Changes in creatine kinase and cortisol in National Collegiate Athletic Association Division I American football players during a season

Acute Response to Training after Returning from the Off-Season in Elite Rugby League Athletes

The purposes of this study were to quantify the physiological response to the initial two-week preseason period in elite male rugby league (RL) athletes, and to determine if a repeated bout effect (RBE) occurs. Eighteen RL players were monitored for the initial two-week preseason period. Blood samples were collected on days (D)1, D2, D4, D5, D8, D9, D11 and D12 to measure creatine kinase (CK). Neuromuscular power was assessed on D1, D5, D8 and D12. During field-based sessions, the external training load was quantified using global positioning system technology, whilst the internal load was quantified using the training impulse and the session rating of perceived exertion. Resistance-based gym session volume was quantified by total repetitions x weight lifted. Perceived measures of fatigue and muscle soreness were assessed on all training days. Two-way (day x week) repeated measures analysis of variance and Bonferroni's corrected post-hoc tests identified significant changes. There were no significant changes in CK activity (649.2 ± 255.0 vs. 673.8 ± 299.1 µL; p = 0.63) or internal training load measures from week 1 to week 2. External training load measures including total distance (4138.1 ± 198.4 vs. 4525.0 ± 169.2 m; p < 0.001) and repeated high-intensity efforts (12.6 ± 1.8 vs. 17.5 ± 1.8 au; p < 0.001) significantly increased in week 2 compared to week 1. Internal training loads and CK activity did not change in response to an increase in external training loads during the initial preseason. The current results provide support for a 'real world' perspective of the RBE phenomenon that may be more applicable for team sport practitioners.

The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season

The objective was to determine the associations between several biochemical indicators and the dynamics of concentration change across four physical fitness phases over the period of a competitive season. Furthermore, associations between serum calprotectin and biomarkers of inflammation or muscle injury and physical indicators were examined.

SUBJECTS AND METHODS

Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity.

RESULTS

Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination.

CONCLUSIONS

Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.

Acute Effects of Training Loads on Muscle Damage Markers and Performance in Semi-elite and Elite Athletes: A Systematic Review and Meta-analysis

BACKGROUND

The relationship between exercise-induced muscle damage (EIMD) indicators and acute training loads (TL) is yet to be reviewed extensively in semi-elite and elite athlete populations.

OBJECTIVES

The objectives of this systematic review and meta-analysis were threefold: (1) to evaluate studies of EIMD following the initial period of the preseason in semi-elite and elite athletes: (2) to examine acute physiological and performance responses across two periods of the season with similar TL; and (3) to examine acute physiological and performance responses to acute changes in TL during the season.

METHODS

The CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science databases were systematically searched for studies that investigated: (1) semi-elite or elite athletes in team or individual sports following a periodised training programme; and (2) measured acute responses to training. Studies were excluded if: (1) conducted in animals; (2) non-English language; or (3) a conference abstract, review or case report. The Kmet Quality Scoring of Quantitative Studies tool was used for study appraisal.

SYNTHESIS METHODS

Data were quantitatively analysed by generating forest plots to report test statistics for statistical significance and inter-trial heterogeneity.

RESULTS

Of the included studies (n = 32), athletes experienced greater creatine kinase (CK) concentrations (Z = 4.99, p < 0.00001, I² = 74%), inflammatory factors and other indirect measures of muscle damage in the initial phase of the preseason period compared to the off-season; there were no changes in CK (Z = 1.43, p = 0.15, I² = 74%) across two time points of similar TL; and there were concurrent increases in CK with increases in TL (Z = 4.26, p < 0.0001, I² = 36%) and vice versa (Z = 4.33, p < 0.0001, I² = 79%).The qualitative analysis identified that the response of inflammatory factors and other indirect measures of muscle damage to changes in load were inconclusive.

LIMITATIONS

This review included varying age, sex, sports and competition levels. The group level meta-analysis failed to identify within-athlete or position-specific differences across time.

CONCLUSION

Blood biomarkers of EIMD may not differ across periods of similar TL, however can be considered a sensitive monitoring tool for assessing responses following acute TL changes in semi-elite and elite athletes.

