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Exercise‐induced respiratory symptoms limit physical activity and sport performance in adolescents. Etiologies include exercise‐induced bronchoconstriction, laryngeal obstruction, dysfunctional breathing, and in rarer cases, large airway obstruction and cardiac pathologies. Accurate diagnosis requires assessment during exercise that elicits the symptoms patients experience in the field. This is particularly important considering that misdiagnosis with asthma is common among those with laryngeal obstruction and leads to ineffective treatment and increased financial burden for patients and families. Continuous laryngoscopy is the gold standard for the evaluation of intermittent upper airway obstruction during exercise. Researchers recently established the feasibility of continuous bronchoscopy during exercise to assess the large airway in adults. We present the case of a 13‐year‐old female patient reporting dyspnea, chest tightness, and wheezing during exercise. A double aortic arch causing mild fixed tracheal compression did not appear to explain her symptoms. Vascular rings can cause tracheomalacia, another possible source of intermittent obstruction during exercise. We performed continuous bronchoscopy during exercise following continuous laryngoscopy during a cardiopulmonary exercise test. We found exercise‐induced laryngeal obstruction and ruled out tracheomalacia and other potential causes. To our knowledge, this was the first continuous bronchoscopy during exercise performed in a pediatric patient worldwide.

Background The ketogenic diet (KD) is the most popular carbohydrate restriction strategy for endurance athletes. However, because the primary goal of employing the KD is to gain a competitive advantage in competition, endurance athletes may be less concerned with the influence of the KD on their cardiometabolic health; particularly their blood lipid profiles. Thus, the purpose of this study was to examine the chronic and postprandial blood lipid alterations following a two-week ad libitum KD compared to an ad libitum high-carbohydrate diet (HCD) and the athletes’ habitual diet (HD) in a group of trained competitive cyclists and triathletes. Methods Six trained competitive cyclists and triathletes (female: 4, male: 2; age: 37.2 ± 12.2) completed this randomized crossover trial, which required them to follow a two-week ad libitum KD and HCD in a randomized order after their HD. Fasting blood lipids were collected following their HD and after two-weeks of the KD and HCD conditions. Postprandial blood lipid responses to a test meal reflective of the assigned diet were collected at the end of each diet condition. Results Fasting total cholesterol (TC) was significantly higher following the KD compared to the HD ( p  < 0.001) and HCD ( p  = 0.006). Postprandial incremental area under the curve for triglycerides (TRG), TRG:HDL ratio, and VLDL-C were significantly higher following the KD test meal compared to the HD (all p  < 0.001) and HCD (all p  = 0.001) test meals but LDL-C and LDL:HDL ratio were significantly lower following the KD compared to the HD and HCD test meals (all p  < 0.001). Conclusions Trained competitive cyclists and triathletes demonstrate increased TC in response to a two-week KD compared to a HCD or HD. Endurance athletes contemplating a KD should consider the potential for these blood lipid alterations, and future research should focus on postprandial blood lipid responses to determine if these changes manifest in chronic blood lipid shifts. Trial registration ClinicalTrials.gov Identifier: NCT04097171 (11 October 2019).

Background Frequent dieting is common in athletes attempting to achieve a body composition perceived to improve performance. Excessive dieting may indicate disordered eating (DE) behaviors and can result in clinical eating disorders. However, the current nutrition patterns that underly dieting culture are underexplored in endurance athletes. Therefore, the purpose of this study was to identify the sex differences in nutrition patterns among a group of endurance athletes. Methods Two-hundred and thirty-one endurance athletes (females = 124) completed a questionnaire regarding their dieting patterns and associated variables. Results The majority of athletes did not follow a planned diet (70.1%). For endurance athletes on planned diets (n = 69), males were more likely follow a balanced diet ( p  = 0.048) and females were more likely to follow a plant-based diet ( p  = 0.021). Female endurance athletes not on a planned diet (n = 162) were more likely to have attempted at least one diet ( p  < 0.001). Male athletes attempted 2.0 ± 1.3 different diets on average compared to 3.0 ± 2.0 for females ( p  = 0.002). Female athletes were more likely to attempt ≥ three diets ( p  = 0.022). The most common diet attempts included carbohydrate/energy restrictive, plant-based, and elimination diets. Females were more likely to attempt ketogenic ( p  = 0.047), low-carbohydrate ( p  = 0.002), and energy restricted diets ( p  = 0.010). Females made up the entirety of those who attempted gluten-/dairy-free diets (F = 22.0%, M = 0.0%). Conclusions Being a female athlete is a major determinant of higher dieting frequency and continual implementation of popular restrictive dietary interventions. Sports dietitians and coaches should prospectively assess eating behavior and provide appropriate programming, education, and monitoring of female endurance athletes.

