Respiratory disorders in endurance athletes - how much do they really have to endure?

Comparison of face mask effects on cardiorespiratory responses between physically active and sedentary individuals

BACKGROUND

Alterations caused by face masks on physiological responses vary among different population groups. This study aimed to investigate whether physically active and sedentary individuals respond differently to face mask use during exercise.

METHODS

Sixteen healthy college students were divided into two groups: Physically active group (N.=10; 26.50±2.80 years) and Sedentary group (N.=6; 26.33±2.81 years). They performed three maximal cardiopulmonary exercise test (CPET)s following the Bruce protocol: one without a face mask (NON), one with a surgical mask (SUR) and one with a cloth mask (CLO). Cardiorespiratory parameters and heart rate were monitored continuously during the test. Blood pressure, oxygen saturation and lactate level were measured immediately before and after exertion.

RESULTS

Significant differences were found between the Physically active and the Sedentary group in peak VO2 (VO2peak) in NON (P=0.030). However, this difference disappeared when the face masks were used. Furthermore, VO2/kg (P=0.002) and METs (P=0.002) decreased significantly at the respiratory compensation point (RCP) only in the Physically active group with face masks. No significant differences were found between the two groups for exercise time, lactate level and dyspnea (P>0.05).

CONCLUSIONS

The decrease in exercise tolerance and cardiorespiratory responses, particularly VO2peak, due to face mask use was greater in physically active individuals compared to sedentary individuals. Population group characteristics should be considered when adapting face masks to daily life.

Functional nutrition for the health of exercising individuals and elite sportspersons

INTRODUCTION

Elite sportspersons who are involved in high-intensity physical sports indulge in severe training and competition schedules, which exposes them to high levels of inflammatory and oxidative stress, hence it may hamper their health sometimes. Disturbance in the health of sportspersons also induces compromised performances.

THE PREMISE FOR FUNCTIONAL NUTRITION

Functional nutrition is essential for elite sportspersons training for securing both rest and recovery to have proper health and anticipated performance. Apart from serving the energy needs of the sportspersons, the nutrition strategies should provide them with certain metabolic advantages, which provide greater health and immunity, to ensure proper training and competition. The diet of the sportspersons needs to contain appropriate anti-inflammatory and antioxidative nutrients, to ensure to reduction and control of the physiological stress of tissues during high-intensity physical sports, especially during marathon running. Preserving anabolic valence among sportspersons for muscle myokine optimization is an essential aspect of sports nutrition, which secures health and provides excellent performance potential. Preservation and optimization of gut microbiome among sportspersons enhance immune health and performance, through proper gut integrity and enhanced metabolic cascades. As the genes are to be properly expressed for excellent manifestation in protein synthesis and other metabolic signaling, achieving genetic valance through proper nutrition ensures the health of the sportspersons.

CONCLUSION

Functional nutrition seems a very necessary and potent factor in the training and competition aspects of elite sportspersons since nutrition not only provides recovery but also ensures proper health for elite sportspersons.

Examining the Interaction between Exercise, Gut Microbiota, and Neurodegeneration: Future Research Directions

Physical activity has been demonstrated to have a significant impact on gut microbial diversity and function. Emerging research has revealed certain aspects of the complex interactions between the gut, exercise, microbiota, and neurodegenerative diseases, suggesting that changes in gut microbial diversity and metabolic function may have an impact on the onset and progression of neurological conditions. This study aimed to review the current literature from several databases until 1 June 2023 (PubMed/MEDLINE, Web of Science, and Google Scholar) on the interplay between the gut, physical exercise, microbiota, and neurodegeneration. We summarized the roles of exercise and gut microbiota on neurodegeneration and identified the ways in which these are all connected. The gut-brain axis is a complex and multifaceted network that has gained considerable attention in recent years. Research indicates that gut microbiota plays vital roles in metabolic shifts during physiological or pathophysiological conditions in neurodegenerative diseases; therefore, they are closely related to maintaining overall health and well-being. Similarly, exercise has shown positive effects on brain health and cognitive function, which may reduce/delay the onset of severe neurological disorders. Exercise has been associated with various neurochemical changes, including alterations in cortisol levels, increased production of endorphins, endocannabinoids like anandamide, as well as higher levels of serotonin and dopamine. These changes have been linked to mood improvements, enhanced sleep quality, better motor control, and cognitive enhancements resulting from exercise-induced effects. However, further clinical research is necessary to evaluate changes in bacteria taxa along with age- and sex-based differences.