The Association Between Alterations in Redox Homeostasis, Cortisol, and Commonly Used Objective and Subjective Markers of Fatigue in American Collegiate Football

PURPOSE

To assess associations between a free oxygen radical test (FORT), free oxygen radical defense test (FORD), oxidative stress index, urinary cortisol, countermovement jump (CMJ), and subjective wellness in American college football.

METHODS

Twenty-three male student athlete American college football players were assessed over 10 weeks: off-season conditioning (3 wk), preseason camp (4 wk), and in season (3 wk). Assessments included a once-weekly FORT and FORD blood sample, urinary cortisol sample, CMJ assessment including flight time, reactive strength index modified and concentric impulse, and a daily subjective wellness questionnaire. Linear mixed models analyzed the effect of a 2 within-subject SD change in the predictor variable on the dependent variable. The effects were interpreted using magnitude-based inference and are presented as standardized effect size (ES) ± 90% confidence intervals.

RESULTS

Small negative associations were observed between FORT-flight time, FORT-fatigue, FORT-soreness (ES range = -0.30 to -0.48), FORD-sleep (ES = 0.42 ± 0.29), and oxidative stress index soreness (ES = 0.56 ± 0.29). Small positive associations were observed between FORT-cortisol (ES = 0.36 ± 0.35), FORD-flight time, FORD reactive strength index modified and FORD-soreness (0.37-0.41), oxidative stress index concentric impulse (ES = 0.37 ± 0.28), and with soreness-concentric impulse, soreness-flight time, and soreness reactive strength index modified (0.33-0.59). Moderate positive associations were observed between cortisol-concentric impulse and cortisol-sleep (0.57-0.60).

CONCLUSION

FORT/FORD was associated with CMJ variables and subjective wellness. Greater amounts of subjective soreness were associated with decreased CMJ performance, increased FORT and cortisol, and decreased FORD.

Neuromuscular, Endocrine, and Perceptual Recovery After a Youth American Football Game

ABSTRACT

Davis, JK, Wolfe, AS, Basham, SA, Freese, EC, and De Chavez, PJD. Neuromuscular, endocrine, and perceptual recovery after a youth American football game. J Strength Cond Res 35(5): 1317-1325, 2021-American football is a high-intensity intermittent sport consisting of various movements and repeated collisions which highlights the importance of adequate recovery from a game to prepare for the next competition. Therefore, the purpose of this study was to determine the time course of recovery markers after a youth American football game. Thirteen male American football youth players were monitored for 7 days after a single football game. Baseline measures were taken 28 hours pregame for lower-body neuromuscular function by countermovement jumps (CMJs) to determine peak power (PP), jump height (JH), flight time (FT), and takeoff velocity (TOV). Saliva was analyzed for cortisol, testosterone, and C-reactive protein (CRP). Perceptual recovery was assessed by the modified profile of mood states (POMS), perceived recovery status (PRS), and a daily wellness questionnaire. These measures were repeated immediately postgame (30 minutes) and at 20, 44, 68, 92, 116, and 140 hours postgame. Compared with baseline values, there was a significant decrease (p < 0.05) in CMJ PP, JH, and TOV up to 68 hours postgame and FT 44 hours postgame. No significant difference existed among time points for salivary testosterone and CRP. Cortisol levels significantly increased postgame compared with baseline (p < 0.05). Total mood disturbance, assessed by POMS, and daily wellness markers for energy were significantly decreased (p < 0.05), whereas daily wellness markers for soreness were significantly increased (p < 0.05) immediately after the game. Players exhibited a significant decrease in PRS up to 44 hours postgame (p < 0.05), similar to the decrease in neuromuscular function. Neuromuscular function and PRS are impaired for up to 44-68 h postgame.

Muscle Damage, Soreness, and Stress During Preseason Training in Collegiate Swimmers

BACKGROUND

In 2014, 6 collegiate swimmers were hospitalized for symptomatic exertional rhabdomyolysis.

