Dietary strategies to promote glycogen synthesis after exercise

The ergogenic effects of acute carbohydrate feeding on endurance performance: a systematic review, meta-analysis and meta-regression

A systematic review with meta-analysis was conducted to analyze the effect of carbohydrate (CHO) intake during exercise and some variables that could moderate this effect on endurance performance. We included 136 studies examining the effect of CHO ingestion during endurance exercise in the meta-analysis. The overall effect on performance showed a significant increase after CHO intake compared to the placebo/control groups. A larger effect of CHO consumption is observed in time to exhaustion than in time trials performance test. Moreover, the effectiveness of CHO supplementation was greater the longer the duration of the events. Also, there seems to be a higher effect of CHO intake in lower trained than in higher trained participants. In contrast, the magnitude of performance change of CHO intake is not affected by the dosage, ergometer used, the type of intake of the CHO ingestion and the type of CHO. In addition, a lower rate of perceived exertion and higher power and heart rate are significantly associated with the ingestion of CHO during endurance exercise. These results reinforce that acute CHO feeding is an effective strategy for improving endurance performance, especially, in less trained subjects participating in time to exhaustion tests of longer durations.

Analysis and Screening of Commercialized Protein Supplements for Sports Practice

Recent years have seen a rise in the popularity of the consumption of sports-related supplements. However, the hypothesis is raised that it is necessary to analyze the quality aspects of these supplements in relation to the information provided on the label, to avoid associated risks and obtain the greatest possible benefit from their consumption. Therefore, the aim of this study has been to carry out an analysis or screening of the protein supplements that are currently marketed in Spain. We analyzed the labels of 52 protein sports supplements available both in physical stores and online. The analysis consisted of addressing three relevant aspects considering the labeling: (a) the legislative framework in which the supplements are marketed, (b) the quality of the protein, and (c) the presence of other ingredients according to the specifications of the label. In the legislative context, there do not seem to be any specific regulations to guarantee consumer protection, which can lead to unfair practices and misleading advertising. Most of the supplements analyzed to comply with the requirements of their current regulations. However, claims about their benefits that are not allowed under European legislation have been found in some of them. Regarding composition and according to label information, the supplements have been found to provide a sufficient dose of protein in terms of recommended protein intake per serving. Regarding the presence of other ingredients and according to the information on the label, most of them, except for egg supplements, contain other ingredients. Colostrum was also found in one of the supplements evaluated. The conclusions of the study reveal that, due to a lack of knowledge or misleading advertising practices, supplements are often not used properly. The information provided is essential for both professionals and consumers to avoid the risks associated with consumption, such as unintentional doping, interactions between ingredients that reduce the quality of the supplement, and consumption of supplements inappropriately, among others.

Fueling and Recovery

As ultra-endurance races continue to rise in popularity, it is critical that athletes understand how to nourish their bodies with proper amounts of calories from carbohydrate, protein, and fat. The importance of carbohydrate for fueling endurance exercise and protein for recovery is well established; however, the role of fat is debated. Specific amounts of carbohydrate per kilogram of body weight are recommended for before, during, and after ultra-endurance exercise. Total grams of protein per day and after exercise are established. After carbohydrate and protein needs are determined the balance of calories typically come from fat. Using fat for energy during endurance exercise is not a new concept, but continues to be studied as way of fueling while sparing muscle glycogen.

Restoration of Muscle Glycogen and Functional Capacity: Role of Post-Exercise Carbohydrate and Protein Co-Ingestion

The importance of post-exercise recovery nutrition has been well described in recent years, leading to its incorporation as an integral part of training regimes in both athletes and active individuals. Muscle glycogen depletion during an initial prolonged exercise bout is a main factor in the onset of fatigue and so the replenishment of glycogen stores may be important for recovery of functional capacity. Nevertheless, nutritional considerations for optimal short-term (3–6 h) recovery remain incompletely elucidated, particularly surrounding the precise amount of specific types of nutrients required. Current nutritional guidelines to maximise muscle glycogen availability within limited recovery are provided under the assumption that similar fatigue mechanisms (i.e., muscle glycogen depletion) are involved during a repeated exercise bout. Indeed, recent data support the notion that muscle glycogen availability is a determinant of subsequent endurance capacity following limited recovery. Thus, carbohydrate ingestion can be utilised to influence the restoration of endurance capacity following exhaustive exercise. One strategy with the potential to accelerate muscle glycogen resynthesis and/or functional capacity beyond merely ingesting adequate carbohydrate is the co-ingestion of added protein. While numerous studies have been instigated, a consensus that is related to the influence of carbohydrate-protein ingestion in maximising muscle glycogen during short-term recovery and repeated exercise capacity has not been established. When considered collectively, carbohydrate intake during limited recovery appears to primarily determine muscle glycogen resynthesis and repeated exercise capacity. Thus, when the goal is to optimise repeated exercise capacity following short-term recovery, ingesting carbohydrate at an amount of ≥1.2 g kg body mass⁻¹·h⁻¹ can maximise muscle glycogen repletion. The addition of protein to carbohydrate during post-exercise recovery may be beneficial under circumstances when carbohydrate ingestion is sub-optimal (≤0.8 g kg body mass⁻¹·h⁻¹) for effective restoration of muscle glycogen and repeated exercise capacity.

