The impact of circadian misalignment on athletic performance in professional football players

Motoric performance variation from morning to evening: 80% intensity post-activation potentiation protocol impacts performance and its diurnal amplitude in basketball players

Introduction

Post-activation potentiation (PAP) can be defined as the acute enhancement in muscle performance after preload stimulation that occurs during strength exercises or warm-up protocols, and the contractile history of any muscle group can directly influence the presented performance. The purpose of this study was to compare the results of motoric performance tests carried out at two different times of the day using three different PAP protocols.

Methods

Thirty-two male basketball players with at least 2 years of training experience and who competed at the national level were recruited for this study [age: 21.80 ± 1.91 years; body height: 178.40 ± 6.85 cm; body mass: 72.50 ± 7.16 kg; body mass index (BMI): 22.81 ± 2.28]. After control and experimental-specific warm-up (SWU) sessions, participants completed a countermovement jump (CMJ) and seated medicine ball throw (SMBT). The SWU protocol was developed based on the athlete's typical warm-up routine. The experimental warm-ups included the same exercises as the SWU, with one set of bench presses for five repetitions at 80% (80% PAP) and one repetition at 100% of 1 RM (100% PAP). Each of the protocols consists of 15 min. The SWU and experimental warm-up sessions were completed in a random, counterbalanced order, completed in a period of 3-weeks.

Results

According to the research findings, carrying out the protocols in the evening led to a larger improvement in SMBT than in the morning (F = 35.94, p < 0.001, η ² _p = 0.537). Additionally, the SMBT results were statistically more significant in the group that received 80% PAP compared to the SWU (p = 0.034), and the SMBT results were also higher in the group that received 100% PAP compared to the SWU (p = 0.002). Furthermore, the interaction effect (time × PAP) was statistically significant in SMBT (F = 6.39, p = 0.003, η ² _p = 0.17).

Discussion

These results may provide more particular recommendations than previously thought to basketball coaches for the planning of basketball-specific PAP exercises prior to the start of training programs.

Travel across time zones and the implications for human performance post pandemic: Insights from elite sport

Notwithstanding technological innovation, the COVID-19 pandemic, and new communication tools, the need for travel is growing again and, in some travel segments, it is stronger than ever. Interestingly, the public health implications of traveling across time zones are still poorly understood and this is especially true for organizations that send their workers across the globe. Using data from 173 Olympic teams over 15 Olympic Games, we show that crossing multiple time zones has negative implications for human (sports) performance. More importantly, the results indicate that performance impairment is especially visible after flying east, with peak performance particularly impaired, leading to a "gold demotion effect" of gold medals to silver medals as a result. Given that Olympic sporting teams typically have dedicated medical staff and active mitigation strategies, these findings have important public health implications. For example, organizations are demanding their workers to be on "top of their game" while traveling, without providing them with the support and tools to do so. The implications for public health management and human resource management are discussed.

Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association

STUDY OBJECTIVES

Travel fatigue and circadian disruptions are known factors that can hinder performance in professional athletes. The present study focused on travel distance and direction on back-to-back games over the 2013-2020 seasons in the National Basketball Association (NBA).

METHODS

The outcomes were based on winning percentage with additional covariates including the direction of travel (eastward or westward), the distance traveled (0-500 km; 501-1,000 km; 1,001-1,500 km; 1,501 km and more), team quality, and season. If a team played both games of a back-to-back sequence on the road, they were considered Away-Away; if a team played the first game of a back-to-back sequence at home they were considered Home-Away; if a team played the first game of a back-to-back sequence on the road they were considered Away-Home.

RESULTS

The sequence Away-Home significantly increases the likelihood of winning compared with the Away-Away and Home-Away sequences: 54.4% (95% confidence interval [CI], 54.4%-54.5%), 39.2% (95% CI, 37.2%-41.2%), and 36.8% (95% CI, 36.7%-36.8%), respectively. When teams travel back home, every additional 500 km reduces the likelihood of winning by approximately 4% (P = .038). Finally, after withdrawing the Away-Home sequence, traveling eastward significantly increases the chance of winning (P = .024) compared with westward travel but has no significant impact on the probability of winning compared with neutral time zone travel (P = .091).

CONCLUSIONS

The accumulation of travel fatigue and the chronic circadian desynchronization that occurs over the NBA season can acutely disturb sleep and recovery. It appears that tailored sleep and recovery strategies need to be dynamically developed throughout the season to overcome the different challenges of the NBA schedule.

CITATION

Charest J, Samuels CH, Bastien CH, Lawson D, Grandner MA. Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association. J Clin Sleep Med. 2021;17(11):2269-2274.

How does sleep help recovery from exercise-induced muscle injuries?

OBJECTIVES

Athletes and military personnel may experience sleep disturbances due to conditions of training and competitions or military missions/field operations. The risk of muscle injuries is greater for them when sleep duration decreases, and training load increases simultaneously, which can be exacerbated by fatigue. Accumulating evidence demonstrates that sleep extension improved performance, pain sensitivity and GH/IGF-I anabolic responses, which may be beneficial in accelerating recovery from muscle injuries.

