Analyzes for the athlete. What do you need to take before going to the gym? Biochemical blood tests Prevention of increased creatine kinase levels
Biochemical studies make it possible to determine the state of individual organs and systems of the body, which prevents the body from functioning normally and limits the development of special performance in an athlete.
Glucocorticoids ( cortisol) - its main effect is that it increases the level of glucose in the blood, including due to its synthesis from protein precursors, which can significantly improve the energy supply of muscle activity. Insufficient activity of glucocorticoid function can become a serious factor limiting the growth of sports readiness.
At the same time, an excessively high level of cortisol in the blood indicates a significant stressor load for the athlete, which can lead to the predominance of catabolic processes in protein metabolism over anabolic ones and, as a consequence, the disintegration of both individual cellular structures and groups of cells. First of all, the cells of the immune system are destroyed, resulting in a decrease in the body’s ability to resist infectious agents. A negative effect on bone metabolism is the destruction of the protein matrix and, as a result, an increased risk of injury (fractures).
Elevated cortisol levels also have a negative impact on the cardiovascular system. Therefore, it is necessary to regularly monitor the level of cortisol in the blood in order to maintain it at a high level (500-800 nmol/l), necessary for the body to effectively adapt to intense physical activity. Elevated levels of cortisol in the blood (above 900 nmol/l) indicate insufficient efficiency of recovery processes, and can lead to fatigue.
One of the most effective anabolic hormones that counteracts the negative effect of cortisol on protein metabolism in the athlete’s body is testosterone. Testosterone effectively restores muscle tissue. It also has a positive effect on the bone and immune systems.
Under the influence of prolonged intense exercise, testosterone decreases, which undoubtedly negatively affects the effectiveness of recovery processes in the body after the loads endured. The higher the testosterone level, the more effectively the athlete’s body recovers.
Urea. Urea is a product of protein breakdown in the body (catabolism). Determining the urea concentration in the morning, on an empty stomach, allows you to assess the overall load tolerance of the previous day. Those. used to assess delayed recovery in sports activities. The more intense and longer the work, the shorter the rest intervals between loads, the more significant the depletion of protein/carbohydrate resources and, as a result of this, the greater the level of urea production. According to long-term observations in athletes at rest, the level of urea in the blood should not exceed 8.0 mmol/l - this value was taken as the critical level of severe underrecovery.
However, it should be borne in mind that a high-protein diet, food supplements containing large amounts of proteins and amino acids also increase the level of urea in the blood. The level of urea also depends on muscle mass (weight), as well as kidney and liver function. Therefore, it is necessary to establish an individual norm for each athlete.
It should be noted that the level of cortisol used in the practice of biochemical control is a more modern and accurate indicator of the intensity of catabolic processes in the body.
Glucose. It is the most important source of energy in the body. The change in its concentration in the blood during muscle activity depends on the level of fitness of the body, the power and duration of physical exercise. The change in glucose content in the blood is used to judge the rate of its aerobic oxidation in body tissues during muscle activity and the intensity of mobilization of liver glycogen.
It is recommended to use this indicator in combination with determining the level of the hormone insulin, which is involved in the processes of mobilization and utilization of blood glucose.
CPK (Creatine phosphokinase).
Determining the total activity of CPK in the blood serum after physical exercise makes it possible to assess the degree of damage to the cells of the muscular system, myocardium and other organs. The higher the stress (severity) of the load transferred to the body, the greater the damage to cell membranes, the greater the release of the enzyme into the peripheral blood.
CPK activity is recommended to be measured 8-10 hours after exercise, in the morning after sleep. Elevated levels of CPK activity after a night of recovery indicate significant physical activity endured the day before and insufficient recovery of the body.
It should be noted that CPK activity in athletes during training is approximately twice the upper limits of the norm for a “healthy person.” Those. we can talk about under-recovery of the body after previous loads with a CPK level of at least 500 U/l. CPK levels above 1000 U/l cause serious concern, because damage to muscle cells is significant and causes pain. It should be noted the importance of differentiating overstrain of skeletal muscles and cardiac muscle. For this purpose, measurement of myocardial fraction (CPK-MB) is recommended.
Inorganic phosphorus (Fn). Used to assess the activity of the creatine phosphate mechanism. By assessing the increase in Fn in response to a short-term load of maximum power (7-15 seconds), the participation of the creatine-phosphate mechanism in the energy supply of muscle activity in speed-strength sports is judged. It is also used in team sports (hockey). The greater the increase in Fn per load, the greater the involvement of the creatine phosphate mechanism and the better the functional state of the athlete.
ALT (Alanine aminotransferase). An intracellular enzyme found in the liver, skeletal muscles, cardiac muscle and kidneys. An increase in the activity of ALT and AST in plasma indicates damage to these cells.
AST (Aspartate aminotransferase) - also an intracellular enzyme contained in the myocardium, liver, skeletal muscles, kidneys.
Increased activity of AST and ALT allows us to identify early changes in the metabolism of the liver, heart, muscles, assess tolerance to physical exercise, and the use of pharmaceuticals. Physical activity of moderate intensity, as a rule, is not accompanied by an increase in AST and ALT. Intense and prolonged exercise can cause an increase in AST and ALT by 1.5-2 times (N 5-40 units). In more trained athletes, these indicators return to normal after 24 hours. For less trained people, it takes much longer.
In sports practice, not only individual indicators of enzyme activity are used, but also the ratio of their levels:
De Ritis coefficient (AST/ALT) - 1.33. If transaminases are elevated and their ratio is lower than the de Ritis ratio, then this is presumably liver disease. Below is heart disease.
Muscle Damage Index (KFK/AST). With increased enzyme activity, if their ratio is below 9 (from 2 to 9), then this is most likely due to damage to cardiomyocytes. If the ratio is higher than 13 (13-56), then this is due to damage to the skeletal muscles. Values from 9 to 13 are intermediate.
O. Ipatenko
CPK is a very important enzyme that is predominantly located in brain cells, muscles and heart. And if at least one cell is damaged, the enzyme immediately enters the blood. That is why a blood test for CPK is used for an accurate diagnosis.
Most often, a test for CPK content is prescribed:
- If it is necessary to diagnose such a serious disease as myocardial infarction, as well as monitor its course.
- If it is necessary to diagnose dangerous and incurable diseases of human skeletal muscles.
- If a person has suffered a serious injury that resulted in damage to one or more muscle groups.
- If a person is suspected of having a malignant tumor.
- If a person is undergoing treatment due to cancer.
Such an analysis is very rarely prescribed in outpatient settings, since not all laboratories in clinics are able to accurately produce the correct result. That is why it is better to take it directly in hospitals or in specialized laboratories, since the correctness of the result is very important.
Preparation and blood collection procedure
As a rule, in order to donate blood for CPK levels, you need to prepare in advance and tell the doctor who prescribes the test and who takes it information about what medications you are currently taking.
This must be done because some medications affect the content of enzymes, and the results can be either false positive or false negative, or there will be a large error.
Preparation includes:
- Avoid eating immediately before the test. The last appointment should be at least eight hours before the test.
- Blood is donated strictly on an empty stomach.
- Blood should be donated before taking medications so that they have minimal effect. Therefore, you need to choose the time so that it is not stressful for the body.
- The day before the test, completely eliminate fatty and spicy foods, as well as any alcoholic drinks and kvass.
- If an x-ray or ultrasound was performed before the test, it is better to reschedule the procedure, as the results may be incorrect.
Currently, there is a need to assess the degree of physical activity or the level of vitality of the body and its elements, which is one of the key tasks of preventing injuries and assessing the degree of fitness of football players. This assessment makes it possible to objectively record the rate of wear and tear of the body and its changes during therapeutic and prophylactic interventions. There are various approaches to obtaining this assessment, for example, you can measure the degree of deviation of various structural and functional characteristics of the body from the norm and thus assess the degree of their fatigue and recovery or wear. However, for different organs and systems of the body, the typical onset is different times, different degrees of severity and different directions of these changes (usually as a result of the development of compensatory processes). Often, pronounced individual and species differences in these changes are revealed. When choosing indicators for assessing the intensity of physical activity (PE) and fatigue from a huge variety of possible biomarkers, a number of requirements should be taken into account, the fulfillment of which significantly increases the information content and quality of the assessment:
1. The indicator must change significantly(preferably several times) in the period from the start of training to the recovery (rest) period.
2. The indicator must be highly correlated with the degree of physical function and the athlete's fitness.
3. Interindividual variance of the indicator should not exceed the magnitude of the change its average value.
4. Must take place low sensitivity of the selected indicator to diseases(diseases should not imitate changes in the indicator).
5. Must be observed change in indicator for all members of the population.
6. The indicator must be an indicator of a fairly significant process of age-related physiology and must have a semantic, morphological and functional interpretation , reflect the degree of physical fitness of the body or wear and tear of any system.
In addition, when determining the biochemical marker of FN, it is desirable:
· take into account age indicators;
· provide for an assessment of the degree of fitness by systems and organs;
· take into account tests and formulas tested in world practice;
· use modern computer science tools.
To date, unfortunately, there is no comparative analysis of sets of biochemical indicators according to any quality criteria. So far, it has not been possible to unambiguously answer the question of what number of indicators is optimal for determining the degree of physical activity and fatigue. It is clear, however, that increasing the number of indicators by more than 10-15 gives little in terms of the accuracy of determining the physical function. A small number of indicators (3-4) does not allow differentiating the types and profile of the body’s response to physical activity.
In various countries b Many attempts have been made to use changes in biochemical parameters as markers of physiological fatigue, but all of them were invariably associated with a number of difficulties associated with the lack of clear standards. Since different systems and organs react unevenly to physical exercise, the selection of the most informative, “leading” criterion for a given type of training becomes of primary importance. Its correlation with other parameters of the biochemical status and the similarity (identity) of the state of the trait upon completion of the fatigue processes are very important.
