1
|
Han Q, Xiang M, An N, Tan Q, Shao J, Wang Q. Effects of vitamin D3 supplementation on strength of lower and upper extremities in athletes: an updated systematic review and meta-analysis of randomized controlled trials. Front Nutr 2024; 11:1381301. [PMID: 38860160 PMCID: PMC11163122 DOI: 10.3389/fnut.2024.1381301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Coaches and athletes are increasingly interested in understanding athletes' serum vitamin D levels, their impact on strength, physical performance, and athletic outcomes. Previous meta-analyses were reported with limited sample size and no significant overall effect was found. Hence, it is crucial to conduct a thorough and up-to-date systematic examination and meta-analysis to elucidate the potential advantages of supplementing with vitamin D3 in enhancing muscle strength for athletes. Methods We performed a thorough investigation, spanning three databases (PubMed, EBSCO, and Cochrane Library), seeking randomized controlled trials (RCTs) in all languages. These trials delved into the influence of vitamin D3 supplementation on the changes of pre- and post-intervention muscle strength in healthy athletes. Our systematic examination and meta-analysis took into account serum 25(OH)D levels exceeding 30 ng/mL as a marker of adequacy. Results Ten RCTs, comprising 354 athletes (185 in the vitamin D3 group and 169 in the placebo group), fulfilled the inclusion criteria. During the study, 36 athletes were lost to follow-up, leaving 318 athletes (166 in the vitamin D3 group and 152 in the placebo group) with documented complete results. In comparison with the placebo group, there is a significant increase between the changes of pre- and post-intervention serum 25(OH)D levels among athletes following a period of vitamin D3 supplementation (MD 14.76, 95% CI: 8.74 to 20.77, p < 0.0001). Overall effect of four strength measurements including handgrip, one repetition maximum Bench Press (1-RM BP), vertical jump, and quadriceps contraction was not significantly improved (SMD 0.18, 95% CI: -0.02 to 0.37, p = 0.08), but there was a significant increase in quadriceps contraction (SMD 0.57, 95% CI: 0.04 to 1.11, p = 0.04). Conclusion This updated meta-analysis indicates the potential benefits of vitamin D supplementation for enhancing muscle strength in athletes when analyzing its quantitatively synthesized effects. With limited available studies for the quantitative synthesis, it cannot warrant significant overall enhancements in muscle strength when athletes attain adequate serum 25(OH)D levels through supplementation.
Collapse
Affiliation(s)
- Qi Han
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- Sport Science College, Beijing Sport University, Beijing, China
- National Testing & Research Center for Sports Nutrition, Ministry of Science and Technology of the People’s Republic of China, Beijing, China
| | - Mai Xiang
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- Sport Science College, Beijing Sport University, Beijing, China
| | - Nan An
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- National Testing & Research Center for Sports Nutrition, Ministry of Science and Technology of the People’s Republic of China, Beijing, China
| | - Qiushi Tan
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- National Testing & Research Center for Sports Nutrition, Ministry of Science and Technology of the People’s Republic of China, Beijing, China
| | - Jing Shao
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- National Testing & Research Center for Sports Nutrition, Ministry of Science and Technology of the People’s Republic of China, Beijing, China
| | - Qirong Wang
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
- Key Lab of Sports Nutrition, State General Administration of Sport of China, Beijing, China
- National Testing & Research Center for Sports Nutrition, Ministry of Science and Technology of the People’s Republic of China, Beijing, China
| |
Collapse
|
2
|
Jiménez-Casquet MJ, Conde-Pipo J, Valenzuela-Barranco I, Rienda-Contreras R, Olea-Serrano F, Monserrat-Mesquida M, Tur JA, Bouzas C, Mariscal-Arcas M. Cross-Sectional Study of the Anthropometric Profile and Nutrient Status of Elite Female Ice Hockey Players: Differences by Play Position. Nutrients 2024; 16:471. [PMID: 38398795 PMCID: PMC10891979 DOI: 10.3390/nu16040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Both the characteristics of ice hockey and the environmental conditions in which it is played affect the maintenance of the player's nutritional status and, therefore, their state of health and performance. The primary aim of this work was to examine the anthropometric profile, estimated energy expenditure, and macronutrient and micronutrient dietary intake of elite female ice hockey players by play position. As a secondary aim, their dietary intakes were compared with the recommendations. Hypotheses suggest variations in body composition based on ice hockey players' positions, with the expectation that these athletes may not align with energy and nutrient recommendations. Fifteen elite female ice hockey players were anthropometrically measured, basal metabolic rate and total energy expenditure were estimated, a 3-day, 24 h recall questionnaire was registered, and the results were compared with the recommended dietary intake for the Spanish population. Each player's position on the field requires an individualized physical and nutritional approach. There are no significant imbalances (p > 0.05) between energy and nutrient intake in relation to the Recommended Daily Intake (RDI); however, increasing the consumption of vegetables and seafood while reducing meat and fat intake would assist these athletes in maintaining a healthier energy balance, optimizing body composition, and aligning with nutritional parameters that are better suited to enhance physical performance.
