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Explore the Applicability, Novel Microbiological Markers for Assessment of Persistent Physical Fatigue in Athletes - A Study of Salivary Human Herpesviruses 6 and 7 -

玉井, 伸典 筑波大学 DOI:10.15068/0002005656

2022.11.24

概要

Fatigue in athletes – Problem and stage classification –
In order to improve performance, athletes strive for training. Performance improvement presents as adaptations to repeated bouts of exercise (Coffey and Hawley, 2007); thus, athletes need to impose overload in training. Correspondingly, physical fatigue emerges as a primary underperformance factor. Such fatigue in athletes is classified into four stages according to the time required for recovery (Figure 1) (Meeusen et al., 2013).
　The first stage, acute fatigue (AF), is a transient underperformance that athletes often experience immediately after exercise, from which they can recover in several hours. The second stage is functional overreaching (FOR); this is experienced after high-intensity training, such as resistance training for muscle hypertrophy. Though several days are required to recover from it, the atheletes can improve their performance. The third stage is non-functional overreaching (NFOR), which occurs if athletes continue intensive training over FOR. Athletes may realize a persistent underperformance from this stage and need several weeks to recover. The final stage is overtraining syndrome (OTS), which results from continues hyper intensity training even after reaching NFOR. The distinctive symptoms of this stage include not only persistent underperformance but also various symptoms such as depression (Kuipers and Keizer, 1988; O'Connor et al., 1989). Once athletes develop OTS, several months are often required to return to competition. These four stages can be largely divided into transient fatigue (AF and FOR) and persistent fatigue (NFOR and OTS).
　As stated above, change of performance can be explained as a physical allostatic response caused by the training-recovery balance. Since training is essential to improve performance, transient fatigue is inevitable; however, persistent fatigue should be prevented. Therefore, for successful training, proper assessment of persistent physical fatigue (PPhF) that has been accumulated over several weeks, is necessary to adequately maintain training-recovery balance.

Traditional Assessments
General assessments include subjective and objective ones. A commonly used subjective assessment is the Profile of Mood States (POMS) (Heuchert and McNair, 2012). Some of the merits of the POMS are its low costs and ability to be administered in a short time, making it suitable for any sports field. The POMS assessment has been used to determine OTS (Morgan et al., 1987), reportedly useful in assessing physiological fatigue and athletic performance (Saw et al., 2016; Lochbaum et al., 2021). However, subjective assessments have the risk of overlooking actual physical fatigue because they are affected by psychological stressors such as the athlete’s motivation and life events (Aoki et al., 2016).
　Meanwhile, biomarkers in biofluids, such as blood, urine, and saliva, can be used for objective assessments. In particular, saliva is the most suitable biofluid to collect in the sports field because it can be collected easily, non-invasively, rapidly, and frequently without any medical license (Papacosta and Nassis, 2011). Moreover, numerous physiological or biochemical markers can be measured from saliva. Specifically, cortisol and secretory immunoglobulin A (SIgA) are traditionally used representative salivary biomarkers (Cook et al., 1986; Tomasi et al., 1982).
　Cortisol, well known as a ‘stress hormone,’ is a steroid produced in the response of the hypothalamic-pituitary-adrenal axis (Selye, 1936; Keller et al., 2017). As training can be regarded as a kind of stressor, salivary cortisol levels increase after high-intensity training (Aguiar et al., 2021). In addition, SIgA is an immunoglobulin that plays a major role in mucosal immune function (Macpherson et al., 2008; Yang and Palm, 2020). Athletes have been reported to experience a higher frequency of upper respiratory tract infections (URTI) compared to non-athletes (Fahlman and Engels, 2005), attributable to a decrease in salivary SIgA levels due to high-intensity training (Neville et al., 2008).
　Although those biomarkers are useful for evaluating the conditions of athletes (Gatti et al., 2011; Trochimiak and Hübner-Woźniak, 2012), the current consensus is that no proper marker to assess PPhF exists (Meeusen et al., 2013).

Novel Assessments
In contrast to these protein markers, recent studies have focused on salivary nucleic acids markers, such as cell-free DNA, mitochondrial DNA, or viral DNA (Hyun et al., 2018; Chen et al., 2017; Corstjens et al., 2016). Specifically for assessment of PPhF, salivary human herpesvirus 6 and/or 7 (HHV-6/7) have attracted attention as novel microbiological markers.
　Salivary HHV-6/7 can be considered a sufficiently available marker for assessment in athletes because both viruses are known to establish latent infection at a high rate of more than 90% in the general adult population (Agut et al., 2017). Furthermore, several previous studies have reported that salivary HHV-6/7 increase in response to physiological fatigue accompanied by physical stressors (Fukuda et al., 2008; Osaki et al., 2016; Aoki et al., 2016). Therefore, I hypothesized that salivary HHV-6/7 are applicable markers for PPhF assessment in athletes striving for high-intensity training.

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