A randomized, cross-over trial assessing effects of beverage sodium concentration on plasma sodium concentration and plasma volume during prolonged exercise in the heat.

PURPOSE: This study assessed whether increasing sodium in a sports drink above that typical (~ 20 mmol L-1) affects plasma sodium and volume responses during prolonged exercise in the heat. METHODS: Endurance trained males (N = 11, 36 ± 14 y, 75.36 ± 5.30 kg, [Formula: see text]O2max 60 ± 3 mL min-1 kg-1) fulfilled requirements of the study including one 1-h exercise pre-trial, to estimate fluid losses (to prescribe fluid intake), and two, experimental trials (3-h or until tolerance), in random order, cycling (55% [Formula: see text]O2max, 34 °C, 65% RH). Beverages contained 6% carbohydrate and either 21 mmol L-1 (Low Na+) or 60 mmol L-1 sodium (High Na+). Analyses included linear mixed models and t-tests. RESULTS: Cycling time was similar 176 ± 9 min (Low Na+); 176 ± 7 min (High Na+). Fluid intake was 1.12 ± 0.19 L h-1; 1.14 ± 0.21 L h-1, resp. Body mass change was - 0.53 ± 0.40%; - 0.30 ± 0.45%, resp. Sodium intake was 69 ± 12 mmol; 201 ± 40 mmol, resp. Plasma sodium concentration was greater in High Na+ than Low Na+ (p < 0.001); decreasing in Low Na+ (- 1.5 ± 2.2 mmol L-1), increasing in High Na+ (0.8 ± 2.4 mmol L-1) (p = 0.048, 95% CI [- 4.52, - 0.02], d = 0.99). Plasma volume decreased in Low Na+ (- 2 ± 2%) but remained unchanged in High Na+ (0 ± 3%) (p = 0.01, 95% CI [- 3.2, - 0.5], d = 0.80). CONCLUSIONS: When conducting prolonged exercise in the heat, those who fully hydrate would benefit by increased sodium content of the beverage by improved plasma volume and sodium maintenance. Australian New Zealand Clinical Trials Registry (ACTRN12616000239460) 22/02/16.

Physical activity, dietary protein and insulin-like growth factor 1: Cross-sectional analysis utilising UK Biobank.

BACKGROUND: Insulin-like growth factor-I (IGF-1) is an anabolic hormone that stimulates cell growth and division. The effects of IGF-1 may be beneficial (muscle growth/repair) or detrimental (increased risk of several types of cancer and mortality) for health. Dietary protein and physical activity are thought to be factors that modulate IGF-1. OBJECTIVE: This study analysed the relationships dietary protein vs IGF-1 and physical activity vs IGF-1 independently with a large sample size, and determined if/how physical activity affected the association between dietary protein and IGF-1 in healthy adults. METHODS: Regression models were used to assess the association between dietary protein and/or physical activity on serum IGF-1 in a cross-sectional sample of 60,677 healthy adults that were enrolled in the UK Biobank project. RESULTS: Dietary protein was positively associated with IGF-1 (0.030 nmol/L;95%CI 0.027-0.033;p < 0.001). Individuals undertaking 10-50 excess MET h/week of physical activity had 0.129 nmol/L greater IGF-1 than participants completing less than 10 excess MET h/week (95%CI 0.028-0.230). The "high" category of physical activity (>50 excess MET h/week) was not correlated with IGF-1 (-0.055 nmol/L;95%CI -0.185-0.076). When dietary protein and physical activity were included in the same model, physical activity did not change the relationship between dietary protein and IGF-1, nor visa-versa. CONCLUSIONS: The positive association between dietary protein and IGF-1 was not influenced by physical activity. The former association was stronger than the latter. Thus, when seeking to adjust IGF-1 for possible health concerns, regulating dietary protein may be more pertinent than physical activity as a primary intervention.

Exercise, Dietary Protein, and Combined Effect on IGF-1.

