Monitoring Fatigue Status with HRV Measures in Elite Athletes : An Avenue Beyond RMSSD?

Among the tools proposed to assess the athlete's "fatigue," the analysis of heart rate variability (HRV) provides an indirect evaluation of the settings of autonomic control of heart activity. HRV analysis is performed through assessment of time-domain indices, the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals (RMSSD) measured during short (5 min) recordings in supine position upon awakening in the morning and particularly the logarithm of RMSSD (LnRMSSD) has been proposed as the most useful resting HRV indicator. However, if RMSSD can help the practitioner to identify a global "fatigue" level, it does not allow discriminating different types of fatigue. Recent results using spectral HRV analysis highlighted firstly that HRV profiles assessed in supine and standing positions are independent and complementary; and secondly that using these postural profiles allows the clustering of distinct sub-categories of "fatigue." Since, cardiovascular control settings are different in standing and lying posture, using the HRV figures of both postures to cluster fatigue state embeds information on the dynamics of control responses. Such, HRV spectral analysis appears more sensitive and enlightening than time-domain HRV indices. The wealthier information provided by this spectral analysis should improve the monitoring of the adaptive training-recovery process in athletes.

Monitoring Fatigue Status with HRV Measures in Elite Athletes: An Avenue Beyond RMSSD?

Among the tools proposed to assess the athlete's "fatigue," the analysis of heart rate variability (HRV) provides an indirect evaluation of the settings of autonomic control of heart activity. HRV analysis is performed through assessment of time-domain indices, the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals (RMSSD) measured during short (5 min) recordings in supine position upon awakening in the morning and particularly the logarithm of RMSSD (LnRMSSD) has been proposed as the most useful resting HRV indicator. However, if RMSSD can help the practitioner to identify a global "fatigue" level, it does not allow discriminating different types of fatigue. Recent results using spectral HRV analysis highlighted firstly that HRV profiles assessed in supine and standing positions are independent and complementary; and secondly that using these postural profiles allows the clustering of distinct sub-categories of "fatigue." Since, cardiovascular control settings are different in standing and lying posture, using the HRV figures of both postures to cluster fatigue state embeds information on the dynamics of control responses. Such, HRV spectral analysis appears more sensitive and enlightening than time-domain HRV indices. The wealthier information provided by this spectral analysis should improve the monitoring of the adaptive training-recovery process in athletes.

Typology of "Fatigue" by Heart Rate Variability Analysis in Elite Nordic-skiers.

This study investigated changes in heart rate variability (HRV) in elite Nordic-skiers to characterize different types of "fatigue" in 27 men and 30 women surveyed from 2004 to 2008. R-R intervals were recorded at rest during 8 min supine (SU) followed by 7 min standing (ST). HRV parameters analysed were powers of low (LF), high (HF) frequencies, (LF+HF) (ms(2)) and heart rate (HR, bpm). In the 1 063 HRV tests performed, 172 corresponded to a "fatigue" state and the first were considered for analysis. 4 types of "fatigue" (F) were identified: 1. F(HF(-)LF(-))SU_ST for 42 tests: decrease in LFSU (- 46%), HFSU (- 70%), LFST (- 43%), HFST (- 53%) and increase in HRSU (+ 15%), HRST (+ 14%). 2. F(LF(+) SULF(-) ST) for 8 tests: increase in LFSU (+ 190%) decrease in LFST (- 84%) and increase in HRST (+ 21%). 3. F(HF(-) SUHF(+) ST) for 6 tests: decrease in HFSU (- 72%) and increase in HFST (+ 501%). 4. F(HF(+) SU) for only 1 test with an increase in HFSU (+ 2161%) and decrease in HRSU (- 15%). Supine and standing HRV patterns were independently modified by "fatigue". 4 "fatigue"-shifted HRV patterns were statistically sorted according to differently paired changes in the 2 postures. This characterization might be useful for further understanding autonomic rearrangements in different "fatigue" conditions.

The effect of an aerobic training program on the electrical remodeling of the heart: high-frequency components of the signal-averaged electrocardiogram are predictors of the maximal aerobic power

