Blood-Borne Markers of Fatigue in Competitive Athletes - Results from Simulated Training Camps

Anabolic/Catabolic Hormone Imbalance but Still Jumping Further? Negative Association of Free Testosterone With Jumping Performance in Elite Handball Players Following a Preparatory Period

Purpose: The present study investigated the effects of a 10-week preparatory training period on biomarkers and jumping performance and associations of changes in biomarkers, load, and jumping performance from the beginning (PRE) to the end of the preparatory period (POST) in elite handball players. Methods: Seventeen elite handball players competing in the first Slovenian men's League were recruited. Training, competition and academic loads were reported weekly, while biomarkers and jumping performance were assessed at PRE and POST. Results: At POST, decreased levels of free testosterone (large effect size [ES] = -1.69, p < .001) and free testosterone to cortisol ratio [FTCR] (large ES = -.95, p = .004) were observed; whereas, better performance on the single leg lateral hop test [SLLH] (large ES = .85, p = .007) and single leg triple hop test [SLTH] (large ES = 1.05, p = .002) were observed compared to PRE. Furthermore, changes in FTCR correlated with changes in cortisol (high r = -.751, p = .001), SLLH (moderate r = -.603, p = .022), and SLTH (moderate r = -.643, p = .013), while changes in free testosterone correlated with SLTH (moderate r = -.645, p = .013). Conclusions: High intensity trainings with a saturated competition schedule can result in disturbed anabolic/catabolic hormone ratio observed through FTCR decrease, which could indicate either an optimal state or early exhaustiveness. It seems that SLLH and SLTH are more sensitive to changes in biomarkers than a single leg hop test. Sport professionals may use the results for individualized monitoring of an athlete's health and performance, specifically, as an aid for adjusting training loads accordingly to prevent performance declines and potential injury/illness events.

Effect of 2 weeks rest-pause on oxidative stress and inflammation in female basketball players

Intense exercise leads to increased production of free radicals, resulting in an inflammatory response in athletes. For this reason, it was decided to investigate whether a single intensive exercise until exhaustion applied after a 2-week rest period would result in a violation of the pro-oxidant-antioxidant balance. Twenty-seven trained female basketball players (age: 16.55 ± 0.96 years, body mass: 66.40 ± 13.68 kg, height: 173.45 ± 5.14 cm) were enrolled to the study following the application of inclusion and exclusion criteria. Study was conducted at the end of the competitive training phase. Participants underwent incremental treadmill exercise, with blood samples collected before the test, immediately post-exercise, and after a 3-h restitution period. Total antioxidant capacity (TAC) levels increased significantly after exercise and remained unchanged after 3 h. Concentration of interleukin-10 (IL-10) and creatine kinase (CK) significantly increased after exercise and then decreased. Concentration of interleukin-2 (IL-2) was significantly reduced immediately and 3 h after exercise, while interleukin-13 (IL-13), interleukin-1α (IL-1α), and tryptophan (TRP) decreased 3 h after exercise. No significant changes were observed in other biochemical parameters. Obtained results show an increased antioxidant capacity which reduced oxidative stress and inflammation in response to intense exercise indicating that rested athletes have a high adaptation and elevated tolerance to effort.

Evaluation of sweat-based biomarkers using wearable biosensors for monitoring stress and fatigue: a systematic review

Objectives. This systematic review aims to report the evaluation of wearable biosensors for the real-time measurement of stress and fatigue using sweat biomarkers. Methods. A thorough search of the literature was carried out in databases such as PubMed, Web of Science and IEEE. A three-step approach for selecting research articles was developed and implemented. Results. Based on a systematic search, a total of 17 articles were included in this review. Lactate, cortisol, glucose and electrolytes were identified as sweat biomarkers. Sweat-based biomarkers are frequently monitored in real time using potentiometric and amperometric biosensors. Wearable biosensors such as an epidermal patch or a sweatband have been widely validated in scientific literature. Conclusions. Sweat is an important biofluid for monitoring general health, including stress and fatigue. It is becoming increasingly common to use biosensors that can measure a wide range of sweat biomarkers to detect fatigue during high-intensity work. Even though wearable biosensors have been validated for monitoring various sweat biomarkers, such biomarkers can only be used to assess stress and fatigue indirectly. In general, this study may serve as a driving force for academics and practitioners to broaden the use of wearable biosensors for the real-time assessment of stress and fatigue.

Pupillometry as a new window to player fatigue? A glimpse inside the eyes of a Euro Cup Women's Basketball team

A rapidly emerging area of interest in high-pressure environments is that of pupillometry, where handheld quantitative infrared pupillometers (HQIPs) are able to track psycho-physiological fatigue in a fast, objective, valid, reliable, and non-invasive manner. However, the application of HQIPs in the context of athlete monitoring is yet to be determined. Therefore, the main aim of this pilot study was to examine the potential usefulness of a HQIP to monitor game-induced fatigue inside a professional female basketball setting by determining its (1) test-retest repeatability, (2) relationship with other biomarkers of game-induced fatigue, and (3) time-course from rested to fatigued states. A non-ophthalmologic practitioner performed a standardized Pupil Light Reflex (PLR) test using a medically graded HQIP among 9 professional female basketball players (2020-2021 Euro Cup) at baseline, 24-h pre-game (GD-1), 24-h post-game (GD+1) and 48-h post-game (GD+2). This was repeated over four subsequent games, equalling a total of 351 observations per eye. Two out of seven pupillometrics displayed good ICCs (0.95-0.99) (MinD and MaxD). Strong significant relationships were found between MaxD, MinD, and all registered biomarkers of game-induced fatigue (r = 0.69-0.82, p < 0.05), as well as between CV, MCV, and cognitive, lower-extremity muscle, and physiological fatigue markers (r = 0.74-0.76, p < 0.05). Three pupillometrics were able to detect a significant difference between rested and fatigued states. In particular, PC (right) (F = 5.173, η2 = 0.115 p = 0.028) and MCV (right) (F = 3.976, η2 = 0.090 p = 0.049) significantly decreased from baseline to GD+2, and LAT (left) (F = 4.023, η2 = 0.109 p = 0.009) significantly increased from GD-1 to GD+2. HQIPs have opened a new window of opportunity for monitoring game-induced fatigue in professional female basketball players. However, future research initiatives across larger and heterogenous samples, and longer investigation periods, are required to expand upon these preliminary findings.

Recovery Methods in Basketball: A Systematic Review

Although different strategies have been implemented to manage recovery-fatigue status in athletes, there is still a lack of consensus on which recovery protocols have the greatest impact and effectiveness when implemented with basketball players, including both physiological and psychological recovery methods. Thus, the purpose of this systematic review is to: (a) determine which recovery methods attain the greatest benefit in restoring the process of attenuating fatigue and (b) provide sports practitioners with guidelines on how some of the most effective recovery strategies can be used to optimize athletes' recovery and ultimately enhance their performance. Using the PRISMA guidelines, a total of 3931 research reports were obtained through four database searches (i.e., PubMed, Scopus, Cochrane, and Web of Science), from which only 25 met the inclusion and exclusion criteria. The recovery protocols analyzed in this systematic review were: sleep, nutrition, hydration, ergogenic aids, cold-water immersion, compression garments, massage, acupuncture, tapering, mindfulness, and red-light irradiation. The results revealed that all recovery strategies are capable of attenuating fatigue and enhancing recovery in basketball players to a certain degree. However, an individualized approach should be promoted, where a combination of proactive recovery modalities appears to result in the most rapid rates of recovery and athletes' ability to maintain high-level performance. Recovery should be programmed as an integral component of training regimens. Also, cooperation and communication between coaches, players, and the rest of the team staff members are essential in minimizing the risk of non-functional overreaching or injury and optimizing basketball players' on-court performance.

