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The microorganisms in the gastrointestinal tract play a significant role in nutrient uptake, vitamin synthesis, energy harvest, inflammatory modulation, and host immune response, collectively contributing to human health. Important factors such as age, birth method, antibiotic use, and diet have been established as formative factors that shape the gut microbiota. Yet, less described is the role that exercise plays, particularly how associated factors and stressors, such as sport/exercise-specific diet, environment, and their interactions, may influence the gut microbiota. In particular, high-level athletes offer remarkable physiology and metabolism (including muscular strength/power, aerobic capacity, energy expenditure, and heat production) compared to sedentary individuals, and provide unique insight in gut microbiota research. In addition, the gut microbiota with its ability to harvest energy, modulate the immune system, and influence gastrointestinal health, likely plays an important role in athlete health, wellbeing, and sports performance. Therefore, understanding the mechanisms in which the gut microbiota could play in the role of influencing athletic performance is of considerable interest to athletes who work to improve their results in competition as well as reduce recovery time during training. Ultimately this research is expected to extend beyond athletics as understanding optimal fitness has applications for overall health and wellness in larger communities. Therefore, the purpose of this narrative review is to summarize current knowledge of the athletic gut microbiota and the factors that shape it. Exercise, associated dietary factors, and the athletic classification promote a more “health-associated” gut microbiota. Such features include a higher abundance of health-promoting bacterial species, increased microbial diversity, functional metabolic capacity, and microbial-associated metabolites, stimulation of bacterial abundance that can modulate mucosal immunity, and improved gastrointestinal barrier function.

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO). Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications. Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent. Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown. The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components. Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes’ exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections. Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes. Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise. The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product’s shelf life, as measured by colony forming units (CFU) or live cells. Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population.

Changes in myonuclear architecture and positioning are associated with exercise adaptations and ageing. However, data on the positioning and number of myonuclei following exercise are inconsistent. Additionally, whether myonuclear domains (MNDs; i.e., the theoretical volume of cytoplasm within which a myonucleus is responsible for transcribing DNA) and myonuclear positioning are altered with age remains unclear. The aim of this investigation was to investigate relationships between age and activity status and myonuclear domains and positioning. Vastus lateralis muscle biopsies from younger endurance‐trained (YT) and older endurance‐trained (OT) individuals were compared with age‐matched untrained counterparts (YU and OU; OU samples were acquired during surgical operation). Serial, optical z‐slices were acquired throughout isolated muscle fibres and analysed to give three‐dimensional coordinates for myonuclei and muscle fibre dimensions. The mean cross‐sectional area (CSA) of muscle fibres from OU individuals was 33%–53% smaller compared with the other groups. The number of nuclei relative to fibre CSA was 90% greater in OU compared with YU muscle fibres. Additionally, scaling of MND volume with fibre size was altered in older untrained individuals. The myonuclear arrangement, in contrast, was similar across groups. Fibre CSA and most myonuclear parameters were significantly associated with age in untrained individuals, but not in trained individuals. These data indicate that regular endurance exercise throughout the lifespan might better preserve the size of muscle fibres in older age and maintain the relationship between fibre size and MND volumes. Inactivity, however, might result in reduced muscle fibre size and altered myonuclear parameters. What is the central question of the study? How do endurance exercise and the ageing process affect the positioning and number of myonuclei within muscle fibres? What are the main findings and their importance? There was reduced muscle fibre size, with smaller myonuclear domains and altered myonuclear domain scaling in older, untrained individuals. However, older trained individuals maintained similar muscle and myonuclear characteristics to younger trained individuals. This suggests that inactivity, rather than ageing, influences muscle fibre and myonuclear characteristics. These observations suggest that consistent endurance exercise over one's lifetime might help to preserve muscle fibre size and quality and myonuclear arrangement into old age.

Few data are available that describe how probiotics influence systemic metabolism during endurance exercise. Metabolomic profiling of endurance athletes will elucidate mechanisms by which probiotics may confer benefits to the athlete. In this study, twenty-four runners (20 male, 4 female) were block randomised into two groups using a double-blind matched-pairs design according to their most recent Marathon performance. Runners were assigned to 28-days of supplementation with a multi-strain probiotic (PRO) or a placebo (PLB). Following 28-days of supplementation, runners performed a competitive track Marathon race. Venous blood samples and muscle biopsies (vastus lateralis) were collected on the morning of the race and immediately post-race. Samples were subsequently analysed by untargeted 1H-NMR metabolomics. Principal component analysis (PCA) identified a greater difference in the post-Marathon serum metabolome in the PLB group vs. PRO. Univariate tests identified 17 non-overlapped metabolites in PLB, whereas only seven were identified in PRO. By building a PLS-DA model of two components, we revealed combinations of metabolites able to discriminate between PLB and PRO post-Marathon. PCA of muscle biopsies demonstrated no discernible difference post-Marathon between treatment groups. In conclusion, 28-days of probiotic supplementation alters the metabolic perturbations induced by a Marathon. Such findings may be related to maintaining the integrity of the gut during endurance exercise.