The question of what indicators are most suitable for determining fatigue in football players remains unresolved due to their significant physiological and individual variation. To answer this question, it is useful to take into account the ratio of the change in the indicator during the training process to the interindividual dispersion.
Order 337 of 2001 (extract)
3.2. Laboratory research:
3.2.1. Clinical blood test;
3.2.2. Clinical urine analysis;
3.2.3. Clinical and biochemical analysis of blood from a vein for:
Definitions of regulators of energy metabolism: cortisol, testosterone, insulin;
Thyroid status assessments: T3 total, T4 total, TSH (thyrotropin);
Enzyme Level Estimates: ALT (alanine aminotransferase), AST (aspartate aminotransferase), alkaline phosphatase, CPK (creatine phosphokinase).
Assessment of biochemical parameters: glucose, cholesterol, triglycerides, phosphorus.
All of the listed indicators, in almost arbitrary combinations, are used by various schools to determine the degree of fatigue. The optimal, apparently, is a set of the most different tests, covering various systems and organs and reflecting:
· age physiology,
· adaptation limits and functional reserves,
· physical and neuropsychic performance,
· characteristics of the most important systems.
In the practice of sports, the definition of activity and content is usually used;
. energy substrates ( ATP, CrP, glucose, free fatty acids acids);
. energy metabolism enzymes ( ATPase, CrP kinase, cytochrome oxidase, lactate dehydrogenase, etc.);
. intermediate and final products of metabolism of carbohydrates, lipids andproteins ( lactic and pyruvic acids, ketone bodies, urea, creatinine, creatine, uric acid, carbon dioxide and etc.);
. indicators of acid-base blood status (blood pH, parts real CO 2 pressure, reserve alkalinity or excess buffer bases vanii, etc.);
. metabolic regulators ( enzymes, hormones, vitamins, actives tori, inhibitors );
. minerals in biochemical fluids ( bi carbonates and salts of phosphoric acid are determined to characterize theblood ferment capacity );
. protein and its fractions in blood plasma.
In this report, we will limit ourselves to a general overview of the proposed indicators, systematizing them into classes and the possibility of using them to assess the intensity of the impact of physical activity on various body systems. As studies show, changes in substrates that occur in a trained body and are reflected both in the structure of the muscles and in integral form - in the blood, are a reflection of oxidative processes in the muscles. By studying the rate of mobilization and utilization of energy substrates, under one or another type of load in the dynamics of the training process, one can get an idea of the phase in which the formation of the main quality that determines endurance, speed-strength qualities, and oxidative abilities of working muscles is located.
Indicators of carbohydrate metabolism.
Glucose.The change in its content in the blood during muscle activity is individual and depends on the level of fitness of the body, the power and duration of physical exercise.Short-term physical activity of submaximal intensitymay cause an increase in blood glucose levels due to increasedmobilization of liver glycogen. Long-term physical activity leads to a decrease in blood glucose levels. In untrained individuals this isthe movement is more pronounced than in trained ones. Increased contentglucose in the blood indicates intensive breakdown of liver glycogen or relatively low use of glucose by tissues, and decreasedits content - about the depletion of liver glycogen reserves or intensiveactive use of glucose by body tissues.
The rate of aerobic activity is determined by changes in blood glucose levels.its significant oxidation in body tissues during muscle activity and the intensity of mobilization of liver glycogen. This exchange rateLevodov rarely used independently in sports diagnostics, since the level of glucose in the blood depends not only on the effects of physicalphysical loads on the body, but also from the emotional state of the personka, humoral regulation mechanisms, nutrition and other factors.
The appearance of glucose in the urine during physical activity indicates intensive mobilization of glycogen in the liver.neither. The constant presence of glucose in the urine is a diagnostic test for diabetes mellitus.
Organic acids. This test can detect metabolic abnormalities associated with generalized pain and fatigue, which are thought to be caused by reactions to toxic load, nutrient imbalances, digestive dysfunction, and other factors. This test provides important clinical information information about: organic acids that accurately reflect carbohydrate metabolism, mitochondrial function and beta fatty acid oxidation; mitochondrial dysfunction, which may underlie chronic symptoms of fibromyalgia, fatigue, ailments, hypotension (weakened muscle tone), acid-base imbalance, low exercise tolerance, muscle and joint pain, and headaches. Normal health and well-being depend on from healthy cell functioning. Every cell has a mitochondrion that acts as a “powerhouse.” The main function of mitochondria is to efficiently produce the energy required for life. Cellular Energy Profile measures specially selected groups of organic acids. These metabolites mainly reflect carbohydrate metabolism, functioning mitochondria and fatty acid oxidation that occursduring the process of cell respiration. Measured by this analysis organic acids are the main components and intermediate elements of metabolic pathways for energy conversion associated with the Krebs cycle and the production of adenosine triphosphate, the main source of cellular energy. You may find this profile particularly useful for patients with chronic malaise, fibromyalgia, fatigue, hypotension (weakened muscle tone), acid-base imbalance, poor exercise tolerance, muscle or joint pain, and headaches. Organic acids play a dominant role in producing energy for muscle tissue. Therefore defects mitochondria are associated with a variety of neuromuscular disorders. The accumulation of lactate, a natural substance for anaerobic glycolysis, in plasma indicates the depletion of oxidative metabolic potential due to increased energy needs. The glycolytic mechanism of ATP resynthesis in skeletal muscles ends with the formation lactic acid, whichthen enters the blood. Its release into the blood after cessation of physical activity is aboutcomes out gradually, reaching a maximum at 3-7 minutes after the windowsexpectations of the FN. Lactic acid content in blood exists significantly increases when performing intense physical work. At the same time, its accumulation in the blood coincides with an increasedcalling in the muscles.Significant concentrations of lactic acid in the blood after performing maximum work indicate a higher level of training with good athletic results or a greater metabolic capacity of glycolysis, greater resistance of its enzymes topH shift to the acidic side. Thus, changes in the concentration of lactic acid in the bloodafter performing a certain physical activity is associated with the athlete’s state of fitness. By changes in its content in the blood determine the anaerobic glycolytic capabilities of the body, which is importantbut when selecting athletes, developing their motor qualities, monitoring training loads and the progress of the body’s recovery processes.
Lipid metabolism indicators.
Free fatty acids . As structural components of lipi Thus, the level of free fatty acids in the blood reflects the rate of lipolysis of triglycerides in the liver and fat depots. Normally, their content is blood is 0.1-0.4 mmol. l" 1 and increases with long fi ical loads.
By changing the content of FFA in the blood, the degree of subconsumption is monitored connection of lipids to the processes of energy supply to muscle activityty, as well as the efficiency of energy systems or the degree of interconnectionbetween lipid and carbohydrate metabolism. High degree of coupling these mechanisms of energy supply during aerobic exercise is an indicator of a high level of functional training of an athlete.
Ketone bodies. They are formed in the liver from acetyl-CoA whenslow oxidation of fatty acids in body tissues. Ketone bodies fromlivers enter the blood and are delivered to tissues in which there is a largepart is used as an energy substrate, and the smaller part is excreted from the body. The level of ketone bodies in the blood isreduces the rate of fat oxidation.When they accumulate in the blood (ketonemia), they may appear in the urine, whereas normallyKetone bodies are not detected in urine. Their appearance in the urine (ketonuria) inhealthy people are observed during fasting, excluding carbohydrates from the dietdiet, as well as when performing physical activity, greatpower or duration.
By increasing the content of ketone bodies in the blood and their appearance inurine determine the transition of energy production from carbohydrate sources to lipid during muscle activity. Earlier connection lipid These sources indicate the efficiency of aerobic mechanisms for energy supply to muscle activity, which is interconnected with the increase in tension level of the body.
Cholesterol. It is a representative of steroid lipids and is not involvedin the processes of energy formation in the body. However, systematic physical activity can lead to its decrease in the blood. Three types of changes (increase, decrease and unchanged) in the content of total cholesterol after muscular effort can be distinguished. The nature of changes in cholesterol depends on its initial level: with a higher content of total cholesterol, there is a decrease in response to the load; with a relatively low level, on the contrary, it increases. Athletes experience an increase in cholesterol levels both at rest and after physical activity.
Phospholipids. The content of phospholipids reflects the severity of lipid metabolism disorders associated with liver dystrophy. An increase in their level in the blood is observed in diabetes, kidney disease, hypothyroidism and others. metabolic disorders, decrease - with fatty liver degeneration. Since prolonged physical activity is accompanied fatty liver, in sports practice they sometimes use control of the content of triglycerides and phospholipids in the blood.
Products of lipid peroxidation (LPO). During intense physicalunder load, the processes of lipid peroxidation intensify and the products of these processes accumulate in the blood, which is one of the factorssimulating physical performance. D All components of this mechanism: the level of peroxide processes in skeletal muscle and the involvement of leukocytes in the damage process. FN causes increased peroxide processes in skeletal muscles while reducing the activity of the main enzyme of antioxidant defense - superoxide dismutase, which leads to damage to the integrity of myocyte membranes. The result of damage to the cell membrane is a change in its permeability and the release of both cytoplasmic (myoglobin, aspartate aminotransferase) and structural (tropomyosin) skeletal muscle proteins into the blood. Tissue damage during hypoxia and due to the development of the process of peroxidation during restoration of blood flow (reperfusion) stimulates the attraction of leukocytes to the site of damage, which, as a result of activation, release a large number of reactive oxygen species (OMG test), thereby destroying healthy tissue. One day after intense physical activity, the activity of blood granulocytes is approximately 7 times higher than the control value and remains at this level for the next 3 days, then begins to decrease, however, exceeding the control level after 7 days of recovery.