DESIGN & METHODS

This narrative review describes the importance of sleep for the recovery/prevention of exercise-induced muscle injuries and provides perspectives on the transferability of currently available scientific evidence to the field.

RESULTS

The first part presents the role of sleep and its interaction with the circadian system for the regulation of hormonal and immune responses, and provides information on sleep in athletes and soldiers and its relationship to injury risk. The second part is an overview of muscle injuries in sport and presents the different phases of muscle regeneration and repair, i.e. degeneration, inflammation, regeneration, remodeling and maturation. Part three provides information on the deleterious effects of sleep deprivation on muscle tissue and biological responses, and on the benefits of sleep interventions. Sleep extension could potentially help and/or prevent recovery from exercise-induced muscle-injuries through increasing local IGF-I and controlling local inflammation.

CONCLUSIONS

Although the science of sleep applied to sport is still an emerging field, the current scientific literature shows many potential physiological pathways between sleep and exercise-related muscle injuries. More direct studies are needed to establish clear guidelines for medical personnel and coaches.

Influence of circadian rhythms on sports performance

Chronobiology is the scientific discipline of study of biological rhythms, a term that has gained ground in the sports world. Recently numerous studies have indicated that the time of day in which sports are practiced influences the achievement of good physical performance. The aim of this review was to study the relationship between circadian rhythms and physical performance, according to the latest published data. In addition, the physiological processes involved in the physical response and the differences according to the type of sport and athletes' characteristics were studied. A bibliographic search was carried out through five databases (Pubmed, Scopus, Researcher Gate, Google Scholar, UOC Library), focusing on articles published in the last ten years and written in English and Spanish. 36 papers met the inclusion criteria. Body temperature is a factor that shows a circadian pattern with a marked peak in the later afternoon, time of the day at which physical performance is at its highest, i.e. speed, agility, distance covered, jumping power. The perception of effort is also higher in the afternoon. Regarding the chronotype, evening types seem to be the most affected to do sports out of their optimal time-of-day. The tendency shows more morning types as age increases. Training sessions should be planned according to the optimal time of day for each athlete. It's essential to take into account individual chronotype. The desynchronization of circadian rhythms can cause a decrease in physical performance.

Does the chronotype distribution vary between different level football leagues? Insights gained from Czech elite football players

Chronotype refer to individuals' time-of-day preferences for activities, which can be classified as "morning types = (M-types)", "evening types = (E-types)", and "neither types (N-types)". The primary aim of this study was to compare the chronotype distribution of Czech First League (1L) and Czech National Football League (2L) male elite football players, which was divided into two secondary aims: (i) statistically identify and compare the number (presence) of particular chronotypes in 1L, and (ii) statistically identify and compare the number (presence) of particular chronotypes in 2L. The present cross-sectional study employed a self-reported standardized questionnaire, the Composite Scale of Morningness, to study the chronotype distribution among the male elite football players. The chronotype distribution of 139 (85 from 1L with mean age ± S.D. = 25.5 ± 3.7 years and 54 from 2L age = 24.4 ± 4.5 years) players was assessed. Overall, 61 (71.8%) of the participants from 1L were mainly N-types, followed by M- and E-types. Similarly, 40 (74.1%) participants from 2L were mainly N-types, followed by M- and E-types. The statistical analysis of the 1L players showed a significantly higher presence of N-types compared to M- and E-types (χ²₍₂₎ = 57.62, p < .05, V = .58). The same results were detected in 2L, where the N-type was identified in the majority of football players (χ²₍₂₎ = 57.62, p < .05, V = .58). The statistical comparison of the number of presented chronotypes did not show a significant difference (F = 3.29, p > .05, V = .16) between players of the 1L and 2L. Thus, N-types are dominant among Czech elite football players, and the chronotype distribution of male elite football players from the Czech First League and the Czech National Football League does not vary.

Urgent wake up call for the National Basketball Association

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Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) team during the season, often results in accompanying sleep disturbances related to sleep length, sleep quality, and sleep timing (with highly harmful impacts on health, both physical and mental). These issues are not only problematic for NBA players, but also the coaches, training staff, and management support. In this narrative review, we summarize the detrimental effects that this travel and game schedule could have on NBA team members' sleep, as well as their physical and mental health. Multiple peer-reviewed articles address the role of sleep in athletic performance and health; however, to date, the literature focused on sleep-related issues that are unique to the NBA schedule is scarce. Firstly, this review addresses the impact of the NBA schedule, outlining the number of games and the travel involved (number of flights, the timing of flights, timings of arrival at destination and hotel); we also outline a typical daily NBA travel schedule, providing the reader a glimpse of what this encompasses. Secondly, we provide a brief overview of sleep science and discuss specific applications related to the NBA. Finally, we provide comment on the unique current situation of the NBA "bubble". Based on this review, there appears to be considerable scope for further investigation of the acute and chronic effects of sleep disturbances concerning the NBA travel and game schedule. Sleep science recommendations need to inform practice, target sleep interventions, and personalized protocols designed to enhance sleep health that can be incorporated at the organizational level.

