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Abstract

An editorial on "Practical tips to manage travel fatigue and jet lag in athletes". Most evidence on travel fatigue and jet lag management is from non-athletic populations in laboratory settings. We aimed to provide practical tips on pre-travel, during travel and post-travel settings, based on currently available evidence. We included an infographic for ease of reference.
1
Janse van RensburgDC(Christa), etal. Br J Sports Med Month 2020 Vol 0 No 0
Practical tips to manage travel fatigue
and jet lag inathletes
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 RensburgDC(Christa), etal. 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 RensburgDC(Christa), FowlerP,
RacinaisS. 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
PeterFowler http:// orcid. org/ 0000- 0002- 5853- 9119
SebastienRacinais http:// orcid. org/ 0000- 0003- 0348-
4744
REFERENCES
1 Fowler PM, Knez W, Thornton HR, etal. Sleep hygiene
and light exposure can improve performance following
long- haul air travel. Int J Sports Physiol Perform
2020:1–10 https:// doi. org/
2 Roach GD, Sargent C. Interventions to minimize jet
lag after westward and eastward flight. Front Physiol
2019:10.
3 Janse van Rensburg DCC, Jansen van Rensburg A,
Fowler P, etal. How to manage travel fatigue and jet lag
in athletes? A systematic review of interventions. Br J
Sports Med 2020;54:960–8.
4 Janse Van Rensburg DCC, Jansen van Rensburg A,
Schwellnus MP. Coping with jet lag and protecting
athlete health when travelling. Aspetar Sports Medicine
Journal 2019;8:214–22 https://www. aspetar. com/
journal/ viewarticle. aspx? id= 474
5 Fowler PM, Knez W, Crowcroft S, etal. Greater effect of
East versus West travel on jet lag, sleep, and team sport
performance. Med Sci Sports Exerc 2017;49:2548–61.
6 Arnal PJ, Lapole T, Erblang M, etal. Sleep extension
before sleep loss: effects on performance and
neuromuscular function. Med Sci Sports Exerc
2016;48:1595–603.
7 Piérard C, Beaumont M, Enslen M, etal.
Resynchronization of hormonal rhythms after
an eastbound flight in humans: effects of slow-
release caffeine and melatonin. Eur J Appl Physiol
2001;85:144–50.
8 Halson SL. Sleep in elite athletes and nutritional
interventions to enhance sleep. Sports Med
2014;44:13–23.
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
... Sleep hygiene represents a collective range of lifestyle and environmental practices congruent with supporting sleep heath, including; circadian aligned sleep schedule consistency that ensure 7-9 hours of sleep, strategic modulation of incandescent lighting and light exposure, avoidance of activities in bed other than sleep and intimacy, maintaining regular exercise and a healthy diet, sleep-disruptor avoidance in the evening (for example, caffeine or alcohol), and prebed routines supportive of arousal reduction and relaxation (Nishinoue et al., 2012;Perlis et al., 2000). Furthermore, targeted sleep hygiene strategies for pilots such as preemptive adjustment of sleep schedule and prior to commencement of a new shift schedule or time zone arrival, specifically timed bright light exposure and/or light filtering eyewear, and tailored or modified nutrient timing (Atlantis et al., 2006;Halson et al., 2019) may support in reducing decrements in sleep quality and support jet lag recovery time (Fowler et al., 2020;Janse van Rensburg et al., 2020). Thus, sleep hygiene is a valuable element of health promotion for pilots, particularly within pilots of advanced age, where occupational circadian disruption may be compounded by natural age associated degradation of sleep quality and quantity (Li et al., 2018). ...
... Sleep hygiene represents a collective range of lifestyle and environmental practices congruent with supporting sleep heath, including; circadian aligned sleep schedule consistency that ensure 7-9 hours of sleep, strategic modulation of incandescent lighting and light exposure, avoidance of activities in bed other than sleep and intimacy, maintaining regular exercise and a healthy diet, sleep-disruptor avoidance in the evening (for example, caffeine or alcohol), and prebed routines supportive of arousal reduction and relaxation (Nishinoue et al., 2012;Perlis et al., 2000). Furthermore, targeted sleep hygiene strategies for pilots such as preemptive adjustment of sleep schedule and prior to commencement of a new shift schedule or time zone arrival, specifically timed bright light exposure and/or light filtering eyewear, and tailored or modified nutrient timing (Atlantis et al., 2006;Halson et al., 2019) may support in reducing decrements in sleep quality and support jet lag recovery time (Fowler et al., 2020;Janse van Rensburg et al., 2020). Thus, sleep hygiene is a valuable element of health promotion for pilots, particularly within pilots of advanced age, where occupational circadian disruption may be compounded by natural age associated degradation of sleep quality and quantity (Li et al., 2018). ...
