Physiological and Nutritional Considerations for Elite Squash: A Systematic Review

Abstract

Purpose

To systematically review all the physiological and nutritional research conducted in squash to guide practitioners and researchers on how best to interpret the data, while identifying gaps in the literature to determine future directions of research within squash.

Methods

Following PRISMA guidelines, studies investigating an aspect of physiology or nutrition within squash were identified using scientific databases CINAHL, MEDLINE, PUBMED, and SPORTDiscus, from March 2022 to October 2023.

Results

Of the 1208 studies identified, 35 met the inclusion criteria across a variety of physiological and nutritional topics, such as the physiological demands of squash, anthropometric and physiological characteristics of squash players, squash-specific performance tests, training demands of squash, nutritional requirements of squash, hydration demands of squash, nutrition knowledge of squash players, and nutritional supplements for squash players. Ten studies had poor methodological quality, 19 as fair, four as good, and two as excellent. Seventeen out of 35 studies included were undertaken post the 2009 rule change, and 14 studies were conducted on either elite or world class players. Twenty-nine of the studies involved male players, with 15 involving female players.

Conclusion

Much of the physiological and nutritional literature is of low quality and outdated. We present future research focuses throughout the review, such as quantifying the game characteristics of male and female players, the energy expenditures during a training and competition microcycle, and the efficacy of certain nutritional supplements. These efforts aim to create sport specific guidelines and advance evidence-based practice within squash.

Keywords

Sports physiology / Sports nutrition / Racket sports / Squash / High intensity intermittent sport

References

[1] Ackland TR, Lohman TG, Sundgot-Borgen J, Maughan RJ, Meyer NL, Stewart AD, Müller W. Current status of body composition assessment in sport: review and position statement on behalf of the ad hoc research working group on body composition health and performance, under the auspices of the I.O.C. medical commission. Sports Med, 2012, 42: 227-249

[2] Ament W, Verkerke GJ. Exercise and fatigue. Sports Med, 2009, 39: 389-422

[3] Anderson L, Close GL, Morgans R, Hambly C, Speakman JR, Drust B, Morton JP. Assessment of energy expenditure of a professional goalkeeper from the english premier league using the doubly labeled water method. Int J Sports Phys Perf, 2019, 14: 1-684

[4] Anderson L, Orme P, Naughton RJ, Close GL, Milsom J, Rydings D, Morton JP. Energy intake and expenditure of professional soccer players of the english premier league: Evidence of carbohydrate periodization. Int J Sport Nut Exer Metab, 2017, 27: 228-238

[5] Baker LB. Sweating rate and sweat sodium concentration in athletes: a review of methodology and Intra/Interindividual variability. Sports Med, 2017, 47: 111-128

[6] Barnes KA, Anderson ML, Stofan JR, Dalrymple KJ, Reimel AJ, Roberts TJ, Baker LB. Normative data for sweating rate, sweat sodium concentration, and sweat sodium loss in athletes: an update and analysis by sport. J Sports Sci, 2019, 37: 2356-2366

[7] Beaudin P, Zapiec C, Montgomery D. Heart rate response and lactic acid concentration in squash players. Res Q, 1978, 49: 406-412

[8] Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, Day NE. Comparison of dietary assessment methods in nutritional epidemiology: Weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr, 1994, 72: 619-643

[9] Blanksby BA, Elliott BC, Bloomfield J. Telemetered heart rate responses of middle-aged sedentary males, middle aged active males and 'A' grade male squash players. Med J Aus, 1973, 2: 477-481

[10] Blanksby BA, Elliott BC, Davis KH, Mercer MD. Blood pressure and rectal temperature responses of middle-aged sedentary, middle-aged active and "A"-grade competitive male squash players. Bri J Sports Med, 1980, 14: 133-138

[11] Bottoms LM, Hunter AM, Galloway SR. Effects of carbohydrate ingestion on skill maintenance in squash players. Eur J Sport Sci, 2006, 6: 187-195

