SPORTSCIENCE sportsci.org News & Comment / Training and Performance Viagra at Altitude and Other Performance-Related Highlights of the ACSM 2006 Annual Meeting Will G Hopkins Sportscience 10, 1-7, 2006 (sportsci.org/2006/wghACSM.htm) Sport and Recreation, AUT University, Auckland 1020, New Zealand. Email. Reviewers: James C Martin, Exercise and Sport Science, University of Utah, Salt Lake City, UT 84112-0920; Louise M Burke, Australian Institute of Sport, Canberra, ACT 2617, Australia.

Acute Strategies: Effects of ibuprofen, pre-tensing, pre-cooling, circadian rhythym, warm-ups, ice-cold recovery, bike fitting, stretching, post-activation potentiation, whole-body vibration, and massage. Altitude: Viagra for perfor- mance at high altitude; the live-high train-low mechanism debate; effects of adaptation to artificial altitude. Mechanisms: maximum effort is related to a criti- cal fatigue level in muscle; hard training stimulates EPO; evidence that muscle pH limits intense exercise. Nutrition: training on low carbohydrate; galactose vs other carbs and caffeine; milk protein, amino acids and cherry juice for recov- ery; colostrum for training; vitamin C and fish oil for asthmatics; echinacea stim- ulates EPO; caffeine for team-sport and tennis performance; effects of mild hy- pohydration. Performance Genes: minor findings. Tests and Technology: us- ing modeling to optimize cycling performance; soccer tests; mountain-bike sus- pensions. Training: big gains with respiratory-muscle, core-stability and high-re- sistance training; nothing new on overtraining. Reviewer's Comment: a bal- anced view of train-low compete-high on carbohydrate. KEYWORDS: elite ath- letes, ergogenic aids, nutrition, tests, training. Reprint pdf · Reprint doc · Commentary by Stephen Seiler

The 53rd annual meeting of the American those I attended. College of Sports Medicine was held this year Accessing the abstracts is difficult, so here's in Denver, May 31 through June 3. There were a guide. You must be a member of ACSM, or nearly 3000 presentations on health, injury and you or your institution must have a subscription performance aspects of physical activity and to ACSM's journal, Medicine and Science in sport in multiple parallel sessions. So many Sports and Exercise. ACSM members, log in people reported so much good research that I via this link. Enter your username (default is consider it an obligation and privilege to write first 3 letters of your family name followed by this report. I have limited it to my own re- your member number) and password (your search interest of athletic performance. If your member number). Click on the MEMBER interest is health or injury, I strongly advise you SERVICES tab, then on the link for Member to peruse the relevant abstracts. The book of ab- Journals, then the link for MSSE. Otherwise stracts was distributed only to attendees, but I get to this point at the MSSE site via your insti- explain below how you can access each section tution and/or log in with your own subscription of the book as a PDF online. info. Now, click on the main Search tab (not the Even limiting myself to athletic perfor- one in the Quick Search box). In the Title field mance, I could only attend a sample of what of the search form, type the presentation num- was on offer. This report is therefore based ber shown [in brackets] in this article, select mainly on the abstracts for the podium and 2006 to 2006 for the date range, then click poster presentations of original research. Un- SEARCH. You should get one hit, the abstract fortunately there were no abstracts for the sym- you want. posia and other special presentations, some of Some of the hits have a link to a PDF for the which were outstanding. I have reported on entire section of the abstracts. I found it useful 2 to download the PDFs and search keywords tion in both the G (S: 0.9 (0.0/2.5)µM, M: within the PDF reader (even though the PDF 0.0 (-1.3/1.3)µM, E: -11.3 (-14.9/-7.1)µM; search form is badly designed). The presenta- p= 0.001) and in the NG condition (S: 0.3 (- tion numbers in each section are: featured ses- 0.1/1.1)µM, M: -0.7 (-2.7/0.2)µM, E: -6.7(- sions, 1-582 (symposia etc, and some original 10.3/-3.0)µM; p=0.001). research with abstracts); slides, 583-1124; clini- I am grateful to the Division of Sport and cal cases, 1125-1303; thematic posters, 1304- Recreation of AUT University for providing 1361; and posters, 1362-2915. I note that the full funding and leave to attend this conference. PDF links for the posters have now been re- moved. You may need to contact ACSM and Acute