UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research.

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Hyperbaric oxygen therapy is well tolerated and effective for ulcerative colitis patients hospitalized for moderate-severe flares: a phase 2A pilot multi-center, randomized, double-blind, sham-controlled trial.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) markedly increases tissue oxygen delivery. Case series suggest it may have a potential therapeutic benefit in ulcerative colitis (UC). We investigated the therapeutic potential of HBOT as an adjunct to steroids for UC flares requiring hospitalization. METHODS: The study was terminated early due to poor recruitment with 18 of the planned 70 patients enrolled. UC patients hospitalized for moderate-severe flares (Mayo score ≥6, endoscopic sub-score ≥2) were block randomized to steroids + daily HBOT (n = 10) or steroids + daily sham hyperbaric air (n = 8). Patients were blinded to study assignment, and assessments were performed by a blinded gastroenterologist. Primary outcome was the clinical remission rate at study day 5 (partial Mayo score ≤2 with no sub-score >1). Key secondary outcomes were: clinical response (reduction in partial Mayo score ≥2, rectal bleeding sub-score of 0-1) and progression to second-line therapy (colectomy or biologic therapy) during the hospitalization. RESULTS: A significantly higher proportion of HBOT-treated patients achieved clinical remission at study day 5 and 10 (50 vs. 0%, p = 0.04). HBOT-treated patients less often required progression to second-line therapy during the hospitalization (10 vs. 63%, p = 0.04). The proportion requiring in-hospital colectomy specifically as second-line therapy for medically refractory UC was lower in the HBOT group compared to sham (0 vs. 38%, p = 0.07). There were no serious adverse events. CONCLUSION: In this small, proof-of-concept, phase 2A trial, the use of HBOT as an adjunctive therapy to steroids for UC patients hospitalized for moderate-severe flares resulted in higher rates of clinical remission, and a reduction in rates of progression to second-line therapy during the hospitalization. Larger well-powered trials are needed, however, to provided definitive evidence of therapeutic benefit.

Impact of the Alexander technique on well-being: a randomised controlled trial involving older adults with visual impairment.

BACKGROUND: Older adults with visual loss have high rates of depression, restricted participation and reduced quality of life. We sought to measure the impact of lessons in the Alexander technique on vision-related emotional and social well-being, as secondary outcomes to a study on improving physical functioning in this population. METHODS: This is a single-blind randomised controlled trial. One hundred and twenty community-dwelling adults aged 50 to 90 years with visual impairments were randomised to either 12 Alexander lessons over 12 weeks and usual care or usual care. The Perceived Visual Ability Scale, the Keele Assessment of Participation, the emotional subscale of the Impact of Vision Impairment Profile, the Positive and Negative Affect Scale and the five-item Geriatric Depression Scale were administered at baseline and three and 12 months. Participants were receiving services from Guide Dogs NSW/ACT. RESULTS: None of the validated questionnaires found statistically significant improvements after adjustment for baseline at three or 12 months, although the emotional subscale of the Impact of Vision Impairment approached significance in favour of the intervention group (4.54 points, 95 per cent CI: -0.14 to 9.21, p = 0.06). Depressive symptoms were prevalent and associated with greater impact of visual impairment on emotional well-being (odds ratio: 1.12, 95 per cent CI: 1.07 to 1.17, p < 0.0001). Faster gait, an indicator of general mobility, was associated with less depressive symptoms (odds ratio: 1.27, 95 per cent CI: 1.06 to 1.54, p = 0.01). CONCLUSION: On average, there was no significant impact of weekly lessons in the Alexander technique on social and emotional well-being, although the emotional impact of visual impairment showed a trend toward less distress in the intervention group. Our data found that emotional distress associated with visual impairment influences depressive symptoms but contrary to expectations, the level of social support received was not significant. Additionally, gait speed is a significant predictor of depressive symptoms, suggesting that general mobility is of importance to the well-being of older adults with visual impairments.

Is there an optimal vitamin D status for immunity in athletes and military personnel?

