Reference intervals for serum creatine kinase in athletes

Changes in Plasma Concentration of Free Proteinogenic and Non-Proteinogenic Amino Acids in High-Performance Sprinters over a 6-Month Training Cycle

Background/Objectives: Free amino acids substantially contribute to energy metabolism. Also, their profile may identify (over)training status and effectiveness. The long-term effects of speed-power training on plasma free amino acid (PFAA) profiles are not known. We aimed to observe variations in PFAA levels in high-performance sprinters in a six-month training cycle. Methods: Ten male athletes (24.6 ± 3.3 years) were examined during four training phases: transition (1 month), general preparation (2 months), specific preparation (1 month), and pre-competition/competition (2 months). Venous blood was collected at rest, after exhaustive exercise, and recovery. Forty-two PFAAs were analyzed by the LC-ESI-MS/MS method. Results: Significant decreases in resting concentrations were observed between the transition and competition phases for glutamine (762 ± 117 vs. 623 ± 53 μmol∙L-1; p < 0.001, η2 = 0.47) and histidine (89 ± 15 vs. 75 ± 10 μmol∙L-1; p = 0.010, η2 = 0.27), whereas β-alanine (30 ± 7 vs. 41 ± 9 μmol∙L-1; p = 0.024, η2 = 016) and sarcosine (3.6 ± 0.4 vs. 4.8 ± 0.6 μmol∙L-1; p = 0.006, η2 = 0.188) levels increased. Between the specific and competition phases, significant decreases in the resting levels of 1-methylhistidine (22.1 ± 19.4 vs. 9.6 ± 8.8 μmol∙L-1; p = 0.14, η2 = 0.19), 3-methylhistidine (7.1 ± 1.5 vs. 6.5 ± 1.6 μmol∙L-1; p = 0.009, η2 = 0.18), citrulline (40 ± 10 vs. 29 ± 4 μmol∙L-1; p = 0.05, η2 = 0.29), and ornithine (74 ± 15 vs. 56 ± 10 μmol∙L-1; p = 0.015, η2 = 185) were noticed. Also, for β-alanine and sarcosine, the pattern of response to exercise strongly changed between the training phases. Blood ammonia levels at exhaustion decreased between the transition and competition phases (32 ± 4 vs. 23 ± 5 μmol∙L-1; p < 0.001, η2 = 0.67), while lactate, the phenylalanine-tyrosine ratio, the glutamine-glutamate ratio, hematological parameters, and cardiorespiratory indices remained at similar levels. Conclusions: Speed-power training seems to affect PFAAs involved in skeletal muscle metabolic pathways responsible for neutralizing toxic ammonia (glutamine, arginine, citrulline, ornithine), attenuating the deleterious effects of H+ ions (histidine, β-alanine), and reducing exercise-induced protein breakdown (1- and 3-methylhistidine). Our findings suggest that sprint-oriented training supports metabolic pathways that are responsible for the removal of harmful metabolites produced during exercise.

Periodontal disease and sports performance: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the association between athletic performance and periodontal disease (PD). Observational studies published up to April 2022 were searched in online databases (PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar). PECO statement focused on studies with professional athletes (Participants) with PD (Exposition) compared to those with healthy periodontium (Comparison) and its effects on sports performance (outcome). Searches were conducted according to the PRISMA guidelines (registration protocol: 10.17605/OSF.IO/7ADH6) and risk of bias evaluation according to the Joanna Briggs Institute checklist. A total of 793 references were retrieved, of which eight were considered eligible. Two studies did not show an association between clinical PD parameters and performance. A meta-analysis with 396 participants suggested a relationship between PD and self-reported reduction in sports performance (odds ratio [OR] = 1.55; 95% confidence interval [CI] 1.04-2.31; p = 0.03; I2 = 0%) with moderate quality of evidence accordingly GRADE analysis. Despite the differences in performance evaluations between studies, PD was associated with reduced self-reported sports performance. Additional studies assessing confounding factors and objective assessment of PD and performance are needed to clarify the real effect of both conditions.

Exercise-induced response of proteinogenic and non-proteinogenic plasma free amino acids is sport-specific: A comparison of sprint and endurance athletes

Circulating blood is an important plasma free amino acids (PFAAs) reservoir and a pivotal link between metabolic pathways. No comparisons are available between athletes with opposite training adaptations that include a broader spectrum of both proteinogenic and non-proteinogenic amino acids, and that take into account skeletal muscle mass. We hypothesized that the levels of the exercise-induced PFAAs concentration are related to the type of training-related metabolic adaptation. We compared highly trained endurance athletes (n = 11) and sprinters (n = 10) aged 20‒35 years who performed incremental exercise until exhaustion. Venous blood was collected before and during the test and 30-min recovery (12 samples). Forty-two PFAAs were assayed using LC-ESI-MS/MS technique. Skeletal muscle mass was estimated using dual X-ray absorptiometry method. Glutamine and alanine were dominant PFAAs throughout the whole exercise and recovery period (~350‒650 μmol∙L-1). Total, combined proteinogenic, non-essential, and non-proteinogenic PFAAs levels were significantly higher in endurance athletes than sprinters (ANOVA group effects: p = 0.007, η2 = 0.321; p = 0.011, η2 = 0.294; p = 0.003, η2 = 0.376; p = 0.001, η2 = 0.471, respectively). The exercise response was more pronounced in endurance athletes, especially for non-proteinogenic PFAAs (ANOVA interaction effect: p = 0.038, η2 = 0.123). Significant between-group differences were observed for 19 of 33 PFAAs detected, including 4 essential, 7 non-essential, and 8 non-proteinogenic ones. We demonstrated that the PFAAs response to incremental aerobic exercise is associated with the type of training-related metabolic adaptation. A greater turnover and availability of circulating PFAAs for skeletal muscles and other body tissues is observed in endurance- than in sprint-trained individuals. Non-proteinogenic PFAAs, despite low concentrations, also respond to exercise loads, indicating their important, though less understood role in exercise metabolism. Our study provides additional insight into the exercise-induced physiological response of PFAAs, and may also provide a rationale in discussions regarding dietary amino acid requirements in high-performance athletes with respect to sports specialization.

Exploring sex differences in blood-based biomarkers following exhaustive exercise using bioinformatics analysis

This study examined the acute effects of exercise testing on immunology markers, established blood-based biomarkers, and questionnaires in endurance athletes, with a focus on biological sex differences. Twenty-four healthy endurance-trained participants (16 men, age: 29.2± 7.6 years, maximal oxygen uptake (V ˙ O 2 max ): 59.4 ± 7.5 ml · min-1 · kg-1; 8 women, age: 26.8 ± 6.1 years,V ˙ O 2 max : 52.9 ± 3.1 ml · min-1 · kg-1) completed an incremental submaximal exercise test and a ramp test. The study employed exploratory bioinformatics analysis: mixed ANOVA, k-means clustering, and uniform manifold approximation and projection, to assess the effects of exhaustive exercise on biomarkers and questionnaires. Significant increases in biomarkers (lymphocytes, platelets, procalcitonin, hemoglobin, hematocrit, red blood cells, cell-free DNA (cfDNA)) and fatigue were observed post-exercise. Furthermore, differences pre- to post-exercise were observed in cytokines, cfDNA, and other blood biomarkers between male and female participants. Three distinct groups of athletes with differing proportions of females (Cluster 1: 100% female, Cluster 2: 85% male, Cluster 3: 37.5% female and 65.5% male) were identified with k-means clustering. Specific biomarkers (e.g., interleukin-2 (IL-2), IL-10, and IL-13, as well as cfDNA) served as primary markers for each cluster, potentially informing individualized exercise responses. In conclusion, our study identified exercise-sensitive biomarkers and provides valuable insights into the relationships between biological sex and biomarker responses.