Biochemical control of the body's response to physical activity, assessment of specialathlete’s physical preparedness, identifying the depth of biodestructiveprocesses during the development of stress syndrome should include determination of the content of peroxidation products in the blood: malondialdehyde, diene conjugates , as well as enzyme activity glutathione peroxide zy, glutathione reductase and catalase, superoxide dismutase . Peroxide damage to protein substances leads to their degradation and the formation of toxic fragments, including molecules of medium weight (MSM), which are considered to be markers of endogenous intoxication, including in athletes after intense exercise.
Protein metabolism indicators
Hemoglobin. The main protein of red blood cells is hemoglobin,which performs an oxygen transport function. It contains iron,binding air oxygen. During muscular activity it sharply increases the body's need for oxygen increases, which is satisfied more fully by extracting it from the blood, increasing the speed of blood flow, as well as a gradual increase in the amount of hemoglobin in the blood due to changes of the total blood mass. With an increase in the level of training of the athletenew in endurance sports, the concentration of hemoglobin in the blood in grows. Increase in hemoglobin content in the bloodreflects the body's adaptation to physical stress in hypoxical conditions. However, with intense training, about there is destruction of red blood cells and a decrease in hemoconcentrationglobin, which is considered as iron deficiency"sports anemia" In this case, you should change the training program rovok, and in the diet increase the content of protein foods, jelly for and B vitamins.
The content of hemoglobin in the blood can be used to judge aerobic activity. the body's capabilities, the effectiveness of aerobic training sessions, the athlete's health condition. Hematocrit- this is the proportion (%) of the total blood volume that is made up of red blood cells. Hematocrit reflects the ratio of red blood cells and blood plasma and is extremely important when adapting to physical activity. Determining it allows you to assess the state of blood circulation in the microvasculature and determine factors that complicate the delivery of oxygen to tissues. Hematocrit during FN increases, resulting in an increase in the ability of the blood to transport oxygen to the tissues. However, this also has a negative side - it leads to an increase in blood viscosity, which impedes blood flow and speeds up blood clotting time. An increase in the level of hemoglobin in the blood is due to a decrease in blood plasma as a result of fluid transfusion from the bloodstream into tissues and the release of red blood cells from the depot.
Ferritin. The most informative indicator of iron reserves in the body, the main form of deposited iron. Under physiological conditions of iron metabolism, ferritin plays an important role in maintaining iron in a soluble, nontoxic, and biologically useful form. During physical activity, a decrease in ferritin levels indicates the mobilization of iron for hemoglobin synthesis, a pronounced decrease indicates the presence of hidden iron deficiency anemia. Elevated serum ferritin levels not only reflect the amount of iron in the body, but are also a manifestation of the acute-phase response to the inflammatory process. However, if the patient does have iron deficiency, the acute-phase increase in iron levels is not significant.
Transferin . Plasma protein, glycoprotein, is the main carrier of iron. Transferrin synthesis occurs in the liver and depends on the functional state of the liver, the need for iron and iron reserves in the body. Transferrin is involved in the transport of iron from the site of its absorption (small intestine) to the site of its use or storage (bone marrow, liver, spleen). As iron concentration decreases, transferrin synthesis increases. A decrease in the percentage of transferrin saturation with iron (a consequence of a decrease in iron concentration and an increase in transferrin concentration) indicates anemia due to a lack of iron intake. Long-term intense exercise can lead to an increase in the content of this transport protein in the blood. In untrained athletes, FN can cause a decrease in its level.
Myoglobin. In the sarcoplasm of skeletal and cardiac muscles there is a highly specialized protein that performs the function of transporting oxygen like hemoglobin.Under the influence of physical activity,in pathological conditions of the body, it can leave the muscles inblood, which leads to an increase in its content in the blood and the appearancein the urine (myoglobinuria). The amount of myoglobin in the blood depends on the volumethe amount of physical activity performed, as well as the degree of trainingathlete's abilities. Therefore, this indicator can be usedfor diagnosing the functional state of working skeletal muscles.
Actin. The content of actin in skeletal muscles as a structural and contractile protein increases significantly during training. Based on its content in the muscles, it would be possible to control the development of an athlete’s speed-strength qualities during training, however determination of its content in muscles is associated with large methodological our difficulties. However, after performing physical activity the appearance of actin in the blood is noted, which indicates the destruction or renewal of the myofibrillar structures of skeletal muscles.
Proteins of the blood coagulation system. “The age of a person is the age of his blood vessels” (Democritus) and this point of view is shared by most modern researchers. Therefore, the issue of standardizing hemostasiological criteria for fatigue and assessing the degree of physical function by assessing the effectiveness of microcirculation in the body is very relevant. The heterochronicity of the process of fatigue and recovery implies uneven rates of fatigue of individual human systems. The hemostatic system is the most ancient in the phylogenetic sense and reflects generalized changes occurring at the level of the whole organism. It is the most mobile system and is highly sensitive to any disturbances in the internal environment of the body. To study microcirculation and hemostasiogram, the level of fibrinogen (FG), platelet count (Tg), activated partial thromboplastin time (APTT), fibrinolytic activity (FA), concentration of soluble fibrin monomer complexes (SFMC), and level of antithrombin III (ATIII) are determined.
Total protein. It determines the physical and chemical properties of blood - density, viscosity, oncotic pressure. Plasma proteins are the main transport proteins. Albumins and globulins . These are low molecular weight basic proteins blood plasma. They perform various functions in the body: they are part of the immune system,protect the body from infections, participate in maintaining blood pH, transport various organic and inorganic substances using are used to build other substances. Their quantitative ratio in blood serum is normally relatively constant and reflects the condition human health. The ratio of these proteins changes with fatigue, many diseases and can be used in sports medicine as diagnostic indicator of health status.
Albumin- the most homogeneous fraction of plasma proteins. Their main function is to maintain oncotic pressure. In addition, the large surface area of albumin molecules plays a significant role in the transport of fatty acids, bilirubin, and bile salts. Albumin partially binds a significant portion of calcium ions. After performing physical activity, the protein concentration in blood serum taken on an empty stomach does not change. Alpha globulins- fraction of proteins, including glycoproteins. The main function is the transfer of hydrocarbons, as well as transport proteins for hormones, vitamins and microelements. They transport lipids (triglycerides, phospholipids, cholesterol. After athletes perform a load, the concentration of alpha globulins in blood taken on an empty stomach decreases compared to the resting level. Beta globulins- a fraction of blood proteins involved in the transport of phospholipids, cholesterol, steroid hormones, cations, and carries iron in the blood. After athletes perform physical exercise, the concentration of beta globulins in the blood increases noticeably. Gamma globulins. This fraction includes various antibodies. The main function of immunoglobulins is protective. The content of gamma globulins in the blood serum decreases after exercise.
Ammonia. Hypoperfusion of skeletal muscles during physical activity leads to cellularhypoxia , which, along with other factors, causes symptoms of fatigue. Muscle fatigue - the inability of muscles to maintain muscle contraction of a given intensity - is associated with excessammonia , which enhances anaerobic glycolysis, blocking the exitlactic acid . Elevated ammonia levels and acidosis underlie the metabolic disturbances associated with muscle fatigue. The reason for the latter is disturbances in mitochondrial metabolism and increased catabolism of protein structures. Ammonia accumulation stimulates glycolysis by blocking aerobic utilizationpyruvate and restarting gluconeogenesis, which leads to excess lactate formation. For this process, which represents a vicious circle, the term “metabolic death” is used. Lactic acid accumulation andacidosis lead to glycolysis and “paralysis” of energy processes. Ammonium ion, influencing metabolism, stimulateshyperpnea , which worsens fatigue. A decrease in muscle contractility is accompanied by an increase in ammonia levels in the blood and cells. Increased acidosis and excessively high levels of ammonia make it difficult to maintain cell structure. The consequence of this is myofibril damage. In reality, there is increased catabolism of muscle proteins affecting the skeletal muscles. This can be measured by urinary excretion 3-methyl-histidine, a specific metabolite of muscle proteins. Overtraining results in depletion of glucose and lipid reserves associated with extreme acid-base conditions. Increased acidosis and excessively high levels of ammonia make it difficult to maintain cell structure. Hyperammonemia is a sign metabolic disorders in the muscle and is associated with a state of fatigue.
Urea. With increased breakdown of tissue proteins, excessive pos. dulling of amino acids into the body in the liver during the process of toxin binding ammonia (MH 3), which is commercial for the human body, is synthesized non-toxicSome nitrogen-containing substance is urea. Urea comes from the liverenters the blood and is excreted in the urine.The normal concentration of urea in the blood of every adult isindividual. It may increasewith a significant intake of proteins from food,in case of impaired excretory function of the kidneys, as well as after performing prolonged physical work due to the strengthening of kata protein pain. In sports practice, this indicator is widely used in assessing athlete's tolerance to training and competitive physiotherapyphysical loads, progress of training sessions and recovery processesbody. To obtain objective information, urine concentration guilt is determined the next day after training in the morning on an empty stomach. If the physical activity performed is adequate to the functional capabilities of the body and a relatively rapid recovery occursmetabolism, then the urea content in the blood in the morning on an empty stomach returnsgoes back to normal. This is due to speed balancing synthesis and breakdown of proteins in body tissues, which indicates its recovery. If the urea content remains higher than normal the next morning, this indicates that the body is not recovering well. due to the development of his fatigue.
Detection of protein in urine . A healthy person has no protein in his urineexists. Its appearance (proteinuria) is noted with kidney disease (nephrosis), damage to the urinary tract, as well as with excessive intake of proteins from food or after anaerobic muscular activity. This is due to impaired permeability of kidney cell membranesdue to acidification of the body environment and the release of plasma proteins into the urine.By the presence of a certain concentration of protein in the urine after performingPhysical work is judged by its power. So, when working in a high power zone it is 0.5%, when working in a submaximal zone power can reach 1.5%.
