Nutrition for Athletes

athletes medical infrmatin Nutritin fr Athletes A practical guide t eating fr health and perfrmance Prepared by the Nutritin Wrking Grup f the Internatinal Olympic Cmmittee Based n an Internatinal Cnsensus Cnference held at the IOC in Lausanne in Octber 2010 Revised and Updated in April 2012 by Prfessr Rn Maughan and Prfessr Luise Burke

athletes medical infrmatin Message frm Muhtar Kent Since 1928, The Cca-Cla Cmpany has been a prud supprter f the Olympic Mvement. As such, we ve been privileged t witness sme f the greatest athletic achievements f the past century. Tday, wrld-class athletes share an unwavering cmmitment t a balanced nutritinal diet and an active, healthy lifestyle. T supprt yu in this regard, The Cca-Cla Cmpany, thrugh ur POWERADE brand, has partnered with the IOC Nutritin Wrking Grup and the IOC Athletes Cmmissin t create this nutritin brchure fr all athletes. Helping yu achieve peak perfrmance is the missin f POWERADE, a refreshing beverage designed t prevent dehydratin and the nset f fatigue during exercise. Yur peak perfrmance als depends n a clean and healthy envirnment, which is ne reasn Cca-Cla is cmmitted t a visin f zer waste thrugh increasingly sustainable packaging and recycling effrts. We re als reducing ur ptential climate impacts thrugh leading-edge technlgies including ur hydrflurcarbn-free (HFCfree) cling technlgies. And we ve imprved the energy efficiency f ur cling equipment by up t 40 percent since 2000. On behalf f the mre than 700,000 Cca-Cla system assciates acrss 200-plus natins, I cngratulate yu n yur Olympic jurney thus far. Everyne at Cca-Cla wishes yu the very best as yu cmpete and frge lasting friendships with yur fellw Yuth Olympians frm arund the wrld! Muhtar Kent Chairman & CEO The Cca-Cla Cmpany OFFICIAL SPORTS DRINK

Frewrd by Dr Patrick Schamasch athletes medical infrmatin The IOC and its Medical Cmmissin are pleased t prvide athletes with this updated brchure, develped under the leadership f the IOC Nutritin wrking grup, in clse cllabratin with the IOC Athletes Cmmissin. Its simplicity and reader-friendly layut make this wrk a reference fr all thse wh, like the IOC Medical Cmmissin, believe that nutritin is ne f the decisive elements in high-level athletes preparatins and ne f the key factrs in athletes health. Pwerade is the partner f the IOC s Medical Cmmissin fr this publicatin and helps us t spread the infrmatin in a wrldwide campaign t athletes at all levels. Fr all thse wh, withut aspiring t take part in the Olympic Games, place sprt and physical activity as a tp pririty, this brchure will ensure better management f their effrts and preparatins. Patrick Schamasch Frmer IOC Medical Directr

athletes medical infrmatin Key messages Many factrs cntribute t success in sprt, including talent, training, mtivatin and resistance t injury. When highly talented, mtivated and well trained athletes gather fr cmpetitin, the margin between victry and defeat is usually small. Attentin t every detail can make that vital difference, and nutritin is a key element f the serius athlete s preparatin. Diet affects perfrmance, and the fds that we chse in training and cmpetitin will affect hw well we train and cmpete. Athletes need t be aware f their nutritinal gals and f hw they can select an eating strategy t meet thse gals. Diet may have its biggest impact n training, and a gd diet will help supprt cnsistent intensive training while reducing the risk f illness r injury. Gd fd chices can als prmte adaptatins in muscle and ther tissues in respnse t the training stimulus. Athletes are all different, and there is n single diet that meets the needs f all athletes at all times. Individual needs als change acrss the seasn and athletes must be flexible t accmmdate this. Getting the right amunt f energy t stay healthy and t perfrm well is key. T much and bdy fat increases: t little and perfrmance falls and illness results. Carbhydrate is a key nutrient fr energy supply, but carbhydrate needs will depend n the training lad and therefre vary frm day t day and acrss the seasn. Athletes must be aware f fds that are gd surces f carbhydrate and make these a fcus f their diet. Prtein fds are imprtant fr building and repairing muscles, but a varied diet cntaining everyday fds will generally supply mre than enugh prtein. The timing and type f prtein are as imprtant as the amunt f prtein in the diet. Well-chsen vegetarian diets can meet an athlete s prtein needs. A varied and whlesme nutrient-rich diet that meets energy needs and is based largely n vegetables, fruits, beans, legumes, grains, lean animal meats, ils and carbhydrate shuld ensure an adequate intake f all essential vitamins and minerals. Maintaining hydratin is imprtant fr perfrmance. An adequate intake f fluid befre, during (where apprpriate), and after exercise is especially imprtant in ht climates. Salt replacement is imprtant when sweat lsses are high, but needs vary between athletes. Athletes are cautined against the indiscriminate use f dietary supplements, but careful use f a small number f supplements and sprts fds may benefit sme athletes. Fd is an imprtant part f life, and athletes shuld enjy the fds that they eat, cnfident in the knwledge that they have made wise chices. This bklet cntains infrmatin that will help athletes t make infrmed chices t meet their nutritinal needs in different situatins. It is n substitute fr individual advice frm a qualified prfessinal, but tries t give practical infrmatin that will be f use t the serius athlete.

Nutritin fr the elite athlete athletes medical infrmatin Well-chsen eating practices have much t ffer the athlete: l Fuel t train and perfrm at the elite level l Optimum gains frm the training prgram l Enhanced recvery between wrkuts and between events l Achievement and maintenance f an ideal bdy mass and physique l Benefits frm the many health-prmting cmpnents f fd l A reduced risk f injury, vertraining fatigue and illness l Cnfidence in being well-prepared t face cmpetitin l Cnsistency in achieving high-level cmpetitin perfrmances l Enjyment f fd and scial eating ccasins at hme and during travel Despite these advantages, many athletes d nt meet their nutritin gals. Cmmn prblems and challenges include: l Pr knwledge f fds and inadequate cking skills l Pr r utdated knwledge f sprts nutritin l Lack f access t dietitians /nutritin prfessinals r ther credible resurces l Inadequate finances l Busy lifestyle leading t inadequate time t btain r cnsume apprpriate fds l Pr availability f gd fd chices l Frequent travel l Indiscriminate use f large amunts f supplements r failure t use evidencebased supplements and sprts fds in the apprpriate way The infrmatin in this bklet is designed t prvide caches and athletes with an verview f the latest guidelines in sprts nutritin. While there is n such thing as a magic diet r fd, there are many ways in which eating well can allw athletes at all levels f perfrmance t achieve the specific gals f their training and cmpetitin prgrams. It makes n sense t train hard and ignre the benefits that fllw frm gd fd chices. Nutritin fr Athletes is based n the cnclusins f the IOC Cnsensus Cnference n Nutritin fr Sprt, held in Lausanne in Octber 2010. We gratefully acknwledge the cntributin f the cnference participants as the expert scientific surces fr this bklet. We are als especially grateful t Pwerade fr their supprt. The infrmatin was updated in April 2012 in preparatin fr the Lndn Olympic Games f 2012 t ensure that athletes have access t the latest infrmatin. This revised versin f the bklet was prepared fr the IOC Medical Cmmissin Wrking Grup n Sprts Nutritin by l Prfessr Rn Maughan, UK l Prfessr Luise Burke, Australia We thank Dr Patrick Schamasch fr his insight and cmments in the preparatin f this bklet.

athletes medical infrmatin Energy needs Energy intake sets the budget frm which an athlete must meet their needs fr carbhydrate, prtein and fat, as well as the range f fds that prvide vitamins, minerals and ther healthprmting dietary factrs. An athlete s energy requirements are made up f several cmpnents: baseline metablic needs (such as the energy required t supprt cellular maintenance, temperature regulatin and immune health), grwth, and physical activity. Energy expended in ne f these prcesses is nt available fr thers, s the diet must prvide sufficient energy t meet the needs f all essential functins. Physical activity r in the case f an athlete, the intensity, duratin and frequency f training sessins and cmpetitin will play a strng rle in determining daily energy requirements. When daily intake f fd energy frm carbhydrate, fat, prtein and alchl is equal t energy expenditure, the athlete is said t be in energy balance. Energy balance = Energy intake energy expenditure This means there is neither a net lss nr gain frm the bdy s energy stres f fat, prtein and carbhydrate. These energy stres play a number f imprtant rles related t exercise perfrmance, cntributing t: l an athlete s size and physique (e.g. bdy fat stres and muscle mass) l functin (e.g. muscle mass) l fuel fr exercise (e.g. muscle and liver glycgen stres) Athletes ften want t change their energy balance, either t prduce an energy deficit (principally t reduce the size f bdy fat stres) r t achieve an energy surplus (principally t supprt grwth r supprt the gain f muscle mass). This can be dne either by altering energy intake, energy expenditure r bth cmpnents. Hwever, an imprtant new cncept is that f energy availability. This is defined as the energy that is available t the bdy after the energy cst f physical activity has been deducted frm daily energy intake. Energy availability is therefre, the amunt f energy that can be expended t lk after the bdy s physilgical needs. Energy availability = Energy intake Energy cst f training/cmpetitin The bdy can cpe with a small drp in energy availability, but if it becmes t great, this will cmprmise its ability t undertake the prcesses needed fr ptimum health and functin. We nw recgnise that many health and perfrmance prblems cmmnly seen in athletes are assciated with lw energy availability these include menstrual disturbances in female athletes, reduced basal metablic rate, cmprmised immunity, pr hrmnal functin and impaired bne density. Althugh any reductin in energy availability has sme effect n the bdy, researchers have identified a threshld belw which the cnsequences are particularly harmful. This is usually discussed in terms f an athlete s Fat Free