... While CBT-I yields significantly more effective outcomes on sleep metrics such as duration, latency and efficiency, sleep hygiene interventions as a single therapy provide small to medium effects (Chung et al., 2018). A sleep hygiene intervention during travel and combined with light exposure following long-haul trans meridian travel has shown significant improvements in physical performance within athletes (Fowler et al., 2020), however this has yet to be tested in a cognitive performance context with pilots. Sleep restriction therapy has demonstrated moderate-to-large effect sizes for reducing night waking and enhancing sleep latency and efficiency, however the impact on daytime sleepiness is inconclusive and this strategy may not be appropriate for airline pilots (Miller et al., 2014). ...
Thesis
Full-text available
Cardiometabolic non-communicable diseases (NCD) and their major risk factors are associated with adverse acute and chronic health outcomes and may pose risks to flight safety and economic burden. Restorative sleep, healthy nutrition, and sufficient physical activity are powerful lifestyle behaviours that are fundamental for human health and well-being, and each are independently associated with NCD risk reduction. Although occupational preventive medicine research is increasing, airline pilots are largely underrepresented in the literature. Through a series of seven studies, this PhD thesis aimed to enhance the understanding of modifiable health risk factor status for airline pilots and to investigate evidence-based strategies for promoting positive health, wellness, and NCD risk factor mitigation among airline pilots. To identify priority health risks among airline pilots and to serve as a foundation for further studies within the thesis, Study One systematically explored the global literature pertaining to the prevalence of cardiometabolic health risk factors among airline pilots. Study Two investigated the prevalence and distribution of subjective and objective cardiometabolic health risk factors among New Zealand airline pilots and compared these with the general population. Study Three synthesised global literature and summarised evidence-based considerations regarding the health benefits of sleep hygiene, healthy eating, and physical activity for cardiometabolic health promotion in airline pilots and further discussed evidence-based considerations for enhancing health behaviours in this occupational group. Study Four evaluated the efficacy of a 17-week, three-component personalised sleep, healthy eating, and physical activity lifestyle intervention for enhancing self-report health parameters during the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, Study Five performed a 12-month follow-up investigation of the longitudinal effects of the 17-week intervention on self-report health parameters in addition to body mass and blood pressure management. Study Six further evaluated the effects of the three-component lifestyle intervention with utilisation of a wider range of objective cardiometabolic health parameters. Finally, Study Seven evaluated the efficacy of a smartphone-based app delivery of the three-component lifestyle intervention as a potentially scalable strategy for enhancing health and fitness parameters in airline pilots. In Study One, A total of 47 studies derived from 20 different countries among a total pooled sample of 36,454 airline pilots were reviewed. The systematic review revealed substantial prevalence of > 50% for overweight and obesity, insufficient physical activity, and elevated fatigue among airline pilots globally. Further, this study highlighted the heterogeneity in methodology and lacking quality and quantity among the current literature pertaining to airline pilots, identifying the need for further research to better understand health risk factors and risk factor mitigation strategies among airline pilots. In Study Two, the cross-sectional comparison of health risk factor prevalence between airline pilots (n = 504) and the general population (n = 2,033) identified notable and similar health risk factor prevalence between groups, with elevated prevalence of short sleep, physical inactivity, ‘at risk’ for hypertension, and lower positive self-rated health among airline pilots. Accordingly, findings called for further research to examine targeted, cost-effective intervention methods for promoting healthy body weight, managing blood pressure, and enhancing health behaviours to mitigate the risks of occupational morbidity, medical conditions causing loss of license, medical incapacity, and to support flight safety. In Study Three, the narrative review outlined occupational health risks in airline pilots, summarised the evidence on health benefits of sleep hygiene, healthy eating, and physical activity as preventive medicine, and discussed evidence-based considerations for promoting health behaviours in this occupational group. In Study Four, 38 airline pilots completed an acute 17-week personalised sleep hygiene, healthy eating, and physical activity intervention which elicited significant improvements in sleep quality and quantity, fruit and vegetable intake, and moderate-to-vigorous physical activity compared to the control group and suggested that achieving