COVID-19 - Why we should monitor Fatigue Indicators in Endurance Athletes
Assuming the progressive resumption of training at the highest level, I come to share with you some of the current concerns transversal to the High Performance Medical Community, which are related to the integration of the risk of exposure to SARS-COV2 in the management of training considering the impact of high volume and intensity training on athletes' immune capacity.
It is widely known to the athletic community that the individual's immunity is dynamic and actively influenced by the intensity, type and duration of exercise (1,2,3). Several studies have shown that high intensity / volume exercise mimics in the acute phase and in cellular and immunological terms, trauma and some disease states, inducing the production of numerous pro and anti-inflammatory mediators (2,3). The individual's immunity profile reflects the balance or imbalance between these mediators and, therefore, the relationship between the volume and intensity of physical exercise and the susceptibility to infection, namely of the upper airways, has been attributed a “J” curve (4,5) (such as shown in the following image):
This topic has been the subject of more intense investigation since the 1980s, which has shown a greater risk of dysfunction of the immune system associated with physical exercise in endurance / ultra endurance athletes (with higher risk for females) presenting in addition to persistently high volumes and intensities of training or competition, decreased sleep quantity and quality, inadequate food / nutrition restrictions and prolonged states of psychological stress (6-8). In this context, the periods of immune system dysfunction associated with strenuous physical exercise have been crudely referred to as “Window of Opportunity” period for infections, namely viral.
The International Olympic Committee has been actively involved in the discussion of this topic and has underlined the need to carry out an active and aggressive integrated management among the variables mentioned above in order to avoid the disease states and respective complications that inexorably condition the performance and compromise the health of the athletes .
Nevertheless, the progression of performance is based on the concept of Hormesis, and as such, preparation at the highest level implies breaking physiological boundaries through tissue damage and consequent transient physiological and immune dysfunction that in turn will induce an adaptive counter-regulating response that generates a functionally more effective and effective balance that translates into progression in performance. This concept places sometimes athletes in overreaching states, increasing the probability of exposure to altered immune regulation considered by some as the “window of opportunity” described above.
Consequently, carrying out the preparation of athletes at the highest level implies assuming the risk of transient dysfunction of the immune system, even if diminished by an aggressive and integrated control of rest / sleep, psychological management, nutrition and careful management of the competitive calendar.
Until now, the FAWZ team, aware of this need, has made every effort to control the indicators of fatigue and the risk of illness and injury. Nevertheless, the presence in the community of a new variable such as the new coronavirus SARS-COV2, responsible for COVID19, has imposed the need to change the previously installed model, or simply to enforce it even more rigorously.
One of the effects of the “Lock-Down” was the reduction of the training load in high-performance athletes and as such, there is still insufficient information published about the SARS-COV2 relationship and exercise-induced immunosuppression. In this context, the medical community in general and our FAWZ team in particular are (allow me the term), under “navigation in sight”, which implies approaching this issue in the near future with prudence and responsibility.
Therefore, I consider that, for the first macrocycle to come after the end of the "Lock-Down", the application of the following conditions, aimed at the prevention and early identification of the states of immunodesregulation induced by physical exercise, should be considered (9):
1. Stimulate and verify the application of public health rules, namely the use of masks in closed places, comply with social distance and maintain hygiene rules;
2. Be aware of the signs and symptoms that may indicate infection by SARS-COV2 and immediately communicate with the health authorities in case of suspicion;
3. Monitoring of fatigue states, namely signs and symptoms of overreaching, overtraining or illness, using subjective and objective indicators. In this context, consider using, whenever necessary, analytical biochemical tools (hematological, serum and / or salivary).
4. Following the previous point, maintain, whenever possible, the monthly evaluation and the issuance of personalized Nutrition and Supplementation Plans aimed at increasing immunity / recovery and performance;
5. Promote an integrated analysis of the general state of the athletes involving the Doctor and the respective coach and intervene accordingly;
With regard to physical exercise load management and competitive calendar, I suggest:
1. Creation of detailed and individualized training and competition plans that promote sufficient recovery based on rest and sleep, nutrition, hydration and psychological coping strategies;
2. Use a progressive model, although not very aggressive, to increase the workload, with a percentage of weekly increase estimated at 10%, obviously adjusted to the adaptive parameters expressed by the athlete;
3. Develop an individualized competitive calendar based on the athlete's health status;
4. Avoid training whenever the athlete is ill or has symptoms and / or early signs of illness (which may increase the severity and duration of illness);
Rui Escaleira
References:
1. H.B. Simon The immunology of exercise: a brief review JAMA, 252 (1984), pp. 2735-2738
2. R.J. Simpson, H. Kunz, N. Agha, R. Graff Exercise and the regulation of immune functions Prog Mol Biol Transl Sci, 135 (2015), pp. 355-380
3. H. Northoff, A. Berg Immunologic mediators as parameters of the reaction to strenuous exercise Int J Sports Med, 12 (Suppl. 1) (1991), pp. S9-15
4. D.C. Nieman, L.M. Johanssen, J.W. Lee Infectious episodes in runners before and after a roadrace J Sports Med Phys Fitness, 29 (1989), pp. 289-296
5. D.C. Nieman, L.M. Johanssen, J.W. Lee, K. Arabatzis Infectious episodes in runners before and after the Los Angeles Marathon J Sports Med Phys Fitness, 30 (1990), pp. 316-328
6. M. Drew, N. Vlahovich, D. Hughes, R. Appaneal, L.M. Burke, B. Lundy, et al. Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games
7. A. Prien, M. Mountjoy, J. Miller, K. Boyd, C. van den Hoogenband, D. Gerrard, et al. Injury and illness in aquatic sport: how high is the risk? A comparison of results from three FINA World Championships Br J Sports Med, 51 (2017), pp. 277-282
8. L. Engebretsen, T. Soligard, K. Steffen, J.M. Alonso, M. Aubry, R. Budgett, et al. Sports injuries and illnesses during the London Summer Olympic Games 2012 Br J Sports Med, 47 (2013), pp. 407-414
9. David C.Nieman, Laurel M. Wentz The compelling link between physical activity and the body's defense system Journal of Sport and Health Science Volume 8, Issue 3, May 2019, Pages 201-217