MEDICAL CHALLENGES: EFFECTS of TRAVEL FATIGUE and JET LAG

Size: px

Start display at page:

Download "MEDICAL CHALLENGES: EFFECTS of TRAVEL FATIGUE and JET LAG"

Julian Strickland
5 years ago
Views:

1 MEDICAL CHALLENGES: EFFECTS of TRAVEL FATIGUE and JET LAG Prof Christa Janse van Rensburg MBChB, MSc, MMed, MD FACSM, FFIMS Sports Medicine & SEMLI, University of Pretoria Consultant Rheumatologist, Eugene Marais Hospital South Africa

2 CONTENT Introduction A) Description of: Travel fatigue & Jet lag B) Potential mechanisms of impact: Circadian rhythm Performance C) #IOCATPC2018 No disclosures

INTRODUCTION International & National Travel: = lifestyle for elite

Travel fatigue / travel stress / jet lag (Christa JvR) 2.

3 INTRODUCTION International & National Travel: = lifestyle for elite athletes disruption of regular routine, preparation concerns, competition anxiety, etc. Factors that come into play that will be discussed in this session: 1. Travel fatigue / travel stress / jet lag (Christa JvR) 2. Substantial environmental changes (Olaf Schumacher) 3. Illness (Martin Schwellnus) 4. Meticulous planning (Wayne Derman & Emin Ergin)

A) DESCRIPTION OF: Controllable factors Journey anxiety Nutrition Hydration (extra 15-20ml for

Passenger next to you Confined space Length of flight Crossing time zones Altitude changes Air

4 A) DESCRIPTION OF: Controllable factors Journey anxiety Nutrition Hydration (extra 15-20ml for each hour in flight) Time of sleep Body temperature Movement / activity Reilly T et al. Nutrition for travel. Jnl Sports Sc, 2007, 25(S1): S TRAVEL FATIGUE & JET LAG Uncontrollable factors Passenger next to you Confined space Length of flight Crossing time zones Altitude changes Air pressure fluctuations Stopovers /Delays Turbulence Greenleaf J, et al. Airline chair-rest deconditioning: Induction of immobilisation thromboemboli. Sports Med, 2004, 34(11):

Travel fatigue Jet lag Definition Temporary exhaustion, tiredness Temporary disorder / desynchronosis Mechanism / Cause Associated with any long journey

length Direction of travel N S Seasonal change e.g. Depart from JHB at 30 C, disembark in Frankfurt at 0 C W E 2 time zones in any direction W E Shift in local time e.

5 Travel fatigue Jet lag Definition Temporary exhaustion, tiredness Temporary disorder / desynchronosis Mechanism / Cause Associated with any long journey (irrespective of mode of transport) Body`s daily rhythms out of sync with destination time zone Rapid long-distance, trans-meridian travel Flight s direction > length Direction of travel N S Seasonal change e.g. Depart from JHB at 30 C, disembark in Frankfurt at 0 C W E 2 time zones in any direction W E Shift in local time e.g. Depart 10h00 from London, arrive 13h00 in NY (watch indicating London time 18h00) = 8-hour flight across 5 time zones 3 time zones in directions E-W / W-E

shower / night s sleep Quicker overcome BUT can accumulate over course of season Can be

Resolves with resynchronisation 1 day/time zone Sleep disturbance (daytime sleepiness,

6 Characteristics NB! Travel: Direction Distance Frequency Length of season Travel fatigue Subsides next day / after shower / night s sleep Quicker overcome BUT can accumulate over course of season Can be persistent & impact athlete s capacity to recover & perform Jet lag Lasts several days to weeks Resolves with resynchronisation 1 day/time zone Sleep disturbance (daytime sleepiness, intermittent fatigue, sleep deprivation) GIT disturbance (indigestion, diarrhoea, constipation) Severity Vast inter- & intra-individual variations Frequency of trips & length of season play a role

Sports Medicine Journal. www.aspetar.com/journal p.

