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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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Dan Benardot, Wes Zimmermann, Gregory R. Cox and Saul Marks

Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3–8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2–1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

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Gregory R. Cox, Iñigo Mujika and Cees-Rein van den Hoogenband

Water polo is an aquatic team sport that requires endurance, strength, power, swimming speed, agility, tactical awareness, and specific technical skills, including ball control. Unlike other team sports, few researchers have examined the nutritional habits of water polo athletes or potential dietary strategies that improve performance in water polo match play. Water polo players are typically well muscled, taller athletes; female players display higher levels of adiposity compared with their male counterparts. Positional differences exist: Center players are heavier and have higher body fat levels compared with perimeter players. Knowledge of the physical differences that exist among water polo players offers the advantage of player identification as well as individualizing nutrition strategies to optimize desired physique goals. Individual dietary counseling is warranted to ensure dietary adequacy, and in cases of physique manipulation. Performance in games and during quality workouts is likely to improve by adopting strategies that promote high carbohydrate availability, although research specific to water polo is lacking. A planned approach incorporating strategies to facilitate muscle glycogen refueling and muscle protein synthesis should be implemented following intensified training sessions and matches, particularly when short recovery times are scheduled. Although sweat losses of water polo players are less than what is reported for land-based athletes, specific knowledge allows for appropriate planning of carbohydrate intake strategies for match play and training. Postgame strategies to manage alcohol intake should be developed with input from the senior player group to minimize the negative consequences on recovery and player welfare.

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C. Peter Schokman, Ingrid H.E. Rutishauser and Roger J. Wallace

This study describes pre- and postcompetition mean energy and macronutrient intakes of 40 elite Australian Football players. Carbohydrate intake, expressed both as a percentage of total energy intake (En %) and as grams per kilogram of body mass (g/kg BM), was significantly less (51.7% En and 4.8 g/kg BM, p < . 001) than minimum recommendations for endurance athletes (60% En and 6 g/kg BM). Pregame carbohydrate intake (53.6% En) was significantly greater (p < .01) than postgame (49.7% En). However, expressed as g/kg BM, pre- and postgame macronutrient intakes did not differ significantly. Protein and fat intakes (as g/kg BM) fell within guidelines, whereas energy intake (13.2 MJ/ day or 153.8 kJ/kg BM) was lower than expected. Results suggest that for athletes engaging in endurance team sports where body mass and energy requirements vary considerably, carbohydrate recommendations are more appropriately expressed as g/kg BM rather than En %.

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Sue Reeves and Kieran Collins

The aim of this study was to investigate the dietary intakes and anthropometric profiles of county and club Gaelic football players and compare them to soccer players and control subjects. Seven-day dietary records were analyzed and anthropometric measurements were taken midway through the Gaelic football competitive season. The county group with a mean height of 1.82 ± 0.04 m were significantly taller (p < .05) and had less body fat than any other group. The county and club teams consumed 151 ± 11 and 150 ± 16 kJ · kg−1 · day−1, respectively, with 52.2 ± 5% and 49.5 ± 9% of their energy intakes as carbohydrate. This compares to 173 ± 11 kJ · kg−1 · day−1 for the soccer players and 159 ± 8 kJ · kg−1 · day−1 for the controls, with 57 ± 4% and 44.9 ± 5% of their energy from carbohydrate. The nature of Gaelic football demands a balanced diet, rich in energy and carbohydrate and with adequate calcium is consumed; the subjects needed to increase these dietary components in order to meet the energetic demands of competition and training. Additional nutritional counseling was provided on an individual basis.

