The Physiology of Training

ADVANCES IN SPORT AND EXERCISE SCIENCE SERIES
The
Physiology
ofTraining
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First published 2006
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vii
Contributors
Colin Boreham BSc MSc PhD FACSM FECSS

Colin Boreham is Professor of Sport and Exercise at the University of Ulster. His research
interests lie in exercise and health in young people and elite sport. Colin is a former UK
record holder in the high jump, and represented GB and NI at the 1984 Los Angeles
Olympics as a decathlete.
Richard Budgett OBE MA MBBS DipSportsMed DRCOG DCH MRCGP FFSEM FISM
Richard is currently the Director of Medical Services to the British Olympic Association,
Chief Medical Officer at the Olympic Medical Institute, and Sports Physician, English
Institute of Sport South East Region. Richard has published extensively in the area of
chronic fatigue in elite athletes and the overtraining syndrome. Richard was an Olympic
Gold Medallist in rowing (coxed fours) at the 1984 Olympic Games.
Roslyn Carbon MSc(SportsMed)Lond MBBS DipSportsMed MLCOM FACSP FFISEM
Roslyn Carbon is a sports physician based in London, UK. She served as a medical officer
with the British team and at world championships in six different sports. She was the senior
lecturer and clinician at the Academic Department of Sports Medicine at the Royal London
Hospital during the 1990s. Having been the inaugural Sports Medicine Fellow at the
Australian Institute of Sport, she was more recently the National Medical Director of the
English Institute of Sport. She is currently working in professional rugby union and is a
consultant for the lrish Sports Council.
Nicholas Diaper BSc MSc
A former international swimmer, having captained the Kenyan national swimming team at the
1998 and 2002 Commonwealth Games, Nicholas holds a Masters degree in exercise physiology
from Manchester Metropolitan University and at the time of writing he was a sports science
intern working with the English Institute of Sport.
Andrew Franco BSc
Andrew Franco is a postgraduate student at Brunel University currently studying the
influence of different types of training upon cardiac structure and function. Andrew is also
an active rugby coach, currently responsible for a large inner city rugby project targeting
children from ethnic minorities and low-income backgrounds.
Richard Godfrey BSc PhD
During 12 years working as a Chief Physiologist for the BOA, Richard Godfrey staffed 60
elite athlete training camps, attended two Olympic Games, and completed his PhD in growth
hormone and exercise. He is currently a Senior Research Lecturer at Brunel University.
viii Contributors
Stephen Ingham BSc PhD

During 7 years as Senior Sports Physiologist at the Olympic Medical Institute and the
English Institute of Sport, Steve has supported track athletes and rowers to numerous
Olympic medals. He has a BSc in sports science and a PhD in exercise physiology and is
BASES accredited and holds NSCA certification. Steve is a national league sprinter.
Yiannis Koutedakis BSc MA PhD
Yiannis has attended many national, international and world championships and Olympic
Games as competitor, professional coach/trainer and scientific advisor. He was one of the
founders of the British Olympic Medical Centre. He is currently a Professor in Applied
Physiology at the University of Thessaly (Greece) and a Visiting Professor at
Wolverhampton University (UK), and has published extensively in the area of human
physical fitness.
Alison K. McConnell BSc MSc PhD FACSM
Alison is Professor of Applied Physiology at Brunel University. Originally a graduate of
biological sciences (physiology), she made the transition into exercise physiology after
completing an MSc in human and applied physiology at King’s College London, and a PhD
in the Department of Thoracic Medicine at King’s College Hospital. Alison’s main research
interest is in ‘respiratory limitations to exercise’, which has its roots in her competitive
background in track and field and, later, rowing.
Giorgos S. Metsios BSc MSc
Giorgos has been a member of the Greek national water-polo team. He obtained his BSc in
sport and exercise science from Thessaly University (Greece) and his MSc in sport science
from Wolverhampton University (UK). He is currently extending his studies to PhD level in
the area of exercise science.
Robert Shave BSc MSc PhD
Rob is a Reader in Sport and Exercise Physiology within the School of Sport and Education
at Brunel University. Prior to his appointment at Brunel Rob was an applied physiologist at
the British Olympic Medical Centre for 3 years where he provided physiological support to a
number of Olympic and professional sports.
Antonis Stavropoulos-Kalinoglou BSc MSc
Antonis has been a member of the Greek national skiing team. He obtained his BSc in sport
and exercise science from Thessaly University (Greece) and his MSc in sport science from
Wolverhampton University (UK). He is currently extending his studies to PhD level in the
area of exercise science.
Ken van Someren BSc PhD
Ken is currently the National Physiology Lead at the English Institute of Sport. He competed
in four Sprint Kayaking World Championships and has supported a wide range of national
and international athletes. His research interests include physiological determinants of sports
performance, training techniques and exercise-induced muscle damage.
Contributors ix
Gregory Whyte BSc MSc PhD FACSM

Formerly Director of Research for the British Olympic Association, Greg is currently the
Director of Science and Research at the English Institute of Sport. He is an Associate
Professor at Brunel University and has published extensively in the area of cardiovascular
function in health and disease and performance physiology. Greg represented Great Britain at
the 1992 and 1996 Olympic Games and is a World and European medallist in modern
pentathlon.
xi
Foreword
Human athletic performance continues to improve across all sporting activities.

However the margins of improvement are reducing. Indeed, there are suggestions
that the limits to human performance have been reached in some events. A closer
examination of the determinants of performance and the optimal adaptation of those
determinants is required as athletes move closer to the genetic ceiling of perform-
ance. The advancement of sports science and sports medicine in recent years has
created an avenue of exploration in the identification of the determinants of athletic
performance and the optimization of training and health. Physiology, as a sub-
discipline of sports science and sports medicine, has made a significant contribution
to our understanding of athletic performance. In an attempt to understand what the
human body goes through when training and competing, with an end goal of learn-
ing how to make the most of mine, I studied for a Masters in Sports Science. The
knowledge it gave me was invaluable, allowing me to exploit whatever ability I had.
The physiological examination of exercise was first documented in the early 1900s.
However it was not until the 1960s that we observed a growing interest in exercise
and, by inference, sports physiology. Since that time there has been a growing body
of literature examining athletic performance, its determinants and training-induced
adaptations. Despite the large volume of available research there are only a limited
number of books that examine the physiological aspects of athletic performance.
Indeed, those texts currently available tend to focus on single sporting disciplines.
The Physiology of Training represents a significant contribution to the available liter-
ature, offering a contemporary, across-sport account of training physiology. Opening
with a detailed review and update of the principles of training, it focuses upon the
key areas of periodization, specificity and tapering. Understanding the principles of
training is of paramount importance in the development of effective training
programmes. Having provided a comprehensive commentary on the principles of
training The Physiology of Training examines, in detail, all facets of physiology
associated with athletic performance across aerobic, anaerobic, power and strength-
based sports. These chapters draw upon available knowledge to give an under-
standable and concise review of each area and, underpinned by the authors’ practical
experience and expertise in the area, offer practical applications of the available
research across sport. In contrast to the books currently available, The Physiology of
Training goes on to examine the impact of the environment on training and offers
practical solutions to common problems encountered when training in the heat, cold
and at altitude. Furthermore, it explores some commonly observed health problems
associated with training. Environment and health are important areas that receive
little coverage in training texts.
xii Foreword
Drawing upon the knowledge and expertise of an outstanding group of authors,

this book is a ‘must have’ for sports scientists, coaches, personal trainers and phys-
ical educators. The Physiology of Training is an excellent ‘one stop’ resource offering
a contemporary, in-depth and concise mix of theory and practice that should be
found on the bookshelves of all those involved in sport, at all levels.
James Cracknell
xiii
Preface
During the late 19th Century and early part of the 20th Century the Victorians
imposed an amateur ethic on athletic participation that resulted in only the wealthy
being able to compete in the vast majority of sports. Along with this amateur ethos
came a belief that physical training was unsportsmanlike and not in the true spirit
of competition. With the end of the Victorian era came an expansion of physical par-
ticipation, sport and competition, leading the way to a ‘professionalization’ of sport
with the development of training and the introduction of dedicated coaches. This
period of emancipation coincided with the first attempts of scientists to describe the
physiological response to exercise in man. The mid-1900s saw an acceleration of
focused programmes of research designed to evaluate the result of physical train-
ing on performance. Since that time, exercise physiology has become an integral part
of coaching and training science.
Despite the ever increasing library of research evidence there are very few com-
prehensive texts examining the physiology of training. While many books contain sin-
gle chapters on the subject, often the coverage lacks depth and academic rigor.
Furthermore, advances in training science have led to a large number of original
research and review publications in recent years. These publications have yet to be
fully reviewed and presented in a single text dedicated to the physiology of training.
This book encompasses the available research evidence supported by practical exam-
ples that will provide a valuable, contemporary addition to the existing literature.
Existing texts on the physiology of training often focus on individual sports and
fail to provide the breadth or depth of information necessary for undergraduate and
postgraduate students, and the coaching community. The goal of this book is to offer
a significant contribution to the field of training physiology by providing an in-
depth explanation of coaching science using both theoretical and practical models
for training, across a wide range of sporting disciplines. This book will fulfil an
important role in the teaching of training science to a broad community of scien-
tists and coaches. It is envisaged that The Physiology of Training will become a key
element in the education of those involved in sport and exercise science, and coach-
ing, and act as an ongoing resource to all those involved in sport and exercise phys-
iology, coaching, teaching and the fitness industry.
The contents are arranged to allow the reader to access information in an organ-
ized and sequential fashion, covering all key areas underpinning the physiology of
training. The principles of training are the focus of attention in Chapters 1, 2 and 3,
examining the areas of periodization, specificity and tapering. Using these princi-
ples, Chapters 4, 5, 6 and 7 cover the physiology of endurance training, anaerobic
endurance training, sprint and power training, and strength training. Chapter 8, on
xiv Preface
the environment and training, examines the impact of heat, cold and altitude on
training physiology, offering practical guidelines in combating the potentially dele-
terious effects of such environments. Finally, Chapter 9 presents an overview of four
common medical conditions associated with training – ‘reproduction health in exer-
cising women’, ‘the athlete’s heart’, ‘unexplained underperformance syndrome’ and
‘asthma and exercise-induced asthma’.
In addition to the dedicated, contemporary coverage, The Physiology of Training
has drawn upon high-profile authors who are proven academics in the field of coach-
ing science and who have worked closely with high-performance athletes and
coaches. Each author offers a wealth of theoretical knowledge underpinned by a
proven record of application in the practical setting. The authorship team includes
major championship medallists from a variety of sports, enabling them to offer a
unique perspective on the physiology of training.
In summary, the expertise and experience of the authors has resulted in a unique,
contemporary text examining the physiology of training that will become a key
resource for sport and exercise scientists, coaches, teachers and health professionals.
In preparing this text, I would like to acknowledge the assistance I have received
from Professor Craig Sharp; I would also like to thank him for his mentorship
throughout my career.
Buckinghamshire 2006 Gregory Whyte

1
Chapter 1
Periodization of exercise training
in sport
Yiannis Koutedakis, Giorgos S. Metsios and Antonis
Stavropoulos-Kalinoglou
CHAPTER CONTENTS
Learning objectives: 1 Periodization phases 12
Summary 2 Preparation phase 12
Introduction 2 Competition phase 13
Exercise training 3 Transition phase 13
Training theories and
Components of periodization –
methodologies 3
training cycles 13
Training adaptation 5 Microcycle 13
The supercompensation Mesocycle 15
cycle 5 Macrocycle 15
Recovery 7
Periodization of selected physical
Training fatigue and
fitness elements 15
over-reaching 8
Aerobic endurance 15
Unexplained underperformance
syndrome (UPS) 9 Periodization for developing
Aspects contributing to UPS 9 endurance 16
Symptoms 9 Foundation of endurance 16
Signs 10 Introduction of specific endurance 17
Acute UPS 10 Specific endurance 17
Chronic UPS 10
Strength 17
Management of UPS 10
Periodization for developing strength 18
Periodization 11
Key points 19
Definition and concepts 11
References 20
Scientific research 11
Further Reading 21
Types of periodization 12
LEARNING OBJECTIVES:
This chapter is intended to ensure that the reader:
1. Appreciates the historical, theoretical and scientific background of periodization.
2. Distinguishes between fatigue due to normal training, over-reaching and over-
training.
3. Understands the importance of recovery following exercise training.
4. Understands the concepts and components of periodization.
2 THE PHYSIOLOGY OF TRAINING
5. Structures periodized training programmes on the basis of basic principles of peri-

odization.
6. Understands differences between training cycles.
7. Distinguishes periodization procedures for developing aerobic endurance and
strength.
SUMMARY
The necessity of superior performance in sport has impelled coaches to use increas-
ingly effective and sophisticated training methods. This has been better served by
applying the principals of periodization whereby, as levels of a particular fitness-
component increase, a higher exercise stress is required to create overload and lead
to specific physiological adaptations. The modern theory of periodization was
advanced in the early 1960s when coaches realized that focusing on an important
competition was more effective than preparing the athlete for a year-round compe-
tition programme. This has been supported by limited scientific data indicating that
athletes who train using periodized models attain levels of performance superior to
those who use non-periodized models. Performance improvements in most sport
activities have been directly linked to changes in structures and metabolic capacities
of skeletal muscle. Periodized resistance training, for instance, causes hypertrophy of
muscle fibres of all types, especially those with fast-twitch characteristics. In contrast,
aerobic training leads to increases in the number and volume of mitochondria (essen-
tial for energy production trough aerobic pathways), mainly in slow-twitch fibres.
INTRODUCTION
Ever since sport began, athletes have been trying to get the most out of their train-
ing. However, it was not until the last few decades, that levels of sport performance
have exhibited a spectacular increase. Records that once were imaginary can now
be regularly reached. At the same time, the amount of training of modern competi-
tors is considerably higher than that used in the past. This would not be possible
without the concurrent evolution in training methodology. The necessity of superior
performances in competition has impelled coaches to introduce increasingly effective
and sophisticated training methods.
Several sciences have contributed to the understanding of the effects of exercise
on the body, and together have formed a science of their own, the science of train-
ing. The latter focuses on sports performance and aims to understand, measure and
improve the effects of exercise on the body and minimize the prevalence of injury.
During competition, the participant is expected to withstand several stressful stim-
uli, while performance can be influenced by numerous internal factors (e.g. physi-
ological, biochemical, technical and tactical) and/or external factors (e.g. climatic,
travelling, financial). Training has to be structured in a way that simulates these con-
ditions and prepares for the actual event. For optimal performance, therefore, com-
petitors must be experts in the technical side of their event, be psychologically
prepared to handle the enormous stress of critical situations, and be free from injury;
they must also be physically ‘fit’.
Physical fitness is served by individual sciences such as paediatric and adult phys-
iology, biochemistry, biomechanics and sports medicine (Fig. 1.1) and it can be
defined as the individual’s ability to meet the demands of a specific task. It prima-
rily consists of elements of aerobic and anaerobic fitness, muscular strength and flex-
ibility. Regardless of the performance level, sex and age, all competitors use one or
more of these elements of fitness during their daily practice. For example, in an
Periodization of exercise training in sport 3
Paediatric
Anatomy Adult physiology Statistics
physiology
Tests and
Psychology
measurements
Science of training
Motor learning Sports medicine
Pedagogy Nutrition Biomechanics Biochemistry
Figure 1.1 The science of training and selected contributing elements.
endurance event such as the marathon, aerobic capacity is the most important ele-
ment for success, whereas in sprinting events, such as the 100 m, anaerobic power
predominates. Consequently, training programmes have to address the most
important elements of physical fitness for each individual sport.
Training planning has existed, though in a crude form, since the ancient times and
was used for the Olympic Games or military purposes. The Greek athlete Milon from
the city of Croton was the first known competitor who, perhaps unwittingly, imple-
mented the principle of periodization as early as the 6th Century BC. He determined
the training cycles by carrying a bull calf on his back each day until the animal reached
maturity. As levels of a particular fitness component increase, a higher quality of exer-
cise stress is needed to create overload and lead to physiological adaptations.
As early as the middle of the 19th Century appeared the first studies on human
muscular performance, published in the then popular Philosophical Magazine.
However, the modern practice of periodization can be traced to the 1950s and early
1960s when East European coaches observed that their athletes could not withstand
the enormous training load to which they where subjected. In contrast, coaches
observed that focusing on just a few important competitions was far more effective
than preparing the athlete for a year-round competition programme. This anecdotal
evidence was later supported by some scientific data, suggesting that athletes who
trained using periodized models attained superior levels of performance than those
who used non-periodized models (Fleck 1999). The aim of this chapter is to provide
information on the appropriate planning of exercise training programmes for the
purpose of enhancing performance in sports, utilizing the principle of periodization.
EXERCISE TRAINING
Training theories and methodologies

The human body is structured in such a way that it maintains relatively stable inter-
nal physiological conditions, or homeostasis. Blood volume, haematocrit, arterial
pressure and core temperature are among the most important physiological indica-
tors of homeostasis. When this balance is disturbed, the body reacts acutely in an
attempt to preserve homeostasis and, if the ‘disturbance’ continues, it adapts its func-
tions to a higher level. Physical training aims to cause such an imbalance in the
body over a period of time, while training theory and methodology deals with
the understanding of the cause and optimization of training results. The theoretical
background of training originally comes from the work of Dr Hans Seyle, who first
introduced the General Adaptation Syndrome (GAS) theory in 1956. In his model,
Seyle suggested that the body responds to stress in three different stages.
The first stage, or ‘shock stage’, is when the source of biological stress is identi-
fied by the body, which responds to this change and tries to overcome the imbal-
ance caused by the stressor. As the stressor persists, physical and mental performance
is reduced below baseline levels. In terms of training, this stage refers to the intro-
duction of a training programme where the individual experiences soreness, stiff-
ness and tiredness due to the initial ‘shock’ caused by the exercise.
The second stage of the GAS is termed the ‘resistance stage’ which starts as soon
as the stressor is removed. During this stage, the human body recovers from the
temporary imbalance and adapts at a higher level of performance to compensate for
the increased demands. These two stages are natural responses to the stressor and
have positive effects on the body. The third stage is referred to as the ‘exhaustion’
or ‘fatigue’ stage, and can be reached when the stressor is of great longitude or mag-
nitude, and the body does not have sufficient time to adapt.
Performance optimization is the result of long-term, demanding and well-
structured exercise training. For the athlete to gain maximum benefits from exercise,
several factors involved in the adaptation mechanism have to be considered. These
factors include overload, specificity, individual differences and reversibility.
Overload refers to the intensity and duration of the training stimuli. Exercise
training has to be sufficient in its intensity and duration to activate the adaptation
mechanism and bring about changes in structural, physiological, neural, psycho-
logical and endocrine functions. If the training exercise does not stress the body suf-
ficiently, no adaptation occurs. On the other hand a very high stress can lead to
injury or over-training, hence, any new increase should be followed by an unload-
ing phase during which the body relaxes, adapts and prepares for a new increase
in load (Harre 1982).
Not every type of exercise is appropriate for all sports. The performed exercise
has to be sport-specific and focus on the muscles and organs stressed during the
actual competition. Low-intensity strength training, for example, does not prepare
the muscle for the demands of competition in which high muscle forces are required,
while speed increases should be possible only if training loads are low but with
high-velocity muscular actions (Fig. 1.2). In general, similarities should exist between
the training conditions and those required in the field during competition. Chapter
2 will examine the principles of specificity in greater detail.
A B
Training
zone
Force
Force
Force
Force
Training
zone
Velocity Velocity Velocity Velocity
Figure 1.2 The force–velocity relationship (redrawn from Komi & Häkkinen 1988).
If one wants to increase force levels, exercises should be characterized by high loads
and low velocities (A). Alternatively, if the speed of movement is the intended adaptation,
exercise-loads should be low but with high-velocity muscular actions (B).
A training programme has also to be planned according to the training principle

of individuality in order to meet the needs of each athlete. Inter-individual varia-
tion in responses to exercise and adaptation rate are partially because of genetic dif-
ferences. The relative predominance of fast- or slow-twitch motor units in muscles
and endocrine factors determine to a great extent the level of adaptation. The com-
petition level can also affect individual training programmes, particularly in relation
to overall length, which may extend from 8 to more than 30 hours per week.
The opposite of training is detraining. When an athlete is not subjected to suffi-
cient training over a period of time, performance deteriorates significantly. In other
words, reversibility (or detraining) is a deconditioning process caused by the reduc-
tion or cessation of optimal training stimuli. As a general rule, the longer the train-
ing period the slower the detraining (Moritani & deVries 1979). The time needed for
this decrease is shorter than that required by the athlete to regain the previous level
of performance. In addition, much consideration has to be given for the time allowed
for detraining because an unduly prolonged deconditioning period may significantly
compromise the regaining of performance. For instance, it has been found that
although 4 weeks of reduced training or inactivity provided no decreases in mus-
cular strength, the ability to generate power declined dramatically (Neufer et al
1987).
TRAINING ADAPTATION
Adaptations due to exercise training can be either acute or long-term in nature. The
former includes homeostatic regulatory responses, activation of oxygen transport
and use of energy reserves with the main aim being to optimize ATP resynthesis.
Structural and functional changes occurring during prolonged periods of training
are associated with long-term adaptations, which, in turn, are founded on adap-
tive protein synthesis. For instance, endurance (i.e. aerobic) training results in an
increased concentration of myoglobin, mitochondrial enzyme activity, mitochondrial
density, increased respiratory capacity and oxygen transport, as well as enhanced
cardiac output (Viru & Viru 2001). On the other hand, strength and power training
results in increased muscle cross-sectional areas, or hypertrophy. However, these
training-induced adaptations at the muscle cell level are also associated with con-
comitant adaptations in myocardial, hepatic, renal, endocrine and other cells. Bone
growth is also affected by exercise. It has been found that low- and high-intensity
exercise training may respectively enhance and hinder bone growth in children
(Matsuda et al 1986).
THE SUPERCOMPENSATION CYCLE

The supercompensation cycle (SC) is the direct transposition of GAS into the the-
ory and methodology of training and deals with the association between training
load and regeneration as the biological bases for physical arousal (Bompa 1999). SC
is divided in four parts: exercise, fatigue, recovery and adaptations (Fig. 1.3).
When an athlete trains, the body has to supply muscle and organs with energy
at a higher rate than resting. These excess energy needs are covered by stored sup-
plies. The drainage of energy stores as well as the accumulation of by-products, such
as lactic acid, in the blood and cells leads to fatigue. This is the first phase of the
SC, which is characterized by temporary decrements in performance.
Following exercise training, homeostasis has to be restored. Energy stores are
replenished and by-products are removed, while tissue micro-damage is repaired to
Exercise Adaptions
load
Recovery
Fatigue (rest)
Figure 1.3 Supercompensation cycle. Following recovery, the tissues adapt to tolerate
higher exercise load, i.e. athletes are in a higher state of fitness.
prevent further, more serious damage. These functions take place during the second
phase of SC, the compensation, or recovery phase. However, the third phase of the
SC, or supercompensation phase, is the most important one as the body achieves a
new, higher level of homeostasis. This means – inter alia – that more energy is stored,
especially in the form of glycogen, more contractile proteins are synthesized for effi-
cient and dynamic muscular work, while oxygen is supplied to the mitochondria at
a higher rate via a sufficiently developed capillary network.
For these adaptation processes to succeed, an appropriate length of time is required
where little or no physical activity is involved. This appears to be about 24 hours
following exercise, when glycogen stores are completely replenished and muscle pro-
tein synthesis reaches its highest rates. However, the length of recovery time depends
on the intensity and duration of training, and it is influenced by the appropriate-
ness or otherwise of nutrition. Inadequate recovery negatively affects adaptation and,
therefore, levels of fitness and even health. In particular, any imbalance between
training and recovery may bring about the characteristic impairment in physical per-
formance, which is referred to as ‘overtraining’ (Koutedakis & Sharp 1999,
Koutedakis 2000). On the other hand, if the time between two consecutive training
sessions is greater than required, the supercompensation state will start to deterio-
rate until it reaches the original level of homeostasis. This unwelcome development,
termed involution, should be avoided.
Ideally, the exercise-training stimulus should be applied when the athlete is at
the phase of supercompensation, so that the new supercompensation cycle can
begin at a higher level of homeostasis, which may increase the possibilities for
improved performances over time (Fig. 1.4). However, most elite athletes do not
Training
stimuli
Performance
improvement
Figure 1.4 Accumulative effects of exercise training on performance.

have sufficient recovery time between consecutive training sessions. Coaches have
to find ways to alternating high- and low-intensity training so that the different
energy sources are stressed. In this way, several training sessions may result in
decreases in homeostatic level for a given period of time, but eventually allow the
athlete to reach the desired levels of supercompensation (Fig. 1.5).
RECOVERY
Structural and functional changes incurred during prolonged periods of training
are associated with long-term adaptations. As mentioned earlier, however, most of
these changes take place during recovery periods following training. Recovery or
regeneration refers to the procedures followed by the body to restore homeostasis
and adapt its functions and systems at a higher level. These include increased
contractile protein synthesis, elevated glycolytic and Krebs’ cycle enzymes mobi-
lization, and the return to normal function of endocrine, nerve and immune sys-
tems. In a properly structured training schedule, recovery is of equal significance to
the training itself.
The time required for recovery depends on several factors and varies consider-
ably among athletes. Physical conditioning and experience play a very important
role in recovery rates. Highly conditioned individuals demonstrate higher rates of
energy transfer into and removal of waste out of the cells compared to their less
conditioned counterparts. Also, in general, supercompensation in athletes younger
than 18 years of age requires more time to materialize, while athletes older than 25
require more recovery time.
Hormones, such as testosterone and cortisol augment or inhibit recovery respec-
tively. Males, due to their higher levels of testosterone, exhibit faster recovery rates
than females (Noakes 2001). On the other hand, high concentrations of cortisol inhibits
muscle growth and repair, as well as impairing the neuromuscular co-ordination
(Davis et al 2000). The type of exercise used in each training session can further affect
recovery rates.
External factors, such as nutrition, environmental conditions and travelling may
also affect recovery. Administration of the required nutrients soon after the training
session is completed can positively influence recovery. There seems to be a 2-hour
optimal window after the cessation of exercise for the ingestion of carbohydrate.
Exercising at altitude, of higher than 2500 to 3000 metres, results in impaired recov-
ery rate due to the reduced partial pressure of oxygen. Similarly, cold adversely affects
the production of regenerative hormones such as testosterone and human growth
hormone and in this way inhibits recovery. Human growth hormone may also be
Training
stimuli
Performance
improvement
Figure 1.5 Effects of successive exercise-training sessions with different loadings.

affected chronobiologically by travel. Travelling over time zones with 3–10 hours
difference affects circadian rhythms with negative effects on recovery.
Accordingly, researchers have tried to establish a time course for recovery. It has
been shown that heart rate and blood pressure will return to baseline values in the
hour following exercise. After intensive aerobic exercise, 10–48 hours are required
for the body to replenish glycogen stores depending on intensity and duration of
exercise, whereas 5–24 hours would usually be needed for glycogen replenishment
after anaerobic exercise (Koutedakis & Sharp 1999). Following resistance training
24–36 hours are required for the muscle to be completely normalized (Viru & Viru
2001). Recovery of the nervous system, depending on the severity of the stimuli,
may take up to 48 hours (McArdle et al 2001).
Recovery rate follows a curvilinear pattern (Fig. 1.6), divisible into three parts. In
the first, almost 70% of the required recovery is completed; the rate is then reduced
so that an additional 20% is accomplished and the remaining 10% occurs in the third
part of the recovery curve (Bompa 1999). Depending on the energy system used dur-
ing training and the required recovery, the shift from the first to the last part of the
recovery curve can last from a few hours to several days, or even months in the
case of overtraining (Koutedakis 2000).
TRAINING FATIGUE AND OVER-REACHING

Training stimuli, when properly applied, result in a disturbance to the homeostatic
balance. As indicated above, this imbalance may last several hours depending on
the training load and the other factors discussed.
When a training stimulus exceeds the tolerance levels of the athlete, a greater dis-
turbance in homeostasis may occur. This short, acute imbalance appears as acute
fatigue and lasts for 1–2 days. Acute fatigue is usually accompanied by muscular
overstrain and results in muscle soreness, insomnia and increased allergenic response.
When this is followed by a second intense training session, without an appropriate
intervening recovery period, a state of overload stimulus with muscular strain devel-
ops, where the same symptoms are present but last for more than 2 days.
Further engagement in intense training without adequate recovery leads to
accumulation of fatigue and to the condition termed ‘over-reaching’. This usually
occurs slowly over the course of several weeks. Symptoms are similar to those of
100
Fatigue level (%)
0
1st part 2nd part 3rd part
70% 20% 10%
Figure 1.6 Recovery rate.
the overload stimulus, but more severe. Additionally, athletes in a state of over-
reaching might observe an increased resting heart rate, increased heart rate and
lactic acid concentrations during sub-maximal exercise, early fatigue during train-
ing, reduced ability to tolerate training load and increased thirst. Over-reaching is
a temporary state and usually lasts from a few days to 2 weeks.
Coaches utilize training methods to voluntarily place the athlete in one of the
above described states. These methods are used to achieve a greater training impact.
However, such techniques have to be implemented with extreme caution and after
careful planning and monitoring of the effects of training, otherwise overtraining –
or the recently introduced ‘unexplained underperformance syndrome’ – may result
(Budgett et al 2000).
UNEXPLAINED UNDERPERFORMANCE SYNDROME (UPS)

The terms unexplained underperformance syndrome (UPS; also referred to as ‘over-
training’, ‘overtraining syndrome’ or ‘burnout’), staleness, chronic fatigue (or ‘chronic
fatigue syndrome’) and post-viral fatigue are often used interchangeably to describe
the condition in which active individuals complain of reduced physical perform-
ances for no apparent medical or other obvious reasons.
Although these terms are used by many as synonyms to describe more or less
the same condition – i.e. poor physical performances, coupled with chronic and
unexplained fatigue and certain behavioural changes – the condition itself may have
different origins or may be triggered by different chains of events.
Aspects contributing to UPS

UPS is a clinically complex condition of indeterminate cause with a range of indi-
vidually varying symptoms and signs. It tends to occur in athletes during periods
of increased commitments, either in training or competition, and in individuals whose
daily practices produce an imbalance between physical activity and recovery.
Inadequate recovery may negatively affect adaptation and, therefore, levels of fit-
ness and/or health. Steinacker (1993) has cautioned that if high volumes of exercise
and training are undertaken (more than 1000 hours per year) even work at moder-
ate levels may be felt as an intensive effort.
Relatively low levels of physical fitness may also contribute to the development
of UPS. For the same workload, fitter athletes are working relatively more easily
than their unfit counterparts. Also, ‘individual’ activities (e.g. cycling, swimming
and dance) are more likely to induce UPS than team-events such as basketball and
volleyball. External stresses, personal relationships and financial difficulties may
further contribute to the development of the condition.
Symptoms
When feelings of constant fatigue and poor performance are simultaneously pres-
ent, other symptoms have to be considered. These are non-specific and may vary
from individual to individual. Symptomatology may include:
● excessive sweating;
● inability to recover optimally following intensive exercise;
● loss of desire and enthusiasm for exercise training (feelings of helplessness);
● breakdown of technique;
● poor concentration;
● loss of appetite and loss of body weight;
● disturbed sleep often with nightmares or vivid dreams;
● increased susceptibility to injuries.
Signs
As in the case of symptoms, there are no consistent signs on clinical examination or
laboratory tests associated with overtraining. However, the known signs could be
grouped according to those indicating acute UPS (lasting for up to 1 month) and
those related to chronic UPS (lasting for many weeks or months).
Acute UPS
Acute or short-term UPS is the result of an imbalance between exercise and recov-
ery over a period of just a few days or weeks. However, the effects of acute UPS
quickly disappear when the reasons for causing it are removed. Muscle damage
is perhaps the most common outcome indicating that the work volumes exceeded
the capabilities of the muscle in question. The most common signs include:
● increased normal resting heart rates by 5–10 beats per minute;
● increased resting blood pressure;
● raised resting lactic acid concentrations;
● decreased maximal lactic acid levels following intensive physical exercise;
● following specific exercise/training routines, heart rate return to resting levels
may take 2–3 times longer than normal;
● decreased ability by the body to utilize oxygen during maximal exercise;
● muscle damage.
Chronic UPS
Chronic or long-term UPS is the result of an imbalance between exercise and recov-
ery over a period of weeks or months. When the condition is fully developed, the
following signs may appear in addition to those mentioned above:
● menstrual irregularities, even cessation of menstruation;
● susceptibility to infections, especially of the skin and upper respiratory tract;
● increased rates of allergies and minor scratches may heal more slowly.
Management of UPS
The concept ‘no pain no gain’ should be played down by athletes as there is nor-
mally little gain to be made by working through fatigue, illness or injury. Research
has clearly demonstrated that periods of physical rest (or reduced activity) may be
beneficial to underperforming elite competitors (Koutedakis et al 1990). Once a case
of UPS has been diagnosed and dealt with, there is danger of relapse in about
3 months. During this period, athletes should never attempt to increase physical
loads by more than 5% per week.
PERIODIZATION
Definition and concepts

Periodization can be defined as the purposeful variation of a training programme over
time, so that the competitor will approach his/her optimal adaptive potential just prior
to an important event. It is based on the principles of multilateral development, spe-
cialization, variety and long-term planning. The first three are necessary for the opti-
mization of physiological factors, whereas long-term planning provides both the athlete
and the coach with time to gradually increase physical performance. In the simplest
form of periodization, competitors use a hard/easy model for daily workouts. In its
more advanced form, training is arranged into blocks of time, the magnitude of which
may range from days to weeks to months or even years. During each of these blocks,
a particular element of physical performance (e.g. physical fitness, technique etc.) is
highlighted. As a framework for structuring an athlete’s training, the practice of peri-
odization has much to offer. Although performance is allowed to decrease temporar-
ily (i.e. over-reaching), complete recovery is ensured between each training period to
avoid long-term performance decrements (i.e. UPS or overtraining).
Scientific research
Although the structural, physiological and metabolic characteristics of athletes have
been thoroughly studied over the years, the physiological mechanisms which sup-
port the efficiency of periodized training programmes remain unclear. Existing sci-
entific data have mainly focused on observations and comparisons of periodized
regimes with non-periodized training programmes.
The majority of such studies have been conducted on males and have used
strength and power training interventions over periods of 7–24 weeks. Specifically,
researchers have investigated the effects of systematic variation in training volume
and intensity in relation to linear programmes using a constant-sets-and-repetitions
approach. Results have demonstrated that both methods significantly increase
strength and power compared to pre-exercise levels. However, the effects were of a
greater magnitude in the groups that followed periodized programmes than their
counterparts engaging in linear training programmes. Even in relatively short train-
ing regimes, periodized programmes are able to elicit significantly greater adapta-
tions in selected performance indices than non-periodized (Fleck 1999).
The most plausible explanation for such results is the use of different types of
muscle fibres, neural activation and utilization of different energy pathways result-
ing from the variation of training intensity and duration. Human muscle is formed
of comparable proportions of slow- and fast-twitch muscle fibres within a person’s
body (McArdle et al 2001). The systematic variation of training duration, intensity
and type of exercise used in periodized programmes acts as a sufficient overload to
the targeted muscle fibre type and as a facilitator for the required recovery for the
other type of muscle fibres and the neurons which activate them (Kraemer et al
1996). Moreover, this variation results in a similar alteration in the utilized energy
source, which again operates as an overload or recovery drill for the energy sys-
tems. Another explanation for the supremacy of the periodized training approach
may be that, compared to controls, higher training loads have been reported by
groups practising these programmes, which eventually bring about significantly
greater adaptations and performance improvements (Stone et al 1999).
Types of periodization
Not all sports or athletes have the same competition calendar. For instance, several
sports require their competitors to participate in just one major competition every
year. The training plan that supports these needs is termed the ‘monocycle’
(Fig. 1.7A). A different planning approach is required for sports that need more than
one performance peak each year and typically those peaks are months apart. Training
programmes that incorporate two peaks in a year are termed ‘bi-cycle’ (Fig. 1.7B),
and consist of two monocycles in a single year with a short transition phase between
them. To achieve the required adaptations during bi-cycles, competitions have to be
more than 4 months apart. Levels of performance might be lower in one cycle, so
the most important competition of the calendar should take place in the other.
When competitors are required to participate in three competitions in the course
of a single year, a triple ‘tri-cycle’ periodization is adopted (Fig 1.7C). An unload-
ing phase is required following each peak for the athlete to regenerate for the fol-
lowing cycle. Models with more than three peaks within a year do not allow the
athlete to adapt properly.
PERIODIZATION PHASES
Preparation phase
This is the longest phase of the annual cycle. During this phase, selected endurance,
technical and tactical components should to be developed, in order to prepare the
athlete for the next phase. It usually contains three training periods, each lasting 4–8
weeks. In the first period, the training mode is general and the load varies from
medium to high aiming at a continuous development of performance. In the second
period, special training methods have to be applied and the load must be close to
the athlete’s personal best. The third period requires a clear shift from general to spe-
cial training, which closely resembles actual competition. The training methods are
strictly sport-specific, and the load is high, necessary for adaptation and further
progress in the next phase. At the end of each of the three training cycles, both coaches
and athletes should monitor progress through established laboratory or field-testing.
Figure 1.7 Types of periodization: monocycle (A), bi-cycle (B) and tri-cycle (C).
Competition phase
This phase is determined from the competition dates and can be either simple or
complex in nature. The former is usually divided into two periods; the first of these
periods is reserved for the development of desirable fitness levels, while in the sec-
ond, the acquired fitness has to be optimally maintained. The latter normally embraces
three periods; the first is for minor competition, the second is a transitional cycle for
regeneration, and the third is the main competitive cycle. Simple competition phases
last 2–3 months, while complex ones last longer.
Transition phase
This is a regeneration phase following a year’s hard training and competition, which
normally last 3–6 weeks. It is characterized by:
● decreases in training loads;
● lack of competition;
● maintenance of the acquired fitness levels;
● ‘recharging of the energy batteries’.
COMPONENTS OF PERIODIZATION – TRAINING CYCLES

Training volumes and intensities are inversely varied by cycle; increases in training
volumes are accompanied by decreases in intensities and vice versa. However, the
profile of each cycle depends on the competition level and on the specific demands
of a given sporting event. In rowing, for instance, sustained distance and aerobic
interval training in the boat make up most of the work, supplemented by some
medium- to high-resistance and medium- to low-volume weight training in the gym.
As rowers progress toward competition, training volumes are decreased and inten-
sities increased. There is no evidence that periodization should be different for male
and female competitors.
The longest blocks of training-time are called macrocycles; these could last from
2 months to a whole year. Smaller blocks are called mesocycles, usually 6–8 weeks’
duration, and are typically incorporated within each macrocycle. The smallest train-
ing cycles, microcycles, usually last 1 week and constitute the mesocycles. In this
chapter, the microcycle will be discussed first.
Microcycle
A microcycle is a group of training units and it normally refers to a weekly train-
ing programme (Monday to Sunday). Each microcycle is constructed according to
the objective of the training and can be repeated more than once in a period, for the
required training elements to be improved and performance to be enhanced. There
are several aspects to be considered in designing a microcycle (Ozolin 1971):
● perfect technique at submaximal and maximal intensity exercise;
● develop speed of short duration;
● develop anaerobic endurance;
● improve strength;
● develop muscular endurance at medium and low loads;
● develop muscular endurance with high and maximum intensity;
● develop cardiorespiratory endurance with maximum intensity;
● develop cardiorespiratory endurance with medium intensity.
Structuring a microcycle
Structuring a microcycle requires two or three repeated training units of similar
objectives and content. This repetitive nature is crucial for learning a technical ele-
ment or developing a motor ability. This is also important for general endurance
and strength purposes during the early phases of periodization, which require a
training stimulus every second day. Approaching competition, specificity in train-
ing units takes place, with maximal specific endurance and strength development
requiring two, and two to three training sessions per week, respectively.
Regeneration to avoid fatigue is the most important aspect of training. Therefore,
after a strenuous training session, regeneration units have to be applied. The reason
is that the athlete has to restore the energy lost, recuperate, and be physiological
ready for the next session.
When designing a microcycle, the coach has to identify the objectives (i.e. the tar-
geted physical component), the exact level of intensity and has to decide on the spe-
cific training methods that have to be applied. Each microcycle has to start with
low- (50–70% of maximum) to moderate-intensity (70–90% of maximum) training
units and to progress with subsequent intensity increases ranging from 90 to 100%
of maximum. According to the period of the athlete’s training programme and sport,
the coach has to decide whether the athlete has to perform one or two training ses-
sions per day. Based on low-intensity training, application of regeneration micro-
cycles has to be considered in order to eliminate fatigue and restore energy supplies.
However, a decrease in training demand facilitates supercompensation before com-
petition and sets the body up for good performance (Bompa 1999). There are three
models for the configuration of loading during the week (Fig. 1.8):
1. Low-load microcycle with only one maximum-load training session.
2. Medium-load microcycle with two maximum-load training units.
3. High-load microcycle with two maximum-load training units and a demanding
exercise training programme between the two maximum-load units.
High intensity
Medium intensity 3
Low intensity 1 2
Recovery
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Figure 1.8 Three models for the exercise loading dynamics during training microcycles.
In general, variations in microcycle designing vary because the load in training is

sport- and individual-specific. Nevertheless, based on training principles, the peak
should be planned during one of the three middle days of the week. Medium- and
high-load intensity or energy-demanding microcycles should be placed during the
two ends of the week, always followed by one or two regeneration training sessions.
To ensure optimal training quality and quantity for a given microcycle, the fol-
lowing steps should be adopted. First, each day’s intensity has to be planned for the
whole week, to enable the athlete alternate intensities, energy systems, and the type
of work. Secondly, the technical, tactical, or physical elements of training have to be
separated, and decide which of them should be present at any given time. Finally, no
more than two types of work, which strain the same energy system, should be applied.
Mesocycle
Mesocycles are periods of similar objectives, content, training volumes and intensities.
However, the last mesocycle before a key event normally incorporates two parts. In
the first, the emphasis is on maximal intensity work specific to the endurance, strength
and/or power requirements of the particular sport. The second part is reserved for the
taper. This is thought to be a means of optimizing performance by allowing adequate
recovery from intensive training prior to a significant competition. Evidence indicates
that up to a 50% reduction of the usual training volume, in conjunction with short but
intense workouts, provides the basis for optimal results (Houmard & Jones 1994).
Macrocycle
A macrocycle consists of two or three mesocycles which are required to meet spe-
cific objective(s) and/or a desirable level of performance, although some differences
exist from sport to sport. Careful consideration must be given in macrocycles longer
than 8 weeks because the athletes’ motivation might be reduced, a phenomenon that
might compromise the adaptation processes.
Macrocycles that form the preparatory phase are usually the longest and their
objectives are mainly dependent on the technical, tactical or physiological elements
that need to be developed or perfected. Conversely, the competitive phase requires
shorter macrocycles which end with the competition itself. Planners have to decide
on the most important competition and prepare the athlete accordingly, giving less
but enough attention to other athletic engagements. In general, in designing a macro-
cycle the following should be considered:
● objectives set for each microcycle and mesocycle;
● percentages of general, special and competition-specific training;
● number of training sessions according to the individual’s available time;
● number of repetitions, sets, intervals, intensity and load-progression;
● degree of flexibility in changing the training methods when necessary.
PERIODIZATION OF SELECTED PHYSICAL FITNESS ELEMENTS
Aerobic endurance
Athletes exhibiting higher levels of aerobic endurance (or cardiorespiratory fitness)
can exercise longer before fatigue develops and can continue exercising for more time
in a state of fatigue than those with lower levels of endurance. Maximum oxygen
•
uptake (VO2max) is a major indicator of endurance as it represents the maximum
ability of an athlete to utilize oxygen. Improved aerobic endurance requires enhanced
oxidative potential of muscle fibres, which is founded in an increased number and
volume of mitochondria (increased mitochondrial density) and elevated activity of
oxidative enzymes. Recovery rates are also highly related to endurance performance.
Faster recovery allows the athlete to decrease rest intervals in and between training
sessions, and to increase the overall training load.
Aerobic training brings about adaptations that influence the processes of energy
transportation and use by the working muscle. Major cell and anatomical adapta-
tions include increases in the size and number of mitochondria, density of capil-
laries, haemoglobin concentration,
•
and left ventricular enlargement. These directly
contribute to increments in VO2max, providing the foundation for improved phys-
ical performance. However, such increments have to take place in stages (or phases)
during which the foundations for further improvements are established and the
special needs of each sport are addressed. For example, on the basis of a single
periodization model (monocycle), the athlete develops endurance in three phases;
foundation of endurance, introduction of specific endurance, and specific endurance
(see Ch. 4).
PERIODIZATION FOR DEVELOPING ENDURANCE
Foundation of endurance
The athlete builds or maintains the basic fitness levels required for further progres-
sion, improves general endurance and copes with fatigue. This phase lasts from 6 weeks
up to more than 3 months depending on the desired level of adaptation, and takes
place during the transition and preparatory phases of the annual plan (Fig. 1.9).
The most suitable training mode is that of steady-state exercise with moderate
intensity for 30 minutes to more than 2 hours. As this phase progresses, adjustments
in the training load must be made by primarily increasing volume and, to a lesser
Month 1 2 3 4 5 6 7 8 9 10 11 12
Max
Duration
Intensity
Min Performance
Introduction of
Foundation of endurance Specific endurance
specific endurance
General preparation Specific preparation Pre-competitive Competitive Transition
Figure 1.9 Duration, intensity and performance curves during each phase, for the
development of endurance.
extent, intensity. This exercise mode does not place high levels of stress on the mus-
culoskeletal or the physiological systems and the athlete trains below his/her lac-
tate threshold (Pate & Branch 1992). Nevertheless, it does induce glycogen depletion
in the muscle, increases lipid metabolism, and forces the body to maintain or enhance
the acquired functional adaptations within the heart and muscle.
Introduction of specific endurance

In this phase (Fig. 1.9), training aims to enhance the athlete’s physiological adapta-
tions and introduce aspects of sport-specific activities. Aerobic endurance is still the
main component of training, although several elements of anaerobic activity are
introduced into the programme. Depending on the complexity of the activity, and
the adaptation rate of the athlete, this phase might last 2–4 months.
At the beginning of this phase, duration remains elevated while intensity increases
progressively. After the desirable endurance levels have been reached, it is recom-
mended that sport-specific activities during training be introduced. At this time,
duration gradually decreases to eventually reach moderate levels, while the inten-
sity of exercise is in the range of the athlete’s lactate threshold. This should be applied
towards the end of that period as it stresses the body to a considerable extent and
may lead to negative effects if the underlying adaptations have not been achieved.
Specific endurance
In this phase, the maximum potential performance of the athlete has to be addressed.
The use of activities above the anaerobic threshold is introduced while intensity
reaches the highest possible level with a concomitant decrease in duration (Fig. 1.9).
Nevertheless, the duration curve remains generally higher than that of intensity
to ensure that training focuses on the dominant energy system for performance
(Bompa 1999). This phase lasts approximately 3 months and coincides with the pre-
competitive and competitive phases of the annual plan.
The most effective training mode is the intermittent interval training, which results
in increased accumulation of lactic acid. Short rest intervals of up to 2 minutes are
provided between the activities. This type of training allows the athlete to perform
exercise of an increased total duration at an intensity that could not be tolerated
for a prolonged period. At the end of this phase, and for the last week before the
competition, both intensity and duration of training decrease so that the athlete
supercompensates before the competition.
STRENGTH
Strength is among the most important components for almost every sport. Strength
training aims to increase the athlete’s competition performance by: (a) enhancing the
neural component of muscle contraction, and (b) augmenting the muscle-fibre size
(Fig. 1.10). The latter has been based on the hypothesis that exercise training causes
an accumulation of metabolites which specifically induce the adaptive synthesis of
structural and enzyme proteins resulting in larger and more efficient muscle (Viru &
Viru 2001). Consequently, muscle hypertrophy is the result of a cumulative effect of
several training sessions arranged in particular training cycles.
Resistance training induces hypertrophy in muscle fibres of all types, particularly
those designated as fast-twitch or type II fibres, the area occupied by which may
increase by as much as 90%, mainly due to increased rates of protein synthesis and
Strength
Adaptations
of strength Neural adaptation
Hypertrophy
3 weeks 6 weeks 1 year 2 years
Figure 1.10 Strength training adaptations.
the associated augmentation in myofibrilar size (see Ch. 7). However, speed or power
training results in a selective hypertrophy of fast-twitch glycolytic (type IIb) or fast-
twitch oxidative (type IIa) fibres (see Ch. 6). It should be stressed here that stretch-
ing exercise can increase protein synthesis in the exercised muscle through a chain
of events which involve satellite cell multiplication.
Periodization for developing strength

Following the principles of periodization, a strength-training programme requires
the arrangement of the annual plan into different phases, each having specific goals
and objectives (Fig. 1.11). The first phase is reserved for neural adaptations; strength
training should involve most muscle groups to prepare the athlete for the next phases
and for future increases in strength load. A very important aspect during this first
phase is the strengthening of the antagonist muscles, which will help to balance
the musculature surrounding joints. Its duration depends on the athlete’s strength-
training background and it is sport-specific. For instance, in young athletes this phase
lasts 8–10 weeks, whereas for athletes involved in strength-dependent sports it takes
3–5 weeks (Kraemer 1998).
The neural-adaptation phase is followed by the maximum strength training phase,
which aims at developing the highest level of strength. This phase lasts 1–3 months
depending on the sport’s requirements and athlete’s needs. Exercises are at intensities
Preparation Competition Transition
General Specific Pre-competition Main competition Transition

Strength training training training training training
training
Strength
Anatomical Maximum
endurance Maintenance Active rest
adaptations strength
& power
Figure 1.11 Periodization of strength training: goals and objectives.

above 75% of maximum; this appears to be the most effective loading as it brings
about the larger accumulation of non-protein nitrogen in the blood compared to lower
exercise intensities.
This is followed by the ‘conversion phase’ (or third phase) that aims to convert
the benefits gained during the previous phase into sport-specific strength (i.e.
strength endurance, or power), and which normally lasts 4–8 weeks. The fourth
phase is for maintenance, as the athlete approaches the competition. Strength train-
ing at this stage enters a very sport-specific phase which is short and intensive, and
which must not generally exceed 45 minutes to 1 hour. The maintenance phase has
to end 1 week prior to competition.
The last phase is for an ‘active rest’ characterized by a considerable reduction in
the training intensity and volume. For the elite athlete, this ‘rest’ lasts between 4 and
6 weeks, which can be extended up to 10 weeks in competitors of lower calibre.
Ideally, strength training should be part of the athlete’s plan to excel in every
phase of the yearly plan. However, given that muscle utilizes glycogen as its main
fuel, strength training has to be conducted during days on which the total energy
demands are kept low. Following a demanding strength-training session, glycogen
stores can be restored within 24 hours. Additional intensive exercise, along with
strength-training, may extend glycogen restoration by up to 48 hours. To circumvent
these difficulties, strength training microcycles should be arranged according to
whether the aims are for low, medium or high training loads (Fig. 1.12). It should be
noted here that the weekly frequency of strength sessions is higher during the prepara-
tory (four or five sessions) compared to competition (two or three sessions) period.
Load Low load microcycle Medium load microcycle High load microcycle
High
Medium
Low
Recovery
1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
Days Days Days
Figure 1.12 Low-, medium- and high-load microcycles.
KEY POINTS
1. The human body responds to exercise-stress in three stages, i.e. shock, resistance
and exhaustion or fatigue. Exercise training with the use of periodization proce-
dures stresses the body’s systems and factions to adapt at a higher level without
causing prolonged fatigue. Thus, periodization is the purposeful variation of a
training programme over time, so that the competitor will approach his/her opti-
mal adaptive potential just prior to an important event.
2. Not all sports or athletes have the same competition calendar. For instance, sev-
eral sports require their competitors to participate in just one major competition
every year. Training plans that support these needs are different from those serv-
ing more than one performance peak each year. An unloading phase is required
following each peak for the athlete to regenerate and to be ready for the follow-
ing cycle. Models with more than three peaks within a year do not allow the
athlete to adapt properly.
3. Using the principles of periodization, each annual training cycle normally con-
sists of three phases (preparation, competition and transition) with different aims
and training context.
4. Based on time-lengths, annual training cycles can also be divided into smaller
sections. The longest section (macrocycle) could last from 2 months to a whole
year. Smaller sections (mesocycles) usually are 6–8 weeks long. The smallest train-
ing cycle (microcycle) usually lasts for just 1 week.
5. Periodization of aerobic power and muscular strength involve incremental work
in stages (or phases) during which the foundations for further improvements are
established and the special needs of each sport are addressed.
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Ozolin NG 1971 Athlete’s training system for competition. Phyzkultura I sports, Moscow
Pate RR, Branch JD 1992 Training for endurance sport. Medicine and Science in Sports
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Steinacker JM 1993 Physiological aspects of training in rowing. International Journal of

Sports Medicine 14:3–10
Stone MH, O’Bryant HS, Schilling BK et al 1999 Periodization: effects of manipulating
volume and intensity. Journal of Strength and Conditioning 21:54–60
Viru A, Viru M 2001 Biochemical monitoring of sport training. Human Kinetics,
Champaign IL
Further reading
•
Astrand PO, Rodahl K 2003 Textbook of work physiology, 4th edn. Human Kinetics,
Champaign IL
Bompa T 1999 Periodization. Theory and methodology of training. Human Kinetics,
Champaign IL
Dick FW 2002 Sports training principles, 4th edn. A & C Black, UK
23
Chapter 2
Training specificity
Richard Godfrey and Gregory Whyte
CHAPTER CONTENTS
Learning objectives: 23 Specificity in the physiological
Introduction 23 assessment of athletes 35
Specificity 25 Identifying the physiological factors
Biochemistry and molecular exercise underpinning performance 35
physiology 25 Laboratory-based testing 35
Training for strength and power 26 Designing a laboratory test for an elite
Strength 26 distance runner 37
•
Local muscular endurance 28 Derivation of VO2max and fractional
Power 28 utilization 38
Training for speed 29 Derivation of economy 38
Derivation of lactate threshold 38
Training for endurance
Field-based testing 40
performance 30
Cardiopulmonary endurance 30 Conclusion 41
Key points 41
Specificity and triathlon 30
References 41
Cross-training 31
Further reading 43
Circuit training 33
Training for flexibility 33
1. Understands the concept of specificity.
2. Appreciates the physiological adaptations associated with specific types of training.
3. Appreciates the meaning of specificity within the context of some selected sports.
4. Understands the role of cross-training in athletic performance.
5. Appreciates the importance, practical applications and limitations of specificity
in the field and laboratory based testing of athletes.
INTRODUCTION
Within the context of sports performance there are a number of basic principles
which, when appropriately applied, can aid optimal adaptation. Collectively these
are known as the ‘training principles’ and they include: individuality, reversibil-
ity, progression, overload (progressive overload), periodization and specificity.
Chapter 1 examined the principles of progressive overload, reversibility and period-
ization. It is the aim of this chapter to focus on the principle of specificity with ref-
erence to individuality of training prescription, and its relationship to the other key
principles of training.
Training specificity is encapsulated by the acronym ‘SAID’ – specific adaptations
to imposed demands – and is defined as:
‘A basic training principle which states that in order to improve a particular
component of physical fitness, a person must emphasise that component in training.
A training programme must stress the physiological systems used to perform a
particular activity in order to achieve specific training adaptations’ (Kent 1998,
p 402).
In order to optimally stress the physiological systems associated with perform-
ance, three components of specificity exist: (i) skill specificity, (ii) muscle group speci-
ficity, and (iii) energy system specificity. Often athletes and coaches interpret the
definition of specificity as the requirement to replicate performance in terms of the
mode of exercise and pace in all training sessions. Indeed, there are numerous exam-
ples of coaches and athletes who think that the only way to train is at race pace as
that is the pace they must specifically learn to cope with. One example of the folly
of this is the marathon runner who only ever runs at race pace. The athlete may be
unaware that the best training pace to improve the body’s ability to minimize deple-
tion of carbohydrate stores and lactate production, and hence reduce the onset of
fatigue, is to work at a pace associated with ‘lactate threshold’, a pace that is gen-
erally faster than marathon pace (see Ch. 4). Indeed, there are often a number of
physiological factors underpinning performance that must all be addressed if per-
formance is to be optimized. Thus, specificity is best addressed when considering
those stimuli leading to adaptations that allow the individual to best cope with the
physiological demands of the ‘target’ activity. Accordingly, there is no single inten-
sity, duration or frequency to prepare the individual for all of the physiological
demands of a given sport or event. Hence, training will always require a range of
intensities and durations. The elements of training prescription are specific to the
individual and his/her current level of conditioning. Further, the role of supple-
mental training, in the form of cross training, may enhance the adaptive response
and avoid the potential for over use injuries and possible overtraining resulting in
underperformance (see Ch. 9).
Knowledge of the underpinning physiology associated with training adaptation
is crucial to an understanding of specificity. This underpinning physiology knowl-
edge will also assist in understanding the secondary and even tertiary adaptations
that are possible as a result of a training stimulus. In this chapter specificity of
training will be examined by first selecting a number of individual attributes
(strength and power, flexibility, speed, endurance). Second, the effects of some
selected, commonly applied, training sessions on tissues and on physiological sys-
tems will be explored. Third, a few individual sports will be examined. In this way
there will first be a reductionist view of training specificity, leading through to the
effects of training type and ending with a reintegration of information such that a
whole systems/whole person perspective is achieved. This will allow greater ease
of application to ‘real-world’ performance. Finally, the chapter will end with a brief
examination of the importance of specificity when testing athletes in the field and
laboratory.
Training specificity 25
Summary box 2.1
Specificity is best addressed when considering those stimuli that result in adaptations
allowing the individual to best cope with the physiological demands of the ‘target’
activity. Specificity addresses the three key areas of skill, muscle group and energy
system. There is no single intensity, duration or frequency to prepare the individual for
all of the physiological demands of a given sport or event. Training, therefore, requires a
range of intensities, durations and frequencies to optimize training adaptation and,
therefore, performance.
SPECIFICITY
A specific stimulus results in specific adaptation. If the stimulus is reduced or
removed reversibility or detraining begins. In every biological system there is a ten-
dency to revert to the lowest ‘energy state’ for that individual. This is largely pre-
programmed; in other words, it is dependent on heredity and such a state exists
as a result of evolution. In our ancient past humans evolved as hunter gatherers
with developed systems that protected the organism against times when food was
in short supply. A good example of this is the muscle growth inhibitor myostatin.
Muscle is extremely energy costly and so it makes sense that there should be a
limit to the development of muscle beyond that required for normal function. The
genotype of the organism is the result of genetic heritability that is further influ-
enced by environmental pressures. The result is ‘phenotype’: the function and/or
appearance. Remove the environmental pressure and the organism will revert to
•
‘type’ (i.e. genotype). Let’s take an example. Aerobic power (VO2max) has a large
genetic component but it can also be influenced by environmental factors (e.g. train-
ing). Hence your genetic ‘pre-programming’ may mean that at 25 years of age, with-
•
out any training, your VO2max might be 60 mL.kg−1.min−1. With training this might
improve by 20% to 72 mL.kg−1.min−1. Remove training and you revert to your geno-
type of 60 mL.kg−1.min−1. Accordingly, to maintain a given trained state requires
regular application of the stimulus that created it. Research has demonstrated that
detraining can begin between 2 and 6 weeks after cessation of the exercise stimu-
lus (Mujika & Padilla 2000). To prevent detraining an appropriate regular stimulus
is required. Clearly, it is not possible to achieve optimal conditioning of every phys-
iological parameter or system at once. Hence a cycling of stimuli is required and
so specificity, and preventing detraining, forms the basis for the rationale behind
the development of periodization (see Ch. 1).
BIOCHEMISTRY AND MOLECULAR EXERCISE PHYSIOLOGY

There is a growing trend throughout sport and exercise science towards examina-
tion and elucidation of the molecular processes that operate as a result of the exer-
cise stimulus. This is a reflection of the same trend operating throughout the life
sciences. Although this has been ongoing for almost 15 years, the early completion
of the human genome project in 2003 has accelerated interest and research into
molecular, cell and genetic biology. Much of the research in this field in exercise sci-
ence has focused on two major areas: strength and endurance; however, research
into other areas is expanding. In broad terms, the general principle is that exercise
represents a broad class of differing stimuli each of which initiates adaptation sig-
nalling and gene regulation. The nature of that signalling, the gene regulated, the
subsequent cascade of events, and ongoing modification of an initiated cascade, are
all entirely dependent on a specific stimulus. So, again, specificity plays a key role.
Exercise can activate signal transduction pathways in a number of specific ways
through growth factors and hormones binding to membrane and nuclear receptors (as
discussed below), through changes such as a flux in the concentration of Ca2+, mechan-
ical stretch or tension, energy status, hypoxia and cell damage. Any one of these exam-
ples (from a vast array of possible stimuli) will each, in isolation or in combination,
initiate a specific response or pathway activation. As one pathway is initiated, cross-
talk between transduction proteins can occur, mainly, by covalent phosphorylation. As
the final step in the pathway, a nuclear transduction signal is activated and translo-
cated into the cell’s nucleus. This can then act as a transcription factor (to aid the copy-
ing of a transcript of the relevant portion of the cell’s DNA) or activate existing
nucleus-dwelling transcription factors. Depending on the tissue and the nature of
the stimulus (mode, duration, intensity) exercise stimulates: (i) expression of growth
factors, (ii) synthesis of contractile proteins, enzymes and other functional proteins,
(iii) satellite cell proliferation and donation of nuclei to skeletal muscle fibres,
(iv) mitochondrial biogenesis, and (v) apoptosis (i.e. programmed cell death) (Wackerhage
& Woods 2002).
Summary box 2.2
Specificity is key at the molecular level. Depending on the tissue and the nature of the
stimulus (mode, duration, intensity) exercise stimulates expression of (i) growth factors,
(ii) contractile proteins, enzymes and other functional proteins, (iii) satellite cell
proliferation and donation of nuclei to skeletal muscle fibres, (iv) mitochondrial
biogenesis, and (v) apoptosis (programmed cell death).
TRAINING FOR STRENGTH AND POWER
Strength
Improvements in strength occur initially as a result of neuromuscular adaptations
associated with an improved recruitment of motor units (Sale 1988). Although
changes in muscle cross-sectional area also begin in the initial stages of a strength-
specific training programme this only begins to contribute to strength as hypertro-
phy becomes more observable. There is a direct relationship between muscle
cross-sectional area and the force it is capable of generating. Fast-twitch (type II) fibres
have larger cross-sectional area and generate more force than slow-twitch (type I)
fibres. Hypertrophy is dependent on increased myofibrillar protein synthesis and
translocation of nuclei from satellite cells. These two parameters are regulated by a
number of factors. For many years the main explanation for muscle hypertrophy
was believed to be encapsulated in the ‘somatomedin hypothesis’ in which, origi-
nally, somatic growth was believed to be controlled by growth hormone (hGH) and
mediated by circulating insulin-like growth factor (IGF-1) of hepatic origin.
A number of studies over the last 10–15 years have, however, demonstrated a
wider distribution of IGF-1 and it is now accepted that many tissues have their own
IGFs which effect their actions by autocrine or paracrine means. (‘Autocrine’ means
that the tissue releases the substance which then acts on the tissue of origin; ‘paracrine’
refers to a substance which acts close to the point of secretion – as opposed to
‘endocrine’, which refers to a substance released into the general circulation and which
has effects on tissues distal to the point of secretion.) Indeed, many specific tissue
IGFs are increasingly being renamed; in particular, there is a suggestion that muscle-
specific IGF should be renamed MGF (mechano growth factor) (Yang et al 1996). This
term also recognizes that this growth factor can be released in response to muscle
contraction per se (in a similar way that muscle contraction per se can facilitate the
peripheral uptake of glucose in the absence of insulin).
Recent evidence suggests that growth hormone (GH) has a more direct role in
increases in muscle strength and hypertrophy than previously believed. It is already
widely accepted that exercise, particularly high-intensity resistance exercise, stimu-
lates GH secretion. As a result, increases in muscle strength and size are likely to
be the combined effect of the somatomedin hypothesis coupled with the direct action
of GH on myostatin (Liu et al 2003). The normal function of myostatin is to ‘switch
off’ muscle growth and so mutations of the gene for myostatin generally result in
individuals that have greater muscle hypertrophy and, coincidently, a lower fat mass.
Because heavy resistance exercise tends to target the fast-twitch motor units it is
primarily these that undergo major adaptation with increases in myofibrillar protein
synthesis. Strength training specifically targets fast-twitch fibres, leading to an increased
cross-sectional area further differentiating force production and cross-sectional area
between slow- and fast-twitch motor units. While fast-twitch motor units generate
much more force than slow-twitch motor units, they also fatigue more rapidly.
One non-specific and perhaps surprising benefit of training for strength is an
attendant increase in local muscular endurance. Improved muscular endurance is
linked to an increased strength of individual motor units and so when working with
a standardized, sub-maximal load, once strength is improved through appropriate
training, the load represents a lesser stress on the muscle. This reduced stress is
primarily associated with the need to recruit fewer motor units for the same sub-
maximal load and hence as working motor units become fatigued other motor units
can be brought into play.
Specificity exists in a number of areas when considering resistance training; strength
will, in general, only be increased in those muscle groups which are activated dur-
ing the exercise. Movement pattern is also important because, particularly in the ini-
tial stages of strength development, adaptation is largely via neural activation (see
Ch. 7). Neural feedback from joint proprioceptors also ensures the joint angles at
which training occurs will specifically relate to strength improvements at those same
joint angles. It is therefore important, where safety and injury prevention allow, that
resistance training reflects the specific range of motion of the target activity.
Summary box 2.3
Originally the mechanism for hypertrophy was described solely by the somatomedin
hypothesis. Somatic growth was believed to be stimulated by the action of growth
hormone (GH) and mediated by circulating IGF-1 of hepatic origin. It is now known,
however, that local IGF-1 (renamed mechano-growth factor, MGF) is probably a more
important mediator of muscle growth. In addition, MGF can be stimulated by muscle
contraction per se. A more direct role for GH is also recognized in muscle hypertrophy in
targeting and inhibiting myostatin, the factor that normally inhibits muscle growth.
Local muscular endurance

‘Local muscular endurance is the degree to which specific muscle groups can con-
tinue contracting against a given load in a given period of time or for a given num-
ber of repetitions. It is determined by the type of muscular contraction, the speed
of contraction, the cadence of repetitions, and the magnitude of the resistance. The
limiting factors to muscular endurance exist within the muscle groups being exer-
cised and their neuromuscular control, and are not associated with cardiorespira-
tory/cardiovascular factors’ (Jenkins 1997, p 154).
Local muscular endurance is usually a mix of both aerobic and anaerobic
endurance and once the demands of the sport or activity are identified training
should be structured to address these demands.
Training to improve local muscular endurance generally requires the imposition
of fatigue, but in a controlled manner, as fatigue often acts as a powerful stimulus
to adaptation. Changes in energy substrates (fuels) within cells act as a gauge in
this instance and increasingly the enzyme adenosine monophosphate kinase (AMPK)
is recognized as an energy sensor initiating cell signalling that effects adaptation.
Fatigue can be better controlled by using interval training where intervals of work
are separated by periods of active or passive recovery. Circuit training is tradition-
ally a more general way of addressing improvements in local muscular endurance,
which also has some benefits for cardiovascular conditioning, and will be covered
in detail later in the chapter.
It is clear that strength training results in specific adaptations of fast-twitch motor
units that are joint angle specific. What is also apparent, however, is that strength
training can lead to non-specific adaptation of local muscular endurance leading to
a broader role for strength training than may be immediately obvious.
Power
In the context of muscle, power can be described as the force produced per unit
time and so is largely the result of entraining the motor unit to recruit muscle fibres
rapidly. Accordingly, this is largely a neuromuscular phenomenon where strength is
a prerequisite and speed is an important cofactor. Power cannot be considered with-
out reference to the interaction between tendon and muscle (i.e. the tendon–muscle
complex) and the specific training which can optimize this interaction to allow max-
imal power generation. The relationship between muscle and tendon can be com-
plex but in many movements can be described as muscle causing the tendon to
stretch (storage of potential energy) prior to recoil of the tendon (kinetic
energy/energy return). Designing strength training programmes therefore requires
an understanding of the movement pattern and how muscle and tendon behave
during that movement. At certain times of year it is important to improve muscle
strength and power and at other times improvement of tendon elasticity is the aim.
Hence periodization is again demonstrated to be intimately linked to specificity, in
this case in attempting to optimize force generation (see Ch. 6).
Specific training focusing on power has led to the development of specialist train-
ing techniques involving explosive movements in which adaptation relies on the
rapid switch from an eccentric (muscle lengthening during contraction) to a con-
centric contraction (muscle shortening during contraction) i.e. plyometrics. Typically,
this type of training comprises the use of hopping, bounding and jumping per-
formed with maximal effort. The emphasis is on very short foot–ground contact
times when training explosive power in the legs for example. Exercises can also be
used to develop explosive power in the upper body in a similar way. For legs another
means of improving explosive power is by using drop jumping from a height of
1.10 m as demonstrated by Verhoshansky (1986). In drop jumping the individual
drops from a platform 1.10 m high and, immediately following landing, jumps up
as high as possible. In general, plyometric training has been suggested as being par-
ticularly useful in sports demanding high anaerobic power or explosive movements.
This includes sports such as basketball, volleyball, weightlifting and sprinting or
athletic events requiring jumping or throwing (see Ch. 6). In theory the benefits in
such training are derived from adaptations in the central nervous system (CNS) and
the muscle. The extreme transient stretch may facilitate neural adaptation while the
extremely high tension, derived as the combined result of several times body weight
landing and muscle contracting to overcome this and lift the body off the ground,
results in muscle adaptation. Counter-intuitive to this, as it provides an argument
which does not appear to support specificity, is the recent use of plyometric train-
ing in middle distance running, which is discussed further below.
The highly explosive nature of plyometric activity is in stark contrast to rhythmic
aerobic activity; however, research evidence suggests plyometrics training may be of
value in middle distance running. Paavolainen et al (1999) examined the effect of
substituting 32% of training volume for explosive strength training in the training
programmes of elite cross-country runners and demonstrated a significant improve-
ment in 5 km running time and in running economy. Hence, again we can see that
the issue of specificity is less straightforward than might be, at first, supposed.
Training for speed