7 B) POTENTIAL MECHANISM OF IMPACT Peter M. Fowler. Performance Recovery Following Long-haul International Travel in Team Sport Athletes. Sports Medicine Journal. p Schwellnus M, Derman W, Page T, Lambert M, Readhead C, Roberts C, et al. Illness during the 2010 Super 14 Rugby Union tournament a prospective study involving player days. BJSM, 2012;46(7):

8 CIRCADIAN RHYTHM SHIFTS The light-dark cycle seems to be the strongest influence 2017 Nobel Prize Winners Michael Rosbash Michael W. Young Jeffrey Hall Pioneering discovery that our circadian clocks are regulated by a small group of genes working at the individual cell level John Hogenesch from the University of Pennsylvania estimates around 50% of the mammalian genome cycle is under circadian control Purpose of body clock Ensure physical & mental state Active day Sleep at night

EFFECT ON PERFORMANCE Br J Sports Med 2013;47:561 567. doi:10.1136/bjsports-2012-091449 Performance advantage if fewer time zones were crossed Winning percentage of 60.

9 EFFECT ON PERFORMANCE Br J Sports Med 2013;47: doi: /bjsports Performance advantage if fewer time zones were crossed Winning percentage of 60.6% for teams with a 3hr advantage over the other team (more powerful than home-ground advantage) Hypothesised that there is a circadian rhythmicity to athletic performance Performance of an athletic task several hours before or after the circadian peak window will potentially be completed with less than optimal efficiency Home team winning percentage according to relative circadian advantage or disadvantage (Major League Baseball Teams) Winter, et al

10 Biological responses to hypoxia begin during acute exposures e.g. hypoxic conditions associated with air travel Beneficial to understand the extent to which any negative effects of hypoxia remain once destination is reached endurance athletes competing at moderate altitudes should expose themselves to similar altitude at least 14 days before competition Mean Sat(O 2 ) before flight, during flight and upon arrival at destination (Measurements obtained by pulse oximetry) Schuler, et al

C) MANAGEMENT Much effort, but only partial success Effects depend on internal circadian time of treatment circadian status determined by: Melatonin (plasma, salivary or urinary) Habitual sleep onset

(2012) Jet Lag and Travel Fatigue: A Comprehensive Management Plan for Sport Medicine Physicians and High-Performance Support Teams Clin J Sport Med 2:268 273 Arendt, J.

11 C) MANAGEMENT Much effort, but only partial success Effects depend on internal circadian time of treatment circadian status determined by: Melatonin (plasma, salivary or urinary) Habitual sleep onset at home Tmin C Janse Van Rensburg, et al. (2018) Illness among Paralympic Athletes: Epidemiology, Risk Markers, and Preventative Strategies. Phys Med Rehabil Clin N Am 29: Samuels CH. (2012) Jet Lag and Travel Fatigue: A Comprehensive Management Plan for Sport Medicine Physicians and High-Performance Support Teams Clin J Sport Med 2: Arendt, J. (2018) Approaches to the Pharmacological Management of Jet Lag. Drugs (2018). Jim Waterhouse, et al. (2007) Jet lag: trends and coping strategies. Lancet 2007; 369: Simmons E, et al. Jet Lag Modification. Curr Sport Med Report, 2015, 14,2:

12 TRAVEL FATIGUE & JET LAG: Travel Direction and Body Clock Eastward Westward Phase shift Body clock cycle Advance (!!only if <8 hrs time zone difference, otherwise same as westward) Shortens 60 min/d (each day in new time zone) More difficult (easier for morning type person) Delay (up to 12 hrs time zone difference) Extends 90 min/d (each day in new time zone) Easier for most travellers Sleep pattern Difficult to fall asleep Difficult to wake up Sleepy early evening Wake up early

13 NON-PHARMACOLOGICAL MANAGEMENT General On arrival Journey planning Arrive at night fall Eastbound: Westbound: Arrive mid afternoon Pre-adaptation Eastbound: Rise 1 hour earlier Eastbound: Westbound: Stay up 1hr later Westbound: not>1hr p.d before departure Full adaptation not recommended for trips only 1-2d long Most effective BUT difficult and limited application to sport Bright light therapy Minimum Core Temp (@ home ±4:30am) Eastbound: Just after Westbound: Shortly before Blue light (stimulate) Amber lenses (block) Natural light better Avoid screen time in evening Most potent time cue Timing NB in relation to core temperature exposure vs. avoidance

