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Abstract and Figures

Long-distance traveling is a concern for professional basketball coaches, players, and owners, as sport-based research has demonstrated that short-haul flights (≤6 h) increase injury risk and impede performance. However, examination of the impact of air travel on players’ health and performance specifically in the National Basketball Association of the United States of America (NBA) is scarce. Therefore, this chapter examines the literature pertaining to the influence of air travel on health and performance in team sport athletes with suggestions for future research directions in NBA basketball. Prominent empirical findings and practical recommendations are highlighted pertaining to sleep, nutrition, medication, recovery, and scheduling strategies to alleviate the negative effects of air travel on health and performance in elite basketball players.
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L. Laver et al. (eds.), Basketball Sports Medicine and Science,
https://doi.org/10.1007/978-3-662-61070-1_74
Long-Distance Traveling
inBasketball: Practical
Applications Based onScientic
Evidence
ThomasHuyghe andJulioCalleja-Gonzalez
74.1 Introduction
The National Basketball Association (NBA) is
the premier basketball league in the world [1, 2]
and in recent years a greater emphasis has been
placed on player safety [3, 4]. In regard to player
safety, there has been increased attention in the
areas of training load [3, 5] as well as schedule
and travel requirements [5]. In an attempt to
reduce the training load and schedule require-
ments of players, the NBA has modied the
preseason schedule. Prior to 2017, NBA teams
played eight preseason games across 3–4weeks
in preparation for the regular season [6, 7] Since
the 2017–2018 season, the NBA season has
consisted of four to six preseason games played
across 3–4weeks followed by an 82-game regu-
lar season played across 26 weeks (177 days).
During the regular season, each team plays two
to ve games per week (~3.2 games per week),
with games lasting an average duration of 2h and
15 min. NBA teams rarely practice during the
season, and practices that occur are typically less
than 1h [1, 2].
In response to teams resting players during
back-to-back (two games within a 2-day span)
games [8], the league extended the duration of
the regular season by 7days with the purpose of
scheduling fewer back-to-back games [6]. During
the 2017–2018 season, NBA teams played an
average of 14.4±0.9 back-to-back games, which
was the lowest on record compared to any pre-
vious season in the NBA [2]. Furthermore, the
2017–2018 NBA season marked the rst season
in NBA history in which no team played four
games in ve nights [6]. Despite adjustments to
the NBA schedule, air travel demands remain
high due to the geographical span of teams
across four time zones (eastern, central, moun-
tain, and western). In this regard, NBA players
spend more time above 30,000ft than athletes
competing in all other team sports in the United
States of America (USA) [7]. Consequently,
air travel requirements are a concern for NBA
coaches, players, and owners, as research has
demonstrated that short-haul ights (e.g., domes-
tic 6 h ights) increase injury risk [2, 913]
and impede performance [9, 1420] with more
regular or longer periods of travel (e.g., 6 h
international transfers) more likely to result in
negative responses [21, 22]. In this chapter, we
aim to provide a comprehensive summary of sci-
entic evidence about air traveling on ve criti-
cal aspects: (1) fatigue, (2) athletic performance,
(3) sleep, (4) health and injuries, and (5) mood
state alongside suggestions for future research
T. Huyghe (*)
BC Filou Oostende, Oostende, Belgium
J. Calleja-Gonzalez
Physical Education and Sport Department, University
of Basque Country (UPV-EHU),
Vitoria-Gasteiz, Spain
74
930
and real- world applications in professional bas-
ketball, particularly in the NBA.
74.2 The Inuence ofTraveling
onFatigue
74.2.1 Scientic Evidence
Frequent air travel can negatively affect hydra-
tion status, nutritional behaviors, sleep qual-
ity, and sleep quantity, thus extending the time
for sufcient recovery between games and/or
training in athletes [15]. As a result, air travel
should be considered as an additional stressor
imposed on NBA players in conjunction with
competition and training schedules [15], espe-
cially when less than 72h of rest is experienced
between games [23, 24].
Depending on the magnitude of air travel
exposure, traveling can result into a variety of
negative consequences (Fig. 74.1). One of the
main consequences associated with frequent air
travel exposure is “travel fatigue.” While jet lag
refers to the physiologic adaptations after a single
trip across one or more time zones, travel fatigue
is a more complex summation of physiological
and psychological consequences accumulating
over a longer period of time (e.g., competitive
season) which reduces the player’s ability to
recover and perform [18]. Hence, travel fatigue
is characterized by feelings of disorientation,
light- headedness, gastrointestinal disruption,
impatience, lack of energy, loss of motivation,
recurrent illness, changes in behavior, and gen-
eral discomfort following travel across time zones
[13, 18], while jet lag is mainly characterized by
gastrointestinal disturbance such as heartburn,
indigestion, diarrhea, sleep disturbance, intermit-
tent fatigue, loss of appetite, impaired concentra-
tion, and disruption of situational awareness [18,
25] (Fig.74.2).
Fig. 74.1 Characteristics of travel fatigue (chronic) versus jet lag (acute)
T. Huyghe and J. Calleja-Gonzalez
931
The magnitude of travel fatigue depends on
many factors such as regularity, duration, and con-
ditions of travel [13, 26] (Fig.74.1). Specic causes
of air-related travel fatigue include the following:
Prolonged exposure to mild hypoxia
[16, 27, 28].
Difculties in standing, walking, and moving
around due to limited room inside the air cabin.
Reduced air quality in the cabin, which may
impair immune function [12].
Dry cabin air and low hypobaric pressure
potentially causing dehydration [29].
Prolonged sitting in a cramped position reduc-
ing mobility and exibility [10, 16].
Disruption of routines (e.g., eating and sleep-
ing) [30].
Noise of plane and cabin (e.g., sleep distur-
bance) [16].
Formalities of air travel may induce negative
mood states [30].
A primary issue regarding air travel occurs
as a result of signicant reductions in oxygen
saturation, which has been found to decrease
signicantly from 97% at ground level to 93%
at cruising altitude (p<0.05) [28]. This nding
is signicant as oxygen saturation levels of 94%
or less may prompt physicians to administer sup-
plemental oxygen in hospital patients and thus
would slow muscle recovery [28]. Furthermore,
researchers examined markers of skeletal muscle
damage following trans-American jet travel, but
since a non-exercise control was not included in
this investigation, meaningful interpretations of
the data cannot be determined [32].
The regularity, duration, and direction of air
travel, combined with in-cabin conditions, likely
predispose NBA players to one or more symp-
toms of travel fatigue [13]. In turn, travel fatigue
can have deleterious effects on player recovery
and subsequent performance, particularly when
scheduled soon after practices or games. When
ying across two or more time zones, symptoms
of travel fatigue can remain up to 2–3days after
arrival [13]. Consequently, it is recommended
that recovery and practices administered before
and after air travel are modied to account for
Fig. 74.2 Potential underlying factors and negative consequences of long-distance traveling in NBA basketball
players
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
932
travel fatigue, especially considering the travel
direction and ight duration experienced travel-
ing in NBA basketball players.