Effect of training load on sleep parameters and biochemical fatigue markers in elite swimmers

The effect of strenuous exercise on sleep patterns in swimmers is equivocal. Therefore, the purpose of the study was to describe possible changes in sleep parameters among elite swimmers subjected to different training loads (TL). Methods: Eighteen elite swimmers (8 females) were monitored across two high-volume preparatory 1-wk periods (P1, P2) and a lower-volume tapering 1-wk period (P3) before a major competition. Internal (the session rating of perceived exertion [sRPE]) and external TL (training duration and volume) were measured, along with several sleep indices (e.g., bedtime, get-up time, sleep time, wake after sleep onset [WASO]). Serum measurements of urea, creatine kinase (CK), testosterone and cortisol were taken before and after training sessions at the beginning (Mondays) and end (Fridays) of each micro cycle. Athlete TL decreased significantly in a stepwise manner from P1 to P2 and from P2 to P3. Of all sleep parameters, only significant differences in bedtime and get-up time emerged (P3 > P1 and/or P2). Sleep duration (~6.3 h) or quality (WASO: 41-45 min) were also unaffected by TL. CK levels declined from P1 to P3 (d = -0.8), and from P2 to P3 (d = -0.6). Positive exercise-induced changes in CK were also seen in each training period. The other biomarkers did not show the same temporal or acute patterns. Irrespective of the TL, the monitored swimmers experienced insufficient and fragmented sleep across this study. Neither sleep quality nor quantity were affected by different magnitudes of TL. Among the biochemical markers of fatigue, baseline plasma CK activity best reflected the physiological response to TL.

Individualised reference ranges for markers of muscle recovery assessment in soccer

Recently an individualisation algorithm has been developed and shown to significantly improve the diagnostic accuracy of creatine kinase (CK) and urea in endurance sports and Badminton. In this study, the applicability and benefit of this algorithm was evaluated using repeated measures data from 161 professional German soccer players monitored during the 2015-2017 seasons. Venous blood samples were collected after a day off (recovered state) and after a minimum of two strenuous training sessions within 48 h (non-recovered state) and analysed for CK and urea. Group-based reference ranges were derived from that same dataset to ensure the best possible reference for comparison. A z-test was conducted to analyse differences in error rates between individualised and group-based classifications. CK values for the individualised approach showed significantly lower error rates in the assessment of muscle recovery compared to both a population-based (p < .001; z-value: -17.01; test-pass error rate: 21 vs. 67%; test-fail: 19 vs. 64%) and a group-based cut-off (p < .001; z-value: -15.29; test-pass error rate: 65%; test-fail: 67%). It could be concluded that the assessment of muscle recovery in soccer using individualised interpretations of blood-borne markers may offer higher diagnostic accuracy than a population-based and a sample-specific group-based approach.HighlightsAssessing muscle recovery via CK using individualised ranges seems to offer a higher diagnostic accuracy than a sample-specific group-based analysis.Using an individualised algorithm seems to be a promising approach to overcome diagnostic problems arising from large inter- and intraindividual variability in blood parameters as it significantly improved the diagnostic accuracy of CK as a recovery marker.As recovery assessment in elite soccer ultimately aims at the accurate detection of differences in the individual player this algorithm seems to offer coaches and sport scientists a more sensitive approach compared to group-specific evaluations.

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 dietary anthocyanins on biochemical, physiological, and subjective exercise recovery: a systematic review and meta-analysis

Anthocyanins (ACN), the sub-class of (poly)phenols responsible for the red-blue-purple pigmentation of fruit and vegetables, have gained considerable interest in sport and exercise research due to their potential to facilitate exercise recovery. A systematic literature search was performed using PubMed, The Cochrane Library, MEDLINE, SPORTDiscus and CINAHL. Thirty nine studies were included and the standardized mean difference (Hedges g) for creatine kinase (CK), anti-oxidative and inflammatory markers, strength, power and delayed onset muscle soreness (DOMS) indices were pooled in separate meta-analyses; meta-regression was also performed on reported ACN dose. Immediately post-exercise there was an increase in antioxidant capacity (g: 0.56) and reduced C reactive protein (g: -0.24) and tumor necrosis factor α (g: -40); p ≤ 0.02. Strength was improved with ACN at all time points (g: 0.45-0.67). DOMS (g: -0.23) was lower 24 hours post-exercise and power was improved 24 hours (g: 0.62) and 48 hours (g: 0.57) post exercise. The CK was lower 48 hours post-exercise (g: -0.31) and there was a trend for a positive association with ACN dose (p = 0.057). This systematic review provides new data showing ACN-rich foods promote functional and subjective recovery likely due to the antioxidant and anti-inflammatory properties of ACN.

Assessment of Fatigue and Recovery in Sport: Narrative Review

Fatigue is a phenomenon associated with decreases in both physical and cognitive performances and increases in injury occurrence. Competitive athletes are required to complete demanding training programs with high workloads to elicit the physiological and musculoskeletal adaptations plus skill acquisition necessary for performance. High workloads, especially sudden rapid increases in training loads, are associated with the occurrence of fatigue. At present, there is limited evidence elucidating the underlying mechanisms associating the fatigue generated by higher workloads and with an increase in injury risk. The multidimensional nature and manifestation of fatigue have led to differing definitions and dichotomies of the term. Consequently, a plethora of physiological, biochemical, psychological and performance markers have been proposed to measure fatigue and recovery. Those include self-reported scales, countermovement jump performance, heart rate variability, and saliva and serum biomarker analyses. The purpose of this review is to provide an overview of fatigue and recovery plus methods of assessments.

mHealth system (ATOPE+) to support exercise prescription in breast cancer survivors: a reliability and validity, cross-sectional observational study (ATOPE study)

Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https://clinicaltrials.gov/ct2/show/NCT03787966.

Evaluation of Ibuprofen Use on the Immune System Indicators and Force in Disabled Paralympic Powerlifters of Different Sport Levels

Background: Paralympic powerlifting (PP) training is typically intense and causes fatigue and alterations in the immune system. Objective: To analyze whether IBU would affect performance and the immune system after training in PP. Methodology: 10 athletes at the national level (NL) and 10 at the regional level (RL) participated in the study, where force and blood indicators were evaluated after training. The study took place over three weeks: (1) familiarization and (2 and 3) comparison between recovery methods, with ibuprofen or placebo (IBU vs. PLA), 800 mg. In the evaluation of the force, the peak torque (PT), fatigue index (FI), and blood immune system biomarkers were analyzed. The training consisted of five sets of five repetitions with 80% of one maximum repetition (5 × 5, 80% 1RM) on the bench press. Results: The PT at the national level using IBU was higher than with PLA (p = 0.007, η2p = 0.347), and the FI in the NL was lower with IBU than with PLA (p = 0.002, η2p = 0.635), and when comparing the use of IBU, the NL showed less fatigue than the regional level (p = 0.004, η2p = 0.414). Leukocytes, with the use of IBU in the NL group, were greater than in the RL (p = 0.001, η2p = 0.329). Neutrophils, in the NL with IBU, were greater than in the RL with IBU and PLA (p = 0.025, η2p = 0.444). Lymphocytes, in NL with IBU were lower than in RL with IBU and PLA (p = 0.001, η2p = 0.491). Monocytes, in the NL with IBU and PLA, were lower than in the RL with IBU (p = 0.049, η2p = 0.344). For hemoglobin, hematocrit, and erythrocyte, the NL with IBU and PLA were higher than the RL with IBU and PLA (p < 0.05). Ammonia, with the use of IBU in the NL, obtained values higher than in the RL (p = 0.007), and with the use of PLA, the NL was higher than the RL (p = 0.038, η2p = 0.570). Conclusion: The training level tends to influence the immune system and, combined with the use of the IBU, it tends to improve recovery and the immune system.

