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Graeme L. Close, Craig Sale, Keith Baar, and Stephane Bermon

Injuries are an inevitable consequence of athletic performance with most athletes sustaining one or more during their athletic careers. As many as one in 12 athletes incur an injury during international competitions, many of which result in time lost from training and competition. Injuries to skeletal muscle account for over 40% of all injuries, with the lower leg being the predominant site of injury. Other common injuries include fractures, especially stress fractures in athletes with low energy availability, and injuries to tendons and ligaments, especially those involved in high-impact sports, such as jumping. Given the high prevalence of injury, it is not surprising that there has been a great deal of interest in factors that may reduce the risk of injury, or decrease the recovery time if an injury should occur: One of the main variables explored is nutrition. This review investigates the evidence around various nutrition strategies, including macro- and micronutrients, as well as total energy intake, to reduce the risk of injury and improve recovery time, focusing upon injuries to skeletal muscle, bone, tendons, and ligaments.

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Tim Donovan, Tim Ballam, James P. Morton, and Graeme L. Close

The aim of this study was to test the hypothesis that β-alanine supplementation improves punch power and frequency in amateur boxers during a simulated contest. Sixteen amateur boxers (each approximately 6 yr experience) were assigned to β-alanine (n = 8; 1.5 g 4 times/d for 4 wk) or placebo supplementation (n = 8) after initially being assessed for baseline punch performance. Before and after the supplementation period, all boxers completed a simulated contest consisting of 3 × 3-min rounds (interspersed with 60-s rests) on a punching bag (with a force transducer attached). Each round involved performing 2 min 50 s standardized punching (standardized jab, cross combination) based on notation analysis, whereas the last 10 s involved maximal-output punching (standardized jab, cross combination), during which time punch force and frequency were recorded. Postcontest blood lactate was significantly increased in the β-alanine group (presupplementation 9.5 ± 0.9 mmol/L, postsupplementation 12.6 ± 0.5 mmol/L, p < .05), whereas the placebo group showed no change (presupplementation 8 ± 2.8 mmol/L, postsupplementation 7.0 ± 2.7 mmol/L; p > .05). During the 10-s maximal-output punching, changes in mean punch force (β-alanine 20 ± 1.01 kg, placebo 1 ± 1 kg) and punch frequency (β-alanine 5 ± 4, placebo –2 ± 3) were greater (p < .05) in the β-alanine-supplemented group. The authors conclude that β-alanine supplementation improves punching performance in amateur boxers and suggest that this supplementation protocol may also prove ergogenic for other combat-related sports.

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George Wilson, Dan Martin, James P. Morton, and Graeme L. Close

Despite consistent reports of poor bone health in male jockeys, it is not yet known if this is a consequence of low energy availability or lack of an osteogenic stimulus. Given the rationale that low energy availability is a contributing factor in low bone health, we tested the hypothesis that both hip and lumbar bone mineral density (BMD) should progressively worsen in accordance with the years of riding. In a cross-sectional design, male apprentice (n = 17) and senior (n = 14) jockeys (matched for body mass and fat-free mass) were assessed for hip and lumbar spine BMD, as well as both measured and predicted resting metabolic rate (RMR). Despite differences (p < .05) in years of race riding (3.4 ± 2 vs. 16.3 ± 6.8), no differences were apparent (p > .05) in hip (−0.9 ± 1.1 vs. −0.8 ± 0.7) and lumbar Z-scores (−1.3 ± 1.4 vs. −1.5 ± 1) or measured RMR (1,459 ± 160 vs. 1,500 ± 165 kcal/day) between apprentices and senior jockeys, respectively. Additionally, years of race riding did not demonstrate any significant correlations (p > .05) with either hip or lumbar spine BMD. Measured RMR was also not different (p > .05) from predicted RMR in either apprentice (1,520 ± 44 kcal/day) or senior jockeys (1,505 ± 70 kcal/day). When considered with previously published data examining underreporting of energy intake and direct assessments of energy expenditure, we suggest that low BMD in jockeys is not due to low energy availability per se but rather the lack of an osteogenic stimulus associated with riding.

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Conor Taylor, Daniel Higham, Graeme L. Close, and James P. Morton

