Living kidney donor evaluation for all candidates with normal estimated GFR for age.

Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m2 (KDIGO guidelines) or 80 ml/min/1.73 m2 (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (Sage ) higher than 90 or 80 ml/min/1.73 m2 (S90 and S80, respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute- and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S90 than in S80 or Sage but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.

Sleep and the athlete: narrative review and 2021 expert consensus recommendations.

Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1-3 nights, a more real-world scenario, remains unclear. Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health. Studies in the wider population show that habitually sleeping <7 hours/night increases susceptibility to respiratory infection. Fortunately, much is known about the salient risk factors for sleep inadequacy in athletes, enabling targeted interventions. For example, athlete sleep is influenced by sport-specific factors (relating to training, travel and competition) and non-sport factors (eg, female gender, stress and anxiety). This expert consensus culminates with a sleep toolbox for practitioners (eg, covering sleep education and screening) to mitigate these risk factors and optimise athlete sleep. A one-size-fits-all approach to athlete sleep recommendations (eg, 7-9 hours/night) is unlikely ideal for health and performance. We recommend an individualised approach that should consider the athlete's perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).

IMPact of the COVID-19 epidemic on the moRTAlity of kidney transplant recipients and candidates in a French Nationwide registry sTudy (IMPORTANT).

End stage kidney disease increase the risk of COVID-19 related death but how the kidney replacement strategy should be adapted during the pandemic is unknown. Chronic hemodialysis makes social distancing difficult to achieve. Alternatively, kidney transplantation could increase the severity of COVID-19 due to therapeutic immunosuppression and contribute to saturation of intensive care units. For these reasons, kidney transplantation was suspended in France during the first epidemic wave. Here, we retrospectively evaluated this strategy by comparing the overall and COVID-19 related mortality in kidney transplant recipients and candidates over the last three years. Cross-interrogation of two national registries for the period 1 March and 1 June 2020, identified 275 deaths among the 42812 kidney transplant recipients and 144 deaths among the 16210 candidates. This represents an excess of deaths for both populations, as compared with the same period the two previous years (mean of two previous years: 253 in recipients and 112 in candidates). This difference was integrally explained by COVID-19, which accounted for 44% (122) and 42% (60) of the deaths in recipients and candidates, respectively. Taking into account the size of the two populations and the geographical heterogeneity of virus circulation, we found that the excess of risk of death due to COVID-19 was similar for recipients and candidates in high viral risk area but four-fold higher for candidates in the low viral risk area. Thus, in case of a second epidemic wave, kidney transplantation should be suspended in high viral risk areas but maintained outside those areas, both to reduce the excess of deaths of candidates and avoid wasting precious resources.

Validity and Reliability of the Stages Cycling Power Meter.

Granier, C, Hausswirth, C, Dorel, S, and Le Meur, Y. Validity and reliability of the stages cycling power meter. J Strength Cond Res 34(12): 3554-3559, 2020-This study aimed to determine the validity and the reliability of the Stages power meter crank system (Boulder, United States) during several laboratory cycling tasks. Eleven trained subjects completed laboratory cycling trials on an indoor cycle fitted with SRM Professional and Stages systems. The trials consisted of an incremental test at 100 W, 200 W, 300 W, 400 W, and four 7-s sprints. The level of pedaling asymmetry was determined for each cycling intensity during a similar protocol completed on a Lode Excalibur Sport ergometer. The reliability of Stages and SRM power meters was compared by repeating the incremental test during a test-retest protocol on a Cyclus 2 ergometer. Over power ranges of 100-1,250 W, the Stages system produced trivial to small differences compared with the SRM (standardized typical error values of 0.06, 0.24, and 0.08 for the incremental, sprint, and combined trials, respectively). A large correlation was reported between the difference in power output (PO) between the 2 systems and the level of pedaling asymmetry (r = 0.58, p < 0.001). Recalculating PO of the Stages system according to the level of pedaling asymmetry provided only marginal improvements in PO measures. The reliability of the Stages power meter at the submaximal intensities was similar to the SRM Professional model (coefficient of variation: 2.1 and 1.3% for Stages and SRM, respectively). The Stages system is a suitable device for PO measurements, except when a typical error of measurement <3.0% over power ranges of 100-1,250 W is expected.

Pneumocystis Infection Outbreaks in Organ Transplantation Units in France: A Nation-Wide Survey.

