Characterising the individual performance responses to mild illness in international swimmers

Acute Effects of Loaded and Unloaded Whole-Body Vibration on Vertical Jump Performance in Karate Athletes

We investigated the acute effects of different whole-body vibration (WBV) interventions on the jump height of highly trained karate practitioners. Fifteen male karate club athletes (age: 20.0 ± 3.8 years; stature: 177.3 ± 4.7 cm; body mass: 76.9 ± 11.2 kg; % body fat: 9.2 ± 4.3) performed six randomized interventions: [a] static half-squat (SHS); [b] SHS with external loads at 30% of the body weight (SHS + 30%BW); [c] WBV at frequency (f) 25 Hz, and 2 mm amplitude (A) (WBV 25/2); [d] WBV 25/2 with external loads of 30% of the body weight (WBV 25/2 + 30% BW); [e] WBV at f = 50 Hz, and A = 4 mm (WBV 50/4), and [f] WBV 50/4 with external loads of 30% of the body weight (WBV 50/4 + 30% BW). Each intervention was performed for 5 sets at 60 s/set, with a rest interval of 30 s between sets. Countermovement jump (CMJ) data were collected at 2, 4, 6, 8 and 10 min after each preconditioning intervention. Two-way repeated-measures ANOVA revealed a non-significant main effect of intervention [F(5, 10) = 1.44, η2 = 0.42, p = 0.29)] and a significant main effect of the rest interval [F(4, 11) = 3.51, η2 = 0.56, p = 0.04)] on CMJ height. A rest interval of 4 min resulted in significantly higher CMJ values than a rest interval of 2 min (p = 0.031). In conclusion, utilizing a 4-min rest interval irrespective of the intervention schemes may have potential for enhancing jumping performance among highly trained karate athletes.

Effects of Probiotic Supplementation on Sports Performance and Performance-Related Features in Athletes: A Systematic Review

This review aims to evaluate the effects of probiotic supplementation on performance and performance-related conditions in athletes by evaluating randomized controlled studies from the MEDLINE (Pubmed), Web of Science, Scopus, and SPORTDiscus (EBSCO) databases. From a total of 2304 relevant articles, 13 studies fulfilled the inclusion criteria. Seven studies concern endurance athletes, one to rugby players, three refer to non-specified athletes, one to badminton players, and one involves baseball players. The evidence suggests that the integration of athletes' diets with some bacterial strains and also the consumption of multi-strain compounds may lead to an improvement in performance and can positively affect performance-related aspects such as fatigue, muscle pain, body composition, and cardiorespiratory fitness. However, the type of supplementation and sport is very variable among the studies examined. Therefore, to obtain more solid evidence, further controlled and comparable studies are needed to expand the research regarding the possible repercussions of probiotics use on athletes' performance.

The effects of acute respiratory illness on exercise and sports performance outcomes in athletes - a systematic review by a subgroup of the IOC consensus group on "Acute respiratory illness in the athlete"

Acute respiratory infections (ARinf) are common in athletes, but their effects on exercise and sports performance remain unclear. This systematic review aimed to determine the acute (short-term) and longer-term effects of ARinf, including SARS-CoV-2 infection, on exercise and sports performance outcomes in athletes. Data sources searched included PubMed, Web of Science, and EBSCOhost, from January 1990-31 December 2021. Eligibility criteria included original research studies published in English, measuring exercise and/or sports performance outcomes in athletes/physically active/military aged 15-65years with ARinf. Information regarding the study cohort, diagnostic criteria, illness classification, and quantitative data on the effect on exercise/sports performance were extracted. Database searches identified 1707 studies. After full text screening, 17 studies were included (n = 7793). Outcomes were acute or longer-term effects on exercise (cardiovascular or pulmonary responses), or sports performance (training modifications, change in standardised point scoring systems, running biomechanics, match performance or ability to start/finish an event). There was substantial methodological heterogeneity between studies. ARinf was associated with acute decrements in sports performance outcomes (4 studies) and pulmonary function (3 studies), but minimal effects on cardiorespiratory endurance (7 studies in mild ARinf). Longer-term detrimental effects of ARinf on sports performance (6 studies) were divided. Training mileage, overall training load, standardised sports performance-dependent points and match play can be affected over time. Despite few studies, there is a trend towards impairment in acute and longer-term exercise and sports outcomes after ARinf in athletes. Future research should consider a uniform approach to explore relationships between ARinf and exercise/sports performance.

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVE

To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Electronic databases: PubMed-Medline, EbscoHost and Web of Science.

ELIGIBILITY CRITERIA

Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15-65 years.

RESULTS

Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3).

SUMMARY/CONCLUSIONS

These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported.

PROSPERO REGISTRATION NUMBER

CRD42020160472.

Effects of Probiotic Supplementation on Exercise with Predominance of Aerobic Metabolism in Trained Population: A Systematic Review, Meta-Analysis and Meta-Regression

The scientific literature about probiotic intake and its effect on sports performance is growing. Therefore, the main aim of this systematic review, meta-analysis and meta-regression was to review all information about the effects of probiotic supplementation on performance tests with predominance of aerobic metabolism in trained populations (athletes and/or Division I players and/or trained population: ≥8 h/week and/or ≥5 workouts/week). A structured search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA®) statement and PICOS guidelines in PubMed/MEDLINE, Web of Science (WOS), and Scopus international databases from inception to 1 November 2021. Studies involving probiotic supplementation in trained population and execution of performance test with aerobic metabolism predominance (test lasted more than 5 min) were considered for inclusion. Fifteen articles were included in the final systematic review (in total, 388 participants were included). After 3 studies were removed due to a lack of data for the meta-analysis and meta-regression, 12 studies with 232 participants were involved. With the objective of assessing the risk of bias of included studies, Cochrane Collaboration Guidelines and the Physiotherapy Evidence Database (PEDro) scale were performed. For all included studies the following data was extracted: authors, year of publication, study design, the size of the sample, probiotic administration (dose and time), and characteristics of participants. The random effects model and pooled standardized mean differences (SMDs) were used according to Hedges’ g for the meta-analysis. In order to determine if dose and duration covariates could predict probiotic effects, a meta-regression was also conducted. Results showed a small positive and significant effect on the performance test with aerobic metabolic predominance (SMD = 0.29; CI = 0.08−0.50; p < 0.05). Moreover, the subgroup analysis displayed significant greater benefits when the dose was ≥30 × 109 colony forming units (CFU) (SMD, 0.47; CI, 0.05 to 0.89; p < 0.05), when supplementation duration was ≤4 weeks (SMD, 0.44; CI, 0.05 to 0.84; p < 0.05), when single strain probiotics were used (SMD, 0.33; CI, 0.06 to 0.60; p < 0.05), when participants were males (SMD, 0.30; CI, 0.04 to 0.56; p < 0.05), and when the test was performed to exhaustion (SMD, 0.45; CI, 0.05 to 0.48; p < 0.05). However, with references to the findings of the meta-regression, selected covariates did not predict probiotic effects in highly trained population. In summary, the current systematic review and meta-analysis supported the potential effects of probiotics supplementation to improve performance in a test in which aerobic metabolism is predominant in trained population. However, more research is needed to fully understand the mechanisms of action of this supplement.

