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Sherry Robertson, Dan Benardot and Margo Mountjoy

The sport of synchronized swimming is unique, because it combines speed, power, and endurance with precise synchronized movements and high-risk acrobatic maneuvers. Athletes must train and compete while spending a great amount of time underwater, upside down, and without the luxury of easily available oxygen. This review assesses the scientific evidence with respect to the physiological demands, energy expenditure, and body composition in these athletes. The role of appropriate energy requirements and guidelines for carbohydrate, protein, fat, and micronutrients for elite synchronized swimmers are reviewed. Because of the aesthetic nature of the sport, which prioritizes leanness, the risks of energy and macronutrient deficiencies are of significant concern. Relative Energy Deficiency in Sport and disordered eating/eating disorders are also of concern for these female athletes. An approach to the healthy management of body composition in synchronized swimming is outlined. Synchronized swimmers should be encouraged to consume a well-balanced diet with sufficient energy to meet demands and to time the intake of carbohydrate, protein, and fat to optimize performance and body composition. Micronutrients of concern for this female athlete population include iron, calcium, and vitamin D. This article reviews the physiological demands of synchronized swimming and makes nutritional recommendations for recovery, training, and competition to help optimize athletic performance and to reduce risks for weight-related medical issues that are of particular concern for elite synchronized swimmers.

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Angela de Silva, Yasas Samarasinghe, Dhammika Senanayake and Pulani Lanerolle

Intake of dietary supplements is widespread among athletes in developed countries. This study evaluated the use of dietary supplements in athletes from a developing country. Dietary supplementation practices of 113 national-level athletes age 15–35 yr in Sri Lanka were assessed. All athletes from track-and-field, badminton, football, swimming, cycling, and karate squads who consented to participate in the study were administered an anonymous questionnaire by an interviewer. Information on number of supplements taken, frequency of use, nature of product, rationale, sources of advice, and reasons for taking supplements was obtained. Most athletes (94%) consumed dietary supplements. On average, 3.7 products/day were consumed. Footballers had significantly lower intake of supplements than other athletes (footballers 71%, others 98%; p < .05). They also consumed fewer products per day (footballers 0.7, others 3.5; p < .05). Popular supplements included multivitamins, vitamin E, calcium, energy foods and drinks, and creatine. Multiple supplement use was common, with 29% athletes taking 4 products/day. The athletes sought advice on supplement use from sports doctors (45%), team coaches (40%), or friends (15%). Most took supplements to improve performance (79%), and 19% claimed to take supplements to improve their overall health status. Dietary supplement use is widespread among national-level Sri Lankan athletes. The ad hoc use of supplements indicates that educational intervention in the sporting community is essential.

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Adamasco Cupisti, Claudia D’Alessandro, Silvia Castrogiovanni, Alice Barale and Ester Morelli

This study aims to investigate dietary composition and nutrition knowledge of 60 athlete and 59 non-athlete adolescent females (age, 14-18 years), using a 3-day food recall and a questionnaire on nutrition. The reported daily energy intake was similar in athletes and non-athletes, but less than the recommended and the estimated requirements. In the athletes, the energy supply from breakfast was higher than in the non-athletes (18.5 ± 6.6 vs. 15.0 ± 8.2%, p < .005). Energy intake from carbohydrates was higher (53.6 ± 6.2 vs. 49.8 ± 63%, p < .05) and that from lipids was lower (30.4 ± 5.5 vs. 34.2 ± 5.2%, p < .001) in athletes than in non-athletes. Athletes also showed higher fiber (20.0 ± 5.8 vs. 14.1 ± 4.3 g/day, p < .001). iron (10.6±5.1 vs. 7.5 ± 2.1 mg/day,/7 < .001) and vitamin A (804 ± 500 vs, 612 ± 456 μg/day, p < .05) reported intake than non-athletes. Calcium, iron, and zinc intake were less than 100% RDA in both groups. Athletes gave a slightly higher rate of correct answers on the nutrition knowledge questionnaire (77.6 vs. 71.6%,p < .01) than non-athletes. In conclusion, the overall recalled dietary intake and nutrition knowledge of the studied adolescent females show some misconceptions and nutrient deficiencies, but the results in athletes are quite better man in non-athletes, suggesting a favorable role of sport practice on dietary habits and nutrition knowledge.