Effect of green tea extract supplementation on glycogen replenishment in exercised human skeletal muscle

The purpose of this study was to investigate the effects of 8-week green tea extract (GTE) supplementation on promoting postexercise muscle glycogen resynthesis and systemic energy substrate utilisation in young college students. A total of eight healthy male participants (age: 22·0 (se 1·0) years, BMI: 24·2 (se 0·7) kg/m2, VO2max: 43·2 (se 2·4) ml/kg per min) participated in this study. GTE (500 mg/d for 8 weeks) was compared with placebo in participants in a double-blind/placebo-controlled and crossover study design with an 8-week washout period. Thereafter, all participants performed a 60-min cycling exercise (75 % VO2max) and consumed a carbohydrate-enriched meal immediately after exercise. Vastus lateralis muscle samples were collected immediately (0 h) and 3 h after exercise, and blood and gaseous samples were collected during the 3-h postexercise recovery period. An 8-week oral GTE supplementation had no effects on further promoting muscle glycogen resynthesis in exercised human skeletal muscle, but the exercise-induced muscle GLUT type 4 (GLUT4) protein content was greater in the GTE supplementation trial (P<0·05). We observed that, during the postexercise recovery period, GTE supplementation elicited an increase in energy reliance on fat oxidation compared with the placebo trial (P<0·05), although there were no differences in blood glucose and insulin responses between the two trials. In summary, 8-week oral GTE supplementation increases postexercise systemic fat oxidation and exercise-induced muscle GLUT4 protein content in response to an acute bout of endurance exercise. However, GTE supplementation has no further benefit on promoting muscle glycogen resynthesis during the postexercise period.

The effects of protein supplements on muscle mass, strength, and aerobic and anaerobic power in healthy adults: a systematic review

BACKGROUND

Protein supplements are frequently consumed by athletes and recreationally active adults to achieve greater gains in muscle mass and strength and improve physical performance.

OBJECTIVE

This review provides a systematic and comprehensive analysis of the literature that tested the hypothesis that protein supplements accelerate gains in muscle mass and strength resulting in improvements in aerobic and anaerobic power. Evidence statements were created based on an accepted strength of recommendation taxonomy.

DATA SOURCES

English language articles were searched through PubMed and Google Scholar using protein and supplements together with performance, exercise, strength, and muscle, alone or in combination as keywords. Additional articles were retrieved from reference lists found in these papers.

STUDY SELECTION

Studies recruiting healthy adults between 18 and 50 years of age that evaluated the effects of protein supplements alone or in combination with carbohydrate on a performance metric (e.g., one repetition maximum or isometric or isokinetic muscle strength), metrics of body composition, or measures of aerobic or anaerobic power were included in this review. The literature search identified 32 articles which incorporated test metrics that dealt exclusively with changes in muscle mass and strength, 5 articles that implemented combined resistance and aerobic training or followed participants during their normal sport training programs, and 1 article that evaluated changes in muscle oxidative enzymes and maximal aerobic power.

STUDY APPRAISAL AND SYNTHESIS METHODS

All papers were read in detail, and examined for experimental design confounders such as dietary monitoring, history of physical training (i.e., trained and untrained), and the number of participants studied. Studies were also evaluated based on the intensity, frequency, and duration of training, the type and timing of protein supplementation, and the sensitivity of the test metrics.

RESULTS

For untrained individuals, consuming supplemental protein likely has no impact on lean mass and muscle strength during the initial weeks of resistance training. However, as the duration, frequency, and volume of resistance training increase, protein supplementation may promote muscle hypertrophy and enhance gains in muscle strength in both untrained and trained individuals. Evidence also suggests that protein supplementation may accelerate gains in both aerobic and anaerobic power.