Insulin-like growth factor 1 (IGF-1) is a dichotomous hormone. While beneficial for growth/repair, and regulating muscle hypertrophy, high concentrations of IGF-1 are associated with increased risk of cancer and mortality. Factors thought to mediate IGF-1 include dietary protein and exercise. The purpose of this study was to analyze acute effects of dietary protein and/or exercise on plasma free IGF-1 and the time-course thereof to inform individuals who may benefit from increased IGF-1 (muscle growth/repair) or reduced IGF-1 (risk/diagnosis of cancer). Twenty-four participants (11 females, 24.9±4.6y) completed the three-way crossover study consisting of: (1)a high protein (42g) meal; (2)exercise (20min with four 30sec sprints); and (3)exercise followed by a high protein meal. Blood samples were collected fasted at rest, immediately after rest (or 5min after exercise), and at regular intervals throughout a 5h recovery. An additional fasted venipuncture was performed the morning following each condition (24h after baseline). Free IGF-1 was higher at immediately after exercise in the exercise condition (p=0.04). In the protein condition the 24h IGF-1 was 17.5% higher (p=0.02) than baseline. IGF-1 did not change over time in response to exercise with protein. The data gleaned from this study can enhance the knowledge of the time-course effects from protein and/or exercise on IGF-1. This study can provide a foundation for future research to investigate optimal timing and dosage to enhance muscle protein synthesis for athletes, as well as investigate whether consistent high protein meals may chronically elevate IGF-1 and increase the risk of deleterious health outcomes.

Energy utilization associated with regular activity breaks and continuous physical activity: A randomized crossover trial.

AIMS: To quantify and compare energy utilization associated with prolonged sitting alone, or interrupted with regular activity breaks and/or an additional bout of continuous physical activity. METHODS AND RESULTS: Thirty six adults (11 males, BMI 24.1 ± 4.6) completed four interventions: (1) prolonged sitting (SIT), (2) sitting with 2-min of walking every 30 min (RAB), (3) prolonged sitting with 30-min of continuous walking at the end of the day (SIT + PA), (4) a combination of the activities in (2) and (3) above (RAB + PA). All walking was at a speed and incline corresponding to 60% V̇O2max. Energy utilization over 7 h for each intervention was estimated using indirect calorimetry. Compared to SIT, SIT + PA increased total energy utilization by 709 kJ (95% CI 485-933 kJ), RAB by 863 kJ (95% CI 638-1088 kJ), and RAB + PA by 1752 kJ (95% CI 1527-1927 kJ) (all p < 0.001). There was no difference in total energy utilization between SIT + PA and RAB, however, post-physical activity energy utilization in RAB was 632 kJ greater than SIT + PA (95% CI 561-704 kJ; p < 0.001). CONCLUSIONS: Short frequent activity, results in greater accumulation of elevated post-physical activity energy utilization compared to a single bout of continuous activity; however the total energy utilization is similar. Combining activity breaks with a longer continuous bout of activity will further enhance energy utilization, and in the longer term, may positively affect weight management of a greater magnitude than either activity pattern performed alone. TRIAL REGISTRATION: ANZCTR12614000624684.

Restricting dietary sodium reduces plasma sodium response to exercise in the heat.