Collapse
Affiliation(s)
- María José Jiménez-Casquet
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain (J.C.-P.); (F.O.-S.); (M.M.-A.)
| | - Javier Conde-Pipo
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain (J.C.-P.); (F.O.-S.); (M.M.-A.)
| | | | - Raquel Rienda-Contreras
- Department of Sports and Women, Andalusian Federation of Winter Sports (FADI), 18008 Granada, Spain;
| | - Fátima Olea-Serrano
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain (J.C.-P.); (F.O.-S.); (M.M.-A.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Margalida Monserrat-Mesquida
- Research Group on Community Nutrition and Oxidative Stress, Laboratory of Physical Activity Sciences, University of Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain; (M.M.-M.); (J.A.T.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, Laboratory of Physical Activity Sciences, University of Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain; (M.M.-M.); (J.A.T.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - Cristina Bouzas
- Research Group on Community Nutrition and Oxidative Stress, Laboratory of Physical Activity Sciences, University of Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain; (M.M.-M.); (J.A.T.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - Miguel Mariscal-Arcas
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain (J.C.-P.); (F.O.-S.); (M.M.-A.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| |
Collapse
|
3
|
Jiménez-Casquet MJ, Conde-Pipó J, Valenzuela-Barranco I, Rienda-Contreras R, Olea-Serrano F, Bouzas C, Tur JA, Mariscal-Arcas M. Nutrition Status of Female Winter Sports Athletes. Nutrients 2023; 15:4472. [PMID: 37892548 PMCID: PMC10609974 DOI: 10.3390/nu15204472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Eating disorders, especially restrictive eating, are common among female athletes. There are two main types of winter sports: those that are practiced outdoors on snow (-25 to +5 °C and 2500 m), such as alpine skiing and snowboarding, and those that are practiced indoors on ice (5-10 °C at low altitude), such as figure skating and ice hockey. The aim of this research was to identify the nutritional status and potential risk of female athletes practicing winter sports, considering the altitude of training. The sample was composed of 58 women (aged 19.81 years (SD: 12.61)) who were competitors in some winter sports. Anthropometrics and nutritional variables were taken. Statistically significant differences were found between HA and LA groups for all the characteristics except thigh skinfold, and neither group had an energy intake (EI) that matched their total energy expenditure (TEE). Both groups met at least two-thirds of the RDI for all minerals and vitamins except iodine, fluorine, vitamin D, vitamin E, and retinol. This study suggests that female winter sports athletes have insufficient energy, vitamin, and mineral intake, which can be worsened with altitude.
Collapse
Affiliation(s)
- María José Jiménez-Casquet
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain; (M.J.J.-C.); (J.C.-P.); (F.O.-S.)
| | - Javier Conde-Pipó
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain; (M.J.J.-C.); (J.C.-P.); (F.O.-S.)
