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individual&#44; de manera que l&#8217;abordatge pugui ser diferent&#44; d&#8217;acord amb la gen&#232;tica&#44; per&#242; sobretot amb expressi&#243; adequada dels gens esmentats o de <span class="elsevierStyleItalic">l&#8217;epigen&#232;tica</span>&#44; que inclou la valoraci&#243; dels diferents efectes de les c&#224;rregues de treball sobre els par&#224;metres de rendiment f&#237;sic&#44; mesurats mitjan&#231;ant GPS&#44; la composici&#243; corporal&#44; una nutrici&#243; saludable&#44; el descans i el control mental&#44; originant el fenotip de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> Cada vegada hi ha m&#233;s biomarcadors que permeten valorar si ha existit una adaptaci&#243; adequada a l&#8217;esfor&#231;&#44; que mostren una millora progressiva o en canvi un augment dels indicadors d&#8217;inflamaci&#243;&#44; sobreentrenament i risc de lesi&#243;&#46; &#201;s important no considerar els diferents marcadors d&#8217;una manera a&#239;llada i independent entre si&#44; sin&#243; valorar la situaci&#243; d&#8217;una manera global prenent els mesuraments en els moments m&#233;s adequats&#44; amb una perspectiva dels canvis&#44; d&#8217;acord amb el moment i amb les difer&#232;ncies interindividuals&#46;</p><p class="elsevierStylePara"> Els per&#237;odes de descans&#44; les pretemporades&#44; els diferents moments de la competici&#243; i els moments d&#8217;agenda amb 2-3 partits per setmana s&#243;n situacions en qu&#232; els objectius i els resultats obtinguts s&#8217;han de valorar de manera diferent i les estrat&#232;gies a aplicar tamb&#233; s&#8217;han d&#8217;individualitzar en aquests moments&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Aplicabilitat dels conceptes</span></p><p class="elsevierStylePara"> Un exemple pr&#224;ctic de l&#8217;aplicabilitat dels conceptes explicats pot ser el de la fam&#237;lia de les citocines&#44; com la inter-leucina 6 &#40;IL-6&#41;&#44; que t&#233; un significat doble segons el moment de mesurament&#44; essent un est&#237;mul per a la recuperaci&#243; muscular en el postesfor&#231; immediat&#44; i tamb&#233; un indicador d&#8217;inflamaci&#243; acumulada quan augmenta progressivament al llarg de la temporada&#46;</p><p class="elsevierStylePara"> A la figura 1 es pot veure com a mesura que avan&#231;a la temporada i s&#8217;acumulen sessions d&#8217;entrenament i partits&#44; marcadors com la IL-6 que presentaven valors baixos en la majoria d&#8217;un equip a l&#8217;inici&#44; comencen a incrementar-se tot i les estrat&#232;gies de recuperaci&#243; que es duen a terme&#44; com les de tipus nutricional i suplementaci&#243; amb complements antioxidants del tipus curcumina o <span class="elsevierStyleItalic">tart cherry juice</span> &#40;extracte de cireres &#224;cides&#41;&#44; entre altres&#46;</p><p class="elsevierStylePara"><img alt="Figura 1&#46; Tend&#232;ncia a l’increment de biomarcadors inflamatoris&#44; com la IL-6&#44; des de la meitat de la temporada &#40;blau&#41; fins a les setmanes de m&#224;xima competici&#243; &#40;taronja&#41;&#46;" src="278v53n199-90463093fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 1&#46; </span>Tend&#232;ncia a l&#8217;increment de biomarcadors inflamatoris&#44; com la IL-6&#44; des de la meitat de la temporada &#40;blau&#41; fins a les setmanes de m&#224;xima competici&#243; &#40;taronja&#41;&#46;</p><p class="elsevierStylePara"> Un altre exemple poden ser els nivells elevats d&#8217;homociste&#239;na&#44; que &#233;s un indicador de risc cardiovascular en la poblaci&#243; general&#44; per&#242; amb un altre significat&#44; encara no prou clar&#44; en els esportistes&#46; En els jugadors amb un alt nivell d&#8217;exig&#232;ncia &#233;s freq&#252;ent veure augmentat aquest marcador i es necessiten quantitats augmentades de vitamines del grup B per controlar-lo&#46; El seu augment correspon moltes vegades amb variants gen&#232;tiques desfavorables del gen de la metilaci&#243; MTHFR&#44; i la seva determinaci&#243; pot ser &#250;til de cara a una suplementaci&#243; personalitzada amb aquestes vitamines&#46; Altres exemples poden observar-se a la taula 1&#46;</p><p class="elsevierStylePara"><img alt="Taula 1&#46; Exemples pr&#224;ctics de la funci&#243; de diferents biomarcadors i de la seva aplicaci&#243; pr&#224;ctica " src="278v53n199-90463093fig2.