Klinogicare® StarLab
POCT testing system
Portable biochemical analyzer for professional sports
Page summary in 15 seconds:
Monitoring creatine kinase (CK) levels has been scientifically proven to be one of the most effective strategies for preventing injury in professional sports. An elevated CK level is one of the predictors of possible future injury.
Our device is used on the ISS (International Space Station)
It utilizes microfluidics, one of the most advanced technologies available today. Our latest-generation machine, equipped with Lab-on-a-chip technology, delivers highly accurate results that far exceed the precision of traditional dry chemistry methods.
Creatine kinase analyzer for sports, Portable biochemical analyzer, Sports biochemical monitoring, CK level testing device, Sports performance monitoring
Prevention of sports injuries, Injury prevention in professional sports, Sports injury management, Athlete injury prevention strategies, Professional sports health solutions
Klinogicare® Starlab POCT testing system
Price: from $20,000 (analyzer + annual reagent kit)
In vitro quantification of clinical chemical analytes can be performed using whole blood, lithium-heparinized blood, heparinized plasma, or serum. The analysis requires just 100 µl of sample (approximately 3-4 drops), with results delivered in 7 to 13 minutes, depending on the number of parameters analyzed during a single session. Updates via Wi-Fi or USB.
ECONOMIC BENEFIT CALCULATOR FOR 1 SEASON
(Adjust the sliders below to set the desired values)
Economic Justification. Compare the cost of purchasing an analyzer to the potential financial losses from athlete injuries. Early detection of injury risks helps prevent muscle injuries and reduces athlete downtime, which directly translates into cost savings for the club.
Calculation parameters:
- Average Player Salary: Calculate the financial loss to the club when a key player is unable to participate due to injury, including the minimum payments during the athlete's downtime.
- Absence Duration: Assume that an injury sidelines a player for 4 weeks. Calculate the salary the club continues to pay the player during this period, even though they are not playing.
- Number of Injuries per Season: Multiply this by the number of similar injuries across all players in the club during the season.
Now, compare these costs to the price of the analyzer and its regular use for injury prevention. Most likely, the analyzer's cost will be significantly lower than the financial losses associated with player absences due to injuries. Additionally, the analyzer can help optimize training programs and adjust workloads, further reducing injury risks.
Example: The average cost of the analyzer and consumables per season, depending on the size of the team, ranges from $20,000 to $30,000. In subsequent years, consumables typically cost around $10,000 per year, given that the device has a lifespan of at least 5 years.
For instance, if the average player salary is $50,000 per month and 5 key players sustain injuries over the course of the season, each missing nearly a month of play (with muscle healing taking an average of 3 to 4 weeks and full recovery requiring several months), the total payroll loss due to downtime could amount to $250,000 in just one season.
Useful link:
“Losses of the leading leagues from injuries to players of the five strongest national championships in Europe exceeded €700 million”, Risk Factors for Lower Extremity Muscle Injury in Professional Soccer: The UEFA Injury Study Risk Factors for Lower Extremity Muscle Injury in Professional Soccer: The UEFA Injury Study
“Muscle injuries are the most common type of injury in professional soccer players.” https://journals.sagepub.com/doi/abs/10.1177/0363546512470634
Based on microfluidics technology (find the technologies comparison below), the system consists of a portable analyzer and disposable reagent discs. The analyzer is equipped with a variable-speed motor that rotates the disc, a photometer to measure analyte concentrations, a microprocessor to control the system and process data, and a capacitive touchscreen for user interaction.
Each reagent disc is a self-contained transparent plastic unit, 7.8 cm (3.07 inches) in diameter and 0.68 cm (0.27 inches) thick, with a plastic film on top. The disc contains lyophilized reagent pellets in cuvettes around the edge. Blood separation and sample diluent mixing are carried out within the disc by centrifugal force generated by the motor's rotation. The device uses either an external scanner or a built-in scanning module to read the disc’s information.
To perform an analysis, the operator collects a blood sample—either whole blood, lithium-heparinized blood, heparinized plasma, or serum—pipettes the sample into the reagent disc, then places the disc into the analyzer's compartment. The operator inputs patient information via the touchscreen. After the analysis is completed, the results can be printed, stored in the analyzer's memory, and transferred to an external printer, computer, memory card, or integrated with Laboratory Information Systems (LIS) or Electronic Medical Records Systems (EMRS).
Each reagent disc is a self-contained transparent plastic unit, 7.8 cm (3.07 inches) in diameter and 0.68 cm (0.27 inches) thick, with a plastic film on top. The disc contains lyophilized reagent pellets in cuvettes around the edge. Blood separation and sample diluent mixing are carried out within the disc by centrifugal force generated by the motor's rotation. The device uses either an external scanner or a built-in scanning module to read the disc’s information.