The aim of this study was to test the hypothesis that adding caffeine to postexercise carbohydrate (CHO) feedings improves subsequent high-intensity interval-running capacity compared with CHO alone. In a repeated-measures design, 6 men performed a glycogen-depleting exercise protocol until volitional exhaustion in the morning. Immediately after and at 1, 2, and 3 hr postexercise, participants consumed 1.2 g/kg body mass CHO of a 15% CHO solution, a similar CHO solution but with addition of 8 mg/kg body mass of caffeine (CHO+CAFF), or an equivalent volume of flavored water only (WAT). After the 4-hr recovery period, participants performed the Loughborough Intermittent Shuttle Test (LIST) to volitional exhaustion as a measure of high-intensity interval-running capacity. Average blood glucose values during the 4-hr recovery period were higher in the CHO conditions (p < .005) than in the WAT trial (4.6 ± 0.3 mmol/L), although there was no difference (p = .46) between CHO (6.2 ± 0.8 mmol/L) and CHO+CAFF (6.7 ± 1.0 mmol/L). Exercise capacity during the LIST was significantly longer in the CHO+CAFF trial (48 ± 15 min) than in the CHO (32 ± 15 min, p = .04) and WAT conditions (19 ± 6 min, p = .001). All 6 participants improved performance in CHO+CAFF compared with CHO (95% CI for mean difference = 1–32 min). The study provides novel data by demonstrating that adding caffeine to postexercise CHO feeding improves subsequent high-intensity interval-running capacity, a finding that may be related to higher rates of postexercise muscle glycogen resynthesis previously observed under similar feeding conditions.

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Louise M. Burke, Graeme L. Close, Bronwen Lundy, Martin Mooses, James P. Morton, and Adam S. Tenforde

Low energy availability (LEA) is a key element of the Female Athlete Triad. Causes of LEA include failure to match high exercise energy expenditure (unintentional) or pathological behaviors of disordered eating (compulsive) and overzealous weight control programs (misguided but intentional). Recognition of such scenarios in male athletes contributed to the pronouncement of the more inclusive Relative Energy Deficiency in Sport (RED-S) syndrome. This commentary describes the insights and experience of the current group of authors around the apparently heightened risk of LEA in some populations of male athletes: road cyclists, rowers (lightweight and open weight), athletes in combat sports, distance runners, and jockeys. The frequency, duration, and magnitude of the LEA state appear to vary between populations. Common risk factors include cyclical management of challenging body mass and composition targets (including “making weight”) and the high energy cost of some training programs or events that is not easily matched by energy intake. However, additional factors such as food insecurity and lack of finances may also contribute to impaired nutrition in some populations. Collectively, these insights substantiate the concept of RED-S in male athletes and suggest that a specific understanding of a sport, subpopulation, or culture may identify a complex series of factors that can contribute to LEA and the type and severity of its outcomes. This commentary provides a perspective on the range of risk factors that should be addressed in future surveys of RED-S in athletic populations and targeted for specific investigation and modification.

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James C. Morehen, Carl Langan-Evans, Elliot C.R. Hall, Graeme L. Close, and James P. Morton

Weight cycling is thought to increase the risk of obesity and cardiometabolic disease in nonathletic and athletic populations. However, the magnitude and frequency of weight cycling is not well characterized in elite athletes. To this end, we quantified the weight cycling practices of a male World Champion professional boxer competing at super middleweight (76.2 kg). Over a 5-year period comprising 11 contests, we assessed changes in body mass (n = 8 contests) and body composition (n = 6 contests) during the training camp preceding each contest. Time taken to make weight was 11 ± 4 weeks (range: 4–16). Absolute and relative weight loss for each contest was 12.4 ± 2.1 kg (range: 9.8–17.0) and 13.9% ± 2.0% (range: 11.3–18.2), respectively. Notably, the athlete commenced each training camp with progressive increases in fat mass (i.e., 12.5 and 16.1 kg for Contests 1 and 11) and reductions in fat-free mass (i.e., 69.8 and 67.5 kg for Contests 1 and 11, respectively). Data suggest that weight cycling may lead to “fat overshooting” and further weight gain in later life. Larger scale studies are now required to characterize the weight cycling practices of elite athletes and robustly assess future cardiometabolic disease risk. From an ethical perspective, practitioners should be aware of the potential health consequences associated with weight cycling.

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Llion A. Roberts, Kris Beattie, Graeme L. Close, and James P. Morton

Purpose:

To test the hypothesis that antioxidants can attenuate high-intensity interval training–induced improvements in exercise performance.

Methods:

Two groups of recreationally active males performed a high-intensity interval running protocol, four times per week for 4 wk. Group 1 (n = 8) consumed 1 g of vitamin C daily throughout the training period, whereas Group 2 (n = 7) consumed a visually identical placebo. Pre- and posttraining, subjects were assessed for VO2max, 10 km time trial, running economy at 12 km/h and distance run on the YoYo intermittent recovery tests level 1 and 2 (YoYoIRT1/2). Subjects also performed a 60 min run before and after training at a running velocity of 65% of pretraining VO2max so as to assess training-induced changes in substrate oxidation rates.

Results:

Training improved (P < .0005) VO2max, 10 km time trial, running economy, YoYoIRT1 and YoYoIRT2 in both groups, although there was no difference (P = .31, 0.29, 0.24, 0.76 and 0.59) between groups in the magnitude of training-induced improvements in any of the aforementioned parameters. Similarly, training also decreased (P < .0005) mean carbohydrate and increased mean fat oxidation rates during submaximal exercise in both groups, although no differences (P = .98 and 0.94) existed between training conditions.

Conclusions:

Daily oral consumption of 1 g of vitamin C during a 4 wk high-intensity interval training period does not impair training-induced improvements in the exercise performance of recreationally active males.