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 1&#46; &#40;continuaci&#243;&#41;" src="278v53n199-90463093fig3.jpg"></img></p><p class="elsevierStylePara"> El jugador entrena i competeix durant espais de temps limitats en qu&#232; l&#8217;exercici suposa un est&#237;mul global important per a l&#8217;organisme&#44; amb una marcada resposta inflamat&#242;ria&#44; hormonal i immunit&#224;ria&#46; Tanmateix&#44; la resta del dia hi ha la possibilitat de manejar aspectes b&#224;sics com el descans&#44; l&#8217;alimentaci&#243; i la digesti&#243;&#44; entre altres&#44; que poden ajudar a una adaptaci&#243; &#242;ptima i a una millora progressiva del rendiment de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> En aquest sentit&#44; per exemple&#44; el coneixement de polimorfismes gen&#232;tics associats a la sensibilitat individual a la cafe&#239;na&#44; al gluten o a la lactosa&#44; entre d&#8217;altres&#44; poden ajudar a un abordatge individualitzat i a una nutrici&#243; i medicina de precisi&#243; de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> Durant la temporada resulta indispensable con&#232;ixer a fons l&#8217;evoluci&#243; del jugador i els seus valors &#242;ptims per treballar cada vegada m&#233;s els aspectes en els quals pugui millorar de manera espec&#237;fica&#46;</p><p class="elsevierStylePara"> La fatiga &#233;s concebuda com a percepci&#243; d&#8217;incapacitat per fer front a l&#8217;exig&#232;ncia plantejada&#44; considerant no sols aspectes musculars que es reflecteixen en biomarcadors que demostren l&#8217;acumulaci&#243; del lactat i acidosi&#44; inflamaci&#243; o immunitat &#40;fatiga perif&#232;rica&#41;&#44; sin&#243; que a vegades els mateixos nivells d&#8217;aquests indicadors poden ser elevats per&#242; poden ser ben tolerats per l&#8217;esportista&#44; gr&#224;cies a la motivaci&#243; i a la capacitat d&#8217;afrontar-los&#44; degut a qu&#232; la seva resposta o fatiga mental actua d&#8217;una manera completament diferent&#46; Per aix&#242; no es pot extrapolar la informaci&#243; de par&#224;metres a&#239;llats&#44; com els nivells elevats de CK o cortisol&#44; ja que en ocasions coincideixen amb el moment del m&#224;xim rendiment del jugador i &#233;s bo valorar-los en comparaci&#243; amb el perfil individual i&#44; si &#233;s possible&#44; amb els seus valors hist&#242;rics&#46;</p><p class="elsevierStylePara"> No es aconsellable valorar el jugador simplement per la pres&#232;ncia d&#8217;algunes d&#8217;aquestes alteracions&#44; sin&#243; intentar donar-li significat en un eventual enfocament d&#8217;adaptaci&#243; continuada i millora enfront de situacions de dany controlat o <span class="elsevierStyleItalic">h&#242;rmesi</span>&#46;</p><p class="elsevierStylePara"> Es busca la millora del seu estat general sabent que la via per arribar-hi pot ser diferent en cada cas&#44; per&#242; el repte &#233;s l&#8217;optimitzaci&#243; de la versi&#243; de cada jugador&#44; que condueix a una millora del grup&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions</span></p><p class="elsevierStylePara"> En el decurs d&#8217;una temporada resulta imprescindible el control de com els esportistes toleren les diferents c&#224;rregues de treball a les que se sotmeten&#46; Una de les principals maneres de fer-ho es a trav&#233;s del control bioqu&#237;mic de l&#8217;estat de fatiga i de recuperaci&#243; de cada esportista de manera individual i en diferents moments de la temporada&#46;</p><hr></hr><p class="elsevierStylePara"> &#42; Autor per a la correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58;</span><a href="mailto&#58;drpedret&#64;gmail&#46;com" class="elsevierStyleCrossRefs">drpedret&#64;gmail&#46;com</a> &#40;C&#46; Pedret&#41;</p>"
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Estratègies d’ajut al rendiment d’alta competició
Support strategies for high competition performance
Ricard Prunaa, Antonia Lizarragab, Luis Vergarac, Carles Pedretd
a F.C. Barcelona Medical Services, FIFA Excellence Centre, Barcelona, Espanya.
