Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians

Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.

Optimizing strength training for running and cycling endurance performance: A review

Here we report on the effect of combining endurance training with heavy or explosive strength training on endurance performance in endurance-trained runners and cyclists. Running economy is improved by performing combined endurance training with either heavy or explosive strength training. However, heavy strength training is recommended for improving cycling economy. Equivocal findings exist regarding the effects on power output or velocity at the lactate threshold. Concurrent endurance and heavy strength training can increase running speed and power output at VO2max (Vmax and Wmax, respectively) or time to exhaustion at Vmax and Wmax. Combining endurance training with either explosive or heavy strength training can improve running performance, while there is most compelling evidence of an additive effect on cycling performance when heavy strength training is used. It is suggested that the improved endurance performance may relate to delayed activation of less efficient type II fibers, improved neuromuscular efficiency, conversion of fast-twitch type IIX fibers into more fatigue-resistant type IIA fibers, or improved musculo-tendinous stiffness.

Effect of training cessation on muscular performance: a meta-analysis

The purpose of this study was to assess the effect of resistance training cessation on strength performance through a meta-analysis. Seven databases were searched from which 103 of 284 potential studies met inclusion criteria. Training status, sex, age, and the duration of training cessation were used as moderators. Standardized mean difference (SMD) in muscular performance was calculated and weighted by the inverse of variance to calculate an overall effect and its 95% confidence interval (CI). Results indicated a detrimental effect of resistance training cessation on all components of muscular performance: [submaximal strength; SMD (95% CI) = -0.62 (-0.80 to -0.45), P < 0.01], [maximal force; SMD (95% CI) = -0.46 (-0.54 to -0.37), P < 0.01], [maximal power; SMD (95% CI) = -0.20 (-0.28 to -0.13), P < 0.01]. A dose-response relationship between the amplitude of SMD and the duration of training cessation was identified. The effect of resistance training cessation was found to be larger in older people (> 65 years old). The effect was also larger in inactive people for maximal force and maximal power when compared with recreational athletes. Resistance training cessation decreases all components of muscular strength. The magnitude of the effect differs according to training status, age or the duration of training cessation.

Intense training: the key to optimal performance before and during the taper

The training load is markedly reduced during the taper so that athletes recover from intense training and feel energized before major events. Load reduction can be achieved by reducing the intensity, volume and/or frequency of training, but with reduced training load there may be a risk of detraining. Training at high intensities before the taper plays a key role in inducing maximal physiological and performance adaptations in both moderately trained subjects and highly trained athletes. High-intensity training can also maintain or further enhance training-induced adaptations while athletes reduce their training before a major competition. On the other hand, training volume can be markedly reduced without a negative impact on athletes' performance. Therefore, the training load should not be reduced at the expense of intensity during the taper. Intense exercise is often a performance-determining factor during match play in team sports, and high-intensity training can also elicit major fitness gains in team sport athletes. A tapering and peaking program before the start of a league format championship or a major tournament should be characterized by high-intensity activities.

A comparative study between serve mode and speed and its effectiveness in a high-level volleyball tournament

AIM

This study carries out a comparative analysis between serve mode and speed and its effectiveness at the 2004 Men's Olympic Qualification Tournament.

METHODS

A total of 377 serves were analysed, 124 of which belonged to Cuba vs Holland, 63 to Spain vs Cameroon, 100 to Spain vs Cuba, and 91 to Holland vs Cameroon. Serve were recorded using a tripod mounted radar gun.

RESULTS

The analysis has shown the predominance of jump serve (JUMP, 84.9%) compared with float serve with jump (FLOAT JUMP, 5.6%) and float serve (FLOAT, 9.5%). Only 25.3% of the total jump serves analysed was successfully stricken back making the first tempo attack possible. The respective percentages for FLOAT JUMP and FLOAT were 42.9% and 55.6%. Ball speed in JUMP (23.03+/-3.94 m.s(-1)) was markedly higher compared with FLOAT JUMP and FLOAT (12.05+/-3.44 m.s(-1) and 11.47+/-4.22 m.s(-1)). While negative outcomes (66.7%) in FLOAT stand out, a better balance between negative and positive outcomes were found in both JUMP (50%) and FLOAT JUMP (42.9%). However, no relationship was found between serve speed and its effectiveness outcome (R2=0 in the overall sample and R2=0.005, when pooling the five serve effectiveness categories into negative and positive outcomes. In fact, JUMP was mainly performed in the span of velocities between 23.06 and 28.06 m.s(-1) in both error and direct point categories.

CONCLUSION

We found no significant relationship between serve velocity and a better outcome related to effectiveness. In addition, JUMP and FLOAT JUMP present a better balance between negative and positive outcomes compared with FLOAT.

Physique traits of lightweight rowers and their relationship to competitive success

OBJECTIVES

Physique traits and their relationship to competitive success were assessed amongst lightweight rowers competing at the 2003 Australian Rowing Championships.

METHODS

Full anthropometric profiles were collected from 107 lightweight rowers (n = 65 males, n = 45 females) competing in the Under 23 and Open age categories. Performance assessments were obtained for 66 of these rowers based on results in the single sculls events. The relationship between physique traits and competitive success was then determined.

RESULTS

Lower body fat (heat time estimate -8.4 s kg(-1), p<0.01), greater total body mass (heat time estimate -4.4 s kg(-1), p = 0.03), and muscle mass (heat time estimate -10.2 s kg(-1), p<0.01) were associated with faster 2000 m heat times.

CONCLUSIONS

The more successful lightweight rowers were those who had lower body fat and greater total muscle mass.