Vitamin D is mainly obtained through sunlight ultraviolet-B (UVB) exposure of the skin, with a small amount typically coming from the diet.It is now clear that vitamin D has important roles beyond its well-known effects on calcium and bone homeostasis. Immune cells express the vitamin D receptor, including antigen presenting cells, T cells and B cells, and these cells are all capable of synthesizing the biologically active vitamin D metabolite, 1, 25 hydroxy vitamin D.There has been growing interest in the benefits of supplementing vitamin D as studies report vitamin D insufficiency (circulating 25(OH)D < 50 nmol/L) in more than half of all athletes and military personnel tested during the winter, when skin sunlight UVB is negligible. The overwhelming evidence supports avoiding vitamin D deficiency (25(OH)D< 30 nmol/L)to maintain immunity and prevent upper respiratory illness (URI) in athletes and military personnel.Recent evidence supports an optimal circulating 25(OH)D of 75 nmol/L to prevent URI and enhance innate immunity and mucosal immunity and bring about anti-inflammatory actions through the induction of regulatory T cells and the inhibition of pro-inflammatory cytokine production. We provide practical recommendations for how vitamin D sufficiency can be achieved in most individuals by safe sunlight exposure in the summer and daily 1, 000 IU vitamin D3 supplementation in the winter. Studies are required in athletes and military personnel to determine the impact of these recommendations on immunity and URI; and,to demonstrate the purported benefit of achieving 25(OH)D>75 nmol/L.

Impact of intensified training and carbohydrate supplementation on immunity and markers of overreaching in highly trained cyclists.

PURPOSE: To determine effects of intensified training (IT) and carbohydrate supplementation on overreaching and immunity. METHODS: In a randomized, double-blind, crossover design, 13 male cyclists (age 25 ± 6 years, VO2max 72 ± 5 ml/kg/min) completed two 8-day periods of IT. On one occasion, participants ingested 2 % carbohydrate (L-CHO) beverages before, during and after training sessions. On the second occasion, 6 % carbohydrate (H-CHO) solutions were ingested before, during and after training, with the addition of 20 g of protein in the post-exercise beverage. Blood samples were collected before and immediately after incremental exercise to fatigue on days 1 and 9. RESULTS: In both trials, IT resulted in decreased peak power (375 ± 37 vs. 391 ± 37 W, P < 0.001), maximal heart rate (179 ± 8 vs. 190 ± 10 bpm, P < 0.001) and haematocrit (39 ± 2 vs. 42 ± 2 %, P < 0.001), and increased plasma volume (P < 0.001). Resting plasma cortisol increased while plasma ACTH decreased following IT (P < 0.05), with no between-trial differences. Following IT, antigen-stimulated whole blood culture production of IL-1α was higher in L-CHO than H-CHO (0.70 (95 % CI 0.52-0.95) pg/ml versus 0.33 (0.24-0.45) pg/ml, P < 0.01), as was production of IL-1ß (9.3 (95 % CI 7-10.4) pg/ml versus 6.0 (5.0-7.8) pg/ml, P < 0.05). Circulating total leukocytes (P < 0.05) and neutrophils (P < 0.01) at rest increased following IT, as did neutrophil:lymphocyte ratio and percentage CD4+ lymphocytes (P < 0.05), with no between-trial differences. CONCLUSION: IT resulted in symptoms consistent with overreaching, although immunological changes were modest. Higher carbohydrate intake was not able to alleviate physiological/immunological disturbances.

The effect of 14 weeks of vitamin D3 supplementation on antimicrobial peptides and proteins in athletes.

Heavy training is associated with increased respiratory infection risk and antimicrobial proteins are important in defence against oral and respiratory tract infections. We examined the effect of 14 weeks of vitamin D3 supplementation (5000 IU/day) on the resting plasma cathelicidin concentration and the salivary secretion rates of secretory immunoglobulin A (SIgA), cathelicidin, lactoferrin and lysozyme in athletes during a winter training period. Blood and saliva were obtained at the start of the study from 39 healthy men who were randomly allocated to vitamin D3 supplement or placebo. Blood samples were also collected at the end of the study; saliva samples were collected after 7 and 14 weeks. Plasma total 25(OH)D concentration increased by 130% in the vitamin D3 group and decreased by 43% in the placebo group (both P = 0.001). The percentage change of plasma cathelicidin concentration in the vitamin D3 group was higher than in the placebo group (P = 0.025). Only in the vitamin D3 group, the saliva SIgA and cathelicidin secretion rates increased over time (both P = 0.03). A daily 5000 IU vitamin D3 supplement has a beneficial effect in up-regulating the expression of SIgA and cathelicidin in athletes during a winter training period, which could improve resistance to respiratory infections.