Increased heart rate variability (HRV) and high-frequency content of the terminal region of the ventricular activation of signal-averaged ECG (SAECG) have been reported in athletes. The present study investigates HRV and SAECG parameters as predictors of maximal aerobic power (VO2max) in athletes. HRV, SAECG and VO2max were determined in 18 high-performance long-distance (25 ± 6 years; 17 males) runners 24 h after a training session. Clinical visits, ECG and VO2max determination were scheduled for all athletes during thew training period. A group of 18 untrained healthy volunteers matched for age, gender, and body surface area was included as controls. SAECG was acquired in the resting supine position for 15 min and processed to extract average RR interval (Mean-RR) and root mean squared standard deviation (RMSSD) of the difference of two consecutive normal RR intervals. SAECG variables analyzed in the vector magnitude with 40-250 Hz band-pass bi-directional filtering were: total and 40-µV terminal (LAS40) duration of ventricular activation, RMS voltage of total (RMST) and of the 40-ms terminal region of ventricular activation. Linear and multivariate stepwise logistic regressions oriented by inter-group comparisons were adjusted in significant variables in order to predict VO2max, with a P < 0.05 considered to be significant. VO2max correlated significantly (P < 0.05) with RMST (r = 0.77), Mean-RR (r = 0.62), RMSSD (r = 0.47), and LAS40 (r = -0.39). RMST was the independent predictor of VO2max. In athletes, HRV and high-frequency components of the SAECG correlate with VO2max and the high-frequency content of SAECG is an independent predictor of VO2max.

A Pragmatic Approach to Ethical Inquiry on Transhuman Athletes and Gene Doping in Sport

Gene doping is the most recent addition to the list of banned practices formulated by the World Anti-doping Agency. It is a subset of doping that utilizes the technology involved in gene therapy. The latter is still in the experimental phase but has the potential to be used as a type of medical treatment involving alterations of a patient‘s genes. I apply a pragmatic form of ethical inquiry to evaluate the application of this medical innovation in the context of sport for performance-enhancement purposes and how it will affect sport, the individual, society and humanity at large. I analyze the probable ethical implications that will emerge from such procedures in terms of values that lie at the heart of the major arguments offered by scholars on both affirmative and opposing sides of the debate on gene doping, namely fairness, autonomy and the conception of what it means to be human.

The Effects of Physical Fitness and Body Composition on Oxygen Consumption and Heart Rate Recovery After High-Intensity Exercise

The aim of this study was to investigate the potential relationship between excess post-exercise oxygen consumption (EPOC), heart rate recovery (HRR) and their respective time constants (tvo(2) and t(HR)) and body composition and aerobic fitness (VO(2)max) variables after an anaerobic effort. 14 professional cyclists (age = 28.4 +/- 4.8 years, height = 176.0 +/- 6.7 cm, body mass = 74.4 +/- 8.1 kg, VO(2)max = 66.8 +/- 7.6 mL. kg(-1) . min(-1)) were recruited. Each athlete made 3 visits to the laboratory with 24h between each visit. During the first visit, a total and segmental body composition assessment was carried out. During the second, the athletes undertook an incremental test to determine VO(2)max. In the final visit, EPOC (15-min) and HRR were measured after an all-out 30s Wingate test. The results showed that EPOC is positively associated with % body fat (r = 0.64), total body fat (r = 0.73), fat-free mass (r = 0.61) and lower limb fat-free mass (r = 0.55) and negatively associated with HRR (r = - 0.53, p < 0.05 for all). HRR had a significant negative correlation with total body fat and % body fat (r = - 0.62, r = - 0.56 respectively, p < 0.05 for all). These findings indicate that VO(2)max does not influence HRR or EPOC after high-intensity exercise. Even in short-term exercise, the major metabolic disturbance due to higher muscle mass and total muscle mass may increase EPOC. However, body fat impedes HRR and delays recovery of oxygen consumption after effort in highly trained athletes.

Sudden cardiac death athletes: a systematic review

Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords sudden death, athletes and mortality. The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD. © 2010 Ferreira et al; licensee BioMed Central Ltd.

Doppler echocardiography in athletes from different sports

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Differential effects of variation in athletes training on myocardial morphophysiological adaptation in men: Focus on I-123-MIBG assessed myocardial sympathetic activity

High intensity systematic physical training leads to myocardial morphophysiological adaptations. The goal of this study was to investigate if differences in training were correlated with differences in cardiac sympathetic activity.58 males (19-47 years), were divided into three groups: strength group (SG), (20 bodybuilders), endurance group (EG), (20 endurance athletes), and a control group (CG) comprising 18 healthy non-athletes. Cardiac sympathetic innervation was assessed by planar myocardial I-123-metaiodobenzylguanidine scintigraphy using the early and late heart to mediastinal (H/M) ratio, and washout rate (WR).Left ventricular mass index was significantly higher both in SG (P < .001) and EG (P = .001) compared to CG without a statistical significant difference between SG and EG (P = .417). The relative wall thickness was significantly higher in SG compared to CG (P < .001). Both left ventricular ejection fraction and the peak filling rate showed no significant difference between the groups. Resting heart rate was significantly lower in EG compared to CG (P = .006) and SG (P = .002). The late H/M ratio in CG was significantly higher compared to the late H/M for SG (P = .003) and EG (P = .004). However, WR showed no difference between the groups. There was no significant correlation between the parameters of myocardial sympathetic innervation and parameters of left ventricular function.Strength training resulted in a significant increase in cardiac dimensions. Both strength and endurance training seem to cause a reduction in myocardial sympathetic drive. However, myocardial morphological and functional adaptations to training were not correlated with myocardial sympathetic activity.

