Sweat Science

A few months ago, I blogged about a placebo-controlled test of the “live high, train low” altitude training paradigm (here, and with a follow-up here). That test found no benefit to altitude training, which prompted some rather heated responses — including a comment from someone who works for an altitude tent company:

One bogus study cannot change the work that guys like David Martin and the Australia of Sport (AIS) have performed.

As it happens, the Australian Institute of Sport, working with Australia’s national swim team, has just published a massive new study of altitude training in the European Journal of Applied Physiology. They took 37 elite swimmers and divided them into three groups:

1. “Classic” altitude training: three weeks in Sierra Nevada, Spain (2,320 m) or Flagstaff (2,135 m);
2. LHTL, spending at least 14 hours a day for three weeks at simulated 3000 m at the Australian Institute of Sport in Canberra;
3. a control group that didn’t go to altitude.

To assess the effects of altitude training, they looked at blood parameters like total hemoglobin mass, and measured race performances 1, 7, 14 and 28 days after returning from altitude, as well as assessing season-long performance profiles (including performance at the World Championships).

Let’s start with the good news. Unlike the previous study, this study did find a clear increase in total hemoglobin mass, of about 4%, in both altitude groups. Here’s the individual scatter:

But what about performance? There, the results weren’t so good:

Or in words:

Swimming performance was substantially impaired for up to 7 days following 3 weeks of either Classic or LHTL altitude training. Despite ~4% increases in tHb resulting from both Classic and LHTL altitude training, there were no clear beneficial performance effects in the 28 days following altitude… A season-long comparison of two tapered performances at major championships also did not reveal a benefit for athletes who completed mid-season altitude training despite the substantial physiological changes associated with the altitude.

So does this “prove” that altitude training doesn’t help endurance performance? Of course not. But it’s a pretty interesting data point. This is the Australian swim team — one of the world’s powerhouses — supported by the Australian Institute of Sport, who have done lots of research into altitude training, and believe in it enough to construct an altitude house on their campus. They understand how it’s supposed to be done, and they executed it effectively enough to produce hemoglobin changes… but still, they didn’t manage to improve performance. If anything, they got worse.

If you’re doing altitude training, are you confident that you’re doing it better than they are?

[UPDATE: Sam McGlone and Paulo Sousa raised an important point on Twitter: the swim distances that they tested in this study were 100 or 200m. That's pretty short - I don't know the numbers for swimming, but maybe 50% aerobic at most? Here's what the researchers say:

Based on the calculated aerobic contribution to energy production during competitive 100 and 200 m swimming races, the 3.8% increase in tHb we observed could elicit a 0.3–0.7% improvement in race time... Although improvements of this magnitude are equivalent to the smallest worthwhile change for swimming performance, detecting such changes can be difficult due to the variability associated with racing and the modest sample sizes available when targeting an elite athlete population.

Certainly something to keep in mind in interpreting this study.]

sports technology

Back in 2010, researchers at Florida State published a study showing that trained distance runner became about 5% less efficient and covered 3% less distance in a time trial if they did static stretching before the run. This was significant because, after a long series of studies showing that stretching compromises strength and power, it was one of the first to look at endurance performance.

Now the same researchers have published another study, in the current issue of Journal of Strength & Conditioning Research, this time looking at “dynamic” stretching instead of static stretching. Other than the stretching routine, the protocol is exactly the same. The runners spend 15 minutes stretching (or sitting quietly, during the control condition), then run for 30 minutes at 65% VO2max for a running economy measurement, then run as far as they can in the next 30 minutes.

This time, stretching had no significant effect on the distance covered in the time trial: stretchers covered 6.1 +/- 1.3 km, non-stretchers covered 6.3 +/- 1.1 km. On the other hand, the dynamic stretching did increase range of motion in the sit-and-reach test just as much as static stretching (from 32.3 to 37.6 cm). So the basic conclusion: if you’re really into stretching before a run, dynamic stretching will allow you to work on your flexibility without hurting your running performance.

One subtlety, which you pick up if you look at the individual results:

The dynamic warm-up routine takes a fair amount of energy (more details on that below). So you might wonder: for the less fit runners in the group, is it possible that they’re just tired out? The researchers do allude to this possibility:

[I]t is interesting to note that our top 2 performance runners both increased their performance under the dynamic stretching condition with the top runner seeing the largest increase in distance covered in the dynamic stretching condition of 0.2 km. Furthermore, the 2 runners in our study who covered the shortest distance performed better during the nonstretching control condition with the worst performance runner seeing the largest decline in performance after the stretching condition (i.e., 0.6 km). It is possible that elite endurance runners need a warm-up protocol of greater intensity and duration than do recreationally trained runners.