Effect of Transcranial Pulsed Current Stimulation on Fatigue Delay after Medium-Intensity Training

The purpose of this study was to investigate the effect of transcranial pulsed current stimulation (tPCS) on fatigue delay after medium-intensity training. Materials and Methods: Ninety healthy college athletes were randomly divided into an experimental group (n = 45) and control group (n = 45). The experimental group received medium-intensity training for a week. After each training, the experimental group received true stimulation of tPCS (continuous 15 min 1.5 mA current intensity stimulation). The control group received sham stimulation. The physiological and biochemical indicators of participants were tested before and after the experiment, and finally 30 participants in each group were included for data analysis. Results: In the experimental group, creatine kinase (CK), cortisol (C), time-domain heart rate variability indices root mean square of the successive differences (RMSSD), standard deviation of normal R-R intervals (SDNN), and frequency domain indicator low frequency (LF) all increased slowly after the intervention. Among these, CK, C, and SDNN values were significantly lower than those in the control group (p < 0.05). Testosterone (T), T/C, and heart rate variability frequency domain indicator high frequency (HF) in the experimental group decreased slowly after the intervention, and the HF value was significantly lower than that in the control group (p < 0.05). The changes in all of the indicators in the experimental group were smaller than those in the control group. Conclusion: The application of tPCS after medium-intensity training enhanced the adaptability to training and had a significant effect on the maintenance of physiological state. The application of tPCS can significantly promote the recovery of autonomic nervous system function, enhance the regulation of parasympathetic nerves, and delay the occurrence of fatigue.

High Energetic Demand of Elite Rowing - Implications for Training and Nutrition

Purpose: Elite rowers have large body dimensions, a high metabolic capacity, and they realize high training loads. These factors suggest a high total energy requirement (TER), due to high exercise energy expenditure (EEE) and additional energetic needs. We aimed to study EEE and intensity related substrate utilization (SU) of elite rowers during rowing (EEE_ROW) and other (EEE_NON-ROW) training.

Methods: We obtained indirect calorimetry data during incremental (N = 174) and ramp test (N = 42) ergometer rowing in 14 elite open-class male rowers (body mass 91.8 kg, 95% CI [87.7, 95.9]). Then we calculated EEE_ROW and SU within a three-intensity-zone model. To estimate EEE_NON-ROW, appropriate estimates of metabolic equivalents of task were applied. Based on these data, EEE, SU, and TER were approximated for prototypical high-volume, high-intensity, and tapering training weeks. Data are arithmetic mean and 95% confidence interval (95% CI).

Results: EEE_ROW for zone 1 to 3 ranged from 15.6 kcal·min⁻¹, 95% CI [14.8, 16.3] to 49.8 kcal·min⁻¹, 95% CI [48.1, 51.6], with carbohydrate utilization contributing from 46.4%, 95% CI [42.0, 50.8] to 100.0%, 95% CI [100.0, 100.0]. During a high-volume, a high-intensity, or a taper week, TER was estimated to 6,775 kcal·day⁻¹, 95% CI [6,651, 6,898], 5,772 kcal·day⁻¹, 95% CI [5,644, 5,900], or 4,626 kcal∙day⁻¹, 95% CI [4,481, 4,771], respectively.

Conclusion: EEE in elite open-class male rowers is remarkably high already during zone 1 training and carbohydrates are dominantly utilized, indicating relatively high metabolic stress even during low intensity rowing training. In high-volume training weeks, TER is presumably at the upper end of the sustainable total energy expenditure. Periodized nutrition seems warranted for rowers to avoid low energy availability, which might negatively impact performance, training, and health.

Dwarfs on the Shoulders of Giants: Bayesian Analysis With Informative Priors in Elite Sports Research and Decision Making

While sample sizes in elite sports are necessarily small, so are the effects that may be relevant. This conundrum is complicated by an understandable reluctance of athletes to comply with extensive study requirements. In Bayesian analyses, pre-existing knowledge (e.g., from sub-elite trials) can be formally included to supplement scarce data. Moreover, some design specifics for small sample research extend to the extreme case of a single subject. This provides the basis for actionable feedback (e.g., about individual responses) thereby incentivising participation. As a proof-of-concept, we conducted a replicated cross-over trial on the effect of cold-water immersion (CWI) on sprint performance recovery in soccer players. Times for 30 m linear sprint and the initial 5 m section, respectively, were measured by light gates before and 24 h after induction of fatigue. Data were analysed by Bayesian and by standard frequentist methods. Informative priors are based on a published metaanalysis. Seven players completed the trial. Sprint performance was 4.156 ± 0.193 s for 30 m linear sprint and 0.978 ± 0.064 s for the initial 5 m section. CWI improved recovery of sprint time for the initial 5 m section (difference to control: −0.060 ± 0.060 s, p = 0.004) but not for the full 30 m sprint (0.002 ± 0.115 s, p = 0.959), with general agreement between Bayesian and frequentist interval estimates. On the individual level, relevant differences between analytical approaches were present for most players. Changes in the two performance measures are correlated (p = 0.009) with a fairly good reproducibility of individual response patterns. Bayesian analyses with informative priors may be a practicable and meaningful option particularly for very small samples and when the analytical aim is decision making (use / don't use in the specific setting) rather than generalizable inference.

Seasonal Training Load Monitoring Among Elite Level Soccer Players: Perceived Exertion and Creatine Kinase Variations Between Microcycles

The primary aim of the investigation was to determine the daily load variations between the microcycles of an entire season of an elite group of professional soccer players. The second aim of this study was to determine the relationships between Foster’s rating of perceived exertion (RPE), the Hooper index (HI) and CK levels over the weekly microcycles of the season. Thirty-five male professional soccer players participated in this study (3 goalkeepers, 6 wide defenders, 4 central defenders, 9 midfielders, 8 wide midfielders and 4 forwards) (25.7 ± 5.0 years, 182.3 ± 6.4 cm; 79.1 ± 7.0 kg). Significant differences between months in the variables of HI (p = 0.001; ES = 0.052), minT (p = 0.001; ES = 0.066), IL (p = 0.001; ES = 0.052, minimum effect) and CK (p = 0.002; ES = 0.031) were found. Comparison of the HI (p = 0.044; ES = 0.002), minT (p = 0.001; ES = 0.045), and IL (p = 0.001; ES = 0.045) revealed significant differences between microcycles. No significant differences were found in CK (p = 0.710; ES = 0.001) across the period. A significantly higher internal training load and fatigue perception in microcycles with only one official match was found. The greater load occurred 3 to 4 days before the game. In addition, it can be concluded that the first quarter of the season seemed to induce a greater physical demand on elite professional players.

Theacrine does not enhance physical performance or training status over 8 weeks

Fatigue is a condition that may affect physical performance during training sessions. Consequently, this will impact training performance and will also affect the performance of the individual in the long term. Caffeine is extensively used to counteract fatigue; however, it contains several side effects. Theacrine might be used as an alternative to caffeine, providing the same benefits without the side effects. The current study aimed to investigate the effects of 8 weeks of supplementation with theacrine on physical performance and training status of young amateur athletes. Twenty-two subjects were divided into two groups – Theacrine Group (T) and Placebo Group (P) – and evaluated before and after the intervention period. Evaluations included physical tests and hormonal values of insulin like growth factor (IGF)-I and IGF binding protein (IGFBP)-3, used as markers of training status. Results demonstrated that theacrine was not capable of promoting benefits regarding the physical performance of the subjects. It also had no effects on serum secretion of IGF-I and its binding protein, IGFBP-3. Therefore, the findings of this study do not support the use of theacrine to increase physical performance.