Salivary hormones and anxiety in winners and losers of an international judo competition.

The purpose of this study was to investigate the responses of salivary hormones and salivary secretory immunoglobulin A (SIgA) and anxiety in winners and losers during an international judo competition. Twenty-three trained, male, national-level judo athletes provided three saliva samples during a competition day: morning, in anticipation of competition after an overnight fast, mid-competition, and post-competition within 15 min post-fight for determination of salivary cortisol, salivary testosterone, salivary testosterone/cortisol ratio, SIgA absolute concentrations, SIgA secretion rate and saliva flow rate. The competitive state anxiety inventory questionnaire was completed by the athletes (n = 12) after the first saliva collection for determination of somatic anxiety, cognitive anxiety and self-confidence. Winners were considered 1-3 ranking place (n = 12) and losers (n = 11) below third place in each weight category. Winners presented higher anticipatory salivary cortisol concentrations (p = 0.03) and a lower mid-competition salivary testosterone/cortisol ratio (p = 0.003) compared with losers with no differences for salivary testosterone. Winners tended to have higher SIgA secretion rates (p = 0.07) and higher saliva flow rates (p = 0.009) at mid-competition. Higher levels of cognitive anxiety (p = 0.02) were observed in the winners, without differences according to the outcome in somatic anxiety and self-confidence. The results suggest that winners experienced higher levels of physiological arousal and better psychological preparedness in the morning, and as the competition progressed, the winners were able to control their stress response better.

Immunological aspects of sport nutrition.

Prolonged bouts of exercise and heavy training regimens are associated with depression of immune system functions that can increase the risk of picking up opportunistic infections such as the common cold and influenza. Some common sport nutrition practices including high-carbohydrate diets and carbohydrate ingestion during exercise, training with low-glycogen stores, intentional dieting for weight loss, ingestion of high-dose antioxidant supplements and protein ingestion post exercise may influence immune system status in athletes. In order to maintain robust immunity, athletes need to consume a well-balanced diet that is sufficient to meet their requirements for energy, carbohydrate, protein and micronutrients. Dietary deficiencies of protein and specific micronutrients are well known to be potential causes of immune dysfunction and an adequate intake of some essential minerals including iron and zinc and the vitamins A, D, E, B6 and B12 are important to maintain a healthy immune function. Vitamin D may be a particular concern as recent studies have emphasised its importance in limiting infection episode incidence and duration in both the general population and in athletes and many individuals exhibit inadequate vitamin D status during the winter months. There is only limited evidence that individual amino acids, ß-glucans, herbal extracts and zinc are capable of boosting immunity or reducing infection risk in athletes. The ingestion of carbohydrate during exercise and daily consumption of probiotics, vitamin D3, bovine colostrum and plant polyphenol containing supplements or foodstuffs currently offer the best chance of success, particularly for those individuals who are prone to illness.

Effects of acute postexercise chocolate milk consumption during intensive judo training on the recovery of salivary hormones, salivary SIgA, mood state, muscle soreness, and judo-related performance.