In order to achieve optimal performance, endurance athletes need to implement a variety of recovery strategies that are specific to their training and competition. Recovery is a multidimensional process involving physiological, psychological, emotional, social, and behavioral aspects. The purpose of the study was to examine current implementation, beliefs, and sources of information associated with recovery strategies in endurance athletes. Participants included 264 self-identified endurance athletes (male = 122, female = 139) across 11 different sports including placing top three overall in competition (n = 55) and placing in the top three in their age group or division (n = 113) during the past year. Endurance athletes in the current study preferred hydration, nutrition, sleep, and rest in terms of use, belief, and effectiveness of the recovery strategy. Female endurance athletes use more recovery strategies for training than males (p = 0.043, d = 0.25), but not in competition (p = 0.137, d = 0.19). For training, top three finishers overall (p < 0.001, d = 0.61) and by division (p < 0.001, d = 0.57), used more recovery strategies than those placing outside the top three. Similar findings were reported for competition in top three finishers overall (p = 0.008, d = 0.41) and by division (p < 0.001, d = 0.45). These athletes are relying on the people around them such as coaches (48.3%) and fellow athletes (47.5%) along with websites (32.7%) for information and recommendations. Endurance athletes should be educated on other strategies to address the multidimensionality of recovery. These findings will be useful for healthcare professionals, practitioners, and coaches in understanding recovery strategies with endurance athletes.

Our aim was to determine the effects of probiotic supplementation (Bifidobacterium longum 35624; 1 billion CFU·d−1) on exercise performance, immune modulation, and cognitive outlook in collegiate female athletes during six weeks of offseason training. Seventeen National Collegiate Athletic Association (NCAA) Division 1 collegiate female swimmers participated in this two-group matched, double-blind, placebo controlled design. Via stratified randomization, participants were assigned to probiotic (B. longum 35624; n = 8) or placebo (n = 9) groups. Pre, mid, and post-training, all participants completed exercise performance testing (aerobic/anaerobic swim time trials and force plate vertical jump) as well as provided serum (cytokine and gastrointestinal inflammatory markers) and salivary immunoglobulin A samples. Recovery-stress questionnaire for athletes (RESTQ-Sport) was administered at baseline and conclusion of each week. Data were analyzed by analysis of covariance (ANCOVA) by time point with the respective baseline values of each dependent variable being the covariate. No significant differences in exercise performance and biochemical markers were observed between groups following offseason training. Recovery-Stress Questionnaire for Athletes (RESTQ-sport) values in B. longum 35624 group had significantly higher (i.e., more desired; p < 0.05) values in sport recovery (weeks five and six) than placebo. Probiotic supplementation in collegiate female swimmers did not affect exercise performance or immune function throughout offseason training, but did indicate alterations in cognitive outlook.

Purpose: The purpose of this study was to determine whether session rating of perceived exertion-derived training load (sRPE-TL) correlates with GPS-derived measures of external load in National Collegiate Athletics Association (NCAA) Division I female soccer athletes. Methods: Twenty-one NCAA Division 1 collegiate women’s soccer athletes (11 starters, 10 non-starters; 65.1 ± 7.2 kg, 168.4 ± 7.9 cm, 20.3 ± 1.5 yrs) volunteered to take part in this study. Data for this study were collected over the course of 16 weeks during the 2018 NCAA women’s soccer season. External load and heart rate (HR) data were collected during each training session and match during the season. At least 30 min after the end of an activity (e.g., match or practice), athletes were prompted to complete a questionnaire reporting their perceived exertion for the session. sRPE-TL was calculated at the end of the season by multiplying perceived exertion by the respective session duration. Results: sRPE-TL was very strongly correlated with total distance, distance covered in velocity zones 1–3, the number of accelerations in zones 4 and 5, total PlayerLoad™, and PlayerLoad™. For internal load, sRPE-TL correlated very strongly (0.70 ≤ |r| < 0.90) with Edward’s and Bannister’s TRIMP and strongly (0.50 ≤ |r| < 0.70) with duration spent in in heart rate zones 5 and 6 (80–90% and 90–100% max HR, respectively) while correlations with maximum HR (bpm), mean HR (bpm), and mean HR (%) and sRPE-TL were moderate (0.30 ≤ |r| < 0.50). Conclusions: In NCAA Division I women soccer, sRPE-TL is strongly associated with external measures of workload. These relationships were stronger during match play, with acceleration load and total distance exhibiting the strongest relationship with sRPE-TL.

