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International Olympic Committee Expert Group on Dietary Supplements in Athletes

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Ronald J. Maughan, Louise M. Burke, Jiri Dvorak, D. Enette Larson-Meyer, Peter Peeling, Stuart M. Phillips, Eric S. Rawson, Neil P. Walsh, Ina Garthe, Hans Geyer, Romain Meeusen, Luc van Loon, Susan M. Shirreffs, Lawrence L. Spriet, Mark Stuart, Alan Vernec, Kevin Currell, Vidya M. Ali, Richard G.M. Budgett, Arne Ljungqvist, Margo Mountjoy, Yannis Pitsiladis, Torbjørn Soligard, Uğur Erdener and Lars Engebretsen

Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition program. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including the management of micronutrient deficiencies, supply of convenient forms of energy and macronutrients, and provision of direct benefits to performance or indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can offer benefits to the athlete, but others may be harmful to the athlete’s health, performance, and/or livelihood and reputation if an anti-doping rule violation results. A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome, and habitual diet. Supplements intended to enhance performance should be thoroughly trialed in training or simulated competition before implementation in competition. Inadvertent ingestion of substances prohibited under the anti-doping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete’s health and awareness of the potential for harm must be paramount, and expert professional opinion and assistance is strongly advised before embarking on supplement use.

Open access

Ronald J. Maughan, Susan M. Shirreffs and Alan Vernec

The use of dietary supplements is widespread among athletes in all sports and at all levels of competition, as it is in the general population. For the athlete training at the limits of what is sustainable, or for those seeking a shortcut to achieving their aims, supplements offer the prospect of bridging the gap between success and failure. Surveys show, however, that this is often not an informed choice and that the knowledge level among consumers is often low and that they are often influenced in their decisions by individuals with an equally inadequate understanding of the issues at stake. Supplement use may do more harm than good, unless it is based on a sound analysis of the evidence. Where a deficiency of an essential nutrient has been established by appropriate investigations, supplementation can provide a rapid and effective correction of the problem. Supplements can also provide a convenient and time-efficient solution to achieving the necessary intake of key nutrients such as protein and carbohydrate. Athletes contemplating the use of supplements should consider the potential for both positive and negative outcomes. Some ergogenic supplements may be of benefit to some athletes in some specific contexts, but many are less effective than is claimed. Some may be harmful to health of performance and some may contain agents prohibited by anti-doping regulations. Athletes should make informed choices that maximize the benefits while minimizing the risks.

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Louise M. Burke and Peter Peeling

Many expert sporting bodies now support a pragmatic acceptance of the use of performance supplements which have passed a risk:benefit analysis of being safe, effective, and permitted for use, while also being appropriate to the athlete’s age and maturation in their sport. However, gaining evidence of the performance benefits of these supplements is a process challenged by the scarcity of research in relation to the number of available products, and the limitations of the poor quality of some studies. While meta-analyses and systematic reviews can help to provide information about the general use of performance supplements, the controlled scientific trial provides the basis on which these reviews are undertaken, as well as an opportunity to address more specific questions about supplement applications. Guidelines for the design of studies include the choice of well-trained athletes who are familiarized with performance tasks that have been chosen on their basis of their known reliability and validity. Supplement protocols should be chosen to maximize the likely benefits, and researchers should also make efforts to control confounding variables, while keeping conditions similar to real-life practices. Performance changes should be interpreted in light of what is meaningful to the outcomes of sporting competition. Issues that have been poorly addressed to date include the use of several supplements in combination and the use of the same supplement over successive events, both within a single, and across multiple competition days. Strategies to isolate and explain the variability of benefits to individuals are also a topic for future investigation.

