Health, Hormones and Human Performance Part 2

Endocrine and Metabolic aspects of Sports and Exercise Medicine are crucial determinants of health and human performance, from reluctant exerciser through to elite athlete and professional dancer. This is what the recent BASEM spring conference set out to demonstrate. The previous blog described functional disruption of Endocrine networks caused by non-integrated periodisation of the three key lifestyle factors of exercise/training, nutrition and recovery/sleep, can lead to adverse effects on health and athletic performance.

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Integrated periodisation of exercise, nutrition, recovery for optimisation of health and performance (Keay BJSM 2017)

Grace, aesthetic line and ethereal quality belie the athletic prowess required in ballet. What are the Endocrine, metabolic and bone health consequences for this unique group of athletes? Dr Roger Wolman (Medical Advisor to National Institute for Dance Medicine and Science) returned to the important topic of insufficient energy availability in sport/dance where being lightweight confers a performance advantage, resulting in dysfunction in multiple endocrine axes. Dr Wolman discussed his recent research studies in dancers revealing an intriguing synergistic action between oestrogen and vitamin D, which is itself a steroid hormone. Evidence was presented to demonstrate how being replete in vitamin D has beneficial effects on bone, immunity and muscle function. Thus it is key in preventing injury and supporting health in athletes, with particular relevance in premenarchal and postmenopausal women, who are in relative oestrogen deficient states. This presentation will certainly change my clinical practice and, I am sure, that of many in the audience, in ensuring that athletes/patients are vitamin D replete. This may have to be achieved in the form of strategic use of sports informed vitamin D supplementation, given that even walking naked for 5 hours a day outside during UK winter, would not stimulate enough vitamin D production. Therefore, to the relief of many in the audience, Dr Wolman did not recommend this strategy.

Dr Kate Ackerman (member of RED-S IOC working group) explained why we should all tap into our inner endocrinologist. Sport and Exercise Medicine (SEM) goes far beyond diagnosing and treating injury. Is there any underlying endocrine cause for suboptimal health, performance or injury? Be this an endocrine diagnosis that should not be missed, or a functional endocrine dysfunction due to relative energy deficiency in sports (RED-S). Dr Ackerman explained the importance of the multidisciplinary team in both identifying and supporting an athlete experiencing the consequences of RED-S. New research from Dr Ackerman’s group was presented indicating the effects of RED-S on both health and athletic performance.

Females now have combative roles alongside their male counterparts. What are the implications of this type of intensive exercise training? Dr Julie Greaves (Research Director of the ministerial women in ground close combat research programme) presented insightful research revealing that differences in the geometry of bone in men and women can predispose towards bone stress injury and account for increased incidence in this type of injury in female recruits.

Lunchtime discussion and debate was focused on the determinants of athletic gender, lead by Dr Joanna Harper and Professor Yannis Pitsiladis (International Federation of Sports Medicine). Rather than relying on genetic sex, testosterone concentration was proposed as the criteria for determining whether an athlete competes in male or female events. That testosterone concentration is linked to performance was demonstrated in a study published last year in the BMJ where female athletes in the upper tertile of testosterone were shown to have a performance advantage in certain strength based track and field disciplines. This could potentially be an objective, functional metric used to determine sporting categories for transgender and intersex athletes. The only current uncertainty is how previously high levels of testosterone seen in male, or intersex athletes would have already had an impact on physiology, if this athlete then wished to compete as female and therefore lower testosterone levels with medication.

Nutrition is a key component in optimising health and performance through the Endocrine system. Dr Sophie Killer (English Institute of Sport) explained practical implications for athletes. In a study stimulating a training camp, there were distinct differences between athletes on different regimes of carbohydrate intake in terms of endocrine markers and psychological effects. Those athletes on restricted carbohydrate intake fared worse.

Insulin insensitivity is the underlying pathological process in developing type 2 diabetes mellitus (T2DM) and metabolic syndrome. What is the crucial lifestyle intervention to combat this? Dr Richard Bracken (Swansea University) presented the science behind why and how exercise improves blood glucose control and therefore ultimately risk of developing the macro and microvascular complications of diabetes. T2DM is an increasing health issue in the population, which has to be addressed beyond reaching for the prescription pad for medication. Dr Bracken outlined some effective strategies to encourage the reluctant exerciser to become more active. Having worked myself in NHS diabetic clinics over many years, this was a key presentation at the conference to demonstrate that SEM goes far beyond a relatively small group of elite athletes. Highlighting the crucial role of physical activity in supporting health and performance through optimisation of endocrine networks: uniting the elite athlete and the reluctant exerciser.

One road to Rome
One Road to Rome (BJSM Keay 2017)

Motivate2Move initiative aims to shift the emphasis from treating disease, to preventing disease. Dr Brian Johnson presented the excellent resource for healthcare professionals to encourage, motivate and educate patients in order to consider exercise as an effective and enjoyable way to improve health.

Hormones play a key role in health and human performance, applicable to all levels of exerciser from reluctant exerciser to elite athlete.

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References

Health, Hormones and Human Performance BASEM Spring Conference

Video of presentation on Endocrine and Metabolic aspects of Sport and Exercise Medicine from BASEM Spring Conference

Sports Endocrinology – what does it have to do with performance? Keay BJSM 2017

Lifestyle Choices for optimising health: exercise, nutrition, sleep Keay BJSM 2017

One road to Rome: Exercise Keay, BJSM 2017

 

 

Healthy Hormones

Is your training in tune with your hormones and nutrition to optimise your athletic performance?

Hormones are internal chemical messengers regulating all aspects of your health and athletic performance. Discussed at recent BASEM conference “Health Hormones and Human Performance”

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Bone health can be at risk if hormone status not optimal

How? To enable your hormones to do the best job they can for your health and sport performance, you need to find a balance between what, how much and when you train, eat and sleep. In the diagram below, this represents staying on the healthy green plateau. Too much, or too little of any of these choices can lead to imbalances and tipping off the green plateau into the red, less healthy peripheries.

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Integrated periodisation of training, nutrition and recovery for optimal health and performance (Keay, BJSM 2017)

What? Imbalances between training load, nutrition and recovery can cause problems in the Endocrine system: the whole network of hormone interactions throughout your body. The bottom line is that if insufficient energy is provided through nutrition to cover both your training demands and the “housekeeping” activities within the body to keep you alive, then your body goes into energy saving mode. This situation is called relative energy deficiency in sports (RED-S) and has the potential to adversely impact one or more of the important systems in your body vital for optimal health and performance.

