Abstract
Purpose
The aim of this study was to evaluate the respiratory function and symptom perception in professional cyclists completing a Grand Tour (GT).
Methods
Nine male cyclists completed La Vuelta or Tour de France (2018/19). At study entry, airway inflammation was measured via fractional exhaled nitric oxide (FeNO). Respiratory symptoms and pulmonary function were assessed prior to the first stage (Pre-GT), at the second rest day (Mid-GT) and prior to the final stage of the GT (Late-GT). Sniff nasal inspiratory pressure (SNIP) was assessed at pre and late-GT timepoints.
Results
Seven cyclists reported respiratory symptoms during the race (with a prominence of upper airway issues). Symptom severity increased either mid or late-GT for most cyclists. A decline in FEV1 from pre-to-mid GT (− 0.27 ± 0.24 l, − 5.7%) (P = 0.02) and pre-to-late GT (− 0.27 ± 0.13 l, − 5.7%) (P < 0.001) was observed. Similarly, a decline in FVC (− 0.22 ± 0.17 l, − 3.7%) (P = 0.01) and FEF25-75 (− 0.49 ± 0.34 l/s, − 11%) (P = 0.02) was observed pre-to-late GT. Overall, eight (89%) and six (67%) demonstrated a clinically meaningful decline (> 200 ml) in FEV1 and FVC during the GT follow-up, respectively. SNIP remained unchanged pre-to-late GT (n = 5), however, a positive correlation was observed between ΔSNIP and ΔFVC (r = 0.99, P = 0.002).
Conclusion
GT competition is associated with a high prevalence of upper respiratory symptoms and a meaningful decline in lung function in professional cyclists. Further research is now required to understand the underpinning physiological mechanisms and determine the impact on overall respiratory health and elite cycling performance and recovery.
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Abbreviations
- EIB:
-
Exercise-induced bronchoconstriction
- FEF25-75 :
-
Mean forced expiratory flow between 25 and 75% of forced vital capacity
- FeNO:
-
Fractional exhaled nitric oxide
- FEV1 :
-
Forced expiratory volume in one second
- FVC:
-
Forced vital capacity
- GT:
-
Grand tour
- ICS:
-
Inhaled corticosteroid
- IQR:
-
Interquartile range
- LTRA:
-
Leukotriene receptor antagonist
- PEF:
-
Peak expiratory flow
- PPB:
-
Parts per billion
- RMF:
-
Respiratory muscle fatigue
- SABA:
-
Short-acting beta-2 agonist
- SNIP:
-
Sniff nasal inspiratory pressure
- TDF:
-
Tour de France
- UCI:
-
Union Cycliste International
- VAS:
-
Visual Analogue Scale
- VO2max :
-
Maximal Oxygen Uptake
- Vuelta:
-
Vuelta a España
References
Aaron E, Seow K, Johnson BD, Dempsey J (1992) Oxygen cost of exercise hyperpnea: implications for performance. J Appl Physiol 72:1818–1825. https://doi.org/10.1152/jappl.1992.72.5.1818
Abbiss CR, Menaspà P, Villerius V, Martin DT (2013) Distribution of power output when establishing a breakaway in cycling. Int J Sports Physiol Perform 8:452–455. https://doi.org/10.1123/ijspp.8.4.452
Babcock MA, Pegelow DF, Harms CA, Dempsey JA (2002) Effects of respiratory muscle unloading on exercise-induced diaphragm fatigue. J Appl Physiol 93:201–206. https://doi.org/10.1152/japplphysiol.00612.2001
Bell PG, Furber MJ, Van Someren KA, Anton-Solanas A, Swart J (2017) The physiological profile of a multiple tour de france winning cyclist. Med Sci Sports Exerc 49:115–123. https://doi.org/10.1249/mss.0000000000001068
Bogaerts K, Notebaert K, Van Diest I, Devriese S, De Peuter S, Van den Bergh O (2005) Accuracy of respiratory symptom perception in different affective contexts. J Psychosom Res 58:537–543. https://doi.org/10.1016/j.jpsychores.2004.12.005
Bonini M et al (2020) Minimal clinically important difference for asthma endpoints: an expert consensus report. Eur Respir Rev 29:190137. https://doi.org/10.1183/16000617.0137-2019
Bonini M, Lapucci G, Petrelli G, Todaro A, Pamich T, Rasi G, Bonini S (2007) Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletes. Allergy 62:1166–1170. https://doi.org/10.1111/j.1398-9995.2007.01503.x
