Altitude Training and Recombinant Human Erythropoietin: Considerations for Doping Detection.

The benefit of training at altitude to enhance exercise performance remains equivocal although the most widely accepted approach is one where the athletes live and perform lower-intensity running at approximately 2300 m with high-intensity training at approximately 1250 m. The idea is that this method maintains maximal augmentations in total hemoglobin mass while reducing the performance impairment of high-intensity sessions performed at moderate altitude and thus preventing any detraining that can occur when athletes live and train at moderate altitude. This training regimen, however, is not universally accepted and some argue that the performance enhancement is due to placebo and training camp effects. Altitude training may affect an athlete's hematological parameters in ways similar to those observed following blood doping. Current methods of detection appear insufficient to differentiate between altitude training and blood doping making the interpretation of an athlete's biological passport difficult. Further research is required to determine the optimal method for altitude training and to enhance current detection methods to be able to differentiate better blood doping and altitude exposure.

Prolonged dry apnoea: effects on brain activity and physiological functions in breath-hold divers and non-divers.

PURPOSE: The aim of the study was to investigate the effects of voluntary breath-holding on brain activity and physiological functions. We hypothesised that prolonged apnoea would trigger cerebral hypoxia, resulting in a decrease of brain performance; and the apnoea's effects would be more pronounced in breath-hold divers. METHODS: Trained breath-hold divers and non-divers performed maximal dry breath-holdings. Lung volume, alveolar partial pressures of O2 and CO2, attention and anxiety levels were estimated. Heart rate, blood pressure, arterial blood oxygenation, brain tissue oxygenation, EEG, and DC potential were monitored continuously during breath-holding. RESULTS: There were a few significant changes in electrical brain activity caused by prolonged apnoea. Brain tissue oxygenation index and DC potential were relatively stable up to the end of the apnoea in breath-hold divers and non-divers. We also did not observe any decrease of attention level or speed of processing immediately after breath-holding. Interestingly, trained breath-hold divers had some peculiarities in EEG activity at resting state (before any breath-holding): non-spindled, sharpened alpha rhythm; slowed-down alpha with the frequency nearer to the theta band; and untypical spatial pattern of alpha activity. CONCLUSION: Our findings contradicted the primary hypothesis. Apnoea up to 5 min does not lead to notable cerebral hypoxia or a decrease of brain performance in either breath-hold divers or non-divers. It seems to be the result of the compensatory mechanisms similar to the diving response aimed at centralising blood circulation and reducing peripheral O2 uptake. Adaptive changes during apnoea are much more prominent in trained breath-hold divers.

Hematological and performance adaptations to altitude training (2,320 m) in elite middle-distance and distance swimmers.

Purpose: Elite swimmers often schedule altitude training camps ahead of major events in an attempt to maximize performance. However, the relationships between altitude-induced hematological changes, markers of training adaptation, and performance changes in such context are unclear. This study assessed hematological status, markers of daily adaptation, and swimming performance in elite middle-distance and distance swimmers during a 22-day altitude training camp at 2,320 m, 2 weeks prior to World Championship qualification competition. Methods: Venous blood was obtained and total hemoglobin mass (tHbmass) measured (CO rebreathing) in 7 elite swimmers (4 females, 3 males) 8 days before and on day 22 of the altitude camp. Resting heart rate, peripheral oxygen saturation, urinary specific gravity, body mass, fatigue and self-reported sleep duration and quality were monitored daily during the altitude camp. Swimming performance was assessed through a standardized set (6 sets of 4 maximal repetitions of 100 m front crawl) on days 3, 10 and 17 of the camp, and at sea level competitions (200 m-1,500 m) immediately after the camp, and 2 weeks later. Results: tHbmass (+5.6 ± 3.3%; range: 2.1%-11.0%; p < 0.05), red blood cell count, hemoglobin concentration, hematocrit increased at the end of the training camp (p < 0.05). Performance at altitude improved throughout the camp (+1.4 ± 0.4%; range: 0.7%-2.5%; p < 0.05). No significant relationship was noted between hematological changes, the change in altitude performance and any of the monitored daily markers of adaptation during the camp. Compared to the swimmers' previous personal best, competition performances did not improve immediately (2.5% ± 1.9% slower times) and 2 weeks after altitude (1.2% ± 1.4% slower times). Conclusion: The 22-day altitude training camp at 2,320 m was beneficial for elite swimmers' tHbmass, hematological status and performance at altitude, but these benefits did not clearly translate into enhanced sea level performance immediately after or 2 weeks later. The present study confirms the large inter-individual variability in hematological responses to altitude training, and that the improvement in performance at altitude and sea level may depend on factors other than the increase in tHbmass alone.