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Romain Meeusen and Lieselot Decroix

Cognitive function plays an important role in athletic performance, and it seems that brain functioning can be influenced by nutrition and dietary components. Thus, the central nervous system might be manipulated through changes in diet or supplementation with specific nutrients including branched-chain amino acids, tyrosine, carbohydrates, and caffeine. Despite some evidence that branched-chained amino acids can influence ratings of perceived exertion and mental performance, several well-controlled studies have failed to demonstrate a positive effect on exercise performance. Evidence of an ergogenic benefit of tyrosine supplementation during prolonged exercise is limited. There is evidence that mild dehydration can impair cognitive performance and mood. The beneficial effect of carbohydrate supplementation during prolonged exercise could relate to increased substrate delivery for the brain, with numerous studies indicating that hypoglycemia affects brain function and cognitive performance. Caffeine can enhance performance and reduce perception of effort during prolonged exercise and will influence specific reward centers of the brain. Plant products and herbal extracts such as polyphenols, ginseng, ginkgo biloba, etc. are marketed as supplements to enhance performance. In several animal studies, positive effects of these products were shown, however the literature on their effects on sports performance is scarce. Polyphenols have the potential to protect neurons against injury induced by neurotoxins, suppress neuroinflammation, and to promote memory, learning, and cognitive function. In general, there remains a need for controlled randomized studies with a strong design, sufficient statistical power, and well-defined outcome measures before “claims” on its beneficial effects on brain functioning can be established.

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Amy J. Hector and Stuart M. Phillips

There exists a large body of scientific evidence to support protein intakes in excess of the recommended dietary allowance (RDA) (0.8 g protein/kg/day) to promote the retention of skeletal muscle and loss of adipose tissue during dietary energy restriction. Diet-induced weight loss with as low as possible ratio of skeletal muscle to fat mass loss is a situation we refer to as high-quality weight loss. We propose that high-quality weight loss is often of importance to elite athletes in order to maintain their muscle (engine) and shed unwanted fat mass, potentially improving athletic performance. Current recommendations for protein intakes during weight loss in athletes are set at 1.6–2.4 g protein/kg/day. However, the severity of the caloric deficit and type and intensity of training performed by the athlete will influence at what end of this range athletes choose to be. Other considerations regarding protein intake that may help elite athletes achieve weight loss goals include the quality of protein consumed, and the timing and distribution of protein intake throughout the day. This review highlights the scientific evidence used to support protein recommendations for high-quality weight loss and preservation of performance in athletes. Additionally, the current knowledge surrounding the use of protein supplements, branched chain amino acids (BCAA), β-hydroxy β-methylbutyrate (HMB), and other dietary supplements with weight loss claims will be discussed.

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Øyvind Skattebo and Thomas Losnegard

Purpose: To investigate variability, predictability, and smallest worthwhile performance enhancement in elite biathlon sprint events. In addition, the effects of race factors on performance were assessed. Methods: Data from 2005 to 2015 including >10,000 and >1000 observations for each sex for all athletes and annual top-10 athletes, respectively, were included. Generalized linear mixed models were constructed based on total race time, skiing time, shooting time, and proportions of targets hit. Within-athlete race-to-race variability was expressed as coefficient of variation of performance times and standard deviation (SD) in proportion units (%) of targets hit. The models were adjusted for random and fixed effects of subject identity, season, event identity, and race factors. Results: The within-athlete variability was independent of sex and performance standard of athletes: 2.5–3.2% for total race time, 1.5–1.8% for skiing time, and 11–15% for shooting times. The SD of the proportion of hits was ∼10% in both shootings combined (meaning ±1 hit in 10 shots). The predictability in total race time was very high to extremely high for all athletes (ICC .78–.84) but trivial for top-10 athletes (ICC .05). Race times during World Championships and Olympics were ∼2–3% faster than in World Cups. Moreover, race time increased by ∼2% per 1000 m of altitude, by ∼5% per 1% of gradient, by 1–2% per 1 m/s of wind speed, and by ∼2–4% on soft vs hard tracks. Conclusions: Researchers and practitioners should focus on strategies that improve biathletes’ performance by at least 0.8–0.9%, corresponding to the smallest worthwhile enhancement (0.3 × within-athlete variability).