| | | | - Raquel Rienda-Contreras
- Department of Sports and Women, Andalusian Federation of Winter Sports (FADI), 18008 Granada, Spain;
| | - Fátima Olea-Serrano
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain; (M.J.J.-C.); (J.C.-P.); (F.O.-S.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Cristina Bouzas
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (J.A.T.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (J.A.T.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - Miguel Mariscal-Arcas
- Health Science and Nutrition Research (HSNR-CTS1118), Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071 Granada, Spain; (M.J.J.-C.); (J.C.-P.); (F.O.-S.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| |
Collapse
|
4
|
Ghazzawi HA, Hussain MA, Raziq KM, Alsendi KK, Alaamer RO, Jaradat M, Alobaidi S, Al Aqili R, Trabelsi K, Jahrami H. Exploring the Relationship between Micronutrients and Athletic Performance: A Comprehensive Scientific Systematic Review of the Literature in Sports Medicine. Sports (Basel) 2023; 11:109. [PMID: 37368559 DOI: 10.3390/sports11060109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this systematic review is twofold: (i) to examine the effects of micronutrient intake on athletic performance and (ii) to determine the specific micronutrients, such as vitamins, minerals, and antioxidants, that offer the most significant enhancements in terms of athletic performance, with the goal of providing guidance to athletes and coaches in optimizing their nutritional strategies. The study conducted a systematic search of electronic databases (i.e., PubMed, Web of Science, Scopus) using keywords pertaining to micronutrients, athletic performance, and exercise. The search involved particular criteria of studies published in English between 1950 and 2023. The findings suggest that vitamins and minerals are crucial for an athlete's health and physical performance, and no single micronutrient is more important than others. Micronutrients are necessary for optimal metabolic body's functions such as energy production, muscle growth, and recovery, which are all important for sport performance. Meeting the daily intake requirement of micronutrients is essential for athletes, and while a balanced diet that includes healthy lean protein sources, whole grains, fruits, and vegetables is generally sufficient, athletes who are unable to meet their micronutrient needs due to malabsorption or specific deficiencies may benefit from taking multivitamin supplements. However, athletes should only take micronutrient supplements with the consultation of a specialized physician or nutritionist and avoid taking them without confirming a deficiency.
Collapse
Affiliation(s)
- Hadeel Ali Ghazzawi
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Mariam Ali Hussain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Khadija Majdy Raziq
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Khawla Khaled Alsendi
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Reem Osama Alaamer
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Manar Jaradat
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Sondos Alobaidi
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Raghad Al Aqili
- Department Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman 11942, Jordan
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
- Research Laboratory-Education, Motricity, Sport and Health, University of Sfax, Sfax 3000, Tunisia
| | - Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
- Government Hospitals, Ministry of Health, Manama 323, Bahrain
| |
Collapse
|
5
|
Rakovac M, Sajković D. VITAMIN D AND INJURIES IN DANCERS: A SYSTEMATIC REVIEW. Acta Clin Croat 2023; 62:214-223. [PMID: 38304359 PMCID: PMC10829964 DOI: 10.20471/acc.2023.62.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 02/03/2024] Open
Abstract
Vitamin D is involved in many different functions in the human body. Despite the well-known benefits of vitamin D and increasing trends of testing and supplementation, there is still a high prevalence of vitamin D deficiency worldwide, present in the general but also in the highly-active population such as athletes and dancers. Dancers are at a higher risk of vitamin D deficiency due to their long working hours spent indoors, without exposure to sunlight. The high level of workload and physical demands also put dancers at a high risk of injuries. The aim of this review was to systematically analyze the existing evidence on the association of vitamin D (serum level and supplementation) and injuries in dancers. Medline, Scopus, SportDiscus and Web of Science were searched to identify the available peer-reviewed articles. Five articles met the inclusion criteria (two interventional and three observational studies), three of which additionally investigated the relationship between vitamin D and muscle function. The reported results on positive influence of vitamin D serum level or vitamin D supplementation effect on reduced injury occurrence and enhanced muscular function in adolescent and elite professional ballet dancers are promising but the evidence is limited due to a low number of studies, small samples, and methodological limitations.
Collapse
Affiliation(s)
- Marija Rakovac
- University of Zagreb, Faculty of Kinesiology, Zagreb, Croatia
| | | |
Collapse
|
6
|
Fraemke A, Ferrari N, Friesen D, Haas F, Klaudius M, Mahabir E, Schmidt L, Joisten C. HOMA Index, Vitamin D Levels, Body Composition and Cardiorespiratory Fitness in Juvenile Obesity: Data from the CHILT III Programme, Cologne. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042442. [PMID: 35206632 PMCID: PMC8872273 DOI: 10.3390/ijerph19042442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/22/2022]
Abstract
Juvenile obesity is associated with insulin resistance, among other comorbidities. In the pathogenesis of insulin-resistance-related diseases, including obesity and diabetes, Vitamin D deficiency is very common. Therefore, the relationship between insulin resistance, body composition, vitamin D level, and cardiorespiratory fitness in obese children and youth were analyzed based on the Children's Health InterventionaL Trial III project, Germany. Data on vitamin D levels and homeostatic model assessment (HOMA) indices were available from 147 participants (52.4% female; 90.5% obese; 12.3 ± 2.3 years, BMI: 30.5 ± 5.2 kg/m2, BMI standard deviation score (BMI-SDS): 2.52 ± 0.46). Vitamin D levels correlated negatively with the HOMA index, BMI, BMI-SDS, abdominal circumference, and body fat percentage but positively with relative cardiorespiratory fitness (p < 0.05 in each case). In the backward stepwise linear regression analysis, body fat (in kg; β = 0.403) and vitamin D levels (β = -0.154) explained 21.0% of the variance in the HOMA index. In summary, increased body fat and lower vitamin D levels are associated with increased HOMA indices in overweight and obese children and adolescents. In order to prevent potential negative consequences, including the development of manifest Type 2 diabetes, a healthy lifestyle with a vitamin-D-enriched diet and more time spent outdoors should be promoted.
