International Society of Sports Nutrition Position Stand: Effects of essential amino acid supplementation on exercise and performance.

Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of literature surrounding the effects of essential amino acid (EAA) supplementation on skeletal muscle maintenance and performance. This position stand is intended to provide a scientific foundation to athletes, dietitians, trainers, and other practitioners as to the benefits of supplemental EAA in both healthy and resistant (aging/clinical) populations. EAAs are crucial components of protein intake in humans, as the body cannot synthesize them. The daily recommended intake (DRI) for protein was established to prevent deficiencies due to inadequate EAA consumption. The following conclusions represent the official position of the Society: 1. Initial studies on EAAs' effects on skeletal muscle highlight their primary role in stimulating muscle protein synthesis (MPS) and turnover. Protein turnover is critical for replacing degraded or damaged muscle proteins, laying the metabolic foundation for enhanced functional performance. Consequently, research has shifted to examine the effects of EAA supplementation - with and without the benefits of exercise - on skeletal muscle maintenance and performance. 2. Supplementation with free-form EAAs leads to a quick rise in peripheral EAA concentrations, which in turn stimulates MPS. 3. The safe upper limit of EAA intake (amount), without inborn metabolic disease, can easily accommodate additional supplementation. 4. At rest, stimulation of MPS occurs at relatively small dosages (1.5-3.0 g) and seems to plateau at around 15-18 g. 5. The MPS stimulation by EAAs does not require non-essential amino acids. 6. Free-form EAA ingestion stimulates MPS more than an equivalent amount of intact protein. 7. Repeated EAA-induced MPS stimulation throughout the day does not diminish the anabolic effect of meal intake. 8. Although direct comparisons of various formulas have yet to be investigated, aging requires a greater proportion of leucine to overcome the reduced muscle sensitivity known as "anabolic resistance." 9. Without exercise, EAA supplementation can enhance functional outcomes in anabolic-resistant populations. 10. EAA requirements rise in the face of caloric deficits. During caloric deficit, it's essential to meet whole-body EAA requirements to preserve anabolic sensitivity in skeletal muscle.

Collagen peptides supplementation improves function, pain, and physical and mental outcomes in active adults.

INTRODUCTION: Chronic pain affects 19% of adults in the United States, with increasing prevalence in active and aging populations. Pain can limit physical activity and activities of daily living (ADLs), resulting in declined mental and social health. Nutritional interventions for pain currently target inflammation or joint health, but few influence both. Collagen, the most abundant protein in the human body and constituent of the extra cellular matrix, is such a nutraceutical. While there have been reports of reductions in pain with short-term collagen peptide (CP) supplementation, there are no long-term studies specifically in healthy middle-aged active adults. PURPOSE: To determine the effects of daily CP consumption over 3, 6, and 9 months on survey measures of pain, function, and physical and mental health using The Knee Injury & Osteoarthritis Outcomes Score (KOOS) and Veterans Rand 12 (VR-12) in middle-aged active adults. METHODS: This study was a double-blind randomized control trial with three treatment groups (Placebo, 10 g/d CP, and 20 g/d CP). RESULTS: Improvements in ADLs (p = .031, ηp2 = .096) and pain (p = .037, ηp2 = .164) were observed with 10 g/d CP over 6 months, although pain only improved in high frequency exercisers (>180 min/week). Additionally, VR-12 mental component scores (MCS) improved with 10 g/d of CP over 3-9 months (p = .017, ηp2 = .309), while physical component scores (PCS) improved with 20 g/d of CP over 3-9 months, but only in females (p = .013, ηp2= .582). CONCLUSION: These findings suggest 10 to 20 g/d of CP supplementation over 6 to 9 months may improve ADLs, pain, MCS, and PCS in middle-aged active adults.

Early Detection of COVID-19 in Female Athletes Using Wearable Technology.