Looking back at the data, it actually looks to me like the top runner was better in the non-stretching condition, but maybe that’s just an artifact of the line thickness they used in the graph. Either way, the differences are pretty small in all cases. To me, the moral of the story is: if you’re an endurance athlete, you may have many reasons for why and how you stretch, but “going faster” shouldn’t be one of them.

As an addendum, here’s the stretching routine the study used:

A total of 10 different movements were used and completed in 15 minutes by performing 2 sets of 4 repetitions of each movement. The dynamic stretching movements were performed in the following order:

(a) Toe and Heel Walks: In these exercises, the subjects walked on their toes for 4 steps followed by walking on their heels for 4 steps to stretch the entire calf complex.

(b) Hip Series: The subjects performed a dynamic stretch of the hip flexors and extensors by placing their hands on a wall with their arms fully extended so that their body was at a 45 angle. In this position, each subject lifted his leg off the ground while bringing the knee to the chest and stepping over a hurdle placed laterally before returning to the starting position.

(c) Hand Walks: The subjects stretched their calves and hamstrings by beginning in a pushup position and walking their feet as close to their hands while keeping their heels flat. As soon as the subjects’ heels came off the ground, they walked with their hands back to a pushup position.

After the hand walks, the subjects performed a series of walking lunges, including (d) rear lunges, (e) lateral lunges, (f ) forward lunges, (g) a knee pull to a lunge, and (h) an ankle pull to a lunge to focus on the quadriceps and gluteus maximus.

(i) Walking Groiners: The subjects began this movement in a pushup position and then brought 1 foot next to the same side hand as to perform a groiner. Instead of holding this position, the subjects walked their hands out to return to the starting position before performing the action on the opposite leg.

(j) Frankensteins: The subjects stood with their feet together and their arms extended straight out in front of them so that their arms were parallel to the ground. While walking, the subjects were instructed to kick 1 leg up to touch the opposite hand to focus on the hamstrings. Every time a step was taken, a kick was made.

stretching

My column in today’s Globe and Mail takes a look at some recent field research on carbo-loading the day before a marathon:

[...] To find out whether this revised advice works in practice, researchers in Britain followed 257 London Marathon participants for five weeks prior to the race, collecting data about their training and eating patterns. The runners had an average age of 39 and an average finishing time of 4 1/2 hours. The results were published in the International Journal of Sports Medicine.

Sure enough, day-before carbohydrate consumption mattered. Runners who ate more than seven grams of carbohydrate for every kilogram of body weight (g/kg) ran 13.4 per cent faster than a comparable group of runners who ate fewer carbohydrates but were otherwise identical in terms of age, body mass index, training and marathon experience. Surprisingly, the amount of carbohydrate consumed during the marathon didn’t matter as much. [READ THE WHOLE ARTICLE HERE]

Most people don’t realize what an enormous amount of carbohydrate you have to take in to maximize your glycogen stores — which is why only 12% of the runners in the study hit the 7 g/kg threshold. Trish McAlaster did a nice job with an accompanying graphic showing just how much you’d need to eat and drink to hit 5 g/kg (the average in the study), 7 g/kg, or 10 g/kg (which is the amount suggested for elite athletes). Note that I’m not suggesting you should actually eat four plates of plain pasta for dinner — this is just to put the amounts in context!

[CORRECTION: Reader Mike LaChapelle just pointed out that the math doesn't add up in the graphic. The "threshold" lunch should include 500 ml of sports drink. That being said, I should clarify that I'm not recommending these menus as exactly what you should eat; it's aimed at giving a sense of the quantities involved. In real life, I'd go for more variety, and include things like fruit and vegetables!]

nutrition, running

What type of warm-up optimizes swim performance? A new study from the University of Alabama, just posted in the Journal of Strength and Conditioning Research, ran a simple test with 16 NCAA swimmers. Each of them performed three 50-yard sprints, on separate days, with three different warm-ups:

1. No warm-up.
2. A short warm-up consisting of 50 yards of 40% of max effort followed by 50 yards at 90% of max effort.
3. The swimmer’s individual usual warm-up, which averaged a total of about 1,300 metres for the group.

The results:

Mean 50-yd time was significantly faster (p = 0.01) following regular WU (24.95 ± 1.53 sec) when compared to short WU (25.26 ± 1.61 sec).

But take a look at the individual results for the three conditions:

The researchers raise a very, very important point that is often neglected in sports studies:

It is important to note that swimmers compete individually and not as a “group mean”. Therefore, for swimming, it is important competitively to determine how each individual swimmer responds to different warm-ups.