Hemoglobin Mass and Blood Volume in Swimming: A Comparison Between Highly Trained, Elite, and World-Class Swimmers.

PURPOSE: Total hemoglobin mass (tHbmass) and blood volume (BV) are important determinants of maximal oxygen uptake and endurance capacity. Higher-caliber endurance athletes usually possess higher tHbmass and BV values. This study aimed to compare tHbmass and BV among swimmers of diverse competitive calibers and distances. METHODS: Thirty swimmers (16 female and 14 male) participated in the study: 3 were tier 5, world class (869 [59] FINA points); 15 were tier 4, elite/international (853 [38] points); and 12 were tier 3, highly trained/national (808 [35] points). They specialized in competition distances ranging from 200 m to open-water 10 km. Between February 2019 and February 2020, all swimmers had their tHbmass and BV measured by carbon monoxide rebreathing 1 to 6 times and participated in multiple competitions and race events. RESULTS: Relative tHbmass and BV were not different (P > .05) between tiers among women or among men (pooled tHbmass values 14.5 [0.5], 12.5 [1.5], 12.6 [2.3] g/kg for tier 5, tier 4, and tier 3, respectively). No differences were observed in relative tHbmass (P = .215) and BV (P = .458) between pool and open-water swimmers or between 200-, 400-, and 1500-m specialists (P > .05). No significant correlations were found between the highest measured absolute or relative tHbmass and BV and the highest FINA points scored over the follow-up period (R = -.42-.17, P = .256-.833), irrespective of competition distance. CONCLUSION: tHbmass and BV values did not differ between swimmers of different calibers or among competition distances. Furthermore, these values did not correlate with FINA points, either in males or in females. The present results indicate that hematological characteristics may have a lesser impact on swimming performance than on land-based endurance sports.

Non-enzymatic antioxidant blood plasma profile in the period of high training loads of elite speed skaters in the altitude.

At the altitude, hypoxia and training load are key factors in the development of oxidative stress. Altitude-induced oxidative stress is developed due to the depletion of antioxidant potential. In the current study, we examined the non-enzymatic antioxidant profile of blood plasma in 7 males and 5 females specializing in speed skating at a 21-day training camp at 1 850 â€‹m above sea level. Training included: cycling, roller skating, ice skating, strength training, and special training. At the start point and the endpoint, total hemoglobin mass (tHb-mass), hemoglobin concentration, and circulating blood volume were determined. Antioxidant profiles, hypoxic doses, hypoxic impulses, and training impulses were assessed at 3, 6, 10, 14, and 18 days. Antioxidant profiles consisting of "urate" and "thiol" parts were registered with chemiluminometry. In the training dynamics, antioxidant parameters changed individually, but in total there was a decrease in the "urate" capacity by a factor of 1.6 (p â€‹= â€‹0.001) and an increase in the "thiol" capacity by a factor of 1.8 (p â€‹= â€‹0.013). The changes in "urate" capacity positively correlated (rS â€‹= â€‹0.40) and the changes in "thiol" capacity negatively correlated (rS â€‹= â€‹-0.45) with changes in tHb-mass. Both exercise and hypoxic factors affect the antioxidant parameters bidirectionally. They correlated with a decrease in thiol capacity and with an increase in urate capacity. The assessment of the non-enzymatic antioxidant profile can be a simple and useful addition to screening the reactive oxygen species homeostasis and can help choose the personalized training schedule, individualize recovery and ergogenic support.

Technology Innovation and Guardrails in Elite Sport: The Future is Now.

A growing number of companies are developing or using wearable sensor technologies that can monitor, analyse and transmit data from humans in real time that can be used by the sporting, biomedical and media industries. To explore this phenomenon, we describe and review two high-profile sporting events where innovations in wearable technologies were trialled: the Tokyo 2020 Summer Olympic Games (Tokyo 2020, Japan) and the 2022 adidas Road to Records (Germany). These two major sporting events were the first time academic and industry partners came together to implement real-time wearable solutions during major competition, to protect the health of athletes competing in hot and humid environments, as well as to better understand how these metrics can be used moving forwards. Despite the undoubted benefits of such wearables, there are well-founded concerns regarding their use including: (1) limited evidence quantifying the potential beneficial effects of analysing specific parameters, (2) the quality of hardware and provided data, (3) information overload, (4) data security and (5) exaggerated marketing claims. Employment and sporting rules and regulations also need to evolve to facilitate the use of wearable devices. There is also the potential to obtain real-time data that will oblige medical personnel to make crucial decisions around whether their athletes should continue competing or withdraw for health reasons. To protect athletes, the urgent need is to overcome these ethical/data protection concerns and develop wearable technologies that are backed by quality science. The fields of sport and exercise science and medicine provide an excellent platform to understand the impact of wearable sensors on performance, wellness, health, and disease.