athletes medical infrmatin Mass (FFM) i.e. Bdy mass minus Bdy fat. This threshld is set at 30 kcal (125 kj) per kg FFM. Examples f adequate and lw energy availability are prvided in the table belw. There are three situatins that are typically assciated with lw energy availability. l Disrdered eating and eating disrders. We used t think this was the main cause f energy deficiencies, causing sme stigma t the situatin. Disrdered eating requires early interventin and specialist help, but we nw knw that many athletes can get int situatins f lw energy availability withut this backdrp l Restricted eating fr weight cntrl r lss r bdy fat. Many athletes undertake such campaigns with the best f intentins and, ften, gd reasns. Hwever, the degree f energy deficit achieved by reduced energy intake r increased exercise may be t severe fr gd health. Even when weight lss is undertaken withut any prblem behaviur r undue stress, trying t achieve it at t fast a rate is likely t lead t unnecessary cmprmises f health and perfrmance l Inadvertent failure t increase energy intake sufficiently during perids f high vlume training r cmpetitin. Sme athletes undertake extremely strenuus training r cmpetitin prgrams. Appetite, time fr preparing and eating fd, and awareness f intake are just sme f the factrs influencing ur fd intake that may nt always keep pace, especially when there is a sudden increase in exercise lad. The practicality f eating a high energy intake day after day can be challenging fr many athletes. Sme may be unaware that they are falling behind in meeting their energy needs, r that it is prblematic.

athletes medical infrmatin Tips fr maintaining adequate energy availability Be aware f energy needs and hw these might vary ver time. Be prepared t scale energy intake up and dwn accrding t the changing energy csts f daily training r cmpetitin. Be aware als f additinal needs fr grwth. Ideas fr achieving a high energy intake are fund in the next sectin. Take care when there is a change in yur fd envirnment particularly when travelling r when changing yur hme situatin. It can take time and a cnscius effrt t re-establish new eating patterns when pprtunities t eat r access t suitable fds are altered. D nt embark n drastic diets that limit energy intake r fd variety. Even when lss f weight r bdy fat is likely t achieve better health and perfrmance, severe energy restrictin is assciated with unnecessary cnsequences f lw energy availability. Where pssible, plan weight lss prgrams s that they can be undertaken at a slwer and less harmful pace. If yu are develping stress related t fd and bdy image, seek expert help at an early stage. Female athletes shuld treat an interruptin t a nrmal menstrual cycle as a prblem that als needs early assessment and interventin. If yu are unsure abut yur energy needs and hw t achieve them, cnsult a sprts nutritin expert. Nte that the cnsequences f lw energy availability include irreversible lss f bne, as well as impairment f hrmne, immune and metablic functin. It s nt wrth it! Examples f different levels f energy availability 1. High energy availability fr grwth r gain f bdy mass Energy availability Example > 45 kcal Athlete A: 65 kg and 20% bdy fat (> 189 kj) FFM = 80% x 65 kg = 52 kg per kg fat free mass (FFM) Weekly training = 5600 kcal (23.5 MJ) Daily energy intake = 3520 kcal (14.7 MJ) Energy availability = (3520-800)/52 = 52 kcal/kg FFM (219 kj)

athletes medical infrmatin 2. Adequate energy availability fr weight maintenance Energy availability Example ~ 45 kcal Athlete B: 65 kg and 15% bdy fat (~ 189 kj) FFM = 85% x 65 kg = 55 kg per kg fat free mass (FFM) Weekly training = 5600 kcal (23.5 MJ) Daily energy intake = 3285 kcal (13.8 MJ) Energy availability = (3285-800)/55 = 45 kcal/kg FFM (189 kj) 3. Reduced energy availability but still adequate fr healthy weight lss (r weight maintenance at reduced metablic rate Energy availability Example 30-45 kcal Athlete C: 55 kg and 20% bdy fat (125-189 kj) FFM = 80% x 55 kg = 44 kg per kg fat free mass (FFM) Weekly training = 5600 kcal (23.5 MJ) Daily energy intake = 2340 kcal (9.8 MJ) Energy availability = (2340-800)/44 = 35 kcal/kg FFM (164 kj) 4. Lw energy availability health implicatins Energy availability Example < 30 kcal Athlete D: 55 kg and 25% bdy fat (< 125 kj) FFM = 75% x 55 kg = 41 kg per kg fat free mass Weekly training = 5600 kcal (2.35 MJ) Daily energy intake = 1980 kcal (8.3 MJ) Energy availability = (1980-800)/41 = 29 kcal/kg FFM (120 kj)

athletes medical infrmatin Changing bdy cmpsitin: gaining muscle and lsing bdy fat In many sprts, success is influenced by an athlete s size and shape. Examples include the imprtance f being strng and pwerful, r simply big and tall, in sme sprts. In ther events, being small and light assists in mving yur bdy ver lng distances, up hills r in cmplicated twirls and smersaults. An athlete s appearance may als be a factr in sprts that are judged subjectively, r when the athlete is thinking abut their public image. Gaining the physique characteristics that are useful fr yur sprt starts with chsing the right parents we all get a genetic start t life! But sme f these elements can als be manipulated thrugh diet and training. Mst athletes at sme time f their careers set ut t alter their bdy mass, muscle mass r bdy fat levels smetimes all at the same time. In ther cases, athletes need t take special care t supprt their needs fr grwth. The principles f changing bdy size and shape are: l Altering energy balance t prmte a lss r gain f bdy tissue this can be achieved by changing energy expenditure, altering dietary intake r bth l Undertaking the right training t prmte muscle develpment. Several ther factrs are imprtant fr staying healthy and achieving successful perfrmance utcmes while achieving physique changes. These include: l Chsing targets that are achievable and sustainable in view f yur genetic blueprint l Allwing enugh time fr the targets t be achieved with sensible changes t nutritin and training l Setting the right time f the sprting seasn t undertake the changes s that yur effrts dn t clash with the gals f ptimum cmpetitin perfrmance. Fr mst athletes, this wuld mean during the base phases f training l Aviding getting t ut f shape when injured r n a break between seasns l Seeking the help f sprts nutritin experts wh can wrk with yu and yur cach t integrate a gd nutritin plan int yur training prgram l Unfrtunately, many athletes dn t value r understand the imprtance f these factrs. Sme f the dietary strategies that may be imprtant t achieve these gals include l finding ways t reduce energy intake t assist with lss f bdy fat, r the preventin f a gain in bdy fat when training vlume is reduced l finding ways t supprt the gals f the training needed t increase muscle mass (see prtein sectin) l finding ways t increase energy intake t supprt grwth and an increase in muscle/bdy mass. Useful strategies fr reducing r increasing energy intake are prvided belw.

athletes medical infrmatin Strategies fr reducing energy intake and/r reducing bdy fat levels Set realistic targets: this is a medium-term gal rather than smething t be achieved by next week. Try t create a small energy deficit arund 500 kcal (2 MJ) per day by reducing energy intake and/r increasing energy expenditure. A small but sustained energy deficit ver a lnger perid will prmte fat lss rather than sacrificing muscle mass, and will better supprt training needs and general nutritin gals. Althugh many athletes are impatient and like the idea f a quick but drastic weight lss prgram, the utcmes fr bdy cmpsitin changes and training perfrmance are likely t be better than with a large deficit. Remember that adequate energy availability is needed fr lng term health. Seek a sprts nutritin expert fr an assessment f current eating patterns and where small changes can be made. Keeping a fd diary f what yu really eat can als help t pinpint habits that shuld be changed. Limit prtin sizes at meals rather than skipping meals altgether Maintain carbhydrate intake t maintain fuel levels fr exercise, especially n days when training intensity and quality is imprtant Maintaining a gd spread f prtein intake ver the day will help t preserve muscle mass as well as t make meals and snacks filling Use lw-fat strategies in chsing fds and while cking r preparing meals Limit alchl intake r cut it ut altgether it is nt an essential part f the diet. In additin, many peple lse their gd intentins after a few drinks. It is easy t eat snack fds, fast fds r ther pr fd chices when yu becme t relaxed Make meals and snacks mre filling by including plenty f salads and vegetables and by taking the higher-fibre ptin Include lw glycaemic index frms f carbhydrate-rich fds (e.g. ats, legumes, dense-grainy breads, berries, apples, etc) t als help with satiety Chse nutrient-dense fds s that yu can meet nutritinal requirements frm a lwer energy intake Use well-chsen snacks between meals t maintain fuel levels fr training sessins. Save part f a meal fr a later snack, rather than eating extra fd

athletes medical infrmatin Strategies fr increasing energy intake t supprt grwth r increase in muscle mass Set a pattern f frequent meals and snacks during the day rather than simply trying t eat mre at meals. Plan ahead t have suitable fds and drinks available wherever yur busy day takes yu. It can take sme creativity t find fds that are prtable and easy t cnsume when yu are n the run. A fd recrd can identify the times in a busy day that aren t being well used fr fuelling up. Althugh it is imprtant t eat fruit and vegetables, and whlegrain cereal fds fr their nutrient qualities, vereating these bulky fds can reduce the energy density f yur diet. It is OK t include ptins that are mre cmpact fr example, juices, and sme white cereals. Use pprtunities befre, during and after an exercise sessin t cnsume energy and nutrients. Cmpact frms f carbhydrate and befre and during exercise can add energy t the day as well as fuel the sessin. Sweetened dairy prducts, liquid meal supplements and fruit smthies prvide a cmpact surce f prtein and carbhydrate after the wrkut. Drinks such as fruit smthies, liquid meal supplements and frtified milkshakes and juices can prvide a substantial surce f energy and nutrients that are quick and cmpact t cnsume, and less likely t cause gastrintestinal discmfrt than bulky fds.