Salivary IgA as a Potential Biomarker in the Evaluation of Respiratory Tract Infection Risk in Athletes

In recent years, there has been attention focused on the value of salivary IgA (sIgA) as a potential biomarker for the identification of athletes who may be at increased risk of developing respiratory tract infection (RTI). The utility of sIgA, in this context, is based on biological plausibility and several observational studies revealing an apparent association between sIgA and RTI susceptibility. The overall published evidence evaluating the value of sIgA in this context is however conflicting, and there is currently a lack of clear guidance as to whether this marker has a place in the health surveillance and care of athletes. In this review, we critically appraise the literature assessing the potential for sIgA to be used in this context, evaluating it against 4 key biomarker characteristics, including its (1) practicality, (2) reproducibility, (3) specificity/sensitivity, and (4) potential clinical impact and relevance. This process reveals that although there is an apparent association between respiratory illness and sIgA in many studies, with some promising results, overall there remains a paucity of evidence supporting its overall value in this context. Key deficiencies in the metrics employed to endorse a valid biomarker are apparent, including a lack of reproducibility and low specificity and sensitivity in the detection of RTI susceptibility. The review outlines these issues and makes future recommendations.

Intraday reliability, sensitivity, and minimum detectable change of national physical fitness measurement for preschool children in China

China General Administration of Sport has published and adopted the National Physical Fitness Measurement (NPFM-preschool children version) since 2000. However, studies on intraday reliability, sensitivity, and minimum detectable change (MDC) are lacking. This study aimed to investigate and compare the reliability, sensitivity, and MDC values of NPFM in preschool children between the ages of 3.5 to 6 years. Six items of NPFM including 10-m shuttle run, standing long jump, balance beam walking, sit-and-reach, tennis throwing, and double-leg timed hop, were tested for 209 Chinese kindergarten children in Beijing in the morning. Intraday relative reliability was tested using intraclass correlation coefficient (ICC3,1) with a 95% confidence interval while absolute reliability was expressed in standard error of measurement (SEM) and percentage of coefficient of variation (CV%). Test sensitivity was assessed by comparing the smallest worthwhile change (SWC) with SEM, while MDC values with 95% confidence interval (MDC95) were established. Measurements in most groups, except 10-m shuttle run test (ICC3,1: 0.56 to 0.74 [moderate]) in the 3.5 to 5.5-year-old groups, balance beam test in 4- and 5-year-old (ICC3,1: 0.33 to 0.35 [poor]) and 5.5-year-old (ICC3,1 = 0.68 [moderate]) groups, and double-leg timed hop test (ICC3,1 = 0.67 [moderate]) in the 4.5-year-old group, demonstrated good to excellent relative reliability (ICC3,1: 0.77 to 0.97). The balance beam walking test showed poor absolute reliability in all the groups (SEM%: 11.76 to 22.28 and CV%: 15.40 to 24.78). Both standing long jump and sit-and-reach tests demonstrated good sensitivity (SWC > SEM) in all subjects group, boys, and girls. Pairwise comparison revealed systematic bias with significantly better performance in the second trial (p<0.01) of all the tests with moderate to large effect size.

Coldzyme® Mouth Spray reduces duration of upper respiratory tract infection symptoms in endurance athletes under free living conditions

Upper respiratory tract infection (URTI) can compromise athlete preparation and performance, so countermeasures are desirable. The aim of this study was to assess the effects of ColdZyme® Mouth Spray (ColdZyme) on self-reported upper respiratory tract infection in competitive endurance athletes under free-living conditions. One hundred and twenty-three endurance-trained, competitive athletes (recruited across 4 sites in England, UK) were randomised to control (no treatment, n = 61) or ColdZyme (n = 62) for a 3-month study period (between December 2017 and March 2018; or December 2018 and April 2019). They recorded daily training and illness symptoms (Jackson common cold questionnaire) during the study period. A total of 130 illness episodes were reported during the study with no difference in incidence between groups (episodes per person: 1.1 ± 0.9 Control, 1.0 ± 0.8 ColdZyme, P = 0.290). Episode duration was significantly shorter in ColdZyme compared to Control: Control 10.4 ± 8.5 days vs. ColdZyme 7.7 ± 4.0 days, P = 0.016). Further analysis to compare episodes with poor vs. good compliance with ColdZyme instructions for use (IFU) within the ColdZyme group showed a greater reduction in duration of URTI when compliance was good (9.3 ± 4.5 days in ColdZyme poor IFU compliance vs. 6.9 ± 3.5 days in ColdZyme good IFU compliance, P = 0.040). ColdZyme may be an effective countermeasure to reduce URTI duration, which was significantly lower (by 26-34%) in the ColdZyme treatment group (with no influence on incidence). This may have implications for athlete performance.

The Reliability and Validity of a Novel Sport-Specific Balance Test to Differentiate Performance Levels in Elite Curling Players

Balance as a skill and task-specific capacity is considered an essential physical quality in curling, required for executing effective stone delivery. However, no testing protocols have been developed to test curling-specific balance in the delivery position. Thus, the primary aim of this study was to investigate the reliability, validity and usefulness of a newly-developed, curling-specific balance test (CSBT) which involved the delivery position. The secondary aim was to examine the differences between elite and sub-elite curlers for core strength and flexibility, which have previously been identified as important qualities in curling and determinants of balance. Twenty curling players (13 females aged 19 ± 3.1 years; 7 males aged 19.6 ± 2.3 years) from five Swedish super-league curling clubs were divided into two groups according to playing level: elite and sub-elite. Variables included body mass, body height, body mass index, age, playing experience, training frequency, plank test, sit and reach test, standing single-leg balance test (SLBT) and CSBT. The CSBT was executed on a multiaxial tilting balance plate while mimicking the curling delivery position (i.e., a deep lunge position with the front foot on the plate). The participants completed the CSBT on three separate occasions, with each test consisting of three, 20-s attempts. Both the relative and absolute reliability were good for the CSBT (ICC = 0.90; CV = 14.5%). The CSBT demonstrated good measurement usefulness, being sensitive to detect moderate changes that exceeded 0.5 times the test standard deviation. Construct validity of the CSBT was evidenced by the large discriminatory capacity to differentiate expertise level in curling players (t-test: 2.85, p < 0.01; large ES), irrespective of other physical capacities (e.g., flexibility and core strength). However, the elite and sub-elite players also differed in age, playing experience and training frequency. Content validity was confirmed by a weak correlation (r = 0.21; 95%CI: -0.26 to 0.60) between the CSBT and SLBT, which suggests that curling-specific and standing balance should be considered as independent and task-specific motor skills. In conclusion, the CSBT can be used as a reliable, valid and useful tool for the assessment of curling-specific balance performance. In addition, longer and more extensive involvement in curling training contributed to superior specific balance in elite curlers.