The Impact of Grounding in Running Shoes on Indices of Performance in Elite Competitive Athletes.

The introduction of carbon fiber plate shoes has triggered a plethora of world records in running, which has encouraged shoe industries to produce novel shoe designs to enhance running performance, including shoes containing conductor elements or "grounding shoes" (GS), which could potentially reduce the energy cost of running. The aim of this study was to examine the physiological and perceptual responses of athletes subjected to grounding shoes during running. Ten elite runners were recruited. Firstly, the athletes performed an incremental running test for VO2max and anaerobic threshold (AT) determination, and were familiarized with the two shoe conditions (traditional training shoe (TTS) and GS, the latter containing a conductor element under the insole). One week apart, athletes performed running economy tests (20 min run at 80% of the AT) on a 400 m dirt track, with shoe conditions randomized. VO2, heart rate, lactate, and perceived fatigue were registered throughout the experiment. No differences in any of the physiological or perceptual variables were identified between shoe conditions, with an equal running economy in both TTS and GS (51.1 ± 4.2 vs. 50.9 ± 5.1 mL kg-1 min-1, respectively). Our results suggest that a grounding stimulus does not improve the energy cost of running, or the physiological/perceptual responses of elite athletes.

RNA Sequencing of Whole Blood Defines the Signature of High Intensity Exercise at Altitude in Elite Speed Skaters.

Although high altitude training has been increasingly popular among endurance athletes, the molecular and cellular bases of this adaptation remain poorly understood. We aimed to define the underlying physiological changes and screen for potential biomarkers of adaptation using transcriptional profiling of whole blood. Seven elite female speed skaters were profiled on the 18th day of high-altitude adaptation. Whole blood RNA-seq before and after an intense 1 h skating bout was used to measure gene expression changes associated with exercise. In order to identify the genes specifically regulated at high altitudes, we have leveraged the data from eight previously published microarray datasets studying blood expression changes after exercise at sea level. Using cell type-specific signatures, we were able to deconvolute changes of cell type abundance from individual gene expression changes. Among these were PHOSPHO1, with a known role in erythropoiesis, and MARC1 with a role in endogenic NO metabolism. We find that platelet and erythrocyte counts uniquely respond to altitude exercise, while changes in neutrophils represent a more generic marker of intense exercise. Publicly available data from both single cell atlases and exercise-related blood profiling dramatically increases the value of whole blood RNA-seq for the dynamic evaluation of physiological changes in an athlete's body.

A non-randomized comparative study of olfactory and gustatory functions in children who recovered from COVID-19 (1-year follow-up).

The experimental group included 68 children over 6 years of age who had recovered from COVID-19. The control group included 22 children over 6 years of age who have never had COVID-19. Research methods included neurological examination, verification of cognitive status, examination by an otolaryngologist, and smell and taste assessment. The examination was performed 6-8 weeks after COVID-19 recovery and after 1 year in some patients. Children who recovered from COVID-19 had a reduction in their ability to smell compared to children who had never had COVID-19. The olfactory thresholds and taste identification scores after recovery from COVID-19 were identical, whether the parents had reported anosmia in their children during COVID-19 or not, and irrespective of hyperthermia level and the presence or absence of headache and hyperhidrosis during COVID-19. Analysis of correlation with neuropsychiatric symptoms showed no differences in the olfactory thresholds in children irrespective of the presence of neuropsychiatric symptoms (tics, tremors, enuresis, compulsive movements, seizures, speech disorders, attention deficit, and easy fatigability) both in general, and in particular among subjects performing or not any compulsive movements, and experiencing or not a combination of easy fatigability and daytime sleepiness. Evidence suggests that in children and adolescents, partial hyposmia is associated with depressive symptoms, varying in severity from low to high, but symptoms of depression were not caused by COVID-19 infection itself. Analysis in subgroups with different degrees of state and trait anxiety did not reveal any significant differences in the olfactory threshold. A re-examination of 21 children was performed after 1 year. An objective olfactometric examination showed that the sensitivity to odorants increased significantly. In 1 year, we compared the thresholds of smell in children who had COVID-19 and those who did not have this disease: olfactory sensitivity after COVID-19 in children is restored to normal values. Schulte correction test showed that none of 14 children with asthenic manifestations in the form of fluctuations or exhaustion when performing the test immediately after COVID-19 had these manifestations after 1 year. Thus, asthenization of cognitive activity was recorded within the next 1.5 months after suffering from COVID-19 but was absent after 1 year.

Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations.

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Wearable and telemedicine innovations for Olympic events and elite sport.

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic.

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

Establishing a Global Standard for Wearable Devices in Sport and Exercise Medicine: Perspectives from Academic and Industry Stakeholders.

