TISS funds research with potential to dramatically impact health & performance of athletes across all populations

Timothy Burkhart, Jenna Gillen, Robert Bentley and Catherine Sabiston were recently awarded seed grant funding from TISS for scientific research with potential to dramatically improve athlete health and performance across all populations.
Timothy Burkhart, Jenna Gillen, Robert Bentley and Catherine Sabiston were recently awarded seed grant funding from TISS for scientific research with potential to dramatically improve athlete health and performance across all populations.

Four faculty members of the University of Toronto Faculty of Kinesiology and Physical Education, Timothy Burkhart, Robert Bentley, Jenna Gillen and Catherine Sabiston, have been awarded seed grants funding to conduct pilot studies in areas related to the mission of the Tanenbaum Institute for Science in Sport (TISS) - to translate scientific discoveries into innovations that can dramatically impact the health and performance of athletes across all populations.

Data from the research projects, which include investigations into how wearable technology can be used to optimize training intensity and whether the intensity and volume of training should be adjusted to the menstrual cycle, will be used for external grants applications. The projects will also be an opportunity for undergraduate and graduate students involved in the projects to get exposure to research processes and methodologies. Below we share more details about the awarded projects.

How can wearable technology optimize exercise training intensity? 

Robert Bentley, an assistant professor in KPE, will be working on a feasibility study on optimizing exercise training intensity using wearable technology. Bentley will be working on the study with Adam Di Salvo, a PhD candidate in the faculty.

“Aerobic fitness is critical for high-performance athletes,” says Bentley. “The heart, lung, blood vessels and skeletal muscles remodel and adapt with training. 

“While evidence suggests that personalized training intensities [based on physiological thresholds] produce superior results, the application of advanced wearable technology to guide such training in real-world settings has been elusive to date.”

This project will assess the feasibility of utilizing novel wearable technology to optimize the training intensity for individualized (personalized), aerobic, field-based real-world training. A secondary purpose of the project will be to determine whether physiological responses to typical in-field exercise training assessed in real-time using wearable technology align with laboratory-based physiological thresholds. 

18 varsity athletes (nine male and nine female) training in strength/power, endurance or mixed sport will be recruited to participate in the study over a two-week period. During the first week, there will be three laboratory-based sessions that will identify the physiological thresholds of the varsity athletes. In week two, the athletes will be asked to perform their typical, in-field aerobic exercise training sessions. 

During all sessions, participants will be equipped with advanced wearable technology: VO2 Master Pro to assess pulmonary ventilation (the process of air flowing into the lungs during inhalation and out of the lungs during exhalation)) and the rate of oxygen consumption; Frontier X2 to assess cardiac function, including heart rate, rhythm and strain; and MOXY Monitor to assess skeletal muscle oxygenation. 

“These research-grade wearable devices are an accessible, technological platform that when harnessed will substantially advance efforts to guide athletes through optimized high-performance sport training,” says Bentley. 

Feasibility assessments will be completed after the in-field aerobic exercise training sessions and will focus on acceptability (satisfaction with device), implementation (any issues with device use during training), practicality (ease of device use) and integration of the wearable technology into in-field training. 

“In the short-term, this study will create the foundational knowledge required to develop targeted, personalized or ‘precision’ training interventions, similar to the emerging field of personalized medicine, to optimize high-performance sport training,” says Bentley. “In the long-term, this area of study will serve to increase physical activity participation, enhance exertional capacity and improve performance by tailoring interventions to the unique requirements of individuals across the field of exercise physiology and high-performance sport.”

Can early muscular strength rehabilitation improve subjective and objective measures of knee function following an ACL injury? 

Timothy Burkhart, an assistant professor at KPE, will lead a pilot randomized control trial on the effectiveness of an early muscular strength rehabilitation program prior to anterior cruciate ligament (ACL) reconstruction on subjective and objective measures of knee function.

Burkhart will collaborate on this project with a multi-disciplinary team of U of T experts from the areas of sport science, sport medicine and clinical care.

“This approach will ensure the research is instantly transferable to the clinical experts and practitioners within the Temerty Faculty of Medicine and Sinai Health,” says Burkhart. 

There are more than 250,000 ACL injuries in Canada and the United States annually that primarily occur in young competitive athletes. While approximately 80 per cent of patients return to some form of activity, only 65 per cent return to pre-injury levels, and only 55 per cent return to competitive sport. Of those that return to activity, three to 30 per cent will experience re-injury. ACL injures also have long-term effects on patient quality of life, chronic pain and psychological distress. 

“Delays in neuromuscular and strength rehabilitation may be associated with muscular and ligamentous deficits in both the injured and uninjured limbs, with significant quadriceps and hamstring muscle volume and strength losses observed after only one-week of lower extremity immobilization,” says Burkhart. “These are important findings as hamstring and quadricep strength have been implicated as risk factors for delayed return-to-activity and secondary ACLR injury.”

While there has been increasing interest in early rehabilitation, this has primarily focused on regaining range of motion and early weight-bearing. However, early application of strength focused rehabilitation programs has not been thoroughly researched as a valid approach for optimizing patient outcomes following ACL injury and ACLR. 

The overall objective of this project will be to determine the effectiveness of an early muscular strength rehabilitation (EMSR) program on improving subjective and objective measures of knee function following an ACL injury and subsequent surgical reconstruction compared to standard clinical care (Standard). 

