Tech for talent: monitoring the health and performance of athletes

Over 11,000 athletes are due to compete at the Olympic Games this summer, in 33 different sports. The Tokyo Olympics will be the high point of the year for these athletes and, for many, the pinnacle of their entire careers. Some will never have a better chance to be selected for the Games; for others in their prime, it will be their best chance of winning a medal. There will be experienced athletes in their last Olympics before retirement and younger stars having their first taste of the world’s most famous sporting event, after many years preparing in junior and development squads.

Whatever their situation and objective, all Olympic athletes have one thing in common – a desire to turn up for those two weeks, in peak condition, ready to give their absolute best, or hopefully, push themselves on to something even better.

This is difficult enough under normal circumstances. Pressure from opponents, teammates, coaches, fans, the media, and in some cases politicians and governments, can weigh heavily.

At least under normal circumstances, what an athlete does or doesn’t do to get ready for a major event is in their own hands – barring injury or lack of funding. Not this time, though. Elite athletes, like everyone else, have had their routines swept away by the coronavirus pandemic.

During lockdown, elite athletes lost access to the sophisticated support services, staff, and technologies on which they have become increasingly reliant.

Training alone has not only affected athletes’ ability to hone their skills and technique, but also made it more difficult to keep their fitness levels attuned to the requirements of their sport.

“Every athlete training for the Olympics will have a flight path showing where they need to be over the four years of an Olympic cycle,” says Professor Steve Haake, from the Centre for Sports Engineering and Research at Sheffield Hallam University. “This flight path determines the athlete’s downtime, their training, which competitions they enter. Athletes know that if they’re not on that path they won’t make it to the medals, but with Covid the whole thing has fallen apart. Training is supposed to be optimised for the moment you’re at, but athletes have lost some intelligence about where that might be at any given moment.”

John Brewer, visiting professor of sports and exercise science at the University of Suffolk, adds that athletes have been starved of competition for much of last year and they will likely arrive at the Games without their usual sharpness and extra level of physiological preparedness.

Professor Brewer, a former fitness and nutrition adviser for the London Marathon, says: “You can’t replicate the demands of competition in training or during virtual competitions. You don’t quite push yourself as hard as when you’re up against opponents.”

In May 2020, half the athletes surveyed by the International Olympic Committee (IOC) said that staying motivated during lockdown was a challenge.

Despite this, many Olympic hopefuls have been creative in their efforts to recreate their training environments. To name a few: swimming against the current in a jacuzzi while tied to the edge with rope, using a cable system and a cupcake stand to simulate javelin throwing, a sofa as a pommel horse, dry swimming on beer crates.

Home-made gyms have been set up in the garage, back garden, dining room, or even in a stable. Athletes have trained in parks, playing fields and even in underground car parks.

“Athletes have had to find ways of understanding what they are doing when they’re away from training bases,” says Dr Richard Burden, bioscience, and physiology technical lead with the English Institute of Sport – a government-funded organisation that provides sport science, medical and support services to Olympic and other elite athletes.

This means technologies are needed which can remotely monitor and measure health and performance metrics and provide the athlete and their coaches with instant feedback.

“Athletes need systems that keep them connected, identify relevant information and display it in the simplest way, as quickly as possible with a level of accuracy they can trust,” says Haake. “That could be readiness-to-train data, data on athletes’ weight, urine colour or sleep.”

A fatigue monitor called inCORPUS analyses heart rate variability (HRV) to show athletes how their autonomous nervous system (ANS) is functioning.

HRV is the variation of time in milliseconds between heartbeats, which reflects the ability of the ANS to modulate the heart rate according to external and internal demands – for instance stress or training overload.

The ANS regulates all of our vital activities automatically– breathing, digestion, heart, and blood circulation – without us feeling it; that means that an athlete might not realise when they are overtraining or notice the first signs of fatigue.

The inCORPUS system estimates the energy level of the wearer’s body and its general state of health, and then provides a best-fit with one of eight energy profiles. Three profiles represent good shape, the others show up the need for changes to training, nutrition, hydration, energetic care or suggest the athlete takes more tests.

“This data allows me to adapt the intensity during training and stretching,” says trail and mountain runner Xavier Thévenard. “I also have suggestions on methods to counterbalance my state with, for example, relaxation, essential oils, cold water baths.”

Another technology that monitors heart rate variability is Oura’s titanium ring. It’s sold as a sleep tracker that, on waking, assesses the wearer’s readiness for the day. But during the summer of 2020, NBA basketball players in the US used it to monitor Covid-19 cases, as the league completed its season in a bubble at Disney World.

The ring contains LED sensors, a body temperature sensor, a 3D accelerometer, and a gyroscope. These collect resting heart rate data, overall time spent asleep, time spent in light, deep and REM sleep, night-time movement, latency (time taken to fall asleep) and temperature.

Athletes who don’t get enough quality sleep are less likely to perform at optimum levels and more likely to get injured. Injury can also occur when athletes don’t take in enough fuel, too much, or the wrong sort. Even if an athlete steers clear of injury, if they don’t eat and drink right, they will underperform.