Strategies ask them to make the abstracts available. If all The anti-inflammatory ibuprofen made else fails, contact me. markers of inflammation and muscle damage It's possible to find the titles of the podium worse in an ultramarathon [707]. My guess is presentations in Pubmed, but to access the ab- that it was because the ibuprofen allowed the stracts you get directed to the MSSE site, which athletes to push harder. The sample size was you cannot access without a subscription. Dis- too small (drug, 29; placebo, 25) for quantify- appointingly, the ordinary posters are not in- ing effects on performance with their design (a dexed in Pubmed–all the more reason to opt for post-only parallel-groups randomized placebo- a podium or thematic poster presentation next controlled trial). The authors made one of time. those classic wrong inferences about their In my last report on the ACSM conference marker of muscle damage, creatine kinase: in 2001, I noted frequent flaws in the abstracts. there was no significant difference (P=0.16), Five years later there has been a noticeable im- but the numbers showed much greater damage provement. For example, there are now more in the ibuprofen group. Next sentence: confidence limits, and chances of benefit and "ibuprofen use… did not alter muscle damage". harm are even starting to appear. But there is Sigh… still a long way to go. Here, therefore, is an up- Sprinters are often told to pre-tense by date of my advice on how to improve the ab- pressing backward hard against the blocks, but stracts in future. Not all of this advice is main- this strategy apparently made little difference to stream yet, but it's coming. For more info, click performance [745]. I would have to see the con- on the link in each of the bullet points below fidence limits for the effect before I made my (Batterham and Hopkins, 2005; Curran-Everett decision. and Benos, 2004; Hopkins, 2003; Hopkins, Precooling gave a substantial enhancement 2004): of endurance performance in a hot lab, but turn- ing on the fan gave an even bigger enhance- • Show the magnitude of the effect and its ment, and precooling plus the fan was no better confidence limits so we can see how good than the fan alone [827]. So precooling may or bad the effect might be in reality. Link1. not be beneficial for performance out on the • Describe the magnitude probabilistically, road, but show me the confidence limits. using possible, (un)likely, very (un)likely, In a novel design to assess the effect of cir- almost certainly (not). Link1. cadian rhythm on performance, 200-m swim • Use percent change in performance, for time was worst around the time of lowest body many reasons. Use power output as the mea- temperature (5 am) and best (by about 3%!) sure of performance, if possible. Link2. around 11 pm [1543]. It might be possible to • Use standardized (Cohen) changes to take this effect into account when scheduling gauge qualitative magnitudes of effects, but travel to compete in some time zones. not for performance of solo athletes. Link2. Optimizing the warm-up… A post-warmup • Show standard deviations, not standard er- recovery time of 10 min is better than a 45-min rors of the mean. Link3, Link4. recovery for 200-m swimming performance • Avoid abbreviations and impenetrable [1560]. On the basis of drop-jump performance, thickets of data. Link5. Here's a particularly the authors of a study of 28 female gymnasts egregious example from the abstracts: OXY concluded that the best warm-up consisted of was lower at the E than at the S or M condi- running, stretching and practice jumps [1592]. 3 Warming up with a sequence of standard, light the other six cyclists at altitude, and little effect and heavy bats might increase bat speed in col- on all 10 cyclists at sea level. How come? By legiate baseball players [1617]. dilating arterioles, sildenafil reversed the exces- It's hard to tell from the abstract, but it looks sive hypoxic pulmonary vasoconstriction that like a recovery strategy of ice-cold water im- limited cardiac output in the four cyclists. See mersion for 12 min following a 5-km run had the full paper in J Appl Physiol for more. I no real effect on 5-km performance next day doubt whether there would be substantial bene- [1567]. I can't see any inferential stats for the fit for any athletes at moderate altitude. comparison with control. Part of a symposium on altitude training There was "no significant effect" of various dealing with the live-high train-low strategy bike fitting methods on steady-state oxygen was a re-run of the point-counterpoint articles