Practical application of research outcomes in the field for elite athletes

Coaches, athletes and practitioners are keen to employ effective evidence-based interventions and strategies in the field to reduce the risk of illness compromising training and competitive performance. Factors affecting immune function and the risk of illness in athletes include: the volume, intensity and load of exercise training, degree of exposure to pathogens, underlying health and medical status of individual athletes, lifestyle behaviours including nutrition, sleep and recovery, and psychosocial issues related to training and competition. Given the lack of specific research studies on elite athletes it is necessary to look more broadly at related disciplines including clinical immunology, general medicine, sports medicine, nutrition, psychology, and exercise physiology. Long term planning by organisations, teams or individual athletes should include a yearly sports medicine consultation, review of primary and secondary vaccination schedules, advice on insect avoidance and malaria prevention, review of allergy and asthmatic conditions, establishing a medical network, and managing team and travel logistics. A dental review should also be considered. Environmental issues include strategies for dealing with jet lag, air pollution, water-based pathogens, thermal stress and culture shock when travelling abroad. The effectiveness of illness prevention or sick packs (containing a gel-based hand sanitiser, medicated lozenges, throat gargle, nasal decongestant, vitamins and minerals, and tissues) for immediate field use has been questioned but these are widely used. Athletes should be educated on coughing etiquette and tissue disposal. In terms of physical or exercise training there are several strategies for limiting the risk of training-induced impairments in immune health, including: increasing the frequency of shorter training sessions, reducing the overall weekly training volume or that of individual sessions, avoiding prolonged intensive sessions, reducing the size of load increments in frequency, volume and intensity, employing shorter rather than longer training macrocycles, implementing sufficient recovery after intense workouts and at the end of a long competitive season or the major competition for the year. There should be a review or debriefing session after competition involving medical, scientific and management staff, a written report of the medical events of the season and/or main competition, referral of athletes experiencing long-term or recurrent/persistent illness for medical review, and early preparations for the following season. A combination of experimental research addressing both efficacy (laboratory) and effectiveness (field) of interventions and strategies, emerging technologies, and the hard-earned clinical and practical experience of physicians, athletes and coaches, will pave the way for improved management of illness in athletes

Lactobacillus fermentum (PCC®) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes

BACKGROUND Probiotics purportedly reduce symptoms of gastrointestinal and upper respiratory-tract illness by modulating commensal microflora. Preventing and reducing symptoms of respiratory and gastrointestinal illness are the primary reason that dietary supplementation with probiotics are becoming increasingly popular with healthy active individuals. There is a paucity of data regarding the effectiveness of probiotics in this cohort. The aim of this study was to evaluate the effectiveness of a probiotic on faecal microbiology, self-reported illness symptoms and immunity in healthy well trained individuals. METHODS Competitive cyclists (64 males and 35 females; age 35 ± 9 and 36 ± 9 y, VO2max 56 ± 6 and 52 ± 6 ml.kg-1.min-1, mean ± SD) were randomised to either probiotic (minimum 1 × 109 Lactobacillus fermentum (PCC®) per day) or placebo treatment for 11 weeks in a double-blind, randomised, controlled trial. The outcome measures were faecal L. fermentum counts, self-reported symptoms of illness and serum cytokines. RESULTS Lactobacillus numbers increased 7.7-fold (90% confidence limits 2.1- to 28-fold) more in males on the probiotic, while there was an unclear 2.2-fold (0.2- to 18-fold) increase in females taking the probiotic. The number and duration of mild gastrointestinal symptoms were ~2-fold greater in the probiotic group. However, there was a substantial 0.7 (0.2 to 1.2) of a scale step reduction in the severity of gastrointestinal illness at the mean training load in males, which became more pronounced as training load increased. The load (duration×severity) of lower respiratory illness symptoms was less by a factor of 0.31 (99%CI; 0.07 to 0.96) in males taking the probiotic compared with placebo but increased by a factor of 2.2 (0.41 to 27) in females. Differences in use of cold and flu medication mirrored these symptoms. The observed effects on URTI had too much uncertainty for a decisive outcome. There were clear reductions in the magnitude of acute exercise-induced changes in some cytokines. CONCLUSION L. fermentum may be a useful nutritional adjunct for healthy exercising males. However, uncertainty in the effects of supplementation on URTI and on symptoms in females needs to be resolved. TRIAL REGISTRATION The trial was registered in the Australia and New Zealand Clinical Trials Registry (ACTRN12611000006943).The study was funded by Christian Hansen A/S, Probiomics and the Australian Institute of Sport

