Post-exercise Ingestion of Carbohydrate, Protein and Water: A Systematic Review and Meta-analysis for Effects on Subsequent Athletic Performance

Impact of carbohydrate timing on glucose metabolism and substrate oxidation following high-intensity evening aerobic exercise in athletes: a randomized controlled study

OBJECTIVE

The study aimed to investigate the impact of nutrient timing in relation to evening exercise. Specifically, it examined the effects of pre- or post-exercise carbohydrate (CHO) ingestion on glucose metabolism, glucose regulation, and overall substrate oxidation in well-trained athletes during and after physical exercise (PE), spanning the nocturnal period and the subsequent morning.

METHODS

Ten male endurance cyclists participated in the study. The initial assessments included body composition measurements and an incremental cycle test to determine maximal oxygen uptake (V ˙ O2 max) and maximum power output (Wmax). Following this, participants underwent a control (rest previous day) oral glucose tolerance test (OGTT) and a familiarization exercise trial that had two objectives: (1) to establish the appropriate amount of CHO to use in the pre- or post-exercise drink during the experimental trials, and (2) to familiarize participants with the equipment and study protocol. In the three days prior to both the control and experimental trials, participants followed a standardized, individualized diet designed to meet their energy needs. During the experimental trials, participants completed two separate evening exercise sessions (50 min@70%Wmax +  ~24 min time-trial (TT)) with either pre- or post-exercise CHO ingestion (253 ± 52 g), matching the CHO oxidized during exercise. The CHO drink and a volume-matched placebo (PLA) drink (containing no energy) were randomly assigned to be consumed two hours before and directly after the experimental exercise sessions. Post-exercise nocturnal interstitial glucose levels (24:00-06:00) were continuously monitored, and a 120-min OGTT was conducted the following morning to assess substrate oxidation rates and glucose control.

RESULTS

Pre-exercise CHO intake significantly lowered capillary glucose levels during steady-state exercise (mean difference 0.41 ± 0.27 mmol/L, p = 0.001) without affecting perceived exertion and TT-performance. No difference was observed in nocturnal glucose regulation (00:00-06:00) regardless of whether CHO was consumed before or after exercise. Post-exercise CHO ingestion reduced glucose tolerance during the OGTT compared to the iso-caloric pre-exercise CHO intake (mean difference 0.76 ± 0.21 mmol/L, p = 0.017). However, a post-exercise CHO intake improved respiratory exchange ratio/metabolic flexibility (MetF) significantly. Enhanced MetF during the first OGTT hour after post-exercise CHO ingestion resulted in 70% and 91% higher CHO oxidation compared to pre-exercise CHO and control, respectively (p ≤ 0.029). Average 120-min OGTT fat oxidation rates were higher with both pre- and post-exercise CHO ingestion compared to control (p ≤ 0.008), with no difference between pre- and post-exercise CHO intake.

CONCLUSION

Morning glucose tolerance was markedly reduced in healthy athletes when CHO was ingested after evening exercise. However, the observed improvements in MetF during the OGTT compared to placebo post-exercise suggest a potential for enhanced athletic performance in subsequent exercise sessions. This opens exciting possibilities for future research to explore whether enhanced MetF induced by CHO-timing can translate to improved athletic performance, offering new avenues for optimizing training and performance.

Nutritional Strategies to Improve Post-exercise Recovery and Subsequent Exercise Performance: A Narrative Review

Post-exercise recovery strategies influence the body's ability to restore physiological homeostasis, replenish energy stores, repair muscle damage, and promote desired adaptations, which improve exercise performance. This narrative review examines the impact of nutritional strategies commonly used for enhancing recovery and subsequent exercise performance, particularly when athletes face short recovery periods. Carbohydrate ingestion is essential for glycogen replenishment, especially within the initial hours post-exercise, with its impact dependent on the types, timing, and amount. Protein is essential for accelerating muscle recovery and achieving a positive nitrogen balance, depending on the type and dosage. The co-ingestion of carbohydrates with proteins or fats is explored for its role in maximizing glycogen resynthesis and muscle repair, with evidence supporting the addition of protein to suboptimal carbohydrate intake for enhanced recovery. Moreover, this review addresses the potential benefits of creatine and caffeine co-ingestion for accelerating glycogen synthesis and improving subsequent performance. Hydration strategies, including the use of milk-based beverages and electrolyte solutions, are also discussed, emphasizing their importance in maintaining fluid balance and optimizing recovery. This review also highlights the emerging role of micronutrients such as omega-3 fatty acids, antioxidants, and sodium bicarbonate in reducing muscle damage and improving acid-base balance. Evidence supports the tailored use of these nutritional strategies, particularly for athletes managing tight competition/training schedules. Future research should focus on refining individualized approaches for recovery and investigating the impact of novel supplements on subsequent performance.

