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.

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.

The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism.

PURPOSE: This study aimed to investigate the effect of feeding carbohydrate and protein (CHO + PRO), immediately or 2 h after an exhaustive run, on the bone turnover response in endurance runners. METHODS: Ten men (age = 28 ± 5 yr, height = 1.74 ± 0.05 m, body mass [BM] = 69.7 ± 6.3 kg) performed treadmill running at 75% V˙O2max, until exhaustion, on three occasions. Blood was collected before and immediately, 1, 2, 3, 4, and 24 h postexercise, for measurement of ß-CTX, P1NP, parathyroid hormone, PO4, ACa, and Ca. This was a randomized, counterbalanced, placebo-controlled, and single-blinded crossover study. The three trials were (i) placebo (PLA), where the PLA solution was ingested immediately and 2 h postexercise; (ii) immediate feeding (IF), where CHO + PRO (1.5 g·kg BM dextrose and 0.5 g·kg BM whey) was ingested immediately postexercise and PLA 2 h postexercise; and (iii) delayed feeding (DF), where PLA was ingested immediately postexercise and CHO + PRO solution 2 h postexercise. Data were analyzed using repeated-measures ANOVA and Tukey's HSD post hoc test. RESULTS: At 1 and 2 h postexercise, ß-CTX concentrations were lower in the IF trial compared with the DF and PLA trials (P ≤ 0.001). At 3 h postexercise, ß-CTX concentrations were higher in the PLA trial compared with the IF (P ≤ 0.001) and DF trials (P = 0.026). At 4 h postexercise, ß-CTX concentrations were lower in the DF trial compared with the IF (P = 0.003) and PLA trials (P ≤ 0.001). At 4 h postexercise, P1NP was higher in the IF trial compared with the DF (P = 0.026) and PLA trials (P = 0.001). At 3 h postexercise, parathyroid hormone was higher in the IF trial compared with the DF trial (P ≤ 0.001). CONCLUSIONS: After exhaustive running, immediate ingestion of CHO + PRO may be beneficial, as it decreases bone resorption marker concentrations and increases bone formation marker concentrations, creating a more positive bone turnover balance.

Parathyroid Hormone Secretion Is Controlled by Both Ionized Calcium and Phosphate During Exercise and Recovery in Men.

CONTEXT: The mechanism by which PTH is controlled during and after exercise is poorly understood due to insufficient temporal frequency of measurements. OBJECTIVE: The objective of the study was to examine the temporal pattern of PTH, PO4, albumin-adjusted calcium, and Ca(2+) during and after exercise. DESIGN AND SETTING: This was a laboratory-based study with a crossover design, comparing 30 minutes of running at 55%, 65%, and 75% maximal oxygen consumption, followed by 2.5 hours of recovery. Blood was obtained at baseline, after 2.5, 5, 7.5, 10, 15, 20, 25, and 30 minutes of exercise, and after 2.5, 5, 7.5, 10, 15, 20, 25, 30, 60, 90, and 150 minutes of recovery. PARTICIPANTS: Ten men (aged 23 ± 1 y, height 1.82 ± 0.07 m, body mass 77.0 ± 7.5 kg) participated. MAIN OUTCOME MEASURES: PTH, PO4, albumin-adjusted calcium, and Ca(2+) were measured. RESULTS: Independent of intensity, PTH concentrations decreased with the onset of exercise (-21% to -33%; P ≤ .001), increased thereafter, and were higher than baseline by the end of exercise at 75% maximal oxygen consumption (+52%; P ≤ .001). PTH peaked transiently after 5-7.5 minutes of recovery (+73% to +110%; P ≤ .001). PO4 followed a similar temporal pattern to PTH, and Ca(2+) followed a similar but inverse pattern to PTH. PTH was negatively correlated with Ca(2+) across all intensities (r = -0.739 to -0.790; P ≤ .001). When PTH was increasing, the strongest cross-correlation was with Ca(2+) at 0 lags (3.5 min) (r = -0.902 to -0.950); during recovery, the strongest cross-correlation was with PO4 at 0 lags (8 min) (r = 0.987-0.995). CONCLUSIONS: PTH secretion during exercise and recovery is controlled by a combination of changes in Ca(2+) and PO4 in men.