Exercise-associated hyponatremia can be life-threatening. Excessive hypotonic fluid ingestion is the primary etiological factor but does not explain all variability. Possible effects of chronic sodium intake are unknown. The aim of this study was to determine whether dietary sodium affects plasma sodium concentration [Na+ ] during exercise in the heat, when water intake nearly matches mass loss. Endurance-trained men (n = 9) participated in this crossover experiment. Each followed a low-sodium (lowNa) or high-sodium (highNa) diet for 9 days with 24-h fluid intakes and urine outputs measured before experimental trials (day 10). The trials were ≥2 week apart. Trials comprised 3 h (or if not possible to complete, to exhaustion) cycling (55% VO2max ; 34 °C, 65% RH) with water intake approximating mass loss. Plasma [Na+ ], hematocrit, sweat and urine [Na+ ], heart rate, core temperature, and subjective perceptions were monitored. Urine [Na+ ] was lower on lowNa 24 h prior to (31 ± 24, 76 ± 30 mmol/L, P = 0.027) and during trials (10 ± 10, 52 ± 32 mmol/L, P = 0.004). Body mass was lower on lowNa (79.6 ± 8.5, 80.5 ± 8.9, P = 0.03). Plasma [Na+ ] was lower on lowNa before (137 ± 2, 140 ± 3, P = 0.007) and throughout exercise (P = 0.001). Sweat [Na+ ] was unaffected by diet (54.5 ± 40, 54.5 ± 23 mmol/L, P = 0.99). Heart rate and core temperature were higher on lowNa (P ≤ 0.001). Despite decreased urinary sodium losses, plasma sodium was lower on lowNa, with decreased mass indicating (extracellular) water may have been less, explaining greater heart rate and core temperature. General population health recommendations to lower salt intake may not be appropriate for endurance athletes, particularly those training in the heat.

Short-term heat acclimation is effective and may be enhanced rather than impaired by dehydration.

UNLABELLED: Most heat acclimation data are from regimes longer than 1 week, and acclimation advice is to prevent dehydration. OBJECTIVES: We hypothesized that (i) short-term (5-day) heat acclimation would substantially improve physiological strain and exercise tolerance under heat stress, and (ii) dehydration would provide a thermally independent stimulus for adaptation. METHODS: Nine aerobically fit males heat acclimated using controlled-hyperthermia (rectal temperature 38.5°C) for 90 min on 5 days; once euhydrated (EUH) and once dehydrated (DEH) during acclimation bouts. Exercising heat stress tests (HSTs) were completed before and after acclimations (90-min cycling in Ta 35°C, 60% RH). RESULTS: During acclimation bouts, [aldosterone]plasma rose more across DEH than EUH (95%CI for difference between regimes: 40-411 pg ml(-1); P = 0.03; n = 5) and was positively related to plasma volume expansion (r = 0.65; P = 0.05), which tended to be larger in DEH (CI: -1 to 10%; P = 0.06; n = 9). In HSTs, resting forearm perfusion increased more in DEH (by 5.9 ml 100 tissue ml(-1) min(-1): -11.5 to -1.0; P = 0.04) and end-exercise cardiac frequency fell to a greater extent (by 11 b min(-1): -1 to 22; P = 0.05). Hydration-related effects on other endocrine, cardiovascular, and psychophysical responses to HSTs were unclear. Rectal temperature was unchanged at rest but was 0.3°C lower at end exercise (P < 0.01; interaction: P = 0.52). CONCLUSIONS: Short-term (5-day) heat acclimation induced effective adaptations, some of which were more pronounced after fluid-regulatory strain from permissive dehydration, and not attributable to dehydration effects on body temperature.

Energy intake and expenditure during a 6-day cycling stage race.

Energy intake (EI) and energy expenditure (EE) are relatively easy to measure accurately over short periods in a laboratory setting, but less so during a multi-day competition. Our goal was to measure EI and EE as accurately as possible during a 6-day, 10-stage cycling race. We prepared all meals and supplements, assessed EI (weighed diet-records) and macrontrient intake, total EE (doubly labelled water), resting metabolic rate (respiratory gas exchange), exercise EE (power meters), and body mass. Body composition was measured several days before and after racing (dual x-ray absorptiometry). Body mass remained stable over the course of the race. The mean EI (27.3+/-3.8 MJ/day) nearly matched EE (27.4+/-2.0 MJ/day). The majority (62%) of EE was exercise EE. Macronutrient intake was within or exceeded the recommendations. Lean body mass increased and fat mass decreased in most of our participants. Our study indicates that EI can match high EE with adequate macronutrient intake during multi-day cycle racing and may be facilitated by appropriate foods being available at appropriate times. This optimization of nutritional provision supports positive changes in body composition.

Increased fat oxidation and regulation of metabolic genes with ultraendurance exercise.

