Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining.

Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes. Cramp is notoriously unpredictable, making laboratory studies difficult, but experimental models involving electrical stimulation or intense voluntary contractions of small muscles held in a shortened position can induce cramp in many, although not all, individuals. These studies show that dehydration has no effect on the stimulation frequency required to initiate cramping and confirm a role for spinal pathways, but their relevance to the spontaneous cramps that occur during exercise is questionable. There is a long history of folk remedies for treatment or prevention of cramps; some may reduce the likelihood of some forms of cramping and reduce its intensity and duration, but none are consistently effective. It seems likely that there are different types of cramp that are initiated by different mechanisms; if this is the case, the search for a single strategy for prevention or treatment is unlikely to succeed.

Fluid Needs for Training, Competition, and Recovery in Track-and-Field Athletes.

The 2019 International Amateur Athletics Federation Track-and-Field World Championships will take place in Qatar in the Middle East. The 2020 Summer Olympics will take place in Tokyo, Japan. It is quite likely that these events may set the record for hottest competitions in the recorded history of both the Track-and-Field World Championships and Olympic Games. Given the extreme heat in which track-and-field athletes will need to train and compete for these games, the importance of hydration is amplified more than in previous years. The diverse nature of track-and-field events, training programs, and individuality of athletes taking part inevitably means that fluid needs will be highly variable. Track-and-field events can be classified as low, moderate, or high risk for dehydration based on typical training and competition scenarios, fluid availability, and anticipated sweat losses. This paper reviews the risks of dehydration and potential consequences to performance in track-and-field events. The authors also discuss strategies for mitigating the risk of dehydration.

IOC consensus statement: dietary supplements and the high-performance athlete.

Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition programme. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including (1) the management of micronutrient deficiencies, (2) supply of convenient forms of energy and macronutrients, and (3) provision of direct benefits to performance or (4) indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can benefit the athlete, but others may harm the athlete's health, performance, and/or livelihood and reputation (if an antidoping rule violation results). A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome and habitual diet. Supplements intended to enhance performance should be thoroughly trialled in training or simulated competition before being used in competition. Inadvertent ingestion of substances prohibited under the antidoping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete's health and awareness of the potential for harm must be paramount; expert professional opinion and assistance is strongly advised before an athlete embarks on supplement use.

Making Decisions About Supplement Use.

The use of dietary supplements is widespread among athletes in all sports and at all levels of competition, as it is in the general population. For the athlete training at the limits of what is sustainable, or for those seeking a shortcut to achieving their aims, supplements offer the prospect of bridging the gap between success and failure. Surveys show, however, that this is often not an informed choice and that the knowledge level among consumers is often low and that they are often influenced in their decisions by individuals with an equally inadequate understanding of the issues at stake. Supplement use may do more harm than good, unless it is based on a sound analysis of the evidence. Where a deficiency of an essential nutrient has been established by appropriate investigations, supplementation can provide a rapid and effective correction of the problem. Supplements can also provide a convenient and time-efficient solution to achieving the necessary intake of key nutrients such as protein and carbohydrate. Athletes contemplating the use of supplements should consider the potential for both positive and negative outcomes. Some ergogenic supplements may be of benefit to some athletes in some specific contexts, but many are less effective than is claimed. Some may be harmful to health of performance and some may contain agents prohibited by anti-doping regulations. Athletes should make informed choices that maximize the benefits while minimizing the risks.

IOC Consensus Statement: Dietary Supplements and the High-Performance Athlete.

Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition program. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including the management of micronutrient deficiencies, supply of convenient forms of energy and macronutrients, and provision of direct benefits to performance or indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can offer benefits to the athlete, but others may be harmful to the athlete's health, performance, and/or livelihood and reputation if an anti-doping rule violation results. A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome, and habitual diet. Supplements intended to enhance performance should be thoroughly trialed in training or simulated competition before implementation in competition. Inadvertent ingestion of substances prohibited under the anti-doping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete's health and awareness of the potential for harm must be paramount, and expert professional opinion and assistance is strongly advised before embarking on supplement use.

Optimizing the restoration and maintenance of fluid balance after exercise-induced dehydration.