In terms of whole body displacement (movement from one place to another) speed
is the distance travelled per unit time. Speed, however, can also refer to the ability
to move, not just the whole body but body segments fast. With respect to specificity,
training for speed requires attempts to move as fast as possible. There is however,
a proviso to this and that is where accuracy of movement is also required. Fitts law
states that accuracy is related to the inverse of speed. In other words there is a trade-
off between speed and accuracy. This is particularly important in racket and com-
bat sports, especially when learning a new skill, but becomes less important once
the skill is overlearned. Accordingly, new skills are practiced at slow speeds and
speed built up gradually as the skill becomes ‘engrained’.
Speed drills generally involve short duration maximal speed efforts with long-
duration recoveries so that fatigue does not interfere with speed development. Those
individuals with a higher genetic predisposition for fast-twitch muscle fibres will
have faster speed and speed of movement but everyone can improve speed with
specific training. In general, increased force of muscle contraction is required for
greater speed. This requires more myofibrillar protein and hence, in general, increases
in speed are accompanied by muscle hypertrophy as fast-twitch fibres are targeted:
those with inherently larger cross-sectional area (CSA). Type IIa fibres become more
like type IIx fibres by increasing their glycolytic capacity, and type IIx fibres become
more glycolytic. Thus, both are more able to produce power rapidly. With respect
to rapid limb movement there are a number of techniques that can be employed.
Simply attempting to move the limb fast, using the desired movement pattern, can
improve speed. The use of heavy or weighted objects used in the sports-specific
movement are often used to improve the amount of energy required of the muscle.
Thus, it is common to use weighted balls in ball games, weighted rackets in racket
sports and weighted boxing gloves for boxing training. All of these will improve
the muscle’s ability to generate force. However, after a few minutes of use if these
are substituted for the non-weighted (lighter) implements, and the individual asked
to move the limb as fast as possible, training speed is improved. Much of this
improvement is a result of improved kinesthetics as propriceptor feedback is facil-
itated and the sensation of speed is enhanced associated with a reduction of the nor-
mal process of neuromuscular inhibition. Carrying out such drills regularly can result
in a chronic improvement in limb speed. Care is warranted to focus training on
sports-specific movements as adaptations are skill- and joint-angle-specific.
TRAINING FOR ENDURANCE PERFORMANCE
Cardiopulmonary endurance
Cardiopulmonary, cardiovascular or cardiorespiratory endurance are the terms used,
often interchangeably, when referring to the endurance developed in the cardiovas-
cular and respiratory systems, a necessity for improving endurance in whole-body
rhythmic exercise. This, for example, includes running, cycling, swimming, rowing
and cross-country skiing.
In whole-body activity, improvements in endurance can reflect changes in aero-
bic power, lactate threshold, lactate production and clearance, lactate tolerance,
acid–base balance in muscle and systemically, fractional utilization, muscle temper-
ature, human stress proteins, mitochondria, structural proteins, globular ‘enzymatic’
proteins, gene activation, trainability (genetic factors) and so on.
Summary box 2.4
Endurance involves both local muscular endurance and ‘whole body endurance’ or
cardiopulmonary endurance. For improving local muscular endurance, training centres
around adaptations which will limit future fatigue of specific muscle groups. This
generally involves exercises using high numbers of repetitions and low loads. For
improved cardiopulmonary endurance, whole-body rhythmic exercise utilizing large
muscle groups for periods of 30–90 minutes is generally required. In many sports with a
high endurance requirement specific physiological prerequisites and determinants can be
•
identified. In general, these include VO2max, fractional utilization, lactate threshold (LT),
oxygen and movement economy and power or speed at LT and at maximal intensity. The
relative importance of each of these depends on the intensity and duration of
competition. Hence the fraction of a training programme dedicated to each should be
specific to the demands of the activity and the current conditioned state of the athlete.
SPECIFICITY AND TRIATHLON

Triathlon is comprised of three events completed back to back and continuously.
These are swimming, cycling and running, usually performed in that order. The
main distances are Ironman distance (swim 3 km, cycle 180 km and run 42 km),
Olympic distance (swim 1500 m, cycle 40 km, run 10 km) and sprint distances which
can vary considerably (one example is swim 600 m, cycle 25 km, run 5 km). The
main elite distances tend to be those of Ironman and Olympic distance, with sprint
distances largely contested by recreational or club-level triathletes. Physiologically
triathlon provides a very good example of the importance of specificity with respect
to the level of conditioning found in each discipline. The rapid change from one
discipline to another, i.e. from swimming to cycling and cycling to running, is known
as transition. In recognition of the physiological impact of transition it has often
been referred to as the ‘fourth discipline’. With this in mind many triathletes under-
take ‘brick’ sessions involving the combination of swimming and cycling and/or
cycling and running in a single session. In general, most triathletes practice and train
for the transition from cycling to running. Relatively few, however, train the transi-
tion from swimming to cycling because generally it is quite impractical to do so.
The change from supine, predominantly upper body exercise to upright, predomi-
nantly lower body exercise, together with the removal of hydrostatic pressure asso-
ciated with water submersion in swimming, results in a significant physiological
strain during the swim to bike transition. The inclusion of swim to bike transitions
should, therefore, form a key part of triathlon training.
Swimming exercise elicits specific physiological responses which are imposed as
a result of the body being horizontal, submerged in cool/cold water and using the
arm musculature as the primary means of locomotion. Hence, for the same relative
intensity of work, heart-rate is lower while stroke volume, blood pressure and blood
lactate are all higher. After working in this way for periods lasting 4 minutes (sprint
distance) to 1 hour (Ironman distance) a steady state is achieved with all physio-
logical systems responding to the specific stress of swimming exercise. The rapid
change in modality to cycling, where the body mass is supported, the body is upright
and the primary muscles of locomotion are in the lower body, represents a consider-
able functional stress. Similarly, to then change to running where, although the body
is still upright, the body mass is no longer supported and the primary muscles of
locomotion are in the lower leg, again causes functional stress.
Novice triathletes often report feeling fatigued when leaving the swim and trying
to cycle with perception of exertion being focused in the chest and legs. When switch-
ing from cycling to running the legs can feel heavy and the joints ‘stiff’. Brick train-
ing; alternating between swimming and cycling and between cycling and running,
appears to result in positive adaptations. The primary adaptations following brick
sessions are probably associated with a more rapid shift in blood flow to the work-
ing musculature combined with an improved pacing strategy and experience. Further,
the skill development accrued during brick sessions will result in a reduction in the
transition times between disciplines. Accordingly, as a result of brick sessions, ath-
letes report that during competition they adjust from one discipline to the other more
quickly, resulting in performance enhancement. Examples of brick sessions:
5 × (400 m swim/10 minutes cycling)
3-mile run, 10-mile cycle, 3-mile run
3 × (10 minutes cycling/10 minutes running)
Establishing all factors underpinning performance is crucial to allow specific train-
ing prescription. This may not be a simple task, particularly in those sports in which
physiological, environmental or skill demands of the sport change throughout
performance. Specific testing and monitoring of athletes in the field and labora-
tory allows an interrogation of the factors underpinning performance, together with
profiling of athletes and the monitoring of training adaptation across time.
CROSS-TRAINING
The advent of triathlon has led to a popularization of cross-training in recent years.
Cross-training, however, has been employed by coaches and athletes for decades in
an attempt to optimize the training stimulus and enhance performance. Despite the
fact that cross-training is not a new approach for improving performance, limited
scientific evidence exists examining the transfer of training effects.
Cross-training can be defined in a number of ways: (i) the simultaneous train-
ing for two or more events (i.e. triathlon); (ii) the cross-transfer of training effects
from one sport to another; (iii) the conveyance of training effects from one one limb
to the contralateral or ipsilateral limb (Tanaka 1994). Irrespective of the definition
the primary goal of cross-training is performance enhancement or maintenance.
Anecdotally performance enhancement from cross-training may be obtained through
a number of mechanisms: (i) direct improvement in performance from an alterna-
tive mode of exercise; (ii) improved training compliance associated with a more
interesting/diverse training programme; (iii) reduced incidence of overuse injury;
(d) maintained training stimulus during rehabilitation from injury.
Studies examining cross-training have focused on the transfer effects of: (i) dis-
similar modes of exercise i.e. swimming and running; (ii) modes of exercise employ-
ing similar muscle groups i.e. running and cycling; (iii) simultaneous strength
and endurance training (Loy et al 1995). The vast majority of studies have used
•
VO2max as the criterion measure in the absence of performance measures. Thus, the
conclusions drawn from these studies should be viewed with caution as changes in
•
VO2max do not necessarily confer changes in performance.
The findings of studies examining cross-training using dissimilar modes of exer-
cise in highly trained athletes suggest that limited benefit is gained from the com-
bination of exercise modes whose principle locomotor muscle groups are different,
i.e. swimming and running. While the benefit of this type of cross-training in highly
trained individuals is of limited value, enhanced performance may be observed in
less conditioned individuals. Further, this type of cross-training may improve long-
term training compliance in recreational athletes. Despite the absence of perform-
ance changes for the highly trained athlete, cross-training using dissimilar modes of
exercise may be valuable during rehabilitation where participation in sport-specific
exercise is limited.
The majority of studies examining cross-training using similar modes of exercise
have focused on cycling versus running training. This type of training has received
increasing support based upon anecdotal evidence. Indeed, there is an increasing
trend in elite sport to use cross-training of similar modes during the off-season.
Rowers and canoeists often use cross-country skiing during the winter phase of train-
ing, and skiers use cycling as a training tool during the summer months. The use
of similar muscle groups and energy systems (aerobic and anaerobic) has under-
pinned the belief that cross-training may be beneficial. While running and cycling
use major muscles in the lower body, cycling predominantly uses the quadriceps
muscle group, whereas running uses the plantar flexors. Further, neuromuscular
adaptations associated with the acquisition of skill will be limited between different
exercise modalities. Indeed, even within a particular mode of training, some train-
ing conditions, such as posture (e.g. upright versus supine cycling) and training ter-
rain (uphill versus flat running), result in specific adaptations.
The benefits of cross-training using similar modes of exercise appear to be more
closely linked with improved performance in highly trained athletes than those
observed with dissimilar modes of exercise. Data suggest, however, that the greater
the level of conditioning to begin with the smaller the relative improvement observed.
Cross-training is a commonly used training tool. Evidence supporting the efficacy
of cross-training, however, is limited. For the highly trained athlete, cross-training
may be beneficial during rehabilitation to maintain general conditioning or as a
means of reducing the potential for overuse injury and boredom associated with
a single sport focus. It is clear, however, that cross-training effects never exceed those
induced by specific training.
CIRCUIT TRAINING
Circuit training is composed of a number of specific exercises targeted at muscle
groups (and often skills) involved in the target activity. In order to stress muscular
endurance optimally, recovery periods between exercises are often relatively short
to allow only partial recovery.
There are a large number of formats that can be used with circuit training; the fol-
lowing is one example of many. On the first circuit the individual must attempt to
complete the greatest number of repetitions possible in a selected time interval.
Enough rest is given between exercises to allow full recovery. The number of reps
achieved for each exercise is halved and on the second occasion each exercise, with
the calculated number of reps, is completed one after the other without a break. This
is one circuit and any number of circuits can be programmed but the whole is con-
ducted continuously, without breaks, against the clock. Improvement over weeks is
determined as a faster time for a given number of circuits. After a number of weeks
the individual can be re-tested as on the first occasion or the exercises can be changed
and the whole process re-commenced. While generally adopted for improved mus-
cular endurance, circuit training can be employed to target a variety of performance
variables by altering the number of sets, number of repetitions, and recovery dura-
tion. Table 2.1 suggests the number of repetitions generally used for specific aims.
TRAINING FOR FLEXIBILITY

Many coaches question the need for specific training to address improvements in
flexibility or range of movement. Their argument is that the athlete should not have
too much flexibility as this could impair performance. To some degree this is true,
as we have seen above in training for strength and power if the muscle does not
provide enough stiffness then less energy can be stored in the tendon leading to a
reduction in force generation. Some coaches also insist that the athlete need only be
flexible enough to meet the demands of their sport and hence performing the sports-
specific movements will adequately address these flexibility needs. This may be per-
fectly true for distance running and other closed sports where there is little or no
challenge to the range of movement a joint must work through. This could, how-
ever, be further debated for open sports where the nature of the event or the nature
of play is unpredictable and may force a joint to attempt a range of movement for
which it is not adequately prepared. In sports and activities where more extreme
Table 2.1 The number of repetitions usually associated with development of specific
conditioning
Development of Repetitions
Strength 4–8
Strength-endurance 8–12
Local muscular endurance 14–25
Endurance 30–40
ranges of movements are required, such as martial arts, gymnastics and dance, addi-
tional supplementary training is required which specifically addresses flexibility.
Where flexibility training is agreed as necessary for a given activity two forms should
be addressed: static and dynamic flexibility.
Static flexibility represents the range that a joint or muscle can achieve and is
limited by the structure of bones, joints and muscles and by muscle tone. Improving
static flexibility involves holding the joint at the limit of its range for a minimum
of 7 seconds. The reason for this is that, when stretched, the muscle proprioceptor,
the muscle spindle, is stretched, causing a train of afferent signalling to the spinal
cord. The resulting efferent signal causes the muscle to contract, resisting the stretch.
Holding the stretch for at least 7 seconds allows the golgi tendon organ (GTO) to
be activated, inhibiting the stretch reflex and allowing a reflex relaxation and sub-
sequently the muscle/joint can be stretched further. This process, whereby the GTO
inhibits the muscle spindle, is known as autogenic inhibition. All of the joints requir-
ing greater flexibility must be stretched in this way. Where movement is required
at the limit to the range of movement, however, dynamic flexibility is also required.
Dynamic flexibility refers to the range of movement through which a muscle/joint
can act when in motion and, as such, it can be described as the limit of active range
of movement of the joint. Dynamic flexibility is limited by static flexibility and by
nervous system function and co-ordination. Static flexibility limits dynamic flexibil-
ity to limit joint excursions beyond the maximum range of static flexibility during
movement that could result in injury. Improvements in dynamic flexibility are
extremely important in high-speed movement and so should be a major goal for
many sports. A session which aims to work on improvements in dynamic flexibil-
ity should begin with sports-specific movement patterns performed at low speed
where the limits to range of movement are not explored. Throughout the session
the speed and range of movement pattern should be increased until full-speed move-
ments are being performed to the limit of the range of movement.
In sports where flexibility is a key component, increasing flexibility should typi-
cally involve three to five stretching sessions per week. Because flexibility is signif-
icantly affected by the temperature of soft-tissue structures, sessions are most effective
when the target tissue temperature is increased. Accordingly, stretching for improv-
ing long-term flexibility is best performed at the end of a training session. Any
stretching conducted as part of the warm-up should be ‘non-aggressive’ and should
only aim to have joints and muscles feel comfortable when approaching the limits
to the joint’s current range of movement (Popov 2001).
Summary box 2.5
Depending on the sport, improvements in both static and dynamic flexibility should be
considered. Static flexibility improvement requires the joint to be taken to the limit of its
range of movement and the stretch held for a minimum of 7 seconds. Active static
stretching, including PNF stretching, can involve a partner who helps to fix the stretch
at the limit of the range of movement while the athlete exerts a maximal contraction,
for 7 seconds, resisting the stretch. This can help to stretch antagonist muscle groups
and may potentiate stretching of the agonists. A dynamic flexibility session should begin
with gentle movements in which the range of movement is only just challenged and
over the course of the session very gradually build until at the end range of movement is
severely challenged and in an explosive fashion.
SPECIFICITY IN THE PHYSIOLOGICAL ASSESSMENT

OF ATHLETES
Laboratory- and field-based physiological assessments of the athlete are fundamen-
tal elements in training prescription. Physiological assessment is used to: (i) iden-
tify physiological parameters underpinning performance, (ii) profile athletes, and
(iii) assess training adaptation and programme efficacy. A detailed examination of
physiological testing protocols is beyond the scope of this text; however, a brief
overview of the role of laboratory- and field-based testing is presented here. For a
more detailed review of sports-specific testing protocols the reader is directed to the
work of the Australian Institute of Sport (Australian Sports Commission 2000) and
the British Association of Sport and Exercise Science (BASES 1997). The following
section examines the method of establishing the physiological factors underpinning
performance, and the use of laboratory- and field-based physiological assessments
for training prescription and monitoring, using rowing as an example.
Identifying the physiological factors underpinning performance

The physiological determinants of performance are event-specific and are multi-
factorial, depending on a number of factors. Establishing the physiological factors
underpinning performance is crucial in training prescription if optimal adaptation
is to be achieved. Further, by identifying the determinants of performance, specific
testing protocols can be designed to profile athletes, establishing strengths and weak-
nesses, and focusing training on specific areas leading to an enhanced training stim-
ulus. Continuous and targeted testing can be used to monitor training adaptation
or maladaptation, allowing training programmes to be modified specifically to the
requirements of the athlete. Therefore, establishing the determinants of performance
is crucial for the efficacy of training prescription.
Determining the physiological factors underpinning performance is often a dif-
ficult task, particularly in those sports that have a significant ‘open-skill’ contribu-
tion to performance, for example, football. For this reason, the majority of studies
examining the physiological factors underpinning performance have focused on
‘closed skill’, cyclic events such as running, cycling, swimming and rowing. Recent
attempts have been made to establish the physiological determinants of perform-
ance in ‘open skill’ events and the reader is directed to these studies for further
reading (e.g. Ingham et al 2002). Case study 2.1 outlines the methods employed to
establish the physiological factors underpinning performance in rowing. Having
established the physiological determinants of performance, specific testing proto-
cols can be designed to profile and monitor athletes, enhancing the specificity of
training prescription.
Laboratory-based testing
The demand from coaches for greater amounts of field-based testing and, at the
same time, for reducing the amount of laboratory-based testing is increasing. To a
large degree this demand is justified and justifiable. The limitations of laboratory-
based testing and benefits of field-based testing can be largely encapsulated in the
concept of specificity. It can be very difficult to recreate the exact movement pat-
terns and limb velocities and to utilize exactly the same muscle groups using
laboratory-based ergometers compared to the actual sport performance. The argu-
ment for increased field testing, which centres around the need for greater specificity,
Taking distance running as an example, the physiological parameters important

•
for distance running performance have been reported to be VO2max, fractional uti-
lization, running economy and lactate tolerance (Berg 2003). A treadmill test which
uses 4-minute stages of increasing exercise intensity to maximal exercise will allow
measurement of most of the above. In addition, if re-applied in exactly the same
way, and under exactly the same conditions, each time such a test will provide a
‘snap-shot’ of the athlete’s changing state of conditioning. This allows the design of
a more specific training programme and ensures that training is more precisely cus-
tomized to the individual.
Designing a laboratory test for an elite distance runner

Figure 2.1 demonstrates a typical laboratory-based treadmill protocol that is
employed to obtain information appropriate to the needs of the elite distance run-
ners (marathon or 10 km).
The testing protocol employs 5 × 4-minute stages with each stage being faster than
the previous stage (0.6 km.h−1 per stage). A 30-second rest interval exists between
stages for collection of an earlobe blood sample and subsequent lactate analysis.
Establishing the velocity of each stage begins with the conversion of a recent best
time for 10 km to a treadmill speed. Using the example of an athlete with a best time
of 37 minutes 30 seconds for 10 km, 16.0 km.h−1 is used as the reference velocity. The
third stage is then set at the 10 km race velocity (16.0 km.h−1) and the velocities for
stages 1, 2, 4 and 5 are calculated by subtracting or adding 0.6 km.h−1. Hence, the
protocol will begin with stage 1 at 14.8 km.h−1, stage 2 at 15.4 km.h−1, stage 3 at 16.0
km.h−1, stage 4 at 16.6 km.h−1 and stage 5 at 17.2 km.h−1. To improve the validity of
the assessment, the treadmill gradient is set at 1% as this more accurately reflects the
energy cost of outdoor running at the same velocity (Jones & Doust 1996a).
Gradient
Stages 1-5, 1% grad, +0.6 km.h−1 per stage
1.2.3.4 %
WU
Figure 2.1 An example of a treadmill protocol to test a distance runner. WU is self-paced

10-minute warm-up. In the case of the example chosen here, a distance runner with a
10 km pb of 37.5 minutes stages 1–5 are 14.8, 15.4, 16.0, 16.6 and 17.2 km.h−1 respectively.
The arrows represent earlobe blood samples taken after each 4-minute stage, during
30-second rest interval.
Following the completion of stage 5, and immediately after the 30-second rest
interval, the athlete remounts the treadmill with the belt moving at the same speed
as in stage 5 and the rest of the test is conducted at that speed. After 60 seconds
the gradient is increased by 1% and likewise every subsequent 60 seconds until the
athlete can no longer continue (volitional exhaustion).
Heart rate, preferably using ECG (alternatively telemetry, i.e. Polar), and oxygen
consumption, using indirect calorimetry, are measured continuously throughout the
test, with the collection of a capillary blood sample at the end of each 4-minute
stage, analysed for blood lactate concentration.
•
Derivation of VO2max and fractional utilization
•
Maximum oxygen consumption (VO2max) is established from a test lasting between
9 and 16 minutes. The type of test described above will take about 25 minutes and
• •
hence in this instance maximal oxygen uptake is referred to as ‘VO2peak’. VO2peak
•
has been demonstrated to be within 3% of VO2max (Jones & Doust 1996b). When test-
ing athletes, precision rather than accuracy is the more important issue and, where
athletes have limited time, one test rather than two is considered better, providing
better compliance and so on.
Fractional utilization is the volume of oxygen consumed at lactate threshold
• •
expressed as a percentage of VO2max (%VO2max). It is also sometimes used, how-
• • •
ever, to describe VO2 as a percentage of VO2max (or VO2peak) at a specified inten-
•
sity. For example the %VO2max at marathon or 10 km velocity in running or at
16 km.h−1 on the treadmill or at 330 watts on the rowing ergometer.
Derivation of economy
In exercise physiology the term ‘economy’ is generally used to refer to oxygen econ-
omy or movement economy. Oxygen economy refers to the volume of oxygen taken
up by active muscle at a given sub-maximal exercise intensity. During running on
the treadmill the standard velocity selected, to compare oxygen uptake on succes-
sive occasions, is 16 km.h−1. Reduced volume of oxygen consumed at this sub-
maximal pace is interpreted as an improved oxygen economy. Movement economy,
for example, ‘running economy’, differs from oxygen economy by virtue of the fact
that it concerns not just the physiological measure of oxygen consumption.
Appropriate assessment of movement economy, either acutely or longitudinally,
requires the use of biomechanics, psychology and physiology. Biomechanics is cru-
cial as technique is a key component in the assessment of movement economy. For
example, in running, subtle changes in distance per stride and stride rate at the same
velocity will change the volume of oxygen consumed. Psychology is important
because skill acquisition or changes in acquired skill has a psychological basis.
Derivation of lactate threshold

Lactate threshold (LT) is a complex phenomenon that has received significant atten-
tion in recent years. While a debate exists as to whether an inflection in blood lactate
occurs during incremental exercise, the issue of defining LT remains a key discussion
both in the literature and between scientists and coach. The term ‘lactate threshold’
has been used to describe a number of different physiological points associated with
a sustained increase in blood lactate above resting levels including: (i) a non-linear
increase in blood lactate of at least 1 mmol.L−1 (Coyle 1995); (ii) a workload preceding
a non-linear rise in blood lactate during progressive exercise (Ivy et al 1980); (iii) the
•
point of deflection in the logged blood lactate versus logged VO2 transformation
(Beaver et al 1985). Others have suggested a second breakpoint further along the lac-
tate transition curve associated with a workload at which blood lactate begins to accu-
mulate rapidly, and as such represents the highest work intensity at which blood
lactate can equilibrate. This breakpoint has also been defined by a number of terms:
(i) anaerobic threshold (AT; Kindermann et al 1979); (ii) the onset of blood lactate accu-
mulation (OBLA; Sjodin & Jacobs 1981); (iii) maximum lactate steady state (MLSS);
(iv) critical velocity (CV). While debate regarding the presence and definition of LT
persists, the concept of lactate breakpoints and their identification is central to many
scientific support programmes. It is key that physiologists work closely with coaches
and athletes to accurately define LT and standardize its identification.
Figure 2.2 illustrates the lactate and heart rate profile for the sample endurance
athlete discussed above. From the graph it can be seen that the breakpoint occurs
at 16.0 km.h−1 and the heart rate corresponding to this speed is 140 beats.min−1.
Giving a single heart rate value to an athlete would not provide useful training
information as a range of training intensities is fundamental in targeting the phys-
iological mechanisms underpinning performance. Thus, providing a heart rate range
based on the test information is far more practical. Accordingly, for training out-
doors the athlete would be advised to use a 10-beat range, in this case 135–145
beats.min−1. If training on the treadmill indoors, where weather and terrain do not
change, a 5-beat range of 137–142 beats.min−1 can be given. Because the athlete’s
LT heart rate is now known, heart rates for base endurance training (long slow dis-
tance, LSD) is calculated at 120–130 beats.min−1 (i.e. staying 5 beats below the LT
range). The test will also have provided an estimate for maximal heart rate and in
this athlete it is assumed to be 180 beats.min−1. As a result, for high-intensity train-
ing (of 2–4 minutes) heart rate should be above 90% of maximum heart rate (162
beats.min−1). In this way three training zones are identified (see Ch. 4).
Following a number of weeks training, re-testing would reveal changes in
•
VO2peak, fractional utilization, economy and lactate threshold. As previously stated
an index of improved endurance is characterized by a rightward shift in the work
rate–lactate curve, as can be seen in Figure 2.3. If training goes particularly well and
5 160
4.5 150 Heart rate
4 140 Lactate
Blood lactate conc (mM)
Heart rate (beats.min−1)
3.5 130
3 120
2.5 110
2 100
1.5 90
1 80
14.8 15.4 16.0 16.6 17.2
−1
Treadmill belt speed (km.h )
Figure 2.2 Heart-rate and blood lactate concentration during a discontinuous treadmill
running protocol.
Heart rate Jul - 00

Heart rate Feb - 01
200
Lactate Jul - 00
10 180
Lactate Feb - 01
160
8
140
Heart rate (beats.min−1)

Blood lactate (mM.L−1)
120
6
100
80
4
60
2 40
20
1 0
13.6 14.2 14.8 15.4 16 16.6 17.2 17.8 18.4
Running velocity (km.h−1)
Figure 2.3 This demonstrates the effect of a number of weeks of training on the work
rate–blood lactate profile in an endurance runner. Note the downward and rightward shift
of both the heart rate and blood lactate curves following training.
the prescribed heart-rate zone proves to be ideal for the individual at that time it
may be possible to see an increase in the intensity at which LT occurs. This is seen
in Figure 2.3 where on the first occasion LT pace is 16.0 km.h−1. On the second occa-
sion after a number of weeks of LT specific training, the entire curve has shifted to
the right and the velocity at LT intensity has increased to 16.6 km.h−1, demonstrat-
ing a training-induced physiological adaptation and therefore conferring confidence
in the efficacy of the training programme.
The prescription of training using individual heart rate zones allows specific, tar-
geted training prescription that can have a profound effect on training adaptation.
Establishing laboratory- and field-based tests to identify training intensities for all
underpinning physiological parameters of performance is fundamental in optimiz-
ing training prescription.
Field-based testing
Field-based testing is generally said to have good ecological validity. In other words
it is more sports-specific than laboratory-based testing. However, because it is very
difficult to standardize the test environment from one occasion to the next it can
lack construct validity and test–retest reliability. In short, it tends to be far more sub-
jective. Laboratory-based testing does allow standardization of the test environment,
is more objective and provides better construct validity and test–retest reliability.
Hence, it is clear that a combination of both field- and laboratory-based testing is
best for providing an optimal service to the high-level or elite athlete in any sport.
Summary box 2.6
Field-based testing provides more sport-specific data but is often subjective. Laboratory-
based testing provides objective data which can be less sport-specific; however, it can
provide a good measure of the current conditioning of the athlete and allows the
identification of specific areas that require work. The best physiological support
programme is one which incorporates both field- and laboratory-based support and
achieves the appropriate balance between the two methods of assessment. For
laboratory-based testing, specificity requires the selection of sport-specific ergometers
and the design of exercise protocols which examine the primary demands of the activity.
CONCLUSION
Specificity is a key component in the design of any sports training programme.
Physiological adaptation is specific to the imposed stimulus and as such training
should closely mimic the skill, muscle group(s) and energy system(s) required dur-
ing competition. Knowledge of the physiological mechanisms underlying perform-
ance is fundamental in the design of training programmes. Specific laboratory- and
field-based testing allow a thorough interrogation of the physiological mechanisms
underlying performance and the monitoring of adaptations across the training cycle.
Cross-training lacks specificity and is unlikely to enhance training adaptations; how-
ever, cross-training may be valuable for the rehabilitating athlete and to add vari-
ety to prolonged training periods. Specificity is a complex concept and only a sound
underlying knowledge of physiology will allow appropriate application of this train-
ing principle.
KEY POINTS
1. Specificity is one of the training principles.
2. Physiological adaptation is specific to the stimulus imposed.
3. Specificity should address the three key areas of: skill, muscle group and energy
system.
4. Understanding the physiological mechanisms underlying performance is funda-
mental in the prescription of specific training programmes.
5. Cross-training is unlikely to enhance performance.
6. Cross-training may be efficacious in the treatment of the rehabilitating athlete.
7. To provide the best physiological support to the athlete requires the integrated
use of both field- and laboratory-based assessment.
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Human Kinetics, Champaign IL
BASES 1997 Physiological testing guidelines, 3rd edn, Bird S & Davison R (eds)
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England
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IL
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Human Kinetics, Champaign IL
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Commission Publication. Blackwell Science Ltd, Oxford
45
Chapter 3
The physiology of tapering
Gregory Whyte and Nicholas Diaper
CHAPTER CONTENTS
Learning objectives: 45 Tapering and travel 52
Introduction 45 Prior to travel 52
Types of taper 46 During travel 52
Physiological responses 46 Travel fatigue and jet lag 53
Cardiorespiratory adaptations 47
Carbohydrate loading (glycogen
Muscle fibres 48
supercompensation) 55
Muscle glycogen 49
Summary 57
Strength and power 50 Key points 58
Lactate 50 References 58
Performance changes 51 Further reading 60
Additional considerations during the
taper phase 52
1. Gains an appreciation of the various types of tapering.
2. Gains an understanding of the physiological adaptations that occur in response
to the different tapering modalities employed by athletes.
3. Appreciates the performance changes observed as a result of effective tapering.
4. Understands the impact of travel on performance and strategies employed to
reduce travel fatigue and jet lag.
5. Understands the role of glycogen loading during taper.
6. Appreciates the need for individually tailored tapering programmes.
INTRODUCTION
Tapering can be defined as a specialized exercise training technique designed to
reverse training-induced fatigue without a loss of the training adaptations (Neary
et al 1992). It is the final phase of training prior to competition and involves a reduc-
tion in training load that can elicit improvements in physiological, psychological and
performance indices. A successful taper phase requires careful planning and should
aim to optimize all the determinants of performance at a single point in time. This
amalgamation is often termed ‘peaking’ and is used synonymously with tapering
as the taper period allows an athlete to attain peak performance at important
events.
Tapering is complex and subtle, requiring an in-depth knowledge of sports per-
formance, including physiological, psychological, nutritional and technical aspects.
Psychological aspects of tapering are beyond the scope of this chapter. The reader
is directed to the large number of published reviews examining this crucial element
of tapering (Hooper et al 1999).
The purpose of tapering is to bring about a peak in performance by the manip-
ulation of training volume (intensity, frequency, duration). The period of time
required for an optimal taper may vary dependant on how training volume is
manipulated. The balance between the reduction of training volume and the period
of time employed to elicit a peak is crucial if optimal tapering is to be achieved.
A taper period that is too long, or reduces training volume too rapidly, may not
provide sufficient training stimulus to prevent a detraining effect, whereas a taper
period that is too short or fails to reduce training volume sufficiently will not allow
sufficient time for full physiological and psychological recovery. Each of these sit-
uations may result in athletes ‘missing their peaks’, thus compromising optimal
performance and undoing an otherwise well designed training programme. It is no
surprise therefore that the taper period is a critical period for coaches, sports sci-
entists and athletes alike. This chapter will attempt to unravel some of the com-
plexities of peaking and tapering and offer some guidelines on how best to optimize
performance.
TYPES OF TAPER
As training load or volume is the product of intensity, duration and frequency, one
or more of these aspects of training must be manipulated in order to reduce the
training load. The most potent stimulus to training load is intensity and therefore
any increase in this aspect will significantly increase training load. The primary goal
of tapering, however, is to elicit a performance peak, i.e. velocity, power. Successful
tapers are, therefore, high intensity in nature and as such, duration and/or frequency
should be lowered if volume is to be reduced. This is paramount if sufficient rest
and recovery between or within sessions is to be attained.
Four main types of taper (Fig. 3.1) have been described, each of which reduce
the training volume at varying rates (Mujika & Padilla 2003). Exponential tapers
can be either slow- or fast-decay, with the latter consisting of a lower training load.
The linear taper has the slowest rate of decline and therefore comprises a greater
training load than either of the exponential tapers. These are true tapers by defi-
nition of the word as the work load is gradually ‘tapered’ off in the days leading
up to competition. In contrast, the step taper constitutes a sudden drop in training
load that is then maintained through to competition without a progressive reduc-
tion in work load.
PHYSIOLOGICAL RESPONSES
Despite the relatively short period of time employed during tapering, a number of
physiological adaptations take place during the taper period, some of which are bet-
ter understood than others.
The physiology of tapering 47
Linear taper
100
Exponential taper (slow decay)
90
Exponential taper (fast decay)
80
Step taper
70
% of normal training
Normal training
60
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Days of taper
Figure 3.1 Types of taper.
Cardiorespiratory adaptations
Heart rate
Resting and sub-maximal heart rates (HR) appear to be unaffected by the taper
phase, except when athletes may be in an over-reached state prior to the taper
phase. Over-reaching is often employed by coaches to elicit an enhanced super-
compensation following a reduction in training volume (see Ch. 1). Distinct differ-
ences exist between over-reaching and over-training and as such these terms should
not be confused. Over-reaching is characterized by a transient decline in perform-
ance as a result of a short term heavy training (Busso et al 2002) and can be eas-
ily recovered with a few days of reduced training such as a taper phase.
Over-training (often termed over-training syndrome, unexplained underperfor-
mance syndrome or burn out) on the other hand is characterized in athletes by
reduced capacity to train and perform over long periods and generally weeks or
months are required to recover normal training capacity (see Ch. 9). In an over-
reached state resting heart rate may be increased and maximum exercise capacity
is often reduced due to accumulated fatigue leading to a reduced maximum heart
rate. Jeukendrup et al (1992) described a reduction in sleeping HR of 3 beats.min−1
after tapering in a group of cyclists that were intentionally over-reached during the
period preceding the taper phase.
Results from studies investigating the effects of tapering on maximal HR have
demonstrated inconsistent findings (see Mujika et al 2004). Houmard et al (1994)
observed no change in maximal HR during taper in runners performing a progres-
sive treadmill run to exhaustion. Likewise, Rietjens et al (2001) also reported no
change in maximal HR following taper in a group of cyclists during an incremental
cycling test to exhaustion. In contrast to these studies, slight increases in maximal
HR have been observed following 1 week of taper in cyclists (Martin & Anderson
2000) and 2 weeks of taper in swimmers (Hooper et al 1999). Jeukendrup et al
(1992) observed a 3% increase in maximal HR after a taper period in a group of
male competitive cyclists that had intentionally been over-reached prior to the taper
phase. However, the post-taper value was similar to that measured before the over-
reaching phase.
The opposite effects on maximal HR of blood volume expansion and the level of
catecholamine depletion that may have occurred due to the intense training phase
preceding the taper may account for these inconsistent findings (Mujika et al 2004).
Maximal oxygen uptake

•
Maximal oxygen uptake (VO2max) is a fundamental aspect of fitness for a number
of sports, particularly those that are predominantly aerobic in nature or performed
•
at intensities at or near VO2max. A number of studies have reported significant
•
increases in laboratory assessed VO2max scores in the range of 2.5–9.1% following
•
a taper period. Neary et al (2003a) demonstrated a 2.4% increase in VO2max for
seven male endurance-trained cyclists who maintained training intensity (85–90%
maximum heart rate), while lowering training duration over 7 days. In the same
study, the group that progressively reduced exercise intensity (85–55% maximum
heart rate) but maintained duration demonstrated no significant improvement in
• •
VO2max. Others have shown greater increases in VO2max of 4.5% in cyclists
(Jeukendrup et al 1992) and 9.1% in triathletes (Zarkadas et al 1995).
•
Increases in VO2max are not always evident following a taper phase (Houmard
et al 1994, Shepley et al 1992). Shepley et al (1992) reported a 22% increase in run-
ning time to fatigue following a high-intensity 7-day taper in the presence of an
•
unchanged VO2max. Likewise, Houmard et al (1994) observed a 3% improvement
•
in 5-km running time with no accompanying increase in VO2max in a group of well
trained distance runners. Performance improvements independent of changes in
•
VO2max are commonly associated with adaptations at the skeletal muscle level as
opposed to oxygen delivery (Houmard et al 1994, Shepley et al 1992).
While evidence supports enhanced performance in the absence of an improved
•
VO2max, investigations such as these demonstrate that a well planned and struc-
•
tured taper phase should not result in a detraining effect with regard to VO2max.
•
Training intensity appears to be the key component in ensuring that VO2max is either
enhanced or maintained during the taper period.
Muscle fibres
Trappe et al (2000) reported an 11% increase in the diameter and 24% increase in
the cross-sectional area of type IIa muscle fibres in a group of highly trained swim-
mers following a 21-day taper. Type I fibre diameter and cross-sectional area remained
unaltered. Further type IIa fibres also produced greater peak force, contracted faster
and were more powerful following the taper whereas no change was observed for
type I fibres. These data imply that fast-twitch (type IIa) fibres are more responsive
to tapers following periods of high-volume training. The authors suggest that the
intense high volume of training preceding the taper phase in this group of swim-
mers was responsible for inducing negative changes in type IIa fibres relating to
their size which did not influence type I fibres. Indeed, type IIa fibres have been
shown to decrease 15% in size following a two-fold increase in training volume for
10 days (Fitts et al 1989).
The contention that type IIa fibres are more responsive to tapers has recently
received more support. Neary et al (2003a) demonstrated a 14.2% increase in cross-
sectional area of type II fibres in seven endurance-trained cyclists performing a high-
intensity taper with reducing duration for 7 days with no significant changes in type
I fibres. No significant changes in type IIa fibres were observed in the group employ-
ing a low-intensity, longer duration taper over 7 days, suggesting that successful
tapers should be high intensity in nature.
Examining the metabolic adaptations that occurred at the single fibre level, Neary
et al (2003a) reported significant and differential effects being observed in type I and
IIa fibres. Following a 7-day high-intensity low-volume taper, type IIa fibres demon-
strated an increase of approximately 14% in myofibrillar ATPase (mATPase),
cytochrome oxidase (CYTOX), beta-hydroxyacyl coenzyme A dehydrogenase (β-
HOAD) and succinate dehydrogenase (SDH). In contrast, type I fibres demonstrated
increases of only 10–11% in mATPase and SDH with no change in CYTOX or β-
HOAD. The only increases in enzyme activity in the high-volume low-intensity taper
were a similar increase in β-HOAD (15%) in type IIa fibres, and increases of 9% and
15% in CYTOX and β-HOAD respectively for type I fibres. It is important to note,
however, that such changes in enzyme activity and fibre size must be considered
only an estimate of the exercising musculature due to the nature and limitations of
muscle biopsies. Furthermore, it should be stressed that single cell measurements
are conducted under considerably different conditions than the normal physiologi-
cal environment in which whole muscles perform – and therefore direct compar-
isons from single cell to whole muscle performance should be viewed with caution.
It does seem reasonable, however, to conclude that changes in contractile function
at the single muscle fibre level contribute to enhance whole muscle function and
improved performance.
It is clear from this evidence that the intensity of exercise during endurance-based
tapers determines the nature and extent of muscle fibre adaptation and that type IIa
fibres are more responsive to such training compared to type I fibres.
Muscle glycogen
Muscle glycogen stores can be depleted during periods of heavy training as is often
the case in the training phase preceding the taper. A number of reports have demon-
strated that muscle glycogen concentration is increased following a Taper (Neary
et al 1992, 2003a, Riggs et al 1983, Shepley et al 1992, Walker et al 2000). Neary et al
(1992) reported a 17% increase in muscle glycogen stores after 4 days of taper and
a 25% increase following an 8-day taper. In a more recent study, Neary et al (2003a)
compared muscle glycogen levels in three groups of male endurance cyclists under-
going different 7-day taper strategies. A 26% increase in muscle glycogen concen-
tration was reported for the group that maintained training intensity at 85–90%
of maximum HR with a progressive reduction in exercise duration. A 22% increase
was observed in the group that maintained training duration but lowered exercise
intensity.
Shepley et al (1992) observed a 15% increase in muscle glycogen stores in a group
of highly trained cross-country and middle-distance runners following 7 days of
high-intensity taper. In the same study, glycogen stores were unaffected by a low-
intensity taper and were 8% higher after a rest-only taper. The cessation of training
together with a high-carbohydrate diet may have stimulated this overshoot in glyco-
gen synthesis following the rest-only taper, although this does not explain why a
similar effect was not seen after the low-intensity taper (Shepley et al 1992).
Increases in stored muscle glycogen result in a greater endogenous store of energy

and are particularly beneficial for events where substrate availability can limit per-
formance. The extent to which this supercompensation effect takes place is largely
governed by the dietary intake of carbohydrates. Indeed, dietary intake is a crucial
factor in the successful taper and this will be covered in more detail later.
STRENGTH AND POWER

It is well documented that taper programmes elicit increases in strength and power
(Johns et al. 1992, Martin et al 1994, Shepley et al 1992, Trappe et al 2000). In line
with other components of fitness, strength and power are often suppressed by long
periods of heavy training and the taper period allows the recovery of these com-
ponents to levels above baseline (supercompensation).
Trappe et al (2000) investigated the effects of a 21-day, high-intensity, low-volume
taper on swim bench and tethered swimming power in highly trained swimmers.
The authors reported a 7–20% improvement. Swim bench power was dependent on
the isokinetic velocity employed with consistently higher power outputs for each
velocity ranging from 1.4 m.s−1 to 3.28 m.s−1. In an earlier study Johns et al (1992)
reported that tethered swimming power, measured in the water, improved by 13%
following the taper. Further, the authors observed improvements in tethered swim-
ming power of 5% following a taper of 10–14 days in intercollegiate swimmers.
In a study involving cross-country and middle distance runners, Shepley et al
(1992) reported an increased maximal voluntary isometric strength of the knee exten-
sors following a 7-day taper of high-intensity and low-volume, low-intensity and
moderate-volume, or rest only. It should be noted that running time to fatigue
decreased by 3% in the rest-only taper whereas the low-intensity and moderate-
volume intervention showed no effect and the high-intensity taper resulted in a 22%
improvement in time to fatigue.
Gibala et al (1994) performed one of the few studies to date dealing with strength-
trained athletes. The authors examined voluntary strength of the elbow flexors over
a 10-day rest-only or reduced-volume taper in resistance-trained males. Maximum iso-
metric peak torque increased by 7.5% at day 6 and 6.8% at day 10 of the taper in the
reduced-volume taper and the authors attributed this to enhanced contractile per-
formance and/or to an increase in neural activation. In contrast, maximum isometric
peak torque did not increase in the rest-only condition. Improvements in strength dur-
ing a taper phase have also been documented in cyclists, whereby Martin et al (1994)
reported an increase in quadriceps strength of 8–9% following a 2-week step taper.
The mechanisms responsible for these taper-induced improvements in muscular
strength and power may be related to alterations in local enzymatic activity and sin-
gle muscle fibre characteristics which, in turn, may positively affect neuromuscular,
biomechanical and metabolic efficiency (Mujika et al 2004).
LACTATE
In a study by Jeukendrup et al (1992) a group of competitive male cyclists were sub-
jected to three consecutive periods of training; moderate standardized training, heavy
training (high-intensity intervals) and reduced training. Each period lasted for
2 weeks with the aim of the heavy training phase to intentionally over-reach the
participants. Peak blood lactate levels as measured after a maximal cycle ergometer
test were reduced by 50% during the heavy training phase. The subsequent taper
period resulted in a 78% increase in peak lactate levels. Sub-maximal blood lactate
values were also lower during over-reaching and higher following the taper period.
Such findings may be the result of a decreased glycolysis due to depleted glycogen
stores which have been observed following heavy training (see section above).
In contrast, Shepley et al (1992) observed no significant increases in post-exercise
plasma lactate concentrations following three different tapers (high-intensity, low-
intensity and rest-only) in highly trained runners. Inconsistencies regarding peak
and sub-maximal blood lactate values (see Mujika et al 2004) make it difficult to cat-
egorically state whether lactate is affected by tapering. It may be that changes in
blood lactate are dependent on whether or not athletes are in an over-reached state
prior to the taper phase. The fact that lactate values may be influenced by a taper
period has important implications for the coach and exercise scientist regarding
lactate testing at these times.
PERFORMANCE CHANGES
The improvements in performance following a taper period are associated with phys-
iological, psychological and technical changes that take place over this relatively
short training phase. The following section aims to highlight some of the perform-
ance improvements that have been observed as a result of successful tapering. The
vast majority of the literature investigating performance enhancement through taper-
ing has focused on endurance performance in swimming, running and cycling where
the performance outcome is easily measured by means of time. In contrast, team
and skill based events have received little attention, mainly due to the non-linear
nature of such sports and the difficulties of subjectively measuring performance in
these disciplines.
Trappe et al (2000) demonstrated an improvement of 3–4.7% in swimming times
in a group of highly trained swimmers following a 21-day taper. Unlike some stud-
ies, performance measures were taken from actual competitive races before and after
the taper period. The taper period involved a progressive reduction in training vol-
ume accompanied by an increase in training intensity (80–120% aerobic capacity) in
an attempt to replicate race speeds. Mujika et al (2002a) reported similar results in
swimming race times before (3 weeks) and during the Sydney 2000 Olympic Games,
with performance improvements between 1.1% and 6.0% (mean 2.2%) during the
3-week taper period.
Following a 7-day taper in a group of distance runners where total training vol-
ume was reduced to 15% of previous training volume, Houmard et al (1994) observed
a 3% improvement in 5-km treadmill time. Training during the taper phase con-
sisted mainly of high-intensity, 400-m intervals at 5-km race pace or faster. Mujika
et al (2002b) observed a 2% improvement in competition performance in a group of
800 m runners assigned to a high-frequency taper (training daily) for 6 days. In com-
parison a group that performed a moderate frequency taper (resting every third day)
demonstrated no improvements. These data suggest that training frequency should
also be regarded as an important aspect of tapering together with intensity.
In a simulated 40-km cycling time trial a 4.3% improvement following a 7-day
taper was reported in a group of endurance cyclists whose taper phase involved
maintaining intensity with a progressive reduction in exercise duration (Neary et al
2003a). In the same study the group that maintained exercise duration but progres-
sively reduced exercise intensity demonstrated no improvements. In a shorter time
trial (20 km) a 5.4% improvement in performance was observed in a group of cyclists
whose 7-day taper involved a 50% reduction in baseline training volume with inten-
•
sity maintained at 85% VO2max (Neary et al 2003b). In comparison, two other groups
who reduced training volume to 30 and 80% of baseline, while maintaining the same
intensity, showed no improvements.
In a study investigating the effects of three different tapers (high-intensity, low-
intensity and rest-only), a group of highly trained runners performed a timed run
to exhaustion on a level treadmill at a constant velocity equivalent to each athlete’s
best 1500 m race time (Shepley et al 1992). After the high-intensity taper, running
time to exhaustion increased significantly by 22%, whereas no differences were
observed for the low-intensity or rest-only tapers. This further strengthens the notion
that training intensity is the key variable in terms of a successful taper.
Based on the results of the studies outlined above it may be suggested that per-
formance improvements following an effective taper are generally in the range of
1–6%, but may be as high as 22%. Although the range of 1–6% may seem like a rel-
atively minimal change, such improvements could result in substantial differences
in race placing.
ADDITIONAL CONSIDERATIONS DURING THE TAPER PHASE

Planning of the taper phase should take place well in advanced of the proposed
taper. Care must be taken to avoid ‘panic’ changes during the taper to avoid exces-
sive (or rarely insufficient) training volumes possibly resulting in poor performance.
There are a number of factors that can affect performance in the period immediately
(< 7 days) prior to competition. Two key factors that should be addressed to opti-
mize the taper and resultant performance are travel and nutrition. The following
sections will examine the impact of these two factors on taper and performance and
offer guidelines to optimize performance.
TAPERING AND TRAVEL

International travel for training and competition is a key factor in any tapering
process and there are a number of key areas that need to be addressed to reduce
the impact of travel on subsequent performance.
Prior to travel
The travelling athlete should address any medical issues prior to departure, includ-
ing prescriptions for ongoing medication; the need for immunization; and a dental
check-up. Ensuring that passports are up to date and whether a visa is required to
enter the country of destination will reduce any undue to anxiety and delay at the
airport/port. When flying, the airline should be informed in advance if the athlete
is a vegetarian or has other special dietary requirements.
During travel
Rarely does travel go smoothly. Athletes should be prepared for problems, includ-
ing delays, by taking their own entertainment, for example books/magazines, hand-
held computer games, music. For the journey, athletes should take something
comfortable to change into on long-haul flights and something warm in case the in-
flight temperature drops. Additional food and drinks are important to ensure opti-
mal fluid and food intake while travelling. Alcoholic and caffeinated drinks should
be avoided during travel as these will increase the chances of becoming dehydrated.
Ear plugs and eye masks can assist rest, relaxation and sleep during travel. Eyes
may become sore on long flights if lenses are not removed. Contact lenses should
be removed on long-haul flights to avoid undue discomfort. During long-haul flights
athletes should walk about, stretch and exercise occasionally to avoid ankle oedema.
There may be an increased risk of deep vein thrombosis (DVT) and subsequent pul-
monary embolus following long-haul flights, often termed ‘economy class syndrome’,
associated with long periods of seated inactivity (Brown et al 2001). The risk of DVT
is increased in the elderly and in those using hormonal treatment, such as the oral
contraceptive pill or HRT. A number of airlines now produce literature, available on
flights, giving advice on reducing the side effects of prolonged air travel. Regular
stretching and exercise will reduce this risk of DVT. The ingestion of a paediatric
aspirin (75 mg) may reduce the risk but should not be taken if the athlete has a his-
tory of stomach ulcers and medical advice should be sought if you have a history
of asthma. Wearing support stockings during the flight may also be beneficial (Belcaro
et al 2001).
Travel fatigue and jet lag

There are two key issues that can significantly affect performance when travelling
from home to training and competition venues: travel fatigue and jet lag. Travel
fatigue is characterized by a group of transient negative effects associated with pro-
longed periods of time spent in transit, irrespective of time zone changes. Travel
fatigue generally lasts 1–2 days. Factors associated with travel fatigue include sleep
loss due to early departures and late arrivals; long periods of unusual activity, includ-
ing carrying of heavy bags and equipment; reduced or absent periods of recovery;
and disrupted eating and drinking patterns. Table 3.1 summarizes strategies for deal-
ing with travel fatigue.
When crossing a large number of time zones the body’s natural biological
rhythms (circadian rhythms) are disrupted, leading to a condition termed ‘jet lag’.
Jet lag is simply a lack of synchrony between the body clock and the outside
world (Reilly et al 1997, Waterhouse et al 1992). In addition to a general feeling
of fatigue, symptoms of jet lag include loss of concentration, loss of appetite,
headache, dizziness, nausea and constipation. A decline in performance of activ-
ities involving complex mental activity, reduced hand grip and leg strength,
reduced maximum performance, and a general loss of motivation, are observed
in athletes in the short-term following multiple time zone changes (Reilly et al
1997, Reilly & Mellor 1988).
It may be some days before the body adapts to the new cycle of day and night,
depending on the number of time zones crossed. Arriving well in advance of com-
petition will allow time to fully adjust to the new time zone and reduce the impact
of jet lag on performance. In order to fully adjust, 1 day for every 1 hour time zone
change is optimal.
There are a number of strategies that can be employed to reduce the impact of
jet lag. Pharmacological interventions including sleeping pills and melatonin have
been used successfully to accelerate recovery from jet lag. The most important fac-
tor controlling circadian rhythms are the light–dark cycle and the associated release
of melatonin by the pineal gland (Arendt 1992) during the hours of darkness.
Ingestion of melatonin can also advance or delay the body clock, according to the
time of ingestion (Lewy et al 1998); however, melatonin is not licensed or available
in the United Kingdom. The British Olympic Association Acclimatization Working
Party advises great caution in the use of drugs such as hypnotics (sleeping pills) or
melatonin to help overcome jet lag (Reilly et al 1998). Caffeine, which has recently
Table 3.1 Check list for travel fatigue (based on: Waterhouse J et al 1992 The
stress of travel. Journal of Sports Science 22:946–966)
Symptoms
Fatigue
Disorientation
Headaches
Causes
Disruption of normal routine
Hassles associated with travel (checking in/baggage claim/customs clearance)
Dehydration due to dry cabin air
Restricted movement
Advice
Before the journey:
Plan the journey well in advance
Try to arrange for any stop-over to be comfortable
Make sure about documentation, inoculations, visas
Make arrangements at your destination
On the plane:
Drink plenty of water or fruit juice (rather than tea/coffee/alcohol)
Perform stretching and isometric exercises if possible
Sleep only if it is night at the destination; if not, read, watch the movie or listen to music
On reaching the destination:
Take a brief nap, if required
Take a shower
Relax with a non-alcoholic drink
been removed from the World Anti-Doping Authority (WADA) list of banned sub-
stances, has been employed to enhance alertness following long-haul flights, and
studies suggest that caffeine enhances grip strength following long-haul flights
(Lagarde et al 2001). Caution is warranted, however, as these drugs have unpre-
dictable effects and may result in a slowing of the adjustment to the new time zone.
There are a number of practical strategies that can be used to accelerate the recov-
ery from jet lag (see Table 3.2). Adapting to the local time immediately on arrival
and adopting a local sleep/wake pattern and meal time schedule can accelerate the
recovery from jet lag. Avoiding prolonged (>1 hour) daytime napping and large
meals and caffeinated beverages late at night can assist with quality of sleep. The
circadian rhythm is set by alternating periods of light and dark. Therefore, staying
in daylight or bright artificial light during the day and maintaining a darkened room
during sleeping hours will help to accelerate recovery from jet lag.
Training intensity and duration should be reduced for the first few days follow-
ing travel across multiple time zones. Reduced levels of performance should be antici-
pated by the coach as well as the athlete during the period of adjustment.
The effects of travel fatigue and jet lag can have a profound effect upon perform-
ance. The main objective for the travelling athlete is to reduce the stress of travel and
promote rapid adjustment of the body clock to the new time zone. A successful taper
is more likely to be achieved by eliminating/minimizing the impact of travel.
Table 3.2 Check list for dealing with jet lag (based on: Waterhouse J et al 1992
The stress of travel. Journal of Sports Science 22:946–966)
1. Check to see whether the journey is across sufficient time zones for jet lag to be a
problem. If it is not, then it is necessary only to refer to advice on overcoming travel
fatigue (Table 3.1)
2. If jet lag is likely, then consider whether the stay is too short for adjustment of the
body clock to take place (a stay of less than 3 days). If it is too short, then remain on
home time, and attempt to arrange sleep and activities to coincide with this as much
as possible
3. If the stay is not too short (3 days or more) and it is wished to promote adjustment,
then consider ways of reducing jet lag. Advice relates to: before, during and after the
flight. The most important advice relates to after the flight
4. Advice for promoting adjustment concentrates on: sleep and melatonin; exposure to,
and avoidance of, bright light; behavioral factors
CARBOHYDRATE LOADING (GLYCOGEN SUPERCOMPENSATION)

Previous sections in this chapter have demonstrated an increase in muscle glycogen
stores following the taper phase. Because of the importance of glycogen during exer-
cise a considerable amount of research has been conducted examining techniques
to further increase muscle glycogen stores prior to exercise and examine the impact
on performance. As a result, several carbohydrate loading regimes have been
developed since the late 1960s to enable athletes to store supranormal amounts of
muscle glycogen, ‘glycogen supercompensation’. The original protocol proposed
by Bergstom et al (1967) involves a 6-day period divided into two 3-day periods.
During the first 3-day period the athlete is required to undertake two episodes of
glycogen-depleting exercise separated by 3 days whilst on a high-fat/low-carbohydrate
(CHO) diet. During the following 3-day period the athlete reduces training as part
of a normal taper (see above), and increased CHO intake to about 70–80% of total
energy intake. Early findings suggested that this regime resulted in significantly
elevated muscle glycogen concentrations and improved performance in time trials
lasting longer than 90 minutes (Hawley et al 1997). Sherman et al (1981) proposed
a modification to this protocol whereby the athlete consumed a low CHO diet, equat-
ing to 50% of total energy intake for 3 days, followed by 3 days of high CHO,
equating to 70–80% of total energy intake, in the absence of glycogen-depleting
exercise. This regime was as successful in increasing muscle glycogen stores and en-
hancing prolonged (> 90 minutes) endurance performance. Further, this modified
protocol was better accepted by athletes and coaches as it did not require glycogen-
depleting exercise during the taper phase. Subsequently, this protocol has been
modified to a 3-day protocol eliminating the initial 3 days with similar results (Hawley
et al 1997).
A number of recent attempts have been made to reduce the period required to
induce supranormal muscle stores of glycogen. Fairchild et al (2002) proposed a 1-day
protocol that included a near-maximal intensity episode of exercise (150 seconds at
•
130% VO2max followed by 30 seconds of all out cycling) followed by a 24-hour period
of high CHO ingestion (10.3 g.kg−1.day−1). Results from this study demonstrated
significantly increased levels of muscle glycogen. Care is warranted, however, as few
athletes or coaches are willing to exercise for 3 minutes at near-maximal intensities
on the day prior to competition. As such, the use of high-intensity exercise to induce
glycogen supercompensation in the final stages of a taper are unlikely to be of
practical use.
A recent study examining the time course of muscle glycogen supercompensa-
tion employed the 3-day protocol of increased CHO intake combined with a taper
(Bussau et al 2002). Endurance-trained male athletes consumed a high-CHO diet
(10 g.kg−1.day−1) for 3 days while remaining physically inactive. Results demonstrated
that muscle glycogen content was significantly increased after 1 day of the high-
CHO diet and remained stable over the following 2 days. These data suggest that
a single day of a high-CHO diet may be sufficient to induce muscle glycogen super-
compensation.
Glycogen loading can increase muscle glycogen stores to levels of 160–200
mmol.kg−1 wet muscle mass. In order to achieve these levels the ingestion of 8–10
g.kg−1.day−1 of CHO is required, accounting for 70–80% of total energy intake (Ivy
1991). The observed increase in muscle glycogen content appears to persist for at
least 3 days in resting athletes when a moderate-CHO diet (60% of total energy
intake) is consumed (Goforth et al 1997).
During exercise women tend to use greater levels of lipids as a substrate for
energy production. Observed gender differences may be due to differences in the
distribution and/or activation of α- and β-adrenergic receptors, aerobic capacity
and/or fitness level, exercise intensity, and lack of sufficient ingestion of CHO prior
to exercise. It appears, however, that it is likely to be endocrine differences, and in
particular the female sex hormone 17-β-estradiol that mediates the gender differ-
ences observed (Tarnapolsky et al 2001).
The increased reliance on lipids during exercise led to the suggestion that CHO
loading would be less effective in female compared with male athletes. A number
of studies support this contention, reporting no increases in muscle glycogen con-
tent or performance enhancement in response to CHO loading in highly trained
female athletes (Andrews et al 2003). Two key factors underpinning the absence of
improvement in muscle glycogen content and performance observed in these stud-
ies, however, are the phase of the menstrual cycle and quantity of CHO consumed
during the loading period.
The menstrual cycle phase appears to be a critical factor in the efficacy of car-
bohydrate loading. The rate of glycogen re-synthesis is greater during the luteal
phase compared with the follicular phase. In particular, glycogen loading during the
5–10 days following the first day of menses reduces the impact of gonadotrophic
hormones and enhances glycogen loading. Thus, the equivocal findings reported
from studies examining female athletes are probably due to testing during the fol-
licular phase of the menstrual cycle (Andrews et al 2003). In addition to menstrual
cycle phase, insufficient quantities of CHO (<8.0 g.kg−1.day−1) are often ingested
by female athletes in studies reporting no changes in muscle glycogen content
and performance enhancement following glycogen loading (Andrews et al 2003).
Indeed, in those studies conducted during the luteal phase with CHO consumption
<8.0 g.kg−1.day−1 female athletes exhibited similar levels of muscle glycogen and per-
formance enhancement to their male counterparts (Tarnapolsky et al 2001).
It is generally accepted that increasing muscle glycogen content to supranormal
levels is only valuable for sub-maximal endurance exercise lasting longer than
90 minutes, with improvements in performance of up to 20% (Hawley et al
1997). Indeed, the majority of studies examining short duration (<5 minutes) high-
intensity exercise, and moderate-intensity exercise lasting 60–90 minutes have failed
to demonstrate performance gains following glycogen loading. A small number of
studies, however, examining the role of carbohydrate loading on short duration, high-
intensity exercise have reported improved performances (Pizza et al 1995). Therefore,
in addition to sub-maximal exercise lasting longer than 90 minutes, the nature of
exercise observed in team games, with intermittent, high-intensity efforts over a pro-
longed period of time (>60 minutes), may lend itself to a CHO-loading regime.
As with all forms of training, the use of glycogen supercompensation should be
carefully planned prior to the taper phase. Previous studies have demonstrated that
specific instructions and knowledge of food compositions are required if athletes are
to attain the required CHO intake to optimize muscle glycogen stores. The role of
the performance nutritionist in this process is fundamental.
SUMMARY
It should be noted that there is a significant psychological and technical component
to successful athletic performance following a taper, and that not all of the perform-
ance improvements highlighted above are purely physiological. There is no doubt
that psychological peaking can have an influence on performance (Hooper et al 1999)
and coaches, athletes and exercise physiologists alike should take note of this.
Despite the recent scientific advances in this area, there still remain a number of
physiological adaptations to tapering and their performance implications that are
yet to be addressed. What is clear, however, is that there are significant perform-
ance gains to be achieved by incorporating taper periods into training programmes.
Tapering will remain a subtle and complex technique that requires precise planning,
monitoring and evaluation. A number of key components to successful tapers are
now becoming better understood. Table 3.3 summarizes the components of optimal
tapering strategies that may help increase the chances of achieving peak perform-
ance. Training intensity appears to be a key ‘ingredient’ for effective tapering and
should either be maintained or increased during the taper, together with a decrease
in training volume so as to allow for sufficient rest and recovery. The primary goal
of the taper should be to minimize accumulated fatigue from the previous training
phase rather than achieve additional physiological adaptations. It should always be
remembered that training is individual-specific and therefore the duration and type
of taper will depend largely on the individual athlete as well as on the nature of
the sport.
Table 3.3 Summary of optimal tapering strategies

Ensure precise planning and monitoring
Maintain or increase training intensity to greater than or equal to competition intensity
(i.e. 80–100%)
Reduce training volume by 60–90%
Maintain training frequency at > 80%
Employ exponential taper designs between 4 and 28 days
Increase recovery between sets and/or reps
Ensure that training is race/event-specific
Remember to optimize psychological and technical aspects
Individualize taper programmes whenever possible
Perform post-competition evaluation/assessments so as to inform future tapering
strategies
Although much of the scientific literature regarding tapering is traditionally asso-

ciated with endurance sports such as swimming, cycling and running there is no
reason why such a technique should not be practiced within other sports such as
those that are team, skill or strength based. The physiological adaptations that occur
as a result of the taper phase including increases in glycogen stores and strength
and power will be beneficial to a wide range of sports. The use of nutritional strate-
gies to further increase glycogen storage (glycogen supercompensation) may also be
of value for a number of sports and should be considered as part of the taper phase.
Finally, it should be noted that a number of external factors can affect the taper
period which, if not controlled for, can negatively affect performance. This is par-
ticularly true for long-haul flights and when competition takes place in unfamiliar
environments such as in the heat, cold or at altitude (see Ch. 8).
KEY POINTS
1. Tapering is a specialized exercise training technique designed to reverse training-
induced fatigue without a loss of the training adaptations.
2. A successful taper phase requires careful planning and should aim to optimize
all the determinants of performance at a single point in time.
3. There are four types of taper: fast and slow exponential taper, linear taper and
step taper.
•
4. Physiological adaptations during a taper include an increase in VO2max, type II
fibre size and glycolytic enzyme function, muscle glycogen content, strength and
power, and performance.
5. External factors, including travel fatigue and jet lag, can have profound effects
on an effective taper.
6. Nutritional interventions, including glycogen supercompensation, during the
taper increase muscle glycogen content and may enhance performance.
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Reilly T, Williams M 2002 Science and soccer. Routledge, London
61
Chapter 4
The physiology of endurance
training
Robert Shave and Andrew Franco
CHAPTER CONTENTS
Learning objectives: 61 Fat mobilization 70
Introduction 62 Thermoregulation 70
Maximal oxygen uptake 62 Development of neuromuscular
Lactate threshold 63 patterns 71
Economy 64
The physiology of moderate-duration,
Fractional utilization 64
high-intensity (lactate threshold)
Fuel supply 64
training 71
Training for endurance
The physiology of high-intensity-interval
performance 66
training (HIT) 74
Training intensity 66
Strength training for endurance
Long slow distance (LSD) 66 performance 76
Moderate-duration, high-intensity Flexibility 78
training (threshold training) 67 What percentage of training should
Short-duration, very-high-intensity be devoted to each type
training 67 of training? 79
Resistance training 67 General summary 80
Flexibility 68 Key points 81
The physiology of long slow References 82
distance (LSD) training 68 Further reading 83
Blood volume 68
Mitochondrial size and density 70
1. Gains an understanding of the physiological determinants of endurance per-
formance.
2. Gains an appreciation of the various training modalities that endurance athletes
may use.
3. Gains an understanding of the physiological adaptations that occur in response
to the different training modalities employed by endurance athletes.
4. Understands the multi-factorial nature of endurance training.
5. Appreciates that differences exist between highly trained and sedentary individ-
uals in terms of physiological adaptations to training.
6. Appreciates the need for individually tailored training programmes.
INTRODUCTION
At the outset of this chapter it is appropriate to define what is meant by endurance
performance. A continuum of performance exists with ultra-endurance exercise
(such as the Ironman triathlon) at one end and very rapid sprint events (such as
the 100 m sprint) at the other. Between these two extremes there is a myriad of
events within the sporting field whose energy requirements are met by different
contributions of the anaerobic and aerobic energy pathways. For the purposes of
this chapter, endurance performance will be defined as continuous activity beyond
5 minutes, but less than 4 hours, in duration. Events shorter than this depend largely
upon the anaerobic re-synthesis of ATP (see Ch. 5). While ultra-endurance events
such as those lasting longer than 5 hours are likely to be affected by additional
athlete-specific factors, including nutrition and psychological state, and, as such,
aerobic endurance may not be the principal determinant of performance. From this
definition it is clear that endurance performance covers a wide variety of events
ranging from competitive rowing (~6 minutes) through to marathon competitions
(~2–3 hours), and beyond to some cycle stage races (~4 hours). Although the dura-
tion of these events is different the predominant source of ATP is via aerobic
processes, and thus much of the endurance training completed by these athletes is
comparable in nature.
Many researchers to date have attempted to identify the specific physiological
determinants of endurance performance (Ingham et al 2002). In a similar fashion,
coaches and athletes have endeavoured, largely through a process of trial and error,
to identify appropriate training techniques to elicit the greatest improvements in per-
formance. The purpose of this chapter is to examine these two aspects of endurance
performance by addressing the physiological determinants of endurance perform-
ance and the optimum training techniques to enhance these physiological attributes.
To date, much of the research examining aerobic endurance has employed seden-
tary or moderately active individuals. Recent studies, however, have attempted to
examine the impact of different training techniques upon aerobic endurance in highly
trained individuals. Wherever possible the information presented in this chapter will
be drawn from the literature examining the highly trained athlete.
A large number of studies have examined the relationship between a variety of
physiological variables and endurance performance. Authors have contended that
certain physiological factors may be of greater importance than others; however, it
is clear from the literature that endurance performance is not governed by a single
physiological variable. Rather, endurance performance is dependent upon a number
of variables all of which display varying degrees of trainability. Maximal oxygen
•
uptake (VO2max), lactate threshold, economy, fractional utilization and fuel supply
all affect endurance performance (see Fig. 4.1). Discussion of each of these variables
is provided in the following chapter prior to investigation of how they may be specif-
ically targeted through training.
MAXIMAL OXYGEN UPTAKE

