I hope this blog finds you well and healthy! Though COVID-19 continues to impact the world, it is encouraging to see society come together in order to overcome this trial as quickly as possible. With COVID-19 having a great impact on the lungs, people may be wondering about the health and vulnerability of their own lungs – especially athletes.

Elite endurance athletes experience a high prevalence of exercise induced asthma (EIA) and bronchial hyper responsiveness (BHR) (7, 8, 10, 11, 15). Exercise induced asthma is caused by airflow obstruction or narrowing of the airway which can be caused by increased breathing during exercise. Bronchial hyper responsiveness is excessive bronchial narrowing in response to various inhaled stimuli, both chemical and physical. Swimmers are particularly at risk as chlorine inhalation is thought as an airway provoking factor (3, 10). So, as an athlete, how is your sport, in conjunction with your lifestyle, influencing your risk for breathing problems? What measures can be taken to reduce it?

A group of scientists decided to seek answers, investigating potential association between physical and psychological recovery and breathing problems in elite swimmers.

Let’s Take a Look at Their Science:

This 2012 study, assessed 24 competitive swimmers (15-25 years old) using 3 physiological tests and a series of psychological questionnaires. Each athlete was training a minimum of 2-3 hours a day, as well as attending school full time. Four swimmers had already been diagnosed with asthma and five swimmers had a diagnosed allergy. (10)

Physiological Tests

All swimmers performed a single Methacholine challenge and 2 Eucapnic Voluntary Hyperventilation (EVH) tests.

A Methacholine challenge is type of bronchoprovocation test where methacholine is inhaled, causing mild narrowing of the airways in the lungs. A positive test result occurs if methacholine causes a drop of 20% or more in lung function (FEV1) when compared to your baseline. A negative test results suggest a negative diagnosis for asthma.

Eucapnic voluntary hyperventilation tests entail breathing at greater rate than normal to match a precalculated target breathing rate. During the test, subjects inhale cold, dry air enriched with 5% carbon dioxide over a span of 6 minutes.

While EVH is an indirect test for BHR (1, 10), Methacholine provocation is considered a direct measurement of BHR (2, 10).

Psychological Tests

This study assessed each athlete’s psyche in 4 areas: motivation, recovery, perfectionism, and burnout.

Motivation: Degree of motivation was measured with the Perceived Motivational Climate in Sport Questionnaire (13). This assessment depicts 2 subscales: mastery-motivational, and performance-motivational. A mastery climate suggests a cooperative atmosphere. Meaning, there is emphasis on team work. For example, working together and self-improving to better develop the team. On the other hand, a performance climate has a more competitive atmosphere. Meaning, there is emphasis on your own performance and to be the best. For example, an athlete comparing their own ability and/or scores to others.

Recovery: The degree at which swimmers did well at achieving proper recovery was measured using part the Training Practice Inventory Scale (9). The section used included: 1) different types of recovery, 2) finding the balance between training and recovery, and 3) awareness of body signals.

Perfectionism: The nature of each athletes’ perfectionism was measured using a sport specific version (6) of the Multidimensional Perfectionism Scale (5). This assessment depicts 5 subscales: personal standards, concern over mistakes, doubts about actions, parental expectations, and parental criticism (10).

Burnout: Burnout was measured using the sport specific Athlete Burnout Questionnaire (12). There are 3 subscales depicted in this questionnaire: reduced sense of accomplishment, emotional and physical exhaustion, and reduction of sport participation.

So, what did they find?

At least one of the physical tests (EVH or Methacholine challenge) tested positive for 15 out of the 24 swimmers (10). This study also found significant associations between BHR and several psychological variables. BHR showed a negative relationship with ‘accomplished recovery'(10). Meaning, as the degree of “accomplished recovery” improved, BHR decreased. In addition, BHR showed a positive relationship with perfectionism (10). Meaning, as the degree of perfectionism increased, so did the degree of BHR. To put it in perspective, excessive training due to the need for achieving perfectionism, may put an athlete at greater risk for respiratory issues (10).

What does this mean for me?