Changes in Plasma Free Amino Acid Profile in Endurance Athletes over a 9-Month Training Cycle

We aimed to evaluate long-term changes in proteinogenic and non-proteinogenic plasma free amino acids (PFAA). Eleven male endurance triathletes participated in a 9-month study. Blood was collected at rest, immediately after exhaustive exercise, and during 30-min recovery, in four consecutive training phases: transition, general, specific, and competition. Twenty proteinogenic and 22 non-proteinogenic PFAAs were assayed using the LC-ESI-MS/MS technique. The structured training modified the patterns of exercise-induced PFAA response, with the competition phase being the most distinct from the others. Branched-chain amino acids (p = 0.002; η2 = 0.216), phenylalanine (p = 0.015; η2 = 0.153), methionine (p = 0.002; η2 = 0.206), and lysine (p = 0.006; η2 = 0.196) declined more rapidly between rest and exhaustion in the competition phase. Glutamine (p = 0.008; η2 = 0.255), glutamate (p = 0.006; η2 = 0.265), tyrosine (p = 0.001; η2 = 0.195), cystine (p = 0.042; η2 = 0.183), and serine (p < 0.001; η2 = 0.346) levels were reduced in the competition phase. Arginine (p = 0.046; η2 = 0.138) and aspartate (p = 0.011; η2 = 0.171) levels were highest during exercise in the transition phase. During the competition phase, α-aminoadipic acid (p = 0.023; η2 = 0.145), β-aminoisobutyric acid (p = 0.007; η2 = 0.167), β-alanine (p < 0.001; η2 = 0.473), and sarcosine (p = 0.017; η2 = 0.150) levels increased, whereas phosphoethanolamine (p = 0.037; η2 = 0.189) and taurine (p = 0.008; η2 = 0.251) concentrations decreased. Overtraining indicators were not elevated. The altered PFAA profile suggests adaptations within energy metabolic pathways such as the tricarboxylic acid cycle, oxidative phosphorylation, ammonia neutralization, the purine nucleotide cycle, and buffering of intracellular H+ ions. The changes seem to reflect normal adaptations.

Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review

Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.

The 8:1:1 Supplementation of Branched-Chain Amino Acids in High-Intensity Training: A Case Study of the Protective Effect on Rhabdomyolysis

INTRODUCTION

The increasing prevalence of high-intensity sports activities, notably the burgeoning popularity of CrossFit, underscores the contemporary significance of such physical pursuits. The discernible protective impact of branched-chain amino acids on muscle fatigue and injuries is emerging as a noteworthy area of investigation. Within the realm of sports, integrating BCAA supplementation into dietary practices holds promise for aiding athletes in their recovery, particularly in mitigating Delayed-Onset Muscle Soreness.

METHODOLOGY

This study adopted an experimental pilot design with repeated measures, employing a controlled and randomized approach through double-blind procedures. The participant engaged in high-intensity activity, specifically the CrossFit Karen® test, which entailed executing 150 wall ball throws (9 kg) to a height of 3 m. The trial incorporated three randomized supplementation conditions: BCAAs in an 8:1:1 ratio or a 2:1:1 ratio or a placebo condition. The participant consumed 15 g daily for 7 days, commencing 72 h prior to the initial blood sample and the first Karen® test.

RESULTS

In this study, BCAA supplementation at an 8:1:1 ratio demonstrated a discernible protective effect against muscular damage, as evidenced by creatine kinase values and ratings of perceived exertion.

Hydrogen-rich water supplementation promotes muscle recovery after two strenuous training sessions performed on the same day in elite fin swimmers: randomized, double-blind, placebo-controlled, crossover trial

Purpose: Molecular hydrogen has been shown to possess antioxidant, anti-inflammatory, ergogenic, and recovery-enhancing effects. This study aimed to assess the effect of molecular hydrogen administration on muscle performance, damage, and perception of soreness up to 24 h of recovery after two strenuous training sessions performed on the same day in elite fin swimmers. Methods: Eight females (mean ± SD; age 21.5 ± 5.0 years, maximal oxygen consumption 45.0 ± 2.5 mL.kg-1.min-1) and four males (age 18.9 ± 1.3 years, maximal oxygen consumption 52.2 ± 1.7 mL.kg-1.min-1) performed 12 × 50 m sprints in the morning session and a 400 m competitive performance in the afternoon session. Participants consumed hydrogen-rich water (HRW) or placebo 3 days before the sessions (1,260 mL/day) and 2,520 mL on the experimental day. Muscle performance (countermovement jump), muscle damage (creatine kinase), and muscle soreness (100 mm visual analogue scale) were measured during the experimental day and at 12 and 24 h after the afternoon session. Results: HRW compared to placebo reduced blood activity of creatine kinase (156 ± 63 vs. 190 ± 64 U.L-1, p = 0.043), muscle soreness perception (34 ± 12 vs. 42 ± 12 mm, p = 0.045), and improved countermovement jump height (30.7 ± 5.5 cm vs. 29.8 ± 5.8 cm, p = 0.014) at 12 h after the afternoon session. Conclusion: Four days of HRW supplementation is a promising hydration strategy for promoting muscle recovery after two strenuous training sessions performed on the same day in elite fin swimmers. Clinical Trial Registration: clinicaltrials.gov, identifier NCT05799911.

Relationship Between Objective and Subjective Markers of Muscle Recovery in Professional Handball Players

PURPOSE

To evaluate the relationship between items of the Short Recovery and Stress Scale (SRSS) related to physical stress and recovery and the biomarker creatine kinase (CK) in professional handball.

METHODS

CK and SRSS items (physical performance capability, overall recovery, muscular stress, and overall stress) were assessed in an observational study of 16 adult male professional handball players from a team in the highest German league during the 2019-20 preseason. Their preseason training schedule included several microcycles, each consisting of 3 consecutive days of intense training followed by a rest day. On 5 of these rest days, when players were classified as nonrested, and the 5 immediately following days, when players were classified as rested, players completed the SRSS between 8:00 and 9:00 AM, followed by blood sampling. Correlations between SRSS items were performed using Kendall τ. The relationship between each SRSS item and CK levels over time was examined using a mixed-effects model with a random intercept.

RESULTS

CK levels and SRSS stress items were significantly higher and SRSS recovery items were significantly lower in nonrested players. SRSS items were significantly positively or negatively correlated (all items: P < .001) and showed a significant effect indicating lower CK levels in rested players (all items: P ≤ .001; ηp2=.1-.32).

CONCLUSIONS

The investigated SRSS items may be a viable option for assessing muscle recovery in adult male professional handball players in a cost-effective and noninvasive manner. They can be used as a single monitoring tool or as part of a multimodal approach.

Exertional heat stroke causes long-term skeletal muscle epigenetic reprogramming, altered gene expression, and impaired satellite cell function in mice

The effect of exertional heat stroke (EHS) exposure on skeletal muscles is incompletely understood. Muscle weakness is an early symptom of EHS but is not considered a major target of multiorgan injury. Previously, in a preclinical mouse model of EHS, we observed the vulnerability of limb muscles to a second EHS exposure, suggesting hidden processes contributing to declines in muscle resilience. Here, we evaluated the possible molecular origins of EHS-induced declines in muscle resilience. Female C57BL/6 mice [total n = 56; 28/condition, i.e., EHS and exercise control (EXC)] underwent forced wheel running at 37.5°C/40% relative humidity until symptom limitation (unconsciousness). EXC mice exercised identically at room temperature (22-23°C). After 1 mo of recovery, the following were assessed: 1) specific force and caffeine-induced contracture in soleus (SOL) and extensor digitorum longus (EDL) muscles; 2) transcriptome and DNA methylome responses in gastrocnemius (GAST); and 3) primary satellite cell function (proliferation and differentiation). There were no differences in specific force in either SOL or EDL from EXC. Only EHS solei exhibited lower caffeine sensitivity. EHS GAST exhibited higher RNA expression of genes encoding structural proteins of slow fibers, heat shock proteins, and myogenesis. A total of ∼2,500 differentially methylated regions of DNA that could potentially affect many cell functions were identified. Primary satellite cells exhibited suppressed proliferation rates but normal differentiation responses. Results demonstrate long-term changes in skeletal muscles 1 mo after EHS that could contribute to declines in muscle resilience. Skeletal muscle may join other, more recognized tissues considered vulnerable to long-term effects of EHS.NEW & NOTEWORTHY Exertional heat stroke (EHS) in mice induces long-term molecular and functional changes in limb muscle that could reflect a loss of "resilience" to further stress. The phenotype was characterized by altered caffeine sensitivity and suppressed satellite cell proliferative potential. This was accompanied by changes in gene expression and DNA methylation consistent with ongoing muscle remodeling and stress adaptation. We propose that EHS may induce a prolonged vulnerability of skeletal muscle to further stress or injury.