RED-S has evolved from the female athlete triad described in 1980s by Barbara Drinkwater in NEJM, where although female runners were consuming same dietary intake, those with higher training load were more likely to have menstrual dysfunction and low bone mineral density. Since this original description it has become obvious that the reproductive axis is just one of several hormone networks to be impacted by low energy availability and that RED-S also impacts the other half of the population: men.

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Potential Multisystem effects of RED-S (IOC statement BJSM 2014)

Why? Suboptimal levels of energy availability to support health and performance can arise unintentionally, for example with increased training loads and/or times of growth and development in young athletes. Intentionally restrictive eating patterns can also be the cause of RED-S, particularly in sports/dance where low body weight confers a performance or aesthetic advantage. It is an indisputable fact that in order cycle up a mountain you need to overcome gravity and produce high watts/kg. Equally it is pretty impossible to do pointe work, let alone 32 fouttées en tournant en pointe unless you are a lightweight dancer. However if this at the expense of disrupting your hormones, then the advantage of being low body weight will be lost.

How to know? How to know if you, a teammate or a fellow athlete is at risk of RED-S? If you are a female athlete then your hormones are in balance if you are having regular periods (this does not include withdrawal bleeds as result of being on the oral contraceptive pill). Any woman of reproductive age from 16 years to the menopause should have regular periods (unless pregnant). Regular menstruation acts as the barometer of healthy hormones in women. If this is not the case, whether you are an athlete or not, you need to get this checked out medically to exclude underlying medical conditions. Having excluded these, then you need to review the integrated periodisation of training, nutrition and recovery. In male athletes there is not such an obvious sign that your hormones are at healthy levels. However recurrent injury/illness/fatigue can be warning signs. The diagram below shows all the potential adverse effects of RED-S on performance. Be aware that you do not have to have all, or indeed be aware of any of these effects if you develop RED-S.

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Potential Performance effects of RED-S (IOC statement BJSM 2014)

So What? If you are an athlete/dancer, you may be thinking that none of this applies to you. You are feeling and performing fine. Maybe you have not yet experienced any of the detrimental effects of RED-S. However, you will never know how good an athlete you could be and whether you truly are performing to your full potential unless you put yourself in the best position in terms of your hormones to achieve this goal.

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Suboptimal performance as result of RED-S (Keay, BJSM 2017)

Key Points

• Insufficient nutrition intake (quantity and quality), whether intentional or not, results in RED-S and multiple hormonal disruptions

• RED-S has detrimental health and athletic performance consequences in both the short and the long term

• Some consequences of RED-S are irreversible for example poor bone health, unless intervention is swift

Check points

• Are you suffering with frequent injuries/fatigue/illness over last 3 months or more?

• Female athletes: if 16 years or older have your periods not started? Have you missed more than 3 consecutive periods?

If yes to any of above, seek medical advice from someone with experience Sports Endocrinology. Now! The longer you leave the situation the harder it will be to rectify. Initially underlying Endocrine conditions per se have to be ruled out. RED-S is a functional dysfunction of the Endocrine system, so a diagnosis of exclusion. Having established RED-S as the diagnosis, monitoring Endocrine markers can be very helpful as these are examples of objective metrics in monitoring energy availability and therefore response to optimising integrated periodisation of nutrition, training and recovery.

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Integrated periodisation of key training factors support healthy hormones to drive improvements in performance

What to do? Don’t ignore! Although you may think you are fine, if your hormones are not working for you, then you will never reach your full potential as an athlete/dancer. For female athletes having regular periods means your hormones are in healthy ranges and this is normal. Not starting and/or missing periods is not healthy, for any woman.

For both male and female athletes, if you are experiencing recurrent injury, fatigue or illness, you need to get this checked out. There may be a simple explanation such as viral infection, low vitamin D or iron. However it may be that the underlying reason is due to hormone issues.

If you are an athlete, coach, teacher or parent and concerned that you/an athlete in your care has not got the balance right to optimise health and athletic performance, then a 3 way discussion will help and support the decision to seek medical advice as appropriate.

References

Lifestyle Choices for optimising health: exercise, nutrition, sleep Keay, BJSM 2017

Optimal health: including female athletes! Part 1 BJSM 2017

Optimal health: including male athletes! Part 2 BJSM 2017

Optimal Health: Especially Young Athletes! Part 3 BASEM 2017

Optimal Health: For All Athletes! Part 4 BASEM 2017

Low Energy Availability is Difficult to Assess But Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes Sport Nutrition and exercise Metabolism 2017

Cumulative Endocrine Dysfunction in Relative Energy Deficiency in Sport (RED-S) BJSM 2018

Presentation at BASEM conference “Health, Hormones and Human Performance”

 

Health, Hormones and Human Performance Part 1

How hormones determine health and athletic performance

Endocrine and Metabolic aspects of Sports and Exercise Medicine are crucial determinants of health and human performance, from reluctant exerciser through to elite athlete and professional dancer. This is what I set out to demonstrate as the chair of the recent British Association of Sport and Medicine conference, with insightful presentations from my colleagues whom I had invited to share their research and practical applications of their work. The audience comprised of doctors with interest in sport and exercise medicine, representatives from the dance world, research scientists, nutritionists, physiotherapists, coaches and trainers. In short, all were members of multi-disciplinary teams supporting aspiring athletes. The importance of the conference was reflected in CDP awards from FSEM, BASES, Royal College of Physicians (RCP), REP-S and endorsement for international education from BJSM and National Institute of Dance Medicine and Science (NIDMS).

Exercise is a crucial lifestyle factor in determining health and disease. Yet we see an increasing polarisation in the amount of exercise taken across the general population. At one end of the spectrum, the increasing training loads of elite athletes and professional dancers push the levels of human performance to greater heights. On the other side of the spectrum, rising levels of inactivity, in large swathes of the population, increase the risk of poor health and developing disease states. Which fundamental biological processes and systems link these groups with apparently dichotomous levels of exercise? What determines the outcome of the underlying Endocrine and metabolic network interactions? How can an understanding of these factors help prevent sports injuries and lead to more effective rehabilitation? How can we employ Endocrine markers to predict and provide guidance towards beneficial outcomes for health and human performance?

If you weren’t able to come and participate in the discussion, these are some topics presented. My opening presentation (see video below) set the scene, outlining why having an optimally functioning Endocrine system is fundamental to health and performance. Conversely, functional disruption of Endocrine networks occurs with non integrated periodisation of the three key lifestyle factors of exercise/training, nutrition and recovery/sleep, which can lead to adverse effects on health and athletic performance.