•
Maximal oxygen uptake (VO2max) may be defined as the highest rate at which
oxygen can be extracted, transported and consumed in the process of aerobic ATP
The physiology of endurance training 63
Competition pace
Rate of aerobic energy

Economy
expenditure during competition
(V· O2/pace)
(competition V· O2)
V· O2max Sustainable % V· O2max

(maximal aerobic power) (fractional utilization)
Lactate threshold
Figure 4.1 Physiological model outlining the major physiological determinants of

endurance performance.
•
synthesis. Typically, VO2max is expressed in millilitres of oxygen per kilogram of
body
•
weight per unit of time (i.e. mL.kg−1.min−1). Numerous studies suggest that
VO2max is highly related to endurance performance. It should be noted, however,
that these relationships are based largely upon the study of heterogeneous samples,
•
and when the relationship between VO2max and marathon performance is exam-
ined within a homogeneous group of highly trained runners (with similar per-
•
formance times) there appears to be little relationship between VO2max and
•
performance. Despite the observed lack of relationship between VO2max and per-
•
formance, however, it is clear that a well developed aerobic capacity (VO2max) is a
prerequisite for endurance performance. It would appear, however, that physiolog-
•
ical parameters other than VO2max may be more important in determining endurance
performance, especially within truly elite individuals.
LACTATE THRESHOLD
It is well recognized that an exercise intensity exists beyond which muscle glycogeno-
lysis is markedly increased, thus facilitating the exponential accumulation of lactate
within the active muscles and blood (Coyle 1995). Numerous terms have been used
to describe this phenomenon, including lactate threshold (LT), anaerobic threshold
and ‘onset of blood lactate accumulation’ (OBLA). Discussion regarding the correct
definition persists; further, scientists have also proposed many methods and exercise
protocols of identifying the specific point at which blood lactate begins to accumu-
late. Some have gone so far as to suggest the use of a fixed blood lactate concentra-
tion to represent the point of accumulation. Typically, LT (as the phenomenon will
•
be referred to within this chapter) is defined as a speed, heart rate, or %VO2max rel-
ative to the point of lactate accumulation. Despite the contention surrounding lactate
threshold, its definition, and its measurement, it is clear that a strong relationship
exists between LT and endurance performance. Sjodin & Svedenhag (1985) reported
correlations between 0.88 and 0.99 for the relationship between LT and performance
times in endurance events of varying durations. Further, studies examining marathon
running suggest that the speed associated with LT closely equates to the natural race
pace selected by marathon runners.
ECONOMY
Exercise economy can be defined as the oxygen uptake required to produce a spe-
cific power output or speed. Considerable variations in exercise economy exist
between individuals, even in athletes with comparable aerobic capacities. An
•
improvement in exercise economy manifest by a lower VO2 for the same absolute
power output or speed is advantageous to endurance performance, as it will result
•
in a lower percentage of VO2max being utilized during exercise. Further, in relation
•
to a lower percentage of VO2max, greater economy is also associated with a lower
rate of fuel consumption for a given speed or power output. Thus, improving exer-
cise economy will preserve glycogen stores during endurance performance, favour-
ing the more economical athlete. Although improved exercise economy may result
•
in improved performance, in a similar fashion to VO2max, groups of highly trained
individuals with similar performance times exhibit different exercise economies.
Economy is velocity/power output specific and highly trained athletes will exhibit
high levels of economy at their specialist race distance. It is noteworthy that ath-
letes who participate in long-duration events tend to possess better exercise econ-
omy at slower velocities than athletes who partake in shorter duration endurance
events who posses better economy at higher velocities (e.g. marathon versus 5-km
runners).
FRACTIONAL UTILIZATION
•
Fractional utilization refers to the percentage of VO2max that an athlete can sustain
while exercising at race pace, and is dependent upon both the training status and
the exercise duration. Figure 4.2 demonstrates the relationship between fractional
utilization, exercise duration and training status (Bassett & Howley 2000).
•
Running velocity at VO2max closely corresponds to the velocity that an elite run-
ner can sustain for 3000 m (approximately 8 minutes). Given that most endurance
events last longer than 8 minutes, the majority of endurance athletes are required
•
to work at an intensity below their VO2max. In reality, during competition athletes
perform at the highest possible power output, this being the maximal exercise inten-
sity that does not result in the debilitating effects associated with the accumulation
of metabolic waste products. Fractional utilization is therefore dependent upon the
•
%VO2max associated with LT. Within highly trained athletes who have largely max-
•
imized their VO2max, improving fractional utilization is critical in improving per-
formance. A highly trained individual may demonstrate a fractional utilization of
•
approximately 85% of VO2max while an untrained individual may be able to sus-
•
tain only 50% VO2max.
FUEL SUPPLY
Prolonged endurance exercise requires substantial expenditure of energy. Estimates
of total energy requirement for a marathon range from 9000 to 12 000 kJ. During
high-intensity exercise, muscle glycogen is utilized more readily than blood glucose
and fatty acids, and is therefore preferentially used to generate the required energy.
100 Maximal aerobic power
90
80
Oxygen uptake, % of maximum
70
60
50 Capacity for prolonged work Well trained
40
30
Untrained
20
10
0
0 1 2 3 4 5 6 7 8
Hours
•
Figure 4.2 Percentage of VO2max that can be sustained for different durations of exercise
pre- and post-training (Bassett & Howley 2000).
With training, however, athletes can improve their ability to oxidize fats at sub-
maximal exercise intensities. Thus, highly trained athletes develop the physiologi-
cal ability to spare muscle glycogen during prolonged exercise. The increased reliance
on fat metabolism subsequent to training results in the delayed onset of fatigue asso-
ciated with the depletion of glycogen stores. In practical terms, the ability to spare
glycogen during performance enhances glycogen availability towards the end of an
endurance event when an increase in exercise intensity (the sprint finish) may be
critical to success.
All of the physiological variables discussed above will affect endurance per-
formance; furthermore, they all demonstrate degrees of trainability. Coaches, ath-
letes and support scientists aim to design training programmes to capitalize on an
athlete’s strengths and ameliorate the physiological weaknesses. Training modalities
may be employed to specifically target certain physiological parameters; however,
it is more likely that a training programme will be devised to employ numerous dif-
ferent training modalities, resulting in the adaptation of a number of the physio-
logical determinants of endurance performance. In light of this typical training
approach, researchers examining elite athletes have struggled to delineate the dif-
ferent physiological adaptations to the various training modalities employed.
The concept of training specificity was addressed earlier within this text (see Ch. 2),
and although specificity needs to be at the forefront when considering training
programmes, coaches and athletes should be cognisant of supplementary training
sessions that initially may not appear to comply with specificity. Hence, specificity
does not mean that all training should be completed at race pace. It should be remem-
bered that each of the physiological determinants of endurance performance are
multi-factorial, and thus require multiple stimuli to manifest the desired adaptations.
Accordingly, aerobic, anaerobic, interval, strength, power, speed and flexibility train-
ing all have a place within a well designed training programme of an endurance
athlete.
TRAINING FOR ENDURANCE PERFORMANCE
Training intensity
Over the years different sports have adopted different definitions and terminology
to categorize the various types of training employed within a training programme.
For example, rowing has adopted a scheme that includes five different training zones,
based largely on the blood lactate response to progressively harder exercise inten-
sities (see Table 4.1).
Much discussion has occurred, and debate still continues, regarding the defini-
tion and number of training zones, the terminology used, the physiological mark-
ers that should be assessed while monitoring training intensity and the appropriate
periodization of training zones. Many sports have attempted to identify training
zones in a very similar fashion to that described for rowing. On inspection of the
scientific literature, however, it is apparent that this process may be a little opti-
mistic. Wide-reaching review articles (Pate & Branch 1992) broadly categorize train-
ing associated with endurance performance into three distinct zones:
● Long slow distance;
● Moderate-duration, high-intensity training;
● Short-duration, very high-intensity training.
In addition to the basic training zones, a proportion of an endurance athlete’s
time will be devoted to strength training and flexibility. The following sections of
this chapter aim to examine each of these training methods in turn, and to assess
the physiological impact and importance associated with each specific training
modality. In the first instance, however, a brief overview of each of the training
modalities is presented.
LONG SLOW DISTANCE (LSD)

Prolonged bouts of moderately intense exercise have become the staple training
modality for the vast majority of athletes competing in a variety of endurance sports,
and normally provide the largest volume to any training programme. Typical LSD
sessions require the athlete to train for between 60 and 120 minutes at an intensity
•
that equates to approximately 60–70% VO2max. Such exercise intensity probably
results in a minimal blood lactate concentration well below that observed during
competition, and certainly represents an intensity well below that which would be
considered ‘race pace’.
Table 4.1 The system of training prescription that has been adopted by the sport
of rowing
Heart rate Blood lactate
Code Name reserve (%) (mmol/L)
UT2 Basic oxygen utilization training 59–67 0–2

UT1 Oxygen utilization training 67–75 2–3.5
AT Anaerobic threshold training 75–85 3.6–4.5
TR Oxygen transport training 85–100 4.5–6
AC Anaerobic capacity training >6
MODERATE-DURATION, HIGH-INTENSITY TRAINING

(THRESHOLD TRAINING)
This type of training has typically been performed around an individual’s lactate
threshold (LT). Much discussion has taken place regarding the concept of LT: how
it may be defined, the appropriate protocols to employ in order to assess LT, and
even whether a threshold exists. For a comprehensive review of the LT concept read-
ers are directed to the work of Bourdon (2000). For clarity it is, however, pertinent
to understand some of the definitions employed in the literature to describe lactate
breakpoints. The term ‘lactate threshold’ has been used to describe a number of dis-
tinct physiological phenomena; for example, a non-linear increase in blood lactate
of at least 1 mmol/L (Coyle 1995), a workload preceding a non-linear rise in blood
lactate during progressive exercise (Ivy et al 1980), or, the point of deflection in the
•
logged blood lactate versus logged VO2 transformation (Beaver et al 1985). In effect,
all of these definitions attempt to identify the workload at which there is a sustained
increase in blood lactate above baseline values. In recent times this point has also
been referred to as lactate breakpoint 1. Further along the lactate transition curve
associated with incremental exercise a second breakpoint may also be identified.
This second point relates to the workload at which blood lactate begins to rapidly
accumulate, and as such represents the highest work intensity that blood lactate can
equilibrate. This breakpoint has also been defined by a number of terms; Kindermann
et al (1979) suggested that this point represented the anaerobic threshold (AT) and
was demonstrated by the steep part of the exponential increase in blood lactate con-
centration. The onset of blood lactate accumulation (OBLA) has also been used within
the literature (Sjodin & Jacobs 1981), as has a fixed blood lactate concentration of
4 mmol/L, and the term maximum lactate steady state. Although discussion of
appropriate definition and terminology persists, the concept of lactate breakpoints
and their identification is central to many scientific support programmes.
Notwithstanding the contentious issues surrounding LT, a training zone appears
to exist that coincides with a number of the suggested definitions of LT, which is
sensitive to training and results in improved performance. This type of training is
performed at an intensity that equates to the point at which blood lactate begins to
rise exponentially, and typically lasts in the region of 30–60 minutes.
SHORT-DURATION, VERY-HIGH-INTENSITY TRAINING

High-intensity-interval training (HIT) involves periods of intense exercise inter-
spersed with periods of recovery. Exercise intensity is typically above an athlete’s
•
VO2max, and due to the intense nature of this training modality, the duration of
the repetitions is relatively short (30 seconds to 5 minutes), with rest intervals typ-
ically lasting 15–120 seconds. Coaches attempt to optimize the training stimulus
via manipulation of the duration and intensity of both the repetition and recov-
ery phase. Such optimization depends upon the specific event in which the athlete
performs.
RESISTANCE TRAINING
The umbrella term of resistance training encompasses a number of different train-
ing techniques (e.g. weight training and power training). Typically, however, weight
training involves exercises performed against a resistance to enhance strength and
muscular endurance. Exercises are usually split into repetitions and sets and are
separated by periods of recovery. Similar to HIT, optimization of weight training

sessions is dependent upon the manipulation of the training stimulus via weight,
sets, repetitions and recovery. The period within the athletes training cycle, the ath-
lete’s specific event and the ultimate goal of the training session will influence the
design of the resistance sessions (see Ch. 7). Plyometric exercises may also be included
within this subset of training modalities, which typically involves bounding and
jumping-type exercises, emphasizing the speed of movement and limited ground
contact time principally used in the development of power (see Ch. 6).
FLEXIBILITY
Athletes devote considerable time to improving and maintaining their flexibility.
Flexibility may be defined as the ability to move a joint smoothly through its entire
range of motion. It has been suggested that improved flexibility reduces the risk of
injury and enhances the economy of movement, and thus may facilitate an improved
performance. While there are obvious benefits for improving flexibility in certain
sports, such as gymnastics, the performance benefits of increased flexibility in
endurance sport are less clear. A limited number of studies have examined the rela-
tionship between flexibility and performance; those that exist will be discussed later
in this chapter.
THE PHYSIOLOGY OF LONG SLOW DISTANCE

(LSD) TRAINING
Typical LSD training sessions are performed at very conservative intensities (< 70%
•
VO2max), for prolonged periods of time that greatly exceed the duration of exercise
performed during competition. Because of the mismatch between performance and
LSD training it is often difficult to reconcile the reliance upon this type of training
with the ‘cornerstone’ training principle of specificity.
Closer inspection of the physiological adaptations associated with LSD training,
and a re-examination of the determinants of endurance performance reveal a num-
ber of adaptations associated with LSD training that are critical in the improvement
of endurance performance. LSD training facilitates the adaptation of a number of
physiological variables – including blood volume, mitochondrial size and density,
fat mobilization, the ability to thermoregulate and the development of neuromus-
cular patterns. In addition, LSD training may benefit the athlete via the develop-
ment of muscular endurance in the supporting musculature, and assist in preparing
both psychological and nutritional strategies. A further benefit associated with LSD
training is that although the volume of training is high, the forces placed upon the
musculoskeletal system are relatively low. Due to this relatively modest intensity,
athletes are able to complete a large volume of modality specific training while
minimizing the risk of overuse or high-impact injuries.
Blood volume
Much data has been generated examining the impact of training upon blood vol-
ume (BV). Cross-sectional studies have demonstrated a 20–25% greater BV in
endurance athletes when compared to their sedentary counterparts. The observed
increases in BV occur independently of sex and age (Convertino 1991). Longitudinal
studies, however, suggest that endurance training may lead to a more conservative
rise in BV of 7%. Methodological issues might explain the discrepancies between
cross-sectional and longitudinal studies, specifically the training status of the par-
ticipants studied. Young trained individuals with already relatively well developed
BVs do not appear to be able to further enhance BV. Thus, BV expansion subsequent
to LSD training may be limited by training status, or even by genetic endowment.
The expansion of BV observed during endurance training involves an initial increase
in plasma volume within the first 10 days of the training programme. The prolifera-
tion of red blood cells lags behind the preliminary increase in plasma volume and
may not rise appreciably until 4 weeks of training have been completed. Convertino
et al (1980) report an 8% increase in BV following 8 consecutive days of LSD training
•
(2 hours at 65% VO2max). The observed hypervolaemia in this study was a function
of a 12% increase in plasma volume and no change in red cell volume. Data from the
same study demonstrated that plasma osmolality and protein concentration also
remained constant, hence, homeostatic control of both the osmotic gradient and elec-
trochemical properties of fluids within the vascular space appears to be effective in
maintaining a normal functional physiological environment. The rapid increase in BV
in response to endurance training is matched by an equally rapid return to baseline
values following 7 days of de-training. Such a rapid return demonstrates the impor-
tance of maintaining the training stimulus in order to sustain an enhanced BV.
Blood volume expansion appears to be related to an initial protein and fluid shift
from the extravascular to the intravascular space followed by a sustained increase
in total body water. This two-phase process results in an increased blood volume
while also maintaining interstitial fluid, which is critical in terms of heat dissipation
via increased sweat gland activity (an additional adaptation to endurance training).
The hypervolaemia associated with endurance training benefits the athlete through
three mechanisms: (i) an enhanced ability to cope with increased thermal stress
(which will be discussed later), (ii) an improved cardiac function and (iii) an increased
oxygen-carrying capacity.
Prolonged engagement in LSD training precipitates an enhanced stroke volume
and a concomitant bradycardia, both of which probably occur as a function of the
hypervolaemia propagated by endurance training. Studies have reported a 1% reduc-
tion in exercise heart rate with every 1% increase in plasma volume (Convertino
1991). Such adaptations in heart rate and stroke volume may be explained by the
Frank-Starling mechanism. Hypervolaemia leads to an enhanced central venous pres-
sure both at rest and during exercise, hence, end diastolic volume is increased (car-
diac preload). It is this increase in cardiac preload that will augment stroke volume
via the Frank-Starling mechanism. A greater stroke volume will result in a lower
heart rate for the same absolute workload. If we remember that cardiac output (Q)
is the product of heart rate and stroke volume (Q = HR * SV), the mechanisms for
a reduction in heart rate at sub-maximal exercise subsequent to a training induced
hypervolaemia becomes clear. During maximal exercise, an augmented blood vol-
ume results in an increased maximal cardiac output (Qmax). As cardiac output is a
• •
major factor in determining VO2max (VO2max = Qmax * a-vO2diff max) any improve-
ment in Qmax will probably result in an augmented maximal aerobic capacity.
In addition to the increased SV and resultant Qmax following a prolonged LSD
training programme, the absolute haemoglobin concentration is also enhanced. As
already stated, the increase in red blood cell mass is not as immediate as the increase
in plasma volume; however, following prolonged training, an increased oxygen-
carrying capacity is observed concomitant to an improved capacity to remove the
metabolic waste associated with the production of ATP. Capillary density of the
working musculature is also enhanced in response to LSD training. The main advan-
tage associated with an increased capillary density is not an upgrading of blood
flow but rather an increase in the mean transit time. Thus, even at high rates of
blood flow, as observed during intense exercise, oxygen extraction (a-vO2 difference)
at the muscle bed is maintained. Further, during sub-maximal exercise the muscle
may require a lower blood supply for the same absolute workload due to the
enhanced ability to extract oxygen. Results from Tesch and associates (1984) demon-
strate the difference in capillary density between endurance-trained and strength-
trained athletes, endurance athletes demonstrating a 102% greater capillary density
than their strength-trained counterparts. Although the study does not differentiate
LSD training from other forms of endurance training, it does provide evidence for
the differential capilarization between training methods employed by endurance-
and strength-based athletes.
Mitochondrial size and density

LSD training results in an enhanced size and density of mitochondria. Whether this
increase will be apparent in all types of muscle fibre is dependent upon the recruit-
ment of each type of fibre during exercise training. As LSD training probably recruits
predominantly ‘slow-twitch’ type I fibres, it is likely that the greatest improvement
in mitochondrial size and density will be observed within these fibres. Coupled with
an increase in mitochondrial volume is a concomitant increase in the enzymes of
the Krebs cycle, electron transport chain and malate–aspartate shuttle. It is the
increase in these enzymes subsequent to training that facilitates an increased capac-
ity of aerobic re-synthesis of ATP. These adaptations allow the athlete to exercise at
•
a higher percentage of VO2max and hence may promote improvements in endurance
performance. An improved oxidative capacity within type I fibres may delay the
recruitment of type II fibres. Further, type II fibres depending on their recruitment
within training (intensity dependent) may also experience an increased oxidative
capacity. Both of these adaptations will reduce the contribution of anaerobic glyco-
lysis to the total energy yield during endurance exercise and as such enhance fatigue
resistance within the athlete.
Fat mobilization
Muscle glycogen depletion and an increased rate of fat oxidation – both of which
are encountered within endurance performance – are inherent to LSD training.
Prolonged training in a glycogen-depleted state results in an enhanced ability to
both mobilize and subsequently oxidize fatty acids from adipose tissue. Such adap-
tation will result in a sparing of glycogen and ultimately defer the accumulation of
metabolic waste products associated with ATP production from glycolysis.
Thermoregulation
LSD training may also facilitate improvements in performance via adaptations asso-
ciated with improved heat toleration and heat dissipation. A strong relationship
between elevations in core temperature (Tc) and endurance performance has been
demonstrated within the literature (Gonzalez-Alonso et al 1999) and is anecdotally
supported by the vast majority of athletes. An improved capacity to cope with rises
in Tc is probably a function of adaptations associated with LSD training. An enhanced
plasma volume together with improved cutaneous blood flow and an improved
sweat response all assist in the dissipation of heat generated during exercise.
Although true heat acclimatization requires environmental exposure, high-intensity
exercise may promote Tc in excess of 40˚C which, in turn, may facilitate a level of
physiological adaptation. Thus, an improved ability to tolerate rises in Tc may be
the result of a combination of the adaptations to LSD and high-intensity training.
Development of neuromuscular patterns

The development of neuromuscular patterns has also been lauded as a possible ben-
efit derived from LSD training. It should be noted that developing neuromuscular
patterns during low-intensity exercise does not necessarily reflect the neuromuscu-
lar requirements of competition pace. It is, therefore, important that endurance ath-
letes train over a range of intensities so as to facilitate adaptations in the
neuromuscular patterns recruited during race pace activity.
Many of the adaptations observed in response to LSD training plateau relatively
early in an athlete’s career. Subsequent to this plateau any increase in LSD training
volume is unlikely to lead to improvements in performance; a study by Costill et al
(1988) clearly demonstrates this issue. Costill et al (1988) examined a group of highly
trained swimmers, increasing their training distance by approximately 50% for a
period of 10 days while maintaining training intensity over the same period.
Following the increase in training volume no change was observed in either aero-
bic capacity or swim performance (see Ch. 3). A recent meta-analysis suggests that
•
once an athlete has achieved a VO2max of >60 mL.kg.min−1 further improvements
in endurance performance are not related to increases in training volume (Londeree
1997). Thus, simply increasing the volume of LSD training completed by highly
trained individuals does not appear to be productive as further improvements in
either physiological characteristics or endurance performance do not occur.
In light of the limitations associated with LSD training it is essential for endurance
athletes and coaches to diversify the training modalities employed to elicit further
physiological adaptations that will result in an enhanced performance. Fortunately,
the training stimulus required to maintain the positive adaptations brought about
via LSD training is considerably less than that required to initially foster them.
Therefore, time is available within a training programme to employ additional train-
ing techniques to aid athlete development while still being able to sustain the adap-
tations stimulated by LSD work with a minimal number of LSD maintenance sessions
each week.
THE PHYSIOLOGY OF MODERATE-DURATION, HIGH-INTENSITY

(LACTATE THRESHOLD) TRAINING
Moderate-duration high-intensity training may also be referred to as ‘threshold’,
‘tempo’ or ‘pace’ training. As outlined earlier, this type of training is conducted
around an intensity that equates to an athlete’s individual lactate threshold (LT).
Despite the considerable discussion within the literature regarding the appropriate
definition of LT (Bourdon 2000), it is clear from anecdotal case study and empirical
study data that an effective training intensity exists that can be equated with the
concept of a lactate threshold. Further, numerous studies have suggested that LT is
an excellent predictor of endurance performance in both trained and untrained indi-
viduals. It is therefore not surprising that training at an exercise intensity equiva-
lent to LT is related to both favourable physiological adaptations and improvements
in performance.
Threshold training is typically performed at a pace, workload or heart rate similar
to that observed at LT. It is a logical suggestion that improvements in performance
stimulated by this type of training are related to an improved LT and probably an

improved fractional utilization. Improvements in LT are demonstrated by a rightward
shift in the blood lactate/workload relationship (see Fig. 4.3). In practical terms a shift
such as that presented in Figure 4.3 enables the athlete to perform at a higher inten-
sity prior to the onset of the debilitating effects associated with the accumulation of
blood lactate. The example in Figure 4.3 demonstrates an improvement of approxi-
mately 20 W in LT following training.
The prescription of ‘threshold’ training classically involves a training zone that
encompasses workloads just below and just above the LT. Such prescription usually
follows the completion of an incremental exercise test that identifies the power out-
put, speed and/or heart rate associated with LT. For a thorough discussion of the
appropriate means by which to identify LT readers are directed to Bourdon (2000).
Typically, LT tests involve five or six stages of between 3 and 5 minutes. Each stage
is physiologically more demanding than the last (in heavyweight rowing the incre-
ments may represent a 25 W increase in work, in endurance running the stage incre-
ments may equate to a 0.6 km.h−1 increase in running speed, and in cycling 20 W
stage increments are often used). Following completion of each stage a capillary
blood sample is obtained (from the earlobe or finger tip), from which blood lactate
concentration is measured. Heart rate is also recorded (usually taking the mean HR
for the last 30 seconds of each stage) (see Ch. 2). The data harvested during such a
test may be employed to construct a lactate profile similar to that depicted in Figure
4.3. From such a lactate profile it is possible to calculate a training zone (HR or
power output) that equates to LT.
A meta-analysis study completed by Londeree (1997) combined the results of 34
studies that had assessed the impact of training below, above or at an intensity
equivalent to LT. The combined results of the 34 studies enabled Londeree (1997) to
suggest that training at an intensity equivalent to LT is an adequate stimulus to
6 Pre-training
LACTATE (mmol/l)
5 Post-training
4
0
175 185 195 205 215 225 235 245 255 265 275 285 295 305 315
POWER (W)
Figure 4.3 Blood lactate response to an incremental exercise test (in this case the data
applies to an incremental rowing test performed on a Concept II model C ergometer),
pre- and post-training.
improve the LT in sedentary subjects. The combined data, however, revealed that
highly trained individuals require a more intense stimulus to improve LT. It is there-
fore suggested that highly trained individuals perform a significant proportion of
their ‘threshold’ training slightly above the intensity associated with their LT.
The classic rightward shift in the lactate profile observed following a training pro-
gramme incorporating LT training might be explained by one of two physiological
adaptations. Firstly, improvements in LT may be a function of either a reduced rate
of lactate production, an enhanced removal system or indeed a combination of these
two adaptations. It is possible that lactate production may be diminished due to a
lower reliance upon anaerobic glycolysis at the same relative intensity, propagated
by an increased ability to generate ATP via aerobic processes. Such improvements
are possible due to an increased size and density of mitochondria concomitant with
an increase in the key enzymes involved in the Krebs cycle and electron transport
chain. Ultimately, the increase in size and density of mitochondria facilitate a greater
aerobic contribution to energy production, and subsequently reduce the production
of lactate.
An enhanced ability to transport lactate out of the muscle has also been sug-
gested as a possible mechanism for an enhanced performance following training at
LT. The transport of lactate out of the muscle is dependent upon both diffusion
across the cellular membrane, and more importantly the concentration of monocar-
boxylate transporters (MCTs). MCTs are responsible for the facilitated transport of
lactate both into and out of the active muscles. It has been established that the con-
centration of MCTs is enhanced following intensive training, and thus the ability to
remove lactate from the working muscle is enhanced in sedentary individuals fol-
lowing a training programme. Less information is available regarding the effect of
training upon MCTs in already well-trained individuals. A recent study by Evertsen
et al (2001) does, however, provide some insight into the issue. Evertsen et al exam-
ined a group of highly trained cross-country skiers following either 5 months of a
•
moderate intensity training programme (86% training volume 60–70% VO2max, i.e.
predominantly LSD training) or 5 months of a high-intensity training programme
•
(83% training volume at 80–90% VO2max, i.e. predominantly LT training). Results
from this study suggest that 5 months of high-intensity training did not increase the
concentration of MCTs; however, in the moderate intensity group the concentration
of MCT decreased. This suggests that high-intensity exercise (i.e. around LT) is crit-
ical in maintaining the ability to remove lactate from the working muscles. Despite
no change in MCTs, the high-intensity training group demonstrated improvements
in the lactate threshold and running performance. As these improvements could not
be related to an improved efflux capacity of lactate the authors suggest that a reduced
rate of lactate production is the likely mechanism for an improved performance.
Within an untrained population it appears that improvements in performance
subsequent to a period of LT training are associated with improvements in both
the rate of lactate removal and a reduction in lactate production. Within highly
trained athletes, however, LT training may be critical in maintaining the concentra-
tion of MCTs and thus the ability to transport lactate rather than continuously
enhancing the efflux capability. Improvements in performance in highly trained
individuals following LT training may be explained by a lower lactate production,
possibly stimulated by improved aerobic capabilities.
Improvements in endurance performance following LT training may also be asso-
ciated with an enhanced economy. Franch et al (1998) demonstrated a 3% improve-
ment in running economy following the implementation of higher intensity distance
training into previous LSD programmes. Such improvements in economy may be
•
explained by a reduction in submaximal VE, and hence a reduction in the oxygen
cost of breathing. Other mechanisms have also been suggested as possible media-
tors of an enhanced economy subsequent to LT training; conversion of type II fibres
to type I, in addition to a general stiffening of the musculo-tendon apparatus involved
with movement resulting in a greater elastic return.
THE PHYSIOLOGY OF HIGH-INTENSITY-INTERVAL

TRAINING (HIT)
Coaches and endurance athletes have long recognized the importance of high-intensity-
interval training (HIT) in enhancing endurance performance. HIT may be defined
as repeated bouts of short- to moderate-duration exercise (30 seconds to 5 minutes)
completed at a ‘high’ intensity. Recovery between efforts may be active or passive,
but not of sufficient duration to facilitate full recovery. The underpinning rationale
for HIT is to continually stress the specific physiological components employed
within an athlete’s event, above and beyond the level that is required during
competition, in order to bring about adaptation.
Despite the importance attributed to HIT within an endurance programme, the
scientific study of the area has until relatively recently been largely unexplored. In
addition, apart from a few notable exceptions (Acevedo & Goldfarb 1989, Laursen
et al 2002, Stepto et al 1999) the limited work that has been completed in the area
of HIT has employed recreationally active individuals. Thus, scant data are avail-
able regarding the optimization of HIT programmes for highly trained endurance
athletes. The optimum duration, intensity, and recovery periods are presently not
known.
Although scant data are available, the anecdotal and the limited empirical evi-
dence examining highly trained individuals suggest that HIT will result in signifi-
cant improvements in endurance performance. Acevedo & Goldfarb (1989)
demonstrated an increase in 10-km running performance of approximately 3% in
seven highly trained endurance runners following an 8-week programme of HIT at
90–95% peak heart rate. Stepto et al (1999) and Laursen et al (2002) stimulated an
increase in 40-km cycling time trial performance in different groups of highly trained
cyclists using HIT programmes. Although the benefits of HIT are marked, the under-
pinning physiology is not clear.
It is possible that the improvement in endurance performance observed follow-
ing HIT is related to a reduction in carbohydrate oxidation and lactate accumula-
tion at the same absolute intensity. Studies have demonstrated that following a period
of HIT, athletes oxidize carbohydrate and produce lactate at lower rates for the same
absolute workload. When the workload reflects the same relative workload, how-
ever, both carbohydrate oxidation and lactate accumulation are similar. The shift
away from carbohydrate metabolism following HIT in highly trained athletes does
not appear to be related to an increase in mitochondria size and density, such as
that observed following LSD or LT training. Within sedentary individuals, increases
in both oxidative and glycolytic enzyme activity coupled with an increased expres-
sion of type I muscle fibres have been shown following HIT (for a full review see
Laursen & Jenkins 2002). In highly trained individuals, however, this does not appear
to be the case. Weston et al (1997) demonstrated no change in a number of key
oxidative and glycolytic enzymes following six HIT sessions, which consisted of six
to eight, 5-minute repetitions completed at an intensity equivalent to 80% of the sub-
jects peak power output. Despite no change in the subject’s enzymatic capabilities,
significant improvements in 40-km cycling time trial performance and time to exhaus-
tion at 150% peak power were observed. Other studies have demonstrated similar
findings regarding muscle enzyme activity following HIT based around other exer-
cise modalities such as running. Thus, the improvement in performance observed
in highly trained individuals is not explained by the same adaptations observed in
sedentary individuals. Recent studies have attempted to further elucidate the mech-
anisms for such performance improvements following HIT programmes in highly
trained individuals.
Despite well established improvement in endurance performance following HIT
• •
programmes VO2max remains unchanged. The lack of change in VO2max follow-
ing HIT suggests that the improvements in endurance performance subsequent
to HIT are probably not a reflection of central adaptations. Thus, enhanced
endurance performance following HIT may therefore be related to adaptations in
the periphery.
The capacity of skeletal muscle to buffer hydrogen ions (H+) is a likely determi-
nant of endurance performance as demonstrated by the significant relationship pre-
viously observed between buffering capacity and 40-km cycling time trial
performance (Weston et al 1997). A limited number of studies have demonstrated
an enhanced buffering capacity following HIT, for example Weston et al (1997)
observed a 16% increase in buffering capacity in well trained cyclists following HIT.
An enhanced capacity to buffer H+ may enhance performance by abating the nega-
tive influence of H+ upon muscular force production associated with Ca2+ seques-
tration, ATPase activity and cross-bridge formation. Additionally, the inhibition of
key glycolytic enzymes, including phosphofructokinase (PFK) and phosphorylase,
that typically occurs with H+ accumulation may also be reduced following HIT due
to the enhanced buffering capacity leading to a higher glycolytic ATP yield. At pres-
ent the data available regarding HIT, buffering capacity and enhanced endurance
performance are limited, and as such continued scientific study is required to fully
understand this relationship. The data available to date do provide some evidence
that an enhanced buffering capacity might explain some of the improvements in
endurance performance following HIT.
It is also possible that improved endurance performance subsequent to HIT may
also be related to an enhanced heat tolerance. The significant alteration in Tcore
observed during HIT may lead to adaptations in thermoregulation and heat toler-
ance resulting in an improved performance. Psychological factors should also not
be discarded; completing repeated bouts of exercise above that typically performed
in competition is likely to familiarize the athlete with the sensations associated with
maximal exercise and may improve ‘mental toughness’.
While it is widely accepted that HIT is an important component to the training
programme of an endurance athlete, the optimal make up of HIT sessions is far from
clear. The studies of Laursen et al (2002) and Stepto et al (1999) offer some guidance
regarding HIT optimization, but both studies employed highly trained endurance
cyclists and therefore generalizations to other sports are difficult. Stepto et al (1999)
concluded that eight high-intensity intervals of 4-minute duration with 1.5-minute
recovery completed at race pace resulted in the greatest improvement in 40-km time
•
trial performance, while Laursen et al (2002) suggest that power at VO2max (Pmax)
should be used as the exercise intensity, and 60% of time to exhaustion at Pmax
should be employed as the duration of repetition within HIT for highly trained
endurance cyclists. The dearth of scientific knowledge regarding the optimization of
HIT programmes demonstrates a real need for further work. Notwithstanding the
need for additional scientific study, interdisciplinary discussion between coaches, ath-
letes and scientists will probably facilitate the adoption of effective protocols of HIT.
STRENGTH TRAINING FOR ENDURANCE PERFORMANCE

At face value, training for endurance performance and training for improvements
in strength represent different ends of the training spectrum. Endurance training is
typically based around high-volume low-intensity muscular activity, while typical
resistance training involves relatively short duration high-intensity muscular activ-
ity. Further, the muscular adaptations stimulated by the two types of training are
disparate: resistance training stimulates muscular hypertrophy in all types of fibre
(I, IIa and IIb), while endurance training results in a reduction in cross-sectional area
of type II muscle fibres. Little or no change in the activities of phosphagen, gly-
colytic or oxidative enzymes is observed subsequent to resistance training, con-
trasting with the adaptations observed following endurance training. Although the
activities of key enzymes are not altered following resistance training, their con-
centration is reduced due to a dilution effect. Muscular hypertrophy results in a
reduction in the number of mitochondria per unit of muscle. Despite this apparent
disparity between endurance and resistance training, the vast majority of endurance
athletes take part in at least some form of resistance training, and most believe it is
effective in enhancing performance.
The different physiological responses between endurance and resistance training
have prompted the question of their mutual compatibility within the same training
programme. The evidence to date would suggest that taking part in strength and
endurance training concomitantly interferes with the development of strength. For
an in-depth examination of simultaneous strength and endurance training readers
are directed to the work of Tanaka & Swensen (1998). The following section will,
however, examine the influence of strength/resistance training upon endurance
performance.
A wide variety of studies have investigated the use of strength training for
endurance performance. To date, however, the results are equivocal, probably due
to methodological disparities between studies. Tanaka et al (1993) investigated the
influence of a land-based resistance-training programme in 24 highly trained swim-
mers over the course of a competitive season. The swimmers were split into two
groups and matched for both stroke preference and ability. All athletes completed
their swim training collectively; however, one group also engaged in an 8-week
resistance-training programme. The resistance programme was designed specifically
to develop the musculature involved with freestyle swimming using a model of pro-
gressive overload. Following completion of the 8 weeks of resistance training, the
swimmers applied a 2-week taper before competing at their major competition.
Strength testing before and after the 8-week programme revealed a 25–35% increase
in absolute strength. Despite this improvement in absolute strength, swim per-
formance was not increased. The authors concluded that the lack of transfer from
land-based training to the pool might be due to a lack of specificity within the land-
based training.
The influence of resistance training upon endurance performance has also been
examined in cycling. A 12-week programme of combined upper and lower body
resistance training has been shown to be effective in improving cycling time to
exhaustion (Marcinik et al 1991). The use of time-to-exhaustion trials as a surrogate
of endurance performance is questionable, however, as it does not replicate any com-
petitive event and, as such, does not represent a true reflection of the physiological
requirements of endurance performance. Additional cycling studies have demon-
strated improved muscular strength of up to 30% and improved short-term cycling
performance following the inclusion of resistance training programmes alongside
typical endurance training. It should be noted, however, that these data largely per-
tain to previously sedentary groups of individuals. Thus, it is not clear whether these
results can be extrapolated to the elite population. Data from the USA cycling fed-
eration examining an elite population indicates that higher ranked endurance cyclists
tend to have higher anaerobic power outputs than their lower ranked cyclists. A com-
pelling argument may therefore be to suggest that the improvements observed within
the non-elite populations (improved strength, short-term cycling performance) may
facilitate enhanced endurance performance. Such improvements may be rationalized
when the stoichastic nature of competitive cycling is considered, when sprint efforts
and hill climbing can often have a dramatic influence upon success.
Similar to cycling, competitive endurance running also includes periods of intense
effort (sprint finish, hill climbs) that may be enhanced by improvements in muscu-
lar strength and anaerobic power. Studies to date examining endurance runners fol-
lowing the addition of resistance training to their programme have revealed an
enhanced anaerobic capacity, an increased leg strength of 30–40% and improvements
in short-term running performance. These adaptations will probably benefit the
endurance runner through the ability to generate a greater force per stride – enabling
the runner to exercise longer at each sub-maximal work rate by reducing the force
contribution from each active muscle fibre and/or recruiting fewer fibres (Tanaka &
Swensen 1998). It is also possible that strength/power training may result in a stiffer
musculotendinous unit leading to an improved efficiency and decreased oxygen cost
of running (this will be discussed in more detail later in the chapter).
Recent years have seen the development of additional supplemental
strength/power training methods such as plyometrics. It is this form of power train-
ing that is increasingly advocated by strength and conditioning coaches to the elite
endurance population. A recent paper from a Finish group (Paavolainen et al 1999)
examined a number of athletic parameters, including 5-km running time, running
•
economy, maximal 20-m speed, VO2max, and maximal running velocity before and
after 9 weeks of ‘explosive strength training’ in 22 elite male cross-country runners.
The athletes were split into a control group and an experimental group, with each
respective group replacing 3% and 32% of their normal training volume with explo-
sive training. The explosive training involved both basic sprint training and a vari-
ety of plyometric exercises. Significant improvements in 5-km running performance
were observed in the experimental group following the 9-week training programme,
which was not observed within the control group. Previously it may have been sug-
gested that the observed improvements in performance were probably a function of
•
an enhanced VO2max and/or lactate threshold (LT). Over the course of the study,
•
however, no change in VO2max or LT was observed. Correlation data suggested that
the improvement in 5-km running performance was a reflection of improved run-
ning economy and muscle power, defined as ‘the ability of the neuromuscular sys-
tem to produce power during maximal exercise when glycolytic and/or oxidative
energy production are high and muscle contractility may be limited’. The authors
went on to suggest that running economy was likely to be positively influenced by
the explosive strength training via improved neuromuscular characteristics result-
ing in stiffer and more efficient musculature. Support for this theory is provided by
additional data examining cross-country skiing. The efficacy of strength training in
improving aerobic endurance performance as assessed on a highly sports-specific
cross-country skiing ergometer was examined by Hoff et al (2002). Highly trained
athletes were prescribed 8 weeks of resistance training (three times a week, three sets
of six reps, a rest of 3–4 minutes between sets, at a workload of 85% of 1 RM), with
much emphasis placed upon the maximal mobilization of force in the concentric
movement, suggested by the authors to specifically target neuromuscular adapta-

tion. Following the training programme, a number of positive outcomes were
observed: strength as assessed by 1 RM, time to peak force, time to exhaustion and
work economy were all improved.
As with the previous forms of training for endurance performance, the depth of
empirical evidence examining the use of strength/power training in elite endurance
athletes is sparse. Although early studies suggest that there may be physiological con-
flict in combining strength and endurance training within the same period of an ath-
letes training cycle, recent studies examining explosive power training within an elite
population provide compelling support for this type of training in endurance athletes.
FLEXIBILITY
Flexibility has traditionally been an intrinsic component to training schedules for
almost all athletes. Such universal acceptance is based largely on the belief that
improved flexibility will improve performance and reduce the risk of injury. Recent
investigation has begun to question the efficacy of flexibility in improving per-
formance both in endurance and power events. The impact of flexibility upon power
sports is covered in Chapter 6. The impact of flexibility and, more importantly, flex-
ibility training, upon endurance performance is pertinent at this point.
A number of studies have examined the relationship between flexibility and run-
ning economy. From these studies it appears that flexibility is inversely related to run-
ning economy. Therefore, the less flexible an athlete is the lower the oxygen cost will
be for a given running speed. It has been postulated that this relationship can be
explained by an increase in musculoskeletal stiffness. Repetitive stretch–shortening
cycles, as observed during prolonged exercise, result in a build-up of stored elastic
energy. A stiffer musculotendinous system will enhance the return of this stored elas-
tic energy, resulting in a lower overall energy cost to the activity, and hence lower
oxygen cost. This apparent inverse relationship between flexibility and economy may
result in a dilemma for coaches and athletes. Tradition suggests that stretching is an
important component of any training programme, supposedly providing protection
from injury. Yet, data drawn from these recent studies suggest that improving flex-
ibility might negatively affect economy and therefore performance.
Further insight is provided by Nelson et al (2001) who highlight a number of issues
associated with previous studies examining flexibility, and also question some of the
firm beliefs held within the sporting fraternity regarding flexibility. The authors point
out that correlation studies examining flexibility and running economy do not demon-
strate cause and effect; further, there is a dearth of evidence regarding the relation-
ship between risk of injury and an athlete’s level of flexibility. Lastly, they questioned
the premise that less flexible joints result in stiffer musculotendinous units.
The range of movement about a joint (flexibility) is not the same as musculo-
tendinous stiffness. Improvements in flexibility may be gained via an improved tol-
erance to stretch rather than changes in the musculotendinous unit. Accordingly, it
is possible to improve flexibility whilst retaining the ‘stiffness’ within the musculo-
tendinous unit that is believed to be beneficial in terms of running economy. This
contention is supported by the experimental work of Nelson et al (2001). Thirty-two
physically active subjects were split into two groups. A control group (who main-
tained current activity levels) and an experimental group (who maintained current
activity level, and added three 40-minute sessions of calf/thigh stretching a week)
were examined over a 10-week period. Running economy was assessed prior to and
following the 10-week period. Flexibility, assessed via a basic sit and reach test,
significantly improved in the experimental group, concomitant to no change in run-

ning economy in either group. The authors note a number of limitations to their
study, including a true assessment of musculotendinous stiffness and the use of the
sit and reach test as an assessment of flexibility. Despite the limitations of the study
the data set is none the less persuasive. Continuation, therefore, of stretching rou-
tines within an endurance athlete’s preparation may not result in a reduction in run-
ning economy per se, rather athletes may wish to employ training methods that
enhance the stiffness of the musculotendinous unit and therefore improve economy
(such as resistance or plyometric work).
Further work is clearly needed before the issue of stretching and endurance per-
formance is fully resolved, and requires a series of more in-depth investigations than
are currently available. Such work needs to differentiate between flexibility and stiff-
ness, and examine the interaction between programmes designed to enhance flexi-
bility and musculotendinous stiffness. At present it appears that musculotendinous
stiffness may be a far better determinant of running economy than flexibility.
Notwithstanding the fact that running economy does not appear to be impeded
by improved flexibility, the lack of information regarding the benefits associated with
stretching should also be reiterated. Presently much time is devoted to stretching
routines in order to prevent injury, based largely upon a historical perspective rather
than sound scientific evidence.
WHAT PERCENTAGE OF TRAINING SHOULD BE DEVOTED

TO EACH TYPE OF TRAINING?
The challenge faced by the coach or support scientist is to select the correct train-
ing method with the appropriate volume and timing (in terms of periodization), so
as to optimize performance at key points within the athletes competitive season.
Accordingly, the percentage of training that should be completed within each of the
training zones (LSD, LT and HIT) is a source of much debate.
The distribution of training is largely dependent upon the athlete or group of
athletes in question. Training status, physiological strengths and weaknesses cou-
pled with the time point within the training macrocycle will all influence the per-
centage of training completed within each of the training zones. As such, it is not
possible to provide a definitive answer to the above question. Despite this limita-
tion, it is possible to broadly examine the typical division of training within elite
endurance athletes over an entire training cycle and to draw some general recom-
mendations from the available literature. It should be understood, however, that this
information is purely a starting point. Coaches, athletes and support scientists should,
via the process of a careful ‘needs analysis’, devise appropriate training programmes
according to the individual needs of the athlete.
A limited number of studies have attempted to identify the characteristics of opti-
mal endurance training programmes (Billat et al 2001, Steinacker et al 1998). Results
from a South African study (Coetzer et al 1993) suggest that endurance runners with
superior race performances train at a higher intensity than their slower counterparts.
Slower runners spend 13% of their total training volume performing high-intensity
•
training (defined as an intensity >80% VO2max) whereas faster runners spend 36% of
the total training volume performing high-intensity exercise. This demonstrates a
significantly greater proportion of training volume being completed within the LT
and HIT training zones by the faster athletes.
The work of Billat et al (2001) attempted to quantify the training characteristics
of elite marathon runners by comparing the characteristics of top-class versus high-
level runners (all athletes within this study were of a very high standard). The dif-
ferentiation of athletes, however, was based upon marathon personal bests; top-class
males (2 hours 6 minutes 34 seconds to 2 hours 11 minutes 59 seconds), high-level
males (2 hours 12 minutes to 2 hours 16 minutes), top-class females (2 hours 25 min-
utes to 2 hours 30 minutes) and high-level females (2 hours 31 minutes to 2 hours
38 minutes). Male top-class marathon runners complete a greater training volume
than their high-level counterparts (206 km per week versus 168 km per week); fur-
ther, the volume of high-intensity training (HIT) was also significantly greater for
the top-class male runners. The top-class athletes completed 20.4 km per week at an
intensity equal to or greater than the velocity associated with 10 km race pace, com-
pared to the 17.8 km per week completed at the same intensity by the high-level
athletes. Although the volume of training completed was significantly different
between the top-class and high-level runners, the training load distribution was iden-
tical (18% of the total distance run was at a velocity greater than marathon running
velocity, 4% at marathon running velocity and 78% at a running velocity less than
their marathon running velocity). Differences between the training programmes of
top-class and high-level female marathon runners were also evident within the study
of Billat et al (2001). Top-class female marathon runners appear to engage in a greater
number of high-intensity training sessions than their high-level counterparts (two
sessions versus one session per week).
The division of training within elite rowers has also received some attention.
Steinacker et al (1998) suggests that on-water training represents between 55 and
65% of total training volume, power-based training may represent between 16 and
20%, and general athletic training is in the range of 23 to 26% of total rowing train-
ing volume, dependent upon age. Although these data are somewhat informative,
it is difficult to determine exactly how much time was spent in each of the three
major training zones.
The limited data currently available regarding the appropriate division of
endurance training programmes suggest that elite endurance athletes should per-
form the majority (70–80%) of training within the LSD training zone, with a smaller
but still significant proportion (20–30%) of training being completed in the LT or
HIT training zones. Undoubtedly, this suggested division of training is probably a
little too simplistic. It does, however, provide a suitable starting point from which
individual endurance training programmes may be developed.
GENERAL SUMMARY
At the outset of this chapter, Figure 4.1 provided an overview of the determinants
of endurance performance. Figure 4.4 provides an extension to the original schematic
including greater detail with respect to each of the physiological determinants and
the influence of the different training methodologies discussed in the present chap-
ter, and as such provides a general summary to what has been discussed.
When examining the different types of training employed by endurance athletes,
a considerable cross-over is apparent. Although specific training modalities are
employed in an attempt to bring about specific physiological adaptations, it does
not appear to be possible to specialize the training session to the extent of focusing
on one specific determinant of performance (e.g. lactate threshold). LT training, for
example, may increase mitochondrial size and density in a similar fashion to LSD
training. Many of the individual training modalities discussed thus far stimulate
physiological adaptations that beneficially affect a number of the underpinning deter-
minants of endurance performance as highlighted in Figure 4.4.
Long slow distance Lactate threshold Resistance strength High-intensity interval

training (LSD) training (LT) training training (HIT)
Aerobic power and capacity Anaerobic power and capacity Neuromuscular capacity
·
(V O2max) • glycolysis + lactic acid • neural control
• O2 transport • buffer capacity • musculotendinous stiffness
• O2 utilization • PCr store • exercise mechanics
Maximal
Fractional Running
V· O2max LT performance
utilization economy
velocity
Endurance performance
Figure 4.4 Hypothetical model of determinants of endurance performance in well-trained

athletes as influenced by different training modalities. Based originally on a model provided
by Paavolainen et al (1999).
In order for elite endurance athletes to achieve success at the highest level it is
critical that they optimize all of the physiological determinants of performance. In
order to do this they must employ the appropriate mixture of the different training
stimuli within their training programme. Decisions regarding the appropriate period-
ization of the different training methods require careful consideration of each indi-
vidual athlete’s requirements at any given point within the training cycle. Thus, in
order for a training programme to be truly effective, interdisciplinary assessment,
discussion and review are required between the athlete, coach and support scien-
tists on a regular basis.
KEY POINTS
1. Endurance performance covers a wide variety of events ranging from competi-
tive rowing (~6 minutes) through to marathon competitions (~2–3 hours), and
beyond to some cycle stage races (~4 hours). The predominant source of ATP for
endurance performance is via aerobic processes.
2. Endurance performance is underpinned by a number of physiological variables,
all of which display varying degrees of trainability.
•
3. A well developed aerobic capacity (VO2max) is a prerequisite for endurance per-
formance; however, other physiological parameters may be more important, espe-
cially in truly elite individuals.
4. Lactate threshold, economy, fractional utilization and maximum velocity/power
are important factors in endurance performance.
5. Endurance training is broadly categorized into three distinct zones: long slow dis-
tance; moderate-duration, high-intensity training; short-duration, very-high-intensity
training.
6. In addition to the basic training zones, a proportion of an endurance athlete’s
time will be devoted to strength training and flexibility.
References
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A new form of cross-training? Sports Medicine 25(3):191–200
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Further reading
Australian Sports Commission 2000 Physiological tests for elite athletes. Human
Kinetics, Champaign IL
Docherty D, Sporer B 2000 A proposed model for examining the interference
phenomenon between concurrent aerobic and strength training. Sports Medicine
30(6):385–394
Hawley JA, Myburgh KH, Noakes TD, Dennis SC 1997 Training techniques to improve
fatigue resistance and enhance endurance performance. Journal of Sports Sciences
15:325–333
Hickson RC, Dvorak BA, Gorostiaga EM et al 1988 Potential for strength and
endurance training to amplify endurance performance. Journal of Applied
Jones AM, Carter H 2000 The effect of endurance training on parameters of aerobic
fitness. Sports Medicine 29(6):373–386
Kubukeli ZN, Noakes TD, Dennis SC 2002 Training techniques to improve endurance
exercise performances. Sports Medicine 32(8):489–509
85
Chapter 5
The physiology of anaerobic
endurance training
Ken A. van Someren
CHAPTER CONTENTS
Learning objectives: 86 Canoeing and kayaking 102
Introduction 86 Field sports and court games 102
Physiological bases of anaerobic
Planning of anaerobic endurance
endurance 87
training during the year 103
ATP-CP pathway 87
Planning of day-to-day anaerobic
Anaerobic glycolysis 89
endurance training 104
Energy contributions to short-duration,
Examples of training schedules 104
high-intensity exercise 90
Adaptation to anaerobic endurance
Characteristics of short-duration, high-
training 107
intensity event athletes 90
ATP-CP capacity 109
The relationship of anaerobic
Glycolytic capacity 109
endurance and performance 91
Other adaptations 109
Limitations to performance in short-
Performance 109
duration, high-intensity sports 91
Muscle fibre composition 110
Depletion of ATP-CP 92
Neural 110
Re-synthesis of ATP-CP 92
Aerobic 111
Metabolic acidosis 93
Glycogen depletion 95 Assessment of anaerobic endurance 111
Neuromuscular 95 Estimation of anaerobic energy
Neural 96 yield 111
Training methods 96 Maximal accumulated oxygen deficit
Types of anaerobic endurance (MAOD) 111
training 99 Excess post-exercise oxygen
Short-term anaerobic endurance consumption (EPOC) 111
training 99 Quantification of intramuscular
Long-term anaerobic endurance substrate and enzyme
training 100 activity 112
Resistance training 100 Post-exercise blood lactate
concentration 112
The importance of a warm-down 100
Examples of sport-specific training Performance tests 112
sessions 101 Conclusions 113
Running 101 Key points 113
Cycling 101 References 113
Swimming 101 Further reading 115
1. Understands the physiological bases of anaerobic endurance.
2. Identifies the importance of anaerobic endurance to short-duration, high-intensity
sports events.
3. Understands the scientific underpinning of training methods practised to develop
anaerobic endurance.
4. Appreciates physiological adaptations to anaerobic endurance training.
5. Considers methods to evaluate anaerobic endurance.
INTRODUCTION
High-intensity exercise requires the rapid re-synthesis of ATP to provide energy for
muscular contraction. The demand for ATP and energy exceeds the rate at which
oxygen delivery and consumption can support oxidative energy production.
Consequently, a large part of the total energy demand is derived from anaerobic
sources. While the oxidative pathway provides a relatively efficient but slow re-
synthesis of ATP, the anaerobic pathways are relatively fast. There is, however, a
limit to the energy yield from the anaerobic pathways during maximal exercise (for
reasons discussed later in this chapter); this finite capacity for anaerobic energy pro-
duction is the ‘anaerobic capacity’. It is this capacity that determines an athlete’s
ability to sustain high-intensity exercise; because ‘endurance’ refers to the duration
that work can be sustained, the term ‘anaerobic endurance’ is used to describe this
ability and is often synonymous with ‘anaerobic capacity’. Given that there is a finite
capacity for anaerobic energy production, athletes must maximize this capacity
through training and use it optimally during competition (i.e. effective pacing) to
achieve optimal performance.
It is important to distinguish the term ‘power’, which is the rate at which energy
is produced, from ‘capacity’, which is the total amount of energy produced. While
it is anaerobic power that determines success in short-duration explosive events (e.g.
javelin, shot-putt, high jump, see Ch. 6), it is anaerobic capacity that is important
for many sprint and middle-distance events of between 10 seconds and approxi-
mately 4 minutes (e.g. 100–1500 m running, 50–400 m swimming, 200–1000 m canoe-
ing and kayaking, 1000–4000 m track cycling). In these sprint and middle-distance
events, athletes compete at exercise intensities exceeding their maximal rate of oxy-
•
gen consumption (VO2max). In such events it is the ability to maintain a very high
intensity, and therefore anaerobic endurance, that is crucial for success. In the middle-
distance events athletes often require very high levels of both aerobic and anaerobic
endurance and therefore coaches, scientists and athletes face an enormous challenge
in the successful design of training programmes.
The term ‘sprint’ is normally used to describe the shortest event(s) within a
sport. For example, flatwater canoeing and kayaking comprises sprint and marathon
events; the sprint events are the 200 m, 500 m and 1000 m, which take approximately
40 seconds, 100 seconds and 220 seconds for men’s single kayaks, respectively.
‘Middle-distance’ is a term often used to describe track running events of 800–1500
m and other sports events lasting a similar duration. Because there is a wide range
of exercise durations that rely upon anaerobic endurance, for the purposes of this
chapter, events lasting between 10 seconds and 4 minutes will be classified as short-
duration, high-intensity exercise.
The physiology of anaerobic endurance training 87
The measurement of anaerobic endurance or capacity is a problem that has con-

founded sports scientists for many years. In contrast to other physiological param-
eters such as aerobic power, which can be assessed by the direct measurement of
oxygen consumption, no single gold standard technique for the measurement or cal-
culation of anaerobic capacity exists today. Consequently, many scientists debate the
relative merits of a number of measurement techniques to estimate anaerobic capac-
ity, including the measurement of intramuscular substrate and enzyme content before
and after exercise, the maximal accumulated oxygen deficit (MAOD), excess post-
exercise oxygen consumption (EPOC), post-exercise blood lactate concentration, the
Wingate anaerobic test, and sport-specific performance tests. Such lack of accepted
and validated methods has hindered the progress of scientific research with respect
to the importance of anaerobic capacity for short-duration, high-intensity sports.
Consequently, the academic community has only been able to provide limited empir-
ical evidence to the coach and athlete on which to base their training methods and
evaluation techniques for anaerobic endurance. This presents a challenge for sports
scientists in the future and means that at present much of the anaerobic endurance
training techniques used by coaches and athletes are based upon anecdotal evidence
and personal experience with only limited input from scientific data.
PHYSIOLOGICAL BASES OF ANAEROBIC ENDURANCE

Energy for muscular contraction is derived from the hydrolysis of adenosine
triphosphate (ATP). In order for exercise intensity to be maintained, ATP must be
re-synthesized at the same rate at which it is used. If re-synthesis fails to keep
pace with consumption, the athlete will be forced to reduce exercise intensity. ATP
may be re-synthesized through a number of systems or pathways: (i) the hydrol-
ysis of creatine phosphate (CP), (ii) anaerobic glycolysis, and (iii) the oxidation of
carbohydrate, lipids and protein. A combination of these three pathways is used
during exercise, with the relative contribution of each determined by the exercise
intensity and duration. Table 5.1 provides empirical data quantifying the relative
energetic demands of events of various durations. It is clear that as exercise dura-
tion decreases (and therefore intensity increases), the relative contribution of anaer-
obic energy increases; it is also evident that many of the ‘middle-distance’ events (e.g.
1500 m running, 400 m swimming, 4000 m cycling) have a significant anaerobic
energy contribution.
Anaerobic endurance is determined by the capacities of the two anaerobic energy
pathways: (1) the hydrolysis of intramuscular stores of ATP and CP (together known
as high-energy phosphates or the ATP-CP system); (2) anaerobic glycolysis. Together,
these pathways provide large energy contributions to short-duration, high-intensity
exercise.
ATP-CP PATHWAY
This pathway is often considered the immediate system that provides energy at the
start of high-intensity exercise; it is however relatively short term in duration. The
hydrolysis of intramuscular stores of the high-energy phosphates ATP and CP pro-
vide energy for muscular contraction during maximal exercise. The store of ATP in
skeletal muscle is very small (5 mmol.kg−1 of muscle) and can fuel exercise for just
a couple of seconds. Rather than completely depleting this reserve of ATP, however,
the CP system offers an immediate supply of energy for the rapid re-synthesis of
ATP. The hydrolysis of CP by the enzyme creatine kinase (CK) provides energy and
Table 5.1 Percentage contribution of energy systems for short-duration,

high-intensity maximal ergometry and sports events
Event ATP-CP (%) Anaerobic glycolysis (%) Oxidation (%)
Cycle ergometry
10 sec 53 44 3
30 sec 23 49 28
60* 40
45 sec 60* 40
60 sec 50* 50
90 sec 12 42 46
120 sec 35* 65
Running
100 m 90* 10
200 m 81* 29
400 m 62* 38
800 m 39* 61
1500 m 20* 80
Cycling
1000 m time trial 10 40 50
4000 m pursuit 1 14 85
Sprint kayaking
K1 200 m 63* 37
K1 500 m 38* 62
K1 1000 m 18* 82
Swimming
50 m 20 50 30
100 m 19 26 55
200 m 14 18 68
400 m 6 10 83
(*represents combined percentage of ATP-CP and anaerobic glycolysis columns)
a free phosphate necessary for the phosphorylation of adenosine diphosphate (ADP)

to ATP. Intramuscular stores of CP are approximately 15 mmol.kg−1 of muscle and are
rapidly depleted during maximal exercise. During a 30-second maximal sprint, CP is
depleted by 55% in the first 10 seconds, a further 18% in the subsequent 10 seconds
and a modest 10% in the final 10 seconds (Lakomy 2000). There is clear evidence
from a number of scientific experiments that there is a concomitant decline in power
output and ATP-CP depletion during short-duration maximal exercise. The rate at which
CP is depleted is a function of exercise intensity, therefore it will be very rapidly depleted
during all-out exercise of less than 30 seconds; however, it will be depleted at a
somewhat lower rate during lower-intensity, longer-duration exercise (e.g. 1500 m
running). Figure 5.1 illustrates the depletion of CP during a 10-minute bout of swim-
ming; it is clear that the rate of depletion changes throughout the exercise bout.
As exercise duration increases, anaerobic glycolysis contributes a major part of the
total expended energy, although because this is a slower process than the ATP-CP
system the same exercise intensity cannot be maintained.
8
Exhaustive swimming
7
6
PCr (mmol-100g-1 dry muscle)
1 Recovery
0
0 2 4 6 8 10 12 14 16
Time (min)
Figure 5.1 Creatine phosphate depletion and recovery following 10 minutes exercise.
Reproduced with permission from Costill DL, Maglischo EW & Richardson AB (1992).
Swimming. Blackwell Science, Oxford.
ANAEROBIC GLYCOLYSIS
Glycolysis is an anaerobic process comprising 10 enzymatically controlled chemical reac-
tions that catabolize muscle glycogen or glucose to provide energy for ATP
re-synthesis. During high-intensity exercise it is almost entirely muscle glycogen rather
than extracellular glucose that is metabolized. Although not quite as rapid as the ATP-
CP system, glycolysis synthesises ATP at a faster rate than achieved through the oxida-
tive pathway. This explains why a 100-m sprinter starts to slow down towards the end
of a race and why a 400 m runner can maintain a high, albeit somewhat slower pace,
for the duration of their race. Of course, the winner of a 400 m race is often the ath-
lete who slows the least; the cause of this fatigue is for reasons other than the deple-
tion of the ATP-CP system. Glycolysis results in the formation of pyruvate and it has
long been accepted that when oxygen is available, such as during low-intensity exer-
cise, pyruvate is converted to acetyl-CoA, which then enters the citric acid cycle (Krebs
cycle) to allow the greater yields of ATP achieved through the oxidative pathway. During
very high-intensity exercise where glycolysis occurs at a high rate, hydrogen ions (H+)
are produced faster than they can be removed via the oxidation of NADH in the elec-
tron transport chain. As a consequence of the accumulation of H+, the pyruvate is con-
verted to lactic acid under the control of the enzyme lactate dehydrogenase (LDH). This
has been attributed to a lack of oxygen availability (hypoxia) within the mitochondria.
It is likely, however, that oxygen availability is not the only cause of lactic acid pro-
duction, the recruitment of fast-twitch motor units that preferentially work anaerobi-
cally is also responsible for the production of lactic acid. It is a different isoform of the
enzyme lactate dehydrogenase (LDH) found in fast-twitch motor units that converts
pyruvic acid to lactic acid. Although the production of lactic acid is associated with
muscular fatigue (as discussed later), it does allow high rates of ATP re-synthesis,
although the duration (or capacity) of this system is relatively short (2–3 minutes).
It is important to note that children typically demonstrate lower levels of anaerobic

endurance than adults. This may in part be due to the slower rate of glycolysis observed
in children, presumably a consequence of lower specific enzyme activity. This has impli-
cations for coaches and sports scientists involved with the coaching or evaluation of
young athletes and should be considered in the design of training programmes.
ENERGY CONTRIBUTIONS TO SHORT-DURATION,

HIGH-INTENSITY EXERCISE
The ATP-CP system is the dominant energy pathway in short-duration, high-intensity
sports of less than 10 seconds, for example 100 m sprinting and triple jump. In addi-
tion, the brief repetitive high-intensity bursts that characterize many field-sports and
court games rely heavily upon this pathway. Longer-duration, high-intensity exercise
(e.g. 10 seconds to 4 minutes) will place additional demands upon anaerobic glycol-
ysis. A number of research studies have quantified the contribution of these systems
and the oxidative energy system during maximal short-duration exercise. More dated
literature tended to overestimate the anaerobic contribution to short-duration exer-
cise; it is now evident that there is a significant aerobic component to even the short-
est duration exercise. Table 5.1 illustrates the relative energy contributions to various
durations of ergometry tests and sports events. Although there is some disparity
between investigations in the same event (due primarily to methodological incon-
sistencies in the studies), it is clear that as the duration of the activity increases, the
contribution of the three energy systems changes from predominantly anaerobic to
predominantly aerobic; similarly the anaerobic contribution is in the main from the
ATP-CP system in exercise lasting ≤10 seconds, and largely from the glycolytic sys-
tem in longer-duration exercise (10 seconds to 4 minutes). While these generic data
may be applied to any sports event, it is preferable and more accurate for scientists
and coaches to source data specific to their sport and event.
It is also important to consider the importance of anaerobic energy production
during the ‘final sprint’ in endurance events (e.g. 10 000 m running). Although this
anaerobic energy yield may be very small in terms of percentage contribution of
total energy, it may represent the difference between finishing inside or outside of
the medals in competition. This is one of the reasons why even distance runners
undertake some amount of anaerobic training.
Many of the field-sports (e.g. soccer, field-hockey, rugby) are characterized by repet-
itive changes of pace with sprinting superimposed upon relatively low-intensity activ-
ity. Time–motion analyses of field sports including soccer and field-hockey
demonstrate that 90–95% of match time is spent standing, walking and jogging,
and only 5% of the time spent undertaking, striding and sprinting (Bangsbo et al
1991, Spencer et al 2004). Although sprints rarely exceed a few seconds (≤ 5 seconds),
they are typically interspersed with only short periods of recovery (15–90 seconds).
It is this repetition of high-intensity activity that stresses the anaerobic endurance
of players, particularly in respect of the capacity of the ATP-CP system and the
ability to re-synthesize CP. Increases in blood lactate concentrations during the rep-
etition of short-duration bouts of high-intensity exercise have been reported, reflect-
ing the extent of metabolic acidosis and therefore the athlete’s glycolytic capacity.
CHARACTERISTICS OF SHORT-DURATION, HIGH-INTENSITY

EVENT ATHLETES
There are a number of different sports that place high demands on an athlete’s anaer-
obic capacity, which poses problems in characterizing the ‘typical’ physiological
profile of such athletes. Athletes participating in short-duration, high-intensity sports,

however, tend to exhibit relatively high distributions of fast-twitch (type IIa and IIx)
muscle fibres, high levels of intramuscular ATP, CP and glycogen, high concentra-
tions and activities of specific enzymes (e.g. creatine kinase (CK), phosphofructo-
kinase (PFK), phosphorylase) and high post-exercise blood lactate concentrations.
Consequent to these characteristics, the athletes competing in ‘anaerobic’ sports
display superior measures of anaerobic capacity.
Identification of the energetic demands of sports events and the physiological
characteristics of elite performers provides a comprehensive analysis of the physio-
logical demands of a sport and therefore an understanding of the training required
to improve performance. A sound understanding of both of these factors is imper-
ative prior to the design of any specific training programme. Fortunately, there is
much literature in these areas for most popular sports, although somewhat less for
the minority sports. In addition, an individual’s relative strengths and weaknesses
must also be addressed to optimize the training programme.
THE RELATIONSHIP OF ANAEROBIC ENDURANCE

AND PERFORMANCE
By establishing the relationship between physiological attributes and athletic per-
formance it is possible to identify the factors most closely related to success and
indeed the percentage variance in performance explained by each attribute. Using
these relationships it is possible to predict performance using multiple regression,
thereby developing a structure of the physiological prerequisites for any sport.
Inferences regarding the foci of physical training and physiological assessment may
then be made. Of course, it must be remembered that a relationship does not demon-
strate causation and it is, therefore, possible to misinterpret the relevance of some
relationships. This is further confounded by the fact that many factors that are related
to performance are also related to each other, particularly some of the indirect meas-
ures of anaerobic capacity.
There is extensive literature describing the relationships between physiological
attributes and performance, although the majority of these data are confined to the
popular sports and tend to focus on factors associated with cardiorespiratory fitness
and endurance. In addition, there is a lack of data describing the relationship between
physiological factors and performance in field sports due to the difficulties in defin-
ing and assessing performance in such sports.
The heterogeneity of the subjects used in the available research literature is also
an important issue for the reader to consider. In many studies the samples are quite
disparate in ability and therefore physiological status. This increases the likelihood
of significant relationships between physiological parameters and performance; how-
ever, the relevance of such findings for scientists and coaches working with a homog-
enous group of highly-trained athletes may be limited.
LIMITATIONS TO PERFORMANCE IN SHORT-DURATION,