Brussels Chicory Enhances Exhaustive Aerobic Exercise Performance and Post-Exercise Recovery, Possibly Through Promotion of Lactate Oxidation: A Pilot Randomized, Single-Blind, Placebo-Controlled, Two-Way Crossover Study

BACKGROUND

Brussels chicory affluent in phenolic acids could inhibit atherosclerosis; however, its effects on exercise performance and post-exercise recovery are unknown. We hypothesized that Brussels chicory could enhance exhaustive aerobic exercise performance and post-exercise recovery by promoting lactate oxidation.

METHODS

This is a single-blind, randomized, placebo-controlled two-way cross-over trial involving 32 untrained college students (men 18) who consumed either Brussels chicory juice (100 g of Brussels chicory containing ~130 mg phenolic acids and 180 mL fresh milk) or placebo (180 mL fresh milk) for 7 days with a 2-week washout period. On the 7th day, participants received a short-term, progressive workload, high-intensity, exhaustive aerobic exercise with the Bruce protocol. Time to exhaustion and blood lactate were evaluated after exercise. C2C12 myotubes were treated with Brussels chicory phenolic acids (0.625-10 μM) to evaluate these effects on lactate metabolism and lactate dehydrogenase A (LDHA) and B (LDHB), two enzymes responsible for lactate biosynthesis and oxidation, respectively.

RESULTS

Brussels chicory consumption increased time to exhaustion by 8.3% and 12.2% for men and women participants, respectively. This administration also promoted post-exercise recovery, evidenced by a reduction in blood lactate (14.5% for men and 10.6% for women). In C2C12 myotubes, Brussels chicory protocatechuic acid and caffeic acid did not affect LHDA-mediated lactate production, whereas these compounds dose-dependently promoted LDHB-mediated lactate oxidation through an enrichment of mitochondria LDHB.

CONCLUSIONS

Dietary supplementation with Brussels chicory may enhance short-term, progressive workload, high-intensity, exhaustive aerobic exercise performance and post-exercise recovery in humans, possibly by accelerating LDHB-mediated lactate oxidation.

Recovery Strategies in Endurance Sports: A Survey in Coaches and Athletes

PURPOSE

This study explored endurance athletes' and coaches' views on recovery strategies, focusing on their use across competition levels, perceived importance and effectiveness, and common barriers.

METHODS

Endurance athletes (26.6% international, 35.7% national, 28.7% regional, and 9.1% other levels; mean experience 10.04 [7.84] y, n = 143) and coaches (mean experience 17.45 [12.44] y, n = 20) completed an online survey on frequency of usage, perceived importance, effectiveness, and common barriers of 25 recovery strategies. Data were coded and analyzed thematically. A Fisher exact test (P < .05) was conducted on 5-point Likert-scale responses.

RESULTS

Predominant strategies among athletes were hydration, hot showers, and carbohydrate (mean scores 4.62 [0.60], 4.32 [0.82], and 4.17 [0.87]). Only antioxidants showed significant variation in use across levels (P = .033). Coaches favored warm-down/cooling (4.56 [0.62]), hydration (4.41 [0.80]), and extra protein (4.12 [0.70]). Both groups ranked hydration as most important and effective. Athletes ranked extra protein and warm-down/cooling second and third, while coaches considered extra sleep/naps, warm-down/cooling, and extra protein equally important. Barriers of both populations included insufficient time (14.41%), limited knowledge (13.72%), lack of resources (12.63%), and skepticism regarding benefits and effectiveness (12.63%).

CONCLUSIONS

Athletes show no significant differences in recovery choices based on competitive level, except for antioxidants. Coaches and athletes have partially different views on effective recovery. Furthermore, a lack of time, as well as a lack of (shared) knowledge and education, hinders the effective implementation of recovery strategies for athletes.

The effect of protein intake on athletic performance: a systematic review and meta-analysis

Background

The impact of a protein-rich diet and protein supplements on athletic performance remains a topic of debate. Does protein intake offer benefits for athletes? If so, which specific aspects of athletic performance are most influenced by protein?