Bougault V, Odashiro P, Turmel J, Orain M, Laviolette M, Joubert P, Boulet LP (2018) Changes in airway inflammation and remodelling in swimmers after quitting sport competition. Clin Exp Allergy 48:1748–1751. https://doi.org/10.1111/cea.13257
Dempsey JA, La Gerche A, Hull JH (2020) Is the healthy respiratory system built just right, overbuilt or underbuilt to meet the demands imposed by exercise? J Appl Physiol. https://doi.org/10.1152/japplphysiol.00444.2020
Derchak PA, Stager JM, Tanner DA, Chapman RF (2000) Expiratory flow limitation confounds ventilatory response during exercise in athletes. Med Sci Sports Exerc 32:1873–1879. https://doi.org/10.1097/00005768-200011000-00009
Dickinson JW, Whyte G, McConnell A, Harries M (2005) Impact of changes in the IOC-MC asthma criteria: a British perspective. Thorax 60:629–632. https://doi.org/10.1136/thx.2004.037499
Dickinson JW, Whyte GP, McConnell AK, Harries MG (2006a) Screening elite winter athletes for exercise induced asthma: a comparison of three challenge methods. Br J Sports Med. 40:179–182. https://doi.org/10.1136/bjsm.2005.022764
Dickinson JW, Whyte GP, McConnell AK, Nevill AM, Harries MG (2006b) Mid-expiratory flow versus FEV1 measurements in the diagnosis of exercise induced asthma in elite athletes. Thorax 61:111–114. https://doi.org/10.1136/thx.2005.046615
Dominelli PB et al (2017) Effects of respiratory muscle work on respiratory and locomotor blood flow during exercise. Exp Physiol 102:1535–1547. https://doi.org/10.1113/ep086566
Dominelli PB, Katayama K, Vermeulen TD, Stuckless TJR, Brown CV, Foster GE, Sheel AW (2019) Work of breathing influences muscle sympathetic nerve activity during semi-recumbent cycle exercise. Acta Physiol 225:e13212. https://doi.org/10.1111/apha.13212
Dweik RA et al (2011) An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 184:602–615. https://doi.org/10.1164/rccm.9120-11ST
Fernández-García B, Pérez-Landaluce J, Rodríguez-Alonso M, Terrados N (2000) Intensity of exercise during road race pro-cycling competition. Med Sci Sports Exerc 32:1002–1006. https://doi.org/10.1097/00005768-200005000-00019
Foster GE et al (2014) Pulmonary mechanics and gas exchange during exercise in Kenyan distance runners. Med Sci Sports Exerc 46:702–710. https://doi.org/10.1249/mss.0000000000000161
Fullagar HHK, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T (2015) Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med 45:161–186. https://doi.org/10.1007/s40279-014-0260-0
Gift AG (1989) Validation of a vertical visual analogue scale as a measure of clinical dyspnea. Rehabil Nurs 14:323–325. https://doi.org/10.1002/j.2048-7940.1989.tb01129.x
Graham BL et al (2019) Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med 200:e70–e88. https://doi.org/10.1164/rccm.201908-1590ST
Guenette JA, Witt JD, McKenzie DC, Road JD, Sheel AW (2007) Respiratory mechanics during exercise in endurance-trained men and women. J Physiol 581:1309–1322. https://doi.org/10.1113/jphysiol.2006.126466
Harms CA, Wetter TJ, St. Croix CM, Pegelow DF, Dempsey JA, (2000) Effects of respiratory muscle work on exercise performance. J Appl Physiol 89:131–138. https://doi.org/10.1152/jappl.2000.89.1.131
Helenius I, Rytilä P, Sarna S, Lumme A, Helenius M, Remes V, Haahtela T (2002) Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers. J Allergy Clin Immunol 109:962–968. https://doi.org/10.1067/mai.2002.124769a
Holmberg HC, Rosdahl H, Svedenhag J (2007) Lung function, arterial saturation and oxygen uptake in elite cross country skiers: influence of exercise mode. Scandanavian J Med Sci Sports 17:437–444. https://doi.org/10.1111/j.1600-0838.2006.00592.x
Hull JH, Dickinson JW, Jackson AR (2017) Cough in exercise and athletes. Pulm Pharmacol Ther 47:49–55. https://doi.org/10.1080/15438629609512061
Irwin RS et al (2006) Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 129:1S-23S. https://doi.org/10.1378/chest.129.1_suppl.1s
Kennedy MD, Davidson WJ, Wong LE, Traves SL, Leigh R, Eves ND (2016) Airway inflammation, cough and athlete quality of life in elite female cross-country skiers: a longitudinal study. Scandanavian J Med Sci Sports 26:835–842. https://doi.org/10.1111/sms.12527