Reliability, Validity and Usefulness of a New Response Time Test for Agility-Based Sports: A Simple vs. Complex Motor Task

The importance of response time (RT) in sports is well known, but there is an evident lack of reliable and valid sport-specific measurement tools applicable in the evaluation of RT in trained athletes. This study aimed to identify the validity, reliability, and usefulness of four newly developed RT testing protocols among athletes from agility-saturated (AG) and non-agility-saturated (NAG) sports. Thirty-seven AG and ten NAG athletes (age: 20.9 ± 2.9; eleven females) volunteered to undergo: three randomized simple response time (SRT-1, SRT-2, and SRT-3) protocols that included a single limb movement, and one complex response time (CRT) protocol that included multi joint movements and whole body transition over a short distance (1.5 and 1.8m). Each RT test involved 3 trials with 5 randomized attempts per trial. Two sensors were placed at the left- and right-hand side for SRT-1 and SRT-2. Three sensors were positioned (left, middle, right) in SRT-3 and CRT. The intra-class-correlation coefficient (ICC) was calculated as a measure of reliability. Independent sample t-test, effect size (d), and area-under-the-curve (AUC) were calculated to define discriminative validity of the tests. The results showed the newly developed tests were more reliable and useful in the AG than NAG athletes (i.e., ICC between 0.68 and 0.97 versus 0.31-0.90, respectively). The RT of AG athletes was faster than that of NAG athletes in the CRT test from the left (p <0.01, d = 2.40, AUC: 0.98), centre (p < 0.01, d = 1.57, AUC: 0.89), and right sensor (p < 0.01, d = 1.93, AUC: 0.89) locations. In contrast, there were no differences between the groups in the SRT tests. The weak correlation (i.e., r= 0.00-0.33) between the SRT and CRT tests suggests that response time of the single limb and multijoint limb movements should not be considered as a single motor capacity. In conclusion, this study showed that AG athletes had faster response time than their NAG peers during complex motor tasks. Such enhanced ability to rapidly and accurately reprogram complex motor tasks can be considered one of the essential qualities required for advanced performance in agility-based sports.

Allostatic stress load and CMV serostatus impact immune response to maximal exercise in collegiate swimmers

Collegiate athletes are exposed to varying levels of academic and physical stressors, placing them at increased risk for stress-activated latent viral infections. However, the impact of allostatic stress load on the immune response to maximal exercise in athletes remains largely unknown. This study examined the effects of a 7-mo training period and cytomegalovirus (CMV) serostatus on immune cell response to high-intensity swim tests within a group of collegiate swimmers. Samples were collected from 15 National Collegiate Athletic Association Division I swimmers (9 men, 6 women: 19.87 ± 0.64 yr) before and after exhaustive in-pool swims at 2 time points (V₁: immediately post-season 1 and V₃: beginning of season 2). An additional off-season (V₂) time point was collected in a subset of 9 swimmers. Natural killer (NK) cell, B cell, and T cells were quantified by flow cytometry. Linear mixed models were used to determine the effects of exercise, time point, and CMV serostatus (α = 0.05). Resting senescent CD8+ T cells were higher in CMV-seropositive participants at V₃ (P = 0.005). CMV-seronegative participants had a decrease in resting senescent CD8+ T cells from V₁ to V₃ (P = 0.021). After acute exercise, CMV-seropositive participants had lower naïve CD8+ T cells (P < 0.001) and higher senescent CD8+ T cells (P < 0.001). Increased cumulative stress levels did not appear to affect B-cell and NK-cell compartments. Immune response to exercise was impacted by CMV serostatus and allostatic stress load. Young CMV-seropositive athletes exposed to elevated stressors should be monitored to determine long-term effects of training and academic stressors.NEW & NOTEWORTHY Allostatic stress load is associated with impaired immune response to maximal exercise in cytomegalovirus (CMV)-seropositive subjects but not in CMV-seronegative young healthy adults.

Upper Respiratory Tract Infection and Mucosal Immunity in Young Ice Hockey Players During the Pretournament Training Period

Orysiak, J, Witek, K, Malczewska-Lenczowska, J, Zembron-Lacny, A, Pokrywka, A, and Sitkowski, D. Upper respiratory tract infection and mucosal immunity in young ice hockey players during the pretournament training period. J Strength Cond Res 33(11): 3129-3135, 2019-The aim of this study was to determine the effects of 17 days of training during preparation for the Ice Hockey Under 18 World Championship of the Polish ice hockey national team on the mucosal immune function and monitor upper respiratory tract infection (URTI) incidence before, during, and after the competition. Twelve male ice hockey players (age, 17.7 ± 0.5 years) were recruited for this study. The first saliva and blood collection took place at the beginning of the training camp (without training at the training camp), the second one was collected on the 9th day of the training camp immediately after the intensification of training, and the third collection was performed on the 13th day of training (4 days before leaving for the World Championship) in the tapering phase. To assess the mucosal immune function, concentrations of secretory immunoglobulin A (sIgA), sIgA1, and sIgA2 were analyzed in saliva. Cortisol concentration and creatine kinase activity were determined in blood, as indicators of stress and muscle damage, respectively. The Wisconsin Upper Respiratory Symptom Survey-21 questionnaire was used to assess URTI symptoms. A significant increase in the sIgA1 and sIgA2 concentrations was observed in the third collection compared with the second time point (114.45 ± 33.00 vs. 77.49 ± 27.29 and 88.97 ± 25.33 vs. 71.65 ± 32.44 U, respectively). There were no statistically significant correlations between the URTI incidence and saliva variables. In conclusion, the tapering period positively affects the mucosal immune function, especially sIgA1 and sIgA2 concentrations, with no significant change in the frequency of URTI in young ice hockey players.

No Association between Vitamin D and Acute Respiratory Tract Infections Amongst Elite New Zealand Rugby Players and Rowers

Upper respiratory tract infections are the most common infections reported by elite athletes. Low vitamin D status has been associated with an increased risk of upper respiratory tract infections. The aim of this study was to investigate associations between serum 25-hydroxyvitamin D (25(OH)D), salivary immunoglobulin A (S-IgA) concentrations, and acute respiratory tract infections (colds/flu) (ARI) in elite rowers and rugby players. A total of 53 (23 rugby players, 30 rowers) elite New Zealand athletes volunteered to participate in an interview, and to provide a blood and a saliva sample. Testing occurred twice, 6 months apart. Athletes' serum 25(OH)D concentrations and s-IgA levels were both significantly higher in summer, 108.9 (CI 102.8, 115.4) nmol/L, than in winter, 86.8 (CI 81.8, 92.1) nmol/L (p < 0.01, p = 0.028). The occurrence of an acute respiratory tract infection did not differ significantly between the time points (p = 0.322). However, ARI duration was significantly longer in winter than in summer (6.9 ± 4.3 days vs 4.8 ± 3.0 days; p = 0.044). There were no significant correlations between athletes' 25(OH)D levels and their s-IgA levels (p > 0.05) nor with acute respiratory tract infection occurrence (p > 0.05) nor duration (p > 0.05) in summer or winter. These findings suggest there may not be any associations between serum 25(OH)D concentrations and acute respiratory tract infections in this population. However, this null finding may be attributed to the high vitamin D concentrations seen in these athletes.