Dose response of running on blood biomarkers of wellness in generally healthy individuals

Exercise is effective toward delaying or preventing chronic disease, with a large body of evidence supporting its effectiveness. However, less is known about the specific healthspan-promoting effects of exercise on blood biomarkers in the disease-free population. In this work, we examine 23,237 generally healthy individuals who self-report varying weekly running volumes and compare them to 4,428 generally healthy sedentary individuals, as well as 82 professional endurance runners. We estimate the significance of differences among blood biomarkers for groups of increasing running levels using analysis of variance (ANOVA), adjusting for age, gender, and BMI. We attempt and add insight to our observational dataset analysis via two-sample Mendelian randomization (2S-MR) using large independent datasets. We find that self-reported running volume associates with biomarker signatures of improved wellness, with some serum markers apparently being principally modified by BMI, whereas others show a dose-effect with respect to running volume. We further detect hints of sexually dimorphic serum responses in oxygen transport and hormonal traits, and we also observe a tendency toward pronounced modifications in magnesium status in professional endurance athletes. Thus, our results further characterize blood biomarkers of exercise and metabolic health, particularly regarding dose-effect relationships, and better inform personalized advice for training and performance.

Prescribing statin therapy in physically (in)active individuals vs prescribing physical activity in statin-treated patients: A four-scenario practical approach

Statins are among the most commonly prescribed medications worldwide. Statin-associated muscle symptoms (SAMS) represent a frequent statin-related adverse effect associated with statin discontinuation and increased cardiovascular disease (CVD) events. Emerging evidence indicate that the majority of SAMS might not be actually caused by statins, and the nocebo/drucebo effect (i.e. adverse effects caused by negative expectations) might also explain SAMS. Physical activity (PA) is a cornerstone in the management of CVD risk. However, evidence of increased creatine-kinase levels in statin-treated athletes exposed to a marathon has been generalized, at least to some extent, to the general population and other types of PA. This generalization is likely inappropriate and might induce fear around PA in statin users. In addition, the guidelines for lipid management focus on aerobic PA while the potential of reducing sedentary behavior and undertaking resistance training have been overlooked. The aim of this report is to provide a novel proposal for the concurrent prescription of statin therapy and PA addressing the most common and clinically relevant scenarios by simultaneously considering the different stages of statin therapy and the history of PA. These scenarios include i) statin therapy initiation in physically inactive patients, ii) PA/exercise initiation in statin-treated patients, iii) statin therapy initiation in physically active patients, and iv) statin therapy in athletes and very active individuals performing SAMS-risky activities.

Evaluation of Antioxidant Defence Systems and Inflammatory Status in Basketball Elite Athletes

Intense physical activity can induce metabolic changes that modify specific biochemical biomarkers. In this scenario, the purpose of our study was to evaluate how intense physical activity can affect oxidative metabolism. Following this, fifteen professional basketball players and fifteen sedentary controls were recruited and subjected to two samplings of serum and urine in the pre-season (September) and two months after the start of the competitive season (November). Our results have shown an increase in athletes compared to controls in CK and LDH in September (respectively, p-value 0.003 and p-value < 0.001) and in November (both p-value < 0.001), whereas ALT is increased only in November (p-value 0.09). GGT serum levels were decreased in athletes compared to controls in both months (in September p-value 0.001 and in November p-value < 0.001). A gene expression analysis, carried out using RT-PCR, has revealed that IL-2, IL-6, IL-8, xCT and GCLM are increased in athletes in both months (p-value < 0.0001), while IL-10 and CHAC1 are increased only in September if compared to the controls (respectively, p-value 0.040 and p-value < 0.001). In conclusion, physical activity creates an adaptation of the systems involved in oxidative metabolism but without causing damage to the liver or kidney. This information could be of help to sports doctors for the prevention of injuries and illnesses in professional athletes for the construction of the athlete's passport.

The interactive relationship of dietary choline and betaine with physical activity on circulating creatine kinase (CK), metabolic and glycemic markers, and anthropometric characteristics in physically active young individuals

BACKGROUND

There is conflicting evidence on the relationship between dietary choline and betaine with metabolic markers and anthropometric characteristics. The aim of this study is to investigate the relationship between the interaction effects of dietary choline and betaine and physical activity (PA) on circulating creatine kinase (CK), metabolic and glycemic markers, and anthropometric characteristics in active youth.

METHODS

In this cross-sectional study, data were collected from 120 to 18 to 35-year-old people. The food frequency questionnaire was used to assess dietary data; United States Department of Agriculture website was used to calculate choline and betaine in foods. CK, fasting blood sugar (FBS) and lipid profile markers were measured with ELISA kits. Low-density lipoprotein, and insulin sensitivity markers were calculated. Sociodemographic status, physical activity, and anthropometric characteristics were assessed based on a valid and reliable method. Analysis of co-variance (ANCOVA) tests adjusted for sex, PA, age, energy, and body mass index were used.

RESULTS

Increasing dietary betaine and total choline and betaine was positively related to weight, waist-to-hip ratio, fat-free mass and bone mass (P < 0.05). Increasing dietary betaine lowered total cholesterol (P = 0.032) and increased high density lipoprotein (HDL) (P = 0.049). The interaction effect of dietary choline and physical activity improved insulin resistance (P < 0.05). As well as dietary betaine interacted with physical activity increased HDL (P = 0.049). In addition, dietary total choline and betaine interacted with physical activity decreased FBS (P = 0.047).

CONCLUSIONS

In general, increasing dietary choline and betaine along with moderate and high physical activity improved insulin resistance, increased HDL, and lowered FBS in the higher tertiles of dietary choline and betaine.

Blood-Based Biomarkers for Managing Workload in Athletes: Considerations and Recommendations for Evidence-Based Use of Established Biomarkers

Blood-based biomarkers can provide an objective individualized measure of training load, recovery, and health status in order to reduce injury risk and maximize performance. Despite enormous potentials, especially owing to currently evolving technology, such as point-of-care testing, and advantages, in terms of objectivity and non-interference with the training process, there are several pitfalls in the use and interpretation of biomarkers. Confounding variables such as preanalytical conditions, inter-individual differences, or an individual chronic workload can lead to variance in resting levels. In addition, statistical considerations such as the detection of meaningful minimal changes are often neglected. The lack of generally applicable and individual reference levels further complicates the interpretation of level changes and thus load management via biomarkers. Here, the potentials and pitfalls of blood-based biomarkers are described, followed by an overview of established biomarkers currently used to support workload management. Creatine kinase is discussed in terms of its evidence for workload management to illustrate the limited applicability of established markers for workload management to date. We conclude with recommendations for best practices in the use and interpretation of biomarkers in a sport-specific context.

The Effect of Potassium Nitrate Supplementation on the Force and Properties of Extensor digitorum longus (EDL) Muscles in Mice

Adding potassium nitrate (KNO3) to the diet improves the physiological properties of mammalian muscles (rebuilds weakened muscle, improves structure and functionality). The aim of this study was to investigate the effect of KNO3 supplementation in a mouse model. BALB/c mice were fed a KNO3 diet for three weeks, followed by a normal diet without nitrates. After the feeding period, the Extensor digitorum longus (EDL) muscle was evaluated ex vivo for contraction force and fatigue. To evaluate the possible pathological changes, the histology of EDL tissues was performed in control and KNO3-fed groups after 21 days. The histological analysis showed an absence of negative effects in EDL muscles. We also analyzed 15 biochemical blood parameters. After 21 days of KNO3 supplementation, the EDL mass was, on average, 13% larger in the experimental group compared to the controls (p < 0.05). The muscle-specific force increased by 38% in comparison with the control group (p < 0.05). The results indicate that KNO3 has effects in an experimental mouse model, showing nitrate-diet-induced muscle strength. This study contributes to a better understanding of the molecular changes in muscles following nutritional intervention and may help develop strategies and products designated to treat muscle-related issues.

Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication

This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 - 126.08).    Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents' muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents' muscle tissue. What is Known: • Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal). • Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct "muscular" toxicity" (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma. What is New: • Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). • There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.

