Health promotion through sport: international sport federations’ priorities, actions and opportunities

Objective

To identify areas of priority and activity for international sportsfederations (IFs) with respect to athlete health and safety, and global health. Results serve to direct the work of the Association of Summer Olympic IF Medical and Scientific Consultative Group, the International Olympic Committee and to influence IFs’ planning and priorities.

Methods

The 28 IFs participating in the Summer Olympic Games (2016) were asked to rank the relative importance of 11 health-related topics and to report their activities or research initiatives on 27 identified topics using an electronic survey. A comparison with a similar survey (2012) was made.

Results

The response rate was 100%. In general, the ‘fight against doping’ had the highest priority followed by ‘image as a safe sport’. The topics with the lowest importance ratings were ‘increasing the number of elite athletes’, and ‘health of the general population’. Despite ranking ‘health of your athletes,’ as a top priority, IFs are not addressing all aspects of athlete health. In comparison with 2012, there was a significant decrease in priority for IFs is ‘health of the general population’.

Conclusion

Despite the widespread knowledge of the importance of the promotion of physical activity (sport) on global health, the decreasing priority and programming of the IFs on physical activity promotion is concerning. Although IFs have prioritised the protection of the health of elite athletes, there are gaps in programming demonstrating that IFs are missing important areas of athlete health. Improving recreational athlete health programming could also benefit population health as well as improve IF fan base and sport participation.

Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study

BACKGROUND

Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games.

METHODS

Cross-sectional study at the dental clinic within the Polyclinic in the athletes' village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted.

RESULTS

302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were 'bothered' by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year.

CONCLUSIONS

The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.

The effects of the 5-HT2C agonist m-chlorophenylpiperazine on elite athletes with unexplained underperformance syndrome (overtraining)

A possible link between the neurotransmitter, 5-hydroxytryptamine (5-HT), plasma tryptophan, and branched chain amino acids concentration and exercise-induced fatigue is described by the central fatigue hypothesis. 5-HT receptors and neuroendocrine "challenge" tests, using prolactin release as an indirect measure of 5-HT activity were studied by recent investigations. In the present study, the original hypothesis about the role of amino acids in increasing brain 5-HT with a neuroendocrine challenge test on elite athletes diagnosed with unexplained, underperformance syndrome (UUPS) was combined. There was an apparent increased sensitivity of 5-HT receptors in athletes with UUPS compared with fit, well-trained controls, as measured via increased prolactin release following a bolus dose of m-chlorophenylpiperazine , a 5-HT agonist. No changes were observed in plasma amino acid concentrations in either group. There is evidence that well-trained athletes have a reduced sensitivity of 5-HT receptors. The present study suggests that this adaptation may be lost in athletes with UUPS: this might explain some of their observed symptoms.

Spontaneous atrial fibrillation in a freestyle skier

A male freestyle skier was found to have atrial fibrillation during a routine physiological assessment. This was found to be associated with the consumption of an unusually large amount of alcohol. Athletes should be counselled about the potential dangers of alcohol consumption before exhaustive exercise.

Effect of Low-Dose Temazepam on Physiological Variables and Performance Tests Following a Westerly Flight Across Five Time Zones

