Kieran Fallon

The acute phase response and exercise: court and field sports

Objective—To determine the presence or absence of an acute phase response after training for court and field sports. Participants—All members of the Australian womens soccer team (n = 18) and all members of the Australian Institute of Sport netball team (n = 14). Methods—Twelve acute phase reactants (white blood cell count, neutrophil count, platelet count, serum iron, ferritin, and transferrin, percentage transferrin saturation, α1 antitrypsin, caeruloplasmin, α2 acid glycoprotein, C reactive protein, and erythrocyte sedimentation rate) were measured during a rest period and after moderate and heavy training weeks in members of elite netball and womens soccer teams. Results—Responses consistent with an acute phase response were found in five of 24 tests in the soccer players, and in three of 24 tests in the netball players. Responses in the opposite direction were found in seven of 24 tests in the soccer players and two of 24 tests in the netballers. The most sensitive reactant measured, C reactive protein, did not respond in a manner typical of an acute phase response. Conclusion—An acute phase response does not seem to occur as a consequence of the levels of training typical of elite female netball and soccer teams. This has implications for the interpretation of biochemical variables in these groups.

The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes

Background In 2010, the European Society of Cardiology (ESC) released recommendations for the interpretation of the 12-lead ECG in athletes, dividing changes into group 1 (training related) and group 2 (training unrelated). Recently, the ‘Seattle Criteria’, a series of revisions to these recommendations, was published, with the aim of improving the specificity of ECG screening in athletes. Objectives First, to assess the prevalence of ECG abnormalities in a cohort of elite Australian athletes using the 2010 ESC recommendations and determine how often group 2 ECG changes correlate with the evidence of significant cardiac pathology on further investigation. Second, to assess the impact of the ‘Seattle Criteria’ in reducing the number of athletes with ECG abnormalities in whom further cardiac testing is unremarkable (‘false positives’). Design 1197 elite athletes underwent cardiovascular screening between 2011 and 2012, of whom 1078 aged 16–35 years volunteered and were eligible to participate. Results 186 (17.3%) had an abnormal ECG according to ESC recommendations and a further 30 (2.8)% had unclassified changes. Three athletes (0.3%) were found to have a cardiac abnormality on further investigation. Using the Seattle Criteria, the number of athletes classified as abnormal fell to 48 (4.5%, p<0.0001) and the three with an underlying cardiac abnormality were still identified. The improved specificity was due to reclassification of 71 athletes (6.6%) with an equivocal QTc interval, 42 (3.9%) with T wave inversion isolated to V1–2 and 22 (2%) with either isolated right axis deviation or right ventricular hypertrophy on voltage criteria. Conclusions The ‘Seattle Criteria’ reduced the false-positive rate of ECG screening from 17% to 4.2%, while still identifying the 0.3% of athletes with a cardiac abnormality.

Glycerol hyperhydration improves cycle time trial performance in hot humid conditions

Abstract Eight competitive cyclists [mean peak oxygen consumption, (V˙O2peak) = 65 ml · min−1 · kg−1] undertook two 60-min cycle ergometer time trials at 32°C and 60% relative humidity. The time trials were split into two 30-min phases: a fixed-workload phase and a variable-workload phase. Each trial was preceded by ingestion of either a glycerol solution [1 g · kg−1 body mass (BM) in a diluted carbohydrate (CHO)-electrolyte drink] or a placebo of equal volume (the diluted CHO-electrolyte drink). The total fluid intake in each trial was 22 ml · kg−1 BM. A repeated-measures, double blind, cross over design with respect to glycerol was employed. Glycerol ingestion expanded body water by ≈600 ml over the placebo treatment. Glycerol treatment significantly increased performance by 5% compared with the placebo group, as assessed by total work in the variable-workload phase (P < 0.04). There were no significant differences in rectal temperature, sweat rate or cardiac frequency between trials. Data indicate that the glycerol-induced performance increase did not result from plasma volume expansion and subsequently lower core temperature or lower cardiac frequencies at a given power output as previously proposed. However, during the glycerol trial, subjects maintained a higher power output without increased perception of effort or thermal strain.