OBJECTIVE

To serially monitor and assess relationships between skeletal muscle membrane disruption, upper body soreness (UBS) and lower body soreness (LBS), and stress during the first 6 weeks (timepoints) of preseason training in collegiate male and female swimmers.

DESIGN

Prospective observational study.

SETTING

College/university.

PARTICIPANTS

Forty swimmers.

INDEPENDENT VARIABLES

Upper and lower body soreness rating (0-10); testosterone (T), cortisol (C), and T/C ratio.

MAIN OUTCOME MEASURES

Creatine kinase (CK) and myoglobin (over time) versus independent variables.

RESULTS

Weekly training load consisted of ∼87% swimming, ∼5% running, and ∼8% weight training, which increased from 15.8 hours to 20.5 total training hours per week over the first 6 weeks of training. Muscle damage in collegiate swimmers was modest and peaked after the first week of training (week 2) for men (CK = 438 ± 259 U/L; P < 0.0001; r2 = 0.28; myoglobin = 47 ± 18 ng/mL; P = 0.001; r2 = 0.22) and women (CK = 446 ± 723 U/L; P < 0.01; r2 = 0.13; myoglobin = 63 ± 140 ng/mL, not significant) with high variability. Data were presented as peak mean ± SD, significant P value, and r2 from repeated-measures analysis of variance. A temporal disconnect was noted between muscle damage and UBS, which peaked at week 5 in both men (5 ± 2; P < 0.0001; r2 = 0.44) and women (6 ± 2; P < 0.0001; r2 = 0.57). The serum cortisol level decreased over time, which peaked at week 1 (baseline) in men (15 ± 6 μg/dL; P = 0.0004; r2 = 0.38) and women (19 ± 10 μg/dL; P < 0.0001; r2 = 0.49). The testosterone level remained unchanged, which promoted an anabolic hormonal environment that peaked at week 6 (increasing T/C ratio) in men (58 ± 32; P = 0.0003; r2 = 0.31) and women (4 ± 3; P = 0.04; r2 = 0.18) despite gradual increases in training and soreness.

CONCLUSIONS

Muscle soreness does not parallel muscle membrane disruption. A 1-week "transition" period is required for muscles to adapt to intense/novel training.

More than myalgia: An unusual presentation of exertional rhabdomyolysis

Exertional or exercise-induced rhabdomyolysis (ER) is a condition in which excessive and unaccustomed physical activity results in skeletal muscle damage. The ER is a relatively uncommon condition but can have very serious consequences such as acute renal failure, severe electrolyte abnormalities, acid base disturbances and death if not recognised and managed appropriately. The risk factors for rhabdomyolysis exist in our local setting, hence, it is paramount that healthcare practitioners (GPs) in our settings be made aware of ER, its prevention and symptoms. Cases of ER are often reported in sports men or women. Here, we report a case of a 33-year-old healthy female, with clinical and serological presentation, which is typical of ER following the commencement of a regimen of exercise to lose weight.

Investigation of the Relationship Between Salivary Cortisol, Training Load, and Subjective Markers of Recovery in Elite Rugby Union Players

PURPOSE

Insufficient recovery can lead to a decrease in performance and increase the risk of injury and illness. The aim of this study was to evaluate salivary cortisol as a marker of recovery in elite rugby union players.

METHOD

Over a 10-wk preseason training period, 19 male elite rugby union players provided saliva swabs biweekly (Monday and Friday mornings). Subjective markers of recovery were collected every morning of each training day. Session rating of perceived exertion (sRPE) was taken after every training session, and training load was calculated (sRPE × session duration).

RESULTS

Multilevel analysis found no significant association between salivary cortisol and training load or subjective markers of recovery (all P > .05) over the training period. Compared with baseline (wk 1), Monday salivary cortisol significantly increased in wk 4 (14.94 [7.73] ng/mL; P = .04), wk 8 (16.39 [9.53] ng/mL; P = .01), and wk 9 (15.41 [9.82] ng/mL; P = .02), and Friday salivary cortisol significantly increased in wk 5 (14.81 [8.74] ng/mL; P = .04) and wk 10 (15.36 [11.30] ng/mL; P = .03).