b F.C. Barcelona Medical Services, FIFA Excellence Centre, Barcelona, Espanya. Universitat de Barcelona, Barcelona, Espanya.
c Pontificia Universidad Católica de Chile, Santiago de Chile, Xile.
d Clínica Mapfre de Medicina del Tenis, Barcelona, Espanya. Clínica Diagonal, Barcelona, Espanya.
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a l&#8217;exercici i al tipus d&#8217;entrenament d&#8217;una manera global i amb la perspectiva de canvis al llarg de la temporada&#46; Els par&#224;metres que es poden mesurar s&#243;n de tipus bioqu&#237;mic&#44; gen&#232;tic&#44; la metagen&#242;mica de la femta o fins i tot els metab&#242;lits urinaris associats al propi esfor&#231; i que s&#8217;engloben en les noves t&#232;cniques &#8220;&#242;miques&#8221; de l&#8217;esport o &#8221;esport&#242;miques&#8221;&#46;</p><p class="elsevierStylePara"> El mesurament d&#8217;aquests par&#224;metres en diferents moments de la temporada permet tenir una visi&#243; m&#233;s precisa del jugador&#44; dels seus valors basals&#44; els &#242;ptims&#44; aix&#237; com tamb&#233; dels canvis que s&#8217;esdevenen en cada esportista durant la pretemporada i la competici&#243;&#46; Aquest control adquireix una import&#224;ncia especial en els per&#237;odes d&#8217;agenda m&#233;s atape&#239;da&#44; en qu&#232; es pot arribar a competir tres vegades a la setmana&#44; amb viatges que involucren canvis d&#8217;horari i disposant de menys de 72 h de difer&#232;ncia entre partits&#44; amb la dificultat que suposa una recuperaci&#243; f&#237;sica i mental adequada&#46;</p><p class="elsevierStylePara"> La capacitat d&#8217;una recuperaci&#243; r&#224;pida&#44; despr&#233;s d&#8217;un esfor&#231; de diferent ordre o <span class="elsevierStyleItalic">resili&#232;ncia</span>&#44; difereix entre jugadors i fins i tot en un mateix jugador en diferents moments&#44; i actualment ha esdevingut un dels objectius clau de millora i d&#8217;estudi&#44; ja que engloba m&#250;ltiples aspectes de control de c&#224;rrega&#44; tant externa com interna&#44; que s&#243;n modificables i entrenables de cara a la millor condici&#243; de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> Un dels nous reptes de l&#8217;&#224;mbit de la medicina de l&#8217;esport &#233;s identificar i mesurar les causes potencials de la fatiga i utilitzar-les per dissenyar un pla o estrat&#232;gies d&#8217;adaptaci&#243; individual&#44; de manera que l&#8217;abordatge pugui ser diferent&#44; d&#8217;acord amb la gen&#232;tica&#44; per&#242; sobretot amb expressi&#243; adequada dels gens esmentats o de <span class="elsevierStyleItalic">l&#8217;epigen&#232;tica</span>&#44; que inclou la valoraci&#243; dels diferents efectes de les c&#224;rregues de treball sobre els par&#224;metres de rendiment f&#237;sic&#44; mesurats mitjan&#231;ant GPS&#44; la composici&#243; corporal&#44; una nutrici&#243; saludable&#44; el descans i el control mental&#44; originant el fenotip de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> Cada vegada hi ha m&#233;s biomarcadors que permeten valorar si ha existit una adaptaci&#243; adequada a l&#8217;esfor&#231;&#44; que mostren una millora progressiva o en canvi un augment dels indicadors d&#8217;inflamaci&#243;&#44; sobreentrenament i risc de lesi&#243;&#46; &#201;s important no considerar els diferents marcadors d&#8217;una manera a&#239;llada i independent entre si&#44; sin&#243; valorar la situaci&#243; d&#8217;una manera global prenent els mesuraments en els moments m&#233;s adequats&#44; amb una perspectiva dels canvis&#44; d&#8217;acord