74.2.2 Practical Applications
Considering that skeletal muscle and connective
tissues become shortened during ights and may
stiffen, it is recommended for players to avoid
sitting the entire trip, and instead, walk around
the cabin every hour, unless they are asleep or
advised not to do so by ight staff [33]. With a
tentative agreement between the NBA and Delta
Airlines (Atlanta, GA, USA) charters, walking
inside the air cabin should be attainable, as most
NBA teams (27 out of 30 teams) y with private
jets of Delta Airlines (including Airbus 319s, and
Boeing 757-200s) with almost 50% more cabin
space than standard planes [34]. This cabin space
allows most NBA players, who possess an average
stature of 6feet and 7in, to have more freedom
to stand erect during air travel [34]. Additionally,
simple stretching exercises can be applied while
in the seat or in the cabin, which could help relax
muscles while increasing blood ow and deliver-
ing oxygen and other nutrients to muscles [31,
33]. As a result, stretching may reduce the nega-
tive effects of air travel on exibility and skeletal
muscle recovery. Consequently, future studies are
encouraged to examine the efcacy of these in-
ight travel strategies in NBA players.
74.2.3 Future Research
Despite recent schedule modications and an
increased awareness of the potential negative
consequences of air travel on the health and per-
formance of NBA players, there is still a need to
implement effective strategies to address issues
with travel fatigue to promote greater equity
across western and eastern teams. Future research
exploring various aspects of regularity, duration,
directions, and conditions of air travel [13] in
one or multiple NBA seasons can help identify
origins of fatigue in players. Consequently, a
holistic approach to future research (e.g., applied
chronobiology and jet lag research) is recom-
mended, with some potential topics of interest
encompassing descriptive and intervention-style
studies.
74.3 The Inuence ofTraveling
onAthletic Performance
74.3.1 Scientic Evidence
74.3.1.1 Circadian Rhythm
andPerformance
Shifting a player’s circadian rhythm (body clock)
relative to real time in the destination has demon-
strated to be a major factor in sports performance.
Although peak performance times throughout the
day may vary among players [33], for most play-
ers, peak performance tends to appear between
4:00 and 10:00pm [33]. Proper planning of phys-
ical activities has the ability to support resynchro-
nization of the player’s circadian rhythm, which
in turn can lead into an increase of up to 10%
in endurance, physical strength, and mental func-
tion [19, 33]. Consequently, circadian variations
should be taken into account when scheduling
practices and physical activities before and after
air travel. In particular, strength and endurance
training tend to be optimally planned in the after-
noon or early evening while motor skill training
in the morning [35]. However, future research
studies are needed to validate these ndings in
the NBA as well as other professional basketball
leagues.
74.3.1.2 Travel Direction
andPerformance
The direction of air travel should be considered
by NBA teams as traveling westward exacer-
bates reductions in performance [14, 23]. In a
sample of 8495 NBA games between 1987 and
1995, west coast teams scored four more points
per game (p < 0.05) when traveling to the east
coast than east coast teams scored when traveling
to the west coast [23]. Furthermore, NBA teams
traveling eastward had a winning percentage of
T. Huyghe and J. Calleja-Gonzalez
933
45.4% compared with 36.2% for teams traveling
westward (p < 0.001) between 2010 and 2015
[14]. The increased difculty of traveling west-
ward across the USA to compete has also been
reported in the National Football League and the
National Hockey League [14]. Westward travel is
likely more difcult since performance tends to
peak in the late afternoon, and players traveling
from west to east tend to play games closer to
their circadian peaks, given most NBA games are
played at night.
74.3.1.3 Competition Schedule
andPerformance
The home court advantage during competition
has been reported in multiple team sports [14,
16, 19, 36] including the NBA [37, 38], suggest-
ing either a negative effect of travel or a circa-
dian advantage [39]. However, the magnitude
of the home court advantage may be mitigated
or enhanced depending on other external factors
such as the travel direction, tip-off time, oppo-
nents’ playing style, game/practice volume and
intensity, and travel duration. Therefore, a holis-
tic approach to scheduling and travel manage-
ment is recommended.
Another factor that plays a role into the home
court advantage is the quantity of rest NBA teams
attain prior to games [37]. In particular, a con-
sistent advantage was recorded when a team had
more than 1day of rest between games (the home
team’s score increased by 1.1 points per game and
the away team’s score increased by 1.6 points per
game) in a sample of 8495 regular season NBA
games between 1987 and 1995 [23]. Moreover,
average total scores (home and away teams) were
highest when 3 days of rest were encountered
between games with data collected from the 1987
to 1995 seasons [23]. Consequently, the negative
inuence of air travel during an NBA season may
be mitigated by incorporating supplemental days
to recover from games.
An optimal recovery window of 72h follow-
ing games and practices is needed for an athlete
or team to return to optimal levels of performance
[24]. Nevertheless, the NBA schedule dictates
condensed game schedules that necessitate com-
pressed training schedules, which may inhibit
access to active rest days to fully recover from
accumulated physical and psychological stress
induced by NBA games and practices. In this
way, NBA teams are often obligated to intervene
with various ergogenic practices in an attempt to
speed up the recovery process, such as whole-
body cryotherapy, compression tights, cold water
immersion, contrast water therapy, and soft tissue
massage [40].
74.3.2 Practical Applications
Although age and level of tness can inuence
the severity of symptoms associated with long-
distance traveling [41], air travel should be rec-
ognized and respected as an additional stressor
when planning physical activities before, during,
and after a travel period. Consequently, prac-
tices and workout sessions should be planned on
a chronobiological basis to ensure that perfor-
mance is not impaired during the trip and after
returning home [25]. In particular, it is recom-
mended to reduce the overall volume, intensity,
and frequency of endurance training sessions,
while strength training sessions (neuromuscular
work) tend to be less susceptible to the negative
consequences of long-distance traveling [18].
However, the benets should be weighed with
the potential risks. Hence, high-volume, high-
intensity, and even traditional strength routines
should not be assumed to be indispensable [18].
Additionally, the timing of practices and physical
activities should not be planned during the circa-
dian nadir (2–4PM and 2–4AM of the departure
time zone) until the players are fully adapted to
the new time zone [18].
74.3.3 Future Research
While these commonly employed recovery prac-
tices, including compression tights, [36] cold
water immersion, [42] and massage, [43] have
been investigated in various samples of basket-
ball players, no data are available specically in
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
934
NBA players. Therefore, more research is needed
to ascertain if these recovery practices benet
NBA team and player performance, particularly
around intensive and extensive travel periods.
Furthermore, most of the studies that inves-
tigate performance decrements related to air
travel in team sport athletes have methodologi-
cal aws [33, 44] such as the absence of preight
assessments compared to postight assessments.
Therefore, it is recommended that future studies
take these issues into account when constructing
their research methodology.
74.4 The Inuence ofTraveling
onSleep
74.4.1 Scientic Evidence
74.4.1.1 Desynchronization
oftheCircadian Rhythm
The physiological and perceptual stressors
associated with ying across one or more time
zones may alter sleep patterns in athletes [12],
especially when accumulated over an entire
season [18, 45]. In particular, short-haul air
travel has been reported to impair athletic per-
formance due to the development of an inef-
cient internally- driven circadian rhythm (i.e.,
sleep deprivation or disorientation between the
circadian system and the environment) [44].
