Lifestyle management at altitude

Altitude training is forming an important part of the training programmes of many endurance athletes.  Living at altitude can pose a range of challenges, however, and particular aspects of lifestyle may need additional attention, particularly in relation to preventing overtraining and boredom.

Athletes may become lethargic because of the boredom, and those who fail to embrace the local culture may regret missing out on potentially inspiring and enjoyable experiences.  It would be a shame to fly all the way to South Africa, and never to see and animal in the wild!

Conversely, those to try to fit too much in, fail to recover adequately from training.  Attempting to fill the time between training with some more training will lead to burnout.  You could get addicted to computer games (or sudoko, strib scrabble, or poker for training kit) and delay or skip training as a result.  Spending all day visiting sites and attractions, may result in sore feet, tight muscles and increased risk of injury.

If you fill all your spare time with sleep, and may generally lethargic, or become unable to sleep at night.  You will need more sleep than normal at altitude, and afternoon naps are not only acceptable, but generally recommended.  But oversleeping, or sleeping to kill time may be detrimental to your training.

Spending all your time sunbathing isn’t the answer either.  The sun’s UV rays are stronger at altitude, and you will be more susceptible to sunburn than at sea level. 

You could also dragged into other people’s routine.  Having other people around you is a good thing, but remember that everyone responds to altitude different, and you may need more recovery time than others.  Finally, spending too much time with your friends or training partners can lead you to getting on each other’s nerves.

Of course, these factors may be similar to the challenges that full-time athletes face in their everyday lives.  We will revisit the pros and cons of being a full-time athlete in a future post, but in essence, athletes become full-time athletes when they go away on training camp, and that can have positive and negative aspects. It isn’t all bad of course, but care must be taken to not slip into the many pit falls.

Don't miss out on the opportunities that training abroad can offer

The training camp mentality

Training camps can be a great way of injecting a new impetus into training.  A new environment can be energising and brief, intense spells of training can help athletes reach a new level.  Athletes tend to be more motivated when they are training in a group and have no other distractions.  Training camps are not without their pitfalls, however, and being over motivated can be particularly detrimental when it comes to training stints at altitude.

Taking time to acclimatise to altitude can be the key to a successful training camp.  Too often I hear people saying that they’ve done their hardest ever week of training or hit new ‘personal best’ mileage figures while training at altitude, or tweeted about how much running at altitude has ‘kicked their asses’.  

At sea level, training in a group can help stretch most athletes to achieve their best.  Occasionally trying to keep up with better athletes can sometimes reap results.  Training in a group at altitude, however, is generally a bad thing.  Every athlete respond to altitude differently, and in addition to risking your physical health by working too hard, competing and measuring yourself against others can have detrimental effects on your mental performance. 

Key advice

• Work out your own programme with your coach and follow it
• Monitor your HR, RPE and general wellbeing, and adapt your programme if required
• Remember that less is more.  Just because you’re away on training camp, doesn’t mean that you have to train all the time.  Recovery is part of training too.
• Don’t get dragged into the group mentality
• Avoid going away with training partners that are overly competitive in training

Rest and recovery

We’ve all heard that resting is training too, but nowhere is the sentiment more true than when training at altitude.  Most of the physiological adaptations that occur at altitude, actually happen at rest.  Living at altitude is far more important than training at altitude (unless of course your training to compete at altitude). 

Basic acclimitisation to altitude takes approximately 14 days, though this varies depending on the individual.  During this time resting and training heart rates will be elevated, recovery times between intervals will be significantly increased, and more sleep will be required.  Your body will be working hard to increase EPO secretion, build new red blood cells, and to respond to the acute effects of the lower air pressure and oxygen availability.  Sometimes it’s best to just let the body get on with that.

Key advice

• Reduce overall training volume by 10-20 percent during the first week, and increased gradually over the next three to four weeks.
• Reduce the intensity of interval sessions by 5-10 percent initially, and increased gradually.  Intervals should be shorter than normal, and recovery time between them doubled. 
• Take an additional recovery day between hard workout days.  Use resting HR as an indicator of recovery, and skip any planned workout if the HR is elevated more than normal.
• Remember that there are huge individual variations in response to altitude.  Listen to your own body and don’t measure yourself against others.
• Remember, with altitude training, less is more, particularly during the first two weeks. 

