Alterations in Redox Homeostasis During Recovery From Unexplained Underperformance Syndrome in an Elite International Rower

in International Journal of Sports Physiology and Performance
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $112.00

1 year online subscription

USD  $149.00

Student 2 year online subscription

USD  $213.00

2 year online subscription

USD  $284.00

Purpose: To examine a diagnosis of unexplained underperformance syndrome (UUPS, or overtraining syndrome) in an international rower describing a full recovery and return to elite competition the same year. Methods: On diagnosis and 4 and 14 mo postdiagnosis, detailed assessments including physiological, nutritional, and biomarkers were made. Results: Clinical examination and laboratory results for hematology, biochemistry, thyroid function, immunology, vitamins, and minerals were unremarkable and did not explain the presentation and diagnosis. Redox biomarkers including hydroperoxides, plasma antioxidant capacity, red blood cell glutathione, superoxide dismutase, coenzyme Q10, vitamin E (α- and γ-tocopherol), and carotenoids (lutein, α-carotene, β-carotene) provided evidence of altered redox homeostasis. The recovery strategy began with 12 d of training abstinence and nutritional interventions, followed by 6 wk of modified training. At 4 mo postintervention, performance had recovered strongly, resulting in the athlete’s becoming European champion that same year. Further improvements in physiological and performance indices were observed at 14 mo postintervention. Physiologically relevant increases in concentrations of carotenoids were achieved at each postintervention time point, exceeding the reported critical-difference values. Conclusions: Increasing athlete phytonutrient intake may enhance recovery and tolerance of training and environmental stressors, reducing the risk of unexplained UUPS. Alterations in redox homeostasis should be considered as part of the medical management in UUPS. This is the first reported case study of an elite athlete with alterations in redox homeostasis in conjunction with a diagnosis of UUPS.

Lewis, Burden, and Pedlar are with the School of Sport, Health and Applied Science, St Mary’s University, London, United Kingdom. Redgrave and Homer are with British Rowing Ltd, London, United Kingdom. Martinson is with English Inst of Sport, Manchester, United Kingdom. Moore is with Orreco, Research & Innovation Centre, National University of Ireland, Galway, Ireland.

Lewis (nathan.lewis@eis2win.co.uk) is corresponding author.
  • 1.

    Lewis NA, Collins D, Pedlar CR, Rogers JP. Can clinicians and scientists explain and prevent unexplained underperformance syndrome in elite athletes?: an interdisciplinary perspective and 2016 update. BMJ Open Sport Exerc Med. 2015;1:000063. PubMed doi:10.1136/bmjsem-2015-000063

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    ACSM. Prevention, diagnosis, and treatment of the overtraining syndrome. Med Sci Sports Exerc. 2013;45:186205. doi:10.1249/MSS.0b013e318279a10a

  • 3.

    Lewis NA, Howatson G, Morton K, Hill J, Pedlar CR. Alterations in redox homeostasis in the elite endurance athlete. Sports Med. 2015;45:379409. PubMed doi:10.1007/s40279-014-0276-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Powers SK, Duarte J, Kavazis AN, Talbert EE. Reactive oxygen species are signalling molecules for skeletal muscle adaptation. Exp Physiol. 2010;95:19. PubMed doi:10.1113/expphysiol.2009.050526

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Radak Z, Chung HY, Koltai E, Taylor AW, Goto S. Exercise, oxidative stress and hormesis. Age Res Rev. 2008;7:3442. PubMed doi:10.1016/j.arr.2007.04.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Tanskanen M, Atalay M, Uusitalo A. Altered oxidative stress in overtrained athletes. J Sports Sci. 2010;28:309317. PubMed doi:10.1080/02640410903473844

  • 7.

    Sivoňová M, Žitňanová I, Hlinčíková L, Skodácek I, Trebatická J, Duracková Z. Oxidative stress in university students during examinations. Stress. 2004;7:183188. PubMed doi:10.1080/10253890400012685

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Lewis NA, Newell J, Burden R, Howatson G, Pedlar CR. Critical difference and biological variation in biomarkers of oxidative stress and nutritional status in athletes. PLoS ONE. 2016;11:e0149927. PubMed doi:10.1371/journal.pone.0149927.t002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Pennant M, Steur M, Moore C, Butterworth A, Johnson L. Comparative validity of vitamin C and carotenoids as indicators of fruit and vegetable intake: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr. 2015;114:13311340. PubMed doi:10.1017/S0007114515003165

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Watson TA, Callister R, Taylor RD, Sibbritt DW, MacDonald-Wicks LK, Garg ML. Antioxidant restriction and oxidative stress in short-duration exhaustive exercise. Med Sci Sports Exerc. 2005;37:6371. PubMed doi:10.1249/01.MSS.0000150016.46508.A1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kaulmann A, Bohn T. Carotenoids, inflammation, and oxidative stress—implications of cellular signaling pathways and relation to chronic disease prevention. Nutr Res. 2014;34:907929. PubMed doi:10.1016/j.nutres.2014.07.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Margonis K, Fatouros IG, Jamurtas AZ, et al. Oxidative stress biomarkers responses to physical overtraining: implications for diagnosis. Free Radic Biol Med. 2007;43:901910. PubMed doi:10.1016/j.freeradbiomed.2007.05.022

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Jammes Y, Steinberg JG, Delliaux S. Chronic fatigue syndrome: acute infection and history of physical activity affect resting levels and response to exercise of plasma oxidant/antioxidant status and heat shock proteins. J Intern Med. 2012;272:7484. PubMed doi:10.1111/j.1365-2796.2011.02488.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Lewis NA, Towey C, Bruinvels G, Howatson G, Pedlar CR. Effects of exercise on alterations in redox homeostasis in elite male and female endurance athletes using a clinical point-of-care test. Appl Physiol Nutr Metab. 2016;41:10261032. PubMed doi:10.1139/apnm-2016-0208

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Lands LC, Grey VL, Smountas AA. Effect of supplementation with a cysteine donor on muscular performance. J Appl Physiol. 1999;87:13811385. PubMed

  • 16.

    Bell PG, Walshe IH, Davison GW, et al. Montmorency cherries reduce the oxidative stress and inflammatory responses to repeated days high-intensity stochastic cycling. Nutrients. 2014;6:829843. PubMed doi:10.3390/nu6020829

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 635 426 45
Full Text Views 15 9 0
PDF Downloads 12 10 0