Brian Cunniffe

Characterization of acute ischemia-related physiological responses associated with remote ischemic preconditioning: a randomized controlled, crossover human study

Remote Ischemic Preconditioning (RIPC) is emerging as a new noninvasive intervention that has the potential to protect a number of organs against ischemia–reperfusion (IR) injury. The standard protocols normally used to deliver RIPC involve a number of cycles of inflation of a blood pressure (BP) cuff on the arm and/or leg to an inflation pressure of 200 mmHg followed by cuff deflation for a short period of time. There is little evidence to support what limb (upper or lower) or cuff inflation pressures are most effective to deliver this intervention without causing undue discomfort/pain in nonanesthetized humans. In this preliminary study, a dose–response assessment was performed using a range of cuff inflation pressures (140, 160, and 180 mmHg) to induce limb ischemia in upper and lower limbs. Physiological changes in the occluded limb and any pain/discomfort associated with RIPC with each cuff inflation pressure were determined. Results showed that ischemia can be induced in the upper limb at much lower cuff inflation pressures compared with the standard 200 mmHg pressure generally used for RIPC, provided the cuff inflation pressure is ~30 mmHg higher than the resting systolic BP. In the lower limb, a higher inflation pressure, (~55 mmHg > resting systolic BP), is required to induce ischemia. Cyclical changes in capillary blood O2, CO2, and lactate levels during the RIPC stimulus were observed. RIPC at higher cuff inflation pressures of 160 and 180 mmHg was better tolerated in the upper limb. In summary, limb ischemia for RIPC can be more easily induced at lower pressures and is much better tolerated in the upper limb in young healthy individuals. However, whether benefits of RIPC can also be derived with protocols delivered to the upper limb using lower cuff inflation pressures and with lesser discomfort compared to the lower limb, remains to be investigated.

Home Versus Away Competition: Effect on Psychophysiological Variables in Elite Rugby Union.

This study evaluated the effect of game venue and starting status on precompetitive psychophysiological measures in elite rugby union. Saliva samples were taken from players (starting XV, n = 15, and nonstarters, n = 9) on a control day and 90 min before 4 games played consecutively at home and away venues against local rivals and league leaders. Precompetition psychological states were assessed using the Competitive State Anxiety Inventory-2. The squad recorded 2 wins (home) and 2 losses (away) over the study period. Calculated effect sizes (ESs) showed higher pregame cortisol- (C) and testosterone- (T) difference values before all games than on a baseline control day (ES 0.7-1.5). Similar findings were observed for cognitive and somatic anxiety. Small between-venues C differences were observed in starting XV players (ES 0.2-0.25). Conversely, lower home T- (ES 0.95) and higher away C- (ES 0.6) difference values were observed in nonstarters. Lower T-difference values were apparent in nonstarters (vs starting XV) before home games, providing evidence of a between-groups effect (ES 0.92). Findings show an anticipatory rise in psychophysiological variables before competition. Knowledge of starting status appears a moderating factor in the magnitude of player endocrine response between home and away games.

Characterization of muscle oxygenation response to vascular occlusion: implications for remote ischaemic preconditioning and physical Performance

Remote ischaemic preconditioning is a non‐invasive intervention with potential to protect a number of organs against ischaemia–reperfusion injury and possibly improve athletic performance. Little mechanistic evidence exists to support either limb choice or cuff inflation pressure that is most effective. This preliminary study aimed to establish the dose–response effect of different occlusion pressures on skeletal muscle oxygenation and blood flow in healthy males (n = 6). In a randomized controlled crossover study, cuff inflation pressures (140,160 and 180 mmHg) were used to induce limb ischaemia (× 3 cycles of 5‐min) in upper (UL) and lower (LL) limbs on three separate occasions. Muscle oxygenation and blood flow properties of UL (flexor carpi ulnaris) and LL (vastus lateralis) were assessed using near infrared spectroscopy. Higher deoxyhaemoglobin (ΔHHb) values were consistently observed in UL (versus LL; P<0·05), no difference between pressures. Occlusion at 140 mm Hg failed to elicit decreases in tissue oxyhaemoglobin (ΔHbO2) from resting baseline (UL and LL), with significant HbO2 decreases only observed at 180 mmHg in LL (P<0·05). Increases in ΔHbO2 and muscle oxygenation index (Hbdiff) above baseline were observed with cuff deflation, lasting up to 15 min into recovery in LL irrespective of occlusion pressure (P<0·05). Muscle oxygenation properties are influenced by choice of limb occluded and findings show that tissue ischaemia can be induced at much lower absolute pressures than traditionally used in RIPC studies. Blood flow and muscle oxygenation may be enhanced for at least 15 min following the last occlusion.

