Illustration by Christy Hill

For many people, the notion of what constitutes an Olympic athlete is a mix of superb genetic underpinnings, incredible physical strength and endurance, and the focus and ambition to subscribe to years of grueling training and tough competition. Perhaps  we  can  also  add  such  attributes  as  passion,  commitment,  unwavering family support, and involvement in many different sports and activities at a young age. But is this the full equation? Certainly this is a great start, but in order to be the world's best, today's elite athletes increasingly require the expertise and integration of the world's top sport scientists, engineers, and healthcare teams to achieve the pinnacle of their sport.

The creation of sport science/medical teams that comprehensively monitor and support athletes in their journey have become recent staples in the quest to be the best. The "Integrated Support Team," or IST, is terminology coined by the Canadian Sport Centres to encompass the concept of a truly integrated multidisciplinary team of dedicated professionals. These teams are now widely enlisted with many of the national sport organizations (e.g., bobsleigh, skeleton, speed skating, alpine, etc.) throughout Canada. Consisting of sport-specialized experts, such as strength and condition trainers, nutritionists, chiropractors, physio and massage therapists, physicians, psychologists, sport scientists, and others, depending on the sport, these dedicated professionals formulate an all-encompassing strategic plan, pushing past limitations to aid the athletes in striving for ultimate performance potential. Although the concept is not entirely new, Canada's ISTs have become significantly more extensive and, with new innovations and technological advancements, have made this support system a more precise and regular part of any high-performance program. In essence, the IST serves to provide detailed information at both the individual athlete and group levels in order to assist coaches in making informed decisions regarding training effects and consequent planning, particularly with regard to the approach to key competitions.

Comprehensive Monitoring within the IST
For decades, terms such as periodization, planning, and sequencing have been concepts that elite athletes have lived by in everyday life. However, it has not been until more recent times (at least in North America) that this training and competition regime has been supported by a more comprehensive and tiered ongoing monitoring program through the IST.

The increased utilization of sport psychologists has expanded such monitoring programs beyond the purely physical to involve and integrate key psychological perspectives. This has led to a greater realization and acceptance that psychological skills and emotional competencies are critical factors in achieving a high level of performance outcome, as well as accentuating a potential competitive edge. In addition, it is obvious that the psychological factors of motivation and stress management are imperative to improving the positive outcomes to a particular athlete's training prescription. These aspects, in conjunction with enhanced technological innovations and a greater acceptance of physiological data, have made the sport scientist a key figure in the monitoring template.

Through a combination of scientific study and expert opinion, coaches and athletes are provided with robust, qualitative and quantitative information regarding the athlete's response to training, particularly from a physiological perspective. Certainly, some physiological markers are well established in terms of gauging training volume and performance. Parameters such as oxygen update, heart rate, and blood lactate concentration (among others) are well-entrenched indicators to evaluate an athlete's status. However, more recent utilization of technological innovations have allowed for the implementation of simple and fast diagnostic tools, particularly in the area of blood-borne markers of training response, heart-rate variability (that is, beat-by-beat chronological variation), and neuromuscular excitability.

So, what does this mean? We can, more than ever before, provide truly meaningful and precise physiological information on the athlete's state of well-being. In this way, a wide array of detailed biochemical and physiological information can assist in making informed decisions regarding the effects and consequent planning of training. These aspects are then supported by, or provide support to, the information provided to the coaches and the rest of the IST by the psychological team.

Monitoring through Science and Technology
As previously mentioned, national sport teams and national sport organizations have really begun to commonly embrace sport scientists as key figures in support of their athletes and coaches via the IST concept. Sport scientists serve to provide guidance and commentary concerning elements such as the design of suitable training regimes, sport-specific biomechanics and technical critique, competition rehearsal, as well as in evaluating a myriad of performance markers used to assist in the determination of training response and competitive readiness. One particular area of interest and focus has been that of blood-borne parameters that are of relevance to the training process. A truly advanced method of monitoring the athlete's response to all global stressors, whether it be psychological or physiological, the process typically involves drawing a small blood sample and teasing out the various indicators ("markers") of interest. Through keen examination, scientists can delve into the body's chemical and hormonal response.  Knowing what an ideal state is for each athlete, we can tweak training programs and alter perspective to non-training stresses to maintain the athlete's forward progress with respect to a target performance. It is essential to note that this evaluation process is layered upon the existing training in place and incorporated into the training and competition programs in a non-intrusive manner.

