Medicine at the 2000 Sydney Olympic Games: the New Zealand health team

The Use of Bovine Colostrum in Sport and Exercise

There has been a great deal of interest in bovine colostrum within sports nutrition over the last 25 years. Studies have investigated the effects on body composition, physical performance, recovery, gut damage and permeability, immune function, and illness risk. This narrative review considers available evidence in each of these areas. Although some studies have shown protection against performance decrements caused by periods of intensified training, there is limited evidence for effects on body composition and physical performance. There is stronger evidence for benefit on gut permeability and damage markers and on immune function and illness risk, especially during periods of intensified training. The balance of available evidence for gut permeability and illness risk is positive, but further research is required to fully determine all mechanisms responsible for these effects. Early suggestions that supplementation with bovine colostrum products could increase systemic IGF-1 levels are not supported by the balance of available evidence examining a range of doses over both short- and long-term periods. Nevertheless, dose–response studies would be valuable for determining the minimum efficacious dose, although this is complicated by variability in bioactivity between products, making any dose–response findings applicable only to the specific products used in such studies.

Salivary IgA as a Predictor of Upper Respiratory Tract Infections and Relationship to Training Load in Elite Rugby Union Players

Tiernan, C, Lyons, M, Comyns, T, Nevill, AM, and Warrington, G. Salivary IgA as a predictor of upper respiratory tract infections and relationship to training load in elite rugby union players. J Strength Cond Res 34(3): 782-790, 2020-Upper Respiratory Tract Infections (URTI) are among the most common illnesses reported in athletes. An URTI can result in missed training days, which in turn may lead to performance decrements. The purpose of this study was to investigate the use of salivary immunoglobulin A (sIgA) as a predictor of URTI, while also exploring the relationship to weekly training load in elite rugby union players. Nineteen male elite rugby union players provided morning saliva swabs, biweekly (Monday and Friday), over a 10-week training period. Participants completed an illness log documenting symptoms of URTI. Session Rate of Perceived Exertion (sRPE) was collected to determine training load (sRPE × session duration). Weekly training load was also calculated. Logistic regression was used to analyze the relationship between incidences of URTI with sIgA and training load. Multilevel regression was conducted to compare associations between sIgA and training load. The results found that the likelihood of suffering from an URTI increased when sIgA significantly decreased (p = 0.046). Where sIgA decreased by 65% or more, a player was at a greater risk of contracting an URTI within the following 2 weeks. No association was found between sIgA and training load. In conclusion, sIgA may be a useful predictor for determining the likelihood of players contracting an URTI. This will allow the coach to make informed decisions on training status, helping reduce the risk of players missing training, which may have performance decrements. Coaches will benefit from the fast, easy, and instant results available, to analyze a player's immune function.

Exercise and Rhinitis in Athletes

Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.

Impact of a major sporting event on local orthopaedic service provision: Commonwealth Games 2018, Gold Coast, Australia

BACKGROUND

The Gold Coast (Queensland, Australia) held the 2018 Commonwealth Games. Previous studies have focussed on the socio-economic and employment impact of hosting a major sporting event; however, there is limited research available about the provision of medical recourses required of the host city.

METHODS

Twelve weeks of data were retrospectively collected from the local health service to quantify the orthopaedic department workload for the period surrounding the 2018 Commonwealth Games. Data collected included referrals to Orthopaedic Fracture Outpatient clinic, theatre cases - emergency and category 1 (scheduled trauma) performed, and entries made into electronic medical records by the on-call orthopaedic staff.

RESULTS

A statistically significant increase was found for theatre cases performed during the Commonwealth Games (86 versus 71 cases per week, P = 0.033, 95% confidence interval 1.46-27.5). We found no statistically significant increase in Fracture Outpatient Clinic referrals or medical record entries between peri-games and games periods (P = 0.149 and 0.699, respectively).

CONCLUSION

Based on our experience, orthopaedic departments should plan for an increase in operative intervention requirements of at least 20%, in consultation with other local services. Strategic use of pre-existing resources and staff may be sufficient to address the increased workload during the event period.

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.

Nasal function and dysfunction in exercise

BACKGROUND

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

METHODS

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

RESULTS

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

CONCLUSION

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Illness and injuries in elite football players--a prospective cohort study during the FIFA Confederations Cup 2009

OBJECTIVE

The incidence of injury during elite-level football tournaments has been well documented, but the incidence of illness and medical conditions has not been well studied. The main objective was to analyze the incidence and nature of medical illnesses and injuries in football players.