CONCLUSIONS

The significant increase in salivary cortisol on certain Mondays may indicate that players did not physically recover from the previous week of training or match at the weekend. The increased Friday cortisol levels and subjective marker of perceived fatigue indicated increased physiological stress from that week's training. Regular monitoring of salivary cortisol combined with appropriate planning of training load may allow sufficient recovery to optimize training performance.

Changes in Creatine Kinase and Hormones Over the Course of an American Football Season

Stone, JD, Kreutzer, A, Mata, JD, Nystrom, MG, Jagim, AR, Jones, MT, and Oliver, JM. Changes in creatine kinase and hormones over the course of an American Football Season. J Strength Cond Res 33(9): 2481-2487, 2019-The purpose of this study was to examine changes in creatine kinase and hormones over the course of an entire season of American football. A secondary purpose was to determine differences between starters and nonstarters. Fasting blood samples were obtained from 19 National Collegiate Athletic Association Division I (n = 19; 20 ± 1 years) football athletes over the course of a season beginning before the start of summer off-season conditioning (T1), before (T2) and after preseason (T3) football camp, with remaining samples taken throughout the competitive season (T4-T8). A magnitude-based inference approach was used to define outcomes. Testosterone was higher in starters before the start of the season (T1, Effect Size [ES] = 0.8) and during preconference (T4; ES = 0.7). Postcamp (T3) testosterone was lower in all players, though greater in starters (starters, 0.0%/0.3%/99.7%; nonstarters, 0.2%/2.9%/96.9%). An increase cortisol relative to baseline (T1) was observed in starters early in season (T4, ES = 0.7; T5, ES = 0.5). Creatine kinase was elevated at all time points in all athletes, with starters having higher circulating levels throughout season. These data demonstrate that changes in hormonal markers may be experienced over a season of football and differ by playing status. Differences between starters and nonstarters may be indicative of greater damage and stress experienced by starters, which may result from a greater number of repetitions.

Changes in Lower Body Muscular Performance Following a Season of NCAA Division I Men's Lacrosse

The tactical and technical components of training become a primary emphasis, leaving less time for targeted development of physical qualities that underpin performance during the competition phase of a training program. A deemphasis on physical preparation during the in-season training phase may make athletes more susceptible to injury and decrease performance on the field. Two weeks prior to the start and one week following the conclusion of the 16-week collegiate lacrosse season, lower body force production was assessed in eight National Collegiate Athletic Association (NCAA) Division I Men’s Lacrosse athletes. Lower body force production capabilities were determined via the performance of countermovement jumps (CMJ) and drop jumps (DJ) performed on a force plate and isokinetic strength testing of the quadriceps and hamstring muscle groups across three velocities. Isokinetic strength of the hamstrings and the hamstring to quadriceps strength ratio were maintained or increased over the course of the competition phase of training. Relative peak force obtained from the CMJ and the reactive strength index from the DJ decreased significantly over the season. The maintenance of isokinetic strength and the decrease in CMJ and DJ performance may indicate the presence of neuromuscular fatigue that accumulated over the course of the season.

Twelve cases of exertional rhabdomyolysis in college football players from the same institution over a 23-year span: a descriptive study

BACKGROUND

Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to release of the intracellular contents of muscle cells into the systemic circulation. Rhabdomyolysis due to overexertion is an uncommon but well-known severe complication of strenuous activity. Exertional rhabdomyolysis (ER) is typically described in weight lifters and military recruits undergoing basic training. Few cases have been reported in football players without known predisposing risk factors. We report our experience with this condition in college football players in a single institution.

MATERIALS AND METHODS

College football players hospitalized for heat illness complicated by rhabdomyolysis were identified over a 23-year period. Clinical and laboratory findings were collected. Clinical course was recorded.

RESULTS

Twelve patients were identified. All were Black males. One had sickle cell trait. BMI averaged 33 kg/m² (range 23-45 kg/m²). Peak creatine phosphokinase (CPK) averaged 14,850 IU/L (range 1,021-109,616 IU/L). Serum creatinine averaged 1.9 mg/dl (range 1.2-3.1 mg/dl). Ten of twelve cases occurred in August. All responded to intravenous hydration with normalization of CPK and renal function. All returned to football.