Hypohydration, or a body water deficit, is a common occurrence in athletes and recreational exercisers following the completion of an exercise session. For those who will undertake a further exercise session that day, it is important to replace water losses to avoid beginning the next exercise session hypohydrated and the potential detrimental effects on performance that this may lead to. The aim of this review is to provide an overview of the research related to factors that may affect postexercise rehydration. Research in this area has focused on the volume of fluid to be ingested, the rate of fluid ingestion, and fluid composition. Volume replacement during recovery should exceed that lost during exercise to allow for ongoing water loss; however, ingestion of large volumes of plain water results in a prompt diuresis, effectively preventing longer-term maintenance of water balance. Addition of sodium to a rehydration solution is beneficial for maintenance of fluid balance due to its effect on extracellular fluid osmolality and volume. The addition of macronutrients such as carbohydrate and protein can promote maintenance of hydration by influencing absorption and distribution of ingested water, which in turn effects extracellular fluid osmolality and volume. Alcohol is commonly consumed in the postexercise period and may influence postexercise rehydration, as will the coingestion of food. Future research in this area should focus on providing information related to optimal rates of fluid ingestion, advisable solutions to ingest during different duration recovery periods, and confirmation of mechanistic explanations for the observations outlined.

Thirst responses following high intensity intermittent exercise when access to ad libitum water intake was permitted, not permitted or delayed.

UNLABELLED: An increase in subjective feelings of thirst and ad libitum drinking caused by an increase in serum osmolality have been observed following high intensity intermittent exercise (HIIE) compared to continuous exercise. The increase in serum osmolality is closely linked to the rise in blood lactate and serum sodium concentrations. However, during an ensuing recovery period after HIIE when serum osmolality will decrease, the resultant effect on sensations of thirst and subsequent water intake is unclear. Therefore the aim of the study was to assess the sensations of thirst and subsequent effect on ad libitum water consumption when water intake was immediately allowed, delayed or prevented following a period of HIIE. METHODS: Twelve males (26±4 years, 80.1±9.3 kg, 1.81±0.05 m, V̇O2peak 60.1±8.9 ml·kg(-1)·min(-1)) participated in three randomised trials undertaken 7-14 days apart. Participants rested for 30 min then completed a 60 min HIIE exercise period (20×1 min at 100% V̇O2peak with 2 min rest) followed by 60 min of recovery, during which ad libitum water intake was provided immediately (W), delayed until the final 30 min (W30) or not permitted (NW). Body mass was measured at the start and end of the trial. Blood lactate and serum sodium concentrations serum osmolality and sensation of thirst were measured at baseline, immediately post-exercise and during the recovery. RESULTS: Body mass loss was different between all trials (W: 0.25±0.45, W30: 0.49±0.37, NW: 1.29±0.37%; p<0.05). Sensations of thirst peaked post-exercise and decreased in W and W30 following water ingestion (p<0.05). Total voluntary water intake was greater in W trial (0.846±0.417 vs. 0.630±0.277l; p<0.05) but was similar during the first 30 min period of allowed drinking (0.618±0.297 vs. 0.630±0.277l; p>0.05). Serum osmolality (299±6 vs. 298±5 vs. 298±3 mOsmol·kg(-1)), blood lactate (7.1±1.1 vs. 7.2±1.1 vs. 7.1±1.2 mmol·l(-1)) and serum sodium concentrations (142±2 vs. 145±2 vs. 145±2 mmol·l(-1)) peaked post-exercise (W vs. W30 vs. NW; p<0.05) but were not different between trials (p>0.05). CONCLUSIONS: Sensations of thirst were increased following HIIE and remained until satiated by water intake. This was despite the likely primary stimulus, serum osmolality, decreasing during the recovery period following a post-exercise peak. A combined effect of reduction in blood lactate and serum sodium concentrations, restoration of plasma volume and water intake contributed to the similar decrease in serum osmolality observed throughout the trials.

Effect of Exercise Intensity on Subsequent Gastric Emptying Rate in Humans.