Biomarkers of post-match recovery in semi-professional and professional football (soccer)

High-level football (soccer) players face intense physical demands that result in acute and residual fatigue, impairing their physical performance in subsequent matches. Further, top-class players are frequently exposed to match-congested periods where sufficient recovery times are not achievable. To evaluate training and recovery strategies, the monitoring of players' recovery profiles is crucial. Along with performance and neuro-mechanical impairments, match-induced fatigue causes metabolic disturbances denoted by changes in chemical analytes that can be quantified in different body fluids such as blood, saliva, and urine, thus acting as biomarkers. The monitoring of these molecules might supplement performance, neuromuscular and cognitive measurements to guide coaches and trainers during the recovery period. The present narrative review aims to comprehensively review the scientific literature on biomarkers of post-match recovery in semi-professional and professional football players as well as provide an outlook on the role that metabolomic studies might play in this field of research. Overall, no single gold-standard biomarker of match-induced fatigue exists, and a range of metabolites are available to assess different aspects of post-match recovery. The use of biomarker panels might be suitable to simultaneously monitoring these broad physiological processes, yet further research on fluctuations of different analytes throughout post-match recovery is warranted. Although important efforts have been made to address the high interindividual heterogeneity of available markers, limitations inherent to these markers might compromise the information they provide to guide recovery protocols. Further research on metabolomics might benefit from evaluating the long-term recovery period from a high-level football match to shed light upon new biomarkers of post-match recovery.

Mice from lines selectively bred for voluntary exercise are not more resistant to muscle injury caused by either contusion or wheel running

Muscle injury can be caused by strenuous exercise, repetitive tasks or external forces. Populations that have experienced selection for high locomotor activity may have evolutionary adaptations that resist exercise-induced injury and/or enhance the ability to cope with injury. We tested this hypothesis with an experiment in which mice are bred for high voluntary wheel running. Mice from four high runner lines run ~three times more daily distance than those from four non-selected control lines. To test recovery from injury by external forces, mice experienced contusion via weight drop on the calf. After injury, running distance and speed were reduced in high runner but not control lines, suggesting that the ability of control mice to run exceeds their motivation. To test effects of injury from exercise, mice were housed with/without wheels for six days, then trunk blood was collected and muscles evaluated for injury and regeneration. Both high runner and control mice with wheels had increased histological indicators of injury in the soleus, and increased indicators of regeneration in the plantaris. High runner mice had relatively more central nuclei (regeneration indicator) than control in the soleus, regardless of wheel access. The subset of high runner mice with the mini-muscle phenotype (characterized by greatly reduced muscle mass and type IIb fibers) had lower plasma creatine kinase (indicator of muscle injury), more markers of injury in the deep gastrocnemius, and more markers of regeneration in the deep and superficial gastrocnemius than normal-muscled individuals. Contrary to our expectations, high runner mice were not more resistant to either type of injury.

A case of sub-acute compartment syndrome of bilateral pectoralis major, deltoid and triceps muscles

A 19-year-old healthy bodybuilder presented to the emergency department with gradually worsening pain in both his upper arms and shoulders and inability to fully flex his elbows. The haematological investigations revealed a markedly raised Creatinine Kinase (74,400 U/L) and myoglobinuria. The patient required an emergency surgical decompression of the pectoral and the anterior and posterior compartments of arms of both upper limbs with secondary closure after 48 h. The patient had an uneventful post-op and recovery of his functions with some initial restriction of full flexion of his left elbow and some weakness in his triceps, all of which gradually improved.

Muscle thickness and inflammation during a 50km ultramarathon in recreational runners

Purpose

This study examined changes in circulating levels of inflammatory cytokines [IL-6, sIL-6R, TNF-α, and calprotectin], skeletal muscle morphology, and muscle strength following a 50km race in non-elite athletes.

Methods

Eleven individuals (8 men; 3 women) underwent pre-race assessments of rectus femoris muscle thickness (resting and contracted) using ultrasound, isometric knee extensor torque, and plasma cytokines. Measures were repeated after 10km of running, the 50km finish (post-race), and again 24-hrs post-race.

Results

Compared with baseline values, Δ muscle thickness (resting to contracted) increased significantly 24 hrs post-race (11 ± 11% vs. 22 ± 8%; P = 0.01). Knee extensor torque was significantly reduced immediately post-race (151 ± 46 vs. 134 ± 43 Nm; P = 0.047) but remained similar to post-race values at 24 hrs post-race (P = 0.613). Compared with pre-race levels, IL-6 and calprotectin concentrations increased 302% and 50% after 10km, respectively (P<0.017 for both), peaked post-race (2598% vs. pre-race for IL-6 and 68% vs. pre-race for calprotectin; P = 0.018 for both), and returned to pre-race levels at 24-hrs post-race (P>0.05 for both). Creatine kinase levels rose steadily during and after the race, peaking 24-hrs post-race (184 ± 113 U/L pre-race vs. 1508 ± 1815 U/L 24-hrs post-race; P = 0.005).

Conclusion

This is the first report of delayed increases in Δ muscle thickness at 24 hrs post-50km, which are preceded by reductions in knee extensor torque and elevations in plasma IL-6, and calprotectin. Recreational athletes should consider the acute muscle inflammatory response when determining training and recovery strategies for 50km participation.

Effect of 3 vs. 3 Soccer Small-Sided Game on Various Performance, Inflammatory, Muscle Damage and Hormonal Indicators in Semi-Professional Players

The purpose of this study was to examine the effect of a soccer small-sided game (SSG) on performance, inflammatory, muscle damage and hormonal indicators. Twenty-two male soccer players participated and were assigned to either experimental (EXP = 12) or control (CON = 10) groups. Subjective fatigue (RPE) and lactate (La¯) were measured during the SSG; vertical squat jump (SJ), 20-m sprint, creatine kinase (CK), interleukin-6 (IL-6), cortisol (C), and testosterone (T) were measured before (PRE), after (POST), 24 h, 48 h, and 72 h after the SSG in the EXP group. The heart rate during the SSG reached 92 ± 3% of their HRmax, whereas La¯ and RPE reached 13.02 ± 1.60 mmol·L−1 and 15 ± 1 after SSG, respectively. The IL-6, different among measurements (F (1.04, 11.50) = 504.82, p < 0.001), peaked (3.52 ± 0.43 pg·mL−1 [95%CI; 3.28−3.77]) after the SSG and returned to baseline 24 h later. The CK, different among measurements (F (1.76, 19.32) = 93.96, p < 0.001), peaked (536.58 ± 124.73U·L−1 [95%CI; 466.01−607.15]) 24 h after the SSG and remained significantly higher than PRE condition in POST and up to 72 h later. The T/C ratio, significantly different among measurements (F (1.73, 19.05) = 12.12, p < 0.001), was at its lowest (0.44 ± 0.16 [95%CI; 0.35−0.54]) immediately after the SSG (p < 0.05) and returned to baseline after 24 h. It seems that 48 h (at the most) after an SSG is adequate time for players to recover, and a high training load should be avoided sooner than 24 h after an SSG.

Measurement of Lipid Peroxidation Products and Creatine Kinase in Blood Plasma and Saliva of Athletes at Rest and following Exercise

This study aimed to assess the agreement between quantitative measurements of plasmatic and salivary biomarkers capable of identifying oxidative stress and muscle damage in athletes at rest and following exercise. Thirty-nine high-level athletes participating in track and field (running), swimming or rowing were recruited and assigned to one of three groups depending on the sport. Each athlete group underwent its specific exercise. Blood and saliva samples were collected before and immediately after the exercise. Diene conjugates (DC), triene conjugates (TC), Schiff bases (SB), and creatine kinase (CK) were measured. Comparisons were made using Wilcoxon signed-rank test. Correlation analysis and Bland−Altman method were applied. DC levels were elevated in plasma (p < 0.01) and saliva (p < 0.01) in response to exercise in all three groups, as were the plasmatic (p < 0.01) and salivary (p < 0.01) TC and SB concentrations. CK activity was also significantly higher at postexercise compared to pre-exercise in both plasma (p < 0.01) and saliva (p < 0.01) in all groups. Strong positive correlation between salivary and plasmatic DC (p < 0.001), TC (p < 0.001), SB (p < 0.01), and CK (p < 0.001) was observed at rest and following exercise in each athlete group. The bias calculated for DC, TC, SB, and CK using the Bland−Altman statistics was not significant at both pre-exercise and postexercise in all three groups. The line of equality was within the confidence interval of the mean difference. All of the data points lay within the respective agreement limits. Salivary concentrations of DC, TC, SB, and CK are able to reliably reflect their plasma levels.