To perform an analysis, the operator collects a blood sample—either whole blood, lithium-heparinized blood, heparinized plasma, or serum—pipettes the sample into the reagent disc, then places the disc into the analyzer's compartment. The operator inputs patient information via the touchscreen. After the analysis is completed, the results can be printed, stored in the analyzer's memory, and transferred to an external printer, computer, memory card, or integrated with Laboratory Information Systems (LIS) or Electronic Medical Records Systems (EMRS).
Introduction
The Klinogicare Rapid Analyzer delivers results within minutes, making it essential in situations where timely diagnosis is critical. This portable device can be used in various environments and provides accurate results comparable to those from laboratory tests, making Klinogicare a reliable tool for rapid initial diagnostics.
Applications
- Sports Medicine: Monitoring muscle damage in athletes.
- Traumatology: Assessing the severity of muscle damage in trauma patients.
The device performs quantitative analysis of clinical chemistry markers in lithium-heparinized whole blood*, heparinized plasma, or serum (using an in vitro method). The full assay requires just 100 µl of sample (approximately three drops), with results available in 7 to 10 minutes, depending on the number of parameters being analyzed.
*The kit includes a special lithium-heparin tube and all necessary supplies for the test.
Advanced reagent formulations. The revolutionary reagent disc is a fully self-contained, disposable chemistry panel designed to meet a wide range of testing needs. Just three drops of whole blood are enough to deliver up to 19 precise results.
Types of tests (panels)
General Chemistry Ⅰ
TP ALB GLO ALB/GLO ALT AST TBIL DBIL IBIL TG CHOL HDL-C LDL-C GLU CRE UREA UA
Clinical emergency care
AST CK CK-MB LDH α-HBDH GLU AMY CRE UA K+ Na+ Cl- CO2
Renal function panel
ALB CRE UREA UA Ca2+ P CO2
Liver function panel
TP ALB GLO ALB/GLO ALT AST GGT ALP TBIL DBIL IBIL
Myocardial enzyme panel
AST CK CK-MB LDH α-HBDH
Electrolyte panel
K+ Na+ Cl- Ca2+ P Mg2+ CO2
Glucose and lipid panel
TG CHOL HDL-C LDL-C GLU GSP
GLU, lipids and HCY panel
TG CHOL HDL-C LDL-C GLU HCY
General Chemistry Ⅱ
GLU AMY CRE UREA K+ Na+ Cl- CO2
Liver and kidney function
TP ALB GLO ALB/GLO ALT AST GGT TBIL GLU CRE UREA
Ammonia panel
NH3
General Chemistry Ⅳ
TP ALB GLO ALB/GLO ALT AST GGT ALP TBIL DBIL IBIL TG CHOL HDL-C LDL-C GLU CRE UREA UA
The importance of indicators in sports medicine and training process, their role in assessing the state of the body, regulating the load and preventing injuries.
Chemistry Panel I
TP (Total Protein) – Total Protein
In sports, total protein levels are crucial for assessing recovery and the overall condition of the body. Proteins are a key building material for repairing muscle tissue after intense workouts.
ALB (Albumin) – Albumin
Albumin is responsible for transporting substances in the blood, and its levels help assess liver and kidney function. In athletes, a decrease in albumin may indicate overtraining or inadequate nutrition.
GLO (Globulin) – Globulins
Globulins play a key role in the immune system, and their levels reflect how the body recovers from exercise and manages inflammation.
ALB/GLO (Albumin/Globulin Ratio)
This ratio shows the balance between major blood proteins. A reduced ratio may suggest inflammation or immune system issues.
ALT (Alanine Aminotransferase) – Alanine Aminotransferase
ALT is an enzyme that helps assess liver health. In athletes, elevated ALT levels may indicate muscle damage after intense exercise.
AST (Aspartate Aminotransferase) – Aspartate Aminotransferase
AST is another important marker for assessing both muscle and liver tissue health. In sports, elevated AST is often associated with intense training and muscle damage.
TBIL (Total Bilirubin) – Total Bilirubin
Bilirubin reflects liver function. In athletes, elevated levels may result from impaired hemoglobin processing due to prolonged physical exertion.
DBIL (Direct Bilirubin) – Direct Bilirubin
High direct bilirubin levels can signal issues with the gallbladder or liver, especially under heavy physical stress.
IBIL (Indirect Bilirubin) – Indirect Bilirubin
Indirect bilirubin can increase due to red blood cell breakdown, which is relevant for athletes undergoing intense aerobic exercise.