AIM: Regular endurance exercise stimulates muscle metabolic capacity, but effects of very prolonged endurance exercise are largely unknown. This study examined muscle substrate availability and utilization during prolonged endurance exercise, and associated metabolic genes. METHODS: Data were obtained from 11 competitors of a 4- to 5-day, almost continuous ultraendurance race (seven males, four females; age: 36 +/- 11 years; cycling Vo(2peak): males 57.4 +/- 5.9, females 48.1 +/- 4.0 mL kg(-1) min(-1)). Before and after the race muscle biopsies were obtained from vastus lateralis, respiratory gases were sampled during cycling at 25 and 50% peak aerobic power output, venous samples were obtained, and fat mass was estimated by bioimpedance under standardized conditions. RESULTS: After the race fat mass was decreased by 1.6 +/- 0.4 kg (11%; P < 0.01). Respiratory exchange ratio at the 25 and 50% workloads decreased (P < 0.01) from 0.83 +/- 0.06 and 0.93 +/- 0.03 before, to 0.71 +/- 0.01 and 0.85 +/- 0.02, respectively, after the race. Plasma fatty acids were 3.5 times higher (from 298 +/- 74 to 1407 +/- 118 micromol L(-1); P < 0.01). Muscle glycogen content fell 50% (from 554 +/- 28 to 270 +/- 25 nmol kg(-1) d.w.; n = 7, P < 0.01), whereas the decline in muscle triacylglycerol (from 32 +/- 5 to 22 +/- 3 mmol kg(-1) d.w.; P = 0.14) was not statistically significant. After the race, muscle mRNA content of lipoprotein lipase and glycogen synthase increased (P < 0.05) 3.9- and 1.7-fold, respectively, while forkhead homolog in rhabdomyosarcoma, pyruvate dehydrogenase kinase 4 and vascular endothelial growth factor mRNA tended (P < 0.10) to be higher, whereas muscle peroxisome proliferator-activated receptor gamma co-activator-1beta mRNA tended to be lower (P = 0.06). CONCLUSION: Very prolonged exercise markedly increases plasma fatty acid availability and fat utilization during exercise. Exercise-induced regulation of genes encoding proteins involved in fatty acid recruitment and oxidation may contribute to these changes.

Time - motion analysis of professional rugby union players during match-play.

The aim of this study was to quantify the movement patterns of various playing positions during professional rugby union match-play, such that the relative importance of aerobic and anaerobic energy pathways to performance could be estimated. Video analysis was conducted of individual players (n=29) from the Otago Highlanders during six "Super 12" representative fixtures. Each movement was coded as one of six speeds of locomotion (standing still, walking, jogging, cruising, sprinting, and utility), three states of non-running intensive exertion (rucking/mauling, tackling, and scrummaging), and three discrete activities (kicking, jumping, passing). The results indicated significant demands on all energy systems in all playing positions, yet implied a greater reliance on anaerobic glycolytic metabolism in forwards, due primarily to their regular involvement in non-running intense activities such as rucking, mauling, scrummaging, and tackling. Positional group comparisons indicated that while the greatest differences existed between forwards and backs, each positional group had its own unique demands. Front row forwards were mostly involved in activities involving gaining/retaining possession, back row forwards tended to play more of a pseudo back-line role, performing less rucking/mauling than front row forwards, yet being more involved in aspects of broken play such as sprinting and tackling. While outside backs tended to specialize in the running aspects of play, inside backs tended to show greater involvement in confrontational aspects of play such as rucking/mauling and tackling. These results suggest that rugby training and fitness testing should be tailored specifically to positional groups rather than simply differentiating between forwards and backs.

Muscle glycogen oxidation during prolonged exercise measured with oral [13C]glucose: comparison with changes in muscle glycogen content.