Physiological and performance benefits of halftime cooling

This study examined the effect of a 10-min, halftime cooling application on physiological and psychological parameters known to affect performance. Fourteen volunteers (10 male, 4 female) completed two randomised trials 48 hr to 7 days apart. Trials consisted of a 1-hr cycling protocol: 30 min at 75% VO2max followed by 10 min cooling (application of a cooling jacket) or passive recovery (control), and a second 30-min exercise bout consisting of 20 min at 75% VO2max, immediately followed by a 10-min maximal effort, where work was measured as energy expended (kJ). Performance of the 10-min maximal intensity phase tended to improve (171.5 +/- 30.4 kJ vs 165.4 +/- 29.2 kJ, p = 0.087) following the cooling trial. Heart rate during the 5th min of the maximal effort, (183 +/- 9 beats.min(-1) vs 180 +/- 7 beats.min(-1), p = 0.024), blood lactate concentration at 6 min post-exercise (9.3 +/- 3.1 mmolxL(-1) vs 7.9 +/- 3.2 mmolxL(-1), p = 0.007), rating of perceived exertion at the 20th min post-halftime recovery (15 +/- 2 vs 16 +/- 2, p = 0.042), and subjective rating of feelings and emotions differed between the cooling and control conditions. Sweat loss, core and mean skin temperature and rating of thermal sensation failed to differ significantly between conditions. Halftime cooling tended to result in greater aerobic performance. Psychological assessment revealed a dramatic placebo effect from the cooling application confounding these results. Furthermore, the cooling intervention failed to induce any significant thermoregulatory effects.

Physiological variables to use in the gender comparison in highly trained runners

AIM

The aims of this investigation were to compare physiological characteristics between highly trained middle-distance and marathon male (n=17) and female (n=11) runners; to determine the most suitable variables to use in the gender comparison in these subjects, considering physical difference between genders; and to indicate some of the best predictors of performance in running events in which oxidative metabolism prevails.

METHODS

Subjects performed a progressive maximal exercise on the treadmill to determine maximal oxygen uptake (VO(2max)) and velocities corresponding to a blood lactate concentration of 4 mmol x L(-1) (upsilon(OBLA)) and to the lactate threshold (upsilon(LT)). Cost of running (Cr) and maximal aerobic velocity (upsilon(a max)) were calculated from VO(2) measurements.

RESULTS

Males presented higher VO(2max), upsilon(a max), upsilon(OBLA), upsilon(LT), and VO(2) @ upsilon(OBLA) and upsilon(LT) (p<0.001), but females had higher upsilon(OBLA) and upsilon(LT) (p<0.01) expressed as %VO(2max). upsilon(a max) correlated with performance time relative to the world record in both, females (r=-0.77, p<0.01) and males (r=-0.58, p<0.05); and upsilon(LT) with performance only in males (r=-0.59, p<0.05).

CONCLUSION

In conclusion, female athletes seemed to compensate partly their aerobic profile with higher %VO(2max) @ u(OBLA) and u(LT), suggesting that both maximal and submaximal physiological variables should be considered when evaluating and comparing highly trained athletes of both genders. upsilon(a max) is one of the best predictors of performance in running events in which oxidative metabolism prevails.

Swimming performance changes during the final 3 weeks of training leading to the Sydney 2000 Olympic Games

The purpose of this study was to determine the magnitude of the swimming performance change during the final 3 weeks of training (F3T) leading to the Sydney 2000 Olympic Games. Olympic swimmers who took part in the same event or events at the Telstra 2000 Grand Prix Series in Melbourne, Australia, (26 - 27 August 2000), and 21 - 28 d later at the Sydney 2000 Olympic Games (16 - 23 September 2000) were included in this analysis. A total of 99 performances (50 male, 49 female) were analysed. The overall performance improvement between pre- and post-F3T conditions for all swimmers was 2.18 +/- 1.50 % (p < 0.0001), (range - 1.14 % to 6.02 %). A total of 91 of the 99 analysed performances were faster after the F3T and only 8 were slower. The percentage improvement with F3T was significantly higher (P < 0.01) in males (2.57 +/- 1.45 %) than in females (1.78 +/- 1.45 %). In conclusion, the pre-Olympic F3T elicited a significant performance improvement of 2.57 % for male and 1.78 % for female swimmers at the Sydney 2000 Olympic Games. The magnitude was similar for all competition events, and was achieved by swimmers from different countries and performance levels. These data provide a quantitative framework for coaches and swimmers to set realistic performance goals based on individual performance levels before the final training phase leading to important competitions.

Physiological and performance responses to a 6-day taper in middle-distance runners: influence of training frequency

The purpose of this investigation was to examine the influence of training frequency on performance and some physiological responses during a 6-day taper. After 18 weeks of training, 9 male middle-distance runners were assigned to a high frequency taper (HFT, n = 5) or a moderate frequency taper (MFT, n = 4), consisting of training daily or resting every third day of the taper. Taper consisted of an 80% nonlinear progressive reduction in high intensity interval training. Blood samples were obtained, and 800 m performance and peak blood lactate ([La] peak ) measured before and after taper. Performance improved significantly after HFT (121.8 +/- 4.7 vs 124.2 +/- 4.9 s, p < 0.05), but not after MFT (126.6 +/- 2.8 vs 127.1 +/- 2.1 s). Neutrophils (2.89 +/- 0.68 vs 2.56 +/- 0.61 10 (3) x mm(-3)), granulocytes (3.08 +/- 0.70 vs 2.77 +/- 0.66 10 (3) x mm(-3)), haptoglobin (79.7 +/- 47.9 vs 60.7 +/- 33.6 mg x dl(-1)), total testosterone (7.39 +/- 1.67 vs 5.52 +/- 0.88 microg x l(-1)) and [La] peak (15.5 +/- 1.5 vs 14.4 +/- 2.0 mmol x l(-1)) significantly increased with taper. [La] peak correlated with performance time before taper (r = -0.76, p < 0.05), and change in [La] peak with change in serum cortisol (r = -0.75, p < 0.05) and total testosterone:cortisol ratio (r = 0.82, p < 0.01). In conclusion, training daily during a 6-day taper brought about significant performance gains, whereas resting every third day did not. High [La] peak and a hormonal milieu propitious to anabolic processes seemed to be necessary for optimum performance.