Methods

This study aimed to explore the relationship between protein intake and athletic performance. A systematic database search was conducted to identify randomized controlled trials (RCTs) examining the effects of protein intake on athletes' performance. The databases searched included PubMed, Scopus, Web of Science, EBSCO, and Ovid. The meta-analysis included a total of 28 studies involving 373 athletes. The meta-analysis employed both the fixed-effects model and the random-effects model to investigate the impact of protein intake on sports performance. Subgroup analyses were conducted to provide solid evidence to explain the results of the meta-analysis. Sensitive analysis and funnel plots were used to assess the risk of bias and data robustness.

Results

Overall, protein intake did not show a statistically significant improvement in athletic performance (standardized mean difference [SMD] = 0.12, 95% confidence interval [CI]: -0.01 to 0.25). However, in subgroup analysis, the protein group demonstrated a statistically significant improvement in endurance performance, as indicated by the forest plot of final values (SMD = 0.17, 95% CI: 0.02 to 0.32). Additionally, the change value in the forest plot for endurance performance showed even greater statistical significance than the final value (SMD = 0.31, 95% CI: 0.15 to 0.46). In the subgroup analysis based on physiological indices, muscle glycogen showed a statistically significant improvement in the protein group (standardized mean difference [SMD] = 0.74, 95% confidence interval [CI]: 0.02 to 0.32). Furthermore, subgroup analyses based on protein supplementation strategies revealed that co-ingestion of protein and carbohydrates (CHO) demonstrated statistically significant improvements in endurance performance (SMD = 0.36, 95% CI: 0.11 to 0.61), whereas high protein intake alone did not.

Conclusion

Protein intake appears to provide modest benefits to athletes in improving their performance, particularly by enhancing endurance. Subgroup analysis suggests that protein intake improves muscle glycogen levels and that the co-ingestion of protein with CHO is more effective for endurance athletes than high protein intake alone.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, Identifier CRD42024508021.

Effectiveness of Recovery Strategies After Training and Competition in Endurance Athletes: An Umbrella Review

BACKGROUND

Recovery strategies are used to enhance performance and reduce injury risk in athletes. In previous systematic reviews, individual recovery strategies were investigated to clarify their effectiveness for mixed groups of athletes. However, the current evidence is ambiguous, and a clear overview of (training) recovery for endurance athletes is still lacking.

METHODS

We conducted an umbrella review based on a literature search in PubMed, Cochrane Database of Systematic Reviews, and Web of Science. Reviews published in English and before December 2022 were included. Systematic reviews and meta-analyses were eligible if they investigated the effectiveness of one or more recovery strategies compared with a placebo or control group after a training session in endurance athletes.

RESULTS

Twenty-two reviews (nine systematic reviews, three meta-analyses, and ten systematic reviews with meta-analyses included) met the inclusion criteria. In total, sixty-three studies with 1100 endurance athletes were included in our umbrella review. Out of the sixty-three studies, eight provided information on training recovery time frame for data synthesis. Among them, cryotherapy and compression garments showed positive effects, while applying massage showed no effect. In general, none of the included recovery strategies showed consistent benefits for endurance athletes.

CONCLUSION

There is no particular recovery strategy that can be advised to enhance recovery between training sessions or competitions in endurance athletes. However, individual studies suggest that compression garments and cryotherapy are effective training recovery strategies. Further research should improve methodology and focus on the different time courses of the recovery process.

REGISTRATION

The review protocol was registered with the International Prospective Register of Systematic Reviews with the number CRD42021260509.

The Physiological Requirements of and Nutritional Recommendations for Equestrian Riders

Equestrian sport is under-researched within the sport science literature, creating a possible knowledge vacuum for athletes and support personnel wishing to train and perform in an evidence-based manner. This review aims to synthesise available evidence from equitation, sport, and veterinary sciences to describe the pertinent rider physiology of equestrian disciplines. Estimates of energy expenditure and the contribution of underpinning energy systems to equestrian performance are used to provide nutrition and hydration recommendations for competition and training in equestrian disciplines. Relative energy deficiency and disordered eating are also considered. The practical challenges of the equestrian environment, including competitive, personal, and professional factors, injury and concussion, and female participation, are discussed to better highlight novelty within equestrian disciplines compared to more commonly studied sports. The evidence and recommendations are supported by example scenarios, and future research directions are outlined.