Creatinine. This substance is formed in the muscles during the breakdown process creatine phosphate. Its daily excretion in urine is relatively constant for a given person and depends on lean body mass.Based on the creatinine content in urine, one can indirectly estimate the rate of the creatine phosphokinase reaction, as well as the content of lean body mass.Based on the amount of creatinine excreted in the urine, the content is determined lean lean body mass according to the following formula:
lean body mass = 0.0291 x urine creatinine (mg day ~ 1) + 7.38.
Creatine. Creatine is a substance that is synthesized in the liver, pancreas and kidneys from the amino acids arginine, glycine and methionine. O is formed from phosphocreatine by the enzyme creatine kinase. The presence of such an energy reserve maintains the level of ATP/ADP in those cells where high concentrations of ATP are needed. The phosphocreatine kinase system works in the cell as an intracellular energy transfer system from those places where energy is stored in the form of ATP (mitochondrion and glycolysis reactions in the cytoplasm) to those places where energy is required (myofibrils in the case of muscle contraction). Particularly large amounts of creatine are found in muscle tissue, where it plays an important role in energy metabolism. Heavy, high-intensity training leads to phosphocreatine deficiency. This is what explains physical fatigue, which increases from exercise to exercise and reaches its peak at the end of the workout. Detection of it in urine can be used as a test for identifying overtraining and pathological changes in muscles. An increase in the concentration of creatine in erythrocytes is a specific sign of hypoxia of any origin and indicates an increase in the number of young cells, i.e. about stimulation of erythropoiesis (in young red blood cells its content is 6-8 times higher than in old ones).
Amino acids.Analysis of amino acids (urine and blood plasma) is indispensable a means of assessing the sufficiency and degree of absorption of dietary protein, as well as the metabolic imbalance that underlies many chronic disorders in fatigue after exercise. Life without amino acids is impossible. In free form or bound as peptides, they play an important role in processes such as neurotransmitter function, pH regulation, cholesterol metabolism, pain control, detoxification and control inflammatory processes. Amino acids are the building blocks of all hormones and structural tissues body. Because all these connections are made or built from amino acids, then assessing the intake of “essential” amino acids from food, their sufficiency, the correct balance between them and the activity of enzymes that convert them in hormones, is fundamental for identifying the underlying cause of many chronic disorders. Analysis of amino acids allows you to obtain information about a wide range of metabolic and nutritional disorders, including protein abnormalities and chronic fatigue.
Indicators of the acid-base state (ABS) of the body. During intense muscular activity, large amounts of lactic and pyruvic acids are formed in the muscles, which diffuse into the blood and can cause metabolic acidosis of the body, which leads to muscle fatigue and is accompanied by muscle pain, dizziness, and nausea. Such metabolic changes are associated with the depletion of the body's buffer reserves. Because the state is a buffer systems of the body is important in the manifestation of high physical performance; in sports diagnostics they are used according to KOS indicators - blood pH,BE excess base, or alkaline reserve,pCO 2 - partial pressure of carbon dioxide,BB - buffer bases of whole blood. WWTP indicators reflect not only changes in buffer systemsblood, but also the state of the respiratory and excretory systems of the body, including after exercise. There is a corre relational relationship between the dynamics of lactate content in the blood and changes in blood pH. According to changes in CBS indicators during muscle degeneration activity, you can control the body’s reaction to physical activity load. The most informative indicator of KOS is the value of BE - alkaline reserve, which increases with increasing qualifications athletes, especially those specializing in speed-strength sports.
Active urine reaction (pH) is directly dependent on the acid body-basic state of the body. With metabolic acidosis The volume of urine increases to pH 5, and with metabolic alkalosis it decreases to pH 7.
Metabolism regulators.
Enzymes.Of particular interest in sports diagnostics are tissuenew enzymes that, under various functional states,organisms enter the blood from skeletal muscles and other tissues. Suchenzymes are called cellular or indicator enzymes. These includealdolase, catalase, lactate dehydrogenase, creatine kinase.An increase in indicator enzymes or their individual isoforms in the blood is associated withdisruption of the permeability of cell membranes of tissues and can be used to be used in biochemical monitoring of the athlete’s functional state. The result of damage to the cell membrane is the release of cytoplasmic ( myoglobin, aspartate aminotransferase) and structural ( tropomyosin) skeletal muscle proteins. Diagnosis of microdamage to muscle tissue (MMT) is based on measuring the activity of sarcoplasmic enzymes in the blood plasma (creatine kinase lactate dehydrogenase). Increasing their activity in blood plasma reflects a significant change in the permeability of the membrane structures of the myocyte, until its complete destruction. This fact reflects the adaptation of the athlete’s body to high-intensity physical exercise. When diagnosing microdamage, a combination of biological and clinical parameters is used - for example, plasma LDH and CPK activity, myoglobin and malondialdehyde concentrations, leukocyte levels, as well as physiological parameters of the muscle.
Appearance in blood enzymes in the processes of biological oxidation of substances al dolazy(glycolytic enzyme) and catalase(enzyme that carries outrecovery of hydrogen peroxides) after physical exercise is an indicator inadequate physical activity ki, the development of fatigue, and the speed of their disappearance indicates the speed of recovery of the body. rapid release of enzymes into the blood from tissues and they remain in it for a long timeduring the rest period, this indicates a low level of trainingthe athlete’s health, and, possibly, about the pre-pathological condition body.
Hormones. Indicators of the functional activity of the body include: features of metabolism in general, the activity of a number of enzymes, and the quantitative secretion of many hormones. Therefore, it is important to study the relationship of these indicators with physical function. The influence of muscle load on the state of the internal environment of the body is undeniable. IN more than 20 different hormones can be determined in the blood, regulatingcontaining different parts of metabolism. The magnitude of changes in hormone levels in the blood depends on the power the intensity and duration of the loads performed, as well as the degree of trainingathlete's bath. When working with the same power, more trainedbathed athletes, less significant changes in theseindicators in the blood. In addition, by changes in the content of hormones in the blood, one can judge the body’s adaptation to physical loads, the intensity of metabolic processes regulated by them, the development of fatigue processes, the use of anabolic steroids and other hormones.
Physical activity itself significantly increases the level of many hormones in the blood, and not only during the exercise itself. After starting a continuous exercise, such as submaximal power, during the first 3-10 minutes, the blood levels of many metabolites and hormones change completely unpredictably. This period of “working in” causes some desynchronization in the level of regulatory factors. However, some patterns of such changes still exist. The release of hormones into the bloodstream during exercise is a series of cascade reactions. A simplified diagram of this process may look something like this: physical activity - hypothalamus, pituitary gland - release of tropic hormones and endorphins - endocrine glands - release of hormones - cells and tissues of the body.
Hormone profile serves as an important means identifying hidden biochemical disorders underlying chronic fatigue. Studying the level cortisol in the blood is appropriate for assessing mobilization body reserves. It is considered the main “stress hormone”, and an increase in its concentration in the blood is the body’s response to physical, physiological and psychological stress. Excessive amounts of cortisol can negatively affect bone and muscle tissue, cardiovascular function, immune defense, thyroid function, weight controlbody, sleep, regulation of glucose levels and accelerate the aging process. High cortisol levels after exercise are characterized by under-recovery of the body athletes after a previous load.
In sports medicine to identify fatigue usually determine the content of hormones of the sympathetic-adrenal system ( adrenaline, norepinephrine, serotonin) in blood and urine. These hormones are responsible for the degree of tension of adaptive changes in the body. With inadequate observes the functional state of the body during physical activity a decrease in the level of not only hormones, but also their precursors thesis ( dopamine) in urine, which is associated with the depletion of biosynthetic reserves precrine glands and indicates an overstrain of the body’s regulatory functions that control adaptation processes.
Growth hormone (somatotropic hormone), insulin-like growth factor (Somatomedin C). The main physiological effects of growth hormone: acceleration of body tissue growth - specific action; enhancing protein synthesis and increasing the permeability of cell membranes for amino acids; acceleration of glucose breakdown and fat oxidation. Its effects are manifested in facilitating the utilization of glucose by tissues, activating protein and fat synthesis in them, and increasing the transport of amino acids across the cell membrane. These effects are characteristic of short-term action of somatotropin. Intense physical activity leads to a decrease in the concentration of the hormone in blood serum taken on an empty stomach. As the duration of exercise increases, the concentration of somatotropin in the bloodstream increases.
Parathyroid hormone and calcitonin take part in the regulation of calcium and phosphate levels. Parathyroid hormone acts by activating adenylate cyclase and stimulating the formation of cAMP inside the cell. Main purpose insulin- increases the consumption of glucose by tissues, resulting in a decrease in blood sugar. It affects all types of metabolism, stimulates the transport of substances across cell membranes, inhibits lipolysis and activates lipogenesis. The decrease in insulin concentration in the blood under the influence of muscle work becomes significant within 15-20 minutes after physical activity. The reason for changes in the level of insulin in the blood during work is the inhibition of its secretion, which causes an increase in glucose production. The concentration of the hormone in the blood depends on the rate of glucose oxidation and on the level of other hormones involved in the regulation of content. After athletes perform physical activity, the concentration of the hormone in blood taken on an empty stomach decreases.
Parathyroid hormone and calcitonin are necessary for performance, and during muscular work there is an increase in the level of calcitonin and parathyroid hormone in the blood. The content of calcitonin in the blood plasma varied most significantly. Sports activities had a significant effect on the studied substances. Most likely this is due to athletes’ adaptation to a high level of physical activity.
Testosterone. Testosterone has anabolic effects on muscle tissue, promotes the maturation of bone tissue, stimulates the formation of sebum by the skin glands, participates in the regulation of lipoprotein synthesis by the liver, modulates the synthesis of b-endorphins (“joy hormones”) and insulin. In men, it ensures the formation of the reproductive system according to the male type, the development of male secondary sexual characteristics during puberty, activates sexual desire, spermatogenesis and potency, and is responsible for the psychophysiological characteristics of sexual behavior.
