Monitoring Fatigue Status in Elite Soccer Players

The physical demands of soccer players competing in the English Premier League have significantly increased in recent years (Barnes et al. 2014; Bush et al. 2015). Elite soccer players are required to compete on a weekly and often bi-weekly basis during a 9-month competitive season. During periods of fixture congestion, players may participate in three matches within a 7-day period. Previous researchers have reported that some components of performance and physiological measures may still be below a pre-match baseline 72 hours following match-play (Mohr et al., 2003; Andersson et al., 2008; Ispirlidis et al., 2008; Fatouros et al., 2010). Nevertheless, data are sparse for the quantification of player fatigue status during competitive periods. Therefore, the primary aim of this thesis is to evaluate potential indicators of fatigue which may be easily measured and utilised in elite soccer. The aim of the first study (Chapter 4) was to quantify the test-retest reliability of a range of potential fatigue variables in elite soccer players. During the pre-season period, resting perceived ratings of wellness (fatigue, muscle soreness, sleep quality and stress), counter-movement jump height (CMJ), sub-maximal heart rate (HRex), post-exercise heart rate recovery (HRRbpm and HRR%), heart rate variability (rMSSD and LnrMSSD) and salivary immunoglobulin-A (S-IgA) were measured during the morning on two consecutive non-training days in thirty-five English Premiership players. Mean values of perceived ratings of wellness (7-13 %CV), CMJ (4 %CV) HRex (3 %CV) and HRR% (10 %CV) were not substantially or statistically significantly different between days. HRV measures’ rMSSD (28 %CV) and Ln rMSSD (10 %CV), perceived ratings of sleep (CV 13%CV) and S-IgA (63 %CV) were statistically significantly different between days. All morning-measured fatigue variables with the exception of S-IgA were reliable enough to allow feasible sample sizes in future pre/post studies. These data indicate that the use of perceived ratings of wellness, CMJ, HRR%, and, to a certain extent, HRV (Ln rMSSD) are reliable enough to monitor the fatigue status of a sample of elite soccer players. The aim of the second study (Chapter 5) was to quantify the relationship between daily training load and a range of potential measures of fatigue in elite soccer players during an in-season competitive phase (17-days). Total high-intensity running (THIR) distance, perceived ratings of wellness (fatigue, muscle soreness, sleep quality), CMJ, HRex, HRR% and heart rate variability (Ln rMSSD) were analysed during an in-season competitive period (17 days). Within-subject fluctuations in fatigue (r=-0.51; large; P<0.001), Ln rMSSD (r=-0.24; small; P=0.04), and CMJ (r=0.23; small; P=0.04) were significantly correlated with fluctuations in THIR distance over the study period. Correlations between variability in perceived muscle soreness and sleep quality and HRR% and THIR distance were negligible and not statistically significant. Perceived ratings of fatigue and heart rate variability were sensitive to daily fluctuations in THIR distance in a sample of elite soccer players. Therefore, these specific markers show particular promise as simple, non-invasive assessments of fatigue status in elite soccer players during a short in-season competitive phase. The aim of the third study (Chapter 6) was to determine whether the sensitivity of a range of potential fatigue measures studied in Chapter 5 would be improved compared with the training load accumulated over the previous two, three or four days during a short in-season competitive period (17-days). Fluctuations in fatigue (r=-0.28-0.51; “small” to “large”; p<0.05) were correlated with fluctuations in THIR distance accumulation (1-4-day). Changes in HRex (r=0.28; small; p= 0.02) was correlated with changes in 4-day THIR distance accumulation. Fluctuations in Ln rMSSD (r=-0.24; small; P=0.04), and CMJ (r=0.23; small; P=0.04) were only sensitive to changes in THIR distance for the previous day (Chapter 5). Correlations between variability in muscle soreness, sleep quality and HRR% and THIR distance were negligible and not statistically significant for all accumulation training loads. Perceived ratings of fatigue were sensitive to daily fluctuations in acute THIR distance accumulation although sensitivity attenuated over time. Therefore, the present findings indicate that the sensitivity of morning-measured fatigue measures to changes in training load is not improved when compared with training loads beyond the previous days training. The fourth and final aim of the thesis was to quantify the mean daily changes in training load and parallel changes in measures of fatigue across typical in-season training weeks in elite soccer players. The training load of 29 elite soccer players was measured using the ratings of perceived exertion approach. Perceived ratings of wellness (fatigue, sleep quality and muscle soreness), sub-maximal heart rate (HRex), post-exercise heart rate recovery (HRR) and variability (HRV) were also recorded across training weeks in the in-season competitive period. Morning-measured perceived ratings of fatigue, sleep quality and muscle soreness tracked the changes in RPE-TL, being 35-40% worse on post-match day vs pre-match day (P0.05). Morning-measured perceived ratings of fatigue, sleep quality and muscle soreness are clearly more sensitive than HR-derived indices to the daily fluctuations in session load experienced by elite soccer players within a standard in-season week. The results of this thesis have shown that simple, ratings of perceived wellness are reliable and sensitive to short training and competition phases and thus may be a suitable strategy for practitioners to use in the attempt to establish fatigue status in elite soccer players. In particular, this thesis has demonstrated that the greatest sensitivity was observed on a daily basis and during typical training weeks and not during short term load accumulation. . Future work is required to quantify whether perceived ratings of wellness and vagal-related heart rate responses are sensitive to changes in training and match load across an entire competitive season in elite soccer players