Collapse
Affiliation(s)
- Annika Fraemke
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
- Correspondence:
| | - Nina Ferrari
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
- Cologne Center for Prevention in Childhood and Youth/Heart Center Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - David Friesen
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
| | - Fabiola Haas
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
| | - Marlen Klaudius
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany;
| | - Lisa Schmidt
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany; (N.F.); (D.F.); (F.H.); (M.K.); (L.S.); (C.J.)
| |
Collapse
|
7
|
Abstract
Adolescence (ages 13–18 years) is a period of significant growth and physical development that includes changes in body composition, metabolic and hormonal fluctuations, maturation of organ systems, and establishment of nutrient deposits, which all may affect future health. In terms of nutrition, adolescence is also an important time in establishing an individual’s lifelong relationship with food, which is particularly important in terms of the connection between diet, exercise, and body image. The challenges of time management (e.g., school, training, work and social commitments) and periods of fluctuating emotions are also features of this period. In addition, an adolescent’s peers become increasingly powerful moderators of all behaviours, including eating. Adolescence is also a period of natural experimentation and this can extend to food choice. Adolescent experiences are not the same and individuals vary considerably in their behaviours. To ensure an adolescent athlete fulfils his/her potential, it is important that stakeholders involved in managing youth athletes emphasize eating patterns that align with and support sound physical, physiological and psychosocial development and are consistent with proven principles of sport nutrition.
Collapse
Affiliation(s)
- Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.
| |
Collapse
|
8
|
Wilson-Barnes SL, Hunt JEA, Mendis J, Williams EL, King D, Roberts H, Lanham-New SA, Manders RJF. The relationship between vitamin D status, intake and exercise performance in UK University-level athletes and healthy inactive controls. PLoS One 2021; 16:e0249671. [PMID: 33798240 PMCID: PMC8018647 DOI: 10.1371/journal.pone.0249671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
The potential ergogenic effects of vitamin D (vitD) in high performing athletes has received considerable attention in the literature and media. However, little is known about non-supplemented university athletes and students residing at a higher latitude. This study aimed to investigate the effects of vitD (biochemical status and dietary intake) on exercise performance in UK university athletes and sedentary students. A total of 34 athletes and 16 sedentary controls were studied during the spring and summer months. Serum vitD status and sunlight exposure were assessed using LC-MS/MS and dosimetry, respectively. Muscular strength of the upper and lower body was assessed using handgrip and knee extensor dynamometry (KE). Countermovement jump (CMJ) and aerobic fitness were measured using an Optojump and VO2max test, respectively. Statistical analysis was performed using paired/ independent t-tests, ANCOVA and Pearson/ Spearman correlations, depending on normality. VitD status increased significantly over the seasons, with athletes measuring higher status both in spring (51.7±20.5 vs. 37.2±18.9 nmol/L, p = 0.03) and summer (66.7±15.8 vs 55.6±18.8 nmol/L, p = 0.04) when compared to controls, respectively. Notably, 22% of the subjects recruited were vitD deficient during the spring term only (<25nmol/L, n 9). Subjects with 'insufficient' vitD status (<50nmol/L) elicited significantly lower CMJ when contrasted to the vitD 'sufficient' (>50nmol/l) group (p = 0.055) and a lower VO2 max (p = 0.05) in the spring and summer term (p = 0.05 and p = 0.01, respectively). However, an ANCOVA test showed no significant difference detected for either CMJ or VO2max following adjustments for co-variates. In conclusion, we provide novel information on the vitD status, dietary intake, physical fitness and sunlight exposure of UK young adults across two separate seasons, for which there is limited data at present.