[12] Brady HR, Kinirons M, Lynch T, Ohman EM, Tormey W, O'Malley KM, Horgan JH. Heart rate and metabolic response to competitive squash in veteran players: Identification of risk factors for sudden cardiac death. Eur Heart J, 1989, 10: 1029-1035

[13] Brigden GS, Hughes LO, Broadhurst P, Raftery EB. Blood pressure changes during the game of squash. Eur Heart J, 1992, 13: 1084-1087

[14] Brinkmans NJ, Iedema N, Plasqui G, Wouters L, Saris WM, van Loon LC, van Dijk J. Energy expenditure and dietary intake in professional football players in the dutch premier league: Implications for nutritional counselling. J Sport Sci, 2011, 37: 2759-2767

[15] Burke LM, Hawley JA, Wong SS, Jeukendrup AE. Carbohydrates for training and competition. J Sports Sci, 2011, 29: 17-27

[16] Cashin AG, McAuley JH. Clinimetrics: physiotherapy evidence database (PEDro) scale. J Phys, 1995, 66: 59-59

[17] Chin MK, Steininger K, So RC, Clark CR, Wong AS. Physiological profiles and sport specific fitness of asian elite squash players. Br J Sports Med, 1995, 29: 158-164

[18] Collins J, Maughan RJ, Gleeson M, Bilsborough J, Jeukendrup A, Morton JP, McCall A. UEFA expert group statement on nutrition in elite football. current evidence to inform practical recommendations and guide future research. Br J Sports Med, 2021, 55: 416

[19] Costello N, Deighton K, Dyson J, Mckenna J, Jones B. Snap-N-send: a valid and reliable method for assessing the energy intake of elite adolescent athletes. Eur J Sport Sci, 2017, 17: 1044-1055

[20] Costello N, Deighton K, Preston T, Matu J, Rowe J, Jones B. Are professional young rugby league players eating enough? energy intake, expenditure and balance during a pre-season. Eur J Sport Sci, 2019, 19: 123-132

[21] Costello N, Deighton K, Preston T, Matu J, Rowe J, Sawczuk T, Jones B. Collision activity during training increases total energy expenditure measured via doubly labelled water. Eur J App Phys, 2018, 118: 1169-1177

[22] Cronin J, Mcnair P, Marshall R. Lunge performance and its determinants. J Sports Sci, 2003, 21: 49-57

[23] Currell K, Jeukendrup AE. Validity, reliability and sensitivity of measures of sporting performance. Sports Med, 2008, 38: 297-316

[24] Dasa MS, Friborg O, Kristoffersen M, Pettersen G, Plasqui G, Sundgot-Borgen J, Rosenvinge JH. Energy expenditure, dietary intake and energy availability in female professional football players. BMJ Open Sport Exer Med, 2023, 9

[25] Ebine N, Rafamantanantsoa HH, Nayuki Y, Yamanaka K, Tashima K, Ono T, Jones PH. Measurement of total energy expenditure by the doubly labelled water method in professional soccer players. J Sport Sci, 2002, 20: 391-397

[26] Elkins MR, Moseley AM, Sherrington C, Herbert RD, Maher CG. Growth in the physiotherapy evidence database (PEDro) and use of the PEDro scale. Br J Sports Med, 2013, 47: 188-189

[27] Ellis DG, Speakman J, Hambly C, Cockram A, Morton JP, Close GL, Donovan TF. Case-study: energy expenditure of a world class male wheelchair tennis player during training, grand slam and british open tournaments measured by doubly labelled water. Int J Sports Sci Coach, 2023

[28] Ellis DG, Speakman J, Hambly C, Morton JP, Close GL, Donovan TF. An observational case series measuring the energy expenditure of elite tennis players during competition and training by using doubly labeled water. Int J Sports Physiol Perform, 2023, 18: 547-552

