'The Healthy Athlete' given by Dr Paula Robson-Ansley at Steyning Athletic Club.
Notes by Sean Lightman, President Surrey WC

Dr Robson-Ansley divided the lecture into two parts:
Part 1 Exercise, Immunity and supplementation;
Part 2 Overtraining syndrome in athletes

Part 1 Exercise, Immunity and supplementation
The factors that contribute to increased susceptibility to infection in athletes are physiological stress, physiological stress, environmental stress and inadequate diet all of which leads to the suppression of the immune system. Consequently any exposure to a pathogen (any agent that causes disease) has an increased likelihood of causing an infection especially in the upper respiratory tract (URTI).
Dr. Robson-Ansley concludes that long duration and intensified training has a negative impact on the immune function and may increase the risk of URTI.
The question arises as to whether nutritional supplementation affects the immune responses to exercise. Dr. Robson-Ansley looked at four supplements:
Firstly, antioxidant supplementation: (Vitamin C, vitamin E, B-carotene) her researches showed that antioxidant supplementation may decrease the exercise-induced oxidative stress.

Secondly, zinc. She concluded that zinc lozenges are commonly used as medicine against colds. Low level doses can help maintain the immune function but megadoses are immunosuppressors.
Since 1984, 11 studies looked at zinc in treatment of colds: 45% reported beneficial effects 55% did not. To be effective in reducing the duration or severity of cold symptoms zinc must be taken within 24 hours of the symptom onset.

Thirdly, Echinacea. Echinacea Purpurea is a herb reported to have immune boosting properties, often used as a prophylactic against the common cold. There have been very few studies investigating echinacea. In one study (Berg, et al, 1998) the daily ingestion of pressed Echinacea juice reduced URTI incidence in triathletes. 0% had colds in Echinacea vs 3% of athletes in placebo group

Fourthly, carbohydrate. She concluded that carbohydrate feeding during exercise does enhance performance and reduce the onset of URTI.

To conclude: does nutritional supplementation affect immune responses to exercise? The overwhelming evidence is that it does. Dr. Robson-Ansley suggests that the following actions can be taken to minimise exercise-induced immunosuppression:
1. Increase intake of antioxidants 7 days prior to race.
2. Use zinc supplementation carefully - 15mg/day
3. There is limited research to support echinacea
4. Drink carbohydrate drinks during exercise.

Practical Advice
1. Minimise the potential for transmission of infectious agents:
a. Avoid people with infections
b. Good personal hygiene
c. Never share drink bottles
d. Avoid getting a dry mouth
e. Awareness of vulnerability after training or competition

2. Minimise the chances of developing immunosupression/overtraining syndrome:
a. Include weekly recovery days
b. Avoid very prolonged training sessions
c. Get adequate sleep
d. Eat a well balanced diet with sufficient carbohydrate and micronutrients
e. Consume carbohydrate drinks during and after prolonged workouts.
f. Consider vaccination against influenza

Part 2 Overtraining Syndrome otherwise known as unexplained underperformance syndrome UPS)
Definitions.
Overtraining syndrome (OTS) is an accumulation of training-related stress resulting in a persistent decrement in performance capacity lasting weeks or months.

Overloading/overreaching is an accumulation of training-related stress resulting in temporary decrement in performance capacity lasting less than 2 weeks.

Unexplained underperformance syndrome is perhaps a better term than overtraining syndrome because is relates to a persistent unexplained performance deficit (recognised and agreed by coach and athlete) despite two weeks of relative rest.

Symptoms of OTS/UPS
Increase of the following:
1. Fatigue during exercise - underperformance with an inability to increase the pace at the end of a race
2. Fatigue/sleepy during actual daily living
3. Flu-like symptoms
4. Anxiety, depression, irritability
5. Inability to concentrate.

Decrease in the following:
1. Sleep quality - waking un-refreshed.
2. Appetite

The incidence of UPS British Olympic Medical Centre (1998)
Endurance athletes : around 10% per year
Sprint/power : athletes very rare
Repetitive sprint (games players): increasing.

Possible cause of UPS
There are very few ideas. Depression is a consequence of UPS not a cause.
Cytokine hypothesis to UPS
Definition. Cytokines are polypeptide messenger molecules involved in immunity, cell growth inflammation and repair.
Increased concentrations of cytokines occur during exercise in particular interleukin-6 (IL-6) occur 50 - 100 times higher after 3 hr exercise

IL-6 as a 'fatigueogen'
In an experiment volunteers were administered a low dose of IL-6. At rest these induced:
    an increased sensation of fatigue
    flu-like feeling
    depressed mood state
    disrupted sleep
    inability to concentrate

All symptoms similar to UPS
In some illnesses an increase of IL-6 is associated with debilitating fatigue e.g. CFS, cancer and rheumatoid arthritis.
When IL-6 receptor is blocked by an antibody (Nishimoto et al., 2000) - fatigue instantaneously disappeared.

Does a low dose of rhIL-6 increase fatigue during exercise in trained runners?
Seven subjects were given rhIL-6 to induce post-marathon plasma IL-6 concentrations or levels found following mild infection. The subjects then had to complete 10 km time trail on a treadmill. On average the subjects were 51s slower than they expected.

Dr Robson-Ansley (2003) Sports Medicine. 33(10): 771-81 came to the following conclusion:
"Primary exposure of an athlete to significant stressor, e.g. heat, infection, excess exercise will lead to permanent changes in response to future stressors, e.g. damage to blood brain barriers and protein production. Further exposure to the stressor evokes greater response. It leads to an increase in the production of sensitivity to IL-6 as shown in chronic fatigue syndrome. It also leads UPS athletes to reporting and increase in fatigue with each training session and the worsening of sleep" (Derman et al., 1997)

The trigger factors for UPS are: excess exercise/muscle trauma, infection/endotoxin, heat stress, hypoglycaemia and psychological stress. The coach�s aim is to reduce exposure to trigger factors. This can be done in the following ways: ask the athlete; use questionnaires which profile mood states and daily analyse the life style of the athlete; and finally monitor 'stress load'.

Identification of life demands in athletes� questionnaire (Rushall, 1990)

Sources of stress

Diet
Home-Life
School/college work
Friends
Sport training
Climate
Symptoms of stress
Muscle pains
Loss of technique
Tiredness
Need for a rest
Boredom

Strategic advice for athletes to avoid UPS/OTS

1. Include recovery days in the weekly training programme
2. Give adequate recovery time between sessions
3. Ensure adequate hydration and acclimatisation
4. Monitor mood, fatigue and soreness
5. Ensure adequate sleep
6. Eat a well balanced diet with sufficient carbohydrate and micronutrients
7. Consume carbohydrate drinks during and after exercise.
8. Consider vaccination against influenza
9. Reduce or abstain from exercise following infection, heat-stroke, periods
of high psychological stress.
10. There is no valid blood market of UPS.

Possible method for recovery from UPS

Consult medical practitioner. If there is no underlying problem then:

BE PATIENT
Rest for at least 2 - 4 weeks
Restructure lifestyle by time planning
Eat a balanced diet
Build-up extremely slowly

If the athlete still feels fatigued, take it slower, rest again for 2 weeks.

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BE PATIENT Rest for at least 2 - 4 weeks Restructure lifestyle by time planning Eat a balanced diet Build-up extremely slowly

BE PATIENT
Rest for at least 2 - 4 weeks
Restructure lifestyle by time planning
Eat a balanced diet
Build-up extremely slowly