LIMITATIONS

To demonstrate measureable gains in strength and performance with exercise training and protein supplementation, many of the studies reviewed recruited untrained participants. Since skeletal muscle responses to exercise and protein supplementation differ between trained and untrained individuals, findings are not easily generalized for all consumers who may be considering the use of protein supplements.

CONCLUSIONS

This review suggests that protein supplementation may enhance muscle mass and performance when the training stimulus is adequate (e.g., frequency, volume, duration), and dietary intake is consistent with recommendations for physically active individuals.

Effects of protein in combination with carbohydrate supplements on acute or repeat endurance exercise performance: a systematic review

BACKGROUND

Protein supplements are consumed frequently by athletes and recreationally active adults for various reasons, including improved exercise performance and recovery after exercise. Yet, far too often, the decision to purchase and consume protein supplements is based on marketing claims rather than available evidence-based research.

OBJECTIVE

The purpose of this review was to provide a systematic and comprehensive analysis of the literature that tested the hypothesis that protein supplements, when combined with carbohydrate, directly enhance endurance performance by sparing muscle glycogen during exercise and increasing the rate of glycogen restoration during recovery. The analysis was used to create evidence statements based on an accepted strength of recommendation taxonomy.

DATA SOURCES

English language articles were searched with PubMed and Google Scholar using protein and supplements together with performance, exercise, competition, and muscle, alone or in combination as keywords. Additional articles were retrieved from reference lists found in these papers.

STUDY SELECTION

Inclusion criteria specified recruiting healthy active adults less than 50 years of age and evaluating the effects of protein supplements in combination with carbohydrate on endurance performance metrics such as time-to-exhaustion, time-trial, or total power output during sprint intervals. The literature search identified 28 articles, of which 26 incorporated test metrics that permitted exclusive categorization into one of the following sections: ingestion during an acute bout of exercise (n = 11) and ingestion during and after exercise to affect subsequent endurance performance (n = 15). The remaining two articles contained performance metrics that spanned both categories.

STUDY APPRAISAL AND SYNTHESIS METHODS

All papers were read in detail and searched for experimental design confounders such as energy content of the supplements, dietary control, use of trained or untrained participants, number of subjects recruited, direct measures of muscle glycogen utilization and restoration, and the sensitivity of the test metrics to explain the discrepant findings.

RESULTS

Our evidence statements assert that when carbohydrate supplementation was delivered at optimal rates during or after exercise, protein supplements provided no further ergogenic effect, regardless of the performance metric used. In addition, the limited data available suggested recovery of muscle glycogen stores together with subsequent rate of utilization during exercise is not related to the potential ergogenic effect of protein supplements.

LIMITATIONS

Many studies lacked ability to measure direct effects of protein supplementation on muscle metabolism through determination of muscle glycogen, kinetic assessments of protein turnover, or changes in key signaling proteins, and therefore could not substantiate changes in rates of synthesis or degradation of protein. As a result, the interpretation of their data was often biased and inconclusive since they lacked ability to test the proposed underlying mechanism of action.

CONCLUSIONS

When carbohydrate is delivered at optimal rates during or after endurance exercise, protein supplements appear to have no direct endurance performance enhancing effect.

Effects of a pre-and post-workout protein-carbohydrate supplement in trained crossfit individuals

PURPOSE

The purpose was to assess effects of a pre- and a post-workout protein-carbohydrate supplement on CrossFit-specific performance and body composition.

METHODS

In an open label randomized study, 13 male and 16 female trained Crossfit participants (mean ± SD; age: 31.87 ± 7.61 yrs, weight: 78.68 ± 16.45 kg, percent body fat: 21.97 ± 9.02) were assessed at 0 and 6 weeks for body composition, VO2max, Wingate peak (WPP) and mean power (WMP), in addition to sport-specific workouts (WOD1: 500 m row, 40 wall balls, 30 push-ups, 20 box jumps, 10 thrusters for time; WOD2: 15 minutes to complete an 800 m run "buy in", followed by as many rounds as possible (AMRAP) of 5 burpees, 10 Kettlebell swings, 15 air squats). The supplement (SUP) group consisted of 19 g of a pre-workout drink (extracts of pomegranate, tart cherry, green and black tea) taken 30 minutes before and a post-workout protein (females: 20 g; males: 40 g) and carbohydrate (females: 40 g; males: 80 g) supplement consumed immediately after each workout. The control (CTL) group consumed only water one hour before or after workouts. Participants completed three (minimum) varied workouts per week at a CrossFit gym as typical to habitual training throughout the six week study. Data were analyzed by repeated measures ANOVA (p <0 .05), 95% Confidence Intervals, and Magnitude Inferences.