Wearable technology in the sports medicine clinic to guide the return-to-play and performance protocols of athletes following a COVID-19 diagnosis

The coronavirus disease 2019 (COVID-19) pandemic has enabled the adoption of digital health platforms for self-monitoring and diagnosis. Notably, the pandemic has had profound effects on athletes and their ability to train and compete. Sporting organizations worldwide have reported a significant increase in injuries manifesting from changes in training regimens and match schedules resulting from extended quarantines. While current literature focuses on the use of wearable technology to monitor athlete workloads to guide training, there is a lack of literature suggesting how such technology can mediate the return to sport processes of athletes infected with COVID-19. This paper bridges this gap by providing recommendations to guide team physicians and athletic trainers on the utility of wearable technology for improving the well-being of athletes who may be asymptomatic, symptomatic, or tested negative but have had to quarantine due to a close exposure. We start by describing the physiologic changes that occur in athletes infected with COVID-19 with extended deconditioning from a musculoskeletal, psychological, cardiopulmonary, and thermoregulatory standpoint and review the evidence on how these athletes may safely return to play. We highlight opportunities for wearable technology to aid in the return-to-play process by offering a list of key parameters pertinent to the athlete affected by COVID-19. This paper provides the athletic community with a greater understanding of how wearable technology can be implemented in the rehabilitation process of these athletes and spurs opportunities for further innovations in wearables, digital health, and sports medicine to reduce injury burden in athletes of all ages.

Prevalence of Asthma among Norwegian Elite Athletes

Objective

Asthma is a common problem among elite athletes and represents a health risk interfering with the athlete's performance status. This study aimed to evaluate the asthma prevalence among Norwegian summer and winter elite athletes and asthma prevalence across sport categories. We also aimed to examine whether bronchial hyperresponsiveness (BHR), lung function, fraction of exhaled nitric oxide (FENO), and allergy status differed between asthmatic and non-asthmatic elite athletes.

Methods

Norwegian athletes qualifying for the Beijing Olympic Summer Games 2008 (n = 80) and the Vancouver Olympic Winter Games 2010 (n = 55) were included. The athletes underwent clinical respiratory examination including lung function measurement, methacholine bronchial challenge for assessment of BHR, FENO, and skin prick testing. Asthma was diagnosed based on respiratory symptoms and clinical examination including objective measurements.

Results

Asthma was more prevalent among winter athletes (50%) than summer athletes (20%). Thirty-three (52%) endurance athletes, 3 (6%) team sport athletes, and 7 (33%) technical sport athletes had medically diagnosed asthma. Significantly lower lung function (p < 0.001) and higher prevalence of severe BHR (p < 0.001) were found in asthmatic athletes compared with non-asthmatic athletes.

Conclusion

Asthma is common among Norwegian elite athletes, with winter and endurance athletes showing the highest prevalence. Asthmatic athletes were characterized by lower lung function and more severe BHR compared with non-asthmatic counterparts. The high prevalence among winter and endurance athletes demonstrates a need for increased attention to prevent and reduce the prevalence of asthma among those athletes.

Cardiopulmonary Exercise Test Parameters in Athletic Population: A Review

Although still underutilized, cardiopulmonary exercise testing (CPET) allows the most accurate and reproducible measurement of cardiorespiratory fitness and performance in athletes. It provides functional physiologic indices which are key variables in the assessment of athletes in different disciplines. CPET is valuable in clinical and physiological investigation of individuals with loss of performance or minor symptoms that might indicate subclinical cardiovascular, pulmonary or musculoskeletal disorders. Highly trained athletes have improved CPET values, so having just normal values may hide a medical disorder. In the present review, applications of CPET in athletes with special attention on physiological parameters such as VO₂max, ventilatory thresholds, oxygen pulse, and ventilatory equivalent for oxygen and exercise economy in the assessment of athletic performance are discussed. The role of CPET in the evaluation of possible latent diseases and overtraining syndrome, as well as CPET-based exercise prescription, are outlined.