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athletes medical infrmatin Carbhydrates fr training and recvery Carbhydrate, nce cnsidered the backbne f sprts nutritin, has becme a tpic f debate and differing pinins. Arund the wrld, it typically accunts fr abut half f ur ttal energy intake. In fact, surveys shw that the best endurance athletes in the wrld (the Kenyan and Ethipian distance runners) cnsume diets that are particularly high in carbhydrates. Meanwhile in many Western cuntries, media reprts state that carbhydrates make us fat and unhealthy and the mst ppular diet bks are based n lw and mderate carbhydrate eating plans. Many athletes are nw cnfused. It is true that sprts nutritin experts have cntinued t evlve the recmmendatins fr carbhydrate intakes fr athletes as well as the language used t describe them. A central idea that hasn t changed, hwever, is the imprtance f the bdy s stres f carbhydrate as a surce f fuel fr the muscle and brain during exercise. In many types f sprt, lw levels f carbhydrate stres are a factr in fatigue and reduced perfrmance. Furthermre, strategies t ensure that stres are increased result in perfrmance enhancements. This will play a key rle in cmpetitin nutritin. There are several updates in the way we nw think abut carbhydrate needs in the everyday r training diet: The athlete s carbhydrate needs are clsely tied t muscle fuel csts f their training. The training lad changes frm day t day, ver the varius micrcycles and macrcycles in the peridised training calendar, and at different pints f the athlete s career. Therefre, the new message is that rather than having a static dietary intake, athletes shuld vary their carbhydrate intake accrding t the rise and fall in muscle fuel needs. Sme general targets are suggested, but shuld be fine-tuned accrding t the athlete s energy budget and feedback frm hw well they are training. A further refinement is that athletes shuld particularly target the days where it is imprtant t train hard, at high intensity r with high quality t ensure that they have adequate muscle carbhydrate (glycgen) stres t fuel these gals. A great way t assist carbhydrate intake t track with muscle fuel needs is t include additinal carbhydrate in meals r snacks befre and after a wrkut. This means when training needs increase, s des carbhydrate intake. Cnsuming carbhydrate intake during lengthy sessins will als add t the day s carbhydrate target as well as specifically prvide fuel fr the wrkut. Many athletes shuld take this pprtunity t practise cmpetitin strategies fr eating and drinking during the event. Targets fr carbhydrate shuld be prvided in terms r grams relative t the athlete s size (Bdy mass) rather than as a percentage f ttal energy intake.

athletes medical infrmatin Training lad Carbhydrate intake targets (g per kg f athlete s bdy mass) Light Lw intensity r skill-based activities 3-5 g/kg Mderate Mderate exercise prgram 5-7 g/kg/d (i.e. ~1 hur per day) High Endurance prgram (e.g. 1-3 hurs 6-10 g/kg/d per day f md-high-intensity exercise) Very High Extreme cmmitment (i.e., at 8-12 g/kg/d least 4-5 hurs per day f md-high intensity exercise) Rather than talk abut high carbhydrate diets and lw carbhydrate diets, we shuld nw cnsider carbhydrate availability relative t the muscle s fuel needs is the ttal intake and timing f the day s intake able t meet the fuel demands f a wrkut (= high carbhydrate availability), r are carbhydrate stres depleted r sub-ptimal in cmparisn t the muscle fuel demand (= lw carbhydrate availability). The table abve shws that very different amunts f carbhydrate may be adequate fr different training lads. Therefre tw athletes culd eat the same abut f carbhydrate, but accrding t their training needs, ne culd achieve high carbhydrate availability whereas the carbhydrate availability f the ther athlete is lw. Many athletes d sme f their training sessins with lw carbhydrate availability fr example, when they train first thing in the mrning withut breakfast, when they g fr a lng wrkut withut access t fd r a sprts drink, r when they reduce their energy intake t reduce bdy fat levels. This may nt be a prblem during the base phase f training r n days f light training, when training intensity and quality is lw. In fact, sme studies suggest that ding sme training sessins in this way prvides a gd stimulus t the muscle t help it adapt t training. Of curse, such strategies need t be peridised int the training prgram s that they dn t interfere with training intensity.

athletes medical infrmatin When athletes train mre than nce per day and sessins are clse tgether, speedy recvery f the muscle carbhydrate stres is essential. Cnsuming carbhydrate-rich fds and drinks sn after the sessin helps with rapid refueling, since the muscle can t stre glycgen effectively in the absence f carbhydrate intake. When rapid refueling is needed after a sessin, target a carbhydrate intake f abut 1 g per kg f bdy mass per hur fr the firs.imprtant than the amunt, and athletes shuld make chices based n cnvenience, palatability, cst, and the cntributin these fds can make t ther nutritinal gals. When it isn t pssible t meet these carbhydrate targets during the early hurs f recvery, the presence f prtein in recvery snacks is likely t prmte higher rates f glycgen strage than carbhydrate alne. This is useful since pst-wrkut prtein intake addresses ther gals f recvery eating. During lnger recvery perids (24 hurs), the pattern and timing f carbhydrate-rich meals and snacks des nt appear t be critical, and can be rganised accrding t what is practical and cmfrtable fr each athlete. There is n difference in glycgen synthesis when carbhydrate is cnsumed in liquid frm r as slid fds. Examples f nutrient-rich carbhydrate and prtein cmbinatins (cntains 50-75 g carbhydrate and 15-20 g prtein) l 500-750ml Lw Fat Chclate Milk l 1-2 sprts bars (check labels fr carbhydrate and prtein cntent) l 1 large bwl (2 cups) breakfast cereal with lw fat milk l 1 large r 2 small cereal bars + 200g fruit-flavured ygurt l 1 cup baked beans n 2 slices f tast r n a baked ptat l 1 bread rll with cheese r peanut butter + large banana l 2 cups fruit salad with 200g fruitflavured ygurt l Bagel with thick spread peanut butter + 1-2 cups lw fat milk l 300g (large) baked ptat + lw fat cttage cheese filling + 1-2 cups lw fat milk l 2-3 slices lean meat and veggie pizza l 2 cups breakfast cereal with milk l 400g flavured yghurt l 500-750 ml fruit smthie r liquid meal supplement l Thick bread sandwich with meat and salad filling l 2 cups stir-fry with rice r ndles and meat It is valuable t chse nutrient-rich carbhydrates and t add ther fds t recvery meals and snacks t prvide a gd surce f prtein and ther nutrients in the ttal diet.

Ntes athletes medical infrmatin

athletes medical infrmatin Carbhydrate fr cmpetitin In many sprts lasting lnger than 1 hur, the depletin f carbhydrate stres causes fatigue and a decline in perfrmance ver the curse f the event. By cntrast, nutritin strategies that prvide adequate carbhydrate can reduce r delay the nset f this perfrmance decline. Strategies include the intake f carbhydrate in the hurs r days prir t the event t ensure muscle and liver glycgen stres are well stcked in anticipatin f the fuel needs f the event. In the absence f muscle damage, the athlete can nrmalise their muscle glycgen stres with as little as 24 hurs f carbhydrate-rich eating and exercise taper. Carb-lading Athletes wh cmpete in events lasting lnger than abut 90 minutes may benefit frm carbhydrate-lading fr a few days prir t the cmpetitin. This strategy invlves meeting the highest targets fr carbhydrate intake (9-12 g/kg/d) fr 24-48 hurs while exercise is reduced t an easy taper, and allws muscle glycgen stres t be super-cmpensated abve nrmal levels. As a result, the athlete shuld have fuel t exercise lnger at their ptimal utput befre they face a perfrmance decline. One day example f fds prviding 630 g f carbhydrate fr a carbhydrate lading diet* (fr a persn weighing 70 kg with an intake f 9 g/kg carbhydrate). l Breakfast (150 g) = 2 cups cereal with milk + 250 ml fruit juice + 1 banana + 2 thick slices tast + thick spread f jam l Mrning snack (50 g) = 500 ml sft drink l Lunch (150 g) = 1 large bread rll + 1 medium muffin + fruit smthie l Afternn snack (50 g) = 200 g flavured yghurt + 250 ml fruit juice l Dinner (200 g) = 3 cups cked pasta 2 cups fruit salad + 2 scps ice cream + 500 ml sprts drink l Snack (30 g) = 50 g chclate r dried fruit (*nte that ther fds may be added t the meal, such as mderate amunts f prtein fds. Many athletes like t fllw lw fibre eating ver their carbhydrate lading days, t ensure that the gut is free f bulky fibre n the day f the event)