cost with 15 triathletes [1575], but given the last year (J Appl Physiol 99:2053-2057, 2005). noise in VO2 measurements, and with no com- Ben Levine explained over-simplistically that parison statistics, how can we be sure? the benefit is all due to an increase in red-cell There were numerous posters on stretching mass, but then Chris Gore made it clear in a [1748-1757, 1811], with the usual findings of more scholarly balanced presentation that the an increase in range of motion at the expense of benefit is due at least partly to an improvement some measures of performance. Propriocep- in economy. tive neuromuscular facilitation is OK, though Highlights of a slide session on altitude [1816], presumably because it produces some training [903-909]… It’s hard to figure out the post-activation potentiation. abstract, but it looks like 2 h per day of resting Post-activation potentiation achieved with and training at an artificial altitude of 3000 m an isometric squat enhanced a counter-move- for 28 d was better than sea-level training for ment jump 4-5 min later in experience weight performance at sea level [903]. In a related trainers but not in novices [1789], although study [908], a group of endurance athletes train- training experience had little effect in another ing in an unspecified way at an artificial 3000 study [1833]. A set of dynamic squats also pro- m for 15 sessions over three weeks made gains duced a big enhancement of 30-s cycling sprint in peak power at sea level similar to those of a power 6 min later in collegiate wrestlers [1803]. group training at sea level, but the gains made The phenomenon is probably responsible for an by both groups were too large (~7%) to allow increase in vertical jump performance during a sensible conclusions; on the other hand the alti- weights session [1812]. tude group appeared to perform better at alti- Whole-body vibration had mixed effects tude. The acutely intermittent variety of hypox- on various measures of performance: harmful ic exposure (5 min on, 5 min off, for 60 min, [1685], trivial or non-significant [1599, 1814, for 9-14 sessions, over 14 d) had harmful ef- 2129] and beneficial [1599, 2439]. The ab- fects on some aspects of performance of rugby stracts didn't show enough data. players [907]. A 15-min massage had no significant effect Highlights of a poster session on altitude (no data provided) on 30-m sprint speed in 37 training [2727-2743]… Sleeping in hypoxia active males [2428]. equivalent to altitude of 3000 m for 29 nights Altitude improved running economy but not VO2max or One of the quirkiest presentations [451] was hemoglobin mass [2728]. The acutely intermit- about the effect of viagra (sildenafil) on en- tent variety of exposure to hypoxia did little to durance performance at a simulated moderately prepare rugby players for performance at 1650 high altitude of 3900 m. All 10 of the trained m [2731] or at sea level [2732]. cyclists in the study performed a 6-km time trial Mechanisms worse at altitude than they would have at sea Cycling with different percents of oxygen in level, as you would expect, but four of them the inspired air produced big changes in time- were much worse (15 min to complete the dis- trial time, but there was the same amount of fa- tance instead of 10 min). The extra impairment tigue in the leg muscles (measured by stimulat- in these four cyclists disappeared when they ing the motor nerves magnetically) [452]. So it consumed sildenafil before the performance looks like there is a critical fatigue level in test. There was little effect of the sildenafil on muscle that signals you to feel maximum effort, 4 just like the critical core temperature does. nitely help recovery. Four hours of recovery At last, someone has found that the plasma from 2.5 h of hard cycling with a protein-carbo- volume expansion you get acutely following hydrate drink vs carbohydrate alone produced hard exercise is associated with release of ery- longer time to exhaustion in a subsequent per- thropoietin, probably via a negative feedback formance test [1066]. A similar drink produced mechanism sensing and offsetting the hemodi- beneficial effects on muscle damage and im- lution [953]. The resulting increase in red-cell proved performance following a single hard mass would enhance performance via enhanced session with cyclists [1993], and 6 d of supple- oxygen transport. It's evidence that endurance mentation with such a drink between two cross- athletes have more red cells partly because of country races reduced muscle damage and sore- training (and no doubt partly because