RESULTS

There were no time × group interactions for body composition, WMP, or WOD1 based on ANOVA statistics. VO2MAX, WPP, and WOD2 results revealed that the pre/post supplements were likely beneficial after 95% Confidence Intervals and Magnitude Inferences analysis.

CONCLUSION

The combination of proprietary supplements taken for 6 weeks may provide benefits during certain sport-specific performance in trained CrossFit athletes but not others.

Injury rates in professional soccer players during Ramadan

Many of the socio-cultural lifestyle and dietary changes that take place during Ramadan may affect the risk of injury in athletes, but little evidence is available. The aim of the present study was to examine the effects over two consecutive years of the holy month of Ramadan on injury rates in 42 professional players of a Tunisian top-level professional soccer team. Players were retrospectively organized into fasting and non-fasting groups and monitored for 3 months: 4 weeks before Ramadan, during the month of Ramadan (4 weeks), and 4 weeks after Ramadan each year. During Ramadan, training started at 22.00 h. The circumstances (training/match) and mechanism of injury (traumatic/overuse) were recorded. No significant differences between the three periods were observed for weekly mean training load, training strain, training duration, and Hooper's Index (quality of sleep, and quantities of stress, delayed-onset muscle soreness, and fatigue). Compared with non-fasting players, fasters had a lower (P < 0.05) Hooper's Index and stress during and after Ramadan. No significant difference in injury rates was observed between fasting and non-fasting players. Nevertheless, the rates of non-contact (6.8 vs. 0.6 and 1.1) and training overuse (5.6 vs. 0.6 and 0.5) injuries were significantly higher in fasting players during the month of Ramadan than before or after Ramadan. In conclusion, Ramadan, along with the corresponding changes in nutritional habits, sleeping schedule, and socio-cultural and religious events, significantly increased overuse and non-contact injuries in fasting players despite the fact that the training load, strain, and duration were maintained.

The role of skeletal muscle glycogen breakdown for regulation of insulin sensitivity by exercise

Glycogen is the storage form of carbohydrates in mammals. In humans the majority of glycogen is stored in skeletal muscles (∼500 g) and the liver (∼100 g). Food is supplied in larger meals, but the blood glucose concentration has to be kept within narrow limits to survive and stay healthy. Therefore, the body has to cope with periods of excess carbohydrates and periods without supplementation. Healthy persons remove blood glucose rapidly when glucose is in excess, but insulin-stimulated glucose disposal is reduced in insulin resistant and type 2 diabetic subjects. During a hyperinsulinemic euglycemic clamp, 70-90% of glucose disposal will be stored as muscle glycogen in healthy subjects. The glycogen stores in skeletal muscles are limited because an efficient feedback-mediated inhibition of glycogen synthase prevents accumulation. De novo lipid synthesis can contribute to glucose disposal when glycogen stores are filled. Exercise physiologists normally consider glycogen's main function as energy substrate. Glycogen is the main energy substrate during exercise intensity above 70% of maximal oxygen uptake ([Formula: see text]) and fatigue develops when the glycogen stores are depleted in the active muscles. After exercise, the rate of glycogen synthesis is increased to replete glycogen stores, and blood glucose is the substrate. Indeed insulin-stimulated glucose uptake and glycogen synthesis is elevated after exercise, which, from an evolutional point of view, will favor glycogen repletion and preparation for new "fight or flight" events. In the modern society, the reduced glycogen stores in skeletal muscles after exercise allows carbohydrates to be stored as muscle glycogen and prevents that glucose is channeled to de novo lipid synthesis, which over time will causes ectopic fat accumulation and insulin resistance. The reduction of skeletal muscle glycogen after exercise allows a healthy storage of carbohydrates after meals and prevents development of type 2 diabetes.

Carbohydrate vs protein supplementation for recovery of neuromuscular function following prolonged load carriage

BACKGROUND

This study examined the effect of carbohydrate and whey protein supplements on recovery of neuromuscular function after prolonged load carriage.

