In the U.S. at Least, Onward and Upward

I was recently at a meeting about squash in the U.S. when the talk turned to the sport's fortunes elsewhere. Someone said the situation in Australia was bad, as real estate pressures have caused many clubs to shut down entirely or convert large squash courts into fitness centers. The same is true, to a somewhat lesser extent perhaps, in the U.K. Someone else complained that clubs were closing down in Canada, and the national squash organization there seems too disorganized to do anything effective about it. 

Bad news, then, on several fronts. But the good news, at least for us in the U.S., is that squash is on the ascendancy. The US Squash association, under Kevin Klipstein's remarkable leadership, has in the last 5 years ratcheted up membership by 80%; doubled the number of national championships to 20 and increased participant numbers to 5000; spearheaded the US High School Championships, now the largest squash tournament in the world, with 125 teams and 1000 players; and increased junior squash participation numbers by 88%. And in what I predict will be a continuing trend for the foreseeable future, the Men's and Women's national adult and junior teams are making steady progress in world rankings.

The US Squash organization has also improved its own governance significantly and has demonstrated its desire to hear from as many voices as possible on how best to further the U.S. game. The association will host the inaugural U.S. Squash "Annual Assembly" this October 1-2 in Chicago, which can be attended by any interested player and will include a keynote address, the presentation of programs for the 2010-2011 season, topical breakout sessions on various programs, and constituency breakout sessions covering districts, pros, coaches and referees.

All in all, great news, about which the US Squash association should be proud. That there are still those out there who don't see the value in forking over a couple of bucks to support their sport's association remains a puzzlement. 

Exercise-Induced Illness: The Open Window

Not too long ago a reader of this blog wrote in complaining that he suffered from periodic flu-like symptoms that tended to bedevil him after training hard or playing especially tough squash matches. He is in top shape, and was wondering why this would happen to him of all people and if there might be anything he could do about it.

That's a good question, and unfortunately there is no definitive answer.

There is no doubt that moderate exercise is good for you and, more specifically, your immune function. But exercising at a peak level, such as what one might do during a difficult hourlong squash match, can put the body under immunological stress. Elite athletes in many sports have long suspected that overtraining can lead to bouts of illness, particularly increased upper respiratory tract infections (URTI). Studies have found that these athletes are correct.

Indeed, epidemiologic studies have proven that URTI risk rises with heavy training (Nieman DC, et al. J Sports Med Phys Fit. 1990;30:316-328).

So what exactly is happening immunologically after intense exercise? Well, here comes some science....

There is a decrease in NK cell activity, which may heighten risk of viral transmission. NK cells are 'natural killer' cells that protect against infection.

Development of neutropenia (low blood neutrophil) or neutrophilia (high), depending upon the athlete. Neutrophils are an essential component of the body's innate immune system, and are involved in the phagocytosis of both bacterial and viral pathogens. (Phagocytosis means to encircle and destroy -- a good thing!)

Development of lymphopenia (low blood lymphocyte count), important since these white blood cells are integral to the development of immunity and should increase in number in response to an infection. Also decreasing is mitogen-induced lymphocyte proliferation, which is a way to gauge the function of T lymphocytes (called 'T' because they are dependent upon the thymus).

Increases in pro- and anti-inflammatory cytokines, which mediate cellular interactions. Types of cytokines include interleukin-6, -10, and interleukin-1 receptor antagonist.

Depression of serum immunoglobulin levels, including IgA and IgG, both commonly found in airway secretions.

And there are other changes, but we are not reading this to get an advanced degree in exercise immunology, so let's cut to the chase....

The fact is that most immunologists now believe that there is an 'open window' after intense exercise in which the athlete experiences some level of impaired immunity (which can last anywhere between 3 and 72 hours, depending on the immune measure) and during which both viruses and bacteria may achieve a foothold. Lack of sleep, unusual mental stress, malnutrition and recent weight loss may all decrease immune function further.

So why would my reader be bothered by exercise-induced illnesses while many other squash players of equal intensity not experience these problems? I suspect the answer lies in the difference between the innate immune system and the acquired immune system. The innate system, which as its name implies is the system we are born with, is greatly affected both by genetics as well as nutrition in early life. One's genetics may just not support a vigorous innate immune system. Likewise, poor nutrition as an infant and child may not have provided the needed micronutrients to build up one's innate system. My reader may keep getting tripped up by an innate system that is not as vigilant as it might have been, for want of better nutrition.

