Necessary advances in exercise genomics and likely pitfalls

Personalized Nutrition for the Enhancement of Elite Athletic Performance

Enhancing athletic performance through the manipulation of nutritional intake has ancient roots, with early guidance from "philosophical giants" like Hippocrates, who describes the balance between diet and exercise. Modern sports nutrition emerged in the 20th century, with research identifying carbohydrate (CHO) intake as beneficial for endurance. Studies like Gordon's in the 1920s linked blood glucose levels to marathon performance, while Cade's research in the 1960s on fluid and electrolyte intake led to the founding of Gatorade and the shift toward drinking during exercise to allegedly prevent dehydration and improve sporting performance. Today, sports nutrition is in a "holding pattern" after significant developments in the 1980s, 1990s, and the 2000s. A new era will involve personalized nutrition, but this development will require a game-changing injection of momentum, recognizing that athletes' responses to nutrition interventions vary widely. New technologies will also need to be developed and perfected, including wearables for real-time biometric monitoring (e.g., heart rate variability, glucose, and sweat composition and rate), which offer potential for tailored nutrition (i.e., diet and hydration) strategies. Applications of genetic and multi-omics technologies (like genomics, transcriptomics, metabolomics, proteomics, and epigenomics) are needed to unlock the potential of personalized sports nutrition by analyzing individual responses to factors such as sleep, nutrition, and exercise. The future lies in fast integration of all available data using next-generation bioinformatics and AI to generate personalized recommendations, with an emphasis on empirical evidence rather than solely commercial interests. As technology matures, sports (and exercise) nutrition will continue refining its practices but will need a paradigm shift to deliver precise interventions that may offer athletes the crucial edge needed to maximize performance while promoting short-term and long-term health.

Deciphering V̇ O2,max: limits of the genetic approach

Maximal oxygen consumption (V̇ _O2,max) denotes the upper limit of aerobic energy flux through the cascade of oxygen transfer from the environment to tissue mitochondria, essentially to skeletal muscle mitochondria during intense exercise. A high V̇ _O2,max is a key component for athletic success in human and animal endurance sports. From a public health perspective, a high V̇ _O2,max is a validated negative predictor for cardiovascular disease and all-cause mortality. V̇ _O2,max varies by more than twofold between sedentary subjects and shows a heritability value greater than 50%. Likewise, the capacity for an individual's V̇ _O2,max to be increased with exercise training (i.e. its trainability) varies massively between subjects, independent of each subject's V̇ _O2,max in the absence of training (i.e. their sedentary V̇ _O2,max), and with a similarly high heritability. Athletic as well as public health interests have prompted a search for the genetic profile of sedentary V̇ _O2,max and of trainability. Candidate-gene studies, gene-expression studies and genome-wide-association studies (GWAS) have not been able to identify a genetic signature that distinguishes subjects or athletes with a favorable V̇ _O2,max phenotype or a high trainability from controls. Here, I propose that multigenetic phenotypes such as V̇ _O2,max are emergent properties of multiple underlying transcriptomic networks modified by epistasis, the epigenome and the epitranscriptome. The genetic approach is thus considered to be necessary but insufficient for furthering our understanding of multigenetic higher-level functions.

Letter to the editor: A genetic-based algorithm for personalized resistance training

In a recent paper entitled “A genetic-based algorithm for personalized resistance training”, Jones et al. [1] presented an algorithm of 15 performance-associated gene polymorphisms that they propose can determine an athlete’s training response by predicting power and endurance potential. However, from the design of their studies and the data provided, there is no evidence to support these authors’ assertions. Progress towards such a significant development in the field of sport and exercise genomics will require a paradigm shift in line with recent recommendations for international collaborations such as the Athlome Project (see www.athlomeconsortium.org). Large-scale initiatives, involving numerous multi-centre and well-phenotyped exercise training and elite performance cohorts, will be necessary before attempting to derive and replicate training and/or performance algorithms.