Plasma glucose and muscle glycogen oxidation during prolonged exercise [75-min at 48 and 76% maximal O(2) uptake (Vo(2 max))] were measured in eight well-trained male subjects [Vo(2 max) = 4.50 l/min (SD 0.63)] using a simplified tracer technique in which a small amount of glucose highly enriched in (13)C was ingested: plasma glucose oxidation was computed from (13)C/(12)C in plasma glucose (which was stable beginning at minute 30 and minute 15 during exercise at 48 and 76% Vo(2 max), respectively) and (13)CO(2) production, and muscle glycogen oxidation was estimated by subtracting plasma glucose oxidation from total carbohydrate oxidation. Consistent data from the literature suggest that this small dose of exogenous glucose does not modify muscle glycogen oxidation and has little effect, if any, on plasma glucose oxidation. The percent contributions of plasma glucose and muscle glycogen oxidation to the energy yield at 48% Vo(2 max) [15.1% (SD 3.8) and 45.9% (SD 5.8)] and at 76% Vo(2 max) [15.4% (SD 3.6) and 59.8% (SD 9.2)] were well in line with data previously reported for similar work loads and exercise durations using conventional tracer techniques. The significant reduction in glycogen concentration measured from pre- and postexercise vastus lateralis muscle biopsies paralleled muscle glycogen oxidation calculated using the tracer technique and was larger at 76% than at 48% Vo(2 max). However, the correlation coefficients between these two estimates of muscle glycogen utilization were not different from zero at each of the two work loads. The simplified tracer technique used in the present experiment appears to be a valid alternative approach to the traditional tracer techniques for computing plasma glucose and muscle glycogen oxidation during prolonged exercise.

Effect of carbohydrate on portal vein blood flow during exercise.

Effects of carbohydrate ingestion and exercise on portal vein blood flow were studied. Flow was measured by pulsed-electronic Doppler. Eight male subjects performed four tests after a standardised breakfast and 5 h fast. Beverages were CHO (10 % glucose, 30 mmol . l (-1) NaCl) and W (water, 30 mmol . l (-1) NaCl). Exercise experiments comprised a resting measurement, 10 min warm-up and 60 min 70 % VO(2)max cycling. Every 10 min subjects stopped cycling briefly (approximately 30 s) for measurements. Beverage was consumed after warm-up (500 ml) and at 20 and 40 min (250 ml). Similar tests were done at rest. Blood samples were taken concurrently with flow measurements for hormonal concentrations. Exercise decreased blood flow (repeated measures ANOVA, p < 0.0001) and carbohydrate ingestion increased flow (p = 0.015). At rest, flow was greater with CHO than with W at 20 (177 +/- 31; 101 +/- 25 %, resp.) (mean +/- SE), 30 (209 +/- 37; 120 +/- 20 %), 40 (188 +/- 32; 108 +/- 12 %), and 60 min (195 +/- 19; 112 +/- 12 %) (1-way ANOVA, Fisher's PLSD, p < 0.05). Flow was similar during exercise with CHO and W, with a tendency for CHO to maintain flow better, at 10 (124 +/- 27; 77 +/- 21 %), 20 (81 +/- 10; 60 +/- 13 %), 30 (106 +/- 26; 56 +/- 10 %), 40 (109 +/- 28; 54 +/- 8 %), 50 (85 +/- 17; 54 +/- 13 %), and 60 min (61 +/- 15; 47 +/- 7 %). A positive correlation between glucagon and flow and an inverse correlation between noradrenaline and flow were observed. Exercise reduces, and carbohydrate increases, portal vein flow. Changes in plasma concentrations suggest that noradrenaline and glucagon, respectively, may play a role in modulating flow.

Fluid and electrolyte balance in ultra-endurance sport.