METHODS

TEN MALE PARTICIPANTS (BODY MASS: 81.5 +/- 10.5 kg, age: 28 +/- 9 years, O(2)max: 55.0 +/- 5.5 ml.kg(-1).min(-1)) completed three treadmill walking tests (2 hr, 6.5 km.h(-1)), carrying a 25 kg backpack consuming 500 ml of either: (1) Placebo (flavoured water) [PLA], (2) 6.4% Carbohydrate Solution [CHO] or (3) 7.0% Whey Protein Solution [PRO]. For three days after load carriage, participants consumed two 500 ml supplement boluses. Muscle performance was measured before and at 0, 24, 48 and 72 h after load carriage, during voluntary and electrically stimulated contractions.

RESULTS

Isometric knee extension force decreased immediately after load carriage with no difference between conditions. During recovery, isometric force returned to pre-exercise values at 48 h for CHO and PRO but at 72 h for PLA. Voluntary activation decreased immediately after load carriage and returned to pre-exercise values at 24 h in all conditions (P = 0.086). During recovery, there were no differences between conditions for the change in isokinetic peak torque. Following reductions immediately after load carriage, knee extensor and flexor peak torque (60 degrees .s(-1)) recovered to pre-exercise values at 72 h. Trunk extensor and flexor peak torque (15 degrees .s(-1)) recovered to pre-exercise values at 24 h (P = 0.091) and 48 h (P = 0.177), respectively.

CONCLUSION

Recovery of neuromuscular function after prolonged load carriage is improved with either carbohydrate or whey protein supplementation for isometric contractions but not for isokinetic contractions.

Nutrition concepts for elite distance runners based on macronutrient and energy expenditure

CONTEXT

Elite distance runners (EDR) must optimize their nutrition to maintain their demanding training schedules.

OBJECTIVE

To develop a nutrition concept for EDR based on energy and macronutrient expenditures.

DESIGN

This theoretical study provides calculations for macronutrient and energy expenditures of EDR. Anthropometric and metabolic characteristics of EDR were assumed based on average real EDR.

SETTING

University of Kiel.

PATIENTS OR OTHER PARTICIPANTS

Three prototypic types of male EDR described in the literature as type I (TI; body mass = 72 kg, respiratory quotient = 0.9 at rest, fast-twitch muscle fibers = 60% to 70%), type II (TII; body mass = 67 kg, respiratory quotient = 0.82 at rest, fast-twitch muscle fibers = 50%), and type III (TIII; body mass = 60 kg, respiratory quotient = 0.75 at rest, fast-twitch muscle fibers = 30% to 40%).

MAIN OUTCOME MEASURE(S)

We calculated the macronutrient and energy expenditures of the 3 types of EDR according to body mass, respiratory quotient, and percentage of fast-twitch muscle fibers.

RESULTS

We found that the average energy expenditure was 3750 kcal . d(-1) for TI runners, 3463 kcal . d(-1) for TII runners, and 3079 kcal . d(-1) for TIII runners. The carbohydrate (CHO) expenditure reached an average value of 10.0 g . kg(-1) . d(-1) for TI runners, 8.0 g . kg(-1) . d(-1) for TII runners, and 4.7 g . kg(-1) . d(-1) for TIII runners. When the EDR accomplished running sessions at a pace >or=100% of maximum oxygen consumption, all types of runners had a CHO demand of about 10 g . kg(-1) . d(-1). The TI and TII runners need a CHO intake of 8 to 10 g . kg(-1) . d(-1). For the TIII runners, a CHO intake >6 g . kg(-1) . d(-1) is necessary during anaerobic training sessions.

CONCLUSIONS

Nutrition concepts must be differentiated for EDR according to metabolic and anthropometric characteristics of the runners and their special training emphases.

Recovery nutrition: timing and composition after endurance exercise

Consumption of macronutrients, particularly carbohydrate (CHO) and possibly a small amount of protein, in the early recovery phase after endurance exercise can enhance muscle glycogen resynthesis rates. A target of at least 1.2 g x kg body weight(-1) x h(-1) CHO (over several hours) is suggested. This rate of CHO intake could be sustained with liquid, gel, or solid food rich in CHO for maximizing muscle glycogen. Whether the coingestion of protein with CHO compared with isocaloric CHO results in meaningful differences in glycogen replenishment that translate into subsequent performance enhancement is equivocal. Advantages of added protein with CHO in reducing true muscle damage from endurance exercise remain to be verified. There are, however, no apparent contraindications for using milk or specialty CHO/protein/amino acid products either. Future investigations that examine signaling mechanisms within muscle should be conducted in parallel with translational evidence in humans.