Influence of body mass and height on the energy cost of running in highly trained middle- and long-distance runners

Previous studies about the influence of body dimensions on running economy have not compared athletes specialized in different competition events. Therefore, the purpose of the present study was to assess the influence of body mass (m(b)) and height (h) on the energy cost of running (Cr) in 38 highly trained male runners, specialized in either marathon (M, n = 12), long middle-distance (5000 - 10000 m, LMD, n = 14) or short middle-distance (800 - 1500 m, SMD, n = 12), and to assess possible differences in body dimensions for each event. Subjects performed a progressive maximal exercise on the treadmill to determine oxygen uptake VO(2)) at different submaximal velocities and maximal oxygen uptake VO(2)max). Cr was calculated from VO(2) measurements. LMD runners had significantly higher mean Cr (0.192 +/- 0.007, 0.182 +/- 0.009, and 0.180 +/- 0.009 ml O(2) x kg(-1) x m(-1) for LMD, M and SMD, respectively) and VO(2)max (74.1 +/- 3.7, 68.5 +/- 2.9 and 69.7 +/- 3.4 ml x kg (-1) x min (-1)). Cr correlated with h (r = -0.86, p < 0.001) and m(b) (r = -0.77, p < 0.01) only in the SMD group. In conclusion, these data suggest that highly trained distance runners tend to show counterbalancing profiles of running economy and VO(2)max (the higher Cr, the higher VO(2) max and vice versa), and that anthropometric characteristics related with good performance are different in long-distance and middle-distance events.

Physiological and performance characteristics of male professional road cyclists

Male professional road cycling competitions last between 1 hour (e.g. the time trial in the World Championships) and 100 hours (e.g. the Tour de France). Although the final overall standings of a race are individual, it is undoubtedly a team sport. Professional road cyclists present with variable anthropometric values, but display impressive aerobic capacities [maximal power output 370 to 570 W, maximal oxygen uptake 4.4 to 6.4 L/min and power output at the onset of blood lactate accumulation (OBLA) 300 to 500 W]. Because of the variable anthropometric characteristics, 'specialists' have evolved within teams whose job is to perform in different terrain and racing conditions. In this respect, power outputs relative to mass exponents of 0.32 and 1 seem to be the best predictors of level ground and uphill cycling ability, respectively. However, time trial specialists have been shown to meet requirements to be top competitors in all terrain (level and uphill) and cycling conditions (individually and in a group). Based on competition heart rate measurements, time trials are raced under steady-state conditions, the shorter time trials being raced at average intensities close to OBLA (approximately 400 to 420 W), with the longer ones close to the individual lactate threshold (LT, approximately 370 to 390 W). Mass-start stages, on the other hand, are raced at low mean intensities (approximately 210 W for the flat stages, approximately 270 W for the high mountain stages), but are characterised by their intermittent nature, with cyclists spending on average 30 to 100 minutes at, and above LT, and 5 to 20 minutes at, and above OBLA.

Muscular characteristics of detraining in humans

Skeletal muscle is characterized by its ability to dynamically adapt to variable levels of functional demands. During periods of insufficient training stimulus, muscular detraining occurs. This may be characterized by a decreased capillary density, which could take place within 2--3 wk of inactivity. Arterial-venous oxygen difference declines if training stoppage continues beyond 3--8 wk. Rapid and progressive reductions in oxidative enzyme activities bring about a reduced mitochondrial ATP production. The above changes are related to the reduction in VO(2max) observed during long-term training cessation. These muscular characteristics remain above sedentary values in the detrained athlete but usually return to baseline values in recently trained individuals. Glycolytic enzyme activities show nonsystematic changes during periods of training cessation. Fiber distribution remains unchanged during the initial weeks of inactivity, but oxidative fibers may decrease in endurance athletes and increase in strength-trained athletes within 8 wk of training stoppage. Muscle fiber cross-sectional area declines rapidly in strength and sprint athletes, and in recently endurance-trained subjects, whereas it may increase slightly in endurance athletes. Force production declines slowly and in relation to decreased EMG activity. Strength performance in general is readily maintained for up to 4 wk of inactivity, but highly trained athletes' eccentric force and sport-specific power, and recently acquired isokinetic strength, may decline significantly.

Exercise intensity and load during mass-start stage races in professional road cycling

PURPOSE

To evaluate exercise intensity and load during mass-start stages in professional road cycling, using competition heart rate (HR) recordings.

METHODS

Seventeen world-class cyclists performed an incremental laboratory test during which maximal power output (Wmax), maximal HR (HRmax), onset of blood lactate accumulation (OBLA), lactate threshold (LT), and a HR-power output relationship were assessed. An OBLAZONE (HROBLA +/- 3 beats.min-1) and an LTZONE (HRLT +/- 3 beats.min-1) were described. HR was monitored during 125 flat (< 13 km uphill, < 800-m altitude change; FLAT), 99 semi-mountainous (13-35 km uphill, 800- to 2000-m altitude change; SEMO), and 86 high-mountain (> 35 km uphill, > 2000-m altitude change; HIMO) stages. Each cyclist's competition power output was estimated from competition HR and individual HR-power output relationships. Competition training impulse (TRIMP) values and time spent at "easy," "moderate," and "hard" zones were estimated from HR and race duration.

RESULTS

Average %HRmax were 61 +/- 5%, 58 +/- 6%, and 51 +/- 7% in HIMO, SEMO, and FLAT stages, respectively, and estimated average power outputs were 246 +/- 44, 234 +/- 43, and 192 +/- 45 W. Competition HR values relative to HROBLA and HRLT were, respectively, 69 +/- 6, 79 +/- 9% in HIMO; 65 +/- 7, 74 +/- 11% in SEMO; and 57 +/- 8, 65 +/- 10% in FLAT stages. The amount of TRIMP in HIMO, SEMO, and FLAT stages were, respectively, 215 +/- 38, 172 +/- 31, and 156 +/- 31. Percentage time spent in the "moderate" and "hard" zones was highest in HIMO (22 +/- 14, 5 +/- 6%) followed by SEMO (15 +/- 13, 5 +/- 5%) and FLAT (9 +/- 7, 2 +/- 2%) stages.

CONCLUSIONS

%HRmax, time distribution around HROBLA and HRLT, TRIMP, and load zones reflected the physiological demands of different mass-start cycling stage categories. The knowledge of these demands could be useful for planning precompetition training strategies.

