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Emma Stevenson, Clyde Williams and Helen Biscoe

This study investigated the metabolic responses to high glycemic index (HGI) or low glycemic index (LGI) meals consumed during recovery from prolonged exercise. Eight male, trained athletes undertook 2 trials. Following an overnight fast, subjects completed a 90-min run at 70% VO2max. Meals were provided 30 min and 2 h following cessation of exercise. The plasma glucose responses to both meals were greater in the HGI trial compared to the LGI trial (P < 0.05). Following breakfast, there were no differences in the serum insulin concentrations between the trials; however, following lunch, concentrations were higher in the HGI trial compared to the LGI trial (P < 0.05). This suggests that the glycemic index of the carbohydrates consumed during the immediate post-exercise period might not be important as long as sufficient carbohydrate is consumed. The high insulin concentrations following a HGI meal later in the recovery period could facilitate further muscle glycogen resynthesis.

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Carolina Lundqvist and Göran Kenttä

The purpose of this study was to psychometrically evaluate the Emotional Recovery Questionnaire (EmRecQ) and to describe athletes’ individual response patterns in five repeated assessments using the EmRecQ. Three samples were used. Samples 1 and 2 consisted of 192 and 379 (Mean age 16.4 years, SD = 0.7 and Mean age: 17.0 years, SD = 1.1) elite athletes from different sports. The third sample consisted of 20 (Mean age: 21.3, SD = 19.0) female elite basketball players. The EmRecQ is a 22-item questionnaire that assesses Happiness, Security, Harmony, Love, and Vitality. Results showed acceptable weighted omega reliability and construct reliability. Confirmatory factor analyses supported the a priori specified five-factor correlated model. Case profiles of repeated assessments revealed individual response patterns of the separate EmRecQ subscales that corresponded well with rated training load and total quality of recovery. The findings provide support for the EmRecQ’s psychometric properties and applied usefulness.

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Lindsey K. Lepley and Timothy A. Butterfield

Eccentric exercise is able to mechanically engage muscle, initiating strain-sensing molecules that promote muscle recovery by inducing beneficial adaptations in neural activity and muscle morphology, 2 critical components of muscle function that are negatively altered after injury. However, due to misinterpreted mathematic modeling and in situ and in vitro stretch protocols, a dogma that exposing muscle to eccentric exercise is associated with injury has been perpetuated in the literature. In response, clinicians have been biased toward using concentric exercise postinjury to improve the recovery of muscle function. Unfortunately, this conventional approach to rehabilitation does not restore muscle function, and reinjury rates remain high. Here, the authors present experimental evidence and theoretical support for the idea that isolated eccentric exercise is ideally suited to combat muscle inhibition and muscle strains and is an attractive alternative to concentric exercise.

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Zachary Legault, Nicholas Bagnall and Derek S. Kimmerly

The study aimed to examine the effects that L-glutamine supplementation has on quadriceps muscle strength and soreness ratings following eccentric exercise. It was hypothesized that glutamine ingestion would quicken the recovery rate of peak force production and decrease muscle soreness ratings over a 72-hr recovery period. Sixteen healthy participants (8♀/8♂; 22 ± 4 years) volunteered in a double-blind, randomized, placebo-controlled crossover study. Supplement conditions consisted of isoenergetic placebo (maltodextrin, 0.6 g·kg-1·day-1) and L-glutamine (0.3 g·kg-1·day-1 + 0.3 g·kg-1·day-1 maltodextrin) ingestion once per day over 72 hr. Knee extensor peak torque at 0°, 30°, and 180° per second and muscle soreness were measured before, immediately following, 24, 48, and 72 hr posteccentric exercise. Eccentric exercise consisted of 8 sets (10 repetitions/set) of unilateral knee extension at 125% maximum concentric force with 2-min rest intervals. L-glutamine resulted in greater relative peak torque at 180°/sec both immediately after (71 ± 8% vs. 66 ± 9%), and 72 hr (91 ± 8% vs. 86 ± 7%) postexercise (all, p < .01). In men, L-glutamine produced greater (p < .01) peak torques at 30°/sec postexercise. Men also produced greater normalized peak torques at 30°/sec (Nm/kg) in the L-glutamine condition than women (all, p < .05). In the entire sample, L-glutamine resulted in lower soreness ratings at 24 (2.8 ± 1.2 vs. 3.4 ± 1.2), 48 (2.6 ± 1.4 vs. 3.9 ± 1.2), and 72 (1.7 ± 1.2 vs. 2.9 ± 1.3) hr postexercise (p < .01). The L-glutamine supplementation resulted in faster recovery of peak torque and diminished muscle soreness following eccentric exercise. The effect of L-glutamine on muscle force recovery may be greater in men than women.