Rapid travel across multiple time zones disturbs circadian rhythms and induces "jet lag". The aims of this study were 1) to monitor a selection of subjective, physiological and performance variables in elite athletes and sedentary subjects following a westerly flight across five time zones, and 2) to examine whether the promotion of sleep by means of a low-dose benzodiazepine drug influences these responses to transmeridian travel. Subjects comprised eight members of the British men's gymnastics squad, aged 18-30 years, and nine members of the British Olympic Association's support staff, aged 24- 55 years (4 females, 5 males). Subjects were pair-matched for age, sex and athleticism (apart from one person) and assigned to either the treatment (n = 9) or placebo (n = 8) group. All subjects travelled from U.K., arriving at Tallahassee, Florida, at approximately 22:00 hours local time. A test battery was administered to the subjects at 07:00, 12:00, 17:00 and 21:00 hours on the first full day of arrival (this was designated day one) and then on alternate days (day 3, day 5 and day 7). Immediately before retiring to bed on days 1, 2 and 3, subjects were administered, in a double-blind fashion, either 10mg of temazepam or a placebo. Measures in the test battery included sleep quality, sleep length, subjective jet lag (one-to-ten simple analogue scale), tympanic temperature, one-, two-, four- and eight-choice reaction time, grip strength (left and right), leg strength and back strength. Over the 24 h of each test day, subjects also recorded the volume of each urine voided. Data were analysed with a repeated measures general linear model. Alpha was set at 0.01 to control for type I errors with multiple dependent variables. Mean subjective jet lag reduced from 4.6 units to baseline, and mean sleep quality improved by 2.0 units from day 1 to day 5 (P<0.001), after which no further alterations were noted. Subjective jet lag, left and right grip strength and choice reaction time all showed post-flight day x time of day interactions (P < 0.01). On day 1, these variables deteriorated as the day progressed to the worst recorded values. On days 3, 5 and 7, diurnal variations with the conventional high in the early evening and morning-to-evening differences of about 10% were evident. There was a trend for the reduction in subjective jet lag over the post-flight days to be more rapid following ingestion of a low dose of temazepam (P= 0.037). We cannot rule out the possibility that this could be a type I error, since none of the treatment by day interactions reached the alpha level of significance (set at 0.01). The morning-to-evening variations of body temperature and grip strength were greater in the young athletes than in the older sedentary support staff (P < 0.01). Sleep quality was greater in the athletic subjects after the first full day in Tallahassee. These results suggest that the nightly administration of a low dose (10 mg) of temazepam has little influence on the recovery of subjective, physiological and performance measures following a westward flight across five time zones. In both the treatment and control groups, subjective jet lag and performance were worst in the evening of the first full day after arrival, and the young athletes slept better than the older support staff that same night. This illustrates the importance of monitoring jet lag symptoms and performance variables at different times of day following a flight to a new time zone.

Use of melatonin in recovery from jet-lag following an eastward flight across 10 time-zones

Subjective, physiological and physical performance variables are affected following travel across multiple time-zones (jet-lag). The objective of the study was to examine the effects of oral melatonin in alleviating jet-lag by investigating its effects on subjects who had flown from London to Eastern Australia, 10 time-zones to the east. Melatonin (5 mg day(-1)) or placebo capsules were administered to 14 experimental (13 males and 1 female) and 17 control subjects (15 males and 2 females), respectively, in a double-blind study; the time of administration was in accord with the current consensus for maximizing its hypnotic effect. Grip strength and intra-aural temperature were measured on alternate days after arrival at the destination, at four different times of day (between the times 07:00 - 08:00 h, 12:00 - 13:00 h, 16:00 - 17:00 h and 19:00 - 20:00 h local time). In addition, for the first 6 - 7 days after arrival in Australia, subjective ratings of jet-lag on a 0 - 10 visual analogue scale and responses to a Jet-lag Questionnaire (incorporating items for tiredness. sleep, meal satisfaction and ability to concentrate) were recorded at the above times and also on retiring (at about midnight). Subjects continued normally with their work schedules between the data collection times. Subjects with complete data (13 melatonin and 13 placebo subjects), in comparison with published data, showed partial adjustment of the diurnal rhythm in intra-aural temperature after 6 days. A time-of-day effect was evident in both right and left grip strength during adjustment to Australian time; there was no difference between the group taking melatonin and that using the placebo. Right and left grip strength profiles on day 6 were adjusted either by advancing or delaying the profiles, independent of whether subjects were taking melatonin or placebo tablets. Subjects reported disturbances with most measures in the Jet-lag Questionnaire but, whereas poorer concentration and some negative effects upon sleep had disappeared after 3 - 5 days, ratings of jet-lag and tiredness had not returned to 'zero' (or normal values), respectively, by the sixth day of the study. Subjects taking melatonin showed no significant differences from the placebo group in perceived irritability, concentration, meal satisfaction, ease in getting to sleep and staying asleep, frequency of bowel motion and consistency of the faeces. These results suggest that, in subjects who, after arrival, followed a busy schedule which resulted in frequent and erratic exposure to daylight, melatonin had no benefit in alleviating jet-lag or the components of jet-lag, and it did not influence the process of phase adjustment.