CONCLUSIONS

ER is a serious complication of strenuous physical activity that can threaten renal function. ER tends to occur in August, which coincides with the start of football practice when athletes are more likely to be detrained. The condition can occur in Black athletes in the absence of sickle cell trait. ER carries a good prognosis when recognized early and treated adequately.

Fat-Free Mass Index in NCAA Division I and II Collegiate American Football Players

Fat-free mass index (FFMI) is a height-adjusted assessment of fat-free mass (FFM), with previous research suggesting a natural upper limit of 25 kg·m in resistance trained male athletes. The current study evaluated upper limits for FFMI in collegiate American football players (n = 235) and evaluated differences between positions, divisions, and age groups. The sample consisted of 2 National Collegiate Athletic Association Division I teams (n = 78, n = 69) and 1 Division II team (n = 88). Body composition was assessed via dual-energy x-ray absorptiometry and used to calculate FFMI; linear regression was used to normalize values to a height of 180 cm. Sixty-two participants (26.4%) had height-adjusted FFMI values above 25 kg·m (mean = 23.7 ± 2.1 kg·m; 97.5th percentile = 28.1 kg·m). Differences were observed among position groups (p < 0.001; η = 0.25), with highest values observed in offensive linemen (OL) and defensive linemen (DL) and lowest values observed in offensive and defensive backs. Fat-free mass index was higher in Division I teams than Division II team (24.3 ± 1.8 kg·m vs. 23.4 ± 1.8 kg·m; p < 0.001; d = 0.49). Fat-free mass index did not differ between age groups. Upper limit estimations for FFMI seem to vary by position; although the 97.5th percentile (28.1 kg·m) may represent a more suitable upper limit for the college football population as a whole, this value was exceeded by 6 linemen (3 OL and 3 DL), with a maximal observed value of 31.7 kg·m. Football practitioners may use FFMI to evaluate an individual's capacity for additional FFM accretion, suitability for a specific position, potential for switching positions, and overall recruiting assessment.

Updated Review of the Applied Physiology of American College Football: Physical Demands, Strength and Conditioning, Nutrition, and Injury Characteristics of America’s Favorite Game

While there are various avenues for performance improvement in college American football (AF), there is no comprehensive evaluation of the collective array of resources around performance, physical conditioning, and injury and training/game characteristics to guide future research and inform practitioners. Accordingly, the aim of the present review was to provide a current examination of these areas in college AF. Recent studies show that there is a wide range of body compositions and strength characteristics between players, which appear to be influenced by playing position, level of play, training history/programming, and time of season. Collectively, game demands may require a combination of upper- and lower-body strength and power production, rapid acceleration (positive and negative), change of direction, high running speed, high-intensity and repetitive collisions, and muscle-strength endurance. These may be affected by the timing of and between-plays and/or coaching style. AF players appear to possess limited nutrition and hydration practices, which may be disadvantageous to performance. AF injuries appear due to a multitude of factors—strength, movement quality, and previous injury—while there is also potential for extrinsic factors such as playing surface type, travel, time of season, playing position, and training load. Future proof-of-concept studies are required to determine the quantification of game demands with regard to game style, type of opposition, and key performance indicators. Moreover, more research is required to understand the efficacy of recovery and nutrition interventions. Finally, the assessment of the relationship between external/internal-load constructs and injury risk is warranted.

Longitudinal Body Composition Changes in NCAA Division I College Football Players