In the case of an imbalance in training load and nutrition, this can manifest as the female athlete triad, which has now evolved into relative energy deficiency in sports (RED-S) in recognition of the fact that Endocrine feedback loops are disrupted across many hormonal axes, not just the reproductive axis. And, significantly, acknowledging the fact that males athletes can also be impacted by insufficient energy availability to meet both training and “housekeeping” energy requirements. Why and how RED-S can affect male athletes, in particular male competitive road cyclists, was discussed, highlighting the need for further research to investigate practical and effective strategies to optimise health and therefore ultimately performance in competition.

A degree of overlap and interplay exists between RED-S (imbalance in nutrition and training load), non functional over-reaching and over-training syndrome (imbalances in training load and recovery). Indeed research evidence was presented suggesting that RED-S increases the risk of developing over-training syndrome. In these situations of functional disruption of the Endocrine networks, underlying Endocrine conditions per se should be excluded. Case studies demonstrated this principle in the diagnosis of RED-S. This is particularly important in the investigation of amenorrhoea. All women of reproductive age, whether athletes or not, should have regular menstruation (apart from when pregnant!), as a barometer of healthy hormones. Indeed, since hormones are essential to drive positive adaptations to exercise, healthy hormones are key in attaining full athletic potential in any athlete/dancer, whether male or female. Evidence was presented from research studies for the role of validated Endocrine markers and clinical menstrual status in females as objective and quantifiable measures of energy availability and hence injury risk in both male and female athletes.

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Triumvirate of external factors impacting Endocrine system and hence performance

Alongside training metrics, if female athletes recorded menstrual pattern (as Gwen Jorgensen recently showed on her Training Peaks) and all athletes kept a biological passport of selected Endocrine markers; this could potentially identify at an early stage any imbalances in the triumvirate of training load, nutrition and recovery. Pre-empting development of RED-S or over-training syndrome, supports the maintenance of healthy hormones and hence optimal human performance.

Look out for presentations from speakers which will be uploaded on BASEM website shortly.

References

Video of presentation on the Endocrine and Metabolic Aspects of Sports and Exercise Medicine BASEM conference “Health, Hormones and Human Performance”

Study of hormones, body composition, bone mineral density and performance in competitive male road cyclists Investigation of effective and practical nutrition and off bike exercise interventions

Sports Endocrinology – what does it have to do with performance? Keay BJSM 2017

 

 

 

Male Athletes: the Bare Bones of Cyclists

Chris Boardman is an Olympic gold medal winner and world record breaking cyclist. However, he explains in his biography that he retired in his early thirties with weak bones and low testosterone. At the time he was treated with medication aimed at improving his bone strength, but this severely impacted his performance on the bike.

What was the cause of this superlative male athlete’s unhealthy condition that ultimately lead to his retirement? Is this still an issue for male cyclists today? Is it limited to elite professional riders?

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Periodisation of key training factors support the Endocrine system to optimise performance

In 2014 the IOC published a description of relative energy deficiency in sports (RED-S), where nutrition intake is insufficient to cover training demands and the basic “housekeeping” activities of the body. This induces an energy-saving mode that impacts health and therefore athletic performance. The female athlete triad had been previously described as the combination of disordered eating, menstrual disruption and impaired bone health. RED-S goes beyond the female athlete triad to include a broader range of  impacts on systems other than just the bones and female hormone production. Significantly RED-S includes male athletes. Today, Chris Boardman would be diagnosed with RED-S.

Has this new information improved the identification and support of male athletes at risk of RED-S? In a recent pilot study, 5 out of 10 competitive amateur riders (Category 2 and above) were in the lowest age-matched percentile of body fat and 9 out 10 where in the lowest 6% relative to the population of similar age. Significantly, 7 out of 10 riders had below-average for age bone mineral density (BMD) in the lumbar spine, with two males having bone densities that would be low for an 85 year old.

Why is poor bone health a particular risk for competitive male cyclists? Depending on the type of exercise, beneficial adaptations include mechanical strengthening of specific parts of the skeletal system. For example, assuming good nutrition, runners tend to have strong hips, whereas rowers have more robust spines in terms of BMD and bone microarchitecture. Conversely the non-weight-bearing nature of cycling and the generally lower level of upper-body musculature reduce the mechanical loading forces though the spine: low osteogenic (bone building) stimuli. Although similar to swimming, in the sense that body weight is supported in the water, the major difference between these two forms of exercise is that in cycling, particularly for climbing, low body mass confers a performance advantage. This brings in the additional factor for bone health of potential inadequacies in nutrition and therefore consequences on hormone production.

An optimal balance of training, nutrition and recovery drives beneficial adaptations to exercise throughout the body. The body’s Endocrine system releases hormones that stimulate positive changes, such as the process of improving the efficiency of delivering and utilising oxygen and nutrients to exercising tissues, including the skeletal system. Any imbalances in periodisation between the three inputs of training, nutrition and recovery will compromise health and athletic performance.

Cyclists are at particular risk of insufficient fuelling. This may be an intentional attempt to maintain low body weight, which can lead to healthy eating becoming an unhealthy orthorexic pattern, where vital food groups for endurance sport, such as carbohydrates are excluded. There is also a practical element to fuelling adequately during long rides and refuelling afterwards. Consistency of nutrition throughout the day has been highlighted in a recent study of male endurance athletes where although an average 24 hour intake may be sufficient, if there are any significant deficits during this time, then this is reflected in increased adverse impact on catabolic Endocrine makers. In another study of male athletes if refuelling with carbohydrate and protein after training did not occur promptly, this lead to an increase in bone resorption over formation markers.

Recovery is an essential part of a training schedule, because the adaptations to exercise occur during rest. Sleep, in particular, is a major stimulus for growth hormone release, which drives positive adaptive changes in terms of body composition and bone turnover. Conversely, insufficient recovery time due to a packed schedule of training and work, places extra stresses on the Endocrine system. Getting to bed half an hour earlier than usual every day quickly adds up to an extra night’s sleep.

Does it matter if some areas of the skeleton are weaker than others? Yes, because this increases your risk of fracture, not just if you come off your bike, but also with relatively low force impacts. In the case of runners and triathletes, bone stress injuries are more likely to occur as an early warning sign of impaired bone health due to RED-S. Since low impact forces are absent in cycling, it may take a crash to reveal the strength of a rider’s bones. Studying the list of injuries in elite cyclists there are many fractures, with longer recovery time for vertebral fractures. So potentially cyclists can develop more severe bone health issues than other athletes, before becoming aware of the situation.