This study suggests excessive training and high stress can negatively impact an athlete’s recovery and psychological perspective on the sport. BHR has a high presence among elite swimmers (10) and breathing problems can lead to lack luster performances. Endurance sports tend to require vigorous training regimes (10). In addition, athletes have other life obligations, adding to their overall physical and mental load. Thus, competitive athletes experience an increased risk of over training and burnout – leading to potential breathing problems. Therefore, it is important to monitor your training, physical and mental health. A balanced training regime and lifestyle can reduce risk and improve your mental health.

Things to Remember

While this study provided great insight, it is a single study and had several limitations. For instance, only a small cohort was assessed. Here, only 24 young individuals were evaluated, specifically elite swimmers – a wider age range, amateurs, or other types of athletes may have generated differing results. However, the Cognitive Activation Theory of Stress (CATS) (4, 14), suggested a similar conclusion, stating “if the total load of an athlete becomes elevated, the recovery of the athlete might suffer.”(10) This study was also not assessed over time. A longitudinal study may provide additional information on how breathing issues may change over an athletic season, a year, and so forth.

Thank you for reading! I hope you feel more informed. If you have any questions or comments, please feel free to leave a shout out.

 

 

 

REFERENCES

  1. Anderson, S. D., Sue-Chu, M., Perry, C. P., Gratziou, C., Kippelen, P., McKenzie, D. C., … & Fitch, K. D. (2006). Bronchial challenges in athletes applying to inhale a β2-agonist at the 2004 Summer Olympics. Journal of Allergy and Clinical Immunology, 117(4), 767-773.
  2. Carlsen, K. H., Engh, G., Mørk, M., & Schrøder, E. (1998). Cold air inhalation and exercise-induced bronchoconstriction in relationship to metacholine bronchial responsiveness: different patterns in asthmatic children and children with other chronic lung diseases. Respiratory medicine, 92(2), 308-315.
  3. DROBNIC, F., FREIXA, A., CASAN, P., SANCHIS, J., & GUARDINO, X. (1996). Assessment of chlorine exposure in swimmers during training. Medicine & Science in Sports & Exercise, 28(2), 271-274.
  4. Eriksen, H. R., Murison, R., Pensgaard, A. M., & Ursin, H. (2005). Cognitive activation theory of stress (CATS): from fish brains to the Olympics. Psychoneuroendocrinology, 30(10), 933-938.
  5. Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive therapy and research, 14(5), 449-468.
  6. Hall, H. K., Kerr, A. W., & Matthews, J. (1998). Precompetitive anxiety in sport: The contribution of achievement goals and perfectionism. Journal of Sport and Exercise Psychology, 20(2), 194-217.
  7. Helenius, I. J., Tikkanen, H. O., & Haahtela, T. (1997). Association between type of training and risk of asthma in elite athletes. Thorax, 52(2), 157-160.
  8. Heir, T., & Oseid, S. (1994). Self‐reported asthma and exercise‐induced asthma symptoms in high‐level competitive cross‐country skiers. Scandinavian journal of medicine & science in sports, 4(2), 128-133.
  9. KenttäG, Hassmén P. Träna smart-unvik överträningssyndrom [Smart training – avoid the overtraining syndrome]. SISU idrottsböcker; 1999. 376 p.
  10. Kristiansen, E., Abrahamsen, F. E., & Stensrud, T. (2012). Stress-related breathing problems: An issue for elite swimmers.
  11. Larsson, K., Ohlsen, P., Larsson, L., Malmberg, P., Rydström, P. O., & Ulriksen, H. (1993). High prevalence of asthma in cross country skiers. Bmj, 307(6915), 1326-1329.
  12. Raedeke, T. D., & Smith, A. L. (2001). Development and preliminary validation of an athlete burnout measure. Journal of sport and exercise psychology, 23(4), 281-306.
  13. Selfriz, J. J., Duda, J. L., & Chi, L. (1992). The relationship of perceived motivational climate to intrinsic motivation and beliefs about success in basketball. Journal of sport and exercise psychology, 14(4), 375-391.
  14. Ursin, H., & Eriksen, H. R. (2004). The cognitive activation theory of stress. Psychoneuroendocrinology, 29(5), 567-592.
  15. Weiler, J. M., Layton, T., & Hunt, M. (1998). Asthma in United States Olympic athletes who participated in the 1996 Summer Games. Journal of allergy and clinical immunology, 102(5), 722-726.