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For centuries, the general consensus has been that vigorous, competitive exercise was harmful and shortened life expectancy. Recent data from prospective cohort studies conducted on marathon runners, professional cyclists, and Olympic athletes indicate, however, that regular intense endurance-exercise training has protective benefits against cardiovascular disease and premature death. There are still important questions to be answered, such as what is the optimal dose, in terms of both duration and intensity of training or competition, beyond which the health benefits of regular exercise stabilize or might even potentially disappear.

From its initial inception in 1903 as a race premised on a publicity stunt to sell newspapers, the Tour de France had grown and evolved over time to become one of the most difficult and heralded sporting events in the world. Though sporting science and the Tour paralleled each other, it was not until the midlate 1980s, and especially the midlate 1990s (with the use of heart-rate monitors) that the 2 began to unify and grow together. The purpose of this brief review is to summarize what is currently known of the physiological demands of the Tour de France, as well as of the main physiological profile of Tour de France competitors.

Recent research has analyzed the genetic factors that influence world-class athletic status. Much of what we know comes from association studies, with the ACE I/D and ACTN3 R577X polymorphisms having been extensively studied. The association between the ACTN3 R577X variation and elite athlete status in power sports is strongly documented, yet whether the current body of knowledge on other variants can be extrapolated to athletic champion status remains to be determined. Athletic champion status is a complex polygenic trait in which numerous candidate genes, complex gene–gene interactions, and environment–gene interactions are involved. Besides the need for more studies and new approaches taking into account the complexity of the problem, we believe that factors beyond genetic endowment are likely to have a stronger influence in the attainment of athletic champion status.

Purpose: To determine the acute effects of ketone supplementation on exercise performance (primary outcome) and physiological and perceptual responses to exercise (secondary outcomes). Methods: A systematic search was conducted in PubMed, Web of Science, and SPORTDiscus (since inception to July 21, 2019) to find randomized controlled trials assessing the effects of acute ketone supplementation compared with a drink containing no ketones (ie, control intervention). The standardized mean difference (Hedges g) between interventions and 95% confidence interval (CI) were computed using a random-effects model. Results: Thirteen studies met all inclusion criteria. No significant differences were observed between interventions for overall exercise performance (Hedges g = −0.05; 95% CI, −0.30 to 0.20; P = .68). Subanalyses revealed no differences between interventions when analyzing endurance time-trial performance (g = −0.04; 95% CI, −0.35 to 0.28; P = .82) or when assessing the separate effects of supplements containing ketone esters (g = −0.07; 95% CI, −0.38 to 0.24; P = .66) or salts (g = −0.02; 95% CI, −0.45 to 0.41; P = .93). All studies reported increases in plasma ketone concentration after acute ketone supplementation, but no consistent effects were reported on the metabolic (plasma lactate and glucose levels), respiratory (respiratory exchange ratio, oxygen uptake, and ventilatory rate), cardiovascular (heart rate), or perceptual responses to exercise (rating of perceived exertion). Conclusions: The present findings suggest that ketone supplementation exerts no clear influence on exercise performance (from sprints to events lasting up to ∼50 min) or metabolic, respiratory, cardiovascular, or perceptual responses to exercise. More research is needed to elucidate if this strategy could provide ergogenic effects on other exercise types (eg, ultraendurance exercise).

Purpose: To analyze the relationship between functional threshold power (FTP) and the lactate threshold (LT). Methods: A total of 20 male cyclists performed an incremental test in which LT was determined. At least 48 h later, they performed a 20-min time trial, and 95% of the mean power output was defined as FTP. Participants were divided into recreational (peak power output < 4.5 W·kg⁻¹; n = 11) or trained cyclists (peak power output > 4.5 W·kg⁻¹; n = 9) according to their fitness status. Results: The FTP (240 [35] W) was overall not significantly different (effect size = 0.20; limits of agreement = −2.4% [11.5%]) from the LT (246 [24] W), and both markers were strongly correlated (r = .95; P < .0001). Accounting for the participants’ fitness status, no significant differences were found between FTP and LT (effect size = 0.22; limits of agreement =2.1% [7.8%]) in trained cyclists, but FTP was significantly lower than the LT (P = .0004, effect size = 0.81; limits of agreement =−6.5% [8.3%]) in recreational cyclists. A significant relationship was found between relative peak power output and the bias between FTP and the LT markers (r = .77; P < .0001). Conclusions: FTP is a valid field test-based marker for the assessment of endurance fitness. However, caution should be taken when using FTP interchangeably with LT, as the bias between markers seems to depend on the athlete’s fitness status. Whereas FTP provides a good estimate of LT in trained cyclists, in recreational cyclists, it may underestimate LT.