Effect of chronotype on motor skills specific to soccer in adolescent players

Circadian rhythms influence daily behavior, psychological and physiological functions, as well as physical performance. Three chronotypes are distinguished according to the preferences people typically display for activity at certain times of day: Morning, Neither, and Evening types (M-, N- and E-types). The chronotype changes with age: eveningness tends to be stronger in youth and morningness in older age. The progressive shift toward eveningness during adolescence creates misalignment with morning society schedules and can lead to a deterioration in intellectual and physical performance. Soccer is one of the world's most popular sports practiced by adolescents and soccer workouts are usually held after school in the afternoon or evening. Performance in soccer is related to a host of factors, including physiological variables and motor skills that have a circadian variation. The aim of this study was to determine the effect of chronotype on motor skills specific to soccer, specifically whether agility, aerobic endurance, and explosive power differ among the three chronotypes in relation to the time of day. For this study 141 adolescent soccer players filled in the Morningness-Eveningness Questionnaire (MEQ) for the assessment of chronotype. A subsample of 75 subjects, subdivided in M-types (n= 25), E-types (n= 25), and N-types (n= 25), performed three tests (Sargent Jump Test - SJT, Illinois Agility Test - IAT, and 6-Minutes Run Test - 6MRT) at a morning and an evening training session (9:00 am and 6:00 pm). Mixed ANOVA was used to test the interactions between chronotypes, physical performance, and time. On all tests, better performance during the morning than the evening session was observed for the M-types (p< .05), whereas the E-types performed better in the evening than in the morning session (p< .05), and no differences in test performance were detected for the N-types. These findings underline the importance of a correct chronobiological approach to sports training. Scheduling training sessions according to an athlete's circadian preferences could be a valid strategy to enhance performance.

Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders

Sports psychiatry has developed for the past 3 decades as an emerging field within psychiatry and sports medicine. An International society has been established in 1994 and also national interest groups were implemented, mostly within the national organizations for psychiatry, some also containing the topic of exercise treatment of mental disorders. Where are we now 30 years later? We systematically but also selectively review the medical literature on exercise, sport, psychiatry, mental health and mental disorders and related topics. The number of publications in the field has increased exponentially. Most topics keep remaining on the agenda, e.g., head trauma and concussion, drug abuse and doping, performance enhancement, overtraining, ADHD or eating disorders. Supported by the growing literature, evidence-based recommendations have become available now in many clinical areas. A relatively new phenomenon is muscle dysmorphia, observed in weightlifters, bodybuilders but also in college students and gym users. Further, sports therapy of mental disorders has been studied by more and more high-quality randomized controlled clinical trials. Mostly as a complementary treatment, however, for some disorders already with a 1a evidence level, e.g., depression, dementia or MCI but also post-traumatic stress disorder. Being grown up and accepted nowadays, sports psychiatry still represents a fast-developing field. The reverse side of the coin, sport therapy of mental disorders has received a scientific basis now. Who else than sports psychiatry could advance sport therapy of mental disorders? We need this enthusiasm for sports and psychiatry for our patients with mental disorders and it is time now for a broadening of the scope. Optimized psychiatric prevention and treatment of athletes and ideal sport-related support for individuals with mental disorders should be our main purpose and goal.

Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations

For elite athletes who exercise at a high level, sleep is critical to overall health. Many studies have documented the effects of sleep deprivation in the general population, but few studies exist regarding specific effects in the athlete. This review summarizes the effects of sleep deprivation and sleep extension on athletic performance, including reaction time, accuracy, strength and endurance, and cognitive function. There are clear negative effects of sleep deprivation on performance, including reaction time, accuracy, vigor, submaximal strength, and endurance. Cognitive functions such as judgment and decision-making also suffer. Sleep extension can positively affect reaction times, mood, sprint times, tennis serve accuracy, swim turns, kick stroke efficiency, and increased free throw and 3-point accuracy. Banking sleep (sleep extension prior to night of intentional sleep deprivation before sporting event) is a new concept that may also improve performance. For sports medicine providers, the negative effects of sleep deprivation cannot be overstated to athletes. To battle sleep deprivation, athletes may seek supplements with potentially serious side effects; improving sleep quality however is simple and effective, benefiting not only athlete health but also athletic performance.

