International Journal of Sport Nutrition and Exercise Metabolism, 2015, 25, 480 -486 http://dx.doi.org/10.1123/ijsnem.2014-0267 © 2015 Human Kinetics, Inc.
ORIGINAL RESEARCH
Rapid Weight Loss Elicits Harmful Biochemical and Hormonal Responses in Mixed Martial Arts Athletes Victor Silveira Coswig, David Hideyoshi Fukuda, and Fabrício Boscolo Del Vecchio The purpose of this study was to compare biochemical and hormonal responses between mixed martial arts (MMA) competitors with minimal prefight weight loss and those undergoing rapid weight loss (RWL). Blood samples were taken from 17 MMA athletes (Mean± SD; age: 27.4 ±5.3yr; body mass: 76.2 ± 12.4kg; height: 1.71 ± 0.05m and training experience: 39.4 ± 25 months) before and after each match, according to the official events rules. The no rapid weight loss (NWL, n = 12) group weighed in on the day of the event (~30 min prior fight) and athletes declared not having used RWL strategies, while the RWL group (n = 5) weighed in 24 hr before the event and the athletes claimed to have lost 7.4 ± 1.1kg, approximately 10% of their body mass in the week preceding the event. Results showed significant (p < .05) increases following fights, regardless of group, in lactate, glucose, lactate dehydrogenase (LDH), creatinine, and cortisol for all athletes. With regard to group differences, NWL had significantly (p < .05) greater creatinine levels (Mean± SD; pre to post) (NWL= 101.6 ± 15–142.3 ± 22.9μmol/L and RWL= 68.9 ± 10.6–79.5 ± 15.9μmol/L), while RWL had higher LDH (median [interquartile range]; pre to post) (NWL= 211.5[183–236] to 231[203–258]U/L and RWL= 390[370.5–443.5] to 488[463.5–540.5]U/L) and AST (NWL= 30[22–37] to 32[22–41]U/L and 39[32.5–76.5] to 72[38.5–112.5] U/L) values (NWL versus RWL, p < .05). Post hoc analysis showed that AST significantly increased in only the RWL group, while creatinine increased in only the NWL group. The practice of rapid weight loss showed a negative impact on energy availability and increased both muscle damage markers and catabolic expression in MMA fighters. Keywords: martial arts, blood chemical analysis, athletic performance Mixed martial arts (MMA) is a combat sport characterized by incorporating fighting styles derived from other martial arts, which involve, grappling and striking techniques from both a standing position and on the ground (Amtmann & Berry 2003; Del Vecchio et al., 2011; LaBounty et al., 2010). Generally, the matches have three to five rounds lasting 5 min each, and the winner is determined by a judge’s decision (in case of expiration of the time provided for fighting), knockout (KO), technical knockout (TKO), submission or disqualification (Rainey, 2009). In MMA, competitive success requires high physical fitness (Amtmann, 2004), with well-developed aerobic and anaerobic metabolic systems (Del Vecchio et al., 2011), as well as muscular strength and power (Del Vecchio & Ferreira, 2013). Similar to other combat sports, MMA competitions stratify athletes according weight classes (Jetton et al., 2013). As such, while aiming to challenge smaller oppoCoswig and Del Vecchio are with the Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil. Fukuda is with the Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL. Address author correspondence to Victor Silveira Coswig at vcoswig@ gmail.com.
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nents, fighters often employ different strategies for rapid weight loss (RWL), which may involve exercise in the heat, sauna, water and food restriction and ingestion of diuretics (Reljic et al., 2013). RWL has been characterized by reductions of 5–10% of usual body weight in less than a week (Petterson et al., 2013) and ~4% recovery of body mass in the 22 hr between weigh-in and fight time (Jetton et al., 2013). Despite the cultural and psychological component of RWL in combat sports athletes (Petterson et al., 2013), there appears to be a consensus that this practice has negative implications on physical performance (Koral & Dosseville, 2009; Lambert & Jones, 2010; Smith et al., 2000; 2001), and increases the risk of injuries (Green et al., 2007). Conversely, for fighters who have experience with RWL, the practice does not appear to affect performance in modality-specific tests (Artioli et al., 2010; Fogelholm et al., 1993). Recently, however, no differences were found in the acute response and recovery to RWL between combat sports athletes with and without chronic RWL experience (Mendes et al., 2013). Previously reported hematological changes in response to fighting after RWL include lower than expected lactate levels, reduced glycemic response, and increased levels of cortisol (Sundgot-Borgen & Garthe, 2011), which may be associated with decreased competitive success. Furthermore, the time period between
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weigh-in and competition in MMA events has shown to be inadequately used by athletes to promote rehydration (Jetton et al., 2013). As MMA is a sport with growing international popularity, the number of athletes who perform RWL strategies is also increasing and, generally, these fighters undergo RWL seven to three days before weigh-in (Timpmann et al., 2008) followed by a period of 10–22 hr, which appears to be insufficient for recovery and rehydration (Jetton et al., 2013). While nutritional interventions may be efficiently and effectively implemented to promote adequate recovery, this has yet to be adequately explored within the context of combat sports. In summary, RWL strategies promote dehydration, as evidenced by increased urine specific gravity (Jetton et al., 2013), increased expression of cortisol (Sundgot-Borgen & Garthe, 2011), reduced availability of glucose (Artioli et al., 2010) and decreased testosterone/cortisol (T/C) ratio, which would indicate an increased catabolic state (Degoutte et al., 2006). However, the literature has no data regarding the presence or absence of RWL and its impact on the biological parameters of combat sports athletes in Mixed Martial Arts events. Therefore with consideration for the limitations regarding recovery time following weigh-in (Artioli et al., 2010), and the high prevalence of RWL in combat sports (Franchini, Brito & Artioli, 2012), the aim of the current study was to compare the biochemical and hormonal responses between MMA fighters with minimal prefight weight loss and those undergoing RWL.