Exercise, Immunity, and Illness

It is generally accepted that moderate amounts of exercise improve immune system functions and hence reduce the risk of infection whereas athletes engaged in regular prolonged and/or intensive training have a higher than “normal” incidence of minor infections, especially of the upper respiratory tract (URT, e.g., common cold and influenza). This is likely related to regular acute (and possibly chronic) periods of exercise-induced changes in immune function. URT infections can compromise performance directly if suffered shortly before or during competition or indirectly if suffered at other times via effects on training and/or physiological adaptations. This chapter covers the effects of exercise (acute and chronic), both positive and negative, on immune function and consequent infection risk, and considers the current state-of-the-art for monitoring and assessing this in athletes.

Long-Haul Northeast Travel Disrupts Sleep and Induces Perceived Fatigue in Endurance Athletes

Introduction: Long-haul transmeridian travel is known to cause disruptions to sleep and immune status, which may increase the risk of illness. Aim: This study aimed to determine the effects of long-haul northeast travel for competition on sleep, illness and preparedness in endurance athletes. Methods: Twelve trained (13.8 ± 3.2 training h/week) masters (age: 48 ± 14 years) triathletes were monitored for sleep (quantity via actigraphy and quality via self-report), mucosal immunity (salivary immunoglobulin-A) and stress (salivary cortisol) as well as self-reported illness, fatigue, recovery and preparedness. Baseline measures were recorded for 2 weeks prior to travel for all variables except for the saliva samples, which were collected on three separate days upon waking. Participants completed normal training during the baseline period. Measures were subsequently recorded before, during and after long-haul northeast travel from the Australian winter to the Hawaiian summer, and in the lead up to an Ironman 70.3 triathlon. Results: All comparisons are to baseline. There was a most likely decrease in sleep duration on the over-night flight (-4.8 ± 1.2 h; effect size; ±90% confidence limits = 3.06; ±1.26) and a very likely increase in sleep duration on the first night after arrival (0.7 ± 1.0 h; 1.15; ±0.92). After this time, sleep duration returned to baseline for several days until it was very likely decreased on the night prior to competition (-1.2 ± 1.0 h; 1.18; ±0.93). Nap duration was likely increased on the first day after arrival (36 ± 65 min; 3.90; ±3.70). There was also a likely increase in self-reported fatigue upon waking after the first night in the new destination (1.1 ± 1.6 AU; 0.54; ±0.41) and there were three athletes (25%) who developed symptoms of illness 3-5 days after arrival. There were no changes in sleep quality or mucosal measures across study. Discussion: Long-haul northeast travel from a cool to a hot environment had substantial influences on sleep and self-reported fatigue, but these alterations had returned to pre-departure baseline 48 h after arrival. Endurance athletes undertaking similar journeys may benefit from optimizing sleep hygiene, especially on the first 2 days after arrival, or until sleep duration and fatigue levels return to normal.

Upper Respiratory Symptoms, Gut Health and Mucosal Immunity in Athletes

Upper respiratory symptoms remain the most common illness in athletes. Upper respiratory symptoms during heavy training and competition may impair performance. Preventing illness is the primary reason for the use of supplements, such as probiotics and prebiotics, for maintaining or promoting gut health and immune function. While exercise-induced perturbations in the immune system may increase susceptibility to illness and infection, growing evidence indicates that upper respiratory symptoms are related to a breakdown in the homeostatic regulation of the mucosal immune system of the airways. Balancing protection of the respiratory tract with normal physiological functioning requires dynamic orchestration between a wide array of immune parameters. The intestinal microbiota regulates extra-intestinal immunity via the common mucosal immune system and new evidence implicates the microbiota of the nose, mouth and respiratory tract in upper respiratory symptoms. Omics’ approaches now facilitate comprehensive profiling at the molecular and proteomic levels to reveal new pathways and molecules of immune regulation. New targets may provide for personalised nutritional and training interventions to maintain athlete health.

Training Load, Immune Status, and Clinical Outcomes in Young Athletes: A Controlled, Prospective, Longitudinal Study

Introduction: Beside positive effects on athlete's health, competitive sport can be linked with an increased risk of illness and injury. Because of high relative increases in training, additional physical and psychological strains, and an earlier specialization and professionalization, adolescent athletes needs an increased attention. Training can alter the immune system by inducing a temporary immunosuppression, finally developing infection symptoms. Previous studies identified Epstein Barr Virus (EBV) as potential indicator for the immune status. In addition to the identification of triggering risk factors for recurrent infections, the aim was to determine the interaction between training load, stress sense, immunological parameters, and clinical symptoms.

Methods: A controlled, prospective, longitudinal study on young athletes (n = 274, mean age: 13.8 ± 1.5 yrs) was conducted between 2010 and 2014. Also 285 controls (students, who did not perform competitive sports, mean age: 14.5 ± 1.9 yrs) were recruited. Athletes were examined 3 times each year to determine the effects of stress factors (training load: training hours per week [Th/w]) on selected outcome parameters (clinical [susceptibility to infection, WURSS-21: 21-item Wisconsin Upper Respiratory Symptom Survey], immunological, psychological end points). As part of each visit, EBV serostatus and EBV-specific IgG tiers were studied longitudinally as potential immune markers.

Results: Athletes (A) trained 14.9 ± 5.6 h weekly. Controls (C) showed no lower stress levels compared to athletes (p = 0.387). Twelve percent of athletes reported recurrent infections (C: 8.5%, p = 0.153), the presence of an upper respiratory tract infection (URTI) was achieved in 30.7%. EBV seroprevalence of athletes was 60.3% (C: 56.6%, p = 0.339). Mean EBV-specific IgG titer of athletes was 166 ± 115 U/ml (C: 137 ± 112 U/ml, p = 0.030). With increasing Th/w, higher stress levels were observed (p < 0.001). Analyzes of WURSS-21 data revealed no relationship to training load (p = 0.323). Also, training load had no relation to EBV serostatus (p = 0.057) or the level of EBV-specific IgG titers (p = 0.364).

Discussion: Young elite athletes showed no increased sense of stress, no higher prevalence of recurrent infections, and no different EBV-specific serological parameters compared to controls. Also, no direct relationship between training loads, clinical complaints, and EBV-specific immune responses was found. With increasing training loads athletes felt more stressed, but significant associations to EBV-specific serological parameters were absent. In summary, EBV serostatus and EBV-specific IgG titers do not allow risk stratification for impaired health. Further investigations are needed to identify additional risk factors and immune markers, with the aim to avoid inappropriate strains by early detection and following intervention.

Tear Fluid SIgA as a Noninvasive Biomarker of Mucosal Immunity and Common Cold Risk

PURPOSE

Research has not convincingly demonstrated the utility of saliva secretory immunoglobulin-A (SIgA) as a biomarker of upper respiratory tract infection (URTI) risk, and disagreement exists about the influence of heavy exercise ("open-window theory") and dehydration on saliva SIgA. Prompted by the search for viable alternatives, we compared the utility of tear and saliva SIgA to predict URTI prospectively (study 1) and assessed the influence of exercise (study 2) and dehydration (study 3) using a repeated-measures crossover design.