The burden of nosocomial Pneumocystis infections in transplantation units in France was evaluated through a retrospective survey. Over 12 years, 16 outbreaks occurred, including 13 among renal transplant recipients (RTRs). We performed Pneumocystis jirovecii genotyping in 5 outbreaks, which suggested that specific strains may have been selected by RTRs.

Neuro-computational Impact of Physical Training Overload on Economic Decision-Making.

Overtraining syndrome is a form of burnout, defined in endurance athletes by unexplained performance drop associated with intense fatigue sensation. Our working hypothesis is that the form of fatigue resulting from physical training overload might share some neural underpinnings with the form of fatigue observed after prolonged intellectual work, which was previously shown to affect the cognitive control brain system. Indeed, cognitive control may be required to prevent any impulsive behavior, including stopping physical effort when it hurts, despite the long-term goal of improving performance through intense training. To test this hypothesis, we induced a mild form of overtraining in a group of endurance athletes, which we compared to a group of normally trained athletes on behavioral tasks performed during fMRI scanning. At the behavioral level, training overload enhanced impulsivity in economic choice, which was captured by a bias favoring immediate over delayed rewards in our computational model. At the neural level, training overload resulted in diminished activation of the lateral prefrontal cortex, a key region of the cognitive control system, during economic choice. Our results therefore provide causal evidence for a functional link between enduring physical exercise and exerting cognitive control. Besides, the concept of cognitive control fatigue bridges the functional consequences of excessive physical training and intellectual work into a single neuro-computational mechanism, which might contribute to other clinical forms of burnout syndromes.

A Prospective, Observational Study of Conversion From Immediate- to Prolonged-Release Tacrolimus in Renal Transplant Recipients in France: The OPALE Study.

BACKGROUND Potential benefits of once-daily, prolonged-release tacrolimus over the immediate-release formulation include improved adherence to immunosuppressives post transplantation. An observational study was performed to characterize real-world practice surrounding conversion from immediate- to prolonged-release tacrolimus in kidney transplant recipients. MATERIAL AND METHODS We performed a prospective, observational study of renal transplant recipients converted from immediate- to prolonged-release tacrolimus capsules. Conversion took place at the baseline visit, within the first 6 months of transplantation (early conversion group) or between 6 and 12 months of transplantation (late conversion group). Data collection was performed at routine follow-up at 6 and 12 months. Endpoints included conversion ratio from immediate- to prolonged-release tacrolimus, reasons for conversion, additional visits due to conversion, safety, and tolerability. RESULTS The analysis population comprised 591 patients. Baseline characteristics were similar between the 2 groups. The mean conversion ratio of the daily dose of tacrolimus was 0.98±0.17 in the early group and 0.99±0.09 in the late group. Time from conversion (mean ±SD) to first measurement of trough tacrolimus blood concentration was 12.1±11.6 and 27.6±26.7 days in the early and late groups, respectively. The highest number of additional visits required was 6 in the early conversion group, in 3 patients (0.7%), and 3 in the late conversion group, in 2 patients (1.6%). Conversion from immediate- to prolonged-release tacrolimus was associated with a very low rate of graft rejection. CONCLUSIONS Favorable clinical outcomes and safety profiles were observed with conversion from immediate- to prolonged-release tacrolimus over 1 year following renal transplantation, with no marked differences between the early and late conversion groups.

Epitope load identifies kidney transplant recipients at risk of allosensitization following minimization of immunosuppression.

Human leukocyte antigen (HLA) mismatching and minimization of immunosuppression are two major risk factors for the development of de novo donor-specific antibodies, which are associated with reduced kidney graft survival. Antibodies do not recognize whole HLA antigens but rather individual epitopes, which are short sequences of amino acids in accessible positions. However, compatibility is still assessed by the simple count of mismatched HLA antigens. We hypothesized that the number of mismatched epitopes, or ("epitope load") would identify patients at the highest risk of developing donor specific antibodies following minimization of immunosuppression. We determined epitope load in 89 clinical trial participants who converted from cyclosporine to everolimus 3 months after kidney transplantation. Twenty-nine participants (32.6%) developed de novo donor specific antibodies. Compared to the number of HLA mismatches, epitope load was more strongly associated with the development of donor specific antibodies. Participants with an epitope load greater than 27 had a 12-fold relative risk of developing donor-specific antibodies compared to those with an epitope load below that threshold. Using that threshold, epitope load would have missed only one participant who subsequently developed donor specific antibodies, compared to 8 missed cases based on a 6-antigen mismatch. DQ7 was the most frequent antigenic target of donor specific antibodies in our population, and some DQ7 epitopes appeared to be more frequently involved than others. Assessing epitope load before minimizing immunosuppression may be a more efficient tool to identify patients at the highest risk of allosensitization.