Sports physicians know very well that in our modern industrial society there are two extremes: people who rush into sports with excessive enthusiasm and are as focused on achieving results in their free time as they are at work; and people who exercise too little. Both extremes have a negative impact on testosterone levels. Strenuous physical activity (such as a marathon) lowers testosterone levels almost to the same extent as inactivity. The problem today is the overload resulting from intense athletic training, which appears to cause a significant reduction in testosterone levels in the blood.
Maximum physical activity leads to an increase in the blood concentration of adrenocorticotropic hormone, somatotropic hormone, cortisol and triiodothyronine and a decrease in insulin levels. With prolonged exercise, the concentration of cortisol and the testosterone/cortisol index decreases.
Vitamins. Detection of vitamins in urine is included in the diagnostica complex of characteristics of the health status of athletes, their physical what performance. In sports practice, most often identified the body's abundance of water-soluble vitamins, especially vitamin C. Vitamins appear in the urine when there is sufficient supply of thembody. Data from numerous studies indicate thatThere is a sufficient supply of vitamins for many athletes, so monitoring their content in the body will make it possible to timely adjust the diet or prescribe additional vitamin supplementationby taking special multivitamin complexes.
Minerals. It is formed in the muscles inorganic phosphate as phosphoric acid(H 3 P0 4) during transphosphorylation reactions in creatine phosphokinasethe mechanism of ATP synthesis and other processes. By changing its concentrationtion in the blood can be judged on the power of the creatine phosphokinase mechanism ma of energy supply in athletes, as well as the level of training ty, since the increase in inorganic phosphate in the blood of athletes is highany qualification when performing anaerobic physical work painhigher than in the blood of less qualified athletes.
Iron. Basic functions of iron
1. electron transport (cytochromes, iron sulfur proteins);
2. transport and storage of oxygen (myoglobin, hemoglobin);
3. participation in the formation of active centers of redox enzymes (oxidases, hydroxylases, SOD);
4. activation of peroxidation, previously prepared by copper ions;
5. transport and deposition of iron (transferrin, ferritin, hemosiderin, siderochromes, lactoferrin);
6. participation in DNA synthesis, cell division;
7. participation in the synthesis of prostaglandins, thromboxanes, leukotrienes and collagen;
8. participation in the metabolism of adrenal medulla hormones;
9. participation in the metabolism of aldehydes, xanthine;
10. participation in the catabolism of aromatic amino acids, peroxides;
11. drug detoxification
With Fe deficiency, hypochromic anemia, myoglobin-deficient cardiopathy and atony of skeletal muscles, inflammatory and atrophic changes in the mucous membrane of the mouth, nose, esophagopathy, chronic gastroduodenitis and immunodeficiency states are noted. Excess Fe, first of all, can have a toxic effect on the liver, spleen, brain, and increase inflammatory processes in the human body. Chronic alcohol intoxication can lead to the accumulation of Fe in the body.
Potassium- the most important intracellular electrolyte element and activator of the functions of a number of enzymes. Potassium is especially necessary for “nutrition” of the body’s cells, muscle activity, including the myocardium, maintaining the body’s water-salt balance, and the functioning of the neuroendocrine system. It is the basic element in every living cell. Intracellular potassium is in constant equilibrium with a small amount that remains outside the cell. This ratio ensures the passage of electrical nerve impulses, controls muscle contractions, and ensures blood pressure stability. Potassium improves oxygen supply to the brain. Both emotional and physical stress can also lead to potassium deficiency. Potassium, sodium and chlorine are lost through sweat, so athletes may need to replenish these elements with special drinks and medications. Alcohol abuse leads to potassium loss
Main functions of potassium
1. regulates intracellular metabolism, exchange of water and salts;
2. maintains osmotic pressure and acid-base state of the body;
3. normalizes muscle activity;
4. participates in the conduction of nerve impulses to muscles;
5. promotes the removal of water and sodium from the body;
6. activates a number of enzymes and participates in the most important metabolic processes (energy generation, synthesis of glycogen, proteins, glycoproteins);
7. participates in the regulation of the process of insulin secretion by pancreatic cells;
8. maintains the sensitivity of smooth muscle cells to the vasoconstrictor effect of angiotensin.
The causes of potassium deficiency in athletes are profuse sweating, clinical symptoms are weakness and fatigue, physical exhaustion, overwork.
Calcium is a macronutrient that plays an important role in the functioning of muscle tissue, myocardium, nervous system, skin and, especially, bone tissue when it is deficient. Calcium is extremely important for human health; it controls numerous vital processes of all major body systems. Ca is predominantly found in bones, providing a supporting function and a protective role for the skeleton for internal organs. 1% Ca in ionized form circulates in the blood and intercellular fluid, participating in the regulation of neuromuscular conduction, vascular tone, hormone production, capillary permeability, reproductive function, blood clotting, preventing the deposition of toxins, heavy metals and radioactive elements in the body
Chromium. If there is insufficiency of chromium in the body of athletes, the processes of higher nervous activity are disrupted (the appearance of anxiety, fatigue, insomnia, headaches).
Zinc - It controls muscle contractility, is necessary for protein synthesis (by the liver), digestive enzymes and insulin (by the pancreas), and cleansing the body.
Magnesium. Magnesium, along with potassium, is the main intracellular element - it activates enzymes that regulate carbohydrate metabolism, stimulates the formation of proteins, regulates the storage and release of energy in ATP, reduces excitation in nerve cells, and relaxes the heart muscle. In athletes, a decrease in magnesium levels in the blood is a consequence of overtraining and fatigue. Deficiency predisposes to the development of diseases of the cardiovascular system, hypertension, urolithiasis, and seizures.
Biochemical control of the development of energy supply systems changes in the body during muscular activity.
Sports performance is to a certain extent limited by the level of development of the body's energy supply mechanisms. Therefore, in the practice of sports, the power, capacity and efficiency of anaerobic and aerobic mechanisms of energy generation during training are monitored.
To assess the power and capacity of the creatine phosphokinase mechanismenergy generation indicators can be usedthe amount of creatine phosphate and creatine phosphokinase activity in the blood. In a trained body these indicators are significantbut higher, which indicates an increase in the capabilities of creatine phosphoruskinase (alactate) mechanism of energy formation.The degree of connection of the creatine phosphokinase mechanism when performing physical activity can be assessed by an increase in the blood content of the metabolic products of CrF in the muscles (creatine, creatinine and not organic phosphate) and changes in their content in urine
To characterize the glycolytic mechanism of energy production the value of maximum lactate accumulation in the artery is often usedof blood during maximum physical exertion, as well asblood pH value and indicator whether CBS, blood glucose level, activity enzymes lactate dehydrogenase, phosphorylase. On increasing the capabilities of glycolytic (lactate) energy education among athletes is evidenced by a later exit to poppythe maximum amount of lactate in the blood during extreme physical activity, as well as its higher level.An increase in glycolytic capacity is accompanied by an increase in glycogen reserves in skeletal muscles, especiallyespecially in fast fibers, as well as an increase in glycolytic activity ski enzymes.
To assess the power of the aerobic energy generation mechanism, the level of maximum oxygen consumption (MOC) is most often usedor IE 2 tach) and oxygen trans indicatorblood system porter - hemoglobin concentration. The efficiency of the aerobic mechanism of energy production depends on the rate of oxygen utilization by mitochondria, which is primarily due to with the activity and quantity of oxidative phosphorylation enzymes formation, the number of mitochondria, as well as the proportion of fat during energy production vocation. Under the influence of intense aerobic trainingThis increases the efficiency of the aerobic mechanism due to increased the rate of fat oxidation and increasing their role in energy supply for work. With single and systematic exercise with an aerobic orientation of metabolic processes, an increase in lipid metabolism of both adipose tissue and skeletal muscles is observed. An increase in the intensity of aerobic exercise leads to an increase in the mobilization of intramuscular triglycerides and the utilization of fatty acids in working muscles due to the activation of their transport processes.
Biochemical control over the level of training, fatigue and recovery of the football player’s body.
Control over the processes of fatigue and recovery, which are are integral components of sports activity, necessary for assessing physical activity tolerance and identifying overtraining, sufficient rest time after physical activity, and the effectiveness of means of increasing performance. The recovery time after heavy training is not strictly determined and depends on the nature of the load and the degree of exhaustion of the body systems under its influence.
Level of training assessed by changes in concentration tions lactate in the blood when performing standard or extreme physical exercise physical load for this contingent of athletes. About the higherless lactate accumulation (compared to untrained) when performing a standard load, which is associated with an increase in the proportionaerobic mechanisms in the energy supply of this work; a smaller increase in lactate content in the blood with increasing work power, an increase in the rate of lactate utilization during the recovery period after exercise.
Among women, increasing the rate of lactate utilization during the recovery period after physical activity.
Fatigue maximum power, due to depletion of energy reserves ical substrates (ATP, CrF, glycogen) in the tissues that provide this type of work, and the accumulation of their metabolic products in the blood (lactic acid lots, creatine, inorganic phosphates), and therefore is controlled by these indicators. When performing prolonged strenuous work you development of fatigue can be detected by a prolonged increase in the level of urea in the blood after finishing work, by a change in the composition nents of the immune system of the blood, as well as to reduce the content of hormonesnew in blood and urine.
For early diagnosis overtraining, latent phase leniya uses control over the functional activity of the immune system. To do this, determine the quantity and functional asset activity of T- and B-lymphocyte cells: T-lymphocytes provide processescellular immunity and regulate the function of B lymphocytes; B lymphocytes are responsible for the processes of humoral immunity, their functional activity is determined by the amount of immunoglobulins in the serum a mouthful of blood.