TG (Triglycerides) – Triglycerides
Triglyceride levels help assess cardiovascular risk, particularly in athletes with high-calorie diets.
CHOL (Cholesterol) – Cholesterol
Monitoring cholesterol is important for maintaining cardiovascular health, especially for athletes on high-fat diets.
HDL-C (High-Density Lipoprotein Cholesterol) – High-Density Lipoprotein Cholesterol ("Good" Cholesterol)
Higher levels of HDL are beneficial for athletes, as they reduce the risk of cardiovascular disease.
LDL-C (Low-Density Lipoprotein Cholesterol) – Low-Density Lipoprotein Cholesterol ("Bad" Cholesterol)
Elevated LDL increases the risk of atherosclerosis. Athletes should aim to keep this level within normal limits.
GLU (Glucose) – Glucose
Glucose is the primary source of energy. For athletes, glucose levels help assess readiness for training and the risk of hypoglycemia or diabetes.
CRE (Creatinine) – Creatinine
This is a kidney function marker. Elevated creatinine in athletes may signal overtraining or dehydration.
UREA (Urea) – Urea
A marker of protein breakdown. High levels can indicate significant muscle damage or insufficient recovery.
UA (Uric Acid) – Uric Acid
TP (Total Protein) – Total Protein
In sports, total protein levels are crucial for assessing recovery and the overall condition of the body. Proteins are a key building material for repairing muscle tissue after intense workouts.
ALB (Albumin) – Albumin
Albumin is responsible for transporting substances in the blood, and its levels help assess liver and kidney function. In athletes, a decrease in albumin may indicate overtraining or inadequate nutrition.
GLO (Globulin) – Globulins
Globulins play a key role in the immune system, and their levels reflect how the body recovers from exercise and manages inflammation.
ALB/GLO (Albumin/Globulin Ratio)
This ratio shows the balance between major blood proteins. A reduced ratio may suggest inflammation or immune system issues.
ALT (Alanine Aminotransferase) – Alanine Aminotransferase
ALT is an enzyme that helps assess liver health. In athletes, elevated ALT levels may indicate muscle damage after intense exercise.
AST (Aspartate Aminotransferase) – Aspartate Aminotransferase
AST is another important marker for assessing both muscle and liver tissue health. In sports, elevated AST is often associated with intense training and muscle damage.
TBIL (Total Bilirubin) – Total Bilirubin
Bilirubin reflects liver function. In athletes, elevated levels may result from impaired hemoglobin processing due to prolonged physical exertion.
DBIL (Direct Bilirubin) – Direct Bilirubin
High direct bilirubin levels can signal issues with the gallbladder or liver, especially under heavy physical stress.
IBIL (Indirect Bilirubin) – Indirect Bilirubin
Indirect bilirubin can increase due to red blood cell breakdown, which is relevant for athletes undergoing intense aerobic exercise.
TG (Triglycerides) – Triglycerides
Triglyceride levels help assess cardiovascular risk, particularly in athletes with high-calorie diets.
CHOL (Cholesterol) – Cholesterol
Monitoring cholesterol is important for maintaining cardiovascular health, especially for athletes on high-fat diets.
HDL-C (High-Density Lipoprotein Cholesterol) – High-Density Lipoprotein Cholesterol ("Good" Cholesterol)
Higher levels of HDL are beneficial for athletes, as they reduce the risk of cardiovascular disease.
LDL-C (Low-Density Lipoprotein Cholesterol) – Low-Density Lipoprotein Cholesterol ("Bad" Cholesterol)
Elevated LDL increases the risk of atherosclerosis. Athletes should aim to keep this level within normal limits.
GLU (Glucose) – Glucose
Glucose is the primary source of energy. For athletes, glucose levels help assess readiness for training and the risk of hypoglycemia or diabetes.
CRE (Creatinine) – Creatinine
This is a kidney function marker. Elevated creatinine in athletes may signal overtraining or dehydration.
UREA (Urea) – Urea
A marker of protein breakdown. High levels can indicate significant muscle damage or insufficient recovery.
UA (Uric Acid) – Uric Acid
Elevated uric acid may suggest gout or increased cell breakdown due to intense exercise.
Clinical Emergency Panel
AST (Aspartate Aminotransferase) – Aspartate Aminotransferase
Important for assessing muscle tissue damage after strength training.
CK (Creatine Kinase) – Creatine Kinase
A primary marker of muscle damage. Elevated CK levels are commonly observed after intense physical exertion and may serve as an indicator of overtraining and a predictor of muscle injuries.