athletes medical infrmatin Pre-event meal (1-6 h perid befre cmpetitin) Athletes smetimes find a set f favurite fds t eat in the hurs prir t cmpetitin that nt nly prvide extra energy during the event, but als feel right in terms f curbing hunger, quieting their stmach and being cnvenient as well as practical. In sprts that d nt cause fatigue r carbhydrate depletin (e.g. gymnastics, sprinting, ski-jumping, etc), the pre-event meal need nt be carbhydratefcussed. Hwever, in events invlving exercise f lnger than 60 minutes, athletes are advised t use the pre-event meal t tp up carbhydrate stres especially if the event is in the mrning after an vernight fast. The effect f eating carbhydrate in the hurs befre exercise is t increase the muscle s rate f carbhydrate use. Therefre, the pre-event meal shuld cntain enugh carbhydrate t cmpensate fr this priming f greater carbhydrate reliance. A carbhydrate intake greater than 1 g/kg bdy mass shuld achieve this gal, and pre-event meals which enhance perfrmance in lnger events generally prvide carbhydrate in the range f 1-4 g/kg. Cntinuing t cnsume carbhydrate during the event helps t sustain fuel availability. A mistake sme athletes make is t eat nly a small amunt f carbhydrate (less than 1 g carbhydrate per kg bdy mass) during the 1-6 h perid befre exercise and then fail t cnsume any carbhydrate during exercise. Unfrtunately, this serves t make the bdy mre reliant n bdy carbhydrate supplies withut prviding additinal resurces t sustain this. Depending n the time f day, the athlete s preferences and the availability f fd, an athlete may chse a range f carbhydraterich fds and drinks t make up their pre-even meal. The type, timing and amunt f fds shuld be practiced until a successful plan is develped. Five different examples f fds that each prvide 140 g carbhydrate in a pre-cmpetitin meal* (2 g/kg bdy mass fr a 70 kg persn) are: l 2.5 cups breakfast cereal + milk + large banana l Large bread rll r 3 thick slices bread + thick spread hney l 2 cups biled rice + 2 slices bread l 4 stack pancakes + ½ cup syrup l 60 g sprts bar + 500 ml liquid meal supplement r fruit smthie (*nte that ther fds may be eaten at the meal)

athletes medical infrmatin Carbhydrate intake during exercise We have lng recgnised that perfrmance is enhanced when carbhydrate is cnsumed during exercise. Benefits include a sustaining f ptimum pace, greater time spent at high intensities, and maintenance f skills and cncentratin. A variety f mechanisms seem t explain this, ranging frm the prvisin f high rates f an additinal muscle fuel t making the brain feel happy s that it makes us feel like wrking harder. Until recently, we have taken a ne size fits all apprach t carbhydrate intake during exercise lasting lnger than 60-90 minutes. Hwever, there is nw gd evidence that exercise f different duratin and intensities requires a different carbhydrate feeding apprach. A range f carbhydrate-cntaining drinks and fds may be able t supply these targets, as well as ther needs such as fluid. These include special sprts prducts such as sprts drinks, gels and bars. Many everyday fds and drinks such as fruit, juices and sft drinks and cnfectinery may als be suitable. The athlete shuld practice in training t develp a race r event fuelling plan. This plan will need t take int accunt the pprtunities prvided in the athlete s event t cnsume drinks r fds.

athletes medical infrmatin Exercise Duratin Carbhydrate Cmments target During brief l < 45 min Nt needed l A range f drinks and exercise sprts prducts can prvide easily cnsumed carbhydrate During sustained l 45-75 min Small amunts l Opprtunities t cnsume high intensity including muth fds and drinks vary exercise rinse accrding t the rules and nature f each sprt l A range f everyday dietary chices and specialised sprts prducts ranging in frm frm liquid t slid may be useful l The athlete shuld practice t find a refuelling plan that suits their individual gals including hydratin needs and gut cmfrt During endurance l 1-2.5 h 30-60 g/h l As abve exercise including l Higher intakes f carbhydrate stp and start are assciated with better sprts perfrmance l Prducts prviding multiple transprtable carbhydrates (Glucse: fructse mixtures) will achieve high rates f xidatin f carbhydrate cnsumed during exercise During l > 2.5-3 h Up t 90 g/h ultra-endurance exercise

athletes medical infrmatin Dietary prtein fr athletes: frm requirements t ptimum adaptatin Prtein needs in sprt are anther area in which knwledge and practice have evlved. Very early beliefs included the need fr high prtein intakes r the specific cnsumptin f meat frm animals with favurable characteristics fr sprt (e.g. speed, strength, curage etc). A belief in the benefits f a high prtein intake has cntinued in strength/pwer sprts, althugh there is generally a shared emphasis between prtein-rich fds and specialised prtein supplements. Fr many years there has been debate abut the ttal prtein requirements f athletes, with many experts believing that daily needs are elevated abve thse f sedentary peple, but easily achieved within the energy intakes cnsumed by mst athletes. Prtein intake targets fr bth strength and endurance athletes have been set at abut 1.2-1.6 g/kg bdy mass per day. Dietary surveys shw that mst athletes easily meet these gals, even withut the intake f expensive supplements. Athletes wh are mst at risk f failing t meet these targets are thse wh restrict their energy intake and fd variety. The new way t cnsider prtein needs, hwever, is t cnsider its rle in prmting the utcmes f training and in particular, the way the bdy adapts t the type f exercise undertaken in each wrkut. The respnse t training is specific t the stimulus and prprtinal t the training lad. Every athlete knws that strength training is very different frm endurance training, and the result is that the muscle makes mre f the specific prteins it needs t cause the muscle t perfrm better. Dietary prtein plays an imprtant rle in this respnse t exercise. The amin acids that make up the prteins in the fds that we eat are used as the building blcks fr the manufacture f new tissue, including muscle, and fr the repair f damaged tissue. They are als the building blcks fr hrmnes and enzymes that regulate metablism, supprt the immune system and ther bdy functins. Prtein prvides nly a small surce f fuel fr the exercising muscle. When this apprach t prtein needs is taken, the fcus becmes hw t prmte ptimum prtein synthesis in the perid f recvery and adaptatin frm each wrkut. The fllwing ideas have emerged: Eating a surce f high quality prtein sn after exercise is part f the prcess f prmting muscle prtein synthesis. High quality prtein, particularly frm animal surces (e.g. dairy, meats, eggs etc) is especially valuable. The amunt f prtein required t maximise this respnse t exercise is quite mdest abut 20-25 g. Greater amunts f prtein than this are simply burned as fuel. It may help t chse a prtein surce that is rapidly digested as the pst-wrkut prtein bst. Whey prtein fits this prfile, which explains its ppularity fr pstwrkut recvery. This can easily be fund in everyday dairy fds and drinks. Nevertheless, smetimes there can be value in using a mre cmpact frm that is easy t

athletes medical infrmatin carry and prepare arund the exercise sessin such as a liquid meal supplement r a simple prtein pwder. There is n justificatin fr the mre expensive prtein pwders r amin acid frmulatins with extra ingredients and fancy claims. We knw that the muscle is stimulated t increase its prtein synthetic rates fr up t 24 hurs after a wrkut. Hw best t rganise ur prtein intake ver the day t utilise this is still unknwn. It makes sense, hwever, t spread prtein ver the meals and snacks cnsumed ver the day. This is nt smething that ur traditinal eating patterns always achieve, since mst peple eat the majrity f their prtein intake at the evening meal. It may be mre sensible t redistribute prtein intake t ther meals in the day. Prtein rich fds: 10 g prtein is prvided by: l 2 small eggs l 300 ml cw s milk l 20 g skim milk pwder l 30 g cheese l 200 g yghurt l 35-50 g meat, fish r chicken l 4 slices bread 90 g breakfast cereal l 2 cups cked pasta r 3 cups rice l 400 ml sy milk 60 g nuts r seeds l 120 g tfu r sy meat 150 g legumes r lentils l 200 g baked beans 150 ml fruit smthie r liquid meal supplement