Hence, the circadian rhythm plays a critical role
in sports performance [13, 19, 46, 47]. When an
athlete’s circadian rhythm is synchronized with
the environment, the athlete should achieve
optimal performance during late afternoons
and early evenings [19]. Contrary, a desynchro-
nized circadian rhythm impedes the ability for
muscles to accumulate protein synthesis (the
ability of skeletal muscle to adapt and repair),
which consequently may limit training adapta-
tions [48, 49]. This may be concerning during
the preseason period, given sleep disturbances
are present during higher training volumes [50].
Since sleep loss can also affect vigor, mood, and
perceptual awareness [30, 51], early training
sessions could cause reductions in motivation
and consequently reduce optimal training per-
formance and subsequent adaptations [52].
74.4.1.2 Time Zone Dierential
andSleep
Considering air travel can cause an athlete’s cir-
cadian rhythm to become unsynchronized with
the environment, air travel may contribute to the
home court advantage in the NBA [53, 54] as the
body’s core temperature (an endogenous measure
of circadian rhythm) takes approximately 1day
for each time zone crossed to adapt completely
to the new time zone [13, 39]. Consequently,
the number of time zones traveled plays a criti-
cal role in the magnitude of potential disruptions
in the circadian rhythm of NBA players [13].
Hence, the greater the number of time zones
traveled, the more difcult it is for an athlete to
adapt to a new time zone. For example, a 2-h time
zone shift may cause marginal disruption to the
circadian rhythm, but a 3-h time zone shift (e.g.,
NBA players traveling coast to coast within the
USA) can cause a signicant desynchronization
of circadian rhythm [13]. Therefore, it is rec-
ommended that NBA players focus on physical
activity, eating, and social contact during daylight
in their new time zone in order to resynchronize
their circadian rhythm, especially when traveling
from coast to coast [13].
74.4.1.3 Travel Direction andSleep
One study examined the effects of air travel from
the east coast to the west coast of the USA on
physiological performance measures, sleep qual-
ity, and hormonal alterations [32]. However, it is
important to note the following: participants used
in this investigation were not athletes, a simulated
sporting event most closely related to demands
experienced during soccer was administered,
and a non-exercise (control) group was absent.
However, air travel-induced jet lag symptoms,
which resulted in decreased sleep quality and was
paired with signicantly increased melatonin lev-
els on ight days (travel from east to west coast
and travel from west to east coast) [32].
Finally, ying eastwards requires a phase
delay of the player’s circadian rhythm, while
T. Huyghe and J. Calleja-Gonzalez
935
traveling westwards requires a phase advance
of the players’ circadian rhythm. Typically, the
body adjusts more efciently to a phase delay
compared to a phase advance because the stan-
dard duration of circadian rhythm is approxi-
mately 24.5h (in sync with environmental factors
such as light, temperature, food intake, physical
and social factors) [25]. Hence, it is easier to fall
asleep when days are becoming longer rather
than days becoming shorter.
74.4.2 Practical Applications
Implementing a brief data collection procedure
pertaining to each player’s sleep history during
the initial medical screening process as well as
a month’s worth of sleep logs could help iden-
tify which player is more susceptible to jet lag
or travel fatigue before the ofcial start of the
season. In particular, it is recommended that
sleep quality in team sport athletes is monitored
through actigraphy as well as the Pittsburgh
Sleep Quality Index, Likert scale, Liverpool Jet-
Lag Questionnaire, and RESTQ [55]. However,
more studies are needed to verify their efcacy in
professional basketball teams.
NBA schedule-makers and teams may suc-
ceed in mitigating the negative effects of air travel
from coast to coast on sleep by implementing
up-to-date, evidence-based strategies applied in
other professional sports such as the ingestion of
more frequent and smaller meals [18]. In particu-
lar, a high-carbohydrate, low-protein meal in the
evening is recommended to enhance serotonin
production and subsequently promote drowsi-
ness and sleep [19, 33], while the ingestion of a
high-protein, low-carbohydrate meal is recom-
mended in the morning to induce the uptake of
tyrosine and its conversion to adrenaline, which
elevates arousal and promotes alertness [33, 56].
However, future studies are required to evaluate
the efcacy of the abovementioned strategies in
NBA players.
Besides the implementation of specic travel
management strategies, basic education and
awareness programs on behavioral management
for staff and players to recognize the causes,
symptoms, and solutions of cumulative travel
fatigue and sleep disturbances in professional
basketball players is strongly recommended [18,
47]. For example, prior to long-distance ights
(>6 h), high-performance support staff should
advise their teams to adopt the timing of train-
ing sessions to the destination time zone to help
synchronizing the circadian rhythm of their play-
ers prior to arrival [18]. Furthermore, an evening
ight is recommended for eastward travel (e.g.,
United States to Europe) [18]. During the ight,
eyeshades and earplugs are recommended to
help relaxation and mitigate the noise and over-
stimulation. Furthermore, on-board meals should
be consumed according to the destination time
[18]. Perhaps, having the players bring their own
meals may be helpful in this regard. Additionally,
players should also adapt their watch to the desti-
nation time as soon as boarding the plane, main-
tain proper hydration, and sleep according to the
destination time [18]. Moreover, to aid with a
rapid circadian adaptation to the new destination
immediately after a long-distance ight, high-
performance support staff and their players are
recommended to strategically plan their activities
according to the new time zone. Strategic use of
naps, caffeine, melatonin, light exposure, light
avoidance, and physical activity may all help
with accelerating (or decelerating) the adaptation
process, especially for those who tend to be more
susceptible to travel fatigue compared to others
[18, 5759]. Finally, in the current age of “social
media” consumption and late-night tweeting in
the NBA, players should also be advised to mini-
mize tablet usage or any other form of blue light
exposure before heading to bed as this has dem-
onstrated to sabotage sleep quantity and next-day
game performance [60].
74.4.3 Future Research
Considering frequent time zone transitions often
disrupt the circadian rhythm in athletes [15, 16,
19, 30, 61, 62], future studies may focus on
monitoring both exogenous and endogenous
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
936
parameters, such as the measurement of salivary
melatonin onset, adrenaline concentrations, and
body temperature as these are critical biomark-
ers of circadian rhythm [19, 63]. Measurement
of these biomarkers would provide insight into
how each player individually adapts to air travel
throughout the NBA season. Consequently,
NBA performance support staff may then apply
individualized approaches to training and game
preparation to combat the negative impact of air
travel.
Furthermore, examination of various ergo-
genic aids will provide a better understanding
of practices that may enhance physiological and
perceptual responses to air travel in NBA play-
ers. For instance, nutrition and hydration are fun-
damental aspects underpinning circadian rhythm
[64]. Therefore, analyzing and comparing the
hormonal responses of NBA players adopting
different diets may provide NBA coaches and
support staff with further insight into benecial
nutritional strategies for coping with air travel in
the NBA.
Light therapy, light avoidance, and pharma-
cological techniques have demonstrated to help
shift the circadian phase to optimal time zones
before, during, and after ights [58]. However,
practical recommendations pertaining to this
type of intervention remain difcult due to
interindividual and intraindividual differences
in response to these interventions alongside the
lack of research on light therapy in team sport
environments in general. Future studies have
an opportunity to validate the impact of light
avoidance (e.g., light-blocking glasses), blue
light exposure, chronobiotics (circadian phase
shifters), and chronohypnotics (sleep induc-
ers) on the sleep quantity and quality of NBA
players during one or multiple periods of the
season.