It is well known that fluid and electrolyte balance are critical to optimal exercise performance and, moreover, health maintenance. Most research conducted on extreme sporting endeavour (>3 hours) is based on case studies and studies involving small numbers of individuals. Ultra-endurance sportsmen and women typically do not meet their fluid needs during exercise. However, successful athletes exercising over several consecutive days come close to meeting fluid needs. It is important to try to account for all factors influencing bodyweight changes, in addition to fluid loss, and all sources of water input. Increasing ambient temperature and humidity can increase the rate of sweating by up to approximately 1 L/h. Depending on individual variation, exercise type and particularly intensity, sweat rates can vary from extremely low values to more than 3 L/h. Over-hydration, although not frequently observed, can also present problems, as can inappropriate fluid composition. Over-hydrating or meeting fluid needs during very long-lasting exercise in the heat with low or negligible sodium intake can result in reduced performance and, not infrequently, hyponatraemia. Thus, with large rates of fluid ingestion, even measured just to meet fluid needs, sodium intake is vital and an increased beverage concentration [30 to 50 mmol/L (1.7 to 2.9 g NaCl/L) may be beneficial. If insufficient fluids are taken during exercise, sodium is necessary in the recovery period to reduce the urinary output and increase the rate of restoration of fluid balance. Carbohydrate inclusion in a beverage can affect the net rate of water assimilation and is also important to supplement endogenous reserves as a substrate for exercising muscles during ultra-endurance activity. To enhance water absorption, glucose and/or glucose-containing carbohydrates (e.g. sucrose, maltose) at concentrations of 3 to 5% weight/volume are recommended. Carbohydrate concentrations above this may be advantageous in terms of glucose oxidation and maintaining exercise intensity, but will be of no added advantage and, if hyperosmotic, will actually reduce the net rate of water absorption. The rate of fluid loss may exceed the capacity of the gastrointestinal tract to assimilate fluids. Gastric emptying, in particular, may be below the rate of fluid loss, and therefore, individual tolerance may dictate the maximum rate of fluid intake. There is large individual variation in gastric emptying rate and tolerance to larger volumes. Training to drink during exercise is recommended and may enhance tolerance.

Response to a fluid load in athletes with a history of exercise induced hyponatremia.

PURPOSE: To determine whether athletes who had previously developed hyponatremia during an ultradistance triathlon show an impaired ability to excrete a large fluid load compared with athletes who had completed the same race without developing hyponatremia. METHODS: Six athletes who had developed hyponatremia ([Na] < 135 mmol x L(-1)) in the 1997 Ironman Triathlon (study cases) were compared with six athletes who completed the same race without hyponatremia (controls). All participants consumed 3.4 L of water over 2 h at rest. Weight, urine output, urine electrolytes, serum [Na(+)], hemoglobin, and hematocrit were measured every 30 min. Changes in plasma volume and residual fluid volume in the gut were estimated from these data. RESULTS: There were no significant differences between cases and controls in any parameters measured. Maximal rates of urine production (+/- SD) (1043 +/- 331 mL x h(-1) for cases, 878 +/- 168 mL x h(-1) for controls) were substantially behind the rate of fluid intake (1500 mL x h(-1)). Consequent to fluid retention, serum [Na(+)] fell progressively in both groups. Five cases and four controls developed hyponatremia. There was an inverse correlation between change in body weight and change in [Na(+)] (r = -0.67). Estimated changes in the intra- and extra-cellular fluid volumes could account for all the retained fluid, and there was little evidence for fluid accumulation in the bowel. CONCLUSION: When evaluated at rest, there does not appear to be any unique pathophysiological characteristic that explains why some athletes develop hyponatremia in response to fluid overload during prolonged exercise. Rather, hyponatremia was induced with equal effect in both cases and controls, consequent to progressive fluid overload of all the body fluid compartments and without evidence for fluid retention in the small bowel.

Effect of exercise on portal vein blood flow in man.