Intensive training during a twin pregnancy. A case report

This case study reports the clinical and physiological changes of a 33 year old elite marathoner undertaking intensive endurance training during and following a twin pregnancy. Prior to conception, the subject ran 155 km x week(-1) at an intensity equivalent to 140-180 b x min(-1) which following consultation decreased to 107 +/- 19 km x week(-1) at an intensity equivalent to 130-140 b x min(-1) during pregnancy. Physical exercise ceased 3 days prior to an elective Caesarean section following a 36 week gestation period and recommenced 8 days following the birth of healthy twins. Medical assessments conducted ante/post partum indicated that both the twins and mother were healthy. A field based test demonstrated that running velocity at a steady state HR of 140 b x min(-1), 150 b x min(-1) and 160 b x min(-1) decreased by 20%, 15% and 13% respectively between weeks 1 and 32 antepartum. Whole blood lactate ([La-]B), oxygen uptake (VO2), ventilatory equivalent for oxygen (V(E)/VO2), HR and Borg rating of perceived exertion (RPE) increased during a laboratory-based submaximal treadmill test at 29 weeks antepartum in comparison to a test conducted 10 weeks post partum. These data clearly demonstrate that it is possible for an elite endurance athlete to maintain a high level of cardiovascular fitness during pregnancy with no apparent adverse effects on maternal or foetal health. This will facilitate an earlier return to international competition.

Fatigue and underperformance in athletes: the overtraining syndrome

The overtraining syndrome affects mainly endurance athletes. It is a condition of chronic fatigue, underperformance, and an increased vulnerability to infection leading to recurrent infections. It is not yet known exactly how the stress of hard training and competition leads to the observed spectrum of symptoms. Psychological, endocrinogical, physiological, and immunological factors all play a role in the failure to recover from exercise. Careful monitoring of athletes and their response to training may help to prevent the overtraining syndrome. With a very careful exercise regimen and regeneration strategies, symptoms normally resolve in 6-12 weeks but may continue much longer or recur if athletes return to hard training too soon.

Recovery from infectious mononucleosis after altitude training in an elite middle distance runner

OBJECTIVES

This investigation was designed to monitor altitude acclimatisation in an elite cohort of distance runners and follow the subsequent recovery from infectious mononucleosis which developed in one of these athletes.

METHODS

Twenty six national standard distance runners performed treadmill tests 24 days before they travelled to an altitude camp (1500 to 2000 m). One of these athletes was diagnosed as suffering from infectious mononucleosis 14 days after return to sea level. A physician prescribed an individualised training programme which was designed to maximise recovery from the condition, which was monitored on days 16 and 147 after altitude training.

RESULTS AND CONCLUSIONS

The data suggest that the athlete was in a state of over-reaching during the altitude sojourn. After return to sea level, the early stages of infectious mononucleosis resulted in a marked impairment in physiological response to endurance exercise, which improved over time. Longitudinal physiological monitoring in conjunction with a carefully prescribed training programme made recovery from this condition possible.

Maximal voluntary quadriceps strength patterns in Olympic overtrained athletes

Peak torques were studied in 10 elite male overtrained athletes and 10 controls matched for sex, age, sport, and performance level. Isokinetic concentric (CON) and eccentric (ECC) maximal voluntary contractions (MVC) of quadriceps muscle were assessed at the angular velocities of 60 degrees, 120 degrees, and 180 degrees.s-1. Sustained isometric MVCs were also measured at knee angles of 10 degrees, 45 degrees, and 80 degrees of flexion. Six seconds after the beginning of each isometric MVC, a 40-Hz electrical stimulation was superimposed on the MVC for a further 6 s. The overtrained subjects developed significantly smaller CON peak torques at 180 degrees.s-1 (P < 0.001), although ECC torques were similar at all three velocities. ECC/CON ratios were higher in the overtrained subjects at 120 degrees.s-1 (P < 0.01) and 180 degrees.s-1 (P < 0.001) compared with the controls. Isometric MVCs at 10 degrees and 45 degrees knee flexion were lower in the overtrained at P < 0.01 and P < 0.05, respectively. Also in the overtrained subjects, at knee angle of 10 degrees, the addition of the electrical stimulation to the isometric MVC produced an increase (P < 0.05) in torque levels. It is suggested that impaired central drive may account for the present findings.