BACKGROUND: Heart rate variability (HRV), respiratory rate (RR), and resting heart rate (RHR) are common variables measured by wrist-worn activity trackers to monitor health, fitness, and recovery in athletes. Variations in RR are observed in lower-respiratory infections, and preliminary data suggest changes in HRV and RR are linked to early detection of COVID-19 infection in nonathletes. HYPOTHESIS: Wearable technology measuring HRV, RR, RHR, and recovery will be successful for early detection of COVID-19 in NCAA Division I female athletes. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: Female athletes wore WHOOP, Inc. bands through the 2020 to 2021 competitive season. Of the athletes who tested positive for COVID (n = 33), 14 had enough data to be assessed (N = 14; 20.0 ± 1.3 years; 69.8 ± 7.2 kg; 172.0 ± 8.3 cm). Roughly 2 weeks of noninfected days were used to set baseline levels of HRV, RR, recovery, and RHR to compare with -3, -2, and -1 days before a positive COVID-19 result. RESULTS: Increases in RR (P = 0.02) were detected on day -3. RHR (P < 0.01) and RR increased (P < 0.01), while HRV decreased (P < 0.05) on day -1, compared with baseline. Differences were noted in all variables on the day of the positive COVID-19 result: decreased HRV (P < 0.05) and recovery scores (P < 0.01), and increased RHR (P < 0.01) and RR (P < 0.01). CONCLUSION: In female athletes, wearable technology was successful in predicting COVID-19 infection through changes in RR 3 days before a positive test, and also HRV and RHR the day before a positive test. CLINICAL RELEVANCE: Wearable technology may be used, as part of a multifaceted approach, for the early detection of COVID-19 in elite athletes through monitoring of HRV, RR, and RHR for overall team health.

Collagen peptide supplementation for pain and function: is it effective?

PURPOSE OF REVIEW: Connective tissue injuries are prevalent in active and aging populations, leading to chronic pain and decreased function. Turnover of this tissue is not well understood, especially as it relates to aging and injury. Supplementation of collagen peptides has been shown to improve connective tissue recovery and pain through increased collagen production. RECENT FINDINGS: Collagen peptide supplementation improves pain and function, and upregulates metabolic pathways associated with muscle and tendon growth. Literature from the past 12-18 months supports that these pathways are also involved with increased synthesis and degradation of collagen and other elements of the extracellular matrix. Improvements in body composition and strength have been noted with collagen peptide supplementation when paired with resistance training. Collagen peptide supplements are hydrolyzed into small peptides, termed bioactive peptides, and individual amino acids. These bioactive peptides are associated with the benefits observed with collagen peptide supplementation and may play a critical role in the collagen turnover. SUMMARY: Collagen peptide supplementation has been shown to promote recovery, decrease pain, and improve strength and body composition when paired with resistance training. These benefits may be attributed to bioactive peptides in collagen peptide supplements. Additional research is warranted to examine the specific effects of these bioactive peptides.

Prevalence of Normal Weight Obesity and Health Risk Factors for the Female Collegiate Dancer.

ABSTRACT: Brown, AF, Alfiero, CJ, Brooks, SJ, Kviatkovsky, SA, Smith-Ryan, AE, and Ormsbee, MJ. Prevalence of normal weight obesity and health risk factors for the female collegiate dancer. J Strength Cond Res 35(8): 2321-2326, 2021-The purpose of this study was to investigate the prevalence of normal weight obesity (NWO) and evaluate the relationship between NWO and health risk factors in a collegiate dancer population. Reanalysis of data of female dancers (N = 42) from 2 larger studies was used to assess prevalence and health risk factors of NWO. Dancers completed a dual-energy x-ray absorptiometry scan to assess fat mass (FM), lean mass (LM), and visceral adipose tissue (VAT) and a 3-day food record. Normal weight obesity was defined as a body mass index (BMI) of 18.5-24.9 kg·m-2 and body fat (BF) ≥30%. Twenty-five (60%) dancers were classified as normal weight lean (NWL), and 17 dancers (40%) were classified as NWO. Significant differences were observed for BMI (NWL: 21.1 ± 1.7, NWO: 23.1 ± 1.6, p < 0.001), LM (NWL: 71.0 ± 2.9%, NWO: 62.5 ± 2.7%, p < 0.001), %BF (NWL: 24.8 ± 3.1%, NWO: 33.9 ± 2.6%, p < 0.001), and VAT (NWL: 130.6 ± 43.0 g, NWO: 232.3 ± 70.8 g, p < 0.001) between NWL and NWO. A significant difference was observed for carbohydrate intake (NWL: 4.7 ± 1.8 g·kg-1, NWO: 3.7 ± 1.0 g·kg-1, p = 0.020) between groups. Significant positive correlations with FM were observed between carbohydrate (kcal, p = 0.048), fat (kcal, p = 0.018; g·kg-1, p = 0.040), and total calories (p = 0.019) in NWO. Normal weight obesity in collegiate dancers may be more prevalent than previously perceived and may be significantly related to important health risk factors. The current study demonstrates the need for body composition assessments and emphasizing on promoting overall health in collegiate dancers.