METHODS

In study 1, 40 subjects were recruited during the common-cold season. Subjects provided tear and saliva samples weekly and recorded upper respiratory symptoms (URS) daily for 3 wk. Real-time PCR confirmed common-cold pathogens in 9 of 11 subjects reporting URS (82%). Predictive utility of tear and saliva SIgA was explored by comparing healthy samples with those collected during the week before URS. In study 2, 13 subjects performed a 2-h run at 65% V˙O2peak. In study 3, 13 subjects performed exercise heat stress to 3% body mass loss followed by overnight fluid restriction.

RESULTS

Tear SIgA concentration and secretion rate were 48% and 51% lower, respectively, during URTI and 34% and 46% lower the week before URS (P < 0.05), but saliva SIgA remained unchanged. The risk of URS the following week increased ninefold (95% confidence interval, 1.7-48) when the tear SIgA secretion rate was <5.5 μg·min(-1) and sixfold (95% confidence interval, 1.2-29) when the tear SIgA secretion rate decreased >30%. Tear SIgA secretion rate >5.5 μg·min(-1) or no decrease of >30% predicted subjects free of URS in >80% of cases. Tear SIgA concentration decreased after exercise (-57%, P < 0.05) in line with the "open-window theory" but was unaffected by dehydration. Saliva flow rate decreased and saliva SIgA concentration increased after exercise and during dehydration (P < 0.05).

CONCLUSIONS

Tear SIgA has utility as a noninvasive biomarker of mucosal immunity and common-cold risk.

Short-term heat acclimation prior to a multi-day desert ultra-marathon improves physiological and psychological responses without compromising immune status

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day^‒1, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and T_re was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising T_re and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

Influence of Familiarization and Competitive Level on the Reliability of Countermovement Vertical Jump Kinetic and Kinematic Variables

Understanding typical variation of vertical jump (VJ) performance and confounding sources of its typical variability (i.e., familiarization and competitive level) is pertinent in the routine monitoring of athletes. We evaluated the presence of systematic error (learning effect) and nonuniformity of error (heteroscedasticity) across VJ performances of athletes that differ in competitive level and quantified the reliability of VJ kinetic and kinematic variables relative to the smallest worthwhile change (SWC). One hundred thirteen high school athletes, 30 college athletes, and 35 professional athletes completed repeat VJ trials. Average eccentric rate of force development (RFD), average concentric (CON) force, CON impulse, and jump height measurements were obtained from vertical ground reaction force (VGRF) data. Systematic error was assessed by evaluating changes in the mean of repeat trials. Heteroscedasticity was evaluated by plotting the difference score (trial 2 - trial 1) against the mean of the trials. Variability of jump variables was calculated as the typical error (TE) and coefficient of variation (%CV). No substantial systematic error (effect size range: -0.07 to 0.11) or heteroscedasticity was present for any of the VJ variables. Vertical jump can be performed without the need for familiarization trials, and the variability can be conveyed as either the raw TE or the %CV. Assessment of VGRF variables is an effective and reliable means of assessing VJ performance. Average CON force and CON impulse are highly reliable (%CV: 2.7% ×/÷ 1.10), although jump height was the only variable to display a %CV ≤SWC. Eccentric RFD is highly variable yet should not be discounted from VJ assessments on this factor alone because it may be sensitive to changes in response to training or fatigue that exceed the TE.

Respiratory inflammation and infections in high-performance athletes

Upper respiratory illness is the most common reason for non-injury-related presentation to a sports medicine clinic, accounting for 35-65% of illness presentations. Recurrent or persistent respiratory illness can have a negative impact on health and performance of athletes undertaking high levels of strenuous exercise. The cause of upper respiratory symptoms (URS) in athletes can be uncertain but the majority of cases are related to common respiratory viruses, viral reactivation, allergic responses to aeroallergens and exercise-related trauma to the integrity of respiratory epithelial membranes. Bacterial respiratory infections are uncommon in athletes. Undiagnosed or inappropriately treated asthma and/or allergy are common findings in clinical assessments of elite athletes experiencing recurrent URS. High-performance athletes with recurrent episodes of URS should undergo a thorough clinical assessment to exclude underlying treatable conditions of respiratory inflammation. Identifying athletes at risk of recurrent URS is important in order to prescribe preventative clinical, training and lifestyle strategies. Monitoring secretion rates and falling concentrations of salivary IgA can identify athletes at risk of URS. Therapeutic interventions are limited by the uncertainty of the underlying cause of inflammation. Topical anti-inflammatory sprays can be beneficial for some athletes. Dietary supplementation with bovine colostrum, probiotics and selected antioxidants can reduce the incidence or severity of URS in some athletes. Preliminary studies on athletes prone to URS indicate a genetic predisposition to a pro-inflammatory response and a dysregulated anti-inflammatory cytokine response to intense exercise as a possible mechanism of respiratory inflammation. This review focuses on respiratory infections and inflammation in elite/professional athletes.

High responders and low responders: factors associated with individual variation in response to standardized training

The response to an exercise intervention is often described in general terms, with the assumption that the group average represents a typical response for most individuals. In reality, however, it is more common for individuals to show a wide range of responses to an intervention rather than a similar response. This phenomenon of 'high responders' and 'low responders' following a standardized training intervention may provide helpful insights into mechanisms of training adaptation and methods of training prescription. Therefore, the aim of this review was to discuss factors associated with inter-individual variation in response to standardized, endurance-type training. It is well-known that genetic influences make an important contribution to individual variation in certain training responses. The association between genotype and training response has often been supported using heritability estimates; however, recent studies have been able to link variation in some training responses to specific single nucleotide polymorphisms. It would appear that hereditary influences are often expressed through hereditary influences on the pre-training phenotype, with some parameters showing a hereditary influence in the pre-training phenotype but not in the subsequent training response. In most cases, the pre-training phenotype appears to predict only a small amount of variation in the subsequent training response of that phenotype. However, the relationship between pre-training autonomic activity and subsequent maximal oxygen uptake response appears to show relatively stronger predictive potential. Individual variation in response to standardized training that cannot be explained by genetic influences may be related to the characteristics of the training program or lifestyle factors. Although standardized programs usually involve training prescribed by relative intensity and duration, some methods of relative exercise intensity prescription may be more successful in creating an equivalent homeostatic stress between individuals than other methods. Individual variation in the homeostatic stress associated with each training session would result in individuals experiencing a different exercise 'stimulus' and contribute to individual variation in the adaptive responses incurred over the course of the training program. Furthermore, recovery between the sessions of a standardized training program may vary amongst individuals due to factors such as training status, sleep, psychological stress, and habitual physical activity. If there is an imbalance between overall stress and recovery, some individuals may develop fatigue and even maladaptation, contributing to variation in pre-post training responses. There is some evidence that training response can be modulated by the timing and composition of dietary intake, and hence nutritional factors could also potentially contribute to individual variation in training responses. Finally, a certain amount of individual variation in responses may also be attributed to measurement error, a factor that should be accounted for wherever possible in future studies. In conclusion, there are several factors that could contribute to individual variation in response to standardized training. However, more studies are required to help clarify and quantify the role of these factors. Future studies addressing such topics may aid in the early prediction of high or low training responses and provide further insight into the mechanisms of training adaptation.

