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The Hyponatremia of Exercise

Timothy D. Noakes

The hyponatremia of exercise may exist in symptomatic and asymptomatic forms. Symptomatic hyponatremia is usually characterized by severe alterations in cerebral function including coma and grand ma1 seizures; it develops especially in less competitive athletes who have maintained high rates of fluid intake during endurance events lasting at least 5 hours. The hyponatremia becomes symptomatic when the volume of excess fluid retained exceeds 2 to 3 liters. The etiology of the condition is unknown. Possibly as many as three or more pathologies (abnormal fluid retention possibly due to inappropriate ADH secretion, abnormal regulation of the extracellular fluid volume, translocation of sodium into a "third space") must be present for symptomatic hyponatremia to develop. The avoidance of overhydration would appear to be the only certain way that susceptible individuals can prevent symptomatic hyponatremia. Sodium chloride containing solutions ingested in physiologically significant concentrations would likely prevent a possible "third space" effect.

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Carbohydrate, Fluids and Electrolyte Requirements of the Soccer Player: A Stewiew

John A. Hawley, Steven C. Dennis, and Timothy D. Noakes

Soccer requires field players to exercise repetitively at high intensities for the duration of a game, which can result in marked muscle glycogen depletion and hypoglycemia. A soccer match places heavy demands on endogenous muscle and liver glycogen stores and fluid reserves, which must be rapidly replenished when players complete several matches within a brief period of time. Low concentrations of muscle glycogen have been reported in soccer players before a game, and daily carbohydrate (CHO) intakes are often insufficient to replenish muscle glycogen stores, CHO supplementation during soccer matches has been found to result in muscle glycogen sparing (39%), greater second-half running distances, and more goals being scored with less conceded, when compared to consumption of water. Thus, CHO supplementation has been recommended prior to, during, and after matches. In contrast, there is currently insufficient evidence to recommend without reservation the addition of electrolytes to a beverage for ingestion by players during a game resulting in sweat losses of < 4% of body weight.

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The Effects of Medium-Chain Triacylglycerol and Carbohydrate Ingestion on Ultra-Endurance Exercise Performance

Julia H. Goedecke, Virginia R. Clark, Timothy D. Noakes, and Estelle V. Lambert

The aims of the study were to determine if medium-chain triacylglycerol (MCT), ingested in combination with carbohydrate (CHO), would alter substrate metabolism and improve simulated competitive ultra-endurance cycling performance. Eight endurance-trained cyclists took part in this randomized, single-blind crossover study. On two separate occasions, subjects cycled for 270 min at 50% of peak power output, interspersed with four 75 kJ sprints at 60 min intervals, followed immediately by a 200 kJ time-trial. One hour prior to the exercise trials, subjects ingested either 75 g of CHO or 32 g of MCT, and then ingested 200 mL of a 10% CHO (wt/vol) solution or a 4.3% MCT + 10% CHO (wt/vol) solution every 20 min during the CHO and MCT trials, respectively. During the constant-load phases of the 270 min exercise trial, VO2, RER, and heart rate were measured at 30 min intervals and gastrointestinal (GI) symptoms were recorded. There was no difference in VO2 or RER between the MCT and CHO trials (P = 0.40). Hourly sprint (P = 0.03 for trial x time interaction) and time-trial times (14:30 ± 0.58 vs. 12:36 ± 1:6, respectively, P < 0.001) were slower in the MCT than the CHO trial. Half the subjects experienced GI symptoms with MCT ingestion. In conclusion, MCTs ingested prior to exercise and co-ingested with CHO during exercise did not alter substrate metabolism and significantly compromised sprint performance during prolonged ultra-endurance cycling exercise.

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Free Living Energy Expenditure in Post Menopausal Women before and after Exercise Training

Lara R. Keytel, Michael I. Lambert, Judith Johnson, Timothy D. Noakes, and Estelle V. Lambert

The aim of the study was to determine the effects of 8 weeks of moderate exercise training, on 24-hour free living energy expenditure in previously sedentary post-menopausal women. The experimental group (EX) included 9 women. Ten non-exercising control subjects (CON) were recruited to undergo pre- and post-testing. Estimated total daily energy expenditure (TDEE), total 24-hour heart beats (HB), total energy intake (TEI), resting metabolic rate, maximal oxygen consumption (V̇O2max), body composition, and submaximal heart rate were measured before and after the exercise intervention. Body composition did not change (body fat % in CON 34.0 ± 4.0% vs. 33.9 ± 3.6% and EX 34.1 ± 4.0% vs. 34.0 ± 3.4%). Mean submaximal heart rate during steady-state exercise in EX was lower after training compared to CON (p < .05); however, V̇O2max did not significantly (CON 1.96 ± 0.23 vs. 1.99 ± 0.241 LO2/min and EX 1.86 ± 0.39 vs. 1.94 ± 0.30 LO2/min). Neither estimated TDEE (CON, 11.6 ± 2.0 vs. 11.4 ± 2.78 MJ; and EX 11.4 ± 3.3 vs. 11.5 ± 2.5 MJ, pre vs. post, respectively), RMR (CON 134.2 ± 9.4 vs. 136.9 ± 15.0 KJ/kgFFM/day, and EX 138.4 ± 6.4 vs. 140.7 ± 14.2 KJ/kgFFM/day, pre vs. post, respectively), TEI (CON 7.9 ± 2.2 vs. 8.2 ± 2.5 MJ, and EX 9.4 ±1.6 vs. 8.3 ± 2.8 MJ), nor HB (CON 110,808 ± 12,574 vs. 107,366 ± 12,864 beats, and EX 110,188 ± 9,219 vs. 114,590 ± 12,750 beats) change over 8 weeks in either group. These data suggest that a moderate exercise program may not impact on TDEE, RMR, TEI, or HB in previously sedentary, older women.