This study examined the effects of postexercise chocolate milk (CM) or water (W) consumption during 5 days of intensive judo training with concomitant weight loss on salivary cortisol and testosterone, salivary secretory immunoglobulin A (SIgA), delayed-onset muscle soreness (DOMS), and judo-related performance. Twelve trained male judo athletes engaged in 5 days of intensive judo training followed by a simulated judo competition, on 2 separate training weeks 14 days apart. The athletes consumed 1000 mL of W (week 1) or CM (week 2) immediately post-training. During both weeks, athletes were instructed to "make weight" for the upcoming competition. Performance in timed push-ups and the Special Judo Fitness Test improved by 14.6% and 6.8%, respectively, at the end of the training week with CM consumption (both p < 0.001). Decreased salivary cortisol (p < 0.01) and a trend for an increased salivary testosterone/cortisol ratio (p = 0.07) were also observed midweek in the CM condition. Saliva flow rate was higher during the week with CM intake compared with W intake (p < 0.001). DOMS (p < 0.001) and mood disturbance (p < 0.0001) increased after the first day of training in the W condition but not in the CM condition. Salivary testosterone and SIgA responses were similar between treatments (p > 0.05). Body mass decreased by 1.9% in the W condition and by 1.1% in the CM condition, with no significant difference between treatments. This study indicates that postexercise CM consumption during short-term intensive judo training enhances aspects of recovery without affecting intentional weight loss.

The impact of intensified training with a high or moderate carbohydrate feeding strategy on resting and exercise-induced oxidative stress.

PURPOSE: This study investigated the impact of intensified training (IT) and carbohydrate (CHO) supplementation on resting and exercise-induced oxidative stress. METHODS: Male cyclists (n = 13, mean ± SD: age 25 ± 6 years; [Formula: see text] 72 ± 5 ml/kg/min) undertook two 9 day periods of endurance-based IT. In a counter-balanced, crossover and double-blinded study design, participants completed IT whilst ingesting high (H-CHO) or moderate (M-CHO) CHO beverages before (H-CHO: 24 g vs. M-CHO: 2 g), during (H-CHO: 60 g/h vs. M-CHO: 20 g/h) and after training sessions (H-CHO: 44 g vs. M-CHO: 10 g). Participants completed fasted performance trials without CHO on days 2, 6 and 10. Blood samples were taken before and immediately after exercise to assess plasma oxidative stress. RESULTS: Resting thiol (-SH) and catalase (CAT) activities decreased following 6 days of IT, independent of CHO condition [-SH (µM oxidised NADPH): H-CHO-14.0 ± 18.8, M-CHO-20.4 ± 20.3 and CAT (nmol/min/ml): H-CHO 12.5 ± 12.5, M-CHO 6.0 ± 4.5; all p < 0.05]. Resting total antioxidant capacity (TAC) was reduced after IT in M-CHO. All exercise bouts elicited significant increases in CAT, TAC, protein carbonylation (PC) and lipid hydroperoxides (LOOH), independent of CHO condition (p < 0.05). The magnitude of increase in PC and LOOH was greater on days 6 and 10 compared to day 2 in both conditions. CONCLUSIONS: Short-term IT caused reductions in resting antioxidant capacity in trained cyclists. Exercise-induced increases in PC and LOOH were exaggerated as a result of IT; however, these responses were independent of carbohydrate intake before, during and after the preceding IT sessions.

Can the Alexander Technique improve balance and mobility in older adults with visual impairments? A randomized controlled trial.

OBJECTIVE: To investigate the impact of Alexander Technique lessons on balance and mobility in older adults with visual impairments. DESIGN: Randomized assessor blinded controlled trial with intervention and usual care control groups. SETTING: Participants' homes. SUBJECTS: A total of 120 community-dwellers aged 50+ with visual impairments. INTERVENTION: Twelve weeks of Alexander lessons and usual care. MAIN OUTCOME MEASURES: Short Physical Performance Battery items were primary outcomes at 3 months and secondary outcomes at 12 months. Additional secondary outcomes were postural sway, maximal balance range and falls over 12 months. RESULTS: Between-group differences in primary outcomes were not significant. The intervention group reduced postural sway on a firm surface with eyes open at 3 months after adjusting for baseline values (-29.59 mm, 95%CI -49.52 to -9.67, P < 0.01). Planned sub-group analyses indicated a greater intervention effect among past multiple-fallers (2+) than non-multiple fallers for gait speed (P = 0.02) and step length (P < 0.01) at 3 months and chair stand at 12 months (P < 0.01). There was a non-significant reduction in falls rate (IRR = 0.64, 95%CI 0.34 to 1.15, P = 0.13) and injurious falls (IRR = 0.61, 95% CI 0.28 to 1.30, P = 0.20) in the intervention group compared to the control group. CONCLUSION: The intervention did not have a significant impact on the primary outcomes but benefits for the intervention group in postural sway, trends towards fewer falls and injurious falls and improved mobility among past multiple-fallers suggest further investigation of the Alexander Technique is warranted.