Methods The present study was carried out during two official competitive MMA events with prior authorization of the organization, athletes and their coaches. The sample included 17 male professional MMA athletes who were over 18 years old that had participated in at least two official fights during the previous 12 months and had been specifically training for the event for at least three consecutive months. Before data collection, all athletes responded to a demographic questionnaire and signed an informed consent (protocol n°. 197/2011 of Local Ethics Committee). The athletes went through health screening, and general demographic information, including body weight, height, and weight class were recorded from the official records for each event. In addition, self-reported age, competitive history, training frequency, dietary supplement usage and declaration of the usage of substances that could affect laboratory testing were determined.
MMA Events The professional regional-level events both started at 6:00 p.m. and took place in Pelotas/RS, Brazil. The athletes were separated into groups according to the official weigh-in procedures for each event, as designated by the respective organizations. During the first event, the nonrapid weight loss (NWL, n = 12) group weighed in on the day of the event (~30 min prior fight) and athletes
declared not having used RWL strategies. During the second event, the RWL group (n = 5), consisting of athletes that had not participated in the first event, weighed in 24h before the event and the athletes claimed to have executed lost 7.4 ± 1.1 kg, approximately 10% of their body mass in the one week preceding the event. According to informal conversation with the athletes, the weight loss procedures used were similar to those reported elsewhere, including an increase in physical activities (5), dietary restriction (4) and sauna (2). With the exception of the weigh-in procedures, the other competitive parameters of the events were standardized, including the fighting area, which featured eight sides (Octagon), and fight time (three rounds of five min with one-min rest intervals). Two athletes were excluded from the sample because they did not fit in the inclusion parameters or declared the use of substances that could alter or impair the examined biological variables. During the competitive events, blood samples were collected for analysis of biological variables before (prematch; between 60 and 90 min prior the fight) and after (postmatch; immediately post fight) each athlete’s fight.
Procedures Blood Sample and Laboratory Analysis. Prematch and postmatch 10 ml blood samples were collected through venous phlebotomy in the athlete’s upper limb (Degoutte et al., 2006). The samples were fractionated in tubes containing the additives needed for the purpose of laboratory analysis according to procedures established by the Clinical and Laboratory Standards Institute (CLSI, 2010). After fractionation, samples were immediately transported to the laboratory for preparation, processing and conservation. Samples were transported in a styrofoam box containing recyclable ice packets, with its interior clad with absorbing material to avoid unnecessary mechanical disturbance of the tubes. Serum and plasma was separated by centrifugation of samples for 5 min at 3000 rpm. Samples were stored under refrigeration at 4 °C until all the tests were performed and then discarded properly as biohazardous material. Biochemical analyses were made with Integra 600 equipment, for determination of glucose and magnesium (Mg); lactate, total creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatinine. Elecsys 2010 equipment was used for determination of cortisol and for testosterone. The samples were tested in duplicates with coefficients of variations intra-assay of 3.4% (Mg), 5.6% (lactate), 15.2% (CK), 3.4% (LDH), 2.8% (AST), 2.6% (ALT), 7.8% (creatinine), 3.6% (cortisol) and 2.5% (testosterone). For statistical analysis, the results are presented in tabular and graphical form. Shapiro-Wilk tests for normality were conducted, parametric values are reported as means and standard deviations (SD) and nonparametric values are presented as median and interquartile range
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(IQR, 25–75%). For parametric data, two-way analysis of variance (time x group) was used to compare the dependent variables. In the event of a significant time x condition, independent samples t tests were used to compare the prepost match values between the NWL and RWL groups. In addition, prepost match percent change and standard deviation of select variables were constructed to further illustrate differences between groups. For nonparametric data, the Kruskal-Wallis test was used, and differences were confirmed by Mann-Whitney tests. For all results, p < .05 was considered significant. Analyses were conducted using Microsoft Excel 2010 and SPSS 17.0.
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Results Data from 17 MMA athletes (RWL = 5; NWL = 12) were included in the analysis. No significant differences were observed among the groups for demographic variables, on average, the athletes were 27.4 ± 5.3 years old with a body mass of 76.2 ± 12.4 kg, height of 1.71 ± 0.05 m and had 39.4 ± 25 months of training experience. With regard to competitive history, the athletes had participated in an average of 6.7 ± 5 fights, with 4 ± 3.5 victories and 2.7 ± 1.7 defeats. The matches for the RWL group ended during the second round (6 ± 1.4 min of fight time; 2 by arm bar and 1 by TKO). For the NWL group, all the six fights ended in the first round (1 by KO, 2 by TKO and 3 by submission) with 4 ± 1.3 min of fight time. The values of biochemical markers are shown in Table 1. Lactate concentration was significantly different before and following the fights (F = 86.02; p < .001, power = .99), but no differences were shown between groups (F = 1.45; p = .23, power = .21). Glucose concentration was significantly different before and following the fights (F = 28.03; p < .001, power = .99) and between groups (F = 5.74; p = .02, power = .64). Similarly, LDH activity was significantly different between time points (F = 7.17; p = .01, power = 0.7) and between groups (F = 105.93; p < .001, power = 1). Time × condition interactions were shown for LDH (F = 9.43, p < .01, power = .8). Post hoc analysis showed that LDH was significantly greater in the RWL group compared with the NWL group both before (p < .001) and following the fights (p < .001). Furthermore, LDH increased from pre- to post match in both the NWL and RWL groups (Table 1). The AST activity showed no difference between time points (F = 2.3; p = .1, power = .3), but was significant between groups (F = 13.5; p < .001, power = .9). Enzymatic activity of ALT and CK, and concentrations of Mg and creatinine, showed no difference between time points or groups. Time × condition interactions were shown for AST (F = 10.9, p = .05, power = 0.8) and creatinine (F = 18.3, p = .01, power = .9). Post hoc analysis showed that AST was significantly greater in the RWL group compared with the NWL just following the fights (p < .01). However, AST was not significantly different from pre- to post match in either group. Post hoc analysis showed that creatinine was significantly greater in the NWL group compared with the RWL group both before
(p < .001) and following the fights (p < .001; Table 1). Furthermore, creatinine increased from pre- to post match the NWL group only (Figure 1). No significant differences in testosterone were found between time points or groups, while cortisol was shown to increase following the fights. However, the T/C ratio was significantly different before and following the fights, as well as between the RWL and NWL groups.
