THE TRAVELING ATHLETES OVERCOMING CHALLENGES

Dr. Ahmed Sayed Khashaba, MD. MSc. PhD.

Assistant Professor-Physiology Medicine (RCsDP)

Sports & Exercise Medicine - University of BATH (UK)

Member of the Education Commission of

the International Federation of Sports Medicine (FIMS)

TRAVELING WITH ATHLETES

AND OVERCOMING

CHALLENGES

Website: https://sites.google.com/a/riyadh.edu.sa/dr-ahmedkhashaba/

Dear respected Chairman, respected Professors and

Colleagues,

First of all, I would like to thank the organizing

committee for inviting and giving me the opportunity

to share my practical experience with all of you.

Despite my academic commitment in doing research

and teaching physiology to medical students, I really

enjoy serving as a team physician to various national

teams for fifteen years. Working as a team physician

actually provided me an immense benefit for being

able to bridge the gap between theory and practice.

Copy right Dr. Ahmed Khashaba, 2015

Outlines:

Knowledge base of the team physician.

Responsibilities of the team physician.

Travelling with the team.

Overcoming common traveling challenges.


Knowledge base of team physician

1- (M.B.,B.Ch.) in Medicine and Surgery in good standing, with an unrestricted license.

Musculoskeletal system (Traumatology)

Growth and development

Emergency care & Advanced life support

Internal Medicine

Physical Medicine

Pharmacology (Doping substances)

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Knowledge base of team physician (continued)

2- Exercise science Exercise Physiology Sports Nutrition Applied Biomechanics Sports Psychology Sports Ethics Specific sports-terminology

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Knowledge base of team physician (continued) “PREVENTION IS BETTER THAN CURE”

(Desiderius Erasmus, 1500)

Intrinsic risk factors

Previous injury.

Poor conditioning/muscular imbalances.

Anatomical abnormalities.

Nutritional factors.

Growth (in children).

Extrinsic risk factors

Training errors, including abrupt increases in intensity, duration, or frequency of training.

Inappropriate workout structure.

Improper floors or footwear.


Responsibilities of team physician include:

Pre-participation health screening and examination.

Assessment and management of athletic injuries both on the field and field side; triage.

Supervision of athlete’s rehabilitation and return to play.

Participating in a sports medicine society.

Teaching and publishing research papers in the field of sports medicine.

Condemning the use of artificial performance enhancement and counselling the athletes on substance abuse.

Preparation for traveling with the team.

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Traveling with the team

Traveling with the team

Pre-event

Visit site in advance to avoid any potential hazards facing the team.

Clarify roles and responsibilities of the medical team members.

Clarify IMMUNIZATION, INSSURANCE and DOPING PASSPORT issues in advance.

Educational activities are organized in relation to nutrition, doping, jet lag, travelling, rest and recovery, environmental aspects, sexually transmitted diseases, injury prevention etc.. An information kit for the athletes is recommended.


Traveling with the team (continued)

During traveling

Medical care of athletes and delegation during travelling is

generally neglected. However, especially during long air

travels, there could be health issues like motion sickness,

anxiety, sleep disturbance, gastrointestinal complaints,

headache. Travel medical bag should contain necessary

medications for all these problems and the physician should

be well prepared for such complaints.

Banned medications should be separated from the medical

bag.


Traveling with the team (continued)

During the games Effective communication with all medical staff,

coaches, athletes, and team officials is paramount during the excitement of competition. Be prepared to treat, educate, advocate for, and listen to athletes during their highest highs (victory) and lowest lows (defeat or injury).

Be prepared for drug testing asked for any athlete at any time by thorough understanding of the WADA policies and procedures, and being aware of the team physician role in the proceedings.

(FIMS Team Physician Manual, 2013)


Professionalism

The conduct and dress of a team

physician should reflect that of a medical professional rather than a teammate.

Confidentiality of the athlete must always be respected and preserved in front of the media. No medical details to be provided to the media without explicit consent from the athlete.


Code of ethics

Always make the health of the athlete a priority.

Never do harm.

Never impose your authority in a way that impinges on the individual right of the athlete to make his/her own decisions.

“Do not sacrifice the welfare of the athlete to the welfare of the team”

Do not allow medical decisions to be influenced by third parties.