Effects of the ketogenic diet on performance and body composition in athletes and trained adults: a systematic review and Bayesian multivariate multilevel meta-analysis and meta-regression

This systematic review with meta-analysis aimed to determine the effects of the ketogenic diet (KD) against carbohydrate (CHO)-rich diets on physical performance and body composition in trained individuals. The MEDLINE, EMBASE, CINAHL, SPORTDiscus, and The Cochrane Library were searched. Randomized and non-randomized controlled trials in athletes/trained adults were included. Meta-analytic models were carried out using Bayesian multilevel models. Eighteen studies were included providing estimates on cyclic exercise modes and strength one-maximum repetition (1-RM) performances and for total, fat, and free-fat masses. There were more favorable effects for CHO-rich than KD on time-trial performance (mode [95% credible interval]; -3.3% [-8.5%, 1.7%]), 1-RM (-5.7% [-14.9%, 2.6%]), and free-fat mass (-0.8 [-3.4, 1.9] kg); effects were more favorable to KD on total (-2.4 [-6.2, 1.8] kg) and fat mass losses (-2.4 [-5.4, 0.2] kg). Likely modifying effects on cyclic performance were the subject's sex and VO2max, intervention and performance durations, and mode of exercise. The intervention duration and subjects' sex were likely to modify effects on total body mass. KD can be a useful strategy for total and fat body losses, but a small negative effect on free-fat mass was observed. KD was not suitable for enhancing strength 1-RM or high-intensity cyclic performances.

A Glimpse of the Sports Nutrition Awareness in Spanish Basketball Players

Basketball is a team sport, with many fans and practitioners worldwide from all ages and levels. In all cases, players accumulate high levels of fatigue, and there is also limited time to recover between games or practices. In particular, nutrition plays a key role in optimizing performance and recovery. However, it is typical to observe erroneous nutritional behaviors among basketball players. It has been theorized that these behaviors are influenced by habits acquired based on the individual’s knowledge. Therefore, the main aim of this study was to conduct a descriptive research of the sports nutrition knowledge and practices in a sample of Spanish basketball players, from athletes under 18 years old (n = 69) to nonprofessional (n = 14) and professional adult players (n = 21). The sample was comprised of 49 men and 55 women. This was a transversal, cross-sectional, observational and descriptive study. All participants (n = 104) completed an anonymous online survey in order to analyze their sports nutrition knowledge and practices. In view of the obtained results, we can conclude that the knowledge of sport-specific nutrition in players under 18 years old, as well as non-professional and professional adult basketball players, is insufficient through all the categories and levels. The lack of professional support and time management difficulties were identified as some of the main barriers.

Assessing Overall Exercise Recovery Processes Using Carbohydrate and Carbohydrate-Protein Containing Recovery Beverages

We compared the impact of two different, but commonly consumed, beverages on integrative markers of exercise recovery following a 2 h high intensity interval exercise (i.e., running 70-80% V̇O2 max intervals and interspersed with plyometric jumps). Participants (n = 11 males, n = 6 females) consumed a chocolate flavored dairy milk beverage (CM: 1.2 g carbohydrate/kg BM and 0.4 g protein/kg BM) or a carbohydrate-electrolyte beverage (CEB: isovolumetric with 0.76 g carbohydrate/kg BM) after exercise, in a randomized-crossover design. The recovery beverages were provided in three equal boluses over a 30 min period commencing 1 h post-exercise. Muscle biopsies were performed at 0 h and 2 h in recovery. Venous blood samples, nude BM and total body water were collected before and at 0, 2, and 4 h recovery. Gastrointestinal symptoms and breath hydrogen (H2) were collected before exercise and every 30 min during recovery. The following morning, participants returned for performance assessment. In recovery, breath H2 reached clinical relevance of >10 ppm following consumption of both beverages, in adjunct with high incidence of gastrointestinal symptoms (70%), but modest severity. Blood glucose response was greater on CEB vs. CM (P < 0.01). Insulin response was greater on CM compared with CEB (P < 0.01). Escherichia coli lipopolysaccharide stimulated neutrophil function reduced on both beverages (49%). p-GSK-3β/total-GSK-3β was greater on CM compared with CEB (P = 0.037); however, neither beverage achieved net muscle glycogen re-storage. Phosphorylation of mTOR was greater on CM than CEB (P < 0.001). Fluid retention was lower (P = 0.038) on CEB (74.3%) compared with CM (82.1%). Physiological and performance outcomes on the following day did not differ between trials. Interconnected recovery optimization markers appear to respond differently to the nutrient composition of recovery nutrition, albeit subtly and with individual variation. The present findings expand on recovery nutrition strategies to target functionality and patency of the gastrointestinal tract as a prerequisite to assimilation of recovery nutrition, as well as restoration of immunocompetency.

