Can Creatine Combat the Mental Fatigue–associated Decrease in Visuomotor Skills?

Do prolonged social media use or cognitive tasks impair neuroelectric and visuomotor performance in taekwondo athletes? A randomized and controlled trial

OBJECTIVES

We aimed to compare whether: (1) social media use (SMU) would induce a similar state of mental fatigue compared to the Modified Stroop task (MST); (2) the SMU and the MST would affect neuroelectric responses; and (3) sport-specific visuomotor performance in the taekwondo (TKD) athletes was impaired by mental fatigue.

METHODS

Fifteen TKD athletes underwent a 60-min Modified Stroop Task (MST), engaged in SMU, or watched a documentary (CON) in a randomized order. Pre and post-each conditions they responded to a Stroop task (ST) while the event-related potentials (ERP) were measured. The Visual Analogue Scale for mental tiredness (VAS-MT) was used to measure subjective feelings of mental fatigue Then, the athletes completed TKD-specific visuomotor tests.

RESULTS

The VAS-MT response increases progressively in the MST condition (p < 0.001). The response time of ST was slower in the MST than in SMU (p = 0.04). The accuracy dropped in MST comparing pre- and post-manipulation (p < 0.001) and was lower than post-CON (p = 0.005). The peak amplitude for N200 ERP was higher post-than pre for all conditions (p < 0.001) on the Fz channel. N200 amplitude was higher on CON than MST on post-manipulation (p = 0.02). The amplitude increased significantly from pre-to post in the CON condition (p = 0.009) on the Cz channel. There was no difference in visuomotor performance among conditions (all ps > 0.05).

CONCLUSION

Prolonged performance of the MST, but not SMU, induces a state of mental fatigue. Neuroelectric and cognitive responses were impaired by mental fatigue induced by MST, but the visuomotor performance remained unaffected by any condition.

Creatine and improvement in cognitive function: Evaluation of a health claim pursuant to article 13(5) of regulation (EC) No 1924/2006

Following an application from Alzchem Trostberg GmbH, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Austria, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to creatine and improvement in cognitive function. The Panel considers that the food constituent, creatine, is sufficiently characterised. An improvement in cognitive function in one or more of its domains is a beneficial physiological effect. The applicant identified 21 human intervention studies on creatine supplementation and measures of cognitive function through a literature search. Two additional studies published after the search was conducted were identified through the reference list of a meta-analysis. In weighing the evidence, the Panel took into account that the acute effect of creatine on working memory, observed in two studies at 20 g/day for 5-7 days, was not seen at lower doses (2.2-14 g/day), or with continuous consumption (5 g/day for 6 weeks following a 5-day loading phase). Furthermore, the effect on response inhibition at 20 g/day for 7 days was an isolated finding among 10 intervention studies in healthy individuals, with no effects observed on other cognitive domains. The Panel also considered that the three intervention studies conducted in diseased individuals do not support an effect of creatine supplementation on cognition, and that the available evidence for a mechanism by which creatine could exert the claimed effect is weak. The Panel concludes that a cause-and-effect relationship has not been established between creatine supplementation and an improvement in cognitive function in one or more of its domains.

The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis

Background

This study aimed to evaluate the effects of creatine monohydrate supplementation on cognitive function in adults and explore its potential role in preventing and delaying cognitive impairment-related diseases.

Methods

Following the PRISMA 2020 guidelines, a systematic review with meta-analysis was conducted. Randomized controlled trials (RCTs) published between 1993 and 2024 were retrieved from PubMed, Scopus, and Web of Science databases. The study protocol was registered with PROSPERO (registration number: CRD42024533557). The impact of creatine supplementation on overall cognitive function, memory, executive function, attention, and information processing speed was assessed using standardized mean differences (SMD) and Hedge's g with 95% confidence intervals (CI).

Results

Sixteen RCTs involving 492 participants aged 20.8-76.4 years, including healthy individuals and patients with specific diseases, were selected. Creatine monohydrate was the form used in all included studies. Creatine supplementation showed significant positive effects on memory (SMD = 0.31, 95% CI: 0.18-0.44, Hedges's g = 0.3003, 95% CI: 0.1778-0.4228) and attention time (SMD = -0.31, 95% CI: -0.58 to -0.03, Hedges's g = -0.3004, 95% CI: -0.5719 to -0.0289), as well as significantly improving processing speed time (SMD = -0.51, 95% CI: -1.01 to -0.01, Hedges's g = -0.4916, 95% CI: -0.7852 to -0.1980). However, no significant improvements were found on overall cognitive function or executive function. Subgroup analyses revealed that creatine supplementation was more beneficial in individuals with diseases, those aged 18-60 years, and females. No significant differences were found between short- (<4 weeks) and long-term (≥4 weeks) interventions for improving cognitive function. Low-to-moderate risk of bias was found, and no significant publication bias was detected. The GRADE assessment indicates that the certainty of evidence for memory function is moderate, suggesting a reasonable level of confidence in the positive effects of creatine on memory. However, the evidence for processing speed, overall cognitive function, executive function, and attention is of low certainty, indicating that further research is needed to confirm these potential benefits.

Conclusion

Current evidence suggests that creatine monohydrate supplementation may confer beneficial effects on cognitive function in adults, particularly in the domains of memory, attention time, and information processing speed. Larger robust clinical trials are warranted to further validate these findings. Furthermore, future research should investigate the influence of different populations and intervention durations on the effects of creatine monohydrate supplementation, as well as elucidate the precise mechanisms underlying its potential cognitive-enhancing properties.