of self-se- ness after the second race [1995]. In 8 well- lection into endurance sports). trained athletes, a drink containing carbohy- Evidence that muscle acidity (low pH) lim- drate and hydrolyzed milk protein consumed in its anaerobic performance: supplementing with the 4-h recovery period after 2 h of hard exer- alanine for 14 d increased isometric endurance cise gave a 1.5% enhancement in speed in a time, apparently because this amino acid is con- subsequent 10-km cycle test in comparison with verted to carnosine in muscle, where it acts as a an isocaloric drink containing only the carbohy- hydrogen-ion buffer [1119]. The fact that sup- drate [1118]. Coupled with the effects of galac- plementation with bicarbonate enhances anaer- tose, could milk be the best training drink? obic performance [1123 is an example] has al- Training with supplements of branched-chain ways been the best evidence of the role of pH in amino acids five times a day for 3 d reduced short-term fatigue. Whether pH has a role in muscle soreness and blood markers of inflam- endurance fatigue is less clear; evidence from mation and muscle damage in a double-blind this conference with alanine [1998] and bicar- crossover study of 6 female and 6 male distance bonate [2237] supplementation indicates no runners [1988]. substantial role But protein supplements aren't so good for Nutrition acute performance. Consumption of a protein- A President's Lecture by Bente Pedersen on carbohydrate drink at half time in a simulated train-low compete-high was a paradigm-shifter. football game wasn't as good as a straight car- The "low" and "high" refer to carbohydrate bohydrate drink for performance in the second status, not altitude. She presented her elegant half [1991]. Similarly, adding 1.6% protein to a research on single-leg exercise showing that en- 6% carbohydrate drink if anything impaired durance performance benefits from some train- performance in a ~40-min time trial following a ing sessions in a glycogen-depleted state 120-min pre-load in 10 fairly ordinary cyclists (Hansen et al., 2005). Sure, it wasn't sport-spe- [1392]. And athletes drink less when the drink cific training in elite athletes, but sport scien- has protein in it [1514]. tists are scurrying to do those experiments. She Acute supplementation with the amino-acid also made many of us aware of interleukin-6 alanine didn't do much for endurance perfor- (Il-6) released by skeletal muscle as a potential mance (in a 15-min time trial after a 45-min mediator of the health benefits of exercise. pre-load) in trained cyclists: if anything the Supplementation with drinks containing carbo- placebo was better than the various combina- hydrate inhibits the release of Il-6, so she was tions of alanine and carbohydrate [1998]. critical about the sale of sports drinks in gyms. At last, a believable positive outcome with Go to her website for more. colostrum! The athletes did a 40-km cycling A sports drink based on 4% galactose pro- time trial before and after 5 wk of supplement- duced a bigger enhancement of ~90-min en- ing with colostrum (n=14) or whey-protein durance cycling performance than "a pure gluc- placebo (n=15), then another 40-km time trial ose sports drink, blended carbohydrate sports after an additional 5 d of hard training. The drinks, one of which included caffeine, and colostrum group had several apparently benefi- placebo" [736]. Wow! (The sugar in milk-- cial differences in immune markers, reduced in- lactose--is digested to galactose and glucose, by cidence of upper respiratory symptoms (3/14 vs the way.) 8/15), much more saliva (!), and what looks like Protein or amino-acid supplements defi- about 1.5% better time-trial time after the hard 5 training [896]. formance represented by 30-s sprints and total Although it's not directly related to perfor- weight lifted in a set of chest presses [1331]. It mance, it’s worth knowing that supplementing also reduced muscle pain during maximum vol- with vitamin C reduced the severity of exer- untary activation of muscles already damaged cise-induced asthma [2158]. Supplementing by eccentric exercise [1332]. Finally, it en- with fish oil had a similar effect [2160]. hanced forehand skill during a 60-min tennis Tart cherry juice twice a day for 8 d re- simulation in 10 collegiate players, and if I read duced strength loss and pain in arm muscles re- the faulty table correctly, it looks like backhand sulting from a bout of eccentric exercise on Day skill might have been better, too [1335]. 