Kippelen P, Anderson SD (2012) Airway injury during high-level exercise. Br J Sports Med 46:385. https://doi.org/10.1136/bjsports-2011-090819
Knöpfli BH, Luke-Zeitoun M, von Duvillard SP, Burki A, Bachlechner C, Keller H (2007) High incidence of exercise-induced bronchoconstriction in triathletes of the Swiss national team. Br J Sports Med 41:486. https://doi.org/10.1136/bjsm.2006.030569
Laveneziana P et al (2019) ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 53:1801214. https://doi.org/10.1183/13993003.01214-2018
Le Meur Y et al (2013) Evidence of parasympathetic hyperactivity in functionally overreached athletes. Med Sci Sports Exerc 45:2061–2071. https://doi.org/10.1249/mss.0b013e3182980125
Lee KK, Matos S, Evans DH, White P, Pavord ID, Birring SS (2013) A longitudinal assessment of acute cough. Am J Respir Crit Care Med 187:991–997. https://doi.org/10.1164/rccm.201209-1686oc
Lucía A, Hoyos J, Santalla A, Earnest C, Chicharro JL (2003) Tour de France versus Vuelta a Espana: which is harder? Med Sci Sports Exerc 35:872–878. https://doi.org/10.1249/01.mss.0000064999.82036.b4
Lucia A, Hoyos J, Santalla A, PÉRez M, Chicharro JL, (2002) Kinetics of VO2 in professional cyclists. Med Sci Sports Exerc 34:320–325. https://doi.org/10.1097/00005768-200202000-00021
Medelli J, Lounana J, Messan F, Menuet JJ, Petitjean M (2006) Testing of pulmonary function in a professional cycling team. J Sports Med Phys Fit 46:298
Moreira A, Delgado L, Carlsen K-H (2011) Exercise-induced asthma: why is it so frequent in Olympic athletes? Expert Rev Respir Med 5:1–3. https://doi.org/10.1586/ers.10.88
Niinimaa V, Cole P, Mintz S, Shephard RJ (1980) The switching point from nasal to oronasal breathing. Respir Physiol 42:61–71. https://doi.org/10.1016/0034-5687(80)90104-8
Parsons JP et al (2013) An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med 187:1016–1027. https://doi.org/10.1164/rccm.201303-0437ST
Pichot V et al (2002) Autonomic adaptations to intensive and overload training periods: a laboratory study. Med Sci Sports Exerc 34:1660–1666. https://doi.org/10.1097/00005768-200210000-00019
Price OJ, Ansley L, Bikov A, Hull JH (2016a) The role of impulse oscillometry in detecting airway dysfunction in athletes. J Asthma 53:62–68. https://doi.org/10.3109/02770903.2015.1063647
Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH (2013) Airway dysfunction in elite athletes-an occupational lung disease? Allergy 68:1343–1352. https://doi.org/10.1111/all.12265
Price OJ, Hull JH (2014) Asthma in elite athletes: Who cares? Clin Pulm Med. 21:68–75. https://doi.org/10.1097/CPM.0000000000000030
Price OJ, Hull JH, Ansley L (2014a) Advances in the diagnosis of exercise-induced bronchoconstriction. Expert Rev Respir Med 8:209–220. https://doi.org/10.1586/17476348.2014.890517
Price OJ, Hull JH, Ansley L, Thomas M, Eyles C (2016b) Exercise-induced bronchoconstriction in athletes—a qualitative assessment of symptom perception. Respir Med 120:36–43. https://doi.org/10.1016/j.rmed.2016.09.017
Price OJ, Hull JH, Backer V, Hostrup M, Ansley L (2014b) The impact of exercise-induced bronchoconstriction on athletic performance: a systematic review. Sports Med 44:1749–1761. https://doi.org/10.1007/s40279-014-0238-y
Quanjer PH et al (2012) Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J 40:1324. https://doi.org/10.1183/09031936.00080312
Romer LM, Lovering AT, Haverkamp HC, Pegelow DF, Dempsey JA (2006) Effect of inspiratory muscle work on peripheral fatigue of locomotor muscles in healthy humans. J Physiol 571:425–439. https://doi.org/10.1113/jphysiol.2005.099697
Romer LM, Polkey MI (2008) Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol 104:879–888. https://doi.org/10.1152/japplphysiol.01157.2007
Rundell KW (2004) Pulmonary function decay in women ice hockey players: is there a relationship to ice rink air quality? Inhal Toxicol 16:117–123. https://doi.org/10.1080/08958370490270918
Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP (2015) Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 5:579–610. https://doi.org/10.1002/cphy.c130013
Rundell KW, Im J, Mayers LB, Wilber RL, Szmedra L, Schmitz HR (2001) Self-reported symptoms and exercise-induced asthma in the elite athlete. Med Sci Sports Exerc 33:208–213. https://doi.org/10.1097/00005768-200102000-00006
Rundell KW, Smoliga JM, Bougault V (2018) Exercise-induced bronchoconstriction and the air we breathe. Immunol Allergy Clin 38:183–204. https://doi.org/10.1016/j.iac.2018.01.009
Sanders D, Heijboer M (2019) Physical demands and power profile of different stage types within a cycling grand tour. Eur J Sport Sci 19:736–744. https://doi.org/10.1080/17461391.2018.1554706
Seiler S, Haugen O, Kuffel E (2007) Autonomic recovery after exercise in trained athletes: intensity and duration effects. Med Sci Sports Exerc 39:1366–1373. https://doi.org/10.1249/mss.0b013e318060f17d
Sheel AW, Derchak PA, Morgan BJ, Pegelow DF, Jacques AJ, Dempsey JA (2001) Fatiguing inspiratory muscle work causes reflex reduction in resting leg blood flow in humans. J Physiol 537:277–289. https://doi.org/10.1111/j.1469-7793.2001.0277k.x
Simpson AJ, Romer LM, Kippelen P (2015) Self-reported symptoms after induced and inhibited bronchoconstriction in athletes. Med Sci Sports Exerc. 47:2005. https://doi.org/10.1249/FMSS.0000000000000646
Simpson AJ, Romer LM, Kippelen P (2017) Exercise-induced dehydration alters pulmonary function but does not modify airway responsiveness to dry air in athletes with mild asthma. J Appl Physiol. 122:1329–1335. https://doi.org/10.1152/Fjapplphysiol.01114.2016
Stensrud T et al (2020) Lung function and oxygen saturation after participation in Norseman Xtreme Triathlon. Scandanavian J Med Sci Sports 30:1008–1016. https://doi.org/10.1111/sms.13651
Tammie RE, David TM, Brian S, Warren M, Robert TW (2007) Fluid and food intake during professional men’s and women’s road-cycling tours. Int J Sports Physiol Perform 2:58–71. https://doi.org/10.1123/ijspp.2.1.58
Tiller NB, Turner LA, Taylor BJ (2019) Pulmonary and respiratory muscle function in response to 10 marathons in 10 days. Eur J Appl Physiol 119:509–518. https://doi.org/10.1007/s00421-018-4037-2
Vergès S, Devouassoux G, Flore P, Rossini E, Fior-Gozlan M, Levy P, Wuyam B (2005) Bronchial hyperresponsiveness, airway inflammation, and airflow limitation in endurance athletes. Chest 127:1935–1941. https://doi.org/10.1378/chest.127.6.1935
Vergès S, Flore P, Blanchi MPR, Wuyam B (2004) A 10-year follow-up study of pulmonary function in symptomatic elite cross-country skiers–athletes and bronchial dysfunctions. Scandanavian J Med Sci Sports. 14:381–387. https://doi.org/10.1111/j.1600-0838.2004.00383.x
Vernillo G, Rinaldo N, Giorgi A, Esposito F, Trabucchi P, Millet GP, Schena F (2015) Changes in lung function during an extreme mountain ultramarathon. Scandanavian J Med Sci Sports 25:e374–e380. https://doi.org/10.1111/sms.12325
Widdicombe J, Fontana G, Gibson P (2009) Workshop–cough: exercise, speech and music. Pulm Pharmacol Ther 22:143–147. https://doi.org/10.1016/j.pupt.2008.12.009
Acknowledgements
The authors would like to acknowledge the commitment and support of the World Tour professional cyclists and team staff involved in the completion of this study.
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OP, JG, JH were involved in the conception and design of the study. HA and JG acquired the data. All authors were involved with drafting and critical revision of manuscript and final approval of the version to be published. The results of the study are presented clearly, honestly, and without fabrication or falsification.
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Allen, H., Price, O.J., Greenwell, J. et al. Respiratory impact of a grand tour: insight from professional cycling. Eur J Appl Physiol 121, 1027–1036 (2021). https://doi.org/10.1007/s00421-020-04587-z
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DOI: https://doi.org/10.1007/s00421-020-04587-z