health guidelines for these behaviours promoted positive mental and physical health. Study Five, provides further support that the personalised three-component lifestyle intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviours, and perceived subjective health in overweight and obese airline pilots and may support quality of life during an unprecedented global pandemic. In Study Six, further implementation of the personalised three-component lifestyle intervention among 67 overweight airline pilots elicited significant (p = < 0.001) positive change associated with moderate to large effects sizes for objective health measures (VO2max, body mass, skinfolds, girths, blood pressure, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) at 4-months post-intervention, relative to the control group (n = 58). Lastly, Study Seven utilised a randomised control trial design to deliver a smartphone-based app three-component lifestyle intervention among 94 airline pilots, which elicited positive changes associated with trivial to large effects sizes for objective health measures (Cooper’s 12-minute exercise test, resting heart rate, push-ups, plank isometric hold) and self-report health (weekly moderate-to-vigorous physical activity, sleep quality and quantity, fruit and vegetable intake, self-rated health, and perceived stress and fatigue) at 4-months post-intervention, relative to the control group (n = 92). In summary, the studies in this thesis provide a foundation for understanding cardiometabolic health risk factor prevalence among airline pilots. Furthermore, our series of controlled clinical trials provide preliminary evidence that a personalised three-component physical activity, healthy eating, and sleep hygiene intervention can elicit short-term improvements and may promote sustained long-term positive adaptations in objective and subjective health parameters in airline pilots. These findings are important for health care professionals and researchers to provide insight regarding the efficacy of lifestyle interventions for promoting health, and to inform practices relating to disease prevention, health promotion, and public health policy making. Furthermore, in relation to the limited literature base pertaining to health behaviour intervention research among airline pilots, our findings provide novel contributions to this field.
... A recent systematic review reported that no research exists on interventions that specifically manage travel fatigue in athletes [20] with available studies limited to opinions and collective experience rather than original research [93]. While travel distance or duration may be the key factor in the magnitude of travel fatigue experienced, having an adequate period to recover from travel (e.g. a recovery window) to prepare for training or competition is critical [4] and should be accounted for in travel arrangements. ...
... Confined and uncomfortable space for a prolonged period of time Restricted movement and muscle inactivity Vibration effects from the mode of transport Physiological (external factors causing internal physiological changes) Exposure to dry cabin air and low hypobaric pressure (causing dehydration) Prolonged exposure to low air quality (impairing immunity) Prolonged exposure to mild hypoxia (reducing oxygen saturation) Experiencing sleep disturbances, due to the cabin environment (i.e. cramped conditions, light and noise) and travel schedule Impaired nutritional intake (including timing and quality) Psychological Mental monotony of a journey Concerns regarding the journey, logistics, competition and/or the destination Disruptions to daily routines Noise stress from the mode of transport and fellow passengers Home and societal influences Fulfilment/enjoyment of the craft/trade Table 3 Important information to consider in the application of travel fatigue management [2,4,82,[93][94][95][96][97][98][99][100][101][102][103] Pre-travel Sleep Protect sleep as much as possible Be well-rested before travel (e.g. sleep banking strategy) If sleep deprived avoid aiming to catch up on sleep during travel Planning Start as soon as destinations and dates of sporting events are known Identify optimal travel options (flights, rail or bus) in terms of departure and arrival times, the flow-through security, venues for eating, availability of lounges Calculate the total travel duration and stopover durations Minimise time between last "proper" sleep at the place of departure and first "proper" sleep at the destination Provide exact schedules and individual responsibilities to athletes and management in advance of travel Ensure all documentation is in order Training synchronisation Plan training load and intensity before travel to allow for expected relative rest associated with travel Illness prevention Ensure vaccinations are up to date Treat recurrent illnesses Pack prefilled WADA-approved prescription medication Replace long duration, high volume training which can be immuno-suppressive with shorter duration, high intensity sessions Refuel and rehydrate Implement an evidence-based nutrition and hydration plan to meet macro-and micro-nutrient needs as well as fluid needs well in advance of travel Focus on electrolyte replacement is required for a minority of athletes e.g. ...