Morning Cortisol Is Associated With Stress and Sleep in Elite Military Men: A Brief Report.

INTRODUCTION: Accumulating evidence suggests that trends in salivary cortisol after awakening may be reliable biological predictors of morbidity and mortality. In a sample of elite military men, our lab recently established summary parameters of morning cortisol as well as their stability across 2 d of repeated sampling. MATERIALS AND METHODS: In this follow-on study, we evaluated summary parameters and their relationships to theoretically relevant demographic (i.e., age, body mass index) and biobehavioral correlates (i.e., blood pressure [BP], sleep parameters, fatigue, and perceived stress). Fifty-eight male active duty U.S. Navy SEALs self-collected salivary samples on 2 consecutive, midweek workdays upon waking (WAKE), WAKE+30 min, WAKE+60 min, 4 p.m., and 9 p.m. in a nondeployed, free-living setting. Resting BP was measured manually, and sleep-wake periods were objectively derived using actigraphy. Daily fatigue and perceived stress were measured by self-report. Summary parameters of morning cortisol magnitude (i.e., peak value [Peak], area under the curve in terms of ground [AUCG], and average of morning samples [AVE]) were assessed with respect to each demographic and biobehavioral item via correlational analyses. A subgroup of 29 participants was selected for compliance with salivary sampling in the morning across 2 d. RESULTS: Perceived stress was positively associated with Peak (r[27] = 0.437, p < 0.05), AUCG (r[25] = 0.500, p < 0.01), and AVE (r[25] = 0.506, p < 0.01). Total sleep time was also positively associated with Peak (r[26] = 0.378, p < 0.05). There were borderline associations between some summary parameters and diastolic BP, percent sleep, and wake after sleep onset. Age, systolic BP, body mass index, time in bed, sleep efficiency, and fatigue did not associate with morning cortisol. CONCLUSIONS: Preliminary evidence of morning cortisol summary parameters as biobehavioral indicators was established, and these parameters appeared to associate with stress and sleep in elite military men.

Validity and Reliability of a Portable Balance Tracking System, BTrackS, in Older Adults.