Using a cross-sectional survey concussion knowledge was evaluated among forty university-level athletes (n = 20, rugby union players; n = 20, Gaelic football players) and eight experienced team coaches (n = 2, rugby union; n = 2, Gaelic football; n = 1, soccer; n = 1, hockey; n = 1, netball; n = 1, basketball). Levels of knowledge of concussion were high across all participants. Coaches had higher knowledge scores for almost all areas; however, there was evidence of important gaps even in this group. Knowledge was not sufficient in identifying concussion, and when it is safe to return to play following a concussion. Impaired knowledge of how to recognise a concussion, and misunderstanding the need for rest and rehabilitation before return to play presents a hazard to health from second impact and more catastrophic brain injury. We discuss reasons for these guideline misconceptions, and suggest that attitude issues on the significance of concussion may underlie a willingness to want to play with a concussion. This suggests the current education on sport-related concussion needs to be expanded for the appropriate management of university-level contact sports.

PurposeTo evaluate the effects of probiotic supplementation on gastrointestinal (GI) symptoms, circulatory markers of GI permeability, damage, and markers of immune response during a marathon race.MethodsTwenty-four recreational runners were randomly assigned to either supplement with a probiotic (PRO) capsule [25 billion CFU Lactobacillus acidophilus (CUL60 and CUL21), Bifidobacterium bifidum (CUL20), and Bifidobacterium animalis subs p. Lactis (CUL34)] or placebo (PLC) for 28 days prior to a marathon race. GI symptoms were recorded during the supplement period and during the race. Serum lactulose:rhamnose ratio, and plasma intestinal-fatty acid binding protein, sCD14, and cytokines were measured pre- and post-races.ResultsPrevalence of moderate GI symptoms reported were lower during the third and fourth weeks of the supplement period compared to the first and second weeks in PRO (p < 0.05) but not PLC (p > 0.05). During the marathon, GI symptom severity during the final third was significantly lower in PRO compared to PLC (p = 0.010). The lower symptom severity was associated with a significant difference in reduction of average speed from the first to the last third of the race between PLC (− 14.2 ± 5.8%) and PRO (− 7.9 ± 7.5%) (p = 0.04), although there was no difference in finish times between groups (p > 0.05). Circulatory measures increased to a similar extent between PRO and PLC (p > 0.05).ConclusionProbiotics supplementation was associated with a lower incidence and severity of GI symptoms in marathon runners, although the exact mechanisms are yet to be elucidated. Reducing GI symptoms during marathon running may help maintain running pace during the latter stages of racing.

Gastrointestinal symptoms are abundant among athletes engaging in endurance exercise, particularly when exercising in increased environmental temperatures, at higher intensities, or over extremely long distances. It is currently thought that prolonged ischemia, mechanical damage to the epithelial lining, and loss of epithelial barrier integrity are likely contributors of gastrointestinal (GI) distress during bouts of endurance exercise, but due to the many potential causes and sporadic nature of symptoms this phenomenon has proven difficult to study. In this review, we cover known factors that contribute to GI distress symptoms in athletes during exercise, while further attempting to identify novel avenues of future research to help elucidate mechanisms leading to symptomology. We explore the link between the intestinal microbiome, the integrity of the gut epithelia, and add detail on gut hormone and peptide secretion that could potentially contribute to GI distress symptoms in athletes. The influence of nutrition and dietary supplementation strategies are also detailed, where much research has opened up new ideas and potential mechanisms for understanding gut pathophysiology during exercise. The etiology of gastrointestinal symptoms during endurance exercise is multi-factorial with neuroendocrine, microbial, and nutritional factors likely contributing to specific, individualized symptoms. Recent work in previously unexplored areas of both microbiome and gut peptide secretion are pertinent areas for future work, and the numerous supplementation strategies explored to date have provided insight into physiological mechanisms that may be targetable to reduce the incidence and severity of gastrointestinal symptoms in athletes.

