Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment.

The Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24-72 h after "over-exertion" and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms.

The Effects of a Carbohydrate Hydrogel System for the Delivery of Bicarbonate Mini-Tablets on Acid-Base Buffering and Gastrointestinal Symptoms in Resting Well-trained Male Cyclists.

BACKGROUND: A new commercially available sodium bicarbonate (SB) supplement claims to limit gastrointestinal (GI) discomfort and increase extracellular buffering capacity. To date, no available data exists to substantiate such claims. Therefore, the aim of this study was to measure blood acid-base balance and GI discomfort responses following the ingestion of SB using the novel "Bicarb System" (M-SB). Twelve well-trained male cyclists completed this randomised crossover designed study. Maximal oxygen consumption was determined in visit one, whilst during visits two and three participants ingested 0.3 g∙kg-1 BM SB using M-SB (Maurten, Sweden) or vegetarian capsules (C-SB) in a randomised order. Finger prick capillary blood samples were measured every 30 min for pH, bicarbonate (HCO3-), and electrolytes (potassium, chloride, calcium, and sodium), for 300 min. Visual analogue scales (VAS) were used to assess GI symptoms using the same time intervals. RESULTS: Peak HCO3- was 0.95 mmol∙L-1 greater following M-SB (p = 0.023, g = 0.61), with time to peak HCO3- achieved 38.2 min earlier (117 ± 37 vs. 156 ± 36 min; p = 0.026, r = 0.67) and remained elevated for longer (p = 0.043, g = 0.51). No differences were observed for any electrolytes between the conditions. Aggregated GI discomfort was reduced by 79 AU following M-SB (p < 0.001, g = 1.11), with M-SB reducing stomach cramps, bowel urgency, diarrhoea, belching, and stomach-ache compared to C-SB. CONCLUSIONS: This is the first study to report that M-SB can increase buffering capacity and reduce GI discomfort. This presents a major potential benefit for athletes considering SB as an ergogenic supplement as GI discomfort is almost eliminated. Future research should determine if M-SB is performance enhancing.

The novel 'Bicarb System' (M-SB) reduced, and almost eliminated the gastrointestinal (GI) discomfort compared to vegetarian capsules (C-SB). The changes in acid-base balance following ingestion of M-SB were significantly greater compared to C-SB. It is unkown if this would translate to increased performance benefits, however, and the next step therefore is to determine the performance responses from M-SB. The increase in HCO₃⁻ was sustained >5 mmol L⁻¹ HCO₃⁻ for longer with M-SB ingestion versus C-SB. This might suggest there is an "ergogenic window", and ingestion timing could therefore be flexible prior to exercise.

Nutritional Supplement Use in a UK High-Performance Swimming Club.

The aim of this study was to observe the nutritional supplement practices of highly trained swimmers on a national talent pathway, since it is often reported that swimmers engage in widespread supplement use at the elite level. Thus, this study employed a validated supplement intake questionnaire with forty-four swimmers from a high-performance swimming club, which had three distinct talent stages: development (aged 11-14 years, n = 20), age-group (aged 13-17 years, n = 13), and national level (aged ≥ 16 years, n = 11). Ninety-eight percent of the interviewed swimmers reported using at least one supplement, with performance (34%) and recovery (19%) cited as the primary reasons. National swimmers used more total supplements (8.1 ± 3.4 supplements) compared to age-group (4.8 ± 2.0 supplements, p = 0.003, g = 1.17) and development (3.9 ± 1.7 supplements, p < 0.001, g = 1.69) swimmers, mostly because of a greater intake of ergogenic aids (2.4 ± 1.4 supplements vs. age-group: 0.5 ± 0.5 supplements, p < 0.001, g = 1.12; vs. development: 0.1 ± 0.2 supplements, p < 0.001, g = 1.81). Parents/guardians were the primary supplement informants of development swimmers (74%, p < 0.001, V = 0.50), whereas performance nutritionists informed ~50% of supplements used by age-group and national swimmers (p < 0.001, V = 0.51). Based on these results, supplement education and greater focus on basic sport nutrition practices may be required for parents/guardians at the development level. Moreover, further research is needed to support the high number of ergogenic aids used by national swimmers, with the efficacy of these supplements currently equivocal in the applied setting.