The effect of exercise on innate mucosal immunity

METHODS The authors conducted a prospective observational study comparing salivary lactoferrin and lysozyme concentration over 5 months (chronic changes) in elite rowers (n=17, mean age 24.3+/-4.0 years) with sedentary individuals (controls) (n=18, mean age=27.2+/-7.1 years) and a graded exercise test to exhaustion (acute changes) with a cohort of elite rowers (n=11, mean age 24.7+/-4.1). RESULTS Magnitudes of differences and changes were interpreted as a standardised (Cohen's) effect size (ES). Lactoferrin concentration in the observational study was approximately 60% lower in rowers than control subjects at baseline (7.9+/-1.2 microg/ml mean+/-SEM, 19.4+/-5.6 microg/ml, p=0.05, ES=0.68, 'moderate') and at the midpoint of the season (6.4+/-1.4 microg/ml mean +/- SEM, 21.5+/-4.2 microg/ml, p=0.001, ES=0.89, 'moderate'). The concentration of lactoferrin at the end of the study was not statistically significant (p=0.1) between the groups. There was no significant difference between rowers and control subjects in lysozyme concentration during the study. There was a 50% increase in the concentration of lactoferrin (p=0.05, ES=1.04, 'moderate') and a 55% increase in lysozyme (p=0.01, ES=3.0, 'very large') from pre-exercise to exhaustion in the graded exercise session. CONCLUSION Lower concentrations of these proteins may be indicative of an impairment of innate protection of the upper respiratory tract. Increased salivary lactoferrin and lysozyme concentration following exhaustive exercise may be due to a transient activation response that increases protection in the immediate postexercise period

Pharmacological characterization of the αvβ6 integrin binding and internalization kinetics of the foot-and-mouth disease virus derived peptide A20FMDV2

A20FMDV2 is a peptide derived from the foot-and-mouth disease virus with a high affinity and selectivity for the alphav beta-6 (αvβ6) arginyl-glycinyl-aspartic acid (RGD)-binding integrin. It has been shown to be an informative tool ligand in pre-clinical imaging studies for selective labelling of the αvβ6 integrin in a number of disease models. In a radioligand- binding assay using a radiolabelled form of the peptide ([3H]A20FMDV2), its high affinity (KD:0.22nmol/l) and selectivity (at least 85-fold) for αvβ6 over the other members of the RGD integrin family was confirmed. [3H]A20FMDV2 αvβ6 binding could be fully reversed only in the presence of EDTA, whereas a partial reversal was observed in the presence of excess concentrations of an RGD-mimetic small molecule (SC-68448) or unlabelled A20FMDV2. Using flow cytometry on bronchial epithelial cells, the ligand-induced internalization of αvβ6 by A20FMDV2 and LAP1 was shown to be fast (t1/2:1.5and 3.1 min, respectively), concentration-dependent (EC50:values 1.1 and 3.6nmol/l, respectively) and was followed by a moderately slow return of integrin to the surface. The results of the radioligand-binding studies suggest that the binding of A20FMDV2 to the RGD-binding site on αvβ6 is required to maintain its engagement with the hypothesised A20FMDV2 synergy site on the integrin. In addition, there is evidence from flow cytometric studies that the RGD-ligand engagement of αvβ6 post-internalization plays a role in delaying recycling of the integrin to the cell surface. This mechanism may act as a homeostatic control of membrane αvβ6 following RGD ligand engagement

Manipulating graded exercise test variables affects the validity of the lactate threshold and VO2peak