Discussion The present study aimed to investigate changes in biological markers during MMA fights in events with different weigh-in rules that potentially promote or dissuade the use of RWL strategies. The main findings indicate less glucose availability and increased muscle damage markers in the RWL group that weighed in 24 hr before the fight compared with the NWL group that weighed in on the day of the fight. The findings of this study confirm the initial hypothesis that the concentrations of lactate and glucose would increase from pre to postmatch due to the activation of glycolytic metabolism for ATP production (Barbas et al., 2011). The increase in glycogenolysis and gluconeogenesis is explained by the increased need for energy availability caused by adrenergic activation as a result of physical and psychological stress (Andreato et al., 2013; Kraemer et al., 2001). The currently reported increase in the concentration of cortisol indicates activation of sympathetic activity to enhance energy availability during the fight (Andreato et al., 2013). Although similar responses occurred in both groups, the RWL group possessed lower blood glucose concentrations compared with the NWL group, which may be explained by the possibility of a reduction in precompetition dietary intake (Sundgot-Borgen & Garthe, 2011) and the increase in physical activities which, indeed, could affect glycogen storages (Petterson et al., 2013). However, without dietary assessment in the current sample of athletes, this possibility could not be investigated. The lower blood glucose concentration presented by RWL group appear to in conflict with the reported increase in carbohydrate intake by combat sports athletes following weigh-ins (Pettersson & Berg, 2014). However, this magnitude of carbohydrate intake may be intolerable for some athletes while optimal post weigh-in/prematch nutrition efforts may be limited by a variety of internal and external factors (Pettersson et al., 2012) which may ultimately result in failure to meet the recovery nutrition guidelines for carbohydrates (Pettersson & Berg, 2014). The reduction of glucose following acute weight loss has also been reported in Judo athletes (Artioli et al., 2010) and, according to the authors, provides partial explanation for concomitant hormonal changes, specifically increased cortisol concentrations. Furthermore, other factors related to the hormonal response involving physical and psychological stress resulting from competition and fighting have also been reported (Salvador et al., 2003). Low lactate concentrations tend to be associated
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483
[10.8-22.8] [0.3-0.5]
30.6 18.3 0.3
AST (U/L)†
Testosterone (nmol/L)
T/C ratio*†
0.2
14.1
32.2‡
39.4
231.1‡#
16.9
252
Median
719.8
142.0‡#
0.8
9.4
Mean
[0.1-0.3]
[10.1-21.8]
0.2
10.7
39.9
[22.2-41.8]
390.1
2.2
259
Median
499.9
69.0
0.8
4.6
Mean
31.2
[32.5-57.4]
[203-258.7]
[12.7-24.1]
[146.1-407.1]
IQR
125.1
23
0.1
1.4
SD
Postmatch
[0.1-0.3]
[7.2-12.9]
[32.5-76.5]
[27-34.5]
[370.5-443.5]
[1.7-2.4]
[165.5-2130]
IQR
107.8
10
0.03
0.7
SD
Prematch
0.1
7.0
72.1
40.3
488.0#
15.9
306
Median
731.6
79.0
0.8
7.9
Mean
RWL (n = 5)
[0.05-0.1]
[4.3-9.1]
[38.5-112.5]
[31.4-43.9]
[463.5-540.5]
[12.1-20]
[200-2077.5]
IQR
80.2
16
0.02
3.1
SD
Postmatch
Note. RWL = athletes employing rapid weight loss procedures; NWL = athletes not employing rapid weight loss procedures; IQR = Interquartile range; CK = Creatine kinase; LDH: Lactate dehydrogenase; AST = Aspartate aminotransferase; ALT = Alanine aminotransferase. Difference between pre and post measures: * < 0.01. Difference between groups: † < 0.01; §= 0.2. Within time point difference from RWL: ‡ < 0.01. Within group difference from pre: # < 0.01.
[22.1-37.9]
38.7
ALT (U/L)
[31.1-52.8]
[183.3-236]
211.5‡
(U/L)*†
LDH
[3.3-4.3]
4.0
Lactate (mmol/L)*
[136-345.1]
IQR
Median 230
184.4
NWL (n = 12)
CK (U/L)
Cortisol (nmol/L)*
476.3
15
101.6‡
Creatinine
0.1
0.8
(µmol/L)*†
Magnesium (mmol/L)
1.1
SD
6.1
Mean
Prematch
Glucose (mmol/L)* §
Variables
Table 1 Biochemical and Hormonal Responses to MMA Fights with and without Weight Loss
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Figure 1 — Pre- to postmatch changes (%) in LDH, AST and Creatinine levels. RWL: athletes with rapid weight loss procedures; NWL: athletes with nonweight loss procedures; LDH: Lactate dehydrogenase; AST: Aspartate aminotransferase. * Difference between groups: p < .05.