Creatine supplementation research fails to support the theoretical basis for an effect on cognition: Evidence from a systematic review

Creatine supplementation has been put forward as a possible aid to cognition, particularly for vegans, vegetarians, the elderly, sleep deprived and hypoxic individuals. However, previous narrative reviews have only provided limited support for these claims. This is despite the fact that research has shown that creatine supplementation can induce increased brain concentrations of creatine, albeit to a limited extent. We carried out a systematic review to examine the current state of affairs. The review supported claims that creatine supplementation can increases brain creatine content but also demonstrated somewhat equivocal results for effects on cognition. It does, however, provide evidence to suggest that more research is required with stressed populations, as supplementation does appear to significantly affect brain content. Issues with research design, especially supplementation regimens, need to be addressed. Future research must include measurements of creatine brain content.

"Encephalapp Stroop": Validity and reliability of a smartphone app to measure cognitive performance in physically active subjects

This study aimed to analyze the validity and reliability of a smartphone app (i.e., Encephalapp Stroop) to measure cognitive performance. Ten physically active individuals (mean age: 25.2 ± 4.3 years) participated in three laboratory visits. In a randomized sequence, subjects completed cognitive assessments using the app and a computer separately. The response times from 100 measurements for congruent and incongruent stimuli were compared between the two devices (app and computer) using the intraclass correlation coefficient, Pearson product-moment correlation coefficient (r), Cronbach's alpha (α), and Bland-Altman plots. There was excellent agreement between the computerized Stroop and the app version for response times for congruent (ICC = 0.806, p < 0.001; Bland-Altman bias = 41.3 ± 56.4 ms, p < 0.001) and incongruent stimuli (ICC = 0.755, p < 0.001; Bland-Altman bias = 76.4 ± 75.1 ms, p < 0.001). In comparison to the computerized version, the app demonstrated a moderate correlation for response times of congruent (r = 0.678, p < 0.001) and incongruent (r = 0.623, p < 0.001) stimuli. The results of the present study indicate that the response times of congruent and incongruent stimuli can be easily, accurately, and reliably evaluated using a mobile app.

Counteracting mental fatigue for athletes: a systematic review of the interventions

The deleterious effects of mental fatigue (MF) on athletes have been carefully studied in various sports, such as soccer, badminton, and swimming. Even though many researchers have sought ways to ameliorate the negative impact of MF, there is still a lack of studies that review the interventions used to counteract MF among athletes. This review aims to report the current evidence exploring the effects of interventions on MF and sport-specific performance, including sport-specific motor performance and perceptual-cognitive skills. Web of Science, Scopus, PubMed, and SPORTDicus (EBSCOhost) were combed through to find relevant publications. Additionally, the references and Google Scholar were searched for any grey literature. For the current review, we included only randomized controlled trials that involved athletes, a primary task to induce MF, interventions to counter MF with comparable protocols, and the outcomes of sport-specific motor performance and perceptual-cognitive skill. The selection criteria resulted in the inclusion of 10 articles. The manipulations of autonomous self-control exertion, person-fit, nature exposure, mindfulness, and transactional direct current stimulation showed that positive interventions counteract MF and improve sport-specific performance in different domains, including strength, speed, skill, stamina, and perceptual-cognitive skills. The selected interventions could significantly counteract MF and improve subsequent sport-specific performance. Moreover, self-regulation and attention resources showed the importance of the potential mechanisms behind the relevant interventions.

"Heads Up" for Creatine Supplementation and its Potential Applications for Brain Health and Function

There is emerging interest regarding the potential beneficial effects of creatine supplementation on indices of brain health and function. Creatine supplementation can increase brain creatine stores, which may help explain some of the positive effects on measures of cognition and memory, especially in aging adults or during times of metabolic stress (i.e., sleep deprivation). Furthermore, creatine has shown promise for improving health outcome measures associated with muscular dystrophy, traumatic brain injury (including concussions in children), depression, and anxiety. However, whether any sex- or age-related differences exist in regard to creatine and indices of brain health and function is relatively unknown. The purpose of this narrative review is to: (1) provide an up-to-date summary and discussion of the current body of research focusing on creatine and indices of brain health and function and (2) discuss possible sex- and age-related differences in response to creatine supplementation on brain bioenergetics, measures of brain health and function, and neurological diseases.

The effects of creatine supplementation on cognitive performance-a randomised controlled study

BACKGROUND

Creatine is an organic compound that facilitates the recycling of energy-providing adenosine triphosphate (ATP) in muscle and brain tissue. It is a safe, well-studied supplement for strength training. Previous studies have shown that supplementation increases brain creatine levels, which might increase cognitive performance. The results of studies that have tested cognitive performance differ greatly, possibly due to different populations, supplementation regimens, and cognitive tasks. This is the largest study on the effect of creatine supplementation on cognitive performance to date.

METHODS

Our trial was preregistered, cross-over, double-blind, placebo-controlled, and randomised, with daily supplementation of 5 g for 6 weeks each. We tested participants on Raven's Advanced Progressive Matrices (RAPM) and on the Backward Digit Span (BDS). In addition, we included eight exploratory cognitive tests. About half of our 123 participants were vegetarians and half were omnivores.

RESULTS

Bayesian evidence supported a small beneficial effect of creatine. The creatine effect bordered significance for BDS (p = 0.064, η2P = 0.029) but not RAPM (p = 0.327, η2P = 0.008). There was no indication that creatine improved the performance of our exploratory cognitive tasks. Side effects were reported significantly more often for creatine than for placebo supplementation (p = 0.002, RR = 4.25). Vegetarians did not benefit more from creatine than omnivores.

CONCLUSIONS

Our study, in combination with the literature, implies that creatine might have a small beneficial effect. Larger studies are needed to confirm or rule out this effect. Given the safety and broad availability of creatine, this is well worth investigating; a small effect could have large benefits when scaled over time and over many people.