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Caffeine Ingestion Does Not Alter Performance during a 100-km Cycling Time-Trial Performance

Angus M. Hunter, Allan St, Clair Gibson, Malcolm Collins, Mike Lambert, and Timothy D. Noakes

This study analyzed the effect of caffeine ingestion on performance during a repeated-measures, 100-km, laboratory cycling time trial that included bouts of 1- and 4-km high intensity epochs (HIE). Eight highly trained cyclists participated in 3 separate trials—placebo ingestion before exercise with a placebo carbohydrate solution and placebo tablets during exercise (Pl), or placebo ingestion before exercise with a 7% carbohydrate drink and placebo tablets during exercise (Cho), or caffeine tablet ingestion before and during exercise with 7% carbohydrate (Caf). Placebo (twice) or 6 mg · kg−1 caffeine was ingested 60 min prior to starting 1 of the 3 cycling trials, during which subjects ingested either additional placebos or a caffeine maintenance dose of 0.33 mg · kg−1 every 15 min to trial completion. The 100-km time trial consisted of five 1-km HIE after 10, 32, 52, 72, and 99 km, as well as four 4-km HIE after 20, 40, 60, and 80 km. Subjects were instructed to complete the time trial and all HIE as fast as possible. Plasma (caffeine) was significantly higher during Caf (0.43 ± 0.56 and 1.11 ± 1.78 mM pre vs. post Pl; and 47.32 ± 12.01 and 72.43 ± 29.08 mM pre vs. post Caf). Average power, HIE time to completion, and 100-km time to completion were not different between trials. Mean heart rates during both the 1-km HIE (184.0 ± 9.8 Caf; 177.0 ± 5.8 Pl; 177.4 ± 8.9 Cho) and 4-km HIE (181.7 ± 5.7 Caf; 174.3 ± 7.2 Pl; 175.6 ± 7.6 Cho; p < .05) was higher in Caf than in the other groups. No significant differences were found between groups for either EMG amplitude (IEMG) or mean power frequency spectrum (MPFS). IEMG activity and performance were not different between groups but were both higher in the 1-km HIE, indicating the absence of peripheral fatigue and the presence of a centrally-regulated pacing strategy that is not altered by caffeine ingestion. Caffeine may be without ergogenic benefit during endurance exercise in which the athlete begins exercise with a defined, predetermined goal measured as speed or distance.

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Decreased Resting Metabolic Rate in Ballet Dancers with Menstrual Irregularity

Kathryn H. Myburgh, Claire Berman, Illana Novick, Timothy D. Noakes, and Estelle V. Lambert

We studied 21 ballet dancers aged 19.4 ± 1.4 years, hypothesizing that undernu-trition was a major factor in menstrual irregularity in this population. Menstrual history was determined by questionnaire. Eight dancers had always been regular (R). Thirteen subjects had a history of menstrual irregularity (HI). Of these, 2 were currently regularly menstruating, 3 had short cycles, 6 were oligomenorrheic, and 2 were amenorrheic. Subjects completed a weighed dietary record and an Eating Attitudes Test (EAT). The following physiological parameters were measured: body composition by anthropometry, resting metabolic rate (RMR) by open-circuit indirect calorimetry, and serum thyroid hormone concentrations by radioimmunoassay. R subjects had significantly higher RMR than HI subjects. Also, HI subjects had lower RMR than predicted by fat-free mass, compared to the R subjects. Neitherreported energy intake nor serum thyroid hormone concentrations were different between R and HI subjects. EAT scores varied and were not different between groups. We concluded that in ballet dancers, low RMR is more strongly associated with menstrual irregularity than is currentreported energy intake or serum thyroid hormone concentrations.