"Road to Rio": A Case Study of Workload Periodization Strategy in Rugby-7s During an Olympic Season.

The objective of this manuscript was to examine the periodization strategy of an international Rugby-7s team during an Olympic season. Training load data were collected in 14 elite male players over a 48-week period during the 2015-2016 Olympic season. The season consisted of 3 macrocycles including: preseason (12-weak duration), in-season (25-weak) fragmented into four 4-7 weeks mesocycles (In-1-4) and the final preparation for the Rio 2016 Olympic Games (Olympic preparation, 11-weak). External training load (TL) such as the total distance (TD), the high-intensity distance (HID) and the number of accelerations performed, was monitored in training and competition over the entire duration of the season using a global positioning system (GPS) devices. The rating of perceived exertion (RPE) was multiplied by the session duration (min) to provide an internal TL (session-RPE) value for all training sessions and competitions. The Olympic preparation may enable planning of higher external TL compared to the preseason (TD, 21 ± 13%, moderate; total accelerations, 27 ± 4%, moderate) whereas no difference was observed for internal TL values between these two periods. High-intensity distance (HID) and internal TL (session-RPE) were lower (-11.0 ± 7.8%, small and -38 ± 3%, moderate, respectively) during the in-season compared to preseason. Internal TL, TD as well as HID were lower in the third in-season mesocycle (In-3) compared with the first in-season mesocycle (In-1) (-25 ± 12%, moderate; -32 ± 4%, moderate; -49 ± 8%, moderate, respectively). The staff managed the workload considering the in-season as the main part of the "Road to Rio." The strategy to reduce the workload at the middle of the season and to induce weeks of regeneration at the end of the in-season was highlighted by the training availability of 100% of the squad at the beginning of the Olympic preparation. The workload periodization strategy of an Olympic season differs from the strategy previously described during a non-Olympic season.

Training Periodization Over an Elite Rugby Sevens Season: From Theory to Practice.

PURPOSE: To describe the training periodization in rugby sevens players competing in the World Rugby Sevens Series during a non-Olympic season. METHODS: Workload data were collected over a 33-wk period in 12 male players participating in a full competitive season. Workload was quantified using session rating of perceived exertion and global positioning system-derived data during training and competition. Self-reported well-being was assessed using a questionnaire. Each variable was analyzed weekly and through 5 mesocycles (preseason, in-season 1-4), each of which ended with competition blocks. RESULTS: The perceived load decreased throughout the season for the full squad (-68% [26%] between preseason and final competitive block, large effect) and when unavailable players were removed from the analysis (-38% [42%], moderate). Weekly perceived load was highly variable, with a typical periodization in 4 phases during each mesocycle (regeneration, training overload, taper, and competition). During the preseason, the workload was higher during the overload training phase than during the competitive period (range: +23% to +59%, large to very large, for the distance covered above individual maximal aerobic speed and the number of accelerations). This observation no longer persisted during the season. The well-being score decreased almost certainly from in-season 3 (moderate). CONCLUSIONS: These results highlighted the apparent difficulty in maintaining high-load training periods throughout the season in players engaged on the World Rugby Sevens Series despite ∼4-7 training weeks separating each competitive block. This observation was likely explained by the difficulties inherent to the World Rugby Sevens Series (risk of contact injury, calendar, and multiple long-haul travel episodes) and potentially by limited squad-rotation policies.

Preconditioning Strategy in Rugby-7s Players: Beneficial or Detrimental?