Exercise and physical training improve physical function in older adults with visual impairments but their effect on falls is unclear: a systematic review.

QUESTION: Can exercise or physical training improve physical function and prevent falls in older adults with visual impairments? DESIGN: Systematic review of randomised controlled trials with meta-analysis. PARTICIPANTS: Older adults (≥ 60 years) with visual impairments. INTERVENTION: Individual or group exercise or physical training classes in any settings. OUTCOME MEASURES: Mobility, balance, strength and proprioception measured with performance tests or questionnaires and/or falls with calendars or incident reports. RESULTS: Four eligible trials with a total of 522 participants were identified. Multimodal group exercise (n = 50 and 41) and Tai Chi (n=40) improved physical function among residents of care settings. Meta-analysis of data from two trials indicated a significant positive impact of multimodal exercise on the Berg Balance Score (weighted mean difference 3.9 points, 95% CI 1.8 to 6.0), but not on the Timed Up and Go test (weighted mean difference 1.5seconds, 95% CI -1.7 to 4.6). One trial (n=41) found that multimodal exercise reduced the time to first fall (p=0.049). A factorial trial (n=391) among community dwellers did not find a significant effect on falls from a home-based exercise intervention, although clinically relevant effects in either direction were not excluded by the study (incidence rate ratio=1.15, 95% CI 0.82 to 1.61). CONCLUSION: Exercise interventions in residential care settings improve performance on some tests of physical function that are risk factors for falls but the impact on falls is not yet clear. The impact of exercise and training on physical function and falls in community-dwelling older adults with visual impairments also warrants further investigation.

Improving balance and mobility in people over 50 years of age with vision impairments: can the Alexander Technique help? A study protocol for the VISIBILITY randomised controlled trial.

BACKGROUND: Falls are an increasingly important and costly public health problem. Vision is key to postural stability as we age and this puts adults with visual impairments at greater risk of falls. Physical interventions improve balance in the general population and in older adults with visual impairments in residential care. They also prevent falls in the general community but to date have not been shown effective in community-dwelling adults with visual impairments. OBJECTIVE: To investigate, with a randomised controlled trial, whether the Alexander Technique (AT) can improve balance and mobility in the community-dwelling population with visual impairments and thus reduce the risk of falls. The AT is a form of physical re-education that has recently received attention for its possible value in rehabilitation. METHOD AND DESIGN: One hundred and twenty people with visual impairments over 50 years of age will be recruited from Guide Dogs New South Wales/Australian Capital Territory (NSW/ACT). Participants will be independently mobile and cognitively able to take part in the programme. After baseline assessment participants will be randomly assigned to two groups. The control group will receive usual care from Guide Dogs NSW/ACT, and the intervention group will receive 12 weekly home-based lessons in the AT in addition to usual care. The primary outcome measures will be physical measures from the short physical performance battery at 3 months. Secondary outcome measures will be balance, mobility, social participation and emotional well-being at 3 and 12 months. TRIAL REGISTRATION NUMBER: The protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000634077).

Intense exercise training and immune function.

Regular moderate exercise reduces the risk of infection compared with a sedentary lifestyle, but very prolonged bouts of exercise and periods of intensified training are associated with increased infection risk. In athletes, a common observation is that symptoms of respiratory infection cluster around competitions, and even minor illnesses such as colds can impair exercise performance. There are several behavioral, nutritional and training strategies that can be adopted to limit exercise-induced immunodepression and minimize the risk of infection. Athletes and support staff can avoid transmitting infections by avoiding close contact with those showing symptoms of infection, by practicing good hand, oral and food hygiene and by avoiding sharing drinks bottles and cutlery. Medical staff should consider appropriate immunization for their athletes particularly when travelling to international competitions. The impact of intensive training stress on immune function can be minimized by getting adequate sleep, minimizing psychological stress, avoiding periods of dietary energy restriction, consuming a well-balanced diet that meets energy and protein needs, avoiding deficiencies of micronutrients (particularly iron, zinc, and vitamins A, D, E, B6 and B12), ingesting carbohydrate during prolonged training sessions, and consuming - on a daily basis - plant polyphenol containing supplements or foodstuffs and Lactobacillus probiotics.