OVERCOMING COMMON TRAVELING CHALLENGES

A conscientious, well-prepared team physician can provide a healthy environment, which may increase the confidence of the athletes in their performance and reduce the consequences of sports injuries if they occur.

In the following slides, I am going to focus on common environmental challenges that might face the athletes and how it could be managed by the team physician.


JET LAG

Recent well conduced scientific studies showed that

west-east travel across 6 time zones result in a

decrease in athletic performance of approximately 10%.


It is important for the team physician traveling with

athletes to be aware of the detrimental effect of jet lag

on sports performance, and how to minimize its effect

in athletes.


Practical guidelines to minimize the

effects of Jet lag on athletes

Arrive at the destination at least one day early for each time

zone crossed. However, allow14 days for resynchronization

if the time zone difference is greater than 6 hours.

Attempt to partially synchronize sleep/wake cycles and

meals a few days before departing ( for East-West flights this

means going to bed later).

Indulge in social and exercise activity (training sessions)

immediately after arriving at the destination.

Avoid alcohol during flights.


Practical guidelines to minimize the effect of Jet lag on

athletes (continued)

Travel in one direction when competing at different venues on

an extended trip.

Chronobiotic drugs such as Melatonin may be used.

Melatonin capsules taken in the evening for a few days before

departing (at local time) and after arrival (at local time) may well

facilitate resynchronization. When administrated under this

schedule, melatonin has been shown to reduce the symptoms of

jet lag in both west-east and east-west travel directions.



HEAT ACCLIMATIZATION

Only ~20% of the oxygen consumption during

exercise is converted to mechanical work, whereas

~80% ends up as heat, the major metabolic by

product of strenuous exercise. While much of this

heat is dissipated, at high intensities of exercise and

when the environmental temperature and/or

humidity are elevated, there can be a significant

increase in body core temperature (hyperthermia)

that can cause fatigue and, in extreme cases, death.


Preventing strategies for reducing heat injuries

Identify the athletes who are at risk of heat illnesses.

The acclimatization procedure should be settled

gradually for the athletes over 10-14 days.

Check environmental conditions before and during the

activity by monitoring the wet bulb and globe

temperature (WBGT), and modify activity accordingly.

For example: if the (WBGT) index is above 32.2 ºC all

activities should be stopped, while distance running

may not be allowed when the (WBGT) index exceeds

27.8 ºC. (FIMS Team Physician Manual, 2013)


Weight loss should not be more than 2-3% of body

weight during exercise and it is recommended that the

athlete consume 1 to 1.5 liters of fluid for each

Kilogram weight loss.

Athletes should drink about 500ml of fluid about 2

hours before exercise.

Inclusion of sodium and carbohydrates (6%) in the

rehydration fluid is recommended for exercise events of

duration greater than one hour.

Cooling therapy in case of mild or severe heat illnesses.

Preventing strategies for reducing heat injuries

(continued)


ACCLIMATIZAION TO ALTITUDE

Sleep High and Train Low

Living (or sleeping) high and training low appears to be an

effective way to enhance performance in elite athletes. It is

legal in the context of rules relating to doping and

support. The changes in hemoglobin, red blood cell count

and hematocrit are modest and unlikely to exceed the

absolute standards for hemoglobin (16.0 g/100 ml) and

hematocrit (50%) permitted in international competition.

An alternative to residing at high altitude may be provided

by the use of commercially available "altitude tents".

These allow individuals to sleep in a decompressed or

hypoxic environment while continuing to train in the

daytime at low altitude..


Prevention Strategies for Air Pollution


Training should be scheduled at times associated with the

least air pollution by following the air quality meteorological

news.

When ambient Ozone level is high, do exercise in the

morning or at night. The peak ozone level is around 3 PM.

Activated carbon face masks can be used in urban

environment.

Do exercise preferably in parks or along the ocean.



(continued)

Consider wind direction and run or ride on the

up-wind side.

Keep 10-15 meters distance away of the

exhaust pipes of cars during highway training.

Ingesting some antioxidants such as vitamin C

and E are recommended.



Finally, the team physician has a very

important responsibility to the athletes under

his/her care. Proper training, preparation,

and behavior are fundamental to the task for

the caring and successful team physician.



Thank You For Your Attention!

THE TRAVELING ATHLETES OVERCOMING CHALLENGES

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