Association between match activity variables, measures of fatigue and neuromuscular performance capacity following elite competitive soccer matches

The aim of the study was to assess the relationships between match activity variables, subsequent fatigue and neuromuscular performance capacity in elite soccer players. Subjects (n = 10) were professional soccer players participating in the English Championships. Match activity variables and markers of fatigue status were measured before and following two matches. Creatine kinase (CK) and muscle soreness were measured at baseline, immediately following, as well as 40 and 64 h post-match. Countermovement jump performance and perceived ratings of wellness were measured at baseline, then 40 and 64 h post-match. Relationships were shown between CK and the total number of accelerations and decelerations immediately (r = 0.63; large), 40 h (r = 0.45; moderate) and 64 h post-match (r = 0.35; moderate) (p < 0.05). Relationships between CK and total sprint distance (r = 0.39; moderate) and the number of sprints (r = 0.35; moderate) 40 h post-match (p < 0.05) were observed. Furthermore, relationships were shown between the perceived rating of wellness and number of accelerations 40 (r = 0.52; large) and 64 h (r = 0.40; moderate) post-match, sprint distance 40 h post-match (r = 0.40; moderate) and the total number of sprints 40 h post-match (r = 0.51; large) (p < 0.05). The quantification of match activity variables, particularly the total number of accelerations and decelerations and the number of sprints, provides insights into the fatigue status in elite soccer players 40 and 64 h post-match

The Tracking of Morning Fatigue Status Across In-Season Training Weeks in Elite Soccer Players.

PURPOSE: To quantify the mean daily changes in training and match load and any parallel changes in indicators of morning-measured fatigue across in-season training weeks in elite soccer players. METHODS: Following each training session and match, ratings of perceived exertion (s-RPE) were recorded to calculate overall session load (RPE-TL) in 29 English Premier League players from the same team. Morning ratings of fatigue, sleep quality, delayed-onset muscle soreness (DOMS), as well as sub-maximal exercise heart rate (HRex), post-exercise heart rate recovery (HRR%) and variability (HRV) were also recorded pre-match day and one, two and four days post-match. Data were collected for a median duration of 3 weeks (range:1-13) and reduced to a typical weekly cycle including no mid-week match and a weekend match day. Data were analysed using within-subjects linear mixed models. RESULTS: RPE-TL was approximately 600 AU (95%CI: 546-644) higher on match-day vs the following day (P0.05). CONCLUSIONS: Morning-measured ratings of fatigue, sleep quality and DOMS are clearly more sensitive than HR-derived indices to the daily fluctuations in session load experienced by elite soccer players within a standard in-season week

Monitoring Fatigue Status in Elite Team Sport Athletes: Implications for Practice.