Sodium Bicarbonate and Time-to-Exhaustion Cycling Performance: A Retrospective Analysis Exploring the Mediating Role of Expectation.

BACKGROUND: Research has shown that ingesting 0.3 g·kg-1 body mass sodium bicarbonate (NaHCO3) can improve time-to-exhaustion (TTE) cycling performance, but the influence of psychophysiological mechanisms on ergogenic effects is not yet understood. OBJECTIVE: This study retrospectively examined whether changes in TTE cycling performance are mediated by positive expectations of receiving NaHCO3 and/or the decline in blood bicarbonate during exercise. METHODS: In a randomised, crossover, counterbalanced, double-blind, placebo-controlled design, 12 recreationally trained cyclists (maximal oxygen consumption, 54.4 ± 5.7 mL·kg·min-1) performed four TTE cycling tests 90 min after consuming: (1) 0.3 g·kg-1 body mass NaHCO3 in 5 mL·kg-1 body mass solution, (2) 0.03 g·kg-1 body mass sodium chloride in solution (placebo), (3) 0.3 g·kg-1 body mass NaHCO3 in capsules and (4) cornflour in capsules (placebo). Prior to exercise, participants rated on 1-5 Likert type scales how much they expected the treatment they believe had been given would improve performance. Capillary blood samples were measured for acid-base balance at baseline, pre-exercise and post-exercise. RESULTS: Administering NaHCO3 in solution and capsules improved TTE compared with their respective placebos (solution: 27.0 ± 21.9 s, p = 0.001; capsules: 23.0 ± 28.1 s, p = 0.016). Compared to capsules, NaHCO3 administered via solution resulted in a higher expectancy about the benefits on TTE cycling performance (Median: 3.5 vs. 2.5, Z = 2.135, p = 0.033). Decline in blood bicarbonate during exercise was higher for NaHCO3 given in solution compared to capsules (2.7 ± 2.1 mmol·L-1, p = 0.001). Mediation analyses showed that improvements in TTE cycling were indirectly related to expectancy and decline in blood bicarbonate when NaHCO3 was administered in solution but not capsules. CONCLUSIONS: Participants' higher expectations when NaHCO3 is administered in solution could result in them exerting themselves harder during TTE cycling, which subsequently leads to a greater decline in blood bicarbonate and larger improvements in performance. KEY POINTS: Ingesting 0.3 g·kg-1 body mass sodium bicarbonate in solution and capsules improved time-to-exhaustion cycling performance Positive expectancy about the benefits of sodium bicarbonate and decline in blood bicarbonate were higher when sodium bicarbonate was administered in solution compared with capsules Improvements in time-to-exhaustion cycling performance for sodium bicarbonate administered in solution were related to expectancy and the enhanced extracellular buffering response.

Beneficial effects of oral and topical sodium bicarbonate during a battery of team sport-specific exercise tests in recreationally trained male athletes.