Effects of Red-Fleshed Pitaya (Selenicereus polyrhizus) Ingestion after Strenuous Exercise on Creatine Kinase and Mitochondrial Function in Rat Muscle Cells

BACKGROUND: Free radicals formed during strenuous exercise through an increase in reactive oxygen species induce damage to tissues (e.g., muscle and liver) and cause oxidative damage to cells, resulting in mitochondrial dysfunction. AIM: As an effective method to repair mitochondrial muscle cell function, this study investigated the effects of red-fleshed pitaya (RFP) ingestion on creatine kinase (CK), which is a biomarker for muscle tissue damage, and malondialdehyde (MDA) levels during strenuous exercise. METHODS: This study involved 25 3-month-old male rats with an average weight of 200 g. The RFP extract was obtained through ethanol extraction and concentrated using an air-drying method. Rats were randomly allocated into five groups as follows: Two control groups (K1 [no-exercise, no RFP] and K2 [exercise, no RFP]) and three test groups (P1, P2, and P3; subjected to exercise and treated with 75, 150, and 300 mg kg−1 body weight of RFP, respectively). The exercise was in the form of swimming for 20 min 3 times/week for 31 days. CK and MDA were measured through an enzyme-linked immunosorbent assay, and histopathological examinations were performed through hematoxylin and eosin staining of rat muscles. RESULTS: The MDA levels after the ingestion of RFP extracts were compared between the K2 group and the P1, P2, and P3 groups. The results showed significant differences (p < 0.05 for P1 and P2, and p < 0.01 for P3), indicating the production of free radicals and CK, with features of damaged muscle cells based on histopathology. Ingestion of the RFP extract led to improvements in soleus muscle cells, resulting in cell function repair. CONCLUSION: Levels of MDA and CK increased during exercise, which caused significant muscle damage. However, after treatment with the RFP extract, the levels of both markers decreased. Thus, strenuous exercise causes an increase in reactive oxygen species, resulting in increased free radical levels. RFP ingestion decreased oxidative stress levels, thus repairing mitochondrial cell function.

Basal Values of Biochemical and Hematological Parameters in Elite Athletes

The purpose of this study was to show how continuous exercise affects the basal values of biochemical and hematological parameters in elite athletes. A total of 14,010 samples (male = 8452 and female = 5558 (March 2011–March 2020)) from 3588 elite athletes (male = 2258 and female = 1330, mean age 24.9 ± 6.9 vs. 24.1 ± 5.5 years, respectively) from 32 sport modalities, were studied over 9 years to check the variation of basal biochemical and hematological parameter values. There were differences seen in the basal values of creatine kinase (CK), urea, creatinine, aspartate transaminase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), potassium, total bilirubin, and eosinophil percentage compared to reference population data. However, other analytes showed narrow ranges of variation like glucose, total protein, albumin, sodium, hemoglobin, mean cell volume (MCV), and platelet count. Exercise produces changes in biochemical and hematological basal values of athletes compared to the general population, with the greatest variation in CK, but AST, ALT, LDH, potassium, and total bilirubin (TBil) show high values in serum, only with a wider distribution of values. The data here reflects the effect of exercise on biochemical and hematological parameter baseline ranges in elite athletes. As clinical laboratories use reference intervals to validate clinical reports, these “pseudo” reference intervals should be used when validating laboratory reports.

The Effect of Hot Water Extract of Tilapia on Exercise Capacity in Mice

Tilapia (Oreochromis mossambicus) has become one of the main aquatic products of Taiwan. The aim of this study was to evaluate the efficacy of a hot water extract of tilapia (HWET) in relieving fatigue and enhancing exercise performance in mice in a swimming endurance test. Male ICR mice were randomly divided into four groups (n = 10 per group) and treated with either a vehicle (control group) or different doses of HWET, which were designated as HWET-L (800 mg/kg/day), HWET-M (1600 mg/kg/day), and HWET-H (4000 mg/kg/day). The results of the swimming endurance test showed that HWET treatment significantly improved exercise-induced fatigue as the swimming time of the mice increased (p < 0.05). One hour after the test, blood samples were collected from each mouse and serum biochemical parameters were measured. The serum levels of lactate, creatine kinase (CK), and blood urea nitrogen (BUN) were lower in mice treated with HWET compared to the control group. Moreover, HWET treatment increased serum glucose levels and glycogen content in the liver. Enhanced glutathione (GSH) content in the liver and muscle was also found in the HWET-M and HWET-H groups. Western blot results showed that the expression of tumor necrosis factor-α (TNF-α) in the liver tissue was downregulated by HWET treatment. Taken together, our results demonstrate that HWET supplementation could enhance exercise performance and alleviate fatigue via biochemical profile improvements. This suggests that HWET has the potential for future development into functional foods or nutritional supplements to relieve fatigue.

Biological, Psychological, and Physical Performance Variations in Football Players during the COVID-19 Lockdown: A Prospective Cohort Study

This prospective cohort study aimed to evaluate whether COVID-19 lockdown caused biological, psychological, and/or physical performance variations in footballers. We compared the 2018/2019 and 2019/2020 seasons evaluating the plasma volume, hematological parameters, iron/ferritin, creatine kinase, vitamin D, cortisol, testosterone, and physiological state of players of the Italian football major league (Serie A). Measurements were performed before the preparatory period (T0), at the beginning (T1) and in the middle (T2) of the championship, and in March (T3) and at the end of season (T4). The results showed that in the 2019/2020 season affected by the lockdown, the weight, BMI, and fat mass percentage were higher than in the previous season. Hematocrit, hemoglobin, red blood cells, and ferritin decreased during both seasons, more significantly than in the regular season. During both seasons, creatine kinase increased from T2 whilst iron concentrations decreased in T3. Testosterone increased in both seasons from T0 to T3 and returned to initial levels at T4; cortisol increased in T2 and T3 during the 2018/2019 season but not during the COVID-19 season. Physical performance tests revealed differences associated with lockdown. Thus, although from a medical point of view, none of the evaluated changes between the two seasons were clinically relevant, training at home during lockdown did not allow the players to maintain the jumping power levels typical of a competitive period.

Profiles of anemia in adolescent students with sports club membership in an outpatient clinic setting: a retrospective study

BACKGROUND

Anemia is a common health issue among adolescents. Anemic conditions could affect physical performance; however, the actual profiles of anemia in adolescent students in sports clubs have not been well documented.

METHODS

We conducted a retrospective chart review of individuals aged 13-22 years who belonged to sports clubs in schools and visited an outpatient clinic between August 1, 2016, and August 31, 2020. The medical and laboratory records, including serum levels of ferritin, folate, vitamin B12, and creatinine kinase at their first visit were assessed.

RESULTS

A total of 485 individuals (231 male (48%) and 254 female (52%) patients) were eligible for the study. The most common club activity was track and field (n = 171 (35%)). The overall prevalence of the World Health Organization-defined anemia was 16.5% (95% CI [13.1-20.4]; 9.0% [5.4-13.8] and 23.1% [17.8-29.2] in males and females, respectively) after excluding pre-treated individuals. Hypoferritinemia and elevation of serum creatinine kinase levels were identified as independent contributors to anemia in both sexes (odds ratios: 13.2 (95% CI [4.2-41.1]), p < 0.001 and 14.7 (95% CI [1.8-118.4]), p = 0.012, respectively for males; odds ratios: 6.6 (95% CI [1.3-13.9]), p < 0.001 and 2.7 (95% CI [1.4-5.5]), p = 0.004, respectively for females).

DISCUSSION

Anemia is prevalent in both male and female adolescent students in sports clubs. Iron deficiency and excessive training indicated by elevated creatinine kinase levels may contribute to the risk of anemia. Physicians should assess the amount of exercise, and not merely iron storage, in clinical practice.