4 in a crossover study of 14 college students Bad news for WADA, and good news for [2243]. Again, not exactly sport-specific exer- drug cheats: small doses of testosterone can cise in competitive athletes, but it's pretty clear enhance performance without producing a posi- that natural foods rich in antioxidants and an- tive urine test in some athletes [2249]. ti-inflammatories will help athletes train harder. Highlights of a thematic poster session on Echinacea supplementation raised erythro- hypohydration and performance [1337-1341] poietin by more than 50% over a 21-d period in … Mild hypohydration (3% loss of body mass) a randomized controlled trial with 24 recre- produced small detrimental effects on a resis- ationally active males [2256]. There were no tance-training workout [1338]. Performance in blood measures that would properly indicate a 2-h cycling time trial in the heat with a fan erythropoiesis, and no measures of perfor- blowing was a little worse when the athletes mance. I'd be surprised if it didn't work. drank too little (less than two-thirds of fluid I'm skeptical about the claim in a Taiwanese lost) [1340]. Basketballers showed a substan- study that ciwujia (Siberian ginseng) supple- tial decline in sprinting and shooting perfor- mentation for 28 d enhanced time to exhaustion mance with dehydration above 2% [1341]. significantly by what amounts to 2.8% (which Hyperhydration with glycerol produced would be negligible if it's a constant-speed test) what seems like a substantial increase (8%) in and increased maximum heart rate by an un- performance time in an incremental test follow- heard of 13 beats/min [2232]. ing a 2-h preload in a temperate environment Sodium bicarbonate enhanced performance with some fluid ingestion during exercise in each of three series of judo throws, each sep- [1513]. But with P>0.05, the authors concluded arated by 5 min of recovery [1123]. This find- no effect. ing shows that the extra bicarbonate is not Performance Genes "used up" in a bout of intense exercise: it regen- Variation in a gene related to fat metabo- erates for the next bout. Two protocols of sodi- lism and endurance performance (because its um bicarbonate ingestion vs placebo produced expression changes with training) was associat- "no significant differences" in time to exhaus- ed with marathon running performance [779]. tion at 1500-m pace in elite middle-distance The ACE genotype didn't predict performance runners [2237], but there were only 6 of them level of Mexican marathoners [2089]. The al- and no performance data whatsoever, so who pha-actinin genotype didn't have much of an knows? effect on strength of non-athletes [2084, 2090]. Caffeine doses of 80, 120 and 400 mg en- hanced physical and mental performance in a Tests and Technology team-sport simulation [731]. The sample size A symposium on the science of cycling was was probably too small (11, admittedly in a noteworthy for the practical application of mod- crossover) to conclude confidently that the ef- eling to performance enhancement. Jim Martin fects were independent of dose. Confidence explained how you need only a mobile ergome- limits, please! In a thematic poster session on ter (SRM or PowerTap), an anemometer, and a caffeine [1330-1335], there was no worthwhile test surface with a known gradient. You then effect of low-dose caffeine (2 mg/kg) on 100-m perform several trials to get an estimate of the sprint performance of 15 elite swimmers [1330] drag coefficient (effect of wind resistance). Put or on 50-m sprint performance of 8 elite swim- the numbers into the model and you can predict mers [1334]. Sleep quality suffered in the for- how changes in body mass, power output, drag, mer study. Caffeine enhanced anaerobic per- and pacing profile will affect time-trial time 6 (Martin et al., 2006). Andy Coggan also ex- collegiate rowers, presumably in the base phase plained his approach to condensing down the of training [1586]. There was a similar spectac- stream of data from a mobile ergometer in ular gain in intermittent sprinting with colle- training or competition rides. He smoothes the giate soccer players using a device that trains data with a 30-s moving average, raises the re- inspiratory and expiratory muscles [2152], al- sulting numbers to the 4th power, then averages though there were big individual responses. But the lot and back-transforms to a "normalized" beware: training only the expiratory muscles mean power. (Download a chapter from USA doesn't work, and combined inspiratory-expira- Cycling's coaches' manual for details.) This tory training might not be as good as inspiratory number from a road race