OBJECTIVE: This study examined the effects of oral and topical (PR Lotion; Momentous) sodium bicarbonate (NaHCO3) during a battery of team sport-specific exercise tests. METHOD: In a block randomized, crossover, double-blind, placebo-controlled design, 14 recreationally trained male team sport athletes performed a familiarization visit and three experimental trials receiving: (i) 0.3 g·kg-1 body mass (BM) NaHCO3 in capsules + placebo lotion (SB-ORAL), (ii) placebo capsules +0.9036 g·kg-1 BM PR Lotion (SB-LOTION), or (iii) placebo capsules + placebo lotion (PLA). Supplements were given ~120 min prior to the team sport-specific exercise tests: countermovement jumps (CMJ), 8 × 25 m repeated sprints and Yo-Yo Intermittent Recovery Level 2 (Yo-Yo IR2). Blood acid-base balance (pH, bicarbonate) and electrolytes (sodium, potassium) were measured throughout. Rating of perceived exertion (RPE) was recorded after each sprint and post-Yo-Yo IR2. RESULTS: Distance covered during the Yo-Yo IR2 was 21% greater for SB-ORAL compared with PLA (+94 m; p = 0.009, d = 0.64) whereas performance was only 7% greater for SB-LOTION compared with PLA (480 ± 122 vs. 449 ± 110 m; p = 0.084). Total completion time for the 8 × 25 m repeated sprint test was 1.9% faster for SB-ORAL compared with PLA (-0.61 s; p = 0.020, d = 0.38) and 2.0% faster for SB-LOTION compared with PLA (-0.64 s; p = 0.036, d = 0.34). CMJ performance was similar between treatments (p > 0.05). Blood acid-base balance and electrolytes were significantly improved for SB-ORAL compared with PLA, but no differences were observed for SB-LOTION. Compared to PLA, RPE was lower for SB-LOTION after the fifth (p = 0.036), sixth (p = 0.012), and eighth (p = 0.040) sprints and for SB-ORAL after the sixth (p = 0.039) sprint. CONCLUSIONS: Oral NaHCO3 improved 8 × 25 m repeated sprint (~2%) and Yo-Yo IR2 performance (21%). Similar improvements in repeated sprint times were observed for topical NaHCO3 (~2%), but no significant benefits were reported for Yo-Yo IR2 distance or blood acid-base balance compared to PLA. These findings suggest that PR Lotion might not be an effective delivery system for transporting NaHCO3 molecules across the skin and into systematic circulation, therefore further research is needed to elucidate the physiological mechanisms responsible for the ergogenic effects of PR Lotion.

The Impact of COVID-19 on the Social Determinants of Cardiovascular Health.

Cardiovascular disease is the leading noncommunicable disease and cause of premature mortality globally. Despite well established evidence of a cause-effect relationship between modifiable lifestyle behaviours and the onset of risk of chronic disease, preventive approaches to curtail increasing prevalence have been ineffective. This has undoubtedly been exacerbated by the response to COVID-19, which saw widespread national lockdowns implemented to reduce transmission and alleviate pressure on strained health care systems. A consequence of these approaches was a well documented negative impact on population health in the context of both physical and mental well-being. Although the true extent of the impact of the COVID-19 response on global health has yet to be fully realised or understood, it seems prudent to review effective preventative and management strategies that have yielded positive outcomes across the spectrum (ie, from individual to society). There is also a clear need to heed lessons learned from the COVID-19 experience in the power of collaboration and how this can be used in the design, development, and implementation of future approaches to address the longstanding burden of cardiovascular disease.

COVID-19 and elite sport: Cardiovascular implications and return-to-play.

Curtailing elite sports during the coronavirus disease 2019 (COVID-19) pandemic was necessary to prevent widespread viral transmission. Now that elite sport and international competitions have been largely restored, there is still a need to devise appropriate screening and management pathways for athletes with a history of, or current, COVID-19 infection. These approaches should support the decision-making process of coaches, sports medicine practitioners and the athlete about the suitability to return to training and competition activities. In the absence of longitudinal data sets from athlete populations, the incidence of developing prolonged and debilitating symptoms (i.e., Long COVID) that affects a return to training and competition remains a challenge to sports and exercise scientists, sports medicine practitioners and clinical groups. As the world attempts to adjust toward 'living with COVID-19' the very nature of elite and international sporting competition poses a risk to athlete welfare that must be screened for and managed with bespoke protocols that consider the cardiovascular implications for performance.

Efficacy of sodium bicarbonate ingestion strategies for protecting blinding.