The heritable path of human physical performance: from single polymorphisms to the "next generation"

Human physical performance is a complex multifactorial trait. Historically, environmental factors (e.g., diet, training) alone have been unable to explain the basis of all prominent phenotypes for physical performance. Therefore, there has been an interest in the study of the contribution of genetic factors to the development of these phenotypes. Support for a genetic component is found with studies that shown that monozygotic twins were more similar than were dizygotic twins for many physiological traits. The evolution of molecular techniques and the ability to scan the entire human genome enabled association of several genetic polymorphisms with performance. However, some biases related to the selection of cohorts and inadequate definition of the study variables have complicated the already difficult task of studying such a large and polymorphic genome, often resulting in inconsistent results about the influence of candidate genes. This review aims to provide a critical overview of heritable genetic aspects. Novel molecular technologies, such as next-generation sequencing, are discussed and how they can contribute to improving understanding of the molecular basis for athletic performance. It is important to ensure that the large amount of data that can be generated using these tools will be used effectively by ensuring well-designed studies.

Genomics of elite sporting performance: what little we know and necessary advances

Numerous reports of genetic associations with performance- and injury-related phenotypes have been published over the past three decades; these studies have employed primarily the candidate gene approach to identify genes that associate with elite performance or with variation in performance-and/or injury-related traits. Although generally with small effect sizes and heavily prone to type I statistic error, the number of candidate genetic variants that can potentially explain elite athletic status, injury predisposition, or indeed response to training will be much higher than that examined by numerous biotechnology companies. Priority should therefore be given to applying whole genome technology to sufficiently large study cohorts of world-class athletes with adequately measured phenotypes where it is possible to increase statistical power. Some of the elite athlete cohorts described in the literature might suffice, and collectively, these cohorts could be used for replication purposes. Genome-wide association studies are ongoing in some of these cohorts (i.e., Genathlete, Russian, Spanish, Japanese, United States, and Jamaican cohorts), and preliminary findings include the identification of one single nucleotide polymorphism (SNP; among more than a million SNPs analyzed) that associates with sprint performance in Japanese, American (i.e., African American), and Jamaican cohorts with a combined effect size of ~2.6 (P-value <5×10(-7)) and good concordance with endurance performance between select cohorts. Further replications of these signals in independent cohorts will be required, and any replicated SNPs will be taken forward for fine-mapping/targeted resequencing and functional studies to uncover the underlying biological mechanisms. Only after this lengthy and costly process will the true potential of genetic testing in sport be determined.

Kenyan and Ethiopian distance runners: what makes them so good?

Since the 1968 Mexico City Olympics, Kenyan and Ethiopian runners have dominated the middle- and long-distance events in athletics and have exhibited comparable dominance in international cross-country and road-racing competition. Several factors have been proposed to explain the extraordinary success of the Kenyan and Ethiopian distance runners, including (1) genetic predisposition, (2) development of a high maximal oxygen uptake as a result of extensive walking and running at an early age, (3) relatively high hemoglobin and hematocrit, (4) development of good metabolic "economy/efficiency" based on somatotype and lower limb characteristics, (5) favorable skeletal-muscle-fiber composition and oxidative enzyme profile, (6) traditional Kenyan/Ethiopian diet, (7) living and training at altitude, and (8) motivation to achieve economic success. Some of these factors have been examined objectively in the laboratory and field, whereas others have been evaluated from an observational perspective. The purpose of this article is to present the current data relative to factors that potentially contribute to the unprecedented success of Kenyan and Ethiopian distance runners, including recent studies that examined potential links between Kenyan and Ethiopian genotype characteristics and elite running performance. In general, it appears that Kenyan and Ethiopian distance-running success is not based on a unique genetic or physiological characteristic. Rather, it appears to be the result of favorable somatotypical characteristics lending to exceptional biomechanical and metabolic economy/efficiency; chronic exposure to altitude in combination with moderate-volume, high-intensity training (live high + train high), and a strong psychological motivation to succeed athletically for the purpose of economic and social advancement.