CK-MB (Creatine Kinase-MB) – Creatine Kinase-MB
Specific to cardiac muscle. Used to assess heart damage, especially relevant when there are concerns about heart issues following intense exercise.
LDH (Lactate Dehydrogenase) – Lactate Dehydrogenase
Elevated LDH levels indicate cell damage, both in muscle and heart tissue, making it crucial for evaluating the condition of an athlete after heavy loads.
α-HBDH (α-Hydroxybutyrate Dehydrogenase)
A marker of heart and muscle tissue damage. It may increase after prolonged physical exertion.
GLU (Glucose) – Glucose
Reflects the state of energy metabolism. A drop in glucose levels can result from excessive aerobic exercise.
AMY (Amylase) – Amylase
Amylase may increase due to pancreatic stress, which can occur as a result of unbalanced nutrition in sports.
CRE (Creatinine) – Creatinine
Elevated creatinine levels may indicate muscle overload or kidney issues.
UA (Uric Acid) – Uric Acid
Elevated levels may result from intense training, causing cell breakdown.
K+ (Potassium) – Potassium
Potassium is essential for muscle and heart function. Its levels influence muscle contractions and recovery after training.
Na+ (Sodium) – Sodium
Sodium regulates fluid-electrolyte balance. Sodium levels may fluctuate due to dehydration, which is crucial for athletes training in hot conditions.
Cl- (Chloride) – Chlorides
Chlorides help maintain acid-base and fluid balance in the body, important for physical performance.
CO2 (Carbon Dioxide) – Carbon Dioxide
AST (Aspartate Aminotransferase) – Aspartate Aminotransferase
Important for assessing muscle tissue damage after strength training.
CK (Creatine Kinase) – Creatine Kinase
A primary marker of muscle damage. Elevated CK levels are commonly observed after intense physical exertion and may serve as an indicator of overtraining and a predictor of muscle injuries.
CK-MB (Creatine Kinase-MB) – Creatine Kinase-MB
Specific to cardiac muscle. Used to assess heart damage, especially relevant when there are concerns about heart issues following intense exercise.
LDH (Lactate Dehydrogenase) – Lactate Dehydrogenase
Elevated LDH levels indicate cell damage, both in muscle and heart tissue, making it crucial for evaluating the condition of an athlete after heavy loads.
α-HBDH (α-Hydroxybutyrate Dehydrogenase)
A marker of heart and muscle tissue damage. It may increase after prolonged physical exertion.
GLU (Glucose) – Glucose
Reflects the state of energy metabolism. A drop in glucose levels can result from excessive aerobic exercise.
AMY (Amylase) – Amylase
Amylase may increase due to pancreatic stress, which can occur as a result of unbalanced nutrition in sports.
CRE (Creatinine) – Creatinine
Elevated creatinine levels may indicate muscle overload or kidney issues.
UA (Uric Acid) – Uric Acid
Elevated levels may result from intense training, causing cell breakdown.
K+ (Potassium) – Potassium
Potassium is essential for muscle and heart function. Its levels influence muscle contractions and recovery after training.
Na+ (Sodium) – Sodium
Sodium regulates fluid-electrolyte balance. Sodium levels may fluctuate due to dehydration, which is crucial for athletes training in hot conditions.
Cl- (Chloride) – Chlorides
Chlorides help maintain acid-base and fluid balance in the body, important for physical performance.
CO2 (Carbon Dioxide) – Carbon Dioxide
An indicator of acid-base balance. It is important for evaluating the condition of an athlete under high-intensity training conditions.
Explanation of Indicators and Technologies
Which to choose – Dry Chemistry or Microfluidics?
Which to choose – Dry Chemistry or Microfluidics?
Dry chemistry.
Dry chemistry is a method of analysis that relies on the use of reagents pre-applied to solid surfaces such as strips, plates or chips. When a biological sample (such as a drop of blood or urine) is added, the reagent reacts chemically with the target components of the sample, and the result of the analysis can be determined visually or by using a special reader.
Advantages:
Disadvantages:
Dry chemistry is a method of analysis that relies on the use of reagents pre-applied to solid surfaces such as strips, plates or chips. When a biological sample (such as a drop of blood or urine) is added, the reagent reacts chemically with the target components of the sample, and the result of the analysis can be determined visually or by using a special reader.
Advantages:
- Ease of use. Dry chemistry-based assays typically do not require sophisticated equipment or highly trained personnel.
- Minimal sample requirements. Assays typically require small amounts of biological material (e.g., 10-250 µL).
- Rapidity. Results can be obtained within minutes.
- Convenience and portability. Often used in test strips that can be used not only in the laboratory, but also in medical offices and at the point of care.