Finally, more studies are needed to establish
a denition of parameters inferred by actig-
raphy as well as consistency in sleep quality
algorithms, and the validation of self-perceived
sleep questionnaires, particularly in team sport
athletes [55].
74.5 The Inuence ofTraveling
onPlayer Health andInjury
Propensity
74.5.1 Scientic Evidence
74.5.1.1 Competition Schedule
andInjuries
Competing in away games has been reported to
signicantly increase regular season injury risk
in a sample of 1443 NBA players between 2012
and 2015 [9]. Specically, 54% of regular season
injuries occurred in players playing games away
from home, which was signicantly greater than
the expected injury rate for away games of 50%
(p<0.05) [9].
74.5.1.2 Playing Time andInjuries
Another factor to consider in reducing injury
risk in the NBA is the total amount of in-game
minutes accrued by each player. While coaches
have presumed withdrawing high-minute play-
ers from entire games may reduce injury risk
and enhance performance, a tactic which is
often seen nearing the conclusion of the regular
season, data to support this approach is lacking.
In fact, existing data revealed the average min-
utes played per game did not inuence injury
risk (p < 0.001) in 811 NBA players compet-
ing between 2000 and 2015 [8, 9]. However,
it should be noted these data are not reec-
tive of performance and injury risk in players
who were rested for entire games but rather
are indicative of players completing reduced
game minutes. Subsequently, future studies are
needed to examine the consequences and con-
rm the efcacy of resting high-minute players
for entire games in the NBA.
74.5.1.3 Air Travel andImmune
System Suppression
One of the main concerns with long-distance
air traveling (e.g., transcontinental ights) is
the disturbance of sleep. Subsequently, this
may cause a suppression of the immune system
of the athlete when sleeping 1h less than usual
T. Huyghe and J. Calleja-Gonzalez
937
[65]. This can be exacerbated by dry pressur-
ized air cabin conditions during the ight due to
uid loss, abnormalities in breathing, dry nose
and throat, similar to responses on acute expo-
sure to altitude [25]. Consequently, diuretics
such as caffeine and alcohol should be avoided
during long-distance ights to mitigate these
symptoms [48].
74.5.1.4 Air Travel andDeep-Vein
Thrombosis
A potential negative consequence of prolonged
sitting within the cabin of the airplane is “venous
thromboembolism” [66] (e.g., career-ending
diagnosis of NBA-champion Chris Bosh), often
referred to as “travelers thromboses,” which is a
condition that occurs when a blood clot (throm-
bus) forms in one or more of the deep veins in
the body, usually in the lower limbs. Deep vein
thrombosis can cause leg pain or swelling, but
might occur without any symptoms. On a large
scale, this condition has been reported as a
major health problem with at least 201,000 cases
reported each year in the United States in which
25% of these patients die within 7days [67]. The
risk for venous thromboembolism can remain up
to 2weeks after a long-haul ight. Additionally,
the annual risk of being diagnosed with this condi-
tion increases with 12% if one long-haul ight is
taken yearly [66]. Although no studies have been
published on this regard within the NBA eco-
system, NBA physicians and high- performance
support staff should be well-aware of the poten-
tial risks associated with long- distance traveling
(e.g., during preseason transcontinental NBA
global games) and advise players and staff with
customized travel management strategies as well
as prophylaxis based on other individual risk
factors associated with deep-vein thrombosis
[68]. For example, FlightFit is an iOS applica-
tion which introduces basic stretching techniques
to air travelers in an interactive way [69], which
may help blood circulation, oxygen, and nutrient
supply to the muscles, bones, and connective tis-
sues, and ultimately mitigate the risk for travel-
ers’ thromboses.
74.5.2 Practical Applications
In order to mitigate the negative consequences on
players’ health and injury propensity of air travel-
ing, it is recommended for players to drink more
than usual during ights, approximately 200 ml
extra in 12-h ight [25]. Furthermore, to mitigate
the risk of travelers’ thromboses, it is recom-
mended to implement a comprehensive assess-
ment prior to the competition period to identify
potential high-risk prole players. Additionally,
keeping the body active through in- ight ex-
ibility exercises may also help in reducing joint
stiffness and pooling of blood in the legs [25].
For example, through the mobile application
“FlightFit,” players can stretch different muscle
groups by following an interactive infographic
system and instructions visually and acousti-
cally as well as customizing their own stretching
plans based on their individual characteristics and
needs [69]. FlightFit also includes the possibility
to implement notication reminders and in-ight
tips which may help with educating and cultivat-
ing healthy travel behaviors. Another educational
opportunity might be considered through the form
of a meeting or workshop with the team or players
individually prior to traveling. In this case, keep-
ing the information brief and to-the-point (e.g.,
infographic or summary table) would help players
to comprehend and apply the given recommenda-
tions. Each player should also be advised on an
individual basis as a difference exists in peak core
body temperature and ability to fall asleep or arise
between morning type, intermediate type, and
evening type of players [25].
Consequently, the player’s chronotype should
be taken into consideration when providing
guidelines. Finally, high-performance support
staff who travel with the team should also con-
sider their age as a subsequent factor in the abil-
ity to shift in circadian rhythms because a phase
advance (tendency toward morning-type behav-
ior) might be favored once reaching the age of
47years [25]. Finally, in order to mitigate the sup-
pression of the immune system, special attention
should also be given toward proper food hygiene
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
938
(e.g., avoiding uncooked foods) and ensuring at
least 8h of high-quality sleep before, during, and
after trips [65].
74.5.3 Future Research
In order to mitigate the potential consequences of
air travel on NBA players’ health state and injury
risk, each player’s external and internal work-
load should be monitored and carefully managed
throughout the season. However, future research
should investigate new metrics or biomarkers
that reect a player’s immune system and injury
risk prole. For example, researchers may focus
on salivary cortisol and salivary immunoglobulin
A (SIgA) as demonstrated in a previous study on
monitoring stress tolerance in basketball players
[70] or vitamin D status, cortisol, testosterone, pro-
inammatory cytokines (e.g., TNF-Į and INF-Û),
and anti-inammatory cytokines (e.g., IL-4 and
IL-10) [71, 72]. Additionally, future studies should
approach a holistic mindset to gain a complete
picture about each player. For example, ratings of
perceived exertion (training load) and pyschomet-
ric questionnaires can be included and compared
with other insightful metrics as well. Once this
information has been collected over a longer period
of time (e.g., 4-week period), multiple microcycle
stereotypes could then be identied based upon
the NBA season schedule (e.g., home week, road
week, split week, 3-game week, 2-game week).
Subsequently, this data would allow researchers
to identify the impact of air traveling on player’s
immune system and injury risk and identify which
microcycle might be at higher risk compared to
others. Consequently, this would support more ef-
cient and effective travel management strategies for
NBA players and high-performance support staff.
74.6 The Inuence ofTraveling
onMood State
74.6.1 Scientic Evidence
In addition to sleep disturbances, fatigue, detri-
mental performance, and increased risk of injury,
traveling can result in an impaired mood state
[18, 73, 74] and loss of motivation all of which
can affect recovery [18]. If a player’s motiva-
tion declines, their training intensity and volume
during subsequent practices may decline equiva-
lently, [30] and consequently their performance
as well [74]. In particular, westward travel across
six time zones demonstrated altered mood states
for up to 24h post-travel [74]. Furthermore, sleep
disruption and desynchronized circadian rhythm
induced by long-distance traveling may further
exacerbate these uctuations in mood states [44].