Differences in Immune Response During Competition and Preparation Phase in Elite Rowers

Background: Metabolic stress is high during training and competition of Olympic rowers, but there is a lack of biomedical markers allowing to quantify training load on the molecular level. We aimed to identify such markers applying a complex approach involving inflammatory and immunologic variables. Methods: Eleven international elite male rowers (age 22.7 ± 2.4 yrs.; VO₂max 71 ± 5 ml·min^-1·kg^-1) of the German National Rowing team were monitored at competition phase (COMP) vs. preparation phase (PREP), representing high vs. low load. Perceived stress and recovery were assessed by a Recovery Stress Questionnaire for Athletes (RESTQ-76 Sport). Immune cell activation (dendritic cell (DC)/macrophage/monocytes/T-cells) was evaluated via fluorescent activated cell sorting. Cytokines, High-Mobility Group Protein B1 (HMGB1), cell-free DNA (cfDNA), creatine kinase (CK), uric acid (UA), and kynurenine (KYN) were measured in venous blood. Results: Rowers experienced more general stress and less recovery during COMP, but sports-related stress and recovery did not differ from PREP. During COMP, DC/macrophage/monocyte and T-regulatory cells (T_reg-cell) increased (p = 0.001 and 0.010). HMGB1 and cfDNA increased in most athletes during COMP (p = 0.001 and 0.048), while CK, UA, and KYN remained unaltered (p = 0.053, 0.304, and 0.211). Pro-inflammatory cytokines IL-1β (p = 0.002), TNF-α (p < 0.001), and the chemokine IL-8 (p = 0.001) were elevated during COMP, while anti-inflammatory Il-10 was lower (p = 0.002). Conclusion: COMP resulted in an increase in biomarkers reflecting tissue damage, with plausible evidence of immune cell activation that appeared to be compensated by anti-inflammatory mechanisms, such as T_reg-cell proliferation. We suggest an anti-inflammatory and immunological matrix approach to optimize training load quantification in elite athletes.

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.

Effects of Ibuprofen Use on Lymphocyte Count and Oxidative Stress in Elite Paralympic Powerlifting

Simple Summary

Paralympic Powerlifting (PP) is a strength sport and training tends to promote fatigue. Ten national-level PP athletes were evaluated concerning post-training oxidative stress using Ibuprofen and a placebo. Strength indicators were evaluated. The training consisted of five sets of five repetitions (80–90% 1-Repetition Maximum) in the bench press. The IBU had a positive effect on strength indicators, with decreased fatigue and increased lymphocyte count. There were no differences in oxidative stress. The use of IBU provided improvements in strength and fatigue reduction and did not protect against oxidative stress.

Abstract

Background: Paralympic Powerlifting (PP) training tends to promote fatigue and oxidative stress. Objective: To analyze the effects of ibuprofen use on performance and oxidative stress in post-training PP athletes. Methodology: Ten national level PP athletes (age: 27.13 ± 5.57) were analyzed for oxidative stress in post-training. The study was carried out in three weeks, (1) familiarization and (2 and 3) evaluated the recovery with the use of a placebo (PLA) and ibuprofen (IBU), 800 mg. The Peak Torque (PT), Torque Development Rate (TDR), Fatigue Index (FI), reactive substances to thiobarbituric acid (TBARS) and sulfhydryl groups (SH) were evaluated. The training consisted of five sets of five repetitions (80–90%) 1-Repetition Maximum (1-RM) in the bench press. Results: The IBU showed a higher PT (24 and 48 h, p = 0.04, ɳ² p = 0.39), a lower FI (24 h, p = 0.01, ɳ²p = 0.74) and an increased lymphocyte count (p < 0.001; ɳ²p = 4.36). There was no change in oxidative stress. Conclusions: The use of IBU provided improvements in strength and did not protect against oxidative stress.

Training Load Measures and Biomarker Responses during a 7-Day Training Camp in Young Cyclists-A Pilot Study

Background and Objectives: During intense training periods, there is a high need to monitor the external and especially the internal training load in order to fine-tune the training process and to avoid overreaching or overtraining. However, data on stress reactions, especially of biomarkers, to high training loads in children and youth are rare. Therefore, in this study, we aimed to investigate the training load of youth athletes during a training camp using a multilevel approach. Materials and Methods: Six trained youth male cyclists performed a 7-day preseason training camp. To investigate the internal training load, every morning, minimally invasive “point-of-care testing” (POCT) devices were used to analyze the following biomarkers: creatine kinase (CK), blood urea nitrogen (BUN), albumin (Alb), bilirubin (Bil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein (TP). Additionally, data of training load measures (HR: heart rate, RPE: rating of perceived exertion, sRPE: session-RPE, TRIMP: training impulse, intensity (RPE:HR), and load (sRPE:TRIMP) ratios), self-perception (person’s perceived physical state, questionnaires on muscle soreness, and sleep quality), and measures of the autonomic nervous system (resting heart rate, heart rate variability) were collected. Two days before and after the training camp, subjects performed performance tests (Graded Exercise Test, Wingate Anaerobic Test, Counter Movement Jump). Results: Primarily, the biomarkers CK, BUN, and Alb, as well as the self-perception showed moderate to large load-dependent reactions during the 7-day training camp. The biomarkers returned to baseline values two days after the last training session. Power output at lactate threshold showed a small increase, and no changes were found for other performance parameters. Conclusions: The study suggests that a multilevel approach is suitable to quantify the internal training load and that different parameters can be used to control the training process. The biomarkers CK, BUN, and Alb are suitable for objectively quantifying the internal training load. The self-perception provides additional subjective information about the internal training load.

Recovery during and after a simulated multi-day tennis tournament: Combining active recovery, stretching, cold-water immersion, and massage interventions

The aim of this study was to investigate the effects of a mixed-method recovery intervention (MMR) consisting of active recovery, stretching, cold-water immersion, and massage on physical, technical, physiological, and perceptual recovery during and after a five-day simulated tennis tournament. Nine competitive male tennis players (age, 24.6±4.2 years) with national ranking positions (German Tennis Federation) and Universal Tennis Ratings between approximately 11-13 participated in two singles tennis tournaments, which were separated by a three-month washout period. During the tournaments, participants played five two-and-a-half-hour competitive singles tennis match on five consecutive days. For the assignment to one of two groups, athletes were matched into homogeneous pairs according to their ranking. Then, within each pair, the players were randomly assigned to one of two groups. The first group performed MMR during the first tournament, whereas the other group used passive recovery (PAS). During the second tournament, recovery conditions were interchanged. Measures of physical and technical performance as well as physiological and perceptual responses (heart rate, blood lactate concentration, perceived exertion) were recorded during match-play sessions. Furthermore, muscle soreness, perceived recovery state, blood markers, countermovement jump height (CMJ), and repeated sprint ability (RSA) were determined before, during, and after the five-day tournament periods. Results showed significant changes over time (P < 0.05) in muscle soreness, perceived recovery state, creatine kinase, c-reactive protein, insulin-like growth factor 1, and countermovement jump height. However, no significant differences or recovery strategy x time interactions were noted either for tennis-specific performance (e.g. number of total points won) or any other of the measured parameters between MMR and PAS (P > 0.05). In conclusion, the repeated use of MMR during and after a five-day tennis tournament did not affect match performance, match load, or recovery from repeated days of tennis match play.

Recovery-Stress Response of Blood-Based Biomarkers

The purpose of this study was to investigate blood-based biomarkers and their regulation with regard to different recovery-stress states. A total of 35 male elite athletes (13 badminton, 22 soccer players) were recruited, and two venous blood samples were taken: one in a ‘recovered’ state (REC) after a minimum of one-day rest from exercise and another one in a ‘non-recovered’ state (NOR) after a habitual loading microcycle. Overall, 23 blood-based biomarkers of different physiologic domains, which address inflammation, muscle damage, and tissue repair, were analyzed by Luminex assays. Across all athletes, only creatine kinase (CK), interleukin (IL-) 6, and IL-17A showed higher concentrations at NOR compared to REC time points. In badminton players, higher levels of CK and IL-17A at NOR were found. In contrast, a higher value for S100 calcium-binding protein A8 (S100A8) at REC was found in badminton players. Similar differences were found for BDNF in soccer players. Soccer players also showed increased levels of CK, and IL-6 at NOR compared to REC state. Several molecular markers were shown to be responsive to differing recovery-stress states, but their suitability as biomarkers in training must be further validated.