Trexler, ET, Smith-Ryan, AE, Mann, JB, Ivey, PA, Hirsch, KR, and Mock, MG. Longitudinal body composition changes in NCAA Division I college football players. J Strength Cond Res 31(1): 1-8, 2017-Many athletes seek to optimize body composition to fit the physical demands of their sport. American football requires a unique combination of size, speed, and power. The purpose of the current study was to evaluate longitudinal changes in body composition in Division I collegiate football players. For 57 players (mean ± SD, age = 19.5 ± 0.9 years, height = 186.9 ± 5.7 cm, weight = 107.7 ± 19.1 kg), body composition was assessed via dual-energy x-ray absorptiometry in the off-season (March-Pre), end of off-season (May), mid-July (Pre-Season), and the following March (March-Post). Outcome variables included weight, body fat percentage (BF%), fat mass, lean mass (LM), android and gynoid (GYN) fat, bone mineral content (BMC), and bone mineral density (BMD). For a subset of athletes (n = 13 out of 57), changes over a 4-year playing career were evaluated with measurements taken every March. Throughout a single year, favorable changes were observed for BF% (Δ = -1.3 ± 2.5%), LM (Δ = 2.8 ± 2.8 kg), GYN (Δ = -1.5 ± 3.0%), BMC (Δ = 0.06 ± 0.14 kg), and BMD (Δ = 0.015 ± 0.027 g·cm, all p ≤ 0.05). Across 4 years, weight increased significantly (Δ = 6.6 ± 4.1 kg) and favorable changes were observed for LM (Δ = 4.3 ± 3.0 kg), BMC (Δ = 0.18 ± 0.17 kg), and BMD (Δ = 0.033 ± 0.039 g·cm, all p ≤ 0.05). Similar patterns in body composition changes were observed for linemen and non-linemen. Results indicate that well-trained collegiate football players at high levels of competition can achieve favorable changes in body composition, even late in the career, which may confer benefits for performance and injury prevention.

Effect of two complex training protocols of back squats in blood indicators of muscular damage in military athletes

[Purpose] The aim of this study was to determine the variations in the blood muscular damage indicators post application of two complex training programs for back squats. [Subjects and Methods] Seven military athletes were the subjects of this study. The study had a quasi-experimental cross-over intra-subject design. Two complex training protocols were applied, and the variables to be measured were cortisol, metabolic creatine kinase, and total creatine kinase. For the statistical analysis, Student’s t-test was used. [Results] Twenty-four hours post effort, a significant decrease in cortisol level was shown for both protocols; however, the metabolic creatine kinase and total creatine kinase levels showed a significant increase. [Conclusion] Both protocols lowered the indicator of main muscular damage in the blood supply (cortisol). This proved that the work weight did not generate significant muscular damage in the 24-hour post-exercise period.

Similar hormonal stress and tissue damage in response to National Collegiate Athletic Association Division I football games played in two consecutive seasons

The recovery process from a college football game has been studied, yet the stability of such findings year to year in the same players remains unclear. The purpose of this study was to examine the same players' biochemical recovery process in 2 consecutive seasons to a National Collegiate Athletic Association (NCAA) Division I football game. Ten starting players volunteered to participate in the study in each of the 2 seasons. Players performed a periodized heavy resistance training program over the entire year for each season. Fasted resting blood samples were obtained at similar times the Friday before the game (T1), 18-20 hours after the game (T2), and 42-44 hours after the game (T3). In both seasons, serum creatine kinase (CK) concentrations increased significantly from T1 to T2, and returned to T1 values at T3. When we compared seasons, CK values did not differ at any time point. Myoglobin demonstrated similar patterns and results. Testosterone and cortisol values were similar at all time points and did not differ by season as no significant differences were observed for the resting hormonal concentrations. The results of this study indicate that yearly programs should maintain a periodized progressive program, which seeks to increase physical potential of players while providing a protective effect on skeletal muscle and stabilization of hormonal status in response to both game and season stressors.

Immunity, inflammatory and psychophysiological stress response during a competition of professional rugby union

Neopterin, cortisol and immunoglobulin A were measured to determine what effect a professional rugby competition has on the immunity, inflammatory and psychophysiological stress response. Urine and saliva were collected from 37 professional players at regular intervals throughout a 20 week professional competition. Total neopterin, cortisol and secretory immunoglobulin A were analysed using enzyme linked immunosorbant assay (ELISA) and high performance liquid chromatography (HPLC). All markers did not change significantly when analysed as a group during the course of the season compared to baseline (p>0.05), although long-distance travel had a minor effect on cortisol and secretory immunoglobulin A concentrations (p<0.05). More importantly, a large inter-individual variation for all markers was observed (p<0.001). These results indicate this competition of professional rugby does not cause significant changes in psychophysiological stress. Some players however, may become more susceptible to fatigue and infection during the course of a season as a result of suppressed immunity and sustained activation of the inflammatory response.