Cardiorespiratory and metabolic characteristics of detraining in humans

Detraining can be defined as the partial or complete loss of training-induced adaptations, in response to an insufficient training stimulus. Detraining is characterized, among other changes, by marked alterations in the cardiorespiratory system and the metabolic patterns during exercise. In highly trained athletes, insufficient training induces a rapid decline in VO2max, but it remains above control values. Exercise heart rate increases insufficiently to counterbalance the decreased stroke volume resulting from a rapid blood volume loss, and maximal cardiac output is thus reduced. Cardiac dimensions are also reduced, as well as ventilatory efficiency. Consequently, endurance performance is also markedly impaired. These changes are more moderate in recently trained subjects in the short-term, but recently acquired VO2max gains are completely lost after training stoppage periods longer than 4 wk. From a metabolic viewpoint, even short-term inactivity implies an increased reliance on carbohydrate metabolism during exercise, as shown by a higher exercise respiratory exchange ratio. This may result from a reduced insulin sensitivity and GLUT-4 transporter protein content, coupled with a lowered muscle lipoprotein lipase activity. These metabolic changes may take place within 10 d of training cessation. Resting muscle glycogen concentration returns to baseline within a few weeks without training, and trained athletes' lactate threshold is also lowered, but still remains above untrained values.

Scientific approach to the 1-h cycling world record: a case study

The purpose of this study was to describe the physiological and aerodynamic characteristics and the preparation for a successful attempt to break the 1-h cycling world record. An elite professional road cyclist (30 yr, 188 cm, 81 kg) performed an incremental laboratory test to assess maximal power output (W(max)) and power output (W(OBLA)), estimated speed (V(OBLA)), and heart rate (HR(OBLA)) at the onset of blood lactate accumulation (OBLA). He also completed an incremental velodrome (cycling track) test (VT1), during which V(OBLAVT1) and HR(OBLAVT1) were measured and W(OBLAVT1) was estimated. W(max) was 572 W, W(OBLA) 505 W, V(OBLA) 52.88 km/h, and HR(OBLA) 183 beats/min. V(OBLAVT1), HR(OBLAVT1), and W(OBLAVT1) were 52.7 km/h, 180 beats/min, and 500.6 W, respectively. Drag coefficient and shape coefficient, measured in a wind tunnel, were 0. 244 and 0.65 m(2), respectively. The cyclist set a world record of 53,040 m, with an estimated average power output of 509.5 W. Based on direct laboratory data of the power vs. oxygen uptake relationship for this cyclist, this is slightly higher than the 497. 25 W corresponding to his oxygen uptake at OBLA (5.65 l/min). In conclusion, 1) the 1-h cycling world record is the result of the interaction between physiological and aerodynamic characteristics; and 2) performance in this event can be predicted using mathematical models that integrate the principal performance-determining variables.

Detraining: loss of training-induced physiological and performance adaptations. Part II: Long term insufficient training stimulus

This part II discusses detraining following an insufficient training stimulus period longer than 4 weeks, as well as several strategies that may be useful to avoid its negative impact. The maximal oxygen uptake (VO2max) of athletes declines markedly but remains above control values during long term detraining, whereas recently acquired VO2max gains are completely lost. This is partly due to reduced blood volume, cardiac dimensions and ventilatory efficiency, resulting in lower stroke volume and cardiac output, despite increased heart rates. Endurance performance is accordingly impaired. Resting muscle glycogen levels return to baseline, carbohydrate utilisation increases and the lactate threshold is lowered, although it remains above untrained values in the highly trained. At the muscle level, capillarisation, arterial-venous oxygen difference and oxidative enzyme activities decline in athletes and are completely reversed in recently trained individuals, contributing significantly to the long term loss in VO2max. Oxidative fibre proportion is decreased in endurance athletes, whereas it increases in strength athletes, whose fibre areas are significantly reduced. Force production declines slowly, and usually remains above control values for very long periods. All these negative effects can be avoided or limited by reduced training strategies, as long as training intensity is maintained and frequency reduced only moderately. On the other hand, training volume can be markedly reduced. Cross-training may also be effective in maintaining training-induced adaptations. Athletes should use similar-mode exercise, but moderately trained individuals could also benefit from dissimilar-mode cross-training. Finally, the existence of a cross-transfer effect between ipsilateral and contralateral limbs should be considered in order to limit detraining during periods of unilateral immobilisation.

Detraining: loss of training-induced physiological and performance adaptations. Part I: short term insufficient training stimulus

Detraining is the partial or complete loss of training-induced adaptations, in response to an insufficient training stimulus. Detraining characteristics may be different depending on the duration of training cessation or insufficient training. Short term detraining (less than 4 weeks of insufficient training stimulus) is analysed in part I of this review, whereas part II will deal with long term detraining (more than 4 weeks of insufficient training stimulus). Short term cardiorespiratory detraining is characterised in highly trained athletes by a rapid decline in maximal oxygen uptake (VO2max) and blood volume. Exercise heart rate increases insufficiently to counterbalance the decreased stroke volume, and maximal cardiac output is thus reduced. Ventilatory efficiency and endurance performance are also impaired. These changes are more moderate in recently trained individuals. From a metabolic viewpoint, short term inactivity implies an increased reliance on carbohydrate metabolism during exercise, as shown by a higher exercise respiratory exchange ratio, and lowered lipase activity, GLUT-4 content, glycogen level and lactate threshold. At the muscle level, capillary density and oxidative enzyme activities are reduced. Training-induced changes in fibre cross-sectional area are reversed, but strength performance declines are limited. Hormonal changes include a reduced insulin sensitivity, a possible increase in testosterone and growth hormone levels in strength athletes, and a reversal of short term training-induced adaptations in fluid-electrolyte regulating hormones.

Exercise intensity during competition time trials in professional road cycling

PURPOSE

To estimate, upon competition heart rate (HR), exercise intensity during time trials (TT) in professional road cycling.

METHODS

Eighteen world-class cyclists completed an incremental laboratory cycling test to assess maximal power output (Wmax), maximal HR (HRmax), onset of blood lactate accumulation (OBLA), lactate threshold (LT), and a HR-power output relationship. An OBLA(ZONE) (HR(OBLA) +/- 3 beats x min(-1)) and a LT(ZONE) (HR(LT) +/- 3 beats x min(-1)) were described. HR was monitored during 12 prologue (<10 km, PTT), 18 short (<40 km, STT), 19 long (>40 km, LTT), eight uphill (UTT), and seven team (TTT) time trials. A HR-power output relationship was computed to estimate each cyclist's power output during TT racing from competition HR. Competition training impulse (TRIMP) values were estimated from HR and race duration.