... Other strategies include exercise, nutrition, melatonin analogues, sedatives and stimulants. The literature regarding recommendations on management strategies is published mainly as opinions [4,13,93,106], collective experience manuscripts [3,5,21,121], laboratory research studies on how to induce a phase shift [122][123][124][125] and laboratory research studies on how to recover from a phase shift [20,48,49]. Considering the literature referenced in this consensus paper, extrapolating evidence from healthy community and military populations and following the findings of a recent systematic review [20], the author group collectively summarised current recommendations based on consensus (Table 4, Figs. 4, 5 and 6). ...
Article
Full-text available
Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.
... Sleep hygiene represents a collective range of lifestyle and environmental practices congruent with supporting sleep heath, including; circadian aligned sleep schedule consistency that ensure 7-9 hours of sleep, strategic modulation of incandescent lighting and light exposure, avoidance of activities in bed other than sleep and intimacy, maintaining regular exercise and a healthy diet, sleep-disruptor avoidance in the evening (for example, caffeine or alcohol), and pre-bed routines supportive of arousal reduction and relaxation [71,72]. Furthermore, targeted sleep hygiene strategies for pilots such as preemptive adjustment of sleep schedule and prior to commencement of a new shift schedule or time zone arrival, specifically timed bright light exposure and/or light filtering eyewear, and tailored or modified nutrient timing [73,74] may support in reducing decrements in sleep quality and support jet lag recovery time [75,76]. Thus, sleep hygiene is a valuable element of health promotion for pilots, particularly within pilots of advanced age, where occupational circadian disruption may be compounded by natural age associated degradation of sleep quality and quantity [77]. ...
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Background: Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots. Methods: Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies. Results: The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots. Conclusion: This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.
... 28 The desynchronization of the circadian system to new environment requires time to adjust. 30 Therefore, the repeated travel across time zones for the length of an 82matchs season in the NBA and the NHL 14,25 and 162-matchs season in the Major League Baseball (MLB) will inevitably cause a chronic desynchronization of the circadian system in athletes. In addition to this chronic desynchronization, travel fatigue will parallelly accumulate throughout the season. ...
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Sleep health is an important consideration for athletic performance. Athletes are at high risk of insufficient sleep duration, poor sleep quality, daytime sleepiness and fatigue, suboptimal sleep schedules, irregular sleep schedules, and sleep and circadian disorders. These issues likely have an impact on athletic performance via several domains. Sleep loss and/or poor sleep quality can impair muscular strength, speed, and other aspects of physical performance. Sleep issues can also increase risk of concussions and other injuries and impair recovery after injury. Cognitive performance is also impacted in several domains, including vigilance, learning and memory, decision making, and creativity.
... 28 The desynchronization of the circadian system to new environment requires time to adjust. 30 Therefore, the repeated travel across time zones for the length of an 82-matchs season in the NBA and the NHL 14, 25 and 162-matchs season in the Major League Baseball (MLB) will inevitably cause a chronic desynchronization of the circadian system in athletes. In addition to this chronic desynchronization, travel fatigue will parallelly accumulate throughout the season. ...
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Sleep is recognized as an essential component to optimize health and human performance, and as such the topic is of increasing interest to athletes. Yet, the sleep of athletes is affected by multiple sports-specific and societal factors. Hence the recent emergence of the important role of sleep science in athlete health and performance. This review focuses on the fundamentals of sleep physiology and elaborates on the affects sleep has on athlete health and performance. Despite sports practitioners recognizing the importance of sleep on health and performance, findings report that insufficient sleep and poor sleep quality are prevalent among athletic populations. This paper will describe sleep in athletes, define sleep characteristics, discuss the impact of sleep restriction following travel and competition, and strategies to mitigate sleep difficulties. Sleep is arguably the most undervalued pillar of health and performance.
