Patellar tendinopathy is one of the most common afflictions in jumping sports. This case study outlines the rehabilitation of a professional basketball player diagnosed by magnetic resonance imaging (MRI) with a central core patellar tendinopathy within the proximal enthesis. The player undertook a nutrition and strength-based rehabilitation program combining gelatin ingestion and heavy isometric loading of the patellar tendon designed to produce significant stress relaxation as part of their competition schedule and a whole-body training plan. On follow-up one and a half years into the program an independent orthopedic surgeon declared the tendon normal on MRI. Importantly, the improved MRI results were associated with a decrease in pain and improved performance. This case study provides evidence that a nutritional intervention combined with a rehabilitation program that uses stress relaxation can improve clinical outcomes in elite athletes.
Edgar J. Gallardo and Andrew R. Coggan
Consumption of beetroot juice (BRJ) supplements has become popular among athletes because beets tend to be rich in nitrate (NO3−), which can enhance exercise performance by increasing nitric oxide production. The NO3− content of beets can vary significantly, however, making it difficult to know how much NO3− any product actually contains. Samples from 45 different lots of 24 different BRJ products from 21 different companies were therefore analyzed for NO3− (and nitrite [NO2−]) concentration using high-performance liquid chromatography. The NO3− and NO2− content (i.e., amount per serving) was then calculated based on either (a) the manufacturer’s recommended serving size (for prepackaged/single dose products) or (b) as used in previous studies, a volume of 500 ml (for BRJ sold in bulk containers). There was moderate-to-large variability in NO3− content between samples of the same product, with a mean coefficient of variation of 30% ± 26% (range 2–83%). There was even greater variability between products, with a ∼50-fold range in NO3− content between the lowest and highest. Only five products consistently provided ≥5 mmol of NO3−/serving, which seems to be the minimal dose required to enhance exercise performance in most individuals. NO2− contents were generally low (i.e., ≤0.5% compared with NO3−), although two products contained 10% and 14%. The results of this study may be useful to athletes and their support staff contemplating which (if any) BRJ product to utilize. These data may also offer insight into variability in the literature with respect to the effects of BRJ on exercise performance.
Shona L. Halson, Alan G. Hahn and Aaron J. Coutts
Dean Dudley, John Cairney and Jackie Goodway
Trent Stellingwerff, Ingvill Måkestad Bovim and Jamie Whitfield
Middle-distance runners utilize the full continuum of energy systems throughout training, and given the infinite competition tactical scenarios, this event group is highly complex from a performance intervention point of view. However, this complexity results in numerous potential periodized nutrition interventions to optimize middle-distance training adaptation and competition performance. Middle-distance race intensity is extreme, with 800- to 5,000-m races being at ∼95% to 130% of VO2max. Accordingly, elite middle-distance runners have primarily Type IIa/IIx fiber morphology and rely almost exclusively on carbohydrate (primarily muscle glycogen) metabolic pathways for producing adenosine triphosphate. Consequently, the principle nutritional interventions that should be emphasized are those that optimize muscle glycogen contents to support high glycolytic flux (resulting in very high lactate values, of >20 mmol/L in some athletes) with appropriate buffering capabilities, while optimizing power to weight ratios, all in a macro- and microperiodized manner. From youth to elite level, middle-distance athletes have arduous racing schedules (10–25 races/year), coupled with excessive global travel, which can take a physical and emotional toll. Accordingly, proactive and integrated nutrition planning can have a profound recovery effect over a long race season, as well as optimizing recovery during rounds of championship racing. Finally, with evidence-based implementation and an appropriate risk/reward assessment, several ergogenic aids may have an adaptive and/or performance-enhancing effect in the middle-distance athlete. Given that elite middle-distance athletes undertake ∼400 to 800 training sessions with 10–25 races/year, there are countless opportunities to implement various periodized acute and chronic nutrition-based interventions to optimize performance.
Louise M. Burke, Asker E. Jeukendrup, Andrew M. Jones and Martin Mooses
Distance events in Athletics include cross country, 10,000-m track race, half-marathon and marathon road races, and 20- and 50-km race walking events over different terrain and environmental conditions. Race times for elite performers span ∼26 min to >4 hr, with key factors for success being a high aerobic power, the ability to exercise at a large fraction of this power, and high running/walking economy. Nutrition-related contributors include body mass and anthropometry, capacity to use fuels, particularly carbohydrate (CHO) to produce adenosine triphosphate economically over the duration of the event, and maintenance of reasonable hydration status in the face of sweat losses induced by exercise intensity and the environment. Race nutrition strategies include CHO-rich eating in the hours per days prior to the event to store glycogen in amounts sufficient for event fuel needs, and in some cases, in-race consumption of CHO and fluid to offset event losses. Beneficial CHO intakes range from small amounts, including mouth rinsing, in the case of shorter events to high rates of intake (75–90 g/hr) in the longest races. A personalized and practiced race nutrition plan should balance the benefits of fluid and CHO consumed within practical opportunities, against the time, cost, and risk of gut discomfort. In hot environments, prerace hyperhydration or cooling strategies may provide a small but useful offset to the accrued thermal challenge and fluid deficit. Sports foods (drinks, gels, etc.) may assist in meeting training/race nutrition plans, with caffeine, and, perhaps nitrate being used as evidence-based performance supplements.
Dana M. Lis, Daniel Kings and D. Enette Larson-Meyer
Some track-and-field athletes implement special diets aiming to improve health and/or performance. An evidence-based approach to any diet is recommended to minimize the risks associated with unnecessary dietary restriction, which may potentially do more harm than good. Four prevalent diets are reviewed in this study: (a) gluten-free; (b) low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP); (c) vegetarian; and (d) fasting diets. Recently, gluten-free diets and low FODMAP diets have emerged as novel regimes thought to improve gastrointestinal health and reduce the risk of exercise-associated gastrointestinal symptoms. No direct beneficial outcomes have been associated with avoiding gluten for clinically healthy athletes. Indirectly, a gluten-free diet is associated with other dietary changes, particularly FODMAP reduction, which may improve adverse gastrointestinal symptoms. Vegetarian diets can optimally support athletic demands. However, attention is required to ensure adequate energy and intake of specific nutrients that are less abundant or less well absorbed from plant sources. Finally, fasting is a long-standing concept that is undertaken on a voluntary and obligatory basis. Despite limited supporting research, voluntary fasting is a popular alternative to conventional diets perceptually offering health and body composition benefits. Strict obligatory fasting guidelines likely require the implementation of tailored nutrition strategies to help athletes cope with athletic demands. Overall, a multitude of factors influence adherence to special diets. Even when adherence to a special diet is a necessity, education and advice from an accredited dietitian/nutritionist are recommended for track-and-field athletes to optimize nutrition for health and performance.
Oliver C. Witard, Ina Garthe and Stuart M. Phillips
Track and field athletes engage in vigorous training that places stress on physiological systems requiring nutritional support for optimal recovery. Of paramount importance when optimizing recovery nutrition are rehydration and refueling 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)−1·day−1 for training adaptation, manipulating body composition, and optimizing performance in track and field athletes. To facilitate the remodeling 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−1·day−1. Protein intakes at this level would not necessarily require an overemphasis 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−1·day−1 for athletes who are restricting energy intake and attempting to minimize loss of lean BM. 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 BM.