Sodium bicarbonate (NaHCO3) is a widely researched ergogenic aid, but the optimal blinding strategy during randomised placebo-controlled trials is unknown. In this multi-study project, we aimed to determine the most efficacious ingestion strategy for blinding NaHCO3 research. During study one, 16 physically active adults tasted 0.3 g kg-1 body mass NaHCO3 or 0.03 g kg-1 body mass sodium chloride placebo treatments given in different flavour (orange, blackcurrant) and temperature (chilled, room temperature) solutions. They were required to guess which treatment they had received. During study two, 12 recreational athletes performed time-to-exhaustion (TTE) cycling trials (familiarisation, four experimental). Using a randomised, double-blind design, participants consumed 0.3 g kg-1 body mass NaHCO3 or a placebo in 5 mL kg-1 body mass chilled orange squash/water solutions or capsules and indicated what they believed they had received immediately after consumption, pre-TTE and post-TTE. In study one, NaHCO3 prepared in chilled orange squash resulted in the most unsure ratings (44%). In study two, giving NaHCO3 in capsules resulted in more unsure ratings than in solution after consumption (92 vs 33%), pre-TTE (67 vs. 17%) and post-TTE (50 vs. 17%). Administering NaHCO3 in capsules was the most efficacious blinding strategy which provides important implications for researchers conducting randomised placebo-controlled trials.

Evening Caffeine Did Not Improve 100-m Swimming Time Trials Performed 60 Min Post-Ingestion or the Next Morning After Sleep.

The potential ergogenic benefits of caffeine (CAF) are well known within the athletic community, often leading to its use in adolescent swimming cohorts to enhance their performance. However, it has previously been reported that CAF has sleep-disturbing effects, which could be detrimental to performance over consecutive days in multiday competitions. Moreover, the effects that evening CAF ingestion has on sleep, side effects, and next-day performances are yet to be researched in trained adolescents. In a double-blind, randomized, crossover design, eight national-level swimmers (age: 18 ± 1 years, height: 1.76 ± 0.06 cm, body mass [BM]: 69.4 ± 6.4 kg) ingested a capsule containing 3 mg/kg BM CAF or a placebo 60 min before an evening 100-m swimming time trial. The next morning, sleep was analyzed (Core Consensus Sleep Diary) and 100-m time trials were repeated. Side effects were analyzed via visual analog scales throughout the study. No differences were found for swimming performance (p = .911) in the evening (CAF: 59.5 ± 7.8 s, placebo: 59.9 ± 7.9 s, g = 0.06) or morning (CAF: 59.7 ± 7.7 s, placebo: 60.2 ± 7.9 s, g = 0.07). In addition, no group differences were found for any subjective side effects (e.g., anxiety: p = .468, tachycardia: p = .859, alertness: p = .959) or sleep parameters (e.g., sleep latency: p = .395, total sleep time: p = .574). These results question the use of a standardized 3 mg/kg BM CAF ingestion strategy for 100-m swimming time trials in trained adolescents, although objective measures may be needed to confirm that CAF does not affect sleep within this cohort.

Nutritional intakes of highly trained adolescent swimmers before, during, and after a national lockdown in the COVID-19 pandemic.

Strict lockdown measures were introduced in response to the COVID-19 pandemic, which caused mass disruption to adolescent swimmers' daily routines. To measure how lockdown impacted nutritional practices in this cohort, three-day photograph food diaries were analysed at three time points: before (January), during (April), and after (September) the first UK lockdown. Thirteen swimmers (aged 15 ± 1 years) from a high-performance swimming club submitted satisfactory food diaries at all time points. During lockdown, lower amounts of energy (45.3 ± 9.8 vs. 31.1 ± 7.7 kcal∙kg BM∙day-1, p<0.001), carbohydrate (5.4 ± 1.2 vs. 3.5 ± 1.1 g∙kg BM∙day-1, p<0.001), protein (2.3 ± 0.4 vs. 1.7 ± 0.4 g∙kg BM∙day-1, p = 0.002), and fat (1.6 ± 0.4 vs. 1.1 ± 0.3 g∙kg BM∙day-1, p = 0.011) were reported. After lockdown, no nutritional differences were found in comparison compared to before lockdown (energy: 44.0 ± 12.1 kcal∙kg BM∙day-1; carbohydrate: 5.4 ± 1.4 g∙kg BM∙day-1; protein: 2.1 ± 0.6 g∙kg BM∙day-1; fat: 1.5 ± 0.6 g ∙kg BM∙day-1, all p>0.05), despite fewer training hours being completed (15.0 ± 1.4 vs. 19.1 ± 2.2 h∙week-1, p<0.001). These findings highlight the ability of adolescent swimmers to alter their nutrition based on their changing training circumstances when receiving sport nutrition support. However, some individuals displayed signs of suboptimal nutrition during lockdown that were not corrected once training resumed. This warrants future research to develop interactive education workshops that maintain focus and motivation towards optimal nutrition practices in isolated periods away from training.

