Methodological Considerations for Investigating Iron Status and Regulation in Exercise and Sport Science Studies.

Iron deficiency is a common health issue in active and athlete populations. Accordingly, research into iron status, regulation, absorption, and iron deficiency treatment strategies is increasing at a rapid rate. However, despite the increase in the quantity of research, various methodological issues need to be addressed as we progress our knowledge in this area. The purpose of this review is to highlight specific considerations for conducting iron-related research in active and athlete populations. First, we discuss the methodological importance of assessment and interpretation of iron status, with reference to blood collection protocols, participant screening procedures, and biomarker selection. Next, we consider numerous variables that should be accounted for in the design of iron-related research studies, such as the iron regulatory hormone hepcidin and its interaction with exercise, in addition to an examination of female physiology and its impact on iron metabolism. Subsequently, we explore dietary iron and nutrient interactions that impact iron regulation and absorption, with recommendations made for optimal methodological control. Consideration is then given to key features of long-term study designs, such as the monitoring of training load, oral iron supplementation, dietary analysis, and general lifestyle factors. Finally, we conclude our recommendations with an exploration of stable iron isotope tracers as a methodology to measure iron absorption. Ultimately, it is our intention that this review can be used as a guide to improve study design, biomarker analysis, and reporting of findings, to maximize the quality of future research outputs in iron-related research focused on active and athlete populations.

Neuromechanics of Middle-Distance Running Fatigue: A Key Role of the Plantarflexors?

PURPOSE: This study aimed to investigate the changes in lower limb kinematics, kinetics, and muscle activation during a high-intensity run to fatigue (HIRF). METHODS: Eighteen male and female competitive middle-distance runners performed a HIRF on an instrumented treadmill at a constant but unsustainable middle-distance speed (~3 min) based on a preceding maximum oxygen uptake (V˙O2max) test. Three-dimensional kinematics and kinetics were collected and compared between the start, 33%, 67%, and the end of the HIRF. In addition, the activation of eight lower limb muscles of each leg was measured with surface EMG (sEMG). RESULTS: Time to exhaustion was 181 ± 42 s. By the end of the HIRF (i.e., vs the start), ground contact time increased (+4.0%), whereas flight time (-3.2%), peak vertical ground reaction force (-6.1%), and vertical impulse (-4.1%) decreased (all P < 0.05), and joint angles at initial contact became more (dorsi)flexed (ankle, +1.9°; knee, +2.1°; hip, +3.6°; all P < 0.05). During stance, by the end of the HIRF: peak ankle plantarflexion moment decreased by 0.4 N·m·kg-1 (-9.0%), whereas peak knee extension moment increased by 0.24 N·m·kg-1 (+10.3%); similarly, positive ankle plantarflexion work decreased by 0.19 J·kg-1 (-13.9%), whereas positive knee extension work increased by 0.09 J·kg-1 (+33.3%; both P < 0.05) with no change in positive hip extension work. Hip extensor surface EMG amplitude increased during the late swing phase (+20.9-37.3%; P < 0.05). CONCLUSION: Running at a constant middle-distance pace led primarily to the fatigue of the plantarflexors with a compensatory increase in positive work done at the knee. Improving the fatigue resistance of the plantarflexors might be beneficial for middle-distance running performance.

Is iron treatment beneficial in, iron-deficient but non-anaemic (IDNA) endurance athletes? A systematic review and meta-analysis.

PURPOSE: The aim of this study was to determine whether iron treatments improve the iron status and aerobic capacity of iron deficient non-anaemic endurance athletes. METHOD: A meta-analysis of studies that investigated the effects of iron treatment on serum ferritin (sFer), serum iron (sFe), transferrin saturation (Tsat), haemoglobin concentration ([Hb]) and (VO(2max)). Seventeen eligible studies were identified from online databases. RESULTS: Analysis of pooled data indicated that iron treatments had a large effect on improving sFer (Hedges' g=1.088, 95% CI 0.914 to 1.263, p<0.001), sFe (Hedges' g=1.004, 95% CI 0.828 to 1.181, p<0.001) and Tsat (Hedges g=0.741, 95% CI 0.564 to 0.919, p<0.001) and a moderate effect on improving [Hb] (Hedges' g=0.695, 95% CI 0.533 to 0.836, p<0.001) and (VO(2max)) (Hedges' g=0.610, 95% CI 0.399 to 0.821, p<0.001). Regression analysis revealed a significant interaction between the effect of iron treatment on sFer and treatment duration, suggesting treatments that lasted beyond 80 days appear to have the least effect on sFer. CONCLUSIONS: These results indicate iron treatments improve the iron status and aerobic capacity of iron deficient non-anaemic endurance athletes.

Effect of Intravenous Iron on Aerobic Capacity and Iron Metabolism in Elite Athletes.