So yes, the “normal” warm-up was indeed best on average. But 19% of the swimmers actually had their best time after the short warm-up, and 37% had their best time after no warm-up at all, compared to a relatively modest 44% — less than half! — who performed best after the regular warm-up.

Now, let’s not get carried away with this result. This was a small study, and the swimmers only did one 50-yard swim under each condition. It’s unlikely that no warm-up at all is really optimal. But it’s certainly worth investigating whether a shorter warm-up might do just as well, particularly for swimmers competing in multiple rounds of multiple events over a short period of time. And more generally, athletes and coaches should be open to the idea that different athletes respond differently to routines like warm-up. Maybe there’s an athlete in your group who would do better with an unorthodox warm-up. It’s worth doing some experimentation.

swimming

It was great to see the big response to the MRI pics I posted a couple of days ago showing the well-preserved leg muscles of a 70-year-old triathlete. Very striking stuff. But let me now offer the following caveat:

This is a figure from a new study from the University of Western Ontario, just posted at Medicine & Science in Sports & Exercise. They analyzed the biceps brachii (arm muscles) of nine young runners (average age 27), nine old non-runners (70), and nine lifelong masters runners (67). They measured the number of functional motor units (i.e. group of muscle fibres activated by a single motor neuron), which typically declines with age. As you can see, the two old groups were pretty much the same, far below the young group.

In contrast, the same researchers studied leg muscles (tibialis anterior) in a similar group of volunteers last year (as I blogged about here) — in that case, the older runners did preserve the number of motor units. What this tells us is that exercise, on its own, doesn’t preserve all the muscles in your body: in the words of the researchers, there’s no “whole body neuroprotective effect,” or at least none that shows up in this relatively small study. It just preserves the muscles you’re using on a regular basis. So that’s still good news for triathletes, but maybe not as good for runners and cyclists!

aging

The New Yorker had a great look at the placebo effect last month (unfortunately the full text isn’t available online), focusing on the work of Harvard’s Ted Kaptchuk. He’s the guy who did the study last year that found that placebos can be effective even when patients are aware that they’re receiving a placebo instead of “real medicine.” His hope is that doctors will learn to harness the placebo effect more effectively, and understand that it’s a real physical effect, not just in your head.

To that end, one of the most interesting nuggets in the article was a description of one of the classic placebo studies, from UCSF back in 1978. People recovering from dental surgery were given either morphine or a saline placebo; as expected, some patients responded to the placebo (their pain diminished) while others didn’t (their pain got worse).

What happened next, however, fundamentally reshaped the field. The researchers dismissed the subjects who had received morphine and then divided the remaining participants into those who responded to the placebo and those who didn’t. Then they introduced Naloxone into patients’ I.V. drips. Naloxone was developed to counteract overdoses of heroin and morphine. It works essentially by latching onto, and thus locking up, key opioid receptors in the central nervous system. The endorphins that we secrete attach themselves to the same receptors in the same way, so Naloxone blocks them, too. The researchers theorized that, if endorphins had caused the placebo effect, Naloxone would negate their impact, and it did. The Naloxone caused those who responded positively to the placebos to experience a sharp increase in pain; the drug had no effect on the people who did not respond to the placebo. The study was the first to provide solid evidence that the chemistry behind the placebo effect could be understood — and altered.

In other words, placebo responders were dulling their pain via exactly the same route as morphine recipients. It was a “real” effect. In the realm of sports science, that’s something to bear in mind when we read yet another report showing that some supposedly performance-enhancing substance doesn’t outperform placebos in a controlled trial.

mental

At the U.S. Olympic Marathon Trials, where the top three book tickets to London, fourth is the loneliest place. Here’s my post-race interview with an emotional Dathan Ritzenhein:

He ran a new personal best of 2:09:55, breaking 2:10 for the first time and capping a remarkable comeback from a seemingly never-ending string of injuries. But silver linings don’t matter when you finish fourth at the Olympic Trials – and for Dathan Ritzenhein, the frustration of being hobbled yet again by leg cramps could mark the end of his marathon career.

“It’s the same thing that’s happened in other marathons,” Ritzenhein said after the race, struggling to contain his emotions. “Maybe I’m forcing it. Everybody wants me to be a marathoner. And I want to be a marathoner. But right now maybe it’s not in the cards.” [...]