ABC of sports medicine. The overtraining syndrome

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Plasma amino acid concentrations in the overtraining syndrome: possible effects on the immune system

Overtraining and long-term exercise are associated with an impairment of immune function. We provide evidence in support of the hypothesis that the supply of glutamine, a key fuel for cells of the immune system, is impaired in these conditions and that this may contribute to immunosuppression. Plasma glutamine concentration was decreased in overtrained athletes and after long-term exercise (marathon race) and was increased after short-term, high intensity exercise (sprinting). Branched chain amino acid supplementation during long-term exercise was shown to prevent this decrease in the plasma glutamine level. Overtraining was without effect on the rate of T-lymphocyte proliferation in vitro or on the plasma levels of interleukin-1 and -6, suggesting that immune function is not impaired in this condition. Given the proposed importance of glutamine for cells of the immune system, it is concluded that the decrease in plasma glutamine concentration in overtraining and following long-term exercise, and not an intrinsic defect in T lymphocyte function, may contribute to the immune deficiency reported in these conditions.

Overtraining syndrome

This review discusses the overtraining syndrome which is characterized by fatigue and underperformance precipitated by stress of training. Other stresses, depression and an increased susceptibility to infections may be important. Treatment requires rest and a stress management program over 3 months.

Rest in underperforming elite competitors

This study examines the effects of 3-5 weeks of physical rest on selected physical, physiological and psychological parameters obtained from 12 Olympic but latterly underperforming competitors and their matched control subjects. Cardiorespiratory data were directly determined from their work to volitional exhaustion on either a treadmill, cycle, or rowing ergometer. Anaerobic power and capacity were evaluated through modified Wingate tests. For psychometric assessments, the Profile of Mood States (POMS) was used. For the Olympic competitors, one-way analyses of variance (ANOVA) revealed significant increases (p less than 0.05) in body weight, maximum respiratory exchange ratio, maximum oxygen consumption, and heart rate at the anaerobic threshold, following the rest period. There was also a significant reduction in fatigue and mood profile score, and a significant increase in vigour. No significant changes were found in the matched control subjects. The present data show that resting for 3-5 weeks assists underperforming elite competitors to improve their aerobic performance.

Study of middle ear disease using tympanometry in general practice

Tympanometry was used to provide evidence of middle ear effusions in a prospective study of middle ear disease in 264 children aged 3 months to 6 years in general practice. Adequate measurements on both ears were obtained in 220 children, of whom 68 (31%) had evidence of middle ear effusion in one ear (29 children) or both ears (39 children) at entry to the study. In 28 (42%) of the 68 children persistence of the tympanometric findings was recorded for at least three months. Children of European descent were more likely to have evidence of middle ear effusion at the initial examination compared with African and West Indian children, as were those children whose siblings had a positive history of otitis media compared with those whose siblings had no such history. Children under 3 years were more likely to have evidence of an effusion than older children. Middle ear effusion as shown by tympanometry was not associated with a previous history of otitis media in the child but was associated with recent symptoms of respiratory infection or otalgia. A previous consultation for otitis media was, however, strongly associated with a greater likelihood of a consultation for otitis media during the follow up period. Comparing evidence of effusion by tympanometry with that by pneumatic otoscopy showed that using the appearance of the eardrum alone the sensitivity of otoscopy was 55%; the addition of mobility improved the sensitivity to 76% with little reduction in specificity. Further studies on populations using tympanometry are needed to determine the natural history, aetiology, and indications for referring children with middle ear effusion.