Postexercise High-Fat Feeding Suppresses p70S6K1 Activity in Human Skeletal Muscle.

PURPOSE: This study aimed to examine the effects of reduced CHO but high postexercise fat availability on cell signaling and expression of genes with putative roles in regulation of mitochondrial biogenesis, lipid metabolism, and muscle protein synthesis. METHODS: Ten males completed a twice per day exercise model (3.5 h between sessions) comprising morning high-intensity interval training (8 × 5 min at 85% V˙O2peak) and afternoon steady-state (SS) running (60 min at 70% V˙O2peak). In a repeated-measures design, runners exercised under different isoenergetic dietary conditions consisting of high-CHO (HCHO: 10 g·kg CHO, 2.5 g·kg protein, and 0.8 g·kg fat for the entire trial period) or reduced-CHO but high-fat availability in the postexercise recovery periods (HFAT: 2.5 g·kg CHO, 2.5 g·kg protein, and 3.5 g·kg fat for the entire trial period). RESULTS: Muscle glycogen was lower (P < 0.05) at 3 h (251 vs 301 mmol·kg dry weight) and 15 h (182 vs 312 mmol·kg dry weight) post-SS exercise in HFAT compared with HCHO. Adenosine monophosphate-activated protein kinase α2 activity was not increased post-SS in either condition (P = 0.41), although comparable increases (all P < 0.05) in PGC-1α, p53, citrate synthase, Tfam, peroxisome proliferator-activated receptor, and estrogen-related receptor α mRNA were observed in HCHO and HFAT. By contrast, PDK4 (P = 0.003), CD36 (P = 0.05), and carnitine palmitoyltransferase 1 (P = 0.03) mRNA were greater in HFAT in the recovery period from SS exercise compared with HCHO. Ribosomal protein S6 kinase activity was higher (P = 0.08) at 3 h post-SS exercise in HCHO versus HFAT (72.7 ± 51.9 vs 44.7 ± 27 fmol·min·mg). CONCLUSION: Postexercise high-fat feeding does not augment the mRNA expression of genes associated with regulatory roles in mitochondrial biogenesis, although it does increase lipid gene expression. However, postexercise ribosomal protein S6 kinase 1 activity is reduced under conditions of high-fat feeding, thus potentially impairing skeletal muscle remodeling processes.

Utilizing small nutrient compounds as enhancers of exercise-induced mitochondrial biogenesis.

Endurance exercise, when performed regularly as part of a training program, leads to increases in whole-body and skeletal muscle-specific oxidative capacity. At the cellular level, this adaptive response is manifested by an increased number of oxidative fibers (Type I and IIA myosin heavy chain), an increase in capillarity and an increase in mitochondrial biogenesis. The increase in mitochondrial biogenesis (increased volume and functional capacity) is fundamentally important as it leads to greater rates of oxidative phosphorylation and an improved capacity to utilize fatty acids during sub-maximal exercise. Given the importance of mitochondrial biogenesis for skeletal muscle performance, considerable attention has been given to understanding the molecular cues stimulated by endurance exercise that culminate in this adaptive response. In turn, this research has led to the identification of pharmaceutical compounds and small nutritional bioactive ingredients that appear able to amplify exercise-responsive signaling pathways in skeletal muscle. The aim of this review is to discuss these purported exercise mimetics and bioactive ingredients in the context of mitochondrial biogenesis in skeletal muscle. We will examine proposed modes of action, discuss evidence of application in skeletal muscle in vivo and finally comment on the feasibility of such approaches to support endurance-training applications in humans.

Carbohydrate ingestion improves performance of a new reliable test of soccer performance.