Assessment of Physical Demands and Fluid Balance in Elite Female Handball Players During a 6-Day Competitive Tournament

Little data exists on drinking behavior, sweat loss, and exercise intensity across a competitive handball tournament in elite female athletes. Heart rate (HR), fluid balance and sweat electrolyte content were assessed on 17 international players across a 6-day tournament involving 5 games and 2 training sessions played indoors (23 ± 2 °C, 30 ± 2% relative humidity). Active play (effective) mean HR was 155 ± 14 bpm (80 ± 7.5% HRmax) with the majority of time (64%) spent exercising at intensities >80% HRmax. Mean (SD) sweat rates during games were 1.02 ± 0.07 L · h⁻¹ and on 56% of occasions fluid intake matched or exceeded sweat loss. A significant relationship was observed between estimated sweat loss and fluid intake during exercise (r² = .121, p = .001). Mean sweat sodium concentration was 38 ± 10 mmol · L⁻¹, with significant associations observed between player sweat rates and time spent exercising at intensities >90% HRmax (r² = .181, p = .001). Fluid and electrolyte loss appear to be work rate dependent in elite female handball players, whom appear well capable of replacing fluids lost within a tournament environment. Due to large between-athlete variations, a targeted approach may be warranted for certain players only.

Illness monitoring in team sports using a Web-based training diary.

Objective:Use of Web-based data recording systems has received little attention in sport. An “online” training diary could provide a valuable alternative to pen-paper methods in the regular assessment of physical activity and illness occurrence in athletes. The objective of this study was to design and implement a user-friendly and efficient system to monitor incidences of illness in team sport athletes. Design:Prospective monitoring study over a 48-week rugby season. Players were asked to register presence/absence of weekly illness symptoms with medical staff and also use an online training diary. Submitted self-reported diary illness data were compared with illness complaint data recorded by medical staff. Diary response rates were calculated from the number of completed diary entries against the number of available/required entries over the season. Setting:Web-based training diary. Participants:Thirty professional rugby union players. Intervention:Comparison of gastrointestinal and upper respiratory illnesses (URIs) reported by players using an online diary and to medical staff. Main Outcome Measures:Incidences of URIs. Results:The diary response rate in the reporting of weekly illnesses was 79% over the study period. Discrepancy existed between the number of self-reported URIs by players using the diary (118 URI incidences) compared with those reported to medical staff (23 URI incidences). Totaling all URI episodes (those self-reported + those registered by medical staff) revealed that players reported just 19% of URI episodes to medical staff. Conclusions:Players tend to underreport incidences of banal infections. Closer monitoring of self-reported illnesses using a similar system in the present study may provide a better alternative to previous methods in nonclinical illness assessment.

Warm-up Practices in Elite Boxing Athletes: Impact on Power Output.

Abstract Cunniffe, B, Ellison, M, Loosemore, M, and Cardinale, M. Warm-up practices in elite boxing athletes: Iimpact on power output. J Strength Cond Res 31(1): 95–105, 2017—This study evaluated the performance impact of routine warm-up strategies in elite Olympic amateur boxing athletes and physiological implications of the time gap (GAP) between warm-up and boxing activity. Six male boxers were assessed while performing standardized prefight warm-up routines. Core and skin temperature measurements (Tcore and Tskin), heart rate, and upper- and lower-body power output (PO) were assessed before and after warm-up, during a 25-minutes GAP and after 3 × 2 minutes rounds of sparring. Reflected temperature (Tc) was also determined using high-resolution thermal images at fixed time-points to explore avenues for heat loss. Despite individual differences in warm-up duration (range 7.4–18.5 minutes), increases in Tcore and Tskin occurred (p ⩽ 0.05). Corresponding increases (4.8%; p ⩽ 0.05) in countermovement jump (CMJ) height and upward-rightward shifts in upper-body force-velocity and power-velocity curves were observed. Athletes remained inactive during the 25-minutes GAP with a gradual and significant increase in Tc occurring by the end of GAP suggesting the likelihood of heat loss. Decreases in CMJ height and upper-body PO were observed after 15 minutes and 25 minutes GAP (p ⩽ 0.05). By the end of GAP period, all performance variables had returned to pre–warm-up values. Results suggest routine warm-ups undertaken by elite boxers have acute effects on power-generating capacity. Gradual decreases in performance variables are evident with inactivity and seem related to alterations in body temperature. Considering the constraints of major competitions and time spent in air conditioned holding areas before fights, practitioners should be aware of the potential of nullifying the warm-up effects.