Previous investigations have suggested that exercise at intensities greater than 70% maximal oxygen uptake (VO2max) reduces gastric emptying rate during exercise, but little is known about the effect of exercise intensity on gastric emptying in the postexercise period. To examine this, 8 healthy participants completed 3 experimental trials that included 30 min of rest (R), low-intensity (L; 33% of peak power output) exercise, or high-intensity (H; 10 × 1 min at peak power output followed by 2 min rest) exercise. Thirty minutes after completion of exercise, participants ingested 595 ml of a 5% glucose solution, and gastric emptying rate was assessed via the double-sampling gastric aspiration method for 60 min. No differences (p > .05) were observed in emptying characteristics for total stomach volume or test meal volume between the trials, and the quantity of glucose delivered to the intestine did not differ between trials (p > .05). Half-emptying times did not differ (p = .902) between trials and amounted to 22 ± 9, 22 ± 9, and 22 ± 7 min (M ± SD) during the R, L, and H trials, respectively. These results suggest that exercise has little effect on postexercise gastric emptying rate of a glucose solution.

Electrolyte supplementation during severe energy restriction increases exercise capacity in the heat.

PURPOSE: This study examined the effects of sodium chloride and potassium chloride supplementation during 48-h severe energy restriction on exercise capacity in the heat. METHODS: Nine males completed three 48-h trials: adequate energy intake (100 % requirement), adequate electrolyte intake (CON); restricted energy intake (33 % requirement), adequate electrolyte intake (ER-E); and restricted energy intake (33 % requirement), restricted electrolyte intake (ER-P). At 48 h, cycling exercise capacity at 60 % VO2 peak was determined in the heat (35.2 °C; 61.5 % relative humidity). RESULTS: Body mass loss during the 48 h was greater during ER-P [2.16 (0.36) kg] than ER-E [1.43 (0.47) kg; P < 0.01] and CON [0.39 (0.68) kg; P < 0.001], as well as greater during ER-E than CON (P < 0.01). Plasma volume decreased during ER-P (P < 0.001), but not ER-E or CON. Exercise capacity was greater during CON [73.6 (13.5) min] and ER-E [67.0 (17.2) min] than ER-P [56.5 (13.1) min; P < 0.01], but was not different between CON and ER-E (P = 0.237). Heart rate during exercise was lower during CON and ER-E than ER-P (P < 0.05). CONCLUSIONS: These results demonstrate that supplementation of sodium chloride and potassium chloride during energy restriction attenuated the reduction in exercise capacity that occurred with energy restriction alone. Supplementation maintained plasma volume at pre-trial levels and consequently prevented the increased heart rate observed with energy restriction alone. These results suggest that water and electrolyte imbalances associated with dietary energy and electrolyte restriction might contribute to reduced exercise capacity in the heat.

Implications of active lifestyles and environmental factors for water needs and consequences of failure to meet those needs.

Heat stress and exercise increase water loss from the body, primarily in the form of sweat. For some occupational groups, including miners, construction workers in hot climates, soldiers, and some athletes, daily water losses can reach 10-12 L. These losses must be replaced on a daily basis to maintain functional capacity. Both hyperhydration and hypohydration will, if sufficiently severe, impair all aspects of physiological function. Tests of strength and power are largely unaffected by dehydration of up to about 2%-4% of body mass. However, decrements in the performance of endurance tests may occur at these levels, especially in warm environments. Body water deficits, if sufficiently severe, also have adverse effects on measures of mood and on some elements of cognitive function and result in an increased subjective rating of the perception of effort. Beverages consumed during exercise can provide carbohydrates and electrolytes that may be beneficial in some situations; however, drinking in volumes required to match sweat loss may cause gastrointestinal discomfort that will generally impair performance.

Effect of electrolyte addition to rehydration drinks consumed after severe fluid and energy restriction.

