Post-exercise recovery for the endurance athlete with type 1 diabetes: a consensus statement.

There has been substantial progress in the knowledge of exercise and type 1 diabetes, with the development of guidelines for optimal glucose management. In addition, an increasing number of people living with type 1 diabetes are pushing their physical limits to compete at the highest level of sport. However, the post-exercise recovery routine, particularly with a focus on sporting performance, has received little attention within the scientific literature, with most of the focus being placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout. The post-exercise recovery period presents an opportunity for maximising training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight. The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error, or adhere to guidelines that have been developed for people without diabetes. This Review provides an up-to-date consensus on post-exercise recovery and glucose management for individuals living with type 1 diabetes. We aim to: (1) outline the principles and time course of post-exercise recovery, highlighting the implications and challenges for endurance athletes living with type 1 diabetes; (2) provide an overview of potential strategies for post-exercise recovery that could be used by athletes with type 1 diabetes to optimise recovery and adaptation, alongside improved glycaemic monitoring and management; and (3) highlight the potential for technology to ease the burden of managing glycaemia in the post-exercise recovery period.

Fluid Balance, Sweat Na+ Losses, and Carbohydrate Intake of Elite Male Soccer Players in Response to Low and High Training Intensities in Cool and Hot Environments.

Hypohydration increases physiological strain and reduces physical and technical soccer performance, but there are limited data on how fluid balance responses change between different types of sessions in professional players. This study investigated sweat and fluid/carbohydrate intake responses in elite male professional soccer players training at low and high intensities in cool and hot environments. Fluid/sodium (Na+) losses and ad-libitum carbohydrate/fluid intake of fourteen elite male soccer players were measured on four occasions: cool (wet bulb globe temperature (WBGT): 15 ± 7 °C, 66 ± 6% relative humidity (RH)) low intensity (rating of perceived exertion (RPE) 2-4, m·min-1 40-46) (CL); cool high intensity (RPE 6-8, m·min-1 82-86) (CH); hot (29 ± 1 °C, 52 ± 7% RH) low intensity (HL); hot high intensity (HH). Exercise involved 65 ± 5 min of soccer-specific training. Before and after exercise, players were weighed in minimal clothing. During training, players had ad libitum access to carbohydrate beverages and water. Sweat [Na+] (mmol·L-1), which was measured by absorbent patches positioned on the thigh, was no different between conditions, CL: 35 ± 9, CH: 38 ± 8, HL: 34 ± 70.17, HH: 38 ± 8 (p = 0.475). Exercise intensity and environmental condition significantly influenced sweat rates (L·h-1), CL: 0.55 ± 0.20, CH: 0.98 ± 0.21, HL: 0.81 ± 0.17, HH: 1.43 ± 0.23 (p =0.001), and percentage dehydration (p < 0.001). Fluid intake was significantly associated with sweat rate (p = 0.019), with no players experiencing hypohydration > 2% of pre-exercise body mass. Carbohydrate intake varied between players (range 0-38 g·h-1), with no difference between conditions. These descriptive data gathered on elite professional players highlight the variation in the hydration status, sweat rate, sweat Na+ losses, and carbohydrate intake in response to training in cool and hot environments and at low and high exercise intensities.

UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research.

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Fat Oxidation Rates in Professional Soccer Players.

PURPOSE: Large interindividual variation exists in maximal fat oxidation (MFO) rates and the exercise intensity at which it occurs (FATMAX). However, there are no data describing the shape of the fat oxidation curve or if individual differences exist when tested on separate occasions. Furthermore, there are limited data on fat metabolism in professional team sport athletes. Therefore, the aim of this study was to test-retest the concavity (shape) and intercept (height) of fat oxidation curves within a group of professional soccer players. METHOD: On two occasions, 16 professional male soccer players completed a graded exercise test in a fasted state (≥5 h). Rates of fat oxidation were determined using indirect calorimetry. Maximal oxygen uptake (V˙O2max) was measured to calculate FATMAX (%V˙O2max). The shape of the fat oxidation curves were modeled on an individual basis using third-degree polynomial. Test-by-test differences, in the shape and vertical shift of the fat oxidation curves, were established to assess within-individual variability. RESULTS: Average absolute MFO was 0.69 ± 0.15 g·min (range, 0.45-0.99 g·min). On a group level, no significant differences were found in MFO between the two tests. No differences were found (P > 0.05) in the shape of the fat oxidation curves in 13 of 16 players (test 1 vs test 2). There were also no differences (P > 0.05) in the vertical shift of the fat oxidation curves in 10 players. CONCLUSIONS: In general, the shape of the fat oxidation curve does not change within an individual; however, the vertical shift is more susceptible to change, which may be due to training status and body composition. Understanding a player's metabolism may be of value to practitioners working within sport, with regard to personalizing nutrition strategies.

Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers.

Distance events in Athletics include cross country, 10,000-m track race, half-marathon and marathon road races, and 20- and 50-km race walking events over different terrain and environmental conditions. Race times for elite performers span ∼26 min to >4 hr, with key factors for success being a high aerobic power, the ability to exercise at a large fraction of this power, and high running/walking economy. Nutrition-related contributors include body mass and anthropometry, capacity to use fuels, particularly carbohydrate (CHO) to produce adenosine triphosphate economically over the duration of the event, and maintenance of reasonable hydration status in the face of sweat losses induced by exercise intensity and the environment. Race nutrition strategies include CHO-rich eating in the hours per days prior to the event to store glycogen in amounts sufficient for event fuel needs, and in some cases, in-race consumption of CHO and fluid to offset event losses. Beneficial CHO intakes range from small amounts, including mouth rinsing, in the case of shorter events to high rates of intake (75-90 g/hr) in the longest races. A personalized and practiced race nutrition plan should balance the benefits of fluid and CHO consumed within practical opportunities, against the time, cost, and risk of gut discomfort. In hot environments, prerace hyperhydration or cooling strategies may provide a small but useful offset to the accrued thermal challenge and fluid deficit. Sports foods (drinks, gels, etc.) may assist in meeting training/race nutrition plans, with caffeine, and, perhaps nitrate being used as evidence-based performance supplements.

Toward a Common Understanding of Diet-Exercise Strategies to Manipulate Fuel Availability for Training and Competition Preparation in Endurance Sport.

From the breakthrough studies of dietary carbohydrate and exercise capacity in the 1960s through to the more recent studies of cellular signaling and the adaptive response to exercise in muscle, it has become apparent that manipulations of dietary fat and carbohydrate within training phases, or in the immediate preparation for competition, can profoundly alter the availability and utilization of these major fuels and, subsequently, the performance of endurance sport (events >30 min up to ∼24 hr). A variety of terms have emerged to describe new or nuanced versions of such exercise-diet strategies (e.g., train low, train high, low-carbohydrate high-fat diet, periodized carbohydrate diet). However, the nonuniform meanings of these terms have caused confusion and miscommunication, both in the popular press and among the scientific community. Sports scientists will continue to hold different views on optimal protocols of fuel support for training and competition in different endurance events. However, to promote collaboration and shared discussions, a commonly accepted and consistent terminology will help to strengthen hypotheses and experimental/experiential data around various strategies. We propose a series of definitions and explanations as a starting point for a more unified dialogue around acute and chronic manipulations of fat and carbohydrate in the athlete's diet, noting philosophies of approaches rather than a single/definitive macronutrient prescription. We also summarize some of the key questions that need to be tackled to help produce greater insight into this exciting area of sports nutrition research and practice.

Training the Gut for Athletes.

The gastrointestinal (GI) tract plays a critical role in delivering carbohydrate and fluid during prolonged exercise and can therefore be a major determinant of performance. The incidence of GI problems in athletes participating in endurance events is high, indicating that GI function is not always optimal in those conditions. A substantial body of evidence suggests that the GI system is highly adaptable. Gastric emptying as well as stomach comfort can be "trained" and perceptions of fullness decreased; some studies have suggested that nutrient-specific increases in gastric emptying may occur. Evidence also shows that diet has an impact on the capacity of the intestine to absorb nutrients. Again, the adaptations that occur appear to be nutrient specific. For example, a high-carbohydrate diet will increase the density of sodium-dependent glucose-1 (SGLT1) transporters in the intestine as well as the activity of the transporter, allowing greater carbohydrate absorption and oxidation during exercise. It is also likely that, when such adaptations occur, the chances of developing GI distress are smaller. Future studies should include more human studies and focus on a number of areas, including the most effective methods to induce gut adaptations and the timeline of adaptations. To develop effective strategies, a better understanding of the exact mechanisms underlying these adaptations is important. It is clear that "nutritional training" can improve gastric emptying and absorption and likely reduce the chances and/or severity of GI problems, thereby improving endurance performance as well as providing a better experience for the athlete. The gut is an important organ for endurance athletes and should be trained for the conditions in which it will be required to function.

Periodized Nutrition for Athletes.