Overtraining in Resistance Exercise: An Exploratory Systematic Review and Methodological Appraisal of the Literature

BACKGROUND

The balance between training stress and recovery is important for inducing adaptations to improve athletic performance. However, continuously high training loads with insufficient recovery may cause fatigue to accumulate and result in overtraining. A comprehensive systematic review is required to collate overtraining literature and improve the current understanding of the mechanisms underlying functional overreaching (FOR), non-functional overreaching (NFOR) and the overtraining syndrome (OTS) in resistance training.

OBJECTIVE

The objective of this systematic review was to establish markers of overtraining and elucidate the mechanisms underlying maladaptive resistance training conditions. Furthermore, this review aims to critically evaluate the methodological approaches of the overtraining literature.

METHODS

A systematic literature search was performed on PubMed, Web of Science and SPORTDiscus to identify studies up to June 2019. Electronic databases were searched using terms related to resistance training and overtraining. Records were included if they attempted to induce a state of overreaching or overtraining through resistance exercise in healthy participants.

RESULTS

A total of 22 studies were selected for review. Among these studies, eight resulted in decrements in performance and measured changes in performance during a follow-up period. There were four studies that reported decrease in performance yet failed to implement follow-up measures. A total of 10 studies reported no decline in performance. Overall, a lack of standardisation in methodology (follow-up performance testing) and diagnostic criteria prevents consistent determination of FOR, NFOR and OTS in resistance training.

CONCLUSIONS

Few studies have appropriately established FOR, NFOR or OTS in resistance training. Overtraining may be related to frequent high-intensity and monotonous resistance training. However, no marker other than a sustained decrease in performance has been established as a reliable indicator of overtraining in resistance exercise.

REGISTRATION

This systematic review was registered on the Open Science Framework (https://osf.io/) (https://doi.org/10.17605/osf.io/5bmsp).

Repeatability of the Individual Response to the Use of Active Recovery the Day After High-Intensity Interval Training: A Double-Crossover Trial

PURPOSE

To identify whether the use of active recovery (ACT) the day after high-intensity interval training (HIIT) benefits recovery and to assess whether individual responses to ACT are repeatable.

METHODS

Eleven well-trained, male intermittent-sport athletes (age: 25.5 ± 1.8 y) completed 4 HIIT sessions, each separated by a 2-week washout period. Of the 4 sessions, 2 were followed by passive recovery (PAS) and 2 by 60 minutes of moderate biking (ACT) 24 hours postexercise in the following sequences: ACT→PAS→ACT→PAS or PAS→ACT→PAS→ACT. Before and after HIIT and after 24 and 48 hours of recovery, maximal voluntary isometric strength (MVIC), countermovement jump height (CMJ), tensiomyographic markers of muscle fatigue (TMG), serum concentration of creatine kinase (CK), muscle soreness (MS), and perceived stress state (PS) were determined.

RESULTS

A 3-way repeated-measure analysis of variance with a triple-nested random effects model revealed a significant (P < .05) fatigue-related time effect of HIIT on markers of fatigue (MVIC↓; CMJ↓; TMG↑; CK↑; MS↑; PS↑). No significant (P > .05) main effect of recovery strategy was detected. In 9 subjects, the individual results revealed inconsistent and nonrepeatable responses to ACT, while a consistent and repeatable positive or negative response to ACT was found in 2 individuals.

CONCLUSIONS

The repeated failure of ACT to limit the severity of fatigue was found both at the group level and with most individuals. However, a small percentage of athletes may be more likely to benefit repeatedly from either ACT or PAS. Therefore, the use of ACT should be individualized.

Reliability and suitability of physiological exercise response and recovery markers

There is currently insufficient evidence about the reliable quantification of exercise load and athlete's recovery management for monitoring training processes. Therefore, this test-retest study investigated the reliability of various subjective, muscle force, and blood-based parameters in order to evaluate their suitability for monitoring exercise and recovery cycles. 62 subjects completed two identical 60-min continuous endurance exercise bouts intermitted by a four-week recovery period. Before, immediately after, three, and 24 h after each exercise bout, analysis of parameters were performed. Significant changes over time were found for rating of perceived exertion (RPE), multidimensional mood state questionnaire (MDMQ), maximum voluntary contraction parameters (MVCs), and blood-based biomarkers (p < 0.05). Excellent reliability was calculated for MVCs, mean corpuscular volume and 5-bound distance (ICC > 0.90). A good reliability was found for thiobarbituric acid reactive substances (TBARS) (ICC = 0.79) and haematological markers (ICC = 0.75-0.86). For RPE, MDMQ, interleukin (IL-) 1RA, IL-6, IL-8, IL-15, cortisol, lactate dehydrogenase (LDH), creatine kinase (CK) only moderate reliability was found (ICC < 0.75). Significant associations for IL1-RA and CK to MVC were found. The excellent to moderate reliability of TBARS, LDH, IL-1RA, six measured haematological markers, MVCs and MDMQ implicate their suitability as physiological exercise response and recovery markers for monitoring athletes' load management.

Deceleration, Acceleration, and Impacts Are Strong Contributors to Muscle Damage in Professional Australian Football

Gastin, PB, Hunkin, SL, Fahrner, B, and Robertson, S. Deceleration, acceleration, and impacts are strong contributors to muscle damage in professional Australian football. J Strength Cond Res 33(12): 3374-3383, 2019-The purpose of this study was to investigate the relationships between serum creatine kinase [CK], an indirect marker of muscle damage, and specific indices of match load in elite Australian football. Twenty-six professional players were assessed during a competitive Australian Football League (AFL) season. [CK] was collected 24-36 hours before match and 34-40 hours after match during 8 in-season rounds. An athlete-tracking technology was used to quantify match load. Generalized estimating equations and random forest models were constructed to determine the extent to which match-load indices and pre-match [CK] explained post-match [CK]. There was a 129 ± 152% increase in [CK] in response to AFL competition. Generalized estimating equations found that number of impacts >3g (p = 0.004) and game time (p = 0.016) were most strongly associated with post-match [CK]. Random forest, with considerably lower errors (130 vs. 316 U·L), found deceleration, acceleration, impacts >3g, and sprint distance to be the strongest predictors. Pre-match [CK] accounted for 11% of post-match [CK], and considerable interindividual and intraindividual variability existed in the data. Creatine kinase, an indicator of muscle damage, was considerably elevated as a result of AFL competition. Parametric and machine-learning analysis techniques found several indices of physical load associated with muscle damage during competition, with impacts >3g and high-intensity running variables as the strongest predictors. [CK] may be used as a global measure of muscle damage in field team sports such as AF, yet with some caution given cost, invasiveness, and inherent variability. Quantifying physical load and the responses to that load can guide athlete management decision-making and is best undertaken within a suite of practical, sport-specific measures, where data are interpreted individually and with an understanding of the limitations.

Assessment of muscle fiber adaptation in footballers using a new ELISA assay of myosin isoforms

BACKGROUND

To measure the impact of training models on injury incidence, data of health and performance were integrated to study fiber adaptation during a competitive season. We studied football players over a season, analyzing hours of exposure to sport by serum changes in fast and slow myosin, creatine kinase and lactate dehydrogenase.

METHODS

A new assay was developed to measure the myosin isoforms in 49 non-sporting volunteers and in 27 professional football players.

RESULTS

Myosin isoforms in volunteers with mean ages of 30±8 were 1553 µg/L fast and 1284 µg/L slow; in the group with of 56±7 were 1426 µg/L fast and 1046 µg/L slow. Slow myosin was significantly lower in older subjects (-18%). Samples from the players in preseason had lower mean scores for fast myosin (1123 µg/L) and higher for slow myosin (2072 µg/L) than reference volunteers. During the season, myosins reached the maximum with the maximum load (1537 µg/L fast, 2195 µg/L slow but decreased and adapted to the high level of demand (425 µg/L fast, 1342 µg/L slow). CK and LDH were maximal at the pre-season (227 U/L, 333 U/L) while myosin levels were maximal at the beginning of season (1537 µg/L, 2195 µg/L).