20 males and 20 female patients between the ages of 18 and 35 will be randomly assigned to either the EMSR or Standard group. Patients will be recruited from orthopaedic sports medicine clinics across Toronto, including the David L. Macintosh Sport Medicine Clinic, Sunnybrook, Women’s College Hospital, St. Michael’s Hospital and Mount Sinai Hospital. Following recruitment and randomization, patients will be invited to the Biomechanics of Orthopaedic Sport Medicine (BOSM) lab for five different data collection sessions. 

“Current rehabilitation, immediately following injury, typically focuses on managing inflammation and maintaining range of motion with little concern for the uninjured limb,” says Burkhart. “We contend that a lack of early (immediate) bi-lateral strength focused rehabilitation is partly responsible for the continued high complication rates following ACL treatment and rehabilitation. 

“We hypothesize that this intervention will result in improved patient outcomes and better functional performance allowing athletes to recovery more effectively and return-to-their sport more efficiently and safely.”

Should intensity & volume of training be adjusted to the menstrual cycle? 

Jenna Gillen, an assistant professor at KPE, will be leading a study investigating the influence of the menstrual cycle phase on metabolic and performance adaptations to sprint interval training (SIT). She will be working on the project with Celine Bailleul, a PhD student, and Jennifer Williams, a postdoctoral fellow in the faculty.

The project comes at the heels of an emerging training methodology, known as 'menstrual cycle phase-based training,' which has sparked interest across media, fitness circles and academic research focusing on female athletic performance. This approach involves adjusting training intensity and volume according to the menstrual cycle, with higher levels in the follicular (preovulatory) phase and lower levels in the luteal (post-ovulation) phase. 

While proponents of the approach suggest that the lower levels of estrogen and progesterone in the follicular phase might yield superior performance and metabolic responses to exercise training, the evidence supporting this concept is scant, and existing studies lack robust methods for detecting menstrual cycle phases. 

“Given the attention this method has garnered among coaches and athletes, there's a pressing need for high-quality research to ascertain if the menstrual cycle should be a pivotal and widely applied consideration in female training program design,” says Gillen. 

“We aim to address this gap by investigating how menstrual cycle phases affect adaptations to a two-week sprint interval training (SIT) protocol previously shown to enhance both aerobic and anaerobic performance.”

While Gillen has expertise conducting menstrual cycle phase-based comparisons, those studies have focused on health outcomes such as insulin sensitivity. This will be the first study to investigate the influence of menstrual cycle-phase based aerobic exercise training on endurance exercise performance and adaptations to training. 

Twenty-four recreationally active females will take part in six SIT sessions on a cycle ergometer during either the follicular or luteal phase of their menstrual cycle. Importantly, Gillen and her team will implement best-practice physiological guidelines for menstrual cycle phase determination of participants.

“Our primary objective is to measure time trial performance before and after training, which is a reliable gauge of endurance,” says Gillen. “Additionally, we will assess changes in anaerobic exercise performance (short, fast, high-intensity exercises that don't make your body use oxygen like cardio (or aerobic) activities)) using the Wingate anaerobic bike test and study metabolic adaptations in muscle samples taken pre- and post-training.”

Ultimately, Gillen hopes the findings will provide valuable insights for coaches and athletes, helping determine if menstrual cycle phase should play a significant role in female endurance exercise program design. 

“We hypothesize that there will be no difference in the improvement in aerobic and anaerobic performance, or skeletal muscle metabolism, following follicular and luteal phase-based SIT in eumenorrheic females [women with regular menstruation],” she says.

How do we move from reactive to proactive, preventative strategies in support of elite athlete well-being?

Catherine Sabiston, a professor at KPE, will lead a collaborative project to establish a multidisciplinary preventative elite athlete wellbeing strategy, focusing on managing body image interference and mitigating the effects of performance deficits and injury risk.

“There are a multitude of reactive and treatment-focused approaches to athlete performance deficits
and injury risk at the expense of prevention efforts that mitigate sport challenges before they become
unmanageable,” says Sabiston. “Our project will focus on developing a preventative athlete wellbeing strategy that focuses on an integral factor: body image interference.”

An athlete’s focus on their body is a highly understudied but important factor in limiting sport performance and heightening injury risk, according to Sabiston. Athletes who put attention on their body’s shape, weight and appearance deplete cognitive resources needed to meaningfully engage and perform in their sport while also risking injury. This body image interference is critical to performance and injury risk but is not well-understood or highlighted in clinical practice because there is no way to measure the construct.

The first aim of this study will be to develop and test a measure of body image interference that can be used among athletes and administered by sport leaders. Once the measure is deemed reliable and valid, a second aim will be to collect novel and insightful data to identify predictors and protective factors of body image interference in addition to performance and injury risk outcomes among elite athletes. This data will be analyzed and interpreted collaboratively with clinicians, athletes, coaches and sport psychologists in a series of meetings to inform guidelines for clinical practice and a framework for research insights.

“Taken together, this work will identify the foundations for a multidisciplinary collaborative athlete wellbeing strategy aimed at proactively supporting athletes from a strength-based athlete-centered perspective, and a focus on prevention efforts rather than reactive treatment strategies that are pervasive in sport.”

300 elite athletes will be recruited with support from competitive sport organizations (e.g., Olympic committees and varsity athletics).

“The focus on body image interference is a novel concept that warrants research and practice efforts to improve sport contexts – from environments, uniforms and policies to equipping elite athletes with preventative efforts to secure and manage their own mental and physical health,” says Sabiston. “Importantly, in addition to transforming Canada’s sport culture, we will also be training upcoming sport researchers and developing meaningful partnerships aimed at athlete wellbeing.”