This study examined the effect of electrolyte addition to drinks ingested after severe fluid and energy restriction (FER). Twelve subjects (6 male and 6 female) completed 3 trials consisting of 24-hour FER (energy intake: 21 kJ·kg body mass; water intake: 5 ml·kg body mass), followed by a 2-hour rehydration period and a 4-hour monitoring period. During rehydration, subjects ingested a volume of drink equal to 125% of the body mass lost during FER in 6 aliquots, once every 20 minutes. Drinks were a sugar-free lemon squash (P) or the P drink with the addition of 50 mmol·L sodium chloride (Na) or 30 mmol·L potassium chloride (K). Total void urine samples were given before and after FER and every hour during rehydration and monitoring. Over all trials, FER produced a 2.1% reduction in body mass and negative sodium (-67 mmol), potassium (-48 mmol), and chloride (-84 mmol) balances. Urine output after drinking was 1627 (540) ml (P), 1391 (388) ml (K), and 1150 (438) ml (Na), with a greater postdrinking urine output during P than Na (p ≤ 0.05). Ingestion of drink Na resulted in a more positive sodium balance compared with P or K (p < 0.001), whereas ingestion of drink K resulted in a more positive potassium balance compared with P or Na (p < 0.001). These results demonstrate that after 24-hour FER, ingestion of a high sodium drink results in an increased sodium balance that augments greater drink retention compared with a low electrolyte placebo drink.

Voluntary water intake during and following moderate exercise in the cold.

Exercising in cold environments results in water losses, yet examination of resultant voluntary water intake has focused on warm conditions. The purpose of the study was to assess voluntary water intake during and following exercise in a cold compared with a warm environment. Ten healthy males (22 ± 2 years, 67.8 ± 7.0 kg, 1.77 ± 0.06 m, VO2peak 60.5 ± 8.9 ml·kg⁻¹·min⁻¹) completed two trials (7-8 days). In each trial subjects sat for 30 min before cycling at 70% VO2peak (162 ± 27W) for 60 min in 25.0 ± 0.1 °C, 50.8 ± 1.5% relative humidity (RH; warm) or 0.4 ± 1.0 °C, 68.8 ± 7.5% RH (cold). Subjects then sat for 120 min at 22.2 ± 1.2 °C, 50.5 ± 8.0% RH. Ad libitum drinking was allowed during the exercise and recovery periods. Urine volume, body mass, serum osmolality, and sensations of thirst were measured at baseline, postexercise and after 60 and 120 min of the recovery period. Sweat loss was greater in the warm trial (0.96 ± 0.18 l v 0.48 ± 0.15 l; p < .0001) but body mass losses over the trials were similar (1.15 ± 0.34% (cold) v 1.03 ± 0.26% (warm)). More water was consumed throughout the duration of the warm trial (0.81 ± 0.42 l v 0.50 ± 0.49 l; p = .001). Cumulative urine output was greater in the cold trial (0.81 ± 0.46 v 0.54 ± 0.31 l; p = .036). Postexercise serum osmolality was higher compared with baseline in the cold (292 ± 2 v 287 ± 3 mOsm.kg⁻¹, p < .0001) and warm trials (288 ± 5 v 285 ± 4 mOsm·kg⁻¹; p = .048). Thirst sensations were similar between trials (p > .05). Ad libitum water intake adjusted so that similar body mass losses occurred in both trials. In the cold there appeared to a blunted thirst response.

The effects of high-intensity intermittent exercise compared with continuous exercise on voluntary water ingestion.

Water intake occurs following a period of high-intensity intermittent exercise (HIIE) due to sensations of thirst yet this does not always appear to be caused by body water losses. Thu.s, the aim was to assess voluntary water intake following HIIE. Ten healthy males (22 ± 2 y, 75.6 ± 6.9 kg, VO2(peak) 57.3 ± 11.4 m · kg(-1) · min(-1); mean ± SD) completed two trials (7-14 d apart). Subjects sat for 30 min then completed an exercise period involving 2 min of rest followed by 1 min at 100% VO2(peak repeated for 60 min (HIIE) or 60 min continuously at 33% VO2(peak) (LO). Subjects then sat for 60 min and were allowed ad libitum water intake. Body )mass was measured at start and end of trials. Serum osmolality, blood lactate, and sodium concentrations, sensations of thirst and mouth dryness were measured at baseline, postexercise and after 5, 15, 30, and 60 min of recovery. Vasopressin concentration was measured at baseline, postexercise, 5 min, and 30 min. Body mass loss over the whole trial was similar (HIIE: 0.77 ± 0.50; LO: 0.85 ± 0.55%; p = .124). Sweat lost during exercise (0.78 ± 0.22 vs. 0.66 ± 0.26 L) and voluntary water intake during recovery (0.416 ± 0.299 vs. 0.294 ± 0.295 L; p < .05) were greater in HIIE. Serum osmolality (297 ± 3 vs. 288 ± 4 mOsmol · kg(-1)), blood lactate (8.5 ± 2.7 vs. 0.7 ± 0.4 mmol · L(-1)), serum sodium (146 ± 1 vs. 143 ± 1 mmol · L(-1)) and vasopressin (9.91 ± 3.36 vs. 4.43 ± 0.86 pg · ml(-1)) concentrations were higher after HIIE (p < .05) and thirst (84 ± 7 vs. 60 ± 21) and mouth dryness (87 ± 7 vs. 64 ± 23) also tended to be higher (p = .060). Greater voluntary water intake after HIIE was mainly caused by increased sweat loss and the consequences of increased serum osmolality mainly resulting from higher blood lactate concentrations.