Collapse
Affiliation(s)
- Saskia L. Wilson-Barnes
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Julie E. A. Hunt
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Jeewaka Mendis
- Surrey Clinical Research Centre, Surrey Clinical Trials Unit, NIHR Research Design Service SE, Guildford, Surrey, United Kingdom
| | - Emma L. Williams
- Division of Women’s, Children’s and Clinical Support, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David King
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Harry Roberts
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Susan A. Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Ralph J. F. Manders
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| |
Collapse
|
9
|
Abstract
Vitamin D Deficiency in Sports Abstract. A deficiency in vitamin D is very common in the general population as well as in athletes. The aim of this overview is to assess the level of knowledge about the importance of vitamin D for athletes. A deficiency in vitamin D is present in up to 90 % of athletes. Risk groups are young athletes, female athletes, athletes with a limitation such as paraplegia, vegetarians, athletes with a resorption disorder such as celiac disease, athletes training and competing indoors (e.g. ice hockey, basketball, boxing, rhythmic gymnastics), and older athletes. Dark skin pigmentation, the use of sunscreen, the time of day of the training (early morning, late evening) and the geographical location influence the risk for a deficiency in vitamin D. Exposure to the sun and a balanced diet are often not enough to prevent a vitamin D deficiency.
Collapse
Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, St. Gallen
- Institut für Hausarztmedizin, Universität Zürich, Zürich
| | | | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, Nikaia, Griechenland
- School of Health and Caring Sciences, University of West Attica, Athen, Griechenland
| |
Collapse
|
10
|
Di Luigi L, Antinozzi C, Piantanida E, Sgrò P. Vitamin D, sport and health: a still unresolved clinical issue. J Endocrinol Invest 2020; 43:1689-1702. [PMID: 32632904 DOI: 10.1007/s40618-020-01347-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
Vitamin D metabolites have a pleiotropic role in human physiology, both in static and dynamic conditions, and a lot of vitamin D-related biological effects could influence physical and sport performances in athletes. Probably due to different factors (e.g., drugs, doping, nutrition, ultraviolet B radiation exposure), in athletes a very high prevalence of vitamin D inadequacy (i.e., deficiency or insufficiency) has been observed. Vitamin D inadequacy in athletes could be associated with specific health risks and to alterations of functional capacities, potentially influencing the fine adjustment of physical performances during training and sport competitions. When risk factors for vitamin D inadequacy exist, a preventive vitamin D supplementation is indicated, and if a vitamin D inadequacy is diagnosed, its supplementation is recommended. Unfortunately, on these issues many concerns remain unresolved. Indeed, it is not clear if athletes should be classified as a special population at increased risk for vitamin D inadequacy; moreover, in comparison to the non-athletic population, it is still not clear if athletes should have different reference ranges and different optimal target levels for serum vitamin D, if they have additional health risks, and if they need different type of supplementations (doses) for prevention and/or replacement therapy. Moreover, in athletes also the abuse of vitamin D supplements for ergogenic purposes raise different ethical and safety concerns. In this review, the main physio-pathological, functional and clinical issues that relate vitamin D to the world of athletes are described.
Collapse
Affiliation(s)
- L Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, Università Degli Studi Di Roma "Foro Italico", Piazza Lauro de Bosis, 6, 00135, Rome, Italy.
| | - C Antinozzi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, Università Degli Studi Di Roma "Foro Italico", Piazza Lauro de Bosis, 6, 00135, Rome, Italy
| | - E Piantanida
- Department of Medicine and Surgery, University of Insubria, Via Ravasi 2, 21100, Varese, Italy
| | - P Sgrò
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, Università Degli Studi Di Roma "Foro Italico", Piazza Lauro de Bosis, 6, 00135, Rome, Italy
| |
Collapse
|
11
|
Repeated Sprint Ability Demands in U16 to U19 Highly Trained Handball Players Concerning Playing Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165959. [PMID: 32824520 PMCID: PMC7460303 DOI: 10.3390/ijerph17165959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022]
Abstract
The aim of the study was to determine anaerobic capacity and characterize changes in repeated sprint ability (RSA) within youth elite handball players. For this study, 142 male athletes (17.1 ± 0.9 years) were recruited from a handball sports high school and performed the RSA test on a cycle ergometer, including five 6 s all-out efforts separated by 24 s passive breaks. Maximal (Pmax) and mean (Pmean) power, highest (Wmax), and total work (Wtot) as well as power (Pdec) and work (Wdec) decrement were measured. Significant differences in RSA were noted in relation to age (greater values of Pmax, Pmean, Wtot, Wdec, and Pdec in U19 than U17 as well as greater values of Pmax, Wtot, Wmax, Wdec, and Pdec in U19 than U16 (p < 0.05)) and playing position (wing players had greater Wtot than pivot, 269 vs. 243 (J/kg) (p < 0.05), and wing players differed significantly in absolute and relative power from athletes of other positions). RSA depends on playing position and age in groups of youth handball players and the RSA test can be helpful in the selection of athletes for a playing position. The article introduces normative values for elite youth handball players, empowering coaches in the evaluation of anaerobic abilities and selection.