with lower performance in combat sports (Smith et al., 2001); however, similar to our findings, no differences were found between groups of boxers with and without weight loss (Smith et al., 2000; 2001). In addition, the absence of prior fasting and high prefight stress levels might justify the high lactate values in the first sampling (Viru & Viru, 2001). In addition, the enzymatic activity of CK, AST and LDH indicates the occurrence of muscle damage by cell extravasation of these components from the breakup of the sarcolemma due to the high intensity of efforts (Banfi et al., 2012; Coswig, Neves & Del Vecchio, 2013 and, possibly, injury from the impacts of striking and other physical contact (Cordeiro et al., 2007; Coutts et al., 2007). Moreover, changes in these markers have been observed in judo fighters after competition (Umeda et al., 2008; Ribeiro, Criollo & Martins, 2006). Elevated AST and LDH were significantly higher in the RWL group, indicating that the practice of weight loss interferes with these processes. In addition, after presenting greater AST and LDH concentrations, the RWL group experienced greater increases following the fights when compared with the NWL group indicating a differential response to the competitive environment. Furthermore, despite not presenting statistical significance, the CK values were ~45% larger in the RWL group. This absence of significant differences between groups for CK values appears to be related to time of collection, since the elevation of CK typically occurs after a few hours, reaching peak concentrations between 1 and 4h after exercise and returning to normal values between 3 and 8 days (Banfi et al., 2012). In addition, the concentration of creatinine was lower in the RWL group, which may be due to fluid replacement during the process of weight regain. The behavior of this marker is associated with diet, exercise, body weight and emotional state, and is indicative of glomerular filtration rate (Viru & Viru, 2001). In this sense, the reduced
blood flow to the kidneys caused by intense exercise, promotes significant increases in serum levels of this marker (Banfi et al. 2012, Viru & Viru, 2001), which was evident between time points. The results from the current study show that creatinine values increased to a greater degree following the fights in the NWL group; however, the contribution of hydration status before and during the competition or the intensity of the individual fights to the differential response between groups could not be determined from the collected data. As for magnesium, a reduction caused by caloric restriction and dehydration would be expected, along with a decrease in anaerobic capacity due to its role in glycogenolysis, as reported in judokas after a week of weight reduction (Filaire et al., 2001). However, no significant changes were identified in the current study, and it appears that this reduction may have been blunted by rehydration strategies and weight regain, similar to that observed in a study that investigated the rapid weight loss response in boxers compared with a control group (Reljic et al., 2013). In contrast, a study with MMA fighters verified from urinary specific gravity that, despite the recovery of body weight before competition, indicators of dehydration remain elevated and subsequent health risks and suboptimal performance may be expected (Jetton et al., 2013). As mentioned previously, and as would be expected, cortisol levels increased from pre to postmatch, indicating sympathetic activation and increased physical and mental stress (Viru & Viru, 2001, Degoutte et al., 2006). However, this increase in cortisol and its response to the need for greater energy availability seems to be a positive factor for generating alert status, which may increase fighter competitiveness (Salvador et al., 2003). Nonetheless, the existence of an increased catabolic state is reinforced be the alteration of T/C from pre- to postmatch, as well as the differences between the RWL and NWL groups. The lower reported T/C values postmatch
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Rapid Weight Loss in Mixed Martial Arts Athletes 485
and in the RWL group indicates that these stimuli result in heightened stress levels, possibly caused by organic stress due to the dehydration process (Viru & Viru, 2001). A similar result was found in judo athletes with a decreased T/C ratio following weight loss and competition which was associated with loss of performance in motor tests (Degoutte et al., 2006). The main limitations of the current investigation are: i) the absence of control of food intake and physical efforts between the first data collection time point and the fight; ii) the differing physical fitness levels of the individual fighters. Finally, the weight loss and recovery strategies employed by the athletes in this study were self-selected. Therefore, it is suggested that future investigations implement nutritional interventions during recovery and weight regain period, baseline blood markers and individual response and procedures to control for energy intake and physical activity between the weight and competition.
Summary and Practical Applications The results of the current investigation demonstrate that the practice of rapid weight loss has an influence on blood glucose concentration and increases both muscle damage markers and catabolic expression in MMA fighters. These findings, as well as the generalized biochemical and hormonal response to the competitive environment, may be used to develop appropriate preparation and recovery strategies for combat sports athletes and considered by MMA organizations when implementing weigh-in regulations. Acknowledgments The authors are glad to the athletes and coaches who participated in the study. We declare that we have no conflicts of interest in the authorship or publication of this contribution. The study was designed by Del Vecchio, F B and Coswig, V S; data were collected and analyzed by Del Vecchio, F B, Coswig, V S and Fukuda, D H; data interpretation and manuscript preparation were undertaken by Del Vecchio, F B, Coswig, V S and Fukuda, D H. All authors approved the final version of the paper.