amb el moment i amb les difer&#232;ncies interindividuals&#46;</p><p class="elsevierStylePara"> Els per&#237;odes de descans&#44; les pretemporades&#44; els diferents moments de la competici&#243; i els moments d&#8217;agenda amb 2-3 partits per setmana s&#243;n situacions en qu&#232; els objectius i els resultats obtinguts s&#8217;han de valorar de manera diferent i les estrat&#232;gies a aplicar tamb&#233; s&#8217;han d&#8217;individualitzar en aquests moments&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Aplicabilitat dels conceptes</span></p><p class="elsevierStylePara"> Un exemple pr&#224;ctic de l&#8217;aplicabilitat dels conceptes explicats pot ser el de la fam&#237;lia de les citocines&#44; com la inter-leucina 6 &#40;IL-6&#41;&#44; que t&#233; un significat doble segons el moment de mesurament&#44; essent un est&#237;mul per a la recuperaci&#243; muscular en el postesfor&#231; immediat&#44; i tamb&#233; un indicador d&#8217;inflamaci&#243; acumulada quan augmenta progressivament al llarg de la temporada&#46;</p><p class="elsevierStylePara"> A la figura 1 es pot veure com a mesura que avan&#231;a la temporada i s&#8217;acumulen sessions d&#8217;entrenament i partits&#44; marcadors com la IL-6 que presentaven valors baixos en la majoria d&#8217;un equip a l&#8217;inici&#44; comencen a incrementar-se tot i les estrat&#232;gies de recuperaci&#243; que es duen a terme&#44; com les de tipus nutricional i suplementaci&#243; amb complements antioxidants del tipus curcumina o <span class="elsevierStyleItalic">tart cherry juice</span> &#40;extracte de cireres &#224;cides&#41;&#44; entre altres&#46;</p><p class="elsevierStylePara"><img alt="Figura 1&#46; Tend&#232;ncia a l’increment de biomarcadors inflamatoris&#44; com la IL-6&#44; des de la meitat de la temporada &#40;blau&#41; fins a les setmanes de m&#224;xima competici&#243; &#40;taronja&#41;&#46;" src="278v53n199-90463093fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figura 1&#46; </span>Tend&#232;ncia a l&#8217;increment de biomarcadors inflamatoris&#44; com la IL-6&#44; des de la meitat de la temporada &#40;blau&#41; fins a les setmanes de m&#224;xima competici&#243; &#40;taronja&#41;&#46;</p><p class="elsevierStylePara"> Un altre exemple poden ser els nivells elevats d&#8217;homociste&#239;na&#44; que &#233;s un indicador de risc cardiovascular en la poblaci&#243; general&#44; per&#242; amb un altre significat&#44; encara no prou clar&#44; en els esportistes&#46; En els jugadors amb un alt nivell d&#8217;exig&#232;ncia &#233;s freq&#252;ent veure augmentat aquest marcador i es necessiten quantitats augmentades de vitamines del grup B per controlar-lo&#46; El seu augment correspon moltes vegades amb variants gen&#232;tiques desfavorables del gen de la metilaci&#243; MTHFR&#44; i la seva determinaci&#243; pot ser &#250;til de cara a una suplementaci&#243; personalitzada amb aquestes vitamines&#46; Altres exemples poden observar-se a la taula 1&#46;</p><p class="elsevierStylePara"><img alt="Taula 1&#46; Exemples pr&#224;ctics de la funci&#243; de diferents biomarcadors i de la seva aplicaci&#243; pr&#224;ctica " src="278v53n199-90463093fig2.