For budding Olympians, this doesn’t just mean filling in diet sheets and making sure their daily run doesn’t take them past the chip shop. An elite athlete’s body itself will indicate whether or not they are eating and drinking properly for their sport. If the athlete has the technology to measure the right indicators, that is.

The Libre Sense biosensor from Abbott enables athletes to measure glucose levels using a mobile app. The sensor is the size of a two-euro coin and sticks to the back of the upper arm with a dual-sided patch. From it, a thin filament extends under the skin. This filament monitors the interstitial fluid – which surrounds cells of tissues just below the skin – to track the body’s levels of glucose. The biosensor then sends this data to an app on the user’s smartphone.

Exertion draws on sugar reserves stored in muscles and the liver. The body stores glucose, ready to be burned. Understanding real-time glucose levels can enable athletes to know the best time and foods to replenish their bodies during training and competition to maintain peak performance, as well as muscle recovery after training.

“When someone is exercising at high intensity, they’ll actually see a rise in glucose, which is the body responding to the stress of the event,” says James McCarter, Abbott’s medical affairs director. “That triggers a glucose rise from the liver that eventually is brought back down by an insulin response. Later in exercise (especially endurance exercise) as glycogen stores are depleted, glucose will begin to lower.”

McCarter adds that different people respond differently to different foods. “One person will spike from oatmeal, another person will spike from rice,” he says. “[With the sensor] people can tailor their meals to avoid spiking and crashing their glucose.”

There are other places to put sensors. Steve Haake isn’t sure that an athlete would want something embedded under their skin when trying to do an elite performance.

Light Lace sensor is a stretchable material that uses light to detect muscle fatigue and respiration. It was originally designed as a touch sensor for robots, but according to its designers, the Organic Robotics Corporation (ORC), it can be woven into textiles or even helmets.

“We shine light through one end of these fibres and measure the behaviour of light through the other end,” says Professor Rob Shepherd, ORC co-founder and head of Cornell University’s Organic Robotics Lab. “This means we can measure pressure, motion and stretching.”

Shepherd explains that the information generated can help athletes better assess injury risk factors. “We measure joint angles, muscle change, which we call muscle activity, volume for respiration and interaction pressures on either the ground or hands,” he says.

Sixty per cent of the athletes surveyed in last year’s BBC Women’s Sport Survey said that their performance had been affected by their period, or that because of it, they had missed training and competitions. A Nottingham Trent University Study from 2018 found that 75 per cent of female athletes experienced negative side effects during menses, the start of the follicular, or low-hormone phase.

“Fluctuations in strength, metabolism, inflammation, body temperature and fluid balance are associated with hormonal fluctuations,” says sports scientist Johanna Ihalainen from the Mid Sweden University. “Athletes can also be at greater risk of injury at this time, although the way in which the menstrual cycle affects females and their performance is highly individual, and there are a number of studies that indicate no differences across the cycle.”

The English Institute of Sport (EIS) and biosensing tech start-up Mint Diagnostics are developing a hormone testing technology that female athletes can use on their phones. It’s called Hormonix. Athletes provide a saliva sample and in return are promised clear, rapid, and accurate information on their hormone levels, enabling them to better tailor training to their menstrual cycles.

EIS’s Richard Burden explains that blood sampling, the usual method of getting hormone data, is not as effective as taking a saliva sample. “Blood testing is invasive and requires a laboratory to analyse the samples,” he says. “It’s not possible to do this very often and it’s difficult to take enough samples to get a really good understanding of female athlete health. Saliva, you can take anywhere in the world, in a lab, up a mountain, by a lake.”

Richard White, chief technical officer from Mint Diagnostics, explains that steroid hormones transfer well from blood to saliva. “In saliva, hormones are free, not bound to other proteins as they are in blood,” he says. “This is the biologically active part, so it’s more relevant than the hormones in blood (when taking readings).”

White adds that hormones in saliva are lower concentration than in blood, so Hormonix uses electro-chemical detection, a more sensitive test than the traditional approach of optical detection.

“Athletes can manage their own samples and take daily health monitoring on their phones,” Burden says. “Results are also available for support staff and coaches.”

Hormonix is still at the development stage. “We want to understand female physiology better, so we can support athletes in a more precise way, to reduce injuries and illnesses related to menstrual cycle irregularities,” Burden says.

EIS is also looking at salivary cortisol as a marker of stress and testosterone testing.

Brewer would like to see tests devised for bone and joint stress, haemoglobin and iron levels in blood and blood sugar levels. “Ideally, an athlete needs a physiological blueprint of where they are at,” he says. “Something from which they can monitor what they are physically capable of doing and their potential.”

Haake adds that technologies like these and the demands of lockdown have meant that athletes have had to become more self-reliant.

“It’s created a bit more of a level playing field. Our athletes have experienced what it’s like for athletes from countries who don’t have the resources that we have for elite sport,” he points out.