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Claire E. Badenhorst, Katherine E. Black and Wendy J. O’Brien

Hepcidin, a peptide hormone with an acknowledged evolutionary function in iron homeostasis, was discovered at the turn of the 21st century. Since then, the implications of increased hepcidin activity have been investigated as a potential advocate for the increased risk of iron deficiency in various health settings. Such implications are particularly relevant in the sporting community where peaks in hepcidin postexercise (∼3–6 hr) are suggested to reduce iron absorption and recycling, and contribute to the development of exercise-induced iron deficiency in athletes. Over the last decade, hepcidin research in sport has focused on acute and chronic hepcidin activity following single and repeated training blocks. This research has led to investigations examining possible methods to attenuate postexercise hepcidin expression through dietary interventions. The majority of macronutrient dietary interventions have focused on manipulating the carbohydrate content of the diet in an attempt to determine the health of athletes adopting the low-carbohydrate or ketogenic diets, a practice that is a growing trend among endurance athletes. During the process of these macronutrient dietary intervention studies, an observable coincidence of increased cumulative hepcidin activity to low energy availability has emerged. Therefore, this review aims to summarize the existing literature on nutritional interventions on hepcidin activity, thus, highlighting the link of hepcidin to energy availability, while also making a case for the use of hepcidin as an individualized biomarker for low energy availability in males and females.

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Julian A. Owen, Matthew B. Fortes, Saeed Ur Rahman, Mahdi Jibani, Neil P. Walsh and Samuel J. Oliver

Identifying mild dehydration (≤2% of body mass) is important to prevent the negative effects of more severe dehydration on human health and performance. It is unknown whether a single hydration marker can identify both mild intracellular dehydration (ID) and extracellular dehydration (ED) with adequate diagnostic accuracy (≥0.7 receiver-operating characteristic–area under the curve [ROC-AUC]). Thus, in 15 young healthy men, the authors determined the diagnostic accuracy of 15 hydration markers after three randomized 48-hr trials; euhydration (water 36 ml·kg−1·day−1), ID caused by exercise and 48 hr of fluid restriction (water 2 ml·kg−1·day−1), and ED caused by a 4-hr diuretic-induced diuresis begun at 44 hr (Furosemide 0.65 mg/kg). Body mass was maintained on euhydration, and dehydration was mild on ID and ED (1.9% [0.5%] and 2.0% [0.3%] of body mass, respectively). Urine color, urine specific gravity, plasma osmolality, saliva flow rate, saliva osmolality, heart rate variability, and dry mouth identified ID (ROC-AUC; range 0.70–0.99), and postural heart rate change identified ED (ROC-AUC 0.82). Thirst 0–9 scale (ROC-AUC 0.97 and 0.78 for ID and ED) and urine osmolality (ROC-AUC 0.99 and 0.81 for ID and ED) identified both dehydration types. However, only the thirst 0–9 scale had a common dehydration threshold (≥4; sensitivity and specificity of 100%; 87% and 71%, 87% for ID and ED). In conclusion, using a common dehydration threshold ≥4, the thirst 0–9 scale identified mild intracellular and ED with adequate diagnostic accuracy. In young healthy adults’, thirst 0–9 scale is a valid and practical dehydration screening tool.

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Michele Merlini, Greg Whyte, Sam Marcora, Mike Loosemore, Neil Chester and John Dickinson

Purpose: To investigate the impact of twice-daily inhalation of 100 µg of salmeterol (SAL) or 12 µg of formoterol (FOR) in addition to a strength- and power-training program over a 5-wk period on a 30-m sprint, strength, power, mood, stress, and skinfold thickness. Methods: In a randomized, single-blind study, 23 male and 15 female nonasthmatic, recreationally active individuals were recruited (mean [SD] age 26.3 [5.4] y, weight 76.2 [11.5] kg, height 176.9 [8.5] cm). Participants completed 3 standardized whole-body strength- and power-training sessions per week for 5 wk during which they were assigned to an SAL, FOR, or placebo group. Participants used their inhaler twice per day as instructed and completed assessments of sprint, strength, and power at baseline and 1 wk after cessation of the training program. The assessments included a 30-m sprint, vertical jump, 1-repetition-maximum (1RM) bench press, 1RM leg press, peak torque flexion and extension, anthropometric evaluation, and Rest-Q questionnaires. Results: After 5 wk of strength and power training, 30-m sprint time reduced in the FOR (0.29 [0.11] s, P = .049) and SAL (0.35 [0.05] s, P = .040) groups compared with placebo (+0.01 [0.11] s). No significant change was found in other assessments of strength, mood, or skinfold thickness. Conclusions: When strength and power training are combined with the inhalation of FOR or SAL over a 5-wk period, moderately trained individuals experience an improvement in 30-m sprint performance.