TRIAL REGISTRATION

The trial was prospectively registered (drks.de identifier: DRKS00017250, https://osf.io/xpwkc/ ).

Transcranial direct current stimulation during a prolonged cognitive task: the effect on cognitive and shooting performances in professional female basketball players

The negative effect of prolonged cognitive demands on psychomotor skills in athletes has been demonstrated. Transcranial direct current stimulation (tDCS) could be used to mitigate this effect. This study examined the effects of tDCS over the left dorsolateral prefrontal cortex (DLPFC) during a 30-min inhibitory Stroop task on cognitive and shooting performances of professional female basketball players. Following a randomised, double-blinded, sham-controlled, cross-over design, players were assigned to receive anodal tDCS (a-tDCS, 2 mA for 20 min) or sham-tDCS in two different sessions. Data from 8 players were retained for analysis. Response Time decreased significantly over time (p < 0.001; partial η² = 0.44; no effect of condition, or condition vs. time interaction). No difference in mean accuracy and shooting performance was observed between tDCS conditions. The results suggest that a-tDCS exert no additional benefits in reducing the negative effects of prolonged cognitive demands on technical performance compared to sham (placebo).Practitioner summary: Prolonged cognitive demands can negatively affect the athletes' performance. We tested whether transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) could attenuate these effects on cognitive and shooting performance in professional female basketball players. However, tDCS did not exert any additional benefits compared to sham.Abbreviations: tDCS: transcranial direct current stimulation; a-tDCS: anodal transcranial direct current stimulation; PFC: prefrontal cortex; DLPFC: dorsolateral prefrontal cortex; PCT: prolonged cognitive task; TT: time trial; RT: response time; NASA-TLX: National Aeronautics and Space Administration Task Load Index; RPE: ratings of perceived exertion; CR-10 scale: category rating scale; EEG: electroencephalogram; AU: arbitrary units.

Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials

CONTEXT

From an energy perspective, the brain is very metabolically demanding. It is well documented that creatine plays a key role in brain bioenergetics. There is some evidence that creatine supplementation can augment brain creatine stores, which could increase memory.

OBJECTIVE

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effects of creatine supplementation on memory performance in healthy humans.

DATA SOURCES

The literature was searched through the PubMed, Web of Science, Cochrane Library, and Scopus databases from inception until September 2021.

DATA EXTRACTION

Twenty-three eligible RCTs were initially identified. Ten RCTs examining the effect of creatine supplementation compared with placebo on measures of memory in healthy individuals met the inclusion criteria for systematic review, 8 of which were included in the meta-analysis.

DATA ANALYSIS

Overall, creatine supplementation improved measures of memory compared with placebo (standard mean difference [SMD] = 0.29, 95%CI, 0.04-0.53; I2 = 66%; P = 0.02). Subgroup analyses revealed a significant improvement in memory in older adults (66-76 years) (SMD = 0.88; 95%CI, 0.22-1.55; I2 = 83%; P = 0.009) compared with their younger counterparts (11-31 years) (SMD = 0.03; 95%CI, -0.14 to 0.20; I2 = 0%; P = 0.72). Creatine dose (≈ 2.2-20 g/d), duration of intervention (5 days to 24 weeks), sex, or geographical origin did not influence the findings.

CONCLUSION

Creatine supplementation enhanced measures of memory performance in healthy individuals, especially in older adults (66-76 years).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. 42021281027.

Interindividual Variability in Mental Fatigue-Related Impairments in Endurance Performance: A Systematic Review and Multiple Meta-regression

BACKGROUND

The negative effect of mental fatigue (MF) on physical performance has recently been questioned. One reason behind this could lie in the interindividual differences in MF-susceptibility and the individual features influencing them. However, the range of individual differences in mental fatigue-susceptibility is not known, and there is no clear consensus on which individual features could be responsible for these differences.

OBJECTIVE

To give an overview of interindividual differences in the effects of MF on whole-body endurance performance, and individual features influencing this effect.

METHODS

The review was registered on the PROSPERO database (CRD42022293242). PubMed, Web of Science, SPORTDiscus and PsycINFO were searched until the 16th of June 2022 for studies detailing the effect of MF on dynamic maximal whole-body endurance performance. Studies needed to include healthy participants, describe at least one individual feature in participant characteristics, and apply at least one manipulation check. The Cochrane crossover risk of bias tool was used to assess risk of bias. The meta-analysis and regression were conducted in R.

RESULTS

Twenty-eight studies were included, with 23 added to the meta-analysis. Overall risk of bias of the included studies was high, with only three presenting an unclear or low rating. The meta-analysis shows the effect of MF on endurance performance was on average slightly negative (g = - 0.32, [95% CI - 0.46; - 0.18], p < 0.001). The multiple meta-regression showed no significant influences of the included features (i.e. age, sex, body mass index and physical fitness level) on MF-susceptibility.

CONCLUSIONS

The present review confirmed the negative impact of MF on endurance performance. However, no individual features influencing MF-susceptibility were identified. This can partially be explained by the multiple methodological limitations such as underreporting of participant characteristics, lack of standardization across studies, and the restricted inclusion of potentially relevant variables. Future research should include a rigorous description of multiple different individual features (e.g., performance level, diet, etc.) to further elucidate MF mechanisms.

Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives

Creatine supplementation has been one of the most studied and useful ergogenic nutritional support for athletes to improve performance, strength, and muscular mass. Over time creatine has shown beneficial effects in several human disease conditions. This review aims to summarise the current evidence for creatine supplementation in advanced chronic liver disease and its complications, primarily in sarcopenic cirrhotic patients, because this condition is known to be associated with poor prognosis and outcomes. Although creatine supplementation in chronic liver disease seems to be barely investigated and not studied in human patients, its potential efficacy on chronic liver disease is indirectly highlighted in animal models of non-alcoholic fatty liver disease, bringing beneficial effects in the fatty liver. Similarly, encephalopathy and fatigue seem to have beneficial effects. Creatine supplementation has demonstrated effects in sarcopenia in the elderly with and without resistance training suggesting a potential role in improving this condition in patients with advanced chronic liver disease. Creatine supplementation could address several critical points of chronic liver disease and its complications. Further studies are needed to support the clinical burden of this hypothesis.

Can Prolongate Use of Social Media Immediately Before Training Worsen High Level Male Volleyball Players' Visuomotor Skills?

Our aim was to analyze the effect of mental fatigue caused by prolonged social media use on high-level volleyball players' visuomotor skills. Eighteen high-level male young volleyball players participated in this randomized, counterbalanced, crossover design. All participants underwent a 2-week experiment in which we measured their response times when performing a visuomotor task with and without mental fatigue inducement through repeated use of social media immediately before training sessions. In the control condition, participants watched TV for 30-minutes, and in the social media condition, they used a social media app (Instagram^®) on smartphones for 30-minutes. We found a significant Condition x Time interaction on visuomotor task response time (p = 0.03), but there was no significant main effect of either Time or Condition. Mental fatigue, induced by repeated app-based social media use for 30-minutes immediately before training sessions, affected elite male volleyball players' visuomotor skills.

Brain Stimulation Over the Motion-Sensitive Midtemporal Area Reduces Deleterious Effects of Mental Fatigue on Perceptual-Cognitive Skills in Basketball Players

The objective of this study was to analyze the effect of anodal transcranial direct current stimulation (a-tDCS) over the motion-sensitive midtemporal area on perceptual-cognitive skills (visuomotor and basketball decision-making skills) in mentally fatigued basketball players. A total of 20 male basketball players were recruited. This was a randomized, double-blinded, and counterbalanced crossover study with two experimental conditions: a-tDCS and Sham. The participants completed the basketball decision-making task and visuomotor skill after performing a 60-min sport-based videogame task with anodal (i.e., a-tDCS) or placebo (Sham) stimulation over the motion-sensitive middle temporal area. Worse response time was observed in visuomotor skill for Sham than a-tDCS postexperiment (p < .05). There was no main condition effect for accuracy of visuomotor skill (p > .05). There was more impairment in accuracy and response time in basketball decision-making skills for the Sham condition than a-tDCS (p < .05). Notably, a-tDCS over the motion-sensitive middle temporal area removed the negative effects of mental fatigue on perceptual-cognitive skills.

How to Tackle Mental Fatigue: A Systematic Review of Potential Countermeasures and Their Underlying Mechanisms

INTRODUCTION

Mental fatigue (MF) is a psychobiological state that impairs cognitive as well as physical performance in different settings. Recently, numerous studies have sought ways to counteract these negative effects of MF. An overview of the explored countermeasures for MF is, however, lacking.

OBJECTIVES

The objective of this review is to provide an overview of the different MF countermeasures currently explored in literature. Countermeasures were classified by the timing of application (before, during or after the moment of MF) and type of intervention (behavioural, physiological and psychological).

METHODS

The databases of PubMed (MEDLINE), Web of Science and PsycINFO were searched until March 7, 2022. Studies were eligible when MF was induced using a task with a duration of at least 30 min, when they assessed MF markers in at least two out of the three areas wherein MF markers have been defined (i.e., behavioural, subjective and/or [neuro]physiological) and used a placebo or control group for the countermeasure.

RESULTS

A total of 33 studies investigated one or more countermeasures against MF. Of these, eight studies assessed a behavioural countermeasure, 22 a physiological one, one a psychological countermeasure and two a combination of a behavioural and psychological countermeasure. The general finding was that a vast majority of the countermeasures induced a positive effect on behavioural (e.g., task or sport performance) and/or subjective MF markers (e.g., visual analogue scale for MF or alertness). No definitive conclusion could be drawn regarding the effect of the employed countermeasures on (neuro)physiological markers of MF as only 19 of the included studies investigated these measures, and within these a large heterogeneity in the evaluated (neuro)physiological markers was present.

DISCUSSION

Within the physiological countermeasures it seems that the use of odours during a MF task or caffeine before the MF task are the most promising interventions in combating MF. Promising behavioural (e.g., listening to music) and psychological (e.g., extrinsic motivation) countermeasures of MF have also been reported. The most assumed mechanism through which these countermeasures operate is the dopaminergic system. However, this mechanism remains speculative as (neuro)physiological markers of MF have been scarcely evaluated to date.

CONCLUSION

The present systematic review reveals that a wide range of countermeasures have been found to successfully counteract MF on a subjective, (neuro)physiological and/or behavioural level. Of these, caffeine, odours, music and extrinsic motivation are the most evidenced for countering MF. To provide in-detail practical guidelines for the real-life application of MF countermeasures, more research must be performed into the underlying mechanisms and into the optimal dosage and time of application/intake.

Does Social Media Use on Smartphones Influence Endurance, Power, and Swimming Performance in High-Level Swimmers?