PURPOSE: Preconditioning strategies are considered as opportunities to optimize performance on competition day. While investigations conducted in rugby players on the effects of a morning preconditioning session already exist, additional work is warranted. The aim of this study was to monitor changes in physical and psychophysiological indicators among international Rugby-7s players following a priming exercise. METHODS: In a randomized crossover-design, fourteen under-18 international Rugby-7s players completed, at 8:00am, a preconditioning session consisting of a warm-up followed by small-sided games, accelerations and 2 x 50-m maximal sprints (Experimental) or no pre-loading session (Control). Following a 2-hour break, the players performed a set of six 30-m sprints and a Rugby-7s match. Recovery-stress state and salivary stress-markers levels were assessed before the preloading session (Pre), immediately after (Post-1), before the testing session (Post-2) and after (Post-3). RESULTS: Experimental-Control differences in performance across a repeated sprint test consisting of six 30-m sprints were very likely trivial (+0.2 ±0.7%, 3/97/1%). During the match, the total distance covered and the frequency of decelerations were possibly lower (small) in Experimental compared to Control. Differences observed in the other parameters were unclear or possibly trivial. At Post-2, the perceived recovery-stress state was improved (small difference) in Experimental compared with Control. No difference in salivary cortisol response was observed while the preconditioning session induced a higher stimulation of salivary testosterone and alpha-amylase. CONCLUSIONS: The players' ability to repeat sprints and physical activity in match-play did not improve but their psychophysiological state was positively affected after the present pre-conditioning session.

Power Output and Pacing During International Cross-Country Mountain Bike Cycling.

PURPOSE: To characterize the physiological profiles of elite cross-country mountain-bike (XCO-MTB) cyclists and to examine their pacing and power-output (PO) distribution during international races. METHODS: Over 2 competitive seasons, 8 male XCO-MTB cyclists (VO2max 79.9 [5.2] mL·min-1·kg-1, maximal aerobic power [MAP] 411 [18] W and 6.3 [0.4] W·kg-1) regularly undertook incremental tests to assess their PO and heart rate (HR) at first and second ventilatory thresholds (VT1 and VT2) and at VO2max. During the same period, their PO, HR, speed, and cadence were recorded over 13 international races (total of 30 recorded files). RESULTS: Mean PO, speed, cadence, and HR during the races were 283 (22) W (4.31 [0.32] W·kg-1, 68% [5%] MAP), 19.7 (2.1) km·h-1, 68 (8) rpm, and 172 (11) beats·min-1 (91% [2%] HRmax), respectively. The average times spent below 10% of MAP, between 10% of MAP and VT1, between VT1 and VT2, between VT2 and MAP, and above MAP were 25% (5%), 21% (4%), 13% (3%), 16% (3%), and 26% (5%), respectively. Both speed and PO decreased from the start loop to lap 1 before stabilizing until the end of the race. CONCLUSIONS: Elite off-road cyclists demonstrated typical values of world-class endurance cyclists with an excellent power-to-mass ratio. This study demonstrated that XCO-MTB races are performed at higher intensities than reported in previous research and are characterized by a fast start followed by an even pace.

Optimizing Heat Acclimation for Endurance Athletes: High- Versus Low-Intensity Training.

PURPOSE: To determine the effect of high- versus low-intensity training in the heat and ensuing taper period in the heat on endurance performance. METHODS: In total, 19 well-trained triathletes undertook 5 days of normal training and a 1-wk taper including either low- (heat acclimation [HA-L], n = 10) or high-intensity (HA-H, n = 9) training sessions in the heat (30°C, 50% relative humidity). A control group (n = 10) reproduced their usual training in thermoneutral conditions. Indoor 20-km cycling time trials (35°C, 50% relative humidity) were performed before (Pre) and after the main heat exposure (Mid) and after the taper (Post). RESULTS: Power output remained stable in the control group from Pre to Mid (effect size: -0.10 [0.26]) and increased from Mid to Post (0.18 [0.22]). The HA-L group demonstrated a progressive increase in performance from Pre to Mid (0.62 [0.33]) and from Mid to Post (0.53 [0.30]), alongside typical physiological signs of HA (reduced core temperature and heart rate and increased body-mass loss). While the HA-H group presented similar adaptations, increased perceived fatigue and decreased performance at Mid (-0.35 [0.26]) were evidenced and reversed at Post (0.50 [0.20]). No difference in power output was reported at Post between the HA-H and control groups. CONCLUSION: HA-H can quickly induce functional overreaching in nonacclimatized endurance athletes. As it was associated with a weak subsequent performance supercompensation, coaches and athletes should pay particular attention to training monitoring during a final preparation in the heat and reduce training intensity when early signs of functional overreaching are identified.

Recurrence of Renal Cell Cancer After Renal Transplantation in a Multicenter French Cohort.