However, these ndings often remain inconsis-
tent in the literature [35, 74] and have yet to be
determined in professional basketball players in
particular.
74.6.2 Practical Applications
Although it can be difcult for NBA coaches
to make the most appropriate decisions toward
their training and recovery protocols of the
competition schedule for the entire team, espe-
cially the day after a game, it is important
to consider the type of treatments, timing of
practices and activities, and recovery interven-
tions as all these factors can either induce or
reduce mood disturbances caused by frequent
traveling.
In order to mitigate the negative impact of
air travel on mood state, it is recommended
that each player’s psychological and psycho-
sociological reactions to air travel should be
monitored during the season. For instance,
comprehensive psychometric questionnaires
such as the Acute Recovery and Stress Scale
(ARSS) [75] and the REST-Q Sport [76] have
been established as logical, practical, and ver-
satile tools to measure self-perceived travel
fatigue in professional team sports [75, 76].
Considering the time constraints in the NBA,
shorter customized versions of these question-
naires can be completed on a daily basis [77],
which have been reported to be valid and reli-
able in elite Australian Rules Football [78].
However, further research is necessary to pro-
vide normative standards, especially with a
T. Huyghe and J. Calleja-Gonzalez
939
focus on individual interpretations, recommen-
dations, and compliance in NBA players.
Furthermore, a systematic exercise regime
(even away from home) should be considered as
physical activities have demonstrated to improve
mood state in athletes [79] and immediately after
arriving to the athletes’ new destination [41].
However, the timing of these exercise regimes
should be carefully planned by high-performance
support staff with consideration to the changes in
the athletes’ body temperature as a symptom of
adapting to their new time zone [41].
Unnecessary psychological stress should
be avoided by approaching travel with a pro-
active mindset. For example, players should
be advised to adjust their watch and phone to
the local time of their upcoming destination as
soon as boarding the aircraft [33]. Additionally,
if the budget allows, travel managers should
incorporate 1day of adjustment time for each
time zone crossed [33]. Moreover, family and
friends should be informed about the time dif-
ferences during each travel period to avoid
phone calls at night or during times that may
interfere with sleep [33].
Finally, extending sleep over a period of 3
weeks with a mean addition of 110min per night
has demonstrated to improve shooting accuracy,
energy, mood state, and mental preparedness for
competition in basketball players [80]. However,
benets only occurred in non-sleep deprived
players, which means that sleep extension should
only be considered when players suffer from sig-
nicant less total sleep time [80]. Nevertheless,
more research is needed pertaining to this par-
ticular strategy.
74.6.3 Future Research
More research is needed on the acute and chronic
effects of cumulative travel (e.g., over a season)
on psychological and physiological recovery
parameters of professional team-sport athletes.
Future research has the opportunity to validate
proactive interventions (e.g., light therapy, day-
time nap scheduling) and reactive interventions
(e.g., oxygenation therapy).
Take-Home Message
The NBA travel schedule induces mis-
alignments in circadian rhythm that cannot
be avoided. Hence, air travel across three
time zones has been reported to induce
susceptibility to travel fatigue [18, 44, 56,
61, 62], increase injury risk [13, 44, 81],
disrupt sleep patterns [12, 18], disturb an
optimal mood state [18, 74], and reduce
game performance [13, 14, 17, 44, 53].
First, it is important to understand the
impact of air travel on NBA players at an
individual level, given that each NBA player
adapts to the demands of long- distance
travel differently. Therefore, a well-struc-
tured travel management plan, taking into
account both travel conditions and players’
individual needs, is the rst step in estab-
lishing an effective approach to mitigating
the negative consequences of frequent air
travel. Therefore, adopting a preight, in-
ight, and postight model [47] and incor-
porating a travel fatigue monitoring system
would help NBA high- performance support
personnel to identify problems, limit nega-
tive symptoms induced by traveling, and
subsequently improve players’ health and
performance. Nevertheless, future studies
in collaboration with multiple NBA stake-
holders are needed to identify the impact
of current travel management practices and
approaches implemented by NBA teams
across one or more NBA seasons.
The following recommendations
(Table 74.1) are based on the literature
reviewed within this chapter as well as
empirical ndings from research on air
travel in elite team sports. It should be
noted that there remains a scarcity in
research in long-distance traveling in bas-
ketball. Nonetheless, there tends to be little
risk involved and much (potential) ben-
et in applying these recommendations.
Most importantly, these recommendations
should be tailored toward individual differ-
ences between players.
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
940
Table 74.1 Practical recommendations to mitigate the negative consequences with long-distance traveling for basket-
ball players, coaches, and high-performance support staff
Long distance traveling in basketball
Scientic evidence Practical applications Future research
Fatigue Flying reduces
oxygen saturation
which slows down
muscle recovery
Air travel likely
predisposes NBA
players to one or
more symptoms of
travel fatigue, which
in turn disrupts player
recovery and
performance,
particularly when
scheduled soon after
practices or games
When ying across
two or more time
zones, symptoms of
travel fatigue can
remain up to 2–3days
after arrival
Incorporate educational sessions with
players and staff about the potential
increments in stiffness and self-
perceived fatigue after ying, and how
they can mitigate these negative
consequences before, during, and after
trips
Maintain extra hydration before,
during, and after ights
Avoid sitting the entire trip, but
instead, walk around the cabin every
hour and perform simple seated or
standing stretches (e.g., FlightFit
application), unless you are asleep or
advised not stand up by the on-board
ight crew
If traveling across 3time zones in
eastward direction or traveling across
4time zones in westward direction,
consider the following:
Ultra short-acting as well as
medium-acting and medium
half-life hypnotic;
Intake smaller, more frequent, and
recovery content meals according
to the destination schedule;
If traveling across 3time zones in
eastward direction or 4zones in
westward direction, consider the
following:
Reduce training 2–4days
postight;
Intake 3–5mg melatonin 30min
before bed
Effective strategies to
address issues with
travel fatigue to
promote greater equity
across western and
eastern teams
The regularity,
duration, directions,
and conditions of air
travel across one or
multiple NBA seasons
to identify the origins
of “travel fatigue” in
players
A holistic approach to
future research is
recommended, with
some potential topics
of interest (e.g.,
applied chronobiology)
encompassing both
descriptive and
intervention-style
studies
T. Huyghe and J. Calleja-Gonzalez
941
Long distance traveling in basketball
Scientic evidence Practical applications Future research
Athletic
performance
Traveling westward
reduces performance,
particularly winning
percentage and points
per game
NBA players who
travel from west to
east tend to play
games closer to their
circadian peaks
NBA teams perform
signicantly worse in
away games
compared to home
games
An optimal recovery
window of 72h
following games and
practices is needed
for an athlete or team
to return to optimal
levels of performance
For most athletes,
peak performance
tends to appear
between 4:00 and
10:00pm
Proper planning of