Fatigue Risk Management: The Impact of Anesthesiology Residents' Work Schedules on Job Performance and a Review of Potential Countermeasures

Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being. We then propose countermeasures that have been implemented to mitigate the effects of fatigue and describe how training programs or practice groups who must work overnight can adapt these strategies for use in a hospital setting. Countermeasures include the use of scheduling interventions, strategic naps, microbreaks, caffeine use during overnight and extended shifts, and the use of bright lights in the clinical setting when possible or personal blue light devices when the room lights must be turned off. Although this review focuses primarily on anesthesiology residents in training, many of the mitigation strategies described here can be used effectively by physicians in practice.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Resetting the late timing of 'night owls' has a positive impact on mental health and performance

BACKGROUND

There is conflict between living according to our endogenous biological rhythms and our external environment, with disruptions resulting in negative consequences to health and performance. This is often documented in shift work and jet lag, but 'societal norms' (eg, typical working hours) can create profound issues for 'night owls', people whose internal biological timing predisposes them to follow an unusually late sleep-wake cycle. Night owls have also been associated with health issues, mood disturbances, poorer performance and increased mortality rates.

METHODS

This study used a randomized control trial design aimed to shift the late timing of night owls to an earlier time (phase advance), using non-pharmacological, practical interventions in a real-world setting. These interventions targeted light exposure (through earlier wake up/sleep times), fixed meals times, caffeine intake and exercise.

RESULTS

Overall, participants demonstrated a significant advance of ∼2 h in sleep/wake timings as measured by actigraphy and circadian phase markers (dim light melatonin onset and peak time of the cortisol awakening response), whilst having no adverse effect on sleep duration. Notably, the phase advance was accompanied by significant improvements to self-reported depression and stress, as well as improved cognitive (reaction time) and physical (grip strength) performance measures during the typical 'suboptimal' morning hours.

CONCLUSIONS

Our findings propose a novel strategy for shifting clock timing towards a pattern that is more aligned to societal demands that could significantly improve elements of performance, mental health and sleep timing in the real world.

The elite athlete as a special risk traveler and the jet lag's effect: lessons learned from the past and how to be prepared for the next Olympic Games 2020 Tokyo

BACKGROUND

Elite athletes have to travel long-haul distances and cross multiple meridians; thus, a unique syndrome named as jet-lag is induced. Furthermore, traveler athletes are submitted to several factors negatively affecting their well-being and athletic performance. This qualitative descriptive study aims to promote safely and future promising participations of elite athletes in great events, such as the next Olympic Games 2020 Tokyo, based on the chronobiology of jet-lag, factors affecting the traveler athlete and previous experiences from the 2014 FIFA World Cup Brazil, the 2018 FIFA World Cup Russia and the Olympic Games Rio 2016.

METHODS

A narrative review of the literature across a broad cross-section of the chronobiology of jet-lag and factors affecting the traveler athlete was undertaken. In addition, a general analysis based on the past sport events aforementioned is also included.

RESULTS

The jet-lag disorder may occur after transmeridian travel over more than three time-zones and the resynchronization is dependent on the direction and number of the time-zones crossed and the availability and the intensity of local circadian time cues. Also the athlete's ability to sleep, eat, get hydrated and train, are essential, as well as, others individual tolerance differences, such as age, gender, chronotype and ethnic differences. Athletes should arrive a number of days before the competition according to the number of time-zone transitions experienced.

CONCLUSIONS

Jet-lag is usually benign and self-limited, but can occasionally have serious consequences for the athlete's mental and physical health and performance. A good plan concerning the athlete's traveling schedule, sleeping, eating and training before and after travelling is mandatory.

Association between late-night tweeting and next-day game performance among professional basketball players

OBJECTIVES

In sports, decreased sleep duration is generally associated with poorer performance compared to adequate or enhanced sleep duration. Yet, these findings have primarily been taken from small numbers of athletes performing outside of real games or competitions. It remains unknown how acute decreased sleep duration impacts real-game performance among professional athletes. Here, we merged 2 publicly available datasets to jointly measure late-night social media activity (a proxy for sleep deprivation) and next-day game performance.

SETTING

Professional basketball competition.

PARTICIPANTS

112 players from the National Basketball Association.

MEASUREMENTS

Time-stamped social media activity and in-game individual performance statistics.

RESULTS

Late-night tweeting (compared to not late-night tweeting) is associated with within-person reductions in next-day game performance, including fewer points scored and fewer rebounds. However, we also observe less time played per game following late-night tweets and decreases in the negative outputs of turnovers and personal fouls. The critical measure of shooting accuracy - which is not time dependent - provides the clearest evidence of a performance penalty following late-night tweeting activity (between 11:00 pm and 7:00 am); players successfully make shots at a rate 1.7 percentage points less following late-night tweeting.

CONCLUSIONS

Our findings suggest that acute sleep deprivation, as measured via late-night Twitter activity, is associated with changes in next-day game performance among professional National Basketball Association athletes. More broadly, the use of late-night social media activity may serve as a useful general proxy for sleep deprivation in other social, occupational, and physical performance-based contexts.

The effects of time of day and chronotype on cognitive and physical performance in healthy volunteers

Background

Whether you are a morning lark or a night owl has proven to be a key contributor in the timing of peak athletic performance. Recent evidence suggests that accounting for these differences, known as one’s chronotype, results in significantly different diurnal performance profiles. However, there is limited research investigating multiple measures of performance simultaneously over the course of a socially constrained day.