The Grand Canyon makes a great day out when training at altitude in Flagstaff

The boredom factor

Boredom can be an issue when training at altitude, and striking a balance between killing time, relaxing, and embracing the sites and culture of your training environment, can be difficult.  Boredom can lead to depression, so susceptible athletes should take particular care.

If you’re in charge of your own travel plans, choose somewhere that will cater for your entertainment needs.  If you don’t like sitting around all day talking and drinking tea, then Kenya may not be for you.  Choose a big city if you like to have lots to do; and smaller towns if you prefer to be close to nature.

Key advice

• Decide on one or two things that you would really like to do while you’re away, and then decide where those activities will best fit into your training programme.  A safari might be a good way to recover from a long haul flight and adjust to altitude, while a trip to the grand canyon might be a suitable activity for a rest day. 
• Have one worthwhile task to do while you’re away. Catching up with university work, doing an online course, writing blogs or magazine articles, or updating your website are just some of the projects that you could complete.
• Enjoy your mealtimes; it’s not every day that you can take your time eating food.  Dining halls are also a good way to meet new people, and to soak in the culture of your surroundings. 
• Not everyone loves to eat, sleep and breathe their sport.  Find what works for you and plan accordingly.

Chess or draughts can be a great way to pass the time and keep the brain active

Nutrition and staying healthy

Diet is very important when training at altitude, and adjustments may have to be made to ensure that you are getting all the nutrients that you need.  

Since more oxygen is required to break down fat than carbohydrates, 80 percent of calories should be derived from low glycaemic carbohydrates.  Meals should be taken every 4 hr.  Increased carbohydrate utilization may result in glycogen store depletion, so make a conscious effort to replace carbohydrates during and after training.

Reduced nutrient absorption in the gut at altitude results in greater faecal losses.  Maintaining a high proportion of carbohydrate, and ensuring that overall calorie intake is adequate may reduce or offset this faecal loss.  Basal metabolic rate increases for the first 4 days of altitude exposure, particularly in females.  After 4 days metabolic rate begins to return to normal, but remains above sea level values. 

Some individuals may experience reduced appetite.  Small but regular meals, and eating a variety of fresh products, may help.  Apples and grapes in particular have natural chemicals which increase appetite.

 Iron is also very important and depleted iron stores is one of the reasons why some people do not respond to altitude.  Iron is a mineral that is essential in the production of haemoglobin.  Haemoglobin is the part of the red blood cell which attaches to oxygen and transports it around the body.  As the body turns iron stores into additional red blood cells in response to the hypoxic conditions and subsequent increased erythropoietin syntheses, the demand of iron rises, and with it the risk of developing anaemia, even in health runners.

There is risk of immunosuppression, and a subsequent increased risk of upper respiratory tract infections and gastrointestinal infections, at altitude.  It is important that you listen to your body, have adequate vitamins (A, folic acid, B₆, B₁₂, C and E) and minerals (copper, selenium and zinc) in your diet, and replace carbohydrates quickly after exercise.

Because of increased ventilation, increased urinary water loss, and low humidity at altitude, the potential for dehydration is increased.  Caffeine-free fluid intake should be increased by as much as 4 litres per day.  Monitor morning urine colour to ensure that fluid needs are being met, and reduce caffeine consumption.

Dealing with Injury

If you are training at altitude, and get an injury that prevents you from carrying out your normal training, it is best not to panic.  Depending on the severity of your injury, how far you are into your trip, and on the duration of your planned trip, you have a number of options.

The most important thing is that you get treatment for your injury.  If you do not have support personnel with you, cannot find access to a suitable physiotherapist, and do not know what your injury is and how to treat it, you may be best taking complete rest.  If you have a long trip planned, you could look at shortening your trip.

Even if your ability to train is severely hindered by your injury, you will still benefit from sleeping at altitude.  If you would have to rest even if you were at home, you may still be able get some benefit from your trip, and the solitude of altitude may help with adherence to rehab exercises.

Cross-training may be particularly beneficial at altitude and cycling, aquajogging, or even just walking, may be sufficient to raise the heart rate to sea level easy exercise levels in some individuals.

If you are susceptible to injury, or have a recurring injury, ensure that you have access to physiotherapy, and/or medical backup, have access to cross-training facilities if required, and have investigated if the trails are suitable for you.

