across the 5-day COLL training microcycle (95.07 ± 16.66 MJ) compared with the nCOLL training microcycle (90.34 ± 16.97 MJ). The COLL training session also resulted in a very likely higher (200 ± 102 AU; ES = 1.43 ± 0.74; p = 0.007) session rating of perceived exertion and a very likely greater (- 14.6 ± 3.3%; ES = - 1.60 ± 0.51; p = 0.002) decrease in wellbeing 24 h later.

CONCLUSIONS

A single collision training session considerably increased total energy expenditure. This may explain the large energy expenditures of collision-sport athletes, which appear to exceed kinematic training and match demands. These findings suggest fuelling professional collision-sport athletes appropriately for the "muscle damage caused" alongside the kinematic "work required".

Energy expenditure of rugby players during a 14-day in-season period, measured using doubly labelled water

Criterion data for total energy expenditure (TEE) in elite rugby are lacking, which prediction equations may not reflect accurately. This study quantified TEE of 27 elite male rugby league (RL) and rugby union (RU) players (U16, U20, U24 age groups) during a 14-day in-season period using doubly labelled water (DLW). Measured TEE was also compared to estimated, using prediction equations. Resting metabolic rate (RMR) was measured using indirect calorimetry, and physical activity level (PAL) estimated (TEE:RMR). Differences in measured TEE were unclear by code and age (RL 4369 ± 979; RU 4365 ± 1122; U16, 4010 ± 744; U20, 4414 ± 688; U24, 4761 ± 1523 Kcal day- 1). Differences in PAL (overall mean 2.0 ± 0.4) were unclear. Very likely differences were observed in RMR by code (RL 2366 ± 296; RU 2123 ± 269 Kcal day- 1). Differences in relative RMR between U20 and U24 were very likely (U16, 27 ± 4; U20, 23 ± 3; U24, 26 ± 5 Kcal kg- 1 day- 1). Differences were observed between measured and estimated TEE, using Schofield, Cunningham and Harris-Benedict equations for U16 (187 ± 614, unclear; - 489 ± 564, likely and - 90 ± 579, unclear Kcal day- 1), U20 (- 449 ± 698, likely; - 785 ± 650, very likely and - 452 ± 684, likely Kcal day- 1) and U24 players (- 428 ± 1292; - 605 ± 1493 and - 461 ± 1314 Kcal day- 1, all unclear). Rugby players have high TEE, which should be acknowledged. Large inter-player variability in TEE was observed demonstrating heterogeneity within groups, thus published equations may not appropriately estimate TEE.