HIGH-INTENSITY SPORTS
The term fatigue is used to describe the general feeling of tiredness, but more specif-
ically in relation to sports performance, it is the decline in muscular power output
and thus performance. During short-duration, high-intensity exercise fatigue is
caused by distinct physiological factors that are discussed below. These factors may
also be considered as performance limitations and it is the improvement of these
Muscle ATP and PCr (mmol.kg−1)

22
20
18
16
14
12 PCr
10
8
6
4
ATP
2
0
0 100 200 300 400 8
Distance of running (m) Recovery (min)
Figure 5.2 Changes in muscle ATP and CP during running. Reproduced with permission
from Hirvonen J, Nummela A, Rusko H, Rehunen S & Härkönen M (1992), Fatigue and
changes of ATP, creation phosphate, and lactate during 400-m sprint, Canadian Journal of
Sport Science 17:141–144.
factors that is the aim of any training programme designed for short-duration, high-
intensity sports.
Depletion of ATP-CP
As already discussed, intramuscular CP is depleted by 83% during 30 seconds of
maximal exercise. In addition, 400 m running has been shown to result in an 89%
depletion of CP and a 27% depletion of ATP (Fig. 5.2; Hirvonen et al 1992). The rate
at which the high-energy phosphates are hydrolysed will determine the speed or
power output an individual can attain, and the amount of CP stored within the mus-
cle cell will determine the duration that very high-intensity exercise can be main-
tained. The depletion of CP has been consistently found to be associated with fatigue
in short-duration, high-intensity exercise.
Many athletes have adopted dietary creatine supplementation to enhance intra-
muscular stores and therefore increase the capacity of the ATP-CP system. This sub-
ject has been a focus for much research over the last 10–15 years. Although confounded
by many factors, there is sound evidence that creatine supplementation has an
ergogenic effect in repeated sprint activities, suggesting that supplementation not only
increases the intramuscular CP content but also accelerates the re-synthesis of CP
between sprints.
Re-synthesis of ATP-CP
It appears that power output during exercise is at least in part determined by the
availability of CP. Therefore during intermittent sports, the ability to re-synthesize
CP will affect an athlete’s ability to perform subsequent bouts of high-intensity
100
80
% resting PCr 60
40
20
0 1 2 3 4
Time (min)
Figure 5.3 CP depletion and re-synthesis during multiple sprint exercise. Reproduced with
permission from Bogdanis GC, Williams C, Boobis LH & Lakomy HKA (1996), Contribution of
phosphocreatine and aerobic metabolism to energy supply during repeated sprint exercise,
Journal of Applied Physiology 80:876–884.
exercise. Not only is power output related to CP depletion during exercise, but also
the recovery of power output following maximal high-intensity exercise is related
to the re-synthesis of CP (Bogdanis et al 1995). Figure 5.3 illustrates CP depletion
and repletion during repeated high-intensity exercise. Although there was consid-
erable CP repletion during the 4-minute recovery period following a 30-second
sprint, CP remained below resting values at the start of the second 30-second sprint,
which was concomitant with an 18% reduction in power output. CP is re-synthe-
sized at rest and at low to moderate exercise intensities via oxygen consumption;
indeed an individual’s rate of CP re-synthesis is related to their aerobic power
•
(VO2max). Other factors that determine the rate of replenishment include creatine
availability and the mode of recovery. It takes approximately 1–2 minutes for CP
to be restored to 50% of pre-exercise levels and 3–4 minutes to be 90% restored.
Due to the time required for CP repletion, intermittent sports will often be char-
acterized by a decrease in exercise intensity throughout the training or competition
bout, which is exacerbated by short-duration recovery periods. For this reason there
is a concomitant decrease in the relative anaerobic contribution and an increase in
the aerobic contribution as the exercise bout progresses.
Metabolic acidosis
Since the early 20th Century lactic acid has been considered a primary cause of
muscular fatigue during high-intensity exercise. Lactic acid rapidly dissociates to
lactate and hydrogen ions (H+). Because exercise physiologists often measure the
concentration of lactate in blood to estimate anaerobic energy metabolism, many
coaches, athletes and indeed students mistakenly believe that lactate is the cause
of fatigue. Rather, it is the accumulation of H+ that causes metabolic acidosis.
During high-intensity exercise when H+ accumulates in the cytosol, intracellular

proteins provide buffering of some of the excess acidity; in addition, hydrogen
ions effluxing from the cell are buffered by extracellular bicarbonate. The inges-
tion of exogenous buffering agents (e.g. sodium bicarbonate and sodium citrate)
to enhance this buffering capacity has been practised by athletes and widely
researched by scientists over the last 20 years. Although results are equivocal, there
is evidence that this practice can increase the body’s buffering capacity and improve
anaerobic performance. Any such buffering is not, however, capable of completely
preventing acidosis and the decline in intracellular pH, which drops from normal
resting levels of 7.1 to ≤ 6.5, and possibly lower within individual fast-twitch fibres.
The reduction in pH disturbs the homeostasis of the muscle cell and inhibits key
glycolytic enzymes, particularly phosphofructokinase and phophorylase, thereby
slowing glycolytic energy production. Acidosis also displaces calcium (Ca2+) from
the sarcoplasmic reticulum within the muscle cell and impairs its affinity for bind-
ing to the intramuscular protein troponin. This prevents troponin from regulating
the exposure of the active binding sites on the actin filament and thus the cycling
of cross-bridges between the actin and myosin filaments. This in turn reduces
muscle tension and the force of contraction, which will manifest as a reduction
in exercise intensity. The reduction in pH caused by high-intensity exercise may
persist for several minutes following exercise, as shown in Figure 5.4. Metabolic
acidosis has also been suggested to exert an osmotic pressure that could cause
muscle swelling and blood flow restriction following high-intensity exercise (Sahlin
1986).
Recent evidence suggests that the production of lactic acid and metabolic acido-
sis may not be as important a cause of physiological fatigue as previously accepted.
Much of the previous research that has shaped popular understanding of the role
of acidosis in fatigue was either based on the observation of relationships between
7.1
7.0
6.9
Muscle pH
6.8
6.7
6.6
Sprint
6.5
0 5 10 15 20 25 30 35
Recovery (min)
Figure 5.4 Effects of sprint exercise on muscle pH. Reproduced with permission from
Costill DL, Maglischo EW & Richardson AB (1992) Swimming. Blackwell Science. Oxford.
intramuscular pH and fatigue or was undertaken on in-vitro muscle preparations at

non-physiological temperatures. More recent work that has been undertaken at nor-
mal muscle temperatures suggests that acidosis is not the cause of fatigue; rather it
is one of many associated symptoms (e.g. Westerblad et al 1997). Support for this
argument is that recovery of power output following maximal exercise occurs before
muscle pH is restored; in fact it is closely related to the re-synthesis of CP (Bogdanis
et al 1996). More recent evidence indicates that rather than a cause of muscle fatigue,
acidosis may in fact protect the muscle against fatigue that is in fact caused by other
mechanisms (Nielsen et al 2001).
Another suggested cause of fatigue is an increase in intramuscular inorganic phos-
phate (Pi) during intense exercise, which may interfere with the release of Ca2+ by
the sarcoplasmic reticulum (Fryer et al 1995), which in turn would inhibit cross-
bridge cycling. However, much of the evidence for the role of Pi in muscle fatigue
is again derived from experiments carried out at temperatures below those of exer-
cising skeletal muscle.
It is clear that further research is necessary to clarify the mechanisms of fatigue
during short-duration, high-intensity exercise. Whatever the exact mechanisms of
fatigue, a reduction in anaerobic energy metabolism will result in a greater contri-
bution of aerobic energy as both high-intensity constant load exercise and intermit-
tent exercise progress, concomitant with a decrease in exercise intensity.
Glycogen depletion
Although high-intensity exercise demands high rates of anaerobic glycolysis (~35–40
times higher than during low-intensity, long-duration exercise) and therefore depletes
the body’s carbohydrate stores fairly quickly, it is unlikely that glycogen availabil-
ity will limit high-intensity anaerobic exercise due to the fact that metabolic acido-
sis and/or other associated mechanisms of fatigue will normally precede such
depletion. For instance, the body’s glycogen and glucose stores are capable of fuelling
ATP re-synthesis for up to an hour, or longer in well-trained individuals, at lower
exercise intensities at which metabolic acidosis and associated mechanisms are not
the primary cause of fatigue.
It is possible, however, that for those sports consisting of repetitive sprints or
high-intensity bursts, carbohydrate availability may become a limiting factor
towards the end of the training or competition bout. For example, soccer is an inter-
•
mittent sport with an average exercise intensity of 75% VO2max for outfield play-
ers (van Gool et al 1988). Repetitive demands on anaerobic energy metabolism
during intermittent sprinting, in addition to the ongoing oxidation of carbohydrate,
can significantly deplete muscle glycogen stores throughout a game. Even greater
depletion is experienced in fast-twitch fibres, thereby greatly reducing the muscle’s
ability to perform glycolysis and generate force. Indeed, time–motion analysis has
demonstrated that players cover significantly less distance and achieve lower aver-
age exercise intensities in the second half of matches, presumably in part due to
glycogen depletion.
Neuromuscular
The contraction of muscle fibres requires a complex series of neuromuscular mech-
anisms. This includes innervation of the motor nerve, propagation of the electro-
chemical nerve impulse along the nerve, neurotransmission across the motor
end-plate and propagation of the impulse across the sarcolemma and through the
T tubules. It is possible that fatigue is in part caused by failure of one or more of
these mechanisms. There is evidence that the accumulation of potassium (K+) within
muscle fibres during contraction can stimulate an associated reflex inhibition
(Garland & McComas 1990) and inhibit action potential propagation across the sar-
colemma and through the T tubules. Further evidence is provided by the fact that
the recovery of muscular force exhibits a similar temporal pattern to the return of
K+ to normal levels following exhaustive exercise.
Neural
While many coaches and athletes may argue that mental toughness is key to top-
level sports performance, it is apparent that fatigue in high-intensity exercise is a
physiological rather than purely psychological state. Recently, however, the role of
the central nervous system (CNS) has been highlighted in the perception of fatigue
and the ability to sustain physical effort. There is now some convincing evidence
that local physiological mechanisms may trigger a down-regulation of CNS activity
and therefore muscle recruitment, thereby causing a decrease in power production.
In addition, the cytokine response to exercise (cytokines are proteins that mediate
the immune response) appears to have an effect upon the CNS and thus the sensa-
tion of fatigue.
Having identified the physiological demands and limitations to performance in a

sports event the sports scientist and coach may prescribe a training programme
with scientific underpinning. Specific training that targets the necessary physio-
logical adaptations is required to reduce an individual’s performance limitations
and thus enhance athletic performance. The remainder of this chapter will discus
the training methods for the improvement of anaerobic endurance and provides
examples of specific training techniques used by athletes in short-duration, high-
intensity sports.
TRAINING METHODS
The aim of any physical training programme is to stress the physiological systems
of the body in order to bring about adaptation that in turn improves perform-
ance. An athlete’s capacity for adaptation and their response to training is in part
determined by their genotype (genetic make-up) and phenotype (physical char-
acteristics resulting from the genotype); however, with appropriate training pre-
scription allowing, an athlete will be able to fulfil their potential. With the
appropriate training, physiological adaptation and improvements in performance
will take place. Understanding the demands of the athlete’s event and the impor-
tance of anaerobic endurance to their sport is crucial in developing an appropri-
ate training strategy.
One of the most challenging tasks for the sport and exercise physiologist is to
interpret scientific knowledge and assist in the prescription of effective physical train-
ing programmes for athletes. The understanding of the physiological demands of a
specific sporting event and the identification of the physical characteristics of suc-
cessful athletes provides relevant information to facilitate this. The description of
the physiological profiles of elite performers has been widely reported in a number
of sports, which has allowed for the identification of key physiological variables
related to successful performance in these events. Subsequently, an understanding
of these physiological performance-influencing factors will aid the sports scientist

and coach in the prescription of appropriate physical training regimes.
While there has been considerable research investigating the physiological adap-
tations to specific training programmes, most of the literature in this area has focused
on endurance performance. Typically, it has been the effects of endurance training
on markers of endurance capacity, such as the anaerobic threshold and maximal oxy-
gen consumption which have been investigated. Conversely, there is a relative paucity
of literature reporting the physiological adaptations to specific training for short-
duration, high-intensity sports events. The fact that some authorities have suggested
that most of the existing knowledge regarding the training practices of today’s elite
athletes has come from the field-based observations of successful coaches, rather
than from a scientific basis provided by exercise physiologists, is perhaps in part a
consequence of this.
Many of the adaptations that underpin anaerobic endurance are peripheral and
therefore specific to the muscle and will occur only during high-intensity exercise
•
(i.e. > 90% VO2max) when the fast-twitch (type II) motor units are recruited. Lower-
intensity training will recruit predominantly slow-twitch (type I) motor units and
have little effect on anaerobic endurance or capacity. This is not to say that lower-
intensity aerobic training is not necessary for athletes in short-duration, high-inten-
sity sports; indeed, a well-developed aerobic fitness is necessary in order to perform
the volume of high-intensity training needed to develop anaerobic endurance.
Further, a well developed aerobic capacity is a pre-requisite for many team game
athletes. For this reason many athletes in sports with only modest aerobic energy
demands will perform a considerable amount of aerobic endurance training, partic-
ularly in the off-season. This has implications for the periodization of training and
will be discussed later.
The primary characteristic of anaerobic endurance training is the high-intensity
• •
at which it is performed. At perimaximal (~V O2max) and supramaximal (>VO2max)
exercise intensities the anaerobic energy systems will be heavily taxed. The aim of
anaerobic endurance training is to maximally stress these systems and thereby elicit
the required adaptations. As a consequence of the intensity of training and the
resultant fatigue, exercise bouts will be of short-duration, therefore training is nor-
mally divided into repeated bouts or intervals of short duration. This form of train-
ing is termed ‘high-intensity training’. This should not be confused with ‘interval
training’ which comprises the repetition of longer exercise bouts to develop aero-
bic endurance capacity. Interval training was brought to popular attention in the
1930s by Rudolf Harbig, the German 800 m world record holder; the repetition of
intervals allows the athlete to undertake a greater volume of training at the appro-
priate intensity in any one training session. In contrast, high-intensity training
involves the repetition of short bouts of exercise at supramaximal intensities to elicit
adaptations in anaerobic capacity or anaerobic endurance. In the 1980s the impor-
tance of high-intensity training for middle-distance running was illustrated by the
training methods employed by Sebastian Coe (1984 Olympic medallist in 800 m
and 1500 m), and his father and coach, Peter. Coe’s training adopted a greater
amount of high-intensity training than had previously been considered appropri-
ate for middle-distance running. Coe’s success turned coaching and scientific atten-
tion to the role of high-intensity training and the importance of anaerobic capacity
for middle-distance events.
The nature of some sports in which training may be undertaken on varying ter-
rain, for example running and cycling, allows the use of ‘hill sprints’ to be used to
increase the training intensity. In other sports where the terrain remains constant
(e.g. swimming, rowing, kayaking), however, coaches and athletes must employ
structured training sessions to manipulate the training intensity and duration, as
well as the recovery duration. Factors that must be considered in the design of the
training session include:
1. The required adaptations – these will be specific to the athlete’s event; it may be
to improve the capacity of the ATP-CP system in the shorter-duration events (e.g.
100 m running) or the capacity of the glycolytic system in the longer dura-
tion events. This factor must be decided upon prior to consideration of any of the
following factors.
2. Repetition intensity – gross recruitment of the fast-twitch motor units requires
•
training intensities of > 90% VO2max; at higher intensities the relative energy con-
tribution from the anaerobic sources will be greater, thereby focusing the train-
ing session on the required adaptations. Many athletes make the mistake of trying
to complete repetitions that are too long and/or too many in number. While they
may believe that ‘more is better’, this is simply not the case. By attempting to
undertake excessive volume, training intensity will be compromised. Given that
anaerobic adaptations require high-intensity training, any repetitions that fail to
meet the required intensity will also fail to have the desired effect.
3. Repetition duration – this will be largely determined by the training intensity and
consequent physiological fatigue. Very high-intensity bouts designed to stress the
ATP-CP energy system will be limited to a short duration (≤ 15 seconds) by CP
depletion. On the other hand, repetitions that stress the glycolytic energy system
may be longer with acidosis and other associated mechanisms causing fatigue
over a longer period (e.g. up to 3 minutes).
4. Recovery duration – this will determine the intensity and number of subsequent
repetitions that may be achieved. The duration will also depend upon the aim of
the training session. Recovery of the various mechanisms of fatigue display differ-
ent temporal patterns, for example, while cellular CP is re-synthesized relatively
quickly, metabolic acidosis takes somewhat longer to recover to homeostasis.
Therefore, if the aim of the session is to tax the ATP-CP system then only relatively
short recovery periods will be needed and will be determined by the duration of
the exercise interval. If, however, the restoration of normal pH levels is required
then longer duration recovery will be required between exercise repetitions. Again,
muscle acidity should not be confused with blood lactate concentrations. Blood lac-
tate is merely an indirect marker of metabolic acidosis and can demonstrate a quite
different rate of return to resting levels than that of cellular pH.
5. Number of repetitions and sets performed – this is the factor that can be manip-
ulated to control the volume of each training session. The training intensity
together with the duration of the recovery periods will largely determine the
volume of training that an athlete can complete.
6. Recovery period between training sessions – while the purpose of recovery peri-
ods between repetitions is to allow the re-synthesis of energy substrates and
restoration of cellular homeostasis, the rationale for recovery between training
sessions is to provide for the complete recovery of the whole organism and adap-
tation to the imposed demands. At best, failure to incorporate sufficient recovery
in the training programme will prevent physiological adaptation and improve-
ments in performance; at worst, full recovery will not be achieved. This is known
as ‘over-reaching’ (see Ch. 1); long-term over-reaching will compromise physio-
logical adaptation and may result in overtraining, or as it is now referred to in
the literature, the ‘unexplained under-performance syndrome’ (UUPS) (see Ch. 9).
This condition is characterized by a reduction in athletic performance in the

absence of any clinically diagnosed illness. Many athletes who have experienced
this condition have suffered long-term fatigue with the inability to continue their
training and athletic careers.
TYPES OF ANAEROBIC ENDURANCE TRAINING

The demands of an athlete’s event and therefore the targeted adaptations will shape
the type of training session performed. For example, performance in the shorter
duration events (≤ 20 seconds) is greatly influenced by both the amount of cellular
CP stored within skeletal muscle and the rate at which it can be degraded to
re-synthesize ATP. Therefore a 100 m track athlete wanting to improve their aver-
age speed would need to perform repetitions of 10–15 seconds with recovery peri-
ods of adequate duration to allow almost complete CP re-synthesis. Athletes
competing in longer events (e.g. 20 seconds to 4 minutes) will strive to increase their
ability to tolerate high levels of metabolic acidosis. This can be attained by per-
forming training repetitions of between 10 and 120 seconds, during which cellular pH
will fall and very high levels of blood lactate will be generated (e.g. >12 mmol.L−1).
For this reason, this type of longer-duration anaerobic endurance training is often
referred to as ‘lactate tolerance’ training. This chapter will adopt the terms ‘short-
term anaerobic endurance’ and ‘long-term anaerobic endurance’ to classify training
that targets the ATP-CP capacity and the glycolytic capacity, respectively.
For those athletes whose race distance imposes high demands on anaerobic energy
production and the capacity to produce such energy, race-pace training presents an
effective way of achieving the goals of anaerobic endurance training. This type of
training has the additional benefits of practising and developing specific coordina-
tion and muscle fibre recruitment, and pace judgement. It is likely, however, that
this type of training will be more effective when split into repetitions, thereby allow-
ing a greater volume of high-intensity training to be completed during the session.
Many endurance athletes control training intensity by monitoring their heart rate.
Heart rate monitors today are very accurate and affordable; however they are of
limited use during high-intensity training. Because such training is supramaximal
and of short-duration, heart rate is not a sensitive indicator of exercise intensity.
Instead it is more appropriate to control intensity either by speed or power output,
or simply by maximal effort.
Short-term anaerobic endurance training

The repetition of short-duration exercise bouts (≤ 15 seconds) will develop the capac-
ity for intramuscular CP storage and the rate of ATP re-synthesis, thus resulting in
a greater power output as well as an ability to sustain this power for longer. While
previous research has clearly demonstrated that repetitive sprint exercise of short
duration bouts results in considerable metabolic acidosis and blood lactate accu-
mulation, this can be reduced if recovery periods allow for the restoration of cellu-
lar CP. As previously discussed, CP is re-synthesized relatively quickly (90% in 3–4
minutes), therefore such training sessions may employ work:rest duration ratios in
the order of 1:10, thereby allowing the repetition of maximal short-duration exercise
bouts. Research has consistently shown that CP is re-synthesized at a higher rate
during low-intensity exercise than at rest, therefore rest intervals should be active
rather than passive. Short-term anaerobic endurance training increases the capacity
of the ATP-CP energy pathway and enhances muscular power.
Long-term anaerobic endurance training

Maximal exercise of 1–3 minutes duration will place very high demands on the
anaerobic glycolytic system and, as a consequence, on the intra- and extra-muscular
buffering capacities. Long recovery intervals between repetitions allow for the
restoration of cellular homeostasis, including return of pH towards resting levels
and the removal and oxidation of lactate. A work:rest duration ratio in the region
of 1:4 should be used for such training.
An alternative form of anaerobic endurance training that is commonly used by
athletes in the longer-duration, high-intensity events (i.e. 30–180 seconds) is the
repetition of short-duration (20–120 seconds), maximal exercise bouts interspersed
with short-duration rest periods (work:rest duration ratios of 1:1). This is termed
‘lactate tolerance training’, an example of which is repetitions of 30-second work
periods separated by 30 seconds of rest; four to six repetitions may comprise a set,
after which a longer rest period allows restoration of cellular homeostasis. A total
of four to six sets might be completed in a training session. Such training also
results in very high levels of metabolic acidosis but rather than allowing full recov-
ery between each repetition, the athlete performs further repetitions (within the
set) while the muscle is in a fatigued state. There is a paucity of research investi-
gating the acute and chronic physiological responses to this type of training; how-
ever, it is widely used by coaches and athletes. It is interesting to note that there
is recent evidence that such training methods with similar work and rest dura-
•
tions may be one of the most effective methods to develop V O2max (Billat et al
•
2000), although repetitions are normally performed at 100% V O2max rather than
at supramaximal intensities, and a greater number of repetitions are completed
within a given training session.
Resistance training
Gym-based training may also be used to develop anaerobic endurance. By manip-
ulating the intensity, the number of repetitions and sets, and the duration of rest
periods (as previously discussed in this chapter), training may be designed to tar-
get specific physiological adaptations to enhance the ability to sustain force pro-
duction (sometimes referred to as ‘strength endurance’). It must be remembered,
however, that the physiological adaptations that underpin anaerobic endurance are
specific to the trained muscle. Great care must therefore be taken to ensure that the
resistance training exercises target the relevant muscle in the same way in which it
is recruited during the sports performance (see Ch. 6).
THE IMPORTANCE OF A WARM-DOWN

While many athletes undertake a warm-down after intense training there is a sur-
prising lack of scientific evidence for this practice. The proposed benefits of warm-
ing-down following high-intensity training include a more rapid removal of lactate
from the blood and conversion to glucose within the liver, an accelerated removal
of other metabolic by-products from the muscle, prevention of blood pooling and
the avoidance of the potentially negative effects of increased circulating cate-
cholamines on cardiac function. It is possible that the rate of recovery following
training is increased as a consequence of performing a warm-down; however, as yet
there is a lack of supporting evidence.
EXAMPLES OF SPORT-SPECIFIC TRAINING SESSIONS
Running
Running provides the flexibility of using the terrain to manipulate training intensity;
the use of hill sprints is a common training method for middle-distance runners. Hill
sprints are effective in increasing the intensity and stress on the muscular system and
may therefore be incorporated as part of anaerobic endurance training; many middle-
distance runners use hill sprints as an alternative to gym-based resistance training
to improve strength. A note of caution, however, is that hill running involves the
recruitment of slightly different motor units to that of running on the flat; given that
improvements in anaerobic capacity reside within the muscle, this may therefore have
limited benefit for flat terrain running. Despite this, there is a consensus of opinion
that hill-running can greatly improve anaerobic endurance and strength of runners.
Typical sessions
● 10 repetitions of 100 m, with 3-minute rest intervals
● 6 repetitions of 500 m, with 3-minute rest intervals
● 8 repetitions of hill sprints of approx. 45 seconds, with 4-minute rest intervals
● 3 sets of 4 repetitions of 200 m intervals at 400 m pace, 200 m steady; rest intervals
of 6–8 minutes between sets
Cycling
Cyclists, like runners, may take advantage of hills to perform their high-intensity
training. Alternatively, a structured session on flat terrain or a track may be
performed.
Typical sessions
● Maximal sprints of 10 seconds, with complete recovery
● 8 repetitions of 1000–2000 m, with rest intervals of 5–10 minutes
● 12 repetitions of 30 seconds, with rest intervals of 4–5 minutes
Swimming
Swimming is a sport in which the environment is constant. This has the advantage
of allowing for day-to-day comparison of training performance. The use of hand
paddles may also be effective in increasing the load on the upper body muscula-
ture and therefore promoting adaptation.
Typical sessions
● Maximal sprints of ≤25 m with complete recovery

● 3 sets of 6–10 repetitions of 50 m, with rest intervals of 10–30 seconds; rest inter-
vals of 3–5 minutes between sets
● 2 sets of 200 m, 150 m, 100 m, 50 m, with equal-duration rest intervals; rest inter-
vals of 5 minutes between sets
Canoeing and kayaking

Structured training sessions may be used to develop anaerobic endurance, either on
the water, or through dry-land ergometer training. Although modern ergometers
provide accurate replication of the on-water action, athletes are best advised to carry
out their high-intensity training on the water (due to the specificity of the training
adaptations). Canoeists and kayakers often increase the resistance on the boat through
the water by attaching ropes around the hull; this increases the drag and therefore
the intensity of effort required.
Typical sessions
● 15 repetitions of 10 seconds, with 2-minute rest intervals; rolling starts
● 6 sets of 6 repetitions of 30 seconds, with 30-second rest intervals; rest intervals
of 5–7 minutes between sets
● 8 repetitions of 2 minutes, with 6-minute rest intervals
Field sports and court games

Field sports and court games players can make use of the pitch or court to struc-
ture their anaerobic endurance training. By performing repeated shuttle sprints not
only can players stress the appropriate physiological capacities but they can also
develop acceleration and agility.
Typical sessions
● 3 sets of 10 repetitions of width of pitch, with 1-minute rest intervals; 4-minute
rest intervals between sets

● 10 repetitions of 60 seconds, with 2-minute rest intervals
● Repetitions of shuttle runs (5–15 seconds) up and down length of pitch, with
equal rest intervals; rest intervals of 4–6 minutes between sets
Endurance athletes will often perform what they refer to as ‘speed training’. Of
course they have little need for all-out speed and this training is in fact ‘anaerobic
endurance’ and quite similar to some of the training methods described above.
Endurance athletes will often perform high-intensity training twice a week with bouts
as short as 90 seconds with complete recovery (4–7 minutes) in the final few weeks
prior to major competition. It is clear that such a training plan will be insufficient to
maximize anaerobic endurance for most sprint and middle-distance athletes; how-
ever, it does provide the endurance athlete with their equivalent of speed work.
PLANNING OF ANAEROBIC ENDURANCE TRAINING

DURING THE YEAR
When anaerobic endurance training should commence in the periodized year is a
question that has largely gone unanswered in the scientific community. Some author-
ities recommend that anaerobic endurance training should take place for a period
of 4–8 weeks prior to the start of the taper for major competition. It must be stressed
that these guidelines have largely been derived from endurance-based sports in
which athletes perform only a relatively small amount of anaerobic training super-
imposed upon an extensive base of aerobic conditioning. Clearly the training prin-
ciple of specificity dictates that the amount and duration of anaerobic endurance
development will differ according to the sports event and the individual. What is
more generally accepted, however, is that anaerobic endurance training, due to the
high-intensity at which it is performed, places a high stress on the physiological
capacities of the athlete; consequently the prescription of appropriate rest and recov-
ery is paramount.
For most short-duration, high-intensity sports, the latter part of the preparatory
phase (specific preparatory sub-phase) or the early part of the competitive phase
(pre-competitive sub-phase) is the time that most of the training for anaerobic capac-
ity should take place. During this time the total volume of the training plan will be
reduced as intensity is increased. Anaerobic endurance training may be spread
throughout these sub-phases but will normally be concentrated within alternate
macro- or microcycles (see Ch. 1). Whatever the duration of the event, the anaero-
bic endurance training will commence with longer duration, lower intensity inter-
vals, moving to shorter duration and higher intensity intervals as the competitive
phase progresses. While there is no consensus on the amount of anaerobic endurance
training that should be performed during this phase of training, a guideline of 50%
is recommended, with the other 50% being made up of endurance maintenance, and
strength and power training.
Well-developed aerobic fitness decreases the recovery time between high-inten-
sity exercise bouts, which in turn will prepare the athlete for the necessary vol-
ume of anaerobic training. Aerobic fitness must therefore be incorporated and
targeted in the preparatory phases of training. Indeed, for the many sports that
require high levels of both aerobic and anaerobic endurance (e.g. middle-distance
running, 50–400 m swimming, 500 m and 1000 m canoeing and kayaking, 4000 m
track cycling) this will be particularly relevant. There is, however, some evidence
both in human and in-vitro equine muscle that high-intensity training reduces the
aerobic capacity of muscle (see Ch. 3). This highlights the importance for those
middle-distance athletes whose events demand high levels of both aerobic and
anaerobic endurance of not neglecting aerobic conditioning at any time of the train-
ing year.
High-intensity anaerobic training imposes a high stress upon the organism and
as such requires considerable recovery. The recovery period required for the opti-
mization of adaptation and prevention of chronic overreaching will depend upon
the individual. Genetic endowment will have a large influence on an individual’s
rate of recovery from training. Young athletes (<18 years) and older athletes (>25
years) will require longer to recover and adapt, as will less experienced athletes.
Hormonal differences between males and females usually necessitate longer recov-
ery periods for female athletes.
PLANNING OF DAY-TO-DAY ANAEROBIC ENDURANCE

TRAINING
High-intensity training results in a number of causes and symptoms of fatigue,
including ATP-CP depletion, metabolic acidosis, glycogen depletion and CNS dis-
turbances. High-intensity training also predisposes athletes to ‘high-frequency
fatigue’, which manifests as impaired electrochemical function and excitation-
contraction coupling within the muscle cell. In addition, such high-intensity training
may cause microtrauma and damage to skeletal muscle fibres, particularly if the
training is unaccustomed, as it may be at the start of the training phase in which
anaerobic endurance is developed. All of these factors require recovery before fur-
ther anaerobic training can be effectively completed. For this reason athletes are
advised to alternate types of training sessions and structure their training so that
high overload sessions and low to moderate overload sessions are undertaken on
alternate days. While some of these symptoms and causes of fatigue recover fairly
quickly, depleted glycogen can take up to 48 hours to be restored. Skeletal muscle
damage takes somewhat longer to recover; however, skeletal muscle demonstrates
a very high capacity to adapt to unaccustomed exercise so as to reduce or prevent
further damage when that same exercise is repeated.
There are many ways that the training type and load can be cycled throughout a
week or microcycle, which makes the provision of exact guidelines difficult. The pre-
scription of training must take account of the other elements of physical training that
are also being targeted within that period of training. This will dictate the amount of
recovery required between training sessions and therefore the volume of training that
can be achieved. It is not uncommon for a single training session to target a number
of different physiological capacities and adaptations, for example: base endurance and
sprint training. While the alternating of types of training within a session is one way
in which training may be cycled it does limit the volume of any one type of training
that can be performed within a single training bout. In addition, the fatigue induced
by one type of training may well limit the ability to perform another. Athletes are
therefore best advised to focus on one component of fitness in any single training ses-
sion and to structure the session to target specific adaptations accordingly.
EXAMPLES OF TRAINING SCHEDULES

Tables 5.2 and 5.3 provide examples of training programmes during the pre-
competitive and competitive phases of the periodized year. A training programme for
an elite 400 m runner devised by athletics coach Bruce Tulloh is shown in Table 5.2;
Table 5.3 details the training carried out by Sebastian Coe in preparation for the
1984 Los Angeles Olympics in which he won gold in the 1500 m and silver in the
800 m. Both programmes illustrate how anaerobic endurance training may be struc-
tured within the overall training plan.
The presentation of training schedules is in some ways in stark conflict with the
primary purpose of this chapter, which is to discuss the physiology of training for
anaerobic endurance. Unfortunately these schedules, and indeed any others, are not
the direct result of scientific investigation alone but rather a result of the interpre-
tation and synthesis of scientific training principles, empirical research findings
and a wealth of anecdotal evidence accumulated by coaches. While these training
Table 5.2 Training programme for an elite 400 m runner

(a) Pre-competition phase
Session 1 Session 2
(07:00 hours) (12:00 hours approx.) Session 3 (18:00 hours approx.)
Day 1 2 mile run at 1 × 500 m 4 × 60 sec hard effort through

6 min/mile (50 s/400 m). sand or uphill; 3 min rest.
10 min rest. 4 × 30 sec hard effort through
6 × 60 m bounding; sand or uphill; 2 min rest.
10 × 60 m hopping.
1 mile slow run.
Day 2 as above 3 × 5 × 40 m sprint 4 × differential 400 m with
drills. first 200 m in 28–29 sec
1 mile slow run. then accelerating.
1–2 mile warm-down.
Day 3 as above 3 mile brisk run at 6 × 400 m (60–62 sec);
6 min/mile. 2 min jog recovery.
Day 4 as above 30 min weight-training. 100 m – 200 m – 100 m –
6 × 60 m bounding; 250 m – 150 m – 300 m –
10 × 60 m hopping. 200 m – 200 m
1–3 mile slow run. (11–12 sec/100 m, with rolling
starts); 2 min recovery.
1 mile warm-down.
Day 5 as above 3 × 5 × 40 m sprint REST
drills.
1 mile slow run.
Day 6 REST Warm-up only. 3–4 × 300 m; 10 min recovery
(with blood lactate tests).
Day 7 REST 30 min weight-training. 6 × 150 m sprint – coast – sprint.
Warm-down.
Session 1: daily warm-up

5 min jogging
10 min loosening and stretching
Sessions 2 and 3: daily warm-up
5 min jogging
10 min loosening and stretching
5 min abdominal and back-strengthening exercises
10 min jogging and striding
(b) Competition phase
Session 1
(07:00 hours) Session 2 (12:00 hours approx.)
Day 1 1–2 mile run slow 200 m – 300 m – 300 m − 200 m (race speed);
8–10 min recovery.
2 mile slow jog.
Continued
Table 5.2 Training programme for an elite 400 m runner—Cont’d

(b) Competition phase
Session 1
(07:00 hours) Session 2 (12:00 hours approx.)
Day 2 1–2 mile slow run 3 × 150 m; 3 × 100 m (sub-11 sec/100 m, rolling
start); 5 min recovery.
2 mile warm-down.
Day 3 as above 6 × 120 m fast relaxed running.
1 mile warm-down.
Day 4 as above 3 × differential 400 m with first 200 m in
25–26 sec then maximum effort to finish;
12 min recovery.
2 mile slow jog.
Day 5 as above Warm-up only
Day 6 as above 200 m – 300 m – 300 m − 200 m (race speed);
8–10 min recovery.
2 mile warm-down.
Day 7 as above 5–6 × 150 m tactical running, changing pace
every 50 m.
Day 8 as above Warm-up only
Day 9 as above but omit Warm-up only, omit strengthening exercises
strengthening
exercises
Day 10 as above but omit RACE, omit strengthening exercises in warm-up
strengthening
exercises

5 min jogging
10 min abdominal and back-strengthening exercises 10 min loosening and stretching
10 min either leg strength exercises or sprint drills
5 min jogging
10 min loosening exercises
10–15 min jogging and striding
Reproduced from Newsholme EA, Leech T, Duester G 1994 Keep on running: the science of training and
performance, with permission from Wiley, Chichester.
schedules have not been tested in a research context, they have produced impres-
sive results for high-level athletes. It is refreshing that sports scientists are able to
learn so much from coaches and athletes in competitive sports. Hopefully our learn-
ing will stimulate further applied scientific research to better understand the acute
and chronic responses to physical training, particularly in the case of anaerobic
endurance training, which at present is perhaps the least researched component of
physiological fitness.
While these schedules provide guidelines for training, it is important to remem-
ber the training principle of individualization. This states that training must take
account of the individual characteristics of the athlete, as previously dis-
cussed in this chapter. The sports scientist and coach must therefore evaluate the
Table 5.3 Training programme of Sebastian Coe, July 16–22 1984, leading up to the
Los Angeles Olympics
Session 1 Session 2
Day 1 6 mile recovery run

Day 2 Tempo run: 6 × 800 m in 2 minutes 4 miles easy
with 3 minute recovery; 2 lap cool-
down at 90 sec lap the easy jogging
Day 3 5 miles easy 10 × 100 m steady accelerations to
60 m, maximum speed to 80 m,
then float to 100 m; walk back
to start recovery
Day 4 6 × 300 m at 41 sec with 3 minute 4 miles easy
recovery
Day 5 20 × 200 m in 27–28 sec 5 miles easy
Day 6 11 sprints progressing in distance from
100 m to 200 m in 10 m increments,
increasing from 14 to 35 sec,
with jog-back recovery
Day 7 6–7 miles endurance run including
mixed accelerations
Reproduced from Sandrock M 1996 Running with the legends. training and racing insights from 21 great
runners, with permission from Human Kinetics, Champaign IL.
individual’s unique capacity and response to training before effective training can
be prescribed.
ADAPTATION TO ANAEROBIC ENDURANCE TRAINING

All of the limitations to anaerobic endurance discussed earlier in this chapter may
be addressed and improved through specific training. In contrast to the adaptations
to aerobic endurance training that occur at both central and peripheral sites, adap-
tations in anaerobic capacity occur peripherally and predominantly within the mus-
cle cell. Unfortunately there have been relatively few well-controlled scientific
investigations examining the physiological adaptations to high-intensity training;
however Table 5.4 provides a summary of the key findings of a selection of train-
ing intervention studies that have addressed this question.
The primary adaptations that improve the capacity of the ATP-CP system, and
therefore short-term anaerobic endurance, are increased:
● intramuscular ATP and CP stores;
● intramuscular free creatine stores;
● concentration and activity of specific enzymes (creatine kinase, myokinase).
The primary adaptations that improve the capacity of the glycolytic system, and
therefore long-term anaerobic endurance, are increased:
● glycolytic enzymes (e.g. PFK, phosphorylase);
● intracellular and extracellular buffering capacity.
These and other adaptations to high-intensity training are discussed below.
108
Table 5.4 A summary of the findings of high-intensity training studies

Duration Training activity Adaptations No change Reference
•
6 weeks Intermittent hill-running 17% ↑ high-intensity treadmill test VO2max Houston & Thomson (1977)
14% ↑ peak blood lactate anaerobic power
15% ↑ high-energy phosphates fibre composition
8 weeks Sprint training 20% ↑ peak muscle lactate Sharp et al. (1986)
no change in intramuscular pH *
46% ↑ PFK activity
6 weeks Cycle ergometry sprints, ↑ peak blood lactate Wingate performance Jacobs et al. (1987)
2–3 times weekly ↑ % IIa muscle fibres
THE PHYSIOLOGY OF TRAINING
2 × 15 sec & 2 × 30 sec in week 1 ↑ PFK activity

progressing to 6 × 15 sec & ↓ Mb
6 × 30 sec
6 weeks Treadmill running, 3 times weekly 10% ↑ MAOD in both groups peak blood lactate Medbo & Burgers (1990)
either: 3 × 2 min, 8 min rests
or: 8 × 20 sec, approx. 5 min rests
•
3 weeks Cycle ergometry all-out sprints ↑ mean power in 2 out of 10 sprints VO2max Jenkins et al. (1994)
10 × 6 sec sprint, 24 sec rests ↑ peak power in 3 out of 10 sprints plasma volume
10 sessions in total ↑ peak blood lactate blood glucose
no change in post-ex. blood pH *
8 weeks Treadmill running, 3–4 times 12% ↑ peak power in 30 sec in-vitro muscle buffering Nevill et al. (1989)
each week sprint test capacity
2 × maximal 30 sec, 10 min rest 6% ↑ mean power in 30 sec
6–10 × maximal 6 sec, 54 sec rests sprint test
•
2–5 × 2 min at 110% VO2max, ↑ post-ex. muscle lactate metabolic responses to
•
5 min rests ↓ post-ex. blood pH 2 min test at 110% VO2max
* No change in muscle/blood pH following exhaustive exercise is indicative of increased buffering capacity.

ATP-CP CAPACITY
Short-term anaerobic endurance training (repetitions of ≤15 seconds) increases rest-
ing intramuscular concentrations of ATP and CP. An increase in the amount of free
creatine, used in the re-synthesis of CP, is also observed following training. While
the promotion of substrate storage will increase the duration over which this path-
way may contribute energy, the rates of ATP and CP depletion during maximal exer-
cise appear to be similar for trained and untrained subjects. Strength training has
been shown to increase creatine kinase and myokinase concentrations in fast-twitch
muscle fibres, although surprisingly there is little evidence of such adaptations in
response to other forms of high-intensity training.
GLYCOLYTIC CAPACITY
Long-term anaerobic endurance training has been shown to increase the rate of
glycogen metabolism during high-intensity exercise and to increase post-exercise
levels of muscle acidity and blood lactate, indicating either a higher rate or amount
of anaerobic glycolysis. Indeed, post-exercise blood lactate has been shown to cor-
relate with performance in short-duration, high-intensity events. Consequently,
sports scientists often use post-exercise blood lactate concentration as an indica-
tion of anaerobic contribution during exercise. Concentrations in the blood usu-
ally peak a few minutes after the cessation of maximal exercise and the highest
concentrations are seen in maximal exercise of 2–3 minutes duration. This increase
in anaerobic glycolysis may be due to increases in specific enzyme activity and/or
an enhanced buffering capacity to cope with the metabolic acidosis. Increases in
glycolytic enzymes enhance the rate of ATP re-synthesis via glycolysis, thereby
increasing exercise intensity that can be achieved during short-duration exercise.
Care must be taken not to confuse blood lactate concentrations with muscle and
blood acidity (pH). Sharp et al (1986) and Jenkins et al (1994) have shown that
training-induced increases in buffering capacity result in increases in blood lactate
with no change in muscle or blood pH (Table 5.4). This is due to an increased
buffering capacity that ‘mops up’ the hydrogen ions produced by the rapid dis-
sociation of lactic acid; as a consequence, the rate of glycolysis and therefore exer-
cise intensity are maintained, thus elevating lactate concentrations. The
performance gains resulting from an increase in buffering capacity are also demon-
strated by the administration of exogenous buffers (e.g. sodium bicarbonate,
sodium citrate), that have been shown to increase blood alkalinity prior to exer-
cise and enhance anaerobic exercise performance. Ingestion of these buffers is not,
however, widespread among athletes due partly to the fact that they can often
cause gastrointestinal disturbance.
OTHER ADAPTATIONS
Performance
Performance tests are often used in sports science laboratories to provide a sport-
specific estimation of anaerobic capacity in a controlled environment. These tests
may be used to evaluate the efficacy of anaerobic training in increasing anaero-
bic endurance. Perhaps due to the lack of specificity of some methods used to iden-
tify anaerobic capacity, however, some research has demonstrated adaptations in a
number of physiological measures in the absence of a concomitant improvement in

laboratory performance tests. For example, Jacobs et al (1987) found that 6 weeks
of training results in a number of adaptations with no concomitant improvement in
Wingate cycle test performance (see Table 5.4). This suggests that either cellular adap-
tations do not necessarily result in performance gains or that the Wingate test is not
a sensitive measure of anaerobic capacity.
Muscle fibre composition

The question of whether an individual’s muscle fibre composition is genetically deter-
mined or a result of long-term athletic training has been debated for many years.
The first study showing that athletes from different sports were characterized by
different distributions of fibre type was published in 1972 (Gollnick et al 1972).
Subsequent work by the same group also demonstrated that endurance training
could increase the percentage of slow-twitch fibres by up to 36% (Gollnick et al
1973). This was supported by Tesch & Karlsson (1985) who reported that long-
distance runners exhibit a 67% and 49% slow-twitch fibre composition in the vas-
tus lateralis and medial deltoid, respectively; in contrast, marathon kayakers
demonstrated an opposite profile of 71% and 41% slow-twitch fibres in the medial
deltoid and vastus lateralis, respectively. Differences in fibre composition between
trained and untrained individuals, and indeed between trained and untrained mus-
cles within individuals, are evidence that long-term training and not heredity alone
determine muscle fibre characteristics. The transition towards a predominance of
fast-twitch fibres as a result of high-intensity training is less well-documented. It is
possible, however, that muscle plasticity would also allow some adaptation in ath-
letes in short-duration, high-intensity events. Selective muscle fibre hypertrophy is
also evident with training. Gollnick et al (1972) noted considerable hypertrophy of
slow-twitch muscle fibres in endurance athletes, while Clarkson et al (1982) revealed
that although there was no difference in the percentage fibre composition of the
biceps brachii and vastus lateralis in sprint kayakers, the fast-twitch fibres in
the biceps brachii exhibited hypertrophy and an increase in the percentage of total
muscle area (as opposed to number) compared to the vastus lateralis. Therefore,
both muscle fibre composition and selective fibre hypertrophy are a consequence of
specific physical training. Contemporary understanding of skeletal muscle indicates
that the categorization of fibres into three discrete types is probably overly sim-
plistic; rather, there is a continuum of fibre types based on a number of biochemical
characteristics, all of which exhibit adaptation to exercise training.
Neural
It has been suggested that anaerobic endurance training may result in an increase
in an athlete’s mental toughness or pain tolerance. While it is possible that this occurs
it is likely to only be responsible for improved performance in previously untrained
individuals. It is, however, likely that the high intensities characteristic of anaerobic
training will demand high levels of neural input and coordination. Short-term anaer-
obic endurance training in which maximal speeds/power outputs are attained will
result in a greater number and synchronicity of motor unit recruitment, thereby
increasing muscle force generating capacity. Such neural adaptations occur relatively
quickly in response to training. This is clearly demonstrated by the initial response
to resistance training exercise in which strength gains are observed without any con-
comitant muscle hypertrophy.
Aerobic
Training for anaerobic endurance must be performed at high intensities to elicit the
required training adaptations. As previously highlighted, however, the aerobic con-
tribution to short-duration, high-intensity exercise can be considerable, particularly
over the course of a complete training session. Further, recent research has high-
•
lighted that an effective way of improving aerobic power (VO2max) is by perform-
ing repetitions of short-duration, high-intensity exercise interspersed with active
•
recovery periods, e.g. 30-second bouts at 100% VO2max with 30-second recovery
•
periods at 50% VO2max (Billat et al 2000). It is therefore probable that training for
•
anaerobic endurance will have some effect on VO2max, a fact that may be particu-
larly important for athletes participating in middle-distance events in which there
is a large anaerobic and aerobic energy contribution, and in which performance has
been correlated with both aerobic and anaerobic endurance.
ASSESSMENT OF ANAEROBIC ENDURANCE

It is important to monitor training progression in all components of physical fitness.
This will allow the evaluation of training and the modification of training if neces-
sary. The monitoring or assessment of anaerobic endurance can be undertaken in
either a laboratory of field environment. While field tests may lack some of the con-
trol and reliability of laboratory tests, they often provide a greater degree of sport-
specificity. In contrast to the testing of aerobic power (i.e. maximal oxygen
consumption) there is no one method capable of quantifying anaerobic energy yield.
There are two approaches to measuring anaerobic capacity. Firstly, to estimate anaer-
obic energy yield during exercise. Secondly, to simply measure the work performed
during a short-duration performance test. Some commonly used tests for the assess-
ment of anaerobic endurance are briefly outlined here.
ESTIMATION OF ANAEROBIC ENERGY YIELD
Maximal accumulated oxygen deficit (MAOD)

Proposed in 1988 by Medbo et al, the maximal accumulated oxygen deficit provides
a method for estimating the anaerobic energy contribution during supramaximal
exercise. This procedure requires the calculation of the individual’s submaximal oxy-
gen consumption–power relationship, which can be attained from an incremental
submaximal exercise test. This relationship is then applied to the power output
achieved during a supramaximal test to estimate the oxygen cost of the exercise.
The difference between this estimated oxygen cost and the total oxygen consumed
is termed the oxygen deficit. During exhaustive supramaximal exercise of 2–3 min-
utes duration, in which the anaerobic capacity is fully utilized, this deficit represents
the maximal accumulated oxygen deficit. Although this procedure relies on a num-
ber of assumptions that have been disputed in recent literature, it is perhaps one of
the most robust ways of estimating anaerobic energy yield.
Excess post-exercise oxygen consumption (EPOC)

Following supramaximal exercise, oxygen consumption remains elevated above rest-
ing levels for a period of time. It has been proposed that this represents the repay-
ment of an ‘oxygen debt’ incurred during an exercise bout. It is suggested that the
elevated oxygen consumption was required to replenish the depleted ATP and CP
stores and to oxidize the lactate produced. More recently the term EPOC has replaced
‘oxygen debt’ because the excess oxygen consumption is now known to be influ-
enced by endocrinal and thermal factors. The use of EPOC to estimate anaerobic
energy yield has largely been replaced by the MAOD procedure.
Quantification of intramuscular substrate and enzyme activity

The use of muscle needle biopsy provides researchers with an invasive method of
determining cellular changes in response to exercise and to chronic training. This pro-
cedure may be used to identify depletion rates of ATP, CP and glycogen together
with enzyme activities and intramuscular pH. While research has used this technique
to elucidate cellular responses to high-intensity exercise and training, in practice it is
clearly not a suitable method for the routine assessment of athletes (see Ch. 6).
Post-exercise blood lactate concentration

Blood lactate measurements taken after an exercise bout are often used to monitor
the contribution of anaerobic glycolysis to exercise. While this method attempts
to estimate anaerobic energy yield via the measurement of a glycolytic by-product,
it should be noted that blood concentration is a relatively poor indicator of muscle
lactic acid production. The concentration of lactate in blood reflects a balance between
production and clearance. It is therefore affected by differences in lactate clear-
ance rates as well by the extent of glycolysis. A number of studies have, however,
interpreted an increase in post-exercise blood lactate concomitant with no change in
muscle or blood pH as an indication of enhanced buffering capacity. While this is
a reasonable assumption it is difficult to quantify the magnitude of adaptation in
this way.
PERFORMANCE TESTS
Sports scientists use a variety of performance tests to measure short-duration, high-
intensity power output, and thus estimate anaerobic capacity. The most well-known
of these, the Wingate anaerobic test, is an all-out 30-second cycle ergometry test.
Measures of peak power output, total work done and the rate of fatigue (fatigue
index) are recorded. Work done in the first 10 seconds of the test can be used as an
indirect estimate of the capacity of the ATP-CP system, and the 30-second work out-
put an estimate of total anaerobic capacity. Despite much debate as to the validity
and sensitivity of the Wingate test it remains a popular method of physiological
assessment. The Wingate test has since been modified for use in a variety of exer-
cise modalities and durations.
Other performance tests include Cunningham & Faulkner treadmill test. This is
a supramaximal running test performed at a constant speed of 12.8 km.h−1 and gra-
dient of 20%. Time to exhaustion is recorded and used as an index of anaerobic
endurance. More recently the test has been modified to a speed of 16 km.h−1 so as
to elicit fatigue in less time and therefore reduce the aerobic energy contribution to
the exercise.
Multiple sprint tests are commonly used in the assessment of field sports play-
ers (e.g. soccer, hockey, rugby). These tests comprise a series of repeated sprints over
a specified distance, separated by timed recovery periods; the recording of the fastest
time and the fatigue index provides an indirect estimation of anaerobic endurance.
Variations of such tests include the Bangsbo test (Bangsbo 1994), which consists of
seven repeated sprints over a 34 m course that includes a change of direction, and
which are separated by 25 seconds active recovery.
The major limitation of such performance tests is that they fail to take account
of aerobic energy contribution which, as shown in Table 5.1, can account for up to
40% of total energy during exhaustive 30-second cycle ergometry. For this reason
performance tests often lack validity and may be insensitive to specific training-
induced adaptations in anaerobic endurance.
CONCLUSIONS
Sports events of between 10 seconds and 4 minutes demand a considerable anaer-
obic energy contribution; for many of these events anaerobic endurance may pres-
ent a limitation to performance. Similar characteristics also apply to high-intensity
intermittent sports (e.g. field and court sports). With appropriate training an athlete
can increase their average power production over a short to medium-duration
through physiological adaptation to promote the capacity for anaerobic energy
metabolism. The prescription of effective training requires an understanding of the
principles of training together with an appreciation of the empirical evidence demon-
strating the physiological adaptations to training. It should be noted, however, that
training is not a solely scientific practice; rather it is informed by the practical expe-
rience of coaches and athletes. Indeed, many training methods used by coaches and
athletes today are not yet supported by scientific evidence.
The physiological assessment of athletes can be used to identify factors related to
performance and to monitor specific adaptation, which provides further evidence for
the prescription of training. It is clear that at present high-intensity exercise and train-
ing are relatively under-researched areas of exercise physiology. Further applied research
in this area is needed to elucidate the physiology of training for anaerobic endurance.
KEY POINTS
1. Sports events of between 10 seconds and 4 minutes duration rely upon a signif-
icant energy contribution from the anaerobic energy pathways.
2. Performance in such events is limited, at least in part, by anaerobic capacity, which
in turn is determined by a range of physiological factors.
3. An understanding of the physiological bases of anaerobic endurance and the prin-
ciples of training provide the scientific underpinning for the prescription of anaer-
obic endurance training.
4. There is limited empirical evidence regarding adaptation to high-intensity train-
ing and therefore further research is required to support training methods to
enhance anaerobic endurance.
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Further reading
Bogdanis GC, Williams C, Boobis LH, Lakomy HKA 1996 Contribution of
phosphocreatine and aerobic metabolism to energy supply during repeated sprint
exercise. Journal of Applied Physiology 80:876–884
Champaign IL
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19:32–42
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during short-lasting exhausting bicycle exercise. Journal of Applied Physiology
67:1881–1886
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117
Chapter 6
The physiology of sprint
and power training
Colin Boreham
CHAPTER CONTENTS
Learning objectives: 117 Types of muscle fibre 124
Introduction 117 Muscle elasticity and the stretch
Factors affecting power and speed 118 shortening cycle (SSC) 129
(i) Strength 118 Mechanisms of the SSC 129
(ii) Length–tension relationship 119
Training muscle elasticity:
(iii) Force–velocity relationship 119
plyometrics 131
Strength and the ability to sustain Key points and conclusion 131
power output 122 References 132
Optimizing the power: weight Further reading 134
ratio 123
1. Recognizes the main determinants of human speed and power, namely muscle
strength, muscle fibre – type proportions, and muscle and tendon elasticity.
2. Appreciates how specific forms of resistance training and plyometric training can
lead to adaptations in these properties that are beneficial to speed and power.
3. Appreciates how athletes and coaches might optimize these adaptations by mixing
various training options.
INTRODUCTION
With few exceptions (target activities such as darts, snooker, bowls and shooting being
notable among them), human power production is central to performance in com-
petitive sport. Power (P) can be defined as work done (force [f] × distance [d]) divided
by velocity (v); [P = (f.d)/v]. As distance is usually fixed in sporting contexts
(e.g. the height the barbell must be raised; the distance a sprinter must run; the
circumference of a pedal revolution, etc.) this definition of power can be simplified
for practical purposes to P = f/v. As both movement force and movement velocity
are largely dependent upon the quantity and quality, respectively, of muscle tissue,
these topics will form a major portion of subsequent discussion in this chapter. For
the time being, it is clear that both strength and speed are essential components of
power production, their relative contribution being determined by the specific require-
ments of the sport. Huge amounts of human power can be generated in both speed-
dominated events (e.g. 100 m sprinting generates about 1500–2000 W) and
strength-dominated events (e.g. Olympic weightlifting up to 4000–5000 W), although
it has been shown that optimum power production occurs at about 40–60% of max-
imal voluntary contraction (MVC; Izquierdo et al 2002). Although optimal power pro-
duction is an important consideration for activities of varying duration, involving
energy sources from aerobic (1 minute or greater) to anaerobic alactic (under 10 sec-
onds), the former (aerobic) types of activity are covered elsewhere in this text (see
Chapters 4 and 5). Accordingly, the current chapter will concentrate on those activi-
ties which involve high levels of force development and mechanical and metabolic
power production, relying primarily on high-energy phosphates or anaerobic glycoly-
sis to generate the necessary adenosine triphosphate (ATP). Such activities may be repet-
itive in nature, lasting for several seconds, as in sprinting, or, commonly in sport, single
explosive muscular actions lasting less than 300 milliseconds. In the case of the latter,
large forces (up to 4000 N in both legs) need to be produced in less than one-third of
a second; thus, power production will be dominated by maximal absolute strength and
the time it takes to reach maximal force (so-called force–time characteristics).
Although skeletal muscle is of obvious importance in the generation of short-
term power, it is necessary to stress at this stage that muscles and their tendons act
as the functional unit to augment and transmit power production to the limbs.
Indeed, most movement involves both an eccentric (muscle- and tendon-lengthen-
ing) phase closely followed by a concentric (shortening) phase, commonly termed
the ‘stretch-shortening cycle’ (SSC). The stretching of tendon and other elastic struc-
tures in the muscle during the early phase of the SSC stores a considerable amount
of energy which is subsequently used to boost contractible force production during
the concentric phase. Due to the high coefficient of restitution of tendon, up to 90%
of the stored elastic energy can be re-used in this way, producing a ‘catapult’ action
which can boost subsequent power production considerably, perhaps over 50% of
the total power in jumping (Huijing 1992). Furthermore, such elastic energy is essen-
tially ‘free’ in the metabolic sense, making the enhancement of this elastic compo-
nent through training an important consideration both for power production and
for the metabolic efficiency of movement. Subsequent sections will deal at length
with aspects of the stretch-shortening cycle and the training of elastic recoil by, for
example, plyometric training. The effects of various training regimes on muscle tis-
sue and consequences for power production will also be covered in depth in the
following chapter. Muscle tissue is known to be highly adaptable to environmental
stresses, including habitual training, and several recent studies have highlighted the
role that specific types of resistance training can play in enhancing power produc-
tion for sport.
To return to our simplified definition of power (P = f/v), it is clear that an under-
standing of the training of human muscle power and speed can only be attained
through an examination of the main physiological factors influencing both force and
velocity of contraction, and how they may be modified by specific training regimes.
FACTORS AFFECTING POWER AND SPEED
(i) Strength
Strength can be defined as the ability to produce force. Force may be generated iso-
metrically (as observed by the opposing forwards in a rugby scrum) or dynamically,
The physiology of sprint and power training 119
the latter being more common in sporting contexts. Although anecdotally, strength
and speed/power were often regarded as mutually exclusive (as in ‘too much
strength training slows you down’), this view is now accepted as outmoded and
misinformed. As has already been shown, force is an integral component of power
production and, as maximal muscle force is relatively easily trained (compared with
muscle speed), most power-based athletes spend an inordinate amount of time pur-
suing this goal. Furthermore, Newton’s second law (F = ma) demonstrates that accel-
eration (a critical component in most sports) depends proportionately on the ability
of the musculature to produce force. Although muscle strength and its training are
covered comprehensively elsewhere in this volume (see Ch. 7), certain aspects with
specific relevance to power and speed require emphasizing at this point. We will
start with some intrinsic properties of skeletal muscle governing force development,
and their modification with training.
(ii) Length–tension relationship

Although individual muscle sarcomeres can range in length from approximately 1.2 μm
(fully contracted) to 3.6 μm (fully relaxed), the amount of tension (force) that can be
generated by the cross-bridges at these extremes is not optimal. At the fully con-
tracted, shortened state, the actin filaments overlap and interfere with cross-bridge
attachment, while in the lengthened (relaxed) state, there is insufficient overlap
between actin and myosin filaments, thus reducing the proportion of cross-bridges
which can attach and generate force. In fact, optimal conditions for cross-bridge
attachment occur when the sarcomeres are about 2.2 μm in length, or about 60% of
resting length. In this position, the maximal number of myosin cross-bridges can
attach to the active sites on the actin molecules, and as this happens simultaneously
in all sarcomeres throughout the contracting muscle, whole muscle force production
is maximized. This physiological relationship between muscle length and force out-
put has major implications for power production in sport, most obviously in activ-
ities which require high force production. In the sprint start position, for example,
the sprinter unwittingly ‘sets up’ his or her sarcomeres for optimal force produc-
tion in the initial push off the blocks; the volleyball player squats to the correct posi-
tion (approximately one-third squat) to achieve maximum force in the subsequent
jump, and so on. As far as is known, training has no effect on the length–tension
relationship.
(iii) Force–velocity relationship

The force–velocity relationship was first described in the 1930s and refers to the
reciprocal association between muscle contractile force and contractile velocity, i.e.
the greater the force required, the slower the speed of contraction (see Fig. 6.1). This
phenomenon has been experienced by anyone who has lifted a series of progres-
sively heavier weights in the weight training room. As the weight (resistance)
increases, so does the force produced by the muscle, but at the expense of contrac-
tile speed (velocity). Thus, at one extreme, an unloaded barbell can be moved at
cosiderable speed relatively easily, while a maximal lift can be lifted only once with
a reduced velocity. It is apparent that any change in the force–velocity curve – specif-
ically a shift upwards and to the right (see dotted line) – will have important reper-
cussions for power production, and, therefore, sporting performance. Not
surprisingly, there has been much illuminating research on the effects of specific
strength and power training practices on the force–velocity relationship, much of it
Maximum
velocity
Velocity
Load (force)
Maximum
isometric
force
Figure 6.1 The force–velocity curve. The solid line represents the classic inverse
relationship between the force a muscle exerts and its speed of contraction. The dotted
line represents the shift upwards and to the right which characterizes adaptation to
strength and power training.
by Keijo Häkkinen and colleagues in Jyväsklyä, Finland. Details of this work are
available elsewhere (Häkkinen 2002). In brief, such research shows that different
types of resistance training can result in specific alterations to the shape of the
force–velocity curve. Heavy resistance training (80–100% of 1 repetition maximum
(RM)) results in a shift to the right predominantly at the ‘force’ end of the curve (as
in Fig. 6.2A), while lighter resistances (30–60% 1RM) lifted explosively tend to shift
the ‘velocity’ end of the curve to the right (Fig. 2B). Furthermore, such training vari-
ations may also initiate change in the ‘force–time’ curves, as seen in Figure 6.3. These
latter results show that while absolute increases in force may be greater following
a period of heavy resistance training (Fig. 6.3A), these increases only manifest them-
selves in contractions lasting longer than about 150 milliseconds. Explosive strength
training, on the other hand (Fig. 6.3B), appears to shift the force–time curve to the
right along its entire length (albeit to a lesser absolute extent). Thus, force produc-
tion in very rapid contractions (lasting less than 150 milliseconds) is also enhanced.
The implications of such findings for speed and power training are twofold.
Firstly, all sports and activities that rely on power and speed should endeavour to
shift the force–veloicty and force–time curves of the relevant musculature to the
right. Secondly, this is best achieved by a combination of different types of resist-
ance training, such that heavy, slow lifting is mixed with lighter, more explosive
Heavy resistance Light resistance

low velocity training high velocity training
Velocity
Velocity
Force Force
A B
Figure 6.2 If the training programme concentrates on heavy strength exercises, the shift
in the force–velocity curve will tend to concentrate at the `force’ end of the curve (A).
If the training is more explosive in nature, using lighter resistances, the shift will tend to
concentrate at the `velocity’ end of the curve (B).
actions. This should result in an optimal shift along the whole length of the
force–velocity and force–time curves such that power production is enhanced at all
speeds of movement. Taking sprinting as an example, it is clear that the start involves
relatively high muscular forces applied over a relatively long contact time (approx-
imately 300 milliseconds). By 50 metres, however, relatively small forces are applied
for much shorter durations (foot contact is about 100 milliseconds at top sprinting
speed). Training studies carried out to date have reported results generally in favour
of lighter, more explosive resistance training to enhance sprinting and jumping power
(Delecluse et al 1995, Newton et al 1999, Wilson et al 1993). Blazevitch & Jenkins
Heavy resistance Low resistance

training programme Post explosive training programme
Post
Pre
Pre
Force
Force
0 250 500 0 250 500

Time (ms) Time (ms)
A B
Figure 6.3 Typical force–time curves for isometric leg contractions pre- and post-training
with heavy resistances (A) or lighter, explosive weights (B).
(2002), however, found no differences in the high versus low velocity training
approach, while Aargaard et al (2002) reported a 15% increase in the rate of force
development following 14 weeks of heavy resistance training. Furthermore, it should
be remembered that so-called ‘explosive’ resistance training is prescribed on the basis
of a percentage of maximum strength (1 RM). This prescription is normally between
30 and 60% of 1 RM, corresponding to the resistance which enables maximal power
output for the upper body (30–45% 1 RM) and lower body (45–60% 1 RM) (Izquierdo
et al 2002). Thus, the quality of explosive resistance training is directly related to
maximal strength levels, enabling the stronger athlete to both train and perform at
higher absolute power outputs. Resistance training, in any given training cycle,
should therefore probably start by enhancing the base of maximal strength. Thereafter
(possibly following 6–8 weeks of heavy resistances), lighter, more dynamic exercises
should be progressively incorporated so that power output is enhanced throughout
the range of contraction velocities. There is some experimental evidence to corrob-
orate the effectiveness of such mixed light and heavy resistance training (Harris et al
1996).
STRENGTH AND THE ABILITY TO SUSTAIN POWER OUTPUT

While strength training is generally associated with a reduction in aerobic power
output (Tesch & Alkner 2003), there are good theoretical and experimental grounds
to support the view that enhanced strength improves power output in sustained
high-intensity exercise lasting as long as 40 or 50 seconds (also known as ‘speed
endurance’). The theoretical case is illustrated in Figure 6.4. ‘X’ represents the pro-
portion of pre-training maximal strength required to carry out a repetitive task (say
press ups). For argument’s sake, we will say that X = 50% of 1 RM for the muscle
group in question. If this individual undertakes an intensive strength-training pro-
gramme and doubles his/her strength, X becomes only 25% of 1 RM. Consequently,
Post-training
maximum
Muscle strength
Pre-training
maximum
Pre-training Post-training
Time to fatigue
Figure 6.4 The effect of strength training on local muscular endurance. Before strength
training, X represents a given resistance (in this case, about 50% of maximal strength).
After strength training, maximal strength is almost doubled, so that X is now 25% of
maximal strength. The resulting improvement in the ability to move X repeatedly to
fatigue is shown on the Y axis.
in theory at least, the number of press-ups completed, or the time to fatigue, should
double also. Limited experimental data support this association between short-term
power output (speed endurance) and maximal strength (Costill et al 1980, Robinson
et al 1995). The correlate of this relationship is that a task performed at the same
absolute load (e.g. bench pressing 10 repetitions at 50 kg) after a period of training
becomes less fatiguing. This is thought to be due to the stronger muscles requiring
less neural activation, as shown by electromyographical (EMG) experiments (Sale
2003).
OPTIMIZING THE POWER: WEIGHT RATIO