If all else fails, and if it’s not practical for you to go home early, consider that your injury may be your body telling you to take a break.  Consider if you actually need a holiday.  Make a conscious effort to make the most of the trip, and add in some extra sightseeing, make some new friends, and relax.  Make the most of the hypoxic air!

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My recently published book, Notes from higher grounds, is available through Amazon (click on image below).  It is essentially a travel guide for those looking to arrange a trip to altitude, and covers 15 different venues in detail, but also includes practical advice on how to deal with travel and training at altitude.

Was Jenny Jones really GB’S first Winter Olympic Medallist on snow?

Snowboarder Jenny Jones at this year’s Winter Olympics in Sochi won Great Britain’s first Olympic medal on snow (rather than ice) when she took bronze in the Snowboard Slopestyle.

However, 12-years ago in Salt Lake City Alain Baxter became the first British athlete to win a medal on snow.  The medal was later taken away and awarded to Austria’s Benjamin Raich after Baxter failed a post-race drugs test.  A minute quantity (20 millionths of a gram) of the banned substance methamphetamine was found in the athlete’s urine sample which he claimed was from an over the counter Vicks nasal inhaler.

He was supported by the BOC to appeal the decision to the Court of Arbitration for Sport (CAS) and though CAS agreed with his argument the IOC’s decision was upheld because of the strict liability rule.

Alain Baxter’s error was buying an American version of a nasal inhaler to clear his sinuses.  It had different ingredients to the British version he had used for years, which had been cleared for use by his doctor.  The American version was not checked and contained traces of the banned substance levometamphetamine.

Since the games Alain has told the BBC that it was quite hard to take in when they were saying about it being a historic medal for Britain and he had some explaining to do when the archive pictures of him were shown on television news after Jenny Jones won her medal in Sochi.

“Kerr [my son] saw the pictures of me from Salt Lake City and drugs were mentioned. He started asking me about it and I thought ‘heregoes’.  He knows I won a medal but I nolonger have that medal, and it’s hard to explain why to a seven year old”

Baxter did return to ski racing after serving a ban, and competed at the 2006 Games in Turin where he finished 16^th; he has since retired from competitive racing in 2009. 

So what can athletes learn from this mistake?

What is the Strict Liability Rule?

This is where athletes are 100% responsible for what is ingested into their bodies whether or not the athlete intentionally or unintentionally used a prohibited substance or was otherwise negligent or at fault.

Medication

At some point, an athlete is likely to require medication for an illness or infection to allow them to train or compete and many athletes receive information on what to do through the 100% programme run by UK Anti- Doping (UKAD).

But here are a few pointers:-

1.   Check with your doctor that the medication does not contain a banned substance and that you are able to compete; if it does contain a banned substance is there an alternative medication?
2. Even over the counter medications can contain banned substances so should always be checked
3. Athletes in the UK can check their medication on the Global Drug Reference Online (Global DRO) which provides athletes and support personnel with information about their prohibited status of specific substances-  http://www.globaldro.com
4. Athletes in Ireland can check their medication on- http://www.eirpharm.com/sports/search which provides athletes and support personnel with information about their prohibited status of specific substance.
5. Some medications are banned just in competition, so be specific when you come to check

What happens if you train or compete abroad?

1. Take enough of the prescription with you so you don’t need to buy any abroad
2. If you are in the UK, Canada, United States and Japan check- http://www.globaldro.com
3. If you are in Ireland check- http://www.eirpharm.com/sports/search
4.   If you are in any other country outside of those listed you can check the ingredients listed in the medication

Book Review: The Business of Being an Athlete

The Business of Being an Athlete
Kerri Pottharst
Kez Publishing
2010

When I started supporting high performance student athletes eight years ago, I wished I could find a book or manual that detailed everything that I would have to support them with, and how to go about that.  I'd competed at a relatively high level myself, but lacked the 'world-class' perspective on things.  Luckily as things panned out, I worked with a very mature bunch of athletes, and I could learn on the job.  None of my first cohort of students had quite yet reached the world stage, and their problems (coursework deadlines, not enough hours in the week, money issues) were ones that I could easily relate to; issues such as retirement from sport, Olympic selection (or non-selection as the case might be) and eating disorders didn't arise until later.