Sex Differences in Endurance Running

In recent years, there has been a significant expansion in female participation in endurance (road and trail) running. The often reported sex differences in maximal oxygen uptake (VO_2max) are not the only differences between sexes during prolonged running. The aim of this narrative review was thus to discuss sex differences in running biomechanics, economy (both in fatigue and non-fatigue conditions), substrate utilization, muscle tissue characteristics (including ultrastructural muscle damage), neuromuscular fatigue, thermoregulation and pacing strategies. Although males and females do not differ in terms of running economy or endurance (i.e. percentage VO_2max sustained), sex-specificities exist in running biomechanics (e.g. females have greater non-sagittal hip and knee joint motion compared to males) that can be partly explained by anatomical (e.g. wider pelvis, larger femur-tibia angle, shorter lower limb length relative to total height in females) differences. Compared to males, females also show greater proportional area of type I fibres, are more able to use fatty acids and preserve carbohydrates during prolonged exercise, demonstrate a more even pacing strategy and less fatigue following endurance running exercise. These differences confer an advantage to females in ultra-endurance performance, but other factors (e.g. lower O₂ carrying capacity, greater body fat percentage) counterbalance these potential advantages, making females outperforming males a rare exception. The present literature review also highlights the lack of sex comparison in studies investigating running biomechanics in fatigue conditions and during the recovery process.

Individual-based Creatine Kinase Reference Values in Response to Soccer Match-play

The aim of the present study was to determine the creatine kinase reference limits for professional soccer players based on their own normal post-match response. The creatine kinase concentration was analyzed in response to official matches in 25 players throughout a 3-year period. Samples were obtained between 36-43 hours following 70 professional soccer matches and corresponded to 19.1±12.1 [range: 6-49] samples per player. Absolute reference limits were calculated as 2.5^th and 97.5^th percentile of the samples collected. Creatine kinase values were also represented as a percentage change from the individual's season mean and represented by 90^th, 95^th and 97.5^th percentiles. The absolute reference limits for creatine kinase concentration calculated as 97.5^th and 2.5^th percentiles were 1480 U.L^-1 and 115.8 U.L^-1, respectively. The percentage change from the individual's season mean was 97.45±35.92% and players were in the 90^th, 95^th and 97.5^th percentiles when the percentages of these differences were 50.01, 66.7, and 71.34% higher than player's season mean response, respectively. The data allowed us to determine whether the creatine kinase response is typical or if it is indicative of a higher than normal creatine kinase elevation and could be used as a practical guide for detection of muscle overload, following professional soccer match-play.

Biochemical Monitoring of Muscle Recovery in Elite Handball Using an Individualized Approach

Purpose: To evaluate the classification performance of a new method to individualize reference ranges for biomarkers of muscle recovery in elite handball. Methods: In a longitudinal observational study, creatine kinase (CK) and urea levels were assessed in 16 male elite handball players during the 2019–20 preseason. Blood samples were collected at prespecified time points when players were considered either recovered or nonrecovered. Initially, linear mixed-effects models were calculated, as outlined in the study design, to examine the effect of recovery status on CK and urea levels. Finally, a fixed-effect model was calculated for urea based on the law of parsimony. Individualized reference ranges were calculated using a recently published algorithm. To investigate whether the individualized approach resulted in a more accurate classification of recovery status (recovered or nonrecovered), it was compared with a group-based approach derived from the same data set, utilizing predefined error rates. Results: Linear mixed-effects models showed a large effect of recovery status on CK (P < .001, d = 3.49) and a small effect on urea (P = .018, d = 0.382). In contrast to CK (P = .017), urea had no significant interindividual variation. Hence, individualization was examined only for CK. The numerical decrease in both CK error rates by the individualized approach was significant for the test-pass error rate (P = .0196, ϕ = .19). Conclusions: Our findings underscore the critical role of CK for monitoring in team sports such as handball. The observed improvement in CK error rates suggests a promising opportunity to individualize biochemical monitoring, although further studies encompassing larger sample sizes are warranted.

Temperature and creatine kinase changes during a 10d taper period in sprinters

Objective.The aim of this prospective cohort study, performed during a 10 d training camp, was to analyze the effect of a series of successive speed-power training sessions on the concurrent circadian changes in resting leg skin temperature and blood creatine kinase (CK) levels and to determine the correlation between them.Approach. Seventeen elite sprinters, aged 22-31 years, were examined. Every morning and evening, capillary blood samples were drawn to assay CK levels. Lower limb skin temperature was measured simultaneously, and thermal images were taken using an infrared camera.Main results. From the first day of the training camp, the base temperature levels began to drop to obtain a significant reduction from the 6th day (male) and from the 8th day (female) to the end of the camp. Simultaneously, CK levels increased in the male group from 8th to the end of the camp, but it did not change significantly in females. Regarding the circadian rhythm, the CK levels always rose during the day and declined during the night. The temperature decreased during the day and increased during the night until the 6th day. After that, the temperature changed oppositely till the end of camp, i.e. it increased during the day and decreased during the night. This could suggest that the training microcycle should last about a week because after this time there may be a disturbance in the temperature circadian rhythm and a significant CK accumulationSignificance. Multi-day speed-power training induced a progressive reduction in resting skin temperature and an elevation in CK levels. It also altered the circadian rhythm of the body skin temperature, which may indicate that after about 6 d of regular exercise, physiological deregulation may occur.

Influence of Counter Movement Jump Session with Different Rest Intervals on Muscle Damage and Soreness

Objectives: Plyometrics has been used in sports training and many aspects of this modality are poorly understood. This study measures the magnitude of variations of serum creatine kinase (CK) activity and perceived muscle soreness after one session of Countermovement Jump (CMJ) session and compares 1 and 3 minutes rest intervals between each sets.Methods: A group of 30 young male was dividing in two groups and performed ten sets of ten CMJ with 1 or 3 minutes rest interval between sets. Before and after session (24, 48, and 72-h) they informed the muscle soreness perception and blood samples were collected for dosage of serum CK activity. Two (time) x Two (treatment) ANOVA was used to test differences in serum CK activity and muscle soreness. The alpha level was set at 0.05.Results: Serum CK activity measured 48 h after session augments ~2 and ~1.5 times in 1 min and 3 min rest interval respectively. No significant difference between groups that rests 1 or 3 minutes between sets was found. Muscle soreness rises 24 h after session without significant differences between groups.Conclusions: The findings show that the CMJ increases perceived muscle soreness and increases the serum CK activity, and the intervals of rest do not modulate these variables.

Correlation between strength and skin temperature asymmetries in the lower limbs of Brazilian elite soccer players before and after a competitive season

This study aimed to investigate the correlation between strength and skin temperature (T_sk) asymmetries in the lower limbs of elite soccer players before and after a competitive season. The sample (n = 20) was composed of elite male soccer players. Strength asymmetry and T_sk asymmetry was measured through the countermovement jump (CMJ) test and infrared thermography, respectively. Asymmetries were quantified using the symmetry angle (SA) equation. A strong correlation was found between the SA of rate of force development (RFD) and the SA of T_sk before (baseline) (r = 0.7; r² = 0.43; p = 0.03) and after (r = 0.6; r² = 0.42; p = 0.04) the competitive season. Moreover, after the competitive season there were significant decreases in Peak force (p < 0.018), Impulse (p < 0.04), RFD (p = 0.0001) and CMJ height (p = 0.05), and significant increases in T_sk (p < 0.03), C-reactive protein (p = 0.03), Creatine kinase (p = 0.0001) and Cortisol (p = 0.04), even after a 3-day rest interval (no training). These results suggest that the CMJ test can be combined with infrared thermography for monitoring strength asymmetry and contribute to the prevention of muscle injuries.

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.