No independent or synergistic effects of carbohydrate-caffeine mouth rinse on repeated sprint performance during simulated soccer match play in male recreational soccer players.

The study examined the synergistic and independent effects of carbohydrate-caffeine mouth rinse on repeated sprint performance during simulated soccer match play. Nine male soccer players (21 ± 3 years, 1.75 ± 0.05 m, 68.0 ± 9.0 kg) completed four trials with either 6 mg·kg-1 caffeine + 10% maltodextrin (CHO+CAFMR), 6 mg·kg-1 caffeine (CAFMR), 10% maltodextrin (CHOMR), water (PLA) in a block randomised, double-blinded, counterbalanced and crossover manner separated by minimum 96 h. All solutions were taste-matched and a carbohydrate-rich meal (2 g·kg-1body mass) was provided 2 h before each trial. Each trial consisted of a 90-min soccer-specific aerobic field test (SAFT90) and two bouts of repeated sprint ability tests (RSAT; 6 × 6 s sprints with 24 s recovery) completed at 0 min and 75th min of SAFT90. A 25 ml solution of either CHO+CAFMR, CAFMR, CHOMR or PLA was rinsed immediately before the second RSAT (75 min). Mean power output, peak power output (PPO) or fatigue index (FI) was not impacted by any treatment during the 75th min RAST (p > 0.05). These results suggest that carbohydrate and/or caffeine mouth rinses do not have an ergogenic effect during simulated soccer exercise after a high carbohydrate meal.

The effects of sodium bicarbonate supplementation at individual time-to-peak blood bicarbonate on 4-km cycling time trial performance in the heat.

The purpose of this study was to explore the effect of individualised sodium bicarbonate (NaHCO3) supplementation according to a pre-established individual time-to-peak (TTP) blood bicarbonate (HCO3-) on 4-km cycling time trial (TT) performance in the heat. Eleven recreationally trained male cyclists (age: 28 ± 6 years, height: 180 ± 6 cm, body mass: 80.5 ± 8.4 kg) volunteered for this study in a randomised, crossover, triple-blind, placebo-controlled design. An initial visit was conducted to determine TTP HCO3- following 0.2 g.kg-1 body mass (BM) NaHCO3 ingestion. Subsequently, on three separate occasions, participants completed a 4-km cycling TT in the heat (30 degrees centigrade; °C) (relative humidity ∼40%) following ingestion of either NaHCO3 (0.2 g.kg-1 body mass), a sodium chloride placebo (0.2 g.kg-1 BM; PLA) at the predetermined individual TTP HCO3-, or no supplementation (control; CON) . Absolute peak [HCO3-] prior to the 4-km cycling TT's was elevated for NaHCO3 compared to PLA (+2.8 mmol.l-1; p = 0.002; g = 2.2) and CON (+2.5 mmol.l-1; p < 0.001; g = 2.1). Completion time following NaHCO3 was 5.6 ± 3.2 s faster than PLA (1.6%; CI: 2.8, 8.3; p = 0.001; g = 0.2) and 4.7 ± 2.8 s faster than CON (1.3%; CI: 2.3, 7.1; p = 0.001; g = 0.2). These results demonstrate that NaHCO3 ingestion at a pre-established individual TTP HCO3- improves 4-km cycling TT performance in the heat, likely through enhancing buffering capacity.Highlights This is the first time NaHCO3 ingestion has been shown to improve 4-km cycling TT performance in conditions of high ambient heat.A smaller dose of NaHCO3 (0.2 g.kg-1 BM) is ergogenic in the heat, which is smaller than the dose typically ingested for sports performance (0.3 g.kg-1 BM). This is important, as gastrointestinal discomfort is typically lower as the dose reduces.This study suggests that the individualised time-to-peak HCO3- ingestion strategy with lower doses of NaHCO3 is an ergogenic strategy in conditions of high ambient heat.