[29] Ellis DG, Speakman J, Hambly C, Morton JP, Close GL, Lewindon D, Donovan TF. Energy expenditure of a male and female tennis player during association of tennis professionals/women's tennis association and grand slam events measured by doubly labeled water. Med Sci Sports Exer, 2021, 53: 2628-2634

[30] Foley NC, Bhogal SK, Teasell RW, Bureau Y, Speechley MR. Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Phys Ther, 2006, 86: 817-824

[31] Gibson N, Bell P, Clyne A, Lobban G, Aitken L, Gibbon K. Physical preparation for elite-level squash players: monitoring, assessment, and training practices for the strength and conditioning coach. Strength Cond J, 2019, 41: 51-62

[32] Giersch GW, Charkoudian N, Stearns RL, Casa DJ. Fluid balance and hydration considerations for women: review and future directions. Sports Med, 2020, 50: 253-261

[33] Girard O, Chevalier R, Habrard M, Sciberras P, Hot P, Millet GP. Game analysis and energy requirements of elite squash. J Strength Cond Res, 2007, 21: 909

[34] Girard O, Micallef JP, Noual J, Millet GP. Alteration of neuromuscular function in squash. J Sci Med Sport, 2010, 13: 172-177

[35] Girard O, Sciberras P, Habrard M, Hot P, Chevalier R, Millet GP. Specific incremental test in elite squash players. Br J Sports Med, 2005, 39: 921-926

[36] Gonzalez GZ, MoseleyAM MCG, Nascimento DP, Costa LM, Costa LO. Methodologic quality and statistical reporting of physical therapy randomized controlled trials relevant to musculoskeletal conditions. Arc Phys Med Rehab, 2018, 99: 129-136

[37] Gouttebarge V, Moen M, Boschman JS, Kantebeen M. Squash-specific exercise test for elite squash players: development and validity. Eur J Sports Exerc sci, 2013, 2: 1-6

[38] Hannon MP, Parker LF, Carney DJ, Mckeown J, Speakman JR, Hambly C, Morton JP. Energy requirements of male academy soccer players from the english premier league. Med Sci Sport Exer, 2021, 53: 200-210

[39] James C, Dhawan A, Jones T, Girard O. Quantifying training demands of a 2-week in-season squash microcycle. Int J Sports Phys Perform, 2021, 16: 779

[40] James C, Dhawan A, Jones T, Pok C, Yeo V, Girard O. Minimal agreement between internal and external training load metrics across a 2-wk training microcycle in elite squash. J Sports Sci Med, 2021, 20: 101

[41] James C, Jones T, Farra S. Physiological and performance correlates of squash physical performance. J Sports Sci Med, 2022, 21: 82

[42] James C, Tenllado Vallejo F, Kantebeen M, Farra S. Validity and reliability of an on-court fitness test for assessing and monitoring aerobic fitness in squash. J Strength Cond Res, 2019, 33: 1400-1407

[43] Jones TW, Williams BK, Kilgallen C, Horobeanu C, Shillabeer BC, Murray A, Cardinale MA. Review of the performance requirements of squash. Int J Sports Sci Coach, 2018, 13: 1223-1232

[44] Joyner MJ, Coyle EF. Endurance exercise performance: the physiology of champions. J Phys, 2008, 586: 35-44

[45] Karastergiou K, Smith SR, Greenberg AS, Fried SK. Sex differences in human adipose tissues - the biology of pear shape. Biol Sex Differ, 2012, 2012(3): 13

[46] Kasper AM, Langan-Evans C, Hudson JF, Brownlee TE, Harper LD, Naughton RJ, Close GL. Come back skinfolds, all is forgiven: a narrative review of the efficacy of common body composition methods in applied sports practice. Nutrients, 2021, 13: 1075

[47] Kingsley M, James N, Kilduff L, Dietzig RE, Dietzig B. An exercise protocol that simulates the activity patterns of elite junior squash. J Sports Sci, 2006, 24: 1291-1296

[48] Kirkendall DT. Mechanisms of peripheral fatigue. Med Sci Sports Exerc, 1990, 22: 444-449