Brief cycles of lower-limb occlusion accelerate recovery kinetics in soccer players

Objective: The aim of this study was to assess the effect of intermittent vascular occlusion (IVO) on recovery following simulated soccer physical demand test in soccer players.Methods: Twelve soccer players completed the Loughborough Intermittent Shuttle Test (LIST) in two conditions placebo (PLA) and IVO followed by intermittent lower-limb occlusion. Physical performance (Squat jump: SJ, countermovement jump: CMJ, maximal voluntary contraction: MVC, and 20 m sprint: SP), muscle damage parameters (creatine kinase: CK, Lactate dehydrogenase: LDH), inflammatory parameter (C-reactive protein: CRP), and perceived muscle soreness (DOMS) were assessed before, immediately after (0 h), and 24 h, 48 h, and 72 h following the exercise.Results: Following the LIST, a decrease was observed in all Physical performance within 48 h in PLA condition (p < 0.05), compared to PLA treatment, IVO treatment attenuated the decrease of SJ and CMJ at 24 h and at 48 h and for MVC and SP within 48 h after the LIST (p < 0.05). CK and LDH levels increased within 24 h post-exercise in both conditions (p < 0.05), but with a lower level in IVO compared to PLA condition (p < 0.05). Likewise, DOMS values were significantly lower with IVO condition compared to PLA condition immediately and at 24 h after exercise.Conclusion: The results of the present study suggest that the application of IVO after simulated soccer physical demand test accelerated recovery kinetics in soccer players.

Effects of short duration high intensity competition on cardiac and cell damage biomarkers

The purpose of this study was to investigate the cardiac biomarkers like cardiac troponin T (cTnT), cardiac troponin I, and creatine kinase-MB (CK-MB) and the cell damage biomarkers including creatine phosphokinase (CPK), C-reactive protein (CRP), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) in response to a short-duration high-intensity competition with correction of the post-exercise raw data with the plasma volume loss in trained athletes. Thirty-two male athletes (age, 26.9±4.7 years) competed in 8 min high-intensity competition. The competition items included: running for 400 meters; three-stage deadlifting; bar pulling up; and 30 kg kettlebell swinging. Venous blood samples were obtained before and immediately after the competition and biomarkers analysed. Plasma volume changes were estimated from haemoglobin and haematocrit readings before and after the competition. A significant increase was shown immediately after the competition compared to resting in cTnT, AST, ALT, CPK, and CRP (P<0/001). CK-MB showed no significant difference. When raw data were corrected for plasma volume loss, CPK showed a significant increase (P<0.001), and LDH and CK-MB a significant decrease (P<0.001), however cTnT, AST, ALT and CRP showed no significant difference. The plasma volume loss can affect the response of cardiac and cellular damage biomarkers to exercise. High-intensity competition for 8 min did not elevate the cardiac biomarkers, but elevated the muscle biomarkers.

Effect of a Shock Micro-Cycle on Biochemical Markers in University Soccer Players

This study aimed to examine various biochemical biomarkers changes during a shock micro-cycle in soccer players from a university team. The study had 22 players (age: 22 ± 3 years; body mass: 68.6 ± 7.1 kg; height: 1.73 ± 0.07 m). The study measured total cholesterol (TC), triglycerides (TG), cholesterol linked to high-density lipoproteins (HDL), low-density lipoproteins (LDL), very low density lipoproteins (VLDL), arterial index (AI), creatine kinase (CK), glutamate-oxalacetate-transaminase (GOT), glutamate-pyruvate-transaminase (GPT), creatinine (Cr), catalase (CAT), superoxide dismutase (SOD), cytokines IL6 and TNFα, total antioxidant capacity (Cap antiox tot), hemolysis percentage and glomerular filtration rate (GFR); measurements were conducted during a shock micro-cycle. The lipid profile variables had no statistical significance when compared on day 1 with day 14. Except for TNFα, the other biomarkers compared with day one had progressive increments until day seven, with a subsequent reduction on day 14; however, none of the biomarkers returned to baseline values despite this decrease. The data shown herein suggest the need to research these biomarkers in distinct types of mesocycles, exercise, intensity, load, and duration to diminish fatigue and improve athlete performance.

Clinical Practice Guidelines for Exertional Rhabdomyolysis: A Military Medicine Perspective

ABSTRACT

Exertional rhabdomyolysis (ER) is an uncommon condition with a paucity of evidence-based guidance for diagnosis, management, and return to duty or play. Recently, a clinical practice guideline for diagnosis and management of ER in warfighters was updated by a team of military and civilian physicians and researchers using current scientific literature and decades of experience within the military population. The revision concentrated on challenging and controversial clinical questions with applicability to providers in the military and those in the greater sports medicine community. Specific topics addressed: 1) diagnostic criteria for ER; 2) clinical decision making for outpatient versus inpatient treatment; 3) optimal strategies for inpatient management; 4) discharge criteria; 5) identification and assessment of warfighters/athletes at risk for recurrent ER; 6) an appropriate rehabilitative plan; and finally, 7) key clinical questions warranting future research.

Markers of muscle damage and strength performance in professional football (soccer) players during the competitive period

Background

The present study investigated the impact of competitive soccer on the short-term changes in isometric strength of the adductor muscle group during the competitive season.

Methods

In this cohort study we evaluated the association between a serum marker of muscle damage [creatine phosphokinase (CPK)] and isometric strength of the adductor muscles of the hip in 30 professional football players (age: 26.7±2.9 years) during two seasons of the national top-level championship. Serum CPK level was determined the day before the match, 12–20, 36–48, 60–72 h after the match. The maximum voluntary isometric contraction force of the adductor muscles complex was determined immediately after having taken blood samples.

Results

There was evidence of a statistically significant positive association between age, body mass index (BMI), percentage of body fat, and muscle strength, and between weight and muscle strength. There was evidence of a statistically significant negative association between the level of CPK and the maximum isometric strength of the adductors of soccer players. Changes in CPK levels were associated with the muscle strength recovery trend (P<0.001). The strength/CPK ratio at different time points had a U-shaped curve.

Conclusions

Exercise induced muscle damage significantly affects the strength of the adductor muscle group of professional soccer players during the competitive period. The lower the CPK level, the greater the athletes' strength at a given time point. Also, the greater the decrease in CPK level, the greater the rate of strength restoration.

Biomarkers Correlate With Body Composition and Performance Changes Throughout the Season in Women's Division I Collegiate Soccer Players

The purpose of this study was to evaluate the effects of a competitive soccer season on biomarkers and performance metrics in order to determine the correlation between changes in biomarkers, body composition, and performance outcomes. Twenty-one Division 1 female collegiate soccer players were monitored throughout the 16-week season. Player workload was measured using heart rate and Global Position Satellite systems at all practices and games. Performance testing, including vertical jump, VO_2max, and 3-repetition maximum testing for bench press, squat and deadlift, occurred prior to pre-season and immediately post-season. Blood draws occurred prior to preseason and every 4-weeks thereafter, following a game. Body composition was assessed prior to the start of season (week 0) and weeks 6, 10, 14, and 17 (post-season). Delta area under the curve was calculated for biomarkers and body composition variables to account for seasonal changes adjusted for baseline. Pearson-product moment correlations were used to assess relationships with significance set at p < 0.05. Trends were considered p ≤ 0.10. No significant time main effects were seen for anabolic biomarkers (p > 0.05). Significant time effects were seen for catabolic biomarkers throughout the season (p = 0.001). No changes in body weight, VO_2max, vertical jump, and deadlift occurred. Squat and bench press improved (p = 0.01 and p = 0.02, respectively) with a decline in percent body fat (p = 0.03) and a trend for increased fat free mass (p = 0.09). Additionally, total cortisol (TCORT) negatively correlated with fat free mass (r = −0.48; p = 0.03) and positively correlated with VO_2max (r = 0.47; p = 0.04). A trend was shown for a positive correlation between both TCORT and free cortisol (FCORT) and percent body fat (r = 0.39; r = 0.40; p = 0.08, respectively). IGF-1 and growth hormone positively correlated to deadlift (r = 0.57; P = 0.02 and r = 0.59; p = 0.03), whereas creatine kinase showed a trend for a positive correlation with deadlift (r = 0.49; p = 0.06). IL-6 negatively correlated with bench press (r = −0.53; p = 0.03). These findings support a relationship between biomarkers, performance outcomes, and body composition. Biomarker monitoring may be useful to detect individual player's physiological response to an athletic season and may help provide insights in efforts to optimize performance outcomes.