It is becoming increasingly clear that adaptations, initiated by exercise, can be amplified or reduced by nutrition. Various methods have been discussed to optimize training adaptations and some of these methods have been subject to extensive study. To date, most methods have focused on skeletal muscle, but it is important to note that training effects also include adaptations in other tissues (e.g., brain, vasculature), improvements in the absorptive capacity of the intestine, increases in tolerance to dehydration, and other effects that have received less attention in the literature. The purpose of this review is to define the concept of periodized nutrition (also referred to as nutritional training) and summarize the wide variety of methods available to athletes. The reader is referred to several other recent review articles that have discussed aspects of periodized nutrition in much more detail with primarily a focus on adaptations in the muscle. The purpose of this review is not to discuss the literature in great detail but to clearly define the concept and to give a complete overview of the methods available, with an emphasis on adaptations that are not in the muscle. Whilst there is good evidence for some methods, other proposed methods are mere theories that remain to be tested. 'Periodized nutrition' refers to the strategic combined use of exercise training and nutrition, or nutrition only, with the overall aim to obtain adaptations that support exercise performance. The term nutritional training is sometimes used to describe the same methods and these terms can be used interchangeably. In this review, an overview is given of some of the most common methods of periodized nutrition including 'training low' and 'training high', and training with low- and high-carbohydrate availability, respectively. 'Training low' in particular has received considerable attention and several variations of 'train low' have been proposed. 'Training-low' studies have generally shown beneficial effects in terms of signaling and transcription, but to date, few studies have been able to show any effects on performance. In addition to 'train low' and 'train high', methods have been developed to 'train the gut', train hypohydrated (to reduce the negative effects of dehydration), and train with various supplements that may increase the training adaptations longer term. Which of these methods should be used depends on the specific goals of the individual and there is no method (or diet) that will address all needs of an individual in all situations. Therefore, appropriate practical application lies in the optimal combination of different nutritional training methods. Some of these methods have already found their way into training practices of athletes, even though evidence for their efficacy is sometimes scarce at best. Many pragmatic questions remain unanswered and another goal of this review is to identify some of the remaining questions that may have great practical relevance and should be the focus of future research.

Fructose and Sucrose Intake Increase Exogenous Carbohydrate Oxidation during Exercise.

Peak exogenous carbohydrate oxidation rates typically reach ~1 g∙min-1 during exercise when ample glucose or glucose polymers are ingested. Fructose co-ingestion has been shown to further increase exogenous carbohydrate oxidation rates. The purpose of this study was to assess the impact of fructose co-ingestion provided either as a monosaccharide or as part of the disaccharide sucrose on exogenous carbohydrate oxidation rates during prolonged exercise in trained cyclists. Ten trained male cyclists (VO2peak: 65 ± 2 mL∙kg-1∙min-1) cycled on four different occasions for 180 min at 50% Wmax during which they consumed a carbohydrate solution providing 1.8 g∙min-1 of glucose (GLU), 1.2 g∙min-1 glucose + 0.6 g∙min-1 fructose (GLU + FRU), 0.6 g∙min-1 glucose + 1.2 g∙min-1 sucrose (GLU + SUC), or water (WAT). Peak exogenous carbohydrate oxidation rates did not differ between GLU + FRU and GLU + SUC (1.40 ± 0.06 vs. 1.29 ± 0.07 g∙min-1, respectively, p = 0.999), but were 46% ± 8% higher when compared to GLU (0.96 ± 0.06 g∙min-1: p < 0.05). In line, exogenous carbohydrate oxidation rates during the latter 120 min of exercise were 46% ± 8% higher in GLU + FRU or GLU + SUC compared with GLU (1.19 ± 0.12, 1.13 ± 0.21, and 0.82 ± 0.16 g∙min-1, respectively, p < 0.05). We conclude that fructose co-ingestion (0.6 g∙min-1) with glucose (1.2 g∙min-1) provided either as a monosaccharide or as sucrose strongly increases exogenous carbohydrate oxidation rates during prolonged exercise in trained cyclists.

Maximal Fat Oxidation Rates in an Athletic Population.