Purpose: To characterize, for the first time, the mechanical properties of treadmill surfaces along with a practical interpretation of their influence on physiological and perceived demands during endurance running compared with other widely used surfaces such as asphalt and tartan tracks. Methods: Ten experienced male endurance runners performed a 40-minute running bout at a preferred constant speed on 3 different surfaces (after a randomized, counterbalanced order with a 7-d interval between trials): asphalt, tartan, or treadmill. Shock absorption, vertical deformation, and energy restitution were measured for the 3 surfaces. Intensity (based on heart rate data) and rating of perceived exertion were monitored. Results: The values of shock absorption averaged 0.0% (asphalt), 37.4% (tartan), and 71.3% (treadmill), while those of vertical deformation and energy restitution averaged 0.3, 2.2, and 6.5 mm and 90.8%, 62.6%, and 37.0%, respectively. Running intensity (as determined by heart rate data) was higher overall on the treadmill than tartan but not asphalt running. Except for the first 10 minutes, all mean rating of perceived exertion values were significantly higher in asphalt and treadmill than in tartan. No significant differences were identified between treadmill and asphalt. Conclusions: The considerably higher shock absorption of the treadmill than the tartan surface leads to a reduction in the amount of energy returned to the athlete, which in turn increases physiological stress and rating of perceived exertion during endurance running.

Purpose: To compare the physical demands and performance indicators of male professional cyclists of 2 different categories (Union Cycliste Internationale WorldTour [WT] and ProTeam [PT]) during a cycling grand tour. Methods : A WT team (n = 8, 31.4 [5.4] y) and a PT team (n = 7, 26.9 [3.3] y) that completed “La Vuelta 2020” volunteered to participate. Participants’ power output (PO) was registered, and measures of physical demand and physiological performance (kilojoules spent, training stress score, time spent at different PO bands/zones, and mean maximal PO [MMP] for different exertion durations) were computed. Results: WT achieved a higher final individual position than PT (31 [interquartile range = 33] vs 71 [59], P = .004). WT cyclists showed higher mean PO and kilojoule values than their PT peers and spent more time at high-intensity PO values (>5.25 W·kg⁻¹) and zones (91%–120% of individualized functional threshold power) (Ps < .05). Although no differences were found for MMP values in the overall analysis (P > .05), subanalyses revealed that the between-groups gap increased through the race, with WT cyclists reaching higher MMP values for ≥5-minute efforts in the second and third weeks (Ps < .05). Conclusions: Despite the multifactorial nature of cycling performance, WT cyclists spend more time at high intensities and show higher kilojoules and mean PO than their PT referents during a grand tour. Although the highest MMP values attained during the whole race might not differentiate between WT and PT cyclists, the former achieve higher MMP values as the race progresses.

Purpose: Enhanced external counterpulsation (EECP) is a recovery strategy whose use has increased in recent years owing to the benefits observed in the clinical setting in some cardiovascular diseases (ie, improvement of cardiovascular function). However, its claimed effectiveness for the enhancement of exercise recovery has not been analyzed in athletes. The aim of this study was to determine the effectiveness of EECP on short-term recovery after a fatiguing exercise bout. Methods: Twelve elite junior triathletes (16 [2] y) participated in this crossover counterbalanced study. After a high-intensity interval training session (6 bouts of 3-min duration at maximal intensity interspersed with 3-min rest periods), participants were assigned to recover during 30 min with EECP (80 mm Hg) or sham (0 mm Hg). Measures of recovery included performance (jump height and mean power during an 8-min time trial), metabolic (blood lactate concentration at several time points), autonomic (heart-rate variability at several time points), and subjective (rating of perceived exertion [RPE] and readiness to compete) outcomes. Results: There were no differences between EECP and sham in mean RPE or power output during the high-intensity interval training session, which elicited a significant performance impairment, vagal withdrawal, and increased blood lactate and RPE in both EECP and sham conditions (all P < .05). No significant differences were found in performance, metabolic, or subjective outcomes between conditions at any time point. A significantly lower high-frequency power (P < .05, effect size = 1.06), a marker of parasympathetic activity, was observed with EECP at the end of the recovery phase. Conclusion: EECP did not enhance short-term recovery after a high-intensity interval training session in healthy, highly trained individuals.

