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Blood Biomarker Profiling and Monitoring for High-Performance Physiology and Nutrition: Current Perspectives, Limitations and Recommendations.
Pedlar, CR, Newell, J, Lewis, NA
Sports medicine (Auckland, N.Z.). 2019;(Suppl 2):185-198
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Abstract
Blood test data were traditionally confined to the clinic for diagnostic purposes, but are now becoming more routinely used in many professional and elite high-performance settings as a physiological profiling and monitoring tool. A wealth of information based on robust research evidence can be gleaned from blood tests, including: the identification of iron, vitamin or energy deficiency; the identification of oxidative stress and inflammation; and the status of red blood cell populations. Serial blood test data can be used to monitor athletes and make inferences about the efficacy of training interventions, nutritional strategies or indeed the capacity to tolerate training load. Via a profiling and monitoring approach, blood biomarker measurement combined with contextual data has the potential to help athletes avoid injury and illness via adjustments to diet, training load and recovery strategies. Since wide inter-individual variability exists in many biomarkers, clinical population-based reference data can be of limited value in athletes, and statistical methods for longitudinal data are required to identify meaningful changes within an athlete. Data quality is often compromised by poor pre-analytic controls in sport settings. The biotechnology industry is rapidly evolving, providing new technologies and methods, some of which may be well suited to athlete applications in the future. This review provides current perspectives, limitations and recommendations for sports science and sports medicine practitioners using blood profiling and monitoring for nutrition and performance purposes.
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Hypertensive Medications in Competitive Athletes.
Pelto, H
Current sports medicine reports. 2017;(1):45-49
Abstract
Hypertension is the most common cardiovascular disease in athletes. It is an important cause of long-term morbidity and mortality, even in a fit, athletic population. Management options to reduce these long-term risks exist that have minimal impact on athletic performance. Identification and management of underlying lifestyle factors and diseases that may lead to secondary hypertension is critical. These include substance abuse, medications, and underlying medical conditions. After evaluation and management of these issues, medications can be used to reduce blood pressure. In the athletic population, first-line medication treatment should include ACE inhibitors, angiotensin II receptor blockers (ARB), and calcium channel blockers (CCB). The response to treatment should be followed closely to ensure adequate blood pressure control. Athletic participation in sports with high dynamic load should be limited in individuals with stage 2 hypertension or stage 1 hypertension with evidence of end organ damage.
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Potential harmful effects of dietary supplements in sports medicine.
Deldicque, L, Francaux, M
Current opinion in clinical nutrition and metabolic care. 2016;(6):439-445
Abstract
PURPOSE OF REVIEW The purpose of this article is to collect the most recent data regarding the safety of well-known or emerging dietary supplements used by athletes. RECENT FINDINGS From January 2014 to April 2016, about 30 articles have been published in the field. New data show that 90% of sports supplements contain trace of estrogenic endocrine disruptors, with 25% of them having a higher estrogenic activity than acceptable. About 50% of the supplements are contaminated by melamine, a source of nonprotein nitrogen. Additional data accumulate toward the safety of nitrate ingestion. In the last 2 years, the safety of emerging supplements such as higenamine, potentially interesting to lose weight, creatine nitrate and guanidinoacetic acid has been evaluated but still needs further investigation. SUMMARY The consumption of over-the-counter supplements is very popular in athletes. Although most supplements may be considered as safe when taking at the recommended doses, athletes should be aware of the potential risks linked to the consumption of supplements. In addition to the risks linked to overdosage and cross-effects when combining different supplements at the same time, inadvertent or deliberate contamination with stimulants, estrogenic compounds, diuretics or anabolic agents may occur.
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How to Practice Sports Cardiology: A Cardiology Perspective.
Lawless, CE
Clinics in sports medicine. 2015;(3):539-49
Abstract
The rigorous cardiovascular (CV) demands of sport, combined with training-related cardiac adaptations, render the athlete a truly unique CV patient and sports cardiology a truly unique discipline. Cardiologists are advised to adopt a systematic approach to the CV evaluation of athletes, taking into consideration the individual sports culture, sports-specific CV demands, CV adaptations and their appearance on cardiac testing, any existing or potential interaction of the heart with the internal and external sports environment, short- and long-term CV risks, and potential effect of performance-enhancing agents and antidoping regulations. This article outlines the systematic approach, provides a detailed example, and outlines contemporary sports cardiology core competencies.
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Consensus Recommendations on Training and Competing in the Heat.
Racinais, S, Alonso, JM, Coutts, AJ, Flouris, AD, Girard, O, González-Alonso, J, Hausswirth, C, Jay, O, Lee, JK, Mitchell, N, et al
Sports medicine (Auckland, N.Z.). 2015;(7):925-38
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Abstract
Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise-heat exposures over 1-2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.
