Peter Peeling

Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones

Iron is utilised by the body for oxygen transport and energy production, and is therefore essential to athletic performance. Commonly, athletes are diagnosed as iron deficient, however, contrasting evidence exists as to the severity of deficiency and the effect on performance. Iron losses can result from a host of mechanisms during exercise such as hemolysis, hematuria, sweating and gastrointestinal bleeding. Additionally, recent research investigating the anemia of inflammation during states of chronic disease has allowed us to draw some comparisons between unhealthy populations and athletes. The acute-phase response is a well-recognised reaction to both exercise and disease. Elevated cytokine levels from such a response have been shown to increase the liver production of the hormone Hepcidin. Hepcidin up-regulation has a negative impact on the iron transport and absorption channels within the body, and may explain a potential new mechanism behind iron deficiency in athletes. This review will attempt to explore the current literature that exits in this new area of iron metabolism and exercise.

Training Surface and Intensity : Inflammation, Hemolysis, and Hepcidin Expression

PURPOSE This investigation assessed the effects of training intensity and ground surface type on hemolysis, inflammation, and hepcidin activity during running. METHODS Ten highly trained male endurance athletes completed a graded exercise test, two continuous 10-km runs on a grass (GRASS) and a bitumen road surface (ROAD) at 75%-80% peak VO2 running velocity, and a 10 x 1-km interval running session (INT) at 90%-95% of the peak VO2 running velocity. Venous blood and urine samples were collected before, immediately after, and at 3 and 24 h after exercise. Serum samples were analyzed for circulating levels of IL-6, free hemoglobin (Hb), haptoglobin (Hp), iron, and ferritin. Urine samples were analyzed for changes in hepcidin expression. RESULTS After running, the IL-6 and free Hb were significantly greater, and serum Hp was significantly lower than preexercise values in all three conditions (P < 0.05). Furthermore, IL-6 levels and the change in free Hb from baseline were significantly greater in the INT compared with those in the GRASS (P < 0.05). There were no differences between the GRASS and ROAD training surfaces (P > 0.05). Serum iron and ferritin were significantly increased after exercise in all three conditions (P < 0.05) but were not different between trials. CONCLUSION Greater running intensities incur more inflammation and hemolysis, but these variables were not affected by the surface type trained upon.

Iron status and the acute post-exercise hepcidin response in athletes

This study explored the relationship between serum ferritin and hepcidin in athletes. Baseline serum ferritin levels of 54 athletes from the control trial of five investigations conducted in our laboratory were considered; athletes were grouped according to values <30 μg/L (SF<30), 30–50 μg/L (SF30–50), 50–100 μg/L (SF50–100), or >100 μg/L (SF>100). Data pooling resulted in each athlete completing one of five running sessions: (1) 8×3 min at 85% vVO2peak; (2) 5×4 min at 90% vVO2peak; (3) 90 min continuous at 75% vVO2peak; (4) 40 min continuous at 75% vVO2peak; (5) 40 min continuous at 65% vVO2peak. Athletes from each running session were represented amongst all four groups; hence, the mean exercise duration and intensity were not different (p>0.05). Venous blood samples were collected pre-, post- and 3 h post-exercise, and were analysed for serum ferritin, iron, interleukin-6 (IL-6) and hepcidin-25. Baseline and post-exercise serum ferritin levels were different between groups (p<0.05). There were no group differences for pre- or post-exercise serum iron or IL-6 (p>0.05). Post-exercise IL-6 was significantly elevated compared to baseline within each group (p<0.05). Pre- and 3 h post-exercise hepcidin-25 was sequentially greater as the groups baseline serum ferritin levels increased (p<0.05). However, post-exercise hepcidin levels were only significantly elevated in three groups (SF30–50, SF50–100, and SF>100; p<0.05). An athletes iron stores may dictate the baseline hepcidin levels and the magnitude of post-exercise hepcidin response. Low iron stores suppressed post-exercise hepcidin, seemingly overriding any inflammatory-driven increases.