The influence of carbohydrate and protein ingestion during recovery from prolonged exercise on subsequent endurance performance

Ingesting carbohydrate plus protein following prolonged exercise may restore exercise capacity more effectively than ingestion of carbohydrate alone. The objective of the present study was to determine whether this potential benefit is a consequence of the protein fraction per se or simply due to the additional energy it provides. Six active males participated in three trials, each involving a 90-min treadmill run at 70% maximal oxygen uptake (run 1) followed by a 4-h recovery. At 30-min intervals during recovery, participants ingested solutions containing: (1) 0.8 g carbohydrate x kg body mass (BM)(-1) h(-1) plus 0.3 g kg(-1) h(-1) of whey protein isolate (CHO-PRO); (2) 0.8 g carbohydrate x kg BM(-1) h(-1) (CHO); or (3) 1.1 g carbohydrate x kg BM(-1) h(-1) (CHO-CHO). The latter two solutions matched the CHO-PRO solution for carbohydrate and for energy, respectively. Following recovery, participants ran to exhaustion at 70% maximal oxygen uptake (run 2). Exercise capacity during run 2 was greater following ingestion of CHO-PRO and CHO-CHO than following ingestion of CHO (P< or = 0.05) with no significant difference between the CHO-PRO and CHO-CHO treatments. In conclusion, increasing the energy content of these recovery solutions extended run time to exhaustion, irrespective of whether the additional energy originated from sucrose or whey protein isolate.

Effects of ingesting protein with various forms of carbohydrate following resistance-exercise on substrate availability and markers of anabolism, catabolism, and immunity

Background

Ingestion of carbohydrate (CHO) and protein (PRO) following intense exercise has been reported to increase insulin levels, optimize glycogen resynthesis, enhance PRO synthesis, and lessen the immuno-suppressive effects of intense exercise. Since different forms of CHO have varying glycemic effects, the purpose of this study was to determine whether the type of CHO ingested with PRO following resistance-exercise affects blood glucose availability and insulin levels, markers of anabolism and catabolism, and/or general immune markers.

Methods

40 resistance-trained subjects performed a standardized resistance training workout and then ingested in a double blind and randomized manner 40 g of whey PRO with 120 g of sucrose (S), honey powder (H), or maltodextrin (M). A non-supplemented control group (C) was also evaluated. Blood samples were collected prior to and following exercise as well as 30, 60, 90, and 120 min after ingestion of the supplements. Data were analyzed by repeated measures ANOVA or ANCOVA using baseline values as a covariate if necessary.

Results

Glucose concentration 30 min following ingestion showed the H group (7.12 ± 0.2 mmol/L) to be greater than S (5.53 ± 0.6 mmol/L; p < 0.03); M (6.02 ± 0.8 mmol/L; p < 0.05), and C (5.44 ± 0.18 mmol/L; p < 0.0002) groups. No significant differences were observed among groups in glucose area under the curve (AUC) values, although the H group showed a trend versus control (p = 0.06). Insulin response for each treatment was significant by time (p < 0.0001), treatment (p < 0.0001) and AUC (p < 0.0001). 30-min peak post-feeding insulin for S (136.2 ± 15.6 uIU/mL), H (150.1 ± 25.39 uIU/mL), and M (154.8 ± 18.9 uIU/mL) were greater than C (8.7 ± 2.9 uIU/mL) as was AUC with no significant differences observed among types of CHO. No significant group × time effects were observed among groups in testosterone, cortisol, the ratio of testosterone to cortisol, muscle and liver enzymes, or general markers of immunity.

Conclusion

CHO and PRO ingestion following exercise significantly influences glucose and insulin concentrations. Although some trends were observed suggesting that H maintained blood glucose levels to a better degree, no significant differences were observed among types of CHO ingested on insulin levels. These findings suggest that each of these forms of CHO can serve as effective sources of CHO to ingest with PRO in and attempt to promote post-exercise anabolic responses.

Nutrient supplementation post ambulation in persons with incomplete spinal cord injuries: a randomized, double-blinded, placebo-controlled case series

OBJECTIVE

To examine effects of protein-carbohydrate intake on ambulation performance in persons with incomplete spinal cord injury (SCI).