The aim of the study was to investigate the reliability of a new test of soccer performance and evaluate the effect of carbohydrate (CHO) on soccer performance. Eleven university footballers were recruited and underwent 3 trials in a randomized order. Two of the trials involved ingesting a placebo beverage, and the other, a 7.5% maltodextrin solution. The protocol comprised a series of ten 6-min exercise blocks on an outdoor Astroturf pitch, separated by the performance of 2 of the 4 soccer-specific tests, making the protocol 90 min in duration. The intensity of the exercise was designed to be similar to the typical activity pattern during soccer match play. Participants performed skill tests of dribbling, agility, heading, and shooting throughout the protocol. The coefficients of variation for dribbling, agility, heading, and shooting were 2.2%, 1.2%, 7.0%, and 2.8%, respectively. The mean combined placebo scores were 42.4 +/- 2.7 s, 43.1 +/- 3.7 s, 210 +/- 34 cm, and 212 +/- 17 points for agility, dribbling, heading, and kicking, respectively. CHO ingestion led to a combined agility time of 41.5 +/- 0.8 s, for dribbling 41.7 +/- 3.5 s, 213 +/- 11 cm for heading, and 220 +/- 5 points for kicking accuracy. There was a significant improvement in performance for dribbling, agility, and shooting (p < .05) when CHO was ingested compared with placebo. In conclusion, the protocol is a reliable test of soccer performance, and ingesting CHO leads to an improvement in soccer performance.

Effect of beverage glucose and sodium content on fluid delivery.

BACKGROUND: Rapid fluid delivery from ingested beverages is the goal of oral rehydration solutions (ORS) and sports drinks. OBJECTIVE: The aim of the present study was to investigate the effects of increasing carbohydrate and sodium content upon fluid delivery using a deuterium oxide (D2O) tracer. DESIGN: Twenty healthy male subjects were divided into two groups of 10, the first group was a carbohydrate group (CHO) and the second a sodium group (Na). The CHO group ingested four different drinks with a stepped increase of 3% glucose from 0% to 9% while sodium concentration was 20 mmol/L. The Na group ingested four drinks with a stepped increase of 20 mmol/L from 0 mmol/L to 60 mmol/l while glucose concentration was 6%. All beverages contained 3 g of D2O. Subjects remained seated for two hours after ingestion of the experimental beverage, with blood taken every 5 min in the first hour and every 10 min in the second hour. RESULTS: Including 3% glucose in the beverage led to a significantly greater AUC 60 min (19640 ± 1252 δ per thousand vs. VSMOW.60 min) than all trials. No carbohydrate (18381 ± 1198 δ per thousand vs. VSMOW.60 min) had a greater AUC 60 min than a 6% (16088 ± 1359 δ per thousand vs. VSMOW.60 min) and 9% beverage (13134 ± 1115 δ per thousand vs. VSMOW.60 min); the 6% beverage had a significantly greater AUC 60 min than the 9% beverage. There was no difference in fluid delivery between the different sodium beverages. CONCLUSION: In conclusion the present study showed that when carbohydrate concentration in an ingested beverage was increased above 6% fluid delivery was compromised. However, increasing the amount of sodium (0-60 mmol/L) in a 6% glucose beverage did not lead to increases in fluid delivery.

Plasma deuterium oxide accumulation following ingestion of different carbohydrate beverages.

Optimal fluid delivery from carbohydrate solutions such as oral rehydration solutions or sports drinks is essential. The aim of the study was to investigate whether a beverage containing glucose and fructose would result in greater fluid delivery than a beverage containing glucose alone. Six male subjects were recruited (average age (+/-SD): 22 +/- 2 y). Subjects entered the laboratory between 0700 h and 0900 h after an overnight fast. A 600 mL bolus of 1 of the 3 experimental beverages was then given. The experimental beverages were water (W), 75 g glucose (G), or 50 g glucose and 25 g fructose (GF); each beverage also contained 3.00 g of D2O. Following administration of the experimental beverage subjects remained in a seated position for 180 min. Blood and saliva samples were then taken every 5 min in the first hour and every 15 min thereafter. Plasma and saliva samples were analyzed for deuterium enrichment by isotope ratio mass spectrometry. Deuterium oxide enrichments were compared using a 2-way repeated measures analysis of variance. The water trial (33 +/- 3 min) showed a significantly shorter time to peak than either G (82 +/- 40 min) or GF (59 +/- 25 min), but the difference between G and GF did not reach statistical significance. There was a significantly greater AUC for GF (55 673 +/- 10 020 delta per thousand vs. Vienna Standard Mean Ocean Water (VSMOW).180 min) and W (60 497 +/- 9864 delta per thousand vs. VSMOW.180 min) compared with G (46 290 +/- 9622 delta per thousand vs. VSMOW.180 min); W and GF were not significantly different from each other. These data suggest that a 12.5% carbohydrate beverage containing glucose and fructose results in more rapid fluid delivery in the first 75 min than a beverage containing glucose alone.