The Australians have always led the way in lifestyle and career support for athletes, and it's no coincidence that I happened on this book in a Melbourne bookshop.  It is written by two times Australian Olympic beach volleyball medalist Kerri Pottharst who combines snippets from her own inspiring career with practical advice for high performance athletes of all levels.

Divided into three sections - passion, preparation and belief - the book covers such diverse topics as goal setting, nutrition, dealing with fans and handling competitive nerves.  Within the preparation section are chapters which you won't find in any nutrition or psychology book for athletes.  The author gets to the real nitty-gritty of high performance lifestyle, and deals with communication skills, managing money, keeping records and time management.  There is advice on setting up a website and how to use social media platforms in a professional way.  Good table manners (for all those awards dinners) are even covered.

The Business of Being an Athlete may well be the manual that I sought all those years ago.  It is the ultimate advice book for high performance athletes and a useful guide for support personnel and coaches working with international athletes.  Written in an easy-to-read, non-technical style, it is easy to pick up, pick a page, and be informed and inspired.  It is highly recommended for those working in the area.

Goal Setting - Part II

Last week I blogged about the importance of goal setting in the context of both performance and lifestyle management.  This week I wanted to go into a bit more detail about effective how to set effective goals, and outline some of the different type of goals which can motivate us in different ways.

The acrimony SMART (or SMARTER) is often used in the field of sports psychology to determine what makes up an effective goal, though discrepancies exist in what each of the letters stand for.  Here are just two of the many descriptions that I have come across:

Specific – Target a specific area for improvement.  Non-specific goals can be irrelevant or difficult to define

Measurable – Will you know when you have achieved your goal?

Aspiration or Ambitious – Is the goal stretching?  Easy goals don’t inspire or motivate us.

Realistic – Is the goal achievable?

Time-related – When do you want to achieve the results by?

Evaluated – Check that you are progressing towards your goal and adjust

Re-evaluated – Keep checking that you are progressing towards your goal

Specific – make them as precise and detailed as possible

Measurable – a method by which you can quantify or rate your current position and then determine the amount of improvement required

Accepted – goals need to be shared and negotiated with all others involved

Realistic – the goal is realistic yet challenging

Time phased – date is set for when the goal is to be achieved by

Exciting – goal motivated the individual

Recorded – the goal and progress towards it are recorded

Together these two definitions cover all but one aspect of what makes up a good goal.  I’ll come back to the other in a moment, but I just wanted to highlight the importance of a goal being exciting.  Some of us are excited by challenging goals; some of us are excited by working towards shared goals as part of a team; some of us (particularly those who are extrinsically motivated), are excited by the final outcome and the fame, fortune or reward that achieving the goal will achieve.  Find what excites you, and set your goals accordingly.  Think about how achieving your goals will make you feel.

The final thing that a goal should be is ‘positively phrased.’ This is where goal setting and mental imagery cross over.  The value of positively phrased goals is probably best demonstrated in the following example:

Negatively phrased goal: To not let people pass me in the home straight of an 800m

Positively phrased goal: To stay ahead in the home straight of an 800m

These two goals set about to achieve the very same result, but the athlete with the first goal will imagine himself being passed when he reads his goal, while the second athlete is likely to imagine himself feeling strong and staying ahead of the pack when he rereads his goal.  Very subtle wording adjustments can really help our goals to be more effective.

Types of goals

Not all goals are the same.  In fact there are three main categories of goal; all of which are important.  They are:

Outcome goals – these are goals where the outcome depends on winning or achieving a particular result.  Outcome goals are highly motivational, particularly in the long-term, but sometimes the result is completely beyond the control of the individual.  An athlete might aim to make the Olympic Games.  They might achieve the qualifying time, but still not be selected to compete.  Similarly a team might aim to win a national title.  They might play the game of their lives in the final, but just come up against a better team on the day, or be defeated as a result of incorrect referring decisions.

Performance goals  - these can be very similar to outcome goals, but give a little bit more control back to the athlete.  With performance goals and athlete sets a specific standard which they want to achieve.  For a track athlete that might be to run 4 minutes for the mile; or for a gymnast it might be to achieve a specific score for their floor routine.  Achieving performance goals is usually unaffected by the performance of others, and are highly effective in monitoring progress towards long-term outcome goas.  Athletes can achieve their performance goals without winning.  Extensically-motivated athletes may be more excited by outcome goals, while intrinsically-motivated athletes can be sufficiently motivated by performance goals.