Objectives

This study aimed to investigate the impact of chronotype on indices of cognitive and physical performance at different times of day in healthy volunteers.

Methods

We recruited 56 healthy individuals categorised as early (ECT, n = 25) or late (LCT, n = 31) chronotypes using the Munich ChronoType Questionnaire, circadian phase markers and objective actigraphy. Measures of cognitive and physical performance, along with self-reported daytime sleepiness, were taken at multiple times of day (14:00 h, 20:00 h and 08:00 h the following morning).

Results

Here, we find significantly different diurnal variation profiles between ECTs and LCTs, for daytime sleepiness, psychomotor vigilance, executive function and isometric grip strength. LCTs were significantly impaired in all measures in the morning compared to ECTs.

Conclusion

Our results provide evidence to support the notion that ‘night owls’ are compromised earlier in the day. We offer new insight into how differences in habitual sleep patterns and circadian rhythms impact cognitive and physical measures of performance. These findings may have implications for the sports world, e.g. athletes, coaches and teams, who are constantly looking for ways to minimise performance deficits and maximise performance gains.

Circadian Effects on Performance and Effort in Collegiate Swimmers

Although individual athletic performance generally tends to peak in the evening, individuals who exhibit a strong diurnal preference perform better closer to their circadian peak. Time-of-day performance effects are influenced by circadian phenotype (diurnal preference and chronotype-sleep-wake patterns), homeostatic energy reserves and, potentially, genotype, yet little is known about how these factors influence physiological effort. Here, we investigate the effects of time of day, diurnal preference, chronotype, and PER3 (a circadian clock gene) genotype on both effort and performance in a population of Division I collegiate swimmers (n = 27). Participants competed in 200m time trials at 7:00 and 19:00 and were sampled pre- and post-trial for salivary α-amylase levels (as a measure of physiological effort), allowing for per-individual measures of performance and physiological effort. Hair samples were collected for genotype analysis (a variable-number tandem-repeat (VNTR) and a single nucleotide polymorphism (SNP) in PER3). Our results indicate significant and parallel time-of-day by circadian phenotype effects on swim performance and effort; evening-type swimmers swam on average 6% slower with 50% greater α-amylase levels in the morning than they did in the evening, and morning types required 5-7 times more effort in the evening trial to achieve the same performance result as the morning trial. In addition, our results suggest that these performance effects may be influenced by gene (circadian clock gene PER3 variants) by environment (time of day) interactions. Participants homozygous for the PER3^4,4 length variant (rs57875989) or who possess a single G-allele at PER3 SNP rs228697 swam 3-6% slower in the morning. Overall, these results suggest that intra-individual variation in athletic performance and effort with time of day is associated with circadian phenotype and PER3 genotype.

Sleep and Athletic Performance

Sleep is an essential component of health and well-being, with significant impacts on physical development, emotional regulation, cognitive performance, and quality of life. Along with being an integral part of the recovery and adaptive process between bouts of exercise, accumulating evidence suggests that increased sleep duration and improved sleep quality in athletes are associated with improved performance and competitive success. In addition, better sleep may reduce the risk of both injury and illness in athletes, not only optimizing health but also potentially enhancing performance through increased participation in training. Despite this, most studies have found that athletes fail to obtain the recommended amount of sleep, threatening both performance and health. Athletes face a number of obstacles that can reduce the likelihood of obtaining proper sleep, such as training and competition schedules, travel, stress, academic demands, and overtraining. In addition, athletes have been found to demonstrate poor self-assessment of their sleep duration and quality. In light of this, athletes may require more careful monitoring and intervention to identify individuals at risk and promote proper sleep to improve both performance and overall health. This review attempts to highlight the recent literature regarding sleep issues in athletes, the effects of sleep on athletic performance, and interventions to enhance proper sleep in athletes.

Association Between Playing American Football in the National Football League and Long-term Mortality

Importance

Studies of the longevity of professional American football players have demonstrated lower mortality relative to the general population but they may have been susceptible to selection bias.

Objective

To examine the association between career participation in professional American football and mortality risk in retirement.

Design, Setting, and Participants

Retrospective cohort study involving 3812 retired US National Football League (NFL) players who debuted in the NFL between 1982 and 1992, including regular NFL players (n = 2933) and NFL "replacement players" (n = 879) who were temporarily hired to play during a 3-game league-wide player strike in 1987. Follow-up ended on December 31, 2016.

Exposures

NFL participation as a career player or as a replacement player.

Main Outcomes and Measures

The primary outcome was all-cause mortality by December 31, 2016. Cox proportional hazards models were estimated to compare the observed number of years from age 22 years until death (or censoring), adjusted for birth year, body mass index, height, and position played. Information on player death and cause of death was ascertained from a search of the National Death Index and web-based sources.