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Ben Desbrow, Joanna McCormack, Louise M. Burke, Gregory R. Cox, Kieran Fallon, Matthew Hislop, Ruth Logan, Nello Marino, Susan M. Sawyer, Greg Shaw, Anita Star, Helen Vidgen and Michael Leveritt

It is the position of Sports Dietitians Australia (SDA) that adolescent athletes have unique nutritional requirements as a consequence of undertaking daily training and competition in addition to the demands of growth and development. As such, SDA established an expert multidisciplinary panel to undertake an independent review of the relevant scientific evidence and consulted with its professional members to develop sports nutrition recommendations for active and competitive adolescent athletes. The position of SDA is that dietary education and recommendations for these adolescent athletes should reinforce eating for long term health. More specifically, the adolescent athlete should be encouraged to moderate eating patterns to reflect daily exercise demands and provide a regular spread of high quality carbohydrate and protein sources over the day, especially in the period immediately after training. SDA recommends that consideration also be given to the dietary calcium, Vitamin D and iron intake of adolescent athletes due to the elevated risk of deficiency of these nutrients. To maintain optimal hydration, adolescent athletes should have access to fluids that are clean, cool and supplied in sufficient quantities before, during and after participation in sport. Finally, it is the position of SDA that nutrient needs should be met by core foods rather than supplements, as the recommendation of dietary supplements to developing athletes over-emphasizes their ability to manipulate performance in comparison with other training and dietary strategies.

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Anna Baylis, David Cameron-Smith and Louise M. Burke

Many athletes report using a wide range of special sports foods and supplements. In the present study of 77 elite Australian swimmers, 99% of those surveyed reported the use of these special preparations, with 94% of swimmers reporting the use of non-food supplements. The most popular dietary supplements were vitamin or mineral supplements (used by 94% of the group), herbal preparations (61%), and creatine (31%). Eighty-seven percent of swimmers reported using a sports drink or other energy-providing sports food. In total, 207 different products were reported in this survey. Sports supplements, particularly supplements presented as pills or other non-food form, are poorly regulated in most countries, with little assurance of quality control. The risk of an inadvertent “positive doping test” through the use of sports supplements or sports foods is a small but real problem facing athletes who compete in events governed by anti-doping rules. The elite swimmers in this survey reported that information about the “doping safety” of supplements was important and should be funded by supplement manufacturers. Although it is challenging to provide such information, we suggest a model to provide an accredited testing program suitable for the Australian situation, with targeted athlete education about the “sports safety” of sports supplements and foods.

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Kathryn Froiland, Wanda Koszewski, Joshua Hingst and Lisa Kopecky

A survey was conducted to examine the source of information and usage of nutritional supplements in 115 male and 88 female varsity athletes at a Division I university. The survey asked each athlete to define supplement, and report supplement use and type, source of information, and reasons for use. Supplement use frequencies were determined, and comparisons were made between gender and sport. Eighty-nine percent of the subjects had or were currently using nutritional supplements. Many athletes did not consider sports drinks and calorie replacement products as supplements. Females were more likely to take calcium and multivitamins, and males had significant intake for ginseng, amino acids, glutamine, hydroxy-methyl-buterate (HMB), weight gainers, whey protein, and Juven. The most frequently used supplements overall were energy drinks (73%), calorie replacement products of all types (61.4%), multivitamin (47.3%), creatine (37.2%), and vitamin C (32.4%). There was also significant supplement use noted per sport. Females were more likely to obtain information from family members regarding supplementation, and males from a store nutritionist, fellow athletes, friends, or a coach. Female athletes were more likely to take supplements for their health or because of an inadequate diet, while men reported taking supplements to improve speed and agility, strength and power, or for weight/muscle gain.

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Christina Tsitsimpikou, Nastasia Chrisostomou, Peter Papalexis, Konstantinos Tsarouhas, Aristidis Tsatsakis and Athanasios Jamurtas

Although the use of nutritional supplements by professional athletes and the benefits thereof have been extensively studied, information on recreational athletes’ use of supplements is limited. This study investigated the consumption of nutritional supplements, source of information and supply of supplements, and level of awareness with regard to the relevant legislation among individuals who undertake regular exercise in Athens, Greece. A closed-ended, anonymous questionnaire was answered by 329 subjects (180 men, 149 women), age 30.6 ± 12.1 yr, from 11 randomly selected gym centers. Preparations declared as anabolic agents by the users were submitted to a gas chromatographic analyzer coupled to a mass spectrometric detector. Consumption of nutritional supplements was reported by 41% of the study population, with proteins/amino acids and vitamins being the most popular. Age (r = .456, p = .035), sex (χ2 = 14.1, df = 1, p < .001), level of education (χ2 = 14.1, df = 3, p < .001), and profession (χ2 = 11.4, df = 4, p = .022) were associated with the subjects’ decision to consume nutritional supplements. Most (67.1%) purchased products from health food stores. Only 17.1% had consulted a physician or nutritionist, and one third were aware of the relevant legislation. Two preparations were detected containing synthetic anabolic steroids not stated on the label. In conclusion, use of nutritional supplements was common among recreational athletes in Athens, Greece. A low level of awareness and low involvement of health care professionals as sources of information and supply were observed.