Process goals – these relate to perfecting a strategy or technique necessary to perform well.  The athlete has complete control over process goals, and process goals can help to reduce anxiety and precompetition nerves.  Examples of a process goal for a long jumper might be to maintain controlled rhythm during the run up.  A golfer might focus on their putting technique and tennis player might focus on their forehand technique.  A series of process goals can be set working towards a medium or long term performance of outcome goal.

Activities:

1. Write down your goal (s) for the coming year.  Try to set an outcome, a process and a performance goal.
2. Are your goals intrinsically or extrinsically motivated?  Are they exciting to you?
3. Check that each goal is positively phrased.  Can you imagine yourself achieving your goals?
4. Double-check that each of your goals meets the criteria for a SMARTER goal, and adjust accordingly.

Goal setting: the key to lifestyle management?

Earlier this week I delivered a workshop to a group of talented young athletes.  We covered topics such as goal setting, time management and decision making, in that order, which was planned, but was only as we were discussing each topic, that it really dawned on me, just how important goals are to every aspect, not only of sport, but of life outside and beyond sport.  Knowing what you achieve is paramount in managing time, and it's a lot easier to make decisions, when we know what we want to achieve in the short, medium and long term.

Not all goals are made consciously.  High performing athletes will set goals for each session that they do, without realising that they have even done so.  Some days it will just be to get the session done; other days it'll be to perform a personal best on repetition.  After years of training and competing, goals in the performance setting will just come naturally.  Goals are not so easy in an unfamiliar environment, like when we are injured, or when we're planning for life after sport.  Considerable thought is often required in these situations.


Coping with Injury
Setting goals can be a great way to overcome injury.  You don't have to think about what you want to achieve after the injury - this often results in over-compliance to rehab programmes, and rushing back to training before you're ready - but think about the process goals that will help you get the most out of your time off.  Depending on the individual, the sport, and the injury, these are some goals that you might set for yourself while injured:

1. To undertake all exercises prescribed by they physiotherapist each and every day of rehab - no more and no less
2. To take up a new hobby, which I will practice daily (when I would normally be training), to take the focus away from the injury and not being able to compete
3. To carry out a period of mental imagery each day in which I will focus on perfect technique
4. To have a massage once every two weeks
5. To use the downtime to catch up on dental appointments and other things that normally detract from training
6. To maintain a structured routine

Not all goals need to be performance goals, and outcome and process goals are especially important during times of injury, illness, transition, or poor form.


Managing your time
Over the years of working with high performance athletes, I have noticed that those who manage to fit the most into their lives, are the ones who know what they want to achieve in both sport and outside of sport.  I've come across medical students who have managed to compete at an international level, and triathletes who can fit training for three sports around being a full-time student.  There are enough hours in the week - we just need to be motivated enough to use them wisely.

When planning for the week, it's a good idea to write down a few goals for the week; plan our time; and then reflect on whether or not our allocation of time is reflective of what we want to achieve in that week.  There is no special wand which will suddenly make us 'time-managed' but know what we want to achieve will make us more efficient with out time.


Making decisions
We all have important decisions to make from time to time - what subjects do we choose for A-levels/Leaving Cert? Which university do we attend? What will we do after university? Is it a good idea to become full-time athletes? Do we want children? Is it time to retire?  For some of us, these decisions will be made, or the options at least narrowed down naturally, but for many, we have to actively make the effort to wade through the options and decide what we are going to do next.  This takes energy and effort which we would probably prefer to conserve for training, but not making a decision, and leaving it to sit on the back of our minds, can use a lot more energy.  Decisions are important!

Knowing what are goals are can greatly help when making decisions.  If your sport is the most important thing in your world, then make sure that you choose a university where you have the facilities, coaching and environment to maintain your training.  There are rarely any right or wrong choices, but if your goals can't be achieved by the decisions that you have made, you are unlikely to lead a satisfied life.   Making decisions based on your goals also prevents you making them for the wrong reasons, or making them to keep others happy.


In summary, goals don't just help us to preform better - they help us decide what is important to us, to decide what we want to achieve in life, how to transition from one phase of life to the next, to deal with injury, to manage our time, and to make decisions.  They are the key to managing our lifestyle, whether that be as a student-athlete, retiring sportstar, or active mother.  Goal setting is the key to lifestyle management.