physical activities
during travel can
improve endurance,
physical strength, and
mental function in
athletes up to 10%
Neuromuscular
training tend to be
less susceptible to
negative
consequences of long
distance traveling
compared to
high-volume work
Maintain extra hydration before,
during, and after ights
Reduce training frequency, volume,
and/or intensity 2–4days postight if
traveling across 3time zones in
eastward direction or 4time zones
in westward direction
If possible, plan motor skill training
sessions in the morning, and strength
and endurance sessions in the evening
Consider ergogenic modalities such as
cryotherapy, compression tights, cold
water immersion, contrast water
therapy, and soft tissue massage
If possible, plan individual practices
or workout sessions based upon the
player’s chronobiological prole
If arriving to a new time zone, avoid
planning practices or workout
sessions during the circadian nadir
(2–4PM and 2–4AM at the departure
time) until players are fully adapted to
the new time zone
Validity and reliability
of recovery practices
during traveling in
NBA players across
one or multiple
seasons, encompassing
both behavioral and
pharmacological
strategies
Longitudinal studies
on travel fatigue in
basketball
encompassing
preight, in-ight and
postight assessments
(continued)
Table 74.1 (continued)
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
942
Long distance traveling in basketball
Scientic evidence Practical applications Future research
Sleep Frequent air traveling
may induce sleep
deprivation or
disorientation
between the circadian
system and the
environment
A desynchronized
circadian rhythm
impedes the ability
for muscles to
accumulate protein
synthesis, and thus
the ability of skeletal
muscle to adapt and
repair
The body’s core
temperature takes
approximately 1day
for each time zone
crossed to adapt
completely to the new
time zone
The greater the
number of time zones
traveled, the more
difcult it is for an
athlete to adapt to a
new time zone
Air travel increases
melatonin levels on
ight days in
non-athletes
regardless of the
travel direction
High-volume training
may exacerbate sleep
disturbance (e.g.,
preseason period)
It tends to be easier to
adjust to a circadian
phase delay (e.g.,
eastwards travel) than
a phase advance (e.g.,
westwards travel) as
the standard duration
of the circadian
rhythm is
approximately 24.5h
Late-night social
media use negatively
impacts next-day
performance in NBA
players
Include sleep history and a month’s
worth of sleep logs in the preseason
test battery as well as a month’s worth
of sleep logs to identify players who
are at high risk for sleep issues
Monitor sleep through actigraphy as
well as valid surveys such as the
Pittsburgh Sleep Quality Index, Likert
scale, Liverpool Jet-Lag
Questionnaire or RESTQ
Prior to long-distance travel,
educational sessions should be
considered to communicate effective
strategies moving forward
For example, the coaching staff
should be advised to adopt the
timing of their practice sessions to
the time zone of the prospective
destination. Additionally, an
evening ight should be advised
when traveling in eastward
direction
Consider the following in-ight
strategies to promote relaxation:
Eyeshades and earplugs;
On-board meal intake according to
the destination time;
Bring custom meals;
Modify the time on personal watch
or phone to the destination time as
soon as boarding the plane;
Consume a high-carbohydrate,
low-protein meal in the evening
Consume of a high-protein, low-
carbohydrate meal in the morning
If traveling seems to disturb your
sleep, consider taking 20–30min naps
during the circadian nadir of the
departure time
If traveling across 3time zones in
eastward direction or traveling across
4time zones in westward direction,
seek or avoid light according to a jet
leg calculator
Focus on physical activity, eating, and
social contact during daylight time in
the new time zone
Avoid late-night tablet use or any
form of blue light exposure before bed
Include exogenous and
endogenous parameters
to measure the
circadian rhythms in
NBA players, such as
salivary melatonin,
adrenaline, light
exposure, and body
temperature
Standardized protocols
for the usage of
wearable devices and
progressive strategies
to help with sleep
disturbances induced
by traveling, such as
light-blocking glasses,
exercise regimes,
caffeine consumption,
food intake, melatonin
prescriptions, as well
as the use of other
chronobiotics and
chronohypnotics
Denition of
parameters inferred by
actigraphy,
polysomnography, as
well as consistency in
sleep-quality
algorithms and
self-perceived sleep
questionnaires
Table 74.1 (continued)
T. Huyghe and J. Calleja-Gonzalez
943
Long distance traveling in basketball
Scientic evidence Practical applications Future research
Injury
propensity
Competing in away
games increases
regular season injury
risk in the NBA
Reducing minutes
played per game does
not inuence risk of
injury in NBA players
When sleeping <8h,
the immune system
becomes suppressed
Dry pressurized air
cabin conditions
during the ight or
acute exposure to
altitude may
exacerbate a
suppressed immune
system
Prolonged sitting
increases the risk for
venous
thromboembolism
The annual risk of
deep vein
thromboembolism in
non-athletes increases
with 12% if one
long-haul ight is
taken yearly. This
increased risk may
remain up to 2weeks
after a long-haul
ight
Avoid caffeine and alcohol during the
ight to mitigate uid loss and the
suppression of the immune system.
Instead, drink other beverages,
approximately 200ml extra in a 12-h
ight
Include a baseline assessment during
the preseason medical screening to
gain insight into the risk for deep vein
thromboembolism in each player and
staff member
Perform exibility exercises (e.g.,
FitFlight) during ights (when awake)
Advise players on an individual basis
according to their chronotype, age,
and level of tness
Ensure 8h of quality sleep before,
during, and after trips
Ensure proper food hygiene, and
avoid uncooked foods
Explore which
travel-related
biomarkers indicate an
increased risk for
injury or health
problems in basketball.
For example:
Internal load
variables:
Psychometric
questionnaires,
salivary
immunoglobulin,
vitamin D, cortisol,
testosterone,
pro-inammatory,
and anti-
inammatory
cytokines
External variables:
Type of schedule,
travel duration,
travel direction, and
altitude
The magnitude of
inuence by the NBA
ecosystem on the risk
of its athletes and
employees to being
diagnosed with venous
thromboembolism
The analysis of
preight, in-ight, and
postight interventions
(e.g., FlightFit) and
how these interventions
play a role on the
immune system,
hydration status, and
blood circulation of
NBA players and
employees who travel
with the team
Table 74.1 (continued)
(continued)
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
944
Long distance traveling in basketball
Scientic evidence Practical applications Future research
Mood state Traveling tends to
impair mood and loss
of motivation all of
which can affect
recovery
Altered mood states
after ying may
remain up to 24h
after the ight
Sleep disruption may
further exacerbate any
mood uctuations
Physical activity has
demonstrated to
improve mood state
in athletes
immediately after
ying
Extending sleep over
a 3-week period may
improve energy,
mood state, and
mental preparedness,
especially in
sleep-deprived
basketball players
Monitor subjective loads during travel
periods based on evidence-based
surveys such as the Acute Recovery
and Stress Scale (ARSS) and the
REST-Q Sport.
If traveling across 3time zones in
eastward direction or 4time zones
in westward direction, consider
intaking 50–200mg of caffeine as
required
If traveling across 3time zones in
eastward direction, or traveling across
4time zones in westward direction,
consider intaking 50–200mg of
caffeine in late afternoons and in the
minutes before a nap
Avoid unnecessary psychological
stress by applying a proactive
mindset, such as adjusting your watch
as soon as boarding, and if the budget
allows, travel managers should
incorporate 1day of adjustment
period for each time zone crossed.
