Strategies to Promote Athlete Health.
Strategies to promote athlete health are multifactorial, and the importance of generating a well rounded approach across all factors listed below are imperative to optimise both the health and performance for the athlete.
Training & Competition Load Strategies
The physiological, metabolic and psychological stresses that are involved in training and competition may be associated to immune dysfunction, inflammation, oxidative stress and muscular damage. Physically demanding bouts of exercise has an immumnodepressive response to immune cells, lowering the resistance of pathogens, thus, increasing the risk of infection & illness to the athlete.
It is essential that athletes optimise the management of their training load, as excessive volumes and/or sudden drastic changes in their training frequency can increase the likelihood of illness. This increased susceptibility to illness will interfere with the athletes training consistency, impacting their training availability, consequently, directly affecting athletic performance via the accumulation of absent workouts.
You might be thinking.…Is this really going to impact my performance that much? Well, to put it lightly, you’re 2-3 times less likely to finish an endurance race with acute illness symptoms Burke et al., (2019). So, initiating preventive strategies to reduce the likelihood of illness is imperative to athletes if they’re looking to performance to their maximum capability.
A few practical strategies:
Creating detailed personalised training & competition plans, that promotes adequate recovery using sleep, nutrition, hydration and psychological strategies.
When increasing training loads, perform this increase in volume in small increments (typically <10% weekly).
Monitor early signs & symptoms of overreaching, overtraining and illness.
Avoid intensive training when ill or experiencing early symptoms.
Develop a competition calendar based on the athletes health.
Nutritional Strategies
Traveler’s Diarrhoea
One frequently reported illness among athletes who travel to various continents and countries around the world to compete and/or train is ‘Traveler’s Diarrhoea’. Traveler’s Diarrhoea can be defined as, 3 or more unformed bowl movements during a 24 hour period, associated with symptoms such as vomiting, abdominal pain, nausea, or fever (Castell et al., 2019). Pathogens vary from country to country, however, the most common cause is Escherichia Coli via contaminated water and food (Patel et al., 2018). An infectious episode may seriously impact the ability to train & compete maximally. Not the most pleasant of illnesses, as an athlete, you certainly don’t want to be constantly thinking about where the nearest portable toilet is.
Hence, it is important to create measures to prevent contamination from food and water, such as:
Drink sealed bottled water (from known brands you're familiar with, if possible).
Hot drinks made using boiled water.
Avoid high-risk foods (buffet meals, under-cooked meats, shell-fish, street vendors, salads washed unfiltered water)
Inspect the cleanliness of the kitchen (if possible) make an informed decision based on your intuition if you’re likely to encounter any food hygiene issues eating there.
Common symptoms associated with Traveler’s Diarrhoea.
Runners Diarrhoea
This gastrointestinal problem is fairly common, more so, in endurance and ultra-endurance athletes. Although the pathophysiology is still not fully understood, Runners Diarrhoea, is believed to be caused by ischemic, mechanical or nutritional factors (De Olivera, 2017).
During exercise blood flow is directed to the working muscles, this blood flow to the gut can be reduced by as much as ~80% , as a result, compromising gut function & causing Gastrointestinal (GI) distress. The repetitive high-impact, jarring movements of running can cause damage to the intestinal lining & increase the occurrences of lower GI symptoms. From a mechanical perspective, a cycling aerodynamic posture, where the athlete is hunched over the frame of their bike can cause increased pressure on the abdomen, causing greater occurrences of upper GI distress. Additionally, from a nutrition perspective, the GI distress symptoms could be caused and exacerbated by;
Dehydration.
Training in a fasted state.
NSAID’s (Non Steroidal Anti-Inflammatory Drugs) use.
Dehydration influences gut perfusion & impairs gastric emptying, it is crucial to start training Euhydrated (fully hydrated). Avoid NSAIDs (Non Steroidal Anti-Inflammatory Drugs) such as Ibuprofen is highly recommended as it aggravates exercise induced small intestine injury & induces gut barrier dysfunction.
Avoid poorly tolerated foods during the pre-exercise meal (i.e. high- fibre intakes, high concentrations of carbohydrates solutions, high-fat and high-protein foods) as these can exacerbate the onset of diarrhoea. A carbohydrate sports drink solution that contains ~6% - 8% is currently recommended to minimise the risk of Runners Diarrhoea (Jeukendrup, 2014).
Gut Training
The stomach and gut can possibly be trained to improve the tolerance, gastric emptying, and absorption during exercise (Jeukendrup, 2017). This ‘Gut Training’ can be achieved by experimenting with the particular brand and volume of drinks / sports foods / foods that will be consumed during the event. Increasing the amount gradually over time is a sensible approach to limit any GI distress to the athlete. Additionally, for endurance & ultra-endurance athletes such as Ironman competitors, it is worth investigating to see what particular brands of drinks / sports foods / foods will be available at the event for their race. Therefore, they can practice in training with these products to build up familiarisation of the products and also reduce any psychological concerns they may experience using an unfamiliar product for the first time on race-day (A Big NO, NO!!! Don’t experiment on race-day!!!).