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Pettersson, S., Ekström, M.P., & Berg, C.M. (2013). Practices of weight regulation among elite athletes in combat sports: a matter of mental advantage? Journal of Athletic Training, 48, 99–108. PubMed Rainey, C.E. (2009). Determining the prevalence and assessing the severity of injuries in mixed martial arts athletes. North American Journal of Sports Physical Therapy, 4, 190–199. PubMed Reljic, D., Hässler, E., Jost, J., & Friedmann-Bette, B. (2013). Rapid weight loss and the body fluid balance and hemoglobin mass of elite amateur boxers. Journal of Athletic Training, 48, 109–117. PubMed Ribeiro, S.R., Criollo, C.J.T., & Martins, R.Á.B.L. (2006). Effects of different strengths in the judo fights, muscular electrical activity and biomechanical parameters in elite athletes. British Journal of Sports Medicine, 12, 27–32. Salvador, A., Suay, F., Gonzalez-bono, E., & Serrano, M.A. (2003). Anticipatory cortisol, testosterone and psychological responses to judo competition in young men. Psychoneuroendocrinology, 28, 364–375. PubMed doi:10.1016/S0306-4530(02)00028-8 Smith, M.S., Dyson, R., Hale, T., Harrison, J.H., & McManus, P. (2000). The effects in humans of rapid weight loss of body mass on a boxing related-related task. European Journal of Applied Physiology, 83, 34–39. PubMed doi:10.1007/ s004210000251 Smith, M., Dyson, R., Hale, T., Hamilton, M., Kelly, M., & Wellington, P. (2001). The Effects of Restricted Energy and Fluid Intake on Simulated Amateur Boxing Performance. International Journal of Sport Nutrition and Exercise Metabolism, 11, 238–247. PubMed Sundgot-Borgen, J., & Garthe, I. (2011). Elite athletes in aesthetic and Olympic weight-class sports and the challenge of body weight and body composition. Journal of Sports Sciences, 29, 101–114. PubMed doi:10.1080/02640414. 2011.565783 Timpmann, S., Oöpik, V., Pääsuke, M., Medijainen, L., & Ereline, J. (2008). Acute effects of self-selected regimen of rapid body mass loss in combat sports athletes. Journal of Sports, Science, and Medicine, 7, 210–217. PubMed Umeda, T., Yamai, K., Takahashi, I., Kojima, A., Yamamoto, Y., Tanabe, M., . . . Matsuzaka, M. (2008). The effects of a two-hour judo training session on the neutrophil immune functions in university judoists. The Journal of Biological and Chemical Luminescence, 23, 49–53. PubMed doi:10.1002/bio.1016 Viru, A., & Viru, M. (2001). Biochemical monitoring of sport training. 1ed, Canadá: Human Kinetics.
IJSNEM Vol. 25, No. 5, 2015
ORIGINAL RESEARCH
Rapid Weight Loss Elicits Harmful Biochemical and Hormonal Responses in Mixed Martial Arts Athletes Victor Silveira Coswig, David Hideyoshi Fukuda, and Fabrício Boscolo Del Vecchio The purpose of this study was to compare biochemical and hormonal responses between mixed martial arts (MMA) competitors with minimal prefight weight loss and those undergoing rapid weight loss (RWL). Blood samples were taken from 17 MMA athletes (Mean± SD; age: 27.4 ±5.3yr; body mass: 76.2 ± 12.4kg; height: 1.71 ± 0.05m and training experience: 39.4 ± 25 months) before and after each match, according to the official events rules. The no rapid weight loss (NWL, n = 12) group weighed in on the day of the event (~30 min prior fight) and athletes declared not having used RWL strategies, while the RWL group (n = 5) weighed in 24 hr before the event and the athletes claimed to have lost 7.4 ± 1.1kg, approximately 10% of their body mass in the week preceding the event. Results showed significant (p < .05) increases following fights, regardless of group, in lactate, glucose, lactate dehydrogenase (LDH), creatinine, and cortisol for all athletes. With regard to group differences, NWL had significantly (p < .05) greater creatinine levels (Mean± SD; pre to post) (NWL= 101.6 ± 15–142.3 ± 22.9μmol/L and RWL= 68.9 ± 10.6–79.5 ± 15.9μmol/L), while RWL had higher LDH (median [interquartile range]; pre to post) (NWL= 211.5[183–236] to 231[203–258]U/L and RWL= 390[370.5–443.5] to 488[463.5–540.5]U/L) and AST (NWL= 30[22–37] to 32[22–41]U/L and 39[32.5–76.5] to 72[38.5–112.5] U/L) values (NWL versus RWL, p < .05). Post hoc analysis showed that AST significantly increased in only the RWL group, while creatinine increased in only the NWL group. The practice of rapid weight loss showed a negative impact on energy availability and increased both muscle damage markers and catabolic expression in MMA fighters. Keywords: martial arts, blood chemical analysis, athletic performance Mixed martial arts (MMA) is a combat sport characterized by incorporating fighting styles derived from other martial arts, which involve, grappling and striking techniques from both a standing position and on the ground (Amtmann & Berry 2003; Del Vecchio et al., 2011; LaBounty et al., 2010). Generally, the matches have three to five rounds lasting 5 min each, and the winner is determined by a judge’s decision (in case of expiration of the time provided for fighting), knockout (KO), technical knockout (TKO), submission or disqualification (Rainey, 2009). In MMA, competitive success requires high physical fitness (Amtmann, 2004), with well-developed aerobic and anaerobic metabolic systems (Del Vecchio et al., 2011), as well as muscular strength and power (Del Vecchio & Ferreira, 2013). Similar to other combat sports, MMA competitions stratify athletes according weight classes (Jetton et al., 2013). As such, while aiming to challenge smaller oppoCoswig and Del Vecchio are with the Superior School of Physical Education, Federal University of Pelotas, Pelotas, Brazil. Fukuda is with the Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando, FL. Address author correspondence to Victor Silveira Coswig at vcoswig@ gmail.com.