Utility of hematological and iron-related screening in elite athletes.

Objective:To determine the clinical and performance related utility of hematological and iron-related screening in elite athletes. Design:Prospective cohort study. Setting:The Department of Sports Medicine at the Australian Institute of Sport. Participants:Male and female elite athletes undergoing routine medical screening over a period of 2 to 3 years. Intervention:Blood testing for hematological and iron-related biochemical variables. Measures:White blood cell count, red blood cell count, hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin concentration, platelet count, percent hypochromic red cells, serum iron, ferritin, transferrin, and percent transferrin saturation. Results:Eight female athletes (4.6%) had clinically relevant abnormal results, 6 with an obvious explanation on clinical history and examination and 1 who was diagnosed with hemochromatosis following genetic testing. Eighty-nine (51.1%) female athletes had abnormal results that were not associated with obvious clinical signs or symptoms. Twenty-seven female athletes had a serum ferritin less than 30 ng/mL and were placed on iron supplementation. In male athletes, 5 cases had screening abnormalities that were associated with illness or other factors identified during the clinical consultations. Nonclinically significant abnormalities in males were generally minor reductions in hemoglobin and/or hematocrit or minor alterations in red cell parameters. Five male athletes had a serum ferritin less than 30 ng/mL and were placed on iron supplementation. Conclusion:Screening for hematological and iron-related abnormalities in male athletes has a very low yield. Due to the critical nature of the effects of anemia and low serum ferritin on some aspects of performance, it is reasonable to perform a full blood count and a serum ferritin on male athletes entering an elite training program. Further testing should be performed on clinical grounds. In females, the yield is greater. Again, it is reasonable to perform a full blood count and a serum ferritin on female athletes entering an elite training program. In view of their greater risk of iron depletion and to assess the effect of increased training inherent in elite programs, this could be repeated at 6-month intervals, or an isolated measurement of serum ferritin could be performed. Further testing should be performed on clinical grounds.

Effect of altering substrate availability on metabolism and performance during intense exercise.

The purpose of this study was to determine the effect of altering substrate availability on metabolism and performance during intense cycling. Seven highly trained men ingested a random order of three isoenergetic meals 90 min before cycling at 80% maximal oxygen uptake (VO2max) for 20 min (about 310 W), followed by a 600 kJ time trial lasting about 30 min. Meals consisted of either 1.2 g saturated fat/kg body mass (BM) with 3500 U heparin intravenously (HIFAT) to elevate circulating plasma free fatty acid (FA) concentration, 2.5 g carbohydrate/kg BM (CHO) to elevate plasma glucose and insulin concentrations or 2.5 g carbohydrate +20 mg nicotinic acid/kg BM (NA) to suppress lipolysis and reduce free FA concentration. HIFAT elevated free FA concentration (HIFAT 1.3 (sem 0.2), CHO 0.2 (sem 0.1), NA 0.1 (sem 0.1) mm; P < 0.001) lowered the RER (HIFAT 0.94 (sem 0.01), CHO 0.97 (sem 0.01), NA 0.98 (sem 0.01); P < 0.01) and increased the rate of fat oxidation (HIFAT 24 (sem 3), CHO 12 (sem 2), NA 8 (sem 3) micromol/kg per min; P < 0.01) during the 20 min ride. Marked differences in fat availability and fuel utilisation, however, had little effect on performance in the subsequent time trial (HIFAT 320 (sem 16), CHO 324 (sem 15), NA 315 (sem 13) W). We conclude: (1) increased fat availability during intense cycling increases the rate of fat oxidation; but (2) the reduction in the rate of carbohydrate oxidation in the presence of high circulating plasma free FA is unlikely to enhance intense exercise performance lasting about 1 h; (3) substrate selection during intense (about 80% VO2max) exercise is dominated by carbohydrate oxidation.