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Failure of Magnesium Supplementation to Influence Marathon Running Performance or Recovery in Magnesium-Replete Subjects

Sonja Terblanche, Timothy D. Noakes, Steven C. Dennis, De Wet Marais, and Michael Eckert

This study examined the effect of magnesium supplementation on muscle magnesium content, on running performance during a 42-kni marathon footrace, and on muscle damage and the rate of recovery of muscle function following the race. Twenty athletes were divided equally into two matched groups and were studied for 4 weeks before and 6 weeks after a marathon in a double-blind trial; the experimental group received magnesium supplement (365 mg per day) and the control group, placebo. Magnesium supplementation did not increase either muscle or serum magnesium concentrations and had no measurable effect on 42-km marathon running performance. Extra magnesium ingestion also had no influence on the extent of muscle damage or the rate of recovery of muscle function. The latter was significantly reduced immediately after the marathon but returned to normal within 1 week. Thus, magnesium supplementation in magnesium-replete subjects did not enhance performance or increase resistance to muscle damage during the race, or the rate of recovery of muscle function following the race.

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The Effects of Carbohydrate Loading on Muscle Glycogen Content and Cycling Performance

Laurie H.G. Rauch, Ian Rodger, Gary R. Wilson, Judy D. Belonje, Steven C. Dennis, Timothy D. Noakes, and John A. Hawley

This study compared the effects of supplementing the normal diets of 8 endurance-trained cyclists with additional carbohydrate (CHO), in the form of potato starch, for 3 days on muscle glycogen utilization and performance during a 3-hr cycle ride. On two occasions prior to the trial, the subjects ingested in random order either their normal CHO intake of 6.15 ± 0.23 g/kg body mass/day or a high-CHO diet of 10.52 ± 0.57 g/kg body mass/day. The trial consisted of 2 hr of cycling at ~75% of VO 2 peak with five 60-s sprints at 100% VO 2 peak at 20-min intervals, followed by a 60-min performance ride. Increasing CHO intake by 72 ± 9% for 3 days prior to the trial elevated preexercise muscle glycogen contents, improved power output, and extended the distance covered in 1 hr. Muscle glycogen contents were similar at the end of the 3-hr trial, indicating a greater utilization of glycogen when subjects were CHO loaded, which may have been responsible for their improved cycling performance.

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Variability in Exercise Capacity and Metabolic Response During Endurance Exercise After a Low Carbohydrate Diet

Amanda Claassen, Estelle V. Lambert, Andrew N. Bosch, Ian M. Rodger, Alan St. Clair Gibson, and Timothy D. Noakes

The impact of altered blood glucose concentrations on exercise metabolism and performance after a low carbohydrate (CHO) diet was investigated. In random order, 1 wk apart, 9 trained men underwent euglycemic (CI) or placebo (PI) clamps, while performing up to 150 min of cycling at 70% VO2max, after 48 h on a low CHO diet. The range in improvement in endurance capacity with glucose infusion was large (28 ± 26%, P < 0.05). Fifty-six percent of subjects in CI failed to complete 150 min of exercise despite maintenance of euglycemia, while only 2 subjects in PI completed 150 min of exercise, despite being hypoglycemic. Total CHO oxidation remained similar between trials. Despite longer exercise times in CI, similar amounts of muscle glycogen were used to PI. Maintenance of euglycemia in the CHO-depleted state might have an ergogenic effect, however, the effect is highly variable between individuals and independent of changes in CHO oxidation.

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High-Fat Diet versus Habitual Diet Prior to Carbohydrate Loading: Effects on Exercise Metabolism and Cycling Performance

Estelle V. Lambert, Julia H. Goedecke, Charl van Zyl, Kim Murphy, John A. Hawley, Steven C. Dennis, and Timothy D. Noakes

We examined the effects of a high-fat diet (HFD-CHO) versus a habitual diet, prior to carbohydrate (CHO)-loading on fuel metabolism and cycling time-trial (TT) performance. Five endurance-trained cyclists participated in two 14-day randomized cross-over trials during which subjects consumed either a HFD (>65% MJ from fat) or their habitual diet (CTL) (30 ± 5% MJ from fat) for 10 day, before ingesting a high-CHO diet (CHO-loading, CHO > 70% MJ) for 3 days. Trials consisted of a 150-min cycle at 70% of peak oxygen uptake (V̇O2peak), followed immediately by a 20-km TT. One hour before each trial, cyclists ingested 400 ml of a 3.44% medium-chain triacylglycerol (MCT) solution, and during the trial, ingested 600 ml/hour of a 10% 14C-glucose + 3.44% MCT solution. The dietary treatments did not alter the subjects’ weight, body fat, or lipid profile. There were also no changes in circulating glucose, lactate, free fatty acid (FFA), and β-hydroxybutyrate concentrations during exercise. However, mean serum glycerol concentrations were significantly higher (p < .01) in the HFD-CHO trial. The HFD-CHO diet increased total fat oxidation and reduced total CHO oxidation but did not alter plasma glucose oxidation during exercise. By contrast, the estimated rates of muscle glycogen and lactate oxidation were lower after the HFD-CHO diet. The HFD-CHO treatment was also associated with improved TT times (29.5 ± 2.9 min vs. 30.9 ± 3.4 min for HFD-CHO and CTL-CHO, p < .05). High-fat feeding for 10 days prior to CHO-loading was associated with an increased reliance on fat, a decreased reliance on muscle glycogen, and improved time trial performance after prolonged exercise.