Search

High-intensity interval training (HIIT) prescriptions manipulate intensity, duration, and recovery variables in multiple combinations. Researchers often compare different HIIT variable combinations and treat HIIT prescription as a "maximization problem", seeking to identify the prescription(s) that induce the largest acute VO 2 /HR/RPE response. However, studies connecting the magnitude of specific acute HIIT response variables like work time >90% of VO 2 max and resulting cellular signalling and/or translation to protein upregulation and performance enhancement are lacking. This is also not how successful endurance athletes train. First, HIIT training cannot be seen in isolation. Successful endurance athletes perform most of their training volume below the first lactate turn point (

Burgeoning interest in marathons necessitates an understanding of performance determinants. Research has highlighted the importance of diet, training and sleep, yet relations of circadian preference and sleep inertia with marathon performance remain largely unexplored. Because marathons generally start early-to-mid morning, these characteristics may have relevant impact. This study investigates relationships of circadian preference, sleep inertia and their interaction with marathon completion time. Consenting participants in a 2016 large mass-participation city marathon completed self-report questionnaires capturing circadian preference and sleep inertia, along with demographics and other characteristics. Circadian preference and sleep inertia were described across subgroups. Analyses examined the associations and interactions of circadian preference and sleep inertia with marathon completion times, with adjusted analyses accounting for age, sex and sleep health. Participants were marathon finishers (n = 936; 64.5% male; 66.3% young-adults), with a majority reporting morningness tendencies (60.8%). Results supported a linear association between increasing eveningness preference with slower marathon times (p = 0.003; p adjusted  = 0.002), while some support was provided for a linear relationship between greater sleep inertia and slower marathon times (p = 0.04; p adjusted  = 0.07). A significant interaction was observed (p = 0.02; p adjusted  = 0.01), with the directionality suggesting that the circadian preference relationship weakened when sleep inertia severity increased, and vice-versa. Our results suggest deleterious associations of increasing eveningness preference and greater sleep inertia with marathon completion time. These features may aid identifying marathoners who could be at a disadvantage, while also serving as modifiable targets for personalized training regimens preceding competition., (© 2024 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Background/objectives: Energy availability (EA) is essential for maintaining physiological functions, significantly influencing athletes' health and performance. Nutritional behaviors, however, vary across sports. This study aims to assess EA levels in athletes from different disciplines, focusing on the relationship between EA and body composition in endurance athletes compared to rugby players., Methods: This study involved 18 endurance athletes (15 men, 3 women) and 36 rugby players (all men). Data were gathered through interviews, questionnaires, and bioimpedance analysis. Energy intake (EI) was measured with a 24 h dietary recall, and exercise energy expenditure (EEE) was calculated using the IPAQ questionnaire. EA was calculated as EA = (EI - EEE)/fat-free mass (FFM), with results categorized into clinical, subclinical, and optimal ranges., Results: The endurance group had a lower average FFM (57.81 kg) compared to the rugby players (67.61 kg). EA was also significantly lower in endurance athletes (11.72 kcal/kg FFM) than in rugby players (35.44 kcal/kg FFM). Endurance athletes showed more restrictive nutritional behavior with lower EI and higher EEE, but both groups maintained body composition within normal ranges., Conclusions: Endurance athletes exhibit greater nutritional restrictions compared to rugby players, though their body composition remains healthy. Further research is required to investigate the long-term effects of low EA on performance, injury risk, and potential impairment when EA falls below the optimal threshold of 45 kcal/kg FFM/day.

Peak oxygen pulse (O 2 P peak ) is an important index of cardiorespiratory fitness (CRF). The FRIEND database is a global source of reference values for CRF. However, no reference equation is tailored for endurance athletes (EA) to predict O 2 P peak . Here, we adjusted the well-established FRIEND equation for O 2 P peak to the characteristics of the EA population. 32 (34.0%) female EA and 62 (66.0%) male well-trained EA underwent maximal cardiopulmonary exercise test on a treadmill. V̇O 2max was 4.5 ± 0.5 L min -1 in males and 3.1 ± 0.4 L min -1 in females. O 2 P peak was 23.6 ± 2.8 mL beat -1 and 16.4 ± 2.0 mL beat -1 for males and females, respectively. Firstly, we externally validated the original FRIEND equation. Secondly, using multiple linear regression, we adjusted the FRIEND equation for O 2 P peak to the population of EA. The original FRIEND equation underestimated O 2 P peak for 2.9 ± 2.9 mL beat -1 (P < .001) in males and 2.2 ± 2.1 mL beat -1 (P < .001) in females. The updated equation was 1.36 + 1.07 (23.2 · 0.09 · age - 6.6 [if female]). The new equation explained 62% of the variance and significantly predicted O 2 P peak (R 2  = 0.62, β = 0.78, P < .001). The error of the EA-adjusted model was 0.1 ± 2.9 mL beat -1 (P = .82) and 0.2 ± 2.1 mL beat -1 (P = .65) for males and females respectively. Recalibration of the original FRIEND equation significantly enhances its accuracy among EA. The error of the EA-adjusted model was negligible. A new recalibrated equation should be used to predict O 2 P peak in the population of EA., (© 2024. The Author(s).)

Background: This study used metabolic phenotyping to explore the responses of highly-trained cross-country skiers to a standardized exercise test, which was part of the athletes' routine testing, and determine whether metabolic phenotyping could discriminate specific physiological, performance, and illness characteristics., Methods: Twenty-three highly-trained cross-country skiers (10 women and 13 men) participated in this study. Capillary whole-blood samples were collected before (at rest) and 2.5 min after (post-exercise) a roller-ski treadmill test consisting of 5-6 × 4-min submaximal stages followed by a self-paced time trial (~ 3 min) and analyzed using mass spectrometry. Performance level was defined by International Ski Federation distance and sprint rankings. Illness data were collected prospectively for 33 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. Orthogonal partial least squares-discriminant analyses (OPLS-DA) followed by enrichment analyses were used to identify metabolic phenotypes of athlete groups with specific physiological, performance, and illness characteristics., Results: Blood metabolite phenotypes were significantly different after the standardized exercise test compared to rest for metabolites involved in energy, purine, and nucleotide metabolism (all OPLS-DA p < 0.001). Acute changes in the metabolic phenotype from rest to post-exercise could discriminate athletes with: (1) higher vs. lower peak blood lactate concentrations; (2) superior vs. inferior performance levels in sprint skiing, and (3) ≥ 2 vs. ≤ 1 self-reported illness episodes in the 33-week study period (all p < 0.05). The most important metabolites contributing to the distinction of groups according to (1) post-exercise blood lactate concentrations, (2) sprint performance, and (3) illness frequency were: (1) inosine, hypoxanthine, and deoxycholic acid, (2) sorbitol, adenosine monophosphate, and 2-hydroxyleuroylcarnitine, and (3) glucose-6-phosphate, squalene, and deoxycholic acid, respectively., Conclusion: Metabolic phenotyping discriminated between athlete groups with higher vs. lower post-exercise blood lactate concentrations, superior vs. inferior sprint skiing performance, and more vs. less self-reported illnesses. While the biological relevance of the identified biomarkers requires validation in future research, metabolic phenotyping shows promise as a tool for routine monitoring of highly-trained endurance athletes., (© 2024. The Author(s).)

The aim of this meta-analysis was to analyze allele and genotype pattern frequencies of five different gene polymorphisms associated with endurance athlete status. Endurance sports require prolonged physical performance, and it is well known that physiological and genetic characteristics play a prominent role in this performance. In recent years, research on the impact of genetic factors on endurance athlete status has been on the rise, suggesting that various gene polymorphisms may be associated with physical performance. Specifically, the gene polymorphisms, activin receptor type-1B ( A9CVR1B ) rs2854464, angiotensinogen ( AGT ) rs699, fat mass and obesity-associated ( FTO ) rs9939609, interleukin-6 ( IL-6 ) rs1800795, and nuclear factor erythroid 2 ( NRF2 ) rs12594956, are thought to be related to endurance athlete status. Each of these genes plays a part in different biological processes, such as muscle development, energy metabolism, inflammation, and antioxidant defense mechanisms. For example, the NRF2 gene is a critical player in the regulation of cellular stress responses and may contribute to adaptive responses that enhance performance in endurance athletes. This meta-analysis included a total of 20 articles published between 2009 and 2023. The specific gene polymorphisms explored in this study, i.e., ACVR1B rs2854464, AGT rs699, FTO rs9939609, IL-6 rs1800795, and NRF2 rs12594956, were selected due to their reported associations with physical performance and endurance. A comprehensive search was conducted in the Web of Science and PubMed databases using specific keywords, preliminarily identifying 329 articles. Upon analysis of the abstracts, and full texts, 20 articles were deemed eligible for inclusion in this meta-analysis. Articles lacking control and endurance athlete groups or clear allele/genotype data were excluded. The findings indicated no significant differences in allele and genotype frequencies for ACVR1B , AGT , FTO , and IL-6 gene polymorphisms between endurance athletes and control groups. However, the NRF2 rs12594956 gene polymorphism showed a significantly higher frequency of the major allele (A) and the AA genotype in endurance athletes than in controls. In conclusion, the NRF2 rs12594956 polymorphism may be a genetic variant of interest in determining the status of endurance athletes. These findings highlight the potential clinical implications for genetic screening and personalized training programs in sport genetics. More extensive studies with larger cohorts are needed to further confirm these associations., Competing Interests: The authors have stated that they have no conflicts of interest., (© 2024 The Journal of Biological Methods, All rights reserved.)