Validity, reliability and sensitivity of measures of sporting performance.

Performance testing is one of the most common and important measures used in sports science and physiology. Performance tests allow for a controlled simulation of sports and exercise performance for research or applied science purposes. There are three factors that contribute to a good performance test: (i) validity; (ii) reliability; and (iii) sensitivity. A valid protocol is one that resembles the performance that is being simulated as closely as possible. When investigating race-type events, the two most common protocols are time to exhaustion and time trials. Time trials have greater validity than time to exhaustion because they provide a good physiological simulation of actual performance and correlate with actual performance. Sports such as soccer are more difficult to simulate. While shuttle-running protocols such as the Loughborough Intermittent Shuttle Test may simulate physiology of soccer using time to exhaustion or distance covered, it is not a valid measure of soccer performance. There is a need to include measures of skill in such protocols. Reliability is the variation of a protocol. Research has shown that time-to-exhaustion protocols have a coefficient of variation (CV) of >10%, whereas time trials are more reliable as they have been shown to have a CV of <5%. A sensitive protocol is one that is able to detect small, but important, changes in performance. The difference between finishing first and second in a sporting event is <1%. Therefore, it is important to be able to detect small changes with performance protocols. A quantitative value of sensitivity may be accomplished through the signal : noise ratio, where the signal is the percentage improvement in performance and the noise is the CV.

Superior endurance performance with ingestion of multiple transportable carbohydrates.

INTRODUCTION: The aim of the present study was to investigate the effect of ingesting a glucose plus fructose drink compared with a glucose-only drink (both delivering carbohydrate at a rate of 1.8 g.min(-1)) and a water placebo on endurance performance. METHODS: Eight male trained cyclists were recruited (age 32 +/- 7 yr, weight 84.4 +/- 6.9 kg, .VO(2max) 64.7 +/- 3.9 mL.kg(-1).min(-1), Wmax 364 +/- 31 W). Subjects ingested either a water placebo (P), a glucose (G)-only beverage (1.8 g.min(-1)), or a glucose and fructose (GF) beverage in a 2:1 ratio (1.8 g.min(-1)) during 120 min of cycling exercise at 55% Wmax followed by a time trial in which subjects had to complete a set amount of work as quickly as possible (approximately 1 h). Every 15 min, expired gases were analyzed and blood samples were collected. RESULTS: Ingestion of GF resulted in an 8% quicker time to completion during the time trial (4022 s) compared with G (3641 s) and a 19% improvement compared with W (3367 s). Total carbohydrate (CHO) oxidation was not different between GF (2.54 +/- 0.25 g.min(-1)) and G (2.50 g.min(-1)), suggesting that GF led to a sparing of endogenous CHO stores, because GF has been shown to have a greater exogenous CHO oxidation than G. CONCLUSION: Ingestion of GF led to an 8% improvement in cycling time-trial performance compared with ingestion of G.

Reliability of a cycling time trial in a glycogen-depleted state.

The aim of this study was to investigate the reliability of a protocol designed to simulate endurance performance in events of long duration (approximately 5 h) where endogenous carbohydrate stores are low. Seven male subjects were recruited (age 27 +/- 7 years, VO(2max) 66 +/- 5 ml/kg/min, W (max) 367 +/- 42 W). The subjects underwent three trials to determine the reliability of the protocol. For each trial subjects entered the laboratory in the evening to undergo a glycogen-depleting exercise trial lasting approximately 2.5 h. The subjects returned the following morning in a fasted state to undertake a 1-h steady-state ride at 50% W (max) followed by a time trial of approximately 40-min duration. Each trial was separated by 7-14 days. The trials were analysed for reliability of time to completion of the time trial using a coefficient of variation (CV), with 95% confidence intervals (data are mean +/- SD). The times to complete the three trials were 2,546 +/- 529, 2,585 +/- 490 and 2,568 +/- 555 s for trials 1, 2 and 3, respectively. The CV between trials 1 and 2 was 4.5% (95% CI 2.9-10.4%) and between trials 2 and 3, 3.8% (95% CI 2.4-9.9%). There was no difference in oxygen uptake, respiratory exchange ratio, carbohydrate oxidation, fat oxidation, plasma glucose concentration and plasma lactate concentration between the three trials. Therefore we can conclude that prior glycogen depletion does produce a reliable measure of performance with metabolic characteristics similar to ultraendurance exercise.