Coingestion of Carbohydrate and Protein on Muscle Glycogen Synthesis after Exercise: A Meta-analysis

INTRODUCTION/PURPOSE

Evidence suggests that carbohydrate and protein (CHO-PRO) ingestion after exercise enhances muscle glycogen repletion to a greater extent than carbohydrate (CHO) alone. However, there is no consensus at this point, and results across studies are mixed, which may be attributable to differences in energy content and carbohydrate intake relative to body mass consumed after exercise. The purpose of this study was determine the overall effects of CHO-PRO and the independent effects of energy and relative carbohydrate content of CHO-PRO supplementation on postexercise muscle glycogen synthesis compared with CHO alone.

METHODS

Meta-analysis was conducted on crossover studies assessing the influence of CHO-PRO compared with CHO alone on postexercise muscle glycogen synthesis. Studies were identified in a systematic review from PubMed and Cochrane Library databases. Data are presented as effect size (95% confidence interval [CI]) using Hedges' g. Subgroup analyses were conducted to evaluate effects of isocaloric and nonisocaloric energy content and dichotomized by median relative carbohydrate (high, ≥0.8 g·kg-1⋅h-1; low, <0.8 g·kg-1⋅h-1) content on glycogen synthesis.

RESULTS

Twenty studies were included in the analysis. CHO-PRO had no overall effect on glycogen synthesis (0.13, 95% CI = -0.04 to 0.29) compared with CHO. Subgroup analysis found that CHO-PRO had a positive effect (0.26, 95% CI = 0.04-0.49) on glycogen synthesis when the combined intervention provided more energy than CHO. Glycogen synthesis was not significant (-0.05, 95% CI = -0.23 to 0.13) in CHO-PRO compared with CON when matched for energy content. There was no statistical difference of CHO-PRO on glycogen synthesis in high (0.07, 95% CI = -0.11 to 0.22) or low (0.21, 95% CI = -0.08 to 0.50) carbohydrate content compared with CHO.

CONCLUSION

Glycogen synthesis rates are enhanced when CHO-PRO are coingested after exercise compared with CHO only when the added energy of protein is consumed in addition to, not in place of, carbohydrate.

The Effect of Consuming Carbohydrate With and Without Protein on the Rate of Muscle Glycogen Re-synthesis During Short-Term Post-exercise Recovery: a Systematic Review and Meta-analysis

BACKGROUND

Rapid restoration of muscle glycogen stores is imperative for athletes undertaking consecutive strenuous exercise sessions with limited recovery time (e.g. ≤ 8 h). Strategies to optimise muscle glycogen re-synthesis in this situation are essential. This two-part systematic review and meta-analysis investigated the effect of consuming carbohydrate (CHO) with and without protein (PRO) on the rate of muscle glycogen re-synthesis during short-term post-exercise recovery (≤ 8 h).

METHODS

Studies were identified via the online databases Web of Science and Scopus. Investigations that measured muscle glycogen via needle biopsy during recovery (with the first measurement taken ≤ 30 min post-exercise and at least one additional measure taken ≤ 8 h post-exercise) following a standardised exercise bout (any type) under the following control vs. intervention conditions were included in the meta-analysis: part 1, water (or non-nutrient beverage) vs. CHO, and part 2, CHO vs. CHO+PRO. Publications were examined for methodological quality using the Rosendal scale. Random-effects meta-analyses and meta-regression analyses were conducted to evaluate intervention efficacy.

RESULTS

Overall, 29 trials (n = 246 participants) derived from 21 publications were included in this review. The quality assessment yielded a Rosendal score of 61 ± 8% (mean ± standard deviation). Part 1: 10 trials (n = 86) were reviewed. Ingesting CHO during recovery (1.02 ± 0.4 g·kg body mass (BM)-1 h-1) improved the rate of muscle glycogen re-synthesis compared with water; change in muscle glycogen (MGΔ) re-synthesis rate = 23.5 mmol·kg dm-1 h-1, 95% CI 19.0-27.9, p < 0.001; I2 = 66.8%. A significant positive correlation (R2 = 0.44, p = 0.027) was observed between interval of CHO administration (≤ hourly vs. > hourly) and the mean difference in rate of re-synthesis between treatments. Part 2: 19 trials (n = 160) were reviewed. Ingesting CHO+PRO (CHO: 0.86 ± 0.2 g·kg BM-1 h-1; PRO: 0.27 ± 0.1 g·kg BM-1 h-1) did not improve the rate of muscle glycogen re-synthesis compared to CHO alone (0.95 ± 0.3 g·kg BM-1 h-1); MGΔ re-synthesis rate = 0.4 mmol·kg  dm-1 h-1, 95% CI -2.7 to 3.4, p = 0.805; I2 = 56.4%.