Maintain Adequate Iron Status
Iron, is a significantly important in the diet for its major roles in oxygen transport, energy metabolism and immune function (Beard, 2001). Compromised iron stores and iron deficiencies are more prevalent among athletes compared to the general population, in particular female athletes, who have reported ~35% having an iron deficiency vs. ~5% in the general population. Regular exercise can increase the risk of an iron deficiency, due to the increased inflammatory response in the body post-exercise, decreasing the bodies ability to absorb iron for 3-6 hours (Peeling et al., 2008). This inflammatory response increases the hepcidin hormone levels, which decreases iron transport and absorption. Another potential loss of iron from exercise is via, sweating, gastrointestinal bleeding, and hemolysis (destruction of red blood cells).
The following sub-group of athletes are more vulnerable to iron deficiency:
Endurance athletes: Insufficient dietary intake of iron, potentially as a result of a Low Energy Availability & insufficient overall energy intake to meet the demands for their body).
Vegetarian & vegan athletes: Plant-based foods contain non-heme iron sources are absorbed less efficiently than heme [animal-based] iron sources) (Beard & Tolbin, 2000).
Female athletes: Blood loss via a heavy menstrual cycle. (Pedlar et al., 2018).
Adolescent athletes: Require greater iron requirements during this time period.
One of the the simplest ways to increase dietary intake of iron, is through the consumption of iron-rich foods, such as: red meat, leafy green vegetables, lentils, beans, nuts, seeds, and fortified cereal). Furthermore, the concurrent consumption of iron-rich foods, with Vitamin C can aid in increasing the bio-availability of iron (Castell et al., 2019).
Hygienic, Lifestyle and Behavioural Strategies
With the current COVID-19 pandemic around the world, this has increased the general populations, and athletes awareness to good hygiene practices. Some of the same preventable practices apply to athletes in order to reduce the risk of exposure to pathogens:
Avoid close contact with crowded people.
Avoid sharing or drinking/eating items.
Establish good hygiene practices.
Limit hand-to-face contact (i.e., self-inoculation).
Wash hands regularly and effectively.
Minimise pathogen spread to others (e.g., sneezing & coughing into crook of the elbow).
Promote regular high-quality sleep.
Avoid excessive alcohol consumption.
Psychological Load Management Strategies
Managing psychological stress and the factors that can increase and/or cause extraneous stress to the athlete are often times overlooked, and the significant importance it has on overall for athlete health. However, recently a greater interest in this area has started to become more prevalent not just with athletes, but also in the general population.
A couple of practical ways that manage psychological load:
As you can see strategies to promote athlete health is a multifactorial dynamic process and highlights the importance of generating a well rounded approach across all factors, in order to optimise the health and performance of the athlete.
Hopefully some of the strategies listed in the post above can be implemented practically to promote your own health or to any athletes that you work with.
References:
Burke, L., Castell, L., Casa, D., Close, G., Costa, R., Desbrow, B., Halson, S., Lis, D., Melin, A., Peeling, P., Saunders, P., Slater, G., Sygo, J., Witard, O., Bermon, S. and Stellingwerff, T. (2019) 'International Association of Athletics Federations Consensus Statement 2019: Nutrition for Athletics'. International Journal of Sport Nutrition and Exercise Metabolism, 29(2) pp.73-84. doi:10.1123/ijsnem.2019-0065
Castell, L., Nieman, D., Bermon, S. and Peeling, P. (2019) 'Exercise-Induced Illness and Inflammation: Can Immunonutrition and Iron Help?'. [online] International Journal of Sport Nutrition and Exercise Metabolism, 29(2) pp.181-188. [Accessed on 20 July 2020] https://journals.humankinetics.com/view/journals/ijsnem/29/2/article-p181.xml. doi:10.1007/BF00334429
de Oliveira, E. (2017) 'Runner's Diarrhea'. Current Opinion in Gastroenterology, 33(1) pp.41-46. doi: 10.1097/MOG.0000000000000322
Jeukendrup, A. (2014) 'A Step Towards Personalized Sports Nutrition: Carbohydrate Intake During Exercise'. Sports Medicine, 44(S1) pp.25-33. Doi: 10.1007/s40279-014-0148-z
Jeukendrup, A. (2017) 'Training the Gut for Athletes'. Sports Medicine, 47(S1) pp.101-110. Doi: 10.1007/s40279-017-0690-6
Beard, J. (2001) 'Iron Biology in Immune Function, Muscle Metabolism and Neuronal Functioning'. The Journal of Nutrition, 131(2) pp.568S-580S. Doi: 10.1093/jn/131.2.568S
Peeling, P., Dawson, B., Goodman, C., Landers, G. and Trinder, D. (2008) 'Athletic Induced Iron Deficiency: New Insights Into the Role of Inflammation, Cytokines and Hormones'. European Journal of Applied Physiology, 103(4) pp.381-391. Doi:10.1007/s00421-008-0726-6
Beard, J. and Tobin, B. (2000) 'Iron Status and Exercise'. The American Journal of Clinical Nutrition, 72(2) pp.594S-597S. Doi: 10.1093/ajcn/72.2.594S
Pedlar, C., Brugnara, C., Bruinvels, G. and Burden, R. (2017) 'Iron Balance and Iron Supplementation For the Female Athlete: A Practical Approach'. European Journal of Sport Science, 18(2) pp.295-305. Doi: 10.1080/17461391.2017.1416178