RESULTS

%HRmax were 89+/-3%, 85+/-5%, 80+/-5%, 78+/-3%, and 82+/-2% in PTT, STT, LTT, UTT, and TTT, respectively. The amount of TRIMP were, respectively, 21+/-3, 77+/-23, 122+/-27, 129+/-14, and 146+/-6. Competition HR values relative to HR(OBLA) and HR(LT) were, respectively, 100+/-3%, 114+/-8% in PTT, 95+/-7%, 108+/-9% in STT, 89+/-5%, 103+/-8% in LTT, 87+/-2%, 101+/-5% in UTT, and 91+/-4%, 105+/-11% in TTT.

CONCLUSIONS

%HRmax, TRIMP and time distribution around HR(OBLA) and HR(LT) reflected the physiological demands of different TT categories. HR(OBLA) and HR(LT) were accurate intensity markers in events lasting, respectively, < or =30 (PTT and STT) and > or =30 min (LTT, UTT, TTT).

Carbohydrate loading failed to improve 100-km cycling performance in a placebo-controlled trial

We evaluated the effect of carbohydrate (CHO) loading on cycling performance that was designed to be similar to the demands of competitive road racing. Seven well-trained cyclists performed two 100-km time trials (TTs) on separate occasions, 3 days after either a CHO-loading (9 g CHO. kg body mass(-1). day(-1)) or placebo-controlled moderate-CHO diet (6 g CHO. kg body mass(-1). day(-1)). A CHO breakfast (2 g CHO/kg body mass) was consumed 2 h before each TT, and a CHO drink (1 g CHO. kg(.)body mass(-1). h(-1)) was consumed during the TTs to optimize CHO availability. The 100-km TT was interspersed with four 4-km and five 1-km sprints. CHO loading significantly increased muscle glycogen concentrations (572 +/- 107 vs. 485 +/- 128 mmol/kg dry wt for CHO loading and placebo, respectively; P < 0.05). Total muscle glycogen utilization did not differ between trials, nor did time to complete the TTs (147.5 +/- 10.0 and 149.1 +/- 11.0 min; P = 0.4) or the mean power output during the TTs (259 +/- 40 and 253 +/- 40 W, P = 0.4). This placebo-controlled study shows that CHO loading did not improve performance of a 100-km cycling TT during which CHO was consumed. By preventing any fall in blood glucose concentration, CHO ingestion during exercise may offset any detrimental effects on performance of lower preexercise muscle and liver glycogen concentrations. Alternatively, part of the reported benefit of CHO loading on subsequent athletic performance could have resulted from a placebo effect.

Physiological responses to a 6-d taper in middle-distance runners: influence of training intensity and volume

PURPOSE

This study examined some physiological and performance responses to a 6-d taper, and the influence of training intensity and volume on these responses.

METHODS

After 15 wk of training, 8 well-trained male middle-distance runners were randomly assigned to either a moderate volume taper (MVT, N = 4) or a low volume taper (LVT, N = 4), consisting of either a 50% or a 75% progressive reduction in pretaper low intensity continuous training (LICT) and high intensity interval training (HIIT). Blood samples were obtained and 800-m running performance was measured before and after taper.

RESULTS

Performance was not significantly enhanced by either taper protocol (post- vs pre-taper times 124.9 +/- 4.5 vs 126.1 +/- 4.2 s with LVT, 126.2 +/- 8.0 vs 125.7 +/- 6.6 s with MVT). For the entire group of 8 subjects, red cell count, hemoglobin (Hb), mean corpuscular volume and mean corpuscular Hb concentration significantly decreased with taper, while reticulocyte count increased. Performance changes for all subjects correlated with changes in postrace peak blood lactate concentration (r = 0.87, P < 0.01). Taper LICT correlated with changes in Hb (r = 0.77), hematocrit (r = 0.81), reticulocyte count (r = 0.73), creatine kinase (r = 0.72), and total testosterone (r = -0.78), and with posttaper red cell distribution width (r = -0.75) and lymphocyte count (r = -0.82). Taper HIIT correlated nonsignificantly with changes in red cell count (r = -0.66) and total testosterone (r = 0.68).

CONCLUSION

It is concluded that taper-induced physiological changes in trained middle-distance runners are mainly hematological, and that distinct physiological changes are elicited from LICT and HIIT during taper. Middle-distance runners can progressively reduce their usual training volume by at least 75% during a 6-d taper.

Creatine supplementation and sprint performance in soccer players

PURPOSE

This investigation examined the effects of creatine (Cr) supplementation on intermittent high-intensity exercise activities specific to competitive soccer.

METHODS

On two occasions 7 d apart, 17 highly trained male soccer players performed a counter-movement jump test (CMJT), a repeated sprint test (RST) consisting of six maximal 15-m runs with a 30-s recovery, an intermittent endurance test (IET) consisting of forty 15-s bouts of high-intensity running interspersed by 10-s bouts of low-intensity running, and a recovery CMJT consisting of three jumps. After the initial testing session, players were evenly and randomly included in a CREATINE (5 g of Cr, four times per day for 6 d) or a PLACEBO group (same dosage of maltodextrins) using a double-blind research design.

RESULTS

The CREATINE group's average 5-m and 15-m times during the RST were consistently faster after the intervention (0.95 +/- 0.03 vs 0.97 +/- 0.02 s, P < 0.05 and 2.29 +/- 0.08 vs 2.32 +/- 0.07 s, P = 0.07, respectively). Neither group showed significant changes in the CMJT or the IET. The CREATINE group's recovery CMJT performance relative to the resting CMJT remained unchanged postsupplementation, whereas it tended to decrease in the PLACEBO group.

CONCLUSION

In conclusion, acute Cr supplementation favorably affected repeated sprint performance and limited the decay in jumping ability after the IET in highly trained soccer players. Intermittent endurance performance was not affected by Cr.

Level ground and uphill cycling ability in professional road cycling

PURPOSE

To evaluate the physiological capacities and performance of professional road cyclists in relation to their morphotype-dependent speciality.

METHODS

24 world-class cyclists, classified as flat terrain (FT, N = 5), time trial (TT, N = 4), all terrain (AT, N = 6). and uphill (UH, N = 9) specialists, completed an incremental laboratory cycling test to assess maximal power output (Wmax), maximal oxygen uptake (VO2max), lactate threshold (LT), and onset of blood lactate accumulation (OBLA).