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

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

Probiotics supplementation for athletes - clinical and physiological effects

Probiotic supplementation has traditionally focused on gut health. However, in recent years, the clinical applications of probiotics have broadened to allergic, metabolic, inflammatory, gastrointestinal and respiratory conditions. Gastrointestinal health is important for regulating adaptation to exercise and physical activity. Symptoms such as nausea, bloating, cramping, pain, diarrhoea and bleeding occur in some athletes, particularly during prolonged exhaustive events. Several studies conducted since 2006 examining probiotic supplementation in athletes or highly active individuals indicate modest clinical benefits in terms of reduced frequency, severity and/or duration of respiratory and gastrointestinal illness. The likely mechanisms of action for probiotics include direct interaction with the gut microbiota, interaction with the mucosal immune system and immune signalling to a variety of organs and systems. Practical issues to consider include medical and dietary screening of athletes, sourcing of recommended probiotics and formulations, dose-response requirements for different probiotic strains, storage, handling and transport of supplements and timing of supplementation in relation to travel and competition.

Changes in naïve and memory T-cells in elite swimmers during a winter training season

High intensity training regimens appear to put athletes at a higher risk of illness. As these have been linked to alterations in the proportions of differentiated T cells, how training load affects these populations could have important implications for athlete susceptibility to disease. This study examined the effect of a winter training season on the proportions of circulating naïve and memory T cells subsets of high competitive level swimmers. Blood samples were taken at rest at 4 time-points during the season: before the start of the season (t0-September), after 7weeks of an initial period of gradually increasing training load (t1-November), after 6weeks of an intense training cycle (t2-February) and 48h after the main competition (t3-April) and from eleven non-athlete controls at 2 similar time-points (t2 and t3). CD4, CD8 and gamma-delta (γδ) T cells expressing the naïve (CCR7(+)CD45RA(+)), central-memory (CM-CCR7(+)CD45RA(-)), effector-memory (EM-CCR7(-)CD45RA(-)) and terminal effector (TEMRA-CCR7(-)CD45RA(+)) were quantified by flow cytometry. Statistical analyses were performed using multilevel modeling regression. Both T CD4(+) naïve and CM presented a linear increase in response to the first moment of training exposure, and had an exponential decrease until the end of the training exposure. As for TCD4(+) EM, changes were observed from t2 until the end of the training season with an exponential trend, while TCD4(+) TEMRA increased linearly throughout the season. TCD8(+) naïve increased at t1 and decreased exponentially thereafter. TCD8(+) TEMRA values decreased at t1 and increased exponentially until t3. γδT-EM had an increase at t1 and an exponential decrease afterwards. In contrast, γδT-TEMRA decreased at t1 and exponentially increased during the remaining 20weeks of training. An increase in TEMRA and EM T cells alongside a decrease in naïve T cells could leave athletes more susceptible to illness in response to variation in training stimulus during the season.

Crawling to the finish line: why do endurance runners collapse? Implications for understanding of mechanisms underlying pacing and fatigue

Effective regulation of pace enables the majority of runners to complete competitive endurance events without mishap. However, some runners do experience exercise-induced collapse associated with postural hypotension, which in rare cases results from life-threatening conditions such as cardiac disorders, cerebral events, heat stroke and hyponatraemia. Despite the experience of either catastrophic system failure or extreme peripheral muscle fatigue, some runners persist in attempting to reach the finish line, and this often results in a sequence of dynamic changes in posture and gait that we have termed the 'Foster collapse positions'. The initial stage involves an unstable gait and the runner assumes the 'Early Foster' collapse position with hips slightly flexed and their head lowered. This unstable gait further degrades into a shuffle referred to as the 'Half Foster' collapse position characterized by hip flexion of approximately 90° with the trunk and head parallel to the ground. At this point, the muscles of postural support and the co-ordination of propulsion begin to be compromised. If the condition worsens, the runner will fall to the ground and assume the 'Full Foster' collapse position, which involves crawling forwards on knees and elbows towards the finish line, with their trunk angled such that the head is at a lower angle than the hips. Upon reaching the finish line, or sometimes before that, the runner may collapse and remain prone until recovering either with or without assistance or medical treatment. The Foster collapse positions are indicative of a final, likely primordial, protective mechanism designed to attenuate postural hypotension, cardiac 'pump' insufficiency or cerebral blood flow deficiency. Continuing to attempt to reach the finish line in this impaired state is also perhaps indicative of a high psychological drive or a variety of neurological and psychological pathologies such as diminished sensitivity to interoceptive feedback, unrealistic situational appraisal or extreme motivational drives. A better understanding of the physiological, neurological and psychological antecedents of the Foster collapse sequence remains an important issue with practical implications for runner safety and theoretical understanding of collapses during exercise.

Training load, immune system, upper respiratory symptoms and performance in well-trained cyclists throughout a competitive season

This study aimed to evaluate the leukocyte subset counts, serum immunoglobulin A, performance and upper respiratory symptoms (URS), as well as their interrelationships, of well-trained cyclists for a 29-week training season using monitored loads. The season was divided into three phases: preparatory (nine weeks), first competitive phase (nine weeks) and second competitive phase (11 weeks). The sample consisted of eight well-trained cyclists, aged 18 ± 2 years. Immunological parameters and performance were evaluated during weeks 1 (baseline), 10 (early first competitive phase), 19 (early second competitive phase) and 29 (end of the second competitive phase). The training loads (volume x rating of perceived exertion) were monitored daily while the monitoring of URS was performed every 15 days using the WURSS-44 questionnaire. The data were analyzed using a one-way ANOVA and a Pearson correlation test with the significance level set at p ≤ 0.05. No significant differences were found for training load, leukocyte subset counts or serum immunoglobulin A among the three phases. However, serum immunoglobulin A was 50.9% below the control group values. URS were significantly higher during the preparatory period, and there were significant correlations between URS and training load (strain) in the preparatory period (r = 0.72, p = 0.032) and second competitive phase (r = 0.73, p = 0.036). In conclusion, indicators of training load without a significant change throughout the season did not significantly affect immune parameters measured; however, the increase of strain can cause an increase of upper respiratory symptoms throughout the season, but without loss of performance.

