How do previously inactive individuals restructure their time to 'fit in' morning or evening exercise: a randomized controlled trial.

The objective of this study was to investigate changes in sedentary and active behaviors when previously inactive adults start exercising in the morning or evening. One-hundred adults with overweight or obesity (BMI ≥ 25 kg/m2) were recruited for a 12-week intervention and randomized to one of three groups: (i) morning exercise (AMEx; 0600-0900); (ii) evening exercise (PMEx; 1600-1900); or (iii) waitlist control. AMEx and PMEx were prescribed self-paced aerobic exercise to achieve a weekly total of 250 min via a combination of supervised and unsupervised training. Sedentary and active behavior times were measured at baseline, mid- and post-intervention using the multimedia activity recall for children and adults. Time spent engaging in physical activity was significantly increased from baseline at both mid- (+ 14-22 min·day-1) and post-intervention (+ 12-19 min·day-1), for AMEx and PMEx. At 12-weeks, participants in both morning and evening exercise groups reported increased time spent Sleeping (+ 36 and + 20 min·day-1, respecitively), and reduced time spent watching TV/playing videogames (- 32 and - 25 min·day-1, respectively). In response to an exercise stimulus, previously inactive adults make encouraging modifications in how they use their time, and the patterns of change are similar with morning and evening exercise.

Estimating nitrate intake in the Australian diet: Design and validation of a food frequency questionnaire.

BACKGROUND: Dietary nitrates may play a role in mediating several key physiological processes impacting health and/or exercise performance. However, current methods for assessing dietary nitrate (NO3 - ) consumption are inadequate. The present study aimed to examine the dietary nitrate intake in a sample of 50 healthy adults, as well as test the validity of a purposefully developed food frequency questionnaire (FFQ). METHODS: Dietary nitrate intake was estimated over a week using (i) three 24-h dietary recalls; (ii) a short-term (7-day) FFQ; and (iii) a biomarker (urinary nitrate), in conjunction with a nitrate reference database. RESULTS: Daily dietary nitrate intake estimates were 130.94 mg (average of three 24-h recalls) and 180.62 mg (FFQ). The mean urinary NO3 - excretion was 1974.79 µmol day-1 (or 917.9 µmol L-1 ). Despite the difference between the two dietary assessment methods, there was a moderate positive correlation (r = 0.736, ρ < 0.001) between the two tools. There was also a positive correlation between urinary NO3 - and 24-h recall data (r = 0.632, ρ < 0.001), as well as between urinary NO3 - and FFQ (r = 0.579, ρ < 0.001). CONCLUSIONS: The ability to accurately estimate nitrate intakes depends on having suitable reference methods to estimate the concentrations of nitrate in the food supply, coupled with valid and reliable dietary assessment tools. Based on the findings from the present study, at an individual level, dietary recalls or records may be more accurate in estimating intakes of NO3 - . However, given the lower cost and time needed for administration relative to recalls, the FFQ has merit for estimating NO3 - intakes in health interventions, dietary surveys and surveillance programs.

Nitrate, nitrite and nitrosamines in the global food supply.

Inorganic nitrate provided by either nitrate salts or food supplements may improve cardiometabolic health. However, current methods to assess dietary nitrate, nitrite and nitrosamine consumption are inadequate. The purpose of this study was to develop a reference database to estimate the levels of nitrate, nitrite and nitrosamines in the global food supply. A systematic literature search was undertaken; of the 5,747 articles screened, 448 met the inclusion criteria. The final database included data for 1,980 food and beverages from 65 different countries. There were 5,105 unique records for nitrate, 2,707 for nitrite, and 954 for nitrosamine. For ease of use, data were sorted into 12 categories; regarding nitrate and nitrite concentrations in food and beverages, 'vegetables and herbs' were most reported in the literature (n = 3,268 and n = 1,200, respectively). For nitrosamines, 'protein foods of animal origin' were most reported (n = 398 records). This database will allow researchers and practitioners to confidently estimate dietary intake of nitrate, nitrite and nitrosamines. When paired with health data, our database can be used to investigate associations between nitrate intake and health outcomes, and/or exercise performance and could support the development of key dietary nitrate intake guidelines.