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nents, fighters often employ different strategies for rapid weight loss (RWL), which may involve exercise in the heat, sauna, water and food restriction and ingestion of diuretics (Reljic et al., 2013). RWL has been characterized by reductions of 5–10% of usual body weight in less than a week (Petterson et al., 2013) and ~4% recovery of body mass in the 22 hr between weigh-in and fight time (Jetton et al., 2013). Despite the cultural and psychological component of RWL in combat sports athletes (Petterson et al., 2013), there appears to be a consensus that this practice has negative implications on physical performance (Koral & Dosseville, 2009; Lambert & Jones, 2010; Smith et al., 2000; 2001), and increases the risk of injuries (Green et al., 2007). Conversely, for fighters who have experience with RWL, the practice does not appear to affect performance in modality-specific tests (Artioli et al., 2010; Fogelholm et al., 1993). Recently, however, no differences were found in the acute response and recovery to RWL between combat sports athletes with and without chronic RWL experience (Mendes et al., 2013). Previously reported hematological changes in response to fighting after RWL include lower than expected lactate levels, reduced glycemic response, and increased levels of cortisol (Sundgot-Borgen & Garthe, 2011), which may be associated with decreased competitive success. Furthermore, the time period between
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weigh-in and competition in MMA events has shown to be inadequately used by athletes to promote rehydration (Jetton et al., 2013). As MMA is a sport with growing international popularity, the number of athletes who perform RWL strategies is also increasing and, generally, these fighters undergo RWL seven to three days before weigh-in (Timpmann et al., 2008) followed by a period of 10–22 hr, which appears to be insufficient for recovery and rehydration (Jetton et al., 2013). While nutritional interventions may be efficiently and effectively implemented to promote adequate recovery, this has yet to be adequately explored within the context of combat sports. In summary, RWL strategies promote dehydration, as evidenced by increased urine specific gravity (Jetton et al., 2013), increased expression of cortisol (Sundgot-Borgen & Garthe, 2011), reduced availability of glucose (Artioli et al., 2010) and decreased testosterone/cortisol (T/C) ratio, which would indicate an increased catabolic state (Degoutte et al., 2006). However, the literature has no data regarding the presence or absence of RWL and its impact on the biological parameters of combat sports athletes in Mixed Martial Arts events. Therefore with consideration for the limitations regarding recovery time following weigh-in (Artioli et al., 2010), and the high prevalence of RWL in combat sports (Franchini, Brito & Artioli, 2012), the aim of the current study was to compare the biochemical and hormonal responses between MMA fighters with minimal prefight weight loss and those undergoing RWL.
Methods The present study was carried out during two official competitive MMA events with prior authorization of the organization, athletes and their coaches. The sample included 17 male professional MMA athletes who were over 18 years old that had participated in at least two official fights during the previous 12 months and had been specifically training for the event for at least three consecutive months. Before data collection, all athletes responded to a demographic questionnaire and signed an informed consent (protocol n°. 197/2011 of Local Ethics Committee). The athletes went through health screening, and general demographic information, including body weight, height, and weight class were recorded from the official records for each event. In addition, self-reported age, competitive history, training frequency, dietary supplement usage and declaration of the usage of substances that could affect laboratory testing were determined.
MMA Events The professional regional-level events both started at 6:00 p.m. and took place in Pelotas/RS, Brazil. The athletes were separated into groups according to the official weigh-in procedures for each event, as designated by the respective organizations. During the first event, the nonrapid weight loss (NWL, n = 12) group weighed in on the day of the event (~30 min prior fight) and athletes
declared not having used RWL strategies. During the second event, the RWL group (n = 5), consisting of athletes that had not participated in the first event, weighed in 24h before the event and the athletes claimed to have executed lost 7.4 ± 1.1 kg, approximately 10% of their body mass in the one week preceding the event. According to informal conversation with the athletes, the weight loss procedures used were similar to those reported elsewhere, including an increase in physical activities (5), dietary restriction (4) and sauna (2). With the exception of the weigh-in procedures, the other competitive parameters of the events were standardized, including the fighting area, which featured eight sides (Octagon), and fight time (three rounds of five min with one-min rest intervals). Two athletes were excluded from the sample because they did not fit in the inclusion parameters or declared the use of substances that could alter or impair the examined biological variables. During the competitive events, blood samples were collected for analysis of biological variables before (prematch; between 60 and 90 min prior the fight) and after (postmatch; immediately post fight) each athlete’s fight.
Procedures Blood Sample and Laboratory Analysis. Prematch and postmatch 10 ml blood samples were collected through venous phlebotomy in the athlete’s upper limb (Degoutte et al., 2006). The samples were fractionated in tubes containing the additives needed for the purpose of laboratory analysis according to procedures established by the Clinical and Laboratory Standards Institute (CLSI, 2010). After fractionation, samples were immediately transported to the laboratory for preparation, processing and conservation. Samples were transported in a styrofoam box containing recyclable ice packets, with its interior clad with absorbing material to avoid unnecessary mechanical disturbance of the tubes. Serum and plasma was separated by centrifugation of samples for 5 min at 3000 rpm. Samples were stored under refrigeration at 4 °C until all the tests were performed and then discarded properly as biohazardous material. Biochemical analyses were made with Integra 600 equipment, for determination of glucose and magnesium (Mg); lactate, total creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatinine. Elecsys 2010 equipment was used for determination of cortisol and for testosterone. The samples were tested in duplicates with coefficients of variations intra-assay of 3.4% (Mg), 5.6% (lactate), 15.2% (CK), 3.4% (LDH), 2.8% (AST), 2.6% (ALT), 7.8% (creatinine), 3.6% (cortisol) and 2.5% (testosterone). For statistical analysis, the results are presented in tabular and graphical form. Shapiro-Wilk tests for normality were conducted, parametric values are reported as means and standard deviations (SD) and nonparametric values are presented as median and interquartile range
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(IQR, 25–75%). For parametric data, two-way analysis of variance (time x group) was used to compare the dependent variables. In the event of a significant time x condition, independent samples t tests were used to compare the prepost match values between the NWL and RWL groups. In addition, prepost match percent change and standard deviation of select variables were constructed to further illustrate differences between groups. For nonparametric data, the Kruskal-Wallis test was used, and differences were confirmed by Mann-Whitney tests. For all results, p < .05 was considered significant. Analyses were conducted using Microsoft Excel 2010 and SPSS 17.0.
