Protecting the health and performance of the traveling athlete

One of the topics that will be discussed at the IOC World Conference in Monaco from 16–18 March 2017 is 'Protecting the health and performance of the traveling athlete'.

International travel is an unavoidable part of elite athletes' competitive careers, and as such, its effects on their health and performance have become an important component of the planning that goes into their training and preparation for competition. Prof Christa Janse van Rensburg, Head of the Section Sports Medicine at the University of Pretoria (UP), offers her view on some of the challenges that need to be considered and overcome in order to ensure that peak performance is achieved under foreign conditions.

Challenges faced with international travel 

International travel is part of the lifestyle of any elite athlete. Unfortunately, it is accompanied by physiological disturbances that lead to a complicated set of physical symptoms. Factors that come into play include environmental changes, disruption of the biological clock, and resulting from travel fatigue and/or jet lag. The combination of the demands of travel and the disruption of the circadian rhythms may enhance fatigue and negative mood states. It may also increase the athlete's susceptibility to illness, as was shown by Prof Martin Schwellnus and his team in a cohort of rugby players participating in the Super Rugby Tournament.

Environmental challenges may affect athletes travelling distances as short as 500 kilometres, and include changes in:

• temperature,
• season (Northern versus Southern hemisphere),
• altitude,
• humidity,
• atmospheric pollution,
• aero-allergens,
• strains of pathogenic organisms,
• diet regimens, and
• drinking water.

The athlete's biological clock will be influenced differently depending on the direction of travel. Flying west is usually easier, as it lengthens the day and implies that the body clock needs to be delayed. Flying east, however, shortens the day and therefore the body clock needs to be advanced, which is more problematic. For every time zone travelled (15 degrees) the biological clock has to move one hour. To adapt and resynchronise, it is advised that one should allow one day of rest for every time zone crossed. Physiological adaptations occur, but the sleep-wake cycle recovers faster than other physiological cycles such as heart rate variability (HRV). HRV is an indication of the health of the heart. In general, the higher the variability, the better. Too little variation implies chronic stress or insufficient functioning in different levels of autonomic controlled systems. From previous research, it appears that there is a lag in the HRV response to changes in time zone and climate. Studies are currently being undertaken in the Section Sports Medicine at UP(Grant, Jansen van Rensburg) to further determine the impact that this has on the performance of athletes.

Travel fatigue must be differentiated from jet lag, although the two can exist together. Travel fatigue is associated with any long journey, irrespective of the mode of transport or the direction of travel. Jet lag results from long-distance, trans-meridian travel, and the severity depends on the direction of the flight and the number of time zones crossed.

Measures to counter the effects of travel fatigue and jet lag include non-pharmacologic and pharmacologic treatment. During travel, it is advised to drink lots of water and abstain from alcohol use. Comfortable clothing, compression socks and moving around frequently will enhance blood circulation and prevent swelling of the legs as well as possible clotting. Schedule travel during sleeping hours at the destination, and set your watch to the destination time. Do not share drinking bottles or shake hands with fellow passengers. On arrival, the body clock can be advanced or delayed with the help of bright light therapy. Natural light is better and morning exposure will advance the clock while evening exposure will delay the clock. It also seems that the type of food consumed is not as important as the timing of meals. Melatonin has been used widely to assist with sleep initiation, but also to shift the physiological phases. Use of exogenous melatonin products has been proven effective and safe; however, it may be difficult to attain a product of acceptable quality. Short-acting sleeping tablets have also been used to assist athletes that struggle to fall asleep at their destination.

In conclusion, travel poses a big problem for anyone who travels frequently. It affects not only an individual's physiological well-being, but can also make one more susceptible to disease.

Researchers

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  Professor Christa Janse van Rensburg

  Professor Janse van Rensburg is Head of the Section Sports Medicine (SSM) at the University of Pretoria (UP). Her work can be categorised into the epidemiology of injury and illness in elite and recreational athletes, and currently covers netball players, trail runners, cyclists and rugby players. Research in this field assists in developing preventative programmes to reduce the risk of injury and illness in athletes.
  
  Prof Van Rensburg also looks at the effect of exercise on diseased populations, specifically those suffering from arthritic disease. This research helps people with chronic disease to be more active, which could contribute to a better quality of life as well as a reduced disease burden.
  
  In addition, she investigates the effects of travelling on athletes to help them optimise their performance after a long journey. To this end, she leads an international group of 26 researchers to acquire consensus on the management of travel fatigue and jet lag. The group consists of people from South Africa, Australia, New Zealand, France, Italy, the UK, the USA and Japan. Prof Van Rensburg says this research can be applied to any person travelling for work or holiday purposes.
  
  She published a systematic review on travel fatigue and jet lag in athletes in the British Journal of Sports Medicine (BJSM; IF 12.68) in April 2020, and has received an invitation to present [this paper?] at the Royal Society of Medicine’s Sleep and Sports Medicine Day in November 2021.
  
  In June 2020, her article ‘Should people wear a face mask during exercise: What should clinicians advise?’ was published as a blog post in the British Journal of Sports Medicine, and attracted a significant amount of international attention.
  
  An article in the Journal of Science and Medicine in Sport (IF 3.62) on the effect of lockdown on elite and semi-elite athletes from South Africa, published in May 2020, led to an invitation for Prof Van Rensburg to be part of a global research group that looked at the effects of COVID-19 on athletes. The first paper has been submitted to the Sports Medicine Journal (IF 8.55) and two more papers are in the offing.
  
  Along with international collaborators, she is also the co-developer of a research programme on the epidemiology and risk factors of trail running. The programme involves developing a tool for clinicians to screen trail runners for possible injuries.
  
  Prof Van Rensburg says her research efforts were inspired by the 2004 Olympic Games in Athens, Greece, where she was a team physician for the South African team. “Sport is my passion, and I am truly blessed to work in this environment.”
  
  Her academic role models are clinicians Prof James Ker, Snr and Prof Stan Brighton, who taught her during her undergraduate and postgraduate studies. She says they taught her to ask questions and not to rely on textbook knowledge.
  
  Prof Van Rensburg hopes for publishing outcomes that will optimise the performance of athletes and improve the quality of life of people with chronic disease.
  
  She is an avid runner and cyclist, enjoys watching sport and loves animals, especially dogs.
  

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  Protecting the health and performance of the traveling athlete