Background: Structural changes in the lower limb's arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports., Aim: Study the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers., Methods: Amateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed., Results: The study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m 2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level., Conclusion: The subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors., (© 2024. The Author(s).)

Physical activity is recommended for the prevention of primary and secondary cardiovascular (CV) disease as it is linked to a number of health benefits, especially CV. However, recent research suggests that high-volume, long-term endurance exercise may hasten rather than slow the coronary atherosclerosis progression. This contentious theory has generated a great discussion and is still a major source of doubt when it comes to the clinical treatment of coronary artery disease (CAD) in athletes. CAD is the primary cause of sudden cardiac death in athletes over 35 years. Thus, recent studies evaluated the prevalence of CAD in athletes and its clinical and prognostic implications. Indeed, many studies have shown a relationship between endurance sports and higher volumes of coronary calcified plaque as determined by computed tomography. However, the precise pathogenetic substrate for the existence of an increased coronary calcification burden among endurance athletes remains unclear. Moreover, the idea that coronary plaques in elite athletes present a benign morphology has been cast into doubt by some recent studies showing potential association with adverse cardiovascular events. This review aims to analyze the association between physical activity and CAD, explaining possible underlying mechanisms of atherosclerotic progression and non-ischemic coronary lesions, focusing primarily on clinical and prognostic implications, multimodal evaluation, and management of CAD in endurance athletes.

Background: The global coronavirus disease 2019 (COVID-19) pandemic irrevocably influenced our lives, yet research in a diversity of countries is lacking. Cardiorespiratory fitness may be impaired for up to a year post-COVID-19 infection., Objectives: Our study aimed to compare acute and exertional symptoms, fatigue, and exercise performance in masters-age endurance athletes according to their return-to-sport status., Method: A cross-sectional survey-based observational study of long-distance runners and cyclists was conducted. Data were stratified into two groups: those who returned to their pre-illness level of sport and those who did not and were compared statistically., Results: A total of 308 survey responses were included in the analysis. The mean age of the athletes was 44.9 + 10.2 years, with 55.2% being male. The group that did not return to their pre-illness level of sport (31.5%) had more post-COVID sequelae, worse illness severity, with a higher frequency of resting and exertional symptoms, notably fatigue and dyspnoea. Decreased exercise capacity was correlated with increased physical fatigue scores., Conclusion: Almost one-third of endurance athletes suffered protracted exercise tolerance post-COVID-19. Long-term symptoms may be more consequential in this athlete population., Clinical Implications: Symptoms that may indicate cardiopulmonary consequences in recreational athletes should be investigated in order to facilitate return to sport and the important mental and physical benefits thereof. This will augment outcomes after respiratory tract infections and management of return to sport and expectations of endurance athletes., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Mountain running, distinct from traditional road running, involves natural trails with significant elevation changes. This study aims to analyze dietary and supplementation practices among advanced and elite Polish mountain runners. Conducted from May to October 2023, this study included 36 participants (13 women, 23 men) aged 21-43 years. A custom questionnaire assessed nutrition two days before and during a competition, focusing on macronutrient intake, hydration, and supplementation. Statistical analyses were performed to compare advanced and elite athletes. Participants consumed an average of 3164.14 kcal two days before and 3176.97 kcal the day before the competition. Carbohydrate intake averaged 7.69 g/kg two days before and 7.64 g/kg the day before the race, potentially insufficient for optimal glycogen stores. Protein intake was adequate, averaging 1.63 g/kg two days before and 1.73 g/kg the day before the race. Fluid intake averaged 2811.25 mL two days before and 2891.80 mL the day before the race. During races, carbohydrate intake averaged 58.56 g/h, with variations based on race duration. Most participants used isotonic drinks and water for hydration. Mountain runners generally adhere to proper nutrition guidelines, with adequate protein and fluid intake. However, their carbohydrate intake may be insufficient for longer races. Higher carbohydrate intake during exercise could provide additional benefits.

Purpose: This study aimed to determine whether the initial levels of aerobic fitness and hematological variables in young female road cyclists are related to their athletic performance development during their careers., Methods: Results of graded exercise tests on a cycle ergometer and total hemoglobin mass (tHb-mass) measurements were analyzed in 34 female road cyclists (age 18.6 [1.9] y). Among them, 2 groups were distinguished based on their competitive performance (Union Cycliste Internationale world ranking) over the following 8 years. Areas under the curve in receiver-operating-characteristic curves were calculated as indicators of elite-performance prediction., Results: Initial graded exercise test variables (peak power, peak oxygen uptake, and power at 4 mmol/L blood lactate) were not significantly different in elite (n = 13) versus nonelite (n = 21) riders. In contrast, elite riders had higher tHb-mass expressed either in absolute measures (664 [75] vs 596 [59] g, P = .006) or normalized to body mass (11.2 [0.8] vs 10.3 [0.7] g/kg, P = .001) and fat-free mass (14.4 [0.9] vs 13.1 [0.9] g/kg, P < .001). Absolute and relative erythrocyte volumes were significantly higher in elite subjects (P ranged from < .001 to .006). Of all the variables analyzed, the relative tHb-mass had the highest predictive ability to reach the elite level (area under the curve ranged from .82 to .85)., Conclusion: Measurement of tHb-mass can be a helpful tool in talent detection to identify young female road cyclists with the potential to reach the elite level in the future.

Background: Endurance athletes (EA) are an emerging population of focus for cardiovascular health. The oxygen uptake efficiency plateau (OUEP) is the levelling-off period of ratio between oxygen uptake (VO 2 ) and ventilation (VE). In the cohort of EA, we externally validated prediction models for OUEP and derived with internal validation a new equation., Methods: 140 EA underwent a medical assessment and maximal cycling cardiopulmonary exercise test. Participants were 55% male (N = 77, age = 21.4 ± 4.8 years, BMI = 22.6 ± 1.7 kg·m - 2 , peak VO 2  = 4.40 ± 0.64 L·min - 1 ) and 45% female (N = 63, age = 23.4 ± 4.3 years, BMI = 22.1 ± 1.6 kg·m - 2 , peak VO 2  = 3.21 ± 0.48 L·min - 1 ). OUEP was defined as the highest 90-second continuous value of the ratio between VO 2 and VE. We used the multivariable stepwise linear regression to develop a new prediction equation for OUEP., Results: OUEP was 44.2 ± 4.2 mL·L - 1 and 41.0 ± 4.8 mL·L - 1 for males and females, respectively. In external validation, OUEP was comparable to directly measured and did not differ significantly. The prediction error for males was - 0.42 mL·L - 1 (0.94%, p = 0.39), and for females was + 0.33 mL·L - 1 (0.81%, p = 0.59). The developed new prediction equation was: 61.37-0.12·height (in cm) + 5.08 (for males). The developed model outperformed the previous. However, the equation explained up to 12.9% of the variance (R = 0.377, R 2  = 0.129, RMSE = 4.39 mL·L - 1 )., Conclusion: OUEP is a stable and transferable cardiorespiratory index. OUEP is minimally affected by fitness level and demographic factors. The predicted OUEP provided promising but limited accuracy among EA. The derived new model is tailored for EA. OUEP could be used to stratify the cardiorespiratory response to exercise and guide training., (© 2024. The Author(s).)

This study explores the effects of normobaric hypoxia and intermittent hypoxic training (IHT) on the physiological condition of the cardiac muscle in swimmers. Hypoxia has been reported to elicit both beneficial and adverse changes in the cardiovascular system, but its impact on the myocardium during acute exercise and altitude/hypoxic training remains less understood. We aimed to determine how a single bout of intense interval exercise and a four-week period of high-intensity endurance training under normobaric hypoxia affect cardiac marker activity in swimmers. Sixteen young male swimmers were divided into two groups: one undergoing training in hypoxia and the other in normoxia. Cardiac markers, including troponin I and T (cTnI and cTnT), heart-type fatty acid-binding protein (H-FABP), creatine kinase-MB isoenzyme (CK-MB), and myoglobin (Mb), were analyzed to assess the myocardium's response. We found no significant differences in the physiological response of the cardiac muscle to intense physical exertion between hypoxia and normoxia. Four weeks of IHT did not alter the resting levels of cTnT, cTnI, and H-FABP, but it resulted in a noteworthy decrease in the resting concentration of CK-MB, suggesting enhanced cardiac muscle adaptation to exercise. In contrast, a reduction in resting Mb levels was observed in the control group training in normoxia. These findings suggest that IHT at moderate altitudes does not adversely affect cardiac muscle condition and may support cardiac muscle adaptation, affirming the safety and efficacy of IHT as a training method for athletes.