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 1&#46; &#40;continuaci&#243;&#41;" src="278v53n199-90463093fig3.jpg"></img></p><p class="elsevierStylePara"> El jugador entrena i competeix durant espais de temps limitats en qu&#232; l&#8217;exercici suposa un est&#237;mul global important per a l&#8217;organisme&#44; amb una marcada resposta inflamat&#242;ria&#44; hormonal i immunit&#224;ria&#46; Tanmateix&#44; la resta del dia hi ha la possibilitat de manejar aspectes b&#224;sics com el descans&#44; l&#8217;alimentaci&#243; i la digesti&#243;&#44; entre altres&#44; que poden ajudar a una adaptaci&#243; &#242;ptima i a una millora progressiva del rendiment de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> En aquest sentit&#44; per exemple&#44; el coneixement de polimorfismes gen&#232;tics associats a la sensibilitat individual a la cafe&#239;na&#44; al gluten o a la lactosa&#44; entre d&#8217;altres&#44; poden ajudar a un abordatge individualitzat i a una nutrici&#243; i medicina de precisi&#243; de l&#8217;esportista&#46;</p><p class="elsevierStylePara"> Durant la temporada resulta indispensable con&#232;ixer a fons l&#8217;evoluci&#243; del jugador i els seus valors &#242;ptims per treballar cada vegada m&#233;s els aspectes en els quals pugui millorar de manera espec&#237;fica&#46;</p><p class="elsevierStylePara"> La fatiga &#233;s concebuda com a percepci&#243; d&#8217;incapacitat per fer front a l&#8217;exig&#232;ncia plantejada&#44; considerant no sols aspectes musculars que es reflecteixen en biomarcadors que demostren l&#8217;acumulaci&#243; del lactat i acidosi&#44; inflamaci&#243; o immunitat &#40;fatiga perif&#232;rica&#41;&#44; sin&#243; que a vegades els mateixos nivells d&#8217;aquests indicadors poden ser elevats per&#242; poden ser ben tolerats per l&#8217;esportista&#44; gr&#224;cies a la motivaci&#243; i a la capacitat d&#8217;afrontar-los&#44; degut a qu&#232; la seva resposta o fatiga mental actua d&#8217;una manera completament diferent&#46; Per aix&#242; no es pot extrapolar la informaci&#243; de par&#224;metres a&#239;llats&#44; com els nivells elevats de CK o cortisol&#44; ja que en ocasions coincideixen amb el moment del m&#224;xim rendiment del jugador i &#233;s bo valorar-los en comparaci&#243; amb el perfil individual i&#44; si &#233;s possible&#44; amb els seus valors hist&#242;rics&#46;</p><p class="elsevierStylePara"> No es aconsellable valorar el jugador simplement per la pres&#232;ncia d&#8217;algunes d&#8217;aquestes alteracions&#44; sin&#243; intentar donar-li significat en un eventual enfocament d&#8217;adaptaci&#243; continuada i millora enfront de situacions de dany controlat o <span class="elsevierStyleItalic">h&#242;rmesi</span>&#46;</p><p class="elsevierStylePara"> Es busca la millora del seu estat general sabent que la via per arribar-hi pot ser diferent en cada cas&#44; per&#242; el repte &#233;s l&#8217;optimitzaci&#243; de la versi&#243; de cada jugador&#44; que condueix a una millora del grup&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions</span></p><p class="elsevierStylePara"> En el decurs d&#8217;una temporada resulta imprescindible el control de com els esportistes toleren les diferents c&#224;rregues de treball a les que se sotmeten&#46; Una de les principals maneres de fer-ho es a trav&#233;s del control bioqu&#237;mic de l&#8217;estat de fatiga i de recuperaci&#243; de cada esportista de manera individual i en diferents moments de la temporada&#46;</p><hr></hr><p class="elsevierStylePara"> &#42; Autor per a la correspond&#232;ncia&#46;<br></br><span class="elsevierStyleItalic">Correu electr&#242;nic&#58;</span><a href="mailto&#58;drpedret&#64;gmail&#46;com" class="elsevierStyleCrossRefs">drpedret&#64;gmail&#46;com</a> &#40;C&#46; Pedret&#41;</p>"
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Article information
ISSN: X8866581
Original language: Català
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