INTRODUCTION: The aim of this study was to describe maximal fat oxidation (MFO) rates in an athletic population. METHOD: In total, 1121 athletes (933 males and 188 females), from a variety of sports and competitive level, undertook a graded exercise test on a treadmill in a fasted state (≥5 h fasted). Rates of fat oxidation were determined using indirect calorimetry. RESULTS: The average MFO was 0.59 ± 0.18 g·min, ranging from 0.17 to 1.27 g·min. Maximal rates occurred at an average exercise intensity of 49.3% ± 14.8% V˙O2max, ranging from 22.6% to 88.8% V˙O2max. In absolute terms, male athletes had significantly higher MFO compared with females (0.61 and 0.50 g·min, respectively, P < 0.001). Expressed relative to fat-free mass (FFM), MFO were higher in the females compared with males (MFO/FFM: 11.0 and 10.0 mg·kg·FFM·min, respectively, P < 0.001). Soccer players had the highest MFO/FFM (10.8 mg·kg·FFM·min), ranging from 4.1 to 20.5 mg·kg·FFM·min, whereas American Football players displayed the lowest rates of MFO/FFM (9.2 mg·kg·FFM·min). In all athletes, and when separated by sport, large individual variations in MFO rates were observed. Significant positive correlations were found between MFO (g·min) and the following variables: FFM, V˙O2max, FATMAX (the exercise intensity at which the MFO was observed), percent body fat, and duration of fasting. When taken together these variables account for 47% of the variation in MFO. CONCLUSION: MFO and FATMAX vary significantly between athletes participating in different sports but also in the same sport. Although variance in MFO can be explained to some extent by body composition and fitness status, more than 50% of the variance is not explained by these variables and remains unaccounted for.

Impact of intensified training and carbohydrate supplementation on immunity and markers of overreaching in highly trained cyclists.

PURPOSE: To determine effects of intensified training (IT) and carbohydrate supplementation on overreaching and immunity. METHODS: In a randomized, double-blind, crossover design, 13 male cyclists (age 25 ± 6 years, VO2max 72 ± 5 ml/kg/min) completed two 8-day periods of IT. On one occasion, participants ingested 2 % carbohydrate (L-CHO) beverages before, during and after training sessions. On the second occasion, 6 % carbohydrate (H-CHO) solutions were ingested before, during and after training, with the addition of 20 g of protein in the post-exercise beverage. Blood samples were collected before and immediately after incremental exercise to fatigue on days 1 and 9. RESULTS: In both trials, IT resulted in decreased peak power (375 ± 37 vs. 391 ± 37 W, P < 0.001), maximal heart rate (179 ± 8 vs. 190 ± 10 bpm, P < 0.001) and haematocrit (39 ± 2 vs. 42 ± 2 %, P < 0.001), and increased plasma volume (P < 0.001). Resting plasma cortisol increased while plasma ACTH decreased following IT (P < 0.05), with no between-trial differences. Following IT, antigen-stimulated whole blood culture production of IL-1α was higher in L-CHO than H-CHO (0.70 (95 % CI 0.52-0.95) pg/ml versus 0.33 (0.24-0.45) pg/ml, P < 0.01), as was production of IL-1ß (9.3 (95 % CI 7-10.4) pg/ml versus 6.0 (5.0-7.8) pg/ml, P < 0.05). Circulating total leukocytes (P < 0.05) and neutrophils (P < 0.01) at rest increased following IT, as did neutrophil:lymphocyte ratio and percentage CD4+ lymphocytes (P < 0.05), with no between-trial differences. CONCLUSION: IT resulted in symptoms consistent with overreaching, although immunological changes were modest. Higher carbohydrate intake was not able to alleviate physiological/immunological disturbances.

Effect of Intensive Training on Mood With No Effect on Brain-Derived Neurotrophic Factor.

CONTEXT: Monitoring mood state is a useful tool for avoiding nonfunctional overreaching. Brain-derived neurotrophic factor (BDNF) is implicated in stress-related mood disorders. PURPOSE: To investigate the impact of intensified training-induced mood disturbance on plasma BDNF concentrations at rest and in response to exercise. METHODS: Eight cyclists performed 1 wk of normal (NT), 1 wk of intensified (INT), and 1 wk of recovery (REC) training. Fasted blood samples were collected before and after exercise on day 7 of each training week and analyzed for plasma BDNF and cortisol concentrations. A 24-item Profile of Mood State questionnaire was administered on day 7 of each training week, and global mood score (GMS) was calculated. RESULTS: Time-trial performance was impaired during INT (P = .01) and REC (P = .02) compared with NT. Basal plasma cortisol (NT = 153 ± 16 ng/mL, INT = 130 ± 11 ng/mL, REC = 150 ± 14 ng/ml) and BDNF (NT = 484 ± 122 pg/mL, INT = 488 ± 122 pg/mL, REC = 383 ± 56 pg/mL) concentrations were similar between training conditions. Likewise, similar exercise-induced increases in cortisol and BDNF concentrations were observed between training conditions. GMS was 32% greater during INT vs NT (P < .001). CONCLUSIONS: Consistent with a state of functional overreaching (FOR), impairments in performance and mood state with INT were restored after 1 wk of REC. These results support evidence for mood changes before plasma BDNF concentrations as a biochemical marker of FOR and that cortisol is not a useful marker for predicting FOR.