DESIGN

Prospective cohort study.

SETTING

2009 Fédération Internationale de Football Association Confederations Cup soccer tournament.

PARTICIPANTS

One hundred eighty-four soccer players (8 teams of 23 players).

MAIN OUTCOME MEASURES

Incidence (per 1000 player days) of illnesses and injuries. Each team physician was requested to complete a daily report of injury (match and training) and medical illness of their players during the tournament (2070 player days). A total of 63 daily reports were obtained (70% response rate).

RESULTS

A total of 56 injuries and 35 illness incidents were recorded, resulting in an overall rate of 16.9 illnesses per 1000 player days and 27.0 injuries (match and training) per 1000 player days. The overall injury rate was 64.4 per 1000 match hours or 2.1 per match. About 0.88 days were lost per injury, and 0.46 days were lost per illness. Thirteen (37%) illnesses were because of conditions of the ear, nose, and throat, and 7 (20%) illnesses were because of other respiratory tract symptoms. The lower limb was the most commonly injured body part, with thigh (20%) being the most frequent location, and contusion (44%) the most frequent type of injury.

CONCLUSIONS

Illnesses are as common but less severe compared with match and training injuries during an international football tournament. Illnesses comprise an important component in the day-to-day medical care of a traveling football team. Medical illness therefore needs to be considered by the team physicians when planning for and managing the medical needs of elite football teams.

Salivary IgA is not a reliable indicator of upper respiratory infection in collegiate female soccer athletes

It has been shown that mucosal immunity measures such as salivary immunoglobulin A (s-IgA) can be affected by sport activities and has resulted in an increased susceptibility to infection. However, there is limited research that has evaluated the change in s-IgA throughout a full sport training season. The purpose of the study was to evaluate the change in s-IgA levels and incidence of upper respiratory infection in the National Collegiate Athletic Association Division I level female soccer athletes compared to age matched controls over an entire sport training season. Saliva samples were collected from 12 randomly selected female collegiate soccer athletes and 8 age-matched controls. Samples were collected bimonthly from the athletes' pre-and post-sport training sessions and pre- and post-90-minute sedentary period for the controls. Analysis showed there was a significant (p < 0.05) group × time interaction in total protein (TP) for collections 1 and 4 and a significant (p < 0.05) group × time interaction in s-IgA/TP for collections 2 and 3. There was no significant difference (p > 0.05) between athletes and controls for s-IgA or total symptom days (TSDs). Furthermore, there was no significant correlation between absolute s-IgA and TSDs or s-IgA/TP and TSDs throughout the sport training season. The large range of measurable levels for s-IgA at the different time points for athletes and controls and the lack of relationship between s-IgA levels and TSDs indicate that s-IgA is not an appropriate measure to determine an athlete's susceptibility to during a training season.

Salivary immunoglobulin A and upper respiratory symptoms during 5 months of training in elite tetraplegic athletes

PURPOSE

Altered autonomic innervation in tetraplegic individuals has been shown to depress certain immune parameters at rest and alter exercise-related salivary immunoglobulin A (sIgA) responses. The purpose of this study was to examine resting sIgA responses as a function of training load and episodes of upper respiratory symptoms (URS) in elite tetraplegic athletes.

METHODS

Resting saliva samples were obtained from 14 tetraplegic athletes at 12 predefined time points over 5 months and analyzed for sIgA. Occurrence of self-reported URS and training load was recorded throughout the study's duration. Regression analyses were performed to investigate the relationship between sIgA responses and training load. Furthermore, the relationships between sIgA responses and URS occurrence were examined.

RESULTS

sIgA secretion rate was negatively correlated with training load (P=.04), which only accounted for 8% of the variance. No significant relationships were found between sIgA responses and subsequent URS occurrence. Finally, sIgA responses did not differ between athletes with and without recorded URS during the study period.

CONCLUSIONS

In line with findings in able-bodied athletes, negative relationships between sIgA secretion rate and training load were found in tetraplegic athletes. This may explain some of the higher infection risk in wheelchair athletes with a high training load, which has been previously observed in paraplegic athletes. However, the nonsignificant relationship between sIgA responses and URS occurrence brings into question the use of sIgA as a prognostic tool for the early detection of URS episodes in the studied population.

Issues Encountered by Physicians During International Travel With Youth National Soccer Teams

Background:

Little information is available to guide the selection, preparation, and support of a traveling team physician.