RESULTS

UH had a higher frontal area (FA):body mass (BM) ratio (5.23 +/- 0.09 m2 x kg(-1) x 10(-3)) than FT and TT (P < 0.05). FT showed the highest absolute Wmax (481 +/- 18 W), and UH the highest Wmax relative to BM (6.47 +/- 0.33 W x kg(-1)). WLT and W(OBLA) values were significantly higher in FT (356 +/- 41 and 417 +/- 45 W) and TT (357 +/- 41 and 409 +/- 46 W) than in UH (308 +/- 46 and 356 +/- 41). Scaling of these values relative to FA and BM exponents 0.32 and 0.79 minimized group differences, but considerable differences among mean group values remained. FT and TT had the highest Wmax per FA unit (1300 +/- 62 and 1293 +/- 57 W x m2), whereas TT had the highest absolute W x kg(-0.32) and W x kg(-0.79), as well as W x kg(-0.32), W x kg(-0.79), and W x m2 at the LT and OBLA.

CONCLUSIONS

i) Scaling of maximal and submaximal physiological values showed a performance advantage of TT over FT, AT, and UH in all cycling terrains and conditions; and ii) mass exponents of 0.32 and 1 were the most appropriate to evaluate level and uphill cycling ability, respectively, whereas absolute Wmax values are recommended for performance-prediction in short events on level terrain, and W(LT) and W(OBLA) in longer time trials and uphill cycling.

Performance and physiological responses to a 5-week synchronized swimming technical training programme in humans

A synchronized swimming team routine (TR) is composed of figures of varying degrees of difficulty. Swimmers able to perform these figures separately underwent a 5-week technical training programme (TTP) to assemble a TR. Little is known about the physiological responses to this kind of TTP. A group of 13 trained synchronized swimmers [mean age 14 (SD 1) years] were tested before and after a 5-week TTP. The TR lasted 5 min, and 45% of that time was spent underwater. The swimmers' technique scores in the TR improved significantly from 4.5 (SD 1.9) before to 5.8 (SD 2.3) points after the TTP (P < 0.01), but their swimming performances, peak oxygen uptake (VO2peak), blood lactate concentration, and heart rate measured during a 400-m swim were lower after the TTP. The improvement in the technique scores correlated negatively with the change in VO2peak (r = -0.57; P < 0.05). The greater the improvement in the technique score, the greater the decrease in VO2peak. The overall synchronized swimming skill was assessed by the best score the swimmers obtained in four to six competitions over a season. This score was related to the 400-m swimming performance, VO2peak, maximal distance covered in apnoea, and the breath-hold time. The 5-week TTP therefore improved technical performance during the TR without improving physiological, swimming or apnoea performances. However, the physiological profile of each swimmer was linked to the synchronized swimming skill.

Anaemia and iron deficiency in athletes. Practical recommendations for treatment

Trained athletes frequently experience low levels of blood haemoglobin (13 to 14 g/100ml in men and 12 g/100ml in women) plus low haematocrit and low ferritin levels. These parameters define the concept of 'sports anaemia'. Low iron levels may be due to mechanical haemolysis, intestinal bleeding, haematuria, sweating, low iron intake or poor intestinal absorption. The resulting decrease in blood gas transport and muscle enzyme activity impairs performance. The concept of sports anaemia can be criticised. Simply measuring the blood levels does not take into account the haemodilution that occurs in athletes because of training. The lack of these measurements makes it difficult to diagnose anaemia or evaluate any treatment. Anaemia is treated by preventing decreased iron stores through a balanced food intake or iron supplements. Self-medications must be discouraged because of intolerance, risk of overdose and many other drug interactions.

A new reliable laboratory test of endurance performance for road cyclists

PURPOSE

The purpose of this study was to devise and evaluate a laboratory test of cycling performance that simulates the variable power demands of competitive road racing. The test is a 100-km time trial interspersed with four 1-km and four 4-km sprints.

METHODS

On three occasions separated by 5-7 d, eight endurance-trained cyclists (peak oxygen uptake 5.0 +/- 0.7 L.min-1, peak power output 411 +/- 43 W, mean +/- SD) performed the test on their own bikes mounted on an air-braked Kingcycle ergometer. Subjects were free to regulate their power output but were asked to complete each sprint and the full distance as quickly as possible. The only feedback given to the cyclists during each test was elapsed distance.

RESULTS

In the first test, time for the 100 km and mean times for the 1-km and 4-km sprints were 151:42 +/- 10:36, 1:16 +/- 0:06, and 5:31 +/- 0:16 min:s, respectively; these times improved by 1.6-2.2% in the second test, but there was little further improvement in the third test (0.7 to -0.5%). The between-test correlation for 100-km time was 0.93 (95% CI 0.79 to 0.98), and the within-cyclist coefficient of variation was 1.7% (95% CI 1.1 to 2.5%). Mean sprint performance showed similar good reliability (within-subject variation and correlations for the 1-km and 4-km sprint times of 1.9%, 2.0%, 0.93, and 0.81, respectively).

CONCLUSIONS

The high reliability of this laboratory test will make the test useful for research on performance of competitive road cyclists.

The influence of training characteristics and tapering on the adaptation in highly trained individuals: a review

In the general population, the adaptation to training seems to be dependent on factors such as training intensity, volume and frequency, and the initial level of fitness. In highly trained athletes, however, training intensity and initial performance level appear to be the most important factors influencing the response to training, and therefore competition performance, provided that necessary training volume and frequency are assured. When preparing for a major competition, athletes tend to reduce their training load for a variable period of time. This technique, known as taper, can have a major influence on the athlete's performance. The response to taper may be affected by the degree to which training intensity, volume and frequency are reduced, as well as by the combined effects of these variables. A thorough review of the available literature suggests that training volume and frequency can be reduced to a higher extent than training intensity, if falling into detraining is to be avoided. Moreover, the duration of the taper period and the time constant of decay of the training load can also affect the response to taper. Indeed, slow progressive reductions appear to be more effective than sudden standardized reductions in improving the athlete's performance level.