Muscle strength, as we have just seen, has a direct bearing on human speed and
power output. As muscle strength is proportional to muscle size (about 3–4 kg per
cm2 of cross-sectional area) it might be supposed that increasing muscle size (hyper-
trophy) might be the principal goal of the athlete or coach interested in enhancing
power. This probably is true of sports such as weight lifting or rowing, which are
non-ambulatory (i.e. either the body does not need to transport itself great distances
horizontally or vertically, or, the body mass is supported). The majority of sports,
however, do incorporate ambulatory running and jumping activity, and for these
sports it is imperative to maximize the improvements in muscle strength while min-
imizing increases in muscle mass. This is because, while muscle strength is a squared
function (proportional to cm2 of muscle cross-sectional area, as mentioned above),
muscle mass is a cubed function, proportional to cm3 of muscle tissue. Thus, as mus-
cle size increases, strength increases at an exponentially slower rate than muscle
mass. Recent findings relating to the ‘time course’ of training-induced changes in
muscle strength provide guidance as to how the athlete might avoid the pitfalls of
accumulating too much bulk in the pursuit of greater strength and power.
It is now accepted that the major proportion of strength gains in the initial stages
(4–6 weeks) of a strength-training programme are due to adaptations in the facili-
tatory and/or inhibitory neural pathways controlling muscle contraction, rather than
muscle hypertrophy. This lack of hypertrophy, however, may be more apparent than
real. Indeed, individual muscle fibres may increase their cross-sectional area by 5–8%
in the first month of strength training, but much of this increase may be ‘absorped’
by inter- and intra-fibre space, resulting in no measurable changes in gross appear-
ance (Sale 2003). Neural adaptations to strength training have been reviewed exten-
sively elsewhere (Robinson et al 1995), but can be summarized as: (i) increased
activation of the agonists, and/or (ii) reduced co-activation of antagonist muscles,
and/or (iii) improved co-activation of synergist muscles (synergists are muscles that
contribute to a movement). Increased activation of muscles is usually assessed exper-
imentally by the use of EMG, with most training studies showing an increase in
overall electrical activity of the trained muscles during maximal contractions. This
increase in the quantity of EMG (which, incidentally, may plateau at an earlier stage
in the course of a training programme in women than in men) suggests that the
number of motor units recruited have increased and/or the motor units are firing
at higher rates, or some combination of the two. While these adaptations will increase
the maximal contractile force, it is worth noting that a faster rate of force develop-
ment is an additional neural adaptation which can occur if training involves rapid,
maximal effort (so-called ‘ballistic’) contractions with sub-maximal loads (typically
30–40% RM). This adaptation was referred to earlier (see under ‘Force–velocity rela-
tionship’ and Fig. 6.3) and results from an increased motor-unit firing rate at the
onset of movement, perhaps from 60 Hz to 130 Hz (van Outsem et al 1998). As a
result of such neural adaptations, peak force is both enhanced and reached more
quickly, with obvious implications for power and speed. These changes may become
apparent after as little as 2 weeks of resistance training and precede hypertrophic
changes in trained muscles (Sale 2003), the latter taking about 16 training sessions
to become manifest (equivalent to 4–6 weeks of training in a typical programme).
Thus, the athletes who wish to maximize their power:weight ratio might incorpo-
rate the following training strategies:
● Resistance training which incorporate a combination of high loads (90–100% 1
RM) with low repetitions (1–3 per set), and lower loads (30–50% 1 RM) with more
repetitions (6–10 per set, at very high, ‘ballistic’ movement velocities), are likely
to maximize ‘neural’ adaptations and minimize hypertrophic adaptations in the
trained muscles (Huijing 1992).
● Such resistance training regimes need to be periodized so that breaks of 1–2 weeks
are introduced every 4 weeks, to dampen the hypertrophic response.
It should be emphasized that there is only a limited experimental base to sup-
port these recommendations, and that such training would be considered as an
‘advanced’ option, to be undertaken after prolonged (possibly several years) of foun-
dation training.
For athletes in whom maximal strength, irrespective of muscle mass, is the goal,
more prolonged ‘hypertrophic’ resistance training, over several months and charac-
terized by medium to high loads (60–80% 1 RM) and high volumes (typically 4–6
sets of 6–12 repetitions) is required. While the training ‘triggers’ for increased net
protein synthesis in muscle remain largely unknown, the genetic and molecular basis
for muscle hypertrophy are being unravelled (in particular the interplay between
peptides such as mechano growth factor (MGF) that seems to act as a rapid response
mechanism in muscle to promote protein synthesis following training, and myostatin,
whose normal function is to limit muscle growth).
Two further scientific observations may be of interest to the power/sprint ath-
lete. (i) A recent study by Bowtell et al (2003) demonstrated that rates of protein
synthesis were comparable irrespective of whether subjects lifted weights at 60% or
90% 1 RM. Thus, there may be a lower threshold of resistance beyond which it is
unnecessary to go to achieve hypertrophy. (ii) Earlier experiments by Geoffrey and
David Goldspink indicated in animal models that prolonged stretch may be a potent
anabolic agent for muscle growth, even in the absence of an intact nerve supply.
This is particularly true if the muscle stretch is held under tension, as exemplified
by resistance training exercises when the limits of the range of motion are approached
(for example, the stretching of the pectoralis and triceps muscles as the bar
approaches the chest in a bench press exercise). It may be that athletes seeking to
maximize muscle mass should emphasize this (stretching) portion of the range
through which the muscles must contract. Stretching may, therefore, be about more
than simple flexibility for the power athlete (Shrier 2004), although there is some
evidence that prolonged stretching can have deleterious acute effects on power
output for up to 2 hours post-stretching (Power et al 2004).
TYPES OF MUSCLE FIBRE

Observe any junior school sports day, and an obvious truth emerges from the run-
ning races. In any group of young, untrained children, there is enormous variety in
the sprinting speeds of those taking part. What determines this biological variation
in speed? It is now accepted that speed of muscle movement is largely determined
by the relative proportions of different types of muscle fibre which make up the bulk
of the muscle. Muscle fibres differ according to their contractile and metabolic
properties and can accordingly be broadly categorized into three types: (i) fast-
contracting fibres with a predominantly glycolytic metabolism (commonly known as
type IIb fibres); (ii) fast-contracting fibres with a more oxidative metabolism (type IIa
fibres), and (iii) slow-contracting, oxidative fibres (type I fibres). A fourth type (type IIc
fibres) are thought to be fibres in transition from type II to type I, and are uncommon
except in muscle undergoing intensive training, or in young developing muscle.
Most human muscles are made up of the two main types of fibre, I and IIb,
depending on the function of the muscle. In a fast-contracting muscle which does
not require endurance, such as the blinking muscle of the eye (orbicularis occuli),
more than 90% of the fibre population will be type IIb, while at the other extreme,
a muscle such as the soleus of the lower leg, which is required primarily to main-
tain posture over long periods, is composed mainly of slow, type I fibres. The greater
fatigue resistance displayed by these slower fibres arises from their oxidative metab-
olism and greater metabolic efficiency. All muscles however, are composed of a
mosaic of fast and slow fibres to deal with the contingencies of everyday existence.
A major ambulatory muscle such as the vastus lateralis of the thigh, for example
has, in the average individual, approximately equal proportions of type I and II
fibres, presumably (in the evolutionary sense) to cope with a range of movement
demands from fast, explosive jumping and sprinting, to more prolonged endurance
running. However, there is much genetic variation in the make-up of human mus-
cles, and it is clear that an individual at either end of the fibre-type spectrum may
possess either 90%+ type I, or 90%+ type II fibres in an important (in the sporting
as well as the evolutionary sense) muscle such as the vastus lateralis.
It is possible to biopsy small pieces of human muscle and examine the fibre-type
profile. The biopsy procedure is illustrated in Figure 6.5, and micrographs of thin
slices of muscle stained to differentiate the two main types of muscle fibre are shown
in Figure 6.6. It is abundantly clear that muscle taken from a power lifter (Fig. 6.6A),
has a totally different profile (predominantly type IIb) from that of a marathon run-
ner (Fig. 6.6B; predominantly type I). The differences in contractile speed are largely
complemented by metabolic structures to support energy production. Fast-contracting,
glycolytic fibres are surrounded by few capillaries (normally just one or two), con-
tain relatively few mitochondria (perhaps 2–3% of total cell volume), and have vir-
tually no intracellular myoglobin or fat molecules, while the aerobic type I fibres
have more capillaries (up to five or six per fibre) surrounding each fibre, abundant
mitochondria (perhaps 4–6% of cell volume), myoglobin and fat molecules to sup-
port Krebs cycle and the aerobic supply of ATP. Such differences are illustrated in
the electron micrograph of two adjacent muscle fibres of different types (type IIb
and type I) in Figure 6.7.
Our observation that performance in power lifting and marathon running is
strongly correlated with muscle fibre-type profiles is replicated for other sports along
the power–endurance continuum. This is not surprising given that the myosin iso-
form from fast fibres can split ATP 3–5 times faster than slow fibre myosin, resulting
in much faster contraction velocities (a fast fibre is estimated to shorten maximally
in about 1/10 seconds, compared with one-third of a second for a slow fibre). Not
surprisingly, fast fibres may produce 2.5× more power than slow fibres; thus, a pre-
ponderance of fast fibres in ambulatory muscles is a fundamental advantage in speed
and power activities. It is therefore of obvious concern to coaches and athletes, as
well as scientists, to know whether fibre-type profiles can be altered by training, in
particular if slower type I fibres can be transformed into faster type II muscle.
Figure 6.5 Muscle biopsy. A hollow biopsy needle is inserted through an incision in the
right thigh under local anaesthetic (A) so that small pieces of muscle from the vastus
lateralis can be removed (B) for freezing, transverse sectioning, staining and determination
of fibre type proportions.
Unfortunately for sprinters and other power athletes, the available evidence suggests
that prolonged training may shift the profile from IIb (fast glycolytic) to IIa (fast oxida-
tive glycolytic) and eventually (given sufficient duration of training) (Izquierdo et al
2002), to type I (slow oxidative), but that conversions in the opposite direction – from
slow to fast – are probably not possible (Harris et al 1996, Pette 2001). An exception
to the latter assertion was provided by Almeida-Silveira et al (1994) using chronic
stretch-shortening cycle exercises in rats to induce a significant increase in type II
fibres in the soleus muscle. This training affect has yet to be demonstrated in humans,
although interestingly human muscle subjected to prolonged disuse does become
faster (Goldspink & Harridge 2003). This latter observation gives a clue to the mech-
anisms underlying fibre transformations from fast to slower with chronic exercise,
irrespective of whether that exercise is associated with strength training, sprinting, or
endurance activity. It appears, from the earliest experiments involving the surgical
Figure 6.6 Muscle fibre type profiles from an elite power-lifter (A) and from an elite
marathon runner (B) stained for myosin ATPase (4.2). Approximately 85% of the area of the
power-lifter’s muscle is composed of fast, type II fibres (here stained lightly), while over
90% of the area of the marathon runner’s muscle is composed of slower, oxidative type I
fibres (here stained darkly).
cross innervation (‘switching’) of nerves to fast and slow muscles (and the subsequent
transformation of the muscles) that the nerve supply determines the contractile and
metabolic properties of the fibres supplied. Further experimentation revealed that the
specific quality of the nerve that determined whether its muscle fibres were fast or
slow was the total amount of electrical activity delivered to the muscle cells in con-
junction with a certain level of mechanical strain (Goldspink & Harridge 2003). Thus
the genetic ‘switch’ to upregulate the production of the slow, type I isoform of myosin
Figure 6.7 Electron micrograph of adjacent fast (A) and slow (B) muscle fibres. Note
the abundant dark structures (mitochondria) lying between myofibrils, and the pale, fat
molecule located in the central portion of the slow fibre. This contrasts with the lack of
mitochondria and fat molecules in the faster, glycolytic fibre.
and related proteins seems to be the chronic nerve stimulation experienced by mus-
cles used in posture – or indeed by muscles undergoing heavy training. Similarly,
type IIb fibres, which normally receive relatively little nerve stimulation, do not express
the slower myosin isoforms unless ‘switched on’ by increased contractile (and there-
fore electrical) activity. In this respect genes regulating the expression of fast myosin
phenotypes can be seen as ‘default’ genes in that they are largely expressed in the
absence of chronic activity. This is exemplified by the postural soleus muscle, which
reverts to expressing fast myosin genes when immobilized in the shortened position
or subjected to hypogravity (Goldspink & Harridge 2003).
Interestingly the upregulation of slow myosin in response to increased activity
may take longer than other important responses to training in the power athlete,
notably the induction of hypertrophy. Thus, short, sharp, intense training sessions
may induce muscle hypertrophy (with the attendant advantages for power and speed
improvement described previously) without the decided disadvantage of increasing
the proportion of slower fibres in the muscles. This may be seen as the ‘sprinters
paradox’ – that more (training) may be less (gain).
There is one other advantage in relation to muscle fibre profiles to be gleaned
from training in short bursts of intense activity; that of so-called ‘selective hyper-
trophy’ of type II fibres. This phenomenon is illustrated in Figure 6.8, illustrating
muscle fibres from an international high jumper. In normal untrained muscle, faster
type II fibres are marginally larger than their slower type I neighbours. The type II
(lighter shaded) fibres in Figure 6.8, however, are up to twice as large as the type I
fibres, implying some sort of selective hypertrophy as a result of training. Training
for a power event such as the high jump is characterized by a preponderance of
explosive, dynamic movements of short duration but maximal intensity. Such activity,
according to the ‘size principle’ of motor unit recruitment (whereby motor units
are recruited in an orderly fashion from the smaller, slower motor units to the larger,
faster motor units according to the force and velocity requirements of the contraction
Figure 6.8 Selective hypertrophy in the muscle of a high jumper. In this section of vastus
lateralis from an international high jumper, the selective hypertrophy of the fast, type II
fibres (stained lightly here) is apparent. This is probably the result of dynamic, `ballistic’-
type training repeated over a prolonged period. The result is that a greater proportion of
the muscle cross-sectional area is composed of type II fibres, creating greater power when
these fibres are recruited.
(Moritani 2003)), will recruit all motor units regardless of speed in a well-trained ath-
lete. Fast, type II fibres appear to display greater hypertrophy as a result of regular
resistance-type training than type I fibres (Hather et al 1991), possibly due to a selec-
tive up-regulation of androgen receptors in the former (Kraemer et al 2003). Thus,
intensive, high resistance training of the type performed by high jumpers and other
power athletes may lead to selective hypertrophy of type II fibres simply because
these fibres are more responsive to such stimuli, when recruited. An alternative expla-
nation is that selective hypertrophy of type II fibres may result from selective recruit-
ment of these faster motor units in dynamic, ballistic-type movements, i.e. a reversal
of the ‘size principle’. Although there is some evidence that type II motor units may
be preferentially recruited in fast concentric (Grimby & Hannertz 1977) and eccentric
(Nardone et al 1989) contractions, there is also much evidence to support the
inviolability of the ‘size principle’ (Duchateau & Hainaut 2003).
Whatever the mechanism of selective hypertrophy of type II fibres, the advan-
tage lies in the resultant increased cross-sectional area occupied by these fibres rel-
ative to the slower type I fibres. The greater the cross-sectional area occupied by
type II fibres the greater the number of fast myosin cross-bridges that can produce
force during contraction. Thus, when the type II motor unit pool is recruited to pro-
duce explosive, movements, these can be produced with correspondingly greater
force, thereby enhancing power output. In the case of our high jumper in Figure 6.8,
selective hypertrophy of his fast fibres presumably helped him to achieve competi-
tive success, despite a relatively high proportion (70%) of slower type I fibres.
MUSCLE ELASTICITY AND THE STRETCH SHORTENING

CYCLE (SSC)
The stretch shortening cycle (SSC) was highlighted in the introduction to this chap-
ter, and with good reason. While an enormous amount of research has been carried
out in furthering our knowledge about skeletal muscle physiology (mechanisms of
contraction, training adaptations, muscle fibre types etc.), only recently has it become
clear that muscle contraction per se contributes something less than half of the total
work done in many dynamic sporting movements, including sprinting, throwing
and jumping; the remainder is derived from the release of elastic energy stored dur-
ing the SSC. For example, it has been calculated that without the elastic contribu-
tion of the SSC to force production, the power produced at the ankle during a
one-legged jump would be reduced from about 1700 W to about 750 W (Huijing
1992). Thus, the storage of elastic energy as muscle and tendon are loaded and
stretched (as in the sprinters leg striking the ground), followed by the contraction
of these structures and the boosting of power by the release of the stored ‘energy
pool’, is of critical importance to sporting performance. It is therefore important to
understand both the mechanisms underpinning the SSC and whether training can
enhance the catapult effect arising from it for the benefit of performance.
Mechanisms of the SSC

While a detailed explanation of the SSC has been presented elsewhere, a brief syn-
opsis of this complex phenomenon will be given here (Komi 2003).
The increased production, or ‘potentiation’, of muscle power by the SSC may be
explained by two models, the mechanical and the neurophysiological, both of which
are thought to contribute. In the mechanical model, the rapid stretching of muscle and
tendon causes elastic energy to be stored in the so-called ‘series elastic components’
(SECs) of these tissues. The SECs are thought to reside largely in the tendon (colla-
gen, the main protein of tendon, has a helical or spring-like conformation) but also in
the flexible myosin heads of the muscle cross-bridges. When the musculotendinous
structures are stretched, as in a rapid eccentric movement, the SECs act as a spring
and are lengthened, thereby storing elastic energy. If this lengthening action is rap-
idly followed by a concentric contraction (i.e. a short ‘coupling’ time), the elastic energy
is fed into and supplements that of the contracting muscle to boost power produc-
tion. If the coupling time is too long (for example, if there is a pause after bending
one’s knees prior to a vertical jump), the stored elastic energy will be dissipated and
lost as heat. Similarly, if there is no rapid stretching of the structures, subsequent jump-
ing power will not benefit from this source of additional power.
In the neurophysiological model, muscle spindles (proprioceptive organs that are
sensitive to rate and magnitude of stretch) are thought to be stimulated by rapid
stretch (or even in anticipation of rapid stretch) to both increase the stiffness of
muscle during the eccentric phase, and increase the force production of the agonist
muscles via the stretch reflex during the concentric phase.
The results of these mechanisms on human power output may be clearly and
simply demonstrated in Figure 6.9 (A–C). The first frame depicts the result of a ver-
tical jump to touch a board from a static semi-squatting position, i.e. without a pre-
ceding ‘countermovement’ to stretch the musculotendinous structures. The second
frame depicts the athlete preparing to drop down from a low platform prior to his
next vertical jump. On landing, the high forces resulting from this drop jump cre-
ate rapid stretching of the leg muscles and a considerable storage of elastic energy.
If the coupling time is short, this elastic energy boosts jumping performance, seen
clearly in the final frame (Fig. 6.9C). Before examining the training of the SSC, it is
worth emphasizing the complexity of the mechanisms outlined above. For example,
work done by Fukunaga et al (2002) have demonstrated that not all stretching of
tendon takes place in the eccentric phase of a squat jump. Using real time, ultra-
sonic imaging, they demonstrated that during the first half of the push-off phase,
Figure 6.9 Elastic properties of muscle. In (A) a vertical jump is being performed from a
static, semi-squat position. In (B), the athlete performs a drop jump to the semi-squat
position, before performing the vertical jump. The resulting improvement in performance
(C) is the result of an increase in power arising from the stretch-shortening cycle.
the gastrocnemius muscle shortens by 26%, which in turn causes the stretching (by
about 6%) of the Achilles tendon, most of which recoils to boost power at take off.
Other recent research from the same group in Tokyo has demonstrated clear differ-
ences in the tendon stiffness between men and women, the latter showing a deficit
of about one-third. These differences are yet to be satisfactorily explained, although
they may clearly have implications for performance.
TRAINING MUSCLE ELASTICITY: PLYOMETRICS

While the mechanical and neurophysiological mechanisms underlying the SSC may
be complex and incompletely understood, the movement pattern which elicits the
SSC is relatively straightforward. It consists of three phases. The first of these is the
eccentric phase, during which the agonist muscles are loaded, resulting in the stor-
age of elastic energy by the SEC, and the stimulation of the muscle spindles. The
second phase is the transition between the eccentric and concentric phases, some-
times called the amortization, or coupling phase; this phase is perhaps the most cru-
cial in facilitating greater power production, particularly, as mentioned previously,
the need to minimize delay, or coupling time. The final phase is the concentric phase,
during which the energy stored in the SEC is either used to enhance force production
or is dissipated as heat. The movement pattern described above forms the basis of a
specialized training, plyometrics (from the Greek plio = more, and metric = to meas-
ure) which seeks to improve power output arising from the SSC. The majority of ply-
ometric exercises are based on jumping activities and, as such, cater primarily for the
lower body, although upper body exercises have been developed also (Potach & Chu
2000). Typical jumping activities would include two-legged and single-leg hopping,
jumping over hurdles, bounding activities and drop jumps from various heights.
Rapidity of movement needs to be emphasized, with each effort requiring a maxi-
mal effort. Experience would indicate that plyometric exercises should not be per-
formed by inexperienced of poorly conditioned athletes, and should not be performed
over prolonged periods due to the risk of injury and the rapid onset of fatigue. Due
to the high eccentric contration component inherent in plyometrics, delayed onset
muscle soreness (DOMS) is invariably experienced, particularly in the early stages
of a programme prior to adaptation. Nevertheless, plyometric exercises have become
commonplace and invariably form an important element of the power-athlete’s train-
ing regime. Their efficacy is not only anecdotal but is illustrated by numerous train-
ing studies. For example, Toumi et al (2004) reported that, even in well-conditioned
handball players, 6 weeks of combined weight and plyometric training increased
jumping height (largely as a result of shorter coupling time and increased leg ‘stiff-
ness’). Such improvements did not occur in the weight-training-only group.
Kyrolainen et al (2004) demonstrated that in untrained subjects, a plyometric pro-
gramme (2 × weekly for 15 weeks) improved jumping take-off velocity by 8%, with
a considerable (24%) improvement in mechanical efficiency of sub-maximal jump-
ing. Other training studies employing plyometrics, have also shown improvements
in power performance (Hewett et al 1996, Svantesson et al 1994).
KEY POINTS AND CONCLUSION

1. Human power production is an important contributor to performance in most
sports.
2. Depending on the specific characteristics of the sport, both strength and speed
will contribute to human power production.
3. Although intrinsic muscle speed and strength are highly inheritable character-
istics, both can be enhanced by training.
4. Skeletal muscles and their tendon structures act together as a unit, such that the
stretching of elastic structures in these tissues during limb ‘loading’ boosts sub-
sequent power production as this energy is released in a catapult-like action as
the muscle shortens. This cycle of activity is known as the stretch shortening
cycle (SSC).
5. The SSC can be trained to enhance elastic recoil by the use of specific dynamic
exercises called plyometrics. These normally involve explosive jumping and
bounding activities for the legs, and equivalent actions for the upper body. The
main mechanisms of improvement appear to be a shortening of the transition
time between stretching and shortening phases, and an enhanced stiffness of
musculotendinous structures.
6. Strength training will not only improve maximal voluntary contraction (MVC)
force but will also increase the speed of muscle contraction and power output,
mainly by shifting the force–velocity curve to the right.
7. Heavy weight-training well tend to shift the slower, ‘force’ portion of the
force–velocity curve, while, lighter, more dynamic weight training will tend to shift
the ‘velocity’ portion of the curve in the same direction. A combination of the two
types of strength training will be optimal for most types of sports which require
both acceleration and maximal speed enhancement. An increase in maximal strength
should precede and form the platform for more dynamic training exercises.
8. Local muscular endurance (repeated, dynamic contractions lasting up to 40–50
seconds) also benefits from enhanced strength.
9. To optimize the power:weight ratio, strength training should incorporate a com-
bination of high loads and low repetitions, with lighter resistances and higher
repetitions at very high ‘ballistic’ velocities. After about 16 strength sessions, a
short break of a few weeks may help to minimize hypertrophic adaptations.
10. Muscle speed is largely determined by the proportion of fast-contracting, type
II fibres contained in a given muscle. This is largely genetically determined, but
there is some evidence that the overall volume of training (irrespective of type)
can change fast to slow (type I) fibres. Speed/power athletes should, therefore,
concentrate on the quality of training rather than quantity. A further advantage
of high intensity training may be the selective hypertrophy of type II fibres, so
that they occupy a greater proportion of the overall muscle cross-sectional area.
This adaptation should increase power/speed.
11. To conclude, training for power and speed needs firstly to be based around a
high level of basic strength and conditioning. Thereafter, training practices need
to be characterized by high-quality, dynamic exercises involving both resistance
training and plyometrics. Such exercises should not be prolonged in nature, and
should always commence in a fully rested state.
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Further reading
Baechle TR, Earle RW (eds) 2000 Essentials of strength training and conditioning, 2nd
edn. Human Kinetics, Champaign IL
Komi PV (ed.) Strength and power in sport, 2nd edn. Blackwell, Oxford
Kraemer WJ, Häkkinen K (eds) 2002 Strength training for sport. Blackwell, Oxford
135
Chapter 7
The physiology of strength training
Stephen Ingham
CHAPTER CONTENTS
Learning objectives: 135 Good form 147
Introduction 136 Stability and kinaesthetic
Muscle actions 136 control 147
Quantification of exercise Velocity of action 148
performance 136 The set 148
Measurement of loading 137 The repetition 148
Human force expression 138
Voluntary maximal muscular force
Human force expression –
production 148
muscle 138
Resistance 149
Human force expression – bone
Exercising at proportions of
and connective tissue 140
1 RM 149
Training and adaptation 141
Manipulation of force development
Hypertrophy 141
characteristics 151
Muscle growth 142
Progressive overload 152
Hyperplasia 143
Example of training progression 154
Neurological changes 143
Number of sets 154
Time course of muscle and neural
Rest periods 154
adaptation 144
Training frequency 155
Improvements in strength 144
Workout composition 156
Endocrine responses to strength
Training organization 157
training 145
Key points and overview 159
Strength training principles 146
References 159
Overload 146
Further reading 161
Full range of movement 146
1. Appreciates basic philosophy, definitions and quantification of strength perform-
ance.
2. Appreciates the role of musculoskeletal properties and neural command to max-
imum muscular force expression.
3. Comprehends training-induced physiological adaptations to strength training.

4. Recognizes the principles of strength training as categorized by the exercise rep-
etition and exercise set.
5. Appreciates the progression of strength performance through training.
INTRODUCTION
The development of high muscular forces for the purposes of sporting endeavour
has long been a fascination of humankind. However, the development of pertinent
strength-training techniques has relied as much upon mythology, hearsay, fads and
increasing market pressures as scientific discovery. Nevertheless, the modern strength
and conditioning coach has specialist knowledge of how to successfully and sys-
tematically blend the many factors associated with strength training, such as type
of muscle action, load, number of repetitions and sets, rest periods etc., into a holis-
tic physical training programme eliciting pronounced changes in the neuromusculo-
skeletal unit. Resistance training programmes can be specifically tailored to address
increases in muscle dimension and/or the upper limit of muscle force generating
capability.
MUSCLE ACTIONS
Muscle actions (as they are not always ‘contractions’) correspond to the interaction
between muscle force development and external resistance. Exertion of force is often
associated with the command of body movements, yet muscular actions may take
the shape of static or dynamic exercise. Static efforts involve the application of mus-
cle force with no movement or change in the joint angle, i.e. no work is performed,
and are termed isometric. Actions that involves movement are broadly termed as
concentric, where the muscle shortens, and eccentric, where the muscle lengthens.
Conditions of constant muscular force (isotonic) or angular limb velocity (isokinetic)
are not involved during sporting activities. Even the control of movements using
specialist dynamometry equipment may be at (or as close to as possible) a constant
external velocity or force; uniform conditions are unlikely to be achieved within the
exercising muscle. Consequently, when referring to dynamic human exercising mus-
cular action, the terms isokinetic and isotonic are not appropriate descriptors. Rather,
the human musculoskeletal system operates by way of combining eccentric,
concentric and isometric actions of agonist, antagonist and synergist muscle groups
during sporting pursuits.
QUANTIFICATION OF EXERCISE PERFORMANCE

Exercise is defined as any and all activity involving force generation by activated
skeletal muscles (Knuttgen & Kraemer 1987). Performance can be assessed in terms
of the physical concepts of force, torque, work, power and velocity. Force is that
which changes or tends to change the state of rest or motion in matter (SI unit of
force: newton (N)). Torque is the effectiveness of a force to produce rotation of an
object about an axis and is measured as the product of the force and the perpendi-
cular distance from the line of action of the force to the axis of rotation (SI unit of
torque: newton metre (N.m)). Work is the equivalent to a force expressed through
a displacement with no limitation on time (SI unit of work: joule (J)). Power is the
rate of performing work or the transformation of metabolic potential energy to work
and/or heat (SI unit of power: watt (W)). The application of 1 N expressed through
The physiology of strength training 137
1 m results in 1 J of work. The transformation of 1 J of metabolic energy to work

or heat in 1 s results in 1 W of power. Velocity is measured in metres per second.
Therefore, exercise quantification during dynamic exercise situations is possible as
the opposition of force, e.g. ergometer, exercise machine, gravitational pull to a free
weight; isometric force sustained; power or velocity of progression, e.g. running,
swimming etc.
MEASUREMENT OF LOADING
Strength is defined as the maximal force or torque a muscle or muscle group can
generate in a specified movement pattern at a specified velocity (Komi 2002). In the
practical sense this very definition pertains to a single maximal lift (one repetition
maximum, 1 RM), for example, powerlifting bench press, involving a single repeti-
tion of full eccentric and concentric maximal voluntary muscular action, requiring
heightened motivational control in order to complete.
In this sense the term ‘maximal’ truly does mean that no greater effort can be
generated. Strength exercise, however, is not confined to single maximal muscular
actions. The repetition maximum (RM) is the maximum number of repetitions per set
that can be performed at a given resistance with proper exercise form. Strength exer-
cise performance can be measured by a set of repetitions at a given load performed
to momentary voluntary muscular fatigue or failure. 1 RM is the highest concentric
exercising load. 10 RM is a lighter load that allows performance of 10, but not 11,
repetitions. The RM system can be successfully used as a means of quantifying the
loading during a bout of strength exercise. The test requires determination of the
number of repetitions a person can perform to exhaustion in lifting a certain mass
(kg). Characterization of a particular set can be made as a proportion of one’s 1 RM
for a particular exercise.
Table 7.1 The approximate relationship between the percentage of 1 RM and the
probable maximum number of repetitions
Repetition maximum (RM)
1 2 3 4 5 6 7 8 9 10
Percentage of 1 RM 100 95 90 85 80 ← 75 →← 70 →
Example load (kg) with 90 84 82 80 77 75 73 71 68 66

1 RM of 90 kg
For example:
Set, 8 repetitions with 75 kg squatting;
1 RM for squat of 100 kg;
8 RM = 75% of 1 RM.
Whereas this testing system is useful to provide surface information about an ath-
lete’s abilities and permits comparison of like-for-like exercises for the same person,
it is one-dimensional and fails to fully define strength output because it discounts the
specified or determined velocity of movement and distance. Ideally, when testing
muscle function the force and/or torque measurements must be made when the mus-
cle or muscle groups are at a similar length or as the peak force obtained during a
dynamic action. Work describes more fully the training volume by encompassing
the vertical distance a weight is lifted. For example:
100 kg (or 981 N) lifted vertically 0.8 m during a repetition;
exercise volume = 981 N × 0.8 m = 785 N.m.
If the lift is completed in 0.6 s, the power of the lift equals 785 N.m ÷ 0.6 s = 1308 W.
If the lift is near maximal, it may take considerably longer (e.g. 2.5 s, 785 N.m ÷ 2.5 s =
313 W). Thus, 1 RM efforts are unlikely to yield high-power outputs because of the
time taken to generate the force required to affect the mass lifted. It is for this rea-
son that near-maximal lifts are considered ‘strength oriented’ (i.e. high force), whereas
during high-velocity efforts movement completion is much shorter, thus becoming
‘power orientated’.
The total work or power accomplished can be added for each exercise, body part,
exercise session, microcycle, macrocycle and mesocycle etc. to provide a measure of the
strength stimulus. A plot of the peak work and peak power attained across time is a
useful way of tracking longitudinal periodization of the strength training stimulus.
HUMAN FORCE EXPRESSION

The expression of muscular force (pulling effect) takes place when the central motor
system regulates the contractile operation of the myofilament cross-bridges. The mus-
cle force generated is applied to the attached bone tissue and, if greater than the
external resistance, causes a shortening of the contractile tissues and results in a
turning effect, or torque, about the joint. Equally, if the external resistance exceeds
the muscular force the muscle lengthens and offers a degree of deceleration to the
ensuing load (potential).
Maximal muscular tension comes with only the highest motivation and is expen-
sive to the homeostatic milieu and acts as a potent stimulus for reordering motor
unit involvement, repair to damage tissues and stimulus for growth.
HUMAN FORCE EXPRESSION – MUSCLE

Muscle contractile function takes place when availability of calcium ions permit the
union of myosin and actin myofilaments by cross-bridge head binding. Hydrolysed
ATP provides the energy for the regulation of cross-bridge cycling in order to achieve
sarcomere shortening and generation of a tensile force along the myofibril.
The most obvious determining factor of muscle strength is muscle size. As a gen-
eral principle the cross-sectional area of muscle relates to the force-generating capa-
bility because the greater volume of muscle relates to the number of myofibrillar
units present. The summation of muscular force, therefore, reflects the manifestation
of total sarcomere cross-bridge tension development. However, the tension devel-
oped by a motor unit in response to a single action potential operating upon the
axon terminal, known as the twitch, can vary distinctly between motor units even
belonging to the same muscle. Characterization of motor unit types is based upon
their physical properties of contractile speed of shortening, force development,
endurance and histochemical profile.
Human muscle exists as a variable continuum of types but can broadly be cate-
gorized according to their myosin isoforms that are distinguishable on the basis of
the sensitivity of myofibrillar ATPase (the enzyme that catalyses the breakdown of
ATP for the liberation of energy for cross-bridge function) to staining, revealing the
following types of muscle fibre:
Type I: slow twitch speed (90–140 milliseconds); high aerobic enzyme concentration;
high mitochondrial volume; moderate glycogen content: high capillary perfusion;
resistant to fatigue; small diameter. Engaged specifically for sustained, low-force
activity, e.g. steady cycling.
Type IIa: fast twitch speed (50–100 milliseconds); fatigue resistant; moderate to high
glycolytic and oxidative enzyme concentration; moderate to high mitochondrial
volume; moderate to high capillary perfusion; moderate to high glycogen content.
Engaged during prolonged high-intensity activity, e.g. 400 m track sprint.
Type IIb: fast twitch speed (40–90 milliseconds); fatiguable: high glycolytic enzyme
concentration; moderate to high capillary perfusion; moderate to high glycogen
content. Engaged during intermittent maximal-force activity, e.g. 1 repetition
maximum.
While the types of motor unit differ in their contraction speeds, the force devel-
oped during maximum static efforts is more closely related to the cross-sectional
area of the contractile tissue and not necessarily the fibre type proportions. Moreover,
in elite athlete populations, extreme proportions of muscle fibre types are observed,
for example, track sprinters are known to possess about 80% type II motor units
and marathon runners 80% of type I motor units of the m. vastus medialis. In the
instance of talented sportspersons, the dominance of motor unit type is one of the
fundamental discriminating factors, underpinning gross-motor, high-energy sport-
ing events. Motor unit proportions and the total number of fibres are primarily (and
literally) born out of ones genetic inheritance.
Muscular force expression, however, is not only determined by the cross-
sectional area, type and density of contractile tissue but also by the conductance
of muscle by the neurological system. The major factor determining the recruitment
pattern of motor units is the amount of force necessary to perform the action. The
‘size’, principle (Henneman et al 1965) of motor unit recruitment suggests that as
the intensity of voluntary contraction increases from near resting, motor unit
involvement is hierarchical according to the magnitude of the respective unit, and
thus the potential for force generation. That is, the smallest motor units are recruited
during low-force muscle action, i.e. slow oxidative, followed by fast oxidative gly-
colytic (type IIa), then ‘low-threshold’ fast glycolytic and lastly ‘high-threshold’ fast-
glycolytic (type IIb) as the force of contraction gets closer to the maximal voluntary
muscle contraction. In order for type II fibres to be recruited and thus receive a
training effect, the exercise must be intense. Also, the recruitment order is specific
to the movement executed (Desmedt & Godaux 1977); if the body position is
changed, even if the muscle may be acting at the same intensity, the order of recruit-
ment can change. The selection of motor units from the pectoralis major during the
flat bench press is different from that chosen for the inclined bench press exercise,
for example.
The ensuing force output of a motor unit or muscle can also be modified by the
frequency of the nerve impulse transmission to the motor end plate, known as the
firing rate. Thus, ‘high-threshold’ type IIb units are engaged when very high rates
of motoneuron impulses are achieved. Indeed, the force-generating capability of a
single motor unit can alter tenfold depending upon the excitation of the motoneu-
ron. Therefore, maximum duty of agonist muscle force is determined by the high-
est possible number of motor units recruited and the highest rate of motoneuron
excitation.
For the subconscious co-ordination of body movements and muscular action to
approach maximal level there must be a conscious desire to generate maximal force.
Essentially, the neural programme for maximal force production comes from the
motor cortex that is stimulated by the higher level brain controller to ‘intend to lift’.
Thus, maximal strength efforts are ordered with maximum motivation.
The function of the antagonist muscle during the action of an agonist is to
provide a supportive environment for the active joints and to prevent damaging
consequences of vigorous agonist action. The antagonist acts to stabilize and pro-
tect through deceleration of prime mover co-action. The opposing torque expressed
by the antagonist typically amounts to about 10% of agonist torque, but in essence
acts as an inhibitor by reducing the net torque of the desired movement.
HUMAN FORCE EXPRESSION – BONE AND CONNECTIVE TISSUE

During movements, the affect of the neural stimulus and the concomitant muscle
function only develops into a physical action by transmission of the tensile force to
the skeletal system. The force generated by the soft tissues of muscles is harnessed
by the collagenous connective tissue sheaths that surrounds and binds the entire
muscle (epimysium), groups of muscle fibres (perimysium) and individual muscle
fibres (endomysium). The collective and concentrated muscle force is channelled
through the strong but pliant extension of the muscle sheaths, the collagenous ten-
don. The terminal end point of the muscle is the junction with the bone where mus-
cle function turns from potential into a physical action. Bone is a dynamic tissue in
its resistance to deformation from compressive, tensile and shear loading. The organic
matrix contributes to bone strength and the mineral components give bone its stiff-
ness, both of which adapt to the duty of loading stimuli.
Muscle has the ability to adjust the control of force development in response
to the load taken. When the load is high the muscle increases the speed of short-
ening in order to take time to achieve the necessary force to overcome the load.
In turn, if the load is small, the force generated is correspondingly small, but the
muscle has the capacity to maintain a relative maximal effort, but decreasing the
time taken to accomplish the lift, i.e. increased speed of movement. For example,
with maximal motivation and effort, the time taken to perform a 1 RM bench
press exercise will be slower than pressing, for a single repetition, half of the
1 RM. The relationship between the velocity of muscle shortening and the max-
imal possible force demonstrates a hyperbolic shape. The maximum velocity
attainable can occur with maximum effort against zero loading. The maximum
concentric load is produced when muscle shortening velocity is zero, e.g. while
the muscle is stationary and exercising isometrically. If the load exceeds the
applied force of a maximal muscular effort the muscle must lengthen, as indi-
cated by a negative velocity. Under eccentric conditions greater forces are possi-
ble at increasing velocities, which is thought to be due to the elastic properties
of the muscle tissue. The resilience of muscle and thus sarcomere action is demon-
strated by the transition from near-maximal concentric contractions to isometric
actions through to sub-maximal eccentric actions, in response to incremental load-
ing. The muscle is capable of withstanding up to 40% increases in loading and
only yield about 2% of maximum velocity. This flat portion to the force–velocity
relation provides a broad ranging ability to comfortably withstand loads in excess
of the maximum concentric/isometric force, e.g. walking down stairs, landing
from a jump.
The force–velocity relationship is increasingly recognized as a diagnostic tool for
both the assessment of functional performance and the periodization of strength-
oriented training.
Eccentric Isometric Concentric

100
90
Force production (arbitrary units)
80
70
60
50
40
30
20
10
0
10 8 6 4 2 0 2 4 6 8 10
Velocity (arbitrary units)
Figure 7.1 Theoretical force–velocity curve for eccentric, isometric and concentric muscle
actions.
TRAINING AND ADAPTATION

Resistance exercise dedicated to the advancement of maximal force expression acts
as a physical stimulus for the musculoskeletal system to respond by reordering the
control and architecture of active tissues. The term adaptation (accommodation is a
more passive term also sometimes used) describes the reaction to the strength train-
ing stimulus, such that if the same resistance training regime were performed again
within a reasonable amount of time that the impact of the stimulus upon the integrity
of the cellular milieu would be smaller. An increased potential for even greater func-
tional ability would exist.
There are several mechanisms of how strength can increase. These will be gen-
erally discussed in the following sections, with reference to the targeting of specific
adaptative responses in later sections.
Hypertrophy
A muscle undergoes enlargement in response to a chronic strength training stimu-
lus. The degree of training induced growth can be assessed simply by means of girth
measurements or more accurately by analysing the cross-sectional area as quanti-
fied by direct muscle biopsy, ultrasound, computed tomography imaging (CT) or
magnetic resonance imaging (MRI).
The growth in muscle is thought to be due primarily to an increase in the size
of muscle fibres, known as hypertrophy. Numerous studies have demonstrated the
extent to which muscle fibres increase in response to a programme of resistance
training. MacDougall et al (1979) followed unconditioned young men who trained
their triceps brachii for 6 months. Fibre areas increased by 33% for type II units and
27% for type I units. In older men a 3-month biceps brachii training programme
increased type II units by 30% and type I units by 14% (Brown et al 1988). In a
cross-sectional study, MacDougall et al (1984) noted the muscle fibres of bodybuilders
to be 58% (type II) and 39% (type I) larger than untrained. Komi et al (1982) demon-
strated a change in fibre area diameter of type I and type II units following 16 weeks
of either heavy resistance or power-oriented training. Both types I and II units

increased fibre diameter in response to heavy resistance training, but only type II
units underwent hypertrophy following power training.
The stimulus for muscle growth appears to originate from a loss of sarcomere
integrity. A minor level of strain to individual filaments leads to the addition of actin
and myosin filaments to the periphery of the myofibril. In this process, a larger myofib-
ril is formed because packing density and cross-bridge spacing is left unchanged. More
wholesale changes to myofibrillar architecture occur when the Z line end plates of the
sarcomere experience displacement, also known as streaming. The mechanical stresses
generated during high force activity create an oblique pull, causing the Z line lattice
of actin filaments to tear at the centre, resulting in longitudinal myofibril splitting (not
to be confused with muscle fibre splitting) into two or more daughter myofibrils. As
the myofibrillar mass increases in volume, the sarcoplasmic reticulum, T-tubule sys-
tem and associated sarcoplasm are generated in and around the myofilaments, indeed
adding to muscle mass. Thus, muscle mass size increases due to an increase in myofib-
ril area and number with no change in myofibril packing density.
Muscle growth
The ultrastructural damage experienced following high tensile loading of the mus-
cle tissue acts as the stimulus for active repair and subsequent adaptive growth.
Muscle satellite cells are said to regulate the regeneration of injured tissue by under-
going mitotic proliferation and migrating to the site of repair. The satellite cells then
form a multinucleated myotube from which the transcriptions of new proteins serve
to construct myofilaments.
The induction of messenger RNA (mRNA) species and subsequent nature of gene
expression acts in accordance with the type of mechanical signal developed. For
example, persistent mechanical stimuli are known to encourage the expression of
slow adult genes and repression of fat genes, whereas myosin heavy chain and other
fast contractile protein isoform gene expression is more completely achieved when
active tension development is high. The switching of muscle genes may be related
to changes in metabolites and/or calcium levels, for which the nature of physical
activity is a major stimulus.
The composite stimulus of metabolic and mechanical loads that a muscle expe-
riences is thus the primary modulator of muscle fibre adaptation and phenotype
expression. Because muscle fibres do not exist as distinct types, but are positioned
on a sliding continuum of fast to slow twitch properties, and that motor units are
made up of mixed muscle fibre types, phenotypical expression of the fibre twitch
property is adaptable.
Hence the maximal force-generating capability of a muscle fibre is, in turn,
dependent upon pre-existing contractile protein isoforms and the extent to which
genes progress toward expression of fast genes and regression of slow genes.
Several studies have demonstrated fibre sub-type conversions following resist-
ance training. Staron et al (1994) recruited male and female subjects to performed 2
days of resistance training, of 6–8 RM or 10–12 RM, for 8 weeks. Maximal strength
levels increased without changes in muscle fibre size or fat free mass. Type IIb fibres,
however, were decreased from 21% to approximately 7%. Similar studies of longer
duration (32 weeks, Staron et al 1991; 19 weeks, Dudley et al 1991) have observed
that conversions from type IIb can be almost complete (16–1%, Staron et al 1991),
but that the transformation is completely to type IIa fibres. It would appear that as
soon as a type IIb unit is activated, it begins a conversion to type IIa properties.
The full extent of motor unit translation, particularly in response to a full career
of physical training is relatively unknown. It would appear, however, that the rate
of motor unit conversions, in response to a particular type of training, would not
nearly fully explain the divergence observed between elite, sub-elite and enthusiast
strength athlete that may indeed train to equivalent volumes.
Hyperplasia
The question of whether muscle fibres are able to increase in number is one that
has been keenly debated in the literature in the late 20th Century. It has been gen-
erally accepted that fibre number remains constant and that changes in muscle sizes
occur from the adaptation of existing fibres. Satellite cell proliferation and the ensu-
ing presence of developing myotubes in humans has been used as evidence that
new fibre formation (hyperplasia) is possible, in response to intense exercise train-
ing. The satellite cell proliferation, however, may simply be acting upon necrotic
fibres, following damaging, perhaps eccentric, exercise. Several studies have indi-
cated that muscle growth following training in chicken, cat and rat was accounted
for by hypertrophy and hyperplasia. Numerous observers point to limitations in the
methodology underpinning the treatment of muscle sections and counting proce-
dures, as a way of overestimating total fibre number. As several studies have rea-
soned that, because elite strength athletes possess no more muscle fibres than
untrained or part-trained counterparts, fibre number must be constant, eliminating
hyperplasia as an adaptive mechanism. Moreover, an association between pre-
existing muscle size and muscle fibre number is evidence that, although muscle size
is predetermined by the size of muscle fibres, it is also influenced by the genetically
established fibre number (MacDougall et al 1984).
Neurological changes
Subjects that are not familiar with strength training are initially unlikely to be able
to fully engage the highest threshold motor units, for maximal efforts. As a conse-
quence the potential for agonist muscle force generation is not achieved. During the
early phases of resistance exercise training the reordering of neural control begins
to allow the recruitment of high-threshold motor units, conferring greater force
development by reordering and adding to the number and functional force-
generating capabilities of the motor unit pool. Increased activation of muscle may
also come from a greater rate of neural firing of an individual unit with training,
providing higher force from the same recruited fibre pool.
Electromyography (EMG) is a method of recording the magnitude of electrical
conductance of a muscle. Although, the actual form of neural adaptation is difficult
to fully elucidate from EMG data, the integrated (IEMG) signal recorded from an
agonist muscle increases following strength training can provide information relat-
ing to whether more motor units are being recruited and/or that motor units are being
innervated at a higher rate. The EMG activity-to-muscular force ratio can provide
information relating to the recruitment order utilized during an action. Moritani &
DeVries (1980) noted, following 8 weeks of resistance training, a reduction in EMG
activity for a greater force production. Therefore, the reduced EMG:force ratio led
authors to believe that more selective and effective recruitment order contributes to
increased force production with training. Several studies have also shown that a total
increase in neural drive is associated with increased strength levels. Häkkinen & Komi
(1983) reported an immediate and pronounced increase of 14–35% in IEMG in the
first few weeks of training of the quadriceps muscles. It appears that increased effer-
ent drive, increased motoneuron excitability and a down-regulation of inhibitory
pathways contribute to the excitation of the agonistic muscle.
Training of an agonist is also shown to reduce the EMG activity of the antago-
nist muscle. Häkkinen et al (1998) demonstrated that, while leg extensors increased
strength by 20–30% following 6 months of strength training, a concomitant 5–10%
reduction of bicep femoris EMG activity was observed during leg maximal exten-
sion exercise in older people. The authors reasoned that deactivation of the antag-
onistic muscle following agonist training decreases the opposing pulling force of
antagonist coactivation. Absolute coactivation of the antagonist during agonist mus-
cle contraction is not completely removed with training as it is necessary to assist
stability of the joint and acts as a protective mechanism. Antagonist deactivation,
however, enables the tension of the agonist to take a greater net effect. In addition, Lee
et al (1999) demonstrated that greater activation of synergistic muscles of the arm
enabled improved wrist stability and exercise performance. Together, greater force
production capability of the agonist, coupled with less inhibition from the antago-
nist acting around a more stable platform established from the greater coactivation
of synergistic muscle action, allowed expression of greater strength capability.
TIME COURSE OF MUSCLE AND NEURAL ADAPTATION

Maximal force expression is a product of neural conductance and recruitment of
muscle and of the mass of muscle and their twitch properties. With training, how-
ever, the contribution of neural and hypertrophic changes to the increase in maxi-
mal force production do not occur in tandem. Häkkinen et al (1981) demonstrated
that the increased force production in the first 8 weeks of concentric and eccentric
training was paralleled closely with an increase in IEMG. Further, when non-
strength-trained athletes begin resistance training, the relationship between the
increases in strength and increases in muscle fibre cross-sectional area (Ploutz et al
1994) or muscle girth (Moritani & DeVries 1979), is poor. It is suggested that an
enhancement of the neural firing rate and engagement of high threshold units make
the greatest contribution to increased force production, above that of muscle hyper-
trophy (Sale 1992). It is proposed that during the early stages of strength training
(2–8 weeks) the neuromusculoskeletal system ‘learns’ how to exert force. Changes
in protein quality, as shown by alterations in the type of myosin heavy chains and
type of myosin ATPase enzymes, are observed from the beginning of resistance
training programmes. It is suggested that 16 workouts are required before signifi-
cant improvements in muscle fibre hypertrophy is experienced (Staron et al 1994).
IMPROVEMENTS IN STRENGTH
The literature reflects a wide variety of responses to resistance programmes, mostly
depending upon the age of the group, pre-training status and potential for improve-
ment. The average improvement in strength for sedentary young and middle-aged
participants for up to 6 months of training is 25–30%. Fleck & Kraemer (1997)
reviewed 20 training studies that examined the effect of dynamic constant external
resistance training and testing of 1 or multiple (≤ 10) RM performance with the equip-
ment on which they trained. The 20 studies that were reviewed for bench press
performance (for a mean of 12 ± 4 weeks, 3.3 ± 1 days per week) demonstrated a
mean increase of 19.8 ± 13.5% increase in strength. The 10 studies involving leg press
exercise (for a mean of 14.5 ± 5.8 weeks, 2.8 ± 0.4 days per week) showed improve-
ments in strength of 30.9 ± 17.5%.
Improvements in isometric strength as a result of isometric training have also
been reviewed (Fleck & Kraemer 1993). The 10 studies included assessments of elbow
flexors, quadriceps, triceps surae and triceps brachii muscles exercised for 19.1 ±
14.7 contractions per day each of 5.1 ± 2.7 s duration (totalling 73.6 ± 43.7 s iso-
metric contraction time per day) for a period of 41 ± 22 days resulted in an increase
of maximum voluntary isometric action of 31.3 ± 24.4%.
ENDOCRINE RESPONSES TO STRENGTH TRAINING

The endocrine system is key to many aspects of training-induced increases in
strength. In general, early improvements in strength are dominated by neuro-
muscular changes. The stimulus provided by strength training induces hormonal
secretion from the initiation of training and many of these are responsible for pro-
tein synthesis leading to muscle hypertrophy. In evolutionary terms, however, mus-
cle is costly, requiring a good supply of energy and if food is short muscle is one
of the first tissues to be reduced in size. Accordingly, there is a certain resistance
to greatly increase muscle-derived protein synthesis until constant demand (i.e. a
regular stimulus) dictates that it is required. For this reason, early increases in
strength are dominated by neuromuscular adaptation (which does not require
increased protein synthesis), while later increases in strength are related to mus-
cle hypertrophy.
There are a number of hormones associated with increased muscle protein syn-
thesis whose secretion is stimulated by resistance exercise. These include testosterone
(the primary male sex hormone), growth hormone (hGH) and insulin-like growth
factor-1 (IGF-1).
With respect to growth at puberty, testosterone and hGH play a key role. In terms
of muscle hypertrophy, testosterone acts as a classic steroid hormone. Being lipid-
based, testosterone is easily diffused through the lipid-bilayer membrane of the cell
and is also therefore able to diffuse through the membrane of the cell’s nucleus.
Steroid hormones interact with receptors in the nucleus and encourage the forma-
tion of a copy or transcript of the appropriate section of DNA. This transcript is
made of RNA and can be transferred from the nucleus to the cytoplasm of the cell
(known as sarcoplasm in the muscle cell). In the sarcoplasm the RNA transcript is
used by organelles known as ribosomes that construct the appropriate proteins from
amino acids, hence, more muscle is constructed.
hGH is a peptide hormone whose secretion is also stimulated by resistance exer-
cise. It has a more minor direct effect on muscle cell protein synthesis. Peptide hor-
mones act by interacting with receptors on cell membranes. When the hormone and
receptor bind it causes a ‘second messenger’ to be released inside the cell. This sec-
ond messenger initiates a cascade of reactions involving transcription factors which
interact with receptors in the cytoplasm and nucleus. Until recently, however, hGH
was recognized as having only an indirect role in muscle hypertrophy. hGH inter-
acts with liver membrane receptors to stimulate the release of IGF-1 from liver and
it is this IGF-1 of hepatic origin that was deemed to be the most important initia-
tor of muscle hypertrophy. This central role for IGF-1 is encapsulated in the
somatomedin hypothesis (Daughaday 2000). Recently, IGF-1 has been shown to have
a number of splice variants and IGF-1 is produced in liver and locally in muscle.
Currently, it is suggested that muscle derived IGF-1 will be renamed ‘mechano
growth factor’ (MGF) in recognition of the fact that its major stimulus is muscle con-
traction per se.
With respect to GH, a more direct effect on muscle hypertophy has been recently
demonstrated. GH appears to directly inhibit the muscle protein somatostatin.
Somatostatin normally acts to inhibit muscle growth and so ensure that muscle devel-
opment does not exceed what is functionally required. By inhibiting somatostatin
GH directly facilitates muscle hypertrophy.
In summary, it is obvious from a considerable volume of research literature that
there are a number of routes by which endocrine function directly, indirectly, in iso-
lation and by interaction, can affect muscle hypertrophy and ultimately, therefore,
strength.
STRENGTH TRAINING PRINCIPLES
Overload
When a muscle is required to respond to a load to which it is not accustomed in
normal daily activity, the muscle is ‘overloaded’. The overloading event acts as a
discrete stimulus for the biological mechanisms of adaptation (see Ch. 1).
A stimulus for muscle strength development can take many forms. Simplistically,
the muscle increases in strength to time under tension. To this extent, various com-
binations of exercise mode, type, and intensity of muscle actions are effective at
developing maximal force production capability. Current understanding is a long
way from being able to categorically prescribe accurate loading for the multitude of
requirements for everyday functionality to sporting endeavour; maximum to mini-
mum strength adaptation; for untrained or trained; young or old; male or female.
Further, pre-training status determines the extent to which athletes are able to make
proportional improvements. Well trained athletes will be closer to their genetic ceil-
ing of strength development potential than untrained subjects. Studies that have
examined the responses of untrained young, middle-aged (Pollock et al 1989) and
elderly (Fiatarone et al 1994) participants using lumbar extension strengthening exer-
cises have observed greater than 100% increases in strength in just 8–12 weeks.
Likewise, Häkkinen et al (1981) observed improvements in back squat, following 24
weeks of strength training of about 100% for non-athletes, compared with about 50%
in athlete populations. It appears also that untrained participants require much lighter
loading in order to experience hypertrophy and strength gains.
At one end of the loading spectrum, high-volume, low-tension exercises such as
those undertaken during endurance training will induce hypertrophy of type I units.
Equally, multiple isometric actions will result in moderate hypertrophy and gains in
strength but not of the same magnitude as dynamic strength exercise. It has been
suggested that the threshold training stimulus for strength adaptation should not be
less than one-third of the maximal strength. As adaptation occurs and strength
increases, however, the proportional intensity at which resistance exercise is levelled
in order to constitute a stimulus must increase. Strong evidence from the literature,
coaching, and athlete experience show that light loading regimes are far less effec-
tive in developing strength than programmes that involve maximum athlete exertion.
Full range of movement

No study has adequately examined whether exercises are best performed through
the full range of movement or partial range to optimize strength gains. A number
of studies have considered the strength adaptations to maximal isometric exercise
training, however, and concluded that whereas hypertrophic gains are moderate, the
improvements in strength are specific to a limited joint angle and not throughout
the full range of motion. Resistance training movements are typically performed
through the full possible range of motion allowed by the body positioning and joints
involved, with the greatest consideration to safety of the athlete. Positioning the
muscle so that it acts through a large range of movement requires the muscle to
experience tensile loading along a greater length of its entirety leading to unifor-
mity of loading stimuli and requiring greater forces at the start (long) position. It
may be argued that a greater range of motion is possible for a host of exercises when
using dumbbells versus barbells (e.g. dumbbell bench press versus barbell bench
press), therefore applying the tensile force through a greater range. Indeed, studies
have demonstrated that muscle actions involving greater range of movement (e.g.
seated incline dumbbell bicep curl versus preacher dumbbell bicep curl) result in
greater muscle damage and thus a more potent strength stimulus. In contrast, greater
loads (and thus tensile forces) can be lifted for an equivalent number of repetitions
when using barbells over dumbbells, therefore creating a greater level of work and
thus enhancing the overall stimulus. Movements involving partial range of motion
can be useful for rehabilitation or sports-specific training.
Good form
Exercise form refers to the practice of implementing recommended movement pat-
terns, maintenance of postural control, use of full range of motion and regulation
of breathing. For example, swaying of the torso or excessive movement of the elbow
during barbell bicep curls would be considered a lack of good form. Therefore, good
form allows a muscle or muscle group to be isolated well and to minimize poten-
tial injury. Good form tends to be easier to maintain if the contraction and length-
ening phases of an exercise are performed at a slow velocity because momentum
developed by fast moving body parts is minimized.
Stability and kinaesthetic control

Even the most basic exercise, whether involving the control of free weight, body
resistance or machine system, requires a high level of co-ordination and control.
The level of proprioceptive control afforded for a given exercise depends greatly
upon the experience of the type of movement performed and the refinement of
the hierarchical control of fine and gross motor unit pattern recruitment. The
novice practitioner may struggle, for example, to hold the hips in line with the
torso and legs during a press up; or to control the descent of a weight during the
eccentric phase of a triceps extension with a resistance that required only mod-
erate effort during the concentric phase. A further example, commonly observed,
is the lack of movement control exhibited by experienced weight training athletes
when asked to perform dumbbell bench press, when all previous experience has
been of barbell bench press. Furthermore, there is a heavy dependence of exer-
cises that involve actions exclusively through the sagittal and frontal planes, but
few that are either in the transverse plane or that combine one or more planes of
movement.
Whereas the preponderance for traditional, big, compound exercises such as the
power clean, barbell bench press and back squat is warranted as extremely pro-
ductive movements for strength development – as they allow for the greatest force
production, muscle mass involvement, hormonal release etc. (see later section on
exercise choice) – they are often chosen for these very reasons over more functional,
kinaesthetic, multi-directional oriented movements that may have greater cross-

transfer to sports-specific movement techniques. Strength and conditioning coaches
should give serious programme space to exercises that provide greater kinaesthetic
and therefore, globally valid exercise movements that can be creatively constructed
rather than simple, one-dimensional replication of the customary exercises.
Velocity of action
Training at a low action velocity for strength movements appears to greatly enhance
strength at low action velocities but has a minimal effect upon high-velocity strength.
While high velocity entrainment greatly improves high-velocity strength, in contrast
it has a greater transfer to low-velocity strength than does low-velocity training on
high-velocity strength. Because high-velocity training does not allow enough time
for the development of high forces, however, full development of muscular hyper-
trophy through application of high volumes of tensile loading will only be possible
with low-velocity training. Likewise, low-velocity training may fail to stimulate neu-
ral activation sufficiently, owing to the reduced velocity of contractile excitation.
Therefore, one would consider low-velocity training is more oriented to hypertro-
phy and high-velocity training to neural strength adaptation.
It is thus clear that resistance training produces the greatest strength gains at the
velocity at which training is performed. More importantly, numerous studies have
shown that the effect of fast isokinetic training upon power-based tests of perform-
ance such as jump and sprint ability is much greater than slow isokinetic training.
It has been recommended, however, that medium velocity strength training has the
greatest effect of any one particular velocity of training upon a rightward shift of
the force velocity curve and thus optimal but generic strength performance.
The set
A series of repetitions is termed the set. As the set progresses the neuromuscular
system will fatigue, resulting in an increasing perceptual effort required to perform
an exercise at a given resistance.
The repetition
The basic unit of resistance training is the repetition, defined as the performance of
a complete cycle from start position, through the end of the movement and back to
the start. For isometric training, the repetition refers to a muscle action or effort at
a specified joint angle. For dynamic constant external resistance exercise, one single
number or range of repetitions does not present the optimal stimulus for maximal
strength adaptation. The number of repetitions that is intended for a given exercise
set should depend upon the desired physiological adaptive response. Numerous
studies have examined the effect of varying repetition number upon the strength
gains of novice strength athletes. Many studies that have attempted to standardize
the total work performed have concluded that improvements in strength adaptation
is independent of repetition number (typically between 2 and 12 RM).
VOLUNTARY MAXIMAL MUSCULAR FORCE PRODUCTION

Several studies have shown that a crucial aspect of the impact of multiple repetitions
at a given exercise load is the degree of maximal effort involved. Maximum effort
strength exercise (a voluntary maximal muscular action) is the most effective means of
developing maximal force generating ability (Fleck & Schutt 1985). Perhaps the most
obvious means of maximal exercise is the performance of a 1 RM effort. However,
strength-training programmes, even for competitive lifters, do not commonly involve
1 RM efforts in isolation. A set of multiple continuous repetitions require near maxi-
mal muscular actions. Multiple repetitions are performed with a moderately heavy
resistance in which the acting muscle experiences progressive fatigue until momentary
concentric failure (which needs to be overseen or ‘spotted’ in order to assist the com-
pletion of the final repetition or remove the resistance from the fatigued athlete) or just
before momentary concentric failure. Thus the final repetition of a multiple repetition
exercise set is performed as a voluntary maximal muscular action. Compared with a
single maximal action, the performance of multiple repetitions presents a greater vol-
ume of high tension dynamic actions, which in turn act as a stimulus for adaptation.
RESISTANCE
The most important factor for strength training is the amount of resistance used. It is
the major stimulus for strength adaptation and, assuming maximal voluntary muscu-
lar failure, will decide the number of repetitions possible. Thus, nRM or %RM is the
simplest method of assessing load. Research supports varying training effects derived
from exercise on a continuum of RM. The use of percentage RM for power exercises
such as power clean, clean and jerk and snatch may not be appropriate because the
emphasis for performance of these exercises is velocity of movement and technique
rather than maximal muscular fatigue and thus slowing of movement velocity.
EXERCISING AT PROPORTIONS OF 1 RM
The fatigue rate associated with exercises performed at heavy loads means that as
the weight increases the number of repetitions decreases. Consequently, a number
of investigators have developed equations or charts to facilitate the prediction of
maximal or sub-maximal performance. For many, these charts are integral to the
development of training plans and progression; however, there are a number of lim-
itations to these extrapolations that the strength training athlete and coach should
be aware of. Firstly, many predictions assume a linear relationship between repeti-
tion number and load, whereas this has been shown not to be the case. Secondly,
for exercises involving a large muscle mass (e.g. leg press), the strength athlete will
be able to perform a higher number of repetitions for a given percentage of 1 RM
than possible with a small muscle mass (e.g. bicep curl). Therefore, the strength ath-
lete should seek to maintain a repetition number in a strength zone, for large muscle
mass exercises, by increasing intensity to a higher percentage of 1 RM (Kraemer &
Häkkinen 2002).
Strength appears to increase in the early stages of training consistently regard-
less of the nature of the loading. Equivalent rates of improvement are observed when
loads of 20, 40, 60 and 80% of 1 RM are used for participants with no background
in resistance work. Thus, intricate prescription based upon loading, velocity of move-
ment and rest interval is only warranted for athletes with several months of resist-
ance training experience.
Studies have demonstrated that RM resistances of 6 or less result in the greatest
increases in strength measures and maximal power outputs. Resistances of 20 RM or
above are shown to improve muscular endurance to the greatest degree, but strength
gains experienced from such high number repetitions are minimal. Table 7.2 outlines
Table 7.2 Differentiation in ‘neural’ and ‘hypertrophic’ stimuli with training

repetition ranges
Neural system
Adaptation stimulation Hypertrophy stimulation
1–3 RM Strength/power High Moderate

3–6 RM Strength/power High Moderate–high
6–12 RM Moderate- to high-intensity Moderate High
strength
12+ RM High-intensity endurance Low Moderate
the programme goals that are classically attached to the most popular configurations
of exercise repetitions (Häkkinen, 2002).
A ‘neural’ oriented heavy resistance session involves efforts at 80–90–100% of 1
RM, for less than six repetitions per set. During such high loading the neuromus-
cular system undergoes acute fatigue, as measured by reduced maximal voluntary
neural activation (~20%, for 20 × 1 RM lifts), a reduction in maximal force generat-
ing ability (~25%, for multiple 20 × 1 RM lifts) and a reduction in the force–time
curve characteristics of force application (~one-third, for 20 × 1 RM lifts). Performance
of a few maximal repetitions requires the generation of maximal muscular forces,
and thus maximum motivation. Maximal force performance takes a greater amount
of time to develop than lighter power oriented movements (> 600 milliseconds to
reach maximum force). The power development during 1–6 RM efforts is unlikely
to be maximal owing to the longer time taken to develop maximal force. Indeed,
maximal force development during 100% 1 RM efforts may not reach absolute max-
imal force generating abilities because acceleration is compromised by the high resist-
ance (mass) used. In this way, absolute external mass loading is at its highest during
‘neural’ sessions which should be considered as the primary stimuli for strength
adaptation.
The ‘hypertrophic’ model involves medium to high loads, such as 60–80% of 1
RM, for multiple sequential repetitions until maximal voluntary concentric failure.
The classic hypertrophy workout involving sets of 10 RM is the bedrock of body-
building and recreational athlete programmes. Features of such loading lead to severe
acute fatigue of the neuromuscular unit (~30%, for 10 × 10 RM lifts), reduction in
maximal force generating ability (~50%, for 10 × 10 RM lifts), pronounced accumu-
lation of blood lactate and considerable acute hormonal responses. The common
emphasis for this type of training is to maximize the stimulus to the muscle by bal-
ancing the period of time that the muscle is exposed while ensuring that the load
creates sufficiently high tensile stresses to cause ensuing concentric failure, for exam-
ple within 10 repetitions. Therefore, the combination of moderate-to-high tensile
stresses applied over a significant time period creates the stimulus of tension induced
myofibrillar streaming and high volumes of anaerobic energy release from the pro-
longed nature of high-intensity efforts.
A traditional, hypertrophy oriented technique for repetition performance involves
the active deliberation of concentric and eccentric phases during dynamic constant
external resistance exercise. The, ‘up-for-two, down-for-three’ method of repetition
control, accentuates the ‘time-under-tension’ principle, in order to ensure a quality
tensile and metabolic stimulus. For example, for a barbell bent-over row movement,
the bar is pulled up from the start position to the abdomen for a count of two, and
then returns from the finish to the start position for a count of three.
The emphasis placed upon the eccentric component of this training method
reinforces the uniquely important role that eccentric muscle lengthening has on
strength development. During eccentric actions the IEMG per unit of force is lower
than during concentric actions, meaning that motor unit recruitment per unit of
force is lower and that the tension placed upon each motor unit is greater for
eccentric versus concentric actions. Eccentrically biased activities (such as down-
hill running) are often discussed in relation to delayed onset of muscular soreness
(DOMS), associated Z-line disruption, inflammation, creatine kinase enzyme
release, reduced range of motion and loss of muscle force during the period of
days of recovery.
Observers and practitioners alike often place too much emphasis upon the seem-
ingly deleterious damage response that results from eccentric activity, citing sore-
ness, injury and loss (albeit transient) of strength as reasons to avoid this type of
training. This view overlooks the most rudimentary mechanistic understanding of
the importance of inducing micro-morphological damage, as the very essence of the
neural and myofibrillar adaptive stimuli development. The greater tensile stresses
that motor units undergo during eccentric actions are often magnified beyond the
simple premise that when a sarcomere is loaded excessively its component structure
becomes compromised and thus repairs to a more robust setting.
Studies have demonstrated that the degree of strength development that occurs
in response to concentric training alone is inferior to concentric plus eccentric cyclic
training. Because eccentric actions are integrally involved in many sporting activi-
ties, dynamic constant external resistance exercise involving eccentric actions are
fundamentally important to functional strength development.
Therefore, eccentric work would appear to be a potent stressor of the tensile prop-
erties of muscle tissue and thus should be used as an effective training stimuli when
incorporated into dynamic overloading. An obvious weakness of attempts to create
a muscle loading stimulus without undue strains to the skeletal system, such as iso-
kinetic or isometric training, is a neglect of eccentric modality that frequently results
in less functional kinematic capability, for predominantly land based sports.
Overall, the strength training response is very specific to the type, mode and load-
ing combinations applied to the neuromuscular system. In this way, adaptation is
precise. However, due attention should be given to the requirement for variety and
holistic transfer of training effects to the sporting movement. For example, a par-
ticular exercise, such as bench press, may be considered a bedrock exercise for many
sports’ resistance training programmes and continual use will lead to improved
performance but may not facilitate greater force production in a host of movement
patterns, in proportion to the amount of time spent exercising with it.
MANIPULATION OF FORCE DEVELOPMENT CHARACTERISTICS