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Teun van Erp, Marco Hoozemans, Carl Foster and Jos J. de Koning

Purpose: A valid measure for training load (TL) is an important tool for cyclists, trainers, and sport scientists involved in professional cycling. The aim of this study was to explore the influence of exercise intensity on the association between kilojoules (kJ) spent and different measures of TL to arrive at valid measures of TL. Methods: Four years of field data were collected from 21 cyclists of a professional cycling team, including 11,716 training and race sessions. kJ spent was obtained from power output measurements, and others TLs were calculated based on the session rating of perceived exertion (sRPE), heart rate (Lucia training impulse [luTRIMP]), and power output (training stress score [TSS]). Exercise intensity was expressed by the intensity factor (IF). To study the effect of exercise intensity on the association between kJ spent and various other TLs (sRPE, luTRIMP, and TSS), data from low- and high-intensity sessions were subjected to regression analyses using generalized estimating equations. Results: This study shows that the IF is significantly different for training and race sessions (0.59 [0.03] vs 0.73 [0.03]). Significant regression coefficients show that kJ spent is a good predictor of sRPE, and luTRIMP, as well as TSS. However, IF does not influence the associations between kJ spent and sRPE and luTRIMP, while the association with TSS is different when sessions are done with low or high IF. Conclusion: It seems that the TSS reacts differently to exercise intensity than sRPE and luTRIMP. A possible explanation could be the quadratic relation between IF and TSS.

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Paola Rodriguez-Giustiniani and Stuart D.R. Galloway

The present study examined the impact of hormonal differences between late follicular (LF) and midluteal (ML) phases on restoration of fluid balance following dehydration. Ten eumenorrheic female participants were dehydrated by 2% of their body mass through overnight fluid restriction followed by exercise-heat stress. Trials were undertaken during the LF (between Days 10 and 13 of the menstrual cycle) and ML phases (between Days 18 and 23 of the menstrual cycle) with one phase repeated to assess reliability of observations. Following dehydration, participants ingested a volume equivalent to 100% of mass loss of a commercially available sports drink in four equal volumes over 30 min. Mean serum values for steroid hormones during the ML (estradiol [E2]: 92 ± 11 pg/ml, progesterone: 19 ± 4 ng/ml) and LF (estradiol [E2]: 232 ± 64 pg/ml, progesterone: 3 ± 2 ng/ml) were significantly different between phases. Urine tests confirmed no luteinizing hormone surge evident during LF trials. There was no effect of menstrual cycle phase on cumulative urine volume during the 3-hr rehydration period (ML: 630 [197–935] ml, LF: 649 [180–845] ml) with percentage of fluid retained being 47% (33–85)% on ML and 46% (37–89)% on LF (p = .29). There was no association between the progesterone:estradiol ratio and fluid retained in either phase. Net fluid balance, urine osmolality, and thirst intensity were not different between phases. No differences in sodium (ML: −61 [−36 to −131] mmol, LF: −73 [−5 to −118] mmol; p = .45) or potassium (ML: −36 [−11 to −80] mmol, LF: −30 [−19 to −89] mmol; p = .96) balance were observed. Fluid replacement after dehydration does not appear to be affected by normal hormonal fluctuations during the menstrual cycle in eumenorrheic young women.

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Pål Haugnes, Jan Kocbach, Harri Luchsinger, Gertjan Ettema and Øyvind Sandbakk