is similar to lac- only [2167]. tate-threshold power and time-trial power. But There were no new insights into overtrain- the 30 s and 4th power are arbitrary, and chang- ing [1547-1549, 2148] or tapering [1574, ing their values over reasonable ranges results 1584], although a taper of 3 wk might be better in substantial changes (~5%) in normalized than 4 wk in swimmers [1622]. power. Maybe they need to be individualized. Use of an adjustable sling in a core-stability A soccer-specific running test had a high training program produced beneficial effects correlation with VO2max [1559], as did a test on performance in elite soccer players [1611] for figure skaters [1590]. More interesting and junior golfers [1781]. were performance measures from a soccer sim- Strength of college football players follow- ulation that had small errors of measurement ing an unspecified period of complex training and showed clear effects of supplementation differed little from that of players doing usual with carbohydrate vs placebo [1588]. gym training [1613]. E-3 Fitness Grips don't do anything to im- Here's something novel: do some sessions prove running biomechanics [2207]. with a cuff to restrict blood flow to the legs. It Front-only suspension is better than front raised the antioxidant markers in blood after 10 and rear for mountain bikes, because of the wk in speed skaters [1625]. No measures of difference in weight [2239]. performance. We're always concerned that athletes don't This is cool too: in a case study of a nation- put the same effort into lab tests as into real ally ranked powerlifter who had reached a competitive performance, but maybe we don't plateau, two sessions of forced-assisted reps have to worry so much: an unanticipated mon- with a supra-1RM load increased 1RM bench etary incentive in the last of four 1500-m cy- press by 5% [1837]. cling time trials in the lab made little difference An attempt to model (predict) changes in to performance in seven recreational cyclists performance using measures of fitness and fa- [2696], but what about confidence limits? tigue in swimmers wasn't successful [2585]. There were the usual cross-sectional studies Low-cadence all-out interval training of performance predictors, for example in against high resistance is probably more effec- pole-vaulting [1565], mountain biking [1570], tive than high-cadence interval training (gains soccer [1580, 1585], cross-country skiing in power output of 6-11% vs 2-3%) in highly [1589], kayaking [1593], and football [1595]. trained road cyclists in their competitive season Useful for talent identification? [2588]. Training Reviewer's Comment Training respiratory muscles by hyperven- Some further comments on the "train-low tilating isocapnically (to prevent light-headed- compete-high" President's Lecture… Dr Peder- ness from loss of CO2) improved endurance in sen was reasonably certain about the health 15 runners, although they needed a few days for benefits of exercising on low carbohydrate for their respiratory muscles to recover [740]. those at risk of the metabolic syndrome (obesi- There was no information whatsoever about the ty, insulin resistance, diabetes, cardiovascular training protocol, and was there even a control? disease…). But she included a question mark Contact the author. Or use a device for inspi- in the title of her talk to express caution in the ratory muscle training, 8 weeks of which im- application of her recent findings (Hansen et proved mean power in a 6-min rowing test by al., 2005) to athletes. This theme was taken 12% in an apparently uncontrolled study of 13 further in a symposium on nutritional strategies 7 by this reviewer (Louise Burke), John Hawley elite athletes periodize their nutrition: some ses- and Ron Maughan. Both John and I looked at sions are done with good carbohydrate avail- the pros and cons of training in a carbohydrate- ability (usually athletes practice these strategies deprived state (low glycogen status, no carbo- for the key sessions of the week), while it is hydrate intake during exercise) and concluded more practical to do others after an overnight that there were more cons than pros, both in the fast or without the benefit of aid stations. This effect on ability to train and the effect of the mix may be important in optimizing the overall training stimulus on signaling pathways. Al- outcome. though the study by Pedersen's group has a cool See also commentary by Stephen Seiler. design, John pointed out that it was “train 50% References of the time low, compete high”. Importantly, Published June 2006. ©2006