athletes medical infrmatin Water and salt needs fr training, cmpetitin and recvery Athletes generally appreciate the need t drink befre, during and after exercise and the imprtance f smetimes using drinks that cntain added carbhydrate and salts. Sme athletes, hwever, d nt drink enugh while thers drink t much s it is imprtant t learn the practical aspects f: a) when it may be helpful t drink during exercise b) hw much t drink, c) what type f drinks are best, and d) what mdificatins shuld be made in ht r cld envirnments. Just as general training and cmpetitin strategies shuld be tailred fr individual athletes in accrdance with their unique needs and preferences, s shuld their drinking and eating chices during exercise. Athletes, caches and trainers shuld fine tune these recmmendatin t identify their wn winning frmula. When is helpful t drink during exercise? Fluids cnsumed during exercise can play a number f rles. These include making the athlete feel mre cmfrtable, replacing a bdy fluid deficit, and prviding a means t cnsume ther ingredients. The imprtance f each f these rles will vary accrding t the situatin. It is seldm necessary t drink during exercise that lasts less than abut 40 minutes, but sme athletes feel better after rinsing the muth with cl drinks and this shuld d n harm. Meanwhile, during training r cmpetitins sessins lasting lnger than this, there may be pprtunities and advantages t drinking during the sessin. When it is nt pssible t drink during heavy sweating type exercise lasting lnger than 30 min, an alternative is t hydrate well just befre starting the sessin. The athlete shuld practise drinking during the 15 minutes befre exercise and find hw much is initially filling but cmfrtable nce exercise begins (e.g., 300-800 ml). Hw Much t Drink? Sweating causes a lss f water and salts frm the bdy, but water is als cntinually lst in the breath and thrugh the skin even thugh these lsses may nt be bvius. Small lsses f water have n effect n perfrmance, but severe dehydratin is harmful t perfrmance. There is n clear evidence n the pint at which perfrmance begins t be affected and this almst certainly varies between individuals as well as depending n the type and duratin f exercise and n the envirnmental cnditins. Athletes are ften advised t drink nly when thirsty, but this may nt always be a reliable guide. Furthermre, the rules and pprtunities t drink fluids in many sprts may nt cincide with the times that thirst hits. A mre targeted ptin is t develp a fluid plan t fit the sprt, the individual and ther nutritinal needs. As a starting pint, the athlete shuld try t drink at a rate that replaces enugh f their sweat lsses s that the verall fluid deficit fr a training sessin r cmpetitin is kept t n mre than abut a 2% lss f bdy mass (i.e. 1.0 kg fr 50 kg persn, 1.5 kg fr a 75 kg persn, and 2 kg fr a 100 kg persn). In warm envirnments, dehydratin and exercise

athletes medical infrmatin intensity interact t increase the risk f impaired perfrmance and heat illness. When rates f sweat lss are very high, it isn t always practical t drink enugh t keep fluid deficits belw this target. A mre feasible alternative is simply t try t minimize dehydratin. In sme situatins, athletes ver-hydrate during exercise drinking mre than their sweat lsses. There may be sme reasns when this is justified; fr example, the case f the athlete wh starts a wrkut r event already dehydrated. Hwever, prblems can ccur when the fluid intake is excessive, leading t a serius prblem called hypnatraemia (dilutin f bld sdium cncentratins). This is mst ften seen in recreatinal exercisers wh wrk at lw intensities but drink large vlumes f fluid in the belief that they are ding the right thing. In all f these situatins, it can help fr an athlete t have a feel fr their typical sweat rates and hw hard r easy it is t drink t keep pace with these. The guide belw prvides sme ideas n t hw t check this. When d yu need mre than water? Althugh hydratin is a key fcus f nutritin strategies during exercise, fluids cnsumed during exercise can cntain a range f ingredients. In terms f prven perfrmance benefits, n nutrients match water and/r carbhydrate. During exercise lasting lnger than 1 hur and which elicits fatigue, athletes are advised t cnsume a surce f carbhydrate that is rapidly cnverted t bld glucse. This generally imprves perfrmance allwing the athlete t maintain pace, skills and cncentratin instead f succumbing t fatigue. As utlined in the earlier sectin n Carbhydrates in cmpetitin, the targets fr carbhydrate during exercise will vary accrding t the athlete s preparatin (hw well fuelled), the fuel needs f the event (duratin and intensity f the sessin) and individual tlerance. The use f cmmercial sprts drinks with a carbhydrate cntent f abut 4-8% (4-8 g/100 ml) allws carbhydrate and fluid needs t be met simultaneusly in mst events. This carbhydrate can cme frm sugars (i.e., sucrse, fructse, glucse), maltdextrins r ther rapidly digestible carbhydrates. It is best fr athletes t stick t well-knwn sprt drinks with which they are familiar t avid gastrintestinal distress r ther cnsequences. Sme athletes can tlerate mre cncentrated drinks, especially if these cntain mixtures f sugars. Practising with these drinks in training will help the gut t cpe better during cmpetitin. Typically, when carbhydrate is cnsumed during exercise, it is best cnsumed in a pattern f frequent and cntinued intake. This will prvide a cnstant stimulatin f the brain and central nervus system, r when needed, a cnstant surce f additinal fuel fr the muscle. Sdium shuld be included in fluids cnsumed during exercise lasting lnger than 1-2 hurs r

athletes medical infrmatin by individuals during any event that stimulates heavy sdium lss (i.e., mre than 3-4 grams f sdium, see next page fr assessment). Caffeine cntained in cmmnly available beverages and fds can enhance endurance r perfrmance during the later stages f prlnged exercise. This benefit can be btained with relatively small dses f caffeine (abut 2-3 mg/kg bdy mass r 100-200 mg caffeine). This is equivalent t 1-2 cups f brewed cffee r 750-1500 ml f a cla beverages as cmmnly cnsumed by peple f varius cultures. Varius sprts prducts (gels, drinks etc) may als prvide a cnvenient lw dse serve f caffeine. Rehydratin after exercise Replacement f water and the salts lst in sweat is an essential part f the recvery prcess. Since sweat and urine lsses cntinue t ccur during recvery, the athlete will need t drink abut 1.2-1.5 litres f fluid fr each kg f weight lss in training r cmpetitin t cmpensate and fully restre fluid lsses. Recvery after exercise is part f the preparatin fr the next exercise sessin, and rehydratin shuld be cnsidered as an imprtant part f the equatin. Special strategies Athletes wh have dehydrated t make weight will need special strategies fr drinking befre and during cmpetitins t ptimise perfrmance. These athletes will benefit frm the advice f a qualified and experienced sprts nutritin prfessinal. Athletes training and cmpeting while practising fasting during the mnth f Ramadan must rehearse a hydratin strategy that preserves perfrmance and prtects health. Just like new shes, dn t try ut new plans fr fluid and fuel intake during imprtant cmpetitin. D it in practice and find what fits yu best. Sdium, the main salt lst in sweat, als needs t be replaced. Sdium replacement can be achieved via sdium-cntaining fluids such as sprts drinks and pharmacy ral rehydratin slutins. Hwever, simply a meal r snack can supply the salt that is needed. This may be because the fds are salt-cntaining (e.g. breads, breakfast cereals, cheese, prcessed meats) r because salt is added in the preparatin r serving f the meal.

Practical ways t assess and manage hydratin athletes medical infrmatin Severe dehydratin impairs perfrmance and increases the risk f heat illness, but drinking t much can als be harmful r uncmfrtable. Every athlete is different because they have different sweat lsses and different pprtunities t drink fluid during their wrkuts and events. Yu need a persnal hydratin plan and YOU have t play a rle in develping this Remember that humans d nt adapt t dehydratin, but may learn t cmplain less abut it. Three simple steps may help t guide yur hydratin practices 1. Start the sessin well hydrated. If yu are passing urine less ften than nrmal, yu may be dehydrated. If urine clur becmes darker than what is nrmal fr yu, then yu may nt be drinking enugh. Check yur urine clur against the chart. Nte that the aim shuld NOT be fr yur urine t be as pale as pssible. Drinking t much can be uncmfrtable and, if excessive, pssible harmful. The aim is t develp fluid practices ver the day that keep pace with regular fluid needs and special lsses frm exercise r ht envirnments. As lsses change, s shuld drinking practices. It makes since t spread fluid intake ver the day rather than trying t play catch up at the end. Drinking mre than yu need in the late part f the day can mean interrupted sleep due t tilet breaks. 2. Develp a drinking plan fr training and cmpetitin that is right fr yu. This shuld be based n several pieces f infrmatin including yur typical sweat lsses, the pprtunities t drink in yur sprt, and feedback frm cmfrt and thirst. Mnitr yur sweat lsses and the success f yur drinking plan during training sessins in different situatins (see bx). Hw did yu feel? Hw did yu perfrm? What was yur weight lss ver the sessin? This shuld generally nt exceed abut 1-2% f bdy mass. If yu lst mre than this, yu prbably did nt drink enugh. Drink mre next time. If yu lst less, yu might have drunk t much. Did it make yu feel uncmfrtable? Did yu take time ut t drink that was unnecessary? Drinking s much that yu gain weight dur ing cmpetitin is never likely t be a gd idea. The nly time yu might need t d this is when yu have been dehydrated at the start f the event. 3. If yu are a salty sweater, yu may need drinks with mre salt and may need mre salt in fd when sweat lsses are high. T check whether yu are a salty sweater, wear a black T-shirt in training and lk fr salt stains (white pwder) under the arms and n the chest. High salt lsses may be a cntributing factr in sme cases f muscle cramp. Sprts drinks with higher salt (sdium) levels (e.g. 300-500 mg sdium per 500 ml liquid) may help reduce the risk f cramps.