Purpose: To investigate fluctuations in speed, work rate, and heart rate (HR) when cross-country ski skating across varying terrains at different endurance-training intensities. Methods: Seven male junior Norwegian skiers performed maximal-speed (V max) tests in both flat and uphill terrains. Thereafter, 5-km sessions at low (LIT), moderate (MIT), and high intensity (HIT) were performed based on their own perception of intensity while monitored by a global navigation satellite system with integrated barometry and accompanying HR monitor. Results: Speed, HR, and rating of perceived exertion gradually increased from LIT to MIT and HIT, both for the total course and in flat and uphill terrains (all P < .05). Uphill work rates (214 [24] W, 298 [27] W, and 350 [54] W for LIT, MIT, and HIT, respectively) and the corresponding percentage of maximal HR (79.2% [6.1]%, 88.3% [2.4]%, and 91.0% [1.7]%) were higher than in flat terrain (159 [16] W, 206 [19] W, and 233 [72] W vs 72.3% [6.3]%, 83.2% [2.3]%, and 87.4% [2.0]% for LIT, MIT, and HIT, respectively) (all P < .01). In general, ∼13% point lower utilization of maximal work rate was reached in uphill than in flat terrain at all intensities (all P < .01). Conclusions: Cross-country ski training across varying terrains is clearly interval based in terms of speed, external work rate, and metabolic intensity for all endurance-training intensities. Although work rate and HR were highest in uphill terrain at all intensities, the utilization of maximal work rate was higher in flat terrain. This demonstrates the large potential for generating external work rate when uphill skiing and the corresponding downregulation of effort due to the metabolic limitations.

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Nura Alwan, Samantha L. Moss, Kirsty J. Elliott-Sale, Ian G. Davies and Kevin Enright

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions.

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Grégoire P. Millet and Kilian Jornet

Purpose: To present the acclimatization strategy employed by an elite athlete prior to 2 successful ascents to Mount Everest (including a “fastest known time”) in 1 wk. Methods: Training volume, training content, and altitude exposure were recorded daily. Vertical velocity was recorded by GPS (global positioning system) heart-rate monitor. Results: The subject first used a live high–train low and high preacclimatization method in normobaric hypoxia (NH). Daily, he combined sleeping in a hypoxic tent (total hours: ∼260) and exercising “as usual” in normoxia but also in NH (altitude >6000 m: 30 h), including at high intensity. The hypoxic sessions were performed at the second threshold on treadmill in NH at 6000 m, and the pulse saturation increased from 70% to 85% over 1 mo. Then, the subject was progressively exposed to hypobaric hypoxia, first in the Alps and then in the Himalayas. On day 18, he reached for the second time an altitude >8000 m with the fastest vertical velocity (350 m/h) ever measured between 6300 and 8400 m. Afterward, he climbed twice in a week to the summit of Mount Everest (8848 m, including a “fastest known time” of 26.5 h from Rongbuk Monastery, 5100 m). Conclusion: Overall, this acclimatization was successful and in line with the most recent recommendations: first, using live high–train low and high, and second, using hypobaric hypoxia at increasing altitudes for a better translation of the NH benefits to hypobaric hypoxia. This case study reports the preparation for the most outstanding performance ever acheived at an extreme altitude.

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Stephen S. Cheung

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Paul A. Solberg, Will G. Hopkins, Gøran Paulsen and Thomas A. Haugen

Purpose: To quantify age of peak performance and performance improvements in the years preceding peak age in elite weightlifting and powerlifting athletes using results from powerlifting World Championships in 2003–2017 and weightlifting World Championships and Olympic Games in 1998–2017. Methods: Individual performance trends were derived by fitting a quadratic curve separately to each athlete’s performance and age data. Effects were evaluated using magnitude-based inferences. Results: Peak age (mean [SD]) was 35 (7) y for powerlifters and 26 (3) y for weightlifters, a large most likely substantial difference of 9, ±1 y (mean, 90% confidence limit). Men showed possibly higher peak age than women in weightlifting (0.8, ±0.7 y; small) and a possibly lower peak age in powerlifting (1.3, ±1.8 y; trivial). Peak age of athletes who ever won a medal was very likely less than that of nonmedalists in weightlifting (1.3, ±0.6 y; small), while the difference in powerlifters was trivial but unclear. Five-year improvements prior to peak age were 12% (10%) for powerlifters and 9% (7%) for weightlifters, a small possibly substantial difference (2.9, ±2.1%). Women exhibited possibly greater improvements than men in powerlifting (2.7, ±3.8%; small) and very likely greater in weightlifting (3.5, ±1.6%; small). Medalists possibly improved less than nonmedalists among powerlifters (−1.7, ±2.3%; small), while the difference was likely trivial for weightlifters (2.3, ±1.8%). Conclusion: These novel insights on performance development will be useful for practitioners evaluating strategies for achieving success.