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Nancy Clark

Surveys suggest that 8 to 41% of athletes may struggle with binge/purge and bulimic eating behaviors. Many of these athletes with bulimia struggle alone, receiving no professional help for recovery. This article offers effective counseling strategies for nutrition professionals who want to help bulimic athletes. Through a case study of a triathlete who binges, and then purges through compulsive exercise, a nutrition care plan is discussed that addresses the food and weight concerns commonly expressed by athletes with bulimia. The priorities of the care plan are to reduce preoccupation with weight, establish a pattern of regular eating, and address the underlying causes of the binges. The case demonstrates that nutrition counseling is only one part of the treatment program, and emphasizes the importance of developing a team of health professionals to assist athletes with bulimia.

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Howard L. Nixon II

Efforts to integrate and exclude disabled people in mainstream settings raise questions about the appropriateness of integration. This paper explores problematic aspects of the integration of disabled and able-bodied people in the mainstream, and structural conditions affecting the quality of such integration. In particular, it uses a case study of a partially sighted boy’s experiences in different mainstream sport settings to show how integration efforts can be complicated by the ambiguity of an invisible impairment, by the pressures on disabled persons and their families to ignore or deny impairment and disability, and by a mismatching of structural aspects of sports and the abilities of participants with disabilities.

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Trish Gorely, Anne Jobling, Kellie Lewis and David Bruce

The purpose was to develop an evaluative case study of six 3-hr sessions, spaced over 3 months, of psychological skills training (PST) provided to athletes with an intellectual disability who were training for the Basketball Australia State Championships. Participants were 7 males and 7 females, aged 15.8 to 27.1 years, with a receptive language level of 7 to 13.7 years, 2 female coaches, 2 psychologists, and 1 registered psychologist supervisor. Sessions focused specifically on stress management, with primary attention given to cue words, breathing techniques, and positive thinking. Findings, based on interviews and participant observations, revealed that all participants believed that the PST was appropriate and worthwhile.

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Nancy Clark, Cato Coleman, Kerri Figure, Tom Mailhot and John Zeigler

Every 4 years, rowers from around the world compete in a 50- to 60-day transAtlantic rowing challenge. These ultra-distance rowers require a diet that provides adequate calories, protein, vitamins, minerals, and fluids so they can perform well day after day, minimize fatigue, and stay healthy. Yet, the rowers are confronted with menu planning challenges. The food needs to be lightweight, compact, sturdy, non-spoiling in tropical temperatures, calorie dense, easy to prepare, quick to cook, and good tasting. Financial concerns commonly add another menu planning challenge. The purpose of this case study is to summarize the rowers’ food experiences and to provide guidance for sports nutrition professionals who work with ultra-endurance athletes embarking on a physical challenge with similar food requirements. The article provides food and nutrition recommendations as well as practical considerations for ultra-distance athletes. We describe an 8,000 calorie per day menu planning model that uses food exchanges based on familiar, tasty, and reasonably priced supermarket foods that provide the required nutrients and help contain financial costs.

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Yasuo Sengoku, Kazuteru Nakamura, Hitomi Ogata, Yoshiharu Nabekura, Shoichiro Nagasaka and Kumpei Tokuyama

The current case study intended to measure blood glucose fluctuation in 2 marathon runners during a 100-km race using a continuous glucose-monitoring system (CGMS) and investigate the relationship between glucose profile and change in running speed. Two experienced ultramarathon runners participated in this study. A CGMS glucose sensor was inserted into the subcutaneous abdominal tissue at 35 h before the 100-km race, and the glucose profile was monitored continuously until the end of the race. Race pace and energy intake during the race were recorded. Participants finished the race in 6h:51min:17s (runner A) and 8h:56min:04s (runner B), and the race-pace decrement ratios were 17.6% for runner A and 27.2% for runner B. The average relative intensity throughout the 100-km race was 89.9% ± 5.8% lactate threshold (LT) in runner A and 78.4% ± 8.6% LT in runner B. The total amount of carbohydrate intake during the race was 249 g and 366 g in runners A and B, respectively. Despite lower carbohydrate intake, runner A maintained a normal glucose level throughout the race, while runner B rapidly decreased blood glucose and became hypoglycemic after the 80-km point. These results suggest that elite ultramarathon runners may have the ability to prevent a large decrement in blood glucose level regardless of the amount of energy intake during the race to maintain higher relative running intensity.

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Giulia De Ioannon, Giuseppe Cibelli, Sergio Mignardi, Agnese Antonelli, Laura Capranica and Maria Francesca Piacentini


To evaluate the pacing strategy, rating of perceived exertion (RPE), and mood during a 78.1-km solo ultraendurance open-water swim.


Before and after the event, anthropometric parameters, cortisol, and the profile of mood state (POMS) of 1 male athlete (age 48 y, height 172 cm, body mass 68 kg, body fat 7.2%, athletic achievement: Italian record holder of the Channel Swim) were ascertained. Every 3 h during the event, average swimming speed (SS), stroke rate, stroke length (SL), and RPE were recorded.