Comparison of portable and conventional laboratory analyzers for biochemical tests in chickens

Antemortem blood biochemical and blood gas analyses are routinely used in health screening and diagnosis of disease in domestic veterinary species. These testing modalities are not routinely performed in poultry, in part, due to the distance from the diagnostic laboratory. Portable blood analyzers such as the i-STAT and VetScan (VS2) can be used to obtain results on the farm without delay, potentially offering a more practical option for poultry practitioners. We investigated the time effect on blood chemistry values and compared the results obtained using the i-STAT and VS2 with those obtained using conventional laboratory analyzers (GEM Premier 3000 and Cobas c501, respectively). We tested blood from 60 healthy chickens. Each sample was tested in triplicate using each of the portable analyzers and once using conventional analyzers. All samples were analyzed within 60 minutes of collection. The concentrations of some analytes were outside the limit of detection of the portable analyzers (i.e., bile acids). Although statistically significant differences were found for some biochemical analytes over time, the actual mean or median differences were too small to be considered of clinical importance. As observed in mammals, significant time-dependent changes in blood gas analytes were observed in whole blood samples exposed to ambient air. Correlation coefficients between portable and conventional analyzers were moderate to high for most of the analytes. For the most part, there was an agreement between the portable and conventional analyzers. We identified constant and proportional biases in the measurement of multiple analytes by both the i-STAT and VS2. Future studies are warranted to establish analyzer-specific reference intervals for poultry.

Identification of creatine kinase and alpha-1 antitrypsin as protein targets of alkylation by sulfur mustard

Sulfur mustard (SM) is a toxic chemical warfare agent deployed in several conflicts within the last 100 years and still represents a threat in terroristic attacks and warfare. SM research focuses on understanding the pathophysiology of SM and identifying novel biomarkers of exposure. SM is known to alkylate nucleophilic moieties of endogenous proteins, for example, free thiol groups of cysteine residues. The two-dimensional-thiol-differences in gel electrophoresis (2D-thiol-DIGE) technique is an initial proteomics approach to detect proteins with free cysteine residues. These amino acids are selectively labeled with infrared-maleimide dyes visualized after GE. Cysteine residues derivatized by alkylating agents are no longer accessible for the maleimide-thiol coupling resulting in the loss of the fluorescent signal of the corresponding protein. To prove the applicability of 2D-thiol-DIGE, this technology was exemplarily applied to neat human serum albumin treated with SM, to lysates from human cell culture exposed to SM as well as to human plasma exposed to CEES (chloroethyl ethyl sulfide, an SM analogue). Exemplarily, the most prominent proteins modified by SM were identified by matrix-assisted laser desorption/ionization time-of-flight (tandem) mass spectrometry, MALDI-TOF MS(/MS), as creatine kinase (CK) from human cells and as alpha-1 antitrypsin (A1AT) from plasma samples. Peptides containing the residue Cys²⁸² of CK and Cys²³² of A1AT were unambiguously identified by micro liquid chromatography-electrospray ionization high-resolution tandem-mass spectrometry (μLC-ESI MS/HR MS) as being alkylated by SM bearing the specific hydroxyethylthioethyl-(HETE)-moiety. Both peptides might represent potential biomarkers of SM exposure. This is the first report introducing these endogenous proteins as targets of SM alkylation.

Can A Superimposed Whole-Body Electromyostimulation Intervention Enhance the Effects of a 10-Week Athletic Strength Training in Youth Elite Soccer Players?

Strength training in youth soccer has both a preventive and a sports-specific component. Whole-body electromyostimulation (WB-EMS) could represent an interesting time-saving add-on to classical strength exercises in performance-oriented soccer. The objective of this study was to find out whether a 10-week superimposed WB-EMS training might have a more positive impact on strength parameters in male youth elite soccer players than regular athletic strength exercises alone. A total of 30 male youth soccer players from a youth academy aged 15 to 17 years participated in the study. Before and after the intervention, the isometric extension and flexion forces of trunk and knee, and the hip abduction and adduction forces were tested. Twelve players (control group) absolved a conventional 20-minute strength training once a week for a period of ten weeks. Eighteen players absolved the same exercises but with superimposed WB-EMS. Blood creatine kinase concentration was measured for training control. ANOVAs, Friedman tests and post hoc t-tests were calculated (p = 0.05) to examine the strength development during the training period between the groups. While we could not find significant strength increases in the leg, hip and trunk muscles in the control group (<4%), the strength of the WB-EMS group improved significantly in 4 of the 6 muscle groups tested. In this group, the strength of knee flexors increased significantly by 20.68 ± 21.55%, knee extensors by 31.43 ± 37.02%, hip adductors by 21.70 ± 12.86% and trunk flexors by 33.72 ± 27.43%. The rates of strength increase are partly in line with other studies, partly clearly higher, which might be explained by the athletically active target group. A 10-week superimposed WB-EMS training improves the strength of certain leg, hip and trunk muscles in male adolescent elite soccer players to a greater extent than a pure athletic strength training of the same duration.

Repeated Application of a Novel Creatine Cream Improves Muscular Peak and Average Power in Male Subjects

Whinton, AK, Donahoe, K, Gao, R, Thompson, KMA, Aubry, R, Saunders, TJ, Johnston, A, Chilibeck, PD, and Burr, JF. Repeated application of a novel creatine cream improves muscular peak and average power in male subjects. J Strength Cond Res 34(9): 2482-2491, 2020-Using a multicenter, randomized controlled trial, (N = 123, age 23 ± 4 years) we sought to determine whether administration of a novel, topical creatine supplement could improve muscular performance after acute and repeated (7-day) exposure. To study the acute performance enhancing effects of the supplement, subjects completed 5 sets of 15 maximal concentric single-leg knee extensions with and without the application of a low- (low dose [LD]-3.5 ml) or high-dose (high dose [HD]-7 ml) topical creatine cream. After a wash-out period, subjects had one leg randomized to receive either the creatine or placebo cream, with further randomization into an oral creatine or placebo supplement group. Subjects completed 5 sets of 15 maximal concentric single leg knee extensions before and after the supplementation protocol. After acute application, no significant differences in peak power (LD: 252 ± 93 W, HD: 261 ± 100 W, p = 0.21), average power (LD: 172 ± 65 W, HD: 177 ± 69 W, p = 0.78), or fatigue index (LD: 13.4 ± 10.6%, HD: 14 ± 11.9%, p = 0.79) were observed between experimental and placebo creams (peak power: LD: 244 ± 76 W, HD: 267 ± 109 W; average power: LD: 168 ± 57 W, HD: 177 ± 67 W; fatigue index: LD: 12.4 ± 9.6%, HD: 12.8 ± 10.6%) or when controlling for sex. After the 7-day supplementation protocol, a significant increase in average power (creatine: 203 ± 61-220 ± 65 W, placebo: 224 ± 61-214 ± 61 W) and peak power (creatine: 264 ± 73-281 ± 80 W, placebo: 286 ± 79-271 ± 73 W) in the leg receiving creatine cream was observed in male subjects. No differences were observed in female subjects. The topical creatine cream did not enhance measures of muscle performance after acute application, but was able to improve peak and average power in male subjects after 7 consecutive days of application.

Leisure physical exercise and creatine kinase activity. The Tromsø study

Creatine kinase (CK) is an enzyme catalyzing energy reaction in muscle cells and has proven to modify cardiovascular risks. The influence of skeletal muscle activity on CK concentrations is a potential study confounder but is mainly reported in connection with sport activities. This study investigated the association between leisure physical exercise and CK and estimated the effect of physical exercise on the CK values. CK and leisure physical exercise defined as intensity, frequency, and duration subsets were measured in the population-based Tromsø study. Comparisons of CK at different exercise levels, multivariate analyses, and relative differences in CK between "never exercise" and "heavy exercise" (moderate or hard exercise ≥2 hours per week) subgroups were analyzed age- and sex-stratified in 12 796 men and women. CK increased significantly with higher levels of physical exercise intensity and frequency in both sexes analyzed by ANOVA. In a multivariate analysis, CK was independently associated with heavy exercise after adjusting for age, BMI, and blood pressure; OR 9.38 (95% CI 5.32-16.53), P < .0001 in men and OR 5.20 (95% CI 2.53-10.69), P < .0001 in women. The differences in CK between physically inactive and participants performing heavy exercise varied between 3.1% (women) and 6.4% (men) and was also larger in participants ≥50 years. In conclusion, CK was positively and independently associated with increasing leisure physical exercise in a general population. CK values associated with exercise were approximately twice as high in men than women, but exercise altered CK only modestly.