[49] Krustrup P, Mohr M, Steensberg A, Bencke J, Kjair M, Bangsbo J. Muscle and blood metabolites during a soccer game: implications for sprint performance. Med Sci Sports Exerc, 2006, 38: 1165-1174

[50] Lees A. Science and the major racket sports: a review. J Sports Sci, 2003, 21: 707-732

[51] Lombard AJ, Shaw I, Shaw BS, Watkin SJ, Schoeman HJ, Shaw I, Coetzer EW. Role of physical fitness parameters in squash performance. Af J Phys Health Edu Rec Dance, 2014, 20: 55-962

[52] Lynch T, Kinirons MT, O'Callaghan D, Ismail S, Brady HR, Horgan JH. Metabolic changes during serial squash matches in older men. Can J Sport Sci, 1992, 17: 110-113

[53] MacGowan GA, Ryan R, O'Donovan D, Tempany K, Kinsella A, Horgan JH. Fluid replacements after squash: an analysis of the effects of several fluid regimens on exercise-related metabolic changes. Cardiology, 1994, 84: 356-364

[54] Majumdar P, Mandal M, Yadav D. The effectiveness of training routine with reference to the physiological demand of squash match play. Int J App Sports Sci, 2009, 21: 28-44

[55] Martin AD, Ross WD, Drinkwater DT, Clarys JP. Prediction of body fat by skinfold caliper: assumptions and cadaver evidence. Int J Obes, 1985, 1: 31-39

[56] Maughan RJ, Burke LM, Dvorak J, Larson-Meyer D, Peeling P, Phillips SM, Engebretsen L. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med, 2018, 52: 439-455

[57] McKay AA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey V, Burke LM. Defining training and performance caliber: a participant classification framework. Int J Sports Phys Perf, 2002, 17: 317-331

[58] Micklewright D, Papapdopoulou E. A new squash specific incremental field test. Int J Sports Med, 2008, 29: 758

[59] Mohr M, Draganidis D, Chatzinikolaou A, Barbero-Álvarez JC, Castagna C, Douroudos I, Fatouros IG. Muscle damage, inflammatory, immune and performance responses to three football games in 1 week in competitive male players. Eur J Appl Physiol, 2016, 116: 179-193

[60] Montpetit RR, Beauchamp L, Léger L. Energy requirement of squash and racquetball. Phys Sports Med, 1987, 15: 106-109

[61] Morehen JC, Bradley WJ, Clarke J, Twist C, Hambly C, Speakman JR, Close GL. The assessment of total energy expenditure during a 14-day in-season period of professional rugby league players using the doubly labelled water method. Int J Sport Nut Exer Metab, 2016, 26: 464-472

[62] Morehen JC, Rosimus C, Cavanagh BP, Hambly C, Speakman JR, Elliott-Sale K, Morton JP. Energy expenditure of female international standard soccer players: a doubly labeled water investigation. Med Sci Sport Exer, 2022, 54: 769-779

[63] Murray S, James N, Hughes MD, Perš J, Mandeljc R, Vučković G. Effects of rule changes on physical demands and shot characteristics of elite-standard men's squash and implications for training. J Sports Sci, 2016, 34: 2170-2174

[64] Nana A, Slater GJ, Hopkins WG, Halson SL, Martin DT, West NP, Burke LM. Importance of standardized DXA protocol for assessing physique changes in athletes. Int J Sport Nut Exer Met, 2016, 26: 259-267

[65] Nana A, Slater GJ, Stewart AD, Burke LM. Methodology review: Using dual-energy X-ray absorptiometry (DXA) for the assessment of body composition in athletes and active people. Int J Sport Nut Exer Met, 2015, 25: 198-215

[66] Nédélec M, McCall A, Carling C, Legall F, Berthoin S, Dupont G. Recovery in soccer: part II—recovery strategies. Sports Med, 2013, 43: 9-22

[67] Okura T, Koda M, Ando F, Niino N, Ohta S, Shimokata H. Association of polymorphisms in the estrogen receptor α gene with body fat distribution. Int J Ob, 2003, 27: 1020-1027

[68] Olympics. IOC Session approves LA28’s proposal for five additional sports. 2023. https://olympics.com/ioc/news/ioc-session-approves-la28-s-proposal-for-five-additional-sports. Accessed 20 Oct 2023.