Exercise as a mediator of hepcidin activity in athletes

Iron is a trace mineral used by the body in many physiological processes that are essential for athletic performance. However, it is common that an athlete’s iron stores are compromised via several well-established exercise-related mechanisms such as hemolysis, hematuria, sweating and gastrointestinal bleeding. Recently, however, a new mechanism for athletics-induced iron deficiency has been proposed, involving the influence of physical activity on the post-exercise hepcidin response. Hepcidin is a liver-produced hormone that regulates iron metabolism in the gut and macrophages. This hormone has become the focus of recent investigations into altered iron metabolism in athletes, and may be a mitigating factor implicated in athletics-induced iron deficiency. This review attempts to summarize and disseminate the collective knowledge currently held regarding exercise and hepcidin expression, in addition to suggesting the direction for future research in this area.

Effect of swimming intensity on subsequent cycling and overall triathlon performance.

Objectives: To investigate the effects of different swimming intensities on subsequent cycling and overall triathlon performance. Methods: Nine highly trained, male triathletes completed five separate laboratory sessions comprising one graded exercise test, a swim time trial (STT), and three sprint distance triathlons (TRI). The swimming velocities of the three TRI sessions were 80–85% (S80), 90–95% (S90), and 98–102% (S100) of the STT velocity. Subsequent cycling and running were performed at a perceived maximal intensity. Swimming stroke mechanics were measured during the swim. Plasma lactate concentration and ratings of perceived exertion were recorded at the conclusion of the swim and over the course of subsequent cycling and running. Oxygen consumption was recorded during the cycle. Results: The S80 and S90 cycle times were faster than the S100 cycle time (p<0.05). The overall triathlon time of S80 was faster than that of S100 (p<0.05). The S100 swim was characterised by a greater stroke rate than S80 and S90 (p<0.05) and a greater plasma lactate concentration than S80 (p<0.01). Conclusion: A swimming intensity below that of a time trial effort significantly improves subsequent cycling and overall triathlon performance.

Beetroot juice improves on-water 500 M time-trial performance, and laboratory-based paddling economy in national and international-level kayak athletes

We assessed the ingestion of a beetroot juice supplement (BR) on 4-min laboratory-based kayak performance in national level male (n = 6) athletes (Study A), and on 500 m on-water kayak time-trial (TT) performance in international level female (n = 5) athletes (Study B). In Study A, participants completed three laboratory-based sessions on a kayak ergometer, including a 7 × 4 min step test, and two 4 min maximal effort performance trials. Two and a half hours before the warm-up of each 4 min performance trial, athletes received either a 70 ml BR shot containing ~4.8 mmol of nitrate, or a placebo equivalent (BRPLA). The distance covered over the 4 min TT was not different between conditions; however, the average VO2 over the 4 min period was significantly lower in BR (p = .04), resulting in an improved exercise economy (p = .05). In Study B, participants completed two field-based 500 m TTs, separated by 4 days. Two hours before each trial, athletes received either two 70 ml BR shots containing ~9.6 mmol of nitrate, or a placebo equivalent (BRPLA). BR supplementation significantly enhanced TT performance by 1.7% (p = .01). Our results show that in national-level male kayak athletes, commercially available BR shots (70 ml) containing ~4.8 mmol of nitrate improved exercise economy during laboratory-based tasks predominantly reliant on the aerobic energy system. Furthermore, greater volumes of BR (140 ml; ~9.6 mmol nitrate) provided to international-level female kayak athletes resulted in enhancements to TT performance in the field.

Sleep, anxiety and electronic device use by athletes in the training and competition environments

Abstract This study subjectively assessed sleep quality and quantity, state anxiety and electronic device use during a 7-day training week (TRAIN) and a 7-day competitive tournament (COMP). Eight state-level netball players used wrist-watch actigraphy to provide indirect sleep measures of bedtime, wake time, sleep duration, sleep onset latency, sleep efficiency, wake after sleep onset and fragmentation index. State anxiety was reported using the anxiety sub-scale in the Profile of Mood States-Adolescents. Before bed duration of electronic device use and the estimated time to sleep after finishing electronic device use was also recorded. Significant main effects showed that sleep efficiency (p = 0.03) was greater in COMP as compared to TRAIN. Furthermore, the bedtime and wake time were earlier (p = 0.01) during COMP. No further differences existed between conditions (p > 0.05). However, strong negative associations were seen between state anxiety and the sleep quality rating. Here, sleep efficiency was likely greater in COMP due to the homeostatic need for recovery sleep, resulting from the change in environment from training to competition. Furthermore, an increased anxiety before bed seems to influence sleep quality and should be considered in athletes portraying poor sleep habits.