BACKGROUND AND PURPOSE: Falls are the leading cause of disability, injury, hospital admission, and injury-related death among older adults. Balance limitations have consistently been identified as predictors of falls and increased fall risk. Field measures of balance are limited by issues of subjectivity, ceiling effects, and low sensitivity to change. The gold standard for measuring balance is the force plate; however, its field use is untenable due to high cost and lack of portability. Thus, a critical need is observed for valid objective field measures of balance to accurately assess balance and identify limitations over time. The purpose of this study was to examine the concurrent validity and 3-day test-retest reliability of Balance Tracking System (BTrackS) in community-dwelling older adults. Minimal detectable change values were also calculated to reflect changes in balance beyond measurement error. METHODS: Postural sway data were collected from community-dwelling older adults (N = 49, mean [SD] age = 71.3 [7.3] years) with a force plate and BTrackS in multitrial eyes open (EO) and eyes closed (EC) static balance conditions. Force sensors transmitted BTrackS data via a USB to a computer running custom software. Three approaches to concurrent validity were taken including calculation of Pearson product moment correlation coefficients, repeated-measures ANOVAs, and Bland-Altman plots. Three-day test-retest reliability of BTrackS was examined in a second sample of 47 community-dwelling older adults (mean [SD] age = 75.8 [7.7] years) using intraclass correlation coefficients and MDC values at 95% CI (MDC95) were calculated. RESULTS: BTrackS demonstrated good validity using Pearson product moment correlations (r > 0.90). Repeated-measures ANOVA and Bland-Altman plots indicated some BTrackS bias with center of pressure (COP) values higher than FP COP values in the EO (mean [SD] bias = 4.0 [6.8]) and EC (mean [SD] bias = 9.6 [12.3]) conditions. Test-retest reliability using intraclass correlation coefficients (ICC2.1 was excellent (0.83) and calculated MDC95 for EO (9.6 cm) and EC (19.4 cm) and suggested that postural sway changes of these amounts are meaningful. DISCUSSION: BTrackS showed some bias with values exceeding force plate values in both EO and EC conditions. Excellent test-retest reliability and resulting MDC95 values indicated that BTrackS has the potential to identify meaningful changes in balance that may warrant intervention. CONCLUSION: BTrackS is an objective measure of balance that can be used to monitor balance in community-dwelling older adults over time. It can reliably identify changes that may require further attention (eg, fall-prevention strategies, declines in physical function) and shows promise for assessing intervention efficacy in this growing segment of the population.

The "yin and yang" of the adrenal and gonadal systems in elite military men.

We recently established daily, free-living profiles of the adrenal hormone cortisol, the (primarily adrenal) anabolic precursor dehydroepiandrosterone (DHEA) and the (primarily gonadal) anabolic hormone testosterone in elite military men. A prevailing view is that adrenal and gonadal systems reciprocally modulate each other; however, recent paradigm shifts prompted the characterization of these systems as parallel, cooperative processes (i.e. the "positive coupling" hypothesis). In this study, we tested the positive coupling hypothesis in 57 elite military men by evaluating associations between adrenal and gonadal biomarkers across the day. Salivary DHEA was moderately and positively coupled with salivary cortisol, as was salivary testosterone. Anabolic processes (i.e. salivary DHEA and testosterone) were also positively and reliably coupled across the day. In multivariate models, salivary DHEA and cortisol combined to account for substantial variance in salivary testosterone concentrations across the day, but this was driven almost exclusively by DHEA. This may reflect choreographed adrenal release of DHEA with testicular and/or adrenal release of testosterone, systemic conversion of DHEA to testosterone, or both. DHEA and testosterone modestly and less robustly predicted cortisol concentrations; this was confined to the morning, and testosterone was the primary predictor. Altogether, top-down co-activation of adrenal and gonadal hormone secretion may complement bottom-up counter-regulatory functions to foster anabolic balance and neuronal survival; hence, the "yin and yang" of adrenal and gonadal systems. This may be an adaptive process that is amplified by stress, competition, and/or dominance hierarchy.

Anabolic hormone profiles in elite military men.

We recently characterized the awakening responses and daily profiles of the catabolic stress hormone cortisol in elite military men. Anabolic hormones follow a similar daily pattern and may counteract the catabolic effects of cortisol. This companion report is the first to characterize daily profiles of anabolic hormones dehydroepiandrosterone (DHEA) and testosterone in this population. Overall, the men in this study displayed anabolic hormone profiles comparable to that of healthy, athletic populations. Consistent with the cortisol findings in our prior report, summary parameters of magnitude (hormone output) within the first hour after awakening displayed superior stability versus summary parameters of pattern for both DHEA (r range: 0.77-0.82) and testosterone (r range: 0.62-0.69). Summary parameters of evening function were stable for the two hormones (both p<0.001), while the absolute decrease in testosterone across the day was a stable proxy of diurnal function (p<0.001). Removal of noncompliant subjects did not appreciably affect concentration estimates for either hormone at any time point, nor did it alter the repeatability of any summary parameter. The first of its kind, this report enables accurate estimations of anabolic balance and resultant effects upon health and human performance in this highly resilient yet chronically stressed population.