Beverage consumption habits "24/7" among British adults: association with total water intake and energy intake.

BACKGROUND: Various recommendations exist for total water intake (TWI), yet it is seldom reported in dietary surveys. Few studies have examined how real-life consumption patterns, including beverage type, variety and timing relate to TWI and energy intake (EI). METHODS: We analysed weighed dietary records from the National Diet and Nutrition Survey of 1724 British adults aged 19-64 years (2000/2001) to investigate beverage consumption patterns over 24 hrs and 7 days and associations with TWI and EI. TWI was calculated from the nutrient composition of each item of food and drink and compared with reference values. RESULTS: Mean TWI was 2.53 L (SD 0.86) for men and 2.03 L (SD 0.71) for women, close to the European Food Safety Authority "adequate Intake" (AI) of 2.5 L and 2 L, respectively. However, for 33% of men and 23% of women TWI was below AI and TWI:EI ratio was <1 g/kcal. Beverages accounted for 75% of TWI. Beverage variety was correlated with TWI (r 0.34) and more weakly with EI (r 0.16). Beverage consumption peaked at 0800 hrs (mainly hot beverages/ milk) and 2100 hrs (mainly alcohol). Total beverage consumption was higher at weekends, especially among men. Overall, beverages supplied 16% of EI (men 17%, women 14%), alcoholic drinks contributed 9% (men) and 5% (women), milk 5-6%, caloric soft drinks 2%, and fruit juice 1%.In multi-variable regression (adjusted for sex, age, body weight, smoking, dieting, activity level and mis-reporting), replacing 100 g of caloric beverages (milk, fruit juice, caloric soft drinks and alcohol) with 100 g non-caloric drinks (diet soft drinks, hot beverages and water) was associated with a reduction in EI of 15 kcal, or 34 kcal if food energy were unchanged. Using within-person data (deviations from 7-day mean) each 100 g change in caloric beverages was associated with 29 kcal change in EI or 35 kcal if food energy were constant. By comparison the calculated energy content of caloric drinks consumed was 47 kcal/100 g. CONCLUSIONS: TWI and beverage consumption are closely related, and some individuals appeared to have low TWI. Compensation for energy from beverages may occur but is partial. A better understanding of interactions between drinking and eating habits and their impact on water and energy balance would give a firmer basis to dietary recommendations.

Fluid and electrolyte balance during 24-hour fluid and/or energy restriction.

Weight categorized athletes use a variety of techniques to induce rapid weight loss (RWL) in the days leading up to weigh in. This study examined the fluid and electrolyte balance responses to 24-hr fluid restriction (FR), energy restriction (ER) and fluid and energy restriction (F+ER) compared with a control trial (C), which are commonly used techniques to induce RWL in weight category sports. Twelve subjects (six male, six female) received adequate energy and water (C) intake, adequate energy and restricted water (~10% of C; FR) intake, restricted energy (~25% of C) and adequate water (ER) intake or restricted energy (~25% of C) and restricted (~10% of C) water intake (F+ER) in a randomized counterbalanced order. Subjects visited the laboratory at 0 hr, 12 hr, and 24 hr for blood and urine sample collection. Total body mass loss was 0.33% (C), 1.88% (FR), 1.97% (ER), and 2.44% (F+ER). Plasma volume was reduced at 24 hr during FR, ER, and F+ER, while serum osmolality was increased at 24 hr for FR and F+ER and was greater at 24 hr for FR compared with all other trials. Negative balances of sodium, potassium, and chloride developed during ER and F+ER but not during C and FR. These results demonstrate that 24 hr fluid and/ or energy restriction significantly reduces body mass and plasma volume, but has a disparate effect on serum osmolality, resulting in hypertonic hypohydration during FR and isotonic hypohydration during ER. These findings might be explained by the difference in electrolyte balance between the trials.