- Examples of applications: Blood glucose test strips, pregnancy tests, rapid tests for infectious diseases, control of creatine kinase levels, which is relevant in sports medicine to assess muscle damage.
Disadvantages:
- Limited range of tests. Although there are many tests available in dry chemistry (glucose, cholesterol, renal and hepatic parameters), the method is not always applicable for complex or multicomponent analyses.
- Less accuracy compared to traditional laboratory methods. The accuracy of dry chemistry is often lower than that of more sophisticated methods such as liquid chromatography or microfluidics.
- Dependence on the quality of the test strips. The reliability of the result may depend on the quality of the test strips used, and they may require periodic calibration.
Microfluidics
Microfluidics is a technology that manipulates very small volumes of liquids (in the range of microliters and nanoliters) in microscale channels, typically on microfluidic chips. This technology enables the execution of complex analyses on small samples by integrating multiple stages of the process (such as mixing, reaction, and detection) into a single device, making it suitable for multi-component studies.
Key Features of Microfluidics:
Microfluidics is a technology that manipulates very small volumes of liquids (in the range of microliters and nanoliters) in microscale channels, typically on microfluidic chips. This technology enables the execution of complex analyses on small samples by integrating multiple stages of the process (such as mixing, reaction, and detection) into a single device, making it suitable for multi-component studies.
Key Features of Microfluidics:
- High Precision and Control: Microfluidics allows precise control over liquid movement and reagent interaction, resulting in high-quality and reproducible outcomes. It is ideal for complex and multi-component analyses and offers greater accuracy compared to dry chemistry methods.
- Miniaturization and Integration: Multiple laboratory processes can be integrated into a single microfluidic device, reducing the need for larger sample and reagent volumes. Only minimal sample volumes (from a few microliters) are required, making it particularly useful in fields like pediatrics, sports, or research where obtaining large sample sizes is difficult.
- Speed and Efficiency: Due to the minimal volumes and fast process times, microfluidic devices can deliver results significantly faster than traditional laboratory methods, often within 7-13 minutes.
- Flexibility and Versatility: Microfluidic systems can be adapted to perform a wide range of tests, including biochemical, cellular, and molecular assays.
- Integration and Automation: The technology allows for the integration of multiple stages of analysis on a single chip (e.g., sample preparation, reaction, and detection), reducing the risk of human error and speeding up the overall process.
- DNA and RNA-based diagnostics (real-time PCR) – Lab-on-a-Chip
- Comprehensive analysis of metabolites, proteins, or cells
- Biomarker monitoring and research for early disease detection
- Microfluidic systems for protein analysis
- Devices for high-throughput drug screening
- In professional sports – monitoring creatine kinase levels for accurate muscle damage assessment
- Cost: Microfluidics requires specialized chips and equipment to manage liquid flow, making it more expensive than other methods. The development and production of microfluidic systems are generally more costly compared to dry chemistry techniques.
If your primary goal is to perform quick and simple tests with minimal time and resource investment, dry chemistry is the optimal choice. However, for higher accuracy, complex multi-component analyses, and process automation, microfluidics offers a more powerful and precise—though more expensive—solution.
Scientific Research
Athletes with high levels of KK should be advised to continue physical activity with a lower intensity in order to prevent muscle damage from high-intensity loads and allow for full recovery.
Abstract
Areas of general agreement
Total creatine kinase (CK) levels depend on age, gender, race, muscle mass, physical activity and climatic condition. High levels of serum CK in apparently healthy subjects may be correlated with physical training status, as they depend on sarcomeric damage: strenuous exercise that damages skeletal muscle cells results in increased total serum CK. The highest post-exercise serum enzyme activities are found after prolonged exercise such as ultradistance marathon running or weight-bearing exercises and downhill running, which include eccentric muscular contractions. Total serum CK activity is markedly elevated for 24 h after the exercise bout and, when patients rest, it gradually returns to basal levels. Persistently increased serum CK levels are occasionally encountered in healthy individuals and are also markedly increased in the pre-clinical stages of muscle diseases.
Areas that are controversial
Some authors, studying subjects with high levels of CK at rest, observed that, years later, subjects developed muscle weakness and suggested that early myopathy may be asymptomatic. Others demonstrated that, in most of these patients, hyperCKemia probably does not imply disease. In many instances, the diagnosis is not formulated following routine examination with the patients at rest, as symptoms become manifest only after exercise. Some authors think that strength training seems to be safe for patients with myopathy, even though the evidence for routine exercise prescription is still insufficient. Others believe that, in these conditions, intense prolonged exercise may produce negative effects, as it does not induce the physiological muscle adaptations to physical training given the continuous loss of muscle proteins.