athletes medical infrmatin Hw t estimate sweat lsses and sweat rates: 1) Measure bdy mass bth befre and after at least ne hur f exercise under cnditins similar t cmpetitin r a hard practice. 2) Take these bdy mass measurements wearing minimal clthing and while bare fted. Twel dry after exercise and btain bdy mass as sn as is practical after exercise (e.g. less than 10 min, and befre eating, drinking r ging t the tilet). Example: Pre-exercise weight = 74.5 kg Pst-exercise weight = 72.8 kg Fluid deficit = 1.7 kg 3) Estimate the weight f any fluid r fds yu have cnsumed during the wrkut Example: 800 ml f fluid = 800 g r 0.8 kg). 4) Sweat lss (Litres) = Bdy mass befre exercise (in kg) - Bdy mass after exercise (kg) + weight f fluids/fds cnsumed (kg). Example: 74.5 kg 72.8 kg = 1.7 kg deficit + 0.80 kg (800 ml fluid) = sweat lss f 2.5 kg r 2500 ml. T cnvert t a sweat rate per hur, divide by the exercise time in minutes and multiply by 60. 5) Yur weight deficit at the end f the sessin prvides a guide t hw well yu hydrated during the sessin, and hw much yu need t rehydrate afterwards. T cnvert kg t % bdy mass, divide the weight deficit by starting bdy mass and multiply by 100: Example: 1.7 kg/74.5 X 100 = 2.3% Nte: 2.2 punds equals 1.0 kg and cnverts t a vlume f 1.0 litre r 1,000 ml r 34 unces f water.

athletes medical infrmatin 1 Pale Yellw 2 Straw 3 Glden Yellw 4 Glden Orange 5 Pale Amber 6 Amber 7 Rich Glden Amber 8 Cpper Brwn 9 Orange Brwn 10 11 Mid Brwn Ruby Brwn Use this chart (left) t check yur urine clur. If the clur is dark, yu may need t drink mre.

athletes medical infrmatin Vitamins, minerals and phytchemicals Vitamins and minerals are chemicals that help the bdy t functin smthly by acting as cfactrs in metablism. Sme vitamins and minerals als have a rle as antixidants t mp up the free xygen radicals that are frmed as a by-prduct f metablism. Other minerals frm imprtant tissues such as the calcium in bnes. In shrt, they are imprtant fr maintaining ptimum health and functin. Athletes ften want t knw if their training prgrams create special needs fr additinal intakes f vitamins and minerals. It is likely that this might be the case fr at least sme nutrients, but a well-chsen diet based n adequate energy intake can easily meet any increased demands. Dietary surveys shw that mst athletes are well able t meet the recmmended intakes fr vitamins and minerals by eating everyday fds, such as fruits, vegetables, whle grains, lean dairy and meats. Thse at risk f sub-ptimal intakes f these micrnutrients include: l athletes wh restrict their energy intake, especially ver lng perids t meet weight lss gals l athletes wh fllw eating patterns with restricted fd variety and reliance n fds with a pr nutrient-density The best way t crrect this situatin is t seek advice frm a sprts nutritin expert such as a sprts dietitian. When fd intake cannt be adequately imprved fr example, when the athlete is travelling in a cuntry with a limited fd supply - r if an individual is fund t be suffering frm a lack f a particular vitamin r mineral, then shrt-term supplementatin may be warranted. This shuld be undertaken with the advice f a qualified sprts nutritin expert. In general, a brad-range multivitamin/mineral supplement is the best chice t supprt a restricted fd intake, althugh targeted nutrient supplements may be necessary t crrect an established nutrient deficiency. There are sme special micrnutrients and ther fd chemicals that merit special mentin and discussed belw. Antixidant nutrients We knw that free xygen radicals are prduced during nrmal metablism, and that ur bdy develps antixidant defence systems t neutralise these chemicals and the damage they can cause. We als knw that exercise causes an increased prductin f these radicals, and many athletes feel that antixidant supplements may help t prtect them against this elevated level f harm. Vitamins C and E supplements have been ppularly used fr this purpse. Mre recently, hwever, there have been changes t such thinking. It seems unnecessary t prvide large dses f a few antixidant vitamins when the bdy has its wn mechanisms t increase a mre cmplex antixidant defence system. In fact, supplementatin may unbalance the system and cause mre harm than gd.

athletes medical infrmatin There may be sme benefits assciated with the prductin f free xygen radicals new evidence shws that they functin as signals t prmte imprtant adaptatins t training. It is pssible that the use f antixidant supplements may actually neutralise sme f the signalling that underpins recvery and adaptatin t a wrkut, which means that antixidant supplementatin culd reduce the effectiveness f a training prgram. Fds cntain a large variety f health prmting chemicals in additin t vitamins and minerals. These prducts usually called phytchemicals r phytnutrients prmte functin and health in ur bdy as antixidants, anti-cancer agents, and many ther rles. The names f sme f the chemicals include quercetin and ECGC., New studies are cntinually investigating whether supplemental frms f these prducts culd be useful fr health and perfrmance. T date, these studies haven t been able t translate the ptent health benefits knwn abut these prducts int a functinal utput. Therefre, at present, the mst effective way t apprach these chemicals is thugh eating them in plentiful amunts in fd.

athletes medical infrmatin Ideas fr prmting dietary variety and nutrient-rich eating t achieve a plentiful intake f vitamins, minerals and phytchemicals: Be pen t trying new fds and new recipes and make the mst f fds in seasn. Explre all the varieties f different fds such as different types f fruits, vegetables and grains Mix and match fds at meals, such as salads and sups. Think carefully befre banishing a fd r grup f fds frm yur eating plans. Find substitutin fds that have similar nutrients when excluding a fd grup frm yur diet. Include fruits and/r vegetables at every meal and snack. The strng and bright clurs f many fruits and vegetables are a sign f a high cntent f varius vitamins and phytnutrients. Aim t fill yur plate with a rainbw f highly clured fds t ensure a gd intake f these healthprmting dietary cmpunds. Vitamin D Vitamin D is classified as a fat-sluble vitamin which acts as a hrmne. It has imprtant functins in the bdy including maintenance f gd bne health, muscle functin and immunity. Vitamin D is fund in sme fds, but ur majr surce cmes frm sunshine expsure. There is evidence that many peple have deficient r sub-ptimal vitamin D status. Vitamin D deficiency can lead t several health issues including increased risk f bne injuries, chrnic musculskeletal pain and viral respiratry tract infectins. Reversal f sub-ptimal vitamin D status in athletes may have beneficial effects n athletic perfrmance and health. Athletes at risk f vitamin D deficiency include thse wh have the fllwing characteristics: l train indrs l have dark skin l live further away frm the equatr l wear clthing that cvers mst r all f their bdy l regularly use sunscreen r cnsciusly avid the sun Such athletes shuld be screened fr pr vitamin D status and if levels are sub-ptimal, a curse f vitamin D supplementatin, and perhaps judicius, sunshine expsure shuld be undertaken under medical supervisin.

athletes medical infrmatin Irn Irn plays an imprtant rle in the transprt f xygen in the bld (as haemglbin) and muscle (as myglbin), and inadequate irn status can bviusly impair perfrmance and recvery. There is sme evidence that an athlete s irn requirements may be elevated due t increased levels f lss due t their training lad. Hwever, mst athletes wh becme irn deficient r anaemic d s because f pr irn intake. Athletes wh are at high risk f such prblems are thse wh restrict energy intake and dietary variety. Since meats, including fish and pultry, are a majr surce f well absrbed irn, vegetarian eaters will need t plan their meals carefully t find alternative irn surces. Females are als at risk because f increased irn requirements due t menstrual bld lsses matched against a smaller fd intake. Irn-rich eating will help t reduce this risk. Athletes wh are at risk f pr irn status shuld be mnitred peridically. Athletes wh are undertaking altitude training als need t have irn status mnitred t ensure they have sufficient irn stres t allw the adaptatins t their specialised training demands. Rutine use f irn supplements is nt recmmended: t much irn is just as harmful as t little. Selfmedicatin with irn supplements may nt address the real causes f an athlete s fatigue r ther issues f pr eating. Irn rich eating strategies. Cnsume mderate servings f red meats (well-absrbed irn) in 3-5 meals per week. Chse irn-frtified cereal prducts such as breakfast cereals. Cmbine plant and nn-meat surces f irn (e.g. legumes, cereals, eggs, green leafy vegetables) with fd factrs that enhance irn absrptin. These include vitamin C and an irn enhancing factr fund in meat/fish/chicken. Examples f clever matching include fruit juice r fruit with breakfast cereal, r chilli cn carne (meat and beans). Calcium Calcium is imprtant fr healthy bnes, especially in adlescents and in female athletes, s it is imprtant t ensure adequate calcium intake. The best surces f calcium are dairy fds, including lw fat varieties. Calcium rich eating strategies. Each athlete shuld aim t include at least 3 servings f these fds in their daily eating plans: l glass f milk l slice f cheese l cartn f yghurt. Additinal daily servings are required during grwth spurts in childhd and adlescence, and fr pregnancy and lactatin Calcium frtified sy fds may prvide a useful substitute when an athlete cannt cnsume dairy fds.