The Female Athlete Triad

For many athletes, participation in exercise is a healthy pursuit.  Unfortunately, for a significant proportion, exercise can lead to, or exacerbate one or all of the trio of conditions which constitute what is termed the Female Athlete Triad.  This blog looks at the triad, highlights why it should be of concern to female athletes and their coaches, and suggests some interventions to prevent or treat the conditions of the triad.

The condition comprises the following:

1. Disordered eating or an eating disorder 
2. Low bone mineral density, usually in the form of osteopenia (less severe) or osteoporosis (more severe) 
3. Absent or irregular menstrual cycles (olgiomenorrhoea or amenorrhoea)

According to the American College of Sports Medicine (ACSM), the triad is interrelated in aetiology (causes), pathogenesis (symptoms), and consequences.  The triad can result in long-term medical and psychological illness, as well as in short-term declines in physical performance.

Stress fractures, related to declined oestrogen levels, an insufficient diet and subsequently reduced bone mineral density are a major concern for athletes, and anything that increases osteoporosis, a highly debilitating disease which increases with age, is of major concern to society. 

 

Body composition, eating disorders and disordered eating

Body mass and body composition can be a major obsession of athletes in certain sports, particularly those related to those which are subjectively scored (figure skating, diving, synchronised swimming, body building and gymnastics), those where a lean body mass and low can help performance (high jump), endurance sports associated with low body mass (distance running, cross country skiing), weight-restricted sports (lightweight rowing, boxing and some martial arts, horse racing), and sports which require reviling clothing during performance (cheerleading, diving, swimming, beach volleyball and gymnastics).  Athletes in these sports are particularly susceptible to disordered eating and eating disorders.

A low percent body fat can directly lead to menstrual dysfunction, and low bone mineral density.  Practices, such as restricted or unhealthy eating practices, insufficient calorie intake, insufficient mineral intake, obsessive exercising and eating disorders, which lead to low body mass, can have additional indirect effects on menstrual health, and bone mineral density.

Eating disorders in themselves can lead to severe morbidity, and even death.  Anorexia nervosa and bulimia nervosa are severe psychological illnesses, and require early diagnosis and treatment to limit the long-term effects of the sufferer.  Individuals who develop an eating disorder enter a downward spiral of self-destruction and denial and obsessive behaviour, and the longer it goes untreated, the more difficult it is to break out of the situation.

Anorexia nervosa can be caused by a number of reasons, and suffers will require professional treatment relevant to the source of their illness.  Though clinical eating disorders may not be much more prevalent in sport than in the general population, a range of sub-clinical form of eating issues, known collectively as disordered eating, or anorexia athletic, are extremely prevalent in sports people.  Suffers often intentionally attempt to reduce their weight because they perceive it to be important in their sport, and engage in unhealthy practices to do so.   Disordered eating can lead to menstrual dysfunction, low bone mineral density, impaired performance and a range of other illnesses, and injury risks.

Some warning signs include:

• Excessive concern about body size or shape
• Noticeable fluctuations in weight
• Changes in ‘normal’ eating behaviours
• Obsession with food
• Eating alone
• Excessive exercising
• Depressed mood, low self-esteem
• Use of diet pills, laxatives
• Going to the bathroom frequently after meals
• Fear about gaining weight or becoming fat
• Bloodshot eyes, smell of vomit

Amenorrhoea and menstrual dysfunction

Amenorrhoea, i.e. prolonged absence of menstrual bleeding, is probably the most recognisable and easily assessed of the three component parts of the triad.  Sports participation, with or without the co-existence of disordered eating, is shown to be higher in female athletes than their sedentary counterparts.  Low body mass, inadequate energy intake and physical and psychological stress and training history are just some of the proposed contributing factors.  Prolonged menstrual dysfunction, and the associated reduction in oestrogen levels, can have prolonged detrimental affects on bone mineral density.

Bone mineral density, osteopenia and osteoporosis

Bone mineral density, which generally increases in response to impact exercise, can actually be compromised in response to sudden, sever increases in training volume, low oestrogen levels, insufficient nutrient intake and low body mass.  Low bone mineral density is significant, not only because of the long-term risk of osteoporosis, but also because of the short-term injury risk for the athlete.  Stress fractures have been shown to be higher in athletes with low bone mineral density, and take longer to heal in those with contributing risk factors.