The Effects of a Nutrition Education Intervention on Sports Nutrition Knowledge during a Competitive Season in Highly Trained Adolescent Swimmers.

The aim of this study was to evaluate the effects of a seven-week nutrition education intervention on the sports nutrition knowledge (SNK) of highly trained UK adolescent swimmers. Fifteen national and international adolescent swimmers (males = 5; females = 10, 15.5 ± 1.1 years, 170.2 ± 7.5 cm, 60.3 ± 5.7 kg) participated in the study during seven consecutive weeks of the competitive swimming season. The participants received 30 min of nutrition education once per week in a classroom-based setting after they had completed their regular swim training. An undergraduate sports nutrition student delivered all nutrition education sessions and SNK questionnaires were administered to the participants pre- and post-intervention. The mean total SNK score improved by 8.3% (SD = 8.4%, 95% CI = 4.1-12.6; p = 0.006; ES = 1.0) following the nutrition education sessions. On an individual basis, ten swimmers significantly improved their total SNK score, whereas four swimmers did not improve, and one swimmer performed significantly worse after the intervention. Moreover, the swimmers' knowledge of hydration improved by 22.2% (SD = 20.6%, 95% CI = 11.8-32.6, p = 0.004, ES = 1.1) over the seven-week timeframe, which was the only nutrition topic to have a significantly increased knowledge score. The current study therefore suggests that a nutrition education intervention can positively influence the SNK of highly trained adolescent swimmers.

A critical review of citrulline malate supplementation and exercise performance.

As a nitric oxide (NO) enhancer, citrulline malate (CM) has recently been touted as a potential ergogenic aid to both resistance and high-intensity exercise performance, as well as the recovery of muscular performance. The mechanism has been associated with enhanced blood flow to active musculature, however, it might be more far-reaching as either ammonia homeostasis could be improved, or ATP production could be increased via greater availability of malate. Moreover, CM might improve muscle recovery via increased nutrient delivery and/or removal of waste products. To date, a single acute 8 g dose of CM on either resistance exercise performance or cycling has been the most common approach, which has produced equivocal results. This makes the effectiveness of CM to improve exercise performance difficult to determine. Reasons for the disparity in conclusions seem to be due to methodological discrepancies such as the testing protocols and the associated test-retest reliability, dosing strategy (i.e., amount and timing), and the recent discovery of quality control issues with some manufacturers stated (i.e., citrulline:malate ratios). Further exploration of the optimal dose is therefore required including quantification of the bioavailability of NO, citrulline, and malate following ingestion of a range of CM doses. Similarly, further well-controlled studies using highly repeatable exercise protocols with a large aerobic component are required to assess the mechanisms associated with this supplement appropriately. Until such studies are completed, the efficacy of CM supplementation to improve exercise performance remains ambiguous.

The time to peak blood bicarbonate (HCO3-), pH, and the strong ion difference (SID) following sodium bicarbonate (NaHCO3) ingestion in highly trained adolescent swimmers.

The timing of sodium bicarbonate (NaHCO3) supplementation has been suggested to be most optimal when coincided with a personal time that bicarbonate (HCO3-) or pH peaks in the blood following ingestion. However, the ergogenic mechanisms supporting this ingestion strategy are strongly contested. It is therefore plausible that NaHCO3 may be ergogenic by causing beneficial shifts in the strong ion difference (SID), though the time course of this blood acid base balance variable is yet to be investigated. Twelve highly trained, adolescent swimmers (age: 15.9 ± 1.0 years, body mass: 65.3 ± 9.6 kg) consumed their typical pre-competition nutrition 1-3 hours before ingesting 0.3 g∙kg BM-1 NaHCO3 in gelatine capsules. Capillary blood samples were then taken during seated rest on nine occasions (0, 60, 75, 90, 105, 120, 135, 150, 165 min post-ingestion) to identify the time course changes in HCO3-, pH, and the SID. No significant differences were found in the time to peak of each blood measure (HCO3-: 130 ± 35 min, pH: 120 ± 38 min, SID: 98 ± 37 min; p = 0.08); however, a large effect size was calculated between time to peak HCO3- and the SID (g = 0.88). Considering that a difference between time to peak blood HCO3- and the SID was identified in adolescents, future research should compare the ergogenic effects of these two individualized NaHCO3 ingestion strategies compared to a traditional, standardized approach.