If you are a male cyclist, what can you do to prevent issues of bone health and risk of developing RED-S and suboptimal performance on the bike? Watch this space! A study is planned to investigate practical and effective strategies to optimise health and performance on the bike. In meantime there will be more discussion on “Health, Hormones and Human Performance” at the BASEM conference 22 March. All welcome, including athletes and coaches, alongside healthcare professional working with athletes.

References

Mechanisms for optimal health…for all athletes! BJSM 2017

Optimal health: including female athletes! Part 1 Bones BJSM 2017

Optimal health: including male athletes! Part 2 Relative Energy Deficiency in sports BJSM 2017

Lifestyle Choices for optimising health: exercise, nutrition, sleep BJSM 2017

Sports Endocrinology – what does it have to do with performance? BJSM 2017

Relative Energy Deficiency in Sports (RED-S) Practical considerations for endurance athletes

Within-day Energy Deficiency and Metabolic Perturbation in Male Endurance Athletes International Journal of Sport Nutrition and Exercise Metabolism 2018

The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism Translational Journal of the American College of Sports Medicine 2017

Sleep for health and sports performance BJSM 2017

 

 

 

Conferences in Sport/Dance, Exercise Science and Medicine 2018

Conferences for the New Year:

BAsem2018_SpringConf_BJSM

If you are interested in any aspects of Sport/Dance, Exercise and Lifestyle Medicine here are some suggestions:

British Association of Sport and Exercise Medicine Spring Conference 22 March 2018 “Health, Hormones and Human Performance” Covering the Endocrine and Metabolic aspects of Sport, Dance, Exercise Science and Medicine. From the elite athlete to the reluctant exerciser. Aimed at all those members of the multidisciplinary team working with athletes/dancers, plus athletes/dancers and their coaches/teachers.

CPD points awarded from Faculty of Sports and Exercise Medicine FSEM

BASES British Association of Sport and Exercise Sciences CPD awarded

British Journal of Sports Medicine Quality International Education Approved

CPD points from Royal College of Physicians

CPD from REP-S

 

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Why? The balance and timing of exercise, nutrition and recovery is key to optimising health and all aspects of human performance. Intricate network interactions between the Endocrine system and metabolic signalling pathways drive these positive adaptations. However, non-integration of these lifestyle factors can disrupt signalling feedback pathways and predispose to maladaptation and potentially disease states.

What? Discussion, led by experienced clinicians and researchers will cover:

· Key role of Sports Endocrinology in health and performance

· Effects of exercise modalities on body composition and bone health

· Machine learning in interpreting biochemical & metabolomic patterns

· Endocrine & metabolic markers in assessing health & training status

· Gut metabolism in supporting health and performance

· Exercise as crucial lifestyle factor in pre-existing metabolic dysfunction

Who? This conference is relevant to all members of multidisciplinary teams supporting both reluctant exercisers and elite athletes. Medics, researchers, physiologists, physiotherapists, nutritionists, psychologists, coaches, athletes. All welcome.

Health, Hormones and Human Performance will be a conference of interest to all those involved with aspiring and elite athletes, including dancers (National Institute of Dance Medicine and Science NIDMS) and those supporting reluctant exercisers through Lifestyle Medicine.

Latest news from BASEM. Interview with BASEM Today Issue 41 – Winter 2017

 

Wales Exercise Medicine Symposium by Cardiff Sports & Exercise Medicine Society 27/1/18. This includes Dr Peter Brukner, founder of the Olympic Sports Medicine Park in Melbourne, and an afternoon session discussing the female athlete through the lifespan. CPD points applied for from the Royal College of Physicians, the Faculty of Sports and Exercise Medicine, REPs and the Royal College Of General Practitioners.

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Women in Sport and Exercise Conference 2018  13-14 June Organised by The Women in Sport and Exercise Academic Network and attracting British Association of Sport and Exercise Sciences (BASES) CPD points.

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Body Composition for Health and Sports Performance

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Body Composition from DEXA scan

Focusing on changes in body weight and body mass index (BMI) alone, as outcome measures of lifestyle interventions, ignores the beneficial multi-system and psychological effects of lifestyle medicine, in particular exercise. This includes advantageous changes in body composition for health and performance.

Why is body composition important? Because not all weight is equal in terms of tissue composition and distribution. To support optimal health, favourable levels of lean mass  versus fat mass decreases the risk of sarcopenia, associated bone loss and metabolic syndrome. For athletes, high lean mass coupled with low fat mass is related to improved athletic performance, especially in disciplines where strength to weight ratio a major consideration and/or those disciplines such as gymnastics and ballet where an aesthetic component confers a performance advantage.

The range of methods for measuring body composition have advantages and disadvantages in terms of accuracy, accessibility and expense. Although accurate in experienced hands, skin fold measurements are limited to giving a measure of subcutaneous fat. Impedance scales have the advantage of giving a measure of both total and visceral fat percentage, however accuracy is dependent on hydration status, amongst other variable factors. Dual-Energy X-Ray Absorptiometry (DEXA) scan is the “gold standard” for measuring body composition to include bone, lean and fat: both total and visceral. DEXA scan is relatively inexpensive and very low radiation dose compared to traditional X ray or computerised tomography (CT). This method of assessing body composition during training seasons is used by some professional sports teams. The illustration above shows a trained male with total fat in the athletic range. Although simple to measure, BMI does not accurately reflect body composition. All methods of assessing body composition can potentially have role in monitoring changes, for example over training seasons, and trends for individuals rather than relying on the absolute values of metrics measured.

How to go about optimising body composition? Combined exercise and nutritional strategies trigger and reinforce favourable metabolic and Endocrine signalling pathways. The detail of these lifestyle strategies will depend on the clinical context and the objectives of the individual: ranging from a sedentary person trying to improve health and well being, to an athlete aiming to improve sport performance. In all scenarios protein intake is an important factor in supporting lean mass, alongside tailored exercise/training. Temporal considerations for optimising body composition in athletes include the age of the athlete and targeting key competitions during a training cycle and in long term over athletic career. Ultimately optimising body composition has to translate to improved athletic performance for the endurance athlete. So aiming for “high quality weight loss” with retention or even improved lean mass, is more likely to support performance, rather than focusing on fat mass loss in isolation, which may occur in any case as a secondary consequence of integrated periodised training, nutrition and recovery. Striving for weight loss and reduced fat mass without careful monitoring and attention to effects on performance, can run the risk of athletes developing relative energy deficiency in sports (RED-S). Female athletes with functional hypothalamic amenorrhoea have been shown to decreased levels not only of lean and fat mass, but in addition reduced metabolically active brown fat and the associated hormone isirin which promotes fat “browning” and impacts bone mineralisation. In addition, there are differences between male and female athletes to be considered in terms of body composition and cycling performance.