Growing points
High CK serum levels in athletes following absolute rest and without any further predisposing factors should prompt a full diagnostic workup with special regards to signs of muscle weakness or other simple signs that, in both athletes and sedentary subjects, are not always promptly evident. These signs may indicate subclinical muscle disease, which training loads may evidence through the onset of profound fatigue. It is probably safe to counsel athletes with suspected myopathy to continue to undertake physical activity at a lower intensity, so as to prevent muscle damage from high intensity exercise and allow ample recovery to favour adequate recovery.
Areas timely for developing research
CK values show great variability among individuals. Some athletes are low responders to physical training, with chronically low CK serum levels. Some athletes are high responders, with higher values of enzyme: the relationship among level of training, muscle size, fibre type and CK release after exercise should be investigated further. In addition, more details about hyperCKemia could come from the evaluation of the kinetics of CK after stress in healthy athletes with high levels of CK due to exercise, comparing the results with the ones obtained from athletes with persistent hyperCKemia at rest. Finally, it would be important to quantify the type of exercise more suited to athletes with myopathy and the intensity of exercise not dangerous for the progression of the pathology.
Areas of general agreement
Total creatine kinase (CK) levels depend on age, gender, race, muscle mass, physical activity and climatic condition. High levels of serum CK in apparently healthy subjects may be correlated with physical training status, as they depend on sarcomeric damage: strenuous exercise that damages skeletal muscle cells results in increased total serum CK. The highest post-exercise serum enzyme activities are found after prolonged exercise such as ultradistance marathon running or weight-bearing exercises and downhill running, which include eccentric muscular contractions. Total serum CK activity is markedly elevated for 24 h after the exercise bout and, when patients rest, it gradually returns to basal levels. Persistently increased serum CK levels are occasionally encountered in healthy individuals and are also markedly increased in the pre-clinical stages of muscle diseases.
Areas that are controversial
Some authors, studying subjects with high levels of CK at rest, observed that, years later, subjects developed muscle weakness and suggested that early myopathy may be asymptomatic. Others demonstrated that, in most of these patients, hyperCKemia probably does not imply disease. In many instances, the diagnosis is not formulated following routine examination with the patients at rest, as symptoms become manifest only after exercise. Some authors think that strength training seems to be safe for patients with myopathy, even though the evidence for routine exercise prescription is still insufficient. Others believe that, in these conditions, intense prolonged exercise may produce negative effects, as it does not induce the physiological muscle adaptations to physical training given the continuous loss of muscle proteins.
Growing points
High CK serum levels in athletes following absolute rest and without any further predisposing factors should prompt a full diagnostic workup with special regards to signs of muscle weakness or other simple signs that, in both athletes and sedentary subjects, are not always promptly evident. These signs may indicate subclinical muscle disease, which training loads may evidence through the onset of profound fatigue. It is probably safe to counsel athletes with suspected myopathy to continue to undertake physical activity at a lower intensity, so as to prevent muscle damage from high intensity exercise and allow ample recovery to favour adequate recovery.
Areas timely for developing research
CK values show great variability among individuals. Some athletes are low responders to physical training, with chronically low CK serum levels. Some athletes are high responders, with higher values of enzyme: the relationship among level of training, muscle size, fibre type and CK release after exercise should be investigated further. In addition, more details about hyperCKemia could come from the evaluation of the kinetics of CK after stress in healthy athletes with high levels of CK due to exercise, comparing the results with the ones obtained from athletes with persistent hyperCKemia at rest. Finally, it would be important to quantify the type of exercise more suited to athletes with myopathy and the intensity of exercise not dangerous for the progression of the pathology.
As part of a comprehensive panel of blood-borne markers, fatigue changes are most accurately reflected by urea and IGF-1 for cycling and CK for strength training and team sports players.