Effects of post-exercise sodium bicarbonate ingestion on acid-base balance recovery and time-to-exhaustion running performance: a randomised crossover trial in recreational athletes.

This study investigated the effect of post-exercise sodium bicarbonate (NaHCO3) ingestion on acid-base balance recovery and time-to-exhaustion (TTE) running performance. Eleven male runners (stature, 1.80 ± 0.05 m; body mass, 74.4 ± 6.5 kg; maximal oxygen consumption, 51.7 ± 5.4 mL·kg-1·min-1) participated in this randomised, single-blind, counterbalanced and crossover design study. Maximal running velocity (v-V̇O2max) was identified from a graded exercise test. During experimental trials, participants repeated 100% v-V̇O2max TTE protocols (TTE1, TTE2) separated by 40 min following the ingestion of either 0.3 g·kg-1 body mass NaHCO3 (SB) or 0.03 g·kg-1 body mass sodium chloride (PLA) at the start of TTE1 recovery. Acid-base balance (blood pH and bicarbonate, HCO3-) data were studied at baseline, post-TTE1, after 35 min recovery and post-TTE2. Blood pH and HCO3- concentration were unchanged at 35 min recovery (p > 0.05), but HCO3- concentration was elevated post-TTE2 for SB vs. PLA (+2.6 mmol·L-1; p = 0.005; g = 0.99). No significant differences were observed for TTE2 performance (p > 0.05), although a moderate effect size was present for SB vs. PLA (+14.3 s; g = 0.56). Post-exercise NaHCO3 ingestion is not an effective strategy for accelerating the restoration of acid-base balance or improving subsequent TTE performance when limited recovery is available. Novelty: Post-exercise sodium bicarbonate ingestion did not accelerate the restoration of blood pH or bicarbonate after 35 min. Performance enhancing effects of sodium bicarbonate ingestion may display a high degree of inter-individual variation. Small-to-moderate changes in performance were likely due to greater up-regulation of glycolytic activation during exercise.

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.

The effect of astaxanthin supplementation on performance and fat oxidation during a 40 km cycling time trial.

OBJECTIVES: This study aimed to investigate whether supplementation with 12 mg⋅day-1 astaxanthin for 7 days can improve exercise performance and metabolism during a 40 km cycling time trial. DESIGN: A randomised, double-blind, crossover design was employed. METHODS: Twelve recreationally trained male cyclists (VO2peak: 56.5 ± 5.5 mL⋅kg-1⋅min-1, Wmax: 346.8  ± 38.4 W) were recruited. Prior to each experimental trial, participants were supplemented with either 12 mg⋅day-1 astaxanthin or an appearance-matched placebo for 7 days (separated by 14 days of washout). On day 7 of supplementation, participants completed a 40 km cycling time trial on a cycle ergometer, with indices of exercise metabolism measured throughout. RESULTS: Time to complete the 40 km cycling time trial was improved by 1.2 ± 1.7% following astaxanthin supplementation, from 70.76 ± 3.93 min in the placebo condition to 69.90 ± 3.78 min in the astaxanthin condition (mean improvement = 51 ± 71 s, p = 0.029, g = 0.21). Whole-body fat oxidation rates were also greater (+0.09 ± 0.13 g⋅min-1, p = 0.044, g = 0.52), and the respiratory exchange ratio lower (-0.03 ± 0.04, p = 0.024, g = 0.60) between 39-40 km in the astaxanthin condition. CONCLUSIONS: Supplementation with 12 mg⋅day-1 astaxanthin for 7 days provided an ergogenic benefit to 40 km cycling time trial performance in recreationally trained male cyclists and enhanced whole-body fat oxidation rates in the final stages of this endurance-type performance event.