Treatment

Treatment is often difficult, as athletes will likely resist increasing body weight and decreasing training loads.  Athletes also find it difficult to admit to menstrual problems and eating problems, particularly if they have spiraled deep into the circle if self-destruction and denial.  Early diagnosis is important.  Treatment of eating disorders, which should be undertaken by qualified staff, is paramount.

Menstrual disturbance should be medically assessed to ensure that it’s not pathological.  The return of menses, which should occur after a reduction in training volume and a return to a healthy body weight is ideal.  A reduction in training volume of around 10% is recommended, though this does vary from one individual to the next.  Energy intake should be increased gradually.

The contraceptive pill and other hormonal medications are prescribed in many cases, but don’t cure the underlying causes.  Bone mineral density has been shown to increase after the resumption of menses, but bone mineral density may never return to normal levels, even after years of regular menses and hormonal use.

Further information

• There is lots of useful information relating to the Triad on the Female Athlete Triad Colation website.
• Some useful information relating to eating disorders can be found on the B-eat website (uk) and on Bodywhys (Ireland).
• The Eating Disorders in Sport research group at Loughborough University also have good information on their website, and look for research participants from time to time.
• UK Sport produced a good downloadable booklet entitled Eating Disorders in Sport which is specifically designed for practitioners and coaches working with high performance athletes.

A number of good books are available for those suffering from eating disorders as well as those supporting those suffering from anorexia and bulima.  These are just some of the options available:

Eating disorders are not exclusive to women, and there is an increasing rate of disordered eating, body
dismorphic disorder and biogrexia among male exercisers. This book highlights some of the issues:

 

Here are some good general books looking at issues faced by female athletes:

 

Striking a balance

Last week I delivered a workshop to a group of sports scholarship students at the University of East London.  The session specifically looked how a student-athlete can set about creating a balance in their lives, an environment which will both help them in their sport and facilitate their development as a human being.  Some interesting discussion followed.  Here is a summary of the key points:

No man is an island

Athletes, like everyone else, live in an ever changing environment, and have to interact with many different people, and balance many different aspects in their lives.  These are just some of the many things that athletes (and particularly student-athletes), need to be good at:

• Managing budgets
• Selling themselves (to funders and potential sponsors)
• Dealing with the media
• Managing their time
• Organising and planning
• Coping with setbacks (bouncebackability)
• Managing relationships (with coaches, teammates, fans, sponsors)
• Coping with pressure (from the press, fans, teammates, self, parents)
• Decision making
• Accepting the uncontrollable
• Negociating
• Striking a balance
• Setting goals

All these skills are required in addition to the physical and mental attributes required for their sport, and more than a good measure of hardwork.  The above factors are just some of the elements which make up the ‘athlete lifestyle’

Getting a balance

The best story that I heard of to demonstrate balance, is the one where the university professor gets two pint glasses, and demonstrates to a group of university students how they can go about getting a balance in their lives.  He takes the first glass and fills it to the brim with water (signifying alcohol or a social life).  Filled to the top, there is no room left in the glass to for anything else; place a stone or pebble in it, and some of the water will flow over the edge.  He takes the second glass, and fills it to the top with stones.  The glass takes 5 or 6 medium sized stones and can take no more.  The glass, it could be said, is full of stones.  With the stones, however, there is still some room of other things.  The professor takes some small stones, and puts as many of them as he can in the glass.  He fits a large handful in.  A handful of pebbles follow, and then a small handful of sand.  Just as the audience think that the glass can hold no more, the professor takes a beaker of water, and manages to fit some into the glass.

The glass can be taken as a metaphor for the student-athlete’s life.  Think of the larger stones as the training sessions, the smaller ones as the lectures and coursework, the pebbles as all the little chores of life like shopping, cooking, and eating, the sand as sleep, and the water as relaxing and social time.  This way around, there is plenty of time to fit everything in.

A good route to striking a balance, can be broken into 5 processes:

1. Set goals

Deciding what you want to achieve, and what you want to get from life will help focus your balance.  Some of the questions that you might want to ask yourself include: what do you want to achieve?  What do you need to do to achieve those goals?  Are  the goals realistic?  Do you have goals in multiple areas of your life (sport, academic, career, other hobbies, life)?  What can be done to ensure that those goals fit together?  Are you following your goals for the right reasons (i.e. are they your goals, or are the goals you think others expect you to achieve).