Sports Dietitians Australia position statement: sports nutrition for the adolescent athlete.

It is the position of Sports Dietitians Australia (SDA) that adolescent athletes have unique nutritional requirements as a consequence of undertaking daily training and competition in addition to the demands of growth and development. As such, SDA established an expert multidisciplinary panel to undertake an independent review of the relevant scientific evidence and consulted with its professional members to develop sports nutrition recommendations for active and competitive adolescent athletes. The position of SDA is that dietary education and recommendations for these adolescent athletes should reinforce eating for long term health. More specifically, the adolescent athlete should be encouraged to moderate eating patterns to reflect daily exercise demands and provide a regular spread of high quality carbohydrate and protein sources over the day, especially in the period immediately after training. SDA recommends that consideration also be given to the dietary calcium, Vitamin D and iron intake of adolescent athletes due to the elevated risk of deficiency of these nutrients. To maintain optimal hydration, adolescent athletes should have access to fluids that are clean, cool and supplied in sufficient quantities before, during and after participation in sport. Finally, it is the position of SDA that nutrient needs should be met by core foods rather than supplements, as the recommendation of dietary supplements to developing athletes over-emphasizes their ability to manipulate performance in comparison with other training and dietary strategies.

Response of soluble transferrin receptor and iron-related parameters to iron supplementation in elite, iron-depleted, nonanemic female athletes.

Objectives:To assess the effect of short-term iron supplementation on soluble transferrin receptor (sTfR) and the soluble transferrin receptor/log ferritin ratio in a group of elite, iron-depleted, nonanemic female athletes and to assess the relationship between soluble transferrin receptor and serum ferritin in a group of elite, iron-depleted female athletes. Design:A prospective, interventional study and an observation at 1 point in time. The primary inclusion criteria for each component of the study was serum ferritin less than 30 ng/mL and hemoglobin greater than 12 g/dL. The exclusion criteria were use of iron supplementation within 1 month of the initial assessment, acute or chronic infectious or inflammatory disease, hematological disorders, and recent musculoskeletal injury. Setting:The Department of Sports Medicine at the Australian Institute of Sport. Subjects:For the prospective study, 51, and for the observational study, 85 elite, iron-depleted (serum ferritin <30 ng/mL), nonanemic (hemoglobin <12 g/dL for the prospective study only) female athletes. Athletes were participants at the elite level in netball, basketball, gymnastics, rowing, volleyball, track and field, soccer, sailing, and cricket. Intervention:Ingestion of 1 iron tablet (325 mg dried ferrous sulfate, equivalent to 105 mg elemental iron) plus one 500-mg tablet of vitamin C each morning for 60 days. Results:Following supplementation, the following changes were statistically significant. Serum ferritin increased (19.7 to 37.4 ng/mL; P < 0.00005), serum transferrin decreased (3.34 to 3.16 g/L; P = 0.023), sTfR decreased (3.46 to 3.16 mg/L; P = 0.006), and sTfR/log ferritin index decreased (1.34 to 1.00; P < 0.00005). If it is assumed that iron stores are depleted when serum ferritin is less than 12 ng/mL and that sTfR could be expected to be elevated below that level of serum ferritin, the following figures can be calculated for the value of sTfR in relation to absent iron stores: sensitivity, 33%; specificity, 96%; positive predictive value, 50%; and negative predictive value, 92%. Conclusions:Short-term iron supplementation increases iron stores and leads to reductions in sTfR and the sTfR/log ferritin index in elite female athletes. sTfR is not an accurate predictor of serum ferritin less than 12 ng/mL in this group.