The increase in competition demands in elite team sports over recent years has prompted much attention from researchers and practitioners into the monitoring of adaptation and fatigue in athletes. Monitoring of fatigue and gaining an understanding of athlete status may also provide insights and beneficial information pertaining to player availability, injury and illness risk. Traditional methods used to quantify recovery and fatigue in team sports such as maximal physical performance assessments may not be feasible in order to detect variations in fatigue status throughout competitive periods. The implementation of more quick, simple and non-exhaustive tests such as athlete self-report measures (ASRM), autonomic nervous system (ANS) response via heart rate derived indices and to a lesser extent jump protocols may serve as promising tools to quantify and establish fatigue status in elite team sport athletes. The robust rationalization and precise detection of a meaningful fluctuation in these measures are of paramount importance for practitioners working alongside athletes and coaches on a daily basis. There are various methods for arriving at a minimal clinically important difference (MCID), but these have been rarely adopted by sports scientists and practitioners. The implementation of appropriate, reliable and sensitive measures of fatigue can provide important information to key stakeholders within team sport environments. Future research is required to investigate the sensitivity of these tools to fundamental indicators such as performance, injury and illness

The Influence of Changes in Acute Training Load on Daily Sensitivity of Morning-measured Fatigue Variables in Elite Soccer Players.

PURPOSE: To determine the sensitivity of a range of potential fatigue measures to daily training load accumulated over the previous two, three and four days during a short in-season competitive period in elite senior soccer players (n=10). METHODS: Total high-speed running distance, perceived ratings of wellness (fatigue, muscle soreness, sleep quality), counter-movement jump height (CMJ), submaximal heart rate (HRex), post-exercise heart rate recovery (HRR) and heart rate variability (HRV: Ln rMSSD) were analysed during an in-season competitive period (17 days). General linear models were used to evaluate the influence of two, three and four day total high-speed running distance accumulation on fatigue measures. RESULTS: Fluctuations in perceived ratings of fatigue were correlated with fluctuations in total high-speed running distance accumulation covered on the previous 2-days (r=-0.31; small), 3 -days (r=-0.42; moderate) and 4-days (r=-0.28; small) (p<0.05). Changes in HRex (r=0.28; small; p= 0.02) were correlated with changes in 4-day total high-speed running distance accumulation only. Correlations between variability in muscle soreness, sleep quality, CMJ, HRR% and HRV and total high-speed running distance were negligible and not statistically significant for all accumulation training loads. CONCLUSIONS: Perceived ratings of fatigue and HRex were sensitive to fluctuations in acute total high-speed running distance accumulation, although, sensitivity was not systematically influenced by the number of previous days over which the training load was accumulated. The present findings indicate that the sensitivity of morning-measured fatigue variables to changes in training load is generally not improved when compared with training loads beyond the previous days training

Correlation between CD105 expression and postoperative recurrence and metastasis of hepatocellular carcinoma