High intensity interval training does not result in short- or long-term dietary compensation in cardiac rehabilitation: Results from the FITR heart study.

The aim of this study was to investigate short- and long-term compensatory effects on dietary intake following high intensity interval training (HIIT) compared with usual care moderate intensity continuous training (MICT) during and following a cardiac rehabilitation program. This study investigates secondary outcomes of a clinical trial. Ninety-three participants with coronary artery disease enrolled in a 4-week cardiac rehabilitation program, were randomised to 1) 4x4-minute HIIT; or 2) 40-min of MICT (usual care). Patients were instructed to complete 3 weekly sessions (2 supervised, 1 home-based) for 4-weeks, and 3 weekly home-based sessions thereafter for another 48-weeks. Dietary intake was measured by telephone-based 24-h recall over 2 day at baseline, 4-weeks, 3-months, 6-months, and 12-months. Three-Factor Eating Questionnaire was used to measure dietary behaviour and Leeds Food Preference Questionnaire used to measure food preferences. Appetite was assessed by a visual analogue scale and appetite-regulating hormones. There was no change over the study period or differences between groups for daily energy intake at 4-weeks or 12-months. There were also no group differences for any other measures of dietary intake, fasting hunger or appetite-related hormones, dietary behaviour, or food preferences. These findings suggest that compared to moderate intensity exercise, HIIT does not result in compensatory increases of energy intake or indicators of poor diet quality. This finding appears to be the same for patients with normal weight and obesity. HIIT can therefore be included in cardiac rehabilitation programs as an adjunct or alterative to MICT, without concern for any undesirable dietary compensation.

Physical profiles of elite, sub-elite, regional and age-group netballers.

Physical profile data from elite, sub-elite, regional, under 21s (U21), under 19s (U19) and under 17s (U17) (n = 845) players from a state netball association in Australia were analysed. Within season changes were examined for the elite and sub-elite players. Longitudinal changes were examined for the elite across four consecutive netball seasons. Elite were significantly older (24.3 ± 3.4years), taller (182.4 ± 7.2cm) and heavier (73.42 ± 6.95kg) than other playing levels (p < 0.001, ES 0.49-3.26) and had higher vertical jump (VJ) data compared to all groups (p < 0.001, ES 0.47-0.93). U17's were significantly faster than elite, sub-elite and U19 players over 5m (p < 0.05, ES 0.36-0.58) while elite were faster over 20m compared to all groups (p < 0.01, ES 0.45-0.72). Elite achieved a greater distance (1350.8m; p < 0.05, ES 0.32-0.50) in the Yo-YoIRT1 compared to the sub-elite, regional, U19 and U17. VJ height significantly increased from the 2014 (51.6 ± 4.8cm) to the 2017 season (59.6 ± 6.3cm) for the elite players (p < 0.01, ES 1.18). Yo-YoIRT1 test scores increased significantly between the pre-season and in-season phases (p < 0.05, ES 0.17).

Combined Carbohydrate and Protein Ingestion During Australian Rules Football Matches and Training Sessions Does Not Reduce Fatigue or Accelerate Recovery Throughout a Weeklong Junior Tournament.

