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Janse van RensburgDC(Christa), etal. Br J Sports Med Month 2020 Vol 0 No 0
Practical tips to manage travel fatigue
and jet lag inathletes
Dina Christina (Christa) Janse van Rensburg ,1 Peter Fowler ,2
Sebastien Racinais 3
Travel forms an integral part of
modern- day athletes lives. The interre-
lated effects of travel fatigue, jet lag and
increased risk of illness, are likely to affect
performance unless managed appropri-
ately.1 Travel fatigue follows any long
journey and resolve following a good
night’s sleep, but can accumulate with
frequent travel.2 Jet lag ensues misalign-
ment between the internal circadian
rhythms and new destination time after
rapid travel across more than three time
zones,2–4 resulting in sleep disruption,
daytime fatigue and gastrointestinal
disturbances.3 5 Sleep loss appears to be
central to the detrimental impact of long-
haul travel on performance.5 Additionally,
circadian rhythms of numerous psycho-
logical and physiological variables with a
typical early- morning nadir and late after-
noon peak will be misaligned to the new
destination time, which, depending on
time of competition, could affect perfor-
mance directly.5
Recovery from jet lag requires resyn-
chronisation of the human circadian
systems to the new light–dark cycle.2
Various peripheral rhythms resynchronise
at different rates but internal desynchro-
nisation progressively disappear as all
rhythms synchronise to local time,5 prob-
ably explaining why athletes often feel
worse on day 2–4 compared with day 1
of arrival. The circadian system needs to
either advance (east travel) or delay (west
travel) depending on travel direction.2
Eastward travel is generally tougher as
endogenous circadian rhythms have an
~25 hours period making it harder to
advance than delay your circadian system.3
Resynchronisation takes approximately
1 and 0.5 days respectively per east and
west time- zone crossed.3 Athletes require
a comprehensive travel management plan
to minimise impact on performance.4
Most evidence on travel fatigue and
jet lag management is from non- athletic
populations in laboratory settings.3 Inter-
ventions commonly promoted include:
light exposure/avoidance, sleep, exer-
cise, nutrition, melatonin, stimulants and
sedatives.3 Their application and timing
depends on number of time- zones crossed,
travel direction, length of stay and indi-
vidual chronotype.2 Illness prevention
may seem unrelated to travel fatigue and
jet lag management, but if an athlete
contracts illness both conditions may be
aggravated.4 Based on currently available
evidence, practical tips include (figure 1
explains detail):
1. Pretravel
►Protect sleep—minimise accumulation
of sleep debt and/or bank sleep.1 5 6
►Determine core body temperature
minimum (CBTmin) as the majority of
jet lag interventions are based around
this.2 Assessing CBTmin requires
continuous core body temperature
(CBT) measurement (eg, ingestible
temperature pill), but are invasive,
time- consuming and costly. In the
field, an estimated value can be calcu-
lated based on habitual timing of sleep
and wake.2 If travelling with a team,
individualised timing of interventions
is not feasible. Currently, the best
practice- led option is to calculate the
teams’ average CBTmin and apply
interventions accordingly.2
►In individual cases with known
gastrointestinal disturbances, the
team doctor may consider to use
probiotics.4
2. During travel
►Protect sleep—maximise rest and
sleep during a ‘sleep window’ corre-
sponding to night- time at place of
departure and when it is easier to
initiate sleep.1 5 Sedative usage should
be individualised and only by doctor’s
order.
►Implement illness prevention strate-
gies.4 Avoid touching areas known to
carry micro- organisms, and frequently
wipe those areas clean, for example,
tray table.
