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Case Study: Resumption of Eumenorrhea in Parallel With High Training Load After 4 Years of Menstrual Dysfunction: A 5-Year Follow-Up of an Elite Female Cyclist

José L. Areta

, and the heavy training load of elite athletes has never been addressed longitudinally. This is the first case study that provides detailed information on body mass and body composition data in relation to reported menstrual status together with detailed training records and markers of physical

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Training Load and Carbohydrate Periodization Practices of Elite Male Australian Football Players: Evidence of Fueling for the Work Required

Harry E. Routledge, Stuart Graham, Rocco Di Michele, Darren Burgess, Robert M. Erskine, Graeme L. Close, and James P. Morton

training sessions and had full access to the players to visibly cross-reference player recall. Quantification of Training and Game Load In-season external training load and match activity profiles were quantified using a portable global positioning system microtechnology device (Optimeye S5; Catapult

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Acute Caffeine Ingestion’s Increase of Voluntarily Chosen Resistance-Training Load After Limited Sleep

Christian Cook, C. Martyn Beaven, Liam P. Kilduff, and Scott Drawer

Introduction:

This study aimed to determine whether caffeine ingestion would increase the workload voluntarily chosen by athletes in a limited-sleep state.

Methods:

In a double-blind, crossover study, 16 professional rugby players ingested either a placebo or 4 mg/kg caffeine 1 hr before exercise. Athletes classified themselves into nondeprived (8 hr+) or sleep-deprived states (6 hr or less). Exercise comprised 4 sets of bench press, squats, and bent rows at 85% 1-repetition maximum. Athletes were asked to perform as many repetitions on each set as possible without failure. Saliva was collected before administration of placebo or caffeine and again before and immediately after exercise and assayed for testosterone and cortisol.

Results:

Sleep deprivation produced a very large decrease in total load (p = 1.98 × 10−7). Caffeine ingestion in the nondeprived state resulted in a moderate increase in total load, with a larger effect in the sleep-deprived state, resulting in total load similar to those observed in the nondeprived placebo condition. Eight of the 16 athletes were identified as caffeine responders. Baseline testosterone was higher (p < .05) and cortisol trended lower in non-sleep-deprived athletes. Changes in hormones from predose to preexercise correlated to individual workload responses to caffeine. Testosterone response to exercise increased with caffeine compared with placebo, as did cortisol response.

Conclusions:

Caffeine increased voluntary workload in professional athletes, even more so under conditions of self-reported limited sleep. Caffeine may prove worthwhile when athletes are tired, especially in those identified as responders.

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Energy Intake and Expenditure of Professional Soccer Players of the English Premier League: Evidence of Carbohydrate Periodization

Liam Anderson, Patrick Orme, Robert J. Naughton, Graeme L. Close, Jordan Milsom, David Rydings, Andy O’Boyle, Rocco Di Michele, Julien Louis, Catherine Hambly, John Roger Speakman, Ryland Morgans, Barry Drust, and James P. Morton

In an attempt to better identify and inform the energy requirements of elite soccer players, we quantified the energy expenditure (EE) of players from the English Premier League (n = 6) via the doubly labeled water method (DLW) over a 7-day in-season period. Energy intake (EI) was also assessed using food diaries, supported by the remote food photographic method and 24 hr recalls. The 7-day period consisted of 5 training days (TD) and 2 match days (MD). Although mean daily EI (3186 ± 367 kcals) was not different from (p > .05) daily EE (3566 ± 585 kcals), EI was greater (p < .05) on MD (3789 ± 532 kcal; 61.1 ± 11.4 kcal.kg-1 LBM) compared with TD (2956 ± 374 kcal; 45.2 ± 9.3 kcal.kg-1 LBM, respectively). Differences in EI were reflective of greater (p < .05) daily CHO intake on MD (6.4 ± 2.2 g.kg-1) compared with TD (4.2 ± 1.4 g.kg-1). Exogenous CHO intake was also different (p < .01) during training sessions (3.1 ± 4.4 g.h-1) versus matches (32.3 ± 21.9 g.h-1). In contrast, daily protein (205 ± 30 g.kg-1, p = .29) and fat intake (101 ± 20 g, p = .16) did not display any evidence of daily periodization as opposed to g.kg-1, Although players readily achieve current guidelines for daily protein and fat intake, data suggest that CHO intake on the day before and in recovery from match play was not in accordance with guidelines to promote muscle glycogen storage.