CONCLUSIONS

Athletes with limited time for recovery between consecutive exercise sessions should prioritise regular intake of CHO, while co-ingesting PRO with CHO appears unlikely to enhance (or impede) the rate of muscle glycogen re-synthesis.

TRIAL REGISTRATION

Registered at the International Prospective Register of Systematic Reviews (PROSPERO) (identification code CRD42020156841 ).

Evidence-based post exercise recovery in combat sports: a narrative review

INTRODUCTION

Some methods such as ergo nutritional aids, cooling or massage among others could improve recovery in combat sports (CS). The effects, doses, duration, and timing of these methods remains unknown. Nowadays, there is no clear consensus regarding the recovery strategies and it is necessary to understand the type of fatigue induced in CS and its underlying mechanisms. The main aim of this article is to review the update literature related to recovery strategies in CS.

EVIDENCE ACQUISITION

A literature search was conducted following preferred reporting items for review statement on the topic of: "combat sports," "recovery," "nutrition," "fatigue," "ergogenic aids," "weight cutting" and "hydration."

EVIDENCE SYNTHESIS

The initial search of the literature detected 369 articles about CS. Later, 307 were excluded after being determined unrelated to recovery or after failure to fulfill the inclusion criteria. Of the 80 included articles, 19 satisfied the final inclusion criteria.

CONCLUSIONS

To optimize CS performance, adequate recovery is required during training and competition processes. Traditional ergo nutritional supplementation of carbohydrates and proteins combined. Besides, the consumption of evidence supported supplementation (green tea, beetroot gels, creatine or alkaline water) improve recovery processes. Further methods of recovery including physical (cold water immersion, massage or photobiomodulation) and physiological (types of active recovery, sleep and rest) therapies have also been shown useful. This narrative review elucidates the important role of recovery techniques in CS.

Dependence of Biocatalysis on D/H Ratio: Possible Fundamental Differences for High-Level Biological Taxons

The kinetics of biological reactions depends on the deuterium/protium (D/H) ratio in water. In this work, we describe the kinetic model of biocatalytic reactions in living organisms depending on the D/H ratio. We show that a change in the lifetime or other characteristics of the vital activity of some organisms in response to a decrease or increase in the content of deuterium in the environment can be a sign of a difference in taxons. For animals-this is a curve with saturation according to the Gauss's principle, for plants-it is the Poisson dependence, for bacteria a weakly saturated curve with a slight reaction to the deuterium/protium ratio toward increasing deuterium. The biological activity of the aquatic environment with reduced, elevated, and natural concentrations of deuterium is considered. The results of the study are presented in different vital indicators of some taxons: the bacteria kingdom-the colony forming units (CFU) index (Escherichia coli); animals-the activation energy of the death of ciliates (Spirostomum ambiguum), embryogenesis of fish (Brachydanio rerio); plants-germination and accumulation of trace elements Callisia fragrans L., sprouting of gametophores and peptidomics of moss Physcomitrella patens. It was found that many organisms change their metabolism and activity, responding to both high and low concentrations of deuterium in water.

Nutritional Strategies to Optimize Performanceand Recovery in Rowing Athletes

Rowing is a high-intensity sport requiring a high level of aerobic and anaerobic capacity. Although good nutrition is essential for successful performance in a rowing competition, its significance is not sufficiently established. This review aimed to provide nutritional strategies to optimize performance and recovery in rowing athletes based on a literature review. Following the guidelines given in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), we performed web searches using online databases (Pubmed, Web of Science, Wiley Online Library, ACS Publications, and SciFinder). Typically, a rowing competition involves a 6-8-min high-intensity exercise on a 2000-m course. The energy required for the exercise is supplied by muscle-stored glycogens, which are derived from carbohydrates. Therefore, rowing athletes can plan their carbohydrate consumption based on the intensity, duration, and type of training they undergo. For effective and safe performance enhancement, rowing athletes can take supplements such as β-alanine, caffeine, β-hydroxy-β-methylbutyric acid (HMB), and beetroot juice (nitrate). An athlete may consume carbohydrate-rich foods or use a carbohydrate mouth rinse. Recovery nutrition is also very important to minimize the risk of injury or unexplained underperformance syndrome (UUPS) from overuse. It must take into account refueling (carbohydrate), rehydration (fluid), and repair (protein). As lightweight rowing athletes often attempt acute weight loss by limiting food and fluid intake to qualify for a competition, they require personalized nutritional strategies and plans based on factors such as their goals and environment. Training and competition performance can be maximized by including nutritional strategies in training plans.