The criteria for maximal muscular force production need not only involve the per-
formance of exercises to failure or maximal loading. Newton’s Second Law of Motion
states that ‘The change of motion is proportional to the motive force impressed; and
is made in the direction of the straight line in which that force is impressed’, such
that the rate of change of velocity is proportional to the resultant force acting on
the body and is in the same direction as the force or:
force = mass × acceleration (F = m.a)
Therefore, if the goal of strength training is to utilize the generation of the level of
force during a repetition/set, then the magnitude of force (F) can be manipulated
in several ways:
(i) F = M.a where mass M is large and the acceleration is small;
(ii) F = m.A where the mass is small and the acceleration A is large;
(iii) F = m.a where mass and acceleration are moderate.
Thus, in theory, training can be manipulated using a variety of loading and veloc-
ity combinations to achieve ‘force training’. However, when an athlete trains with
high resistance (i.e. high mass), as does a powerlifter, or trains with high accelera-
tion and small mass, as does a track sprinter or arguably an Olympic lifter, or trains
with moderate mass and acceleration, as does a bodybuilder, very different physi-
cal and importantly performance responses are experienced. This is because the load-
ing and accelerative components of high force generation act as highly specific stimuli
for neural, muscular and metabolic adaptations (Siff 2003).
The force–velocity characteristics of muscle performance dictate that the maxi-
mal force development potential is determined by the velocity of the movement.
During high-velocity movements there is little time for the development of force,
e.g. during the rapid foot contact during a long jump take off. In contrast, during
low-velocity movements, such as a rugby scrum, there is much more time for the
attainment of greater force levels. Likewise, during strength exercises the maxi-
mum movement velocity possible will depend largely on the magnitude of the
load used. Whereas, a 1 RM bench press performance may require maximal effort
and is indeed categorized as maximum strength, the load is so high that it can
only be completed slowly. Likewise, multiple repetition sets may also be volun-
tarily performed at slow speeds for a particular training adaptation. If the athlete
chooses to perform all movements slowly either due to maximal loading or repe-
tition deliberation; however, improvements in maximal force (high force end of
the force–velocity curve) production will occur but little improvements in the veloc-
ity of movement (velocity end of force–velocity curve) will take place. In resist-
ance training, it is common for athletes who are interested in power training to
choose lighter resistances, typically 30–60% of 1 RM, for which the load will not
feel ‘heavy’ per se, but the athlete will be able to turn his/her attentions to per-
forming the movement at maximum possible velocity. Furthermore, ballistic move-
ments will make only small improvements in maximal force ability yet will greatly
enhance rapid development of lower forces (see Ch. 6). Therefore, the character-
istics of force generation adaptation are specific to the rate of force development
training undertaken.
As a general principle, training at a specific velocity will carry over adaptation
to force production ability for velocities ± 20–30% either side of that trained. To this
extent, training between 30 and 60% of 1 RM has been shown to facilitate improve-
ments to all portions of the force–velocity curve. However, continually training at a
fixed intensity and velocity of movement will result in limited improvements in high
force or high velocity generating ability.
PROGRESSIVE OVERLOAD
At the start of a training programme a person will be able to complete a certain
number of repetitions with a given load or be able to lift a certain load for a single
repetition, i.e. an athlete’s strength is definable. If that person undertakes just one
training session (the configuration of which would typically involve multiple

repetitions and sets, of a variety of given exercises specific to the intended muscle
groups, at a given exercise intensity), the subsequent compensation and adaptation
means that the muscle then becomes capable of producing greater force. Therefore,
if the same training session were repeated exactly, the overall impact of the train-
ing stimulus and subsequent provocation of adaptation would be reduced.
Subsequently, if the same training session continues to be repeated, with time,
strength gains would inexorably approach a plateau. If it is the goal of exciting the
appropriate systems into continuous adaptation, the stimulus, i.e. the configuration
of loading, must increase.
For example, an athlete at the start of the training programme may be able to
bench press 40 kg for 10 repetitions and press 53 kg for a 1 RM. The 10 RM load
represents a proportional load of 75% of 1 RM. Using the average responses observed
by Fleck & Kraemer (1997), if the athlete trained for 12 weeks, three times per week
and experienced a 20% increase in strength performance, the athlete would then be
able to perform 10 repetitions with 48 kg and be able to press 64 kg for a 1 RM
effort. Following training, the original 10 RM loading of 40 kg would then repre-
sent a proportional load of 63% of 1 RM.
● Pre-training bench press performance:
10 RM = 40 kg
1 RM = 53 kg
● Following 12 weeks of 3 training sessions per week:
10 RM = 48 kg (40 × 1.2 (+ 20% improvement))
1 RM = 64 kg (53 × 1.2 (+ 20% improvement))
Previous 10 RM of 40 kg = 63% (40/64 × 100) of training enhanced 1 RM
Overload can be progressed in all manner of ways, but perhaps the most obvi-
ous means is to increase the resistance (amount of weight) used for a given num-
ber of repetitions. One of the first steps in the adaptation process is likely to be that
the athlete is able to perform more repetitions with a particular weight. In this cir-
cumstance, for overload to be progressive an athlete may decide to alter subsequent
training sessions by:
● increasing the weight used;
● attempting to perform further repetitions with the same weight;
● reducing the rest interval between sets;
● increasing the number of sets performed.
In most circumstances the resistance chosen must be predetermined before a set
of repetitions begins. Given that individual progression, over time, is highly vari-
able, a fixed increment in resistance for each subsequent training session is likely to
produce unpredictable performances. Assuming that an athlete intends to perform
the set of exercises to voluntary maximal muscular failure, the athlete should select
a weight that will induce fatigue within the prescribed repetition range. In the exam-
ple outlined below, the athlete overloads the elbow flexor muscles by exercising at
70% of 1 RM, resulting in 8–10 repetitions per set. Overload progresses by an increase
in the resistance only when an increase in repetition number is observed. Thus, the
athlete aims to increase resistance while maintaining intensity. This stepwise method
of progression is a logical way of advancing the resistance appropriately and in
accordance with the ability of the active muscle group unit. Detailed record taking
of training performance greatly facilitates step-wise progression, as the athlete is able
to refer back to previous efforts and present reasonable but challenging feats for
current or future workouts.
Example of training progression

Week 1 able to perform barbell curls for 8 repetitions with 30 kg;
Week 4 able to perform barbell curls for 9 repetitions with 32.5 kg.
NUMBER OF SETS
Increases in maximal strength have been reported in response to a single set of an
exercise per training session (American College of Sports Medicine 1998). Strength
gains are not different between programmes that use 1, 2 or 3 sets of 10–12 RM dur-
ing the first few weeks of resistance training. Single-set systems are also useful for
the maintenance of strength during heavy competitive schedules. It is well under-
stood, however, that multiple (3–6 per body part) sets produce significantly supe-
rior results over longer term programmes. In more highly trained athletes strength
gains are very small with low volume, single-set training regimes. It is recommended,
therefore, that the use of one or two sets of an exercise are useful for novice athletes,
for circuit training or for maintenance phases (Fleck & Kraemer 1997).
REST PERIODS
Recently it has been shown that the period of rest provided between sets greatly
influences the nature of the workout stress. Following the performance of an exer-
cise set, a reduction in neuromuscular excitation ability, an increase in local meta-
bolic acidosis and the replenishment of ATP and PC energy sources, occurs. Longer
rest period protocols (3–5 minutes) are more appropriate for ‘neural’ or
strength/power orientated sessions in order to facilitate more complete recovery of
neural performance. Progressive fatigue across sets, resulting from inadequate rest,
will lead to either a reduction in the velocity of the speed of movement for a fixed
load or a reduction in the load in order to maintain movement velocity. Studies
demonstrate that when comparing responses to a strength/neural protocol (5 RM,
3 minutes rest) versus a hypertrophy protocol (10 RM, 1 minute rest), blood lactate
concentration was 50–100% greater and growth hormone response 30–90% greater,
for the latter regime. Thus, metabolic responses are not related to the magnitude of
the resistance used but to the amount of work and the duration of muscle loading.
In simple terms, the intensity, as indicated by the severity of effort or psychologi-
cal anxiety expressed rather than an index of load, can be dramatically increased
with the reduction of rest between sets. Such high-volume–low-rest regimes should
be phased gradually into a novice strength programme in order for the acid–base
balance to progress. One of the common themes that emerges from the literature is
that the degree of lactic acid accumulation in the muscle and blood may be related
to the growth hormone response observed during strength workouts and so may
indeed be an underpinning pre-cursor for muscle growth.
Rest periods of less than 60 seconds are not considered optimal for maximal
strength adaptation and are more indicative of ‘circuit’ training. Where numerous
resistance exercises, often including actions of varying body parts are performed in
rotation or in repetitions, with minimal rest between sets, the loading resistance
tends to be lower than conventional strength loads in order to accomplish many
‘stations’ and ‘circuits’, There is also a marked cardiovascular effort due to the rel-
atively short period of rest between sets. Circuit training tends to be used by athletes
whose primary source of energy is from the glycolytic/lactate pathway; for added
variety to resistance training; or when a gym is not freely available and only body-
weight resistance exercises can be performed.
Table 7.3 The effect of differing rest periods upon loading and programme goals
during resistance training
Rest period Comments Loading Programme goals
0–30 s Very, very short rest Light resistance: Fatigue resistance, muscular
15–25 RM endurance
31–60 s Very short rest Light resistance: High glycolytic stress,
10–20 RM anaerobic endurance,
hypertrophy
61–120 s Short–moderate rest Moderate resistance: Muscular strength,
8–12 RM hypertrophy
120–180 s Moderate–long rest Moderate–heavy: Muscular strength,
6–10 RM hypertrophy, moderate
velocity of movement
180–300 s Long rest Heavy Absolute strength, power,
high velocity of movement
300–420 s Very long rest Very heavy–maximal Maximal RM and power
resistance
The novice strength athlete can take many approaches to controlling the rest peri-
ods between sets, depending upon the desired goal. It is not recommended that the
novice use rest periods of more than 3 minutes in duration in order to develop fun-
damental anaerobic biochemical, ultrastructural and morphological adaptations. In
the early stages of training, even moderate to long rest periods may not prevent a
naïve muscle from fatiguing across multiple sets. In this instance, the regime should
control rest periods to 60–120 seconds, and let the adaptive response be the achieve-
ment of consistent performance across multiple sets. Alternatively, the novice may
begin resistance training with very short rest periods and light loading, experienc-
ing adaptations in muscular endurance before, progressing to heavier loads and
increasing the rest between sets.
TRAINING FREQUENCY
The frequency of strength-training stimulus will depend upon the intensity of the
muscle stimuli, number of muscle groups worked, and recovery potential. Research
shows that muscles should be trained at least 1 day per week in order to initiate
strength gains and to maintain strength adaptations. A number of medium-term lon-
gitudinal studies show that two or three training sessions per muscle group elicit
near-optimal improvements in strength. However, professional strength/hypertro-

phy oriented athletes, such as bodybuilders, rugby players, weightlifters are likely
to conduct 4–6 strength workouts per week, with some conducting two training ses-
sions per day. The configuration of these weekly workout regimes are developed in
order to ‘split’ bodyparts, and accrue rest between workouts in order to increase
training volume.
WORKOUT COMPOSITION
Once the resistance, velocity of movement, number of repetitions, number of sets
and amount of rest between sets have been decided, there are still a multitude of
choices to be made relating to the exercising movements to be performed. Yet com-
monly, despite having thousands of resistance movements to choose from, work-
out composition is frighteningly familiar for all, given the equally infinite individual
factors such as gender, age, body dimension, functional ability and sport. It is
Table 7.4 Classification of exercise according to number of joints involved and

complexity of movementa
Classification - Joint number
- Complexity of movement
Example movements
Categories (joints involved) Weight/force
Single joint Calf raise (ankle) Low–moderate

(also referred to as Knee raise (hip)
isolation) Tricep extension (elbow)
Pec flye (shoulder)
Multi-joint Bench press (shoulder, elbow) Moderate–high
(also referred to Chin-up/Lat pull down
as compound (elbow, shoulder)
combination) Lunge (ankle, knee, hip, back)
Complex multi-joint Snatch (ankle, knee, hip, back, High–maximal possible
(also referred to shoulder, elbow, wrist) weight
as power lift, Power clean (ankle, knee, hip,
compound lift) back, shoulder, elbow, wrist)
a
Comments. Exercises are categorized according to whether a single joint or multiple joints are
involved, and whether the action requires a high level of complexity to perform. This categorization is
used to facilitate decisions about the magnitude of physical loading, i.e. heavier absolute loads are
possible with multi-joint exercises, whereas greater emphasis is possible for a selected muscle with
isolation exercises. Olympic and power lifting athletes tend to perform a large majority of resistance
training with complex multi-joint movements, with a moderate amount of multi-joint actions, with
little or no use of single joint movements. Body building athletes, on the other hand, will use multi-
joint and single-joint exercises almost exclusively with very little use of complex multi-joint exercises.
Strength training for athletic sports tends to involve a combination of all three categories of training,
in order to address power (complex multi-joint), functional strength (multi-joint) and specialized muscle
development (single joint) components of an activity. Complex multi-joint and multi-joint exercises are
best performed at the beginning of the workout, i.e. before isolation, because isolation work may
pre-fatigue a particular body part.
Table 7.5 Classification of exercise according to the priority or specificity of the

exercise movementa
Classification – Priority
Categories Example for sprinter
Primary (also referred Power clean

to as specifics) Snatch
Front squat
Hamstring curls
Calf raise
Push press
Bent over row
Supplementary (also referred Bench press
to as cross training) Front dumbbell raise
Reverse dumbbell raise
Dumbbell bicep curl
Tricep kickbacks
Outer range leg extension
a
Comments. The priority system places emphasis upon the selected exercises based upon one or more
of the following:
● Muscle groups heavily involved in sporting action
● Actions requiring maximum motivation, effort and/or velocity of movement
● Weak muscle groups
The priority system is widely used by athletes participating in a variety of sports primarily as a means
of attaching a hierarchy of importance to what amounts to auxiliary training to event-specific prepara-
tion. Bodybuilders and weightlifters will also use this system to prioritize certain movments. Sports
persons typically use the priority system as it categorizes resistance training. This system can be
applied to a prioritization of neuromuscular patterning, for exercise movements that may be used to
prevent injury or recover from injury, or to present a new movement pattern. Primary exercises are
typically performed at the start of a workout, while the athlete is fresh and free from fatigue,
enabling the performance of high-quality technical and maximum effort movements.
beyond the scope of this text to explore all the possible movements that may be
useful for strength training. It is perhaps more pertinent to present the various clas-
sifications of exercises because decisions of workout composition are primarily
informed by the discrimination of movements based upon its merits for a particu-
lar situation.
The categories shown in Tables 7.4 and 7.5 are among the most commonly used
in Western contemporary strength training.
TRAINING ORGANIZATION
Constant monitoring and adjustment of the imposed load in relation to current abil-
ities is an essential component of training programme effectiveness. However, if an
athlete maintains the same routine with only manipulations in weight used, a plateau
in training adaptation will occur. The simple stress/training–adaptation response
dictates that the human body will respond by altering its function according to the
nature of the stress imposed. The adaptive response is both dynamic and specific.
The adaptive response is an expensive process, in terms of energy and resources,

one which the human system performs only under coercion. Therefore, it is not sur-
prising that the body will, with time, be able to minimize adaptation by maintain-
ing the current homeostatic cellular milieu by attempting to accommodate a
persistent stressor. In this respect, all the fundamental constituents of the training
stimulus must continuously evolve in order to create an incentive for physiological
change. All too frequently a programme is set in stone during the early stages of a
strength-training programme implementation (often based upon the practices of others)
and may deviate only slightly over a long period of time.
In reality, the human system must be exposed to variety in training in order to
‘shock’ the body into change. Variety can only be achieved with constant renova-
tion of the content, style and nature of the training programme. Perhaps the most
established form of organized variation is what has become known as periodiza-
tion, termed to reflect the periodical adjustment of programme variables (see Ch. 1).
Periodization is largely based upon the Eastern European observations that increas-
ing training volume in the early and middle phases of a training season followed
by a decreased training volume, while increasing intensity, in later phases of train-
ing resulted in the greatest adaptive response. Prior to peaking intensity reaches a
peak, while volume reaches its lowest level. Enhancement of the recovery processes
and consequent supercompensation is enhanced by a reduction in intensity just prior
to peaking. The classic periodization programme underpins the development of
power for sporting performance. In this context, the training season can be broken
into five mesocycles:
● hypertrophy – high volume, moderate resistance, little rest between sets, increase
in muscle mass;
● strength – high volume, high resistance, build upon muscle mass gained, develop
neural component;
● power – moderate volume, high levels of rest, high velocity of movement, peak
neural activation and development;
● peaking – reduced volume, increased intensity, maximum rest = enhanced
performance;
● rest – low volume, low intensity, minimize deconditioning.
The typical periodization method utilizes a linear approach, where each subse-
quent microcycle builds upon the progressive intensity of the predecessor. Typically,
the greater volume of repetitions in the first microcycle is progressed to fewer rep-
etitions at a higher load in the following microcycles, depending upon the objec-
tives of the training phase. For example (4-week microcycle):
● Week 1–4: 3–4 sets of 12–15 reps
The linear model fits well for sports that have a competitive schedule containing
few, selected competitions, typically with one or two major competitions per year,
for example, athletics, rowing, cycling.
A more recent strength training model has been formalized in which the athlete
trains all of the different training components (repetition ranges) within a micro-
cycle of 1–2 weeks, known as undulating periodization. The undulating strength
programme accounts for sports with more frequent and perhaps unpredictable
competition patterns, such as football, hockey and netball. An example of an undu-

lating programme (7–10 day microcycle):
● Monday: 3–4 sets of 12–15 reps
● Wednesday: 3–5 sets of 8–12 reps
● Friday: 3–4 sets of 4–8 reps
● Monday: 3–5 sets of 1–5 reps
Whereas research into the effects of periodization versus non-varied programmes
is relatively limited it would appear that periodized programmes (both linear and
undulating) yield greater results in strength performance. Linear and undulating
models of periodization do not show a clear benefit above each other. The practi-
tioner should apply or adapt the periodized model that best suits the training and
competitive needs of the athlete or team.
KEY POINTS AND OVERVIEW

When the musculoskeletal system is presented with high-level loading it responds
dynamically by adapting the command, architecture, morphology and biochemistry
of its tissues in order to be better equipped to withstand and generate high level
forces. Appropriate mechanical overload is achieved with a maximal or near-maxi-
mal resistance that can only performed for few repetitions, with full volitional effort.
1. Muscular hypertrophy seems best achieved by performing multiple sets of 8–12
repetitions with a moderate to high resistance, with 1–3 minutes of recovery
between sets.
2. Enhanced neural command is best stimulated by the use of multiple sets of 1–6
repetitions with a very high resistance, with 3–6 minutes of recovery between
sets.
3. For continuous strength development strength workouts should be performed
two or three times per week. For maximum, long-term strength development,
resistance training should be performed 3–6 times per week in a progressive peri-
odized plan.
4. Sports that have infrequent competitions may best utilize a linear periodized pro-
gramme, whereas unpredictable and/or frequent competition sports would be
advised to use an undulating periodization plan for maximum strength training
gains.
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163
Chapter 8
The physiology of training
and the environment
Gregory Whyte
CHAPTER CONTENTS
Learning objectives: 163 Altitude and training 178
Introduction 164 Introduction 178
The physiological effect
Training and the cold 164
of hypoxia 179
Introduction 164
Altitude acclimatization and endurance
Training in the cold and health 165
performance 180
Performance in the cold 167
Altitude acclimatization and anaerobic
Post-exercise 168
performance 181
Cold injury 169
Sleeping in normobaric
Special populations 170
hypoxia 182
Conclusions 170
Effects of LoHi training 183
Key points 170
Short-term intermittent hypoxic
Training and the heat 171 training at rest (IHT) 183
Introduction 171 Detrimental effects of hypoxia on
Training performance and the exercise 183
heat 172 Clinical issues associated with
Acclimation, acclimatization and hypoxia 184
heat experience 173 Conclusions 186
Heat experience 174 Key points 186
Heat illness 174 References 187
Maintaining performance and Further reading 190
avoiding heat illness 176
Rehydration 176
Selection of clothing 177
Warm-up and pre-cooling 177
Key points 178
1. Comprehends the heat balance equation.
2. Appreciates the physiological responses to exercise in the cold.
3. Appreciates the impact of exercise in the cold on health.

4. Recognizes the signs of cold injury.
5. Recognizes the impact of exercise in the cold on performance.
6. Appreciates the impact of exercise in the cold on special populations.
7. Appreciates the physiological responses to exercise in the heat.
8. Appreciates the impact of exercise in the heat on health.
9. Recognizes the signs of heat illness.
10. Recognizes the impact of exercise in the heat on performance.
11. Comprehends ways in which heat stress can be minimized.
12. Understands the physiological responses to acute hypoxia.
13. Understands the physiological adaptations to chronic hypoxia.
14. Appreciates the different methods of altitude training.
15. Understands the role of hypoxic training in training.
16. Recognizes the adverse effects of hypoxia on performance and health.
INTRODUCTION
While the limit of human performance remains the subject of much conjecture and
debate, what is irrefutable is the impact of the environment upon athletic perform-
ance. Environmental conditions not only have a profound effect on performance but
can also be potentially detrimental to health. Despite the known effects of environ-
mental extremes on performance, sporting events are often programmed in some of
the planet’s most inhospitable venues, at the most inappropriate time. An historical
review of the Olympic marathon suggested that not only have times been affected
by environmental factors, but also that drop-out rates and health have been the prod-
uct of environmental extremes. Early Olympic marathons saw a drop-out rate of up
to 56%; however, despite advancing knowledge regarding the environment and per-
formance, the drop out rate remains at about 20%. These data suggest that, despite
advances in coaching and sports science, we remain at the mercy of the environ-
ment (Pfeisser & Reilly 2004).
This chapter examines the main environmental conditions experienced during
training and competition: heat, cold and altitude. Each section discusses the physi-
ological and performance impact of each environment and reviews the strategies
employed to reduce their impact.
TRAINING AND THE COLD
INTRODUCTION
Athletes competing in the traditional winter sports, including the skiing sports
(alpine, cross-country, biathlon, jumping), ice sports (figure and speed skating, curl-
ing) and sliding sports (bobsleigh, luge, skeleton), regularly train in cold environ-
ments for prolonged periods of time. In addition, most non-winter sport athletes
spend a great deal of time throughout the year training in cold conditions that often
approach those experienced by winter sport athletes. As previously mentioned, envi-
ronmental conditions can have a profound effect on performance. It appears, how-
ever, that the optimum temperature for endurance performance is between 10 and
15˚C. As temperatures decline below this point performance and health are affected
negatively.
The physiology of training and the environment 165
TRAINING IN THE COLD AND HEALTH

Cold environmental conditions impose a significant challenge in the maintenance
of core temperature. If core temperature falls significantly enough to affect physi-
ological function, ‘hypothermia’ (defined as a 20˚C fall in core temperature) may
result, leading to a variety of complications (see Summary box 8.1). In addition,
skin temperature may be reduced dramatically, and if this is not carefully moni-
tored cold injury, including frostbite, can occur.
Summary box 8.1
Risk factors and treatment of hypothermia. Reproduced with permission from Tipton M
(2005) Environmental factors. In: Whyte G et al (eds) ABC of Sports Medicine, BMJ Books,
London.
Hypothermia
Hypothermia exists when deep body temperature falls below 35˚C. Risk factors for
hypothermia include:
● Cold air/water temperature
● Air/water movement: faster moving fluids increase convective heat loss
● Age: children cool faster than adults due to their lower levels of subcutaneous fat and
higher surface area to mass ratio
● Body stature: tall thin individuals cool faster than short fat people
● Body morphology: body fat and unperfused muscle are good insulators
● Gender: females tend to have more subcutaneous fat than men
● Fitness: high fitness enables higher heat production
● Fatigue: exhaustion results in decreased heat production
● Nutritional state: hypoglycaemia attenuates shivering and accentuates cooling
● Intoxication: drug or alcohol depressant effects on metabolism
● Lack of appropriate clothing
Out of hospital treatment of hypothermia
● Lay casualty flat, give essential first aid, enquire about coexisting illness.
● Prevent further heat loss (blankets/sleeping bag) – cover head, leave airway clear.
● Insulate from the ground.
● If possible provide shelter from the wind and rain.
● Allow slow spontaneous re-warming to occur; re-warming too quickly can result in
re-warming collapse.
● Maintain close observation of pulse and respiration.
● Obtain help as soon as possible and transport the casualty to hospital.
● If breathing is absent, becomes obstructed or stops, standard expired air ventilation
should be instituted.
● Chest compression should be started only if:
◆ There is not carotid pulse detectable after palpating for at least 1 minute (the pulse
is slow and weak in hypothermia), AND
◆ Cardiac arrest is observed, or there is a reasonable possibility that a cardiac arrest
occurred within the previous 2 hours, AND
◆ There is a reasonable expectation that effective CPR can be provided continuously
until the casualty reaches more advanced life support. This is likely to mean being
within 2 hours of a suitable hospital.
● The rates of expired air ventilation and chest compression should be the same as for
normothermic casualties. Hypothermia may cause stiffness of the chest wall.
than short, heavy individuals. Body fat is the key insulator, and those individuals
with high body fat will lose heat at a slower rate than thin individuals. It is impor-
tant to note that in air a wet individual will lose heat at a greater rate than if they
were dry. Therefore, care should be taken in cold weather if it is snowing/raining,
or the individual is sweating excessively due to inappropriate clothing.
PERFORMANCE IN THE COLD

The skin is the first tissue to cool on exposure to low environmental temperatures.
The next tissues to cool are the superficial nerves and muscles. As a result the con-
duction of action potentials is slowed (15 m.s−1 per 10˚C fall in local temperature)
and their amplitude reduced. Below a muscle temperature of 27˚C the contractile
force and rate of force application is reduced and fatigue occurs earlier – maximum
power output falls by 3% per ˚C fall in muscle temperature (Reilly & Waterhouse
2004). As a consequence, speed of movement, dexterity, strength and mechanical
efficiency are all reduced with cooling, potentially leading to incapacitation.
During low-intensity exercise in air, including walking, there is a danger that heat
production will not be sufficient to counteract heat loss. However, if precautions are
taken to combat the cold low-intensity exercise can be safely undertaken. Appropriate
clothing is of key importance. Finding a balance, however, may be a difficult task.
A balance must be sought between maintaining core/skin temperature and exces-
sive insulation leading to a rise in core temperature and resultant sweat production.
This sweat production can lead to wet clothing that may effect heat balance, par-
ticularly if exercise intensity falls, or the individual rests. Of greater concern is the
potential for cold injury to the extremities (i.e. hands, face and feet). In air or water,
the first tissue to be affected on exposure to cold is the skin. Skin cooling is accen-
tuated by the peripheral vasoconstriction initiated by the body in order to reduce
heat loss. It is the extremities that are most likely to be affected due to their high
surface area to mass ratio, and the fact that their major source of heat, blood flow,
has been restricted by vasoconstriction. This, in part, explains why it is the extrem-
ities that normally receive cold injuries (Tipton 2005).
During moderate and high-intensity exercise in air i.e. running or cycling, while
performance may be reduced at temperatures below 10˚C there is little concern for
core temperature irrespective of clothing. Obviously care must be taken to avoid
cold injury of the extremities. Similar findings have been observed for maximal and
supra-maximal exercise in the cold (Nimmo 2004). When training in the cold, how-
ever, care is warranted during recovery between reps and sets and immediately fol-
lowing the session. During these periods of light exercise rapid cooling of the
periphery and core may occur as a result of sweat accumulation and limited cloth-
ing. If training in cold water cooling will be exacerbated. Training prescription should
account for low environmental temperatures. A thorough warm-up performed
indoors where possible immediately prior to training, limiting the period of inac-
tivity prior to starting the session. Care should be taken in the choice of clothing
for training sessions, with the aim to balance heat production with heat loss. Reducing
recovery periods and tailoring warm-down for indoor/sheltered spaces helps to
avoid cooling during and post-training.
In cold water, a fall in deep body temperature intensifies shivering, which raises
oxygen consumption during sub-maximal exercise (9% in water at 25˚C; 25.3% in
water at 18˚C) (Tipton 2005). Thus, the energy cost of sub-maximal exercise is
increased in water cooler than 26˚C; this can result in a more rapid depletion of
•
carbohydrate and lipid energy sources and earlier onset of fatigue. VO2max, during
ergometry or swimming, and maximum performance are reduced during cold water
immersion. This reduction occurs in water temperature as high as 25˚C and is approx-
imately linearly related to deep body temperature, with a 10–30% reduction observed
following a 0.5–2˚C fall in deep body temperature. Associated with this reduction
•
in VO2max, lactate appears in the blood at lower workloads and accumulates at a
more rapid rate suggesting a decreased oxygen supply to the muscle and greater
reliance on anaerobic metabolism. A decrease in deep body temperature of 0.5–1.5˚C
results in a reduction of 10–40% in the capacity to supply oxygen to meet the
increased requirements of activity. With more profound cooling, anaerobic metabo-
lism is also reduced due to muscle cooling and direct impairment of the processes
responsible for the anaerobic production of energy.
POST-EXERCISE
Irrespective of exercise intensity care must be taken following exercise due to the
potential for rapid post-exercise cooling. Exercise-induced heat production is reduced
post-exercise and heat is lost to the environment. In response to this negative ther-
mal balance the body responds in two ways. First, vasoconstriction of the periph-
eral vasculature occurs, reducing blood flow to the skin and increasing central blood
volume and central venous pressure. The reduction in blood flow is variable across
different body parts, leaving some areas of skin more susceptible to cold injury. In
response to this increased venous pressure, mean blood pressure increases and,
despite a cold-induced reduction in heart rate, cardiac output rises. Second, invol-
untary metabolic heat production occurs leading initially to an increased skeletal
muscle tone (pre-shivering) and eventually shivering (muscular thermogenesis). The
•
degree of shivering is related to the individual’s aerobic capacity (VO2max). At max-
imum shivering, resting metabolic rate is increased fourfold and equates to approx-
•
imately 40% of VO2max. The response to cold exposure is individual specific and,
therefore, some individuals will be affected to a much greater extent than others. It
is important to reduce heat loss following exercise in cold environments to avoid
possible cold injury. Get out of the cold environment as quickly as possible, remove
wet clothing and replace with dry clothing adding extra layers taking care to cover
high-risk areas, i.e. hands, feet and head.
It is worthy of note that when exercising in the cold energy consumption increases,
primarily in the form of carbohydrates. Therefore, higher quantities of carbohydrate
ingestion are recommended when exercising in the cold. Further, the rate of dehy-
dration in the cold can be the same or greater than that experienced in warm condi-
tions. The reasons underpinning this fluid loss are threefold. First, inappropriate
clothing can lead to an excessive rise in core temperature leading to high sweat rates
(a problem not only for hydration status, but also rapid post-exercise cooling rates).
Second, an increased blood pressure associated with peripheral vasoconstriction can
lead to an increased diuresis (urine excretion). Third, because cold air tends to be dry
(low relative humidity) large volumes of fluid are lost through respiration (Nimmo
2004). These three factors combined result in significant dehydration during prolonged
exercise in the cold. It is, therefore, important to increase fluid and carbohydrate intake
in the cold, similar to or greater than warm conditions (Reilly & Waterhouse 2004).
Acclimatization to the cold is limited in comparison to that of heat with limited
physiological adaptations. Within 5–6 hours of acute cold exposure thyroxine, adren-
aline and adrenocorticoid output is elevated, resulting in an increased metabolic rate.
The observed perturbations of peripheral vasoconstriction and vasodilation are
altered in cold habituated individuals leading to a reduction in the initial vasocon-
strictor response and longer, more frequent episodes of vasodilation. The ‘cold shock’
response to cold water emersion is reduced in habituated individuals. The adapta-

tions are small in magnitude and are unlikely to occur following transient exposure
to the cold. It is, therefore, imperative that behavioural adjustments are made to
avoid the deleterious effects of the cold when training.
COLD INJURY
Due to the pronounced peripheral vasoconstriction during cold exposure, the temper-
ature of the skin and extremities may fall rapidly to temperatures that may lead to
cold injuries. Early warning signs of cold injury include tingling, numbness and/or a
burning sensation in the extremities (fingers, toes, ears and nose). If action is not taken
at this point tissue damage resulting in cold injuries may occur. Cold injuries can be
of the ‘freezing’ (frostbite; FCI) or non-freezing variety (non-freezing cold injury, NFCI).
Human tissue freezes at about −0.55˚C. Rapid cooling leading to the formation
of intracellular crystals results in direct mechanical disruption of the tissues. In con-
trast, slow cooling and freezing results in extracellular water crystallization that
increases plasma and interstitial fluid osmotic pressure. The resulting osmotic out-
flow of intracellular fluid raises intracellular osmotic pressure and can cause dam-
age to capillary walls. This, along with the local reduction in plasma volume, causes
ooedema, reduced local blood flow and encourages capillary sludging. These changes
can produce thrombosis and a gangrenous extremity. The risk of frostbite is low
above air temperatures of −7˚C, irrespective of wind speed, and becomes pronounced
when ambient temperature is below −25˚C, even at low wind speeds (Tipton 2005).
Non-freezing cold injury (NFCI) describes a condition that results from protracted
exposure to low ambient thermal conditions, in the absence of freezing. Immobility,
posture, dehydration, low fitness, inadequate nutrition, constricting footwear, fatigue,
stress or anxiety, concurrent illness or injury can all increase the likelihood of NFCI.
The precise pathophysiology of NFCI is poorly understood but appears to be related
to the neuro-endothelio-muscular components of the walls of local blood vessels.
Debate continues as to whether the primary damage is vascular or neural in origin;
or, whether the aetiology is primarily thermal, ischaemic, post-ischaemic reperfu-
sion, or hypoxic in origin (Tipton 2005).
Treatment depends on whether the dominant injury is FCI or NFCI. All cases of
FCI should be thoroughly re-warmed by immersion of all the chilled part in stirred
water at 38–42˚C. A topical antibacterial should also be diluted into the water bath.
Re-warming should be delayed if there is a chance that re-freezing may occur.
Thawing an FCI can be intensely painful and conventional narcotic analgesics should
be provided as necessary. Continuing treatment for FCI is a twice daily, 30-minute
immersion of the affected part in a 38–42˚C whirlpool bath containing an appropri-
ate antibacterial. In contrast to those with FCI, patients with NFCI should have their
affected extremities re-warmed slowly, by exposure to warm air alone, and must not
be immersed in warm water. The early period after re-warming can be very painful
in NFCI, even in those without any obvious tissue damage. With either form of
injury, once re-warmed, the affected extremities should be treated by exposure to air
and early mobilization (Tipton 2005).
It is unusual for the respiratory tract and lungs to be in danger of damage when
training in the cold. The air is warmed and moistened rapidly during inspiration to
avoid potential damage. This moistening/humidification of the inspired air can result
in airway drying; however, that may lead to respiratory complaints, including dry-
ness of the mouth, a burning sensation in the throat, and general irritation of the
respiratory tract. Cold air inhalation may worsen asthma symptoms in those that
suffer from the disease, and may even lead to the development of exercise-induced
asthma in an otherwise normal individual. In order to reduce these symptoms, the

wearing of a scarf or face mask will improve humidification of the inspired air and
reduce water loss.
SPECIAL POPULATIONS
Elderly individuals are less able to maintain core temperature, and as such are at
higher risk of hypothermia and cold injury. Children are also less able to maintain
core temperature due to a higher body surface area to body mass ratio. Children
counteract this in part by increasing peripheral vasoconstriction; however, this results
in an increased potential for cold injury. Additional precautions for the young and
elderly should be taken when training in cold environments.
CONCLUSIONS
In general, cold presents less of an immediate threat to the exercising individual
than hot/humid conditions. Rarely is it too cold to train if the correct precautions
are taken to avoid hypothermia and cold injury. In general, however, when the tem-
perature falls to below −20˚C (−5˚F) extreme caution should be taken, and exercise
avoided (Fig. 8.2). The most significant problems associated with training in the cold
are cold injury and hypothermia. Take careful note of environmental conditions,
including wind chill, and take steps to avoid excessive heat loss before, during and
after exercise, and protect the extremities from cold injury.
KEY POINTS
1. Cold environments have a limited impact on performance when the correct pre-
cautions are taken to avoid hypothermia and cold injury.
2. Water is 25 times more conductive than air leading to a 3–5 times faster heat loss
compared with air at the same temperature.
Wind speed Thermometer reading (⬚F)

(mph) 50 40 30 20 10 0 – 10 – 20 – 30 – 40 – 50
Equivalent temperature (⬚F)

5 48 37 27 16 6 –5 – 15 – 26 – 36 – 47 – 57
10 40 28 16 4 –9 – 24 – 33 – 46 – 58 – 70 – 83
15 36 22 9 –5 – 18 – 32 – 45 – 58 – 72 – 85 – 99
20 32 18 4 – 10 – 25 – 39 – 53 – 67 – 82 – 96 – 110
25 30 16 0 – 15 – 29 – 44 – 59 – 74 – 88 – 104 – 118
30 28 13 –2 – 18 – 33 – 48 – 63 – 79 – 94 – 109 – 125
35 27 11 –4 – 20 – 35 – 51 – 67 – 82 – 98 – 113 – 129
40 26 10 –6 – 21 – 37 – 53 – 69 – 85 – 100 – 115 – 132
Minimal risk Increasing risk Great risk
Figure 8.2 Wind chill index.

3. Individuals with a high body surface area to body mass ratio will lose heat at a
faster rate.
4. A balance must be sought between maintaining core/skin temperature and exces-
sive insulation leading to a rise in core temperature and resultant sweat production.
5. Care should be taken after exercise to avoid hypothermia and cold injury.
6. There are limited physiological adaptations to the cold.
7. Of greatest concern in cold environments is the potential for cold injury to the
extremities (i.e. hands, face and feet), including non-freezing and freezing cold
injury.
TRAINING AND THE HEAT
INTRODUCTION
Core temperature is tightly controlled within about 1˚C of 37˚C and skin tempera-
tures of about 33˚C. Humans can survive a fall in core temperature of about 10˚C
and an increase of about 6˚C (Tipton 2005). The balance between heat gained and
heat lost is tightly regulated to maintain thermal homeostasis. During exercise the
two most potent stimuli challenging thermal homeostasis are metabolic heat pro-
duction (M), directly associated with measurable external work (W), and environ-
mental conditions. The exchange of heat between the body and the environment is
achieved through convection (C), conduction (K), radiation (R) and evaporation (E)
and the relationship between heat gain and heat loss is represented by the heat bal-
ance equation: M – W = R ± C ± K – E.
The most potent stimulus to variations in metabolic heat production (M) is mus-
cle activity including exercise or shivering. The human is only 25% efficient with
75% of the chemical energy produced during muscular contraction being lost as heat.
During sustained vigorous exercise heat production can reach in excess of 20 kJ. If
the body were prevented from losing any of the heat it produced a fatal level of
heat storage would be reached in about 4 hours at rest, and after just 25 minutes
with moderate exercise (Tipton 2005).
The primary aim of the thermoregulatory system is to maintain body tempera-
ture within safe limits. This is achieved by a complex combination of cold and warm
receptors, afferent and efferent pathways, central nervous system integrating and
controlling centres, and effectors. In air at 25–28˚C, or water at 35˚C, a naked, rest-
ing individual can maintain body temperature by varying the amount of heat deliv-
ered to the skin via the circulation, in this situation cutaneous blood flow averages
250 mL.min−1. As air/water temperature falls, or increases, the physiological
responses of shivering or sweating are initiated in an attempt to defend body tem-
perature. These autonomic responses have only a limited capability to defend body
temperature and are costly in terms of substrate and fluid.
Training in cold and hot environments can have a profound effect on perform-
ance and health. Recognition of the physiological mechanisms associated with exer-
cise in the cold and heat are crucial to avoid the deleterious effects of these
environments. Identification and implementation of strategies to ameliorate their
impact will enhance training performance and reduce the risk of injury.
Training in high ambient temperatures can have a profound effect on performance
and health. The impact of heat on training performance is highly dependent on the
ambient temperature, humidity and radiant heat, combined with the intensity, dura-
tion and mode of exercise and whether the event takes place outdoors or indoors.
During exercise metabolic heat production may increase 25-fold compared with rest-
ing conditions. Core temperature rises in association with the balance of heat produc-
tion and dissipation and the metabolic heat produced during exercise, together with
heat gained by convection, conduction and radiation, must be matched by the heat
loss to maintain homeostasis. The primary mechanism for heat dissipation is through
evaporative sweat loss. In order to facilitate evaporative sweat loss during exercise the
cardiovascular system responds by re-directing blood flow (cardiac output) from the
splanchnic and renal beds to the skin. The sweat glands are activated within seconds
of commencing exercise and reach maximum output after 30 minutes. The rate of evap-
orative sweat loss depends on skin surface area that is wet, the difference between the
water vapour pressure at the skin surface and that in the air, and air movement around
the body (Tipton 2005). It is sweat evaporation that is fundamental to the dissipation
of heat, not sweat production. In humid conditions the increase in water vapour pres-
sure in the air reduces the potential for evaporative sweat loss and therefore impedes
heat dissipation. When relative humidity is 100% no sweat will evaporate. The use of
wet bulb globe temperature (WBGT) is more effective in determining heat stress as it
takes into account humidity and radiant heat (Summary box 8.2):
WBGT = 0.1 Tdb + 0.7 Twb + 0.2 Tg
in which Tdb = dry bulb temperature, Twb = wet bulb temperature, and Tg = globe
temperature.
The associated body fluid loss during training in the heat due to increased sweat-
ing can lead to hypohydration if fluid loss outweighs fluid intake and absorption.
Daily water turnover for sedentary individuals living in a temperate environment
is typically about 2–3 L.day−1. In contrast, athletes training intensively in the heat
can lose up to 10–15 L of fluid per day, with most of the increase coming from sweat
losses (Maughan & Shirreffs 2004). Hypohydration can lead to a lowered plasma
volume resulting in a reduced venous return. In response to a reduced venous return,
heart rate will rise to maintain cardiac output in the face of the reduced stroke vol-
ume. This progressive rise in heart rate, independent of exercise intensity is termed
‘cardiovascular drift’. It is important to account for heat-related rises in heart rate
during training to maintain the appropriate training workloads.
In addition to performance, exercise in the heat can lead to a spectrum of health
issues termed ‘heat illness’. The risk of heat illness is increased if exercise is under-
taken in the heat in a dehydrated condition.
TRAINING PERFORMANCE AND THE HEAT

It is well recognized that outdoor endurance events and team sports are negatively
affected by the heat. The observed decrement in performance becomes progressively
Summary box 8.2
The American College of Sports Medicine (ACSM) WBGT recommendations for

continuous activities such as running and cycling.
< 18˚C Low risk
18–23˚C Moderate risk
23–28˚C High risk. Those with predisposing factors for heat illness should not compete
> 28˚C Very high risk. Postpone competition
greater as heat rises (Galloway & Maughan 1997). In outdoor, short-duration, high-
intensity events, i.e. sprinting, there may be no loss of functional capacity when indi-
viduals are acutely exposed to a hot environment. Indeed, performance may be
improved. While short-duration and indoor events may be unaffected by environ-
mental heat stress in the short term there is a real risk that a chronic fluid deficit
associated with prolonged periods of time spent exercising at low intensities dur-
ing training or at rest in the heat will result from a failure to increase fluid intake
sufficiently to match fluid losses (Shirreffs & Maughan 1998). The effect of hypohy-
dration on training performance will depend on the degree of hypohydration and
the nature of the activity. During endurance activity hypohydration causes an
increased reliance on muscle glycogen as fuel for exercise as evidenced by elevated
blood lactate values for the same absolute workload and a reduced anaerobic thresh-
old (Reilly & Waterhouse 2005). A pre-exercise fluid deficit of as little as 1.5–2% of
body mass is likely to reduce performance and has been shown to cause substan-
tial loss of performance in running events lasting from 4 to 30 minutes (Shirreffs &
Maughan 1998). In high-intensity short-duration activity the distance travelled in
each effort is reduced in the heat. Thus, sprint and team game training is likely to
be affected in the heat.
The reduction in performance in the heat is in part due to the progressive dehy-
dration that results from sweat losses, with negative consequences for cardiovascu-
lar capacity and thermoregulatory function (Gonzalez-Alonso et al 1999a). Recent
evidence suggests that the central nervous system (CNS) may play a key role in the
fatigue process in the heat, and that the fundamental limitation to performance in
the heat may be localized to the CNS rather than the muscles evidenced by a crit-
ical brain temperature in addition to core body temperature (Nielsen et al 2001,
Nielsen & Nybo 2003).
ACCLIMATION, ACCLIMATIZATION AND HEAT EXPERIENCE

Repeated exposure to the heat produces increases in core and skin temperature and
profuse sweating resulting in physiological (and behavioural) adaptations that reduce
the impact of heat on exercise performance. The magnitude of the adaptation to heat
that occurs is closely related to the degree of heat strain to which the individual is
exposed. Exercise during heat exposure is important in optimizing the adaptations
as resting in heat only provides partial acclimatization. The adaptations observed
following chronic training in the heat include the following:
● increased plasma volume;
● less cardiovascular strain;
● more effective distribution of cardiac output;
● improved cutaneous blood flow;
● earlier onset and increased rate of sweating;
● lowered salt content in sweat;
● more effective distribution of sweat over the skin surface;
● lower skin and deep body temperatures for same absolute intensity;
● improved physical work capacity;
● increased comfort;
● decreased reliance on carbohydrate metabolism;
● decreased pre-exercise core temperature.
Adaptation to heat can be achieved in two ways: (i) train and live in a hot climate
(acclimatization), and (ii) train in an artificial climate (acclimation). Often athletes travel
to hot environments for ‘warm weather training camps’ during the winter months.
The reduction in exercise capacity following acute exposure to the heat often means
that training intensity and volumes are reduced for at least the first few days of the
training camp while acclimatization occurs. In order to avoid this loss in training vol-
ume and reduce the impact of other environmental stressors, including jet lag and
travel fatigue associated with travel to the camp, acclimation to the heat prior to depar-
ture may be advantageous.
Acclimatization/acclimation is best achieved by performing moderate intensity
exercise for 60–100 minutes per day in conditions similar to those expected dur-
ing training. There appears to be no advantage in spending longer periods of expo-
sure to the heat (Lind & Bass 1963). Indeed, recent evidence suggests that shorter
•
duration exercise (30 minutes) at higher intensities (75% VO2max) may be as effec-
tive (Houmard et al 1990). Intermittent exercise may also be an effective alterna-
tive to continuous exercise for team game and sprint-based athletes. The total
exposure time, including short breaks, should again be 100 minutes for the optimal
adaptation.
Within the first few days of training in the heat some adaptations are observed
and adaptation is complete for most individuals within 7–14 days. It is not neces-
sary to train every day in the heat, but no more than 2–3 days should elapse between
exposures. Adaptations to heat persist for some time following exposure. In athletes
who are fully acclimatized the major benefits are maintained for up to 7 days and
some of the improved responses are still present after as long as 21 days in a cool
climate (Pichan et al 1985).
It is important to note that every athlete responds differently to the heat, and the
extent and duration of adaptation required will vary between individuals. There
appears to be no way to predict the response of individual athletes (Montain et al
1996). Care is warranted in the use of heat acclimation/acclimatization if acute heat
injury is to be avoided (Sutton 1990). The fatalities that have occurred in recent years
in pre-season training in American football serve as a reminder of the possible
consequences of trying to adapt too quickly.
Heat experience
Repeated exposure to the heat during training allows athletes to develop a variety
of strategies that can significantly enhance performance. The use of training sessions
to help the coach and athlete identify, adapt and implement these strategies is an
important role of heat exposure. Strategies developed to reduce the deleterious effects
of heat on performance include the identification of optimal volume, composition
and timing of fluid ingestion; clothing; and pacing strategies. In team games, iden-
tifying strategies specific to individual player responses and capabilities in the heat
is an important part of heat experience.
HEAT ILLNESS
Hyperthermia (overheating) and hypohydration (loss of body water) lead to a spec-
trum of conditions termed heat illness. The conditions range from simple heat cramps
to heat stroke and death (Summary box 8.3).
The problems caused by training in the heat result from a decreased circulating
blood volume and consequent alterations in regional blood flow, an increased blood
viscosity, and a direct effect of temperature on the respiratory centres and proteins.
High ambient temperatures are not always necessary to cause heat illness. Cool or
Summary box 8.3
Heat illness. Adapted from Tipton M (2005) Environmental factors. In: Whyte G et al
(eds) ABC of Sports Medicine, BMJ Books, London.
Heat illness
Heat cramps: usually occur in the specific muscles exercised due to an imbalance in
the body’s fluid volume and electrolyte concentration, and low energy stores. Core
temperature remains in normal range. Aetiology unknown. Can be prevented by an
appropriate rehydration strategy and treated by stretching and massage.
Heat exhaustion: the most common form of heat illness, defined as the inability to
continue exercise in the heat. Usually seen in unacclimatized individuals. Caused by
ineffective circulatory adjustments and reduced blood volume. Characterized by
breathlessness, hyperventilation, weak and rapid pulse, low blood pressure, dizziness,
headache, flushed skin, nausea, paradoxical chills, irritability, lethargy and general
weakness. Deep body temperature is raised, but not excessively, sweating persists and
there is no organ damage. Heat exhausted individuals should stop exercising, lie down,
control breathing if hyperventilating and rehydrate; failure to do so can result in
progression to severe heat illness. Heat exhaustion is a predominant problem when body
water loss exceeds 7% of body mass.
Heat stroke: medical emergency resulting from failure of the thermoregulatory system
as a result of a high deep body temperature (>40.5˚C). Characterized by confusion, absence
of sweating, hot and dry skin, circulatory instability. If not treated by immediate cooling,
results in death from circulatory collapse and multi-organ damage. Aggressive steps should
be taken to cool the casualty as mortality is related to the degree and duration of
hyperthermia. Consider using ‘artificial sweat’ (spraying with tepid water/alcohol) and
fanning; fluid replacement (do not over-infuse/overload; can result in pulmonary oedema).
Consider colder water immersion/ice packs for those without a peripheral circulation.
Heat stroke should be the working diagnosis in anyone who has an altered mental
state. Deep body temperature should be monitored every 5 minutes; deep (15 cm) rectal
temperature is preferable to mouth or ear canal as these may be influenced by
hyperventilation and/or the active cooling strategy employed. Heat exhausted individuals
should improve rapidly with appropriate immediate care. Any individuals who do not
improve quickly should be evacuated to the next level of medical care. Recovery from
exertional heat stroke is idiosyncratic and in severe cases may take up to a year.
Exertional rhabdomyolysis: is caused by muscle damage resulting in the release
of cellular contents (e.g. myoglobin, potassium, phosphate, creatine kinase and uric
acid) into the circulation. More likely if dehydrated or taking non-steroidal anti-
inflammatory drugs. Overt signs include muscle pain, tenderness and weakness, very
dark urine. Treat by giving fluids, evacuate to intensive medical care, kidney function
should be assessed.
temperate conditions can lead to heat illness if humidity is high, or individuals are
unable to dissipate the heat produced from high work rates due to clothing. There
are a large number of factors that influence an athlete’s ability to thermoregulate
and alter their susceptibility to heat illness (Summary box 8.4). Because some of
these factors can operate acutely (e.g. infection), an individual may suffer heat ill-
ness in circumstances in which they were previously unaffected (Tipton 2005).
Summary box 8.4
Factors influencing thermoregulation and an individual’s susceptibility to heat illness.

Adapted from Tipton M (2005) Environmental factors. In: Whyte G et al (eds) ABC of
Sports Medicine, BMJ Books, London.
● Air temperature, humidity, movement, radiant heat load
● Body size (mass, skinfold thickness) – heat stroke occurs 3.5 times more frequently in
excessively overweight young adults than in individuals of average body mass.
● State of training/sudden increase in training (military recruits with low aerobic fitness
(>12 mins for 1.5 mile run) and a high body mass index (>26 kg.m−2) have a ninefold
greater risk of heat illness).
● Degree of acclimatization
● Hydration status
● Heat production (exercise intensity/duration)
● Clothing worn (vapour permeability, fit, colour)
● State of health (e.g. fever – viral illness, cold, flu; diabetes mellitus, cardiovascular
disease, gastroenteritis/diarrhoea)
● Genetic disorders (e.g. mutations for cystic fibrosis, malignant hyperthermia)
● Skin disorders, including sunburn over 5% of body surface area
● Use of medication (e.g. diuretics; antihistamines; ergogenic stimulants)
● Sweat gland dysfunction (e.g. prickly heat)
● Salt depletion
● Age
● Sleep deprivation
● Glycogen or glucose depletion
● Acute/chronic alcohol/drug abuse
MAINTAINING PERFORMANCE AND AVOIDING HEAT ILLNESS
Rehydration
Replacing sweat losses during and between training sessions is crucial if performance
is to be maintained. Sweat is a hypotonic saline solution (0.3–0.6% NaCl) and as a result
there may also be associated salt losses when sweat rates are high (Maughan et al
2004). This has implications for the composition of fluids to be consumed as well as
the amount of fluid that is necessary. Because of the increased sweat rate observed in
acclimatized athletes the need for fluid replacement is greater (Sawka & Pandolf 1990).
When encouraging an increased fluid intake, palatability (taste) is a key factor
(Passe 2001). Care must be taken to avoid excessive fluid consumption as there is
a danger of developing dilutional hyponatraemia resulting in collapse and even
death if electrolyte-containing foods or drinks are not consumed (Hew et al 2003,
Smith 2002). This problem seems to affect only slower runners during prolonged
exercise (>4–6 hours). Athletes should be aware of this and of the need to ensure
an adequate salt intake (Bergeron 1996). Fluids consumed during training can use-
fully contain some carbohydrate and electrolytes, especially sodium (Murray &
Stofan 2001) and a properly formulated sports drink containing 2–8% carbohydrate
and up to 50 mmol.L−1 of sodium is likely to be the best option in most situations
(Maughan 2001). The volume and composition of human sweat varies widely
between individuals, and the need for fluid and electrolyte replacement therefore
varies accordingly.
Where rapid replacement of fluid losses is a priority after training or competition,
athletes should aim to drink sufficient fluid to replace about 1.5 times the amount of
sweat lost: if this fluid contains no electrolytes, foods containing salt should be con-
sumed at this time (Shirreffs et al 1996). This recommendation may be especially
important when multiple training sessions are undertaken in a single day.
Monitoring of body mass changes before and after training can give some indi-
cation as to the extent of sweat loss in training. Further, monitoring of urine param-
eters, including volume, colour, conductivity, specific gravity or osmolality may
help to identify individuals suffering from dehydration (Shirreffs & Maughan
1998) and can provide feedback that athletes find helpful in establishing their fluid
requirements.
Selection of clothing
During training the type and amount of clothing worn can have a major effect on
thermal balance. There are a number of key considerations in the selection of cloth-
ing for training in the heat. The key factor is to avoid developing a local micro-climate
that is restrictive to evaporative sweat loss (Gonzalez 1988). Clothing should be light
coloured to reflect more radiant heat and lightweight to minimize insulation and
increase exchange of air between the microclimate (beneath the clothing) and envi-
ronment with body movement (‘bellows effect’). To assist the ‘bellows effect’ the cloth-
ing should be loose fitting. Vapour-permeable material that readily absorbs water will
enhance the evaporative heat loss. Protection of the head and neck may be especially
important when prolonged exposures to direct sunlight are unavoidable. When train-
ing in direct sunlight for prolonged periods care should also be taken to avoid sun-
burn. While some degree of tanning of the skin can be beneficial in reducing the risk
of sunburn, even mild sunburn sufficient to cause redness of the skin can impair
thermoregulatory capacity and exercise performance for up to 21 days (Pandolf et al
1980). A high factor sunscreen should be used during training.
For some sports, for example fencing and equestrian, wearing protective cloth-
ing can exacerbate the thermal load on the athlete, resulting in significantly higher
skin and deep body temperatures. The combination of insulating clothing and high
levels of metabolic heat production has resulted in cases of fatal heat stroke – the
most publicized of which are among American Football players during pre-season
training (Tipton 2005).
Warm-up and pre-cooling

The role of warm-up in temperate climates is to elevate body temperature and
increase blood flow to the muscles and associated soft tissues. In hot climates, how-
ever, dramatic increases in core temperature should be avoided to reduce the neg-
ative impact of hyperthermia on performance. Indeed, there is evidence to suggest
that pre-cooling the body may enhance performance in the heat, with time to exhaus-
tion being inversely related to initial body temperature (Gonzalez-Alonso et al 1999b).
While whole-body pre-cooling may not be a practical solution during training,
improved performance has been reported following skin cooling in the absence of
changes in core temperature. Returning body temperature to normal levels between
repeated bouts of exercise during training in the heat helps to maintain perform-
ance and decreases physiological strain. A quick and simple way of achieving this
is by hand immersion in cold water (10˚C). The large surface area and high cuta-
neous blood flow of the hands make them ideal for heat exchange. The rates of heat
exchange achieved by this method are similar to those achieved by the use of ice
vests or forced convective cooling.
The mechanisms responsible for improved performance following pre-cooling
appear to be associated with an increased time to critical temperature during exer-
cise and an enhanced thermal comfort. This is consistent with recent evidence that
high core and brain temperatures are a major factor in the aetiology of fatigue during
prolonged exercise in the heat (Nybo et al 2002).
Modifications to the warm-up in the heat are required to optimize training. This
must be well practised in training, however, to avoid any undue psychological
impact of altering warm-up rituals on competition performance. Simple modifica-
tions include warming up in the shade and reducing the duration and intensity of
exercise.
KEY POINTS
1. During exercise metabolic heat production may increase 25-fold compared with
resting conditions.
2. Evaporative sweat loss is the most effective mechanism in core temperature reg-
ulation in the heat.
3. Training in high ambient temperatures can have a profound effect on perform-
ance and health dependent on ambient temperature, humidity, radiant heat, and
the intensity, duration and mode of exercise.
4. There are a number of physiological adaptations to hot environments termed
‘acclimatization’ that result in improved performance in the heat.
5. Experience of hot environments can enhance performance.
6. In addition to performance, exercise in the heat can lead to a spectrum of health
issues termed ‘heat illness’.
ALTITUDE AND TRAINING
INTRODUCTION
The recent sporting success of high land natives has resulted in an increased interest
in the role of living and training at altitude on performance. The primary aim of alti-
tude training for endurance athletes is to increase the red cell mass (RCM) and haemo-
globin mass (Hb) resulting in an increased arterial blood O2-carrying capacity, and
•
VO2max, with the aim of improving performance at both sea level and altitude. For
sprint/power-based athletes, recent studies have reported performance gains follow-
ing an altitude sojourn probably associated with alterations in acid–base balance.
Rapid ascent to moderate (<3000 m) and high (>3000 m) altitude causes a cas-
cade of physiological responses triggered by hypobaric hypoxia associated with a
reduction in barometric pressure (reducing in a curvilinear relationship with increas-
ing altitude) leading to a reduced partial pressure of oxygen. This cascade of phys-
iological responses to hypoxia acts to increase oxygen supply to body tissues with
the greatest effect observed in those body systems directly associated with oxygen
delivery, i.e. the cardiorespiratory system. Following a period of time these physiolog-
ical responses lead to adaptation and consequent acclimatization. The time course and
success of acclimatization is a function of the interaction between the physiological
characteristics of the individual and the magnitude of the hypoxic stress (elevation
and speed of ascent). The time course of the physiological responses and adapta-
tions to hypoxia are listed in Figure 8.1 on page 166.
Altitude training currently takes a number of forms including: living high, train-
ing high (HiHi); living high, training low (HiLo); living low, training high (LoHi).
The development of ‘hypoxic hotels’, ‘altitude tents’, and special breathing appara-
tus have allowed the generation of a hypoxic stimulus at sea level (normobaric) by
altering the fraction of inspired oxygen (FiO2).
The benefits of living and training at altitude for an improved altitude perform-
ance are clear. Research examining the efficacy of living and training at altitude on
low land natives is equivocal, however, with most controlled studies failing to
observe a positive effect of hypoxic training on sea-level performance (Rusko et al
2004). The reason for the lack of clarity surrounding the role of altitude training on
sea level performance is associated with the equivocal research findings associated
with: (i) the use of insufficient altitude (<2000 m) or inadequate period of time at
altitude (<3 weeks) to elicit an adaptive response; (ii) de-training at altitude as a
result of reduced training volume; (iii) immunosuppression leading to illness and
under performance (Rusko et al 2004).
THE PHYSIOLOGICAL EFFECT OF HYPOXIA

The reduced pressure of inspired oxygen (PiO2), observed following a reduction in
barometric pressure (hypobaric hypoxia) or reduced FiO2 (normobaric hypoxia)
results in a decreased O2 partial pressure in arterial blood (PaO2) and arterial oxy-
gen saturation (SaO2%). The observed reduction in SaO2% results in a cascade of
acute physiological responses that affect all phases of the oxygen delivery from lung
to muscle. The reduced SaO2% stimulates the peripheral and central chemoreceptors
causing an immediate increase in ventilation, termed the hypoxic ventilatory
response (HVR). This hyperventilation causes a respiratory alkalosis that limits the
increase in ventilation during the early stages of altitude exposure. Within several
days an increased bicarbonate secretion is observed that compensates for the respi-
ratory alkalosis allowing resting ventilation to increase reaching a maximum in 7–10
days. This increased ventilation is the principal mechanism responsible for improv-
ing oxygen availability at the cellular level during acclimatization. Concomitant to
an increased ventilation, a decreased plasma volume of 10–20% is observed within
hours of altitude exposure. This decrease in plasma volume is related to a shift of
fluid from intravascular to interstitial and intracellular compartments. This fluid shift
results in an increased urine output (diuresis). The decreased plasma volume leads
to an increased haemoglobin concentration and resultant oxygen-carrying capacity
in the absence of an absolute increase in red cell mass (RCM). The acute decrease
in plasma volume leads to a concomitant decrease in stroke volume (SV). To
combat this decrease in SV, resting and sub-maximal exercise heart rate is increased
associated with an increased sympathetic activity.
The decreased SaO2% induces an increase in the renal release of erythropoietin
(EPO) within a few hours. An altitude of >2100 m is required to induce EPO release
(Ri-Li et al 2001) above which the increase in EPO-concentration in blood is nega-
tively associated with changes in SaO2% (Piehl-Aulin et al 1998). Despite the imme-
diate increase in the secretion of erythropoietin (EPO) observed during hypoxic
exposure, increases in RCM are not observed for several weeks.
Following prolonged hypoxic exposure an increase in plasma volume and RCM
result in an increased oxygen-carrying capacity. Tissue oxygen delivery is further
Table 8.1 Physiological advantages and disadvantages of hypobaric hypoxic (natural

altitude) exposure and response times adapted from Bailey & Davies (1997)
Physiological Physiological
advantages Response time disadvantages Response time
Increased free fatty Weeks Increased ventilation Immediate

acid mobilization Days/months Decreased Q Days
Increased Hb Months/years Decreased blood flow Days
Increased capillarity Weeks Increased oxidative Immediate
density stress and damage
Increased oxidative Weeks Increased dehydration Immediate
enzyme activity Decreased training intensity Immediate
Increased mito- Jet lag Immediate
chondrial density AMS/HAPE/HACE Immediate
Sunburn Immediate
Catecholamine-induced Immediate
glycogen depletion
Increased haemolysis Immediate
enhanced by an increase in red blood cell 2,3-diphosphoglycerate (2,3-DPG) that

shifts the O2-dissociation curve to the right. An increased SV and decrease in sym-
pathetic activity result in a reduction in resting and sub-maximal exercise heart
rate towards sea-level values. As the tissue level increases in capillary density,
mitochondrial size and density and changes in enzymatic pathways are all adap-
tations to chronic hypoxia that result in an improved oxygen consumption (see
Table 8.1).
ALTITUDE ACCLIMATIZATION AND ENDURANCE PERFORMANCE

It is well accepted that living high and training high (HiHi) improves performance
at moderate altitude (>1500 m). In contrast, the role of HiHi for improved sea level
performance is equivocal.
Because of the potential detrimental effects of residing at altitude for prolonged
periods of time (see later), however, scientists have investigated the role of com-
bining periods of hypoxic exposure with normoxic training; living high–training
low (HiLo). The development of HiLo allows the maintenance of the normoxic train-
ing stimulus combined with the benefits altitude acclimatization. Only a limited
number of training venues exist where HiLo training regimes can be employed
using natural altitude (hypobaric hypoxia). A number of techniques have been devel-
oped to overcome this problem, including (i) using an increased oxygen concen-
tration of inspired air during training at natural altitude, and (ii) reducing the FiO2
(normobaric hypoxic) by way of nitrogen dilution often employed in altitude
houses/hotels or tents (Wilber 2001). Despite the equivocal evidence supporting the
efficacy of HiLo training, athletic populations are increasingly using nocturnal
hypoxia in an attempt to gain some physiological benefit. The principle method
used by athletes to achieve a HiLo training regime is to live and train at sea level
and sleep in a normobaric hypoxic environment artificially simulating an altitude

of ~2500 m for periods of 12–20 hours.
The primary goal of hypoxic exposure is to increase RCM and/or haemoglo-
bin mass (HbM) through an increased EPO secretion. During HiLo training, morn-
ing EPO concentration appears to be at a higher level after 2–5 days compared
with HiHi. During the day, however, EPO concentration decreases significantly
from the morning values due to short half-time of EPO elimination following
HiLo exposure.
•
A number of studies have reported an increased sea level VO2max and improved
sea level endurance performance following HiLo (Rusko et al 2004). Levine & Stray-
•
Gundersen (1997) demonstrated an improved VO2max, ventilatory threshold and
5000 m track running performance at sea following HiLo that was not observed fol-
lowing HiHi or LoLo. The authors postulated that the maintenance of a high train-
ing velocity, cardiac output and oxygen flush primarily during interval training was
the key factor underpinning the observed performance gains following HiLo.
Similarly, Rusko et al (1999) showed a significant increase (~5%) in maximal tread-
mill performance after 25 days of HiLo, and Piehl-Aulin (1999) reported a signifi-
cant increase (~3%) in treadmill performance following 21–28 days of HiLo. Not all
studies have demonstrated an improved sea level performance following HiLo (Hahn
et al 2001). However, the low total duration of exposure to hypoxia and lack of
RCM/HbM increase in these studies may be responsible for the absence of change
observed. In those studies reporting an improved sea level performance a minimum
of 3 weeks HiLo exposure was employed, suggesting that a threshold duration may
exist below which no improvement is observed. Thus, HiHi and HiLo may induce
an acclimatization effect and increase RCM/HbM. Importantly, however, the mini-
mum dose to attain acclimatization effect appears to be > 12 hours.day−1 at an altitude
> 2000 m for at least 3 weeks.
Irrespective of outcome, all studies reported considerable individual variation
in response to altitude training. In those studies that reported an improved per-
formance following HiLo the responders, defined as a greater than mean improve-
ment in sea level running performance, had greater EPO response at altitude than
non-responders, and responders also showed significant increase in RCM and
•
VO2max that was not observed in non-responders. In addition, the responders were
better able to maintain normal training velocities and oxygen flux than the non-
responders.
ALTITUDE ACCLIMATIZATION AND ANAEROBIC PERFORMANCE

The decreased air resistance at altitude results in increased maximal sprinting speeds.
Thus, the detrimental effect of reduced training intensities observed for endurance
exercise in hypoxia leading to a reduced neuromuscular training load and resultant
de-training may not effect sprint/power-based sports.
Anaerobic endurance may be affected during hypoxic exposure, probably associ-
ated with a loss of bicarbonate and a plasma volume decrease (Hahn & Gore 2001).
In contrast, however, acute hypoxia does not impair a single short-term (<1 minute)
•
maximal performance despite a reduced VO2max during performance, and an
increased muscle lactate and glycogen decrease following performance.
A number of studies have failed to demonstrate an improved supramaximal anaer-
obic performance at sea level following HiHi for 3–4 weeks (Bailey et al 1998, Levine
Stray-Gundersen 1997). In contrast, studies have reported increases in running time
•
to exhaustion (range 240–380 seconds) during sea level VO2max measurement with-
•
out an increase in VO2max, and an increased maximal accumulated oxygen deficit
(MAOD) and muscle buffer capacity after return to sea level following HiHi train-
ing above 2000 m for 2 weeks.
Nummela & Rusko (2000) demonstrated an improved sea level 400-m race time
in elite sprint-runners as well as a decreased blood lactate concentration during sub-
maximal sprinting on a treadmill following 2 weeks with 14–18 hours daily expo-
sure to normobaric hypoxia (FiO2 15.8%). The limited available evidence suggests
that HiHi and HiLo with sprint-type training may improve subsequent anaerobic
performance at sea-level.
SLEEPING IN NORMOBARIC HYPOXIA

Recently, concern has been raised regarding the impact of hypoxia on sleep quality.
The key area of concern is the impact of disturbed sleep, often observed at altitude,
on recovery and performance.
In a recent study Kinsman et al (2002) attempted to quantify the effect of nor-
mobaric hypoxia (2650 m) upon markers of sleep quality. This study investigated
respiratory events in cyclists participating in a HiLo programme using a nitrogen-
enriched facility. Results suggested a substantial increase in respiratory events dur-
ing sleep, present in nearly 25% of the athletes studied. In a similar study, Pedlar
et al (2005) examined the impact of sleeping in a normobaric hypoxic tent (2500 m)
in eight recreational athletes. Results demonstrated that normobaric hypoxia
resulted in significant sleep disturbance. The observed sleep disturbance manifested
as an increased respiratory disturbance was associated with an increased preva-
lence of apnoeas (a cessation of airflow for longer than 10 seconds) and hypo-
pnoeas (a 50% reduction in airflow for longer than 10 seconds with a 3% reduction
in SpO2). As a result, the subjective analysis of sleep quality, based upon assess-
ment of the ease of ‘getting to sleep’ (GTS), ‘behaviour following waking’ (BFW)
and ‘quality of sleep’ (QS), measured using the Leeds sleep evaluation question-
naire (LSEQ), was significantly reduced. The practical implications of these find-
ings may be that early morning performance may be impaired by sleep in
normobaric hypoxia, and an overall reduction in the quality of rest experienced
during sleep. It is widely believed that the quality of rest and recovery of the ath-
lete between training bouts is an essential part of the adaptation process (the restora-
tive hypothesis of sleep; Shapiro 1981). Therefore, inadequate recovery may lead to
symptoms of overtraining and ultimately underperformance. It must be noted, how-
ever, that the impact of normobaric hypoxia on sleep was highly heterogeneous
with some athletes responding very poorly while others remained unaffected. These
findings suggest that significant implications exist for individuals wishing to com-
mence a HiLo training programme using nocturnal normobaric hypoxia, in order
to avoid the detrimental effects of poor sleep upon training and recovery. The analy-
sis of sleep variables in normobaric hypoxia may assist in the early identification
of poorly responding individuals to altitude environments prior to ascent. Further
study is required to fully elucidate the efficacy of normobaric hypoxic environments
on sleep in trained athletes. It would appear, however, that establishing individual
sleep responses to hypoxia is required to limit the impact of hypoxia on sleep and
resultant recovery and performance.
The potential detrimental effects associated with sleeping in hypoxia has led to
an increased interest in the use of hypoxia for training while living at sea level. The
following section examines the effect of living low and training high (LoHi).
EFFECTS OF LoHi TRAINING

The aim of LoHi training is to induce muscle-specific adaptations to hypoxic expo-
sure while avoiding the detrimental effects of prolonged altitude sojourns or sleep
disturbance associated with nocturnal normobaric hypoxic exposure (Pedlar et al
2005). Further, recent work has examined the role of LoHi training to accelerate alti-
tude acclimatization (Whyte et al 2002), and in injury rehabilitation.
The majority of studies examining the use of LoHi have failed to demonstrate a
positive performance effect, despite observing increases in EPO. In contrast, how-
ever, LoHi training has been shown to increase the work capacity of athletes in
hypoxia. Recent studies have reported an accelerated acclimatization to altitude
(hypobaric hypoxia) in elite biathletes (Whyte et al 2002). Therefore, while LoHi
training appears to have a limited effect on sea level performance it may be valu-
able in the pre-acclimation of athletes prior to altitude ascent.
Interest in the role of LoHi training for injury rehabilitation is based on studies
that have demonstrated improved sea level performance and increased myoglobin
and oxidative capacity when absolute training intensities in hypoxia is equal to that
in normoxia. Therefore, when an athlete is injured and there is a concomitant reduc-
tion in training intensity, LoHi offers an additional physiological stimulus to the
maintenance/improvement of aerobic capacity.
SHORT-TERM INTERMITTENT HYPOXIC TRAINING AT REST (IHT)

Short-term IHT, originally developed in the former Soviet Union, consists of breath-
ing hypoxic air (9–11%) through a mask or mouthpiece for repeated periods of 5–7
minutes, interrupted by equal periods of recovery in normoxia totalling 1–3 hours
for one or two sessions a day (Serebrovskaya 2002).
A number of studies have demonstrated a variety of benefits of short-term IHT
(3–5 hours daily for 2–4 weeks) including improved altitude acclimatization, and
increase performance, Hb-concentration, haematocrit and reticulocytes. Care is war-
ranted in interpreting these results, however, as they failed to employ a control
group. Further, a number of studies have failed to demonstrate positive effects of
IHT. The effect of IHT on subsequent performance remains unclear; however, it
may improve adaptation to subsequent exposure and training at altitude (Rusko
et al 2004).
DETRIMENTAL EFFECTS OF HYPOXIA ON EXERCISE

Training at natural altitude (hypobaric hypoxia) may induce some negative effects
on performance that may mask and prevent the use of benefits obtained from an
•
increased oxygen carrying capacity (see Table 8.1). Exercise performance and VO2max
as well as training response at sea level and at altitude may not only be dependent
on the O2 delivery and utilization, but also on other factors linked to the ability of
the central nervous system to recruit muscle. According to the suggested central
governor hypothesis, the CNS regulates muscle recruitment and force production.
Potentially, both feedback (e.g. chemo- and baroreceptors, proprioceptors) and feed
forward mechanisms could affect the function of the CNS. With optimal training,
the continued increased recruitment of the muscles results in a new higher-level
• •
Q max, VO2max, and exercise performance (Rusko 2003). Therefore, one possible reason
for the absence of a positive altitude training effect following an altitude sojourn is
that even moderate hypoxia during exercise may substantially compromise training
pace and decrease mechanical and neuromuscular stimuli, leading to gradual weak-
ening of some specific determinants of performance.
•
Concomitant to the observed decrease in SaO2% is a reduction in VO2max that is
directly associated with the degree of hypoxic stimulus. For every 1% decrease in
•
SaO2% below the 95% level a 1–2% decrement in VO2max is observed (Dempsey &
•
Wagner 1999). As a result, athletes are obliged to train at lower VO2max values and
at lower maximal, sub-maximal and interval training velocities in hypoxia than in
normoxia (Hahn et al 2001). The reduced training velocities in hypoxia may decrease
the physical and neural stimuli to muscles compared to training in normoxia result-
ing in a possible de-training effect (Peltonen et al 1997).
During exercise hypoxia a leftward shift in the ventilation (VE), heart rate (HR)
and blood lactate (bLA) versus velocity curves is observed. Further, the bLA versus
HR curve is shifted leftwards especially at high HR and, consequently, training HR
may be decreased during training in hypoxia (Levine & Stray-Gundersen 1997). The
paradox in lactate production at altitude, however, dictates a lower maximum bLA
(bLAmax), probably associated with a reduced maximum exercise capacity.
Concomitant to the reduced bLAmax, maximum heart rate (HRmax) is reduced at alti-
tudes above 3100 m (Hahn & Gore 2001). The decrease in HRmax is linearly related
to the decrease in SaO2% and as a result the greater decrease in SaO2% often observed
in highly trained athletes at altitude may result in a decreased HRmax occurring at
altitudes <3100 m.
In addition to the deleterious effects of hypoxia on performance a number of clin-
ical conditions termed ‘altitude illness syndromes’ exist that range in severity from
mildly debilitating to death. The following section examines the syndromes in more
detail.
CLINICAL ISSUES ASSOCIATED WITH HYPOXIA

Rapid accent to moderate altitude (c. 2500 m) and high-altitude environments causes
a spectrum of physiological responses in unacclimatized athletes. This spectrum is
associated with hypobaric hypoxia and often develops into pathological conditions
requiring medical intervention. These conditions include; acute mountain sickness
syndrome (AMS), high-altitude pulmonary oedema (HAPE) and high-altitude cere-
bral oedema (HACE) (Summary box 8.5). The impact of these altitude illness syn-
dromes is heterogeneous, ranging from mild self-limiting discomfort to death. While
the majority of studies examining the incidence of these pathological conditions have
focused on hypobaric hypoxia (HiHi) it is possible to induce these conditions in nor-
mobaric hypoxia (HiLo). The frequency and severity of these problems depend on
altitude, rate of ascent and degree of individual susceptibility.
Acute mountain sickness (AMS) is a benign, self-limited system complex. The cause
of AMS was thought to be associated with hypoxia-induced subclinical cerebral
oedema. Recent evidence, however, suggests that oxidative stress may play a key role
in the aetiology of AMS (Bärtsch et al 2004). Symptoms of AMS include headaches,
anorexia, nausea, vomiting, weakness, malaise, decreased co-ordination and dizzi-
ness. Sleep disturbance associated with an increased incidence of apnoeas and peri-
odic breathing is common following acute exposure to hypoxia (Pedlar et al 2005).
While symptoms appear to intensify at altitudes above 2500 m, AMS may be expe-
rienced at lower altitudes, and may occur during HiLo periods in normobaric hypoxia.
Allowing sufficient time for acclimatization by using graded ascent and staging are
the most effective methods for preventing AMS. Further, pre-acclimation may dimin-
ish AMS symptoms (Bärtsch & Roach 2001) with previous studies demonstrating the
Summary box 8.5
Summary of key points for AMS, HAPE and HACE.