The Effects of a Soccer-Specific Fitness Test on Eccentric Knee Flexor Strength.

CONTEXT: Physiological fitness testing, such as the Yo-Yo Intermittent Recovery Test (YYIR) is a key requirement of the Elite Player Performance Plan, introduced by the English Premier League. Eccentric hamstring strength has been identified as a risk factor for hamstring injuries in soccer players, with fatigue highlighted to further exasperate this issue. OBJECTIVE: The aim of the current study was to examine the effect of the YYIR level 1 (YYIR1) on eccentric knee flexor strength assessed using the NordBord in youth soccer players. DESIGN: Experimental design. SETTING: Soccer club academy. PARTICIPANTS: A total of 67 male academy soccer players (age = 16.58 [0.57] y; height = 175.45 [5.85] cm; mass = 66.30 [8.21] kg) volunteered to participate in the current study during the English competitive soccer season. MAIN OUTCOME MEASURES: Participants conducted eccentric hamstring strength assessments using the NordBord prior to and immediately postcompletion of the YYIR1, with outcome measures of peak force and peak force relative to body mass recorded. RESULTS: Paired t tests highlighted increased absolute eccentric knee flexor strength values (P < .001) immediately post-YYIR1 for both the dominant and nondominant limbs, with the same trend (P < .001) observed for eccentric strength relative to body mass. CONCLUSIONS: The results of this study indicate that the YYIR1 does not induce eccentric knee flexor fatigue and as such is not a valid assessment method to assess the effects of fatigue on hamstring function. However, results do suggest that the NordBord may be considered a viable and more accessible alternative to detect pre-post fitness test/fatigue protocol differences in eccentric knee flexor peak strength while working in the field.

Sodium Bicarbonate Ingestion Improves Time-to-Exhaustion Cycling Performance and Alters Estimated Energy System Contribution: A Dose-Response Investigation.

This study investigated the effects of two sodium bicarbonate (NaHCO3) doses on estimated energy system contribution and performance during an intermittent high-intensity cycling test (HICT), and time-to-exhaustion (TTE) exercise. Twelve healthy males (stature: 1.75 ± 0.08 m; body mass: 67.5 ± 6.3 kg; age: 21.0 ± 1.4 years; maximal oxygen consumption: 45.1 ± 7.0 ml.kg.min-1) attended four separate laboratory visits. Maximal aerobic power (MAP) was identified from an incremental exercise test. During the three experimental visits, participants ingested either 0.2 g.kg-1 BM NaHCO3 (SBC2), 0.3 g.kg-1 BM NaHCO3 (SBC3), or 0.07 g.kg-1 BM sodium chloride (placebo; PLA) at 60 min pre-exercise. The HICT involved 3 × 60 s cycling bouts (90, 95, 100% MAP) interspersed with 90 s recovery, followed by TTE cycling at 105% MAP. Blood lactate was measured after each cycling bout to calculate estimates for glycolytic contribution to exercise. Gastrointestinal (GI) upset was quantified at baseline, 30 and 60 min post-ingestion, and 5 min post-exercise. Cycling TTE increased for SBC2 (+20.2 s; p = 0.045) and SBC3 (+31.9 s; p = 0.004) compared to PLA. Glycolytic contribution increased, albeit non-significantly, during the TTE protocol for SBC2 (+7.77 kJ; p = 0.10) and SBC3 (+7.95 kJ; p = 0.07) compared to PLA. GI upset was exacerbated post-exercise after SBC3 for nausea compared to SBC2 and PLA (p < 0.05), whilst SBC2 was not significantly different to PLA for any symptom (p > 0.05). Both NaHCO3 doses enhanced cycling performance and glycolytic contribution, however, higher doses may maximize ergogenic benefits.