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Abdullah F. Alghannam, Dawid Jedrzejewski, James Bilzon, Dylan Thompson, Kostas Tsintzas and James A. Betts

We examined whether carbohydrate-protein ingestion influences muscle glycogen metabolism during short-term recovery from exhaustive treadmill running and subsequent exercise. Six endurance-trained individuals underwent two trials in a randomized double-blind design, each involving an initial run-to-exhaustion at 70% VO2max (Run-1) followed by 4-h recovery (REC) and subsequent run-to-exhaustion at 70% VO2max (Run-2). Carbohydrate-protein (CHO-P; 0.8 g carbohydrate·kg body mass [BM-1]·h-1 plus 0.4 g protein·kg BM-1·h-1) or isocaloric carbohydrate (CHO; 1.2 g carbohydrate·kg BM-1·h-1) beverages were ingested at 30-min intervals during recovery. Muscle biopsies were taken upon cessation of Run-1, postrecovery and fatigue in Run-2. Time-to-exhaustion in Run-1 was similar with CHO and CHO-P (81 ± 17 and 84 ± 19 min, respectively). Muscle glycogen concentrations were similar between treatments after Run-1 (99 ± 3 mmol·kg dry mass [dm-1]). During REC, muscle glycogen concentrations increased to 252 ± 45 mmol·kg dm-1 in CHO and 266 ± 30 mmol·kg dm-1 in CHO-P (p = .44). Muscle glycogen degradation during Run-2 was similar between trials (3.3 ± 1.4 versus 3.5 ± 1.9 mmol·kg dm-1·min-1 in CHO and CHO-P, respectively) and no differences were observed at the respective points of exhaustion (93 ± 21 versus 100 ± 11 mmol·kg dm-1; CHO and CHO-P, respectively). Similarly, time-to-exhaustion was not different between treatments in Run-2 (51 ± 13 and 49 ± 15 min in CHO and CHO-P, respectively). Carbohydrate-protein ingestion equally accelerates muscle glycogen resynthesis during short-term recovery from exhaustive running as when 1.2 g carbohydrate·kg BM-1·h-1 are ingested. The addition of protein did not alter muscle glycogen utilization or time to fatigue during repeated exhaustive running.

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Bernardo Gialanella, Francesco Grossetti, Marina Mazza, Laura Danna and Laura Comini

ABS affects the rehabilitation program, slowing down the functional recovery of these patients, but its negative impact on outcomes tends to diminish over time, thanks to home exercises and upper limb employment in the activities of daily living. At admission, the patients’ groups differed in age

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William M. Adams, Yuri Hosokawa, Robert A. Huggins, Stephanie M. Mazerolle and Douglas J. Casa

Context:

Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.

Objective:

To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.

Design:

Case study.

Setting:

Warm-weather road race.

Participant:

53-y-old recreationally active man.

Intervention:

A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.

Main Outcomes:

Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.

Results:

The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.

Conclusions:

This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

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Jaebin Shim, Deanna H. Smith and Bonnie L. Van Lunen

Clinical Scenario:

Over the past decade, sport-related concussions have received increased attention due to their frequency and severity over a wide range of athletics. Clinicians have developed return-to-play protocols to better manage concussions in young athletes; however, a standardized process projecting the length of recovery time after concussion has remained an elusive piece of the puzzle. The recovery times associated with such an injury once diagnosed can last anywhere from 1 wk to several months. Risk factors that could lead to protracted recovery times include a history of 1 or multiple concussions and a greater number, severity, and duration of symptoms after the injury. Examining the possible relationship between on-field or sideline signs and symptoms and recovery times would give clinicians the confident ability to properly treat and manage an athlete’s recovery process in a more systematic manner. Furthermore, identifying factors after a head injury that may be predictive of protracted recovery times would be useful for athletes, parents, and coaches alike.

Focused Clinical Question:

Which on-field and sideline signs and symptoms affect length of recovery after concussion in high school and college athletes?

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Franciele Marques Vanderlei, Isadora Lessa Moreno, Luiz Carlos Marques Vanderlei, Carlos Marcelo Pastre, Luiz Carlos de Abreu and Celso Ferreira

Despite the importance of hydration during exercise, the impact of ingesting water or isotonic solution during and after exercise on the regulation of autonomic modulation is unclear. The study aimed to compare the effect of ingesting water or isotonic solution (Gatorade®, Brazil) on cardiac autonomic modulation in young people after submaximal aerobic exercise. Thirty-one young men were subjected to a protocol consisting of 4 steps: 1) incremental test, 2) control protocol without hydration, 3) protocol with ingestion of water, and 4) protocol with ingestion of isotonic solution. The protocol consisted of 10 min of rest, 90 min of treadmill exercise at 60% VO2peak, and 60 min of recovery at rest. In the hydration protocols, hydration occurred during and after exercise, every 15 min beginning after the 15th minute of exercise, with the amount ingested proportional to body mass lost in the control protocol. Autonomic modulation was evaluated by heart rate variability. The hydration protocols promoted a more efficient recovery of autonomic modulation, and for the exercise performed, regardless of the hydration administered, the effect on autonomic modulation was similar.

Open access

Douglas J. Casa, Samuel N. Cheuvront, Stuart D. Galloway and Susan M. Shirreffs

are high, especially if exercise lasts more than about 2 h. Athletes should not drink so much that they gain weight during exercise. During recovery from exercise, rehydration should include replacement of both water and salts lost in sweat. Sports nutrition, and sports hydration in particular, is a