Lee, NA, Fell, JW, Pitchford, NW, Hall, AH, Leveritt, MD, and Kitic, CM. Combined carbohydrate and protein ingestion during Australian rules football matches and training sessions does not reduce fatigue or accelerate recovery throughout a weeklong junior tournament. J Strength Cond Res 32(2): 344-355, 2018-Australian rules football (ARF) is a physically demanding sport that can induce high levels of fatigue. Fatigue may be intensified during periods where multiple matches are played with limited recovery time. Combined carbohydrate and protein (CHO + PRO) intake during physical activity may provide performance and recovery benefits. The aim of this study was to investigate whether CHO + PRO ingestion during ARF matches and training sessions throughout a tournament would enhance performance or recovery in comparison with CHO-only ingestion. Australian rules football players (n = 21) competing in a 7-day national tournament participated in this randomized and double-blinded study. Beverages containing either CHO (n = 10) or CHO + PRO (n = 11) were provided during matches (day 1, day 4, and day 7) and training sessions (day 2 and day 3). Countermovement jumps (CMJs), ratings of muscle soreness, and autonomic function were assessed throughout the tournament. Gastrointestinal tract (GI) discomfort was measured after matches. Countermovement jump peak velocity increased in the CHO + PRO group (p = 0.01) but not in the CHO group. There were no differences in the other CMJ variables. In both groups, muscle soreness increased from days 0 and 1 to day 2 (p ≤ 0.05) but did not remain elevated. R-R intervals (time elapsed between successive peaks in QRS complexes) increased in both groups from day 1 to day 7 (mean difference = 59.85 ms, p < 0.01). Postmatch GI discomfort was not different (p > 0.05) between groups. When daily dietary protein is adequate (>1.8 g·kg·d), the ingestion of CHO + PRO during matches and training sessions throughout a tournament does not reduce muscle soreness nor have clear benefits for neuromuscular recovery or modulate autonomic function in junior ARF athletes, compared with that of CHO alone.

Nutrition therapy with high intensity interval training to improve prostate cancer-related fatigue in men on androgen deprivation therapy: a study protocol.

BACKGROUND: Cancer-related fatigue is one of the most prevalent, prolonged and distressing side effects of prostate cancer treatment with androgen deprivation therapy. Preliminary evidence suggests natural therapies such as nutrition therapy and structured exercise prescription can reduce symptoms of cancer-related fatigue. Men appear to change their habitual dietary patterns after prostate cancer diagnosis, yet prostate-specific dietary guidelines provide limited support for managing adverse side effects of treatment. The exercise literature has shown high intensity interval training can improve various aspects of health that are typically impaired with androgen deprivation therapy; however exercise at this intensity is yet to be conducted in men with prostate cancer. The purpose of this study is to examine the effects of nutrition therapy beyond the current healthy eating guidelines with high intensity interval training for managing cancer-related fatigue in men with prostate cancer treated with androgen deprivation therapy. METHODS/DESIGN: This is a two-arm randomized control trial of 116 men with prostate cancer and survivors treated with androgen deprivation therapy. Participants will be randomized to either the intervention group i.e. nutrition therapy and high intensity interval training, or usual care. The intervention group will receive 20 weeks of individualized nutrition therapy from an Accredited Practising Dietitian, and high intensity interval training (from weeks 12-20 of the intervention) from an Accredited Exercise Physiologist. The usual care group will maintain their standard treatment regimen over the 20 weeks. Both groups will undertake primary and secondary outcome testing at baseline, week 8, 12, and 20; testing includes questionnaires of fatigue and quality of life, objective measures of body composition, muscular strength, cardiorespiratory fitness, biomarkers for disease progression, as well as dietary analysis. The primary outcomes for this trial are measures of fatigue and quality of life. DISCUSSION: This study is the first of its kind to determine the efficacy of nutrition therapy above the healthy eating guidelines and high intensity interval training for alleviating prostate-cancer related fatigue. If successful, nutrition therapy and high intensity interval training may be proposed as an effective therapy for managing cancer-related fatigue and improving quality of life in men during and after prostate cancer treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000512527 . Trial registered on the 22/5/2015.

Dietary Intake, Body Composition, and Nutrition Knowledge of Australian Football and Soccer Players: Implications for Sports Nutrition Professionals in Practice.

