Purpose: Wheelchair athletes experience a reduction in fat-free mass due to the underlying condition and/or muscle disuse. This leads to a lower resting energy expenditure (REE), as well as a lower energy expenditure during exercise or daily activities. Traditional markers of low energy availability (LEA), including amenorrhea and low bone mineral density, are often inconclusive in wheelchair athletes. This case study provides data from a professional female wheelchair badminton player with multiple sclerosis who presented with a reduced measured-to-predicted REE ratio (REEratio), a common indicator of LEA in able-bodied athletes. Furthermore, a nutrition and exercise intervention was conducted to restore REE. Methods: REE and body composition were measured using indirect calorimetry and dual-energy X-ray absorptiometry, respectively. The predicted REE of the REEratio was calculated using 2 separate approaches. An REEratio <0.9 was considered an indicator for LEA. A nutrition and exercise intervention was implemented to normalize REE and induce weight loss through increased meal frequency, a 200- to 400-kcal/d increase in energy intake, and added endurance exercise. Results: The athlete (33 y, 78 kg, 154 cm) initiallly showed an REEratio of 0.65 to 0.70, which increased to 1.00 to 1.09 after 1 year. The athlete lost 11.8 kg, almost exclusively (11 kg) in the form of fat mass. The athlete reported reduced fatigue and higher perceived fitness. Conclusion: The nutrition and exercise intervention successfully restored energy status, induced sustainable weight loss, and reduced fatigue in a wheelchair athlete with multiple sclerosis with presumed LEA. Methods to assess LEA in this population require further validation.
Joelle Leonie Flueck and Karsten Koehler
Bjoern Geesmann, Joachim Mester, and Karsten Koehler
Athletes competing in ultra-endurance events are advised to meet energy requirements, to supply appropriate amounts of carbohydrates (CHO), and to be adequately hydrated before and during exercise. In practice, these recommendations may not be followed because of satiety, gastrointestinal discomfort, and fatigue. The purpose of the study was to assess energy balance, macronutrient intake and hydration status before and during a 1,230-km bike marathon. A group of 14 well-trained participants (VO2max: 63.2 ± 3.3 ml/kg/min) completed the marathon after 42:47 hr. Ad libitum food and fluid intake were monitored throughout the event. Energy expenditure (EE) was derived from power output and urine and blood markers were collected before the start, after 310, 618, and 921 km, after the finish, and 12 hr after the finish. Energy intake (EI; 19,749 ± 4,502 kcal) was lower than EE (25,303 ± 2,436 kcal) in 12 of 14 athletes. EI and CHO intake (average: 57.1 ± 17.7 g/hr) decreased significantly after km 618 (p < .05). Participants ingested on average 392 ± 85 ml/hr of fluid, but fluid intake decreased after km 618 (p < .05). Hydration appeared suboptimal before the start (urine specific gravity: 1.022 ± 0.010 g/ml) but did not change significantly throughout the event. The results show that participants failed to maintain in energy balance and that CHO and fluid intake dropped below recommended values during the second half of the bike marathon. Individual strategies to overcome satiety and fatigue may be necessary to improve eating and drinking behavior during prolonged ultra-endurance exercise.
Hans Braun, Hans Geyer, and Karsten Koehler
Bjoern Geesmann, Jenna C. Gibbs, Joachim Mester, and Karsten Koehler
Ultraendurance athletes often accumulate an energy deficit when engaging in ultraendurance exercise, and on completion of the exercise, they exhibit endocrine changes that are reminiscent of starvation. However, it remains unclear whether these endocrine changes are a result of the exercise per se or secondary to the energy deficit and, more important, whether these changes can be attenuated by increased dietary intake. The goal of the study was to assess the relationship between changes in key metabolic hormones after ultraendurance exercise and measures of energy balance. Metabolic hormones, as well as energy intake and expenditure, were assessed in 14 well-trained male cyclists who completed a 1230-km ultraendurance cycling event. After completion of the event, serum testosterone (–67% ± 18%), insulin-like growth factor-1 (IGF-1) (–45% ± 8%), and leptin (–79% ± 9%) were significantly suppressed (P < .001) and remained suppressed after a 12-h recovery period (P < .001). Changes in IGF-1 were positively correlated with energy balance over the course of the event (r = .65, P = .037), which ranged from an 11,859-kcal deficit to a 3593-kcal surplus. The marked suppression of testosterone, IGF-1, and leptin after ultraendurance exercise is comparable to changes occurring during acute starvation. The suppression of IGF-1, but not that of other metabolic hormones, was strongly associated with the magnitude of the energy deficit, indicating that athletes who attained a greater energy deficit exhibited a more pronounced drop in IGF-1. Future studies are needed to determine whether increased dietary intake can attenuate the endocrine response to ultraendurance exercise.