DESIGN

Double-blinded treatment with washout and placebo crossover.

SETTING

Academic medical center.

PARTICIPANTS

Three subjects aged 34 to 43 years with incomplete SCI at C5-T4.

INTERVENTIONS

Subjects walked to fatigue on 5 consecutive days. On fatigue, participants consumed 48g of vanilla-flavored whey and 1g/kg of body weight of carbohydrate (CH(2)O). Weekend rest followed, and the process was repeated. A 2-week washout was interposed and the process repeated using 48g of vanilla-flavored soy.

MAIN OUTCOME MEASURES

Oxygen consumed (Vo(2); in L/min), carbon dioxide evolved (Vco(2)), respiratory exchange ratio (RER: Vco(2)/Vo(2)), time (in minutes), and distance walked (in meters) were recorded. Caloric expenditure was computed as Vo(2) by time by 21kJ/L (5kcal/L) of oxygen consumed. Data were averaged across the final 2 ambulation sessions for each testing condition.

RESULTS

Despite slow ambulation velocities (range, .11-.34m/s), RERs near or above unity reflected reliance on CH(2)O fuel substrates. Average ambulation time to fatigue was 17.8% longer; distance walked 37.9% longer, and energy expenditure 12.2% greater with the whey and CH(2)O supplement than with the soy drink.

CONCLUSIONS

Whey and CH(2)O ingestion after fatiguing ambulation enhanced ensuing ambulation by increasing ambulation distance, time, and caloric expenditure in persons with incomplete SCI.

Fluid and fuel intake during exercise

The amounts of water, carbohydrate and salt that athletes are advised to ingest during exercise are based upon their effectiveness in attenuating both fatigue as well as illness due to hyperthermia, dehydration or hyperhydration. When possible, fluid should be ingested at rates that most closely match sweating rate. When that is not possible or practical or sufficiently ergogenic, some athletes might tolerate body water losses amounting to 2% of body weight without significant risk to physical well-being or performance when the environment is cold (e.g. 5-10 degrees C) or temperate (e.g. 21-22 degrees C). However, when exercising in a hot environment ( > 30 degrees C), dehydration by 2% of body weight impairs absolute power production and predisposes individuals to heat injury. Fluid should not be ingested at rates in excess of sweating rate and thus body water and weight should not increase during exercise. Fatigue can be reduced by adding carbohydrate to the fluids consumed so that 30-60 g of rapidly absorbed carbohydrate are ingested throughout each hour of an athletic event. Furthermore, sodium should be included in fluids consumed during exercise lasting longer than 2 h or by individuals during any event that stimulates heavy sodium loss (more than 3-4 g of sodium). Athletes do not benefit by ingesting glycerol, amino acids or alleged precursors of neurotransmitter. Ingestion of other substances during exercise, with the possible exception of caffeine, is discouraged. Athletes will benefit the most by tailoring their individual needs for water, carbohydrate and salt to the specific challenges of their sport, especially considering the environment's impact on sweating and heat stress.

Intramyocellular lipid stores increase markedly in athletes after 1.5 days lipid supplementation and are utilized during exercise in proportion to their content

Intramyocellular lipids (IMCL) and muscle glycogen provide local energy during exercise (EX). The objective of this study was to clarify the role of high versus low IMCL levels at equal initial muscle glycogen on fuel selection during EX. After 3 h of depleting exercise, 11 endurance-trained males consumed in a crossover design a high-carbohydrate (7 g kg(-1) day(-1)) low-fat (0.5 g kg(-1) day(-1)) diet (HC) for 2.5 days or the same diet with 3 g kg(-1) day(-1) more fat provided during the last 1.5 days of diet (four meals; HCF). Respiratory exchange, thigh muscle substrate breakdown by magnetic resonance spectroscopy, and plasma FFA oxidation ([1-(13)C]palmitate) were measured during EX (3 h, 50% W (max)). Pre-EX IMCL concentrations were 55% higher after HCF. IMCL utilization during EX in HCF was threefold greater compared with HC (P < 0.001) and was correlated with aerobic power and highly correlated (P < 0.001) with initial content. Glycogen values and decrements during EX were similar. Whole-body fat oxidation (Fat(ox)) was similar overall and plasma FFA oxidation smaller (P < 0.05) during the first EX hour after HCF. Myocellular fuels contributed 8% more to whole-body energy demands after HCF (P < 0.05) due to IMCL breakdown (27% Fat(ox)). After EX, when both IMCL and glycogen concentrations were again similar across trials, a simulated 20-km time-trial showed no difference in performance between diets. In conclusion, IMCL concentrations can be increased during a glycogen loading diet by consuming additional fat for the last 1.5 days. During subsequent exercise, IMCL decrease in proportion to their initial content, partly in exchange for peripheral fatty acids.