Introduction: Inertial measurement units (IMUs) are utilized to measure trunk acceleration variables related to both running performances and rehabilitation purposes. This study examined both the reliability and sex-based differences of these variables during an incremental treadmill running test., Methods: Eighteen endurance runners performed a test-retest on different days, and 30 runners (15 females) were recruited to analyze sex-based differences. Mediolateral (ML) and vertical (VT) trunk displacement and root mean square (RMS) accelerations were analyzed at 9, 15, and 21 km·h -1 ., Results: No significant differences were found between test-retests [effect size (ES)<0.50)]. Higher intraclass correlation coefficients (ICCs) were found in the trunk displacement (0.85-0.96) compared to the RMS-based variables (0.71-0.94). Male runners showed greater VT displacement (ES = 0.90-1.0), while female runners displayed greater ML displacement, RMS ML and anteroposterior (AP), and resultant euclidean scalar (RES) (ES = 0.83-1.9)., Discussion: The IMU was found reliable for the analysis of the studied trunk acceleration-based variables. This is the first study that reports different results concerning acceleration (RMS) and trunk displacement variables for a same axis in the analysis of sex-based differences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Miqueleiz, Aguado-Jimenez, Lecumberri, Garcia-Tabar and Gorostiaga.)

Previous studies have shown that variations in the CD36 gene may affect phenotypes associated with fat metabolism as the CD36 protein facilitates the transport of fatty acids to the mitochondria for oxidation. However, no previous study has tested whether variations in the CD36 gene are associated with sports performance. We investigated the genotypic and allelic distribution of the single-nucleotide polymorphism (SNP) rs1761667 in the CD36 gene in elite Moroccan athletes (cyclists and hockey players) in comparison with healthy non-athletes of the same ethnic origin. Forty-three Moroccan elite male athletes (nineteen cyclists and twenty-four field hockey players) belonging to the national teams of their respective sports (athlete group) were compared to twenty-eight healthy, active, male university students (control group). Genotyping of the CD36 rs1761667 (G>A) SNP was performed via polymerase chain reaction (PCR) and Sanger sequencing. A chi-square (χ 2 ) test was used to assess the Hardy-Weinberg equilibrium (HWE) and to compare allele and genotype frequencies in the "athlete" and "control" groups. The genotypic distribution of the CD36 rs1761667 polymorphism was similar in elite athletes (AA: 23.81, AG: 59.52, and GG: 16.67%) and controls (AA: 19.23, AG: 69.23, and GG: 11.54%; χ 2 = 0.67, p = 0.71). However, the genotypic distribution of the CD36 rs1761667 polymorphism was different between cyclists (AA: 0.00, AG: 72.22, and GG: 27.78%) and hockey players (AA: 41.67, AG: 50.00, and GG: 8.33%; χ 2 = 10.69, p = 0.004). Specifically, the frequency of the AA genotype was significantly lower in cyclists than in hockey players ( p = 0.02). In terms of allele frequency, a significant difference was found between cyclists versus field hockey players (χ 2 = 7.72, p = 0.005). Additionally, there was a predominance of the recessive model in cyclists over field hockey players (OR: 0.00, 95% CI: 0.00-0.35, p = 0.002). Our study shows a significant difference between cyclists and field hockey players in terms of the genotypic and allelic frequency of the SNP rs1761667 of the CD36 gene. This divergence suggests a probable association between genetic variations in the CD36 gene and the type of sport in elite Moroccan athletes.

Background: Atrial fibrillation (AF) is a common arrhythmia characterized by uncoordinated atrial electrical activity. Lone AF occurs in the absence of traditional risk factors and is frequently observed in male endurance athletes, who face a 2- to 5-fold higher risk of AF compared with healthy, moderately active males. Our understanding of how endurance exercise contributes to the pathophysiology of lone AF remains limited. This study aimed to characterize the circulating protein fluctuations during high-intensity exercise as well as explore potential biomarkers of exercise-associated AF., Methods and Results: A prospective cohort of 12 male endurance cyclists between the ages of 40 and 65 years, 6 of whom had a history of exercise-associated AF, were recruited to participate using a convenience sampling method. The circulating proteome was subsequently analyzed using multiplex immunoassays and aptamer-based proteomics before, during, and after an acute high-intensity endurance exercise bout to assess temporality and identify potential markers of AF. The endurance exercise bout resulted in significant alterations to proteins involved in immune modulation (eg, growth/differentiation factor 15), skeletal muscle metabolism (eg, α-actinin-2), cell death (eg, histones), and inflammation (eg, interleukin-6). Subjects with AF differed from those without, displaying modulation of proteins previously known to have associations with incident AF (eg, C-reactive protein, insulin-like growth factor-1, and angiopoietin-2), and also with proteins having no previous association (eg, tapasin-related protein and α 2 -Heremans-Schmid glycoprotein)., Conclusions: These findings provide insights into the proteomic response to acute intense exercise, provide mechanistic insights into the pathophysiology behind AF in athletes, and identify targets for future study and validation.

Objectives: Currently, there are five international screening tools that are recommended to identify individuals who require pre-exercise medical clearance to reduce the risk of medical encounters during exercise. Therefore, the aim was to determine the percentage of race entrants who are advised to obtain pre-exercise medical clearance and the observed agreement between these five different international pre-exercise medical screening tools., Methods: In all, 76,654 race entrants from the Two Oceans Marathon (2012-2015) that completed an online pre-race screening questionnaire. Five pre-exercise medical screening tools (American Heart Association (AHA), pre-2015 American College of Sport Medicine (ACSM), post-2015 ACSM, Physical Activity Readiness Questionnaire (PAR-Q), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR)) were retrospectively applied to all participants. The % (95%CI) race entrants requiring medical clearance identified by each tool and the observed agreement between tools (%) was determined., Results: The % entrants requiring medical clearance varied from 6.7% to 33.9% between the five tools: EACPR (33.9%; 33.5-34.3); pre-2015 ACSM (33.9%; 33.5-34.3); PAR-Q (23.2%; 22.9-23.6); AHA (10.0%; 9.7-10.2); post-2015 ACSM (6.7%; 6.5-6.9). The observed agreement was highest between the pre-2015 ACSM and EACPR (35.4%), for pre-2015 ACSM and PAR-Q (24.8%), PAR-Q and EACPR (24.8%), and lowest between the post-2015 ACSM and AHA (4.1%)., Conclusion: The percentage of race entrants identified to seek medical clearance (and observed agreement) varied considerably between pre-exercise medical screening tools. Further research should determine which tool has the best predictive ability in identifying those at higher risk of medical encounters during exercise.

Background: The ratio of oxygen uptake (VO 2 ) to minute ventilation (VE) is described as the oxygen uptake efficiency slope (OUES). OUES has been suggested as a valuable submaximal cardiorespiratory index; however, its characteristics in endurance athletes remain unknown. In this study, we a) investigated OUES between different time intervals, b) assessed their prediction power for VO 2 peak, and c) derived new prediction equations for OUES tailored for well-trained individuals. Materials and Methods: A total of 77 male (age = 21.4 ± 4.8 yrs; BMI = 22.1 ± 1.6 kg·m -2 ; peak oxygen uptake = 4.40 ± 0.64 L·min -1 ) and 63 female individuals (age = 23.4 ± 4.3 yrs; BMI = 23.1 ± 1.6 kg·m -2 ; peak oxygen uptake = 3.21 ± 0.48 L·min -1 ) underwent the cycling cardiopulmonary exercise test. OUES was measured at 75%, 90%, and 100% of exercise duration. Prediction power and new models were derived with the multiple linear regression method. Results: In male subjects, OUES [mL·min -1 /L·min -1 ] from 75% = 4.53 ± 0.90, from 90% = 4.52 ± 0.91, and from 100% = 4.41 ± 0.87. In female subjects, OUES [mL·min -1 /L·min -1 ] from 75% = 3.50 ± 0.65, from 90% = 3.49 ± 0.62, and from 100% = 3.41 ± 0.58. OUES did not differ between time intervals in male ( p = 0.65) and female individuals ( p = 0.69). OUES strongly predicts peak VO 2 independently from the measuring interval ( β = 0.71-0.80; R 2 = 0.50-0.63). The prediction model designed for elite athletes was OUES [mL·min -1 /L·min -1 ] = -1.54 + 2.99; BSA [m 2 ]-0.0014; (age [in years]; sex [1 = male, 2 = female]) ( R OUES enables an accurate prediction of peak cardiorespiratory fitness in elite endurance athletes. OUES is a feasible alternative to maximal exercise testing. A new prediction equation should be used for highly trained individuals. Physicians should understand OUES physiology to properly assess the cardiorespiratory response to exercise in athletic cohorts.2 = 0.36). Conclusion: OUES enables an accurate prediction of peak cardiorespiratory fitness in elite endurance athletes. OUES is a feasible alternative to maximal exercise testing. A new prediction equation should be used for highly trained individuals. Physicians should understand OUES physiology to properly assess the cardiorespiratory response to exercise in athletic cohorts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kasiak, Kowalski, Rębiś, Klusiewicz, Starczewski, Ładyga, Wiecha, Barylski, Poliwczak, Wierzbiński, Mamcarz and Śliż.)