PURPOSE: Doppler pulsed flow and electronic scanning allow for instantaneous measurement of portal vein flow. This method was used to monitor alterations in splanchnic blood flow during exercise. METHODS: Measurements of portal vein blood flow were performed in eight healthy males at rest and at 10-min intervals during cycle ergometry at 70% of maximal aerobic capacity. Subjects stopped cycling briefly (approximately 30 s) and stopped breathing while measurements were made. Flow was calculated from values obtained for velocity of red blood cell passage and cross-sectional area of the vessel. RESULTS: Cross-sectional area decreased during exercise, resulting in a significant decrease in flow over time (P = 0.0001 by ANOVA). The flow within the portal vein had decreased by 80% after 60 min of exercise (absolute flow, 0.63 +/- 0.13 L x min(-1) at rest and 0.13 +/- 0.04 L x min(-1) at 60 min). CONCLUSION: Electronic Doppler flow measurement of portal vein flow is a viable, noninvasive technique that can be used to measure splanchnic blood flow. Values obtained as a result of intensive exercise are in line with earlier results obtained with other techniques.

Glycaemic control, muscle glycogen and exercise performance in IDDM athletes on diets of varying carbohydrate content.

The aim of this study was to examine the effects of a high carbohydrate diet on glycaemic control, resting muscle glycogen levels and exercise performance in athletes with insulin dependent diabetes (IDDM). Seven trained (mean +/- S.D., VO2max 50.3 +/- 7.4 ml/kg/min) IDDM males consumed a high carbohydrate diet (HCD) or a normal mixed diet (NMD) for 3 week periods in a randomised crossover trial with a one week wash-out. Carbohydrate provided 59% or 50% of total energy intake, respectively, on the two diets. Fasting plasma lipids, mean blood glucose (over 96 h), fructosamine and muscle glycogen were measured and insulin use recorded. Exercise performance was evaluated by a 15 min time trial following a 50 min pre-loading block. Statistical significance was assessed using two tailed paired Student t-tests. Mean blood glucose was 10% higher on HCD than NMD (p = 0.005), fructosamine levels were 375 +/- 54 and 353 +/- 51 (mol/L on HCD and NMD, resp., p = 0.04) and daily insulin requirements were 15% higher on HCD than NMD (p = 0.02). Fasting blood lipids were similar on the two diets. Muscle glycogen was significantly lower on HCD than NMD (88.2 +/- 19.2 and 95.6 +/- 14.6 mmol/kg ww, respectively, p = 0.02). Exercise completed during the time trial was 6% less on HCD than on NMD (p = 0.007). An increased carbohydrate intake for three weeks, in IDDM athletes, is associated with a deterioration in glycaemic control, increased insulin requirements, decreased muscle glycogen and reduced exercise performance. These data do not support recommendations for IDDM athletes to consume a high carbohydrate diet, at least not when glycaemic control worsens upon following this advice, as was observed in this short-term study.

Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat.

This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athletes participated in one 1-h exercise pretrial to estimate fluid needs and two 3-h experimental trials on a cycle ergometer at 55% of maximum O2 consumption at 34 degrees C and 65% relative humidity. In the experimental trials, fluid loss was replaced by distilled water (W) or a sodium-containing (18 mmol/l) sports drink, Gatorade (G). Six subjects did not complete 3 h in trial W, and four did not complete 3 h in trial G. The rate of change in plasma sodium concentration in all subjects, regardless of exercise time completed, was greater with W than with G (-2.48 +/- 2.25 vs. -0.86 +/- 1.61 mmol. l-1. h-1, P = 0.0198). One subject developed hyponatremia (plasma sodium 128 mmol/l) at exhaustion (2.5 h) in the W trial. A decrease in sodium concentration was correlated with decreased exercise time (R = 0.674; P = 0.022). A lower rate of urine production correlated with a greater rate of sodium decrease (R = -0. 478; P = 0.0447). Sweat production was not significantly correlated with plasma sodium reduction. The results show that decreased plasma sodium concentration can result from replacement of sweat losses with plain W, when sweat losses are large, and can precipitate the development of hyponatremia, particularly in individuals who have a decreased urine production during exercise. Exercise performance is also reduced with a decrease in plasma sodium concentration. We, therefore, recommend consumption of a sodium-containing beverage to compensate for large sweat losses incurred during exercise.

Muscle glycogen recovery after exercise during glucose and fructose intake monitored by 13C-NMR.