Sports nutrition professionals aim to influence nutrition knowledge, dietary intake and body composition to improve athletic performance. Understanding the interrelationships between these factors and how they vary across sports has the potential to facilitate better-informed and targeted sports nutrition practice. This observational study assessed body composition (DXA), dietary intake (multiple-pass 24-hr recall) and nutrition knowledge (two previously validated tools) of elite and subelite male players involved in two team-based sports; Australian football (AF) and soccer. Differences in, and relationships between, nutrition knowledge, dietary intake and body composition between elite AF, subelite AF and elite soccer players were assessed. A total of 66 (23 ± 4 years, 82.0 ± 9.2 kg, 184.7 ± 7.7 cm) players participated. Areas of weaknesses in nutrition knowledge are evident (57% mean score obtained) yet nutrition knowledge was not different between elite and subelite AF and soccer players (58%, 57% and 56%, respectively, p > .05). Dietary intake was not consistent with recommendations in some areas; carbohydrate intake was lower (4.6 ± 1.5 g/kg/day, 4.5 ± 1.2 g/kg/day and 2.9 ± 1.1 g/kg/day for elite and subelite AF and elite soccer players, respectively) and protein intake was higher (3.4 ± 1.1 g/kg/day, 2.1 ± 0.7 g/kg/day and 1.9 ± 0.5 g/kg/day for elite and subelite AF and elite soccer players, respectively) than recommendations. Nutrition knowledge was positively correlated with fat-free soft tissue mass (n = 66; r2 = .051, p = .039). This insight into known modifiable factors may assist sports nutrition professionals to be more specific and targeted in their approach to supporting players to achieve enhanced performance.

Seasonal Changes in Soccer Players' Body Composition and Dietary Intake Practices.

Devlin, BL, Kingsley, M, Leveritt, MD, and Belski, R. Seasonal changes in soccer players' body composition and dietary intake practices. J Strength Cond Res 31(12): 3319-3326, 2017-The aims of this study were 2-fold: to determine seasonal changes in dietary intake and body composition in elite soccer players and to evaluate the influence of self-determined individual body composition goals on dietary intake and body composition. This longitudinal, observational study assessed body composition (total mass, fat-free soft tissue mass, and fat mass) using dual-energy x-ray absorptiometry and dietary intake (energy and macronutrients) via multiple-pass 24-hour recalls, at 4 time points over a competitive season in elite soccer players from one professional club in the Australian A-League competition. Self-reported body composition goals were also recorded. Eighteen elite male soccer players took part (25 ± 5 years, 180.5 ± 7.4 cm, 75.6 ± 6.5 kg). Majority (≥67%) reported the goal to maintain weight. Fat-free soft tissue mass increased from the start of preseason (55,278 ± 5,475 g) to the start of competitive season (56,784 ± 5,168 g; p < 0.001), and these gains were maintained until the end of the season. Fat mass decreased over the preseason period (10,072 ± 2,493 g to 8,712 ± 1,432 g; p < 0.001), but increased during the latter part of the competitive season. Dietary intake practices on training days were consistent over time and low compared with sport nutrition recommendations. The self-reported body composition goals did not strongly influence dietary intake practices or changes in body composition. This study has demonstrated that body composition changes over the course of a soccer season are subtle in elite soccer players despite relatively low self-reported intake of energy and carbohydrate.

The Effect of Ad Libitum Consumption of a Milk-Based Liquid Meal Supplement vs. a Traditional Sports Drink on Fluid Balance After Exercise.

The aim of this study was to compare the effect of ad libitum intake of a milk-based liquid meal supplement against a carbohydrate-electrolyte sports drink following exercise induced fluid loss. Seven male participants (age 22.3 ± 3.4 years, height 179.3 ± 7.9 cm, body mass 74.3 ± 7.3 kg; mean ± SD) completed 4 separate trials and lost 1.89 ± 0.44% body mass through moderate intensity exercise in the laboratory. After exercise, participants consumed ad libitum over 2 h a milk-based liquid meal supplement (Sustagen Sport) on two of the trials (S1, S2) or a carbohydrate-electrolyte sports drink (Powerade) on two of the trials (P1, P2), with an additional 1 hr observational period. Measures of body mass, urine output, gastrointestinal tolerance and palatability were collected throughout the recovery period. Participants consumed significantly more Powerade than Sustagen Sport over the 2 h rehydration period (P1 = 2225 ± 888 ml, P2 = 2602 ± 1119 mL, S1 = 1375 ± 711 mL, S2 = 1447 ± 857 ml). Total urine output on both Sustagen trails was significantly lower than the second Powerade trial (P2 = 1447 ± 656 ml, S1 = 153 ± 62 ml, S2 = 182 ± 118 mL; p < .05) and trended toward being lower compared with the first Powerade trial (P1 = 1057 ± 699 ml vs. S1, p = .067 and vs. S2, p = .061). No significant differences in net fluid balance were observed between any of the drinks at the conclusion of each trial (P1 = -0.50 ±0. 46 kg, P2 = -0.40 ± 0.35 kg, S1 = -0.61 ± 0.74 kg, S2 = -0.45 ± 0.58 kg). Gastrointestinal tolerance and beverage palatability measures indicated Powerade to be preferred as a rehydration beverage. Ad libitum milk-based liquid meal supplement results in similar net fluid balance as a carbohydrate-electrolyte sports drink after exercise induced fluid loss.