Purpose To investigate the effects of exercise in combination with, or without, a leucine-enriched whey protein supplement on muscle mass, fat mass, myoelectrical muscle fatigue and health-related quality of life ( HR- QOL) in older adults. Methods 100 community-dwelling older adults [52% women, age: 69 ± 6 years (mean ± SD)] were randomised to four [Control (C); Exercise (E); Exercise + Protein (EP); Protein (P)] independent groups. E and EP groups completed 16 weeks of exercise [resistance (2 times/week) and functional (1 time/week]. EP and P groups were also administered a leucine-enriched whey protein supplement (3 times/day) based on body weight (1.5 g/kg/day). Muscle and fat mass (bioelectrical impedance analysis), myoelectrical muscle fatigue (surface electromyography) and HR- QOL (WHOQOL-BREF) were measured pre- and post-intervention. Results At post-intervention, the rectus femoris ( E : − 4.8%/min, p  = 0.007, ES = 0.86; EP: − 3.3%/min, p  = 0.045, ES = 0.58) and bicep femoris (E: − 3.9%/min, p  < 0.001, ES = 1.46; EP: − 4.3%/min, p  < 0.001, ES = 1.58) muscles became more resistant to fatigue in the E and EP groups, respectively ( p  < 0.05 versus C). HR- QOL improved in the E group only. Muscle and fat mass did not change ( p  > 0.05). Conclusion Physical exercise is a potent method to improve myoelectrical muscle fatigue and HR- QOL in older adults. However, leucine-enriched whey protein did not augment this response in those already consuming sufficient quantities of protein at trial enrolment.

6 The GSRS contains 14 items, each rated on a 7-point Likert scale from no discomfort to very severe discomfort relating to abdominal pain, hunger pains, nausea, heartburn, acid regurgitation, diarrhoea, loose stools, rumbling, abdominal distension, belching, increased flatulence, constipation, hard stools and feeling of incomplete evacuation.1 2 3 4 5 6 7 Upper abdominal pain 76 10 7 3 3 1 1 Heartburn 84 7 5 2 2 0 0 Acid reflux 82 10 4 0 1 1 0 Hunger 52 22 16 8 1 1 0 Nausea 78 11 4 4 1 1 1 Bloated 52 22 14 6 4 1 1 Burping 70 20 3 4 0 2 1 Gas/flatus 56 20 9 9 3 2 1 Constipation 86 8 3 1 0 0 2 Diarrhoea 86 7 2 2 1 1 1 Loose stools 84 9 3 1 1 1 1 Hard stools 84 10 3 1 1 0 1 Urgent need to defecate 79 10 6 2 1 2 1 Incomplete evacuation 73 10 8 4 3 1 1 Data are percentage of total respondents. 1, nodiscomfort; 2, minordiscomfort; 3, milddiscomfort; 4, moderatediscomfort; 5, moderatelysevere discomfort; 6, severediscomfort; 7, verysevere discomfort.[...]formal annual screening and, where appropriate, specialist review by a gastroenterologist with an understanding of the athletic gut may be necessary.

Purpose To examine the dose–response effects of acute glutamine supplementation on markers of gastrointestinal (GI) permeability, damage and, secondary, subjective symptoms of GI discomfort in response to running in the heat. Methods Ten recreationally active males completed a total of four exercise trials; a placebo trial and three glutamine trials at 0.25, 0.5 and 0.9 g kg −1 of fat-free mass (FFM) consumed 2 h before exercise. Each exercise trial consisted of a 60-min treadmill run at 70% of V ˙ O 2max in an environmental chamber set at 30 °C. GI permeability was measured using ratio of lactulose to rhamnose (L:R) in serum. Plasma glutamine and intestinal fatty acid binding protein (I-FABP) concentrations were determined pre and post exercise. Subjective GI symptoms were assessed 45 min and 24 h post-exercise. Results Relative to placebo, L:R was likely lower following 0.25 g kg −1 (mean difference: − 0.023; ± 0.021) and 0.5 g kg −1 (− 0.019; ± 0.019) and very likely following 0.9 g kg − 1 (− 0.034; ± 0.024). GI symptoms were typically low and there was no effect of supplementation. Discussion Acute oral glutamine consumption attenuates GI permeability relative to placebo even at lower doses of 0.25 g kg −1 , although larger doses may be more effective. It remains unclear if this will lead to reductions in GI symptoms. Athletes competing in the heat may, therefore, benefit from acute glutamine supplementation prior to exercise in order to maintain gastrointestinal integrity.