Background: The ketogenic diet (KD) is the most popular carbohydrate restriction strategy for endurance athletes. However, because the primary goal of employing the KD is to gain a competitive advantage in competition, endurance athletes may be less concerned with the influence of the KD on their cardiometabolic health; particularly their blood lipid profiles. Thus, the purpose of this study was to examine the chronic and postprandial blood lipid alterations following a two-week ad libitum KD compared to an ad libitum high-carbohydrate diet (HCD) and the athletes' habitual diet (HD) in a group of trained competitive cyclists and triathletes., Methods: Six trained competitive cyclists and triathletes (female: 4, male: 2; age: 37.2 ± 12.2) completed this randomized crossover trial, which required them to follow a two-week ad libitum KD and HCD in a randomized order after their HD. Fasting blood lipids were collected following their HD and after two-weeks of the KD and HCD conditions. Postprandial blood lipid responses to a test meal reflective of the assigned diet were collected at the end of each diet condition., Results: Fasting total cholesterol (TC) was significantly higher following the KD compared to the HD (p < 0.001) and HCD (p = 0.006). Postprandial incremental area under the curve for triglycerides (TRG), TRG:HDL ratio, and VLDL-C were significantly higher following the KD test meal compared to the HD (all p < 0.001) and HCD (all p = 0.001) test meals but LDL-C and LDL:HDL ratio were significantly lower following the KD compared to the HD and HCD test meals (all p < 0.001)., Conclusions: Trained competitive cyclists and triathletes demonstrate increased TC in response to a two-week KD compared to a HCD or HD. Endurance athletes contemplating a KD should consider the potential for these blood lipid alterations, and future research should focus on postprandial blood lipid responses to determine if these changes manifest in chronic blood lipid shifts., Trial Registration: ClinicalTrials.gov Identifier: NCT04097171 (11 October 2019)., (© 2024. The Author(s).)

Introduction: The different structural modifications that have been described in the heart of the high-performance athlete depend on factors such as age, gender, type of sport, and the intensity and time dedicated to training., Objectives: Evaluation of elite athletes through echocardiography for the description of cardiac structure and function, and the comparison between athletes with cardiorespiratory endurance and the rest of the athletes., Methods: We performed the echocardiographic examination in 224 elite athletes, 96 women and 128 men aged 15 to 38 years (21.7 ± 5.3 years) and they were divided into 2 groups: "Endurance Group" (cardiorespiratory endurance) and "Non-Endurance Group" which included the rest of the sports. Univariate comparison between the two groups was performed by measuring 14 echocardiographic variables., Results: In men, statistically significant higher values were identified in the endurance group for interventricular septum, left ventricular posterior wall, relative wall thickness (RWT), left ventricular mass index and left atrial dimension. In women, the endurance group had significantly lower heart rate values, and significantly higher left ventricular diastolic dimension with normal RWT., Conclusions: Most of the echocardiographic variables showed higher sample means in the endurance athletes. In the subgroup of men from the Endurance Group, eccentric hypertrophy prevailed with a greater increase in wall thickness, as well as in the diameter of the left atrium, while in women the variables indicated eccentric hypertrophy at the expense of an increase in left ventricle diameter, without increased wall thickness.

Purpose: Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects., Methods: Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET)., Results: ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001)., Conclusion: Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior., Level of Evidence: III: Evidence obtained from cohort studies., (© 2023. The Author(s).)

Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier B.V.)

Objective: Endurance athletes such as cyclists may develop intermittent claudication owing to iliac artery endofibrosis after long-lasting extreme hemodynamic challenges. This study investigated short-term (<1.5 years) and long-term (>5 years) satisfaction and safety after a surgical endarterectomy and autologous patching., Methods: Data of endurance athletes who underwent an endarterectomy for flow limitation of the iliac artery owing to endofibrosis between 1997 and 2015 in one center were studied. Maximal cycling exercise tests, ankle-brachial index with flexed hips, echo-Doppler examination (peak systolic velocity), and contrast-enhanced magnetic resonance angiography were performed before and 6 to 18 months after surgery. Short-term and long-term satisfaction were evaluated using questionnaires. Potential patch dilatation was assessed using echo-Doppler., Results: Analysis of 68 patients (79 legs; 55.7% males, median age at the time of surgery, 34 years; interquartile range, 26-41 years) demonstrated that cycling workload at symptom onset improved from 226 ± 97 to 333 ± 101 (P < .001) Watts. Peak workload increased from 326 ± 111 to 352 ± 93 Watts (P < .001). Ankle-brachial index with flexed hips increased from 0.34 (interquartile range [IQR], 0.00-0.47) to 0.59 (IQR, 0.51-0.69; P < .001). Peak systolic velocity with extended and flexed hip decreased from 2.04 m·sec -1 (IQR, 1.52-2.56 m·3sec -1 ) to 1.25 m·sec -1 (IQR, 0.92-1.62 m·sec -1 ; P < .001) and 2.40 m·sec -1 (IQR, 1.81-2.81 m·sec -1 ) to 1.15 m·sec -1 (IQR, 0.97-1.60 m·sec -1 ; P < .001), respectively. Thirty-day major complication rate was 5.1% (hematoma requiring evacuation n Legs  = 2, septic bleeding from deep infection n Legs  = 1, and iliac occlusion requiring thrombectomy n Legs  = 1). In the short term, 91.2% of patients reported symptom reduction with a 93.7% overall satisfaction rate. After a median of 11.1 years (IQR, 7.8-17.6 years), the overall satisfaction was 91.7%; 94.5% of patients reported persistent symptom reduction. Patch dilatation of >20 mm was observed in two patients. Linear mixed model analysis revealed no alarming patch dilatation in the long term., Conclusions: Endarterectomy with an autologous patch for intermittent claudication owing to iliac artery endofibrosis in endurance athletes shows high rates of patient satisfaction and symptom reduction in both the short and long term. The risk of surgical complications or patch dilatation is mild. A surgical intervention for flow limitation of the iliac artery owing to endofibrosis is safe and successful., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: The purpose of this study was to 1. investigate if glucose tolerance is affected after one acute bout of different types of exercise; 2. assess if potential differences between two exercise paradigms are related to changes in mitochondrial function; and 3. determine if endurance athletes differ from nonendurance-trained controls in their metabolic responses to the exercise paradigms., Methods: Nine endurance athletes (END) and eight healthy nonendurance-trained controls (CON) were studied. Oral glucose tolerance tests (OGTT) and mitochondrial function were assessed on three occasions: in the morning, 14 h after an overnight fast without prior exercise (RE), as well as after 3 h of prolonged continuous exercise at 65% of VO 2 max (PE) or 5 × 4 min at ~95% of VO 2 max (HIIT) on a cycle ergometer., Results: Glucose tolerance was markedly reduced in END after PE compared with RE. END also exhibited elevated fasting serum FFA and ketones levels, reduced insulin sensitivity and glucose oxidation, and increased fat oxidation during the OGTT. CON showed insignificant changes in glucose tolerance and the aforementioned measurements compared with RE. HIIT did not alter glucose tolerance in either group. Neither PE nor HIIT affected mitochondrial function in either group. END also exhibited increased activity of 3-hydroxyacyl-CoA dehydrogenase activity in muscle extracts vs. CON., Conclusion: Prolonged exercise reduces glucose tolerance and increases insulin resistance in endurance athletes the following day. These findings are associated with an increased lipid load, a high capacity to oxidize lipids, and increased fat oxidation., (© 2023 The Authors. Acta Physiologica published by John Wiley & Sons Ltd on behalf of Scandinavian Physiological Society.)

Participation in sports, especially those involving impact loading, enhance bone mineral content (BMC) and density (BMD). Additionally, participation in impact loading sports may strengthen relationships between strength or power and bone variables. The purpose of this investigation was to examine relationships between measures of muscular performance and bone variables in Division I endurance athletes (29 males, 31 females, 19.6 ± 1.4 years). Dual-energy x-ray absorptiometry (DXA) scans were analyzed at the anterior-posterior (AP) and lateral (LAT) spine, femoral neck (FN), total hip (TH), whole body (WB), and ultra-distal forearm (UD) for BMC and BMD measures. WB scans provided information for bone-free lean mass (BFLM). Performance measures included absolute, and relative (to body weight), grip strength (GS) and absolute lower body power (LBP) derived from a vertical jump. Pearson correlation coefficients were determined between bone variables and muscular performance measures. Hierarchical multiple regression was used to quantify the variance explained in bone variables. Male runners showed strong relationships between absolute and relative GS and numerous bone variables. Female runner had significant relationships between absolute jump power and numerous bone variables. Sex, GS, and LBP explained 41-76% of BMC at the various bone sites and 12-30% of BMD. Results indicate that in collegiate men, greater strength is related to higher BMC and BMD, however this was not the case for women. In female collegiate distance runners, higher jump power was related to greater BMC and BMD.