Game movements and player performance in the Australian Football League

This study examined the relationship between game movements and team and individual performance in Australian football. Movement data (GPS) was collected from 30 elite players from one club in 17 matches during the 2011 season. Selected movement variables were related to individual (possession number, Champion Data© player rankings and pressure points) and team [quarter points (scored) margin] performance indicators. Playing position (nomadic vs. key position), years of experience, game location (home/away), environmental conditions (wet/dry), time of day (day/night), break between games (6-12 days), quarter number (1-4) and quarter score (+/-) margin were also analysed. Overall, some small-moderate (but inconsistent) positive relationships between individual movement data and performance indicators were observed. Nomadic players had higher movement profiles and performance indicators than key position, whilst players with 7+ years’ experience recorded lower movement profiles than 1-3 and 4-6 years, but were only lower in performance in pressure points. min-1. Dry vs. wet (one exception), home vs. away and day vs. night, saw no differences in movements or performance. A 12 day turnaround saw higher movement profiles and performance indicators than for 6-8 days. For team performance, few moderate, inverse relationships were found between quarter points (scored) margin and movement profiles.

When the going gets tough: Mental toughness and its relationship with behavioural perseverance

OBJECTIVES This study examined the association between self-reported mental toughness and behavioural perseverance among a sample of male Australian footballers in a naturalistic context. DESIGN Cross-sectional field study, with the multistage 20m shuttle run test (MST) employed as a proxy for behavioural perseverance. METHODS 330 male Australian footballers aged between 15 and 18 years (M=16.86; SD=.71) with between 2 and 14 years playing experience (M=9.32; SD=2.51) participated. Initially, footballers completed a mental toughness questionnaire, before having their height and body mass measurements taken. Subsequently, a performance testing session was completed, which included the 20m sprint, Australian football-specific agility run, vertical jump, and the MST. Bayesian estimation was employed to allow for the simultaneous examination of existing findings with our new data in a way that provides an automatic meta-analysis of evidence in this area. RESULTS The analysis indicated a 95% probability that the association between mental toughness and behavioural perseverance lies between .14 and .34, even when controlling for other factors known to influence MST performance, including age, height, body mass, and years playing experience. CONCLUSIONS Taken together with previous research, these findings support the theoretical proposition that persistence, effort or perseverance represents a behavioural signature of mental toughness.

Pre-Altitude Serum Ferritin Levels and Daily Oral Iron Supplement Dose Mediate Iron Parameter and Hemoglobin Mass Responses to Altitude Exposure

Purpose To investigate the influence of daily oral iron supplementation on changes in hemoglobin mass (Hbmass) and iron parameters after 2–4 weeks of moderate altitude exposure. Methods Hematological data collected from 178 athletes (98 males, 80 females) exposed to moderate altitude (1,350–3,000 m) were analysed using linear regression to determine how altitude exposure combined with oral iron supplementation influenced Hbmass, total iron incorporation (TII) and blood iron parameters [ferritin and transferrin saturation (TSAT)]. Results Altitude exposure (mean ± s: 21 ± 3 days) increased Hbmass by 1.1% [-0.4, 2.6], 3.3% [1.7, 4.8], and 4.0% [2.0, 6.1] from pre-altitude levels in athletes who ingested nil, 105 mg and 210 mg respectively, of oral iron supplement daily. Serum ferritin levels decreased by -33.2% [-46.9, -15.9] and 13.8% [-32.2, 9.7] from pre-altitude levels in athletes who supplemented with nil and 105 mg of oral iron supplement daily, but increased by 36.8% [1.3, 84.8] in athletes supplemented with 210 mg of oral iron daily. Finally, athletes who ingested either 105 mg or 210 mg of oral iron supplement daily had a greater TII compared with non-supplemented athletes (0 versus 105 mg: effect size (d) = -1.88 [-2.56, -1.17]; 0 versus 210 mg: effect size (d) = -2.87 [-3.88, -1.66]). Conclusion Oral iron supplementation during 2–4 weeks of moderate altitude exposure may enhance Hbmass production and assist the maintenance of iron balance in some athletes with low pre-altitude iron stores.