When connecting immunological control for functional state of an athlete, it is necessary to know his initial immunological status with subsequent monitoring at various periods years of the training cycle. Such control will prevent the breakdown of adaptation mechanisms, exhaustion of the immune system and the development of infectious diseases among highly qualified athletes during the period.days of training and preparation for important competitions (especially during sudden changes in climatic zones).
Recoverysubstances. Their restoration, as well as the speed of metabolic processesdo not come at the same time. Knowledge of recovery timeThe presence of various energy substrates in the body plays a big role in the correct construction of the training process. Recovery of the body is assessed by changes in the amount of those metabolites of carbohydrate, lipid and protein metabolism in the blood or urine thatchange significantly under the influence of training loads. Of allindicators of carbohydrate metabolism, the rate of utilization of lactic acid during rest, as well as lipid metabolism, is most often studied - increase in the content of fatty acids and ketone bodies in the blood, which during the rest period are the main substrate of aerobicoxidation, as evidenced by a decrease in the respiratory quotient. However, the most informative indicator of organ recoverylow after muscular work is a product of protein metabolism - urea. During muscular activity, tissue catabolism increasesof proteins, which helps increase the level of urea in the blood,therefore, the normalization of its content in the blood indicates a recoveryrenewing protein synthesis in the muscles, and consequently, restoring the body.
Assessing muscle damage . Skeletal muscles provide any motor activity of the body. The performance of this function causes significant biochemical and morphological changes in skeletal muscle tissue, and the more intense the motor activity, the greater the changes are detected. Systematic loads contribute to the consolidation of a number of biochemical changes that have arisen, which determines the development of the state of fitness of skeletal muscles, which ensures the performance of higher physical fitness. At the same time, trained muscles are also damaged when performing physical exercises, although the threshold of damage in this case is higher compared to untrained muscles.
The initial, initiating phase of damage is mechanical, followed by secondary metabolic or biochemical damage, reaching a maximum on days 1-3 after the damaging contraction, which coincides well with the dynamics of the development of the degenerative process. Damage to the muscle structure during prolonged or intense exercise is accompanied by the appearance of fatigue. In the case of prolonged FN, hypoxic conditions, reperfusion, the formation of free radicals and increased lysosomal activity are noted as a factor in muscle damage. An accepted biochemical indicator of muscle damage is the appearance in the blood of muscle proteins (myoglobin, creatine kinase - CK, lactate dehydrogenase, aspartate aminotransferase - AST) and structural (tropomyosin, myosin) proteins of muscle tissue. Detection of skeletal muscle proteins in the blood is evidence of damage to muscle tissue during exercise. The mechanism of damage to skeletal muscles during physical activity includes a number of processes:
1) Disturbances in Ca 2+ homeostasis, accompanied by an increase in the intracellular concentration of Ca 2+, which leads to the activation of calpains (non-lysosomal cysteine proteases), which play an important role in triggering the breakdown of skeletal muscle proteins, inflammatory changes and the regeneration process;
2) Strengthening oxidative processes, including the process of lipid peroxidation (LPO), which leads to increased permeability of myocyte membranes;
3) Aseptic inflammatory reaction occurring with the participation of leukocytes and activation of cyclooxygenase-2;
4) physical rupture of the sarcolemma.
Mechanical stress is considered one of the important factors that initiates a cascade of biochemical reactions that determine muscle damage. The significance of this factor in damage to skeletal muscles emphasizes the uniqueness of this tissue, the structure of which is designed to perform a contractile function. The muscles of a healthy person are not subject to ischemia - the blood flow into them is sufficient. At the same time, highly intense physical activity causes severe metabolic muscle hypoxia, the consequences of which after cessation of physical activity are similar to reperfusion during ischemia. In the development of damage, it is not so much ischemia that is important as subsequent reperfusion, therefore the main markers of damage are a high level of reactive oxygen species (ROS) - initiators of lipid peroxidation and inflammatory leukocytes - neutrophils. The implementation of this mechanism is based on both local enhancement of free radical processes and the accumulation of inflammatory leukocytes. Along with the activation of LPO, a decrease in the activity of superoxide dismutase, one of the key enzymes of antioxidant protection, is detected. The presence of reliable correlations between the activity in the blood of a number of skeletal muscle enzymes (CK, lactate dehydrogenase) and the concentration of malondialdehyde - a product of LPO - in football players, being an important factor in the modification of cell membranes, causes a change in their physicochemical properties, permeability, which determines the release into circulation muscle proteins. Already during the load, which occurs under hypoxic conditions, a complex of “damaging” metabolic reactions develops in the muscles. The concentration of intracellular Ca 2+ increases, which leads to activation of Ca 2+ -dependent proteinases - calpains; due to disturbances in energy metabolism, the reserves of macroergs in the muscle fiber are depleted; Acidosis develops due to the production of large amounts of lactate. Upon completion of the load, damage reactions of the next echelon are activated in the muscles, associated with the activation of oxidative processes and leukocyte infiltration. The most informative markers of muscle damage are the level of CK activity and the concentration of myoglobin in blood plasma/serum.
Damage that occurs in skeletal muscles during exercise of high intensity and duration can be reduced with the help of adequate pharmacological support, as well as appropriate physiotherapeutic preparation of muscles for load performance. Acceleration of damage recovery can also be achieved by using pharmacological support, along with well-known physiotherapeutic measures. Considering the information about the mechanisms of damage to skeletal muscles during high-intensity physical exercise, various complex antioxidant preparations and possibly certain non-steroidal anti-inflammatory drugs can be used for the purpose of advance pharmacological support of skeletal muscles. Both those and others are used by athletes, however, in our opinion, it is very important to determine the tactics of using drugs based on a clear understanding the processes occurring in muscles during exercise and during the period of restitution. From these positions, it is most reasonable to start support with the use of antioxidants at least a few days before the competition and not stop during the competition. Anti-inflammatory drugs should probably be used before exercise, and possibly immediately after it. The use of anti-inflammatory drugs can help suppress the inflammatory process, in particular that stage of it that is associated with the formation of a local structural and metabolic background that determines the influx of leukocytes.
Biochemical markers of overexertion and training.
Overstrain of muscle tissue is one of the most common problems faced by athletes when performing high-intensity physical activity. To date, molecular diagnostics of this phenomenon is mainly based on measuring the activity of various sarcoplasmic enzymes in the blood plasma (creatine kinase (CPK) And lactate dehydrogenase (LDH)). Normally, these enzymes penetrate beyond the cell membrane in small quantities, and an increase in their activity in the blood plasma reflects a significant change in the permeability of the membrane structures of the myocyte, up to its complete destruction. In athletes, the activity of CPK and LDH is significantly higher than that of ordinary people. This fact reflects the adaptation of the athlete’s body to high-intensity physical exercise. If in an untrained person, when skeletal muscles are damaged, the levels of CPK and LDH increase by an order of magnitude, then in athletes they often remain unchanged. When muscle tissue is overstrained, it is better to use a combination of biological and clinical parameters - for example, LDH and CPK activity in plasma, concentration myoglobin and malondialdehyde, leukocyte level, as well as physiological parameters of the muscle. High CPK activity and high levels of malondialdehyde in the blood serum well reflect muscle tissue overstrain.
Assessment of the functional state of the body and readiness for increased stress.
When assessing the adequacy of physical activity during intense sports, the task is to search for objective markers of the condition of muscle tissue and other body systems. We propose to use biochemical indicators of the functioning of the main organs as such criteria: First of all, we pay attention to the state of the muscular system and heart:
- general CPK, as a rule, increases with intense exercise (insufficient blood supply to the muscles leads to increased enzyme levels). However, care must be taken to keep this increase moderate. In addition, due to an increase in the overall level of CPK due to tension in the skeletal muscles, you can miss the beginning of the destruction of the heart muscle - be sure to check the myocardial fraction KFK - MV.
- LDH and AST- sarcoplasmic enzymes will help assess the condition of the heart muscle and skeletal muscles.
- Myoglobin provides transport and storage of oxygen in striated muscles. When muscles are damaged, myoglobin is released into the blood serum and appears in the urine. Its concentration in serum is proportional to muscle mass, so men have a higher baseline myoglobin level (usually). The determination of myoglobin can be used to determine the level of training of an athlete - the release of myoglobin into the serum is delayed in trained athletes and increased in those who are out of shape. A significant increase in myoglobin concentration is observed during the destruction of skeletal muscle cells and during muscle overexertion.
If elevated levels are detected KFK-MV or a significant jump in myoglobin concentration during training, it is necessary to urgently schedule a test for Troponin(quantitative) to exclude the development of myocardial infarction. In addition to this, we propose to determine the level of BNP(sodium uretic hormone produced by the heart muscle).
Examine electrolyte balance (Na, K, Cl, Ca++, Mg).
Intense work of skeletal muscles (especially at the beginning of exercise in untrained individuals or after a long break) is accompanied by the accumulation of lactic acid (lactate) in the muscles. An increase in acidity due to lactic acid (lactic acidosis) can occur due to tissue hypoxia and manifest itself in the form of muscle pain. Therefore, it is necessary to control the level lactate and acid-base balance (blood gases);
An increase in oxygen consumption by muscles affects the intensity of synthesis and breakdown of red blood cells. To assess the state of erythropoiesis and control hemolysis, level monitoring is necessary. hemoglobin and hematocrit, and haptoglobin and bilirubin(direct and general) - indicators of increased hemolysis. If any changes are detected in these indicators, a metabolic study is prescribed iron, vitamin B12 and folate(to check whether the body has enough vitamins and microelements to maintain an intensive level of erythropoiesis.
Types and organization of biochemical control in football players.
Determination of biochemical indicators of metabolism allows you to solve the following problems
Comprehensive examination: monitoring the functional state of the athlete’s body, whichreflects the efficiency and rationality of execution my individual training program, -
- monitoring adaptive changes in the main energy systems and functional restructuring of the body during training,
Di diagnostics of pre-pathological and pathological diseaseschanges in athletes' metabolism.