Collapse
|
12
|
Vitamin D and Cortisol as Moderators of the Relationship Between Testosterone and Exercise Performance in Adolescent Male Athletes. Pediatr Exerc Sci 2020; 32:204-209. [PMID: 32726751 DOI: 10.1123/pes.2019-0229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/16/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Reported associations between vitamin 25(OH)D and exercise performance are equivocal, perhaps due to complex interplay with cortisol and testosterone. In this study, the authors investigated serum 25(OH)D and cortisol as moderators of the testosterone relationship with exercise performance in adolescent male athletes. METHODS A total of 88 ice hockey players were assessed for serum 25(OH)D, cortisol, testosterone, body composition, and exercise performance, based on countermovement jump power and muscle torque. The authors tested independent relationships, before examining complex interactions via moderated regression analyses. RESULTS Most athletes (62.5%) exhibited a suboptimal (20-30 ng·mL-1) serum 25(OH)D concentration, whereas 9.1% of athletes were deficient (<20 ng·mL-1). Serum 25(OH)D was not related to performance when controlling for testing year, age, and fat mass. Further modeling revealed a significant hormonal interaction. Specifically, in low-25(OH)D subjects, testosterone predicted countermovement jump power at a high (β = 7.10, effect size = .43, P < .01), but not low (β = -3.32, effect size = -.20, P = .09), cortisol concentration. CONCLUSIONS Serum 25(OH)D was a poor predictor of exercise performance, but it did moderate (with cortisol) the testosterone link to muscle power. Notably, this relationship emerged among individuals with a 25(OH)D concentration (∼22 ng·mL-1) approaching the deficiency cutoff. Viewing 25(OH)D as a moderating, rather than dose responsive, variable could help explain equivocal cross-sectional associations.
Collapse
|
13
|
Han Q, Li X, Tan Q, Shao J, Yi M. Effects of vitamin D3 supplementation on serum 25(OH)D concentration and strength in athletes: a systematic review and meta-analysis of randomized controlled trials. J Int Soc Sports Nutr 2019; 16:55. [PMID: 31771586 PMCID: PMC6878631 DOI: 10.1186/s12970-019-0323-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022] Open
Abstract
Background The purpose of this systematic review and meta-analysis is to investigate the effects of vitamin D3 supplementation on skeletal muscle strength in athletes. Vitamin D3 supplements or vitamin D3 fortified foods always have claims for bringing people health benefits including bone and muscle health. An up-to-date rigorous systematic review and meta-analysis is important to better understand the effect of vitamin D3 supplementation on muscle strength. Methods English written randomized controlled trials (RCTs) that looked at effects of vitamin D3 supplementation on muscle strength in healthy athletes were searched using three databases (PubMed, Embase and Cochrane Library). Serum 25(OH)D above 30 ng/mL is considered to be sufficient in this systematic review and meta-analysis. Results Five RCTs with 163 athletes (vitamin D3 n = 86, placebo n = 77) met inclusion criteria. Fourteen athletes were lost to follow-up and 149 athletes (vitamin D3 n = 80, placebo n = 69) were documented with complete result. Among athletes with baseline serum 25(OH)D values suggesting insufficiency, vitamin D3 daily dosage at 5000 IU for over 4 weeks led to a serum 25(OH)D concentration of 31.7 ng/mL. Athletes with sufficient serum 25(OH)D level at baseline were recruited in only one study, and the participants of which were assigned to either vitamin D3 at a daily dosage of 3570 IU or placebo for 12 weeks, their serum 25(OH)D sufficiency (VD: 37.2 ± 7.6 vs. 45.6 ± 7.6; PL: 38 ± 6.8 vs. 32 ± 8.4) was well maintained above the cut-off boundary. One repetition maximum Bench Press (1-RM BP) was not improved significantly (SMD 0.07, 95% CI: − 0.32 to 0.47, P = 0.72) and there was no significant increase in maximal quadriceps contraction (SMD -2.14, 95% CI: − 4.87 to 0.59, P = 0.12). Furthermore, there was no significant overall effect of vitamin D3 intervention on muscle strength in this meta-analysis (SMD -0.75, 95% CI: − 1.82 to 0.32, P = 0.17). Conclusion Although, serum 25(OH)D concentrations after supplementation reached sufficiency was observed, muscle strength did not significantly improve at this point of current meta-analysis. Additional well-designed RCTs with large number of participants examined for the effect of vitamin D3 supplementation on serum 25(OH)D concentrations, muscle strength in a variety of sports, latitudes and diverse multicultural populations are needed.