Acute mountain sickness (AMS)
● All athletes are suseptible
● Directly related to rate and magnitude of ascent
● Headache is the most common symptom
● Acclimatization using graded ascent, staging and pre-acclimation reduces AMS
● Can evolve to HAPE and HACE
High-altitude pulmonary oedema (HAPE)
● Non-cardiogenic pulmonary oedema
● Most common cause of death among the altitude illness syndromes
● Risk factors include moderate to severe exertion, cold exposure, anxiety, young age,
male gender and obesity
● High rate of recurrence in individuals who have had a prior episode of HAPE
● Best treatment is immediate descent
High altitude cerebral oedema (HACE)
● Rarely occurs below altitudes < 3600 m
● Less common that AMS and HAPE
● Often a complication of AMS and HAPE
● Distinguished by disturbances in consciousness that may progress to coma, confusion
and ataxia of gate.
● Immediate descent is required for treatment
use of HiLo as a successful pre-acclimatization measure (Pedlar et al 2005). AMS

can be treated with pharmacological prophylaxis using acetazolamide (a carbonic
anhydrase inhibitor). At present, however, acetazolamide is currently on the WADA
banned drug list and care should be taken when using pharmacological agents in
the treatment of AMS.
High-altitude pulmonary oedema (HAPE) is a non-cardiogenic pulmonary
oedema caused by a combination of hypoxia induced pulmonary hypertension and
an increased permeability of the pulmonary capillary endothelium. If left untreated,
HAPE can be rapidly fatal. Symptoms and signs of HAPE are associated with a pro-
gressive pulmonary oedema resulting in a worsening hypoxaemia. Early signs are
often difficult to distinguish from a normal acute response to hypoxia. As pulmonary
oedema progresses, however, a productive cough of frothy, pink/blood streaked spu-
tum is common with wheezing and audible gurgling (especially when supine).
Treatment should be initiated immediately as a delay in treating progressive pul-
monary oedema at altitude usually results in death. Drug therapy has been used
successfully in preventing and treating HAPE, in particular nifedipine, however the
best treatment for HAPE is immediate descent.
High-altitude cerebral oedema (HACE) is caused by a hypoxic induced increase
in permeability of the blood–brain barrier (vasogenic oedema) and/or a hypoxic
induced alteration in cellular fluid regulation with an intracellular fluid shift (cyto-
toxic oedema).While HACE has been reported at altitudes as low as 2500 m the vast
majority of cases occur above 3600 m, well above those altitudes normally experi-
enced by athletes on training camp or during competition.
Another key problem associated with training at altitude is an increased hypoxic
stress leading to possible overtraining symptoms associated with an increased sym-
pathetic activation, oxidative damage mediated by free radicals and glycolytic metab-
olism (Gore et al 1998). A significant increase in resting serum cortisol and decrease
in serum testosterone has been observed following altitude training in elite endurance
athletes. Further, hypoxia decreases immunoreactivity, specifically by suppressing
T-cell mediated immunity. A 50–100% increase in the frequency of upper respiratory
tract and gastrointestinal tract infections during or immediately after altitude
sojourns has been reported (Bailey et al 1998).
Air temperature falls by about 1˚C with every 150 m of ascent. Therefore, low air
temperatures experienced at altitude increase the likelihood of cold-related injuries (see
Training and the cold). The reduction in humidity together with the increased venti-
lation rates (HVR) observed at altitude predisposes to dehydration, as a large volume
of body water can be lost through the respiratory tract as dry cold air is warmed and
humidified during breathing. An additional problem associated with altitude is the
increased solar radiation leading to sunburn. Care should be taken by athletes train-
ing at altitude to increase fluid intake and wear sunscreen to avoid excessive dehy-
dration and sunburn. Clothing choices at altitude are also of key importance in avoiding
cold injury while minimizing the potential for dehydration (see Training and the cold).
CONCLUSIONS
The benefits of living and training at altitude (HiHi) for an improved altitude per-
formance of athletes are clear but controlled studies for an improved sea level per-
formance are less clear. Current evidence suggests that to obtain a positive
acclimatization effect a hypoxic exposure above 2000 m for a minimum of 12 hours
per day for at least 3 weeks is required. Athlete response to hypoxia, however, is
heterogenic, with some individuals failing to respond, ‘non-responders’. Adopting
an individualized approach to the use of hypoxia will optimize acclimatization and
avoid unnecessary performance decrements.
A decrement in performance may be observed following a period of exposure to
hypoxia associated with a decreased mechanical, neuromuscular and cardiovascu-
lar stimuli associated with a reduction in training velocities. Further, a rapid accent
to altitude in unacclimatized individuals may result in altitude illness syndromes,
including AMS, HAPE and HACE. These syndromes are all specific to altitude envi-
ronments and are related to sustained hypoxia. Immediate medical care should be
sought for these syndromes to avoid possible fatalities. Raising the oxygen levels to
the body tissues is the primary treatment and can be achieved by using supple-
mental oxygen. The preferred treatment, however, is to move the athlete to a lower
altitude as rapidly as possible.
KEY POINTS
1. Altitude causes a cascade of physiological responses triggered by hypobaric
hypoxia resulting in a reduced arterial oxygen saturation (SaO2%).
•
2. For every 1% decrease in SaO2% below the 95% level a 1–2% decrement in VO2max
is observed.
3. Acclimatization results in adaptations leading to an improved oxygen delivery
and consumption.
4. The benefits of hypoxic living and training for improved altitude performance
are clear; however, evidence for an improved sea level performance are less
clear.
5. Full acclimatization requires hypoxic exposure for a minimum of 12 hours.day−1
for at least 3 weeks.
6. Altitude training takes a number of forms, including living high, training high
(HiHi); living high, training low (HiLo); living low, training high (LoHi).
7. Rapid accent to altitude can result in medical conditions requiring medical inter-
vention, including AMS, HAPE and HACE.
8. Considerable individual variation occurs in response to altitude training.
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London
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191
Chapter 9
Medical conditions and training
Roslyn J. Carbon (Reproductive health in exercising women)
Gregory Whyte (The athlete’s heart)
Richard Budgett (The unexplained underperformance
syndrome (UUPS))
Alison K. McConnell (Asthma and exercise-induced asthma)
CHAPTER CONTENTS
Introduction 192 The unexplained underperformance
Reproductive health in syndrome (UUPS) 207
exercising women 192 Learning objectives: 207
Learning objectives: 192 Introduction 207
Introduction 193 Symptoms 208
Exercise-related menstrual Diagnosis 208
irregularity 193 Precipitating factors 209
Polycystic ovarian disease (PCOD) Investigation 209
195 Hospital tests 209
Eating disorders and sport 195 Full blood count 210
Secondary effects of hypothalamic Iron stores 210
dysfunction in athletes 196 Viruses 210
Fertility 196 Trace elements and vitamins 210
Bone mineral density 196 Prevention and early detection 210
Incidence of injury 197 Psychological profiling 210
Management of exercise-related Heart rate 211
amenorrhoea 197 Other factors 211
Key points 199 Management 211
Therapeutic exercise 211
The athlete’s heart 199
Conclusions 212
Learning objectives: 199
Key points 212
Introduction 199
Cardiac structure and Asthma and exercise-induced
function in highly trained asthma 213
athletes 200 Learning objectives: 213
The electrocardiogram (ECG) 202 What is asthma? 213
Sudden cardiac death (SCD) 202 Prevalence in the sporting
Arrhythmias and the population 214
athlete 204 The pathophysiology of EIA
Syncope and the athlete 205 and EIB 214
Emergency medical care and athlete The time course of EIA and
evaluation 207 EIB 215
Key points 207
Do EIA and EIB limit exercise Warm-up 221

performance? 216 Dietary modification 221
Diagnosis 217 Inspiratory muscle training
Management 220 (IMT) 222
Pharmacological management 220 Summary 222
Bronchodilators (β2-agonists) 220 Key points 222
Corticosteroids 220 References 223
Non-pharmacological Further reading 228
management 220
INTRODUCTION
Optimal performance is not only associated with optimizing the training stimulus, it
is also associated with the ability to maintain optimal health throughout training and
competition while placing significant physiological demands on the body (Fig. 9.1).
It is beyond the scope of this text to examine, in detail, the health-related factors
related to performance. The reader is directed to a number of key texts offering com-
prehensive coverage of sports medicine, including The ABC of Sports Medicine (edited
by Whyte G, Harries M & Williams C), BMJ Books, London (2005).
This chapter examines four key areas that can have profound effects on the health
and performance of an athlete: (i) reproductive health and the female athlete, (ii)
the athlete’s heart, (iii) asthma and exercise-induced asthma, and (iv) unexplained
underperformance.
Optimal training Maintenance of

adaptation optimal health
Optimal
performance
Figure 9.1 The balance between optimizing the training stimulus and maintaining optimal
health in the attainment of performance.
REPRODUCTIVE HEALTH IN EXERCISING WOMEN
This section is intended to ensure that the reader:
1. Understands that exercise has many positive health benefits for women.
2. Recognizes that some women may require management of menstrual symptoms
in order to train and compete successfully.
3. Has an understanding of the endocrine changes that occur with exercise and the
effect these can have on reproductive function.
4. Acknowledges that athletes may have other significant medical conditions which
present as menstrual disturbance and require formal medical diagnosis.
Medical conditions and training 193
5. Understands the mechanisms behind menstrual disruption in exercising women

and the secondary health consequences.
6. Appreciates the rationale behind the management of amenorrhoea in athletes.
INTRODUCTION
For most girls and women regular physical exercise has a positive impact on gen-
eral and reproductive health. Regular training improves psychological wellbeing,
limits obesity, improves muscle strength and bone density, and is associated with
improved cardiovascular health and lipid profiles.
Physical exercise stimulates the endocrine system. However, in general, the
effect of regular training is to moderate hormonal flux such that the menstrual
cycle tends to be less problematic in active women. In particular, premenstrual
symptoms can be ameliorated by regular aerobic training. Some active sports
women, however, continue to be troubled by dysmenorrhoea (painful periods)
and menorrhagia (heavy bleeding) that may interfere with training and competi-
tion. Management of these problems includes modification of training patterns
where possible but, as this is often not practical, medication may be necessary.
Simple analgesia (paracetamol) may suffice for pain, although mefenamic acid is
often more potent and also controls menstrual flow. These medications and other
non-steroidal pain relief such as ibuprofen are available ‘over the counter’ and
should be instituted immediately symptoms occur. More significant menorrhagia
and pain requires medical consultation to exclude significant pathology.
Medication must always be checked against current doping guidelines to avoid
use of banned drugs.
For some women use of the combined oral contraceptive (OCP) may be indicated
to control menstrual symptoms, with possible manipulation of the cycle around com-
petition. There is very little evidence that this may have any negative effect on per-
formance and many elite performers have competed at their best when taking the
OCP.
EXERCISE-RELATED MENSTRUAL IRREGULARITY

Some highly trained athletes experience disturbance of the menstrual cycle such that
menses become irregular or may cease altogether (amenorrhoea). This ‘exercise-
related amenorrhoea’ is the result of a centrally mediated neuro-endocrine adapta-
tion whereby hypothalamic control of the pituitary–ovarian hormone axis is
disrupted.
The menstrual cycle is initiated from the hypothalamus at the base of the brain
with pulsatile release of the gonadotrophin releasing hormone (GnRH) resulting in
the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from
the anterior pituitary, which in turn control the function of the ovary and secretion
of oestrogen and progesterone. Intricate feedback loops control a finely balanced
hormonal interplay which ultimately results in regular ovulation from the ovary and
subsequent menstrual flow from the uterus.
The system may be disrupted when stresses alter the central control mechanism
in the hypothalamus – so-called hypothalamic hypogonadism. Subsequent diminu-
tion of gonadotrophin secretion leads to ovarian shutdown with low-level oestro-
gen secretion. These changes are essentially an adaptive process rather than an
organic disease process and are reversible should the factors responsible for the onset
of menstrual disruption be addressed.
A similar situation also occurs in highly trained endurance male athletes where
lower testosterone levels have been measured. Menstrual disruption of women, how-
ever, appears to be more common and may have more significant sequelae for repro-
ductive and musculoskeletal health.
Hypothalamic disturbance of the menstrual cycle may take the form of delayed
onset of menarche (primary amenorrhoea). Athletic girls often start menstruation
later than their peers but this may reflect self selection in that late developers often
excel in sport. Should menses not have commenced by the age of 16 the girl should
be referred for medical evaluation as this may also indicate significant organic pathol-
ogy, including chromosomal or endocrine defects.
Hypothalamic amenorrhoea may take various forms, depending on the severity
of the suppression of the reproductive axis. Some girls may have an unusually short
cycle (polymenorrhoea) which is related to an inadequate luteal (post-ovulation)
phase of the cycle. In contrast, anovulation may result in cycles longer than the nor-
mal 28–35 days (oligomenorrhoea). Amenorrhoea is generally defined as no menses
for 6 months, although the International Olympic Committee has recently defined
it as no more than one mense per year.
Menstrual disruption occurs in about 5% of the general population but may be
much more common in some athletic groups. It is rare in team sports such as net-
ball, hockey and football but common in gymnasts, distance runners and ballet
dancers. An interesting example is rowing where the heavy-weight crews typically
have normal cycles but the light-weight crews have a high incidence of amenorrhoea.
Athletic girls may also experience menarche but not establish a normal, regular
cycle for some years. Most amenorrhoeic athletes are younger, may never have estab-
lished a regular cycle and are unlikely to have been pregnant. It appears that once
hormonal patterning is established it is less likely to be disrupted in the future.
Most sports require a low body fat to optimize performance. Some sports have
weight categories and others, such as gymnastics and ballet, encourage a thin appear-
ance for aesthetic reasons. Women, however, naturally carry about twice the body fat
of men because the physiology of ovarian hormones favours fat deposition: Higher
levels of testosterone in men favour an increased lean mass of muscle and bone.
Consequently many female athletes constantly strive to maintain a low body fat while
at the same time needing to ensure adequate nutrition for their sport and health.
It is becoming increasingly evident that exercise-related amenorrhoea is due to
a chronic negative energy balance whereby athletes do not consume enough energy
for the needs of their sport (Zanker & Swaine 1998). Many of these girls have high-
volume aerobic training programmes and stressful competition schedules. While
they may be able to maintain their training level at a relatively stable body mass,
often at a very low level of body fat, they do so as a result of a complex neu-
roendocrine adaptation which includes hypothalamic amenorrhoea (Kaiserauer et al
1989).
Research indicates that these girls have serum markers of energy deprivation,
including altered thyroid function (low T3 levels), low insulin-like growth factor
(IGF1) and high IGF-binding protein (IGF-BP) levels and low leptin levels (Kaufman
et al 2002, Loucks et al 1992, Musey et al 1993). IGF1 is the peripheral metabolite of
growth hormone and is necessary for normal growth and development and mainte-
nance of lean body mass in adulthood. Leptin is produced by adipocytes and is an
indicator of fat stores. These athletes also have high levels of cortisol (hypercortisol-
aemia), indicating chronic stress. High levels of cortisol are associated with low bone
mass and poor tissue repair in patients with adrenal hyperplasia (Cushing’s disease).
It must be remembered that amenorrhoea is a symptom and not a diagnosis and
an athlete with menstrual disturbance requires a medical assessment to determine
the cause. Amenorrhoea may herald significant diseases, including malignancy and
endocrine disorders, which may require urgent intervention. Similarly, a diagnosis
of pregnancy must always be entertained and tested early. True ovarian failure (pre-
mature menopause) may also occur in women under thirty.
There are two other causes of amenorrhoea that are important differential diag-
noses to the athlete: polycystic ovarian disease and eating disorders.
POLYCYSTIC OVARIAN DISEASE (PCOD)

Polycystic ovarian disease is characterized by infertility, hirsutism, obesity and amen-
orrhoea or oligomenorrhoea. On investigation many patients will have enlarged cys-
tic ovaries. The pathogenesis of the PCOD is also related to inappropriate signals
(feedback mechanisms) to the hypothalamus and pituitary. In this case it is the release
of elevated androgens from the adrenal gland at puberty in an obese girl that lead
to increased peripheral aromatization to oestrogen from adipocytes. Feedback loops
to the pituitary result in increased LH and decreased FSH levels. This leads to anovu-
lation in the presence of oestrogen that can cause irregular and severe bleeding.
Eventually as the hormonal imbalance deteriorates amenorrhoea ensues.
This condition is very variable and the classic finding of obesity may not be evi-
dent in an athletic girl. It may present in a somewhat endomorphic athlete in a power
sport. Alternatively, PCOD may persist in athletic girls in whom the initial pubescent
obesity has resolved, and indeed elements of PCOD and athletic amenorrhoea may
co-exist in the same individual. Careful medical evaluation and hormonal profiling is
necessary to diagnose and manage these girls.
EATING DISORDERS AND SPORT

Anorexia nervosa and bulimia are severe psychological disturbances that often
require long-term psychiatric care and, especially in the case of anorexia, carry
significant morbidity and mortality. Anorexia is characterized by fasting (<1200
calories.day−1), weight loss, and amenorrhoea, while bulimia involves food binges
and purging, often with fairly normal body weight. Patients with eating disor-
ders have an extreme disturbance of their own body image and/or perception of
self-worth that is akin to a psychosis. In western adolescent populations the preva-
lence of eating disorders is increasing, with a sex ratio approaching 9:1 toward
girls.
There is unlikely to be a greater incidence of true eating disorders in athletes
compared with the general population (Bale et al 1996), but the stresses of sporting
success (coupled with ignorance of the importance of good nutrition in sport) may
lead a susceptible individual to develop the condition. Furthermore, some true
anorectics may exercise as part of their obsession with thinness. Eating disorder is
not compatible with sporting excellence; these girls may attain competitive standard
for a brief time only for their health and performance to subsequently deteriorate.
Professionals involved in sport, as well as coaches and managers, need to be alert
to signs of eating disorder such as gross weight loss or food avoidance. Nutritional
advice should be given to athletes without undue pressure for unrealistic and unnec-
essary weight control. Body fat should be seen as just one variable of health and
training assessment rather than a ‘performance target’ in itself. As in any form of
medical examination, sensitivity and confidentiality must be exercised when meas-
uring body weight and fat. Should there be a suspicion of a true eating disorder in
an athlete this must be addressed quickly and management sought from a special-
ist (psychiatrist) in the field.
SECONDARY EFFECTS OF HYPOTHALAMIC DYSFUNCTION

IN ATHLETES
While absence of menses to a competitive athlete may seem a benign event, there
are significant ramifications for the short- and long-term health of the athlete. These
include changes in fertility, altered bone metabolism and an increased risk of injury.
FERTILITY
Obviously, if an athlete is anovulatory due to hypothalamic dysfunction she will be
infertile. Most women in heavy training, however, are not seeking pregnancy, and
reproductive function will almost always resume with improved nutrition, higher
body weight, and lower training load. In a very small minority, especially those with
prolonged amenorrhoea since adolescence, infertility remains a problem and requires
specialist fertility treatment to induce ovulation. It is important for athletes, their
coaches and family to understand that reproductive patterning is most likely to occur
in the teenage years. When amenorrhoea persists untreated into the twenties it
becomes increasingly difficult to reverse the adaptations.
Athletes should also be warned that ovulatory function can sometimes return
without warning and there are several reports of high-level athletes being several
months pregnant before they realized their condition. Hence, despite amenorrhoea,
contraception should be used if an athlete is sexually active.
BONE MINERAL DENSITY

Athletes with altered menstrual function have been shown, on average, to have
lower bone mineral density than their eumenorrhoic counterparts. This is partic-
ularly so for those parts of the skeleton with normally high bone turnover such
as the spine. Weight-bearing physical activity is, however, a potent stimulator of
bone deposition and hence athletes generally have higher bone density than the
general population. There is a site-specific effect of exercise on those parts of the
skeleton regularly exercised, so that the long bones of the lower limb may have
normal bone density even in long-term amenorrhoeic runners. Interestingly, amen-
orrhoeic rowers have been shown to have normal spinal bone density commen-
surate with the strength of their trunk muscles in response to the repetitive rowing
action (Wolman et al 1990).
Measured bone mineral content in the skeleton is the combination of bone for-
mation by active osteoblasts, minus the effect of bone loss from osteoclastic activity.
Research on the pathogenesis of low bone mineral content in athletes is limited
but it appears that, unlike the high turnover bone loss that results from oestrogen
deficiency in post-menopausal women, hypothalamic amenorrhoea is associated with
low bone formation (Stacey et al 1998).
Amenorrhoeic athletes should not be labelled as having ‘osteoporosis’ in terms
of the condition of elderly women in whom minimal trauma is likely to cause acute
fractures of the spine, wrist, and neck of the femur. Such fractures do not occur in
young athletes. It is likely that bone quality, or collagen matrix, is superior in young
athletes. Unlike postmenopausal women, young women have the capacity to increase
bone mass once amenorrhoea is reversed (Drinkwater et al 1996). There appears to
be a ‘window of opportunity’, however, during late adolescence when bone mass
accretion is greatest, and it is likely that optimal bone mass may never be achieved
after prolonged amenorrhoea.
True osteoporosis is quantitatively defined as a bone mineral density more than

two standard deviations below the age-matched normal values. Athletes very rarely
record these levels and it is more accurate and relevant to term their bone mass as
‘osteopenia’ that is defined as 1–2 standard deviations below normal. Similarly, it is
not appropriate to define the decreased bone mass of young women as ‘bone loss’
unless sequential measurements indicate a true decrease over time.
Of significance to long-term management is the probability that women who con-
tinue to exercise are more likely to maintain bone mass into old age beyond the
menopause.
INCIDENCE OF INJURY
Of more immediate relevance to the athlete than infertility and lower bone mass
measurements is the observation that amenorrhoeic athletes have a greater injury
incidence than those with a normal menstrual cycle. Interpretation of injury statis-
tics is difficult because there are often confounding factors that cannot be controlled
such as training load and poor training techniques. However, several reports indi-
cate that total trauma incidence, including acute as well as chronic overuse injuries,
is greater in amenorrhoeics (Lloyd et al 1986).
Stress fractures have been shown to be more common in amenorrhoeics and this
is evident even in prospective studies that control for the amount of training under-
taken (Bennell et al 1995, Carbon et al 1990). Clinically, it is common for amenor-
rhoeic athletes to have multiple fractures that are slow to heal. However, these
fractures often occur in weightbearing bones which have been shown to have nor-
mal bone density. It is likely that these women have limited bone repair in the pres-
ence of low bone turnover.
MANAGEMENT OF EXERCISE-RELATED AMENORRHOEA

If a clear diagnosis of exercise-related amenorrhoea has been made, and other con-
ditions excluded, the athlete should be counselled on the adaptive processes asso-
ciated with chronic energy drain. Athletes and coaches must be made aware that
such endocrine changes are an indication that the current training/nutrition/stress
paradigm is counterproductive and must be reversed. Certainly, the benefits of
improved health and strength on physical performance should be emphasized.
Menstrual disturbance must not be allowed to persist in an athlete for more than
6 months without remedy because of the known health consequences for the ath-
lete. It has been suggested that a minimum of four menses per year is required to
confer adequate bone health.
Young athletes in particular should not be allowed to continue training with ongo-
ing oligo-amenorrhoea, especially if normal menses have never been established, as
it becomes increasingly difficult to reverse the problem as it is prolonged. Long-term
amenorrhoeics rarely remain healthy or injury-free long enough to enjoy success from
their hard training. Certainly, there can be little to be gained by being a junior cham-
pion whose career does not survive into senior ranks because of injury and illness.
Formal nutritional advice may be required to ensure adequate energy consump-
tion to balance energy output. Adequate vitamin and mineral intake is also impor-
tant, in particular calcium and iron.
Menstruating women generally require twice the daily iron intake of men – about
15 mg per day. Endurance athletes of both sexes frequently have haemoglobin and
iron levels below reference range and this is, in part, due to the haemodilution in
response to aerobic training. Some athletes, however, will have true iron deficiency
either from low intake or absorption of iron, or from a postulated haemolysis from
the repeated microtrauma of training. Amenorrhoeic athletes often have poor iron
intake as part of their general malnutrition. Hence female endurance athletes, in par-
ticular, should ensure adequate iron levels or risk possible fatigue and poor per-
formance. Serum ferritin is probably the best indicator of iron stores and a level
below 30 ng/mL should be treated. Meat is the best source of iron and should be
eaten daily, although vegetarians can manage to maintain iron stores with a careful
diet. Total daily nutrition should exceed 2000 kcal (8300 kJ) and include fortified
cereals and bread, green vegetables, and fruit. It is useful to remember that vitamin
C improves iron absorption, while phytic acid (found in fibrous cereals) and tannic
acid (found in tea and coffee) bind iron in the gut and hence limit absorption. In
practice, overt iron deficiency often requires supplementation under medical con-
trol. Many athletes find the gastrointestinal disruption of oral iron too debilitating
and, if anaemia persists, intramuscular iron in small doses may be necessary.
All women need adequate calcium intake and regular weightbearing exercise to
ensure optimal bone density. Current guidelines suggest a recommended daily intake
(RDI) of 800 mg per day for young (menstruating) women and 1500 mg per day for
postmenopausal women, and it is likely that amenorrhoeics require similar intake.
In practice this may be difficult to achieve from diet alone. Athletes must be encour-
aged not to avoid dairy products, the main source of dietary calcium. Low-fat cheese,
milk and yoghurt are excellent nutritional choices for sportswomen. Half a litre of
low-fat milk and 300 g of low-fat plain yoghurt will meet the daily calcium needs
of the amenorrhoeic athlete. High-protein, tea, and coffee ingestion have a negative
effect on calcium status because of increased renal excretion.
Any increase in body weight for the amenorrhoeic athlete should be slow and
integrated with alterations in training to ensure that lean mass (muscle and bone)
rather than excess fat is laid down. Some sessions of aerobic work could be replaced
for light resistance work, core stability training or skill acquisition. It is important
that there is adequate rest and recuperation and that ‘quality’ replaces unnecessary
‘quantity’ in the programme. Reduction of stress in the athlete’s life is important
and may require the input of a psychologist.
In practice total weight increase may require only a few kilos but, with improved
nutrition and more targeted training, menses usually restart over 3–4 months. If this
is not successful serious consideration must be given to a more formal break from
training over 3–6 months during an ‘off-season’ to establish a normal menstrual pat-
tern. Often, if this is not done, injury intervenes and the athlete is forced to take an
unscheduled break from their sport that is likely to be more disruptive.
The medical management of exercise-related amenorrhoea is not well researched
or understood and assumptions have been made relating to the use of oestrogen
replacement as a parallel to the treatment of the post-menopausal woman. Low
oestrogen levels are only one factor in the endocrine picture and, as low bone for-
mation rather than bone resorption appears to be responsible for lower bone den-
sity, it is unlikely to be the most significant change. There is no good evidence that
oestrogen administration improves bone density or heals stress fractures in the amen-
orrhoeic athlete (Hergonroeder 1995). Indeed, therapeutic oestrogen could, theoret-
ically, decrease bone formation and repair further by limiting osteoclastic activity
that stimulates bone repair. Hence, oestrogen, as hormone replacement therapy or
the oral contraceptive, is not indicated in exercise-related amenorrhoea.
There are currently several new drugs becoming available for the management
of osteoporosis that may have relevance to the young population of amenorrhoeics
in the near future. However, it is preferable for the holistic health of the athlete that
those factors responsible for amenorrhoea are reversed and training is optimized.
Coaches, athletes and their family need to understand the ramifications of the
problem and be prepared to alter a programme for the long-term health and suc-
cess of the athlete. In practice this is often very difficult to achieve. There may be a
need for long-term cultural change within a sport. The sport of gymnastics in par-
ticular has addressed the problem over the past decade, increasing the minimum
competitive age to 16, and allowing the gymnasts to assume a more healthy physique.
Hopefully, as the understanding of the interrelationship of health, nutrition, exer-
cise and performance increases in the sporting community, more women will be able
to enjoy the health benefits of sport.
KEY POINTS
1. Exercise has both general and reproductive health benefits.
2. Exercise results in significant endocrine changes which, in the presence of chronic
energy drain, may cause hypothalamic dysfunction and subsequent amenorrhoea.
3. These changes are reversible with good nutrition and training programmes.
4. Prolonged amenorrhoea from negative energy balance is associated with infertil-
ity, poor bone health and a high incidence of injury.
5. Athletes can suffer other serious medical conditions that may present with amen-
orrhoea and require formal medical diagnosis.
THE ATHLETE’S HEART
1. Appreciates the physiological adaptation of the heart to training.
2. Appreciates the physiological mechanism underpinning cardiac enlargement.
3. Is able to recall the upper normal limits of left ventricular wall thickness and cav-
ity size.
4. Recognizes the causes of sudden cardiac death in young and aged athletes.
5. Recognizes the types of arrhythmia observed in athletes and their importance.
6. Appreciates the nature of syncope in athletes and recognizes causes of syncope.
7. Recognizes the role of emergency care for athletes
INTRODUCTION
Regular physical training is associated with a number of unique structural and func-
tional adaptations that enhance cardiac output during exercise. Hypertrophy of the
ventricles, increase in cardiac chamber size and enhanced ventricular filling in dias-
tole result in an increased stroke volume at rest and throughout exercise. Athletes
also have reduced resting heart rate (bradycardia) at rest and for a given submaxi-
mal workload, in response to an increased vagal tone possibly associated with the
functional effect of an increased stroke volume. A large heart and slow heart rate
are well-recognized features of athletes’ hearts and manifest as a displaced and force-
ful cardiac apical impulse on physical examination, large QRS complexes, sinus
bradycardia, first and second-degree heart block on the 12-lead ECG, and an
increased cardiothoracic ratio on plain chest radiographs (Sharma et al 1997)

(Summary box 9.1). These physiological adaptations may, however, mimic pathol-
ogy. Differentiation of physiological and pathologic changes of the heart is impor-
tant given the incidence of sudden cardiac death in young athletes.
CARDIAC STRUCTURE AND FUNCTION IN HIGHLY TRAINED

ATHLETES
Training-induced adaptations in cardiac structure have been traditionally divided
into two main types depending upon the specific nature of the haemodynamic load
placed upon the heart. Endurance training imposes an increased preload on the heart
associated with a sustained increase in venous return combined with a mild to mod-
erate increase in blood pressure resulting in an increased afterload. As a result of
this increased preload and afterload, left ventricular cavity dilatation with minor
increases in wall thickness occurs. Resistance training, in contrast, leads to dramatic
elevations in blood pressure as a result of simultaneous muscular contraction and
valsalva manoeuvre. This increased afterload results in an increased left ventricular
wall thickness and a relatively normal sized left ventricular cavity dimension
(Fig. 9.2). Training rarely conforms to this rigid dichotomy of cardiovascular
responses, however, with most programmes utilizing a combination of endurance
and strength training. Thus, the literature supporting a simple division of endurance
and strength athletes does not exist. In the vast majority of athletes the cardiac adap-
tations exhibited tend to reflect a combination of responses to increased preload and
afterload. Indeed, the largest athletic hearts are observed in those athletes that com-
bine elements of strength and endurance exercise during training, often undertak-
ing high resistance exercise for prolonged periods e.g. rowing, cycling, swimming
and rugby (Pelliccia et al 1991, Whyte et al 2004b) (Fig. 9.2).
Cardiac dimensions in athletes are slightly increased compared with non-athletic
matched controls and a large overlap is often observed. While the difference is small
it does reach statistical significance and amounts to a 15–20% larger left ventricular
wall thickness and 10% larger left ventricular cavity size compared with non-athletes.
The modest increases in left ventricular wall thickness and left ventricular cavity size
result in a marked increase in left ventricular mass in the region of 50% (Maron 2002).
The vast majority of athletes have cardiac dimensions within normal limits for the
general population, i.e. a left ventricular wall thickness <12 mm and left ventricular
Summary box 9.1
Characteristics of the athlete’s heart.

● Training results in a reversible increase in left ventricular muscle mass (LVM)
● The largest hearts are observed in athletes participating in events requiring a
combination of both endurance and strength/power.
● Adaptations are similar between males and females and junior and seniors; however,
males exhibit larger hearts than females, and seniors larger hearts than juniors
● Upper normal limits of left ventricular wall thickness for males and females are 14 mm
and 12 mm respectively
● Upper normal limits of left ventricular cavity for males and females are 65 mm and
60 mm respectively
● Diastolic and systolic function are normal or enhanced in the athletes’ heart
Normal Endurance trained
Strength trained Combined strength & endurance trained

Figure 9.2 The athlete’s heart.
cavity size <55 mm. A small proportion of athletes, however, have a left ventricular
wall thickness and more commonly a left ventricular cavity size exceeding predicted
normal limits. In this group of athletes cardiac dimensions may be similar to those
seen in patients with morphologically mild hypertrophic and dilated cardiomyopa-
thy respectively (Pelliccia et al 1991, Sharma et al 2002, Whyte et al 2004b). The dif-
ferentiation between physiological cardiac enlargement (athlete’s heart) and
cardiomyopathy is crucial when one considers that the cardiomyopathies are the com-
monest cause of exercise-related sudden death (Sharma et al 1997).
Studies have identified upper normal limits for left ventricular wall thickness in
adult and adolescent athletes (Pelliccia et al 1991, Sharma et al 2002, Whyte et al 2004b).
Upper wall thickness limits for adult male and female athletes are 14 mm and 12 mm
respectively. In adolescent athletes a left ventricular wall thickness >12 mm warrants
further investigation. Left ventricular cavity size in athletes more commonly exceeds
normal limits with upper limits for male and female athletes of 66 mm and 60 mm
respectively (Whyte et al 2004b). Values in excess of these should be viewed with cau-
tion and should prompt further investigation to identify the underlying cause.
Normal or enhanced indices of left ventricular systolic and diastolic function are
observed in the athlete’s heart despite significant increases in left ventricular mass
(Whyte et al 2004b, c).
THE ELECTROCARDIOGRAM (ECG)

Common ECG manifestations of the athlete’s heart include sinus bradycardia, sinus
arrhythmia, voltage criteria for left ventricular enlargement and early repolarization
changes such as tall T-waves and concave ST segment elevation. Incomplete right
bundle branch block (possibly reflecting right ventricular enlargement) is also rela-
tively common. First-degree heart block and Mobitz type I second degree AV block
are also recognized findings; however, higher degrees of AV block are rare. Minor
T-wave inversions are observed and usually confined to the right chest leads (V1,
V2, V3) but ST segment depression or deep (> 0.3 mV) T-waves are uncommon.
Pathological Q-waves and left bundle branch block are not features of the athlete’s
heart.
SUDDEN CARDIAC DEATH (SCD)

Sudden cardiac death in a young athlete is considered a non-traumatic, non-violent,
unexpected death due to cardiac causes. Sudden death can occur during exercise or
at rest. The time course of death remains equivocal ranging from during or imme-
diately post-exercise to 24 hours post-exercise. Despite this lack of consensus agree-
ment previous studies have reported a tenfold increase in the incidence of
cardiovascular events in individuals with cardiovascular disease during exercise (Seto
2003). The sudden death of a young athlete is an uncommon event with an esti-
mated prevalence between 1:100 000 and 1:300 000, with death rates five times higher
in males than females (Maron et al 1996, van Camp et al 1995). Data from the National
Federation of State High School Associations (USA) estimates 10–25 deaths in young
individuals (<30 years) occur per year (van Camp 1992). The exact prevalence of
sudden cardiac death remains unclear due to the paucity of well controlled studies.
Most studies to date have relied upon self-reporting of physicians and media accounts
of deaths. Despite the relatively low prevalence, the sudden death of an athlete has
a profound effect not only on the athlete’s immediate family but also on their team
mates, the local community and the sport as a whole. Indeed, the sudden cardiac
death of a young athlete is often highly publicized leading to ramifications nation-

ally and internationally.
The causes of sudden cardiac death in young (<35 years) athletes are associated
with a small number of congenital cardiac diseases. The most common cause is
hypertrophic cardiomyopathy accounting for about 50% of sudden deaths (Maron
et al 1996). Other causes include arrhythmogenic right ventricular cardiomyo-
pathy, anomalous coronary arteries, the ion channelopathies (Brugada’s and Long
QT), W-P-W, Marfan’s syndrome and myocarditis (Sharma et al 1997). Physical
training results in cardiac adaptations that may mimic pathology (Sharma et al
1999, Whyte et al 2004b). To avoid false-positive and false-negative diagnosis the
differentiation of physiological and pathological changes in cardiac structure and
function is fundamental. The congenital nature of sudden cardiac death together
with the increased incidence of events during exercise indicates adequate cardio-
vascular screening and evaluation are important to identify individuals with
underlying cardiovascular disease prior to the commencement of rigorous train-
ing and competition.
In 1996 the American Heart Association (AHA) developed consensus recommenda-
tions for the cardiovascular screening of student athletes as part of a comprehensive
pre-participation physical examination. This was incorporated into the pre-participation
physical evaluation guidelines in the USA (Smith et al 1997). This system of pre-
participation screening does not exist for sport in the UK. Indeed, because of the large
differences in design and content of pre-participation screening among sports in the
UK (Batt et al 2004) a national standard for pre-participation medical evaluation, includ-
ing cardiovascular screening would enhance the quality of care offered to athletes.
While limited evidence from the Italians suggests that pre-participation screening
reduces the incidence of sudden cardiac death (Thiene et al 1999), the efficacy of such
programmes remain to be fully elucidated due to the absence of systematic cardio-
vascular screening programmes in other countries, including the UK.
The content of pre-participation cardiovascular screening remains an area of much
debate. In general, a full cardiovascular screen will include family history, med-
ication and drug use history, blood pressure, pulse, recognition of Marfan’s syn-
drome, auscultation of the heart (unnecessary when echocardiography is employed),
ECG and echocardiography. A 12-lead integrated cardiopulmonary stress test may
be a valuable tool in a differential diagnosis and is often part of an athletes sup-
port programme (Whyte et al 1999)(Fig. 9.3). Financial constraints may dictate the
inclusion of ECG and echocardiography in the pre-participation screen. Indeed,
finance is often used as the main factor precluding cardiovascular screening of the
athlete. To date, however, limited evidence exists supporting or refuting the effi-
cacy of pre-participation cardiovascular screening for athletes making discussions
regarding the financial viability of such programmes problematic.
The incidence of sudden death in older athletes (>40 years) has been reported as
1 death per 396 000 man-hours jogging (Thompson et al 1980), but appears to be
lower for men with higher levels of habitual physical activity (American College of
Sports Medicine 1995). No evidence currently exists for death rates in women.
Coronary artery disease is the most common condition leading to exercise related
sudden cardiac death. The increased metabolic and physiological demands experi-
enced during exercise lead to an increased risk of a cardiac event. Sudden death is
often observed in highly conditioned older athletes due to occult coronary atheroma.
Those older athletes at higher risk often have more than one recognized risk factors
including smoking, a family history of myocardial infarction under the age of 55
years, hypertension and hypercholesterolaemia.
Figure 9.3 Integrated cardiopulmonary stress testing.
Education programmes for older athletes should be aimed at increasing aware-

ness of warning symptoms, including chest pain, palpitation, and syncope (faint-
ing). Severe exercise should be undertaken cautiously in patients over the age of
40 years, particularly those with risk factors. Older individuals intending on com-
mencing training for the first time or following a prolonged period of inactivity
should seek medical advice before doing so. Older individuals presenting with symp-
toms suggestive of coronary artery disease during exercise should be fully evalu-
ated prior to re-commencing training.
Another mechanism for SCD in individuals free of cardiac disease is blunt chest
impact produced either by a projectile or by collision with another athlete (com-
motio cordis). Three determinants of a commotio cordis have been identified: (1) rel-
atively low-energy chest impact located directly over the heart; (2) precise timing of
the blow to a narrow 15-millisecond segment of the cardiac cycle vulnerable to poten-
tially lethal ventricular arrhythmias, just prior to the T wave peak, and (3) a nar-
row, compliant chest wall, typical of young children. The majority of commotio cordis
events are fatal; however, a small number of athletes survive, supporting the impor-
tance of early recognition and prompt institution of CPR and defibrillation (Maron
2002).
ARRHYTHMIAS AND THE ATHLETE

Cardiac arrhythmias in athletes range from the benign and asymptomatic to the
symptomatic and potentially life threatening. Supraventriuclar and ventricular
extrasystoles are common and are usually of no clinical significance. The high vagal
Summary box 9.2
Causes of exercise-related sudden cardiac death in young athletes. Adapted from Sharma S,
Whyte G & McKenna WJ (1997) Sudden cardiac death in young athletes – fact or fiction?
British Journal of Sports Medicine 31(4):269–276.
Common Uncommon
Hypertrophic cardiomypathy (HCM)* Myocarditis
Coronary artery anomalies (CAA) Coronary artery disease (CAD)
Arrhythmogenic right ventricular Long QT/Brugada’s syndrome
Cardiomypathy (ARVC)** Marfan’s
Mitral valve prolapse (MVP)
Wolf-Parkinson-White (W-P-W)
Aortic stenosis
* Most common cause of ERSCD
** Most common cause of ERSCD in Northern Italy
tone associated with physical training may result in athletes being more susceptible
to certain bradyarrhythmias. Asymptomatic bradyarrhythmias such as sinus brady-
cardia, nodal bradycardia and Mobitz second degree AV block (Mobitz I) are com-
mon among athletes and are due to the high vagal tone associated with intense
physical training. Higher degrees of AV block and supraventricular arrhythmias are
uncommon in athletes. In a small number of athletes high vagal tone may predis-
pose to atrial fibrillation (Whyte et al 2004a).
Potentially life-threatening ventricular arrhythmias are uncommon in athletes and
are generally associated with underlying structural heart disease, coronary artery
disease or ion channnelopathies. In these circumstances participation in sport of high
and moderate intensities is contraindicated. In a few cases, ventricular tachycardia
may occur in the absence of these predisposing substrates and be amenable to treat-
ment with electrophysiological radiofrequency ablation.
SYNCOPE AND THE ATHLETE

Unexplained syncope in an athlete is a potentially ominous symptom that requires
a thorough cardiovascular evaluation. The most frequent cause is neurocardiogenic
(vasovagal) syncope, commonly associated with neurally mediated mechanisms
but may be compounded by dehydration. The vast majority of cases occur in the
absence of an underlying cardiac cause; however, structural heart disease and other
causes should be eliminated before considering neurocardiogenic syncope as the
aetiology (Summary box 9.3). Integrated cardiopulmonary stress testing is useful
and should be performed while recording the ECG during the sport in which the
athlete participates (Whyte et al 1999) (Fig. 9.3). Athletes with syncope associated
with exercise who have a fully negative cardiac evaluation can safely participate
in sport of all types and intensities. The exception to this rule are individuals
with recurrent syncope who participate in sporting disciplines where even tran-
sient loss of consciousness may be hazardous, i.e. high-speed or water-based
sports.
Traditional pharmaco-therapy for vasovagal syndrome includes β1-andrenergic
blocking agents, anti-arrhythmics and plasma volume expanders. These groups of
Summary box 9.3
Causes of syncope. Adapted from Wang D, Sakaguchi S & Babcoack M (1997) Exercise
induced vasovagal syncope. Physician Sports Med 25:64–74.
Neurally mediated (vasovagal)
Emotional faint
Carotid sinus syncope
Coughing
Swallowing, defecation, micturation
Airway stimulation
Orthostatic and vascular
Idiopathic orthostatic hypotension
Shy-Drager syndrome
Diabetic neuropathy with orthostatic hypotension
Drug-induced orthostasis
Cardiac arrhythmia
Sinus node dysfunction
Atrioventricular conduction system disease
Paroxysmal supraventricular tachycardia
Paroxysmal ventricular tachycardia
Cardiac implant malfunction
Structural cardiac disease
Vascular disease
Myocardial infarction
Obstructive cardiomyopathy
Subclavian steal syndrome
Pericardial disease
Pulmonary embolus
Primary pulmonary hypotension
Neurological
Cerebrovascular (i.e. vertebrobasilar disease)
Central nervous system substrate disorder (i.e. seizure disorder, subarachnoid haemorrhage)
Non-cardiovascular
Hypoglycaemia
Volume depletion
Hypoxaemia
Hyperventilation
Panic attack
Hysteria
drugs are currently prohibited by international governing bodies of sport. In addi-

tion, care must be taken when prescribing drugs that posses negative inotropic
actions. Strategies to reduce/eliminate vaso-vagal symptoms are targeted at main-
taining blood pressure and venous return post-exercise including warm-down,
coughing, muscle tensing and leg crossing (Krediet et al 2002).
EMERGENCY MEDICAL CARE AND ATHLETE EVALUATION

Sudden cardiac death in sport is preventable. Unfortunately most athletes collaps-
ing during or immediately after sport die because cardio-pulmonary resuscitation is
delayed. Facilities to deal with cardiac events should be available at training and
competition venues. These facilities should include personnel trained in basic/
advanced life support and the provision of external automated cardiovertor defib-
rillators. Personnel responsible for athletes during training and competition should
also receive training in basic/advanced life support.
KEY POINTS
1. Athlete’s heart (AH) is characterized by left ventricular enlargement, resting
bradycardia, conduction anomalies and additional heart sounds.
2. Upper normal limits of LV wall thickness and LV cavity diameter for male ath-
letes is 14 mm and 65 mm and for female athletes is 12 mm and 60 mm.
3. Diastolic and systolic function are normal or enhanced in AH.
4. Differentiation of AH and pathological cardiovascular disease is crucial in pre-
venting possible fatalities.
5. The causes of sudden cardiac death in young (<35 years) athletes are associated
with a small number of congenital cardiac diseases. In older athletes (>35 years)
sudden death is most commonly linked to coronary artery disease.
6. Unexplained syncope in an athlete is a potentially ominous symptom that requires
a thorough cardiovascular evaluation.
7. Facilities to deal with cardiac events should be available at training and compe-
tition venues including: personnel trained in basic/advanced life support and the
provision of external automated cardiovertor defibrillators.
THE UNEXPLAINED UNDERPERFORMANCE SYNDROME (UUPS)
1. Recognizes what underperformance syndrome is and how it is caused.
2. Is able to recall the prevalence of underperformance syndrome.
3. Appreciates the symptoms of underperformance syndrome.
4. Recognizes precipitating factors to underperformance syndrome.
5. Appreciates the tools used to identify athletes with underperformance syndrome.
6. Appreciates the ways in which underperformance syndrome can be prevented.
7. Comprehends the management and rehabilitation of an athlete with underper-
formance syndrome.
INTRODUCTION
It is common for athletes to suffer from a short period (<2 weeks) of relative under-
performance at times of hard training. This reversible decrement in performance is
termed over-reaching (see Ch. 1). Sometimes underperformance persists for more
than 2 weeks despite adequate rest. A reduction in performance for >2 weeks
despite adequate recovery has been termed unexplained underperformance syn-
drome (UUPS). Other common terms employed to describe UUPS include burnout,
staleness, overtraining syndrome, chronic fatigue in athletes, sports fatigue syn-

drome or under-recovery syndrome (Budgett et al 2000). Up to 10% of elite
endurance athletes per year may suffer from UUPS (Budgett 1998). Any athlete
training hard, however, is vulnerable. Indeed, Morgan et al (1987) reported 10% of
collegiate swimmers in the USA are identified as ‘burning out’ each year.
It is important to differentiate UUPS from possible pathological conditions.
Exclusion of underlying illness is achieved with an appropriate history and exami-
nation. A full blood count with measurement of iron stores and thyroid function
may identify unexpected causes, otherwise routine blood screening is rarely help-
ful, unless indicated by the history and examination (Budgett 1998, Lac & Maso
2004). No specific medical cause is found in the majority of athletes suffering from
UUPS.
SYMPTOMS
The predominant symptoms in athletes suffering from UUPS are fatigue, heavy mus-
cles and depression (Varlet-Marie et al 2003). Some athletes suffer from frequent
minor infections breaking down with an upper respiratory tract infection (URTI)
every 3–4 weeks due to immunosupression (Lakier-Smith 2003). Many athletes com-
monly describe increased lightheadiness (postural hypotension) and a raised resting
pulse rate (Hedelin et al 2000). There is often a loss of motivation and an increased
emotional lability, anxiety and irritability. A loss of appetite leading to weight loss
is often observed. Direct questioning reveals sleep disturbance with difficulty get-
ting to sleep, nightmares, waking during the night or prolonged sleep but waking
un-refreshed (Lac & Maso 2004) (see Summary box 9.4).
Performance symptoms often manifest as athletes describing an ability to keep
up at the beginning of a race but being unable to lift the pace or sprint for the line.
This inability to increase exercise intensity may be associated with a reduced abil-
ity to recruit type II muscle fibres for maximum power output (Koutedakis et al
1995). This may be related to an increase in type I and reduction in type II muscle
fibres, a myopathy type state (Steinacher et al 2004).
DIAGNOSIS
Distinguishing UUPS from normal training fatigue (over-reaching) is difficult and
can only be achieved once an athlete has failed to recover. Many athletes will be
Summary box 9.4

Symptoms of UUPS.
1. Underperformance
2. Depression with loss of motivation, competitive drive and libido
3. Increased anxiety and irritability
4. Sleep disturbance
5. Loss of appetite and weight
6. Fatigue
7. Frequent minor infections, particularly of the upper respiratory tract
8. Raised resting pulse rate
9. Increase symptoms of postural hypotension
fatigued, irritable, anxious and depressed with increased resting pulse rate and minor
infections, but nevertheless recover quickly once the training volume has been
reduced. The challenge for doctors, sports scientists and coaches is to develop reli-
able measures of recovery so that athletes can train as hard as possible but not so
hard that they break down for many weeks with UUPS. No diagnostic tests cur-
rently exist for UUPS and the diagnosis is often made on the history and objective
underperformance alone (Urhausen & Kindermann, 2002).
PRECIPITATING FACTORS
Many athletes break down when they switch from low-intensity winter training to
high-intensity summer training with intensive interval work. The stress of competi-
tion and selection pressures may also be a contributory factor in the development
of UUPS.
Athletes rarely break down after less than 2 weeks of hard training provided that
they then rest and allow themselves to recover afterwards. This is what happens
with normal tapering after a typical hard training camp. In some sports, however,
training is heavy and monotonous and lacks much periodization (see Ch. 1). This
may result in a lack of programmed recovery resulting in a difficulty recovering
from heavy periods of training. Large volumes of training, however, are generally
well tolerated as long as the intensity is low enough.
While inadequate recovery is likely to be the critical factor, other stressors, includ-
ing exams and other life events, glycogen depletion due to poor diet and dehydra-
tion will reduce the ability to recover from, or respond to, heavy training (Kentta
et al 2001, MacKinnon 2000).
Very hard training may cause immunosuppression associated with raised serum
cortisol concentrations, lowering serum glutamine concentrations, lowering salivary
IgA concentrations and saliva volume, and reducing T helper/T suppressor cell ratios
(Lakier-Smith 2003). An increased catabolism of amino acids as an energy substrate
may explain many of the biochemical changes observed in athletes with so called
‘endurance overtraining’ (Petibois et al 2003).
INVESTIGATION
A diagnosis of UUPS is often poorly accepted by athlete and coach. This situation
has led to the development of some basic screening to convince the athlete/coach
that there is no undiagnosed illness. The history and examination should guide the
doctor in deciding whether further investigations might be helpful. Some serious
diseases have presented as UUPS, such as viral myocarditis, cardiac abnormalities
or hypothyroidism, but this is rare. Prolonged glycogen depletion sometimes due to
disordered eating (or even eating disorders such as anorexia or bulimia) is a more
common cause of fatigue and underperformance (Costill et al 1988, Snyder 1998).
Anaemia may occur particularly in female endurance athletes due to poor diet and/or
blood loss. Allergic rhinitis and atopy may present as recurrent upper respiratory
tract infections (Budgett 1994).
HOSPITAL TESTS
Laboratory tests are occasionally helpful but cannot be used to make a diagnosis of
UUPS.
FULL BLOOD COUNT

Haemoglobin concentrations and packed cell volume may decrease as a normal
response to heavy training associated with a concomitant increase in plasma vol-
ume. This relative haemodilution may be misinterpreted as anaemia in the absence
of a performance decrement (Budgett 1998).
IRON STORES
Low iron stores reflected in a low serum ferritin concentration can cause fatigue in
the absence of anaemia. Serum ferritin levels may be affected by concurrent illness.
The majority of menustruating endurance athletes have ferritin levels of less than
30 ng.L−1 which may contribute to fatigue, and iron stores are particularly impor-
tant if they are considering altitude training. Many sports and exercise medicine
doctors recommend giving oral iron (often a liquid preparation as this seems to be
better tolerated), and vitamin C to help absorption, to most female endurance ath-
letes who are menustruating.
VIRUSES
Viral titres may be shown to rise or the Paul Bunell test may be positive, strongly
suggesting glandular fever. Identifying a specific virus, however, does not change
the management, so is of limited value (Bailey et al 1997).
TRACE ELEMENTS AND VITAMINS

It has not been possible to show any link between vitamins, trace elements and
UUPS or chronic fatigue syndrome in non-athletes. The widespread use of supple-
ments by athletes does not offer protection from fatigue and underperformance and
should be discouraged due to the risks of contamination. Dietary advice should be
sought by all athletes and they must be given strong reassurance that a varied diet
with sufficient calories negates the need for supplements except in specific cases
under medical and dietetic advice (Costill et al 1988).
PREVENTION AND EARLY DETECTION

Athletes can tolerate different levels of training and competition stress. Excessive
training for one athlete may be insufficient training for another. Each athlete’s tol-
erance level will also change through the season so training must be individualized
and varied and should be reduced at times of stresses such as exams. Unfortunately,
athletes are exhausted most of the time, unless they are tapering for a competition,
so it is difficult for them to differentiate early UUPS from over-reaching. Investigators
have tried to identify strategies for early detection with limited success (Urhausen &
Kindermann 2002).
PSYCHOLOGICAL PROFILING
In American college swimmers a 10% incidence of burn out was reduced to zero by
daily mood monitoring with a profile of mood state (POMS) questionnaire, and by
reducing training whenever mood deteriorated and increasing it when mood
improved (Morgan et al 1987).
HEART RATE
Many athletes monitor their early morning heart rate. A 10 beat per minute rise is
non-specific but does provide objective evidence that something is wrong. A more
sophisticated measure is heart rate variability which has been used for decades by
the Eastern bloc to monitor the training status of athletes. Changes in the balance
of the activity of the sympathetic and parasympathetic nervous systems occur with
hard training and then recovery (with high parasympathetic drive after successful
tapering). This may be reflected in heart rate variability giving an objective guide
to the extent of recovery (Hedelin et al 2000, 2001, Mourot et al 2004). Unfortunately
the changes in athletes with UUPS are very variable and so heart rate variability
cannot be used to make a reliable diagnosis (Park et al, personal observation). The
heart rate variability seems to change unpredictably as athletes go through fatigue,
exhaustion, de-training and recovery (Bosquet et al 2003). Nevertheless it is possi-
ble that by profiling individual athletes across time a reliable pattern may be obtained.
OTHER FACTORS
Underperformance after a taper is probably most significant so performance should
be monitored carefully. Serial measurements of blood concentrations of haemoglo-
bin and creatine kinase are unlikely to help (Urhausen & Kindermann 2002). In some
athletes immune parameters may change with low serum glutamine concentrations
(Castell 2003), and changes in salivary IgA and serum cortisol concentration.
Nevertheless, there is still no reliable objective test to predict which athletes are
going to break down after a period of hard training
Prevention requires good diet, full hydration and rest between training sessions.
Coaches and athletes must realize that sports people with full-time jobs and other
commitments will not recover as quickly as those who can relax after training. Correct
periodization of training should ensure recovery.
MANAGEMENT
Following the diagnosis of UUPS the whole support team must work with the coach
and athlete to agree a recovery programme. The most important task is to persuade
both coach and athlete of the diagnosis and that prolonged recovery is needed.
Athletes will benefit from a multidisciplinary approach and should seek the support
of a performance nutritionist and sports psychologist where available. Physiologists
can also help by confirming underperformance, monitoring recovery and helping to
set training levels. During this time, rest and regeneration strategies are essential to
recovery.
THERAPEUTIC EXERCISE
There is evidence that a very low level of exercise will help athletes with UUPS to
recover (Fulcher & White 1997). Athletes with UUPS show improvement in both
performance and mood state with 5 weeks of relative rest (Koutedakis et al 1995).
Athletes are advised to exercise aerobically at a level well below lactate threshold
(see Ch. 4) for a few minutes each day and slowly build this up over many weeks.
The starting level and speed of increase in training volume will depend on the clin-
ical picture and rate of improvement. Recovery generally takes 6–12 weeks (Budgett
1998). Unless held strictly to a recovery programme, many athletes make the mistake
of trying to recommence a normal training session when feeling a little better, suf-
fering from severe fatigue for several days before partially recovering and repeat-
ing the same pattern. Cross-training may be the only way to avoid the tendency
to increase the intensity too fast.
Once athletes can tolerate 20 minutes of light exercise each day then it is useful
to introduce short sprints of less than 10 seconds with at least 3 minutes recovery
between each sprint (Summary box 9.5).
There is a close link between UUPS and depression (Armstrong & van Heest 2002,
Uusitalo et al 2004). If an athlete is severely depressed there is evidence that a graded
exercise programme will be less effective unless the depression is treated (Wearden
et al 1998). Psychological intervention and antidepressants can be used.
Athletes are often surprised at the performance they can produce after 12 weeks
of extremely light exercise. It is then that care must be taken to avoid increasing
training too fast. On return to normal training, it is helpful to consider alternate
hard and light training days. As they return to full training athletes are advised to
train hard but make sure that they rest and recover completely at least once a week
to optimize training adaptation (Budgett 1998).
CONCLUSIONS
Unexplained underperformance syndrome is common in elite endurance athletes
and is difficult to prevent and reliably identify. Once a definitive diagnosis is made
and other medical causes have been excluded then a graded exercise programme
over many weeks normally leads to full recovery. This will be most effective with
the support of a multidisciplinary team and if there is full co-operation of the coach
and athlete with the programme and regeneration strategies.
KEY POINTS
1. A reduction in performance for >2 weeks despite adequate recovery has been
termed unexplained underperformance syndrome (UUPS).
2. Up to 10% of elite endurance athletes per year may suffer from UUPS.
3. UUPS symptoms include: fatigue, heavy muscles, depression, frequent minor
infections, lightheadiness (postural hypotension), raised resting pulse rate, loss of
Summary box 9.5
Typical rehabilitation programme for an athlete suffering from UPS.