Biochemical control also allows you to solve such particular problems as identifying the body’s response to physical activity, assessinglevel of training, adequacy of the use of pharmacologicaland other restorative agents, the role of energy metabolic systems in muscle activity, the effects of climaticfactors, etc. In this regard, in the practice of sports, biochemicaltechnical control at various stages of athletes’ training.
In the annual training cycle for qualified football players, different types of biochemical control are distinguished:
. routine examinations (TO) carried out on a daily basis in accordance withtogether with the training plan;
.
staged comprehensive examinations (IVF), carried out 3-4 times
in year;
.
in-depth comprehensive examinations (ICS), carried out 2 times
in year;
. examination of competitive activity (OSD).
Based on current examinations, the athlete’s functional state is determined - one of the main indicators of fitness,assess the level of immediate and delayed training effectphysical activity, carry out correction of physical activity during training.
In the process of staged and in-depth comprehensive examinations of football players using biochemical indicators, it is possible to evaluate the cumulativesignificant training effect, and biochemical control gives trainingru, teacher or doctor quick and fairly objective information aboutgrowth of fitness and functional systems of the body, as well as other adaptive changes.
When organizing and conducting a biochemical examination, specialattention is paid to the choice of testing biochemical indicators: theymust be reliable or reproducible, repeatablemultiple control examinations, informative, reflectivewe understand the essence of the process being studied, as well as valid or interrelated with sports results.
In each specific case, different testing biochemical indicators of metabolism are determined, since in the process of muscle activity individual links of metabolism change differently.The indicators of those links in the exchange of goods acquire paramount importance.substances that are fundamental in ensuring sports workabilities in this sport.
Of no small importance in biochemical examination are the methods used to determine metabolic parameters, their accuracy and credibility. Currently, laboratory methods for determining many (about 60) different biochemical parameters in blood plasma are widely used in sports practice. The same biochemical methods and indicators can be usedcalled to solve various problems. So, for example, the definition of content The level of lactate in the blood is used to assess the level of fitness, the direction and effectiveness of the exercise used, as well aswhen selecting individuals for individual sports.
Depending on the tasks to be solved, the conditions for conducting biochemical research. Since many biochemical indicators whether a trained and untrained organism is able to relate body rest do not differ significantly, to identify their special If there are any problems, the examination is carried out at rest in the morning on an empty stomach (physio logical norm), in the dynamics of physical activity or immediately after her, as well as during different periods of recovery.
When choosing biochemical parameters, it should be taken into account that the reaction ofthe human body's response to physical activity may depend on factors not directly related to the level of training, in particular fromtype of training, athlete’s qualifications, as well as approx.environmental conditions, ambient temperature, time of day, etc. Lower work ability is observed at elevated ambient temperatures, as well as inmorning and evening time. To testing, as well as to exercise, sports, especially with maximum loads, only the floor should be allowed football players are healthy, so a medical examination should be carried outmarch to other types of control. Control biochemical testing is carried out in the morning on an empty stomach after relative rest. during days. In this case, approximately the same conditions must be met.external environment that influence test results.
To assess the effect of physical activity, biochemical studies are carried out 3-7 minutes after training when the greatest changes in the blood occur. Changes in biochemical parameters under the influence of physicalloads depends on the degree of training, the volume of work performed loads, their intensity and anaerobic or aerobic orientation, and also on the gender and age of the subjects. After standard physical activity, significant biochemical changes are found in less trained people, and after maximum - in highly trained people.Moreover, after performing loads specific to athletes in conditions of competition or in the form of estimates in a trained body significant biochemical changes are possible that are notus for untrained people.
Spectrum of biochemical markers by type of examination of football players.
In-depth medical examination.
Screening that allows you to “filter” a group of athletes who need further examination (readiness for the season):
. UAC (
. OAM
. Coagulogram
. TANK
. Hormones
. Infections(TORCH, STD)
. Drugs
. Microelements(zinc, chromium, selenium)
Staged medical examination.
. UAC, OAM, BAK
. Coagulogram(microcirculation assessment)
. Antioxidant status(malondialdehyde, superoxide dismutase)
. Diagnosis of anemia(iron, ferritin, transferrin, THC, Vitamin B12, folic acid)
Control medical examination.
(at the discretion of the doctor and depending on the physical activity and condition of the player)
. Hemoglobin, red blood cells
. Urea, creatinine, ammonia, lactic acid
Assessment of the body’s condition and readiness for increased stress
(examination of a football player before concluding a contract)
. UAC (RBC, HGB, HCT, MCV, MCH, MCHC, RDW + reticulocytes, PLT)
. Coagulogram(Fg, Pr, At111, TV. APTT, RKMF, D-dimer, FA)
. TANK(urea, uric acid, cholesterol, lipids, glucose, AST, ALT, creatinine, CK, CK MB, ALP, LDH, magnesium, calcium, phosphorus, potassium, sodium, iron, ferritin, amylase, protein, albumin, globulin and fractions , amino acids, SMP, Troponin-T, BNP)
. Hormones(cortisol, testosterone, insulin, C-peptide, adrenaline, erythropoietin, growth hormone, Somatomedin C, parathyroid hormone, calcitonin, TSH, free T4)
. Infections(TORCH, STD)
. Drugs
. Microelements(zinc, chromium, selenium)
. Food intolerance.
. Allergy
. Microelements
. KFK, LDH, AST(moderate increase is the result of insufficient blood supply to the muscles and overstrain of skeletal muscles during intense exercise, a sharp increase is insufficient training)
. KFK - MV(increased with damage to the heart muscle)
. Myoglobin(the concentration in the blood is proportional to muscle mass. Reflects the level of training of the athlete - the release of myoglobin into the serum is delayed in trained athletes and increased in those who have lost their athletic form. The amount of myoglobin in the blood depends on the amount of physical activity performed, as well as on the degree of training of the athlete.)
. Troponin(diagnosis of myocardial infarction)
. BNP(increases in chronic heart failure)
. (Na, K, Cl, Ca++,Mg) (violation of water-electrolyte balance, nerve impulse transmission, muscle contraction)
. Lactate and BOS (blood gases)(intensive work of skeletal muscles (especially at the beginning of exercise in untrained individuals or after a long break) is accompanied by the accumulation of lactic acid and acidosis)
. Hemoglobin and hematocrit(intensity of erythropoiesis and aerobic oxidation)
. Haptoglobin and bilirubin(intensity of erythrocyte hemolysis)
. OAM(pH, density, ketones, salts, protein, glucose)
Spectrum of biochemical markers that allow assessing the impact of physical activity on the body of a football player .
Markers controlling the volume of physical activity
. UAC(hemoglobin, hematocrit, erythrocytes, leukocytes)
. Biochemical indicators(urea, ammonia, cholesterol, triglycerides, CPK, ferritin, iron, magnesium, potassium, protein)
. Hormones(cortisol, adrenaline, dopamine, ACTH, growth hormone, T3, insulin, testosterone) (increased adrenocorticotropic hormone, somatotropic hormone, cortisol, testosterone and triiodothyronine, decreased insulin levels. With prolonged exercise, the concentration of cortisol and the testosterone/cortisol index decreases).
. OAM(by the presence of a certain concentration of protein in the urine after performing physical work, its power is judged. So, when working in a high-power zone, it is 0.5%, when working in a submaximal power zone it can reach 1.5%).
Markers that control the intensity of physical activity.
. UAC(hemoglobin, hematocrit, red blood cells, reticulocytes)
. Biochemical indicators(urea, ammonia, lactic acid, uric acid, cholesterol, triglycerides, CPK, LDH, AST, myoglobin, ferritin, transferrin, iron, magnesium, potassium, total protein and protein fractions, SMP), CBS
. Hormones(cortisol, testosterone, T/C, norepinephrine, dopamine, erythropoietin)
. OAM(pH, density, protein, ketones)
. BAM(creatine, urinary creatinine, ketone bodies)
Markers of overexertion and training.
About the higherlevel of training is evidenced
. Less accumulation lactate(compared to untrained) when performing a standard load, which is associated with an increase in the proportionaerobic mechanisms in the energy supply of this work.
. A smaller increase in blood lactate content with increasing work power.
. Increasing the rate of lactate utilization during the recovery period after physical exercise.
. With an increase in the level of training of athletes the total blood mass increases, which leads to an increase in concentrationhemoglobin levels up to 160-180 g. l" 1 - in men and up to 130-150 g. l" 1 -among women.
. (increased activity reflects a significant change in the permeability of the membrane structures of the myocyte and the body’s adaptation to high-intensity physical activity. If in an untrained person, when skeletal muscles are damaged, the levels of CPK and LDH increase by an order of magnitude, then in athletes they often remain unchanged).
. Myoglobin and malondialdehyde concentrations(the magnitude of the increase in the activity of CPK, myoglobin and the level of malondialdehyde reflects the degree of overexertion and destruction of muscle tissue)
. BAM(detection creatine and 3-methyl-histidine, a specific metabolite of muscle proteins, is used as a test to detect overtraining and pathological changes in muscles,)
. Magnesium, potassium in the blood(With reduced concentration found in people after inadequate physical exercise and is a consequence of overtraining and fatigue - loss with sweat!!!)
. Chromium(with a deficiency of chromium in the body of football players, the processes of higher nervous activity are disrupted, anxiety, fatigue, insomnia, and headaches appear).
Fatigue markers.