COVID-19 has a deteriorating impact on health which is especially important for endurance athletes (EAs) who need to maintain continuity of training. The illness affects sleep and psychology, which influence sport performance. The aims of this study were: (1) to assess the consequences of mild COVID-19 on sleep and psychology and (2) to assess the consequences of mild COVID-19 on cardiopulmonary exercise test (CPET) results. A total of 49 EAs (males = 43, 87.76%; females = 6, 12.24%; age = 39.9 ± 7.8 years; height = 178.4 ± 6.8 cm; weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m -2 ) underwent a maximal cycling or running CPET pre- and post-COVID-19 and completed an original survey. Exercise performance deteriorated after COVID-19 (maximal oxygen uptake, VO 2max = 47.81 ± 7.81 vs. 44.97 ± 7.00 mL·kg·min -1 pre- and post-infection, respectively; p < 0.001). Waking up at night affected the heart rate (HR) at the respiratory compensation point (RCP) ( p = 0.028). Sleep time influenced pulmonary ventilation ( p = 0.013), breathing frequency ( p = 0.010), and blood lactate concentration (Lac) ( p = 0.013) at the RCP. The maximal power/speed ( p = 0.046) and HR ( p = 0.070) were linked to the quality of sleep. Stress management and relaxation techniques were linked with VO 2max ( p = 0.046), maximal power/speed ( p = 0.033), and maximal Lac ( p = 0.045). Cardiorespiratory fitness deteriorated after mild COVID-19 and was correlated with sleep and psychological indices. Medical professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Maximal heart rate (HRmax) is a widely used measure of cardiorespiratory fitness. Prediction of HRmax is an alternative to cardiopulmonary exercise testing (CPET), but its accuracy among endurance athletes (EA) requires evaluation. This study aimed to externally validate HRmax prediction models in the EA independently for running and cycling CPET. A total of 4043 runners (age = 33.6 (8.1) years; 83.5% males; BMI = 23.7 (2.5) kg·m -2 ) and 1026 cyclists (age = 36.9 (9.0) years; 89.7% males; BMI = 24.0 (2.7) kg·m -2 ) underwent maximum CPET. Student t -test, mean absolute percentage error (MAPE), and root mean square error (RMSE) were applied to validate eight running and five cycling HRmax equations externally. HRmax was 184.6 (9.8) beats·min -1 and 182.7 (10.3) beats·min -1 , respectively, for running and cycling, p = 0.001. Measured and predicted HRmax differed significantly ( p = 0.001) for 9 of 13 (69.2%) models. HRmax was overestimated by eight (61.5%) and underestimated by five (38.5%) formulae. Overestimated HRmax amounted to 4.9 beats·min -1 and underestimated HRmax was in the range up to 4.9 beats·min -1 . RMSE was 9.1-10.5. MAPE ranged to 4.7%. Prediction models allow for limited precision of HRmax estimation and present inaccuracies. HRmax was more often underestimated than overestimated. Predicted HRmax can be implemented for EA as a supplemental method, but CPET is the preferable method.

Proper nutrition is critical for optimal performance in endurance athletes. However, it is unclear if endurance athletes are meeting all their energy and nutrient needs. We examined if endurance athletes are meeting their nutritional requirements and if this differed by sex. Ninety-five endurance athletes (n = 95; 50.5% men; 34.9 ± 12.9 y) participated in the study. Dietary intake was evaluated using the 24 h dietary recall method. Energy and nutrient intakes were calculated using the ESHA Food Processor Diet Analysis Software and compared against reference nutrient intakes. Endurance athletes did not consume the recommended amount of energy (76.8% of athletes), carbohydrates (95.8%), linoleic acid (75.8%), α-linolenic acid (ALA) (77.9%), eicosatetraenoic and docosahexaenoic acid (96.8%), dietary fiber (49.5%), vitamins D (93.7%), E (71.6%), and K (54.7%), folate (54.7%), pantothenic acid (70.5%), biotin (83.2%), manganese (58.9%), magnesium (56.8%), chromium (91.6%), molybdenum (93.7%), choline (85.3%), and potassium (56.8%), and consumed too much saturated fat (50.5%) and sodium (94.7%) than recommended. Fisher's Exact test showed that the requirements for dietary fiber (70.8% vs. 27.7%), ALA (87.5% vs. 68.1%), and total water (70.8% vs. 44.7%) were not met by more men versus women ( p < 0.05). The needs for protein (70.2% vs. 25%) and vitamin B12 (46.8% vs. 22.9%) were not met by more women compared to men ( p < 0.05). These findings need to be confirmed by a larger study.

Introduction: Accurate determination of total daily energy expenditure (TDEE) in athletes is important for optimal performance and injury prevention, but current approaches are insufficiently accurate. We therefore developed an approach to determine TDEE in professional cyclists based on power data, basal metabolic rate (BMR), and a non-exercise physical activity level (PAL) value, and compared energy expenditure (EE) between multi-day and single-day races., Methods: Twenty-one male professional cyclists participated. We measured: (1) BMR, (2) the relationship between power output and EE during an incremental cycling test, which was used to determine EE during exercise (EE E ), and (3) TDEE using doubly labeled water (DLW). A non-exercise PAL-value was obtained by subtracting EE E from TDEE and dividing this by BMR., Results: Measured BMR was 7.9 ± 0.8 MJ/day, which was significantly higher than predicted by the Oxford equations. A new BMR equation for elite endurance athletes was therefore developed. Mean TDEE was 31.7 ± 2.8 and 27.3 ± 2.8 MJ/day during the Vuelta a España and Ardennes classics, while EE E was 17.4 ± 1.8 and 10.1 ± 1.4 MJ/day, respectively. Non-exercise PAL-values were 1.8 and 2.0 for the Vuelta and Ardennes classics, respectively, which is substantially higher than currently used generic PAL-values., Conclusion: We show that the proposed approach leads to a more accurate estimation of non-exercise EE than the use of a generic PAL-value in combination with BMR predictive equations developed for non-elite athletes, with the latter underestimating non-exercise EE by ~28%. The proposed approach may therefore improve nutritional strategies in professional cyclists., (© 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Carbohydrate (CHO) supplements such as bars, gels, drinks and powders have become ubiquitous as effective evidence-based CHO sources that improve endurance exercise performance. However, athletes are increasingly turning to more cost-effective 'food-first' approaches for CHO ingestion to improve exercise performance. Mixed CHO foods including cooked lentils, oats, honey, raisins, rice, and potatoes are all effective pre-exercise CHO food sources. Caution is advised when selecting some of these foods as a primary CHO source, as some athletes may be prone to gastrointestinal discomfort-especially regarding those foods where the quantities required for recommended CHO intake may be voluminous (e.g., potatoes). Palatability may be another barrier to the ingestion of some of these CHO-rich foods. Although most of these CHO-rich foods appear effective for exercise performance or recovery when consumed pre- and post-exercise, not all are viable to ingest during exercise due to difficulties in the quantities required, transport, and/or gastrointestinal discomfort. Raisins, bananas and honey may be particularly useful CHO foods for consumption during exercise, as they are easily transportable. Athletes should trial CHO food sources before, during and/or following training before implementation during competition.

The present study aimed to examine the vitamin D receptor ( VDR ), rs2228570 polymorphism, and its effect on elite athletes' performance. A total of 60 elite athletes (31 sprint/power and 29 endurance) and 20 control/ physically inactive, aged 18-35, voluntarily participated in the study. The International Association of Athletics Federations (IAAF) score scale was used to determine the performance levels of the athletes' personal best (PB). Whole exome sequencing (WES) was performed by the genomic DNA isolated from the peripheral blood of the participants. Sports type, sex, and competitive performance were chosen as the parameters to compare within and between the groups by linear regression models. The results showed no statistically significant difference between the CC, TC, and TT genotypes within and between the groups ( p > 0.05). Additionally, our results underlined that there were no statistically significant differences for the association of rs2228570 polymorphism with PBs within the groups of the ( p > 0.05) athletes. The genetic profile in the selected gene was similar in elite endurance, sprint athletes, and in controls, suggesting that rs2228570 polymorphism does not determine competitive performance in the analyzed athlete cohort.

Objective: Endurance athletes are prone to develop flow limitations in iliac arteries (FLIA). Especially in cyclists and ice speed skaters, excessive hemodynamic loading coupled with hip hyperflexion may cause kinking in lengthened iliac arteries necessitating surgical correction. This study investigated the short-term (≤1.5 years) and long-term (≥5 years) satisfaction of operative shortening of the iliac artery in endurance athletes., Methods: All patients who were diagnosed and operated for FLIA owing to lengthened and kinked iliac arteries between 1997 and 2015 in one center were analyzed. Short-term follow-up consisted of an incremental maximal cycling test, ankle-brachial index with flexed hips, echo-Doppler examination with peak systolic velocity measurements and contrast-enhanced magnetic resonance angiography before and 6 to 18 months after surgery. Both short- and long-term satisfaction were assessed using questionnaires., Results: A total of 83 patients (90 operated legs; 96.7% males; median age of 34 years at the time of surgery; interquartile range [IQR], 29-47) were analyzed. In the short-term, 87.5% reported symptom reduction with an 86.4% overall satisfaction rate. Symptom-free cycling improved from 272 ± 84 W to 384 ± 101 W (P < .001), whereas the maximal workload increased from 419 ± 72 W to 428 ± 67 W (P = .01). The ankle-brachial index with flexed hips increased from 0.55 (IQR, 0.45-0.65) to 0.62 (IQR, 0.52-0.74; P = .008), and the peak systolic velocity measured with hips flexed decreased from 2.50 m/s (IQR, 1.77-3.13 m/s) to 1.57 m/s (IQR, 1.20-2.04 m/s; P < .001). After a median of 12 years (IQR, 9.0-15.4 years), symptoms were still decreased in 84.1% of patients with an 81.2% overall satisfaction rate (79.5% response rate). Three patients needed a reintervention (recurrent FLIA, n = 2; failure, n = 1)., Conclusions: Operative shortening of a lengthened and kinked iliac artery causing FLIA is successful both in the short- and long-term., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Endurance performance is positively associated with hematological adaptations; therefore, high total hemoglobin mass and intravascular volumes are commonly observed in high-level endurance athletes. However, it is still unclear whether the fluctuations in exercise capacity that typically occur in endurance athletes during the annual training cycle are directly associated with changes in hematological adaptations, which appear to be relatively stable during this time. To better understand this issue, a study was conducted with 10 Olympic rowers, who followed the same training program. Athletes underwent laboratory testing in the competitive and the general preparation phase of an annual training cycle (a 34% reduction in training volume). This included a graded exercise test on a rowing ergometer (GXT) and blood measurements of hemoglobin concentration (Hb), total hemoglobin mass (tHb-mass), plasma volume (PV), and blood volume (BV). Decreases in maximal values of power relative to body mass (p = 0.028), lactate concentration (p = 0.005), and heart rate (p = 0.017) in the GXT were registered. At the same time, absolute (p = 0.017) and relative (p = 0.005) PV decreased. Changes in PV (rS = 0.842, p = 0.002) and BV (rS = 0.818, p = 0.004), but not in tHb-mass (rS = 0.588, p = 0.074) and Hb (rS = -0.188, p = 0.602), were significantly correlated with changes in maximal power in the GXT. Our results indicate a close relationship between changes in intravascular volumes and maximal exercise capacity after a period of reduced training loads in elite endurance athletes., Competing Interests: The authors declare no conflict of interest., (Copyright: © Academy of Physical Education in Katowice.)

