Endurance athletes commonly consume carbohydrate-electrolyte sports beverages during prolonged events. The benefits of this strategy are numerous—sports-beverage consumption during exercise can delay dehydration, maintain blood glucose levels, and potentially attenuate muscle glycogen depletion and central fatigue. Thus, it is generally agreed that carbohydrate-electrolyte beverages can improve endurance performance. A controversy has recently emerged regarding the potential role of protein in sports beverages. At least 3 recent studies have reported that carbohydrate-protein ingestion improves endurance performance to a greater extent than carbohydrate alone. In addition, carbohydrate-protein ingestion has been associated with reductions in markers of muscle damage and improved post exercise recovery. Although many of these muscle damage and recovery studies examined post exercise nutritional intake, recent evidence suggests that these benefits may be elicited with carbohydrate-protein consumption during exercise. These findings are intriguing and suggest that the importance of protein for endurance athletes has been underappreciated. However, 2 studies recently reported no differences in endurance performance between carbohydrate and carbohydrate-protein beverages. The varied outcomes may have been influenced by a number of methodological differences, including the amounts and types of carbohydrate or protein in the beverages, the exercise protocols, and the relative statistical power of the studies. In addition, although there are plausible mechanisms that could explain the ergogenic effects of carbohydrate-protein beverages, they remain relatively untested. This review examines the existing research regarding the efficacy of carbohydrate-protein consumption during endurance exercise. Limitations of the existing research are addressed, as well as potential areas for future study.
Ben Desbrow, Danielle Cecchin, Ashleigh Jones, Gary Grant, Chris Irwin and Michael Leveritt
The addition of 25 mmol·L−1 sodium to low alcohol (2.3% ABV) beer has been shown to enhance post exercise fluid retention compared with full strength (4.8% ABV) beer with and without electrolyte modification. This investigation explored the effect of further manipulations to the alcohol and sodium content of beer on fluid restoration following exercise. Twelve male volunteers lost 2.03 ± 0.19% body mass (mean ± SD) using cycling-based exercise. Participants were then randomly allocated a different beer to consume on four separate occasions. Drinks included low alcohol beer with 25 mmol·L−1 of added sodium [LightBeer+25], low alcohol beer with 50 mmol·L−1 of added sodium [LightBeer+50], midstrength beer (3.5% ABV) [Mid] or midstrength beer with 25 mmolL−1 of added sodium [Mid+25]. Total drink volumes in each trial were equivalent to 150% of body mass loss during exercise, consumed over a 1h period. Body mass, urine samples and regulatory hormones were obtained before and 4 hr after beverage consumption. Total urine output was significantly lower in the LightBeer+50 trial (1450 ± 183 ml) compared with the LightBeer+25 (1796 ± 284 ml), Mid+25 (1786 ± 373 ml) and Mid (1986 ± 304 ml) trials (allp < .05). This resulted in significantly higher net body mass following the LightBeer+50 trial (-0.97 ± 0.17kg) compared with all other beverages (LightBeer+25 (-1.30 ± 0.24 kg), Mid+25 (-1.38 ± 0.33 kg) and Mid (-1.58 ± 0.29 kg), all p < .05). No significant changes to aldosterone or vasopressin were associated with different drink treatments. The electrolyte concentration of low alcohol beer appears to have more significant impact on post exercise fluid retention than small changes in alcohol content.
Lawrence E. Armstrong, Elaine C. Lee, Douglas J. Casa, Evan C. Johnson, Matthew S. Ganio, Brendon P. McDermott, Jakob L. Vingren, Hyun M. Oh and Keith H. Williamson
Exertional hyponatremia (EH) during prolonged exercise involves all avenues of fluid-electrolyte gain and loss. Although previous research implicates retention of excess fluid, EH may involve either loss, gain, or no change of body mass. Thus, the etiology, predisposing factors, and recommendations for prevention are vague—except for advice to avoid excessive drinking.
This retrospective field study presents case reports of two unacquainted recreational cyclists (LC, 31y and AM, 39 years) who began exercise with normal serum electrolytes but finished a summer 164-km ride (ambient, 34±5°C) with a serum [Na+] of 130 mmol/L.
To clarify the etiology of EH, their pre- and post-exercise measurements were compared to a control group (CON) of 31 normonatremic cyclists (mean ± SD; 37±6 years; 141±3 mmol Na+/L).
Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. These two hyponatremic cyclists consumed a large and similar volume of fluid (191 and 189 ml/kg), experienced an 11 mmol/L decrease of serum [Na+], reported low thirst sensations; however, LC gained 3.1 kg (+4.3% of body mass) during 8.9 hr of exercise and AM maintained body mass (+0.1kg, +0.1%, 10.6h). In the entire cohort (n = 33), post-event serum [Na+] was strongly correlated with total fluid intake (R2 = 0.45, p < .0001), and correlated moderately with dietary sodium intake (R2=0.28, p = .004) and body mass change (R2 = 0.22, p = .02). Linear regression analyses predicted the threshold of EH onset (<135 mmol Na+/L) as 168 ml fluid/kg.
The wide range of serum [Na+] changes (+6 to -11 mmol/L) led us to recommend an individualized rehydration plan to athletes because the interactions of factors were complex and idiosyncratic.
Michael J. Cramer, Charles L. Dumke, Walter S. Hailes, John S. Cuddy and Brent C. Ruby
A variety of dietary choices are marketed to enhance glycogen recovery after physical activity. Past research informs recommendations regarding the timing, dose, and nutrient compositions to facilitate glycogen recovery. This study examined the effects of isoenergetic sport supplements (SS) vs. fast food (FF) on glycogen recovery and exercise performance. Eleven males completed two experimental trials in a randomized, counterbalanced order. Each trial included a 90-min glycogen depletion ride followed by a 4-hr recovery period. Absolute amounts of macronutrients (1.54 ± 0.27 g·kg-1 carbohydrate, 0.24 ± 0.04 g·kg fat-1, and 0.18 ± 0.03g·kg protein-1) as either SS or FF were provided at 0 and 2 hr. Muscle biopsies were collected from the vastus lateralis at 0 and 4 hr post exercise. Blood samples were analyzed at 0, 30, 60, 120, 150, 180, and 240 min post exercise for insulin and glucose, with blood lipids analyzed at 0 and 240 min. A 20k time-trial (TT) was completed following the final muscle biopsy. There were no differences in the blood glucose and insulin responses. Similarly, rates of glycogen recovery were not different across the diets (6.9 ± 1.7 and 7.9 ± 2.4 mmol·kg wet weight- 1·hr-1 for SS and FF, respectively). There was also no difference across the diets for TT performance (34.1 ± 1.8 and 34.3 ± 1.7 min for SS and FF, respectively. These data indicate that short-term food options to initiate glycogen resynthesis can include dietary options not typically marketed as sports nutrition products such as fast food menu items.
Elaine M. Murtagh, Colin Boreham, Alan Nevill, Gareth Davison, Tom Trinick, Ellie Duly, Mawloud El-Agnaf and Marie H. Murphy
Markers of inflammation are emerging as novel indices of cardiovascular risk. These markers have been shown to alter acutely after intense exercise; however, the effects of more moderate intensity exercise in healthy individuals is not known. Walking forms a cornerstone of physical activity promotion, so the inflammatory response to this exercise merits investigation. This study evaluated the effects of a 45-min walk on C-reactive protein (CRP) and interleukin 6 (IL-6), in sedentary, overweight men.
Fifteen men (49.7 ± 5.9 y) walked for 45 min at 60 to 70% of predicted maximum heart rate. Fasted blood samples were taken prior to and immediately 1 hr and 24 h post-walk.
IL-6 decreased from 1 h post-walk to 24 h post-walk (P < 0.01). No significant changes were observed in CRP.
These findings suggest that 45 min walking at 60 to 70% HRmax-p causes a decrease in IL-6 24 h post-exercise, but does not evoke a significant response in CRP levels.
Nicola C. Sutton, David J. Childs, Oded Bar-Or and Neil Armstrong
The purpose of this study was to develop a nonmotorized treadmill sprint test (ExNMT) to assess children’s short-term power output, to establish the test’s repeatability, and to compare the results to corresponding Wingate anaerobic test (WAnT) measurements. Nineteen children (aged 10.9±0.3 years) completed 2 ExNMTs and 2 WAnTs. Statistical analysis revealed coefficients of repeatability for the ExNMT that compared very favorably with the WAnT for both peak power (26.6 vs. 44.5 W) and mean power (15.3 vs. 42.1 W). The validity of the ExNMT as a test of anaerobic performance is reflected by significant correlations (p ≤.05) with the WAnT (peak power, r = 0.82; mean power, r = 0.88) and reinforced by the relatively high post-exercise blood lactate concentrations (7.1 ± 1.3 vs. 5.6 ± 1.5 mmol · L−1 for the ExNMT and WAnT, respectively). This study has developed a promising laboratory running test with which to examine young people’s short-term power output.