Results

Of the 3812 men included in this study (mean [SD] age at first NFL activity, 23.4 [1.5] years), there were 2933 career NFL players (median NFL tenure, 5 seasons [interquartile range {IQR}, 2-8]; median follow-up, 30 years [IQR, 27-33]) and 879 replacement players (median NFL tenure, 1 season [IQR, 1-1]; median follow-up, 31 years [IQR, 30-33]). At the end of follow-up, 144 NFL players (4.9%) and 37 replacement players (4.2%) were deceased (adjusted absolute risk difference, 1.0% [95% CI, -0.7% to 2.7%]; P = .25). The adjusted mortality hazard ratio for NFL players relative to replacements was 1.38 (95% CI, 0.95 to 1.99; P = .09). Among career NFL players, the most common causes of death were cardiometabolic disease (n = 51; 35.4%), transportation injuries (n = 20; 13.9%), unintentional injuries (n = 15; 10.4%), and neoplasms (n = 15; 10.4%). Among NFL replacement players, the leading causes of death were cardiometabolic diseases (n = 19; 51.4%), self-harm and interpersonal violence (n = 5; 13.5%), and neoplasms (n = 4; 10.8%).

Conclusions and Relevance

Among NFL football players who began their careers between 1982 and 1992, career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player during a league-wide strike, was not associated with a statistically significant difference in long-term all-cause mortality. Given the small number of events, analysis of longer periods of follow-up may be informative.

Game Schedules and Rate of Concussions in the National Football League

Background

Concussion prevention in the National Football League (NFL) is an important priority for player safety. The NFL now has modified game schedules, and one concern is that unconventional game schedules, such as a shortened rest period due to playing on a Thursday rather than during the weekend, may lead to an increased risk of injuries.

Hypothesis

Unconventional game schedules in the NFL are associated with an increased rate of concussion.

Study Design

Descriptive epidemiological study.

Methods

This study analyzed concussions and game schedules over the NFL regular seasons from 2012 to 2015 (4 years). Documented numbers of concussions, identified by use of the online database PBS Frontline Concussion Watch, were summarized by regular-season weeks. Association of days of rest and game location (home, away, or overseas) with the rate of concussion was examined by use of the χ² test. Logistic regression analysis was performed to examine the relationships of days of rest and home/away games to the risk of repeated concussions, with adjustment for player position.

Results

A total of 582 concussions were analyzed in this study. A significantly greater number of concussions occurred in the second half of the season (P < .01). No significant association was found between the rate of concussion and the days of rest, game location, or timing of the bye week by the team or the opponent (P > .05). Game schedules were not significantly associated with the occurrence of repeat concussions (P > .05).

Conclusion

Unconventional game schedules in the NFL, including playing on Thursday and playing overseas, do not seem to put players at increased risk of concussions.

Medications for Sleep Schedule Adjustments in Athletes

Context:

Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider.

Evidence Acquisition:

MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports. Pertinent articles were extracted and discussed.

Study Design:

Clinical review.

Level of Evidence:

Level 2.

Results:

There are very few available studies investigating pharmacologic sleep aids in athletes. Data from studies involving shift workers and airline personnel are more abundant and were used to formulate recommendations and conclusions.

Conclusion:

Melatonin, caffeine, and nonbenzodiazepine sleep aids have a role in facilitating sleep schedule changes in athletes and maximizing sports performance through sleep enhancement.

Comparing Performance During Morning vs. Afternoon Training Sessions in Intercollegiate Basketball Players

Heishman, AD, Curtis, MA, Saliba, EN, Hornett, RJ, Malin, SK, and Weltman, AL. Comparing performance during morning vs. afternoon training sessions in intercollegiate basketball players. J Strength Cond Res 31(6): 1557–1562, 2017—Time of day is a key factor that influences the optimization of athletic performance. Intercollegiate coaches oftentimes hold early morning strength training sessions for a variety of factors including convenience. However, few studies have specifically investigated the effect of early morning vs. late afternoon strength training on performance indices of fatigue. This is athletically important because circadian and/or ultradian rhythms and alterations in sleep patterns can affect training ability. Therefore, the purpose of the present study was to examine the effects of morning vs. afternoon strength training on an acute performance index of fatigue (countermovement jump height, CMJ), player readiness (Omegawave), and self-reported sleep quantity. We hypothesized that afternoon training sessions would be associated with increased levels of performance, readiness, and self-reported sleep. A retrospective analysis was performed on data collected over the course of the preseason on 10 elite National Collegiate Athletic Association Division 1 male basketball players. All basketball-related activities were performed in the afternoon with strength and conditioning activities performed either in the morning or in the afternoon. The average values for CMJ, power output (Power), self-reported sleep quantity (sleep), and player readiness were examined. When player load and duration were matched, CMJ (58.8 ± 1.3 vs. 61.9 ± 1.6 cm, p = 0.009), Power (6,378.0 ± 131.2 vs. 6,622.1 ± 172.0 W, p = 0.009), and self-reported sleep duration (6.6 ± 0.4 vs. 7.4 ± 0.25 p = 0.016) were significantly higher with afternoon strength and conditioning training, with no differences observed in player readiness values. We conclude that performance is suppressed with morning training and is associated with a decrease in self-reported quantity of sleep.