Global patterns of water intake: how intake data affect recommendations.

Studies to assess water intake have been undertaken in many countries around the world. Some of these have been large-scale studies, whereas others have used a small number of subjects. These studies provide an emerging picture of water and/or fluid consumption in different populations around the world. Studies of this nature have also formed the basis of a number of recommendations published by different organizations, including the US Institute of Medicine and the European Food Safety Authority. The results of these intake studies indicate substantial differences in water and/or fluid intake in different populations, which have translated into different intake recommendations.

Effect of dilute CHO beverages on performance in cool and warm environments.

PURPOSE: The efficacy of drinks containing low concentrations of CHO (2%-6%) on physical performance in cool and warm environments was evaluated. METHODS: In two separate but related studies, 24 healthy males completed a familiarization trial and four trials to volitional exhaustion (TTE) at 70% VO2max in cool conditions (10°C, n = 12) or 60% VO2max in a warm environment (30°C, n = 12). Subjects ingested 0%, 2%, 4%, or 6% CHO solutions (sucrose, glucose, and fructose in a ratio of 50:25:25) immediately before exercise and every 10 min during exercise. RESULTS: TTE in 10°C was 102.6 ± 33.9, 109.2 ± 33.9, 121.0 ± 25.7, and 122.4 ± 29.9 min in the 0%, 2%, 4%, and 6% trials, respectively (P = 0.012). Compared with the 0% trial, TTE was longer in the 4% (P = 0.032, effect size (ES) = 0.72) and 6% (P = 0.044, ES = 0.66) trials. In addition, TTE was longer in the 6% trial than in the 2% trial (P = 0.025). TTE was also significantly influenced by drink CHO content at 30°C (0% = 94.5 ± 24.5 min, 2% = 104.1 ± 20.1 min, 4% = 105.5 ± 26.7 min, 6% = 112.0 ± 28.7 min; P = 0.046). No differences in TTE were apparent between the 0% and the 2% or 4% trials, but TTE was longer in the 6% trial compared with the placebo (P = 0.045, ES = 0.62). HR, core temperature, or rates of substrate oxidation were not affected by drink CHO content. CONCLUSIONS: These results demonstrate significant improvements in exercise capacity over the placebo trial when 4% and 6% CHO solutions were ingested at 10°C and a 6% CHO drink was ingested at 30°C.

Nutrition for sports performance: issues and opportunities.

Diet can significantly influence athletic performance, but recent research developments have substantially changed our understanding of sport and exercise nutrition. Athletes adopt various nutritional strategies in training and competition in the pursuit of success. The aim of training is to promote changes in the structure and function of muscle and other tissues by selective modulation of protein synthesis and breakdown in response to the training stimulus. This process is affected by the availability of essential amino acids in the post-exercise period. Athletes have been encouraged to eat diets high in carbohydrate, but low-carbohydrate diets up-regulate the capacity of muscle for fat oxidation, potentially sparing the limited carbohydrate stores. Such diets, however, do not enhance endurance performance. It is not yet known whether the increased capacity for fat oxidation that results from training in a carbohydrate-deficient state can promote loss of body fat. Preventing excessive fluid deficits will maintain exercise capacity, and ensuring adequate hydration status can also reduce subjective perception of effort. This latter effect may be important in encouraging exercise participation and promoting adherence to exercise programmes. Dietary supplement use is popular in sport, and a few supplements may improve performance in specific exercise tasks. Athletes must be cautious, however, not to contravene the doping regulations. There is an increasing recognition of the role of the brain in determining exercise performance: various nutritional strategies have been proposed, but with limited success. Nutrition strategies developed for use by athletes can also be used to achieve functional benefits in other populations.