Abstract
Assessing current fatigue of athletes to fine-tune training prescriptions is a critical task in competitive sports. Blood-borne surrogate markers are widely used despite the scarcity of validation trials with representative subjects and interventions. Moreover, differences between training modes and disciplines (e.g. due to differences in eccentric force production or calorie turnover) have rarely been studied within a consistent design. Therefore, we investigated blood-borne fatigue markers during and after discipline-specific simulated training camps. A comprehensive panel of blood-born indicators was measured in 73 competitive athletes (28 cyclists, 22 team sports, 23 strength) at 3 time-points: after a run-in resting phase (d 1), after a 6-day induction of fatigue (d 8) and following a subsequent 2-day recovery period (d 11). Venous blood samples were collected between 8 and 10 a.m. Courses of blood-borne indicators are considered as fatigue dependent if a significant deviation from baseline is present at day 8 (Δfatigue) which significantly regresses towards baseline until day 11 (Δrecovery). With cycling, a fatigue dependent course was observed for creatine kinase (CK; Δfatigue 54±84 U/l; Δrecovery -60±83 U/l), urea (Δfatigue 11±9 mg/dl; Δrecovery -10±10 mg/dl), free testosterone (Δfatigue -1.3±2.1 pg/ml; Δrecovery 0.8±1.5 pg/ml) and insulin linke growth factor 1 (IGF-1; Δfatigue -56±28 ng/ml; Δrecovery 53±29 ng/ml). For urea and IGF-1 95% confidence intervals for days 1 and 11 did not overlap with day 8. With strength and high-intensity interval training, respectively, fatigue-dependent courses and separated 95% confidence intervals were present for CK (strength: Δfatigue 582±649 U/l; Δrecovery -618±419 U/l; HIIT: Δfatigue 863±952 U/l; Δrecovery -741±842 U/l) only. These results indicate that, within a comprehensive panel of blood-borne markers, changes in fatigue are most accurately reflected by urea and IGF-1 for cycling and by CK for strength training and team sport players.
Assessing current fatigue of athletes to fine-tune training prescriptions is a critical task in competitive sports. Blood-borne surrogate markers are widely used despite the scarcity of validation trials with representative subjects and interventions. Moreover, differences between training modes and disciplines (e.g. due to differences in eccentric force production or calorie turnover) have rarely been studied within a consistent design. Therefore, we investigated blood-borne fatigue markers during and after discipline-specific simulated training camps. A comprehensive panel of blood-born indicators was measured in 73 competitive athletes (28 cyclists, 22 team sports, 23 strength) at 3 time-points: after a run-in resting phase (d 1), after a 6-day induction of fatigue (d 8) and following a subsequent 2-day recovery period (d 11). Venous blood samples were collected between 8 and 10 a.m. Courses of blood-borne indicators are considered as fatigue dependent if a significant deviation from baseline is present at day 8 (Δfatigue) which significantly regresses towards baseline until day 11 (Δrecovery). With cycling, a fatigue dependent course was observed for creatine kinase (CK; Δfatigue 54±84 U/l; Δrecovery -60±83 U/l), urea (Δfatigue 11±9 mg/dl; Δrecovery -10±10 mg/dl), free testosterone (Δfatigue -1.3±2.1 pg/ml; Δrecovery 0.8±1.5 pg/ml) and insulin linke growth factor 1 (IGF-1; Δfatigue -56±28 ng/ml; Δrecovery 53±29 ng/ml). For urea and IGF-1 95% confidence intervals for days 1 and 11 did not overlap with day 8. With strength and high-intensity interval training, respectively, fatigue-dependent courses and separated 95% confidence intervals were present for CK (strength: Δfatigue 582±649 U/l; Δrecovery -618±419 U/l; HIIT: Δfatigue 863±952 U/l; Δrecovery -741±842 U/l) only. These results indicate that, within a comprehensive panel of blood-borne markers, changes in fatigue are most accurately reflected by urea and IGF-1 for cycling and by CK for strength training and team sport players.
Creatine Phosphokinase and Urea as Biochemical Markers of Muscle Injuries in Professional Football Players
Sports Medicine Postgraduate Program, Faculty of Medicine, University of Antioquia , Asian Journal of Sports Medicine: Vol.9, issue 4; e60386, 2018 DOI: https://doi.org/10.5812/asjsm.60386
| Link to the source |
Abstract
Background: Although biochemical markers have been used to monitor training loads (TL), it is unknown if they can be used to predict muscle injuries (MI) in professional football (soccer) players (PFP).
Objectives: To evaluate the relationship between the incidence of MI, serum concentration of creatine phosphokinase (CPK) and urea, as well as TL in PFP.
Methods: Twenty-three PFP from a Colombian first-division team were enrolled in a retrospective cohort study. CPK, urea, TL and new MI were measured during 19 weeks. CPK and urea serum levels within 4 weeks before a diagnosed MI were compared to those measured preseason. CPK and urea relationship with TL were analyzed using a mixed-effects model.
Results: The subjects had an age of 25.3 ± 4.2 years. Nine subjects presented with MI during follow-up, 66% of which were localized to hamstrings. Serum CPK and urea profiles were constructed for each player along the season. Injured players had a significant elevation of these markers within 4 weeks before the injury was clinically evident when compared to their own preseason values. Expected individual increases in CPK and urea according to TL during the season were estimated.