Changes in natural killer cell subpopulations over a winter training season in elite swimmers

Immune changes and increased susceptibility to infection are often reported in elite athletes. Infectious episodes can often impair training and performance with consequences for health and sporting success. This study monitored the occurrence of episodes of upper respiratory symptoms (URS) and the variation in circulating NK cells, CD56(bright) and CD56(dim) NK cells subpopulations, over a winter swimming season. Nineteen national elite swimmers and 11 non-athlete controls participated in this study. URS episodes were monitored using daily log books. Blood samples were taken at rest at four time points during the season: before the start of the season (t1--middle September), after 7 weeks of an initial period of gradually increasing training load (t2--early November), after 6 weeks of an intense training cycle (t3--late February) and 48 h after the main competition (t4--early April) and from the controls at three similar time points (t1--early November; t2--late February; t3--early April). In the swimmers, the occurrence of URS clustered around the periods of elevated training load (67 %). No URS were reported at equivalent time points in the non-athletes. Athletes showed a decrease in the percentage (t2 = 21 %; t3 = 27 %; t4 = 17 %) and absolute counts of circulating NK cells (t2 = 35 %; t3 = 22 %; t4 = 22 %), coinciding with the periods of increased training load, never recovering to the initial values observed at the start of the season. The reduction in the CD56(dim) and an increase in the CD56(bright) NK cell subpopulations were significant at t2 and t3 (p < 0.05). Concomitant with the fall in values of NK cells, in athletes that shown more than three URS episodes, a moderate correlation (r = 0.493; p = 0.036) was found between CD56(bright)/CD56(dim) ratio and the number of URS episodes after the more demanding training phase (t3). At t3, a lower value of CD56 cell counts was found in the group who reported three or more URS episodes (t = 2.239; p = 0.032). A progressive significant decrease in the expression of CD119, the receptor for IFN-γ, on the CD56(dim) cells was found over the season and an elevation in Granzyme B expression was coincident with the more demanding training phases. Periods of highly demanding training seem to have a negative impact on innate immunity mediated by NK cell subsets, which could partially explain the higher frequency of URS observed during these training phases.

Systematic review: Annual incidence of ACL injury and surgery in various populations

Accurate documentation of injury incidence is critical for study of injury risk factors and prevention. Comparisons of published incidences of anterior cruciate ligament (ACL) injuries and surgical reconstructions are difficult, however, because of the variations in units. Some studies report absolute time-based denominators (such as annual incidence or incidence per 100,000 person years), whereas others report exposure-based denominators (such as incidence per 1,000 player hours or athlete exposures). We converted exposure-based units into annual incidences to compare various studies. National population studies show annual incidence rates of up to 0.05% per person per year in Australia. Professional athletes in basketball, soccer, and the other football codes report an annual incidence of 0.15%-3.7% in studies with at least a moderate sample size. Annual ACL incidence in amateur sporting groups was generally higher than the entire population but lower than among professional athletes. Converting incidence rates to annual units allowed better comparisons to be made between population rates across different studies.

Modeling the association between HR variability and illness in elite swimmers

PURPOSE

To determine whether HR variability (HRV), an indirect measure of autonomic control, is associated with upper respiratory tract and pulmonary infections, muscular affections, and all-type pathologies in elite swimmers.

METHODS

For this study, 7 elite international and 11 national swimmers were observed weekly for 2 yr. The indexes of cardiac autonomic regulation in supine and orthostatic position were assessed as explanatory variables by time domain (SD1, SD2) and spectral analyses (high frequency [HF] = 0.15-0.40 Hz, low frequency [LF] = 0.04-0.15 Hz, and HF/LF ratio) of HRV. Logistic mixed models described the relationship between the explanatory variables and the risk of upper respiratory tract and pulmonary infections, muscular affections, and all-type pathologies.

RESULTS

The risk of all-type pathologies was higher for national swimmers and in winter (P < 0.01). An increase in the parasympathetic indexes (HF, SD1) in the supine position assessed 1 wk earlier was linked to a higher risk of upper respiratory tract and pulmonary infections (P < 0.05) and to a higher risk of muscular affections (increase in HF, P < 0.05). Multivariate analyses showed (1) a higher all-type pathologies risk in winter and for an increase in the total power of HRV associated with a decline SD1 in supine position, (2) a higher all-type pathologies risk in winter associated with a decline in HF assessed 1 wk earlier in orthostatic position, and (3) a higher risk of muscular affections in winter associated with a decrease SD1 and an increase LF in orthostatic position.

CONCLUSIONS

Swimmers' health maintenance requires particular attention when autonomic balance shows a sudden increase in parasympathetic indices in the supine position assessed 1 wk earlier evolving toward sympathetic predominance in supine and orthostatic positions.

Lactobacillus fermentum (PCC®) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes

Background

Probiotics purportedly reduce symptoms of gastrointestinal and upper respiratory-tract illness by modulating commensal microflora. Preventing and reducing symptoms of respiratory and gastrointestinal illness are the primary reason that dietary supplementation with probiotics are becoming increasingly popular with healthy active individuals. There is a paucity of data regarding the effectiveness of probiotics in this cohort. The aim of this study was to evaluate the effectiveness of a probiotic on faecal microbiology, self-reported illness symptoms and immunity in healthy well trained individuals.

Methods

Competitive cyclists (64 males and 35 females; age 35 ± 9 and 36 ± 9 y, VO₂max 56 ± 6 and 52 ± 6 ml.kg^-1.min^-1, mean ± SD) were randomised to either probiotic (minimum 1 × 10⁹ Lactobacillus fermentum (PCC^®) per day) or placebo treatment for 11 weeks in a double-blind, randomised, controlled trial. The outcome measures were faecal L. fermentum counts, self-reported symptoms of illness and serum cytokines.

Results

Lactobacillus numbers increased 7.7-fold (90% confidence limits 2.1- to 28-fold) more in males on the probiotic, while there was an unclear 2.2-fold (0.2- to 18-fold) increase in females taking the probiotic. The number and duration of mild gastrointestinal symptoms were ~2-fold greater in the probiotic group. However, there was a substantial 0.7 (0.2 to 1.2) of a scale step reduction in the severity of gastrointestinal illness at the mean training load in males, which became more pronounced as training load increased. The load (duration×severity) of lower respiratory illness symptoms was less by a factor of 0.31 (99%CI; 0.07 to 0.96) in males taking the probiotic compared with placebo but increased by a factor of 2.2 (0.41 to 27) in females. Differences in use of cold and flu medication mirrored these symptoms. The observed effects on URTI had too much uncertainty for a decisive outcome. There were clear reductions in the magnitude of acute exercise-induced changes in some cytokines.

Conclusion

L. fermentum may be a useful nutritional adjunct for healthy exercising males. However, uncertainty in the effects of supplementation on URTI and on symptoms in females needs to be resolved.

Trial registration

The trial was registered in the Australia and New Zealand Clinical Trials Registry (ACTRN12611000006943).

Physiological responses to ergometer and on-water incremental rowing tests

PURPOSE

This study evaluated the validity of ergometer tests against the criterion of on-water rowing and determined the reliability of field measurements by comparing results between ergometer (ERG) and on-water (OW) tests.

METHODS

Seven male rowers completed incremental tests on a Concept2 rowing ergometer and in a single scull. Average power output, oxygen consumption (VO2), heart rate (HR), blood lactate concentration (BLa) and distance completed were measured during each ERG and OW workload. DATA TREATMENT: Linear regression between power output and HR, BLa, VO2 and distance allowed submaximal results to be compared between ERG and OW tests at equivalent intensities based on five standard power outputs. Submaximal results were analyzed using repeated measure factorial ANOVAs and maximal data used dependent t tests (P < .05), the magnitude of differences were also classified using effect size analyses. The reliability of repeated measurements was established using Typical Error.