Acute Effects of Carbohydrate Supplementation on Intermittent Sports Performance.

Intermittent sports (e.g., team sports) are diverse in their rules and regulations but similar in the pattern of play; that is, intermittent high-intensity movements and the execution of sport-specific skills over a prolonged period of time (~1-2 h). Performance during intermittent sports is dependent upon a combination of anaerobic and aerobic energy systems, both of which rely on muscle glycogen and/or blood glucose as an important substrate for energy production. The aims of this paper are to review: (1) potential biological mechanisms by which carbohydrate may impact intermittent sport performance; (2) the acute effects of carbohydrate ingestion on intermittent sport performance, including intermittent high-intensity exercise capacity, sprinting, jumping, skill, change of direction speed, and cognition; and (3) what recommendations can be derived for carbohydrate intake before/during exercise in intermittent sports based on the available evidence. The most researched intermittent sport is soccer but some sport-specific studies have also been conducted in other sports (e.g., rugby, field hockey, basketball, American football, and racquet sports). Carbohydrate ingestion before/during exercise has been shown in most studies to enhance intermittent high-intensity exercise capacity. However, studies have shown mixed results with regards to the acute effects of carbohydrate intake on sprinting, jumping, skill, change of direction speed, and cognition. In most of these studies the amount of carbohydrate consumed was ~30-60 g/h in the form of a 6%-7% carbohydrate solution comprised of sucrose, glucose, and/or maltodextrin. The magnitude of the impact that carbohydrate ingestion has on intermittent sport performance is likely dependent on the carbohydrate status of the individual; that is, carbohydrate ingestion has the greatest impact on performance under circumstances eliciting fatigue and/or hypoglycemia. Accordingly, carbohydrate ingestion before and during a game seems to have the greatest impact on intermittent sports performance towards the end of the game.

Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise.

UNLABELLED: It is possible that dietary nitrate (NO3 (-)) supplementation may improve both physical and cognitive performance via its influence on blood flow and cellular energetics. PURPOSE: To investigate the effects of dietary NO3 (-) supplementation on exercise performance and cognitive function during a prolonged intermittent sprint test (IST) protocol, which was designed to reflect typical work patterns during team sports. METHODS: In a double-blind randomised crossover study, 16 male team-sport players received NO3 (-)-rich (BR; 140 mL day(-1); 12.8 mmol of NO3 (-)), and NO3 (-)-depleted (PL; 140 mL day(-1); 0.08 mmol NO3 (-)) beetroot juice for 7 days. On day 7 of supplementation, subjects completed the IST (two 40-min "halves" of repeated 2-min blocks consisting of a 6-s "all-out" sprint, 100-s active recovery and 20 s of rest), on a cycle ergometer during which cognitive tasks were simultaneously performed. RESULTS: Total work done during the sprints of the IST was greater in BR (123 ± 19 kJ) compared to PL (119 ± 17 kJ; P < 0.05). Reaction time of response to the cognitive tasks in the second half of the IST was improved in BR compared to PL (BR first half: 820 ± 96 vs. second half: 817 ± 86 ms; PL first half: 824 ± 114 vs. second half: 847 ± 118 ms; P < 0.05). There was no difference in response accuracy. CONCLUSIONS: These findings suggest that dietary NO3 (-) enhances repeated sprint performance and may attenuate the decline in cognitive function (and specifically reaction time) that may occur during prolonged intermittent exercise.

Acute effects of dietary constituents on motor skill and cognitive performance in athletes.

Performance in many sports is at least partially dependent on motor control, coordination, decision-making, and other cognitive tasks. This review summarizes available evidence about the ingestion of selected nutrients or isolated compounds (dietary constituents) and potential acute effects on motor skill and/or cognitive performance in athletes. Dietary constituents discussed include branched-chain amino acids, caffeine, carbohydrate, cocoa flavanols, Gingko biloba, ginseng, guarana, Rhodiola rosea, sage, L-theanine, theobromine, and tyrosine. Although this is not an exhaustive list, these are perhaps the most researched dietary constituents. Caffeine and carbohydrate have the greatest number of published reports supporting their ability to enhance acute motor skill and cognitive performance in athletes. At this time, there is insufficient published evidence to substantiate the use of any other dietary constituents to benefit sports-related motor skill or cognitive performance. The optimal dose and timing of caffeine and carbohydrate intake promoting enhanced motor skill and cognitive performance remain to be identified. Valid, reliable, and sensitive batteries of motor skills and cognitive tests should be developed for use in future efficacy studies.