BACKGROUND: Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation. METHODS: We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pretransplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed. RESULTS: Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3 ± 2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs 0%, P = 0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (P = 0.025), tumor stage pT2 (P = 0.002), and Fuhrman grade IV (P < 0.001). Recurrences were associated with a high mortality rate; 76.9% of patients with recurrences had died by the end of the follow-up period. CONCLUSIONS: Recurrences of clear cell RCC are not uncommon after kidney transplantation and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.

Supercompensation Kinetics of Physical Qualities During a Taper in Team-Sport Athletes.

Peaking for major competition is considered critical for maximizing team-sport performance. However, there is little scientific information available to guide coaches in prescribing efficient tapering strategies for team-sport players. PURPOSE: To monitor the changes in physical performance in elite team-sport players during a 3-wk taper after a preseason training camp. METHODS: Ten male international rugby sevens players were tested before (Pre) and after (Post) a 4-wk preseason training camp focusing on high-intensity training and strength training with moderate loads and once each week during a subsequent 3-wk taper. During each testing session, midthigh-pull maximal strength, sprint-acceleration mechanical outputs, and performance, as well as repeated-sprint ability (RSA), were assessed. RESULTS: At Post, no single peak performance was observed for maximal lower-limb force output and sprint performance, while RSA peaked for only 1 athlete. During the taper, 30-m-sprint time decreased almost certainly (-3.1% ± 0.9%, large), while maximal lower-limb strength and RSA, respectively, improved very likely (+7.7% ± 5.3%, small) and almost certainly (+9.0% ± 2.6%, moderate). Of the peak performances, 70%, 80%, and 80% occurred within the first 2 wk of taper for RSA, maximal force output, and sprint performance, respectively. CONCLUSIONS: These results show the sensitivity of physical qualities to tapering in rugby sevens players and suggest that an ~1- to 2-wk tapering time frame appears optimal to maximize the overall physical-performance response.

Cognitive Functioning and Heat Strain: Performance Responses and Protective Strategies.

Despite the predominance of research on physical performance in the heat, many activities require high cognitive functioning for optimal performance (i.e. decision making) and/or health purposes (i.e. injury risk). Prolonged periods of demanding cognitive activity or exercise-induced fatigue will incur altered cognitive functioning. The addition of hot environmental conditions will exacerbate poor cognitive functioning and negatively affect performance outcomes. The present paper attempts to extract consistent themes from the heat-cognition literature to explore cognitive performance as a function of the level of heat stress encountered. More specifically, experimental studies investigating cognitive performance in conditions of hyperthermia, often via the completion of computerised tasks (i.e. cognitive tests), are used to better understand the relationship between endogenous thermal load and cognitive performance. The existence of an inverted U-shaped relationship between hyperthermia development and cognitive performance is suggested, and highlights core temperatures of ~38.5 °C as the potential 'threshold' for hyperthermia-induced negative cognitive performance. From this perspective, interventions to slow or blunt thermal loads and protect both task- and hyperthermia-related changes in task performances (e.g. cooling strategies) could be used to great benefit and potentially preserve cognitive performance during heat strain.

Quantifying Neuromuscular Fatigue Induced by an Intense Training Session in Rugby Sevens.

PURPOSE: To compare the sensitivity of a sprint vs a countermovement-jump (CMJ) test after an intense training session in international rugby sevens players, as well as analyze the effects of fatigue on sprint acceleration. METHODS: Thirteen international rugby sevens players completed two 30-m sprints and a set of 4 repetitions of CMJ before and after a highly demanding rugby sevens training session. RESULTS: Change in CMJ height was unclear (-3.6%; ±90% confidence limits 11.9%. Chances of a true positive/trivial/negative change: 24/10/66%), while a very likely small increase in 30-m sprint time was observed (1.0%; ±0.7%, 96/3/1%). A very likely small decrease in the maximum horizontal theoretical velocity (V0) (-2.4; ±1.8%, 1/4/95%) was observed. A very large correlation (r = -.79 ± .23) between the variations of V0 and 30-m-sprint performance was also observed. Changes in 30-m sprint time were negatively and very largely correlated with the distance covered above the maximal aerobic speed (r = -.71 ± .32). CONCLUSIONS: The CMJ test appears to be less sensitive than the sprint test, which casts doubts on the usefulness of a vertical-jump test in sports such as rugby that mainly involve horizontal motions. The decline in sprint performance relates more to a decrease in velocity than in force capability and is correlated with the distance covered at high intensity.