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Background: Sleep is one of the basic needs needed by humans so that the body can function normally. Sleep quality and quantity can be affected by changes in time zones. When someone travels transmeridianly through longitudes and enters a new time zone, there will be flight dysrhythmias or jet lag. This can occur when there is an imbalance between the body's circadian structure and the day to night cycle in the destination area. This study aims to determine the effect of changing time zones on sleep quality in international students. Methods: Non-experimental quantitative research using the cross-sectional correlational descriptive research method was conducted online for one month, from January to February 2023. The sample collection technique used was purposive sampling. Data was collected using the PSQI and LJLQ questionnaires. Research data were analyzed using SPSS version 25.0. Results: Most of the subjects in this study were female (52.72%). As many as 91.8% of international students were found to have poor sleep quality. Meanwhile, 86.4% of international students experience jet lag, which is divided into moderate levels of jet lag (47.3%) and very high levels of jet lag (39.1%). Bivariate analysis showed that there was a significant correlation between jet lag and the sleep quality of international students (p=0.001). Conclusion: Most international students are found to experience jet lag and have poor sleep quality. Changes in time zones assessed through the level of jet lag were found to have a significant effect on the quality of sleep for international students. Latar belakang: Tidur merupakan salah satu kebutuhan pokok yang dibutuhkan oleh manusia agar tubuh dapat berfungsi dengan normal. Kualitas dan kuantitas tidur dapat dipengaruhi oleh perubahan zona waktu. Ketika seseorang melakukan perjalanan transmeridian melalui garis bujur dan masuk dalam zona waktu yang baru, maka akan terjadi disritmia penerbangan atau jet lag. Hal ini dapat terjadi ketika terjadi ketidakselarasan antara struktur sirkadian tubuh dengan siklus siang ke malam pada daerah tujuan. Penelitian ini bertujuan untuk mengetahui pengaruh perubahan zona waktu terhadap kualitas tidur pada mahasiswa internasional. Metode: Penelitian kuantitatif non-eksperimental dengan metode penelitian deskriptif korelatif cross-sectional dilakukan secara dalam jaringan selama satu bulan pada bulan Januari–Februari 2023. Teknik pengumpulan sampel yang digunakan adalah purposive sampling. Data dikumpulkan menggunakan kuesioner PSQI dan LJLQ. Data hasil penelitian dianalisis menggunakan program SPSS ver. 25.0. Hasil: Sebagian besar subjek dalam penelitian ini berjenis kelamin perempuan (52,72%). Sebanyak 91,8% mahasiswa internasional ditemukan memiliki kualitas tidur yang buruk. Sementara itu, sebanyak 86,4% mahasiswa internasional mengalami jet lag yang terbagi ke dalam tingkatan cukup jet lag (47,3%) dan sangat jet lag (39,1%). Analisis bivariat menunjukkan bahwa terdapat korelasi yang signifikan antara jet lag dengan kualitas tidur mahasiswa internasional (p=0,001). Kesimpulan: Sebagian besar mahasiswa internasional ditemukan mengalami jet lag dan memiliki kualitas tidur yang buruk. Perubahan zona waktu yang dinilai melalui tingkat jet lag ditemukan berpengaruh secara signifikan terhadap kualitas tidur pada mahasiswa internasional.
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Purpose: To assess the efficacy of a combined light exposure and sleep hygiene intervention to improve team-sport performance following eastward long-haul transmeridian travel. Methods: Twenty physically trained males underwent testing at 09:00 and 17:00 hours local time on 4 consecutive days at home (baseline) and the first 4 days following 21 hours of air travel east across 8 time zones. In a randomized, matched-pairs design, participants traveled with (INT; n = 10) or without (CON; n = 10) a light exposure and sleep hygiene intervention. Performance was assessed via countermovement jump, 20-m sprint, T test, and Yo-Yo Intermittent Recovery Level 1 tests, together with perceptual measures of jet lag, fatigue, mood, and motivation. Sleep was measured using wrist activity monitors in conjunction with self-report diaries. Results: Magnitude-based inference and standardized effect-size analysis indicated there was a very likely improvement in the mean change in countermovement jump peak power (effect size 1.10, ±0.55), and likely improvement in 5-m (0.54, ±0.67) and 20-m (0.74, ±0.71) sprint time in INT compared with CON across the 4 days posttravel. Sleep duration was most likely greater in INT both during travel (1.61, ±0.82) and across the 4 nights following travel (1.28, ±0.58) compared with CON. Finally, perceived mood and motivation were likely worse (0.73, ±0.88 and 0.63, ±0.87) across the 4 days posttravel in CON compared with INT. Conclusions: Combined light exposure and sleep hygiene improved speed and power but not intermittent-sprint performance up to 96 hours following long-haul transmeridian travel. The reduction of sleep disruption during and following travel is a likely contributor to improved performance.