Collapse
Affiliation(s)
- Qi Han
- National Research Institute of Sports Medicine, Beijing, China. .,Beijing Sport University, Beijing, China.
| | - Xueyang Li
- Institute of Scientific and Technical Information of China, Beijing, China
| | - Qiushi Tan
- National Research Institute of Sports Medicine, Beijing, China
| | - Jing Shao
- National Research Institute of Sports Medicine, Beijing, China
| | - Muqing Yi
- National Research Institute of Sports Medicine, Beijing, China.,Beijing Sport University, Beijing, China
| |
Collapse
|
14
|
Wiciński M, Adamkiewicz D, Adamkiewicz M, Śniegocki M, Podhorecka M, Szychta P, Malinowski B. Impact of Vitamin D on Physical Efficiency and Exercise Performance-A Review. Nutrients 2019; 11:nu11112826. [PMID: 31752277 PMCID: PMC6893541 DOI: 10.3390/nu11112826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Vitamin D deficiency amongst athletes and the general population seems to be a prominent problem. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship between vitamin D and bone health. Moreover, its concentrations are associated with muscle function and immune response in both the general and athletic populations. Vitamin D level is strongly connected with the presence of VDRs (vitamin D receptors) in most human extraskeletal cells. Expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation is caused by an exposure of skeletal muscles to vitamin D. The aim of this review is to summarize current understanding of the significance of vitamin D on exercise performance and physical efficiency, as well to analyze the impact of vitamin D on multiple potential mechanisms. More high-quality research studies, considering free 25(OH)D as a better marker of vitamin D status, the baseline level of 25(OH)D and multiple pathways of vitamin D acting and usage in athletes are required.
Collapse
Affiliation(s)
- Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
- Correspondence: (M.W.); (D.A.); (B.M.)
| | - Dawid Adamkiewicz
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
- Correspondence: (M.W.); (D.A.); (B.M.)
| | - Monika Adamkiewicz
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Maciej Śniegocki
- Department of Neurosurgery, Neurotraumatology and Paediatric Neurosurgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
| | - Marta Podhorecka
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
| | - Paweł Szychta
- Department of Plastic, Reconstructive and Aesthetic Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
| | - Bartosz Malinowski
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
- Correspondence: (M.W.); (D.A.); (B.M.)
| |
Collapse
|
15
|
Abstract
OBJECTIVE Both vitamin D and Fe micronutrient deficiencies are common in Saudi Arabia but the association between them is unclear. The present study aimed to determine whether Fe indices are associated with vitamin D status and other metabolic markers in Arab adolescents. DESIGN Single-centre, cross-sectional study gathering anthropometrics, glucose and lipid profile. Serum 25-hydroxyvitamin D (25(OH)D), Fe, total iron-binding capacity (TIBC), transferrin saturation (%) and other parameters were measured. SETTING Vitamin D School Project Database, King Saud University (2014-2016). PARTICIPANTS Arab adolescents aged 10-17 years randomly selected from the Vitamin D School Project Database (170 Saudi students; 100 girls, seventy boys). RESULTS Among Fe indices, only TIBC was found to be significantly and inversely associated with 25(OH)D (r = -0·20; P < 0·01) and only in girls (r = -0·20; P < 0·05). Among cardiometabolic parameters, serum Fe was associated with TAG in boys (r = 0·36; P < 0·01) and inversely associated with HDL-cholesterol in girls (r = -0·29; P < 0·05). Age was the most significant predictor of serum Fe for all participants, accounting for 5 % (R2 = 0·05; P = 0·004) of variance perceived. Serum 25(OH)D and age, on the other hand, were the most significant predictors for TIBC, accounting for 10·1 % (R2 = 0·10; P < 0·001) of variance perceived. CONCLUSIONS Among healthy Arab adolescents, the association between vitamin D and Fe indices, particularly TIBC, is modest, inverse and sex-dependent. Larger studies with inclusion of markers such as hepcidin and ferritin, vitamin D metabolites and endogenous sex hormones may provide a clearer view of this complex association.