athletes medical infrmatin Supplements and sprts fds Athletes lk t sprts fds and nutritinal supplements fr many benefits, including thse listed belw l prmting adaptatins t training l increasing energy supply l allwing mre cnsistent and intensive training by prmting recvery between training sessins l maintaining gd health and reducing interruptins t training due t chrnic fatigue, illness, r injury l enhancing cmpetitive perfrmance l prviding a cnvenient surce f nutrients that are easy t cnsume when everyday fds are unavailable r impractical t eat. This is mst ften the case just prir t, during, r after an exercise sessin. Sprts fds are generally manufactured t achieve the last f these gals. By prviding a practical way t meet special nutritin needs they may indirectly assist the athlete t achieve sme f the benefits n the list. Examples f useful sprts fds include: l sprts drinks (prviding fluid, electrlytes and carbhydrate during exercise) l sprts gels (additinal carbhydrate intake, especially during exercise) l liquid meals (carbhydrate, prtein, vitamins and minerals fr a pre-event meal, pstexercise recvery r a high-energy diet) l sprts bars (carbhydrate, prtein, vitamins and minerals ften a slid frm f the liquid meal) Of curse, the cst f these sprts fds must be cnsidered befre using them. Athletes shuld recgnise that the sprts fd market includes prducts that are carefully manufactured t prvide nutrients t meet well dcumented gals right thrugh t gimmicky items that have a pr cmpsitin r the additin f ingredients with a pr evidence base. The use f pills, ptins, pwders and ther sprts supplements is widespread amng athletes, but few prducts are supprted by sund research and sme may even be harmful t the athlete. Athletes shuld carefully examine the risks and rewards f individual supplements befre using them. Where there is a demnstrated deficiency f an essential vitamin r mineral, and an increased intake frm fd is nt pssible, a supplement may be h. Fr example, ther sectins f this bklet have nted that athletes with a diagnsed deficiency f irn r vitamin D may benefit frm a curse f supplements, but this shuld be dne nly if a bld test shws it t be necessary. The use f supplements, hwever, des nt cmpensate fr pr fd chices and an inadequate diet. A much better ptin is t learn abut nutritin and fds s that yu can chse fds t ensure that yur nutritinal needs are met. A well-chsen diet will prmte an adequate intake f the essential vitamins and minerals.

athletes medical infrmatin Prtein pwders and supplements Prtein supplements, high prtein bars and amin acid preparatins are amng the biggest selling sprts nutritin prducts. An adequate intake f prtein is essential fr muscle grwth and repair, but this can usually be achieved frm everyday fds and expensive supplements are seldm required. When there is a case fr a mre practical surce f high quality prtein, the preferred prtein supplements are listed belw: Prtein-carbhydrate supplements (knwn als as liquid meal supplements). These prvide an easily prepared and rapidly digested surce f the majr nutrients needed fr recvery after exercise (helping with repair, rehydratin and refuelling). In additin, they can prvide an easily cnsumed surce f energy r help meet energy and nutrient needs while travelling. A simple whey prtein pwder; whey, is a high quality milk prtein, that prvides a rapidly digested surce f leucine and ther essential amin acids. A whey prtein pwder may be useful when repair and adaptatin is the main recvery need, r when a quick fix is needed t add quality prtein t a sub-standard meal. There is n evidence that fancy versins f whey prtein, with special preparatin techniques r ther ingredients, are superir t simpler prducts. A serving that prvides 20-30 g f whey prtein is adequate t meet needs at a single meal r snack. Fat reductin and muscle building A huge array f supplements, claiming t reduce bdy fat levels and build bigger and strnger muscles appeal t athletes and nnathletes alike. The reality is that mst prducts that are effective in ding increasing lean tissue and decreasing bdy fat are either n the banned list r are assciated with serius health risks (r bth). Many weight-lss supplements have been shwn t cntain prhibited drugs that are nt listed n the label, which can lead t failed drug tests. Cmpunds in the muscle building categry include chrmium, brn, hydrxymethylbutyrate (HMB), clstrum and thers. Based n current research, nne f these has anything wrthwhile t ffer the athlete. Increasing energy supply Supplements in this categry include pyruvate and ribse as well as sme mre extic herbal preparatins. Nne f these prducts is likely t imprve perfrmance and, in spite f advertising claims, nne is supprted by gd independent evidence. One exceptin t this rule may be carnitine. There is nw limited evidence that carnitine can affect exercise metablism in sme circumstances, but the evidence fr perfrmance effects is nt yet cnvincing.

athletes medical infrmatin Nutritin and the immune system There is sme evidence that athletes wh are training hard may be at increased risk f minr illnesses and infectins. In themselves, these are generally trivial, but they can interrupt training r cause an athlete t miss imprtant cmpetitins. Hard training may cmprmise the bdy s immune system, and high levels f stress hrmnes reduce its ability t fight these infectins. Many nutritin supplements, including glutamine, zinc, echinacea, clstrum and thers, claim that they can bst the immune system, but there is n strng evidence that any f these prducts are effective. The best strategies t supprt a healthy immune system include scheduling apprpriate rest perids, and matching energy and carbhydrate intake t fuel needs. There is gd evidence that carbhydrate intake during prlnged exercise reduces the release f stress hrmnes. There is als evidence that prbitics, such as the lactbacillus fund in yghurts, may als assist gut health and the immune system. Supplements fr bne and jint health Hard exercise training puts extra wear and tear n the bnes, jints and assciated structures, and numerus supplements are claimed t prtect and repair these tissues. Healthy bnes need a gd supply f calcium, magnesium, phsphrus, Vitamins D and C and prtein. In mst cases these nutrients can be supplied by a well-chsen diet and apprpriate sunshine expsure. Athletes wh suffer frm prblems related t sub-ptimal bne density shuld seek prfessinal advice and supervised treatment frm a sprts physician. Glucsamine, chndritin, methylsulphnylmethane (MSM) and ther prducts are prmted fr jint health. There is sme evidence that lng-term (2-6 mnths) glucsamine treatment can prvide subjective relief in elderly individuals suffering frm stearthritis, but evidence is lacking fr a benefits such as a jint prtective effect frm high-intensity training in healthy athletes. Supplements that might wrk Sme supplements d ffer the prspect f imprved perfrmance fr sme athletes in specific events. These supplements include creatine, caffeine, bicarbnate, β-alanine and perhaps a very few thers.

athletes medical infrmatin Creatine. Creatine supplements can increase the amunt f high energy phsphcreatine stred in the muscles, and may imprve perfrmance in single r multiple sprints. Supplementatin may als lead t gains in strength and/r muscle mass, which is helpful fr sme athletes but the extra weight may be harmful fr thers. As with all supplements, exceeding the maximum effective dse is nt helpful. Creatine is nrmally fund in meat and fish, but the effective dses (10-20 g per day fr 4-5 days t lad, and then 2-3 g per day fr maintenance) are mre than is fund in nrmal fds. Creatine supplementatin des nt appear t be harmful t health. Caffeine. A small amunt f caffeine (1-3 mg/kg) can help perfrmance in prlnged exercise and may als be helpful in exercise f shrter duratin. Such mderate dses can be fund in everyday amunts f cffee, cla drinks and sme sprts prducts (e.g. gels). Fr example, 100 mg f caffeine is supplied by a small cup f brewed cffee r 750 ml f a cla drink. Larger dses f caffeine d nt seem t be mre effective, and may have negative utcmes such as anxiety, gastrintestinal distress, ver-arusal and pr sleep patterns. This is likely t be a prblem in multi-day events and in sprts invlving heats and finals. Energy Drinks. These sugary caffeinated drinks shuld nt be cnfused with sprt drinks that are designed t rehydrate the bdy during exercise. In fact, energy drinks are a pr chice t cnsume when exercising (especially in the heat) due t high sugar cntent that can impair fluid absrptin. While energy drinks may seem refreshing and hydrating, they shuld nt be cnsumed befre, during, r after exercise when yu need t replace sweat lss. These drinks may als be ptentially dangerus if used in excess r in cmbinatin with ther stimulants r alchl. Lastly, energy drinks may be tainted with prhibited substances, such as thse derived frm unregulated herbals. Mst drinks are nt tested fr purity r cntaminatin, and culd lead t a psitive dping test. Buffering agents. During very hard exercise, the muscles prduce lactate and hydrgen ins (acidity). This is bth gd (giving energy t allw hard effrts) and bad (causing pain and interfering with muscle functin). In the same way that excess stmach acidity can be neutralised by taking bicarbnate, s can taking sdium bicarbnate in a dse f abut 0.3 g per kg bdy mass befre an event prvide the bld with extra capacity t buffer the acidity prduced by the muscle. This can reduce the fatigue and perfrmance decline seen in all-ut events lasting frm abut 30 secnds t 8 minutes, and perhaps in team games in which there are repeated effrts f this nature.