Greater circadian disadvantage during evening games for the National Basketball Association (NBA), National Hockey League (NHL) and National Football League (NFL) teams travelling westward

We investigated the effects of a circadian disadvantage (i.e. playing in a different time zone) on the winning percentages in three major sport leagues in North America: the National Basketball Association, the National Hockey League and the National Football League. We reviewed 5 years of regular season games in the National Basketball Association, National Hockey League and National Football League, and noted the winning percentage of the visiting team depending on the direction of travel (west, east, and same time zone) and game time (day and evening games). T-tests and analysis of variance were performed to evaluate the effects of the circadian disadvantage, its direction, the number of time zones travelled, and the game time on winning percentages in each major league. The results showed an association between the winning percentages and the number of time zones traveled for the away evening games, with a clear disadvantage for the teams travelling westward. There was a significant difference in the teams' winning percentages depending on the travelling direction in the National Basketball Association (F_2,5908  = 16.12, P < 0.0001) and the National Hockey League (F_2,5639  = 4.48, P = 0.011), and a trend was found in the National Football League (F_2,1279  = 2.86, P = 0.058). The effect of the circadian disadvantage transcends the type of sport and needs to be addressed for greater equity among the western and eastern teams in professional sports. These results also highlight the importance of circadian rhythms in sport performance and athletic competitions.

Evaluating strategic periodisation in team sport

The planned peaking for matches or events of perceived greatest priority or difficulty throughout a competitive season is commonplace in high-level team sports. Despite this prevalence in the field, little research exists on the practice. This study aimed to provide a framework for strategic periodisation which team sport organisations can use to evaluate the efficacy of such plans. Data relating to factors potentially influencing the difficulty of matches were obtained for games played in the 2014 Australian Football League season. These included the match location, opposition rank, between-match break and team "form". Binary logistic regression models were developed to determine the level of association between these factors and match outcome (win/loss). Models were constructed using "fixed" factors available to clubs prior to commencement of the season, and then also "dynamic" factors obtained at monthly intervals throughout the in-season period. The influence of playing away from home on match difficulty became stronger as the season progressed, whilst the opposition rank from the preceding season was the strongest indicator of difficulty across all models. The approaches demonstrated in this paper can be used practically to evaluate both the long- and short-term efficacy of strategic periodisation plans in team sports as well as inform and influence coach programming.

How jet lag impairs Major League Baseball performance

Laboratory studies have demonstrated that circadian clocks align physiology and behavior to 24-h environmental cycles. Examination of athletic performance has been used to discern the functions of these clocks in humans outside of controlled settings. Here, we examined the effects of jet lag, that is, travel that shifts the alignment of 24-h environmental cycles relative to the endogenous circadian clock, on specific performance metrics in Major League Baseball. Accounting for potential differences in home and away performance, travel direction, and team confounding variables, we observed that jet-lag effects were largely evident after eastward travel with very limited effects after westward travel, consistent with the >24-h period length of the human circadian clock. Surprisingly, we found that jet lag impaired major parameters of home-team offensive performance, for example, slugging percentage, but did not similarly affect away-team offensive performance. On the other hand, jet lag impacted both home and away defensive performance. Remarkably, the vast majority of these effects for both home and away teams could be explained by a single measure, home runs allowed. Rather than uniform effects, these results reveal surprisingly specific effects of circadian misalignment on athletic performance under natural conditions.

Game Times and Higher Winning Percentages of West Coast Teams of the National Football League Correspond With Reduced Prevalence of Regular Season Injury

Brager, AJ and Mistovich, RJ. Game times and higher winning percentages of west coast teams of the National Football League correspond with reduced prevalence of regular season injury. J Strength Cond Res 31(2): 462-467, 2017-West coast teams of the National Football League are more statistically likely to win home night games against east coast opponents. The alignment of game times with daily rhythms of alertness is thought to contribute to this advantage. This study aims to determine whether rates of turnovers and injuries during the regular season, putative measures of mental and physical fatigue, impact winning percentages. Regular season schedules and rates of turnovers for each of the 32 teams were obtained from Pro-Football-Reference. We developed our own metric of injury risk for each position obtained from depth charts and regular season schedules. This metric compared cumulative weeks on injury reserve with cumulative time zone travel. West coast teams traveled 4 times as often as east coast teams. However, teams traveling eastward won twice as many games. There was no relationship between the extent and direction of travel and number of turnovers. Losing teams had more turnovers. The offensive and defensive lines in Central Time (CT) were placed on injury reserve 4 times as often as offensive and defensive lines in Pacific Time (PT). Injury prevalence in CT vs. PT was most prominent midseason. Plotting midseason game time relative to biological time revealed that PT teams play games closer to endogenous peaks in alertness, whereas CT teams play games closer to endogenous troughs in alertness. Overall, closer alignment of game time with the endogenous "alerting" signal may protect west coast teams from fatigue-related injuries and suggests for modified strength and conditioning programs.

