Diagnostics at record speeds – POCT in high-performance sports
Diagnostics at record speeds – POCT in high-performance sports
Interview with Professor Billy Sperlich, Head of Integrative & Experimental Exercise Science & Training, Julius Maximilian University of Würzburg
This is what diagnostic investigation normally looks like: a patient sample is collected, sent to the laboratory and analyzed. Once that's completed, the patient is told of the lab test result. But if the patient is a high-performance athlete and has to follow and stick to a rigid training schedule, he or she needs these results immediately. What makes this possible? Point-of-care testing!
Prof. Billy Sperlich, Head of Integrative & Experimental Exercise Science & Training at Julius Maximilian University of Würzburg
At MEDICA 2018, Professor Billy Sperlich will give a lecture titled "High-performance sports and point-of-care testing". In the run-up to the trade fair, he sat down with MEDICA-tradefair.com for an interview and talked about the many applications of point-of-care testing in high-performance sports and the importance of this type of diagnostic testing for athletes.
Professor Sperlich, you will give a lecture about high-performance sports and point-of-care testing at the MEDICA LABMED FORUM. How is one connected to the other?
Prof. Billy Sperlich: We presently have two ways to monitor the strain on athletes and avoid potential overload that both allow us to initiate interventions. One option is wearable sensors or wearables. They allow us to measure certain stress markers and then quickly make changes to the training process. The other option is point-of-care testing (POCT). Even though the monitoring process is not as tight as that of sensor-based systems, POCT still facilitates other rapid – typically blood or saliva-based –results, enabling coaches or athletes to quickly take action.
Typical laboratory diagnostics work differently. You usually take a blood sample from the veins and send it in for analysis. We don't get the result that can prompt training changes until much later with this process. The fact that monitoring with POCT and wearables enables prompt intervention makes this process so exciting.
Point-of-care tests are often carried out in the form of blood tests, in which even a small drop – taken from the fingertip – is sufficient.
What measurements can you make with point-of-care diagnostic testing?
Sperlich: They differ and depend on the type of sport. For instance, in the case of runners, we can analyze markers that impact cardiovascular values, muscle strain or immune function. The type of tissue we take the sample from also plays a role. We prefer capillary blood samples obtained from the earlobe or the side of the fingertip. We also repeatedly track the resting heart rate in tests. This shows the resilience and strength of the athlete. In addition to the aforementioned blood tests, we also increasingly analyze saliva. This allows us to measure the standard stress hormones including testosterone, cortisol, or amylase, which give us clues about how stress affects the athlete's immune response. Yet the most important marker in everyday training is the tympanic (ear) temperature, because it allows us to detect fever conditions and subsequently change the training schedule. Not only are these options straightforward and minimally invasive, but they are also more accepted by the athletes. Meanwhile, continuous venous blood monitoring simply doesn't work by comparison.
High-performance athletes train 25 hours or more a week before a competition. To do this, they not only need to be permanently fit, but also know whether their training is successful. In both cases, point-of-care tests are a useful tool.
Why is rapid diagnostic testing so important, especially when it comes to high-performance sports?
Sperlich: It's crucial because the training period of high-performance athletes - especially in endurance sports training - is very limited. Some sports require net training times of 25 hours per week or more. This translates into increasingly shorter recovery times, making it essential for the athlete or coach to know as soon as possible whether the athlete experiences chronic overstrain, whether a training session should be canceled or modified and whether the training is ultimately able to achieve the desired results.
This is especially significant for sports where athletes reach the limits of feasible training in terms of time. Examples of this are runners, triathletes, swimmers, cross-country skiers or cyclists. Having said that, team sports like soccer also increasingly want to track muscle stress with the help of POCT to avoid chronic overstrain and injuries. Chronic overuse of muscles prompts frequent injuries, especially in expensive team sports. This makes POCT a great tool to optimize training and ultimately also critical to the prevention of injuries or infection.
In addition to point-of-care tests, wearables are also helpful for monitoring. These allow permanent measurements of the heart rate, for example.
What challenges does POCT have to overcome?
Sperlich: The main challenge pertains to the frequency of measurements. The athlete has to participate and appreciate why he/she does it. Athletes tend to not participate until they are hurt or once they realize that they suffer from recurrent infections or injuries. That's when they are usually willing to use a monitoring system. Or the athletes are in intense training at training camps or embark on altitude training, where they want to determine the actual effectiveness of the training.
How important is point-of-care diagnostic testing right now in high-performance sports?
Sperlich: Training and exercise science is not quite familiar with this concept yet. Usually, we are more likely to refer to blood or salivary diagnostics, regardless of the analytical method. Even though point-of-care testing is not a familiar concept quite yet, the technology itself is actually becoming increasingly popular. Since the huge advantage of POCT is that it delivers rapid test results, I expect its increased importance and rising popularity in the future.
The interview was conducted by Elena Blume and translated from German by Elena O'Meara. MEDICA-tradefair.com