Additionally, inform family and
friends about the time difference to
avoid calls during inappropriate times
Validity and reliability
of pyschometric
surveys specically in
professional basketball
and during travel
periods
The effectiveness of
intervention strategies
on mood state
disturbances in NBA
players induced by
traveling, such as
napping and sleep
extension
Table 74.1 (continued)
References
1. Sampaio J, McGarry T, Calleja-González J, Sáiz SJ,
Alcázar XS, Balciunas M. Exploring game perfor-
mance in the National Basketball Association using
player tracking data. PLoS One. 2015;10:e0132894.
2. Ofcial NBA Statistics and Advanced Analytics.
2018. https://www.stats.nba.com. Accessed 15 Aug
2018.
3. McLean BD, Strack D, Russell J, Coutts
AJ. Quantifying physical demands in the National
Basketball Association (NBA): challenges in develop-
ing best-practice models for athlete care and perfor-
mance. Int J Sports Physiol Perform. 2019;4:414–20.
4. Wilke J, Niederer D, Vogt L, Banzer W.Head coaches’
attitudes towards injury prevention and use of related
methods in professional basketball: a survey. Phys
Ther Sport. 2018;32:133–9.
5. Lewis M. It’s a hard-knock life: game load, fatigue,
and injury risk in the National Basketball Association.
J Athl Train. 2018;53:503–9.
6. The Ofcial Site of the NBA. 2018. https://www.nba.
com. Accessed 15 Aug 2018.
7. NBA Advanced Stats and Analytics. 2018. https://
www.nbasavant.com. Accessed 15 Aug 2018.
8. Belk JW, Marshall HA, McCarty EC, Kraeutler
MJ. The effect of regular-season rest on play-
off performance among players in the National
Basketball Association. Orthop J Sports Med.
2017;5:2325967117729798.
9. Teramoto M, Cross C, Cushman D, et al. Game
injuries in relation to game schedules in the
National Basketball Association. J Sci Med Sport.
2017;20:230–5.
10. Philbrick JT, Shumate R, Siadaty MS, Becker
DM.Air travel and venous thromboembolism: a sys-
tematic review. J Gen Intern Med. 2007;22:107–14.
11. Drakos MC, Domb B, Starkey C, Callahan L, Allen
A. Injury in the National Basketball Association: a
17-year overview. Sports Health. 2010;2:284–90.
12. Coste O, Van Beers P, Touitou Y. Hypoxia-induced
changes in recovery sleep, core body temperature,
urinary 6-sulphatoxymelatonin and free cortisol
after a simulated long-duration ight. J Sleep Res.
2009;18:454–65.
13. Reilly T.Ergonomics in sport and physical activity:
enhancing performance and improving safety. 1st ed.
Champaign, IL: Human Kinetics; 2010. p.75–95.
14. Roy J, Forest G. Greater circadian disadvantage
during evening games for the National Basketball
T. Huyghe and J. Calleja-Gonzalez
945
Association (NBA), National Hockey League (NHL)
and National Football League (NFL) teams travelling
westward. J Sleep Res. 2017;27:86–9.
15. Leatherwood WE, Dragoo JL.Effect of airline travel
on performance: a review of the literature. Br J Sports
Med. 2013;47:561–7.
16. Forbes-Robertson S, Dudley E, Vadgama P, et al.
Circadian disruption and remedial interventions.
Sports Med. 2012;42:185–208.
17. Bishop D.The effects of travel on team performance
in the Australian national netball competition. J Sci
Med Sport. 2004;7:118–22.
18. Samuels CH.Jet lag and travel fatigue: a comprehen-
sive management plan for sport medicine physicians
and high-performance support teams. Clin J Sport
Med. 2012;22:268–73.
19. Manfredini R, Manfredini F, Fersini C, Conconi
F.Circadian rhythms, athletic performance, and jet
lag. Br J Sports Med. 1998;32:101–6.
20. Moore S, Scott J.Beware thin air: altitude’s inuence
on NBA game outcomes. JUR. 2013;4:11–7.
21. Fowler PM, McCall A, Jones M, Dufeld R.Effects
of long-haul transmeridian travel on player prepared-
ness: case study of a national team at the 2014 FIFA
World Cup. J Sci Med Sport. 2017;20:322–7.
22. Fowler P, Dufeld R, Vaile J. Effects of simulated
domestic and international air travel on sleep, perfor-
mance, and recovery for team sports. Scand J Med Sci
Sports. 2015;25:441–51.
23. Steenland K, Deddens JA. Effect of travel and rest
on performance of professional basketball players.
Sleep. 1997;20:366–9.
24. Nédélec M, McCall A, Carling C, etal. Recovery in
soccer. Sports Med. 2013;43:9–22.
25. Reilly T. How can travelling athletes deal with jet-
lag? Kinesiology. 2009;41:128–35.
26. Waterhouse JA, Edwards B, Nevill A, etal. Identifying
some determinants of “jet lag” and its symptoms: a
study of athletes and other travellers. Br J Sports Med.
2002;36:54–60.
27. Palmer BF. Physiology and pathophysiology with
ascent to altitude. Am J Med Sci. 2010;340:69–77.
28. Humphreys S, Deyermond R, Bali I, Stevenson
M, Fee JP. The effect of high altitude commer-
cial air travel on oxygen saturation. Anaesthesia.
2005;60:458–60.
29. Lindgren T. Cabin air quality in commercial aircraft
(PhD thesis). Uppsala, Sweden: Uppsala University;
2003.
30. Reilly T, Edwards B.Altered sleep–wake cycles and
physical performance in athletes. Physiol Behav.
2007;90:274–84.
31. Hoffman JR, Im J, Rundell KW, et al. Effect of
muscle oxygenation during resistance exercise on
anabolic hormone response. Med Sci Sports Exerc.
2003;35:1929–34.
32. Kraemer WJ, Hooper DR, Kupchak BR, et al. The
effects of a roundtrip trans-American jet travel on
physiological stress, neuromuscular performance, and
recovery. J Appl Physiol. 2016;121:438–48.
33. Meir R.Managing transmeridian travel: guidelines for
minimizing the negative impact of international travel
on performance. Strength Cond J. 2002;24:28–34.
34. Sasso M. 2015. https://www.bloomberg.com/news/
articles/2015-07-06/nba-players-get-roomier-char-
tered-jets-as-delta-air-adds-teams. Accessed 28 June
2018.
35. Atkinson G, Reilly T. Circadian variation in sports
performance. Sports Med. 1996;21:292–312.
36. Montgomery PG, Pyne DB, Hopkins WG, etal. The
effect of recovery strategies on physical performance
and cumulative fatigue in competitive basketball. J
Sports Sci. 2008;26:1135–45.
37. Entine OA, Small DS.The role of rest in the NBA
home-court advantage. J Quant Anal Sports. 2008;4:6.
38. Jones MB.Home advantage in the NBA as a game-
long process. J Quant Anal Sports. 2007;3:2.
39. Sack RL.Clinical practice. Jet lag. N Engl J Med.
2010;362:440–7.
40. The Gatorade Sports Science Institute. 2018. https://
www.gssiweb.org. Accessed 15 Aug 2018.
41. Reilly T. Travel and jet lag. Melbourne, Australia:
First Australian Science in Football Congress; 1994.
42. Delextrat A, Calleja-González J, Hippocrate A,
Clarke ND.Effects of sports massage and intermittent
cold-water immersion on recovery from matches by
basketball players. J Sports Sci. 2013;31:11–9.
