Athletes are exposed to numerous nutritional products, attractively marketed with claims of optimizing health, function, and performance. However, there is limited evidence to support many of these claims, and the efficacy and safety of many products is questionable. The variety of nutritional aids considered for use by track-and-field athletes includes sports foods, performance supplements, and therapeutic nutritional aids. Support for sports foods and five evidence-based performance supplements (caffeine, creatine, nitrate/beetroot juice, β-alanine, and bicarbonate) varies according to the event, the specific scenario of use, and the individual athlete’s goals and responsiveness. Specific challenges include developing protocols to manage repeated use of performance supplements in multievent or heat-final competitions or the interaction between several products which are used concurrently. Potential disadvantages of supplement use include expense, false expectancy, and the risk of ingesting banned substances sometimes present as contaminants. However, a pragmatic approach to the decision-making process for supplement use is recommended. The authors conclude that it is pertinent for sports foods and nutritional supplements to be considered only where a strong evidence base supports their use as safe, legal, and effective and that such supplements are trialed thoroughly by the individual before committing to use in a competition setting.
Peter Peeling, Linda M. Castell, Wim Derave, Olivier de Hon, and Louise M. Burke
Elizabeth M. Broad, Louise M. Burke, Greg R. Cox, Prue Heeley, and Malcolm Riley
Fluid losses (measured by body weight changes) and voluntary fluid intakes were measured in elite basketball, netball, and soccer teams during typical summer and winter exercise sessions to determine fluid requirements and the degree of fluid replacement. Each subject was weighed in minimal clothing before and immediately after training, weights, and competition sessions; fluid intake, duration of exercise, temperature and humidity, and opportunity to drink were recorded. Sweat rates were greatest during competition sessions and significantly lower during weights sessions for all sports. Seasonal variation in dehydration (%DH) was not as great as may have been expected, particularly in sports played indoors. Factors influencing fluid replacement during exercise included provision of an individual water bottle, proximity to water bottles during sessions, encouragement to drink, rules of the game, duration and number of breaks or substitutions, and awareness of personal sweat rates. Guidelines for optimizing fluid intakes in these three sports are provided.
Heidi M. Staudacher, Andrew L. Carey, Nicola K. Cummings, John A. Hawley, and Louise M. Burke
We determined the effect of a high-fat diet and carbohydrate (CHO) restoration on substrate oxidation and glucose tolerance in 7 competitive ultra-endurance athletes (peak oxygen uptake [V̇O2peak] 68 ± 1 ml · kg−1 · min−1; mean±SEM). For 6 days, subjects consumed a random order of a high-fat (69% fat; FAT-adapt) or a high-CHO (70% CHO; HCHO) diet, each followed by 1 day of a high-CHO diet. Treatments were separated by an 18-day wash out. Substrate oxidation was determined during submaximal cycling (20 min at 65% V̇O2peak) prior to and following the 6 day dietary interventions. Fat oxidation at baseline was not different between treatments (17.4 ± 2.1 vs. 16.1 ± 1.3 g · 20 min−1 for FAT-adapt and HCHO, respectively) but increased 34% after 6 days of FAT-adapt (to 23.3 ± 0.9 g · 20 min−1, p < .05) and decreased 30% after HCHO (to 11.3±1.4 g · 20 min−1, p < .05). Glucose tolerance, determined by the area under the plasma [glucose] versus time curve during an oral glucose tolerance (OGTT) test, was similar at baseline (545±21 vs. 520±28 mmol · L−1 · 90 min−1), after 5-d of dietary intervention (563 ± 26 vs. 520 ± 18 mmol · L−1 · 90 min−1) and after 1 d of high-CHO (491 ± 28 vs. 489 ± 22 mmol · L−1 · 90min−1 for FAT- adapt and HCHO, respectively). An index of whole-body insulin sensitivity (SI 10000/÷fasting [glucose] × fasting [insulin] × mean [glucose] during OGTT × mean [insulin] during OGTT) was similar at baseline (15 ± 2 vs. 17 ± 5 arbitrary units), after 5-d of dietary intervention (15 ± 2 vs. 15 ± 2) and after 24 h of CHO loading (17 ± 3 vs. 18 ± 2 for FAT- adapt and HCHO, respectively). We conclude that despite marked changes in the pattern of substrate oxidation during submaximal exercise, short-term adaptation to a high-fat diet does not alter whole-body glucose tolerance or an index of insulin sensitivity in highly-trained individuals.