Effect of a 10-Week strength training program and recovery drink on body composition, muscular strength and endurance, and anaerobic power and capacity

OBJECTIVE

We investigated whether postexercise consumption of a supplement containing whey protein, amino acids, creatine, and carbohydrate combined with a strength training program promotes greater gains in fat-free mass (FFM), muscle strength and endurance, and anaerobic performance compared with an isocaloric, carbohydrate-only control drink combined with strength training.

METHODS

The study was double blind and randomized, and the experimental supplement was compared with a carbohydrate-only control. Forty-one males (n = 20 in control group, n = 21 in the supplement group; mean age, 22.2 y) participated in a 4 d/wk, 10-wk periodized strength training program. Subjects had to complete at least 70% of the workouts. Before and after 10 wk of strength training, subjects were tested for body composition by using hydrostatic weighing and skinfold thicknesses, one repetition maximum strength and muscular endurance for the bench press and 45-degree leg press, and anaerobic performance using a 30-s Wingate test. Thirty-three subjects (80.5%) completed the training program (n = 15 in control group, n = 18 in the supplement); these 33 subjects also completed all post-training test procedures. Data were analyzed with two-way analysis of variance with repeated measures on time. P <== 0.05 was set as statistically significant. All statistical analyses, including calculation of effect size and power, were completed with SPSS 11.0.

RESULTS

Across groups, FFM increased during 10 wk of strength training. Although there was no statistically significant time x group interaction for FFM, there was a trend toward a greater increase in FFM for the supplement group (+3.4 kg) compared with the control group (+1.5 kg; P = 0.077). The effect size (eta(2) = 0.100) was moderately large. Percentage of body fat declined and fat mass was unchanged; there were no differences between groups. One repetition maximum strength for the bench press and 45-degree leg press increased, but there were no differences between groups. Muscular endurance expressed as the number of repetitions completed with 85% of the one repetition maximum was unchanged; external work, which was estimated as repetitions completed x resistance used, increased for the 45-degree leg press but not for the bench press over the 10-wk training period; there were no time x group interactions for either measurement. Anaerobic power and capacity improved, but there were no differences between groups for these variables or for fatigue rate.

CONCLUSIONS

Consumption of a recovery drink after strength training workouts did not promote greater gains in FFM compared with consumption of a carbohydrate-only drink; however, a trend toward a greater increase in FFM in the supplement group suggests the need for longer-term studies. Performance variables such as muscle strength and endurance and anaerobic performance were not improved when compared with the carbohydrate-only group.

Nutritional aspects in ultra-endurance exercise

PURPOSE OF REVIEW

Despite much current debate regarding central and peripheral neural mechanisms which may be responsible for the onset of fatigue during prolonged exercise, maintenance of nutritional and hydration status remains critical for successful participation in ultra-endurance exercise. This review focuses on substrate and fluid homeostasis during ultra-endurance exercise and the use of nutritional supplementation both as ergogenic aid and to attenuate exercise-induced immunosuppression.

RECENT FINDINGS

Current evidence continues to support mandatory high carbohydrate intakes (1). before the event to maximize muscle glycogen stores, (2). during the event to prevent hypoglycaemia and (3). after the event to optimize post-event repletion of endogenous carbohydrate stores. No consistent performance benefit has yet been shown following a high-fat diet. Greater utilization of intrafascicular triglyceride stores appears to account for additional fat utilization in females. Recent trends towards excessive fluid intake have resulted in frequent reports of hyponatraemic hyperhydration in ultra-distance athletes, with greater incidence in women than in men. Carbohydrate supplementation during the event attenuates immunosuppressive hormonal and cytokine responses to ultra-endurance exercise, but may impair vitamin C absorption, while the ergogenic value of caffeine supplementation in ultra-endurance performance is currently being questioned.

SUMMARY

Meeting macronutrient and fluid intake demands remains an important priority for ultra-endurance athletes. Yet these athletes are reported to present with a high incidence of disordered eating patterns during periods of training, and excessive fluid replacement strategies have resulted in an increased incidence of water intoxication with resultant central nervous system dysfunction.