Passive interventions in primary healthcare waiting rooms are effective in promoting healthy lifestyle behaviours: an integrative review.

Primary healthcare waiting rooms have the potential to provide health-promoting environments to support healthy lifestyle behaviours such as smoking cessation, weight management and safe contraception. Passive interventions are cost-effective and continually available within an environment or setting, allowing individuals to interact, engage and learn about topics. The aim of this study was to undertake an integrative review to investigate the effectiveness of passive health-related waiting room interventions in improving healthy lifestyle behaviours, as well as precursors to behaviour change. The integrative review encompassed five phases: problem identification, literature search, data evaluation, data analysis and presentation of results. Quantitative, qualitative and mixed methods studies were included. Of the 9205 studies originally identified, 33 publications were included and grouped under four areas: knowledge about a health condition or behaviour, attitudes and intentions towards a health condition or behaviour, healthcare use and interactions, and health-related behaviours. Overall, the passive interventions had a general positive influence on knowledge, intentions, healthcare use and behaviours. Variable outcomes were reported regarding attitude towards a health topic. Few studies were assessed as both high quality and the highest suitability to assess effectiveness of interventions. Consideration of the clinical significance of improvements is warranted before implementation of future interventions. Overall, passive waiting room interventions appear to be effective in promoting healthy lifestyle behaviours.

Development of a validated questionnaire to measure the self-perceived competence of primary health professionals in providing nutrition care to patients with chronic disease.

BACKGROUND: Nutrition is an important aspect of chronic disease prevention and management by primary health professionals, including GPs, dietitians, practice nurses, diabetes educators and exercise professionals. In order to better understand how to improve the delivery of nutrition care, it is important to have valid and reliable tools to measure self-perceived competence. OBJECTIVE: This study aimed to develop a valid, structured, questionnaire that measures the self-perceived competence of primary health professionals to provide nutrition care to patients with chronic disease. METHODS: The development of the questionnaire was carried out in four stages (1): preparation of scope and structure, through a literature review and consultation with an expert reference group (2); development of questionnaire items, which were refined through feedback from the reference group and 18 primary health professionals (3); investigation of internal consistency and concurrent validity through a pilot study on 118 primary health professionals (4) and investigation of test-retest reliability through a pilot study on 33 primary health professionals who completed the questionnaire twice, 2-3 weeks apart. RESULTS: Stages 1 and 2 resulted in four constructs and 35 questions in the questionnaire. Stage 3 confirmed internal consistency, with Cronbach's α ranging from 0.88 to 0.98 for each construct and 0.98 for all items combined. Dietitians scored significantly higher than speech pathologists (P < 0.05) in each construct, confirming concurrent validity. Stage 4 confirmed test-retest reliability, with correlation coefficients ranging from 0.89 to 0.94 for each construct and 0.95 for all items combined. CONCLUSION: The NUTrition COMPetence (NUTCOMP) questionnaire is a valid, reliable and suitable tool that can be used to directly inform professional development and identify opportunities to support safe and effective practice.

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.

BACKGROUND: Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated. OBJECTIVES: The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities. METHODS: A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored. RESULTS: Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role. CONCLUSION: Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.