The purpose of this study was to examine muscle glycogen recovery with glucose feeding (GF) compared with fructose feeding (FF) during the first 8 h after partial glycogen depletion using 13C-nuclear magnetic resonance (NMR) on a clinical 1.5-TNMR system. After measurement of the glycogen concentration of the vastus lateralis (VL) muscle in seven male subjects, glycogen stores of the VL were depleted by bicycle exercise. During 8 h after completion of exercise, subjects were orally given either GF or FF while the glycogen content of the VL was monitored by 13C-NMR spectroscopy every second hour. The muscular glycogen concentration was expressed as percentage of the glycogen concentration measured before exercise. The glycogen recovery rate during GF (4.2 +/- 0.2%/h) was significantly higher (P < 0.05) compared with values during FF (2.2 +/- 0.3%/h). This study shows that 1) muscle glycogen levels are perceptible by 13 C-NMR spectroscopy at 1.5 T and 2) the glycogen restoration rate is higher after GF compared with after FF.

The maintenance of fluid balance during exercise.

Fluid supplementation is necessary for exercise in which fluid losses must be offset by intake to avoid the negative effects of hypohydration on health and performance. Several aspects of gastrointestinal function have been studied to gain information concerning the assimilation of ingested fluids to maintain fluid balance during exercise. Research results with regards to gastric emptying and secretion, intestinal absorption and secretion, and aspects of fluid retention, including urine production and plasma volume changes, can be utilised to formulate an appropriate fluid supplementation regimen. Increasing the volume of ingestate and decreasing the carbohydrate concentration promote gastric emptying of fluids. By maintaining a low osmolality secretion is reduced, thus leading to a greater rate of net fluid absorption. Adding sodium and carbohydrate (up to approximately 7%) increases the net intestinal absorption rate. Increasing carbohydrate concentration above this level begins to have a deleterious effect on intestinal absorption of fluid. Sodium also promotes retention of ingested fluids and leads to an increased plasma volume response during rehydration. The primary goal of supplementation should be considered, fluid vs carbohydrate provision, and the beverage composition altered accordingly. Beverage composition to maximise fluid provision will not maximise carbohydrate availability.

1H editing of 2-deuterated exogenous and natural endogenous D-glucose in biological samples.

A spin-echo based 1H homonuclear pulse sequence, enabling the selective editing of homonuclear first-order J-multiplet types, is presented and analyzed. Its effectiveness in quantification applications is assessed. Its potential usefulness in the quantitative distinction between 2-deuterated and natural D-glucose in biological samples is briefly discussed, with emphasis on studies of hexose metabolism conducted in vitro.

Breath 13CO2 background enrichment during exercise: diet-related differences between Europe and America.

A traditional North American diet contains a high percentage of carbohydrates (CHO) derived from C4 plants (maize, sugar cane), whereas a European diet contains primarily CHO derived from C3 plants (potato, sugar beet). The natural 13C enrichment of the first type of CHO is higher than that of the latter type. 13CO2 production from orally ingested C4 plant-derived CHO can, therefore, be used to quantify oxidation rates of orally ingested CHO at rest and during exercise. Recently it has been shown that oxidation rates assessed this way in North Americans should be corrected for an increase in breath background 13CO2 during exercise. We hypothesized that the indicated difference in metabolic origin of CHO would imply that no such correction is required for subjects on a European diet. We therefore studied changes from rest in breath 13CO2 enrichment in Dutch volunteers during cycle ergometry at 65% maximal work load (experiment 1, 2h, 6 subjects) and 70% maximal oxygen uptake (experiment 2, 90 min, 8 subjects) while ingesting water (experiments 1 and 2) and potato starch-derived glucose (experiment 2). Experiment 1 was done before and after careful instruction of the subjects to refrain from nutrient sources potentially containing CHO of C4 metabolic origin. No significant changes from rest 13CO2 enrichment were observed in tests with water and potato-derived glucose ingestion in subjects who excluded CHO of C4 metabolic origin from their diet.