BACKGROUND: Angiogenesis is one of the mechanisms most critical to the postoperative recurrence and metastasis of hepatocellular carcinoma (HCC). Thus, finding the molecular markers associated with angiogenesis may help identify patients at increased risk for recurrence and metastasis of HCC. This study was designed to investigate whether CD105 or CD34 could serve as a valid prognostic marker in patients with HCC by determining if there is a correlation between CD105 or CD34 expression and postoperative recurrence or metastasis. METHODS: Immunohistochemical staining for the CD105, CD34 and vascular endothelial growth factor (VEGF) antibodies was performed in 113 HCC tissue specimens containing paracarcinomatous tissue and in 14 normal liver tissue specimens. The quantitation of microvessels identified by anti-CD105 and anti-CD34 monoclonal antibodies and the semiquantitation of VEGF expression identified by anti-VEGF monoclonal antibody were analyzed in conjunction with the clinicopathological characteristics of the HCC and any available follow-up information about the patients from whom the specimens were obtained. RESULTS: CD105 was not expressed in the vascular endothelial cells of any normal liver tissue or paracarcinomatous liver tissue but was expressed in the vascular endothelial cells of all HCC tissue. In contrast, CD34 was expressed in the vascular endothelial cells of normal liver tissue, paracarcinomatous tissue, and HCC tissue in the following proportions of specimens: 86.7%, 93.8%, and 100%, respectively. The microvascular densities (MVDs) of HCC determined by using an anti-CD105 mAb (CD105-MVD) and an anti-CD34 mAb (CD34-MVD), were 71.7 ± 8.3 (SD) and 106.3 ± 10.4 (SD), respectively. There was a significant correlation between CD105-MVD and CD34-MVD (r = 0.248, P = 0.021). Although CD34-MVD was significantly correlated with VEGF expression (r = 0.243, P = 0.024), CD105-MVD was more closely correlated (r = 0.300, P= 0.005). The correlation between microscopic venous invasion and CD105-MVD, but not CD34-MVD, was also statistically significant (r = 0.254, P = 0.018). Univariate analysis showed that CD105-MVD was significantly correlated with the 2-year overall survival rate (P = 0.014); CD34-MVD was not (P = 0.601). Multivariate analysis confirmed that CD105-MVD was an independent prognostic factor and that CD34-MVD was not. CONCLUSION: The anti-CD105 mAb is an ideal instrument to quantify new microvessels in HCC as compared with anti-CD34 mAb. CD105-MVD as compared with CD34-MVD is relevant a significant and independent prognostic indicator for recurrence and metastasis in HCC patients

Risk management of biosimilars in oncology: each medicine is a work in progress

Drug licensing and drug safety monitoring for standard chemical entities have been established and are routinely used. These have resulted in a solid foundation of knowledge from which confident therapeutic decisions can be made. For many chemical entities, this advanced level of experience is also present for the generic products. The expertise surrounding the development of biosimilar competitor versions is increasing and progress is encouraging. To address the re-engineering and comparability complexities of biosimilars, the European Union imposed a requirement that risk management plans be included in the medications’ marketing applications. This paper summarizes and discusses the circumstances complicating the public’s view of drug safety, historical incidents during the transition from innovative to competitor products, as well as retrospective assessments of the development and post-marketing experiences thus far with two biosimilars. Through assessing the market entries and post-marketing experiences of biosimilars used in oncology, the healthcare field can better prepare for the next wave of comparator-products: biosimilar monoclonal antibodies

Quantifying morbidities by Adjusted Clinical Group system for a Taiwan population: A nationwide analysis

<p>Abstract</p> <p>Background</p> <p>The Adjusted Clinical Group (ACG) system has been used in measuring an individual's and a population's morbidities. Although all required inputs for running the ACG system are readily available, patients' morbidities and their associations to health care utilizations have been rarely studied in Taiwan. Therefore, the objective of this study was using the ACG system to quantify morbidities for Taiwanese population and to examine their relationship to ambulatory utilizations and costs.</p> <p>Methods</p> <p>This secondary analysis examined claims data for ambulatory services provided to 2.71 million representative Taiwanese in 2002 and 2003. People were grouped by the ACG system according to age, gender, and all ambulatory diagnosis codes in a given year. The software collapses the full set of ACGs into six morbidity categories (Non-users, Healthy, Low-morbidity, Moderate-, High- and Very-high) termed Resource Utilization Bands (RUBs). Each ACG was assigned a relative weight (RW), which was calculated as the ratio of mean ambulatory cost for each ACG to that for the overall. The distribution of morbidities was compared between years 2002 and 2003. The consistency of the distributions of visits, costs, and RWs of each ACG were examined for a two-year period. The relationship between people's morbidities and their ambulatory utilizations and costs was assessed.</p> <p>Results</p> <p>Ninety-eight percent of the subjects were correctly assigned to ACGs. Except for non-users (7.9 ~ 8.3%), most subjects were assigned to ACGs of acute and minor diseases and ACGs of moderate-to-high-morbid chronic diseases. The distributions of ACG-based morbidities were highly consistent (r = 0.949, <it>p < 0.001</it>) between 2002 and 2003. The ACG-specific visits (r = 0.955, <it>p < 0.001</it>), costs (r = 0.966, <it>p < 0.001</it>) and RWs (r = 0.991, <it>p < 0.001</it>) were correlated across two years. People grouped to the high-morbid ACGs had more visits and costs than those grouped to the low-morbid ACGs. Forty-six percent of the total ambulatory costs were spent by eighteen percent of the population, who were grouped to the High- and Very-high-morbidity RUBs.</p> <p>Conclusion</p> <p>This study demonstrated the feasibility, validity, and reliability of using the ACG system to measure morbidities in a Taiwan population and to explain their associations with ambulatory utilizations and costs for the whole country.</p