Comparison of anaerobic threshold, oxygen uptake and heart rate between specific table

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Physiological responses and rate of perceived exertion in Brazilian jiu-jitsu athletes

In this study, the physiological responses and rate of perceived exertion in Brazilian jiu-jitsu fighters submitted to a combat simulation were investigated. Venous blood samples and heart rate were taken from twelve male Brazilian jiu-jitsu athletes (27.1+/-2.7 yrs, 75.4+/-8.8 kg, 174.9+/-4.4 cm, 9.2+/-2.4% fat), at rest, after a warm-up (ten minutes), immediately after the fight simulation (seven minutes) and after recovery (fourteen minutes). After the combat the rate of perceived exertion was collected. The combat of the Brazilian jiu-jitsu fighters did not change blood concentrations of glucose, triglycerides, total cholesterol, low density lipoprotein and very low density lipoprotein, ureia and ammonia. However, blood levels of high density lipoprotein were significantly higher post-fight (before: 43.0+/-6.9 mg/dL, after: 45.1+/-8.0 mg/dL) and stayed at high levels during the recovery period (43.6+/-8.1 mg/dL) compared to the rest values (40.0+/-6.6 mg/dL). The fight did not cause changes in the concentrations of the cell damage markers of creatine kinase, aspartate aminotransferase and creatinine. However, blood concentrations of the alanine aminotransferase (before: 16.1+/-7.1 U/L, after: 18.6+/-7.1 U/L) and lactate dehydrogenase (before: 491.5+/-177.6 U/L, after: 542.6+/-141.4 U/L) enzymes were elevated after the fight. Heart rate (before: 122+/-25 bpm, after: 165+/-17 bpm) and lactate (before: 2.5+/-1.2 mmol/L, after: 11.9+/-5.8 mmol/L) increased significantly with the completion of combat. Despite this, the athletes rated the fight as being light or somewhat hard (12+/-2). These results showed that muscle glycogen is not the only substrate used in Brazilian jiu-jitsu fights, since there are indications of activation of the glycolytic, lipolytic and proteolytic pathways. Furthermore, the athletes rated the combats as being light or somewhat hard although muscle damage markers were generated.

Energy demands in taekwondo athletes during combat simulation

The purpose of this study was to investigate energy system contributions and energy costs in combat situations. The sample consisted of 10 male taekwondo athletes (age: 21 +/- 6 years old; height: 176.2 +/- 5.3 cm; body mass: 67.2 +/- 8.9 kg) who compete at the national or international level. To estimate the energy contributions, and total energy cost of the fights, athletes performed a simulated competition consisting of three 2 min rounds with a 1 min recovery between each round. The combats were filmed to quantify the actual time spent fighting in each round. The contribution of the aerobic (WAER), anaerobic alactic (W-PCR), and anaerobic lactic (Wleft perpendicularLA-right perpendicular) energy systems was estimated through the measurement of oxygen consumption during the activity, the fast component of excess post-exercise oxygen consumption, and the change in blood lactate concentration in each round, respectively. The mean ratio of high intensity actions to moments of low intensity (steps and pauses) was similar to 1:7. The W-AER, W-PCR and (Wleft perpendicularLA-right perpendicular) system contributions were estimated as 120 +/- 22 kJ (66 +/- 6%), 54 +/- 21 kJ (30 +/- 6%), 8.5 kJ (4 +/- 2%), respectively. Thus, training sessions should be directed mainly to the improvement of the anaerobic alactic system (responsible by the highintensity actions), and of the aerobic system (responsible by the recovery process between high- intensity actions).