Week 1: 20 minutes light exercise at 120 pulse rate per day
7 × 10 seconds sprints or weights 3 times per week
Week 2: 30 minutes light exercise including 10 × 10 seconds sprint
Week 6: 60 minutes light exercise including 2 × 2 minutes normal intensity
Weeks 6–10: Build-up normal intensity within 60 minutes to full 60 minutes
at normal intensity
Weeks 10–12: Add second session. Increase to normal training
motivation, increased emotional lability, anxiety, irritability, loss of appetite, and

sleep disturbance.
4. Distinguishing UUPS from normal training fatigue (over reaching) is difficult and
can only be achieved once an athlete has failed to recover.
5. No diagnostic tests currently exist for UUPS and the diagnosis is often made on
the history and objective underperformance alone.
6. Following the diagnosis of UUPS the whole support team must work with the
coach and athlete to agree a recovery programme.
ASTHMA AND EXERCISE-INDUCED ASTHMA
1. Recognizes what asthma is and how it is caused.
2. Is able to recall the prevalence of asthma in sporting and non-sporting populations.
3. Appreciates the mechanisms that underlie the triggering of exercise-induced
asthma and the potential long-term implications of airway drying.
4. Appreciates the time course of the airway response to exercise in susceptible indi-
viduals.
5. Appreciates the mechanisms by which asthma may limit exercise performance.
6. Recognizes the cardinal signs and symptoms of exercise-induced asthma, as well
as the methods used for diagnosis.
7. Comprehends the ways in which exercise-induced asthma can be managed.
WHAT IS ASTHMA?
Asthma is the most common chronic condition affecting the sporting population.
Asthma is defined as ‘a chronic inflammatory disorder of the airways’ (Global
Initative for Asthma 1995), the cardinal symptoms of which are wheezing, breath-
lessness, chest tightness and cough. These symptoms are the result of airway
inflammation and narrowing in response to an inflammatory trigger. Acute air-
way narrowing occurs via a complex cascade of events that start with the release
of inflammatory mediators and culminate in the contraction of smooth muscle
around the airways. The resulting airway narrowing is called bronchoconstriction.
Details of this cascade are beyond the scope of this chapter, and the reader is
referred to Rundell & Jenkinson (2002) for further information. In addition to the
airway narrowing induced by smooth muscle contraction, narrowing can become
a chronic event due to the inflammation-induced swelling and incursion of the
airway lining into the lumen of the airway, as well as the build-up of mucus.
These events reduce the internal diameter of the airways, inducing the symptoms
described above.
The trigger factors that induce bronchoconstriction vary enormously between indi-
viduals, but common triggers include animal dander, house dust mite, pollen, ciga-
rette smoke and air pollution. In addition, colds, influenza and other viral infections
can trigger bronchoconstriction. Less common triggers are moulds and fungi, and cer-
tain foods, for example, dairy products, fish, shellfish, yeast products, nuts, and some
food colourings and preservatives. A small proportion of asthmatics also respond
adversely to some common drugs such as aspirin, ibuprofen and paracetamol. This
is particularly relevant to people with asthma who are regular exercisers, as these
medications are often used to treat musculoskeletal injuries or strains.
Perhaps the most common trigger of bronchoconstriction is exercise. In about 90%
of people with allergic asthma, and some people without allergic asthma, exercise
is a potent bronchoconstrictor (Lacroix 1999). The severity of exercise-induced asthma
(EIA) varies between individuals and peaks at about 10 minutes after stopping exer-
cise (Beck et al 1999). The bronchoconstriction is accompanied by cough, airway
inflammation and mucus production. Because airway responsiveness to exercise may
occur in people who do not have allergic asthma, the term exercise-induced bron-
choconstriction (EIB) has been suggested as a more precise definition of the condi-
tion (Anderson & Henricksen 1999).
PREVALENCE IN THE SPORTING POPULATION

The prevalence of asthma in the general population varies between nations, being
highest in the developed, Western countries such as the UK, where 8% of the adult
population and 12–15% of children are diagnosed with asthma (National Asthma
Campaign 2001). New Zealand has the highest rates of asthma internationally, with
15% of adults affected (ISAAC 1998). Rundell & Jenkinson (2002) suggest that the
prevalence of EIA in elite athletes is between 10 and 50%, depending upon the sport
in question. Winter sports athletes are reported to have the highest prevalence rates,
especially those engaged in endurance events. For example, Wilbur et al (2000)
reported the prevalence of asthma in cross-country skiers to be 50% and 21% in fig-
ure skaters. Other endurance-based events with high prevalence rates include cycling
and triathlon (Helenius & Haahtela 2000). In addition, certain indoor environments
are also associated with high prevalence rates for asthma, for example, swimming
(Helenius & Haahtela 2000).
Data obtained as part of routine screening of Team GB athletes prior to the Athens
Olympics confirms the relatively high prevalence of asthma/EIA/EIB in high-
performance athletes (Dickinson et al 2005). The recorded prevalence for Team GB
across all sports was 21%, which is more than double the prevalence rate in the
UK’s general population (see below). These data were the first to systematically
assess prevalence across sports using rigorous, quantitative International Olympic
Committee (IOC) criteria (see Diagnosis below). The two sports with the highest
prevalence rates were swimming and cycling (both over 40%).
Generally, the consensus is that the prevalence of asthma is higher in the sport-
ing population than it is in the general population (Nystad et al 2000). Recent insight
into the aetiology of EIA and EIB have helped to shed light on the reasons for the
variations in prevalence rates between sports, and between sports people and the
sedentary population (see The pathophysiology of EIA and EIB, below). The higher
than expected prevalence rates in some sports demands further research in order
that the respiratory health of sports people can be protected.
THE PATHOPHYSIOLOGY OF EIA AND EIB

Many people with asthma find the severity of EIA is greater in cold weather.
However, this effect is not thought to be due to cold per se, but rather to the fact
that cold air is dryer than warm air (Hahn et al 1984). Data from Anderson et al
(1982) have demonstrated a dose–response relationship between water loss from the
airways and the severity of EIB, suggesting that dry air, whether warm or cold, is
a more potent stimulus to EIB than humid air. More recent research has confirmed
that the severity of EIA is proportional to the water content of the inspired air
(Eschenbacher et al 1992). Furthermore, bronchoconstriction is attenuated, or even
abolished, if the inspirate is hot and humid (Anderson et al 1979).
Thus, the current consensus regarding the aetiology of EIA centres around one
major trigger, airway drying (Rundell & Jenkinson 2002). The high ventilatory flow
rates associated with exercise are thought to induce a cascade of responses that begin
with water loss from the airway surface liquid, and a consequential change in the
osmotic potential of the airway lining cells. When exercise stops, the rate of water
loss from the airway returns to normal, and there is a restoration of normal osmo-
larity within the airway lining cells. However, this re-equilibration is accompanied
by the release of inflammatory mediators from the affected cells, which trigger
constriction of airway smooth muscle, causing bronchoconstriction.
The greater prevalence rates of EIA in cold weather sports are thought to be due
to the chronic influence of airway drying and resulting inflammation, which induce
airway remodelling (Karjalainen et al 2000). This remodelling leads to a condition
known as airway hyper-reactivity or hyper-responsiveness, such that the athlete may
become sensitized to the effects of airway drying. Under these conditions, the ath-
lete has EIB, rather than EIA. Other environmental stimuli may also exacerbate EIA,
as well as being responsible for the development of hyper-reactivity, e.g. vehicle
exhaust gases, chlorine (swimming pools), and ice-resurfacing machine pollutants
(Rundell 2004).
A recent 10-year follow-up study of three cross-country skiers suggests that their
participation in their sport had led to permanent, detrimental remodelling of their
respiratory systems (Verges et al 2004). These changes were associated with an
obstructive pattern of lung disease and associated flow limitation. Further sys-
tematic research is needed before clear linkages can be identified, but the fact that
repeated episodes of airway drying may lead to airway remodelling and the devel-
opment of EIB is of growing concern. If a causal relationship is established, future
research must seek to identify methods of minimizing the potentially damaging
effects of airway drying and air pollution upon the respiratory health of sports
people.
THE TIME COURSE OF EIA AND EIB

The zenith of the EIA and EIB response generally occurs within 10–15 minutes of
the cessation of exercise (Beck et al 1999). Previously, the literature has contained
contradictory evidence regarding the occurrence of bronchoconstriction during exer-
cise. However, it is now generally accepted that the bronchoconstrictor response does
not occur until after the cessation of exercise (Beck et al 1999). These observations
are consistent with a mechanism for EIA and EIB based upon airway water loss dur-
ing exercise, followed by a recovery of osmolarity and the induction of inflamma-
tory mediators post-exercise.
The fact that broncoconstriction does not occur during continuous exercise, but
does occur during intermittent exercise has implications for athlete management.
For endurance athletes, symptoms are unlikely to occur until they cease training or
competition. During training, however, endurance athletes may experience symp-
toms during interval training. In contrast, athletes from repeated sprint sports are
likely to experience symptoms during training and competition. Surprisingly, it is
not uncommon for sprint and power athletes with EIA/EIB to remain undiagnosed.
This is most likely because they perceive the symptoms of breathlessness that they
experience between bouts of intense exercise to be a normal part of exercise, and

therefore do not report them.
DO EIA AND EIB LIMIT EXERCISE PERFORMANCE?

The human lung is traditionally thought to be overbuilt relative to the rest of the
oxygen transport system (Dempsey & Babcock 1995). However, it has been known
for some time that there are some highly trained endurance athletes for whom this
is not true (Dempsey & Babcock 1995); these athletes exhibit arterial hypoxaemia
during heavy exercise, indicating a diffusion limitation to oxygen transport. Two of
the underlying mechanisms proposed to explain exercised-induced arterial hypox-
aemia (EIAH) may also have relevance to athletes with EIA and EIB. First, there is
evidence linking EIAH to hypoventilation due to a mechanical ventilatory limita-
tion (Johnson et al 1992), and second to a diffusion limitation due to interstitial pul-
monary oedema (Hopkins et al 1998). The inflammation and increased airways
resistance that accompany asthma, EIA and EIB induce both a mechanical ventila-
tory limitation and an increase in the diffusion distance. Thus, in theory at least, it
is conceivable that asthma, EIA and EIB may limit exercise performance.
The impairment of expiratory flow generating capacity that accompanies asthma
(see Fig. 9.4) may not only induce hypoventilation (and EIAH), it also generates a
condition known as ‘dynamic hyperinflation’. This forces breathing into the inspiratory
12 Exercise (normal)
Rest
10
Exercise (hyperinflation)
8
Maximal flow-volume loop
6
Predicted normal flow-volume
4
2
Flow (L.sec−1)
0 Volume (L)
2 4 6
−2
−4
−6
−8
Figure 9.4 Dynamic hyperinflation: comparison of the response of the exercise tidal flow
volume in a person with asthma (solid red lines), compared with that predicted for someone
with normal lungs (grey lines). Note that in the presence of expiratory flow limitation the
person with asthma must encroach upon their inspiratory capacity in order to increase
minute ventilation (flow volume loop shifts to the left). The person with normal lungs is
able to increase minute ventilation by utilizing both their inspiratory and expiratory reserve
volumes.
reserve volume, towards total lung capacity (a shift to the left of the flow–volume
envelope). This is a region where the work of breathing is raised by an increased
elastic load, which increases the requirement for inspiratory muscle work. The main
symptom of hyperinflation and increased inspiratory muscle work is a heightened
sensation of respiratory effort, or breathlessness (Lougheed et al 1993). It is the inten-
sification of respiratory effort sensation that limits the degree to which dynamic
hyperinflation develops, i.e. hyperinflation is limited by effort sensation. Because
breathlessness contributes significantly to total body effort sensation, the consequence
of dynamic hyperinflation is an increased overall sense of effort during exercise.
Most athletes rely upon effort sensation as a means of pacing; the consequences of
dynamic hyperinflation and increased airways resistance for an athlete’s ability to
achieve and maintain a given pace are therefore self-evident. It is also possible that
the increased inspiratory muscle work may exacerbate inspiratory muscle fatigue,
which would intensify respiratory effort sensation further. It is currently unknown
whether respiratory effort sensation and/or inspiratory muscle fatigue are greater
in athletes with EIA or EIB.
As well as performance impairment due to mechanical changes, it is also rea-
sonable to suggest that inflammation within the respiratory endothelium may impair
gas exchange by increasing the diffusion distance (as occurs in interstitial pulmonary
oedema) thereby inducing a potential diffusion limitation. However, confirmation
that either ventilatory flow limitation or diffusion limitation impair performance in
athletes with EIA/EIB awaits experimental verification.
DIAGNOSIS
Until relatively recently, the diagnosis of asthma for the purposes of using asthma
medications during competition was made almost exclusively on the basis of symp-
toms. However, this has been shown to be very unreliable. For example, Rundell
et al (2001) demonstrated that the proportion of their athlete sample reporting two
or more symptoms was the same for athletes with a spirometrically-confirmed diag-
nosis of EIA as it was for those who were EIA-negative (39% versus 41%). This sug-
gests that diagnosis on the basis of symptoms is no better than flipping a coin. These
observations are supported to some extent by those of Dickinson et al (2005) who
screened 84 members of Team GB prior to participation in the Athens Olympics.
Sixty-two of these had a previous diagnosis of asthma (either by questionnaire or
spirometry), while a further 15 athletes reported symptoms, but had no formal diag-
nosis. Thirteen (21.0%) of the 62 athletes with a previous diagnosis of asthma tested
negative using International Olympic Committee criteria (IOC; see below). Seven of
the 15 athletes with no previous diagnosis of asthma tested positive. Though not
quite as bad as flipping a coin, these data support the notion that accurate diagno-
sis requires more than just a symptom-based approach.
The cardinal sign of asthma is ‘reversible airways obstruction’. Diagnosis of air-
ways obstruction is most commonly made using electronic spirometry (see Fig. 9.5).
By plotting flow against volume during a maximal expiratory and inspiratory manoeu-
vre, a flow–volume loop is constructed. Abnormalities are confined primarily to the
expiratory loop, and Figure 9.6 illustrates the typical findings in an athlete with EIA
or EIB. At baseline, lung function typically appears normal (black line), or even supe-
rior to normal (as denoted by the measured loop being outside the loop predicted for
the athlete’s age and body size). However, following exercise, abnormalities of the
expiratory loop become apparent, with evidence of a characteristic concavity to the
expiratory flow profile (red line). The single diagnostic index that is derived from
Figure 9.5 An electronic spirometer.
these measurements is most commonly the forced expiratory volume in 1 second

(FEV1). This is the volume of air that is exhaled during the first second of a force expi-
ratory manoeuvre, and it is normalized to the individual’s forced vital capacity (FVC).
‘Normality’ of FEV1 is represented by an FEV1/FVC ratio of >80%.
The International Olympic Committee (IOC) guidelines for the diagnosis of EIA
require the use of ‘spirometric’ methods, i.e. the production of a flow–volume loop
using an electronic spirometer (see Fig. 9.6). The IOC rules make provision for two
methods of diagnosis: (1) response to inhaled bronchodilator medication (β2-agonists),
and (2) response to a bronchoprovocation challenge.
The criteria for a positive response differ depending upon which test is under-
taken. For test 1, the IOC accepts a 15% increase in the FEV1 within 10 minutes
of taking a bronchodilator as a positive test for the presence of asthma. However,
athletes may have very little ongoing airway inflammation, and conse-
quently, no ongoing bronchoconstriction, particularly if they have EIB (airway
Baseline
12
Post exercise
10
Predicted normal flow-volume
8
2
Flow (L.sec−1)
0 Volume (L)
2 4 6
−2
−4
−6
−8
Figure 9.6 EIA-positive provocation challenge: Typical flow–volume loops generated before
and after a bronchoprovocation challenge. The grey line represents the predicted normal
flow–volume loop (based upon the subject’s age, weight and height); the black line is the
baseline loop; the red line is the post-challenge loop showing characteristic changes (lower
peak expiratory flow rate, concave expiratory flow profile, reduced vital capacity due to
airway closure).
hyper-responsiveness) and not EIA. Thus, the IOC also accepts the results of ‘bron-
choprovocation’ challenges.
Bronchoprovocation challenges are of three main types, the simplest of which is a
straightforward exercise test. In order to provoke a response in a susceptible individ-
ual, the exercise must be high intensity (>85% maximum heart rate) and last for at
least 6 minutes; this ensures that the ventilatory requirement is sufficient to provoke
airway drying. The main problem with an exercise challenge is that it is difficult to
control environmental variables and the environmental conditions may not favour a
positive response, e.g. it may be a warm humid day. The second type of test is a some-
what artificial, but very standardized method of inducing airway drying. This test is
known as ‘eucapnic voluntary hyperpnoea’ (EVH), and requires the athlete to hyper-
ventilate for 6 minutes into an apparatus that supplies dry air. This challenge has been
shown to have high specificity and sensitivity for EIA and EIB (Rundell et al 2004).
The third challenge involves the inhalation of a substance that triggers an inflamma-
tory response in the airways of susceptible individuals (e.g. saline, mannitol, metha-
choline or histamine). The IOC regulations for diagnosis on the basis of an inhalation
challenges are complex, involving reference to the dose–response of the athlete. For
this reason these challenges are not the preferred method of diagnosis, although the
use of a mannitol challenge may become so. The specificity and sensitivity of man-
nitol has recently been shown to be at least as good as EVH (Holzer et al 2003).
In the case of exercise and EVH, the IOC requires a fall of 10% in FEV1 within
30 minutes of the provocation challenge, for a positive demonstration of EIA. In all
of these tests, the athlete must have ceased taking any prescribed medication as
follows:
● short-acting β2-agonists 12 hours prior;
● long-acting β2-agonists 48 hours prior;
● corticosteriods (anti-inflammatory) 72 hours prior.
Because athletes must be removed from their medication, EIA provocation chal-
lenges should only be conducted by appropriately qualified individuals, and under
conditions where medical support is available.
MANAGEMENT
The management of EIA is dependent upon whether an athlete is in competition,
and therefore bound by the doping regulations of their governing body. If in doubt,
athletes should refer to the rules of their governing body for up-to-date guidance
on permissible pharmacological management of EIA.
The goal of any management strategy is to minimize symptoms, reduce the risk
of exacerbations, and to optimize the athlete’s ability to compete to the limits of
their potential. The ‘traditional’ method of managing asthma is under the supervi-
sion of a GP or chest physician using medication (pharmacological management).
For athletes who are in competition, however, this requires a thorough understand-
ing of the doping regulations for their sport, and it is inadvisable to take any pre-
scribed medication without first referring to the most recent version of the doping
regulations for the sport in question.
Assuming that the regulations governing the use of asthma medications have
been met, the following pharmacological treatment options are available:
PHARMACOLOGICAL MANAGEMENT
Pharmacological management of EIA must be undertaken under the supervision of
a physician. There are large inter-individual variations in EIA, which necessitate a
highly individualistic approach to its management (Rundell & Jenkinson 2002). The
most commonly used pharmacological agents are:
Bronchodilators (b2-agonists)
Frequently known as ‘reliever’ medication, β2-agonists relax the muscles around
the airways, dilating them and reducing their resistance to airflow. Short-acting
β2-agonists can be used up to four times daily, and are most effective when taken
prophylactically immediately prior to exercise, or in response to the development
of acute EIA. If EIA is mild and infrequent, this may be the only pharmacological
treatment required. However, if it is not, then it may be necessary to supplement
with inhaled corticosteroids.
Corticosteroids
Known as ‘preventer’ medication, corticosteroids suppress the chronic inflammation
that is associated with asthma, or frequent bouts of EIA. Reducing inflammation
will improve pre-exercise lung function, as well as reducing the sensitivity of the
airways to EIA. For athletes with mild EIA, a once-daily dose of inhaled cortico-
steroid may be the only medication required to manage EIA effectively.
Increasingly, pharmaceutical companies are providing so-called ‘combination’

therapies that combine a β2-agonists and a corticosteroid in a single inhaler.
NON-PHARMACOLOGICAL MANAGEMENT
Both athletes and the general public are increasingly turning to non-pharmacologi-
cal methods of managing chronic conditions such as asthma. Furthermore, there may
be a small number of athletes who have noticeable symptoms but whose airway
responsiveness to provocation falls short of the minimum criteria required for use
of β2-agonists during competition. Accordingly, it is relevant to consider the range
of non-pharmacological methods that exist to manage EIA and EIB.
Warm-up
About half of the people with asthma experience what is known as a ‘refractory
period’ following a 10- to 15-minute bout of moderate intensity exercise (50–60%
maximum heart rate), or ‘warm up’. For up to 2 hours after the ‘warm up’, asth-
matics can exercise (even intensely) and not experience EIA (McKenzie et al 1994).
The precise mechanisms for refractoriness remain unknown, but it can be used to
good effect in those who show refractoriness.
Dietary modification
The relationship between diet and the severity of EIA has only recently been the
subject of systematic research, but the results to date appear promising.
One of the earliest dietary components to be linked to exacerbation of asthma
was dietary salt. A high-sodium diet has been found to worsen post-exercise falls
in FEV1 (Gotshall et al 2000). In contrast, recent evidence suggests that restricting
salt intake reduces (by about two-thirds) the severity of the post-exercise decline in
lung function in people with asthma, after as little as 1 week of restriction (Gotshall
et al 2003). The effective range of sodium intake for EIA attenuation is 1000–1800
mg.day–1. This is considerably lower than the recommended daily allowance for
reducing hypertension (2400 mg.day–1), but it is nonetheless, readily achievable.
Consumption of fish oils also appears to alleviate EIA. Fish oils are rich sources of
omega-3 poly-unsaturated fatty acids (PUFAs), which have been implicated in the
reduction of inflammatory responses. The link between fish oils and asthma was made
by the observation that the prevalence of asthma is very low in Eskimo populations
who have high intakes of fish oils (Mickleborough & Gotshall 2003). A recent study
has demonstrated a positive effect of 3 weeks of supplementation with fish oils cap-
sules on the severity of EIA in elite athletes. The double-blind, randomized, cross-over
design compared a normal diet with a placebo diet and a fish-oil-supplemented diet.
The fish oil supplementation reduced the post-exercise fall in FEV1 from 17% on the
normal diet to just 3% on the supplemented diet (Mickleborough et al 2003).
Asthma is an inflammatory disease, and inflammatory cells produce oxidants;
thus, the role of antioxidants in EIA has been investigated. The principle antioxi-
dant vitamins studied are C and E, and recent studies have demonstrated benefi-
cial effects of both upon asthma. Preliminary data from Murphy et al (2003) suggest
that a 3-week supplementation with a combination of vitamin C (500 mg/day) and
vitamin E (33 IU/day) reduced the post-exercise fall in FEV1 by 10%. An earlier
study examined the effect of vitamin C alone, and with a much shorter supple-
mentation period; just 90 minutes. Schachter & Schlesinger (1982) showed a halving
of the post-exercise fall in FEV1 from 20% to 10% after the acute supplementation
with 500 mg of vitamin C; they saw no effect of a placebo in the same subjects.
Inspiratory muscle training (IMT)

The principal symptom of bronchoconstriction is an increased sense of respiratory
effort, or breathlessness. There is a strong relationship between the strength of the
inspiratory muscles and the sense of respiratory effort (see McConnell & Romer 2004a
for a review), and this has been demonstrated directly for people with asthma. Weiner
and colleagues (1992) have conducted a number of studies examining the influence
of specific inspiratory muscle resistance training upon symptoms, respiratory effort
and consumption of medication in asthmatics. They made some impressive obser-
vations, with subjects showing huge reductions in their consumption of both β2-ago-
nists, and their ratings of breathlessness (Weiner et al 1992, 2002). No studies have
yet examined the influence of IMT upon EIA per se, but it is very unlikely that IMT
has a direct effect upon the severity of bronchoconstriction. However, it appears that
IMT ameliorates the principal symptoms of bronchoconstriction (breathlessness), as
well as providing an ergogenic effect (see McConnell & Romer 2004b for a review).
The mainstay of asthma management continues to be pharmacological. However,
for those athletes who have mild symptoms, or for those wishing to optimize man-
agement using all means available, the approaches described above offer evidence-
based alternatives or additions to traditional pharmacological management.
SUMMARY
Unfortunately, asthma, EIA and EIB continue to increase in prevalence in both the ath-
letic and general populations. A major cause for concern is the higher prevalence rate
for EIA in elite athletes, especially when evidence begins to point to a causal rela-
tionship between participation in some sports, and the development of EIA/EIB.
Careful diagnosis and management are essential for optimal care of the athlete, as well
as to ensure that she/he achieves their full performance potential. Future research must
clarify the relationship between sports participation and the development of EIA/EIB,
as well as identifying methods of protecting the respiratory health of athletes.
KEY POINTS
1. Asthma and EIA are inflammatory disorders of the lung airways.
2. EIA occurs in approximately 90% of people with allergic asthma.
3. Asthma, EIA and EIB are more prevalent in the sporting population than in the
general population (e.g. UK prevalence data = 21% versus 8%, respectively).
4. EIA occurs through mechanism(s) linked to airway drying during exercise.
5. EIA is more prevalent in endurance- and cold-weather athletes.
6. EIA develops only after exercise has ceased, reaching a maximum about 10 min-
utes after exercise has ceased.
7. It is possible that EIA and EIB may limit exercise performance, but this awaits
experimental verification.
8. The diagnosis of EIA can be made accurately only by using spirometry in con-
junction with standardized bronchoprovocation challenges.
9. The mainstay of asthma management is pharmacological, but a number of evi-
dence-based non-pharmacological approaches do exist.
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Further reading
Reproductive health in exercising women

Harries M, Williams C, Stanish W, Micheli L (eds) 2000 Oxford textbook of sports
medicine. Oxford University Press, Oxford
Landry G, Bernhardt D (eds) 2005 Essentials of primary care sports medicine. Human
Whyte G, Harries M, Williams C (eds) 2005 The ABC of sports medicine, 3rd edn. BMJ
Books, London
The athlete’s heart

Harries M, Williams C, Stanish C (eds) 2000 Oxford textbook of sports medicine.
Oxford University Press, Oxford
Books, London
The unexplained underperformance syndrome (UUPS)

Harries M, Williams C, Stanish C (eds) 2000 Oxford textbook of sports medicine.
Oxford University Press, Oxford
Books, London
Asthma and exercise-induced asthma

Cotes JE 1993 Lung function, 5th edn. Blackwell, London
Rundell KW, Wilder RL, Lemanske RF (eds) 2002 Exercise-induced asthma. Human
West JB 2001 Pulmonary physiology and pathophysiology. Lippincott, Williams &
Wilkins, London
229
Glossary
Acclimatization: The adaptation of associated with the finite capacity for

physiological systems and processes to anaerobic energy production. The term
environmental stressors leading to an ‘anaerobic endurance’ is synonymous
enhanced functional capacity in that with ‘anaerobic capacity’
environment. Anaerobic glycolysis: An anaerobic
Asthma: A chronic inflammatory process comprising 10 enzymatically
disorder of the airways. Symptoms controlled chemical reactions that
include: wheezing, breathlessness, catabolize muscle glycogen or glucose
chest tightness and cough. These to provide energy for ATP resynthesis.
symptoms are the result of airway Anaerobic endurance training: The
inflammation and narrowing aim of anaerobic endurance training is
(bronchoconstriction) in response to maximally stress anaerobic energy
to an inflammatory trigger. systems (ATP-CP, anaerobic glycolysis).
Adenosine triphosphate (ATP): The As a consequence of the intensity of
hydrolysis of ATP (catalysed by the training and the resultant fatigue,
enzyme ATPase) is the primary source exercise bouts will be of short-duration
of energy. The store of ATP in skeletal (<3 min), therefore training is
muscle is very small (5 mmol.kg−1 of normally divided into repeated bouts
muscle). or intervals of short duration with
Athlete’s Heart (AH): The adaptation variable work: rest ratios.
of the heart to physical training Anaerobic endurance training (short-
characterized by resting bradycardia, duration): The repetition of short-
cardiac remodelling, ECG changes duration maximal intensity exercise
and additional heart sounds. bouts (≤ 15 seconds) with a work : rest
ATP/CP system: The system used to ratio in the region of 1: 10. This type
produce energy from the hydrolysis of of training increases the capacity of
endogenous intra-muscular stores of the ATP-CP energy pathway and
the high energy phosphates ATP and enhances muscular power.
CP. The ATP-CP system is the Anaerobic endurance training (long-
dominant energy pathway in duration): The repetition of maximal
short-duration, high-intensity sports intensity exercise of 1–3 minutes
of less than 10 seconds duration with a work:rest ratio in the
Anaerobic capacity: It is this capacity region of 1 : 4. This type of training
that determines an athlete’s ability to places significant demands on the
sustain high-intensity exercise anaerobic glycolysis energy system.
Anaerobic endurance training (Lactate Flexibility: The ability to move a joint

Tolerance Training): The repetition of smoothly through its entire range of
short-duration (20–120 sec) maximal motion.
intensity exercise bouts interspersed Form: The practice of implementing
with short duration rest periods with a recommended movement patterns,
work : rest ratios of 1: 1. maintenance of postural control, use of
Circuit training: A training session full range of motion and regulation of
composed of a number of specific breathing.
exercises targeted at specific muscle Fractional utilization: The % of
groups (and often skills) involved in •
VO2max that can be sustained whilst
the target activity. exercising at race pace, and is
Creatine phosphate (CP): The dependent upon both the training
hydrolysis of CP (catalysed by the status and exercise duration.
enzyme creatine kinase, CK) provides Glycogen supercompensation: The use
an immediate supply of energy for the of carbohydrate loading regimes
rapid resynthesis of ATP. resulting in supra-normal amounts of
Intramuscular stores of CP are muscle glycogen storage.
approximately 15 mmol.kg−1 of muscle
Hypertrophy: An increase in muscle
Cross-training: Defined in a number fibre cross-sectional area associated
of ways: (1) the simultaneous training with an addition of contractile proteins
for 2 or more events (i.e. triathlon); (2) (actin and myosin) to the periphery of
the cross-transfer of training effects the myofibril. In this process, a larger
from one sport to another; (3) the myofibril is formed since packing
conveyance of training effects from density and cross bridge spacing is left
one limb to the contralateral or unchanged
ipsilateral limb.
Interval training: The repetition of
Endurance performance: For the exercise bouts with defined periods of
purpose of this text endurance recovery to develop aerobic endurance
performance is defined as continuous capacity. The repetition of intervals
activity beyond 5 minutes, but less allows the athlete to undertake a
than 4 hours in duration. Whilst this greater volume of training at the
represents a wide spectrum of sporting appropriate intensity in a single
endeavors the predominant source of training session.
ATP is via aerobic processes.
Interval training – High Intensity
Exercise economy: The oxygen uptake Interval Training (HIT): Short duration
required to produce a specific power (30 seconds to 5 minutes) repetitions
output or speed. performed at an intensity above an
•
Exercise induced asthma: Where athlete’s VO2max, with rest intervals
exercise is the inflammatory trigger typically lasting 15–120 seconds.
responsible for an asthma response Jet lag: A lack of synchrony between
(see above). In around 90% of people the body clock and the outside world.
with allergic asthma, and some people Symptoms include: general feeling of
without allergic asthma, exercise is a fatigue, loss of concentration, loss of
potent bronchoconstrictor. appetite, headache, dizziness, nausea
Fatigue: A term often used to describe and constipation. A decline in
the general feeling of tiredness. In performance of activities involving
relation to sports performance, it is the complex mental activity, reduced hand
decline in muscular power output and grip and leg strength, reduced
thus performance. maximum performance, and a general
Glossary 231
loss of motivation is often observed in expressed in millilitres of oxygen per

athletes suffering from jet lag. kilogram of body weight per unit of
Lactic acid: Considered the primary time (i.e. ml.kg−1.min−1).
cause of muscular fatigue during high- Menstrual cycle: The cycle of the
intensity exercise, lactic acid rapidly female reproductive system regulated
dissociates to lactate and hydrogen by periodic changes in the secretion of
ions (H+). It is the accumulation of follicular-stimulating hormone (FSH)
H+ that causes metabolic acidosis. and luteinizing hormone (LH). The
During high-intensity exercise when normal menstrual cycle (eumenorrhea)
H+ accumulates in the cytosol, lasts 28–35 days. There are a number
intracellular proteins provide buffering of disorders of the menstrual cycle
of some of the excess acidity; in including: dysmenorrhoea (painful
addition, hydrogen ions efflux from periods), menorrhagia (heavy
the cell are buffered by extracellular bleeding), amenorrhoea (loss of
bicarbonate. menses for a minimum of 6 months),
Lactate threshold: The velocity, power, oligomenorrhoea (cycles longer than
•
heart rate, or VO2max resulting in a the normal 28–35 days), polymenor-
sustained increase in blood lactate rhoea (unusually short cycle).
above baseline values. Muscle fibre types: Muscle fibres
Long Slow Distance training (LSD): differ according to their contractile
LSD training sessions are performed at and metabolic proportion, and can
very conservative intensities (<70% accordingly be broadly categorized
•
VO2max), for prolonged periods that into three types; fast contracting fibres
greatly exceed the duration of exercise with a predominantly glycolytic
performed during competition. metabolism (type IIb fibres); fast
contracting fibres with a more
Maximal Accumulated Oxygen
oxidative metabolism (type IIa fibres)
Deficit (MAOD): A method for
and slow contracting, oxidative fibres
estimating the anaerobic energy
(type I fibres). A fourth type (type IIc
contribution during supramaximal
fibres) are thought to be fibres in
exercise. This procedure requires the
transition from type II to type I,
calculation of the individual’s
and are uncommon except in
submaximal oxygen consumption-
muscle undergoing intensive training,
power relationship, which can be
or in young developing muscle.
attained from an incremental
Most human muscles are made up
submaximal exercise test. This
of the two main fibre types, I
relationship is then applied to the
and IIb
power output achieved during an
exhaustive supramaximal exercise of Overload: An increase in training
2–3 minutes duration in which the volume above that normal imposed
anaerobic capacity is fully utilized. achieved by increasing the intensity
The difference between this estimated and/or duration of the training
oxygen cost and the total oxygen stimulus. The overload event acts as a
consumed is termed the MAOD. discrete stimulus for the biological
mechanisms of adaptation.
Maximal oxygen consumption
•
(VO2max): The highest rate at which Over-reaching: A reversible decrement
oxygen can be extracted, transported in performance associated with a
and consumed, in the process of period of high training volume.
aerobic ATP synthesis. Measured in Periodization: The purposeful
litres of oxygen consumption per variation of a training programme
minute (L.min−1) it is typically over time, so that the athlete attains
optimal adaptive potential just prior to voluntary muscular fatigue or failure

an important event. (repetition maximum).
Plyometrics: A specialist exercise Supercompensation cycle: The
aimed at improving power output association between training load and
arising from the stretch shortening regeneration characterized by four
cycle. distinct elements; exercise, fatigue,
Power (P): The rate of force recovery and adaptations
production calculated as work done Tapering: A specialized exercise
(force [f] × distance [d]) divided by training technique designed to reverse
velocity (v); [P = (f.d)/v]. training-induced fatigue without a loss
Repetition maximum (RM): The of the training adaptations, often
maximum number of repetitions termed as ‘peaking’.
per set that can be performed at a Threshold training: Typically lasting
given resistance with correct exercise 30–90 minutes at an intensity
technique and form. associated with lactate threshold (LT).
Resistance training: A physical Training principles: A number of
stimulus for the musculoskeletal basic principles which, when
system to respond by reordering the appropriately applied, result in
control and architecture of active optimal adaptation and performance,
tissues resulting in an advancement of they include: individuality,
maximal force expression. reversibility, progression, overload
Reversibility: A de-conditioning (progressive overload), periodization
process caused by the reduction or and specificity.
cessation of optimal training stimuli Travel fatigue: Characterized by a
often termed ‘detraining’. group of transient negative effects
Specificity: The use of training associated with prolonged periods of
stressors that optimally stress the time spent in transit, irrespective of
physiological systems associated time zone changes. Travel fatigue
with performance. Three components generally lasts 1–2 days.
of specificity exist: (1) skill Unexplained Under Performance
specificity, (ii) muscle group specificity, Syndrome (UUPS): A reduction in
and (iii) energy system performance for >2 weeks despite
specificity. adequate recovery. Other, common
Strength: The ability to produce force, terms employed to describe UUPS
generated isotonically, isometrically, or include: burnout, staleness, over-
isokinetically. Strength is often training syndrome, chronic fatigue
measured by a set of repetitions at a in athletes, sports fatigue syndrome
given load performed to momentary or under-recovery syndrome.
233
Index
Note: page numbers in italics refer to figures, tables and boxes
A Altitude, 178–186
acclimatization, 178–179, 180–182
Acceleration, 119 anaerobic endurance, 181–182
Acclimation to environmental heat, clothing, 186
173–174 cold injury, 186
Acclimatization, 229 dehydration, 186
altitude, 178–179, 180–182 oxygen-carrying capacity, 179–180
cold environments, 168–169 rapid ascent, 178
environmental heat, 173–174 solar radiation, 186
Acetazolamide, 185 training at, 178–179, 180, 181–182
Actin filaments, 119 Altitude illness syndromes, 184
muscle growth, 142 Amenorrhoea
Action velocity, 148 bone mineral density, 196
Acute mountain sickness (AMS), 184–185 exercise-induced, 193–195
Adaptation, strength training, 141–144 management, 197–199
Adenosine monophosphate kinase medical management, 198–199
(AMPK), 28 hypothalamic, 193, 194
Adenosine triphosphate see ATP iron intake, 198
β1-adrenergic blocking agents, 205–206 long-term, 197
Aerobic endurance, 15–16, 86, 111 Anaemia, 209
Aerobic fitness and anaerobic endurance, Anaerobic capacity, 86, 229
103–104 measurement, 87
Aerobic power, 25 Anaerobic endurance, 86
output with strength training, altitude, 181–182
122–123 assessment, 111
periodization, 20 ATP-creatine phosphate capacity, 109
Air, inspired high-intensity, 97
cold environment, 169–170 index, 112
hot environment, 214, 215 long-term, 99, 100
water content, 214–215 neural function, 96
Airway neuromuscular function, 95–96
drying, 215, 219 performance
hyper-reactivity, 215 limitations, 91–96
increased resistance, 217 relationship, 90
remodelling, 215 tests, 109–110
reversible obstruction, 217 physiological basis, 87
234 Index
Anaerobic endurance, 86 (Continued) Atrioventricular block, Mobitz type 1,

recovery, 98, 104 202, 205
repetitions, 98
resistance training, 100
short-term, 99 B
speed training, 102–103
types, 99–100 β2-agonists, 220, 221
Anaerobic endurance training, 229–230 Bangsbo test, 113
adaptation, 107, 108 Blood pressure, peripheral vasoconstric-
methods, 96–99 tion, 168
planning, 103–104 Blood volume, 68–70
schedules, 104, 105–106, 106–107 expansion, 69
sessions, 101–103 Body weight
Anaerobic energy yield, 111–112 increase in amenorrhoea, 198
Anaerobic glycolysis, 87, 88, 89–90, 95, unexplained underperformance syn-
229 drome, 208
capacity, 98 Bone
pathway, 87, 88, 89–90 growth, 5
Anaerobic power, 86 health, 197
Anaerobic threshold see lactate threshold mass in female athletes, 194
Analgesia, 193 strength training, 140
Anorexia nervosa, 195 Bone mineral density, 196–197, 198
Anti-arrhythmics, 205–206 Bradycardia, 69, 199, 202, 205
Antioxidants, 221–222 Breathlessness, 217
Appetite loss, 208 Brick training, 31
Arrhythmia, cardiac, 202, 204–205, 206 Bronchial hyper-responsiveness, 215
Arterial hypoxaemia, exercise-induced Bronchoconstriction, exercise-induced,
(EIAH), 216 214
Asthma, 213–222, 229 diagnosis, 217–220
cold air inhalation, 169–170 exercise performance, 216–217
dietary modification, 221–222 pathophysiology, 214–215
exercise-induced, 214, 230 time course, 215–216
diagnosis, 217–220 Bronchoconstriction triggers, 213–214
exercise performance, 216–217 Bronchodilators, 220, 221
management, 220–222 Bronchoprovocation challenges, 218–219,
pathophysiology, 214–215 220
time course, 215–216 Buffering
prevalence, 214 agents, 94
refractory period, 221 capacity, 109
Atopy, 209 HiHi training, 182
ATP, 229 hydrogen ion in muscle, 75
anaerobic endurance, 87 Buffers, exogenous, 109
resynthesis, 86 Bulimia, 195
anaerobic, 62 Burnout see unexplained underperfor-
optimization, 5 mance syndrome (UUPS)
rate, 99
ATPase enzymes, 144
ATP-creatine phosphate, 229 C
capacity, 109
depletion, 92 Caffeine, jet lag, 53–54
resynthesis, 92 Calcium intake, 198
ATP-creatine phosphate pathway, 87–88, Calcium ion displacement in metabolic
90 acidosis, 94
short-duration, high-intensity training, Canoeing, anaerobic endurance training
90 sessions, 102
Index 235
Capillary density, endurance training, water immersion, 166, 167–168

69–70 Cold air inhalation, 169–170
Carbohydrate Cold injury, 169–170
ingestion in cold environment, 168 altitude, 186
loading, 55–57 extremities, 167
Cardiac output, 69, 168 frostbite, 165, 169
hypohydration, 172 non-freezing, 169
Cardiomyopathy, 202 protection, 170
sudden cardiac death, 202–203 susceptibility, 168
Cardiopulmonary endurance, 30 Cold shock response, 168–169
Cardiopulmonary resuscitation, 207 Cold weather sports, 164
Cardiorespiratory adaptations, tapering, exercise-induced asthma, 215
47–48 Commotio cordis, 204
Cardiorespiratory response to cold water Competition
immersion, 166 calendar, 19
Cardiothoracic ratio, 200 simulation, 2
Cardiovascular capacity, dehydration, 173 Construct validity testing, 40
Cardiovascular drift, 172 Conversion phase, 19
Cardiovascular response to training, 200 Cooling, body, 167
Cardiovascular screening, 203–204 Coronary arteries, anomalous, 203
Central governor hypothesis, 183 Coronary atheroma, 203
Central nervous system (CNS) Corticosteroids, 220
fatigue, 96 inhaled, 220–221
in heat, 173 Cortisol
muscle recruitment regulation, 183 altitude training, 186
Cerebral oedema, high-altitude, 184, female athletes, 194
185–186 recovery process, 7
Chest impact, blunt, 204 Court games, anaerobic endurance
Children training sessions, 102
anaerobic endurance, 90 Creatine phosphate, 230
cold environments, 170 anaerobic endurance training, 109
Chronic fatigue see unexplained under- depletion, 88–89, 92
performance syndrome (UUPS) intramuscular storage capacity, 99
Circadian rhythms, jet lag, 53 pathway, 87–89
Circuit training, 33, 230 resynthesis, 91, 92–93, 95
rest periods, 154–155 rate, 100
Citric acid cycle see Krebs’ cycle supplementation, 92
Clothing Cross-country runners, explosive
altitude, 186 training, 29
bellow effect, 177 Cross-country skiing
cold environments, 167, 168 airway remodelling, 215
hot environments, 175, 177 strength training, 77–78
protective, 177 Cross-training, 31–33, 230
Cold, environmental, 164–171 efficacy, 32–33
acclimatization, 168–169 unexplained underperformance
children, 170 syndrome, 212
core temperature maintenance, Cunningham & Faulkner treadmill test,
165–167 112
elderly people, 170 Cycling
exercise-induced asthma, 215 anaerobic endurance training sessions,
heat loss, 166–167 101
humidity of air, 168, 169–190, 214 cross-training, 32
low-intensity exercise, 167 resistance training, 76–77
performance, 167–168 tapering, 51–52
post-exercise, 168–169 triathlon, 30, 31
236 Index
Cycling (Continued) specific, 16, 17

Wingate cycle test, 110, 112 whole body, 30
Cytochrome oxidase (CYTOX), 49 see also aerobic endurance; anaerobic
endurance
Endurance performance, 62, 230
D determinants, 81
flexibility, 68, 78–79
Death see sudden cardiac death glycolytic capacity, 109–110
Deep vein thrombosis, risk with flight, high-intensity-interval training, 74–75
53 lactate threshold, 63–64
Dehydration, 168, 173 long slow distance (LSD) sessions,
altitude, 186 68–71
prevention, 176–177 maximum oxygen uptake, 62–63
Delayed onset muscle soreness (DOMS), motor unit recruitment, 110
131, 151 muscle fibre composition, 110
Depression, unexplained underperfor- neural adaptations, 110
mance syndrome, 208, 209, 212 percentage of types of training, 79–80
Detraining, 5, 25, 232 physiological determinants, 65
Diet plyometric training, 77
asthma, 221–222 strength training, 76–78
see also nutrition Endurance training, 61–82
Distance runners, laboratory testing, blood volume, 68–69
37–38 cardiac structure adaptations, 200, 201
Diuresis, 168, 179 exercise economy, 64
Dysmenorrhoea, 193 fractional utilization, 64
fuel supply, 64–65
intensity, 66
E muscle strength, 146
specificity, 65
Eating disorders, 195 Energy
Echocardiography, 203 anaerobic pathways, 87
Economy consumption in cold environment, 168
derivation, 38 contributions to short-duration,
endurance performance following high-intensity training, 90
lactate threshold training, 73–74 deprivation in female athletes, 194
movement, 38 elastic, 118, 129–130
oxygen, 38 jumping performance, 130
running, 76 expenditure in endurance exercise,
flexibility, 78 64–65
Effort sensation, 217 gender differences in production, 56
Elastic recoil, 118 glycolytic production, 93–94
Elasticity, stretch-shortening cycle, store replenishing, 5–6
129–131 Energy system specificity, 24, 232
Elbow flexors, maximum isometric peak Environmental factors, 164–186
torque, 50 recovery process, 7
Elderly people, cold environments, 170 see also altitude; cold, environmental;
Electrocardiography (ECG), 202–204 heat, environmental
Electrolyte intake, 176–177 Enzyme activity quantification, 112
Electromyography (EMG), 143–144 Ergometry, 36
Emergency medical care, 207 cross-country skiing, 77–78
Endurance Erythropoietin, 179, 181
events, final sprint, 90 Eucapnic voluntary hyperpnoea (EVH),
foundation, 16–17 219
local muscle, 27, 28 Exercise
performance training, 30 bronchoconstriction trigger, 214
periodization of development, 16–17 form, 147
Index 237
hypoxia detrimental effects, 183–184 Flights, 52–53

long slow distance sessions, 66 long-haul, 53
performance quantification, 136–137 Fluid intake, 168, 176–177
proportions of 1 RM, 149–151 palatability, 176
steady-state, 17 Fluid loss, 172
therapeutic, 211–212 see also sweat
Exercise economy, 230 Force, 117, 136
endurance training, 64 development characteristics, 151–152
Exercise physiology, 25–26 expression, 138
Exercise stress, response of body, 19 maximal, 141
Exercise training, 3–5 muscle
stimulus timing, 6–7 expression, 139–140
Exercise-induced arterial hypoxaemia shortening velocity, 140
(EIAH), 216 training, 152
Exhaustion, 210 voluntary maximal muscular produc-
stage, 4 tion, 148–149
Extremities, cold injury, 167 Forced expiratory volume in 1 second
see also frostbite (FEV1), 218, 219, 220
Forced vital capacity (FVC), 218
Force–time characteristics, 118
F Force–velocity relationship, 4
muscle, 119–122, 140, 141
Fat, body, 167 performance, 152
female athletes, 194 Fractional utilization, 38, 64, 230
Fat mobilization/oxidation, 70 Fractures, stress, 197
Fatigue, 8–9, 230 Frostbite, 165, 169
anaerobic endurance, 97 Fuel supply, endurance training, 64–65
CNS, 96
delayed onset, 65
environmental heat, 173 G
index, 112
lactic acid, 93–94 General Adaptation Syndrome (GAS)
onset reduction, 24 theory, 3–4
physiological, 93–94, 95 Genetic pre-programming, 25
rate, 112 Genetics, exercise physiology, 25–26
resistance enhancement, 70 Glandular fever, 210
short-duration, high-intensity sports, Glucose stores, ATP resynthesis, 95
92 Glycogen
stage, 4 depletion, 17, 95
training-induced, 45 loading, 56
travel, 53–54, 232 metabolism, 109
unexplained underperformance muscle, 49–50
syndrome, 208 sparing during exercise, 65
Ferritin, serum levels, 198, 210 stores, 56
Fertility, 196 stores
Field sports, 95 ATP resynthesis, 95
anaerobic endurance training sessions, depletion, 65, 70
102 exercise economy, 64
energy contribution, 90 muscle, 56
Field-based testing, 35, 40, 41 replenishing, 5–6, 19
Fish oils, 221 supercompensation, 55–57, 230
Flexibility, 230 Glycolysis see anaerobic glycolysis
dynamic, 34 Glycolytic capacity, endurance perform-
endurance performance, 68, 78–79 ance, 109
static, 34 Glycolytic enzymes, 109
Flexibility training, 33–34 Golgi tendon organ (GTO), 34
238 Index
Good form, 147 exercise-induced, 168

Growth hormone (GH), 26, 27 metabolic, 171, 172
lactic acid accumulation, 154 involuntary, 168
strength training, 145, 146 Heat stroke, 175
Gymnastics, 199 High-altitude cerebral oedema, 184,
185–186
High-altitude pulmonary oedema, 184,
H 185
High-fat/low-carbohydrate (CHO) diet,
Haemodilution, 197–198, 210 55–57
Haemoglobin High-intensity training
concentration, 210 anaerobic endurance, 103–104,
levels in endurance athletes, 197–198 105–106, 106–107, 108
Haemoglobin mass, 178 lactate threshold, 73
increase, 181 High-intensity-interval training (HIT), 67
Hand immersion in cold water, 178 endurance performance, 74–76
Heart, athlete’s, 199–200, 201, 202–207, proportion in training, 79–80
229 physiology, 74–76
function, 200, 201, 202 Homeostasis
size, 199 disturbance, 8
structure, 200, 201, 202 muscle cell, 94
Heart block, 202 restoration after exercise training,
Heart disease 5–6
congenital, 203 thermal, 171
structural, 206 Hormone replacement therapy, 198
see also sudden cardiac death Hormones, recovery process, 7
Heart rate Humidity, environmental
exercise hypoxia, 184 cold air, 168, 214
heat-related rise, 172 heat dissipation, 172
monitoring, 99, 211 heat illness, 175
resting, 199 hot air, 172, 214, 215
slow, 199 β-hydroxyacyl coenzyme A dehydroge-
tapering, 47–48 nase (β-HOAD), 49
variability, 211 Hyperinflation, dynamic, 216–217
Heat Hyperthermia, heat illness, 174–175,
dissipation mechanisms, 172 176
environmental, 171–178 Hyperventilation, 179
acclimation/acclimatization, Hypobaric hypoxia, 179, 180
173–174 detrimental effects, 183–184
adaptations, 173–174 LoHi training, 183
fatigue, 173 Hypohydration, 172
fluid intake, 176–177 heat illness, 174–175, 176
humidity of air, 172, 214, 215 training performance, 173
performance, 171–172, 172–173 Hypothalamic dysfunction, secondary
exchange, 177–178 effects, 196–197
tolerance in high-intensity-interval Hypothalamic hypogonadism, 193, 194
training, 75 Hypothermia, 165
Heat cramps, 175 Hypoxia
Heat experience, 174 clinical issues, 184–186
Heat illness, 172, 174–175, 176 detrimental effects on exercise,
avoiding, 176–178 183–184
susceptibility, 176 physiological effect, 179–180
Heat loss, 166–167, 168 short-term hypoxia at rest, 183
mechanisms, 172 sleeping in normobaric, 182
reduction after exercise in cold, 168 Hypoxic stress, 186
Heat production Hypoxic ventilatory response, 179, 186
Index 239
Lactate
I
blood levels, 109
cold water immersion, 167–168
Ice sports, 164
exercise hypoxia, 184
Immunoreactivity, 186
post-exercise, 112
Immunosuppression, 208, 209
breakpoint, 39
Individualization, 107
tapering, 50–51
Infections, 208
transition curve, 67
unexplained underperformance
transport from muscle, 73
syndrome, 209
Lactate threshold, 24, 231
Infertility, 196
derivation, 38–40
Inhalation see air, inspired
endurance performance, 63–64
Injuries, incidence with amenorrhoea, 197
proportion in training, 79–80
Inspiratory muscle training (IMT), 222
high-intensity exercise, 73
Insulin-like growth factor (IGF), 26–27
moderate-duration, high-intensity
Insulin-like growth factor 1 (IGF-1), 26,
training, 67
27
tests, 72
levels in female athletes, 194
training, 71–74
strength training, 145–146
Lactate tolerance training, 99, 100, 230
Insulin-like growth factor-binding protein
Lactic acid, 89, 231
(IGF-BP), 194
accumulation, 154
Intermittent hypoxic training at rest
fatigue, 93–94
(IHT), short-term, 183
Lactic dehydrogenase, 89–90
International Olympic Committee (IOC)
Length–tension relationship of muscle,
asthma criteria, 217–220
119
Interval training, 97, 230
Leptin, 194
Intramuscular substrate, quantification,
Lifts, power/strength oriented, 138
112
Lipids, 56
Ion channelopathies, 203
Living high
Iron
training high (HiHi), 179, 180, 181–182
deficiency, 198
training low (HiLo), 179, 180–181
oral, 210
Living low, training high (LoHi), 179, 183
requirements, 197–198
Loading mechanism, 137–138
stores, 210
Long slow distance (LSD) sessions, 66,
231
J endurance performance, 68–71
proportion in training, 79–80
Jet lag, 53–54, 55, 230–231 Low-intensity exercise, cold environment,
adaptations, 54, 55 167
Joint, range of movement, 78
M
K
Macrocycles, 13, 15
Kayaking, anaerobic endurance training Marathon runners, training type propor-
sessions, 102 tion, 79–80
Kinaesthetic control, 147–148 Marfan’s syndrome, 203
Kinaesthetics, improved, 30 Maximal voluntary contraction, 118
Krebs cycle, 89–90 Mechano-growth factor (MGF) see
enzymes, 73 insulin-like growth factor 1 (IGF-1)
Mefenamic acid, 193
Melatonin, jet lag, 53
L Men
energy production, 56
Laboratory-based testing, 35–40, 41 hormonal disturbance, 194
distance runners, 37–38 sudden cardiac death, 203
240 Index
Menarche, delayed, 194 delayed onset soreness (DOMS), 131,

Menorrhagia, 193 151
Menstrual cycle, 193, 231 eccentric lengthening, 151
bone health, 197 elasticity, 129–131
carbohydrate loading, 56 training, 131
exercise-related irregularity, 193–195 energy needs for contraction, 86
hypothalamic disturbance, 193, 194 force expression, 139–140
restarting, 198 force–velocity
Mesocycles, 13, 15 characteristics of performance,
Messenger RNA (mRNA), 142 152
Metabolic acidosis, 93–95 relationship, 119–122, 140, 141
Microcycles, 13–15 glycogen stores, 49–50
Middle-distance events, high-intensity growth, 124, 142–143
training, 97 stimulus, 142
Mitochondria, 127 heavy, 208
density/size with endurance training, hydrogen ion buffering, 75
70 hypertrophy, 128, 230
Mitochondrial enzymes, 73 strength training, 76, 141–142
endurance training, 70 lactate transport from, 73
Moderate-duration, high-intensity train- length–tension relationship, 119
ing, 67 local endurance, 27, 28
physiology, 71–74 movement patterns, 28
Monocarboxylate transporters (MCTs), 73 neural adaptation, 143–144
Mood monitoring, 210 power transmission, 118
Motor units resilience, 140
fast-twitch, 89–90, 97 shortening velocity, 140
firing rate, 123–124 size, 138
recruitment, 128–129 strength, 138–140
endurance performance, 110 periodization, 20
slow-twitch, 97 stimulus for development, 146
tension, 138 strength training frequency, 155–156
types, 138 stretch, 124
Movement tensile loading, 147
ballistic, 152 voluntary maximal force production,
control, 147 148–149
economy, 38 Muscle cell homeostasis, 94
high-velocity, 152 Muscle fibres
patterns, 27, 28 adaptation, 142
range of, 146–147 composition, 110
velocity, 117, 152 contractile properties, 127
Muscle fast twitch, 91, 95, 109
acidity, 109 endurance performance, 110
actions, 136 hyperplasia, 143
activity and metabolic heat produc- hypertrophy, 17–18, 110
tion, 171 selective, 128–129
adaptation time course, 144 lactate threshold training, 74
agonist, 143–144 metabolic properties, 127
antagonist co-action, 140 neuromuscular mechanisms, 96
biopsy, 112, 125, 126 phenotype expression, 142
buffer capacity, 182 slow twitch endurance performance,
contractile function, 138–140 110
contraction speed training, 29
ballistic, 123 strength training, 123
energy needs, 86 sub-type conversions with resistance
maximal voluntary, 118 training, 142
cross-sectional area, 26 tapering, 48–49
Index 241
transformation from fast to slower, Older athletes, 203–205

125–126 Older people, cold environments, 170
type(s), 124–129, 231 Onset of blood lactate accumulation
elite athletes, 139 (OBLA) see lactate threshold
performance, 125–126 Oral contraceptives, 193
unexplained underperformance Osteopenia, 197
syndrome, 208 Osteoporosis, 196–197
type I, 125 management, 198–199
hypertrophy, 146 Ovarian failure, 195
type II, 125 Overload, 4, 231
selective hypertrophy, 128–129 progressive, 152–154
sub-type conversions, 142 Over-reaching, 8–9, 47, 210, 231
Muscle group specificity, 24, 232 Overtraining, 6, 9–10, 47
Muscle spindles, rapid stretch, 130 endurance, 209
Musculoskeletal stiffness, 78 symptoms with hypoxic stress, 186
Myocarditis, 203 see also unexplained underperfor-
Myofibrillar ATPase (mATPase), 49 mance syndrome (UUPS)
Myofibrils Ovulatory function, 196
muscle growth, 142 Oxidation pathway, 87, 88
tension-induced streaming, 150 Oxygen
Myokinase, 109 economy, 38
Myosin excess post-exercise consumption
ATPase enzymes, 144 (EPOC), 87, 111–112
cross-bridged, 119 fractional utilization, 38
genes, 127–128 maximal accumulated deficit (MAOD),
isoforms, 138–139 87, 111, 231
alterations, 144 HiHi training, 182
fast, 139 maximal uptake, 15–16, 25, 38, 62–63,
slow, 127–128, 139 231
Myosin filaments, 119 aerobic endurance, 111
muscle growth, 142 development, 100
Myostatin, 25, 27, 124 HiHi training, 182
HiLo training, 181
hypoxia, 184
N
tapering, 48
Oxygen dissociation curve, 180
Neural adaptation
Oxygen-carrying capacity, altitude, 179–180
ballistic contractions, 123
endurance performance, 110
phase, 18
strength training, 143–144
P
Neuromuscular pattern development, 71
Packed cell volume, 210
Nifedipine, 185
Paracetamol, 193
Nutrition
Peaking, 46
advice, 197
Performance
asthma management, 221–222
anaerobic endurance relationship,
eating disorders, 195
91
iron intake, 197–198
cold temperatures, 164
recovery process, 7
heat illness avoidance, 176–178
unexplained underperformance
heat impact, 171–173
syndrome prevention, 211
improvement, 2
jet lag, 54
O limitations in short-duration, high-
intensity sports, 91–92
Oestrogen, therapeutic, 198 optimization, 4
Off-season training, 32 physiological factors, 35
242 Index
Performance (Continued) explosive, 28–29

quantification, 136–137 factors affecting, 118–122
superior, 2 generation, 118
tapering changes, 51–52 output sustaining, 122–123
tests, 109, 112–113 production transmission, 118
travel fatigue, 54 tapering, 50
Periodization, 2, 231 Power training, force–velocity relation-
aerobic power, 20 ship, 120–121
competition phase, 13 Power:weight ratio optimizing, 123–124
components, 13–15 Pre-cooling, 177–178
concepts, 11 Premenstrual symptoms, 193
definition, 11 Proprioceptive control, 147
endurance development, 16–17 Proprioceptor feedback, 30
linear, 158, 159 Protein synthesis, 124
macrocycles, 13, 15 Psychological profiling, 210
mesocycles, 13, 15 Pulmonary oedema, high-altitude, 184,
microcycles, 13–15 185
modern practice, 3 Pulse rate, unexplained underperfor-
muscle strength, 20 mance syndrome, 209
phases, 12–13
physical fitness elements, 15–16
preparation phase, 12 R
research, 11
strength development, 18–19 Recovery, 7–8
strength training, 158–159 Red cell mass, 178, 179
training increase, 181
cycles, 13–15 Rehabilitation, partial range of motion
specificity, 28 movements, 147
transition phase, 13 Rehydration, 176–177
types, 12 Relative humidity
undulating, 158–159 cold air, 168
unexplained underperformance heat dissipation, 172
syndrome recovery, 211 heat illness, 175
Peripheral vasoconstriction, blood Repetition
pressure, 168 duration, 98
Phosphate, inorganic intramuscular, 95 hypertrophy oriented technique,
Phosphofructokinase, 94 150–151
Phosphorylase, 94 intensity, 98
Physical fitness, 2–3 multiple, 149, 152
element periodization, 15–16 neural oriented, 150
unexplained underperformance number, 149
syndrome, 9 resistance in progressive overload, 153
Physiological assessment of athletes, set, 148
specificity, 35–41 strength training, 148, 149
Plasma volume expanders, 205–206 Repetition maximum (RM), 137, 149–151,
Plyometric training, 29, 68, 131, 232 232
elastic recoil, 118 resistances, 149–150
endurance performance, 76–77 Reproductive health in women, 192–199
Polycystic ovarian disease, 195 Resistance
Polyunsaturated fatty acids (PUFAs), 221 progressive overload, 153
Post-viral fatigue see unexplained under- stage, 4
performance syndrome (UUPS) strength training, 149
Potassium accumulation in muscle fibres, Resistance training, 67–68, 232
96 anaerobic endurance, 100
Power, 28–29, 136–137, 232 cardiac structure adaptations, 200, 201
definition, 117 explosive, 121–122
Index 243
force–velocity relationship, 120 Short-duration, high-intensity training

hypertrophic, 124 aerobic endurance, 111
hypertrophy of type II fibres, 128–129 energy contributions, 90
land-based for swimmers, 76 energy demands, 91
maximal force expression, 141 performance limitations, 91–92
movements, 147 physiological profile, 91
muscle fibre sub-type conversions, 142 Short-duration, very-high-intensity
muscle stretch, 124 training, 67
neural control, 143 Short-duration maximal exercise bouts,
physiological responses, 76 99
power:weight ratio, 124 Signal transduction pathways, 26
recovery time course, 8 Skiing, 164
strength improvements, 144–145 see also cross-country skiing
velocity, 152 Skill specificity, 24, 232
Respiratory alkalosis, 179 Skin
Respiratory effort, 217 blood flow reduction, 168
Respiratory tract, cold air inhalation, temperature, 165
169–170 cooling, 166, 167
Rest Sleep
active, 19 normobaric hypoxia, 182
periods, 154–155 unexplained underperformance
Reversibility see detraining syndrome, 208
Rhabdomyolysis, exertional, 175 Sleeping pills, jet lag, 53
Rhinitis, allergic, 209 Sliding sports, 164
Rowing, training type proportion, 80 Solar radiation, 186
Running Somatomedin hypothesis, 26, 27
anaerobic endurance training sessions, Speed
101, 104, 105–106, 106, 107 factors affecting, 118–122
cross-country, 29 training for, 29–30
cross-training, 32 Speed drills, 29
economy, 77 Speed training, 102
flexibility, 78–79 force–velocity relationship, 120–121
ergometry, 37 Spirometry, 218
explosive training, 29 Sports fatigue syndrome see unexplained
tapering, 51 underperformance syndrome
treadmill test, 37–38 (UUPS)
triathlon, 30, 31 Sprinters’ paradox, 128
Sprints, 86
hill, 97
S intermittent, 95
tests, 112–113
Salt intake, 176 velocity relationship, 120–121
asthma management, 221 ST segment, 202
Sarcomeres, 119 Staleness see unexplained underperfor-
action, 140 mance syndrome (UUPS)
cross-bridge tension, 138 Strength, 17–19, 118–119, 232
integrity loss, 142 definition, 137
Satellite cells development, 18–19
multiplication, 18 high-velocity, 148
proliferation, 143 improvements with resistance train-
Series elastic components (SECs), ing, 144–145
129–130, 131 isometric, 145
Sets, 148 low-velocity, 148
number, 154 maximum, 18–19
Shivering, 167, 168, 171 power output sustaining, 122–123
Shock stage, 4 tapering, 50
244 Index
Strength training, 17–18, 26–27, 136 Supplemental training, 24

action velocity, 148 Sweat
adaptation, 141–144 body cooling, 167
adaptive response, 157–158 loss
aerobic power output, 122–123 clothing, 177
agonist muscles, 143–144 dehydration, 173
bone, 140 evaporative, 172
connective tissue, 140 replacement, 176
cross-country skiing, 77–78 rate, 168
eccentric muscle lengthening, 151 Swimming
endocrine responses, 145–146 anaerobic endurance training sessions,
endurance performance, 76–78 101–102
exercise classification, 156, 157 physiological responses, 31
explosive, 28–29, 76 resistance training, 76
force development characteristic tapering, 51
manipulation, 151–152 tethered power, 50
frequency, 155–156 triathlon, 30, 31
kinaesthetic control, 147–148 Syncope, 205–206
maximum movement velocity, 152
microcycles, 19
muscle, 138–140 T
actions, 136
neurological change, 143–144 Tapering, 45–58, 232
organization, 157–159 carbohydrate loading, 55–57
periodization, 158–159 cardiorespiratory adaptations, 47–48
principles, 146–148 cycling, 51–52
progressive overload, 152–154 lactate, 50–51
repetitions, 148 muscle fibres, 48–49
resistance, 149 muscle glycogen stores, 49–50
rest periods, 154–155 optimal strategies, 57
sets, 148, 154 performance changes, 51–52
stability, 147–148 physiological responses, 46–50
strength planning, 52
gains, 123–124 power, 50
improvement, 144–145 running, 51
velocity, 151–152 strength, 50
volume, 156 swimming, 51
voluntary maximal muscular force travel, 52–54, 55
production, 148–149 types, 46, 47
Stress underperformance after, 211
exercise, 19 T-cell mediated immunity, 186
hypoxic, 186 Temperature, body, 70–71
tolerance, 210 core, 165, 168
unexplained underperformance control, 171
syndrome, 209 metabolic heat production, 172
Stretching, 34 Tendons, 118
prolonged, 124 movement patterns, 28
Stretch-shortening cycle, 118, 129–131 stiffness, 131
Stroke volume, 69, 199 Testosterone
altitude, 179, 180 altitude training, 186
Succinate dehydrogenase (SDH), 49 endurance male athletes, 194
Sudden cardiac death, 202–204, 205, 207 recovery process, 7
exercise-related, 202–204, 205 strength training, 145
Sunburn prevention, 177, 186 Test–retest reliability, 40
Sunscreen, 177, 186 Thermoregulation, 171
Supercompensation cycle, 5–7, 232 clothing, 167, 168, 175, 177
Index 245
dehydration, 173 investigation, 209

endurance training, 70–71 management, 10, 211
factors influencing, 176 precipitating factors, 209
heat illness susceptibility, 175 signs/symptoms, 9–10, 208
Threshold training, 67, 71–74, 232 therapeutic exercise, 211–212
Tissue micro-damage repair, 5–6 vulnerability, 208
Torque, 136 Urine excretion, 168, 179
Trace elements, 210
Training
adaptation, 5, 24 V
cycle, 20
intermittent interval, 17 Vagal tone, 204–205
methodologies, 2, 3–5 Vasovagal syndrome, 205–206
planning, 3 Velocity, 137
principles, 24, 232 Ventilation, exercise hypoxia, 184
programme planning, 5 Ventilatory response, hypoxic, 179, 186
resistance, 17–18 Ventricular arrhythmias, 204–205
stimulus, 24 Ventricular hypertrophy, 199
theories, 3–5 Ventricular wall thickness, 200, 202
volume manipulation, 46 Viral titres, 210
Training specificity, 24, 25 Vitamin C, 210
endurance performance, 65 asthma management, 221–222
periodization, 28 Vitamins, 210
physiological assessment of athletes,
35–41
triathlon, 30–31 W
Transcription factors, 26
Transition, 31 Warm-down, 100–101
Travel Warm-up, 177–178, 221
recovery process, 7, 8 Water
tapering, 52–54, 55 body heat loss, 166, 167–168
Travel fatigue, 53–54, 232 hand immersion, 178
Treadmill test, 37 Wind chill, 170
endurance performance, 113 Wingate cycle test performance, 110,
running, 37–38 112
Triathlon, training specificity, 30–31 Winter sports, 164, 215
Troponin, 94 Wolff–Parkinson–White syndrome, 203
T-waves, 203 Women
body fat, 194
energy production, 56
U lipid use, 56
reproductive health, 192–199
Ultra-endurance events, 62 tendon stiffness, 131
Unexplained underperformance syn- Work, 136, 138
drome (UUPS), 9–10, 47, 207–213, Work rate–lactate curve, 39–40
232 Workout composition, 156–157
acute, 10
chronic, 10
diagnosis, 208–209 Z
heart rate variability, 211
hospital tests, 209–210 Z line, 142

The Physiology of Training

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ADVANCES IN SPORT AND EXERCISE SCIENCE SERIES

No part of this publication may be reproduced, stored in a retrieval system, or

First published 2006

ISBN 0 443 10117 5

British Library Cataloguing in Publication Data

Library of Congress Cataloging in Publication Data

Colin Boreham BSc MSc PhD FACSM FECSS

Stephen Ingham BSc PhD

Gregory Whyte BSc MSc PhD FACSM

Human athletic performance continues to improve across all sporting activities.

Drawing upon the knowledge and expertise of an outstanding group of authors,

Buckinghamshire 2006 Gregory Whyte

5. Structures periodized training programmes on the basis of basic principles of peri-

Motor learning Sports medicine

Pedagogy Nutrition Biomechanics Biochemistry

Figure 1.1 The science of training and selected contributing elements.

Training theories and methodologies

A training programme has also to be planned according to the training principle

THE SUPERCOMPENSATION CYCLE

Figure 1.4 Accumulative effects of exercise training on performance.

Figure 1.5 Effects of successive exercise-training sessions with different loadings.

TRAINING FATIGUE AND OVER-REACHING

UNEXPLAINED UNDERPERFORMANCE SYNDROME (UPS)

Aspects contributing to UPS

Definition and concepts

COMPONENTS OF PERIODIZATION – TRAINING CYCLES

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

In general, variations in microcycle designing vary because the load in training is

PERIODIZATION OF SELECTED PHYSICAL FITNESS ELEMENTS

PERIODIZATION FOR DEVELOPING ENDURANCE

General preparation Specific preparation Pre-competitive Competitive Transition

Introduction of specific endurance

3 weeks 6 weeks 1 year 2 years

Figure 1.10 Strength training adaptations.

Periodization for developing strength

Preparation Competition Transition

General Specific Pre-competition Main competition Transition

Figure 1.11 Periodization of strength training: goals and objectives.

Steinacker JM 1993 Physiological aspects of training in rowing. International Journal of

Summary box 2.1

BIOCHEMISTRY AND MOLECULAR EXERCISE PHYSIOLOGY

Summary box 2.2

TRAINING FOR STRENGTH AND POWER

Summary box 2.3

Local muscular endurance

Training for speed

TRAINING FOR ENDURANCE PERFORMANCE

Summary box 2.4

SPECIFICITY AND TRIATHLON

TRAINING FOR FLEXIBILITY

Summary box 2.5

SPECIFICITY IN THE PHYSIOLOGICAL ASSESSMENT

Identifying the physiological factors underpinning performance

Taking distance running as an example, the physiological parameters important

Designing a laboratory test for an elite distance runner

Figure 2.1 An example of a treadmill protocol to test a distance runner. WU is self-paced

Derivation of lactate threshold

4.5 150 Heart rate

Heart rate (beats.min−1)

Heart rate Jul - 00