CONCLUSIONS

Measuring serum myosin isoforms we identify the type and amount of damage caused by training and matches, making it a new control tool capable of advising training towards a minimum of blood slow myosin but controlling the fast fiber participating and be able to improve the performance of the players.

Changes in Creatine Kinase and Hormones Over the Course of an American Football Season

Stone, JD, Kreutzer, A, Mata, JD, Nystrom, MG, Jagim, AR, Jones, MT, and Oliver, JM. Changes in creatine kinase and hormones over the course of an American Football Season. J Strength Cond Res 33(9): 2481-2487, 2019-The purpose of this study was to examine changes in creatine kinase and hormones over the course of an entire season of American football. A secondary purpose was to determine differences between starters and nonstarters. Fasting blood samples were obtained from 19 National Collegiate Athletic Association Division I (n = 19; 20 ± 1 years) football athletes over the course of a season beginning before the start of summer off-season conditioning (T1), before (T2) and after preseason (T3) football camp, with remaining samples taken throughout the competitive season (T4-T8). A magnitude-based inference approach was used to define outcomes. Testosterone was higher in starters before the start of the season (T1, Effect Size [ES] = 0.8) and during preconference (T4; ES = 0.7). Postcamp (T3) testosterone was lower in all players, though greater in starters (starters, 0.0%/0.3%/99.7%; nonstarters, 0.2%/2.9%/96.9%). An increase cortisol relative to baseline (T1) was observed in starters early in season (T4, ES = 0.7; T5, ES = 0.5). Creatine kinase was elevated at all time points in all athletes, with starters having higher circulating levels throughout season. These data demonstrate that changes in hormonal markers may be experienced over a season of football and differ by playing status. Differences between starters and nonstarters may be indicative of greater damage and stress experienced by starters, which may result from a greater number of repetitions.

The Associations of Vitamin D Status with Athletic Performance and Blood-borne Markers in Adolescent Athletes: A Cross-Sectional Study

The purpose of this study was to examine the associations of vitamin D status with athletic performance and blood-borne markers in adolescent athletes. This cross-sectional study included forty-seven Taekwondo athletes, aged 15–18 years old. Athletic performance was assessed using maximal oxygen consumption (VO_2max), Wingate anaerobic power test, vertical jump, agility T-test, lower limb muscle strength, and fatigue resistance. Blood samples were collected to assess serum 25-hydroxyvitamin D [25(OH)D], free-testosterone, cortisol, creatine kinase, and urea. One-way ANOVAs were applied using Bonferroni adjusted alpha levels, which was 0.02 (i.e., 0.05/3). Multiple linear regressions analyses as well as Pearson and partial correlation analyses were used to examine the relationship among 25(OH)D concentration, athletic performance, and blood-borne markers. The participants 25(OH)D concentration were ranged from 16 to 73.25 nmol/L, indicating that 74.5% of the adolescent athletes have vitamin D insufficiency or deficiency. The vitamin D status did not show any significant effects on the performance factors or blood-borne markers. Serum 25(OH)D concentration was positively correlated with mean power output (r = 0.359, p < 0.05) and relative mean power output (r = 0.325, p < 0.05) after adjusting for bone age, height, weight, training experience, lean body mass, and fat mass. However, 25(OH)D concentration was not associated with other performance-related factors and blood-borne markers. In addition, multiple linear regressions analyses revealed that serum 25(OH)D concentration were not significant predictors of athletic performance in adolescent athletes. In conclusion, vitamin D status is weakly correlated with anaerobic capacity; moreover, the underlying mechanisms of how vitamin D influence anaerobic performance is unclear in the present study. Nevertheless, the importance of vitamin D on health benefits should not be underestimated, especially during growth periods.

Z-scores-based methods and their application to biological monitoring: an example in professional soccer players

The clinical and biological follow-up of individuals, such as the biological passport for athletes, is typically based on the individual and longitudinal monitoring of hematological or urine markers. These follow-ups aim to identify abnormal behavior by comparing the individual's biological samples to an established baseline. These comparisons may be done via different ways, but each of them requires an appropriate extra population to compute the significance levels, which is a non-trivial issue. Moreover, it is not necessarily relevant to compare the measures of a biomarker of a professional athlete to that of a reference population (even restricted to other athletes), and a reasonable alternative is to detect the abnormal values by considering only the other measurements of the same athlete. Here we propose a simple adaptive statistic based on maxima of Z-scores that does not rely on the use of an extra population. We show that, in the Gaussian framework, it is a practical and relevant method for detecting abnormal values in a series of observations from the same individual. The distribution of this statistic does not depend on the individual parameters under the null hypothesis, and its quantiles can be computed using Monte Carlo simulations. The proposed method is tested on the 3-year follow-up of ferritin, serum iron, erythrocytes, hemoglobin, and hematocrit markers in 2577 elite male soccer players. For instance, if we consider the abnormal values for the hematocrit at a 5% level, we found that 5.57% of the selected cohort had at least one abnormal value (which is not significantly different from the expected false-discovery rate). The approach is a starting point for more elaborate models that would produce a refined individual baseline. The method can be extended to the Gaussian linear model, in order to include additional variables such as the age or exposure to altitude. The method could also be applied to other domains, such as the clinical patient follow-up in monitoring abnormal values of biological markers.

Individualized Monitoring of Muscle Recovery in Elite Badminton

Purpose: Individualized reference ranges for serum creatine kinase (CK) and urea are a promising tool for the assessment of recovery status in high-level endurance athletes. In this study, we investigated the application of this approach in racket sports, specifically for the monitoring of elite badminton players during the preparation for their world championships.

Methods: Seventeen elite badminton players were enrolled of which 15 could be included in the final analysis. Repeated measurements of CK and urea at recovered (R) and non-recovered (NR) time points were used for the stepwise individualization of group-based, prior reference ranges as well as for the evaluation of classificatory performance. Specifically, blood samples were collected in the morning following a day off (R) or following four consecutive training days (NR), respectively. Group based reference ranges were derived from the same data. Error rates were compared between the group-based and individualized approaches using the Fisher exact test.

Results: Error rates were numerically lower for the individualized as compared to the group-based approach in all cases. Improvements reached statistical significance for urea (test-pass error rate: p = 0.007; test-fail error rate: p = 0.002) but not for CK (p vs. group-based: test-pass error rate: p = 0.275, test-fail error rate: p = 0.291). Regardless of the chosen approach, the use of CK was associated with lower error rates as compared to urea.

Conclusion and Practical Applications: Individualized reference ranges seem to offer diagnostic benefits in the monitoring of muscle recovery in elite badminton. The lack of significant improvements in error rates for CK is likely due to the large difference between R and NR for this parameter with error rates that are already low for the group-based approach.

Ketone ester supplementation blunts overreaching symptoms during endurance training overload

KEY POINTS

Overload training is required for sustained performance gain in athletes (functional overreaching). However, excess overload may result in a catabolic state which causes performance decrements for weeks (non-functional overreaching) up to months (overtraining). Blood ketone bodies can attenuate training- or fasting-induced catabolic events. Therefore, we investigated whether increasing blood ketone levels by oral ketone ester (KE) intake can protect against endurance training-induced overreaching. We show for the first time that KE intake following exercise markedly blunts the development of physiological symptoms indicating overreaching, and at the same time significantly enhances endurance exercise performance. We provide preliminary data to indicate that growth differentiation factor 15 (GDF15) may be a relevant hormonal marker to diagnose the development of overtraining. Collectively, our data indicate that ketone ester intake is a potent nutritional strategy to prevent the development of non-functional overreaching and to stimulate endurance exercise performance.