Daniel G. Syrotuik, Kirsten L. MacFadyen, Vicki J. Harber and Gordon J. Bell
To examine the effects of elk velvet antler supplementation (EVA) combined with training on resting and exercise-stimulated hormonal response, male (n = 25) and female (n = 21) rowers ingested either E VA (560 mg/d) or placebo (PL) during 10 wk of training. VO2max, 2000 m rowing time, leg and bench press strength were determined before and after 5 and 10 wk of training. Serum hormone levels were measured prior to and 5 and 60 min after a simulated 2000 m rowing race. VO2max and strength increased and 2000 m times decreased similarly (P < 0.05) with training. There was no significant difference between the EVA and PL group for any hormonal response. Testosterone (males only) and growth hormone (both genders) were higher 5 min after the simulated race (P < 0.05) but returned to baseline at 60 min. Cortisol was higher 5 and 60 min compared to rest (both genders) (P < 0.05) and was higher 60 min post-exercise following 5 and 10 wk of training. It appears that 10 wk of EVA supplementation does not significantly improve rowing performance nor alter hormonal responses at rest or after acute exercise than training alone.
Paula Robson-Ansley, Martin Barwood, Clare Eglin and Les Ansley
Fatigue is a predictable outcome of prolonged physical activity; yet its biological cause remains uncertain. During exercise, a polypeptide messenger molecule inter-leukin-6 (IL-6) is actively produced. Previously, it has been demonstrated that administration of recombinant IL-6 (rhIL-6) impairs 10-km run performance and heightened sensation of fatigue in trained runners. Both high carbohydrate diets and carbohydrate ingestion during prolonged exercise have a blunting effect on IL-6 levels post endurance exercise. We hypothesized that carbohydrate ingestion may improve performance during a prolonged bout of exercise as a consequence of a blunted IL-6 response. Seven recreationally trained fasted runners completed two 90-min time trials under CHO supplemented and placebo conditions in a randomized order. The study was of a double-blinded, placebo-controlled, cross-over study design. Distance covered in 90 min was significantly greater following exogenous carbohydrate ingestion compared with the placebo trial (19.13 ± 1.7 km and 18.29 ± 1.9 km, respectively, p = .0022). While post exercise IL-6 levels were significantly lower in the CHO trial compared with the placebo trial (5.3 ± 1.9 pg·mL−1 and 6.6 ± 3.0 pg·mL−1, respectively; p = .0313), this difference was considered physiologically too small to mediate the improvement in time trial performance.
Andrea D. Marjerrison, Jonah D. Lee and Anthony D. Mahon
This study examined the effect of pre exercise carbohydrate (CHO) feeding on performance on a Wingate anaerobic test (WAnT) in 11 boys (10.2 ± 1.3 y old). Four WAnTs with 2 min recovery were performed 30 min after consuming a CHO (1 g CHO/kg) or placebo drink. Peak power (PP) and mean power (MP) were similar between trials. PP ranged from 241.1 ± 82.2 to 223.1 ± 57.9 W with carbohydrate and from 238.2 ± 76.1 to 223.4 ± 52.3 W with placebo. MP ranged from 176.3 ± 58.4 to 151.1 ± 37.5 W with carbohydrate versus 178.0 ± 45.8 to 159.1 ± 32.7 W with placebo. Pre exercise glucose was significantly higher in CHO versus placebo (7.0 ± 1.0 vs. 5.5 ± 0.5 mmol/L), but post exercise values were not different. Blood lactate was similar between trials but increased over time. This study found that the ingestion of a CHO solution before exercise did not influence power output during repeated performances of the WAnT.
Maple Liu, Linda J. Gillis, Nicholas R. Persadie, Stephanie A. Atkinson, Stuart M. Phillips and Brian W. Timmons
There is some evidence that a combination of factors can reduce inflammation and associated metabolic risk factors. We studied the early cardiometabolic and inflammatory adaptations to a short-term exercise intervention with and without milk in obese adolescents. Fifty-four adolescents were randomized to consume milk post exercise (MILK) or a carbohydrate beverage (CONT) during one-week of daily exercise. Insulin levels were not different between the groups post training. Glucose was reduced over time in both groups (-9 ± 13 mg/dl MILK and -6 ± 14 mg/dl CONT, p < .05) but not different between groups. There was a greater decrease in mean arterial pressure (MAP) in the MILK group (-3 ± 6 mmHg MILK vs. 2 ± 7 mmHg CONT, p < .04). Milk provided postexercise did not affect C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) or interleukin-6 (IL-6). The exercise intervention led to an increase in TNF-α in both groups (0.27 ± 0.7 pg/ml MILK and 0.48 ± 0.6 pg/ml CONT, p < .001). The early adaptations to a short-term exercise intervention in obese adolescents include a reduction in MAP and an increase in some inflammatory markers.