Read the whole interview here.

running

Here’s a pretty graphic illustration, via Toronto physiotherapist Laura McIntyre, of the importance of lifelong physical activity:

It’s from a new study freely available at The Physician and Sportsmedicine that took detailed measurements of 40 masters athletes between the ages of 40 and 81, and found a surprising lack of age-related muscle loss:

This study contradicts the common observation that muscle mass and strength decline as a function of aging alone. Instead, these declines may signal the effect of chronic disuse rather than muscle aging.

aging, resistance

There’s a big new study out in the New England Journal of Medicine that takes a comprehensive look at every case of cardiac arrest during every marathon or half-marathon in the U.S. with more than 100 participants between 2000 and 2010. It’s being widely covered in the press; you can read a good summary in the New York Times or in the Globe and Mail, among other places. The primary message: these events are rare. There 59 cases of cardiac arrest, of which 42 were fatal. That translates to a 1 in 259,000 chance of dying, which is much lower than previous reports and than many other sports.

I’m actually in Houston right now for the U.S. Olympic Marathon Trials, and it happens that Aaron Baggish of Mass General, the senior author of the study, was giving a talk this morning to the members of the World Road Race Medical Society — so I popped in to hear what he had to say. A couple points he made that I found interesting:

Weather wasn’t a factor. The average starting temperature during events where someone suffered a heart attack was almost identical to the 10-year average (55.9 vs. 55.5 F), and the average deviation was just 0.3 degrees.

For 31 of the cases, they were able to track down either the survivor or the next-of-kin and get full medical records, autopsy results, and running history — so this allowed them to really look at the causes of death in detail. One of the surprises is that none of the runners died from a ruptured plaque producing a blood clot, which is (or at least was) thought to be one of the possible mechanisms of sudden death in athletes. The problem with ruptured plaques is that they’re hard to predict in advance. But if underlying coronary artery disease is the real problem (more on that in a sec), then pre-exercise cardiac screening should be able to pick some of that up, Baggish argues.

The average age of the people who survived cardiac events was 53; the average age of the people who died was 34. There are two distinct groups here. One is young people with thick hearts (“hypertrophic cardiomyopathy”), an underlying genetic conditionl; when they collapse, they’re very hard to revive and tend to die. The other is older men with narrowed arteries (coronary artery disease) due to the usual risk factors; when they collapse, they can often be revived if someone gets to them soon enough.

That brings me to one of Baggish’s key point: the absolute best predictor of whether someone would survive cardiac arrest during a race was simple: did a bystander start CPR immediately, before paramedics got there? The lesson is simple: we should all — runners, family members, spectators, heck, everyone in society — have basic CPR training. It could make all the difference to someone, including you.

Baggish’s overall message: running (and by extension, other aerobic activity) is generally safe — but it doesn’t give you immunity from heart disease. That means that everyone, and particularly older males, should be alert for warning signs and not ignore them. Some key ones:

• a burning sensation in the chest (could be confused with acid reflux) that comes on when you start running then gradually fades away, and keeps recurring;
• breathing more heavily than you’d expect given your effort;
• persistent, unusual fatigue.

None of these risk factors necessarily mean something is wrong, but they can be a signal that it’s worth checking in with your doctor to see is you’ve got coronary artery disease that needs to be addressed before racing a marathon.

Last point. Previous studies have shown that most marathon race deaths occur in the final mile or at the finish; this study confirms that. The implication: if you have reason to worry about your heart’s health and want to minimize that risk, think twice about your final sprint. Here’s the data, broken down by race quartile:

cardio

A few months ago, I blogged about a study that observed correlation between in-race carb intake and race time in Ironman triathletes. What was significant about that paper is that it looked at a topic that has been studied to death in the lab, and took it out into the real world. There are a lot of “problems” with the real world that make it hard to nail down causes and effects — but ultimately, the whole point of this type of research is to understand what’s happening in the real world. So these observational studies, despite their challenges, are very important.

That’s by way of intro for another small study, just published in the International Journal of Sport Nutrition and Exercise Metabolism, from researchers in New Zealand. They looked at the nutritional intake of participants in a brutal cycling race, the K4, which covers 384K and includes 4,600 metres of climbing. The average finishing time of the 18 study participants was 16 hours and 21 minutes! The key points:

• The estimated calorie burn for the race was about 6,000 calories; the average intake was just 4,500 calories, so there was a big caloric deficit.
• There was a significant inverse relationship (p=0.023) between number of calories consumed and finishing time. The more calories you managed to cram down your gullet, the faster you finished!

Is this a surprise? Given that the race was so long, it makes sense that taking in enough energy was a significant challenge. Obviously the same thing doesn’t apply during, say, a 100-metre sprint. The question is: where’s the breakpoint, beyond which energy intake becomes a significant independent predictor of performance? I think the general assumption is that it’s probably a bit below marathon distance — so it would be really interesting to see a study like this, with a very large number of participants, at a marathon.

nutrition