RESULTS

Differences between ERG and OW submaximal results were not statistically significant for power output, HR, BLa, and VO2, but distance completed (P < .001) was higher during the ERG test. However, the magnitude of physiological response differences between the ERG and OW tests varied between individuals. Mean HR at anaerobic threshold showed good agreement between both tests (r = .81), but the standard error of the estimate was 9 beats per minute.

CONCLUSIONS

Individual variation in physiological response differences between ERG and OW tests meant that training intensity recommendations from the ERG test were not applicable to on-water training for some rowers, but provided appropriate prescriptions for most athletes.

A self-reported questionnaire for quantifying illness symptoms in elite athletes

Purpose

To develop and evaluate a questionnaire that quantifies the self-reported frequency, duration and severity of illness symptoms in highly-trained athletes. We examined whether runners had more symptoms than recreationally-active individuals, and whether runners more prone to illness were undertaking more strenuous training programs.

Methods

A daily illness questionnaire was administered for three months during the summer to quantify the type, frequency, duration, and severity of illness symptoms as well as the functional impact on the ability to undertake exercise performance. A total of 35 participants (12 highly-trained runners living in a community setting and 23 recreationally-active medical students) completed the questionnaire.

Results

Runners had a similar frequency of illness (2.1 ± 1.2 vs. 1.8 ± 2.3 episodes, mean ± SD, P = 0.58), but substantially longer duration (5.5 ± 9.9 vs 2.8 ± 3.1 days, P < 0.01) and illness load (7.7 ± 16.2 vs 4.5 ± 4.8 units, P = 0.001) than age- and sex-matched recreationally-active individuals respectively. Runners more prone to illness symptoms had marginally higher training loads.

Conclusions

The athlete illness questionnaire is useful for quantifying the pattern of self-reported symptoms of illness in field settings. Highly-trained runners experience longer episodes of illness with a greater impact on daily activity than recreationally-active individuals.

Illness monitoring in team sports using a Web-based training diary

OBJECTIVE

Use of Web-based data recording systems has received little attention in sport. An "online" training diary could provide a valuable alternative to pen-paper methods in the regular assessment of physical activity and illness occurrence in athletes. The objective of this study was to design and implement a user-friendly and efficient system to monitor incidences of illness in team sport athletes.

DESIGN

Prospective monitoring study over a 48-week rugby season. Players were asked to register presence/absence of weekly illness symptoms with medical staff and also use an online training diary. Submitted self-reported diary illness data were compared with illness complaint data recorded by medical staff. Diary response rates were calculated from the number of completed diary entries against the number of available/required entries over the season.

SETTING

Web-based training diary.

PARTICIPANTS

Thirty professional rugby union players.

INTERVENTION

Comparison of gastrointestinal and upper respiratory illnesses (URIs) reported by players using an online diary and to medical staff.

MAIN OUTCOME MEASURES

Incidences of URIs.

RESULTS

The diary response rate in the reporting of weekly illnesses was 79% over the study period. Discrepancy existed between the number of self-reported URIs by players using the diary (118 URI incidences) compared with those reported to medical staff (23 URI incidences). Totaling all URI episodes (those self-reported + those registered by medical staff) revealed that players reported just 19% of URI episodes to medical staff.

CONCLUSIONS

Players tend to underreport incidences of banal infections. Closer monitoring of self-reported illnesses using a similar system in the present study may provide a better alternative to previous methods in nonclinical illness assessment.

The Effects of Wearing Lower-Body Compression Garments During Endurance Cycling

Purpose:

The present investigation examined the physiological and performance effects of lower-body compression garments (LBCG) during a one-hour cycling time-trial in well-trained cyclists.

Methods:

Twelve well-trained male cyclists ([mean ± SD] age: 20.5 ± 3.6 years; height: 177.5 ± 4.9 cm; body mass: 70.5 ± 7.5 kg; VO2max: 55.2 ± 6.8 mL·kg−1·min−1) volunteered for the study. Each subject completed two randomly ordered stepwise incremental tests and two randomly ordered one-hour time trials (1HTT) wearing either full-length SportSkins Classic LBCG or underwear briefs (control). Blood lactate concentration ([BLa−]), heart rate (HR), oxygen consumption (VO2) and muscle oxygenation (mOxy) were recorded throughout each test. Indicators of cycling endurance performance were anaerobic threshold (AnT) and VO2max values from the incremental test, and mean power (W), peak power (W), and total work (kJ) from the 1HTT Magnitude-based inferences were used to determine if LBCG demonstrated any performance and/or physiological benefits.

Results:

A likely practically significant increase (86%:12%:2%; η2 = 0.6) in power output at AnT was observed in the LBCG condition (CONT: 245.9 ± 55.7 W; LBCG: 259.8 ± 44.6 W). Further, a possible practically significant improvement (78%:19%:3%; η2 = 0.6) was reported in muscle oxygenation economy (W·%mOxy−1) across the 1HTT (mOxy: CONT: 52.2 ± 12.2%; LBCG: 57.3 ± 8.2%).

Conclusions:

The present results demonstrated limited physiological benefits and no performance enhancement through wearing LBCG during a cycling time trial.

Clinical and laboratory evaluation of upper respiratory symptoms in elite athletes

OBJECTIVE

To characterize the etiology of upper respiratory symptoms in elite athletes presenting to a sports physician for treatment.

DESIGN

Prospective clinical and laboratory investigations.

SETTING

Sports medicine clinic.

PARTICIPANTS

Seventy elite-level athletes.

MAIN OUTCOME MEASUREMENTS

Physician-recorded symptoms and diagnosis; health/training questionnaires; laboratory investigations of respiratory pathogens, white blood cell differential counts, and immune parameters.

RESULTS

Physicians characterized 89% of presentations as viral or bacterial upper respiratory tract infection. Only 57% of presentations were associated with an identified pathogen or other laboratory parameters indicative of infection. Demographic information, previous illness, and training history did not distinguish between presentations with or without objective measures of infection. Elevated white blood cell and neutrophil counts and lower vitamin D concentrations partially distinguished infectious episodes. The number of systemic symptoms/behaviors at presentation (cough, headache, earache, fatigue, fever/rigors, myalgia/arthralgia, or cessation of training before clinic attendance) had some predictive value for infection: odds ratio per symptom, 1.23 (90% confidence interval: 0.91 to 1.66); probability of infection, 48% with no symptoms to 77% with 6 symptoms. Laboratory investigation identified allergy in a considerable proportion of the cohort (39%).

CONCLUSIONS

The discrepancy between physician and laboratory diagnosed infection in elite athletes highlights the need for consideration of alternate diagnostic options when evaluating upper respiratory symptoms in athletes. A considerable proportion of episodes of respiratory symptoms in athletes were not associated with identification of a respiratory pathogen; other potentially treatable causes of upper respiratory symptoms should be considered, particularly in athletes with recurrent symptoms.