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George Wilson, Neil Chester, Martin Eubank, Ben Crighton, Barry Drust, James P. Morton, and Graeme L. Close

Professional jockeys are unique among weight-making athletes, as they are often required to make weight daily and, in many cases, all year-round. Common methods employed by jockeys include dehydration, severe calorie restriction, and sporadic eating, all of which have adverse health effects. In contrast, this article outlines a structured diet and exercise plan, employed by a 22-yr-old professional National Hunt jockey in an attempt to reduce weight from 70.3 to 62.6 kg, that does not rely on any of the aforementioned techniques. Before the intervention, the client’s typical daily energy intake was 8.2 MJ (42% carbohydrate [CHO], 36% fat, 22% protein) consumed in 2 meals only. During the 9-wk intervention, daily energy intake was approximately equivalent to resting metabolic rate, which the athlete consumed as 6 meals per day (7.6 MJ, 46% CHO, 19% fat, 36% protein). This change in frequency and composition of energy intake combined with structured exercise resulted in a total body-mass loss of 8 kg, corresponding to reductions in body fat from 14.5% to 9%. No form of intentional dehydration occurred throughout this period, and mean urine osmolality was 285 mOsm/kg (SD 115 mOsm/kg). In addition, positive changes in mood scores (BRUMS scale) also occurred. The client was now able to ride light for the first time in his career without dehydrating, thereby challenging the cultural practices inherent in the sport.

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Reuben G. Stables, Andreas M. Kasper, S. Andy Sparks, James P. Morton, and Graeme L. Close

The remote food photography method, often referred to as “Snap-N-Send” by sport nutritionists, has been reported as a valid method to assess energy intake in athletic populations. However, preliminary studies were not conducted in true free-living conditions, and dietary assessment was performed by one researcher only. The authors, therefore, assessed the validity of Snap-N-Send to assess the energy and macronutrient composition in experienced (EXP, n = 23) and inexperienced (INEXP, n = 25) sport nutritionists. The participants analyzed 2 days of dietary photographs, comprising eight meals. Day 1 consisted of “simple” meals based around easily distinguishable foods (i.e., chicken breast and rice), and Day 2 consisted of “complex” meals, containing “hidden” ingredients (i.e., chicken curry). The estimates of dietary intake were analyzed for validity using one-sample t tests and typical error of estimates (TEE). The INEXP and EXP nutritionists underestimated energy intake for the simple day (mean difference [MD] = −1.5 MJ, TEE = 10.1%; −1.2 MJ, TEE = 9.3%, respectively) and the complex day (MD = −1.2 MJ, TEE = 17.8%; MD = −0.6 MJ, 14.3%, respectively). Carbohydrate intake was underestimated by INEXP (MD = −65.5 g/day, TEE = 10.8% and MD = −28.7 g/day, TEE = 24.4%) and EXP (MD = −53.4 g/day, TEE = 10.1% and −19.9 g/day, TEE = 17.5%) for both the simple and complex days, respectively. Interpractitioner reliability was generally “poor” for energy and macronutrients. The data demonstrate that the remote food photography method/Snap-N-Send underestimates energy intake in simple and complex meals, and these errors are evident in the EXP and INEXP sport nutritionists.

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George Wilson, Jerry Hill, Daniel Martin, James P. Morton, and Graeme L. Close

Flat jockeys in Great Britain (GB) are classified as apprentices if they are aged less than 26 years and/or have ridden less than 95 winners. To gain experience, apprentices are allocated a weight allowance of up to 7 lb (3.2 kg). Given that there is no off-season in GB flat horseracing, jockeys are required to maintain their racing weight all year round. In light of recent work determining that current apprentices are considerably heavier than previous generations and that smaller increases have been made in the minimum weight, the aim of this study was to assess if the minimum weight in GB was achievable. To make the minimum weight (50.8 kg) with the maximal weight allowance requires a body mass of ∼46.6 kg while maintaining a fat mass >2.5 kg (the lowest fat mass previously reported in weight-restricted males). Thirty-two male apprentice jockeys were assessed for body composition using dual-energy X-ray absorptiometry. The mean (SD) total mass and fat mass were 56 (2.9) kg and 7.2 (1.8) kg, respectively. Given that the lowest theoretical body mass for this group was 51.2 (2.3) kg, only one of 32 jockeys was deemed feasible to achieve the minimum weight with their current weight allowance and maintaining fat mass >2.5 kg. Furthermore, urine osmolality of 780 (260) mOsmol/L was seen, with 22 (out of 32) jockeys classed as dehydrated (>700 mOsmols/L), indicating that body mass would be higher when euhydrated. Additionally, we observed that within new apprentice jockeys licensed during this study (N = 41), only one jockey was able to achieve the minimum weight. To facilitate the goal of achieving race weight with minimal disruptions to well-being, the authors’ data suggest that the minimum weight for GB apprentices should be raised.