Cough in the Athlete: CHEST Guideline and Expert Panel Report

BACKGROUND

Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed.

METHODS

This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process.

RESULTS

Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes.

CONCLUSIONS

The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.

Asthma prevalence in German Olympic athletes: A comparison of winter and summer sport disciplines

BACKGROUND

Prevalence of asthma in elite athletes shows very wide ranges. It remains unclear to what extent this is influenced by the competition season (winter vs. summer) or the ventilation rate achieved during competition. The aim of this study was to evaluate prevalence of asthma in German elite winter and summer athletes from a wide range of sport disciplines and to identify high risk groups.

METHODS

In total, 265 German elite winter athletes (response 77%) and 283 German elite summer athletes (response 64%) answered validated respiratory questionnaires. Using logistic regression, the asthma risks associated with competition season and ventilation rate during competition, respectively, were investigated. A subset of winter athletes was also examined for their FENO-levels and lung function.

RESULTS

With respect to all asthma outcomes, no association was found with the competition season. Regarding the ventilation rate, athletes in high ventilation sports were at increased risk of asthma, as compared to athletes in low ventilation sports (doctors' diagnosed asthma: OR 2.32, 95% CI 1.19-4.53; use of asthma medication: OR 4.46, 95% CI 1.52-13.10; current wheeze or use of asthma medication: OR 2.78, 95% CI 1.34-5.76). Athletes with doctors' diagnosed asthma were at an approximate four-fold risk of elevated FENO-values.

CONCLUSIONS

The clinically relevant finding of this study is that athletes' asthma seems to be more common in sports with high ventilation during competition, whereas the summer or winter season had no impact on the frequency of the disease. Among winter athletes, elevated FENO suggested suboptimal control of asthma.

Airway dysfunction in elite swimmers: prevalence, impact, and challenges

The prevalence of airway dysfunction in elite swimmers is among the highest in elite athletes. The traditional view that swimmers naturally gravitate toward swimming because of preexisting respiratory disorders has been challenged. There is now sufficient evidence that the higher prevalence of bronchial tone disorders in elite swimmers is not the result of a natural selection bias. Rather, the combined effects of repeated chlorine by-product exposure and chronic endurance training can lead to airway dysfunction and atopy. This review will detail the underpinning causes of airway dysfunction observed in elite swimmers. It will also show that airway dysfunction does not prevent success in elite level swimming. Neither does it inhibit lung growth and might be partially reversible when elite swimmers retire from competition.

Asthma prevalence in Olympic summer athletes and the general population: An analysis of three European countries

BACKGROUND

Some studies have shown a higher prevalence of asthma in elite athletes as compared to the general population. It is inconclusive to what extent certain sport categories are especially affected. The present study offered a unique opportunity to assess these differences in asthma prevalence in the general population and elite summer athletes from a wide range of sport disciplines across various geographical areas.

METHODS

Cross-sectional data for 1568 general population participants from the European Community Respiratory Health Survey II and 546 elite athletes from the Global Allergy and Asthma European Network Olympic study from three European countries were analyzed. Using logistic regression, the asthma risks associated with athlete sport practice, endurance level and aquatic sport practice, respectively, were investigated.

RESULTS

Athletes in the highest endurance category had increased risk of doctor-diagnosed asthma (OR 3.5; 95% CI 1.7-7.5), asthma symptoms (OR 3.0; CI 1.5-6.0) and asthma symptoms or medication use (OR 3.5; CI 1.8-6.7) compared to the general population. Aquatic athletes were at increased risk of doctor-diagnosed asthma (OR 2.0; CI 1.1-3.9), asthma symptoms (OR 2.6; CI 1.3-5.0) and asthma symptoms or medication use (OR 2.3; CI 1.2-4.4) when compared to individuals not involved in aquatic sports. Regarding the entire athlete population, no increase in asthma was found when compared to the general population.

CONCLUSIONS

Practice of very high endurance and aquatic sports may be associated with increased asthma risks. Athlete participation as such showed no association with asthma risk.