The toll of the gridiron: damage-associated molecular patterns and hypertension in American football

American football has unequivocally been linked to elevations in blood pressure and hypertension, especially in linemen. However, the mechanisms of this increase cannot be attributed solely to increased body weight and associated cardiometabolic risk factors (e.g.,dyslipidemia or hyperglycemia). Therefore, understanding the etiology of football-associated hypertension is essential for improving the quality of life in this mostly young population, as well as for lowering the potential for chronic disease in the future. We propose that inflammatogenic damage-associated molecular patterns (DAMPs) released into the circulation from football-induced musculoskeletal trauma activate pattern-recognition receptors of the innate immune system-specifically, high mobility group box 1 protein (HMGB1) and mitochondrial (mt)DNA which activate Toll-like receptor (TLR)4 and -9, respectively. Previously, we observed that circulating levels of these 2 DAMPs are increased in hypertension, and activation of TLR4 and -9 causes endothelial dysfunction and hypertension. Therefore, our novel hypothesis is that musculoskeletal injury from repeated hits in football players, particularly in linemen, leads to elevated circulating HMGB1 and mtDNA to activate TLRs on endothelial cells leading to impaired endothelium-dependent vasodilation, increased vascular tone, and hypertension.

Creatine kinase levels during preseason camp in National Collegiate Athletic Association Division I football athletes

OBJECTIVE

To investigate mean creatine kinase (CK) levels in National Collegiate Athletic Association (NCAA) Division I football athletes and the relationship between mean CK levels and demographic variables.

DESIGN

Observational cohort.

SETTING

NCAA Division I football program.

PARTICIPANTS

NCAA Division I football athletes.

INTERVENTIONS

Blood and urine samples were obtained from 32 athletes on the first (time 1), third (time 2), and seventh (time 3) days of football camp.

MAIN OUTCOME MEASURES

Mean CK levels. The hypotheses were formulated before the data were collected.

RESULTS

All urine samples tested negative for blood. Mean CK levels were 284.7 U/L at time 1, 1299.8 U/L at time 2, and 1562.4 U/L at time 3. The increases in means were statistically significant (P < 0.005 for all pairwise comparisons). Most demographic variables were not related to mean CK levels. The number of days in the precamp conditioning program was negatively associated with mean CK levels (P = 0.0284).

CONCLUSIONS

Mean CK levels in NCAA Division I football athletes during camp were higher than the serological criteria for rhabdomyolysis commonly used in clinical practice. More data are needed to assess if the number of days of participation in precamp conditioning is related to lower CK levels in NCAA Division I football athletes during camp.

Exertional rhabdomyolysis in the athlete: a clinical review

CONTEXT

Exertional rhabdomyolysis is a relatively uncommon but potentially fatal condition affecting athletes that requires prompt recognition and appropriate management.

EVIDENCE ACQUISITION

A search of the PubMed database from 2003 to 2013 using the term exertional rhabdomyolysis was performed. Further evaluation of the bibliographies of articles expanded the evidence.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 3.

RESULTS

Exertional rhabdomyolysis (ER) is a relatively uncommon condition with an incidence of approximately 29.9 per 100,000 patient years but can have very serious consequences of muscle ischemia, cardiac arrhythmia, and death. The athlete will have pain, weakness, and swelling in the muscles affected as well as significantly elevated levels of creatine kinase (CK). Hydration is the foundation for any athlete with ER; management can also include dialysis or surgery. Stratifying the athlete into high- or low-risk categories can determine if further workup is warranted.

CONCLUSION

Exertional rhabdomyolysis evaluation requires a history, physical examination, and serology for definitive diagnosis. Treatment modalities should include rest and hydration. Return to play and future workup should be determined by the risk stratification of the athlete.

STRENGTH-OF-RECOMMENDATION TAXONOMY SORT

C.