Purpose:

To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams.

Study Design:

Descriptive epidemiology.

Methods:

Physicians assigned to travel abroad with the under-17 men’s and women’s US national soccer teams during a 2-year period documented all encounters with team and staff members. Physicians also documented consultations related to team health and performance issues.

Results:

The 108 cases (5.71 per 10 days) were evenly divided between injuries (n = 54) and noninjuries (n = 54). Players sought care at a higher rate than did staff (2.28 vs 1.09 per 100 person days). Mean severity for all player cases was 5.19 days missed (injuries, 10.48; noninjuries, 0.23). Nearly 69% of injuries involved the lower extremities: strains, sprains, and contusions accounted for 74.1% of injuries. Gastrointestinal, dermatologic, and otolaryngologic complaints accounted for 77.8% of noninjuries. Medications were administered in 71% of cases, with analgesics, cough and cold remedies, antibiotics, and gastrointestinal agents accounting for the majority. The leading team health and performance concerns were nutrition/hydration, conditioning, prevention, and doping control.

Conclusion:

Physicians traveling internationally with youth soccer teams manage an equal proportion of musculoskeletal and medical problems using simple medications.

Planning of traumatological hospital resources for a major winter sporting event as illustrated by the 2005 Winter Universiad

INTRODUCTION

The 22nd Student World Winter Games took place in January 2005 in Innsbruck and Seefeld, Austria. Exactly 1,500 athletes of 50 nationalities competed in 69 events in ten winter sports. A total number of 750 functionaries, 800 volunteers and 85,000 spectators participated in the second largest winter sports event behind the Olympic winter games.

AIM

The aim of this study was to evaluate the needed resources to ensure traumatological care for an event of that size.

MATERIAL

At the medical "call-center" all consultations, as well as patient data, diagnosis, and medical treatment were recorded using a preset protocol. Further, all patients treated in the University Hospital Innsbruck were registered with an emphasis on trauma patients.

RESULTS

Forty-eight of 65 patients transported to the hospital as a result of the Universiade were trauma patients, 37 of whom were athletes. The gender distribution was 34:14 (m:f). Ice hockey players had the highest rate of injury (25% of all injured athletes), followed by alpine skiers (20.8% of injured athletes). The highest ISS was nine. Forty-three patients got ambulatory treatment, five were admitted to the hospital and surgical treatment was conducted in three cases. Mean patient number was 4.8 per day. No additional personnel, structural, or technical hospital resources were needed to accommodate a large winter sports event like the Universiad. Thus, a level-B trauma center with an emergency room and independent traumatological department with around the clock surgical capability seems to be sufficient to provide traumatological care for an event of this size if the possibility of patient transport to a larger facility exists in the case of catastrophic events.

Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes

PURPOSE

Upper respiratory illness (URI) is the most common medical condition affecting elite athletes. The aims of this study were to identify and evaluate the incidence, pathogenic etiology, and symptomatology of acute URI during a 5-month training and competition period.

METHODS

Thirty-two elite and 31 recreationally competitive triathletes and cyclists, and 20 sedentary controls (age range 18.0-34.1 yr) participated in a prospective surveillance study. Nasopharyngeal and throat swabs were collected from subjects presenting with two or more defined upper respiratory symptoms. Swabs were analyzed using microscopy, culture, and PCR testing for typical and atypical respiratory pathogens. The Wisconsin Upper Respiratory Symptom Survey (WURSS-44) was used to assess symptomatology and functional impairment.

RESULTS

Thirty-seven URI episodes were reported in 28 subjects. Incidence rate ratios for illness were higher in both the control subjects (1.93, 95% CI: 0.72-5.18) and elite athletes (4.50, 1.91-10.59) than in the recreationally competitive athletes. Infectious agents were identified in only 11 (two control, three recreationally competitive, and six elite) out of 37 illness episodes. Rhinovirus was the most common respiratory pathogen isolated. Symptom and functional impairment severity scores were higher in subjects with an infectious pathogen episode, particularly on illness days 3-4.

CONCLUSION

The results confirm a higher rate of URI among elite athletes than recreationally competitive athletes during this training and competition season. However, because pathogens were isolated in fewer than 30% of URI cases, further study is required to uncover the causes of unidentified but symptomatic URI in athletes. Despite the common perception that all URI are infections, physicians should consider both infectious and noninfectious causes when athletes present with symptoms.