From middle-age, both lean mass and bone mineral density (BMD) decline: sarcopenia and bone health intertwined. In order to mitigate against these changes, resistance exercise is particularly beneficial to stimulate muscle and load the skeleton and for metabolic and cognitive benefits. BMI is particularly misleading as a metric to assess risk of disease in menopausal women. Rather, the finer detail of body composition, for example visceral fat area, is more informative in terms of metabolic and psychological health.

Body composition is a more reliable indicator of health than body weight or BMI. Nevertheless body composition in isolation is not the sole determinant of health and performance. Rather body composition is just one of many multi-system effects mediated by integrated metabolic and Endocrine signalling pathways. These network effects are driven by lifestyle factors including exercise, nutrition and recovery, to determine health and sports performance.

For more discussion and debate on the role of body composition for health and performance BASEM Spring Conference 2018 6 CPD points from FSEM and BJSM approved for international education

BAsem2018_SpringConf_BJSMFSEM_CPD_AwardScreen Shot 2017-12-12 at 14.47.15

References

Challenging those hard to shift, big fat obesity risks BMJ 2017; 359: j5303 British Journal of Medicine 2017

Lifestyle Choices for optimising health: exercise, nutrition, sleep British Journal of Sport Medicine 2107

One road to Rome: Exercise British Journal of Sport Medicine 2107

Current Status of Body Composition Assessment in Sport Review and Position Statement on Behalf of the Ad Hoc Research Working Group on Body Composition Health and Performance, Under the Auspices of the I.O.C.Medical Commission

International society of sports nutrition position stand: diets and body composition Journal of the International Society of Sports Nutrition 2017
Case-Study: Body Composition Periodization in an Olympic-Level Female Middle-Distance Runner Over a 9-Year Career International Journal of Sport Nutrition and Exercise Metabolism 2017

Body composition assessment of English Premier League soccer players: a comparative DXA analysis of first team, U21 and U18 squads Journal of Sports Sciences

Protein Recommendations for Weight Loss in Elite Athletes: A Focus on Body Composition and Performance International Journal of Sport Nutrition and Exercise Metabolism 2017

Optimal Health: For All Athletes! Part 4 – Mechanisms British Association for Sport and Exercise Medicine 2017

Effect of Chronic Athletic Activity on Brown Fat in Young Women Plos One 2106

Irisin levels are lower in young amenorrheic athletes compared with eumenorrheic athletes and non-athletes and are associated with bone density and strength estimates Plos One

Kings and Queens of the Mountains Science4Performance

Low bone mineral density in middle-aged women: a red flag for sarcopenia Menopause 2017

Resistance training – an underutilised drug available in everybody’s medicine cabinet BJSM 2017

Benefits of resistance training in physically frail elderly: a systematic review Ageing Clinical and Experimental Research 2017

Is BMI a valid measure of obesity in postmenopausal women? Menopause 2017

Association of visceral fat area with the presence of depressive symptoms in Chinese postmenopausal women with normal glucose tolerance Menopause 2017

 

 

 

Health and Performance during Lifespan: latest research

LifeSeasonDay

Your lifespan depends on genetic and key lifestyle choices

Lifespan is dependent on a range of genetic factors combined with lifestyle choices. For example a recent study reported that an increase in one body mass index unit reduced lifespan by 7 months, whilst 1 year of education increased lifespan by 11 months. Physical activity was shown to be a particularly important lifestyle factor through its action on preventing age-related telomere shortening and thus reducing of cellular ageing by 9 years. Nevertheless, even though males and females have essentially identical genomes, genetic expression differs. This results in different disease susceptibilities and evolutionary selection pressures. More studies involving female participants are required!

Circadian clock

Much evidence is emerging about the importance of paying respect to our internal biological clocks when considering the timing of lifestyle factors such as eating, activity and sleep. For example intermittent fasting, especially during the night, and time restricted eating during the day enables metabolic flexibility. In other words, eating within a daylight time window will support favourable metabolism and body composition. No midnight snacks!

For athletes, even more care needs be given to timing of nutrition to support athletic performance. In the short term there is evidence that rapid refuelling after training with a combination of carbohydrate and protein favours a positive balance of bone turnover that supports bone health and prevents injury in the longer term. Periodised nutrition over a training season, integrated with exercise and recovery, is important in order to benefit from training adaptations and optimise athletic performance.

Protein intake in athletes and non athletes

Recovering from injury can be a frustrating time and some athletes may be tempted to reduce food intake to compensate for reduced training. However, recommendations are to maintain and even increase protein consumption to prevent a loss of lean mass and disruption of metabolic signalling. In the case of combined lifestyle interventions, such as nutrition and exercise aimed at reducing body weight, these should be directed at improving body composition. Adequate protein intake alongside exercise will maintain lean mass in order to minimise the risk of sarcopenia and associated bone loss which can occur during hypocaloric regimes. Good protein intake is important for bone health to support bone mineral density and reduce the risk of osteoporosis and fracture.

Adolescent Athlete

In the young athlete, integrated periodisation of training, nutrition and recovery is of particular importance, not only to support health and performance, but as an injury prevention strategy.  Sufficient sleep and nutrition to match training demands are key.

Differences between circadian phenotype and performance in athletes

For everyone, whether athlete or reluctant exerciser, balancing and timing key lifestyle choices of exercise, nutrition and sleep are key for optimising health and performance. However there are individual differences when it comes to the best time for athletes to perform, according to circadian phenotype/chronotype. In other words personal biological clocks which run on biological time. An individual’s performance can vary by as much as 26% depending on the time of day relative to one’s entrained waking time.

Later in Life

Ageing can be can be confused with loss of fitness and ability to perform activities of daily living. Although a degree of loss of fitness does occur with increasing age, this can be prevented to a certain degree and certainly delayed with physical activity. Exercise attenuates sarcopenia, which supports bone mineral density with the added benefit of improved proprioception, helping to reduce risk of falls and potential fracture; not to mention the psychological benefits of exercise.