The clinical utility of screening of biochemical parameters in elite athletes: analysis of 100 cases

Objective: To determine the clinical utility of screening for biochemical parameters in elite athletes. Design: A prospective sequential case series. Setting: The Department of Sports Medicine at the Australian Institute of Sport. Participants: 100 elite athletes from 11 sports (56 male and 44 female athletes, mean age 19 years, range 16–27), undergoing routine medical screening. Intervention: Initial and follow-up assessment of the following biochemical parameters in association with clinical assessment; serum iron, ferritin, transferrin, percent transferrin saturation, sodium, potassium, chloride, calcium, magnesium, phosphate, urate, urea and creatinine, total protein, albumin, creatine kinase (CK), lactate dehydrogenase, aspartate aminotransaminase (AST), alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, cholesterol and triglycerides (non-fasting), and random glucose. Results: 18 athletes showed no abnormalities on biochemical screening. 194 abnormal results were found in 82 athletes. 115 abnormalities were noted in 46 male and 79 in 36 female athletes. In 43 individual tests, the results did not return to normal on repeat testing. The most common abnormalities were increases in AST (27%), phosphate (13%), CK (13%), urea (12%) and bilirubin (12%). Three cases of hypercholesterolaemia and one case of haemochromatosis were identified, and one athlete, who was asymptomatic, was diagnosed with Epstein–Barr virus infection, which was suspected because of an abnormal liver function test. The other abnormalities found appeared not to be of clinical significance. Conclusion: Most abnormalities found on routine biochemical screening in elite athletes are of no clinical significance, therefore such testing should, if used only for clinical purposes, be abandoned. When athletes are tested for iron status it would be prudent to include assessment of serum cholesterol in those with a family history of hyperlipidaemia.

Clinical utility of blood tests in elite athletes with short term fatigue

Objective: To determine, in a population of elite athletes at their initial presentation with tiredness or fatigue, whether a set of haematological and biochemical investigations enhances the diagnostic process over and above the information gained from clinical history and examination. Methods: A sequential series of 50 elite athletes were studied at the initial consultation for a primary complaint of fatigue, tiredness, or a synonym thereof. A standardised clinical history, physical examination, and series of haematological and biochemical test were performed. The effects of the results of the blood tests on the diagnosis made after the clinical history and examination were examined. Results: In only one case did the test results lead to an alteration in diagnosis. Physical examination did not provide any findings that would not have been suspected from the history, except for a number of incidental findings not relevant to the presenting symptom. Discussion: In cases of short term fatigue in elite athletes, a thorough clinical history is mandatory. Physical examination is unlikely to reveal any findings not suspected from the history. Routine ordering of a panel of blood tests at the initial consultation should be discouraged. Unless specifically indicated by the history and examination, investigations are not required at the initial consultation.

The effects of Lyprinol(®) on delayed onset muscle soreness and muscle damage in well trained athletes: a double-blind randomised controlled trial.

OBJECTIVES The aim of the study was to determine if Lyprinol(®) is effective in reducing pain, indicators of inflammation and muscle damage, and in turn improving performance in well trained athletes suffering from delayed onset muscle soreness (DOMS). DESIGN A double blind randomised placebo controlled trial. SETTING Twenty well trained male volunteers, matched by VO(2max) were randomly assigned to consume 200mg of Lyprinol(®) or an indistinguishable placebo daily for 8 weeks prior to a downhill treadmill running episode designed to induce DOMS. MAIN OUTCOME MEASURES Performance measures (Kin-Com, counter movement and squat jump), pain assessments (visual analogue scale, algometer) and blood analyses (Interleukin-1, Interleukin-6, Interleukin-10, tumour necrosis factor-α, C-reactive protein, myoglobin, creatine kinase) were assessed at 7 time points over 5 days (pre, post, 4, 24, 48, 72 and 96h after the downhill run). RESULTS No statistically significant differences were identified in any parameters between the active and placebo groups at any time point. CONCLUSION After 2 months ingestion of Lyprinol(®) at the currently recommended dosage (200mg/day) and a demanding eccentric exercise intervention, Lyprinol(®) did not convincingly affect DOMS and indicators of muscle damage.