The effect of a caffeinated mouth-rinse on endurance cycling time-trial performance.

The purpose of this study was to investigate if acute caffeine exposure via mouth-rinse improved endurance cycling time-trial performance in well-trained cyclists. It was hypothesized that caffeine exposure at the mouth would enhance endurance cycling time-trial performance. Ten well-trained male cyclists (mean ± SD: 32.9 ± 7.5 years, 74.7 ± 5.3 kg, 176.8 ± 5.1cm, VO2peak = 59.8 ± 3.5 ml·kg⁻¹·min⁻¹) completed two experimental time-trials following 24 hr of dietary and exercise standardization. A randomized, double-blind, placebo-controlled, cross-over design was employed whereby cyclists completed a time-trial in the fastest time possible, which was equivalent work to cycling at 75% of peak aerobic power output for 60 min. Cyclists were administered 25 ml mouth-rinses for 10 s containing either placebo or 35 mg of anhydrous caffeine eight times throughout the time-trial. Perceptual and physiological variables were recorded throughout. No significant improvement in time-trial performance was observed with caffeine (3918 ± 243 s) compared with placebo mouth-rinse (3940 ± 227 s). No elevation in plasma caffeine was detected due to the mouth-rinse conditions. Caffeine mouth-rinse had no significant effect on rating of perceived exertion, heart rate, rate of oxygen consumption or blood lactate concentration. Eight exposures of a 35 mg dose of caffeine at the buccal cavity for 10s does not significantly enhance endurance cycling time-trial performance, nor does it elevate plasma caffeine concentration.

The efficacy of morning versus evening exercise for weight loss: A randomized controlled trial.

OBJECTIVE: The aim of this study was to investigate the influence of morning versus evening exercise on weight loss, cardiometabolic health, and components of energy balance. METHODS: A total of 100 inactive adults with overweight or obesity were randomized to morning exercise (AMEx; 06:00-09:00), evening exercise (PMEx; 16:00-19:00), or wait-list control (CON). AMEx and PMEx were prescribed 250 min·wk-1 of self-paced aerobic exercise for 12 weeks. Anthropometry and body composition, physical activity, and dietary intake were assessed at baseline, 6 weeks, and 12 weeks. Cardiorespiratory fitness (V̇O2 peak), resting metabolic rate, and blood markers were assessed at baseline and 12 weeks. Body composition and V̇O2 peak were also measured at 3- and 6-month follow-up. RESULTS: AMEx and PMEx lost weight during the intervention (mean [SD], AMEx, -2.7 [2.5] kg, p < 0.001; PMEx, -3.1 [3.4] kg, p < 0.001). V̇O2 peak significantly increased in both intervention groups, and these changes were different from CON (AMEx, +4.7 mL·kg-1 ·min-1 , p = 0.034; PMEx, +4.2 mL·kg-1 ·min-1 , p = 0.045). There were no between-group differences for resting metabolic rate or physical activity. At 12 weeks, total energy intake was significantly reduced in both AMEx and PMEx versus CON (AMEx, -3974 kJ, p < 0.001; PMEx, -3165 kJ, p = 0.001). CONCLUSIONS: Adults with overweight and obesity experience modest weight loss in response to an exercise program, but there does not appear to be an optimal time to exercise.

Assessment of dietary nitrate supplementation: prevalence of use, knowledge, attitudes and beliefs among active Australians.