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Innovative Operations Measures and Nutritional Support for Mass Endurance Events.
Chiampas, GT, Goyal, AV
Sports medicine (Auckland, N.Z.). 2015;(Suppl 1):S61-9
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Abstract
Endurance and sporting events have increased in popularity and participation in recent years worldwide, and with this comes the need for medical directors to apply innovative operational strategies and nutritional support to meet such demands. Mass endurance events include sports such as cycling and running half, full and ultra-marathons with over 1000 participants. Athletes, trainers and health care providers can all agree that both participant outcomes and safety are of the utmost importance for any race or sporting event. While demand has increased, there is relatively less published guidance in this area of sports medicine. This review addresses public safety, operational systems, nutritional support and provision of medical care at endurance events. Significant medical conditions in endurance sports include heat illness, hyponatraemia and cardiac incidents. These conditions can differ from those typically encountered by clinicians or in the setting of low-endurance sports, and best practices in their management are discussed. Hydration and nutrition are critical in preventing these and other race-related morbidities, as they can impact both performance and medical outcomes on race day. Finally, the command and communication structures of an organized endurance event are vital to its safety and success, and such strategies and concepts are reviewed for implementation. The nature of endurance events increasingly relies on medical leaders to balance safety and prevention of morbidity while trying to help optimize athlete performance.
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Evaluation and treatment of injury and illness in the ultramarathon athlete.
Krabak, BJ, Waite, B, Lipman, G
Physical medicine and rehabilitation clinics of North America. 2014;(4):845-63
Abstract
Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.
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Complementary and alternative treatments in sports medicine.
Malone, MA, Gloyer, K
Primary care. 2013;(4):945-68, ix
Abstract
Many patients suffering from pain and dysfunction attributable to musculoskeletal conditions will use some form of complementary and alternative medicine (CAM). Unfortunately, there is a paucity of both the quantity and quality of CAM treatments for specific musculoskeletal conditions. Many CAM treatments are used for a variety of musculoskeletal conditions, but may be more commonly used for specific conditions. This article addresses the use of CAM for specific musculoskeletal conditions, followed by a review of other CAM treatments and their potential indications for a multitude of conditions, based on the current medical literature and traditional use.
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Ultrasound in athletes: emerging techniques in point-of-care practice.
Yim, ES, Corrado, G
Current sports medicine reports. 2012;(6):298-303
Abstract
Ultrasound offers sports medicine clinicians the potential to diagnose, treat, and manage a broad spectrum of conditions afflicting athletes. This review article highlights applications of ultrasound that hold promise as point-of-care diagnostics and therapeutic tools that can be used directly by clinicians to direct real-time management of athletes. Point-of-care ultrasound has been examined most in the context of musculoskeletal disorders in athletes, with attention given to Achilles tendinopathy, patellar tendinopathy, hip and thigh pathology, elbow tendinopathy, wrist pathology, and shoulder pain. More research has focused on therapeutic applications than diagnostic, but initial evidence has been generated in both. Preliminary evidence has been published also on abdominal ultrasound for splenic enlargement in mononucleosis, cardiopulmonary processes and hydration status, deep vein thrombosis, and bone mineral density. Further research will be required to validate these applications and to explore further applications of portable ultrasound that can be used in the care of athletes.
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10.
Arginine and citrulline supplementation in sports and exercise: ergogenic nutrients?
Sureda, A, Pons, A
Medicine and sport science. 2012;:18-28
Abstract
Dietary L-citrulline malate supplements may increase levels of nitric oxide (NO) metabolites, although this response has not been related to an improvement in athletic performance. NO plays an important role in many functions in the body regulating vasodilatation, blood flow, mitochondrial respiration and platelet function. L-Arginine is the main precursor of NO via nitric oxide synthase (NOS) activity. Additionally, L-citrulline has been indicated to be a second NO donor in the NOS-dependent pathway, since it can be converted to L-arginine. The importance of L-citrulline as an ergogenic support derives from the fact that L-citrulline is not subject to pre-systemic elimination and, consequently, could be a more efficient way to elevate extracellular levels of L-arginine by itself. L-Citrulline malate can develop beneficial effects on the elimination of NH(3) in the course of recovery from exhaustive muscular exercise and also as an effective precursor of L-arginine and creatine. Dietary supplementation with L-citrulline alone does not improve exercise performance. The ergogenic response of L-citrulline or L-arginine supplements depends on the training status of the subjects. Studies involving untrained or moderately healthy subjects showed that NO donors could improve tolerance to aerobic and anaerobic exercise. However, when highly-trained subjects were supplemented, no positive effect on performance was indicated.