 

For more discussion on Health Hormones and Human Performance come to British Association of Sport and Exercise Medicine Spring Conference 

BAsem2018_SpringConf_BJSM

References

Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity Nature Communications 2017

Physical activity and telomere length in U.S. men and women: An NHANES investigation Preventive Medicine 2017

The landscape of sex-differential transcriptome and its consequent selection in human adults BMC Biology 2017

Temporal considerations in Endocrine/Metabolic interactions Part 1 British Journal of Sport and Exercise Medicine, October 2017

Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting Obesity 2017

Temporal considerations in Endocrine/Metabolic interactions Part 2 British Journal of Sport and Exercise Medicine, October 2017

Time-restricted eating may yield moderate weight loss in obesity Endocrine Today 2017

The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism Translational Journal of the American College of Sports Medicine 2017

Periodized Nutrition for Athletes Sports Medicine 2017

Internal Biological Clocks and Sport Performance British Journal of Sport and Exercise Medicine, October 2017

Nutritional support for injuries requiring reduced activity Sports in Science Exchange 2017

Balance fat and muscle to keep bones healthy, study suggests NTU October 2017

Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis Journal of the American College of Nutrition 2017

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes Scandinavian Journal of Medicine & Science in Sports

Sleep for health and sports performance British Journal of Sport and Exercise Medicine, 2017

The impact of circadian phenotype and time since awakening on diurnal performance in athletes Current Biology

Successful Ageing British Association of Sport and Exercise Medicine 2017

Focus on physical activity can help avoid unnecessary social care BMJ October 2017

Biochemical Pathways of Sarcopenia and Their Modulation by Physical Exercise: A Narrative Review Frontiers in Medicine 2017

 

Lifestyle Choices

Slide1
Lifestyle Choices: Exercise, Nutrition, Sleep

Lifestyle factors of exercise, nutrition and sleep are vital for optimising health. In the illustration shown, ideally we should be in the green zone representing a balance between these lifestyle factors. Slipping into the peripheral red zone represents an imbalance: either too much or too little of any of these three elements. In particular exercise is of paramount importance being the most effective way of producing beneficial, multi-system effects mediated via the Endocrine system to optimise health and playing an important role in chronic disease prevention. However, it is not just a matter of what, but when: timing is crucial in integrating lifestyle factors with internal biological clocks. Beyond these guiding principles, personal preference and choice is emerging as being just as important as the lifestyle factor itself.

In a fascinating study, 58 participants were given either a prescribed exercise session, or a choice of exercise. Afterwards the participants were presented with a choice of foods, which they believed was simply as way of thank you for taking part in the exercise study. Post exercise, in those given no choice exercise, higher energy intake of food was consumed with larger proportion of “unhealthy” food compared to choice exercise group. The choice exercise group reported greater value and enjoyment of the exercise session. Thus autonomous choice of exercise not only provides positive reinforcement of exercising, but subsequent food choice is improved.

This concept of facilitating self determination, particularly when it comes to exercise was explored at the the recent annual British Association of Sport and Exercise conference. “Practicalities of intervention design, adherence and motivation” was presented by Dr Carly McKay from Bath University, who described how empowering people to make choices is far more likely to mean they will adhere to those lifestyle options that will optimise health.

What about the optimal timing of exercise which might improve motivation and performance? Well this depends on the context and what you are trying to achieve. In the case of training for competition and competition itself, optimal performance tends to be early evening, providing the most favourable hormonal milieu. Although in theory the morning diurnal release of cortisol might help with exercise, the downside is that this may interfere with blood glucose regulation. Furthermore, focusing on just one hormone in the Endocrine system, rather than the integrated function of the hypothalamic-pituitary axis could be misleading. Although due respect should be paid to internal biological clocks, to prevent circadian misalignment between internal pacemakers and external factors; equally becoming too obsessive about sticking to a rigid schedule would psychologically take away that essential element of choice. Practicality is a very important consideration and a degree of flexibility when planning the timing of exercise. For example, my choice of cardiovascualar exercise is swimming, which I fit in according to work commitments and when public lane swimming is available. Fortunately whilst at the BASEM conference in Bath, these practical conditions were met during the lunch break to take advantage of the 50m pool at Bath University. Pragmatic, not dogmatic when it comes to timing of exercise.

Timing of nutrition post exhaustive exercise is an important factor in supporting bone health. Immediate, rather than delayed refuelling with carbohydrate and protein is more advantageous in the balance of bone turnover markers; favouring formation over resorption. In the longer term, prolonged low energy availability as in the situation of relative energy deficiency in sport (RED-S) has a potentially irreversible adverse effect on bone health. In terms of the timing of meals, not eating too close to going to sleep, ideally 2 hours before melatonin release, is best for metabolic health.

Backing up the lifestyle choices of exercise and nutrition is sleep. Timing, duration and quality of sleep is essential for many aspects of health such as hormonal release of growth hormone, functional immunity and cognitive function. Certainly it is well recognised that shift workers, with circadian misalignment: disturbed sleep patterns relative to intrinsic biological clocks, are more at risk of developing cardio-metabolic disease.

In summary, a prescriptive approach to lifestyle factors could be counter productive. Discussing options and encouraging individuals to make their own informed and personal choices is far more likely to enable that person to take responsibility for their health and adhere to changes in lifestyle that are beneficial for their health. Having worked in hospital based NHS diabetic clinics for many years, I appreciate that supporting reluctant exercisers is not always an easy task. Equally it can be difficult to distinguish between the effects of ageing and loss of fitness. However, this does not mean that this supportive and inclusive approach should be abandoned. Rather, encouraging people to participate in decision making that they feel leads to options that are realistic and beneficial, is the approach most likely to work, especially in the long term.

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
— Hippocrates

 

For more discussion on Health Hormones and Human Performance come to British Association of Sport and Exercise Medicine Spring Conference 

BAsem2018_SpringConf_BJSM

References

Presentations

One road to Rome: Exercise Dr N. Keay, British Journal of Sports Medicine 2017

Endocrine system: balance and interplay in response to exercise training Dr N. Keay 2017

Temporal considerations in Endocrine/Metabolic interactions Part 1 Dr N. Keay, British Journal of Sports Medicine 2017

Temporal considerations in Endocrine/Metabolic interactions Part 2 Dr N. Keay, British Journal of Sports Medicine 2017

Internal Biological Clocks and Sport Performance Dr N. Keay, British Association of Sport and Exercise Medicine 2017

Providing Choice in Exercise Influences Food Intake at the Subsequent Meal Medicine & Science in Sports & Exercise October 2017

BASEM/FSEM Annual Conference 2017, Assembly Rooms, Bath

Addiction to Exercise – what distinguishes a healthy level of commitment from exercise addiction? Dr N. Keay, British Journal of Sports Medicine 2017

The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism Translational Journal of the American College of Sports Medicine October 2107