Pseudoephedrine enhances performance in 1500-m runners.

UNLABELLED: Pseudoephedrine is an over-the-counter drug to relieve nasal and sinus congestion. Although it has been suggested that pseudoephedrine could be a stimulant and ergogenic aid, pseudoephedrine was recently removed from the banned substance list by the International Olympic Committee and placed on the monitoring program (from January 2004). It was felt that evidence was lacking for an ergogenic effect, although few studies have investigated the effects of pseudoephedrine on exercise performance. This study, therefore, aimed to investigate the effects of pseudoephedrine on 1500-m running performance. METHODS: In a double-blind, randomized crossover design, seven male athletes completed two 1500-m running trials on an outdoor track after having completed a familiarization trial. All trials were 7 d apart. After a 12-h overnight fast, subjects reported to the laboratory and received a standardized breakfast (energy asymptotically equal to 500 kcal 50% CHO). Subjects were given either 2.5 mg.kg(-1) bw pseudoephedrine or 2.5 mg.kg(-1) bw maltodextrins (placebo) in gelatin capsules 70 min before the start of the warm-up, which started 20 min before they ran 1500 m all-out. Pre- and postexercise blood samples were collected and analyzed for lactate and glucose concentrations, partial pressure of oxygen (PO2) and carbon dioxide (PCO2), and percent oxygen saturation. RESULTS: Pseudoephedrine significantly decreased time to completion of 1500-m time trials in the present study by 2.1% (from 279.65 +/- 4.36 s with placebo to 273.86 +/- 4.36 s with pseudoephedrine) with no reported side effects. No changes in the measured blood parameters were found, suggesting a central effect of pseudoephedrine rather than a metabolic effect. CONCLUSION: The finding was that 2.5 mg.kg(-1) bw pseudoephedrine ingested 90 min preexercise improves 1500-m running performance.

Exogenous carbohydrate oxidation rates are elevated after combined ingestion of glucose and fructose during exercise in the heat.

The first purpose of this study was to investigate whether a glucose (GLU)+fructose (FRUC) beverage would result in a higher exogenous carbohydrate (CHO) oxidation rate and a higher fluid availability during exercise in the heat compared with an isoenergetic GLU beverage. A second aim of the study was to examine whether ingestion of GLU at a rate of 1.5 g/min during exercise in the heat would lead to a reduced muscle glycogen oxidation rate compared with ingestion of water (WAT). Eight trained male cyclists (maximal oxygen uptake: 64+/-1 ml.kg-1.min-1) cycled on three different occasions for 120 min at 50% maximum power output at an ambient temperature of 31.9+/-0.1 degrees C. Subjects received, in random order, a solution providing either 1.5 g/min of GLU, 1.0 g/min of GLU+0.5 g/min of FRUC, or WAT. Exogenous CHO oxidation during the last hour of exercise was approximately 36% higher (P<0.05) in GLU+FRUC compared with GLU, and peak oxidation rates were 1.14+/-0.05 and 0.77+/-0.08 g/min, respectively. Endogenous CHO oxidation was significantly lower (P<0.05) in GLU+FRUC compared with WAT. Muscle glycogen oxidation was not different after ingestion of GLU or WAT. Plasma deuterium enrichments were significantly higher (P<0.05) in WAT and GLU+FRUC compared with GLU. Furthermore, at 60 and 75 min of exercise, plasma deuterium enrichments were higher (P<0.05) in WAT compared with GLU+FRUC. Ingestion of GLU+FRUC during exercise in the heat resulted in higher exogenous CHO oxidation rates and fluid availability compared with ingestion of GLU and reduced endogenous CHO oxidation compared with ingestion of WAT.