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Michael Wälchli, Jan Ruffieux,, Audrey Mouthon, Martin Keller and Wolfgang Taube

Purpose: Balance training (BT) studies in children reported conflicting results without evidence for improvements in children under the age of 8. The aim of this study therefore was to compare BT adaptations in children of different age groups to clarify whether young age prevents positive training outcomes. Methods: The effects of 5 weeks of child-oriented BT were tested in 77 (38 girls and 39 boys) participants of different age groups (6–7 y, 11–12 y, and 14–15 y) and compared with age-matched controls. Static and dynamic postural control, explosive strength, and jump height were assessed. Results: Across age groups, dynamic postural sway decreased (−18.7%; P = .012; ηp2=.09) and explosive force increased (8.6%; P = .040; ηp2=.06) in the intervention groups. Age-specific improvements were observed in dynamic postural sway, with greatest effects in the youngest group (−28.8%; P = .026; r = .61). Conclusion: In contrast to previous research using adult-oriented balance exercises, this study demonstrated for the first time that postural control can be trained from as early as the age of 6 years in children when using child-oriented BT. Therefore, the conception of the training seems to be essential in improving balance skills in young children.

Open access

Salomé Aubert, Joel D. Barnes, Chalchisa Abdeta, Patrick Abi Nader, Ade F. Adeniyi, Nicolas Aguilar-Farias, Dolores S. Andrade Tenesaca, Jasmin Bhawra, Javier Brazo-Sayavera, Greet Cardon, Chen-Kang Chang, Christine Delisle Nyström, Yolanda Demetriou, Catherine E. Draper, Lowri Edwards, Arunas Emeljanovas, Aleš Gába, Karla I. Galaviz, Silvia A. González, Marianella Herrera-Cuenca, Wendy Y. Huang, Izzeldin A.E. Ibrahim, Jaak Jürimäe, Katariina Kämppi, Tarun R. Katapally, Piyawat Katewongsa, Peter T. Katzmarzyk, Asaduzzaman Khan, Agata Korcz, Yeon Soo Kim, Estelle Lambert, Eun-Young Lee, Marie Löf, Tom Loney, Juan López-Taylor, Yang Liu, Daga Makaza, Taru Manyanga, Bilyana Mileva, Shawnda A. Morrison, Jorge Mota, Vida K. Nyawornota, Reginald Ocansey, John J. Reilly, Blanca Roman-Viñas, Diego Augusto Santos Silva, Pairoj Saonuam, John Scriven, Jan Seghers, Natasha Schranz, Thomas Skovgaard, Melody Smith, Martyn Standage, Gregor Starc, Gareth Stratton, Narayan Subedi, Tim Takken, Tuija Tammelin, Chiaki Tanaka, David Thivel, Dawn Tladi, Richard Tyler, Riaz Uddin, Alun Williams, Stephen H.S. Wong, Ching-Lin Wu, Paweł Zembura and Mark S. Tremblay

Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5–17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations’ human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of “C-,” “D+,” and “C-” was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

Open access

Taru Manyanga, Joel D. Barnes, Chalchisa Abdeta, Ade F. Adeniyi, Jasmin Bhawra, Catherine E. Draper, Tarun R. Katapally, Asaduzzaman Khan, Estelle Lambert, Daga Makaza, Vida K. Nyawornota, Reginald Ocansey, Narayan Subedi, Riaz Uddin, Dawn Tladi and Mark S. Tremblay

Background: This study compares results of physical activity report cards from 9 countries with low to medium human development indices, participating in the Global Matrix 3.0 initiative. Methods: Country-specific report cards were informed by relevant data and government policy documents, reporting on 10 core indicators of physical activity for children and youth. Data were synthesized by report card working groups following a harmonized process. Grade assignments for each indicator utilized a standard grading rubric. Indicators were grouped into one of 2 categories: daily behaviors and settings and sources of influence. Descriptive statistics (average grades) were computed after letter grades were converted into interval variables. Spearman’s rank correlation coefficients were calculated for all correlation analyses. Results: Mean grades for daily behaviors were higher (C) than those for settings and sources of influence (D+). Twenty-nine out of the possible 90 grades were assigned an incomplete. There were moderate to strong positive and negative relationships between different global indices and overall physical activity, organized sport and physical activity, active play, family, community and environment, and government. Conclusions: Findings demonstrate an urgent need for high-quality data at the country level in order to better characterize the physical activity levels of children and youth in countries with low to medium human development indices.