43. Delextrat A, Hippocrate A, Leddington-Wright S,
Clarke ND.Including stretches to a massage routine
improves recovery from ofcial matches in basketball
players. J Strength Cond Res. 2014;28:716–27.
44. Youngstedt SD, O’connor PJ. The inuence of
air travel on athletic performance. Sports Med.
1999;28:197–207.
45. Fullagar HH, Dufeld R, Skorski S, etal. Sleep and
recovery in team sport: current sleep-related issues
facing professional team-sport athletes. Int J Sport
Physiol. 2015;10:950–7.
46. Reilly T, Waterhouse J.Sports performance: is there
evidence that the body clock plays a role? Eur J Appl
Physiol. 2009;106:321–32.
47. Reilly T, Waterhouse J, Edwards B. Jet lag and air
travel: implications for performance. Clin Sports
Med. 2005;24:367–80.
48. Halson SL.Nutrition, sleep and recovery. Eur J Sport
Sci. 2008;8:119–26.
49. Samuels C.Sleep, reovery, and performance: the new
frontier in high-performance athletics. Neurol Clin.
2008;26:169–80.
50. Taylor SR, Rogers GG, Driver HS.Effects of training
volume on sleep, psychological, and selected physi-
ological proles of elite female swimmers. Med Sci
Sport Exer. 1997;29:688–93.
51. Skein M, Dufeld R, Minett G, et al. The effect of
overnight sleep deprivation after competitive rugby
league matches on postmatch physiological and
74 Long-Distance Traveling inBasketball: Practical Applications Based onScientic Evidence
946
perceptual recovery. Int J Sport Physiol Perform.
2013;8:556–64.
52. Sargent C, Halson S, Roach GD. Sleep or swim?
Early-morning training severely restricts the amount
of sleep obtained by elite swimmers. Eur J Sport Sci.
2014;14:310–5.
53. Pollard R, Gómez MA.Components of home advan-
tage in 157 national soccer leagues worldwide. Int J
Sport Exerc Psychol. 2014;12:218–33.
54. Goumas C. Home advantage in Australian soccer. J
Sci Med Sport. 2014;17:119–23.
55. Claudino J, Gabbet T, de Sá SH, etal. Which param-
eters to use for sleep quality monitoring in team sport
athletes? A systematic review and meta-analysis.
BMJ Open Sport Exerc Med. 2019;5:e000475.
56. Leathwood P. Circadian rhythms of plasma amino
acids, brain neurotransmitters and behaviour. In:
Arendt J, Minors D, Waterhouse J, editors. Biological
rhythms in clinical practice. 1st ed. London:
Butterworths; 1989. p.136–59.
57. Czeisler CA, Allan JS, Strogatz SH. Bright light
resets the human circadian pacemaker indepen-
dent of the timing of the sleep-wake cycle. Science.
1986;233:667–71.
58. Waterhouse J, Reilly T.Managing jet lag. Sleep Med
Rev. 2009;13:247–8.
59. Mednick S, Cai D, Kanady J, Drummond
S.Comparing the benets of caffeine, naps and pla-
cebo on verbal, motor and perceptual memory. Behav
Brain Res. 2008;193:79–86.
60. Jones J, Kirschen G, Kancharla S, Hale L.Association
between late-night tweeting and next-day game per-
formance among professional basketball players.
Sleep Health. 2019;5:68–71.
61. Fowler PM, Knez W, Crowcroft S, Mendham AE,
Miller J, etal. Greater effect of east vs. west travel on
jet-lag, sleep and team-sport performance. Med Sci
Sports Exerc. 2017;49:2548–61.
62. Thornton HR, Miller J, Taylor L, et al. Impact
of short-compared to long-haul international
travel on the sleep and wellbeing of national
wheelchair basketball athletes. J Sports Sci.
2017;36:1476–84.
63. Roach GD, Rogers M, Dawson D.Circadian adapta-
tion of aircrew to transmeridian ight. Aviat Space
Environ Med. 2002;73:1153–60.
64. Halson SL. Sleep in elite athletes and nutri-
tional interventions to enhance sleep. Sports Med.
2014;44:13–23.
65. Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D,
Turner RB.Sleep habits and susceptibility to the com-
mon cold. Arch Intern Med. 2009;169:62–7.
66. Kelman CW, Kortt MA, Becker NG, etal. Deep vein
thrombosis and air travel: record linkage study. Br
Med J. 2003;327:1072.
67. Heit JA, Silverstein MD, Mohr DN, etal. Risk factors
for deep vein thrombosis and pulmonary embolism:
a population-based case-control study. Arch Intern
Med. 2000;160:809–15.
68. Geerts WH, Heit JA, Clagett GP, et al.
Prevention of venous thromboembolism. Chest.
2001;119:132S–75S.
69. Jiang N. 2018. FlightFit: an application enabling air
travelers to do stretches onboard. https://scholar-
works.rit.edu/cgi/viewcontent.cgi?article=11070&co
ntext=theses. Accessed July 2019.
70. Moreira A, Arsati F, de Oliveira Lima-Arsati YB,
Simões AC, de Araújo VC.Monitoring stress toler-
ance and occurrences of upper respiratory illness in
basketball players by means of psychometric tools and
salivary biomarkers. Stress Health. 2001;27:e166–72.
71. Papacosta E, Nassis GP.Saliva as a tool for monitor-
ing steroid, peptide and immune markers in sport and
exercise science. J Sci Med Sport. 2011;14:424–34.
72. Willis KS. Vitamin D status & immune system bio-
markers in athletes. Ann Arbor, Michigan: University
of Wyoming, ProQuest Dissertations Publishing;
2008.
73. Srinivasan V, Singh J, Pandi-Perumal SR, et al. Jet
lag, circadian rhythm sleep disturbances, and depres-
sion: the role of melatonin and its analogs. Adv Ther.
2010;27:796–813.
74. O’Connor PJ, Morgan WP.Athletic performance fol-
lowing rapid traversal of multiple time zones. Sports
Med. 1990;10:20–30.
75. Kölling S, Hitzschke B, Holst T, etal. Validity of the
acute recovery and stress scale: training monitoring
of the German junior national eld hockey team. Int J
Sports Sci Coach. 2015;10:529–42.
76. Bresciani G, Cuevas MJ, Garatachea N, Molinero O,
Almar M, et al. Monitoring biological and psycho-
logical measures throughout an entire season in male
handball players. Eur J Sports Sci. 2010;10:377–84.
77. Gastin PB, Meyer D, Robinson D. Perceptions of
wellness to monitor adaptive responses to training and
competition in elite Australian football. J Strength
Cond Res. 2013;27:2518–26.
78. Taylor K, Chapman D, Cronin J, Newton MJ, Gill
N. Fatigue monitoring in high performance sport:
a survey of current trends. J Aust Strength Cond.
2012;20:12–23.
79. Casper RC.Exercise and mood. World Rev Nutr Diet.
1993;71:115–43.
80. Mah CD, Mak KE, Kezirian EJ, etal. The effects of
sleep extension on the athletic performance of colle-
giate basketball players. Sleep. 2011;34:943–50.
81. Fuller CW, Taylor AE, Raftery M.Does long-distance
air travel associated with the sevens world series
increase players’ risk of injury? Br J Sports Med.
2015;49:458–64.
T. Huyghe and J. Calleja-Gonzalez
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