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.

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.

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.

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.

Water and salt balance in young male football players in training during the holy month of Ramadan.

The aim of this study was to assess water and salt balance in young football players in training during Ramadan. Measurements were made in 92 young male football players before and during the month of Ramadan. Fifty-five participants were observing Ramadan fasting, while the other 37 participants were eating and drinking without restriction. In week 3 of Ramadan, water and salt balance measures were made during a training session of 60-70 min duration that was performed at an ambient temperature of 25-28 degrees C and relative humidity of 50-53%. Body mass was recorded before and after training. Fluid intake was assessed in non-fasting players by weighing drink bottles before and after training, and the volume of any urine output was recorded. Sweat composition was estimated from absorbent patches applied to four skin sites for the duration of training. Mean sweat loss of players amounted to 1.41 litres (s = 0.36) in fasting players and 1.61 litres (s = 0.51) in non-fasting players (P = 0.038). Mean fluid intake during training in non-fasting players was 1.92 litres (s = 0.66). Sweat sodium concentration was 20 mmol . l(-1) (s = 8) in fasting players and 17 mmol . l(-1) (s = 7) in non-fasting players, and total sweat sodium loss during training was 0.67 g (s = 0.41) and 0.65 g (s = 0.37) [corresponding to a salt loss of 1.7 g (s = 1.1) and 1.7 g (s = 0.9)] respectively, with no difference between fasting and non-fasting players. Sweat sodium loss was not related to estimated dietary sodium intake (r = -0.07). These descriptive data show large individual variations in all measured parameters with relatively little difference in sweat parameters between fasting and non-fasting individuals.

Nutrition for the young athlete.

Athletics is a popular sport among young people. To maintain health and optimize growth and athletic performance, young athletes need to consume an appropriate diet. Unfortunately, the dietary intake of many young athletes follows population trends rather than public health or sports nutrition recommendations. To optimize performance in some disciplines, young athletes may strive to achieve a lower body weight or body fat content and this may increase their risk for delayed growth and maturation, amenorrhoea, reduced bone density, and eating disorders. Although many of the sports nutrition principles identified for adults are similar to those for young athletes, there are some important differences. These include a higher metabolic cost of locomotion and preferential fat oxidation in young athletes during exercise. Young athletes, particularity children, are at a thermoregulatory disadvantage due to a higher surface area to weight ratio, a slower acclimatization, and lower sweating rate. An appropriate dietary intake rather than use of supplements (except when clinically indicated) is recommended to ensure young athletes participate fully and safely in athletics.

Nutrition and hydration concerns of the female football player.

There is little information on the nutritional habits of female football players at any level of the game. There is also a shortage of information on the nutrition and hydration strategies that players should adopt. In general, differences in nutritional needs between males and females are smaller than differences between individuals, so that principles developed for male players also apply to women. There is a need to address energy balance and body composition: prolonged energy deficits cannot be sustained without harm to health and performance. Published reports show mean carbohydrate intakes for female players of about 5 g/kg/day, and this seems to be too low to sustain consistent intensive training. The timing of protein intake may be as important as the amounts consumed, provided that the total intake is adequate. Dehydration adversely affects skill and stamina in women as it does in men, so an individualised hydration strategy should be developed. The prevalence of iron deficiency in women generally is high, but it seems to be alarmingly high in female players. All players should adopt dietary habits that ensure adequate iron intake. Football training seems to increase bone mass in the weight-bearing limbs, with positive implications for bone health in later life, but some players may be at risk from inadequate calcium dietary intake.

The effect of acute branched-chain amino acid supplementation on prolonged exercise capacity in a warm environment.

Eight males were recruited to examine the effect of branched-chain amino acid (BCAA) supplementation on exercise capacity in a glycogen-depleted state in a warm environment. Following a exercise and dietary regimen designed to reduce glycogen availability, subjects returned to the laboratory the following morning and remained seated for 2 h, before cycling to volitional exhaustion at 50% VO2 peak in a warm environment [30.0 (0.2) degrees C; mean (SD)]. Four 250 ml aliquots of a 12 g l(-1) BCAA solution or placebo were ingested at 30 min intervals prior to exercise, with an additional 150 ml consumed every 15 min throughout exercise. BCAA ingestion had no effect on exercise capacity [placebo 103.9 (26.9) min; BCAA 111.0 (29.2) min; P = 0.129). No difference in heart rate (P = 0.345), core temperature (P = 0.628), or weighted mean skin temperature (P = 0.114) was apparent between trials. Ingestion of the BCAA solution produced a marked increase in plasma BCAA immediately prior to exercise [+ 1126 (158) micromol l(-1); P < 0.001) with this difference maintained throughout. Consequently, a significant reduction in the plasma concentration ratio of free tryptophan to BCAA was observed during the BCAA trial when compared to the placebo (P < 0.001). Plasma ammonia concentration was significantly elevated during exercise throughout the BCAA trial (P < 0.001), with no change from rest apparent during the placebo trial (P = 0.608). Blood glucose (P = 0.114) and lactate (P = 0.836) concentrations were not different between trials. Ingestion of a BCAA solution prior to, and during, prolonged exercise in glycogen-depleted subjects did not influence exercise capacity in a warm environment.