Optimizing sleep to maximize performance: implications and recommendations for elite athletes

Despite a growing body of literature demonstrating a positive relationship between sleep and optimal performance, athletes often have low sleep quality and quantity. Insufficient sleep among athletes may be due to scheduling constraints and the low priority of sleep relative to other training demands, as well as a lack of awareness of the role of sleep in optimizing athletic performance. Domains of athletic performance (e.g., speed and endurance), neurocognitive function (e.g., attention and memory), and physical health (e.g., illness and injury risk, and weight maintenance) have all been shown to be negatively affected by insufficient sleep or experimentally modeled sleep restriction. However, healthy adults are notoriously poor at self-assessing the magnitude of the impact of sleep loss, underscoring the need for increased awareness of the importance of sleep among both elite athletes and practitioners managing their care. Strategies to optimize sleep quality and quantity in athletes include approaches for expanding total sleep duration, improving sleep environment, and identifying potential sleep disorders.

Stress, Sleep and Recovery in Elite Soccer: A Critical Review of the Literature

In elite soccer, players are frequently exposed to various situations and conditions that can interfere with sleep, potentially leading to sleep deprivation. This article provides a comprehensive and critical review of the current available literature regarding the potential acute and chronic stressors (i.e., psychological, sociological and physiological stressors) placed on elite soccer players that may result in compromised sleep quantity and/or quality. Sleep is an essential part of the recovery process as it provides a number of important psychological and physiological functions. The effects of sleep disturbance on post-soccer match fatigue mechanisms and recovery time course are also described. Physiological and cognitive changes that occur when competing at night are often not conducive to sleep induction. Although the influence of high-intensity exercise performed during the night on subsequent sleep is still debated, environmental conditions (e.g., bright light in the stadium, light emanated from the screens) and behaviours related to evening soccer matches (e.g., napping, caffeine consumption, alcohol consumption) as well as engagement and arousal induced by the match may all potentially affect subsequent sleep. Apart from night soccer matches, soccer players are subjected to inconsistency in match schedules, unique team schedules and travel fatigue that may also contribute to the sleep debt. Sleep deprivation may be detrimental to the outcome of the recovery process after a match, resulting in impaired muscle glycogen repletion, impaired muscle damage repair, alterations in cognitive function and an increase in mental fatigue. The role of sleep in recovery is a complex issue, reinforcing the need for future research to estimate the quantitative and qualitative importance of sleep and to identify influencing factors. Efficient and individualised solutions are likely needed.

Circadian Phenotype Composition is a Major Predictor of Diurnal Physical Performance in Teams

Team performance is a complex phenomenon involving numerous influencing factors including physiology, psychology, and management. Biological rhythms and the impact of circadian phenotype have not been studied for their contribution to this array of factors so far despite our knowledge of the circadian regulation of key physiological processes involved in physical and mental performance. This study involved 216 individuals from 12 different teams who were categorized into circadian phenotypes using the novel RBUB chronometric test. The composition of circadian phenotypes within each team was used to model predicted daily team performance profiles based on physical performance tests. Our results show that the composition of circadian phenotypes within teams is variable and unpredictable. Predicted physical peak performance ranged from 1:52 to 8:59 p.m. with performance levels fluctuating by up to 14.88% over the course of the day. The major predictor for peak performance time in the course of a day in a team is the occurrence of late circadian phenotypes. We conclude that circadian phenotype is a performance indicator in teams that allows new insight and a better understanding of team performance variation in the course of a day as often observed in different groupings of individuals.

The impact of circadian phenotype and time since awakening on diurnal performance in athletes

Circadian rhythms, among other factors, have been shown to regulate key physiological processes involved in athletic performance. Personal best performance of athletes in the evening was confirmed across different sports. Contrary to this view, we identified peak performance times in athletes to be different between human "larks" and "owls" (also called "morningness/eveningness types" or "chronotypes" and referred to as circadian phenotypes in this paper), i.e., individuals with well-documented genetic and physiological differences that result in disparities between their biological clocks and how they entrain to exogenous cues, such as the environmental light/dark cycle and social factors. We found time since entrained awakening to be the major predictor of peak performance times, rather than time of day, as well as significant individual performance variations as large as 26% in the course of a day. Our novel approach combining the use of an athlete-specific chronometric test, longitudinal circadian analysis, and physical performance tests to characterize relevant sleep/wake and performance parameters in athletes allows a comprehensive analysis of the link between the circadian system and diurnal performance variation. We establish that the evaluation of an athlete's personal best performance requires consideration of circadian phenotype, performance evaluation at different times of day, and analysis of performance as a function of time since entrained awakening.