When the innate immune system fails, the acquired immune system kicks in. The term 'acquired' is used because this system relies on the immunological memory of specific infectious agents to which the body has been subjected. The acquired immune system relies on such cells as the B- and T-lymphocytes -- the very cells that are temporarily decreased following strenuous exercise.

OK, so what to do? In addition to the obvious -- eat right, get enough sleep, don't stress out too much -- is there anything one might take? Several micronutrients are very important for optimum enzyme function, including zinc, iron, copper, selenium, and vitamins A, B-6, C and E. Eating correctly, however, easily takes care of these nutritional needs, and studies testing if high-dose supplements of these vitamins are beneficial against exercise-induced illness have failed to show any definitive benefit. Other studies looking at plant sterols, N-acetylcysteine, butylated hydroxyanisole, and glutamine have also failed to show a definitive effect. The jury still seems out on newer immunonutrition supplements, including beta-glucan, curcumin, and quercetin, but I have my doubts about them as well.

And here I would stress caveat emptor -- buyer beware. There are a lot of nutrition and supplement companies out there, none of which have to answer to the FDA and thus can pretty much say just about anything about their product. The usual line is: "This product supports [body part] health." It's a load of crap -- this industry needs much better regulation, because people are wasting a lot of money on often useless supplements, and sometimes are ingesting these agents at toxic levels. Don't be a sucker!

The one nutritional intervention that HAS proved helpful for elite athletes is carbohydrates, usually ingested in the form of a sports drink (or flavored cookies and bars). Carbohydrates reduce perturbations in immune cell levels and lower inflammatory cytokines.

So for my reader I would suggest two things:

Carbohydrates, before, during and after intense activity. In addition, there are many specific approaches one can take that involve food (e.g., avoid refined carbs and saturated fats, etc.), so a consultation with an experienced exercise nutritionist would likely be money well spent.

Moderation of his most intense activities. If he is currently playing 4 tough matches a week, then he should try ratcheting back to 3, and using that extra day to work in the gym on core strength, without raising his heart rate too high.

My reader is an athlete in great condition, so cutting back is not what he wants to read, but he should consider this: 3 good matches played fit is better than 4 played sick.

For those interested, the following reference is a good overall review of this issue: Moreira A, et al. Does exercise increase the risk of upper respiratory tract infections? Br Med Bull. 2009;90:111-131.

Tennis Squash

In the olden days there was a variant of squash called 'squash tennis,' which enjoyed a rather brief popularity before sliding off the face of the world. You can still read about it in places like Wikipedia (here), but the game is no longer played by anyone. There is a new game developing however, called 'tennis squash.' This game could be around for a long while.

The French Open is underway and the men's final is in place, with the surging Robin Söderling, heir apparent to the great viking Bjorn Borg, ready to take on Rafael Nadal, who would dearly like to prove that his defeat by Söderling in last year's French Open was a fluke. I've always maintained that Nadal, with his quickness and maneuverability around the court, would make an absolutely fantastic squash player, and lo and behold recent press reports claim that he has taken up the game. Squash aficionados are well aware that Roger Federer is no stranger to squash, and occasionally will use a wristy slice shot when he is in trouble, particularly on the forehand side. Andy Murray, England's great tennis player, enjoyed squash as a kid, and Ivan Lendl, even when playing pro tennis at the highest level, is said to have used squash as an exercise to build up his backhand strength (see here).

The use of the wrist to apply extra spin and the breaking of the historically stiff tennis wrist has become a noteworthy recent innovation in tennis, with observers attributing the development to advancements in racket technology.

But what about the obverse? Are there any stiff-wristed, topspin shots that would be at home on a tennis court that we in squash might adopt? I know of one, and it's quite effective. Here is the scenario: your opponent has played a ball into one of the front corners, but you are on it without difficulty. You obviously have several choices here, including a hard wide cross-court, a hard rail, or a looping cross-court lob, among others. But another shot is to hit the loose ball into the corner with topspin at medium speed. The topspin makes the ball whip around the corner faster than either a flat or undercut ball, and the surprising shot selection will either leave your opponent flat-footed, forcing a weak return, or even outright fool him. Try it sparingly, and you might be surprised how effective it is.