Louise M. Burke, Gary Slater, Elizabeth M. Broad, Jasmina Haukka, Sofie Modulon, and William G. Hopkins
We undertook a dietary survey of 167 Australian Olympic team athletes (80 females and 87 males) competing in endurance sports (n = 41), team sports (n = 31), sprint- or skill-based sports (n = 67), and sports in which athletes are weight-conscious (n = 28). Analysis of their 7-day food diaries provided mean energy intakes, nutrient intakes, and eating patterns. Higher energy intakes relative to body mass were reported by male athletes compared with females, and by endurance athletes compared with other athletes. Endurance athletes reported substantially higher intakes of carbohydrate (CHO) than other athletes, and were among the athletes most likely to consume CHO during and after training sessions. Athletes undertaking weight-conscious sports reported relatively low energy intakes and were least likely to consume CHO during a training session or in the first hour of recovery. On average, athletes reported eating on ~5 separate occasions each day, with a moderate relationship between the number of daily eating occasions and total energy intake. Snacks, defined as food or drink consumed between main meals, provided 23% of daily energy intake and were chosen from sources higher in CHO and lower in fat and protein than foods chosen at meals. The dietary behaviors of these elite athletes were generally consistent with guidelines for sports nutrition, but intakes during and after training sessions were often sub-optimal. Although it is of interest to study the periodicity of fluid and food intake by athletes, it is difficult to compare across studies due to a lack of standardized terminology.
Joanne G. Mirtschin, Sara F. Forbes, Louise E. Cato, Ida A. Heikura, Nicki Strobel, Rebecca Hall, and Louise M. Burke
The authors describe the implementation of a 3-week dietary intervention in elite race walkers at the Australian Institute of Sport, with a focus on the resources and strategies needed to accomplish a complex study of this scale. Interventions involved: traditional guidelines of high carbohydrate (CHO) availability for all training sessions; a periodized CHO diet which integrated sessions with low and high CHO availability within the same total CHO intake; and a ketogenic low-CHO high-fat diet. Seven-day menus and recipes were constructed for a communal eating setting to meet nutritional goals as well as individualized food preferences and special needs. Menus also included nutrition support before, during, and after exercise. Daily monitoring, via observation and food checklists, showed that energy and macronutrient targets were achieved. Diets were matched for energy (∼14.8 MJ/d) and protein (∼2.1 g·kg−1·day−1) and achieved desired differences for fat and CHO, with high CHO availability and periodized CHO availability: CHO = 8.5 g·kg−1·day−1, 60% energy, fat = 20% of energy and low-CHO high-fat diet: 0.5 g·kg−1·day−1 CHO, fat = 78% energy. There were no differences in micronutrient intake or density between the high CHO availability and periodized CHO availability diets; however, the micronutrient density of the low-CHO high-fat diet was significantly lower. Daily food costs per athlete were similar for each diet (∼AU$ 27 ± 10). Successful implementation and monitoring of dietary interventions in sports nutrition research of the scale of the present study require meticulous planning and the expertise of chefs and sports dietitians. Different approaches to sports nutrition support raise practical challenges around cost, micronutrient density, accommodation of special needs, and sustainability.
Iñigo Mujika, Shona Halson, Louise M. Burke, Gloria Balagué, and Damian Farrow
Sports periodization has traditionally focused on the exercise aspect of athletic preparation, while neglecting the integration of other elements that can impact an athlete’s readiness for peak competition performances. Integrated periodization allows the coordinated inclusion of multiple training components best suited for a given training phase into an athlete’s program. The aim of this article is to review the available evidence underpinning integrated periodization, focusing on exercise training, recovery, nutrition, psychological skills, and skill acquisition as key factors by which athletic preparation can be periodized. The periodization of heat and altitude adaptation, body composition, and physical therapy is also considered. Despite recent criticism, various methods of exercise training periodization can contribute to performance enhancement in a variety of elite individual and team sports, such as soccer. In the latter, both physical and strategic periodization are useful tools for managing the heavy travel schedule, fatigue, and injuries that occur throughout a competitive season. Recovery interventions should be periodized (ie, withheld or emphasized) to influence acute and chronic training adaptation and performance. Nutrient intake and timing in relation to exercise and as part of the periodization of an athlete’s training and competition calendar can also promote physiological adaptations and performance capacity. Psychological skills are a central component of athletic performance, and their periodization should cater to each athlete’s individual needs and the needs of the team. Skill acquisition can also be integrated into an athlete’s periodized training program to make a significant contribution to competition performance.
Peter Peeling, Martyn J. Binnie, Paul S.R. Goods, Marc Sim, and Louise M. Burke
A strong foundation in physical conditioning and sport-specific experience, in addition to a bespoke and periodized training and nutrition program, are essential for athlete development. Once these underpinning factors are accounted for, and the athlete reaches a training maturity and competition level where marginal gains determine success, a role may exist for the use of evidence-based performance supplements. However, it is important that any decisions surrounding performance supplements are made in consideration of robust information that suggests the use of a product is safe, legal, and effective. The following review focuses on the current evidence-base for a number of common (and emerging) performance supplements used in sport. The supplements discussed here are separated into three categories based on the level of evidence supporting their use for enhancing sports performance: (1) established (caffeine, creatine, nitrate, beta-alanine, bicarbonate); (2) equivocal (citrate, phosphate, carnitine); and (3) developing. Within each section, the relevant performance type, the potential mechanisms of action, and the most common protocols used in the supplement dosing schedule are summarized.