Collapse
|
16
|
Mielgo-Ayuso J, Calleja-González J, Urdampilleta A, León-Guereño P, Córdova A, Caballero-García A, Fernandez-Lázaro D. Effects of Vitamin D Supplementation on Haematological Values and Muscle Recovery in Elite Male Traditional Rowers. Nutrients 2018; 10:nu10121968. [PMID: 30545134 PMCID: PMC6315465 DOI: 10.3390/nu10121968] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Deficient levels of 25-hydroxyvitamin D (25(OH)D) (<30 ng/mL) may compromise health and athletic performance. Supplementation with oral vitamin D can favor the state of iron metabolism, and testosterone and cortisol as an indicator of muscle recovery of the athlete with a deficiency. The main aim of this study was to evaluate the influence of eight weeks of supplementation with 3000 IU/day of vitamin D on the hematological and iron metabolism profile, as well as on the analytical values of testosterone and cortisol on elite male traditional rowers. The secondary aim was to examine if serum 25(OH)D is a predictor of testosterone and cortisol levels. MATERIAL AND METHODS Thirty-six elite male rowers (27 ± 6 years) were assigned to one of the two groups randomly: 1) Control group (CG, n = 18, height: 181.05 ± 3.39 cm and body mass: 77.02 ± 7.55 kg), 2) Group treated with 3,000 IU of vitamin D3/day (VD3G, s = 18, height: 179.70 ± 9.07 cm and body mass: 76.19 ± 10.07 kg). The rowers were subjected to blood tests at the beginning of the study (T1) and after eight weeks of treatment (T2), for the analysis of hematological and hormonal values. Repeated-measures ANOVA with group factor (GC and GVD3) were used to examine if the interaction of the different values was the same or different between the groups throughout the study (time × group) after vitamin D3 treatment. To analyze if 25(OH)D was a good predictor of testosterone, cortisol, and testosterone/cortisol ratio a stepwise regression model was performed. RESULTS Statistically significant and different increases were observed in the group-by-time interaction of 25(OH)D in VD3G in respect to CG during the study (p < 0.001; VD3G (T1: 26.24 ± 8.18 ng/mL vs. T2: 48.12 ± 10.88 ng/mL) vs CG (T1: 30.76 ± 6.95 ng/mL vs. T2: 35.14 ± 7.96 ng/mL). Likewise, significant differences between groups were observed throughout the study in the group-by-time interaction and changes of hemoglobin (GC: -2.89 ± 2.29% vs. VD3G: 0.71 ± 1.91%; p = 0.009), hematocrit (CG: -1.57 ± 2.49% vs. VD3G: 1.16 ± 1.81%; p = 0.019) and transferrin (CG: 0.67 ± 4.88% vs. VD3G: 6.51 ± 4.36%; p = 0.007). However, no differences between groups were observed in the group-by-time interaction of the hormonal parameters (p > 0.05). Regression multivariate analysis showed that cortisol and testosterone levels were associated with 25(OH)D levels (p < 0.05). CONCLUSION Oral supplementation with 3000 IU/day of vitamin D3 during eight weeks showed to be sufficient to prevent a decline in hematological levels of hemoglobin and hematocrit, and improve transferrin of 25(OH)D levels. However, although it was not sufficient to enhance muscle recovery observed by testosterone and cortisol responses, it was observed that serum 25(OH)D levels could be a predictor of anabolic and catabolic hormones.
Collapse
Affiliation(s)
- Juan Mielgo-Ayuso
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, 42004 Soria, Spain.
| | - Julio Calleja-González
- Department of Physical Education and Sports, University of Basque Country (UPV-EHU), 01007 Vitoria, Spain.
| | | | - Patxi León-Guereño
- Faculty of Psychology and Education, University of Deusto, Campus of Donostia-San Sebastián, 20012 San Sebastián, Guipúzcoa, Spain.
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, 42004 Soria, Spain.
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Physical Therapy, University of Valladolid, 42004 Soria, Spain.
| | - Diego Fernandez-Lázaro
- Department of Cell Biology, Histology and Pharmacology, Faculty of Physical Therapy, University of Valladolid, 42004 Soria, Spain, .
| |
Collapse
|