Curcumin, a turmeric extract, may protect against cardiovascular diseases by enhancing endothelial function. In this randomized controlled double-blind parallel prospective study, fifty-nine healthy adults were assigned to placebo, 50 mg (50 mg), or 200 mg (200 mg) curcumin, for 8 weeks. The higher curcumin (200 mg) supplementation produced a dose-mediated improvement in endothelial function measured by flow-mediated dilation (FMD). The outcome was a clinically substantial 3.0% increase (90% CI 0.7 to 5.3%, p = 0.032 ; benefit : harm odds ratio 546 : 1) with the 200 mg dose, relative to placebo. The 50 mg dose also increased FMD relative to placebo by 1.7% (−0.6 to 4.0%, p = 0.23 ; 25 : 1), but the outcome was not clinically decisive. In apparently healthy adults, 8 weeks of 200 mg oral curcumin supplementation resulted in a clinically meaningful improvement in endothelial function as measured by FMD. Oral curcumin supplementation may present a simple lifestyle strategy for decreasing the risk of cardiovascular diseases. This trial was registered at ISRCTN registry (ISRCTN90184217).

Proper nutrition is critical for optimal performance in endurance athletes. However, it is unclear if endurance athletes are meeting all their energy and nutrient needs. We examined if endurance athletes are meeting their nutritional requirements and if this differed by sex. Ninety-five endurance athletes (n = 95; 50.5% men; 34.9 ± 12.9 y) participated in the study. Dietary intake was evaluated using the 24 h dietary recall method. Energy and nutrient intakes were calculated using the ESHA Food Processor Diet Analysis Software and compared against reference nutrient intakes. Endurance athletes did not consume the recommended amount of energy (76.8% of athletes), carbohydrates (95.8%), linoleic acid (75.8%), α-linolenic acid (ALA) (77.9%), eicosatetraenoic and docosahexaenoic acid (96.8%), dietary fiber (49.5%), vitamins D (93.7%), E (71.6%), and K (54.7%), folate (54.7%), pantothenic acid (70.5%), biotin (83.2%), manganese (58.9%), magnesium (56.8%), chromium (91.6%), molybdenum (93.7%), choline (85.3%), and potassium (56.8%), and consumed too much saturated fat (50.5%) and sodium (94.7%) than recommended. Fisher’s Exact test showed that the requirements for dietary fiber (70.8% vs. 27.7%), ALA (87.5% vs. 68.1%), and total water (70.8% vs. 44.7%) were not met by more men versus women (p < 0.05). The needs for protein (70.2% vs. 25%) and vitamin B12 (46.8% vs. 22.9%) were not met by more women compared to men (p < 0.05). These findings need to be confirmed by a larger study.