Introduction: Use of nitrate as a dietary supplement has gained popularity among athletes and recreationally active individuals to enhance exercise performance. However, the prevalence and patterns of use, and knowledge of nitrate as a dietary supplement are unknown. Methods: Individuals (≥16y) completed a 42-item online questionnaire to collect (i) sociodemographic information; (ii) participation in activity and sport; (iii) nitrate supplementation use and reasons; (iv) attitudes and beliefs regarding information sources and the safety of nitrate as a dietary supplement; and (v) knowledge of dietary nitrate supplements. Results: In total, 1,404 active adults (66% female) took part in the study. Only about one in 10 respondents (11.9%) reported they had consumed dietary nitrate ("users") in the past, most commonly as beetroot juice (31.3%). Over two-thirds (69.4%) of users could not correctly identify the correct timing of intake relative to performance time to best improve exercise performance, and most users (82.3%) were unsure of the contraindications to oral consumption of dietary nitrate supplements. Only 3.9% of users experienced adverse effects after ingesting dietary nitrate supplements. Among non-users, the most common reasons respondents selected for not using dietary nitrate supplements were "I do not think I need to" (70.2%) and "I have never thought about it" (69.2%). Discussion: There is evidence to support the efficacy of dietary nitrate intake in improving exercise performance. However, findings from this study suggest dietary nitrate is under-utilized. Educational messages that target dietary nitrate consumption should be targeted toward nutritionists, coaches, and exercise physiologists to bridge the gap between knowledge-to-practice.

The effects of different doses of caffeine on endurance cycling time trial performance.

This study investigated the effects of two different doses of caffeine on endurance cycle time trial performance in male athletes. Using a randomised, placebo-controlled, double-blind crossover study design, sixteen well-trained and familiarised male cyclists (Mean ± s: Age = 32.6 ± 8.3 years; Body mass = 78.5 ± 6.0 kg; Height = 180.9 ± 5.5 cm VO2(peak) = 60.4 ± 4.1 ml x kg(-1) x min(-1)) completed three experimental trials, following training and dietary standardisation. Participants ingested either a placebo, or 3 or 6 mg x kg(-1) body mass of caffeine 90 min prior to completing a set amount of work equivalent to 75% of peak sustainable power output for 60 min. Exercise performance was significantly (P < 0.05) improved with both caffeine treatments as compared to placebo (4.2% with 3 mg x kg(-1) body mass and 2.9% with 6 mg x kg(-1) body mass). The difference between the two caffeine doses was not statistically significant (P = 0.24). Caffeine ingestion at either dose resulted in significantly higher heart rate values than the placebo conditions (P < 0.05), but no statistically significant treatment effects in ratings of perceived exertion (RPE) were observed (P = 0.39). A caffeine dose of 3 mg x kg(-1) body mass appears to improve cycling performance in well-trained and familiarised athletes. Doubling the dose to 6 mg x kg(-1) body mass does not confer any additional improvements in performance.

Does the Time-of-Day of Exercise Influence the Total Volume of Exercise? A Cross-Sectional Analysis of Objectively Monitored Physical Activity Among Active Individuals.

BACKGROUND: To improve compliance and adherence to exercise, the concept of temporal consistency has been proposed. Before- and after-work are periods when most working adults may reasonably incorporate exercise into their schedule. However, it is unknown if there is an association between the time-of-day that exercise is performed and overall physical activity levels. METHODS: Activity was assessed over 1 week in a sample of 69 active adults (n = 41 females; mean age = 34.9 [12.3] y). At the end of the study, participants completed an interviewer-assisted questionnaire detailing their motivation to exercise and their exercise time-of-day preferences. RESULTS: Participants were classified as "temporally consistent" (n = 37) or "temporally inconsistent" (n = 32) exercisers based on their accelerometry data. The "temporally consistent" group was further analyzed to compare exercise volume between "morning-exercisers" (n = 16) and "evening-exercisers" (n = 21). "Morning-exercisers" performed a greater volume of exercise than "evening-exercisers" (419 [178] vs 330 [233] min by self-report; 368 [224] vs 325 [156] min actigraph-derived moderate to vigorous physical activity, respectively). CONCLUSIONS: Our findings suggest that active individuals use a mixture of temporal patterns to meet PA guidelines. Time-of-day of exercise should be reported in intervention studies so the relationship between exercise time-of-day, exercise behavior, and associated outcomes can be better understood.

Nutrition in general practice: role and workforce preparation expectations of medical educators.