Background To determine the validity of the lactate threshold (LT) and maximal oxygen uptake (V_ O2max) determined during graded exercise test (GXT) of different durations and using different LT calculations. Trained male cyclists (n = 17) completed five GXTs of varying stage length (1, 3, 4, 7 and 10 min) to establish the LT, and a series of 30-min constant power bouts to establish the maximal lactate steady state (MLSS). V_ O2 was assessed during each GXT and a subsequent verification exhaustive bout (VEB), and 14 different LTs were calculated from four of the GXTs (3, 4, 7 and 10 min)—yielding a total 56 LTs. Agreement was assessed between the highest V_ O2 measured during each GXT (V_ O2peak) as well as between each LT and MLSS. V_ O2peak and LT data were analysed using mean difference (MD) and intraclass correlation (ICC). Results The V_ O2peak value from GXT1 was 61.0 ± 5.3 mL.kg-1.min-1 and the peak power 420 ± 55 W (mean ± SD). The power at the MLSS was 264 ± 39 W. V_ O2peak from GXT3, 4, 7,10 underestimated V_ O2peak by ~1–5 mL.kg-1.min-1. Many of the traditional LT methods were not valid and a newly developed Modified Dmax method derived from GXT4 provided the most valid estimate of the MLSS (MD = 1.1 W; ICC = 0.96). Conclusion The data highlight how GXT protocol design and data analysis influence the determination of both V_ O2peak and LT. It is also apparent that V_ O2max and LT cannot be determined in a single GXT, even with the inclusion of a VEB

Unlocking the Role of Exercise on CD4+ T Cell Plasticity.

A hallmark of T cell ageing is a loss of effector plasticity. Exercise delays T cell ageing, yet the mechanisms driving the effects of exercise on T cell biology are not well elucidated. T cell plasticity is closely linked with metabolism, and consequently sensitive to metabolic changes induced by exercise. Mitochondrial function is essential for providing the intermediate metabolites necessary to generate and modify epigenetic marks in the nucleus, thus metabolic activity and epigenetic mechanisms are intertwined. In this perspective we propose a role for exercise in CD4+ T cell plasticity, exploring links between exercise, metabolism and epigenetic reprogramming. [Abstract copyright: Copyright © 2021 Goldsmith, Donovan, Vlahovich and Pyne.

Training and Competition Readiness in Triathlon

Triathlon is characterized by the multidisciplinary nature of the sport where swimming, cycling, and running are completed sequentially in different events, such as the sprint, Olympic, long-distance, and Ironman formats. The large number of training sessions and overall volume undertaken by triathletes to improve fitness and performance can also increase the risk of injury, illness, or excessive fatigue. Short- and medium-term individualized training plans, periodization strategies, and work/rest balance are necessary to minimize interruptions to training due to injury, illness, or maladaptation. Even in the absence of health and wellbeing concerns, it is unclear whether cellular signals triggered by multiple training stimuli that drive training adaptations each day interfere with each other. Distribution of training intensity within and between different sessions is an important aspect of training. Both internal (perceived stress) and external loads (objective metrics) should be considered when monitoring training load. Incorporating strength training to complement the large body of endurance work in triathlon can help avoid overuse injuries. We explore emerging trends and strategies from the latest literature and evidence-based knowledge for improving training readiness and performance during competition in triathlon

The Physical Preparation of Players for the Rugby World Cup

The quadrennial showcase of rugby is the Rugby World Cup (RWC), with the 10th Cup being held in France in September and October 2023. The RWC is the third most popular global sporting event after the soccer World Cup and the summer Olympic games. The 2022 Women’s RWC final drew a record crowd of 45,000 in New Zealand. World Rugby has the vision of a global sport for all; it can be played by individuals of all sizes, genders, and abilities. The heart of the game centers on possession of the ball, the expression of free running, and the physicality of tackling and contact

Capture, analyse, visualise:An exemplar of performance analysis in practice in field hockey

The goal of performance analysis is to capture the multitude of factors that affect sports strategy, and present them in an informative, interpretable, and accessible format. The aim of this study was to outline a performance analysis process in field hockey that captures, analyses and visualises strategy in layers of detail culminating in the creation of an RStudio Shiny application. Computerised notational analysis systems were developed to capture in-game events and ball tracking data of 74 matches from the Women’s Pro League 2019. Game styles were developed using k-means cluster analysis to reduce detailed in-game events into practical profiles to identify the attack types, game actions and tempo of a team’s strategy. Ball movement profiles were developed to identify the predictability (entropy) and direction (progression rates) of ball movements, and consequent distribution of possession in different attacking zones. The Shiny application, an interactive web-platform, links the information from simple game profiles with detailed game variables to understand each teams’ holistic game plan, how they are different, and how to exploit these differences. The process outlined can be applied to any team invasion sport to understand, develop and communicate successful strategies under different match situations