1. Glutamine (Gm)/Glutamate Ratio (Ga): Glutamine is the most abundant free amino acid in the blood, but under high stress loads (physical or psychological), the demand for glutamine exceeds the body's ability to make it. Glutamate, a salt of glutamic acid, is a major excitatory neurotransmitter of the central nervous system. The Gm/Ga blood concentration ratio may be used as an indicator of tolerance to training. For example, athletes that have a relatively low Gm/Ga ratio particularly after a rest and recovery period appear to be more susceptible to over-reaching and overtraining than those athletes who have high ratios. This occurrence would lead to a training program modification to best meet the individual athlete needs.

2.  Norepinephrine: As a stress hormone, norepinephrine affects attention and responding actions, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle tissue. Low levels may indicate the direct overstress of training on the body and the requirement of a program alteration.

3.  Testosterone: This hormone plays a key role in health and well-being and has many anabolic effects, including the growth of muscle mass and strength, and increased bone density and strength. Among many other negative effects, low levels can reduce athletic performance.

4.  Iron: Iron is important for an athlete because it is a component of hemoglobin, which transports oxygen from the lungs to muscle cells via the blood. Some athletes, especially women or vegetarians, may not get enough iron in their diet. Furthermore, intense training can result in iron loss through red blood cell damage, and even high rates of sweating may contribute to an overall loss, as well. Iron deficiency can lead to fatigue, lack of energy, high exercise heart rate, frequent injury, and increased recovery time. If low iron levels are observed in a particular athlete, the sport medicine specialists belonging to a particular IST will recommend a particular course of action to remedy the situation.

5.  Serum Ferritin: A protein that helps store iron in the body, decreased levels serve as an early warning sign of declining stores of body iron.

6.  Salivary Immunoglobulin-A (IgA): An immunoglobulin present in saliva, salivary immunoglobulin-A may help protect the upper respiratory tract from infection. Very intense exercise is associated with a drop in salivary immunoglobulin-A concentration, but the level usually returns to normal a few hours after the exercise has stopped. However, an inappropriately high training load can prolong the effect, resulting in a chronic state of immune-suppression that makes the over-reached/overtrained athlete particularly vulnerable to viral infections.

7.  Serum Albumin: The most abundant blood plasma protein, serum albumin is important in regulating blood volume by maintaining the pressure of the blood compartment. High albumin is almost always caused by dehydration; a concept in sport medicine that has been highly investigated in recent years. From these few examples, it is clear that an athlete's biochemical profile can assist a coach or sport scientist in characterising athletes for specific suitable training regimes. Undertaken at appropriately spaced and frequent intervals within the athlete's training and competition regime, the body's response can be mapped and training design modified to ensure the athlete is better prepared for high-performance execution specific to their sport.

Summary
As the 2010 Olympic Winter Games in Vancouver approach, many of our coaches and athletes have taken the next step in highly specialized sport science. To a higher degree than previously achieved, teams have better utilized scientific innovations within the framework of the Integrated Support Team to best serve the athlete's interests. With a minimally intrusive and specialized systematic monitoring program intertwined, the ISTs have designed modern and innovative ways to focus efforts on effective recovery and adaptation for enhanced performance.

In addition to a strong training and conditioning basis, the inclusion of a solid psychological platform, coupled with a sound technical execution capability and an appropriate tactical awareness, housed within a healthy and well-fuelled body, provide the "launch pad" for an optimal performance outcome. However, the key to success does not simply lie in training hard, but in training purposely and carefully. Through a focused use of expertise and scientific knowledge, Canada's athletes are optimizing their physical and mental attributes to perform at their best when it counts the most.

"Go, Canada, Go!"

About the Authors
Steve Norris, Ph.D., is director of sport physiology and strategic planning at the Canadian Sport Centre Calgary, and adjunct assistant professor, Faculty of Kinesiology, University of Calgary.

Dr. Greg Uchacz, D.C., FCCSS(C), CSCS, FICC, is clinic director of the Chiropractic Performance and Sports Therapy Centre in Calgary, and member of the Canadian Medical Team for the Vancouver 2010 Olympic Winter Games.

"Testing for Excellence" first appeared in the January/Februray 2010 Olympic Issue of IMPACT Magazine.