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Objectives We investigated the management of travel fatigue and jet lag in athlete populations by evaluating studies that have applied non-pharmacological interventions (exercise, sleep, light and nutrition), and pharmacological interventions (melatonin, sedatives, stimulants, melatonin analogues, glucocorticoids and antihistamines) following long-haul transmeridian travel-based, or laboratory-based circadian system phase-shifts. Design Systematic review Eligibility criteria Randomised controlled trials (RCTs), and non-RCTs including experimental studies and observational studies, exploring interventions to manage travel fatigue and jet lag involving actual travel-based or laboratory-based phase-shifts. Studies included participants who were athletes, except for interventions rendering no athlete studies, then the search was expanded to include studies on healthy populations. Data sources Electronic searches in PubMed, MEDLINE, CINAHL, Google Scholar and SPORTDiscus from inception to March 2019. We assessed included articles for risk of bias, methodological quality, level of evidence and quality of evidence. Results Twenty-two articles were included: 8 non-RCTs and 14 RCTs. No relevant travel fatigue papers were found. For jet lag, only 12 athlete-specific studies were available (six non-RCTs, six RCTs). In total (athletes and healthy populations), 11 non-pharmacological studies (participants 600; intervention group 290; four non-RCTs, seven RCTs) and 11 pharmacological studies (participants 1202; intervention group 870; four non-RCTs, seven RCTs) were included. For non-pharmacological interventions, seven studies across interventions related to actual travel and four to simulated travel. For pharmacological interventions, eight studies were based on actual travel and three on simulated travel. Conclusions We found no literature pertaining to the management of travel fatigue. Evidence for the successful management of jet lag in athletes was of low quality. More field-based studies specifically on athlete populations are required with a multifaceted approach, better design and implementation to draw valid conclusions. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019126852).
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Purpose: Determine the recovery timeline of sleep, subjective jet-lag and fatigue, and team-sport physical performance following east and west long-haul travel. Methods: Ten, physically-trained males underwent testing at 09:00 (AM) and 17:00 (PM) local time on four consecutive days two weeks prior to outbound travel (BASE), and the first four days following 21 h of outbound (WEST) and return (EAST) air travel across eight time-zones between Australia and Qatar. Data collection included performance (countermovement jump [CMJ], 20-m sprint and Yo-Yo Intermittent Recovery level 1 [YYIR1] test) and perceptual (jet-lag, motivation, perceived exertion and physical feeling) measures. In addition, sleep was measured via wrist activity monitors and self-report diaries throughout the aforementioned data collection periods. Results: Compared to the corresponding day at BASE, the reduction in YYIR1 distance following EAST was significantly different to the increase WEST on day 1 post-travel (p<0.001). On day 2, significantly slower 20-m sprint times were detected in EAST compared to WEST (p=0.03), with large effect sizes also indicating a greater reduction in YYIR1 distance in EAST compared to WEST (d=1.06). Mean sleep onset and offset were significantly later and mean time in bed and sleep duration were significantly reduced across the four days in EAST compared to BASE and WEST (p<0.05). Lastly, mean jet-lag, fatigue and motivation ratings across the four days were significantly worse in EAST compared to BASE and WEST (p<0.05), and WEST compared to BASE (p<0.05). Conclusions: Long-haul transmeridian travel can impede team-sport physical performance. Specifically, travel east has a greater detrimental effect on sleep, subjective jet-lag, fatigue and motivation. Consequently, maximal- and intermittent-sprint performance is also reduced following travel east, particularly within 72 h following arrival.
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