Objective: This study aimed to investigate the repeated effect of social media on smartphones immediately before training sessions on inhibitory control (Stroop task), endurance (tethered swimming), countermovement jump (CMJ), and swimming performance (50, 100, and 400-m freestyle) in high-level female swimmers. Methods: It is a randomized and experimental investigation with parallel groups. Twenty-two participants underwent the eight weeks of the experiment. The swimmers (eight to twelve sessions per week with 15.9 ± 1.6 hours/week, and training experience of ~ 5.6 years) were randomized in two groups: control (CON, n = 11) and smartphone (SMA, n = 11). Immediately before each training session, the CON group watched videos about Olympic Games for 30-min. The SMA group used social network smartphone apps during 30-min. The inhibitory control, endurance, CMJ, and swimming performance were measured before and after the eight weeks of intervention. Results: No group x time interaction for 50-m freestyle (F_{(4, 18)} = 1.04; p = .33; η² = 0.09) and CMJ performance (F_{(4, 18)} = 0.31; p = .58; η² = 0.03) was found. Both experimental groups improved CMJ (F_{(2, 20)} = 8.71; p = .01; η² = 0.46). Only the CON group improved the 100-m (p = .02), 400-m freestyle (p = .01), and endurance performance (p = .01). The CON group improved the inhibitory control response (p = .01). Conclusion: It is concluded that the repeated effect of social media on smartphones immediately before swimming training sessions might reduce or nullify training gains on swimming and endurance performance.

Effects of Creatine Supplementation on Brain Function and Health

While the vast majority of research involving creatine supplementation has focused on skeletal muscle, there is a small body of accumulating research that has focused on creatine and the brain. Preliminary studies indicate that creatine supplementation (and guanidinoacetic acid; GAA) has the ability to increase brain creatine content in humans. Furthermore, creatine has shown some promise for attenuating symptoms of concussion, mild traumatic brain injury and depression but its effect on neurodegenerative diseases appears to be lacking. The purpose of this narrative review is to summarize the current body of research pertaining to creatine supplementation on total creatine and phophorylcreatine (PCr) content, explore GAA as an alternative or adjunct to creatine supplementation on brain creatine uptake, assess the impact of creatine on cognition with a focus on sleep deprivation, discuss the effects of creatine supplementation on a variety of neurological and mental health conditions, and outline recent advances on creatine supplementation as a neuroprotective supplement following traumatic brain injury or concussion.

Mental Load and Fatigue Assessment Instruments: A Systematic Review

Mental load and fatigue are important causes of performance decreases and accidents in different activities. However, a robust systematic review, detailing the instruments used to quantify them, is currently lacking. The purpose of this study was to summarize and classify by derivations the validated instruments used to quantify mental load and fatigue. The most representative electronic databases in the scope of this review, PubMed, WOS, Scopus, SPORTDiscus, and PsycINFO (until September 2020) were searched for studies that included instruments to analyze mental load and fatigue. The quality of the selected studies was scored using a quality assessment checklist. A total of 40 papers were included. Most of the papers used subjective scales (75%) to quantify mental load and fatigue, with a small presence of behavioral (n = 5) and objective techniques (n = 5). Less is known about the analysis of mental load and fatigue using a combination of derivations. Despite the high cost and complexity of objective techniques, research that applies these measures is important for further analysis of brain processes in mental load and fatigue. The design of a battery of tests that include the three types of derivations also seems necessary.

Effects of Nutritional Interventions on Accuracy and Reaction Time with Relevance to Mental Fatigue in Sporting, Military, and Aerospace Populations: A Systematic Review and Meta-Analysis

Background: Research in sport, military, and aerospace populations has shown that mental fatigue may impair cognitive performance. The effect of nutritional interventions that may mitigate such negative effects has been investigated. This systematic review and meta-analysis aimed to quantify the effects of nutritional interventions on cognitive domains often measured in mental fatigue research. Methods: A systematic search for articles was conducted using key terms relevant to mental fatigue in sport, military, and aerospace populations. Two reviewers screened 11,495 abstracts and 125 full texts. A meta-analysis was conducted whereby effect sizes were calculated using subgroups for nutritional intervention and cognitive domains. Results: Fourteen studies were included in the meta-analysis. The consumption of energy drinks was found to have a small positive effect on reaction time, whilst the use of beta-alanine, carbohydrate, and caffeine had no effect. Carbohydrate and caffeine use had no effect on accuracy. Conclusions: The results of this meta-analysis suggest that consuming energy drinks may improve reaction time. The lack of effect observed for other nutritional interventions is likely due to differences in the type, timing, dosage, and form of administration. More rigorous randomized controlled trials related to the effect of nutrition interventions before, during, and after induced mental fatigue are required.

Mental Fatigue-Associated Decrease in Table Tennis Performance: Is There an Electrophysiological Signature?

Mental fatigue (MF) is a psychobiological state negatively impacting both cognitive and physical performance. Although recent research implies that some table tennis (TT) performance outcomes are impaired by MF, open skill sports such as TT require a more detailed overview of MF-related performance decrements. Moreover, research into MF and sport-specific psychomotor performance lacks the inclusion of brain-related measurements to identify MF mechanisms. Eleven experienced TT players participated in this randomized counterbalanced crossover trial. Participants were either required to perform an individualized Stroop task (MF condition) or watch a documentary (control condition). The primary outcomes were reaction time on a sport-specific visuomotor task and EEG activity throughout the trial. The subjective feeling of MF was significantly different between both conditions and confirmed that the MF condition induced the mentally fatigue state of participants (p < 0.001), though no behavioral indicators (i.e., decrease in performance on Stroop and flanker task) of MF. MF worsened reaction time on the visuomotor task, while other secondary measurements remained largely ambiguous. Spectral power (i.e., decreases in upper α band and θ band) was influenced by MF, while ERPs measured during the visuomotor task remained unaltered. The present study confirms that MF negatively impacts table tennis performance, specifically inhibitory stimuli during the visuomotor task. These findings also further augment our understanding of the effects of MF on human performance.