Endurance sports, including running, cycling, and swimming, remain popular among recreational athletes in the U.S. and across the world. Many of these athletes compete in local, regional, and national races throughout the year. Their performance in competitions is affected by many factors, including genetics, nutrition, and training. Often, recreational athletes receive conflicting recommendations regarding strategies to optimize performance. Direct-to-consumer genetic testing companies promise to give insights into supposed genetic markers of endurance ability; blogs and social media tout the latest diet strategies to lose weight and perform better; virtual coaches and performance-improvement websites sell training plans with sometimes contradictory training strategies. It remains unclear which of these strategies actually benefit endurance athletes. Therefore, this dissertation examined the effects of genetics, diet composition, and training characteristics on endurance performance in recreational athletes, who often spend a considerable percentage of their disposable income and their time on improving race outcomes.Single-nucleotide polymorphisms (SNPs), variations in a single base pair of a gene, have been proposed to affect physical performance. A SNP in the ACTN3 gene (XX genotype), results in deficiency of α-actinin-3, a structural muscle protein that appears important for explosive movements. Studies in rodents suggest that this deficiency could be beneficial for endurance performance. Yet, few studies in humans have directly assessed the effects of ACTN3 genotype on endurance performance. In our first study, we compared self-reported 1-mile and 5-km running personal records (PR) between participants expressing the three different ACTN3 genotypes. Among women, those with the ACTN3 XX genotype reported faster 1-mile PRs compared to those with the RR and RX genotype. We found no differences between genotypes for 1-mile PRs among men or 5-km PRs among either sex.A long-standing strategy to improve endurance performance is to increase carbohydrate (CHO) availability before and during competition to slow the fatigue process. An opposing approach introduced by researchers, coaches, and athletes, is to increase fat oxidation (FATox) capacities by employing a low-CHO or ketogenic diet (KD). This improved ability for FATox at typical race-intensities would open access to an essentially limitless supply of energy substrates stored in the body as fat. However, studies investigating the effects of KD and high-CHO diets (HC) on endurance performance have found conflicting results. In our second study, participants followed an HC and a KD for two weeks each in a random order. They performed a simulated 30-km cycling time trial (TT) at baseline and following each intervention. Participants’ average power output or endurance performance during the TT was substantially lower following the KD when compared with the HC.Endurance training is the main mechanism to improve general cardiorespiratory fitness and performance in races. Training characteristics include frequency, volume, intensity, and training intensity distribution (TID). TID can be determined by the time spent in the easy (Zone 1), moderate (Zone 2), and hard (Zone 3) training zones. Recently, a polarized TID (time in Z1 > Z3 > Z2) has gained popularity, after research suggested that many elite endurance athletes appear to follow this approach. However, the TID employed by recreational athletes and its association with performance is unknown. In our third study, we analyzed the training characteristics of recreational cyclists and triathletes. We investigated their association with endurance performance as measured by estimated relative critical power (CPrel). In our sample, very few recreational athletes followed a polarized TID. When controlling for age, we found that increased training volume and polarization were positively associated with CPrel.In conclusion, ACTN3 genotype does not appear to have a strong effect on endurance performance. Our results, along with findings from other studies investigating so-called endurance SNPs, suggest that individual genetic markers are not good indicators of endurance performance ability; thus, athletes and coaches should not rely upon direct-to-consumer genetic testing for talent identification and sport selection. Further, based on the results of our second study, the KD appears to decrease endurance performance. While additional research using longer nutrition interventions and different performance measures is needed, it appears that maximizing CHO availability remains the best strategy to improve endurance performance. Finally, we found that few recreational athletes follow a polarized TID despite its potentially beneficial effect on performance.

The primary means of disseminating sport and exercise science research is currently through journal articles. However, not all studies, especially those with null findings, make it to formal publication. This publication bias towards positive findings may contribute to questionable research practices. Preregistration is a solution to prevent the publication of distorted evidence resulting from this system. This process asks authors to register their hypotheses and methods before data collection on a publicly available repository or by submitting a Registered Report. In the Registered Report format, authors submit a stage 1 manuscript to a participating journal that includes an introduction, methods, and any pilot data indicating the exploratory or confirmatory nature of the study. After a stage 1 peer review, the manuscript can then be offered in-principle acceptance, rejected, or sent back for revisions to improve the quality of the study. If accepted, the project is guaranteed publication, assuming the authors follow the data collection and analysis protocol. After data collection, authors re-submit a stage 2 manuscript that includes the results and discussion, and the study is evaluated on clarity and conformity with the planned analysis. In its final form, Registered Reports appear almost identical to a typical publication, but give readers confidence that the hypotheses and main analyses are less susceptible to bias from questionable research practices. From this perspective, we argue that inclusion of Registered Reports by researchers and journals will improve the transparency, replicability, and trust in sport and exercise science research. The preprint version of this work is available on SportR χ iv: https://osf.io/preprints/sportrxiv/fxe7a/ .