Hematological responses to training and taper in competitive swimmers: relationships with performance

The purpose of this study was to monitor hematological changes during 12 weeks of intense training and 4 weeks of taper in 8 highly trained competitive swimmers, and to assess the relationships between hematological variables and competition performance. Venous blood samples were obtained in the mid-season (wk 10), before taper (wk 22) and after taper (wk 26). Swimmers participated in actual competitions within 1 wk of each blood testing. Comparisons were made between swimmers improving performance with taper by more than 2% (n = 4), efficient (GE) or less than 2% (n = 4), less efficient (GLE). Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) increased significantly during training. MCH and MCHC decreased during taper, while serum iron tended to increase (P = 0.07). Improvement in performance during taper was positively correlated with post-taper red cell count (RCC): r = 0.83, P < 0.05. GE swimmers had higher pre- and post-taper RCC, and post-taper Hb and hematocrit. In conclusion, intense training and taper appeared to influence the hematological status and performance capacity of the studied group of swimmers.

Creatine supplementation as an ergogenic aid for sports performance in highly trained athletes: a critical review

Creatine supplementation has become a common practice among competition athletes participating in different sports over the last few years. The mechanism by which supplementary creatine could have potential ergogenic effects would be an increased muscle creatine and phosphocreatine concentration, leading to a higher rate of ATP resynthesis, a delay in the onset of muscular fatigue and a facilitated recovery during repeated bouts of high-intensity exercise. A critical review of the literature reveals that these ergogenic effects, when found, have been generally shown in untrained subjects performing several exercise bouts under laboratory conditions. The limited body of scientific data available concerning highly trained athletes performing single competition-like exercise tasks indicates that this type of population does not benefit from creatine supplementation. Therefore, the widespread use of creatine ingestion to improve competition performance does not seem to be justified. The potential interest of creatine supplementation for elite athletes could be related to an increased ability to perform repeated high-intensity exercise bouts, either during training or during competition in sports in which repeated efforts are required (e.g. soccer, basketball), but this possibility needs scientific confirmation.

Creatine supplementation does not improve sprint performance in competitive swimmers

This study was conducted to examine the effects of creatine (Cr) supplementation on sprint swimming performance and energy metabolism. Twenty highly trained swimmers (9 female, 11 male) were tested for blood ammonia and for blood lactate after the 25-, 50-, and 100-m performance in their best stroke on two occasions 7 d apart. After the first trial, subjects were evenly and randomly assigned to either a creatine (5 g creatine monohydrate 4 times per day for 5 d) or a placebo group (same dosage of a lactose placebo) in a double-blind research design. No significant differences in performance times were observed between trials. Post-exercise blood ammonia concentration decreased in the 50- and 100-m trials in the creatine group and in the 50-m trial in the placebo group. The supplementation period had no effect on post-exercise blood lactate. Therefore, creatine supplementation cannot be considered as an ergogenic aid for sprint performance in highly trained swimmers although adenine nucleotide degradation may be reduced during sprint exercise after 5 d of creatine ingestion.

Hormonal responses to training and its tapering off in competitive swimmers: relationships with performance

During a winter training season, the effects of 12 weeks of intense training and 4 weeks of tapering off (taper) on plasma hormone concentrations and competition performance were investigated in a group of highly trained swimmers (n = 8). Blood samples were collected and the swimmers performed their speciality in competition at weeks 10 (mid-season), 22 (pre-taper) and 26 (post-taper). No statistically significant changes were observed in the concentrations of total testosterone (TT), non-sex hormone binding globulin-bound-testosterone (NSBT), cortisol (C), luteinising hormone, thyroid stimulating hormone, triiodothyronine, thyroxine plasma catecholamines, creatine kinase and ammonia during training and taper. Mid-season NSBT: C ratio and the amount of training were statistically related (r = 0.82, P < 0.05). Competition performance slightly declined during intense training [0.52 (SD 2.51)%, NS] and improved during taper [2.32 (SD 1.69)%, P < 0.01]. Changes in performance during training and taper correlated with changes in ratios TT: C (r = 0.86, P < 0.01 and r = 0.81, P < 0.05, respectively) and NSBT: C (r = 0.77, P < 0.05 and r = 0.76, P < 0.05, respectively). In summary, these results showed that the monitored plasma hormones and metabolic indices were unaltered by 12 weeks of intense training and 4 weeks of taper. The TT: C and NSBT: C ratios, however, appeared to be effective markers of the swimmers' performance capacities throughout the training season.

Blood lactate recovery measurements, training, and performance during a 23-week period of competitive swimming

The purpose of this study was to relate measurements of blood lactate concentration, performance during a maximal anaerobic lactic test (MANLT) and training loads during a 23-week swimming season. Six elite 200-m freestyle male swimmers [mean age 19.5 (SD 1.6) years, height 184 (SD 5) cm and body mass 77.7 (SD 9.0) kg], participated in the study. The MANLT consisted of four all-out 50-m swims interspersed with 10-s recovery periods. Blood lactate concentrations were determined at 3 and 12-min post-exercise and were performed on weeks 2,6,10,14,18 and 21. Swimmers participated in 200-m freestyle competitions on weeks 1,7,13 and 23 (national championships). During weeks 1-10, training mostly involved aerobic exercise, while during weeks, 11-23, it involved anaerobic exercise. At 3-min and 12-min post-MANLT lactate concentrations varied throughout the season [range from 14.9 (SD 1.2) to 18.7 (SD 1.0) mmol.l-1] but demonstrated non-systematic variations. In contrast, the percentage of mean blood lactate decrease (% [La-]recovery) between min 3 and min 12 of the passive recovery post-MANLT increased from week 2 to 10 with aerobic training and decreased from week 10 to 21 with anaerobic training. The MANLT performance improved continuously throughout the season, while competition performance improved during the first three competitions but declined in the final championships, coinciding with the lowest % [La-]recovery and signs of overtraining, such as bad temper and increased sleeping heart rate. The results of this study indicated that % [La-]recovery could be an efficient marker for monitoring the impact of aerobic and anaerobic training and avoiding overtraining in elite 200-m swimmers.