Muscle fatigue- inability of muscles to maintain muscle contraction of a given intensity - associated with excess ammonia, lactate, creatine phosphate, protein deficiency
. Recovery rate:
- carbohydrate metabolism(recycling rate lactic acid during rest)
- lipid metabolism(increasing content fatty acids And ketone bodies in the blood, which during the rest period are the main substrate of aerobic oxidation),
- protein metabolism(normalization speed urea when assessing an athlete’s tolerance to training and competitive physical activity, the progress of training sessions and the body’s recovery processes). If the urea content remains higher than normal the next morning, this indicates a lack of recovery of the body or its development. fatigue).
. Microcirculation coefficient (CM)= 7,546Fg-0,039Tr-0,381APTV+0,234F+0,321RFMK-0,664ATIII+101.064 (must equal calendar age)
. Determination of the content of peroxidation products in the blood of malondialdehyde, diene conjugates. Biochemical control of the body’s response to physical activity, assessment of the athlete’s special preparedness, identification of the depth of biodestructive processes during the development of stress syndrome
. enzyme activity.
. Determination of average mass molecules (MMM)(peroxide damage to protein substances leads to their degradation and the formation of toxic fragments of medium-weight molecules, which are considered to be markers of endogenous intoxication in athletes after intense exercise. In the early stages of fatigue, the level of MPS increases compared to the norm by an average of 20-30%, in the middle stage - by 100-200%, later - by 300-400%.)
. Endogenous intoxication coefficient= SMP/ECA* 1000(effective albumin concentration)
. OMG test(attraction of leukocytes to the site of damage, which, as a result of activation, release a large number of reactive oxygen species, thereby destroying healthy tissue. One day after intense physical exercise, the activity of blood granulocytes is approximately 7 times higher than the control value and remains at this level for the next 3 days, then begins to decrease, however, exceeding the control level even after 7 days of recovery)
Markers of muscle tissue damage.
. Level of sarcoplasmic enzymes (CPK) and (LDH)
. Myoglobin, troponin, BNP
. Determination of the content of peroxidation products in the blood of malondialdehyde, diene conjugates
. Enzyme activity glutathione peroxidases, glutathione reductases and catalases, superoxide dismutases
. Level of reactive oxygen species (OMG test)
. BAM(detection creatine and 3-methyl-histidine)
Markers of body recovery after physical exercise.
Recovery the body is associated with the renewal of the amountenergy substrates consumed during operation and othersubstances. The level of biochemical markers is studied on days 1, 3, 7 after intense physical activity.
. Glucose level.
. Insulin and cortisol levels.
. Rate of recovery of lactic acid (lactate) levels
. The rate of restoration of the level of enzymes LDH, CPK,
. Rate of urea level recovery,
. Increase in free fatty acid content
. Reduced levels of malondialdehyde, diene conjugates
. Total protein and protein fractions
. Restoring changed indicators to the original level.
Candidate of Medical Sciences, Associate Professor
B. A. Nikulin.
● Briefly about the main thing
Biochemical blood tests make it possible to determine the state of organs and systems of the body and assess the degree of their functional activity.
Basic indicators:
Cortisol
- Testosterone
- Urea
- Glucose
- CPK (Creatine phosphokinase)
- Inorganic phosphorus (Fn)
- ALT (Alanine aminotransferase)
- AST (Aspartate aminotransferase)
- De Ritis coefficient
- Muscle tissue damage index
● Full article
Biochemical blood tests make it possible to determine the state of individual organs and systems of the body, which prevents the body from functioning normally and limits the development of performance in an athlete.
Glucocorticoids (cortisol)
Its main effect is that it increases the level of glucose in the blood, including due to its synthesis from protein precursors, which can significantly improve the energy supply of muscle activity. Insufficient activity of glucocorticoid function can become a serious factor limiting the growth of sports readiness.
At the same time, an excessively high level of cortisol in the blood indicates a significant stressor load for the athlete, which can lead to the predominance of catabolic processes in protein metabolism over anabolic ones and, as a consequence, the disintegration of both individual cellular structures and groups of cells. First of all, the cells of the immune system are destroyed, resulting in a decrease in the body’s ability to resist infectious agents. A negative effect on bone metabolism is the destruction of the protein matrix and, as a result, an increased risk of injury.
Elevated cortisol levels also have a negative impact on the cardiovascular system. Elevated levels of cortisol in the blood indicate insufficient efficiency of recovery processes, and can lead to fatigue.
Testosterone
One of the most effective anabolic hormones that counteracts the negative effects of cortisol on protein metabolism in an athlete’s body is testosterone. Testosterone effectively restores muscle tissue. It also has a positive effect on the bone and immune systems.
Under the influence of prolonged intense exercise, testosterone decreases, which undoubtedly negatively affects the effectiveness of recovery processes in the body after the loads endured. The higher the testosterone level, the more effectively the athlete’s body recovers.
Urea
Urea is a product of protein breakdown in the body (catabolism). Determining the urea concentration in the morning, on an empty stomach, allows you to assess the overall load tolerance of the previous day. Those. used to assess recovery in sporting conditions. The more intense and longer the work, the shorter the rest intervals between loads, the more significant the depletion of protein/carbohydrate resources and, as a result of this, the greater the level of urea production. However, it should be borne in mind that a high-protein diet, food supplements containing large amounts of proteins and amino acids also increase the level of urea in the blood. The level of urea also depends on muscle mass (weight), as well as kidney and liver function. Therefore, it is necessary to establish an individual norm for each athlete.
It should be noted that the level of cortisol used in the practice of biochemical control is a more modern and accurate indicator of the intensity of catabolic processes in the body.
It is the most important source of energy in the body. The change in its concentration in the blood during muscle activity depends on the level of fitness of the body, the power and duration of physical exercise. The change in glucose content in the blood is used to judge the rate of its aerobic oxidation in body tissues during muscle activity and the intensity of mobilization of liver glycogen.
It is recommended to use this indicator in combination with determining the level of the hormone insulin, which is involved in the processes of mobilization and utilization of blood glucose.
CPK (Creatine phosphokinase)
Determining the total activity of CPK in the blood serum after physical exercise makes it possible to assess the degree of damage to the cells of the muscular system, myocardium and other organs. The higher the stress (severity) of the load transferred to the body, the greater the damage to cell membranes, the greater the release of the enzyme into the peripheral blood.
CPK activity is recommended to be measured 8-10 hours after exercise, in the morning after sleep. Elevated levels of CPK activity after a night of recovery indicate significant physical activity endured the day before and insufficient recovery of the body.
It should be noted that CPK activity in athletes during training is approximately twice the upper limits of the norm for a “healthy person.” Those. we can talk about under-recovery of the body after previous loads with a CPK level of at least 500 U/l. CPK levels above 1000 U/l cause serious concern, because damage to muscle cells is significant and causes pain. It should be noted the importance of differentiating overstrain of skeletal muscles and cardiac muscle. For this purpose, measurement of myocardial fraction (CPK-MB) is recommended.
Inorganic phosphorus (Fn)
Used to assess the activity of the creatine phosphate mechanism. By assessing the increase in Fn in response to a short-term load of maximum power (7-15 seconds), the participation of the creatine-phosphate mechanism in the energy supply of muscle activity in speed-strength sports is judged. It is also used in team sports (hockey). The greater the increase in Fn per load, the greater the activity of the creatine phosphate mechanism and the better the functional state of the athlete.
ALT (Alanine aminotransferase)
An intracellular enzyme found in the liver, skeletal muscles, cardiac muscle and kidneys. An increase in the activity of ALT and AST in plasma indicates damage to these cells.
AST (Aspartate aminotransferase)
Also an intracellular enzyme found in the myocardium, liver, skeletal muscles, and kidneys.
Increased activity of AST and ALT allows us to identify early changes in the metabolism of the liver, heart, muscles, assess tolerance to physical exercise, and the use of pharmaceuticals. Physical activity of moderate intensity, as a rule, is not accompanied by an increase in AST and ALT. Intense and prolonged exercise can cause an increase in AST and ALT by 1.5-2 times (N 5-40 units). In more trained athletes, these indicators return to normal after 24 hours. For less trained people, it takes much longer.
In sports practice, not only individual indicators of enzyme activity are used, but also the ratio of their levels:
De Ritis ratio (also known as AST/ALT and AST/ALT)
The ratio of the activity of serum AST (aspartate aminotransferase) and ALT (alanine aminotransferase). The normal value of the coefficient is 1.33±0.42 or 0.91-1.75.
In clinical practice, determination of AST and ALT activity in blood serum is widely used to diagnose certain diseases. Determining the activity of these enzymes in the blood has diagnostic value because these enzymes have organ specificity, namely: ALT predominates in the liver, and AST predominates in the myocardium, therefore, with myocardial infarction or hepatitis, increased activity in the blood of any given enzyme will be detected . Thus, during myocardial infarction, the activity of AST in the blood increases 8-10 times, while ALT only increases by 1.5-2 times.
With hepatitis, the activity of ALT in the blood serum increases 2-20 times, and AST - 2-4 times[. The norm for AST is up to 40 IU or up to 666 nmol/s*l, for ALT up to 30 IU or up to 666 nmol/s*l.
The de Ritis coefficient within normal values (0.91-1.75) is usually characteristic of healthy people. However, an increase in AST with a simultaneous increase in the AST/ALT ratio (de Ritis coefficient greater than 2) indicates cardiac damage, and we can confidently speak about myocardial infarction or another process associated with the destruction of cardiomyocytes. A de Ritis coefficient less than 1 indicates liver damage. High levels of fermentemia in all types of viral hepatitis with the exception of delta hepatitis are characterized by a low de Ritis coefficient and are prognostically an unfavorable sign of the course of the disease.
Calculation of the De Ritis Coefficient is advisable only when AST and/or ALT exceed the reference values.
Muscle Damage Index
(KFK/AST)
With increased enzyme activity, if their ratio is below 9 (from 2 to 9), then this is most likely due to damage to cardiomyocytes. If the ratio is higher than 13 (13-56), then this is due to damage to the skeletal muscles. Values from 9 to 13 are intermediate.