Nutrition advice from general practitioners (GPs) is held in high regard by the general public, yet the literature investigating the role of GPs in the provision of nutrition care is limited. This qualitative study aimed to explore the perceptions of general practice medical educators (GPMEs) regarding the role of GPs in general practice nutrition care, the competencies required by GPs to provide effective nutrition care and the learning and teaching strategies best suited to develop these competencies. Twenty medical educators from fourteen Australian and New Zealand universities participated in an individual semi-structured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and thematically analysed. Medical educators identified that nutrition was an important but mostly superficially addressed component of health care in general practice. Numerous barriers to providing nutrition care in general practice were identified. These include a lack of time and associated financial disincentives, perceptions of inadequate skills in nutrition counselling associated with inadequate training, ambiguous attitudes and differing perceptions about the role of GPs in the provision of nutrition care. Further research is required to identify strategies to improve nutrition care and referral practices provided in the general practice setting, in order to utilise the prime position of GPs as gatekeepers of integrated care to the general public.

Short-term and Long-term Feasibility, Safety, and Efficacy of High-Intensity Interval Training in Cardiac Rehabilitation: The FITR Heart Study Randomized Clinical Trial.

Importance: High-intensity interval training (HIIT) is recognized as a potent stimulus for improving cardiorespiratory fitness (volume of oxygen consumption [VO2] peak) in patients with coronary artery disease (CAD). However, the feasibility, safety, and long-term effects of HIIT in this population are unclear. Objective: To compare HIIT with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and efficacy of improving VO2 peak in patients with CAD. Design, Setting, and Participants: In this single-center randomized clinical trial, participants underwent 4 weeks of supervised training in a private hospital cardiac rehabilitation program, with subsequent home-based training and follow-up over 12 months. A total of 96 participants with angiographically proven CAD aged 18 to 80 years were enrolled, and 93 participants were medically cleared for participation following a cardiopulmonary exercise test. Data were collected from May 2016 to December 2018, and data were analyzed from December 2018 to August 2019. Interventions: A 4 × 4-minute HIIT program or a 40-minute MICT program (usual care). Patients completed 3 sessions per week (2 supervised and 1 home-based session) for 4 weeks and 3 home-based sessions per week thereafter for 48 weeks. Main Outcomes and Measures: The primary outcome was change in VO2 peak during the cardiopulmonary exercise test from baseline to 4 weeks. Further testing occurred at 3, 6, and 12 months. Secondary outcomes were feasibility, safety, adherence, cardiovascular risk factors, and quality of life. Results: Of 93 randomized participants, 78 (84%) were male, the mean (SD) age was 65 (8) years, and 46 were randomized to HIIT and 47 to MICT. A total of 86 participants completed testing at 4 weeks for the primary outcome, including 43 in the HIIT group and 43 in the MICT group; 69 completed testing at 12 months for VO2 peak, including 32 in the HIIT group and 37 in the MICT group. After 4 weeks, HIIT improved VO2 peak by 10% compared with 4% in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [3.4] mL/kg/min; MICT, 1.2 [3.4] mL/kg/min; P = .02). After 12 months, there were similar improvements from baseline between groups, with a 10% improvement in the HIIT group and a 7% improvement in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [4.5] mL/kg/min; MICT, 1.8 [4.3] mL/kg/min; P = .30). Both groups had high feasibility scores and low rates of withdrawal due to serious adverse events (3 participants in the HIIT group and 1 participant in the MICT group). One event occurred following exercise (hypotension) in the HIIT group. Over 12 months, both home-based HIIT and MICT had low rates of adherence (HIIT, 18 of 34 [53%]; MICT, 15 of 37 [41%]; P = .35) compared with the supervised stage (HIIT, 39 of 44 [91%]; MICT, 39 of 43 [91%]; P > .99). Conclusions and Relevance: In this randomized clinical trial, a 4-week HIIT program improved VO2 peak compared with MICT in patients with CAD attending cardiac rehabilitation. However, improvements in VO2 peak at 12 months were similar for both groups. HIIT was feasible and safe, with similar adherence to MICT over 12-month follow-up. These findings support inclusion of HIIT in cardiac rehabilitation programs as an adjunct or alternative modality to moderate-intensity exercise. Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001292561.