Dietary Protein for Training Adaptation and Body Composition Manipulation in Track and Field Athletes

Track and field athletes engage in vigorous training that places stress on physiological systems requiring nutritional support for optimal recovery. Of paramount importance when optimising recovery nutrition are rehydration and refuelling which are covered in other papers in this volume. Here, we highlight the benefits for dietary protein intake over and above requirements set out in various countries at ~0.8-1.0 g/kg body mass (BM)/day for training adaptation, manipulating body composition, and optimising performance in track and field athletes. To facilitate the remodelling of protein-containing structures, which are turning over rapidly due to their training volumes, track and field athletes with the goal of weight maintenance or weight gain should aim for protein intakes of ~1.6 g/kg BM/day. Protein intakes at this level would not necessarily require an over-emphasis on protein-containing foods and, beyond convenience, does not suggest a need to use protein or amino acid-based supplements. This review also highlights that optimal protein intakes may exceed 1.6 g/kg BM/day for athletes who are restricting energy intake and attempting to minimise loss of lean body mass. We discuss the underpinning rationale for weight loss in track and field athletes, explaining changes in metabolic pathways that occur in response to energy restriction when manipulating protein intake and training. Finally, this review offers practical advice on protein intakes that warrant consideration in allowing an optimal adaptive response for track and field athletes seeking to train effectively and to lose fat mass while energy restricted with minimal (or no) loss of lean body mass

Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q

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Screening for low energy availability in male athletes : Attempted validation of LEAM-Q

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA

Short-term effects and long-term changes of FUEL—a digital sports nutrition intervention on REDs related symptoms in female athletes

Female endurance athletes are at high risk for developing Relative Energy Deficiency in Sport (REDs), resulting in symptoms such as menstrual dysfunction and gastrointestinal (GI) problems. The primary aim of this study was to investigate effects of the FUEL (Food and nUtrition for Endurance athletes—a Learning program) intervention consisting of weekly online lectures combined with individual athlete-centered nutrition counseling every other week for sixteen weeks on REDs related symptoms in female endurance athletes at risk of low energy availability [Low Energy Availability in Females Questionnaire (LEAF-Q) score ≥8]. Female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47) were recruited. Fifty athletes with risk of REDs (LEAF-Q score ≥8) and with low risk of eating disorders [Eating Disorder Examination Questionnaire (EDE-Q) global score <2.5], with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a sixteen-week control period (n = 18) (CON). All but one completed FUEL and n = 15 completed CON. While no evidence for difference in change in LEAF-Q total or subscale scores between groups was detected post-intervention (BFincl < 1), the 6- and 12-months follow-up revealed strong evidence for improved LEAF-Q total (BFincl = 123) and menstrual score (BFincl = 840) and weak evidence for improved GI-score (BFincl = 2.3) among FUEL athletes. In addition, differences in change between groups was found for EDE-Q global score post-intervention (BFincl = 1.9). The reduction in EDE-Q score remained at 6- and 12- months follow-up among FUEL athletes. Therefore, the FUEL intervention may improve REDs related symptoms in female endurance athletes.Clinical Trial Registrationwww.clinicaltrials.gov (NCT04959565)

A Three Year Case Study with a Multidisciplinary Treatment of Relative Energy Deficiency and Anorexia in a Female Tennis Player

Tennis is an all-year racket sport requiring qualities such as speed, agility, flexibility, and endurance, as competitions may last up to five hours.Elite players have an estimated daily need of carbohydrate (CHO) between 6-10 g/kg to sustain high amounts of training and frequent competitions. Low energy availability (LEA), over time, may impair both health and performance. LEA may cause metabolic suppression and altered hormone levels via hypothalamic–pituitary– gonadal axis (HPG). Female athletes with LEA have an increased risk of developing menstrual dysfunction, low bone mineral density (BMD), disordered eating behavior (DE) and an eating disorder (ED). This article provides a case-study of an internationally ranked female tennis player, with a recent performance-driven weight loss of 11 kg. She was diagnosed with functional hypothalamic primary amenorrhea (FHA) and anorexia nervosa (AN). The predetermined goal was to return to play and the treatment was based on the guidelines for relative Energy Deficiency in Sport (REDS-CAT). After three years of multidisciplinary interventions, the athlete safely returned to play. Her weight and body composition improved, her menstrual cycle was normalized and the diagnostically scores of AN indicated non-clinical significance. The multidisciplinary treatment enabled the athlete to return to play despite several years of LEA and AN

Bone health in elite Norwegian endurance cyclists and runners: a cross-sectional study

Background: Athletes who compete in non-weight-bearing activities such as swimming and cycling are at risk of developing low bone mineral density (BMD). Athletes in long-distance running are at risk of low BMD. Objective: (1) To evaluate the bone health in Norwegian male and female national elite road cyclists and middle-distance and long-distance runners, and to identify cases of low BMD. (2) To identify possible risk factors associated with low BMD. Methods: Twenty-one runners (11 females and 10 males) and 19 road cyclists (7 females and 12 males) were enrolled in this cross-sectional study. Dual-energy X-ray absorptiometry measurement of BMD in total body, femoral neck and lumbar spine was measured. Participants completed a questionnaire regarding training, injuries, calcium intake and health variables. Results: The cyclists had lower BMD for all measured sites compared with the runners (p≤0.05). Ten of 19 cyclists were classified as having low BMD according to American College of Sports Medicine criteria (Z-score ≤−1), despite reporting to train heavy resistance training on the lower extremities. Low BMD was site specific having occurred in the lumbar spine and the femoral neck and was not confined to females. Type of sport was the only factor significantly associated with low BMD. Conclusion: National elite Norwegian road cyclists had lower BMD compared with runners, and a large proportion was classified as having low BMD, despite having performed heavy resistance training. Interventions to increase BMD in this population should be considered

Neuromuscular fatigue and recovery in elite female soccer : effects of active recovery

PURPOSE: To investigate the time course of recovery from neuromuscular fatigue and some biochemical changes between two female soccer matches separated by an active or passive recovery regime. METHODS: Countermovement jump (CMJ), sprint performance, maximal isokinetic knee flexion and extension, creatine kinase (CK), urea, uric acid, and perceived muscle soreness were measured in 17 elite female soccer players before, immediately after, 5, 21, 45, 51, and 69 h after a first match, and immediately after a second match. Eight players performed active recovery (submaximal cycling at 60% of HRpeak and low-intensity resistance training at < 50% 1RM) 22 and 46 h after the first match. RESULTS: In response to the first match, a significant decrease in sprint performance (-3.0 +/- 0.5%), CMJ (-4.4 +/- 0.8%), peak torque in knee extension (-7.1 +/- 1.9%) and flexion (-9.4 +/- 1.8%), and an increase in CK (+ 152 +/- 28%), urea (15 +/- 2), uric acid (+ 11 +/- 2%), and muscle soreness occurred. Sprint ability was first to return to baseline (5 h) followed by urea and uric acid (21 h), isokinetic knee extension (27 h) and flexion (51 h), CK, and muscle soreness (69 h), whereas CMJ was still reduced at the beginning of the second match. There were no significant differences in the recovery pattern between the active and passive recovery groups. The magnitude of the neuromuscular and biochemical changes after the second match was similar to that observed after the first match. CONCLUSION: The present study reveals differences in the recovery pattern of the various neuromuscular and biochemical parameters in response to a female soccer match. The active recovery had no effects on the recovery pattern of the four neuromuscular and three biochemical parameters