[69] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Sur, 2021, 88

[70] Physiotherapy Evidence Database. PEDro Scale. 2022. https://pedro.org.au/english/resources/pedro-scale/. Accessed 15 Mar 2022.

[71] Périard J, Eijsvogels T, Daanen H. Exercise under heat stress: Thermoregulation, hydration, performance implications, and mitigation strategies. Physiol rev, 2021, 101: 1873-1979

[72] Professional Squash Association. PSA squash tour. 2022. https://www.psaworldtour.com. Accessed 16 Mar 2022.

[73] Professional Squash Association. PSA World Championsips. 2023. https://www.psaworldtour.com/tournament/cib-psa-world-championships-cairo-2022/. Accessed 16 Jan 2023.

[74] Professional Squash Association. PSA Tournamets. 2024. https://www.psaworldtour.com/tournaments/. Accessed 1 June 2024.

[75] Raman A, Macdermid PW, Mündel T, Mann M, Stannard SR. The effects of carbohydrate loading 48 hours before a simulated squash match. Int J Sports Nut Exerc Metab, 2014, 24: 157

[76] Ranchordas MK, Dawson JT, Russell M. Practical nutritional recovery strategies for elite soccer players when limited time separates repeated matches. J Int Soc Sports Nutr, 2017

[77] Ranchordas MK, Rogersion D, Ruddock A, Killer SC, Winter EM. Nutrition for tennis: practical recommendations. J Sports Sci Med, 2013, 12: 211-224

[78] Rodriguez-Giustiniani P, Rodriguez-Sanchez N, Galloway SR. Fluid and electrolyte balance considerations for female athletes. Eur J Sport Sci, 2022, 22: 697-708

[79] Research Registry. Registry of systematic reviews & meta-analyses. 2022. https://www.researchregistry.com. Accessed 18 Apr 2022.

[80] Rollo I, Gonzalez JT, Fuchs CJ, van Loon LC, Williams C. Primary, secondary, and tertiary effects of carbohydrate ingestion during exercise. Sports Med, 2020, 50: 1863-1871

[81] Romer LM, Barrington JP, Jeukendrup AE. Effects of oral creatine supplementation on high intensity, intermittent exercise performance in competitive squash players. Int J Sports Med, 2001, 22: 546-552

[82] Rosimus C. Case study: the effect of nutritional intervention on body composition and physical performance of a female squash player. Int J Sport Nut Exerc Metab, 2018, 28: 279-283

[83] Sagayama H, Hamaguchi G, Toguchi M, Ichikawa M, Yamada Y, Ebine N, Tanaka H. Energy requirement assessment in japanese table tennis players using the doubly labeled water method. Int J Sport Nut Exer Metab, 2017, 27: 421-428

[84] Silva AM, Santos DA, Matias CN, Minderico CS, Schoeller DA, Sardinha LB. Total energy expenditure assessment in elite junior basketball players: a validation study using doubly labeled water. J Str Cond Res, 2013, 27: 1920-1927

[85] Smekal G, Von Duvillard SP, Rihacek C, Pokan R, Hofmann P, Baron R, Bachl N. A physiological profile of tennis match play. Med Sci Sports Exer, 2001, 33: 999-1005

[86] Smith DR, King RJ, Duckworth LC, Sutton L, Preston T, O’Hara JP, Jones B. Energy expenditure of rugby players during a 14-day in-season period, measured using doubly labelled water. Eur J App Phys, 2018, 118: 647-656

[87] Spronk I, Kullen C, Burdon C, O'Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr, 2014, 111: 1713-1726