Louise M. Burke, John A. Hawley, Asker Jeukendrup, James P. Morton, Trent Stellingwerff, and Ronald J. Maughan
From the breakthrough studies of dietary carbohydrate and exercise capacity in the 1960s through to the more recent studies of cellular signaling and the adaptive response to exercise in muscle, it has become apparent that manipulations of dietary fat and carbohydrate within training phases, or in the immediate preparation for competition, can profoundly alter the availability and utilization of these major fuels and, subsequently, the performance of endurance sport (events >30 min up to ∼24 hr). A variety of terms have emerged to describe new or nuanced versions of such exercise–diet strategies (e.g., train low, train high, low-carbohydrate high-fat diet, periodized carbohydrate diet). However, the nonuniform meanings of these terms have caused confusion and miscommunication, both in the popular press and among the scientific community. Sports scientists will continue to hold different views on optimal protocols of fuel support for training and competition in different endurance events. However, to promote collaboration and shared discussions, a commonly accepted and consistent terminology will help to strengthen hypotheses and experimental/experiential data around various strategies. We propose a series of definitions and explanations as a starting point for a more unified dialogue around acute and chronic manipulations of fat and carbohydrate in the athlete’s diet, noting philosophies of approaches rather than a single/definitive macronutrient prescription. We also summarize some of the key questions that need to be tackled to help produce greater insight into this exciting area of sports nutrition research and practice.
Amelia J. Carr, Gary J. Slater, Christopher J. Gore, Brian Dawson, and Louise M. Burke
Sodium bicarbonate (NaHCO3) is often ingested at a dose of 0.3 g/kg body mass (BM), but ingestion protocols are inconsistent in terms of using solution or capsules, ingestion period, combining NaHCO3 with sodium citrate (Na3C6H5O7), and coingested food and fluid.
To quantify the effect of ingesting 0.3 g/kg NaHCO3 on blood pH, [HCO3−], and gastrointestinal (GI) symptoms over the subsequent 3 hr using a range of ingestion protocols and, thus, to determine an optimal protocol.
In a crossover design, 13 physically active subjects undertook 8 NaHCO3 experimental ingestion protocols and 1 placebo protocol. Capillary blood was taken every 30 min and analyzed for pH and [HCO3−]. GI symptoms were quantified every 30 min via questionnaire. Statistics used were pairwise comparisons between protocols; differences were interpreted in relation to smallest worthwhile changes for each variable. A likelihood of >75% was a substantial change.
[HCO3−] and pH were substantially greater than in placebo for all other ingestion protocols at almost all time points. When NaHCO3 was coingested with food, the greatest [HCO3−] (30.9 mmol/kg) and pH (7.49) and lowest incidence of GI symptoms were observed. The greatest incidence of GI side effects was observed 90 min after ingestion of 0.3 g/kg NaHCO3 solution.
The changes in pH and [HCO3−] for the 8 NaHCO3-ingestion protocols were similar, so an optimal protocol cannot be recommended. However, the results suggest that NaHCO3 coingested with a high-carbohydrate meal should be taken 120–150 min before exercise to induce substantial blood alkalosis and reduce GI symptoms.
Milou Beelen, Louise M. Burke, Martin J. Gibala, and Luc J.C. van Loon
During postexercise recovery, optimal nutritional intake is important to replenish endogenous substrate stores and to facilitate muscle-damage repair and reconditioning. After exhaustive endurance-type exercise, muscle glycogen repletion forms the most important factor determining the time needed to recover. Postexercise carbohydrate (CHO) ingestion has been well established as the most important determinant of muscle glycogen synthesis. Coingestion of protein and/or amino acids does not seem to further increase muscle glycogensynthesis rates when CHO intake exceeds 1.2 g · kg−1 · hr−1. However, from a practical point of view it is not always feasible to ingest such large amounts of CHO. The combined ingestion of a small amount of protein (0.2–0.4 g · (0.2−0.4 g · kg−1 · hr−1) with less CHO (0.8 g · kg−1 · hr−1) stimulates endogenous insulin release and results in similar muscle glycogen-repletion rates as the ingestion of 1.2 g · kg−1 · hr−1 CHO. Furthermore, postexercise protein and/or amino acid administration is warranted to stimulate muscle protein synthesis, inhibit protein breakdown, and allow net muscle protein accretion. The consumption of ~20 g intact protein, or an equivalent of ~9 g essential amino acids, has been reported to maximize muscle protein-synthesis rates during the first hours of postexercise recovery. Ingestion of such small amounts of dietary protein 5 or 6 times daily might support maximal muscle protein-synthesis rates throughout the day. Consuming CHO and protein during the early phases of recovery has been shown to positively affect subsequent exercise performance and could be of specific benefit for athletes involved in multiple training or competition sessions on the same or consecutive days.