Nutritional support to maintain proper immune status during intense training.

Prolonged exercise and heavy training are associated with depressed immune function which can increase the risk of picking up minor infections. To maintain robust immunity, athletes should eat a well-balanced diet sufficient to meet their energy, carbohydrate, protein, and micronutrient requirements. Dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction and an adequate intake of iron, zinc, and vitamins A, D, E, B6 and B12 is particularly important in the maintenance of immune function. Consuming carbohydrate during prolonged strenuous exercise attenuates rises in stress hormones and appears to limit the degree of exercise-induced immune depression. Similar effects can be seen with daily ingestion of high-dose antioxidant vitamin supplements, though concerns have been expressed that excessive antioxidant intake may impair exercise training adaptations. It is safe to say with reasonable confidence that individual amino acids, colostrum, Echinacea, and zinc are unlikely to boost immunity or reduce infection risk in athletes. The ingestion of carbohydrate during exercise and daily consumption of probiotic and plant polyphenol (e.g. quercetin)-containing supplements or foodstuffs (e.g. non-alcoholic beer) currently offer the best chance of success. This approach is likely to be most effective for individuals who are particularly prone to illness.

Salivary hormones, IgA, and performance during intense training and tapering in judo athletes.

The aims of this study were to identify the time course of change of salivary testosterone (sT), cortisol (sC), and IgA (SIgA); mood state; and performance capacity during a 2-week taper in judo athletes and to examine the diurnal variation in these salivary markers. Eleven male judo athletes completed 5 weeks of training: 1 week of normal training (NORM), 2 weeks of intensified training (INT), and 2 weeks of exponential tapering (TAPER). Once per week subjects completed vertical and horizontal countermovement jump tests, a grip strength test, a Special Judo Fitness Test, a multistage aerobic fitness test, a 3 × 300-m run test, and anthropometric measurement. Subjects also completed questionnaires to assess mood state and muscle soreness. Two daily saliva samples (at 0700 and 1900) were collected at the end of each week during NORM and INT and every day during TAPER. Increased morning sT, decreased evening sC, lower muscle soreness, and enhanced mood state (p < 0.05) were evident by the early phases of TAPER. A significant 7.0% improvement in 3 × 300-m performance time, a 6.9% improvement in the vertical jump (p < 0.05), and increased morning and evening SIgA secretion rate (p < 0.01) were observed during the middle-late phases of TAPER. The higher values of salivary variables were observed in the morning. This study indicates that salivary hormones display diurnal variation. Furthermore, changes in hormonal responses, mood state, and muscle soreness precede enhancements in performance and mucosal immunity, suggesting that judo athletes taper for at least a week before competition.

Effects of a Lactobacillus salivarius probiotic intervention on infection, cold symptom duration and severity, and mucosal immunity in endurance athletes.

The purpose of this study was to examine the effects of a probiotic supplement during 4 mo of spring training in men and women engaged in endurance-based physical activities on incidence of upper respiratory tract infections (URTI) and mucosal immune markers. Sixty-six highly active individuals were randomized to probiotic (n = 33) or placebo (n = 33) groups and, under double-blind procedures, received probiotic (PRO: Lactobacillus salivarius, 2 × 1010 bacterium colony-forming units) or placebo (PLA) daily for 16 wk. Resting blood and saliva samples were collected at baseline and after 8 and 16 wk. Weekly training and illness logs were kept. Fifty-four subjects completed the study (n = 27 PRO, n = 27 PLA). The proportion of subjects on PRO who experienced 1 or more wk with URTI symptoms was not different from that of those on PLA (PRO .58, PLA .59; p = .947). The number of URTI episodes was similar in the 2 groups (PRO 1.6 ± 0.3, PLA 1.4 ± 0.3; p = .710). Severity and duration of symptoms were not significantly different between treatments. Blood leukocyte, neutrophil, monocyte, and lymphocyte counts; saliva IgA; and lysozyme concentrations did not change over the course of the study and were not different on PRO compared with PLA. Regular ingestion of L. salivarius does not appear to be beneficial in reducing the frequency of URTI in an athletic cohort and does not affect blood leukocyte counts or levels of salivary antimicrobial proteins during a spring period of training and competition.