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The Assessment of Total Energy Expenditure During a 14-Day In-Season Period of Professional Rugby League Players Using the Doubly Labelled Water Method

James Cameron Morehen, Warren Jeremy Bradley, Jon Clarke, Craig Twist, Catherine Hambly, John Roger Speakman, James Peter Morton, and Graeme Leonard Close

Rugby League is a high-intensity collision sport competed over 80 min. Training loads are monitored to maximize recovery and assist in the design of nutritional strategies although no data are available on the total energy expenditure (TEE) of players. We therefore assessed resting metabolic rate (RMR) and TEE in six Super League players over 2 consecutive weeks in-season including one game per week. Fasted RMR was assessed followed by a baseline urine sample before oral administration of a bolus dose of hydrogen (deuterium 2H) and oxygen (18O) stable isotopes in the form of water (2H2 18O). Every 24 hr thereafter, players provided urine for analysis of TEE via DLW method. Individual training load was quantified using session rating of perceived exertion (sRPE) and data were analyzed using magnitude-based inferences. There were unclear differences in RMR between forwards and backs (7.7 ± 0.5 cf. 8.0 ± 0.3 MJ, respectively). Indirect calorimetry produced RMR values most likely lower than predictive equations (7.9 ± 0.4 cf. 9.2 ± 0.4 MJ, respectively). A most likely increase in TEE from Week 1 to 2 was observed (17.9 ± 2.1 cf. 24.2 ± 3.4 MJ) explained by a most likelyincrease in weekly sRPE (432 ± 19 cf. 555 ± 22 AU), respectively. The difference in TEE between forward and backs was unclear (21.6 ± 4.2 cf. 20.5 ± 4.9 MJ, respectively). We report greater TEE than previously reported in rugby that could be explained by the ability of DLW to account for all match and training-related activities that contributes to TEE.

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The Effects of 8 Weeks of Endurance Running on Hepcidin Concentrations, Inflammatory Parameters, and Iron Status in Female Runners

Irena Auersperger, Bojan Knap, Ales Jerin, Rok Blagus, Mitja Lainscak, Milan Skitek, and Branko Skof

Exercise-associated iron deficiency is a common disorder in endurance athletes. The authors investigated the effects of long-term endurance exercise on hepcidin concentrations, inflammatory parameters, and iron status in moderately trained female long-distance runners. Eighteen runners were assigned to either an interval- or a continuous-training exercise group. The physical training consisted of two 3-week progressive overload periods, each followed by a week’s recovery, and concluded with a 10- or 21-km competitive run. Samples were taken 6 times during the 8-wk training program, first at baseline (BPre), then after the first and second 3-wk training loads (TPost1, TPost2), after each recovery week (Recovery1 and Recovery2), and poststudy (BPost). Soluble transferrin receptor (sTfR) concentrations were increased in Recovery2 and BPost compared with BPre (p = .02), hemoglobin decreased in TPost1 and TPost2 (p < .001), and red blood cells decreased in TPost2 (p = .01). Hepcidin decreased with time in TPost1 and in BPost compared with BPre (p < .001) and increased in TPost2 compared with TPost1 (p < .001). No differences over time were found for high-sensitivity C-reactive protein. The main findings of the current study indicate that serum hepcidin and sTfR were affected after 8 weeks of endurance running in women. No positive relation was found with inflammation.

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Hematological Status of Male Runners in Relation to the Extent of Physical Training

John D. Robertson, Ronald J. Maughan, Ann C. Milne, and Ronald J.L. Davidson

Blood biochemical indices of iron status were measured in venous blood from 20 runners and 6 control subjects. All subjects were.male, ages 20 to 40 years, and stable with regard to body weight and degree of physical activity. Dietary analysis was undertaken using a 7-day weighed food intake. There was no evidence of iron deficiency: hemoglobin concentrations and serum femtin levels were within the normal population range for all individuals. However, serum ferritin was negatively correlated with the amount of training. Daily iron intake appeared to be adequate; iron intake was correlated with protein intake but not related to training or energy intake. Serum ferritin, an indicator of iron status, was significantly correlated with vitamin C intake but not iron intake. Serum transferrin concentration was higher in the group of athletes undertaking a high weekly training load compared with the control subjects, suggesting an alteration in iron metabolism although there was no evidence of increased erythropoiesis. The biological significance of this is unclear.

