The prevention of illness is a key component in athlete health management. Illness prevention strategies are not only important to optimise uninterrupted training, but also to reduce the risk of illness that can prevent participation in important competitions. In this second article on prevention strategies we examine current guidelines on nutritional strategies to maintain robust immunity, managing the training and competition load, proactive psychological stress management and implementing the monitoring of athletes to detect early signs and symptoms of illness, overreaching and overtraining (Schwellnus et al. 2016).
The athlete support team can consider adopting nutritional measures to maintain robust immunity in athletes (Gleeson 2016), including the following:
Introduce personalised nutrition programs to avoid deficiencies of essential micronutrients
Encourage athletes to ingest carbohydrate during and after exercise and to ingest both carbohydrate and protein after exercise
Measure and monitor the vitamin D status of athletes and supplement if required
Consider advising athletes to ingest probiotic such as Lactobacillus probiotics on a daily basis
Consider advising athletes on the regular consumption of fruits and plants, polyphenol supplements (e.g. quercetin), or foodstuffs (e.g. non-alcoholic beer and green tea) that may reduce risk of illness
Training and competition load management
There is evidence that poor load management with ensuing maladaptation can be a significant risk factor for acute illness and overtraining. However, data are limited to a few select sports and athlete populations, and this, combined with the unique nature of different sports make it difficult to provide sport-specific guidelines for load management. However, the following general recommendations can be made:
Athletes should have a detailed individualised training and competition planning, including post-event recovery measures (encompassing nutrition and hydration, sleep, and psychological recovery)
The training load is monitored using measurements of external and internal load
Training load is managed by adopting the following two main principles:
Changes in training load should be individualised as there are large intra- and inter-individual variances in the timeframe of response and adaptation to load
Changes in training load should be in small increments, with data (from the injury literature) indicating that weekly increments should be less than 10%
The competition load is monitored and managed
Variation in an athlete’s psychological stressors should guide the prescription of training and/or competition loads
It is recommended that coaches and support staff schedule adequate recovery, particularly after intensive training periods, competitions and travel, including nutrition and hydration, sleep and rest, active rest, relaxation strategies and emotional support.
Psychological load management
Psychological load (stressors) such as negative life event stress and daily hassles can significantly increase the risk of illness in athletes. Practical recommendations centre on reducing state-level stressors and educating athletes, coaches and support staff in proactive stress-management, and comprise the following:
Developing resilience strategies that help athletes understand the relationship between personal traits, negative life events, thoughts, emotions, and physiological states, which, in turn, may help them minimise the impact of negative life events and the subsequent risk of illness
Educating athletes in stress-management techniques, confidence building, and goal setting, optimally under supervision of a sport psychologist, to help minimise the effects of stress and reduce the likelihood of illness
Reducing training and/or competition loads and intensities to mitigate illness risk for athletes who appear unfocused as a consequence of negative life events or on-going daily hassles
Implementing periodical stress assessments (e.g., hassle and uplift scale) to inform adjustment of athletes’ training and/or competition loads. An athlete who reports high levels of daily hassle or stress could likely benefit from reducing the training load during a specified time period to prevent potential fatigue, illness, or burnout
Measuring and monitoring for early signs and symptoms of illness, overreaching and overtraining
The use of sensitive measures to monitor an athlete’s health can lead to early detection of symptoms and signs of illness, early diagnosis and appropriate intervention. Athletes’ innate tendency to continue to train and compete despite the existence of physical complaints or functional limitations, particularly at the elite level, highlight the pressing need to use appropriate illness monitoring tools. It is recommended that:
On-going illness (and injury) surveillance systems should be implemented in all sports
Athletes be monitored, using sensitive tools, for sub-clinical signs of illness such as non-specific symptoms and signs, or selected special investigations
Athletes be monitored for overt symptoms and signs of illness
Athletes be monitored for early symptoms and signs of overreaching or overtraining
Illness monitoring should be on-going, and long enough to detect early indicators of illness particularly during alterations in training load, travel and competitions
Strategies to reduce illness risk in athletes
Part 1: Behavioural, lifestyle and medical strategies
How common are illnesses amongst athletes?
International Olympic Committee consensus statement on load in sport
Gleeson M (2016) Immunological aspects of sport nutrition. Immunology and Cell Biology 94:117–123.
Schwellnus M, Soligard T, Alonso JM, Bahr R, Clarsen B, Dijkstra P, Gabbett TJ, Gleeson M, Hägglund M, Hutchinson MR, Van Rensburg CJ, Khan K, Meeusen R, Orchard JW, Pluim BM, Raftery M, Erdener U, Budgett R and Engebretsen L (2016) How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. British Journal of Sports Medicine 50(17):1043-1052.