Monitoring of post-match fatigue in professional soccer: Welcome to the real world

Participation in soccer match-play leads to acute and transient subjective, biochemical, metabolic and physical disturbances in players over subsequent hours and days. Inadequate time for rest and regeneration between matches can expose players to the risk of training and competing whilst not entirely recovered. In professional soccer, contemporary competitive schedules can require teams to compete in-excess of 60 matches over the course of the season while periods of fixture congestion occur prompting much attention from researchers and practitioners to the monitoring of fatigue and readiness to play. A comprehensive body of research has investigated post-match acute and residual fatigue responses. Yet the relevance of the research for professional soccer contexts is debatable notably in relation to the study populations and designs employed. Monitoring can indeed be invasive, expensive, time-inefficient and difficult to perform routinely and simultaneously in a large squad of regularly competing players. Uncertainty also exists regarding the meaningfulness and interpretation of changes in fatigue response values and their functional relevance, and practical applicability in the field. The real-world need and cost-benefit of monitoring must be carefully weighed up. In relation to professional soccer contexts, this opinion paper intends to: 1) debate the need for PMF monitoring, 2) critique the real-world relevance of the current research literature, 3) discuss the practical burden relating to measurement tools and protocols and the collection, interpretation and application of data in the field, and, 4) propose future research perspectives

Effect of lifestyle intervention for people with diabetes or prediabetes in real-world primary care: propensity score analysis

<p>Abstract</p> <p>Background</p> <p>Many lifestyle interventions for patients with prediabetes or type 2 diabetes mellitus (T2DM) have been investigated in randomised clinical trial settings. However, the translation of these programmes into primary care seems challenging and the prevalence of T2DM is increasing. Therefore, there is an urgent need for lifestyle programmes, developed and shown to be effective in real-world primary care. We evaluated a lifestyle programme, commissioned by the Dutch government, for patients with prediabetes or type 2 diabetes in primary care.</p> <p>Methods</p> <p>We performed a retrospective comparative medical records analysis using propensity score matching. Patients with prediabetes or T2DM were selected from ten primary healthcare centres. Patients who received the lifestyle intervention (n = 186) were compared with a matched group of patients who received usual care (n = 2632). Data were extracted from the electronic primary care records. Propensity score matching was used to control for confounding by indication. Outcome measures were exercise level, BMI, HbA1c, fasting glucose, systolic and diastolic blood pressure, total cholesterol, HDL and LDL cholesterol and triglycerides and the follow-up period was one year.</p> <p>Results</p> <p>There was no significant difference at follow-up in any outcome measure between either group. The reduction at one year follow-up of HbA1c and fasting glucose was positive in the intervention group compared with controls, although not statistically significant (-0.12%, <it>P </it>= 0.07 and -0.17 mmol/l, <it>P </it>= 0.08 respectively).</p> <p>Conclusions</p> <p>The effects of the lifestyle programme in real-world primary care for patients with prediabetes or T2DM were small and not statistically significant. The attention of governments for lifestyle interventions is important, but from the available literature and the results of this study, it must be concluded that improving lifestyle in real-world primary care is still challenging.</p