Karsten Koehler, Frank Huelsemann, Markus de Marees, Bjoern Braunstein, Hans Braun, and Wilhelm Schaenzer
During prolonged periods of high energy expenditure (EE), restricted food intake can lead to a loss of body mass. This case study describes the preexpedition support for an unsupported 3-wk crossing of the Atacama Desert in Chile. The goals were to simulate the energy requirements of walking under varying conditions and to predict energy intake and EE to evaluate whether the expected weight loss was in acceptable limits. The expeditionist (male, 35 yr, 197 cm, basal weight 80 ± 0.5 kg) was a well-trained endurance athlete with experience of multiple expeditions. During the simulation, he walked on a treadmill at speeds of 2–7 km/hr under varying conditions of inclination (0%, 7.5%), backpack weight (0 kg, 30 kg), and altitude (sea level, simulated altitude of 3,500 m). Under all conditions, the lowest EE was observed at 5 km/hr. Based on the simulation data, we predicted an average EE of 4,944 kcal/day for the expedition. Because energy intake was restricted to 2,249 kcal/day, we expected the expeditionist to lose considerable weight and consequently advised him to gain 5 kg of body-fat reserves. During the actual desert crossing, he covered a distance of 26 ± 7 km/day at an average speed of 3.8 ± 0.4 km/hr. Daily EE (4,817 ± 794 kcal/day) exceeded energy intake (1,771 ± 685 kcal/day), and the negative energy balance was in agreement with the actual weight loss of 10.5 kg, which was most notable in the lower trunk.
Billy Sperlich, Karsten Koehler, Hans-Christer Holmberg, Christoph Zinner, and Joachim Mester
The aim of the study was to determine the cardiorespiratory and metabolic characteristics during intense and moderate table tennis (TT) training, as well as during actual match play conditions.
Blood lactate concentration (Lac), heart rate (HR, beats per minute [bpm]), oxygen uptake (VO2), and energy expenditure (EE) in 7 male participants of the German junior national team (age: 14 ± 1 y, weight: 60.5 ± 5.6 kg height; 165 ± 8 cm) were examined during six training sessions (TS) and during an international match. The VO2 was measured continuously with portable gas analyzers. Lac was assessed every 1 to 3 min during short breaks.
Mean (peak) values for Lac, HR, VO2, and EE during the TS were 1.2 ± 0.7 (4.5) mmol·L–1, 135 ± 18 (184) bpm, 23.5 ± 7.3 (43.0) mL·kg–1· min–1, and 6.8 ± 2.0 (11.2) METs, respectively. During match play, mean (peak) values were 1.1 ± 0.2 (1.6) mmol·L–1, 126 ± 22 (189) bpm, 25.6 ± 10.1 (45.9) mL·kg–1·min–1, and 4.8 ± 1.4 (9.6) METs, respectively.
For the frst time, cardiorespiratory and metabolic data in elite junior table tennis have been documented demonstrating low cardiorespiratory and metabolic demands during TT training and match play in internationally competing juniors.