Physical Activity and Music to Counteract Mental Fatigue

Mental fatigue impairs both cognitive and physical performance. Bioactive substances (e.g., caffeine) have been used to counteract mental fatigue but could have side effects. The present study aimed to test two non-bioactive strategies to counteract mental fatigue: physical activity and listening to music. The participants first performed an arm-pointing task, then carried out a 32-min cognitively demanding task to induce mental fatigue (TLDB task), followed by another arm-pointing task at the end of the experiment. Between the end of the cognitively demanding task and the last arm-pointing task, 20 min went during which participants performed either 15 min of physical activity, of listening to music or of discussion (control). The subjective feeling of mental fatigue was assessed before each arm-pointing task and after the cognitively demanding task. For "physical activity" and "listening to music" groups, EEG was recorded at rest after each evaluation of subjective feeling of mental fatigue and during the cognitively demanding task. An increase in alpha power during the cognitively demanding task evidenced the presence of mental fatigue, without recovery during the following 20-min period. In the control condition, the arm-pointing task performance was deteriorated 20-min after the cognitively demanding task, while it remained stable after both physical activity and listening to music. Furthermore, recovery on the subjective feeling of mental fatigue was similar for both groups. The present results suggested that practicing physical activity and listening to music could be efficient strategies to counteract the negative effects of mental fatigue on motor performances.

Mental Fatigue Over 2 Elite Netball Seasons: A Case for Mental Fatigue to be Included in Athlete Self-Report Measures

PURPOSE

Mental fatigue is emerging as an important consideration for elite sporting performance, yet it is rarely monitored. The present study assessed changes in mental fatigue in professional team-sport athletes across 2 seasons and examined the relationship between mental fatigue and other athlete self-report measures of well-being.

METHODS

Elite netballers contracted to all teams competing in Australia's premier professional netball competition during the 2018 and 2019 seasons (N = 154) participated. Using 5-point Likert scales, mental fatigue, fatigue (physical), tiredness, sleep quality, stress, mood, and motivation were assessed daily across 2 seasons composed of 14 round and finals series.

RESULTS

The ratings of mental fatigue significantly changed during both seasons. In 2018, lower ratings of mental fatigue were reported in round 1 versus 3, 4, 6, 8, and 14; round 7 versus 6; and round 6 versus 10 (P < .05). In 2019, lower ratings of mental fatigue were identified for round 1 versus 3, 9, 10 to 14, and semifinal; round 2 versus 10 to 13; and 5 versus 10 to 12 (P < .05). Ordinal regression revealed significant differences between mental fatigue and physical fatigue (P < .001), tiredness (P < .001), stress (P < .001), mood (P < .001), and motivation (P < .05).

CONCLUSIONS

The present study found mental fatigue to significantly fluctuate across a season in elite netballers. Moreover, perceived mental fatigue differed from physical fatigue, tiredness, stress, mood, and motivation. The data impress the need for mental fatigue to be included as an independent measure of athlete well-being. Monitoring of mental fatigue can allow practitioners to implement strategies to manage its influence on performance.

How Mentally Fatiguing Are Consecutive World Padel Tour Matches?

It is currently unknown whether mental fatigue occurs throughout a WPT competition and whether consecutive matches affect how mentally fatiguing a match is perceived to be. The objective was to quantify the effects of successive professional matches on mental fatigue. A total of 14 professional players (9 males, Mage = 25, 5 females, Mage = 21) participated during qualified rounds of a WPT with three eliminatory matches: Match 1 (morning) and 2 (afternoon) on day 1 (n = 14), Match 3 (morning) on day 2 (n = 6). Mental fatigue and motivation, with scales, and reaction time, with a 3-min Psychomotor Vigilance Test, were measured at two time intervals (pre and post matches (<30 min)). To analyze the evolution of these variables, a two-way repeated measures MANOVA was performed. An increase in mental fatigue from pre- to post-matches was observed (p < 0.01), with an accumulation of mental fatigue between matches played on day 1 (p < 0.01), maximizing the mental fatigue perceived during Match 2. Padel matches impair motivation and reaction time (p = 0.04), without effects between successive matches, which reinforced the idea that mental fatigue may impair padel performance (i.e., reaction time). Coaches should use training interventions and recovery strategies to counteract/avoid the accumulation of mental fatigue during professional tournaments.

Creatine Supplementation: An Update

ABSTRACT

Creatine is a popular and widely used ergogenic dietary supplement among athletes, for which studies have consistently shown increased lean muscle mass and exercise capacity when used with short-duration, high-intensity exercise. In addition to strength gains, research has shown that creatine supplementation may provide additional benefits including enhanced postexercise recovery, injury prevention, rehabilitation, as well as a number of potential neurologic benefits that may be relevant to sports. Studies show that short- and long-term supplementation is safe and well tolerated in healthy individuals and in a number of patient populations.

How do elite female team sport athletes experience mental fatigue? Comparison between international competition, training and preparation camps

Mental fatigue has been shown to negatively influence physical, technical and tactical aspects of sporting performance. However, mental fatigue is not routinely monitored or managed in elite sport and it is not clear whether mental fatigue occurs and/or changes across the varied contextual demands experienced by elite athletes in training, preparation and competition. This study explored self-report measures of mental fatigue across eight training camps and six competition periods (two benchmark tournaments and four international test series) with international netballers (n = 22, 25.9 ± 2.7 years) during the 2018-2019 representative period. Mental fatigue was higher during training camps (p < 0.001; 3.20 [3.12, 3.27]) and preparation camps (p < 0.05; 3.27 [3.19, 3.34]) compared to the competition periods (3.49 [3.44, 3.55]). Significant within-group differences were also identified between individual preparation camps and competition subsets. Higher mental fatigue was reported during the preparation camp for international test series 2 comparative to the preparation camp for benchmark tournament 1 (p = 0.047). For individual competitions; greater mental fatigue was found during the international test series 3 competition in comparison to both the benchmark tournament 1 (p <0.001) and international test series 1 (p = 0.020) competition periods. International representative netballers experience differing levels of mental fatigue across training and preparation camps and competition periods. Practitioners should be aware that athletes report instances of elevated mental fatigue across camps, and competition. Mental fatigue is not limited to competition and thus is recommended to be monitored during periods of training and preparation for competition. HighlightsInternational representative netballers experience differing levels of mental fatigue across camp and competition environments.Mental fatigue was higher during training camps and preparation camps compared to the competition periods.Mental fatigue is not limited to competition so is recommended to be monitored during periods of training and preparation for competition.