The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat-related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to disease pathophysiology. Contemporary research has focused to understand the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is strongly characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion-mediated ischemic injury, and neuroendocrine-immune alterations. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress.

Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance

The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.

The Temporal Relationship Between Exercise, Recovery Processes, and Changes in Performance

Physiological and psychological demands during training and competition generate fatigue and reduce an athlete’s sport-specific performance capacity. The magnitude of this decrement depends on several characteristics of the exercise stimulus (eg, type, duration, and intensity), as well as on individual characteristics (eg, fitness, profile, and fatigue resistance). As such, the time required to fully recover is proportional to the level of fatigue, and the consequences of exercise-induced fatigue are manifold. Whatever the purpose of the ensuing exercise session (ie, training or competition), it is crucial to understand the importance of optimizing the period between exercise bouts in order to speed up the regenerative processes and facilitate recovery or set the next stimulus at the optimal time point. This implies having a fairly precise understanding of the fatigue mechanisms that contribute to the performance decrement. Failing to respect an athlete’s recovery needs may lead to an excessive accumulation of fatigue and potentially “nonfunctional overreaching” or to maladaptive training. Although research in this area recently increased, considerations regarding the specific time frames for different physiological mechanisms in relation to exercise-induced fatigue are still missing. Furthermore, recommendations on the timing and dosing of recovery based on these time frames are limited. Therefore, the aim of this article is to describe time courses of recovery in relation to the exercise type and on different physiological levels. This summary supports coaches, athletes, and scientists in their decision-making process by considering the relationship of exercise type, physiology, and recovery.

Performance Effects of Carbohydrate Ingestion Between Bouts of Intense Aerobic Interval Exercise

PURPOSE

This study tested whether CHO intake during a 2-h rest between exercise bouts improved performance in the subsequent bout.

METHODS

In a randomized, single-blinded, crossover design, 10 recreationally-active participants (23 ± 4 yr, 70.8 ± 6.6 kg, VO_2peak:47.0 ± 5.4 mL O₂·min^-1·kg body mass^-1) arrived at the lab post-prandial and completed 2 exercise bouts separated by 2-h rest. Bouts included 5 x 4-min intervals at ~80% VO_2peak separated by 2-min at ~40% VO_2peak and ended with an endurance trial (ET) to voluntary exhaustion at ~90% VO_2peak. During intervals 1 and 4 in each bout expired gases were collected and O₂ deficit was estimated. Immediately following bout-1, either a CHO (1.2 g CHO·kg body mass^-1) or placebo (PL) solution was consumed.

RESULTS

ET duration decreased in bout-2 vs. 1 in both conditions (P<0.01) but was ~35% longer in bout-2 with CHO vs. PL (Interaction, P=0.03; post-hoc, P=0.03). VO₂ increased during interval 4 vs. 1 in both bouts (P<0.01) but was unaffected by CHO (P≥0.58). O₂ deficit was unaffected by CHO (P=0.93), bout or interval (P≥0.15). Perceived exertion was higher in bout-2 vs. 1 (P<0.001) and reduced in intervals 2 and 4 in CHO (P≤0.01).

CONCLUSIONS

When rest between training sessions is 2 hours, athletes may improve subsequent performance by consuming CHO during recovery. Supported by NSERC, Canada.

The effect of different post-exercise beverages with food on ad libitum fluid recovery, nutrient provision, and subsequent athletic performance