Extreme carbohydrate deficits during a ketogenic diet (KD) may result in metabolic adaptations reflective of low energy availability; however, the manifestation of these adaptations outside of exercise have yet to be elucidated in cyclists and triathletes. The purpose of this study is to investigate the chronic and postprandial metabolic responses to a KD compared to a high-carbohydrate diet (HCD) and habitual diet (HD) in trained competitive cyclists and triathletes. For this randomized crossover trial, six trained competitive cyclist and triathletes (F: 4, M: 2) followed an ad libitum KD and HCD for 14 d each after their HD. Fasting energy expenditure (EE), respiratory exchange ratio (RER), and fat and carbohydrate oxidation (FatOx and CarbOx, respectively) were collected during their HD and after 14 d on each randomly assigned KD and HCD. Postprandial measurements were collected on day 14 of each diet following the ingestion of a corresponding test meal. There were no significant differences in fasting EE, RER, FatOx, or CarbOx among diet conditions (all p > 0.050). Although postprandial RER and CarbOx were consistently lower following the KD meal, there were no differences in peak postprandial RER (p = 0.452), RER incremental area under the curve (iAUC; p = 0.416) postprandial FatOx (p = 0.122), peak FatOx (p = 0.381), or FatOx iAUC (p = 0.164) between the KD and HD meals. An ad libitum KD does not significantly alter chronic EE or substrate utilization compared to a HCD or HD; postprandial FatOx appears similar between a KD and HD; this is potentially due to the high metabolic flexibility of cyclists and triathletes and the metabolic adaptations made to habitual high-fat Western diets in practice. Cyclists and triathletes should consider these metabolic similarities prior to a KD given the potential health and performance impairments from severe carbohydrate restriction.

COVID-19 and imposed restrictions are linked with numerous health consequences, especially among endurance athletes (EA). Unfavorable changes in physical activity and nutrition may affect later sports and competition performance. The aims of this study were: (1) to assess the impact of COVID-19 infection and pandemic restrictions on the nutrition and physical activity of EAs and (2) to compare them with the results of cardiopulmonary exercise testing (CPET). In total, 49 EAs (nmale = 43, nfemale = 6, mean age = 39.9 ± 7.8 year., height = 178.4 ± 6.8 cm, weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m−2) underwent pre- and post-COVID-19 CPET and fulfilled the dietary and physical activity survey. COVID-19 infection significantly deteriorated CPET performance. There was a reduction in oxygen uptake and in heart rate post-COVID-19 (both p < 0.001). Consuming processed meat and replacing meat with plant-based protein affected blood lactate concentration (p = 0.035). Fat-free mass was linked with consuming unsaturated fatty acids (p = 0.031). Adding salt to meals influenced maximal speed/power (p = 0.024) and breathing frequency (p = 0.033). Dietary and Fitness Practitioners and Medical Professionals should be aware of possible COVID-19 infection and pandemic consequences among EA. The results of this study are a helpful guideline to properly adjust the treatment, nutrition, and training of EA.

Triathlon is a physically demanding sport, requiring athletes to make informed decisions regarding their daily food and fluid intake to align with daily training. With an increase in uptake for online learning, remotely delivered education programs offer an opportunity to improve nutritional knowledge and subsequent dietary intake in athletes. This single-arm observational study aimed to evaluate the effectiveness of a remotely delivered nutrition education program on sports nutrition knowledge and the dietary intake of junior elite triathletes (n = 21; female n = 9; male n = 12; 18.9 ± 1.6 y). A total of 18 participants completed dietary intake assessments (4-day food diary via Easy Diet DiaryTM) and 14 participants completed an 83-question sports nutrition knowledge assessment (Sports Nutrition Knowledge Questionnaire (SNKQ)) before and after the 8-week program. Sports nutrition knowledge scores improved by 15% (p < 0.001, ES = 0.9) following the program. Male participants reported higher energy intakes before (3348 kJ, 95% CI: 117−6579; p = 0.043) and after (3644 kJ, 95% CI: 451−6836; p = 0.028) the program compared to females. Carbohydrate intake at breakfast (p = 0.022), daily intakes of fruit (p = 0.033), dairy (p = 0.01) and calcium (p = 0.029) increased following nutrition education. Irrespective of gender, participants had higher intakes of energy (p < 0.001), carbohydrate (p = 0.001), protein (p = 0.007), and fat (p = 0.007) on heavy training days compared to lighter training days before and after the program with total nutrition knowledge scores negatively correlated with discretionary food intake (r = −0.695, p = 0.001). A remotely delivered nutrition education program by an accredited sports nutrition professional improved sports nutrition knowledge and subsequent dietary intake of junior elite triathletes, suggesting remote delivery of nutrition education may prove effective when social distancing requirements prevent face-to-face opportunities.