Hans Braun, Karsten Koehler, Hans Geyer, Jens Kleinert, Joachim Mester, and Wilhelm Schänzer
Little is known about the prevalence and motives of supplement use among elite young athletes who compete on national and international levels. Therefore, the current survey was performed to assess information regarding the past and present use of dietary supplements among 164 elite young athletes (16.6 ± 3.0 years of age). A 5-page questionnaire was designed to assess their past and present (last 4 weeks) use of vitamins, minerals, carbohydrate, protein, and fat supplements; sport drinks; and other ergogenic aids. Furthermore, information about motives, sources of advice, supplement sources, and supplement contamination was assessed. Eighty percent of all athletes reported using at least 1 supplement, and the prevalence of use was significantly higher in older athletes (p < .05). Among supplement users, minerals, vitamins, sport drinks, energy drinks, and carbohydrates were most frequently consumed. Only a minority of the athletes declared that they used protein/amino acids, creatine, or other ergogenic aids. Major motives for supplement use were health related, whereas performance enhancement and recommendations by others were less frequently reported. Supplements were mainly obtained from parents or by athletes themselves and were mostly purchased in pharmacies, supermarkets, and health-food stores. Among all athletes, only 36% were aware of the problem of supplement contamination. The survey shows that supplement use is common and widespread among German elite young athletes. This stands in strong contrast to recommendations by leading sport organizations against supplement use by underage athletes.
Neele R. Mattausch, Kirsten Domnik, Karsten Koehler, Wilhelm Schaenzer, and Hans Braun
Alexandra Martin, Hande Hofmann, Clemens Drenowatz, Birgit Wallmann-Sperlich, Billy Sperlich, and Karsten Koehler
Energy availability describes the amount of dietary energy remaining for physiological functionality after the energy cost of exercise is deducted. The physiological and hormonal consequences of low energy availability (LEA) are well established, but the impact of LEA on physical activity behavior outside of exercise and, specifically, nonexercise activity thermogenesis (NEAT) has not been systematically examined. The authors conducted a secondary analysis of a repeated-measures crossover study in which recreationally trained young men (n = 6, 25 ± 1.0 years) underwent two 4-day conditions of LEA (15 kcal·kg fat-free mass−1 ·day−1) with and without endurance exercise (LEA + EX and LEA EX) and two energy-balanced control conditions (CON + EX and CON EX). The duration and intensity of physical activity outside of prescribed exercise were assessed using the SenseWear Pro3 armband. LEA did not alter NEAT (p = .41), nor time spent in moderate to vigorous (p = .20) and low-intensity physical activity (p = .17). However, time spent in low-intensity physical activity was lower in LEA + EX than LEA − EX (13.7 ± 0.3 vs. 15.2 ± 0.3 hr/day; p = .002). Short-term LEA does not seem to impact NEAT per se, but the way it is attained may impact physical activity behavior outside of exercise. As the participants expended similar amounts of energy during NEAT (900–1,300 kcal/day = 12.5–18.0 kcal·kg fat-free mass−1·day−1) and prescribed exercise bouts (15.0 kcal·kg fat-free mass−1·day−1), excluding it as a component of energy expenditure may skew the true energy available for physiological functionality in active populations.
Karsten Koehler, Thomas Abel, Birgit Wallmann-Sperlich, Annika Dreuscher, and Volker Anneken
Inactivity and overweight are major health concerns in children and adolescents with disabilities. Methods for the assessment of activity and energy expenditure may be affected negatively by the underlying disability, especially when motor function is impaired. The purpose of this study was to assess the validity of the SenseWear Armband in adolescents with cerebral palsy and hemiparesis.
Ten volunteers (age: 13.4 ± 1.6 years) were equipped with SenseWear Armbands on the hemiparetic and nonhemiparetic side of the body. Energy expenditure was measured at rest and during treadmill exercise (speed range: 0.85 to 2.35 m/s). Indirect calorimetry served as independent reference method.
The mean error was between −0.6 and 0.8 kcal/min and there were no significant differences between SenseWear and indirect calorimetry at any speed. Differences between body sides in expenditure (mean: −0.2 to 0.0 kcal/min) and step count (mean: −3.4 to 9.7 steps/min) were not significant.
The validity of the SenseWear Armband does not appear to be negatively affected by cerebral palsy during laboratory treadmill exercise. Future field studies are necessary to assess the validity and practicability of energy expenditure and physical activity assessment in children and adolescents with physical disabilities.