2. Make a plan

Plans can be set on a daily, weekly, termly, seasonal, or yearly basis.  Some specific forms of planning are included in the timemanagement blog below.  Use the tools and planning process that work best for you.  Constantly consider your goals when planning.  Do your plans work towards your goals?  Review your plans to ensure that you are realistic in what you can achieve on a daily basis.  Identify where you are losing time, or being inefficient (are you spending two hours travelling each day, when the journey would be quicker to cycle? Did you spend time travelling because you failed to pack everything you needed for the day before you left the house in the morning?).

3. Make any important decisions

Student athletes constantly need to make decisions as they attempt to strike a balance in their lives, and often make decisions on a daily basis which they don’t even realise that they are making.  At certain times, however, important decisions which affect one’s goals and plans, need to be made.  Procrastination over making decisions can be an additional source of stress for an athlete, and delaying making the decision can result in missed opportunities.  Athletes should develop sound decision-making skills.  The following task, helps to highlight some of the processes involved in making decisions:

• Pick an important decision that you need to make now, or in the near future
• Consider what happens if you don’t make a decision, or delay making the decision
• List all your available options (include at least one ‘dream’ option i.e. in an ideal world what would you do?)
• List where you can find further information to help you make your decision
• List all the people that you can seek advice from (don’t just include people who will tell you what you want to hear)
• List any factors that you will use to help you make your decision (e.g. your goals, values, abilities, time, financial or family situation, location, things that you will/won’t compromise on)
• Consider what sort of things stop you from making decisions
• After seeking further information and advice, and considering any factors that your decision will be influenced by, choose 2 or 3 viable options from your initial list
• List the positive and negatives for each option
• It will be a lot easier to make a decision once you know what exactly your options are.  Imagine yourself in different situations.

In many cases, there are no right or wrong decisions, just decisions that cause stress because they haven’t been make.

4. Build in relaxation or recover time

Planned recovery time can be far more rewarding and beneficial than ad hoc down time.  Consider how you are going to relax and recover each day, week or season and use recover to refresh and revitalise the mind as well as the body.  Use down-time at the end of the season to cross things off your bucket list that you don’t get to do during the season.

5. See everything as a choice, not a sacrifice

Sport for most is a hobby, and the choices you make to achieve your goals should never be seen as sacrifices.  Choose to be successful.

Hay Fever and Sport

With hay fever season well and truly here, I thought it appropriate to share some advice on the illness.  I, like many others it seems this year, am relatively new to the illness, and am beginning to realise that summer time is not all sunshine so to speak!

Firstly, all high performance athletes who suffer from hay fever, should check that any medication that they take complies with anti-doping regulations.  While there are many over-the-counter and prescription treatments which are permitted, some are not, especially intra-muscular injections with are sometimes prescribed to treat the condition, and products containing pseudoephedrine which is prohibited in competition (e.g. Zirtex Plus Decongestant Prolonged Release Tablets).  Athletes should check the status of any medication (intra-muscular, oral, nasal or otherwise) that they take on their national drug database - www.globaldro.com for medications purchased in UK, including Northern Ireland, USA and Canada and www.eirpharm.com for products purchased in the Republic of Ireland.

Any athlete who is prescribed a prohibited cortiosteriod intra-muscular injection will need to take additional measures, including obtaining documentation to show that such a treatment was necessary, over and above the permitted medications available.  Athletes who are part of their national testing pool (i.e. subject to out-of-competition testing) will need to obtain a Therapeutic Use Exemption (TUE) prior to use, and other high performance athletes will need to obtain and provide TUE permission after testing.

Further information can be obtained here (for athletes in the UK) and here  (for athletes in Ireland).

As well as the potential of failing a drug test, taking hay fever medication can result in drowsiness; not ideal when you're trying to compete at the top of your game!  Any steps that you can take to avoid the symptoms may be better than taking medication.  Simple things like wearing wrap-around sunglasses can help prevent pollen getting the eyes, and can therefor reduce at least one of the symptoms of hay fever.

This article provides useful basic information on hay fever.  Remember though you should always seek medical advice for any condition that you suffer from, and check all medications, even if they have been prescribed by a doctor.