ABSTRACT

It is well known that elevated blood ketones attenuate net muscle protein breakdown, as well as negate catabolic events, during energy deficit. Therefore, we hypothesized that oral ketones can blunt endurance training-induced overreaching. Fit male subjects participated in two daily training sessions (3 weeks, 6 days/week) while receiving either a ketone ester (KE, n = 9) or a control drink (CON, n = 9) following each session. Sustainable training load in week 3 as well as power output in the final 30 min of a 2-h standardized endurance session were 15% higher in KE than in CON (both P < 0.05). KE inhibited the training-induced increase in nocturnal adrenaline (P < 0.01) and noradrenaline (P < 0.01) excretion, as well as blunted the decrease in resting (CON: -6 ± 2 bpm; KE: +2 ± 3 bpm, P < 0.05), submaximal (CON: -15 ± 3 bpm; KE: -7 ± 2 bpm, P < 0.05) and maximal (CON: -17 ± 2 bpm; KE: -10 ± 2 bpm, P < 0.01) heart rate. Energy balance during the training period spontaneously turned negative in CON (-2135 kJ/day), but not in KE (+198 kJ/day). The training consistently increased growth differentiation factor 15 (GDF15), but ∼2-fold more in CON than in KE (P < 0.05). In addition, delta GDF15 correlated with the training-induced drop in maximal heart rate (r = 0.60, P < 0.001) and decrease in osteocalcin (r = 0.61, P < 0.01). Other measurements such as blood ACTH, cortisol, IL-6, leptin, ghrelin and lymphocyte count, and muscle glycogen content did not differentiate KE from CON. In conclusion, KE during strenuous endurance training attenuates the development of overreaching. We also identify GDF15 as a possible marker of overtraining.

Heart Rate Variability Monitoring During Strength and High-Intensity Interval Training Overload Microcycles

Objective: In two independent study arms, we determine the effects of strength training (ST) and high-intensity interval training (HIIT) overload on cardiac autonomic modulation by measuring heart rate (HR) and vagal heart rate variability (HRV). Methods: In the study, 37 well-trained athletes (ST: 7 female, 12 male; HIIT: 9 female, 9 male) were subjected to orthostatic tests (HR and HRV recordings) each day during a 4-day baseline period, a 6-day overload microcycle, and a 4-day recovery period. Discipline-specific performance was assessed before and 1 and 4 days after training. Results: Following ST overload, supine HR, and vagal HRV (Ln RMSSD) were clearly increased and decreased (small effects), respectively, and the standing recordings remained unchanged. In contrast, HIIT overload resulted in decreased HR and increased Ln RMSSD in the standing position (small effects), whereas supine recordings remained unaltered. During the recovery period, these responses were reversed (ST: small effects, HIIT: trivial to small effects). The correlations between changes in HR, vagal HRV measures, and performance were weak or inconsistent. At the group and individual levels, moderate to strong negative correlations were found between HR and Ln RMSSD when analyzing changes between testing days (ST: supine and standing position, HIIT: standing position) and individual time series, respectively. Use of rolling 2-4-day averages enabled more precise estimation of mean changes with smaller confidence intervals compared to single-day values of HR or Ln RMSSD. However, the use of averaged values displayed unclear effects for evaluating associations between HR, vagal HRV measures, and performance changes, and have the potential to be detrimental for classification of individual short-term responses. Conclusion: Measures of HR and Ln RMSSD during an orthostatic test could reveal different autonomic responses following ST or HIIT which may not be discovered by supine or standing measures alone. However, these autonomic changes were not consistently related to short-term changes in performance and the use of rolling averages may alter these relationships differently on group and individual level.

Role of heat shock proteins 70/90 in exercise physiology and exercise immunology and their diagnostic potential in sports

Heat shock proteins (HSPs) are molecular chaperones facilitating the unfolding or folding of secondary structures of proteins, their client proteins, in cellular stress situations. Various internal and external physiological and mechanical stress factors induce a homeostatic imbalance, followed by an increased expression of HSP70 and HSP90. Exercise is a stress factor, too, and its cumulative physiological perturbation manifests at a cellular level by threatening the protein homeostasis of various cell types. Consequently, an increase of HSP70/90 was described in plasma and mononuclear cells and various organs and tissues, such as muscle, liver, cardiac tissue, and brain, after an acute bout of exercise. The specific response of HSP70/90 seems to be strongly related to the modality of exercise, with several dependent factors such as duration, intensity, exercise type, subjects’ training status, and environmental factors, e.g., temperature. It is suggested that HSP70/90 play a major role in immune regulation and cell protection during exercise and in the efficiency of regeneration and reparation processes. During long-term training, HSP70/90 are involved in preconditioning and adaptation processes that might also be important for disease prevention and therapy. With regard to their highly sensitive and individual response to specific exercise and training modalities, this review discusses whether and how HSP70 and HSP90 can be applied as biomarkers for monitoring exercise and training.

Achievements and Challenges for Real-Time Sensing of Analytes in Sweat within Wearable Platforms

Physiological sensors in a wearable form have rapidly emerged on the market due to technological breakthroughs and have become nearly ubiquitous with the Apple Watch, FitBit, and other wearable devices. While these wearables mostly monitor simple biometric signatures, new devices that can report on the human readiness level through sensing molecular biomarkers are critical to optimizing the human factor in both commercial sectors and the Department of Defense. The military is particularly interested in real-time, wearable, minimally invasive monitoring of fatigue and human performance to improve the readiness and performance of the war fighter. However, very few devices have ventured into the realm of reporting directly on biomarkers of interest. Primarily this is because of the difficulties of sampling biological fluids in real-time and providing accurate readouts using highly selective and sensitive sensors. When additional restrictions to only use sweat, an excretory fluid, are enforced to minimize invasiveness, the demands on sensors becomes even greater due to the dilution of the biomarkers of interest, as well as variability in salinity, pH, and other physicochemical variables which directly impact the read-out of real-time biosensors. This Account will provide a synopsis not only on exemplary demonstrations and technological achievements toward implementation of real-time, wearable sweat sensors but also on defining problems that still remain toward implementation in wearable devices that can detect molecular biomarkers for real world applications. First, the authors describe the composition of minimally invasive biofluids and then identify what biomarkers are of interest as biophysical indicators. This Account then reviews demonstrated techniques for extracting biofluids from the site of generation and transport to the sensor developed by the authors. Included in this discussion is a detailed description on biosensing recognition elements and transducers developed by the authors to enable generation of selective electrochemical sensing platforms. The authors also discuss ongoing efforts to identify biorecognition elements and the chemistries necessary to enable high affinity, selective biorecognition elements. Finally, this Account presents the requirements for wearable, real-time sensors to be (1) highly stable, (2) portable, (3) reagentless, (4) continuous, and (5) responsive in real-time, before delving into specific methodologies to sense classes of biomarkers that have been explored by academia, government laboratories, and industry. Each platform has its areas of greatest utility, but also come with corresponding weaknesses: (1) ion selective electrodes are robust and have been demonstrated in wearables but are limited to detection of ions, (2) enzymatic sensors enable indirect detection of metabolites and have been demonstrated in wearables, but the compounds that can be detected are limited to a subset of small molecules and the sensors are sensitive to flow, (3) impedance-based sensors can detect a wide range of compounds but require further research and development for deployment in wearables. In conclusion, while substantial progress has been made toward wearable molecular biosensors, substantial barriers remain and need to be solved to enable deployment of minimally invasive, wearable biomarker monitoring devices that can accurately report on psychophysiological status.

Effects of different recovery strategies following a half-marathon on fatigue markers in recreational runners

Purpose

To investigate the effects of different recovery strategies on fatigue markers following a prolonged running exercise.

Methods

46 recreational male runners completed a half-marathon, followed by active recovery (ACT), cold water immersion (CWI), massage (MAS) or passive recovery (PAS). Countermovement jump height, muscle soreness and perceived recovery and stress were measured 24h before the half-marathon (pre), immediately after the recovery intervention (post_rec) and 24h after the race (post₂₄). In addition, muscle contractile properties and blood markers of fatigue were determined at pre and post₂₄.