Optimal Health: For All Athletes! Part 4 – Mechanisms Dr N. Keay, British Association of Sport and Exercise Medicine 2017

Sleep for health and sports performance Dr N. Keay, British Journal of Sports Medicine 2017

Focus on physical activity can help avoid unnecessary social care British Medical Journal October 2017

Relative Energy Deficiency in Sports (RED-S) Practical considerations for endurance athletes

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Performance Implications of RED-S (IOC statement 2014)

Introduction Relative Energy Deficiency in Sport (RED-S) has developed out of the concept of the Female Athlete Triad (menstrual dysfunction, disordered eating and decreased bone mineral density) as it has become apparent that low energy availability, ie not eating enough calories to support training levels, has more widespread adverse impacts on health consequently performance in athletes than previously recognised. RED-S can impact both male and female athletes of all ages – if you are a male athlete, please do not stop reading! Young developing athletes can be at particular risk of RED-S as this represents a time of growth and development, which entails many nutritional demands in addition to those to support training. This represents a time to set up the template for health into adulthood.

Why does RED-S occur? RED-S is particularly prevalent in sports where low body weight confers a performance advantage or for aesthetic reasons. For example: long distance running, triathlon, gymnastics, dance and cycle road racing. However, RED-S could also occur not as an intentional strategy to control body weight, but rather during cycles of increased training load where periodised nutrition has not been synchronised with the increased demand on the body.

What is RED-S? Fundamentally there is a mismatch between food intake (in terms of energy and micronutrients) and the demand for nutrition required to cover expenditure, both for training and for basic “housekeeping” tasks in the body. If there is insufficient energy availability, then the body switches into an energy saving mode. This “go slow” mode has implications for hormone production and metabolic processes, which impacts all systems throughout the body. The reason why RED-S was originally described as the Female Athlete Triad is that in women the “energy saving mode” involves menstrual periods being switched off: a pretty obvious external sign as all women of child bearing age should have periods (apart from when pregnant). Low oestrogen levels have an adverse effect on bone health, resulting in decrease in bone mineral density. This effectively renders young women at increased risk of both soft tissue and bone injury, as seen in post-menopausal women. As described in the IOC statement published 2014 in British Journal of Sports Medicine on RED-S, the Female Athlete Triad is now recognised as just the tip of the iceberg. Disruption of hormone levels does not only adversely impact menstrual periods and bone health. There are knock on effects impacting the immune system, cardiovascular system, muscles, nervous system, gut health and the list goes on. Importantly, this situation is also seen in male athletes: for example, whether or not a sport is weight bearing, which traditionally improves bone health, in RED-S the predominant effect of disrupted hormones is to decrease bone density, leading to increased fracture risk.

What is the significance of RED-S? Do these effects of RED-S matter? Yes: there is a detrimental effect on not only health, but on all elements of sports performance. These include an inability to improve as expected in response to training and increased risk of injury. In the long-term there are potential implications for health with inability to reach peak bone mass for young athletes and at the other end of the scale, irreversible bone loss being seen in retired athletes.

Here is a summary of the potential impact of RED-S:

• Endocrine dysfunction: decreased training response

• Metabolic disruption: decreased endurance performance

• Bone health: increased risk bone stress injuries

• Decreased functional immunity: prone to infection

• Gut malfunction: impaired absorption of nutrients

• Decreased neuromuscular co-ordination: injury risk

• Psychological impact: inability to recognise risk developing RED-S

As you can see, these adverse effects are all relevant to performance in endurance sport.

What to do if you are concerned you may have RED-S?

Health Considerations:

• Women: even if your adult weight is steady, if you are a female athlete of reproductive age whose periods have stopped, then do not ignore this! In the first instance, you need to exclude any other causes (for example polycystic ovary syndrome and other hormone issues) in conjunction with your doctor. Then take a look at how you are eating in line with your training load – see the nutritional considerations section below.

• Men: if you are a male athlete struggling to improve sport performance, then review both your training load and your periodised nutrition and recovery. If the cause is RED-S then do not wait until your sport performance drops or you get injured before taking action. You may also want to consider having your testosterone levels measured to check that these are in the normal range.

For further updates 2018 UPDATE: Relative Energy Deficiency in Sport (RED-S) BJSM

Nutritional Considerations: From colleague Jo Scott-Dalgleish BSc (Hons), mBANT, CNHC

• Ensure an adequate energy intake. Use My Fitness Pal or a similar app to track your food intake over the course of week. On any day when you train, if you are consuming fewer than 2500 calories as a male endurance athlete and 2000 calories as a female endurance athlete, your intake is likely to be inadequate as these are the guidelines for the general population. If you are taking in fewer than 2750 calories (male) or 2250 calories (female) on a day when you are training for two hours or more, you are likely to be at increased risk of RED-S. Use this data to learn more about appropriate food choices and serving sizes, and introduce some changes to increase your intake in line with your training load. But I do not suggest using apps like these on a long-term basis as they may encourage an unhealthy obsession with your food intake.

• Focus on nutrient density. Make good quality food choices to help you get enough vitamins and minerals as well as carbohydrates, protein, fat and fibre. Try to eat fresh, minimally processed foods rather than too much packaged food, including 3-5 servings of vegetables and 2-3 pieces of fresh fruit each day.

• Avoid excluding foods, whole food groups or following ‘fad diets’. Unless you have a genuine allergy or a diagnosed medical condition such as coeliac disease or lactose intolerance. Or you have been advised to avoid certain foods by a dietician or other well-qualified nutrition practitioner to help manage a health condition such as Irritable Bowel Syndrome. If you are vegetarian or vegan, see Jo’s blog here for tips on ensuring a well-balanced approach.

• Periodise your carbohydrate intake in line with your training. Increase your intake of starches and sugars (including vegetables and fruit) on your heavier training days. A low daily carbohydrate intake might be in the range of 2-4 g/kg of body weight. This is OK for lower volume training days, but should be increased to 5-8 g/kg when training for 2-3 hours or more in a single day. Again, use an app like My Fitness Pal for a week to help you assess your carbohydrate intake. If you are experiencing RED-S, avoid following approaches like fasted training or low carb-high fat diets (LCHF) due to potential adverse effects on hormones.

• Pay attention to your recovery nutrition. Consuming 15-25g of protein and 45-75g of carbohydrate in the hour after exercise, whether as a snack or as part of a meal will help you to each your energy intake goals, restock your glycogen stores for your next training session and protect lean muscle mass.