The aim of this systematic review and meta-analysis was to identify the genetic variants of (inter)national competing long-distance runners and road cyclists compared with controls. The Medline and Embase databases were searched until 15 November 2021. Eligible articles included genetic epidemiological studies published in English. A homogenous group of endurance athletes competing at (inter)national level and sedentary controls were included. Pooled odds ratios based on the genotype frequency with corresponding 95% confidence intervals (95%CI) were calculated using random effects models. Heterogeneity was addressed by Q-statistics, and I 2 . Sources of heterogeneity were examined by meta-regression and risk of bias was assessed with the Clark Baudouin scale. This systematic review comprised of 43 studies including a total of 3938 athletes and 10 752 controls in the pooled analysis. Of the 42 identified genetic variants, 13 were investigated in independent studies. Significant associations were found for five polymorphisms. Pooled odds ratio [95%CI] favoring athletes compared with controls was 1.42 [1.12-1.81] for ACE II (I/D), 1.66 [1.26-2.19] for ACTN3 TT (rs1815739), 1.75 [1.34-2.29] for PPARGC1A GG (rs8192678), 2.23 [1.42-3.51] for AMPD1 CC (rs17602729), and 2.85 [1.27-6.39] for HFE GG + CG (rs1799945). Risk of bias was low in 25 (58%) and unclear in 18 (42%) articles. Heterogeneity of the results was low (0%-20%) except for HFE (71%), GNB3 (80%), and NOS3 (76%). (Inter)national competing runners and cyclists have a higher probability to carry specific genetic variants compared with controls. This study confirms that (inter)national competing endurance athletes constitute a unique genetic make-up, which likely contributes to their performance level., (© 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Introduction: Previous studies have shown variable within-subject hemoglobin mass (Hb mass ) responses to altitude training. We investigated whether Hb mass responses depend on individual variations in pre-altitude Hb mass during repeated altitude sojourns., Methods: Nine elite endurance athletes carried out 3-5 altitude sojourns over 17 ± 10 months (mean ± 95% confidence interval), at an altitude of 1976 ± 62 m, for 21 ± 1 days, and a total hypoxic dose of 989 ± 46 km·h, with Hb mass assessed before and after each sojourn (carbon monoxide rebreathing). The individual mean baseline was calculated as the mean of all pre-altitude Hb mass values for an athlete, and it was investigated whether the percent deviation from the individual mean baseline affected the altitude-induced Hb mass response., Results: On average, Hb mass increased by 3.4 ± 1.1% (p < 0.001) from pre- to post-altitude. The intra-individual changes in Hb mass were highly inconsistent (coefficient of variation, CV: 88%), and we found no relationship between Hb mass changes in successive altitude sojourns (r = 0.01; p = 0.735). However, the percent increase in Hb mass was highly correlated with the pre-altitude Hb mass , expressed as the percent deviation from the individual mean baseline (y = -0.7x + 3.4; r = 0.75; p < 0.001). Linear mixed-model analysis confirmed a -0.6 ± 0.2% smaller increase in Hb mass for each 1% higher pre-altitude Hb mass than the individual mean baseline (p < 0.001) after adjusting for the covariates hypoxic dose (p = 0.032) and the relative Hb mass (g·kg -1 body weight; p = 0.031)., Conclusion: Individual variations in pre-altitude Hb mass significantly influence the athletes' Hb mass responses to repeated altitude sojourns, with a potentiated response after traveling to altitude with a low pre-altitude Hb mass ., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Declines in iron status are frequently reported in those who regularly engage in strenuous physical activity. A possible reason is increases in the iron regulatory hormone hepcidin, which functions to inhibit dietary iron absorption and can be induced by the inflammatory cytokine interleukin-6 (IL-6)., Objectives: The current study aimed to determine the impact of a prolonged bout of running on hepcidin and dietary iron absorption in trained female and male runners., Methods: Trained female and male collegiate cross country runners (n = 28, age: 19.7 ± 1.2 y, maximal oxygen uptake: 66.1 ± 6.1 mL $\cdot$ kg -1$\cdot$ min-2, serum ferritin: 21.9 ± 13.3 ng/mL) performed a prolonged run (98.8 ± 14.7 min, 21.2 ± 3.8 km, 4.7 ± 0.3 min/km) during a team practice. Participants consumed a stable iron isotope with a standardized meal 2 h postrun and blood was collected 1 h later. The protocol was repeated 2 wk later except participants abstained from exercise (rest). RBCs were collected 15 d after exercise and rest to determine isotope enrichment. Differences between exercise and rest were assessed by paired t tests and Wilcoxon matched-pairs signed rank tests. Data are means ± SDs., Results: Plasma hepcidin increased 51% after exercise (45.8 ± 34.4 ng/mL) compared with rest (30.3 ± 27.2 ng/mL, P = 0.0010). Fractional iron absorption was reduced by 36% after exercise (11.8 ± 14.6 %) compared with rest (18.5 ± 14.4 %, P = 0.025). Plasma IL-6 was greater after exercise (0.660 ± 0.354 pg/mL) than after rest (0.457 ± 0.212 pg/mL, P < 0.0001). Exploratory analyses revealed that the increase in hepcidin with exercise may be driven by a response in males but not females., Conclusions: A prolonged bout of running increases hepcidin and decreases dietary iron absorption compared with rest in trained runners with low iron stores. The current study supports that IL-6 contributes to the increase in hepcidin with prolonged physical activity, although future studies should explore potential sex differences in the hepcidin response.This trial was registered at Clinicaltrials.gov as NCT04079322., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Purpose: Cherry juice (CJ) and cold water immersion (CWI) are both effective recovery strategies following strenuous endurance exercise. However, athletes routinely combine recovery interventions and less is known about the impact of a combined CJ and CWI protocol. Therefore, this study investigated the effects of combining CWI and CJ (a "cocktail" (CT)) on inflammation and muscle damage following a marathon., Methods: A total 39 endurance trained males were randomly assigned to a placebo (PL), CWI, CJ, or CT group before completing a trail marathon run. Muscle damage (creatine kinase (CK)), muscle function (maximal voluntary isometric contraction (MVIC)), and inflammation (interleukin-6 (IL-6); C-reactive protein (CRP)) were measured at baseline, immediately after marathon (only IL-6), 24 h, and 48 h after marathon., Results: There were no statistically significant differences between groups and no group × time interaction effects for any of the dependent variables. Confidence intervals (CI) illustrated that CT had unclear effects on inflammation (IL-6; CRP) and MVIC, but may have increased CK to a greater extent than PL and CJ conditions., Conclusion: There is no evidence of an additive effect of CJ and CWI when the treatments are used in conjunction with each other. On the contrary, combining CJ and CWI may result in slightly increased circulating CK., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Difranco, Cockburn, Dimitriou, Paice, Sinclair, Faki, Hills, Gondek, Wood and Wilson.)

The aim of this study was to determine the influence of training volume alterations on diversity and composition of the gut microbiome in a free-living cohort of middle-distance runners. Fourteen highly-trained middle-distance runners ( n  = 8 men; V ˙ O 2peak  = 70.1 ± 4.3 ml·kg·min -1 ; n  = 6 women, V ˙ O 2peak : 59.0 ± 3.2 ml·kg·min -1 ) completed three weeks of normal training (NormTr), three weeks of high-volume training (HVolTr; a 10, 20 and 30% increase in training volume during each successive week from NormTr), and a one-week taper (TaperTr; 55% exponential reduction in training volume from HVolTr week three). Faecal samples were collected before and immediately after each training phase to quantify alpha-diversity and composition of the gut microbiome. A three-day diet record was collected during each training phase and a maximal incremental running test was completed after each training phase. Results showed no significant changes in nutritional intake, alpha-diversity, or global microbial composition following HVolTr or TaperTr compared to NormTr ( p 's > 0.05). Following HVolTr, there was a significant decrease in Pasterellaceae ( p  = 0.03), Lachnoclostridium ( p  = 0.02) , Haemophilus ( p  = 0.03) , S. parasagunis ( p  = 0.02) , and H. parainfluenzae ( p  = 0.03), while R. callidus ( p  = 0.03) significantly increased. These changes did not return to NormTr levels following TaperTr. This study shows that the alpha-diversity and global composition of the gut microbiome were unaffected by changes in training volume. However, an increase in training volume led to several changes at the lower taxonomy levels that did not return to pre-HVolTr levels following a taper period.

Introduction: Arrhythmias also occur among elite endurance athletes. Conventional diagnostic tools for assessment of arrhythmias suffer from limited availability and usability challenges, particularly under the demanding training conditions of an elite athlete. Among endurance athletes, there is a need for out-of-hospital monitoring to enhance detection of arrhythmias under conditions that are relevant and potentially provocative of underlying pathology. The Norwegian patch ECG247 Smart Heart Sensor has been developed to simplify the assessment of heart rhythm disorders. The current study aimed to evaluate the ECG247 Smart Heart Sensor function and usability in an elite athlete environment., Methods: A total of 13 professional cyclists from the UNO-X Pro Cycling Team were examined with the ECG247 Smart Heart Sensor during training camp in Spain, December 2021. All ECG data were analyzed by cardiologists at Sorlandet Hospital Arendal, Norway. The athletes also completed a brief questionnaire registering their training (from on-bike monitoring units) and provided self-assessment of usability parameters after the test., Results: In 8 of 13 athletes (69% male, age 23 ± 4 years), two test periods were performed with different ECG patches, resulting in a total of 21 tests with continuous ECG monitoring. Average total ECG test duration per athlete was 144 ± 47 h (89 ± 24 h/patch). Athletes performed an average of 15 ± 5 training h during each test. The ECG quality from all tests was considered satisfactory for rhythm analysis-also during exercise. The reported usability of the ECG247 Smart Heart Sensor was high, and no athletes reported trouble sleeping or training with the sensor. The automatic arrhythmia algorithm reported episodes of possible arrhythmias in 5 (24%) tests; 2 atrial flutter, 2 supraventricular tachycardia and 1 bradycardia (heart rate <30/min). Manual assessment by physicians verified the episode of bradycardia but revealed normal sinus rhythm in all other tests. No false negative events were identified in over 1,800 h of ECG collection., Conclusion: The ECG247 Smart Heart Sensor allowed for high quality ECG monitoring with high usability during intensive exercise in athletes., (Copyright © 2022 Ausland, Sandberg, Jortveit and Seiler.)

Work rate has a direct impact on the systolic blood pressure (SBP) during aerobic exercise, which may be challenging in the evaluation of the SBP response in athletes reaching high work rates. We aimed to investigate the exercise SBP response in endurance athletes in relation to oxygen uptake (VO2), work rate and to recent reference equations for exercise SBP in the general population. Endurance athletes with a left-ventricular end-diastolic diameter above the reference one performed a maximal bicycle cardiopulmonary exercise test. The increase in SBP during exercise was divided by the increase in VO2 (SBP/VO2 slope) and in Watts, respectively (SBP/W slope). The maximum SBP (SBPmax) and the SBP/W slope were compared to the predicted values. In total, 27 athletes (59% men) were included; mean age, 40 ± 10 years; mean VO2max, 50 ± 5 mL/kg/min. The mean SBP/VO2 slope was 29.8 ± 10.2 mm Hg/L/min, and the mean SBP/W slope was 0.27 ± 0.08 mm Hg/W. Compared to the predicted normative values, athletes had, on average, a 12.2 ± 17.6 mm Hg higher SBPmax and a 0.12 ± 0.08 mm Hg/W less steep SBP/W slope (p < 0.01 and p < 0.001, respectively). In conclusion, the higher SBPmax values and the less steep SBP/W slope highlight the importance of considering work rate when interpreting the SBP response in endurance athletes and suggest a need for specific normative values in athletes to help clinicians distinguish physiologically high maximal blood pressure from a pathological blood pressure response.

Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r 2 of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Heimark, Eitzen, Vianello, Bøtker-Rasmussen, Mamen, Hoel Rindal, Waldum-Grevbo, Sandbakk and Seeberg.)