Validity of a velodrome test for competitive road cyclists

The aim of this study was to evaluate the validity of a velodrome field test consisting of repeated rides of 2,280 m, with an initial speed of 28 km.h-1 and increments of 1.5 km.h-1 interspersed with 1-min recovery periods until exhaustion. A group of 12 male competitive road cyclists performed maximal cycling tests under velodrome and laboratory conditions. Velodrome oxygen uptake (VO2) and power output were estimated using equations previously published. Physiological responses to the two tests were compared. Relationships between performance in the velodrome and physiological parameters measured in the laboratory were studied. Maximal power output, heart rate and VO2 were similar in the velodrome and the laboratory [372 (SD 50) vs 365 (SD 36) W, 195 (SD 8) vs 196 (SD 9) beats.min-1 and 4.49 (SD 0.56) vs 4.49 (SD 0.46) l.min-1, respectively], while maximal velodrome blood lactate concentration was significantly higher [13.5 (SD 2.1) vs 11.8 (SD 3.1) mmol.l-1]. Velodrome heart rate was higher at submaximal exercise intensities representing 40%, 50% and 60% of maximal aerobic power, and velodrome blood lactate concentration was also higher at 60%, 70% and 80% of maximal aerobic power. The laboratory parameter that showed the highest correlation with the maximal cycling speed in the velodrome was maximal oxygen uptake (VO2max) expressed per unit of body mass (r = 0.93). In addition, the accuracy of different methods of estimation of the metabolic cost of cycling, rolling resistance, air resistance coefficients and VO2max were compared. Significant differences were found. In conclusion, the present results indicated the validity of a velodrome test used to estimate maximal aerobic parameters of competitive road cyclists, as long as the estimation is made using established equations. When road cyclists are tested in the laboratory, physiological values should be expressed per unit of body surface area or body mass, to predict more accurately the cyclist's performance level under specific field conditions.

Effects of training and taper on blood leucocyte populations in competitive swimmers: relationships with cortisol and performance

The effects of 12 weeks of training and 4 weeks of taper on blood leucocyte populations and cortisol were investigated in 8 well-trained competition swimmers. Blood samples were taken at rest in the mid-season (week 10), before taper (week 22) and after taper (week 26). Swimmers improving by more than 2% with taper (N = 4), efficient (GE), were compared with swimmers improving by less than 2% (N = 4), less efficient (GLE). No significant changes were observed in leucocyte subpopulations or cortisol during training. The percentage of neutrophils decreased during taper (p < 0.05). Basophils and the percentage of granulocytes tended to decrease, while lymphocytes tended to increase. The increment in lymphocytes was positively related with the reduction in training volume during taper (r = 0.86, p < 0.05). Cortisol levels did not change with taper and were not related with leucocyte status and kinetics. GE swimmers had higher pre- and post-taper eosinophil counts than GLE swimmers (p < 0.05). Lymphocyte counts in GE tended to be higher, too. Cortisol decreased with taper in GE, while it increased in GLE. In conclusion, taper appeared to have an influence on leucocyte populations, which did not seem to be related with blood cortisol.

Modeled responses to training and taper in competitive swimmers

This study investigated the effect of training on performance and assessed the response to taper in elite swimmers (N = 18), using a mathematical model that links training with performance and estimates the negative and positive influences of training, NI and PI. Variations in training, performance, NI, and PI were studied during 3-, 4-, and 6-wk tapers. The fit between modeled and actual performance was significant for 17 subjects; r2 ranged from 0.45 to 0.85, P < 0.05. Training was progressively reduced during tapers. Performance improved during the first two tapers: 2.90 +/- 1.50% (P < 0.01) and 3.20 +/- 1.70% (P < 0.01). Performance improvement in the third taper was not significant (1.81 +/- 1.73%). NI was reduced during the first two tapers (P < 0.01 and P < 0.05, respectively), but not during the third. PI did not change significantly during tapers. Thus, the present results show that the model used is a valuable method to describe the effects of training on performance. Performance improvement during taper was attributed to a reduction in NI. PI did not improve with taper, but it was not compromised by the reduced training periods.

Effects of training on performance in competitive swimming

The relationships between the mean intensity of a training season, training volume and frequency, and the variations in performance were studied in a group of 18 elite swimmers. Additionally, differences between the swimmers who improved their personal record of the previous year during the follow-up training season (GIR, n = 8) and those who did not (GNI, n = 10) were investigated. The improvement in performance during the follow-up season was significantly correlated with the mean intensity of the training season (r = 0.69, p < 0.01), but not with training volume or frequency. The performance improvement during the follow-up season was negatively related to the initial performance level (r = 0.90, p < 0.01). The decline in performance during detraining from the previous year was less for the GIR than for the GNI (6.21 +/- 2.30% vs. 9.79 +/- 2.18%, p < 0.01). The present findings suggest that training intensity is the key factor in performance improvement in a group of elite swimmers. Factors such as previous detraining and initial performance level could jeopardize success in spite of a good adaptation to training.

Mitochondrial ATP production rate in 55 to 73-year-old men: effect of endurance training

The effect of 6-week endurance training on mitochondrial ATP production rate was investigated in 14 elderly men. Mean age, body weight and height were 63 +/- 6 yr, 75.6 +/- 9.2 kg and 174 +/- 4 cm, respectively. Subjects trained on a Monark cycle ergometer at 79 +/- 8% of their maximal heart rate for 1 h day-1, 4 days week-1. Muscle samples were obtained at rest, before and after endurance training, by a needle biopsy technique and used for determination of mitochondrial ATP production rate in isolated mitochondria and enzyme assays. Endurance training resulted in a significant increase in maximal oxygen uptake (L min-1) (P < 0.01). Citrate synthase activity, a mitochondrial marker enzyme, and hexokinase activity increased significantly (both P < 0.01) in response to training while 3-hydroxyacyl-CoA dehydrogenase and carnitine palmitoyltransferase I activities remained statistically unchanged. A higher mitochondrial ATP production rate was observed after endurance training with the substrate combinations pyruvate+palmitoyl-L-carnitine+L-glutamate+malate (P < 0.01), L-glutamate (P < 0.001), pyruvate+malate (P < 0.05) and palmitoyl-L-carnitine+malate (P < 0.01). The largest increase was obtained with L-glutamate (170%). Significant correlations were observed between the percent increase in citrate synthase activity and those of mitochondrial ATP production rates. It was concluded that the increased mitochondrial ATP production rate of aged human skeletal muscle with training seems mainly to occur through an increased mitochondrial content, and in a way similar to those observed in young men.