The athlete completed the event in 23:44 h:min. Compared with the first 3 h of swimming, decreases in SS (−33%) and SL (−25%) were observed between 18 h and 21 h. Thereafter, the athlete increased SS (+41%) and SL (+17%) between 21 h and the end. RPE steadily increased from the beginning to the last 6 h of swimming. Cortisol showed a 23-fold increase. After the event, POMS showed a 500% increase in fatigue, 44% decrease in tension, and 77% decrease in vigor.


For the first time ever an athlete crossed the Adriatic Sea. This case study shows that the athlete adopted a variable pacing strategy to complete 78 km. Despite the athlete perceiving his effort at maximum during the last 6 h, the observed increases in SS at the end of the event might substantiate his high potential motivation to accomplish this challenging and unique event.

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Nancy Clark

A new type of athlete is appearing in the offices of sports dietitians: formerly obese people who have undergone gastric bypass surgery and now aspire to be marathoners, triathletes, and other types of endurance athletes. The standard nutrition advice offered to bypass patients is contrary to the standard sports advice given to athletes. Bypass athletes need to limit carbohydrates, fluids, and energy intake and consume a protein-based diet. This case study describes the sport nutrition concerns of a woman who, after having gastric bypass surgery, trained to run a marathon (42 km). Because of her limited ability to consume food and fluids, she experienced difficulty preventing fatigue and dehydration during her long training runs and the marathon itself. She learned through trial and error how to survive the nutritional challenges and complete the marathon. Health professionals need to be aware of the potential medical risks associated with endurance exercise in gastric bypass patients. Research is needed to determine the best sports nutrition practices for bypass patients. Only then can sport dietitians better educate this small but growing contingent of endurance athletes so the athletes can meet their training and performance goals and reduce their risk of experiencing serious health consequences.

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Dana Lis, Kiran D.K. Ahuja, Trent Stellingwerff, Cecilia M. Kitic and James Fell

Athletes employ various dietary strategies in attempts to attenuate exercise-induced gastrointestinal (GI) symptoms to ensure optimal performance. This case-study outlines one of these GI-targeted approaches via the implementation of a short-term low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet, with the aim to attenuate persistent running specific GI symptoms in a recreationally competitive multisport athlete (male, 86 kg, 57.9 ml·kg·min-1 V02max, 10–15 hr/week training, with no diagnosed GI disorder). Using a single-blinded approach a habitual diet was compared with a 6-day low FODMAP intervention diet (81 ± 5g vs 7.2 ± 5.7g FODMAP s/day) for their effect on GI symptoms and perceptual wellbeing. Training was similar during the habitual and dietary intervention periods. Postexercise (During) GI symptom ratings were recorded immediately following training. Daily GI symptoms and the Daily Analysis of Life Demands for Athletes (DALDA) were recorded at the end of each day. Daily and During GI symptom scores (scale 0–9) ranged from 0–4 during the habitual dietary period while during the low FODMAP dietary period all scores were 0 (no symptoms at all). DALDA scores for worse than normal ranged from 3–10 vs 0–8 in the habitual and low FODMAP dietary periods, respectively, indicating improvement. This intervention was effective for this GI symptom prone athlete; however, randomized-controlled trials are required to assess the suitability of low FODMAP diets for reducing GI distress in other symptomatic athletes.

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Kate L. Pumpa, Sharon M. Madigan, Ruth E. Wood-Martin, Richelle Flanagan and Noreen Roche

The use of sport supplements presents a dilemma for many of those involved in supporting athletes, including coaches, families, support staff, and the athletes themselves. Often the information that they source can be incorrect and promote a biased view regarding the use of nutritional supplements. The aim of this case study was to describe the process that occurred around the development of a series of targeted educational fact sheets on a range of nutritional supplements for Irish athletes. It describes the initiation and support of the process by the Irish Sports Council; one of its subgroups, the Food and Food Supplements Committee; and the Irish Institute of Sport. A needs assessment through questionnaires was carried out to establish the most commonly used sport nutrition supplements by athletes age 16 or over in Ireland. Respondents completed 105 questionnaires over a 4-mo period in 2008–09 that led to the production of 20 supplement fact sheets. These supplement fact sheets will enable Irish athletes to access high-quality, up-to-date, scientific information about the supplements they have reported consuming. Since personal reading had a strong influence over athletes’ decision-making process for taking nutritional supplements, as did scientific research, fact sheets available on the Internet from a reliable source are an ideal way to educate Irish athletes.

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Katherine Elizabeth Black, Paula Skidmore and Rachel Clare Brown

Food intolerance is becoming increasingly prevalent, and increasing numbers of athletes have celiac disease. This poses challenges as dietary recommendations for exercise are largely based on gluten-containing carbohydrate-rich foods. The K4 cycle race covers 384 km around the Coromandel Peninsula, New Zealand. Lack of sleep, darkness, and temperature variations pose a number of nutritional challenges. Limited food choices present those with celiac disease with even greater challenges. This case study describes the intakes of one such athlete during training and competing in the K4. Nutritional intakes were obtained during training using weighed-food records and during the race via dietary recall and the weighing of foods pre- and postrace. As simple substitution of gluten-containing foods for gluten-free foods leads to increased energy intake, alternatives need to be considered. During the race, insufficient energy was consumed to meet the nutritional guidelines for endurance performance. This was probably due to the nature of the course, racing conditions, the consistency of gluten-free food, and, toward the end of the race, sensory-specific satiety.