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Susan Heaney, Helen O’Connor, Janelle Gifford and Geraldine Naughton

Purpose:

This study aimed to compare strategies for assessing nutritional adequacy in the dietary intake of elite female athletes.

Methods:

Dietary intake was assessed using an adapted food-frequency questionnaire in 72 elite female athletes from a variety of sports. Nutritional adequacy was evaluated and compared using mean intake; the proportion of participants with intakes below Australian nutrient reference values (NRV), U.S. military dietary reference intakes (MDRI), and current sports nutrition recommendations; and probability estimates of nutrient inadequacy.

Results:

Mean energy intake was 10,551 ± 3,836 kJ/day with macronutrient distribution 18% protein, 31% fat, and 46% carbohydrate, consistent with Australian acceptable macronutrient distribution ranges. Mean protein intake (1.6 g · kg−1 · d−1) was consistent with (>1.2 g · kg−1 · d−1), and carbohydrate intake (4.5 g · kg−1 · d−1), below, current sports nutrition recommendations (>5 g · kg−1 · d−1), with 30% and 65% of individuals not meeting these levels, respectively. Mean micronutrient intake met the relevant NRV and MDRI except for vitamin D and folate. A proportion of participants failed to meet the estimated average requirement for folate (48%), calcium (24%), magnesium (19%), and iron (4%). Probability estimates of inadequacy identified intake of folate (44%), calcium (22%), iron (19%), and magnesium (15%) as inadequate.

Conclusion:

Interpretation of dietary adequacy is complex and varies depending on whether the mean, proportion of participants below the relevant NRV, or statistical probability estimate of inadequacy is used. Further research on methods to determine dietary adequacy in athlete populations is required.

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Vitor Teixeira, Hugo Valente, Susana Casal, Franklim Marques and Pedro Moreira

Strenuous physical activity is known to generate reactive oxygen species to a point that can exceed the antioxidant defense system and lead to oxidative stress. Dietary intake of antioxidants, plasma enzymatic (superoxide dismutase, glutathione reductase [Gr], and glutathione peroxidase [GPx]) activities, nonenzymatic (total antioxidant status [TAS], uric acid, α-tocopherol, retinol, α-carotene, β-carotene, lycopene, and lutein + zeaxanthin) antioxidants, and markers of lipid peroxidation (thiobarbituricacid-reactive substances [TBARS]) and muscle damage (creatine kinase [CK]) were measured in 17 elite male kayakers and canoeists under resting conditions and in an equal number of age- and sex-matched sedentary individuals. Athletes showed increased plasma values of α-tocopherol (p = .037), α-carotene (p = .003), β-carotene (p = .007), and superoxide dismutase activity (p = .002) and a lower TAS level (p = .030). Antioxidant intake (α-tocopherol, vitamin C, and β-carotene) and plasmatic GPx, Gr, lycopene, lutein + zeaxanthin, retinol, and uric acid levels were similar in both groups. Nevertheless, TBARS (p < .001) and CK (p = .011) levels were found to be significantly higher in the kayakers and canoeists. This work suggests that despite the enhanced levels of antioxidants, athletes undergoing regular strenuous exercise exhibited more oxidative stress than sedentary controls.

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Jorunn Sundgot-Borgen

This study assessed the nutrient intake and eating behavior in Norwegian female elite athletes suffering from eating disorders (ED) who met the criteria for anorexia nervosa (AN), anorexia athletica (AA), or bulimia nervosa (BN). The subjects included 7 AN, 43 AA, 42 BN, and 30 controls. Three-day and 24-hr food records were used to assess energy and nutrient intake. Results revealed that a significant number of AN and AA athletes have diets too low in energy and nutrients, the mean intake for energy and CHO being lower than recommended for active females. A significant number did not reach the protein level recommended for athletes. In addition, there were low intakes of several micronutrients, most notably calcium, vitamin D, and iron. The energy and nutritional inadequacy, combined with the use of purging, are of major concern since the athletes in this study were relatively young. It is unknown whether the abnormal eating pattern is a consequence of ED or is typical of top level athletes.