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Results Data from 17 MMA athletes (RWL = 5; NWL = 12) were included in the analysis. No significant differences were observed among the groups for demographic variables, on average, the athletes were 27.4 ± 5.3 years old with a body mass of 76.2 ± 12.4 kg, height of 1.71 ± 0.05 m and had 39.4 ± 25 months of training experience. With regard to competitive history, the athletes had participated in an average of 6.7 ± 5 fights, with 4 ± 3.5 victories and 2.7 ± 1.7 defeats. The matches for the RWL group ended during the second round (6 ± 1.4 min of fight time; 2 by arm bar and 1 by TKO). For the NWL group, all the six fights ended in the first round (1 by KO, 2 by TKO and 3 by submission) with 4 ± 1.3 min of fight time. The values of biochemical markers are shown in Table 1. Lactate concentration was significantly different before and following the fights (F = 86.02; p < .001, power = .99), but no differences were shown between groups (F = 1.45; p = .23, power = .21). Glucose concentration was significantly different before and following the fights (F = 28.03; p < .001, power = .99) and between groups (F = 5.74; p = .02, power = .64). Similarly, LDH activity was significantly different between time points (F = 7.17; p = .01, power = 0.7) and between groups (F = 105.93; p < .001, power = 1). Time × condition interactions were shown for LDH (F = 9.43, p < .01, power = .8). Post hoc analysis showed that LDH was significantly greater in the RWL group compared with the NWL group both before (p < .001) and following the fights (p < .001). Furthermore, LDH increased from pre- to post match in both the NWL and RWL groups (Table 1). The AST activity showed no difference between time points (F = 2.3; p = .1, power = .3), but was significant between groups (F = 13.5; p < .001, power = .9). Enzymatic activity of ALT and CK, and concentrations of Mg and creatinine, showed no difference between time points or groups. Time × condition interactions were shown for AST (F = 10.9, p = .05, power = 0.8) and creatinine (F = 18.3, p = .01, power = .9). Post hoc analysis showed that AST was significantly greater in the RWL group compared with the NWL just following the fights (p < .01). However, AST was not significantly different from pre- to post match in either group. Post hoc analysis showed that creatinine was significantly greater in the NWL group compared with the RWL group both before
(p < .001) and following the fights (p < .001; Table 1). Furthermore, creatinine increased from pre- to post match the NWL group only (Figure 1). No significant differences in testosterone were found between time points or groups, while cortisol was shown to increase following the fights. However, the T/C ratio was significantly different before and following the fights, as well as between the RWL and NWL groups.
Discussion The present study aimed to investigate changes in biological markers during MMA fights in events with different weigh-in rules that potentially promote or dissuade the use of RWL strategies. The main findings indicate less glucose availability and increased muscle damage markers in the RWL group that weighed in 24 hr before the fight compared with the NWL group that weighed in on the day of the fight. The findings of this study confirm the initial hypothesis that the concentrations of lactate and glucose would increase from pre to postmatch due to the activation of glycolytic metabolism for ATP production (Barbas et al., 2011). The increase in glycogenolysis and gluconeogenesis is explained by the increased need for energy availability caused by adrenergic activation as a result of physical and psychological stress (Andreato et al., 2013; Kraemer et al., 2001). The currently reported increase in the concentration of cortisol indicates activation of sympathetic activity to enhance energy availability during the fight (Andreato et al., 2013). Although similar responses occurred in both groups, the RWL group possessed lower blood glucose concentrations compared with the NWL group, which may be explained by the possibility of a reduction in precompetition dietary intake (Sundgot-Borgen & Garthe, 2011) and the increase in physical activities which, indeed, could affect glycogen storages (Petterson et al., 2013). However, without dietary assessment in the current sample of athletes, this possibility could not be investigated. The lower blood glucose concentration presented by RWL group appear to in conflict with the reported increase in carbohydrate intake by combat sports athletes following weigh-ins (Pettersson & Berg, 2014). However, this magnitude of carbohydrate intake may be intolerable for some athletes while optimal post weigh-in/prematch nutrition efforts may be limited by a variety of internal and external factors (Pettersson et al., 2012) which may ultimately result in failure to meet the recovery nutrition guidelines for carbohydrates (Pettersson & Berg, 2014). The reduction of glucose following acute weight loss has also been reported in Judo athletes (Artioli et al., 2010) and, according to the authors, provides partial explanation for concomitant hormonal changes, specifically increased cortisol concentrations. Furthermore, other factors related to the hormonal response involving physical and psychological stress resulting from competition and fighting have also been reported (Salvador et al., 2003). Low lactate concentrations tend to be associated
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483
[10.8-22.8] [0.3-0.5]
30.6 18.3 0.3
AST (U/L)†
Testosterone (nmol/L)
T/C ratio*†
0.2
14.1
32.2‡
39.4
231.1‡#
16.9
252
Median
719.8
142.0‡#
0.8
9.4
Mean
[0.1-0.3]
[10.1-21.8]
0.2
10.7
39.9
[22.2-41.8]
390.1
2.2
259
Median
499.9
69.0
0.8
4.6
Mean
31.2
[32.5-57.4]
[203-258.7]
[12.7-24.1]
[146.1-407.1]
IQR
125.1
23
0.1
1.4
SD
Postmatch
[0.1-0.3]
[7.2-12.9]
[32.5-76.5]
[27-34.5]
[370.5-443.5]
[1.7-2.4]
[165.5-2130]
IQR
107.8
10
0.03
0.7
SD
Prematch
0.1
7.0
72.1
40.3
488.0#
15.9
306
Median
731.6
79.0
0.8
7.9
Mean
RWL (n = 5)
[0.05-0.1]
[4.3-9.1]
[38.5-112.5]
[31.4-43.9]
[463.5-540.5]
[12.1-20]
[200-2077.5]
IQR
80.2
16
0.02
3.1
SD
Postmatch
Note. RWL = athletes employing rapid weight loss procedures; NWL = athletes not employing rapid weight loss procedures; IQR = Interquartile range; CK = Creatine kinase; LDH: Lactate dehydrogenase; AST = Aspartate aminotransferase; ALT = Alanine aminotransferase. Difference between pre and post measures: * < 0.01. Difference between groups: † < 0.01; §= 0.2. Within time point difference from RWL: ‡ < 0.01. Within group difference from pre: # < 0.01.