This study examines the effectiveness of probiotic supplementation on gastrointestinal (GI) symptoms, the gut barrier function, and inflammatory markers in athletes based on data from randomised controlled trials. Searches were conducted in PubMed, the Cochrane Library, and the Web of Science up to October 2021. The protocol for this review was registered with PROSPERO (CRD42021284938). Two reviewers independently screened the titles, abstracts, and full texts to identify articles on the influence of probiotics or symbiotics on GI symptoms, gut barrier function, and cytokines, and the quality of the studies was assessed using RoB2. Ten articles involving 822 athletes were included in this review. A single strain Lactobacillus bacteria was used in three studies, seven studies used a Lactobacillus and Bifidobacterium multi-strain cocktail, and one study used this cocktail with a prebiotic. Only slight evidence was found for a positive effect of probiotics on GI symptoms in athletes during training, exercise, and competition, so it was not possible to identify the best product for managing GI symptoms in athletes. Due to the small number of studies, it was also difficult to find a direct association between the reduced exercise-induced perturbations in cytokines, gut barrier function, and GI symptoms after probiotic supplementation.

Critical power represents an important parameter of aerobic function and is the highest average effort that can be sustained for a period of time without fatigue. Critical power is determined mainly in the laboratory. Many different approaches have been applied in testing methods, and it is a difficult task to determine which testing protocol it the most suitable. This review aims to evaluate all possible tests on bicycle ergometers or bicycles used to estimate critical power and to compare them. A literature search was conducted in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) published from 2012 to 2022 and followed the PRISMA guidelines to process the review. Twenty-one articles met the eligibility criteria: records with trained or experienced endurance athletes (adults > 18), bicycle ergometer, a description of the testing protocol, and comparison of the tests. We found that the most widely used tests were the 3-min all-out tests set in a linear mode and the traditional protocol time to exhaustion. Some other alternatives could have been used but were not as regular. To summarize, the testing methods offered two main approaches in the laboratory (time to exhaustion test andthe 3-min all-out test with different protocols) and approach in the field, which is not yet completely standardized.

Objective: Endurance athletes can develop intermittent claudication due to sports-related flow limitations of the iliac artery (FLIA) caused by arterial kinking. In the present study, we investigated the short- and long-term efficacy of an operative release for iliac artery kinking., Methods: Between 1996 and 2015, all patients with a diagnosis of FLIA due to iliac artery kinking without substantial arterial stenosis (<15%) or an excessive arterial length (vessel length to straight ratio, <1.25) who had undergone surgery were included. The short-term follow-up protocol consisted of cycling tests, the ankle brachial index with a flexed hip, and Doppler echography examinations to determine the peak systolic velocity before and 6 to 18 months after surgery. Additionally, the short- and long-term efficacy were evaluated using questionnaires., Results: A total of 142 endurance athletes (155 legs; 88.4% male; median age, 26 years; interquartile range [IQR], 22-31 years) were available for analysis. In the short term, the symptoms had decreased in 83.9% of the patients, with an overall 80.3% satisfaction rate. Power during a maximal cycling test had improved from 420 W (IQR, 378-465 W) to 437 W (IQR, 392-485 W; P < .001). The symptom-free workload had increased from 300 W (IQR, 240-340 W) to 400 W (IQR, 330-448 W; P < .001). The postexercise ankle brachial index with a flexed hip had increased from 0.53 (IQR, 0.40-0.61) to 0.57 (IQR, 0.47-0.64; P = .002), and the peak systolic velocity with a flexed hip had decreased from 1.88 m/s (IQR, 1.45-2.50 m/s) to 1.52 m/s (IQR, 1.19-2.07 m/s; P < .001). Postoperative imaging studies revealed some degree kinking in 33.9%, mostly asymptomatic. The long-term results were evaluated after a median of 15.2 years (IQR, 10.9-19.5 years). The athletes had cycled an additional 125.500 km (IQR, 72.00-227.500 km), which was approximately equal to the 131.000 km (IQR, 98.250-220.000 km) cycled before the diagnosis of FLIA. On the long term, 63.9% of the athletes reported persistent reduction of complaints, with an overall 59.1% satisfaction rate. Eight patients had required reintervention, six because of treatment failure and two because of newly developed FLIA., Conclusions: Operative iliac artery release for sports-related functional kinking in the absence of stenosis or an excessive vessel length was effective for most athletes in the short and long term., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine (1) the effect of a 40-minute steady-state run on muscle membrane integrity of elite athletes as reflected by serum creatine kinase (CK), (2) whether antioxidant supplementation (AS) with vitamins E and C has a protective effect, and (3) if a minimal blood concentration of vitamin E or C is required for any such protection., Methods: Fifteen elite-level endurance athletes (V˙O2max=71.5±1.2 mL·kg-1 min-1) were randomly assigned to 6 weeks AS (1000 IU·d-1 natural vitamin E and 1000 mg·d-1 vitamin C) or placebo. Using a double-blind crossover design and 4-week washout period, each treatment was followed by a 40-minute steady-state run at 3 mM blood lactate. Blood samples before and 0 and 24 hours after the run were assayed for serum and red cell α-tocopherol (α-TOH), serum ascorbate, and CK., Results: The AS produced a 2.5-fold, well-correlated (r = .84) increase in serum and red cell α-TOH (P < .001) that attenuated the increase in postrun CK (P = .01). There was no change in serum ascorbate with AS and no relationship with CK (P > .1). Curvilinear regression revealed some evidence that a critical level of serum α-TOH in the vicinity of 12 mg·L-1 was required to attenuate CK efflux, a level only achieved with AS., Conclusion: The muscle membrane integrity of elite-level athletes is compromised even during steady-state running of moderate intensity and duration. The AS provided a protective effect, with evidence that a serum α-TOH concentration of around 12 mg·L-1 is required.

Carbohydrate (CHO) intake during exercise can optimize endurance performance. However, there is limited information regarding fueling practices of endurance athletes during training. Accordingly, an anonymous German-language online survey was circulated examining the determinants of CHO choices, and intake practices among runners, triathletes, and cyclists during training. Survey questions included predefined answers, and a Likert scale with response of CHO food choice intakes from 1 = never to 5 = always. 1,081 endurance participants (58.0% male, 68.6% aged 18-39 years) of varying competitive levels were included in the analysis. Overall, most participants consumed a combination of commercial sport nutrition products and everyday foods (67.4%, n = 729) with their primary reason that food-first was preferred, but in some exercise scenarios, commercial sport nutrition products were deemed more convenient (61.3%, n = 447). Participants consuming commercial sport nutrition products only (19.3%, n = 209) most often valued their ease of intake during exercise (85.2%, n = 178). Among those consuming everyday foods only (13.2%, n = 143), the most common reason was the perceived importance of eating wholesome foods/natural ingredients (84.6%, n = 121). Between the most frequently consumed CHO sources during training at low-to-moderate intensities ( n = 1032), sports drinks (mean ± SD; 2.56 ± 1.33) were consumed significantly more often than bananas (2.27 ± 1.14, p < 0.001), with no significant difference in intake frequency between bananas and traditional muesli/fruit/energy bars (2.25 ± 1.14, p = 0.616). Whereas during high intensities ( n = 1,077), sports drinks (3.31 ± 1.51) were significantly more often consumed than gels (2.79 ± 1.37), and gels significantly more often than energy bars (2.43 ± 1.28), all commercial sport nutrition products (all, p < 0.001). Overall, 95.1% ( n = 1028) of all participants consumed CHO during training at all exercise intensities, with males ( n = 602; 2.35 ± 0.70) consuming significantly more often commercial sport nutrition products than females ( n = 424; 2.14 ± 0.79, p < 0.001); females consumed significantly more often everyday foods than males (1.66 ± 0.47 vs. 1.54 ± 0.42, p < 0.001). Most participants used mixed CHO forms during low-to-moderate (87.9%), and high exercise intensities (94.7%). 67.6% ( n = 731) of all participants reported guiding their CHO intake rates during training by gut feeling. These large-scale survey findings suggest a preference of endurance participants' CHO intake during training in liquid form independent of exercise intensities and offer novel insights into CHO intake practices to guide sports nutrition strategies and education., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Reinhard and Galloway.)

A growing number of endurance athletes have considered switching from a traditional high-carbohydrate/low-fat (HCLF) to a low-carbohydrate/high-fat (LCHF) eating pattern for health and performance reasons. However, few studies have examined how LCHF diets affect blood lipid profiles in highly-trained runners. In a randomized and counterbalanced, cross-over design, athletes (n = 7 men; VO2max: 61.9 ± 6.1 mL/kg/min) completed six weeks of two, ad libitum, LCHF (6/69/25% en carbohydrate/fat/protein) and HCLF (57/28/15% en carbohydrate/fat/protein) diets, separated by a two-week washout. Plasma was collected on days 4, 14, 28, and 42 during each condition and analyzed for: triglycerides (TG), LDL-C, HDL-C, total cholesterol (TC), VLDL, fasting glucose, and glycated hemoglobin (HbA1c). Capillary blood beta-hydroxybutyrate (BHB) was monitored during LCHF as a measure of ketosis. LCHF lowered plasma TG, VLDL, and TG/HDL-C (all p < 0.01). LCHF increased plasma TC, LDL-C, HDL-C, and TC/HDL-C (all p < 0.05). Plasma glucose and HbA1c were unaffected. Capillary BHB was modestly elevated throughout the LCHF condition (0.5 ± 0.05 mmol/L). Healthy, well-trained, normocholesterolemic runners consuming a LCHF diet demonstrated elevated circulating LDL-C and HDL-C concentrations, while concomitantly decreasing TG, VLDL, and TG/HDL-C ratio. The underlying mechanisms and implications of these adaptive responses in cholesterol should be explored.