This study investigated the effect of consuming either water or a carbohydrate (CHO)-electrolyte sports beverage ('Sports Drink') ad libitum with food during a 4 h post-exercise recovery period on fluid restoration, nutrient provision and subsequent endurance cycling performance. On two occasions, 16 endurance-trained cyclists; 8 male [M] (age: 31 ± 9 y; VO_2max: 54 ± 6 mL·kg^-1·min^-1) and 8 female [F] (age: 33 ± 8 y; VO_2max: 50 ± 7 mL·kg^-1·min^-1); lost 2.3 ± 0.3% and 1.6 ± 0.3% of their body mass (BM), respectively during 1 h of fixed-intensity cycling. Participants then had ad libitum access to either Water or Sports Drink and food for the first 195 min of a 4 h recovery period. At the conclusion of the recovery period, participants completed a cycling performance test consisting of a 45 min fixed-intensity pre-load and an incremental test to volitional exhaustion (peak power output, PPO). Beverage intake; total water/nutrient intake; and indicators of fluid recovery (BM, urine output, plasma osmolality [P_OSM]) were assessed periodically throughout trials. Participants returned to a similar state of net positive fluid balance prior to recommencing exercise, regardless of the beverage provided (Water: +0.4 ± 0.5 L; Sports Drink: +0.3 ± 0.3 L, p = 0.529). While Sports Drink increased post-exercise energy (M: +1.8 ± 1.0 MJ; F: +1.3 ± 0.5 MJ) and CHO (M: +114 ± 31 g; F: +84 ± 25 g) intake (i.e. total from food and beverage) (p's < 0.001), this did not improve subsequent endurance cycling performance (Water: 337 ± 40 W [M] and 252 ± 50 W [F]; Sports Drink: 340 ± 40 W [M] and 258 ± 47 W [F], p = 0.242). Recovery beverage recommendations should consider the post-exercise environment (i.e. the availability of food), an individual's tolerance for food and fluid pre-/post-exercise, the immediate requirements for refuelling (i.e. CHO demands of the activity) and the athlete's overall dietary goals.

Immunometabolism: A Multi-Omics Approach to Interpreting the Influence of Exercise and Diet on the Immune System

Immunometabolism is an evolving field of scientific endeavor that merges immunology and metabolism and has provided valuable context when evaluating the influence of dietary interventions on exercise-induced immune dysfunction. Metabolomics, lipidomics, and proteomics provide a system-wide view of the metabolic response to exercise by simultaneously measuring and identifying a large number of small-molecule metabolites, lipids, and proteins. Many of these are involved with immune function and regulation and are sensitive to dietary influences, especially acute carbohydrate ingestion from either sugar beverages or fruits such as bananas. Emerging evidence using large multi-omics data sets supports the combined intake of fruit sugars and phytochemicals by athletes during heavy exertion as an effective strategy to improve metabolic recovery, augment viral defense, and counter postexercise inflammation and immune dysfunction at the cell level. Multi-omics methodologies have given investigators new outcome targets to assess the efficacy of various dietary interventions for physiologically stressed athletes.

Fluid, energy, and nutrient recovery via ad libitum intake of different commercial beverages and food in female athletes

This study investigated the effect of consuming different commercial beverages with food ad libitum after exercise on fluid, energy, and nutrient recovery in trained females. On 4 separate occasions, 8 females (body mass (BM): 61.8 ± 10.7 kg; maximal oxygen uptake: 46.3 ± 7.5 mL·kg^-1·min^-1) lost 2.0% ± 0.3% BM cycling at ∼75% maximal oxygen uptake before completing a 4-h recovery period with ad libitum access to 1 of 4 beverages: Water, Powerade (Sports Drink), Up & Go Reduced Sugar (Lower Sugar (LS)-MILK) or Up & Go Energize (Higher Protein (HP)-MILK). Participants also had two 15-min opportunities to access food within the first 2 h of the recovery period. Beverage intake, total water/nutrient intake, and indicators of fluid recovery (BM, urine output, plasma osmolality), gastrointestinal tolerance and palatability were assessed periodically. While total water intake (from food and beverage) (Water: 1918 ± 580 g; Sports Drink: 1809 ± 338 g; LS-MILK: 1458 ± 431 g; HP-MILK: 1523 ± 472 g; p = 0.010) and total urine output (Water: 566 ± 314 g; Sports Drink: 459 ± 290 g; LS-MILK: 220 ± 53 g; HP-MILK: 230 ± 117 g; p = 0.009) differed significantly by beverage, the quantity of ingested water retained was similar across treatments (Water: 1352 ± 462 g; Sports Drink: 1349 ± 407 g; LS-MILK: 1238 ± 400 g; HP-MILK: 1293 ± 453 g; p = 0.691). Total energy intake (from food and beverage) increased in proportion to the energy density of the beverage (Water: 4129 ± 1080 kJ; Sports Drink: 5167 ± 643 kJ; LS-MILK: 6019 ± 1925 kJ; HP-MILK: 7096 ± 2058 kJ; p = 0.014). When consumed voluntarily and with food, different beverages promote similar levels of fluid recovery, but alter energy/nutrient intakes. Providing access to food and understanding the longer-term dietary goals of female athletes are important considerations when recommending a recovery beverage.