Jo Scott-Dalgleish BSc (Hons), mBANT, CNHC, is a registered nutritional therapist specialising in nutrition for endurance sport, based in London. She works with triathletes, distance runners and cyclists to help optimise both their performance and their health through the creation of an individual nutritional plan. For more details, please visit www.endurancesportsnutritionist.co.uk.

For further discussion on Health, Hormones and Human Performance, come to the BASEM annual conference

Conferences in Sport/Dance, Exercise Science and Medicine 2018

References

Optimal health: including female athletes! Part 1 Bones Dr N. Keay, British Journal of Sport Medicine 2017

Optimal health: including male athletes! Part 2 Relative Energy Deficiency in sports Dr N. Keay, British Journal of Sport Medicine 2017

Optimal Health: Especially Young Athletes! Part 3 – Consequences of Relative Energy Deficiency in Sports Dr N. Keay, British Association of Sport and Exercise Medicine 2017

Mechanisms for optimal health…for all athletes! Dr N. Keay, British Journal of Sport Medicine 2017

The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) British Journal of Sports Medicine 2014

Nutritional considerations for vegetarian endurance athletes Jo Scott-Dalgleish, Endurance Sports Nutrition 2017

 

Athletic Fatigue: Part 2

A degree of athletic fatigue following a training session, as described in part 1, is required to set in motion mechanisms to drive beneficial adaptations to exercise. At what point does this process of functional over-reaching tip into non-functional over-reaching denoted by failure to improve sports performance? Or further still along the spectrum and time scale, the chronic situation of overtraining and decrease in performance? Is this a matter of time scale, or degree, or both?

Slide1
Integrated Periodisation of Training Load, Nutrition and Recovery keeps an individual on the green plateau, avoiding descent into the red zone, due to an excess or deficiency

Determining the tipping point between these fatigue situations is important for health and performance. A first step is always to exclude underlying organic disease states, be these of Endocrine, systemic inflammatory or infective aetiologies. Thereafter the crucial step is to assess whether the periodisation of training, nutrition and recovery are integrated over a training block and in the longer term over a training season.

What about the application of Endocrine markers to monitor training load? Although the recent studies described below are more applicable to research scenarios, they give some interesting insights into the interactive networks effects of the Endocrine system and the multifactorial nature of fatigue amongst individual athletes.

In the short term, during a 2 day rowing competition, increases in wakening salivary cortisol were noted followed by return towards baseline in subsequent 2 day recovery. Despite individual variability with salivary cortisol measurement, this does at least offer a noninvasive way to adjust training loads around competition time for elite athletes.

Over an 11 day stimulated training camp and recovery during the sport specific preparatory phase of the training season, blood metabolic and Endocrine markers were measured. In the case of an endurance based training camp in cyclists, a significant increase in urea (due to protein breakdown associated with high energy demand training) and decrease in insulin-like growth factor 1 (IGF1) from baseline were noted. Whereas for the strength-based athletes for ball sports, an increase in creatine kinase (CK) was seen, as a result of muscle damage. This study demonstrates how different markers of fatigue are specific to sport discipline and mode of training. Large inter-individual variability existed between the degree of change in markers and degree of fatigue.

In the longer term, for the case of overtraining syndrome potential Endocrine markers have been reviewed. Whilst basal levels of most measured hormones remained stable, a blunted submaximal exercise response of growth hormone (GH), prolactin and ACTH could be indicative of developing overtraining syndrome. Whilst this review is interesting, dynamic testing is not a practical approach and these findings are not specific to over training. Rather this blunted dynamic exercise response would indicate relative suppression of the neuroendocrine hypothalamic-pituitary axis which could potentially involve other stressors such as inadequate sleep or poor nutrition. Although basal levels may lie “within the normal range”, if both pituitary derived stimulating hormone and end endocrine gland hormone concentrations fall in the lower end of the normal ranges (eg low end of range TSH and T4) this is consistent with mild hypothalamic suppression observed over the range of training and fatigue conditions (functional/non-functional and overtraining) and/or Relative Energy Deficiency in Sports (RED-S).

Although the studies above are of research interest, non invasive monitoring, specific to an athlete is more practical for monitoring the effects of training. Several useful easily measurable metrics can give clues: resting heart rate, heart rate variability, power output. Tools on Strava and Training Peaks provide practical insights in monitoring training effectiveness via these metrics. A range of mobile apps makes it ever easier to augment a personal training log to include these training metrics, along with feel, sleep and nutrition. Such a log provides feedback on health and fitness for the individual athlete, in order to personalise training plans. Certainly adding the results from any standard basal blood tests will also help add to the picture, along the lines of building a longitudinal personal biological passport. After all, “normal ranges” are based on the general population, of which top level athletes may represent a subgroup. The more personalised the metics recorded over a long time scale, the more sensitive and useful the process to guide improvement in sport performance.

Context is key when considering athletic fatigue: temporal considerations and individual variation. Certainly the interactive network effects of the Endocrine system are important in determining the degree of adaptation to exercise and therefore sports performance. However the Endocrine system acts in conjunction with many other systems (metabolic, immune and inflammatory), in determining the effectiveness of training in improving sports performance. So it is not surprising that one metric or marker in isolation is not predictive of fatigue status in individual athletes.

For more discussion on Health, Hormones and Human Performance come to the British Association of Sport and Exercise Medicine annual conference

Presentations

References

Athletic Fatigue: Part 1

Endocrine system: balance and interplay in response to exercise training

Temporal considerations in Endocrine/Metabolic interactions Part 1

Fatigue, sport performance and hormones..more on the endocrine system Dr N Keay, British Journal of Sports Medicine 2017

Sport Performance and RED-S, insights from recent Annual Sport and Exercise Medicine and Innovations in Sport and Exercise Nutrition Conferences Dr N Keay, British Journal of Sports Medicine 2017

Capturing effort and recovery: reactive and recuperative cortisol responses to competition in well-trained rowers British Journal of Sports Medicine

Blood-Borne Markers of Fatigue in Competitive Athletes – Results from Simulated Training Camps Plos One

Hormonal aspects of overtraining syndrome: a systematic review BMC Sports Science, Medicine and Rehabilitation 2017

Clusters of Athletes – A follow on from RED-S blog series to put forward impact of RED-S on athlete underperformance Dr N Keay, British Association of Sport and Exercise Medicine 2017

Strava Fitness and Freshness Science4Performance 2017

From population based norms to personalised medicine: Health, Fitness, Sports Performance Dr N Keay, British Journal of Sports Medicine 2017

Sports Endocrinology – what does it have to do with performance? Dr N Keay, British Journal of Sports Medicine 2017