Assessing Overreaching With Heart-Rate Recovery: What Is the Minimal Exercise Intensity Required?

PURPOSE: Faster heart-rate recovery (HRR) after high to maximal exercise (≥90% of maximal heart rate) has been reported in athletes suspected of functional overreaching (f-OR). This study investigated whether this response would also occur at lower exercise intensity. METHODS: Responses of HRR and rating of perceived exertion (RPE) were compared during an incremental intermittent running protocol to exhaustion in 20 experienced male triathletes (8 control subjects and 13 overload subjects led to f-OR) before and immediately after an overload training period and after a 1-wk taper. RESULTS: Both groups demonstrated an increase in HRR values immediately after the training period, but this change was very likely to almost certainly larger in the f-OR group at all running intensities (large to very large differences, eg, +16 ± 7 vs +3 ± 5 beats/min, in the f-OR and control groups at 11 km/h, respectively). The highest between-groups differences in changes in HRR were reported at 11 km/h (13 ± 4 beats/min) and 12 km/h (10 ± 6 beats/min). A concomitant increase in RPE at all intensities was reported only in the f-OR group (large to extremely large differences, +2.1 ± 1.5 to +0.7 ± 1.5 arbitrary units). CONCLUSION: These findings confirm that faster HRR does not systematically predict better physical performance. However, when interpreted in the context of the athletes' fatigue state and training phase, HRR after submaximal exercise may be more discriminant than HRR measures taken after maximal exercise for monitoring f-OR. These findings may be applied in practice by regularly assessing HRR after submaximal exercise (ie, warm-up) for monitoring endurance athletes' responses to training.

Pacing Adjustments Associated With Familiarization: Heat Versus Temperate Environments.

PURPOSE: To describe the effect of the initial perceptual experience from heat familiarization on the pacing profile during a freepaced endurance time trial (TT) compared with temperate conditions. METHODS: Two groups of well-trained triathletes performed two 20-km TTs in either hot (35°C and 50% relative humidity [RH], n = 12) or temperate (21°C and 50% RH, n = 22) conditions, after standardization of training for each group before both trials. To ensure no physiological acclimation differences between conditions, the TTs for both groups were separated by 11 ± 4 d. RESULTS: Performance improvement in the heat (11 ± 24 W) from the 1st to 2nd trial appeared comparable to that in temperate conditions (8 ± 14 W, P = .67). However, the specific alteration in pacing profile in the heat was markedly different than temperate conditions, with a change from "positive" to an "even" pacing strategy. CONCLUSIONS: Altered perceptions of heat during heat familiarization, rather than physiological acclimatization per se, may mediate initial changes in pacing and TT performance in the heat. These results highlight the need for athletes without time for sufficient heat acclimatization to familiarize themselves with hot conditions to reduce the uncertainty from behavior-based outcomes that may impede performance.

The Development of Functional Overreaching Is Associated with a Faster Heart Rate Recovery in Endurance Athletes.

PURPOSE: The aim of the study was to investigate whether heart rate recovery (HRR) may represent an effective marker of functional overreaching (f-OR) in endurance athletes. METHODS AND RESULTS: Thirty-one experienced male triathletes were tested (10 control and 21 overload subjects) before (Pre), and immediately after an overload training period (Mid) and after a 2-week taper (Post). Physiological responses were assessed during an incremental cycling protocol to exhaustion, including heart rate, catecholamine release and blood lactate concentration. Ten participants from the overload group developed signs of f-OR at Mid (i.e. -2.1 ± 0.8% change in performance associated with concomitant high perceived fatigue). Additionally, only the f-OR group demonstrated a 99% chance of increase in HRR during the overload period (+8 ± 5 bpm, large effect size). Concomitantly, this group also revealed a >80% chance of decreasing blood lactate (-11 ± 14%, large), plasma norepinephrine (-12 ± 37%, small) and plasma epinephrine peak concentrations (-51 ± 22%, moderate). These blood measures returned to baseline levels at Post. HRR change was negatively correlated to changes in performance, peak HR and peak blood metabolites concentrations. CONCLUSION: These findings suggest that i) a faster HRR is not systematically associated with improved physical performance, ii) changes in HRR should be interpreted in the context of the specific training phase, the athletes perceived level of fatigue and the performance response; and, iii) the faster HRR associated with f-OR may be induced by a decreased central command and by a lower chemoreflex activity.