14 NON-PHARMACOLOGICAL MANAGEMENT General During flight On arrival Sleep Adequate sleep before travel More rigid sleeping habits more symptoms Schedule flight during sleeping hours at destination Least amount of connecting flights Set watch to destination time Diet Timing more important than type of meal Avoid alcohol Avoid caffeine at night time Exercise Not proven to shift circadian rhythm May maintain arousal level Change training routine (consider timing and intensity) Argonne Anti-Jet Lag Diet Harvard Anti-Jet Lag Fast (Limited Evidence) Night time at destination Avoid sleep debt Light energy meals Alcohol 2-3x more potent at flight altitude Hydrate with water Frequent movement Compression socks Follow time pattern of destination Good night`s sleep Power naps (20-30min) Consistent bed and wake times Cool, dark, quiet room? High protein meal improves arousal? High CHO meal improves sleepiness Morning caffeine increase alertness Hydrate with water Low to moderate intensity Higher risk of injury 1 st few days

PHARMACOLOGICAL MANAGEMENT Melatonin Derived from serotonin/tryptophan Cochrane review in 2002 concluded exogenous use effective and safe Chronobiotic (phase shifter, 0.

on rising (day of flight) To induce sleep and/or shift the body clock Eastbound: Low dose mid afternoon to bedtime advances clock Westbound: Low dose during early morning delays clock Sleeping

15 PHARMACOLOGICAL MANAGEMENT Melatonin Derived from serotonin/tryptophan Cochrane review in 2002 concluded exogenous use effective and safe Chronobiotic (phase shifter, 0.5mg) Chronohypnotic (sleep initiator, 3-10mg) Product quality may be a concern General During flight On arrival To induce sleep and/or shift the body clock Eastbound: take on boarding Westbound: take on rising (day of flight) To induce sleep and/or shift the body clock Eastbound: Low dose mid afternoon to bedtime advances clock Westbound: Low dose during early morning delays clock Sleeping tablets Short acting Zolpidem + Melatonin increase daytime somnolence Stimulants Most stimulants are banned substances Consider for team management to assist with daytime sleepiness (Modafinil) Melatonin agonists Ramelteon,Tasimelteon and PRM Longer duration of action than Melatonin No evidence Recommended in athletes with persistent insomnia that have tolerated it well before Caffeine: take in the morning avoid at night time No evidence No evidence Melatonergic anti-depressants Agomelatine Treatment of depressive sx`s associated with jet lag No evidence No evidence

by shifting schedule towards time at morning delays - mid-afternoon to bedtimences advances our body clock destination

16 Diet: - timing of meal seems more important than EAST WEST xbiological night time Bright light: - late evening delays - morning (after Tmin) advances advances type of meal Low dose melatonin: kk - very late evening to Sleep: - pre-adapt by shifting schedule towards time at morning delays - mid-afternoon to bedtimences advances our body clock destination Exercise: - power naps - cannot reliably shift - avoid sleep debt circadian rhythms kkkkk - may maintain arousal level

CONCLUSION Travel fatigue and jet lag poses a big

habits / chronotype / sex / time zones crossed /

of destination / previous experience Many

body clock no cure yet (preserve sleep and

com/travel/drsleep/public/en_gb www.jetlagrooster.

17 CONCLUSION Travel fatigue and jet lag poses a big problem for athletes with RF`s including: sleeping habits / chronotype / sex / time zones crossed / flight direction / physical fitness / age / time of destination / previous experience Many uncertainties on methods to advance or delay the body clock no cure yet (preserve sleep and alertness) Jet lag calculators: #IOCATPC2018

18 CALL FOR PROPOSALS IS NOW OPEN Submit your proposal on the website: #IOCprev2020

The Diagnosis and Treatment of Circadian Rhythm Disorders

Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA The Diagnosis and Treatment of Circadian Rhythm Disorders Professor Leon Lack School of Psychology, Flinders University