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Case Study: Impact of Inter- and Intra-Day Energy Parameters on Bone Health, Menstrual Function, and Hormones in an Elite Junior Female Triathlete

Jason D. Vescovi and Jaci L. VanHeest

This observational case study examined the association of inter- and intraday energy intake and exercise energy expenditure with bone health, menstrual status and hematological factors in a female triathlete. The study spanned 7 months whereby energy intake and exercise energy expenditure were monitored three times (13 d); 16 blood samples were taken, urinary hormones were assessed for 3 months, and bone mineral density was measured twice. Energy availability tended to be sustained below 30 kcal/kg FFM/d and intraday energy intake patterns were often “back-loaded” with approximately 46% of energy consumed after 6 p.m. Most triiodothyronine values were low (1.1–1.2nmol/L) and supportive of reduced energy availability. The athlete had suppressed estradiol (105.1 ± 71.7pmol/L) and progesterone (1.79 ±1.19nmol/L) concentrations as well as urinary sex-steroid metabolites during the entire monitoring period. Lumbar spine (L1-L4) bone mineral density was low (age-matched Z-score −1.4 to −1.5). Despite these health related maladies the athlete was able to perform typical weekly training loads (swim: 30–40 km, bike: 120–300 km, run 45–70 km) and was competitive as indicated by her continued improvement in ITU World Ranking during and beyond the assessment period. There is a delicate balance between health and performance that can become blurred especially for endurance athletes. Education (athletes, coaches, parents) and continued monitoring of specific indicators will enable evidence-based recommendations to be provided and help reduced the risk of health related issues while maximizing performance gains. Future research needs to longitudinally examine how performance on standardized tests in each discipline (e.g., 800-m swim, 20-km time trial, 5-km run) is impacted when aspects of the female athlete triad are present.

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Case Study: Natural Bodybuilding Contest Preparation

Brandon M. Kistler, Peter J. Fitschen, Sushant M. Ranadive, Bo Fernhall, and Kenneth R. Wilund

The purpose of this study was to document the physiological changes that occur in a natural bodybuilder during prolonged contest preparation for a proqualifying contest. During the 26-week preparation, the athlete undertook a calorically restrictive diet with 2 days of elevated carbohydrate intake per week, increased cardiovascular (CV) training, and attempted to maintain resistance-training load. The athlete was weighed twice a week and body composition was measured monthly by DXA. At baseline and every 2 weeks following CV structure and function was measured using a combination of ultrasound, applanation tonometry, and heart rate variability (HRV). Cardiorespiratory performance was measured by VO2peak at baseline, 13 weeks, and 26 weeks. Body weight (88.6 to 73.3 Kg, R 2 = .99) and percent body fat (17.5 to 7.4%) were reduced during preparation. CV measurements including blood pressure (128/61 to 113/54mmHg), brachial pulse wave velocity (7.9 to 5.8m/s), and measures of wave reflection all improved. Indexed cardiac output was reduced (2.5 to 1.8L/m2) primarily due to a reduction in resting heart rate (71 to 44bpm), and despite an increase in ejection faction (57.9 to 63.9%). Assessment of HRV found a shift in the ratio of low to high frequency (209.2 to 30.9%). Absolute VO2 was minimally reduced despite weight loss resulting in an increase in relative VO2 (41.9 to 47.7ml/Kg). In general, this prolonged contest preparation technique helped the athlete to improve body composition and resulted in positive CV changes, suggesting that this method of contest preparation appears to be effective in natural male bodybuilders.

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The Effectiveness of Daily and Alternate Day Oral Iron Supplementation in Athletes With Suboptimal Iron Status (Part 2)

Rachel McCormick, Alex Dreyer, Brian Dawson, Marc Sim, Leanne Lester, Carmel Goodman, and Peter Peeling

. All Hb mass measurements were conducted by the same technician. Training load, dietary, and menstrual monitoring Participants were required to document their daily exercise, necessitating duration (in minutes), distance (in kilometers), and a rating of perceived exertion ( Borg, 1982 ) with anchors 6