PURPOSE: Iron-deficient athletes are often treated with long-term, low-dose iron therapy. Such treatments may be efficacious in correcting iron deficiency; however, the effect on acute and chronic iron metabolism and subsequent endurance capacity is less clear. METHODS: Fifteen national and international standard runners were identified as iron deficient nonanemic (IDNA) and assigned to either an intravenous iron treatment group or placebo group. Participants completed three exercise tests to volitional exhaustion, as follows: before treatment, within 24 h, and 4 wk after treatment. RESULTS: Serum ferritin, serum iron, and transferrin saturation were significantly improved in the iron group after intervention and compared with those in placebo (P < 0.05). Hepcidin levels were significantly greater before and after exercise after the iron injection (P < 0.05), and this was independent of changes in interleukin-6. There were no differences between groups in red cell indices, total hemoglobin mass, V˙O2max, submaximal blood lactate, running economy, RPE, or time to exhaustion (P > 0.05). CONCLUSIONS: A single 500-mg intravenous iron injection is effective for improving iron status for at least 4 wk, but this does not lead to improved aerobic capacity. This investigation suggests that iron availability supersedes inflammation in the regulation of hepcidin in IDNA endurance athletes after acute intravascular iron injection treatment.

Eight weeks of intermittent hypoxic training improves submaximal physiological variables in highly trained runners.

It is unclear whether intermittent hypoxic training (IHT) results in improvements in physiological variables associated with endurance running. Twelve highly trained runners (VO2peak 70.0 ± 3.5 ml·kg-1·min-1) performed incremental treadmill tests to exhaustion in normobaric normoxia and hypoxia (16.0% FIO2) to assess submaximal and maximal physiological variables and the limit of tolerance (T-Lim). Participants then completed 8 weeks of moderate to heavy intensity normoxic training (control [CONT]) or IHT (twice weekly 40 minutes runs, in combination with habitual training), in a single blinded manner, before repeating the treadmill tests. Submaximal heart rate decreased significantly more after IHT (-5 ± 5 b·min-1; p = 0.001) than after CONT ( -1 ± 5 b·min-1; p = 0.021). Changes in submaximal V[Combining Dot Above]O2 were significantly different between groups (p ≤ 0.05); decreasing in the IHT group in hypoxia (-2.6 ± 1.7 ml·kg-1·min-1; p = 0.001) and increasing in the CONT group in normoxia (+1.1 ± 2.1 ml·kg-1·min-1; p = 0.012). There were no VO2peak changes within either group, and while T-Lim improved post-IHT in hypoxia (p = 0.031), there were no significant differences between groups. Intermittent hypoxic training resulted in a degree of enhanced cardiovascular fitness that was evident during submaximal, but not maximal intensity exercise. These results suggest that moderate to heavy intensity IHT provides a mean of improving the capacity for submaximal exercise and may be useful for pre-acclimatization for subsequent exercise in hypoxia, but additional research is required to establish its efficacy for athletic performance at sea level.

The effects of ionized and nonionized compression garments on sprint and endurance cycling.

The aim of this study was to examine the effects of ionized and nonionized compression tights on sprint and endurance cycling performance. Using a randomized, blind, crossover design, 10 well-trained male athletes (age: 34.6 ± 6.8 years, height: 1.80 ± 0.05 m, body mass: 82.2 ± 10.4 kg, VO2max: 50.86 ± 6.81 ml·kg(-1)·min(-1)) performed 3 sprint trials (30-second sprint at 150% of the power output required to elicit VO2max [pVO2max] + 3 minutes recovery at 40% pVO2max + 30-second Wingate test + 3 minutes recovery at 40% pVO2max) and 3 endurance trials (30 minutes at 60% pVO2max + 5 minutes stationary recovery + 10-km time trial) wearing nonionized compression tights, ionized compression tights, or standard running tights (control). There was no significant effect of garment type on key Wingate measures of peak power (grand mean: 1,164 ± 219 W, p = 0.812), mean power (grand mean: 716 ± 68 W, p = 0.800), or fatigue (grand mean: 66.5 ± 6.9%, p = 0.106). There was an effect of garment type on blood lactate in the sprint and the endurance trials (p < 0.05), although post hoc tests only detected a significant difference between the control and the nonionized conditions in the endurance trial (mean difference: 0.55 mmol·L(-1), 95% likely range: 0.1-1.1 mmol·L(-1)). Relative to control, oxygen uptake (p = 0.703), heart rate (p = 0.774), and time trial performance (grand mean: 14.77 ± 0.74 minutes, p = 0.790) were unaffected by either type of compression garment during endurance cycling. Despite widespread use in sport, neither ionized nor nonionized compression tights had any significant effect on sprint or endurance cycling performance.