Millions of consumer sport and fitness wearables (CSFWs) are used worldwide, and millions of datapoints are generated by each device. Moreover, these numbers are rapidly growing, and they contain a heterogeneity of devices, data types, and contexts for data collection. Companies and consumers would benefit from guiding standards on device quality and data formats. To address this growing need, we convened a virtual panel of industry and academic stakeholders, and this manuscript summarizes the outcomes of the discussion. Our objectives were to identify (1) key facilitators of and barriers to participation by CSFW manufacturers in guiding standards and (2) stakeholder priorities. The venues were the Yale Center for Biomedical Data Science Digital Health Monthly Seminar Series (62 participants) and the New England Chapter of the American College of Sports Medicine Annual Meeting (59 participants). In the discussion, stakeholders outlined both facilitators of (e.g., commercial return on investment in device quality, lucrative research partnerships, and transparent and multilevel evaluation of device quality) and barriers (e.g., competitive advantage conflict, lack of flexibility in previously developed devices) to participation in guiding standards. There was general agreement to adopt Keadle et al.'s standard pathway for testing devices (i.e., benchtop, laboratory, field-based, implementation) without consensus on the prioritization of these steps. Overall, there was enthusiasm not to add prescriptive or regulatory steps, but instead create a networking hub that connects companies to consumers and researchers for flexible guidance navigating the heterogeneity, multi-tiered development, dynamicity, and nebulousness of the CSFW field.

Recommendations for return to sport during the SARS-CoV-2 pandemic.

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted - from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

Comprehensive overview of hemoglobin mass and blood volume in elite athletes across a wide range of different sporting disciplines.

BACKGROUND: The aim of the study was to compare total hemoglobin mass (tHb-mass) and blood volume (BV) across elite athletes with different sporting specializations. METHODS: The study enrolled 222 members of Russian national teams from 12 different sporting disciplines and non-Olympic sports. The athletes were tested in the middle of a competitive season for tHb-mass, BV, plasma volume (PV), hemoglobin concentration (Hb), and hematocrit level (Hct) determination. tHb-mass measurements were performed using CO- rebreathing technique, alongside Hb and Hct (capillary blood). RESULTS: In elite endurance athletes both male and female values for tHb-mass, BV and PV, were significantly higher compared to anaerobic, technical sports and untrained subjects. The highest values of relative tHb-mass across all 15 groups were found in cross-country skiers (15.1±0.1 g/kg) and cyclists (15.0±0.5 g/kg). In the anaerobic group the highest value of tHb-mass was within the short-track group - i.e. 12.9±0.5 g/kg which was significantly lower than in cycling. In all aerobic groups, anaerobic and breath-hold divers we found significant difference in relative tHb-mass compared to untrained subjects. The difference between relative tHb-mass in the cycling group and untrained subjects was 31.3%, 17% for short track, 30.1% for handball and 33.5% for motor sport. For the largest group (biathlon) we performed correlation analysis for males and females with competitive performance and found relationship in both groups (P<0.05). CONCLUSIONS: The study clearly demonstrates the difference between endurance and non-endurance athletes in tHb-mass for elite males and females athletes and its importance in competitive aerobic performance.

Relationship between total hemoglobin mass and competitive performance in endurance athletes.

BACKGROUND: Determine the relationships between total hemoglobin mass (tHb-mass), h emoglobin (Hb), hematocrit (Hct) and competitive performance. METHODS: The team of 35 elite endurance athletes (biathlon men [BM, N.=12] & women [BW, N.=10], long track speed-skating men [SM, N.=7] and women [SW, N.=6]) were examined before participate in seven different competitions (C1 through C7) during the 2012-2013 and 2013-2014 seasons. Total hemoglobin mass measurement and biochemical analysis were performed using carbon monoxide rebreathing technique 24 hours before the competition. RESULTS: In BM correlations were found between results of two 10-km sprint competitions and tHb-mass between C1 and C2 (r=-0.94 and r=-0.87). Correlations were also found between tHb-mass and performance in C3 individual races for BM (16.765 km, r=-0.88; and 10-km sprint, r=0.80) and BW (7.2 km, r=-0.79; and 10-km sprint, r=-0.81). In SM, a correlation was found between tHb-mass and performance (r=-0.83) in C5. In SM and SW correlations were seen between tHb-mass and performance (SM, 5,000-m; r=-0.80; SW, 3,000-m; r=-0.77) in C6. CONCLUSIONS: No correlation was found between performance and Hb or Hct in any group. The demonstration of significant and direct correlation between tHb-mass and competitive performance highlights the importance of tHb-mass in this context and may be relevant for coaches providing one more piece of information for training.