The interaction of acute physical fatigue with three traditional functional performance tests and the reactive balance test

OBJECTIVES

To assess the impact of acute physical fatigue on traditional and neurocognitive functional performance tests in recreational athletes.

DESIGN

randomized counterbalanced cross-over study, pre-post design SETTING: laboratory PARTICIPANTS: Twenty recreational athletes (age = 24 ± 3 years) MAIN OUTCOME MEASURES: We evaluated fatigue impairments following a 30 s all-out effort in three traditional and one neurocognitive functional performance test. The traditional functional performance tests encompassed the single leg hop for distance (SLH), countermovement jump (CMJ) and Y-balance test (YBT). The neurocognitive functional performance test encompassed the reactive balance test (RBT). A 30 s modified Wingate was used to induce acute physical fatigue.

RESULTS

Acute physical fatigue was successfully induced as indicated by a significant increase in heart rate, systolic blood pressure, blood lactate levels and rating of perceived exertion (p < 0.001). Acute physical fatigue induced significant decreases in RBT accuracy (p = 0.004) and SLH performance (p < 0.001). YBT, CMJ and RBT visuomotor reaction time remained unaffected by acute physical fatigue.

CONCLUSIONS

Acute physical fatigue impairs SLH performance and decreases accuracy in the RBT. YBT and CMJ performance remained unaffected by acute physical fatigue. Clinicians should be aware of this divergent neurocognitive functional impairments caused by one all-out effort to allow well-informed selection of functional performance tests.

Mental Fatigue and Sport-Specific Psychomotor Performance: A Systematic Review

BACKGROUND

Mental fatigue (MF) is a psychobiological state that impairs endurance performance in healthy athletes. Recently, multiple studies indicated that MF could also impair sport-specific psychomotor performance (SSPP). Nevertheless, a systematic overview detailing the effects of MF on SSPP is currently lacking.

OBJECTIVE

The objective of this study is to collate relevant literature and examine the effect of MF on SSPP. A secondary aim was to create an overview of the potential subjective and physiological factors underlying this MF effect.

METHODS

PubMed (MEDLINE), Web of Science, PsycINFO and SPORTDiscus were searched (5th of November 2020). Studies were eligible when study outcomes encompassed any form of SSPP skill in a sport-specific context, the intervention was targeted to induce MF, and the population included healthy individuals. The presence of a manipulation check, to indicate the successful induction of MF, was obligatory for inclusion. Secondary outcomes were all outcomes (either physiological or psychological) that could explain the underlying mechanisms of the effect of MF on SSPP.

RESULTS

In total, 21 papers were included. MF was successfully induced in all but two studies, which were excluded from further analysis. MF negatively impacts a myriad of SSPP outcomes, including decision-making, reaction time and accuracy outcomes. No changes in physiological outcomes, that could underlie the effect of MF, were reported. Subjectively, only ratings of perceived of exertion increased due to MF in some studies.

CONCLUSIONS

Overall, the selected papers indicated that MF negatively affects SSPP. Research that assesses brain function, while evaluating the effect of MF on SSPP is essential to create further insight.

Creatine Supplementation and Brain Health

There is a robust and compelling body of evidence supporting the ergogenic and therapeutic role of creatine supplementation in muscle. Beyond these well-described effects and mechanisms, there is literature to suggest that creatine may also be beneficial to brain health (e.g., cognitive processing, brain function, and recovery from trauma). This is a growing field of research, and the purpose of this short review is to provide an update on the effects of creatine supplementation on brain health in humans. There is a potential for creatine supplementation to improve cognitive processing, especially in conditions characterized by brain creatine deficits, which could be induced by acute stressors (e.g., exercise, sleep deprivation) or chronic, pathologic conditions (e.g., creatine synthesis enzyme deficiencies, mild traumatic brain injury, aging, Alzheimer’s disease, depression). Despite this, the optimal creatine protocol able to increase brain creatine levels is still to be determined. Similarly, supplementation studies concomitantly assessing brain creatine and cognitive function are needed. Collectively, data available are promising and future research in the area is warranted.

Creatine in Health and Disease

Although creatine has been mostly studied as an ergogenic aid for exercise, training, and sport, several health and potential therapeutic benefits have been reported. This is because creatine plays a critical role in cellular metabolism, particularly during metabolically stressed states, and limitations in the ability to transport and/or store creatine can impair metabolism. Moreover, increasing availability of creatine in tissue may enhance cellular metabolism and thereby lessen the severity of injury and/or disease conditions, particularly when oxygen availability is compromised. This systematic review assesses the peer-reviewed scientific and medical evidence related to creatine's role in promoting general health as we age and how creatine supplementation has been used as a nutritional strategy to help individuals recover from injury and/or manage chronic disease. Additionally, it provides reasonable conclusions about the role of creatine on health and disease based on current scientific evidence. Based on this analysis, it can be concluded that creatine supplementation has several health and therapeutic benefits throughout the lifespan.