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Ida A. Heikura, Trent Stellingwerff, Antti A. Mero, Arja Leena Tuulia Uusitalo and Louise M. Burke

Contemporary nutrition guidelines promote a variety of periodized and time-sensitive recommendations, but current information regarding the knowledge and practice of these strategies among world-class athletes is limited. The aim of this study was to investigate this theme by implementing a questionnaire on dietary periodization practices in national/international level female (n = 27) and male (n = 21) middle- and long-distance runners/race-walkers. The questionnaire aimed to gain information on between and within-day dietary choices, as well as timing of pre- and posttraining meals and practices of training with low or high carbohydrate (CHO) availability. Data are shown as percentage (%) of all athletes, with differences in responses between subgroups (sex or event) shown as Chi-square x2 when p < .05. Nearly two-thirds of all athletes reported that they aim to eat more food on, or after, hard training days. Most athletes said they focus on adequate fueling (96%) and adequate CHO and protein (PRO) recovery (87%) around key sessions. Twenty-six percent of athletes (11% of middle vs 42% of long-distance athletes [x 2 (1, n = 46) = 4.308, p = .038, phi = 0.3])) reported to undertake training in the fasted state, while 11% said they periodically restrict CHO intake, with 30% ingesting CHO during training sessions. Our findings show that elite endurance athletes appear to execute pre- and post-key session nutrition recovery recommendations. However, very few athletes deliberately undertake some contemporary dietary periodization approaches, such as training in the fasted state or periodically restricting CHO intake. This study suggests mismatches between athlete practice and current and developing sports nutrition guidelines.

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Julien Louis, Fabrice Vercruyssen, Olivier Dupuy and Thierry Bernard

optimized. Finally, we provided practical nutritional recommendations and suggestions for the next stage of research. To prepare this narrative review, a literature search was conducted on the PubMed, Scopus, and SPORTDiscus databases. Search terms included master or senior or older or veteran or

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Alba Reguant-Closa, Margaret M. Harris, Tim G. Lohman and Nanna L. Meyer

periodized nutrition recommendations of the AP can be maintained. In fact, some countries have adopted the AP system, integrating their cultural foods (e.g., Costa Rica and Mexico; https://www.gob.mx/conade/prensa/platos-nutricionales-herramienta-para-revitalizar-la-alimentacion-en-mexico ). Figure 1 —The

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Maria Heikkilä, Raisa Valve, Mikko Lehtovirta and Mikael Fogelholm

sports nutrition knowledge: (a) nutrition recommendations for endurance athletes, (b) dietary supplements, (c) fluid balance and hydration, (d) energy intake and recovery, and (e) association between food choices and body image. The questionnaire was developed in collaboration with an expert panel ( n

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Floris C. Wardenaar, Rianne Dijkhuizen, Ingrid J.M. Ceelen, Emma Jonk, Jeanne H.M. De Vries, Renger F. Witkamp and Marco Mensink

Purpose:

The objective of this study was to investigate whether ultramarathon runners were able to meet nutrition recommendations during a training period and on a competition day.

Methods:

In preparation for a 60 or 120 km ultramarathon covering a varied terrain, male and female ultramarathon runners (n = 68, age 46.5 ± 7.1 y) reported habitual dietary intake during three independent days using a web-based 24-hr recall and questionnaires. The diet was assessed using probability of inadequacy or by qualitative evaluation using reference dietary intakes or sports nutrition recommendations. A small group of 120 km runners (n = 4) was observed continuously during the race. After the race, 60 km runners (n = 41) received a questionnaire to assess dietary intake and gastrointestinal (GI) distress on the race day. Spearman rank correlation coefficients (r) were applied to investigate the association between intake and general GI distress symptoms.

Results:

In men and women, habitual mean carbohydrate (CHO) intake was lower than recommended, as was mean protein intake by women. CHO intake during the race was <60 g/h in 75% of the athletes. A large variation of nutrient and fluid intake was seen. GI distress during the race was reported in 82% of the runners; severe GI distress was low. In general, moderate, mostly negative, correlations with nutrient intake were seen for GI distress.

Conclusions:

Sports nutrition recommendations for the habitual diet were not achieved. During a competition day, a large variation was found in nutrient intake; this may be related to a high incidence of GI distress.