►Drink to thirst, avoid alcohol and
caffeine, and ensure frequent move-
ment around the plane.4
3. Post- travel
►Plan light exposure and/or avoidance
around CBTmin, depending on timing
for east versus west.2
►If feasible, coincide training sessions
with light exposure. Although sunlight
is the best option, indoor training with
the aid of artificial light may be an
alternative when dark outside. Keep
training intensity low for the first few
1Section Sports Medicine, University of Pretoria,
Pretoria, South Africa
2School of Exercise and Nutrition Sciences, Queensland
University of Technology, Brisbane, Queensland,
Australia
3Research Education Centre, Aspetar Orthopaedic and
Sports Medicine Hospital Research Department, Doha,
Ad- Dawhah, Qatar
Correspondence to Professor Dina Christina (Christa)
Janse van Rensburg, Section Sports Medicine, University
of Pretoria, Pretoria 0002, South Africa;
christa. jansevanrensburg@ up. ac. za
Editorial
Figure 1 How to manage travel fatigue and jet lag in athletes.
by copyright. on November 18, 2020 at University of Pretoria. Protectedhttp://bjsm.bmj.com/Br J Sports Med: first published as 10.1136/bjsports-2020-103163 on 18 November 2020. Downloaded from
2Janse van RensburgDC(Christa), etal. Br J Sports Med Month 2020 Vol 0 No 0
Editorial
days building up to higher intensity
and skill- specific training.2
►Melatonin has both chronobi-
otic (circadian phase- shifting) and
hypnotic (sleep- inducing) proper-
ties. Product availability, dosages and
purity differ between countries. Team
doctors should be cautious and pref-
erably use known products.7 The effi-
cacy of melatonin for the treatment of
jet lag has recently been questioned.
►Protect sleep—follow a sleep schedule
and adjust sleep timings as the body
clock adjusts to the new time- zone.
Use sleep hygiene interventions and
supplement night- time sleep with a
daytime nap (this can correspond
with light avoidance).1 Sedatives,
specifically short- acting (eg, zolpidem
10 mg), may be an option in athletes
previously tolerating the drug with
no adverse events.4 Athletes should
adhere to the most recent WADA
regulations for all pharmacological
interventions.
►Implement illness prevention
strategies.4
►Caffeine may be used to increase alert-
ness and manage daytime fatigue.7
►Meal timing and meal composition
may help to reduce jet lag symp-
toms. Schedule meals according to
destination time. Consume protein-
rich meals to help with alertness and
carbohydrate- rich meals to induce
drowsiness.8
We recommend that practitioners focus
first on the easier to implement interven-
tions that help treat the symptoms of jet lag
(ie, protecting sleep) and prevent illness,
before employing more difficult interven-
tions such as accelerating the adjustment
of the circadian system to the new time
zone. Considering cost of travel research,
multicentre studies should be conducted
using standardised, simple measures in
athletes who travel frequently.
Twitter Dina Christina (Christa) Janse van Rensburg
@ChristaJVR, Peter Fowler @fowlerp85 and Sebastien
Racinais @ephysiol
Acknowledgements Audrey Jansen van Rensburg.
Contributors DC(C)JvR: manuscript (first draft),
manuscript editing, infographic finalisation. PF:
manuscript editing, infographic development,
infographic finalisation. SR: manuscript editing,
infographic finalisation.
Funding The authors have not declared a specific
grant for this research from any funding agency in the
public, commercial or not- for- profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned;
externally peer reviewed.
© Author(s) (or their employer(s)) 2020. No commercial
re- use. See rights and permissions. Published by BMJ.
To cite Janse van RensburgDC(Christa), FowlerP,
RacinaisS. Br J Sports Med Epub ahead of print:
[please include Day Month Year]. doi:10.1136/
bjsports-2020-103163
Accepted 6 November 2020
Br J Sports Med 2020;0:1–2.
doi:10.1136/bjsports-2020-103163
ORCID iDs
Dina Christina (Christa)Janse van Rensburg http://
orcid. org/ 0000- 0003- 1058- 6992
PeterFowler http:// orcid. org/ 0000- 0002- 5853- 9119
SebastienRacinais http:// orcid. org/ 0000- 0003- 0348-
4744
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by copyright. on November 18, 2020 at University of Pretoria. Protectedhttp://bjsm.bmj.com/Br J Sports Med: first published as 10.1136/bjsports-2020-103163 on 18 November 2020. Downloaded from