Results

Magnitude-based inferences revealed substantial differences in the changes between the groups. At post_rec, ACT was harmful to perceived recovery (ACT vs. PAS: effect size [ES] = −1.81) and serum concentration of creatine kinase (ACT vs. PAS: ES = 0.42), with CWI being harmful to jump performance (CWI vs. PAS: ES = −0.98). It was also beneficial for reducing muscle soreness (CWI vs. PAS: ES = −0.88) and improving perceived stress (CWI vs. PAS: ES = −0.64), with MAS being beneficial for reducing muscle soreness (MAS vs. PAS: ES = −0.52) and improving perceived recovery (MAS vs. PAS: ES = 1.00). At post₂₄, both CWI and MAS were still beneficial for reducing muscle soreness (CWI vs. PAS: ES = 1.49; MAS vs. PAS: ES = 1.12), with ACT being harmful to perceived recovery (ACT vs. PAS: ES = −0.68), serum concentration of creatine kinase (ACT vs. PAS: ES = 0.84) and free-testosterone (ACT vs. PAS: ES = −0.91).

Conclusions

In recreational runners, a half-marathon results in fatigue symptoms lasting at least 24h. To restore subjective fatigue measures, the authors recommend CWI and MAS, as these recovery strategies are more effective than PAS, with ACT being even disadvantageous. However, runners must be aware that neither the use of ACT nor CWI or MAS had any beneficial effect on objective fatigue markers.

Validity and Usability of a New System for Measuring and Monitoring Variations in Vertical Jump Performance

Loturco, I, Pereira, LA, Kobal, R, Kitamura, K, Cal Abad, CC, Marques, G, Guerriero, A, Moraes, JE, and Nakamura, FY. Validity and usability of a new system for measuring and monitoring variations in vertical jump performance. J Strength Cond Res 31(9): 2579-2585, 2017-Vertical jump (VJ) height is one of the most sensitive measures to quantify training-related fatigue and athletic performance in elite athletes. Currently, however, there is no equipment designed to graphically deliver the daily performance changes in VJ compared with the smallest worthwhile change (SWC), which is considered essential in "progressive statistics" to judge meaningful performance fluctuations. The aims of the study were to analyze the criterion validity of a new contact mat (i.e., Elite Jump), alongside testing its usability to detect meaningful changes in VJ of elite team sport athletes. A total of 31 athletes participated in the criterion validity part of the study, whereas 17 rugby players participated in the VJ sensitivity part. When compared with the force plate, the contact mat produced squat jump (SJ) and countermovement jump (CMJ) values with very high intraclass correlation coefficients (0.998 and 0.997, respectively) and very low biases (-0.11 and -0.08 cm, respectively), as assessed by the Bland-Altman plot. In addition, during a training microcycle, rugby players presented identical meaningful changes in performance in both SJ and CMJ when comparing the Elite Jump and Hopkins' spreadsheet outputs. Therefore, the contact mat is valid and the proprietary software can properly execute the SWC calculations, providing coaches and researchers with accurate information concerning variations in the physical performance of elite athletes.

Recovery and Performance in Sport: Consensus Statement

The relationship between recovery and fatigue and its impact on performance has attracted the interest of sport science for many years. An adequate balance between stress (training and competition load, other life demands) and recovery is essential for athletes to achieve continuous high-level performance. Research has focused on the examination of physiological and psychological recovery strategies to compensate external and internal training and competition loads. A systematic monitoring of recovery and the subsequent implementation of recovery routines aims at maximizing performance and preventing negative developments such as underrecovery, nonfunctional overreaching, the overtraining syndrome, injuries, or illnesses. Due to the inter- and intraindividual variability of responses to training, competition, and recovery strategies, a diverse set of expertise is required to address the multifaceted phenomena of recovery, performance, and their interactions to transfer knowledge from sport science to sport practice. For this purpose, a symposium on Recovery and Performance was organized at the Technical University Munich Science and Study Center Raitenhaslach (Germany) in September 2016. Various international experts from many disciplines and research areas gathered to discuss and share their knowledge of recovery for performance enhancement in a variety of settings. The results of this meeting are outlined in this consensus statement that provides central definitions, theoretical frameworks, and practical implications as a synopsis of the current knowledge of recovery and performance. While our understanding of the complex relationship between recovery and performance has significantly increased through research, some important issues for future investigations are also elaborated.

Influence of platinum harmonized textile on neuromuscular, systemic and subjective recovery

The clothing manufacturer Venex Life-Science tracks the strategy to enhance recovery process through implementing platinum harmonized technology (PHT) into their Venex^® Regeneration Wear. The proposed mechanisms of the regeneration wear are an increase of parasympathetic activity and an increase of the temperature due far-infrared radiation. The purpose of this study was to investigate potential effects of Venex regeneration wear on the recovery of neuromuscular, systemic and subjective parameters following exercise. In a randomized, single-blinded cross-over design, 13 strength-trained male participants performed two exercise sessions in one day. After the first exercise session and for 3 nights following the exercise day participants wore the Venex regeneration wear or a placebo product. Measures of isometric maximum voluntary contraction (MVC), voluntary activation (VA) and potentiated twitch torque (PTT) of the knee extensors, as well as maximum jump height during the Counter-Movement and Drop Jump, creatinkinase (CK) and subjective parameters (perceived pain, recovery condition and sleep quality) were obtained before and after each exercise session and 24, 48, and 72 hours after the first exercise session. MVC, PTT, CK and jump parameters changed over time during the exercise day as well as on the following days, however, there were no significant differences between treatments. Subjective parameters showed strong effect sizes (i. e. Cohen’s d > 0.6) in favor for Venex but no significant differences between treatments. Based on these findings, it is concluded that wearing a platinum harmonized textile following exercise did not improve neuromuscular and systemic recovery in a trained male population to a statistical noticeable extent. However, the findings for the subjective parameters suggest some potential for enhanced recovery that requires further research.

Load management in elite German distance runners during 3-weeks of high-altitude training

There is a debate on the optimal way of monitoring training loads in elite endurance athletes especially during altitude training camps. In this case report, including nine members of the German national middle distance running team, we describe a practical approach to monitor the psychobiological stress markers during 21 days of altitude training (~2100 m above sea-level) to estimate the training load and to control muscle damage, fatigue, and/or chronic overreaching. Daily examination included: oxygen saturation of hemoglobin, resting heart rate, body mass, body and sleep perception, capillary blood concentration of creatine kinase. Every other day, venous serum concentration of blood urea nitrogen, venous blood concentration of hemoglobin, hematocrit, red and white blood cell were measured. If two or more of the above-mentioned stress markers were beyond or beneath the athlete's normal individual range, the training load of the subsequent training session was reduced. Running speed at 3 mmol L(-1) blood lactate (V3) improved and no athlete showed any signs of underperformance, chronic muscle damage, decrease body and sleep perception as well as activated inflammatory process during the 21 days. The dense screening of biomarkers in the present case study may stimulate further research to identify candidate markers for load monitoring in elite middle- and long-distance runners during a training camp at altitude.

Myokines in Response to a Tournament Season among Young Tennis Players

The study investigated changes in myokines, heat shock proteins, and growth factors in highly ranked, young, male tennis players in response to physical workload during the competitive season and their potential correlations with match scores. Blood collections were carried out at the beginning, the midpoint, and the end of the tournament season. Data analysis revealed a significant increase in interleukin 6 and its inverse correlation with the number of lost games (r = -0.45; 90% CI -0.06 to 0.77). Neither the irisin nor BDNF level changed notably, yet delta changes of irisin across the season significantly correlated with the number of games won. The concentration of HSP27 recorded a small increase (31.2%; 90% CI 10.7 to 55.5, most likely). A negative correlation was noted between IGF-1 and HSP27 concentration at baseline (-0.70 very high; 90% CI -0.89 to -0.31, very likely). At the end of the season IGF-1 correlated positively with the number of games won (r = 0.37 moderate, 90% CI -0.16 to 0.73, likely) but negatively with the number of games lost (r = -0.39, 90% CI -0.14 to -0.74, likely). In conclusion our data indicated that Il-6, irisin, and growth factor IGF-1 may modify overall performance during a long lasting season, expressed in the amount of games won or lost.