Aerobic power in child, cadet and senior judo athletes

The aim of the present study was to compare performance and physiological responses during arm and leg aerobic power tests of combat duration in male child, cadet and senior judo athletes. Power output and physiological parameters, i.e., peak oxygen uptake ((V)over dotO(2)peak), peak ventilation, peak heart rate, lactate, and rate of perceived exertion, of 7 child (under 15 years: age class U15, 12.7 +/- 1.1 yrs), 10 cadet (U17, 14.9 +/- 0.7 yrs) and 8 senior (+20, 29.3 +/- 9.2 yrs) male judo athletes were assessed during incremental tests of combat duration on an arm crank and a cycle ergometer. Children as well as cadets demonstrated higher upper body relative VO(2)peak than seniors (37.3 +/- 4.9, 39.2 +/- 5.0 and 31.0 +/- 2.1 ml.kg(-1).min(-1), respectively); moreover, upper and lower body relative VO(2)peak decreased with increasing age (r = -0.575, p < 0.003 and r = -0.580, p < 0.002, respectively). Children showed lower blood lactate concentrations after cranking as well as after cycling when compared to seniors (7.8 +/- 2.4 vs. 11.4 +/- 2.1 mmol.l(-1) and 7.9 +/- 3.0 vs. 12.0 +/- 1.9 mmol.l(-1), respectively); furthermore, blood lactate values after cranking increased with age (r = 0.473, p < 0.017). These differences should be considered in planning the training for judo athletes of different age classes.

Gender differences of atrial and ventricular remodeling and autonomic tone in nonelite athletes

Veteran endurance athletes have an increased risk of developing atrial fibrillation (AF), with a striking male predominance. We hypothesized that male athletes were more prone to atrial and ventricular remodeling and investigated the signal-averaged P wave and factors that promote the occurrence of AF. Nonelite athletes scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race, were invited. Of the 873 marathon and nonmarathon runners who were willing to participate, 68 female and 70 male athletes were randomly selected. The runners with cardiovascular disease or elevated blood pressure (>140/90 mm Hg) were excluded. Thus, 121 athletes were entered into the final analysis. Their mean age was 42 ± 7 years. No gender differences were found for age, lifetime training hours, or race time. The male athletes had a significantly longer signal-averaged P-wave duration (136 ± 12 vs 122 ± 10 ms; p <0.001). The left atrial volume was larger in the male athletes (56 ± 13 vs 49 ± 10 ml; p = 0.001), while left atrial volume index showed no differences (29 ± 7 vs 30 ± 6 ml/m²; p = 0.332). In male athletes, the left ventricular mass index (107 ± 17 vs 86 ± 16 g/m²; p <0.001) and relative wall thickness (0.44 ± 0.06 vs 0.41 ± 0.07; p = 0.004) were greater. No differences were found in the left ventricular ejection fraction (63 ± 4% vs 66 ± 6%; p = 0.112) and mitral annular tissue Doppler e' velocity (10.9 ± 1.5 vs 10.6 ± 1.5 cm/s; p = 0.187). However, the tissue Doppler a' velocity was higher (8.7 ± 1.2 vs 7.6 ± 1.3 cm/s; p < 0.001) in the male athletes. Male athletes had a higher systolic blood pressure at rest (123 ± 9 vs 110 ± 11 mm Hg; p < 0.001) and at peak exercise (180 ± 15 vs 169 ± 19 mm Hg; p = 0.001). In the frequency domain analysis of heart rate variability, the sympatho-vagal balance, represented by the low/high-frequency power ratio, was significantly greater in male athletes (5.8 ± 2.8 vs 3.9 ± 1.9; p < 0.001). Four athletes (3.3%) had at least one documented episode of paroxysmal AF, all were men (p = 0.042). In conclusion, for a comparable amount of training and performance, male athletes showed a more pronounced atrial remodeling, a concentric type of ventricular remodeling, and an altered diastolic function. A higher blood pressure at rest and during exercise and a higher sympathetic tone might be causal. The altered left atrial substrate might facilitate the occurrence of AF.

Training-related modulations of the autonomic nervous system in endurance athletes: is female gender cardioprotective?

The risk of sudden death is increased in athletes with a male predominance. Regular physical activity increases vagal tone, and may protect against exercise-induced ventricular arrhythmias. We investigated training-related modulations of the autonomic nervous system in female and male endurance athletes. Runners of a 10-mile race were invited. Of 873 applicants, 68 female and 70 male athletes were randomly selected and stratified according to their average weekly training hours in a low (≤4 h) and high (>4 h) volume training group. Analysis of heart rate variability was performed over 24 h. Spectral components (high frequency [HF] and low frequency [LF] power in normalized units) were analyzed for hourly 5 min segments and averaged for day- and nighttime. One hundred and fourteen athletes (50 % female, mean age 42 ± 7 years) were included. No significant gender difference was observed for training volume and 10-mile race time. Over the 24-h period, female athletes exhibited a higher HF and lower LF power for each hourly time-point. Female gender and endurance training hours were independent predictors of a higher HF and lower LF power. In female athletes, higher training hours were associated with a higher HF and lower LF power during nighttime. In male athletes, the same was true during daytime. In conclusion, female and male athletes showed a different circadian pattern of the training-related increase in markers of vagal tone. For a comparable amount of training volume, female athletes maintained their higher markers of vagal tone, possibly indicating a superior protection against exercise-induced ventricular arrhythmias.