Conclusions: Since CPK and urea values rose several weeks before the MI became overt, constructing CPK and urea profiles for each player during the whole preseason and season may help identify peaks in their concentration as early markers of MI. A tight biochemical control of training may become a preventive strategy for MI, but the use of published reference values is discouraged.
Background: Although biochemical markers have been used to monitor training loads (TL), it is unknown if they can be used to predict muscle injuries (MI) in professional football (soccer) players (PFP).
Objectives: To evaluate the relationship between the incidence of MI, serum concentration of creatine phosphokinase (CPK) and urea, as well as TL in PFP.
Methods: Twenty-three PFP from a Colombian first-division team were enrolled in a retrospective cohort study. CPK, urea, TL and new MI were measured during 19 weeks. CPK and urea serum levels within 4 weeks before a diagnosed MI were compared to those measured preseason. CPK and urea relationship with TL were analyzed using a mixed-effects model.
Results: The subjects had an age of 25.3 ± 4.2 years. Nine subjects presented with MI during follow-up, 66% of which were localized to hamstrings. Serum CPK and urea profiles were constructed for each player along the season. Injured players had a significant elevation of these markers within 4 weeks before the injury was clinically evident when compared to their own preseason values. Expected individual increases in CPK and urea according to TL during the season were estimated.
Conclusions: Since CPK and urea values rose several weeks before the MI became overt, constructing CPK and urea profiles for each player during the whole preseason and season may help identify peaks in their concentration as early markers of MI. A tight biochemical control of training may become a preventive strategy for MI, but the use of published reference values is discouraged.
Biochemical markers of muscular damage
Paola Brancaccio , Giuseppe Lippi and Nicola Maffulli (Servizio di Medicina dello Sport, Seconda Universita` di Napoli, Napoli, Italy; U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero- Universitaria di Parma, Parma, Italy; Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Center for Sports and Exercise Medicine, Mile End Hospital, London, England, UK)
Journal Clinical Chemistry and Laboratory Medicine
https://doi.org/10.1515/CCLM.2010.179
Journal Clinical Chemistry and Laboratory Medicine
https://doi.org/10.1515/CCLM.2010.179
| Link to the source |
Abstract
Muscle tissue may be damaged following intense prolonged training as a consequence of both metabolic and mechanical factors. Serum levels of skeletal muscle enzymes or proteins are markers of the functional status of muscle tissue, and vary widely in both pathological and physiological conditions. Creatine kinase, lactate dehydrogenase, aldolase, myo- globin, troponin, aspartate aminotransferase, and carbonic anhydrase CAIII are the most useful serum markers of muscle injury, but apoptosis in muscle tissues subsequent to strenuous exercise may be also triggered by increased oxidative stress.
Conclusions
Muscle damage may occur following physiological and pathological conditions. Blood analysis and urinalysis provide a composite picture of muscle status and a better estimation of muscle stress. In addition, the evaluation of oxidative stress by markers of protein and lipid oxidation may be useful to better assess and quantify muscle stress following exercise.
Muscle tissue may be damaged following intense prolonged training as a consequence of both metabolic and mechanical factors. Serum levels of skeletal muscle enzymes or proteins are markers of the functional status of muscle tissue, and vary widely in both pathological and physiological conditions. Creatine kinase, lactate dehydrogenase, aldolase, myo- globin, troponin, aspartate aminotransferase, and carbonic anhydrase CAIII are the most useful serum markers of muscle injury, but apoptosis in muscle tissues subsequent to strenuous exercise may be also triggered by increased oxidative stress.
Conclusions
Muscle damage may occur following physiological and pathological conditions. Blood analysis and urinalysis provide a composite picture of muscle status and a better estimation of muscle stress. In addition, the evaluation of oxidative stress by markers of protein and lipid oxidation may be useful to better assess and quantify muscle stress following exercise.
See also other studies:
- Creatine Phosphokinase and Urea in High-Performance Athletes During Competition. a Framework for Predicting Injuries Caused by Fatigue
- Creatine-Kinase- and Exercise-Related Muscle Damage Implications for Muscle Performance and Recovery
- Acute fatigue in endurance athletes: The association between countermovement jump variables and creatine kinase response.
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Specification
Size
21 × 12 × 17 cm (8.27 × 4.72 × 6.69 in)
Weight
2.9 kg (6.39 lbs)
Operating mode
Continuous
Ambient operating temperature
10~30°C (50-86°F), indoor use
Atmospheric pressure
86.0 kPa~106.0 kPa/2000 m (6562 ft)
Humidity
up to 85%
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120 VA
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100-240V AC, 50-60 Hz
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37°C (98.6°F)
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