[22.1-37.9]
38.7
ALT (U/L)
[31.1-52.8]
[183.3-236]
211.5‡
(U/L)*†
LDH
[3.3-4.3]
4.0
Lactate (mmol/L)*
[136-345.1]
IQR
Median 230
184.4
NWL (n = 12)
CK (U/L)
Cortisol (nmol/L)*
476.3
15
101.6‡
Creatinine
0.1
0.8
(µmol/L)*†
Magnesium (mmol/L)
1.1
SD
6.1
Mean
Prematch
Glucose (mmol/L)* §
Variables
Table 1 Biochemical and Hormonal Responses to MMA Fights with and without Weight Loss
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484 Coswig et al.
Figure 1 — Pre- to postmatch changes (%) in LDH, AST and Creatinine levels. RWL: athletes with rapid weight loss procedures; NWL: athletes with nonweight loss procedures; LDH: Lactate dehydrogenase; AST: Aspartate aminotransferase. * Difference between groups: p < .05.
with lower performance in combat sports (Smith et al., 2001); however, similar to our findings, no differences were found between groups of boxers with and without weight loss (Smith et al., 2000; 2001). In addition, the absence of prior fasting and high prefight stress levels might justify the high lactate values in the first sampling (Viru & Viru, 2001). In addition, the enzymatic activity of CK, AST and LDH indicates the occurrence of muscle damage by cell extravasation of these components from the breakup of the sarcolemma due to the high intensity of efforts (Banfi et al., 2012; Coswig, Neves & Del Vecchio, 2013 and, possibly, injury from the impacts of striking and other physical contact (Cordeiro et al., 2007; Coutts et al., 2007). Moreover, changes in these markers have been observed in judo fighters after competition (Umeda et al., 2008; Ribeiro, Criollo & Martins, 2006). Elevated AST and LDH were significantly higher in the RWL group, indicating that the practice of weight loss interferes with these processes. In addition, after presenting greater AST and LDH concentrations, the RWL group experienced greater increases following the fights when compared with the NWL group indicating a differential response to the competitive environment. Furthermore, despite not presenting statistical significance, the CK values were ~45% larger in the RWL group. This absence of significant differences between groups for CK values appears to be related to time of collection, since the elevation of CK typically occurs after a few hours, reaching peak concentrations between 1 and 4h after exercise and returning to normal values between 3 and 8 days (Banfi et al., 2012). In addition, the concentration of creatinine was lower in the RWL group, which may be due to fluid replacement during the process of weight regain. The behavior of this marker is associated with diet, exercise, body weight and emotional state, and is indicative of glomerular filtration rate (Viru & Viru, 2001). In this sense, the reduced
blood flow to the kidneys caused by intense exercise, promotes significant increases in serum levels of this marker (Banfi et al. 2012, Viru & Viru, 2001), which was evident between time points. The results from the current study show that creatinine values increased to a greater degree following the fights in the NWL group; however, the contribution of hydration status before and during the competition or the intensity of the individual fights to the differential response between groups could not be determined from the collected data. As for magnesium, a reduction caused by caloric restriction and dehydration would be expected, along with a decrease in anaerobic capacity due to its role in glycogenolysis, as reported in judokas after a week of weight reduction (Filaire et al., 2001). However, no significant changes were identified in the current study, and it appears that this reduction may have been blunted by rehydration strategies and weight regain, similar to that observed in a study that investigated the rapid weight loss response in boxers compared with a control group (Reljic et al., 2013). In contrast, a study with MMA fighters verified from urinary specific gravity that, despite the recovery of body weight before competition, indicators of dehydration remain elevated and subsequent health risks and suboptimal performance may be expected (Jetton et al., 2013). As mentioned previously, and as would be expected, cortisol levels increased from pre to postmatch, indicating sympathetic activation and increased physical and mental stress (Viru & Viru, 2001, Degoutte et al., 2006). However, this increase in cortisol and its response to the need for greater energy availability seems to be a positive factor for generating alert status, which may increase fighter competitiveness (Salvador et al., 2003). Nonetheless, the existence of an increased catabolic state is reinforced be the alteration of T/C from pre- to postmatch, as well as the differences between the RWL and NWL groups. The lower reported T/C values postmatch
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Rapid Weight Loss in Mixed Martial Arts Athletes 485
and in the RWL group indicates that these stimuli result in heightened stress levels, possibly caused by organic stress due to the dehydration process (Viru & Viru, 2001). A similar result was found in judo athletes with a decreased T/C ratio following weight loss and competition which was associated with loss of performance in motor tests (Degoutte et al., 2006). The main limitations of the current investigation are: i) the absence of control of food intake and physical efforts between the first data collection time point and the fight; ii) the differing physical fitness levels of the individual fighters. Finally, the weight loss and recovery strategies employed by the athletes in this study were self-selected. Therefore, it is suggested that future investigations implement nutritional interventions during recovery and weight regain period, baseline blood markers and individual response and procedures to control for energy intake and physical activity between the weight and competition.
Summary and Practical Applications The results of the current investigation demonstrate that the practice of rapid weight loss has an influence on blood glucose concentration and increases both muscle damage markers and catabolic expression in MMA fighters. These findings, as well as the generalized biochemical and hormonal response to the competitive environment, may be used to develop appropriate preparation and recovery strategies for combat sports athletes and considered by MMA organizations when implementing weigh-in regulations. Acknowledgments The authors are glad to the athletes and coaches who participated in the study. We declare that we have no conflicts of interest in the authorship or publication of this contribution. The study was designed by Del Vecchio, F B and Coswig, V S; data were collected and analyzed by Del Vecchio, F B, Coswig, V S and Fukuda, D H; data interpretation and manuscript preparation were undertaken by Del Vecchio, F B, Coswig, V S and Fukuda, D H. All authors approved the final version of the paper.
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