[88] Steininger K, Wodick RE. Sports-specific fitness testing in squash. Br J Sports Med, 1987, 21: 23

[89] Tam R, Beck KL, Manore MM, Gifford J, Flood VM, O’Connor H. Effectiveness of education interventions designed to improve nutrition knowledge in athletes: a systematic review. Sports Med, 2019, 49: 1769-1786

[90] Thompson FE, Subar AF. Dietary assessment methodology. Nutrition in the prevention and treatment of disease, 2017, London, England Academic Press: Elsevier 5-48

[91] Tomlin DL, Wenger HA. The relationship between aerobic fitness and recovery from high intensity intermittent exercise. Sports Med, 2001, 31: 1-11

[92] Trakman GL, Brown F, Forsyth A, Belski R. Modifications to the nutrition for sport knowledge questionnaire (NSQK) and abridged nutrition for sport knowledge questionnaire (ANSKQ). J Int Soc Sports Nut, 2019, 16: 26

[93] Trakman GL, Forsyth A, Hoye R, Belski R. The nutrition for sport knowledge questionnaire (NSKQ): development and validation using classical test theory and rasch analysis. J Int Soc Sports Nutr, 2017, 14: 26

[94] Turner O, Mitchell N, Ruddock A, Purvis A, Ranchordas MK. Elite squash players nutrition knowledge and influencing factors. J Int Soc Sports, 2021, 18: 1

[95] Turner O, Mitchell N, Ruddock A, Purvis A, Ranchordas MK. Fluid balance, sodium losses and hydration practices of elite squash players during training. Nutrients, 2023, 15: 1749

[96] Ventura-Comes A, Martínez-Sanz JM, Sánchez-Oliver AJ, Domínguez R. Analysis of foods habits in squash players. J Phys Ed Sport, 2019, 19: 1300-1307

[97] Ventura-Comes A, Sánchez-Oliver AJ, Martínez-Sanz JM, Domínguez R. Analysis of nutritional supplements consumption by squash players. Nutrients, 2018, 10: 1341

[98] Vučković G, Dežman B, Erčulj F, Kovačič S, & Perš J,. Comparative movement analysis of winning and losing players in men’s elite squash. Kinesiol Slov, 2003, 9: 74-84

[99] Wang J, Thornton JC, Kolesnik S, Pierson RN Jr. Anthropometry in body composition: an overview. Ann N Y Acad Sci, 2001, 904: 317-326

[100] Wilkinson M, Cooke M, Murray S, Thompson KG, St Clair Gibson A, Winter EM. Physiological correlates of multiple-sprint ability and performance in international-standard squash players. J Strength Cond Res, 2012, 26: 540-547

[101] Wilkinson M, Leedale-Brown D, Winter EM. Reproducibility of physiological and performance measures from a squash-specific fitness test. Int J Sports Phys Perf, 2009, 4: 41

[102] Wilkinson M, Leedale-Brown D, Winter EM. Validity of a squash-specific test of change-of-direction speed. Int J Sports Phys Perf, 2009, 4: 176-185

[103] Wilkinson M, Leedale-Brown D, Winter EM. Validity of a squash-specific fitness test. Int J Sports Phys Perf, 2009, 4: 29-40

[104] Wilkinson M, McCord A, Winter EM. Validity of a squash-specific test of multiple-sprint ability. J Strength Cond Res, 2010, 24: 3381-3386

[105] World Squash Federation. A sport with history. 2022. https://www.worldsquash.org/a-sport-with-history/. Accessed 16 Mar 2022.

[106] World Squash Federation. World squash singles rules. 2022. https://www.worldsquash.org/wp-content/uploads/2021/12/201127_Rules-of-Singles-Squash-2020-V2.pdf. Accessed 16 Mar 2022.

[107] World Squash Federation. Info about WSF. 2022. https://www.worldsquash.org/wsf-information/. Accessed 16 Mar 2022.

Funding

Sheffield Hallam University