Fatigue management in the preparation of Olympic athletes.

Fatigue is often a consequence of physical training and the effective management of fatigue by the coach and athlete is essential in optimizing adaptation and performance. In this paper, we explore a range of practical and contemporary methods of fatigue management for Olympic athletes. We assesses the scientific merit of methods for monitoring fatigue, including self-assessment of training load, self-scored questionnaires, and the usefulness of saliva and blood diagnostic markers for indicating fatigued and under-recovered athletes, effective nutrition and hydration strategies for optimizing recovery and short-term recovery methods. We conclude that well-accepted methods such as sufficient nutrition, hydration, and rest appear to be the most effective strategies for optimizing recovery in Olympic athletes.

Integrated media presentation in multidisciplinary head and neck oncology meetings.

Multidisciplinary meetings (MDMs) are an essential part of the management of head and neck cancer. Practice care guidance set up by the British Association of Head and Neck Oncologists has recommended that MDMs should have appropriate projection equipment for computer-generated images so that all members of group have access to the same information. The aim of this paper is to review our experience with the integrated visual presentation of head and neck oncology patients and to demonstrate its advantages over conventional approaches. Digital photographs are taken of patients and of their index tumour at presentation or at the time of diagnostic endoscopy. All relevant pre-treatment digitised images from tumour sites and radiological images and histological slides are incorporated into a single presentation using Microsoft PowerPoint software. During the past 2 years, on-line radiological scans have also become accessible for the meeting to aid treatment planning. Subsequently, all peri-operative pictures and post-surgical macroscopic and microscopic histopathological images are added to each patient's presentation, which is then hyperlinked into the agenda. The Guy's and St Thomas' Head and Neck Cancer Centre treats over 400 patients a year, and since 2002, all new cancer diagnoses have been discussed in the weekly MDM as described above. A total of 1,638 presentations have been incorporated in a centralized database that is updated in the event of recurrence, further primary tumours or other clinical developments. Satisfactory documentation and staging of head and neck tumours must include a verbal description, accurate measurement, diagrammatic representation, photographic recording and appropriate radiological imaging. Integrated presentation at MDM collates all relevant findings for clinical management decisions on patients with head and neck cancer. This approach is also an extremely valuable adjunct to long-term clinical monitoring.

Dosing and efficacy of glutamine supplementation in human exercise and sport training.

Some athletes can have high intakes of l-glutamine because of their high energy and protein intakes and also because they consume protein supplements, protein hydrolysates, and free amino acids. Prolonged exercise and periods of heavy training are associated with a decrease in the plasma glutamine concentration and this has been suggested to be a potential cause of the exercise-induced immune impairment and increased susceptibility to infection in athletes. However, several recent glutamine feeding intervention studies indicate that although the plasma glutamine concentration can be kept constant during and after prolonged strenuous exercise, the glutamine supplementation does not prevent the postexercise changes in several aspects of immune function. Although glutamine is essential for lymphocyte proliferation, the plasma glutamine concentration does not fall sufficiently low after exercise to compromise the rate of proliferation. Acute intakes of glutamine of approximately 20-30 g seem to be without ill effect in healthy adult humans and no harm was reported in 1 study in which athletes consumed 28 g glutamine every day for 14 d. Doses of up to 0.65 g/kg body mass of glutamine (in solution or as a suspension) have been reported to be tolerated by patients and did not result in abnormal plasma ammonia levels. However, the suggested reasons for taking glutamine supplements (support for immune system, increased glycogen synthesis, anticatabolic effect) have received little support from well-controlled scientific studies in healthy, well-nourished humans.