Effects of Creatine Supplementation on Properties of Muscle, Bone, and Brain Function in Older Adults: A Narrative Review

Aging is associated with reductions in muscle and bone mass and brain function, which may be counteracted by several lifestyle factors, of which exercise appears to be most beneficial. However, less than 20% of older adults (> 55 years of age) adhere to performing the recommended amount of resistance training (≥ 2 days/week) and less than 12% regularly meet the aerobic exercise guidelines (≥ 150 min/week of moderate to vigorous intensity aerobic exercise) required to achieve significant health benefits. Therefore, from a healthy aging and clinical perspective, it is important to determine whether other lifestyle interventions (independent of exercise) can have beneficial effects on aging muscle quality and quantity, bone strength, and brain function. Creatine, a nitrogen containing organic compound found in all cells of the body, has the potential to have favorable effects on muscle, bone, and brain health (independent of exercise) in older adults. The purpose of this narrative review is to examine and summarize the small body of research investigating the effects of creatine supplementation alone on measures of muscle mass and performance, bone mineral and strength, and indices of brain health in older adults.

Evidence-based post exercise recovery in combat sports: a narrative review

INTRODUCTION

Some methods such as ergo nutritional aids, cooling or massage among others could improve recovery in combat sports (CS). The effects, doses, duration, and timing of these methods remains unknown. Nowadays, there is no clear consensus regarding the recovery strategies and it is necessary to understand the type of fatigue induced in CS and its underlying mechanisms. The main aim of this article is to review the update literature related to recovery strategies in CS.

EVIDENCE ACQUISITION

A literature search was conducted following preferred reporting items for review statement on the topic of: "combat sports," "recovery," "nutrition," "fatigue," "ergogenic aids," "weight cutting" and "hydration."

EVIDENCE SYNTHESIS

The initial search of the literature detected 369 articles about CS. Later, 307 were excluded after being determined unrelated to recovery or after failure to fulfill the inclusion criteria. Of the 80 included articles, 19 satisfied the final inclusion criteria.

CONCLUSIONS

To optimize CS performance, adequate recovery is required during training and competition processes. Traditional ergo nutritional supplementation of carbohydrates and proteins combined. Besides, the consumption of evidence supported supplementation (green tea, beetroot gels, creatine or alkaline water) improve recovery processes. Further methods of recovery including physical (cold water immersion, massage or photobiomodulation) and physiological (types of active recovery, sleep and rest) therapies have also been shown useful. This narrative review elucidates the important role of recovery techniques in CS.

Endurance exercise-induced and mental fatigue and the brain

NEW FINDINGS

What is the topic of this review? It provides an overview of the recent papers linking brain neurotransmission with exercise-induced and/or mental fatigue. What advances does it highlight? The noradrenergic neurotransmitter system hastens central fatigue during prolonged exercise, a finding that coincides with a faster rate of increase in the rating of perceived exertion. 2) Mental fatigue affects several neurotransmitter systems, with presumably an important role for dopamine and adenosine, in multiple brain regions such as the prefrontal cortex and the anterior cingulate cortex.

ABSTRACT

In sports and exercise science, fatigue is an elusive concept that has important implications in performance during exercise. It has been described in many ways (tiredness, exhaustion, lethargy or weariness) and describes a physical and/or mental state of being tired and lack of energy. Exercise-induced fatigue can be defined as an acute impairment of exercise performance, and a distinction has been made between peripheral and central fatigue. Mental fatigue can be defined as a psychobiological state caused by prolonged exertion that has the potential to reduce cognitive performance and exercise performance. Recent studies have given clear indications that brain catecholamines are involved in the onset of fatigue during endurance exercise. Evidence is provided indicating that the noradrenergic neurotransmitter system hastens central fatigue, a finding that coincides with a faster rate of increase in the rating of perceived exertion. Brain neurotransmission is also suggested to play an important role in mental fatigue. Several neurotransmitter systems might be implicated (with the most important role for dopamine and adenosine) in multiple brain regions, such as the prefrontal cortex and the anterior cingulate cortex, and the summation of these alterations might explain the impairment in endurance performance in a mentally fatigued state. Obviously, we have to keep in mind that fatigue is a very complex construct and that, besides brain neurochemistry, several other factors play a role in its onset.

Changes in subjective mental and physical fatigue during netball games in elite development athletes

OBJECTIVES

To assess the magnitude of changes in, and relationships between, physical and mental fatigue pre-to-post match in elite development netballers.

DESIGN

Observational.

METHODS

Twelve female netballers (21.3±2.9 years) competing in the Australian Netball League reported perceptual measures of mental and physical fatigue pre- and post-match on 12 separate competition occasions. Minutes played, to allow for calculation of weighted changes (ratings proportional to playing time), positional groups and performance analysis variables were also assessed.

RESULTS

Post-match ratings were higher (p<0.01) than pre-match for both mental (pre: 31.02±19.28; post: 44.73±24.47) and physical fatigue (pre: 28.86±15.37; post: 47.21±24.67). The correlation coefficient between change in mental and physical fatigue (r=0.37, p<0.01) revealed a shared variance of 13.9%. Acute changes in mental fatigue were related to minutes played (r=0.32, p<0.01) as was change in physical fatigue (r=0.59, p<0.01). No differences in change in mental fatigue were found between positional groups (p=0.07) though change in physical fatigue was higher for shooters compared to defenders (p<0.05). Performance variables revealed no relationships with mental or physical fatigue, with the exception of turnover number with both post-match weighted physical (r= -0.23, p<0.01) and weighted-change in physical fatigue (r=-0.16, p<0.05).

CONCLUSIONS

Mental and physical fatigue were found to increase across netball matches in elite development athletes. Mental fatigue emerged as a largely separate construct to physical fatigue.