Purpose: The authors investigated the association between risk of tendinopathies and genetic markers in professional team sports. Methods: The authors studied 363 (mean [SD]; 25 [6] y, 89% male) elite players (soccer, futsal, basketball, handball, and roller hockey) from a top-level European team (FC Barcelona, Spain). Of 363, 55% (cases) had experienced 1+ episodes of tendinopathy during 2008–2018 and 45% (controls) remained injury free. The authors first examined the association between single-nucleotide polymorphisms (SNPs) and tendinopathy risk in a hypothesis-free case-control genome-wide association study (495,837 SNPs) with additional target analysis of 58 SNPs that are potential candidates to influence tendinopathy risk based on the literature. Thereafter, the authors augmented the SNP set by performing synthetic variant imputation (1,419,369 SNPs) and then used machine learning-based multivariate modeling (support vector machine and random forest) to build a reliable predictive model. Results: Suggestive association (P < 10⁻⁵) was found for rs11154027 (gap junction alpha 1), rs4362400 (vesicle amine transport 1-like), and rs10263021 (contactin-associated protein-like 2). Carriage of 1+ variant alleles for rs11154027 (odds ratio = 2.11; 95% confidence interval, 1.07–4.19, P = 1.01 × 10⁻⁶) or rs4362400 (odds ratio = 1.98; 95% confidence interval, 1.05–3.73, P = 9.6 × 10⁻⁶) was associated with a higher risk of tendinopathy, whereas an opposite effect was found for rs10263021 (odds ratio = 0.42; 95% confidence interval, 0.20–0.91], P = 4.5 × 10⁻⁶). In the modeling approach, one of the most robust SNPs was rs10477683 in the fibrillin 2 gene encoding fibrillin 2, a component of connective tissue microfibrils involved in elastic fiber assembly. Conclusions : The authors have identified previously undescribed genetic predictors of tendinopathy in elite team sports athletes, notably rs11154027, rs4362400, and rs10263021.

Purpose: To determine the validity of field-derived mean maximum power (MMP) values for monitoring maximal cycling endurance performance. Methods: Twenty-seven male professional cyclists performed 3 timed trials (TTs) of 1-, 5-, and 20-minute duration that were used as the gold standard reference. Field-based power output data (3336 files; 124 [25] per cyclist) were registered during the preparatory (60 d pre-TT, including training data only) and specific period of the season (60 d post-TT, including both training and competitions). Comparisons were made between TT performance (mean power output) and MMP values obtained for efforts of the same duration as TT (MMP of 1-, 5-, and 20-min duration). The authors also compared TT- and MMP-derived values of critical power (CP) and anaerobic work capacity. Results: A large correlation (P < .001, r > .65) was found between MMP and TT performance regardless of the effort duration or season period. However, considerable differences (P < .05, standard error of measurement [SEM]  > 5%) were found between MMP and TT values for all effort durations in the preparatory period, as well as for the derived CP and anaerobic work capacity. Significant differences were also found between MMP and TT of 1 minute in the specific period, as well as for anaerobic work capacity, yet with no differences for MMP of 5- and 20-minute duration or the derived CP (P > .05, SEM < 5%). Conclusion: MMP values (for efforts ≥5 min) and the associated CP obtained from both training sessions and competitions can be considered overall accurate indicators of the cyclist’s maximal capabilities, but specific tests might be necessary for shorter efforts or when considering training sessions only.