athletes medical infrmatin There is a risk f gastrintestinal prblems, and athletes shuld experiment in training. Sdium citrate is anther buffering agent, but appears less effective. Mre recently, chrnic intake f β-alanine supplement ver 4-10 weeks has been shwn t increase muscle levels f carnsine, an imprtant buffer. There is sme evidence that this might imprve perfrmance in sme high intensity exercise mdels, but further wrk is required t be sure f the range f situatins in which it might be useful. In sme events there may be benefits frm cmbining β-alanine supplementatin (internal muscle buffer) and bicarbnate lading (external buffer in the bld) t maximise buffering ptential. Nitrate. Shrt-term supplementatin with nitrate may reduce the amunt f xygen required t d a set amunt f wrk. This increased efficiency might imprve perfrmance in events lasting a few minutes r lnger. Many vegetables, including beets, are high in nitrate; thus, beetrt juice has becme a ppular supplement with athletes. Mre research is needed t cnfirm the efficacy f beetrt juice/nitrate supplementatin n perfrmance and t determine the range f events in which it might be useful. Althugh increasing nitrate intake thrugh vegetable cnsumptin is nt harmful, the safety f using nitrate pwders is yet t be studied. Supplements and dping Athletes wh are liable fr drug testing under natinal r internatinal prgrams shuld be especially cautius abut supplement use. Sme supplements are prepared in unhygienic cnditins and cntain txins that may cause gastrintestinal prblems. Others d nt cntain sme r all f the ingredients - especially the expensive nes that are listed n the label. Cntaminatin f dietary supplements with substances that may cause an athlete t fail a dping test is widespread sme surveys have suggested that as many as ne in fur supplements may result in a psitive test. These prhibited cmpunds have nt been declared n the label, s there is n way fr the athlete t knw that they are present. Purchases thrugh the internet pse an even greater risk, and extreme cautin shuld be taken. A sprts nutritin expert shuld be cnsulted befre taking any supplements. At present, there can be n guarantee f the purity f any cmmercial supplement. The nly way t be sure is t avid supplements altgether, but many athletes are unwilling t accept this advice. The sensible athlete will want t see very gd reasns fr using a supplement and a very lw risk f an adverse test befre deciding t use it.

athletes medical infrmatin Many herbal supplements claim t increase teststerne levels and hence have an anablic actin. These supplements include the fllwing: Tribulis Terrestris; Chrysin; Indle-3- Carbinl; Saw Palmett; Gamma-ryzanl; Yhimbine; Smilax; Mummi. These claims are based n studies in test tubes and nne have been shwn t wrk in humans. Athletes are cautined against the use f these supplements. Athletes must be aware f the strict liability principle that makes them respnsible fr everything they eat and drink. Ignrance is nt an acceptable excuse fr a psitive dping result. Check all supplements with a medical fficer r qualified sprts nutritin prfessinal. If there is any dubt at all, dn t take it. Issues t cnsider when deciding t use a sprts fd r supplement l Is it safe? l Is it legal? l Is there evidence that it wrks at the dse recmmended? l Am I aware f the crrect prtcls f hw and when t take it? l Can I affrd it?

athletes medical infrmatin Nutritin needs fr special ppulatins The yung athlete Every child and adlescent arund the wrld shuld have the pprtunity t participate in sprt and shuld be encuraged t d s. Sprt ffers the benefits f aerbic fitness, skill develpment, and experience wrking in a team envirnment. Girls and bys can start practising and cmpeting at an early age, thugh the fcus shuld be n fun and skills develpment rather than perfrmance. Nnetheless, mst children are naturally cmpetitive and it wuld be a mistake t suppress this instinct. Thse with particular talent may prgress t serius training and cmpetitin, but thers cntinue fr reasns f recreatin, fitness r scial cntact. Training issues Depending n the age and calibre f the yung athlete, training may range frm the weekly schl PE lessn t structured sessins at a lcal club. The gals f training may range frm simply having fun t a prgressive prgram aimed at develping the skills and specific fitness and physique required t prgress t serius cmpetitin. Talented yung athletes may be invited t train with anther age grup r with a senir squad, ften in additin t their invlvement with their age-grup team. Cmpetitin issues Fr the yungest age grups, there shuld be n special need fr any change t diet in the days befre cmpetitin r n cmpetitin day itself. The main dietary aims are t minimise the risk f gastrintestinal upset and t avid prblems f dehydratin n ht days. It may be best t avid slid fd fr 2-3 hurs befre cmpetitin the cmbinatin f exercise and nerves can cause sme gastric distress. Children can ften be ut in the sun fr many hurs n sprts days, and adults shuld be vigilant t ensure frequent applicatin f sun cream and be aware f any child wh seems t be having prblems. Ample fluid shuld be available, and children may need t be reminded t take small amunts f drinks at regular intervals. Special issues and eating strategies: Parents are ften asked t serve as caches and trainers f age-grup teams. They may accept these psitins withut an appreciatin r knwledge f the nutritinal needs f the sprt r yung peple, and withut any resurces t implement an effective training and diet prgram. It is imprtant that educatin resurces are made available t these caches s that they can guide yung athletes int gd habits.

athletes medical infrmatin Athletes shuld be encuraged t develp gd nutritinal habits at an early age. Adlescence is a time marked by an increased independence, and this extends t greater freedm f fd chice and respnsibility fr fd preparatin. The prmise f sprting success may prvide strng mtivatin t develp gd dietary practices. Infrmatin and the example f gd rle mdels may help a yung persn t develp sund eating practices in everyday (training) diets as well as the specific preparatin fr cmpetitin. The physilgy f children and adlescents differs frm that f adults in several ways. The mechanisms f thermregulatin are less effective in children, and special attentin must be paid t the envirnment, activity patterns, clthing and hydratin t avid prblems f hyperthermia r hypthermia. The grwth spurts during childhd and adlescents require nutritinal supprt including adequate intake f energy, prtein and vitamins and minerals. Active yung peple may find it difficult t meet their needs fr energy and nutrients when the csts f training and grwth are added. Yung peple may nt have develped the nutritinal knwledge and time management skills t fit in all the eating ccasins required t achieve high energy, nutrient-rich eating. Althugh the rate f besity in children is still rising, active yungsters and yung athletes still need a plentiful supply f energy frm fds, including nutritius snacks between meals and energy-cntaining drinks. A snack befre and after schl r afternn activities will be valuable in prviding extra fuel fr the sessin as well as an energy bst during the lng perid between lunch and dinner. Yung athletes have been shwn t drink mre f a flavured drink than water during activity, which may be an imprtant cnsideratin fr prmting fluid intake, especially if exercise is in the heat. They may als be invlved in sprts in which there are benefits t cnsuming carbhydrate during exercise t supply an additinal surce f muscle fuel. Therefre, there may be legitimate benefits t making sprt drinks available t yung athletes during exercise. After exercise, recvery is prmting by speedy intake f prtein, carbhydrate and fluids. Snacks cnsumed befre and after the wrkut may need t be eaten in the car r while travelling between activities. Hwever, there are many prtable nutrient-rich chices that can be cnsumed n the run including sandwiches, cereal and milk, flavured milk drinks, yghurt and ther dairy fds, fruit and dried fruit/nut mixes. It is nt always pssible t find apprpriate chices at sprting venues, s it is wise t plan ahead. Many children and adlescents are nt aware f their hunger until they becme fatigued r suddenly ravenus s it is gd t educate them abut being rganised and preparing ahead f time.

athletes medical infrmatin Many yung athletes are eager t increase the rate f their grwth and muscular develpment in pursuit f the physique f an adult. While grwth and maturatin are genetically determined, high-energy eating plans can assist the yung athlete t maximise the utcmes f grwth and specialised training prgrams. Yung athletes eating a wide range f fds shuld nt need t use dietary supplements, including the use f energy drinks that cntain high amunts f caffeine and are nt suitable fr yung athletes. Athletes and caches shuld be aware that supplements d nt prvide a shrt cut t success. Ways t encurage gd nutritin practices in children Encurage children t becme invlved in menu planning fr the family meals, and fr special needs assciated with their training and cmpetitin sessins. Encurage psitive messages that gd eating practices, invlving gd chices f fds and drinks, are part f the frmula fr sprting success, and a healthy life. Plan ahead t have nutrient-rich snacks t meet energy needs ver the day, and the special needs f fuelling up fr sprt r recvering after the sessin. Sme preparatin is needed t have these chices n hand thrughut the day, and befre r after sprt. The female athlete As well as the specific nutritinal needs f their sprt, female athletes face sme additinal dietary needs and challenges t their male cunterparts: l Having additinal requirements fr sme nutrients (e.g. irn). l Having lwer energy requirements due t lw bdy mass and muscle mass, and perhaps a lighter training lad. l Facing pressure t achieve lwer levels f bdy fat than seems natural r healthy fr their bdy. l Greater risk f succumbing t stress related t bdy image and fd. Infrmatin related t gd practice in these areas is fund in ther sectins f this bklet. Hwever, it is wrth nting here that there is enrmus pressure n many female athletes t achieve an unrealistic bdy mass and bdy fat level. This can cmprmise bth shrt-term athletic perfrmance and lng-term health, with the real pssibility f harm t reprductive and bne health. Any athlete with menstrual irregularities shuld treat this as a pssible warning sign, and seek prfessinal advice. Female athletes, and indeed any athlete wh develps stress related t eating and their physique, shuld seek expert help at an early stage.

Eating while travelling athletes medical infrmatin Mst elite athletes are well-seasned travellers, seeking cmpetitin r specialised training envirnments far away frm hme. In many team sprts, high-level cmpetitin is rganised in a natinal r reginal league that requires weekly r biweekly travel t matches. Frequent travel can pse a number f challenges, sme f which are listed belw: l Disruptins t the nrmal training rutine and lifestyle while en rute. l Changes in climate and envirnment that create different nutritinal needs. l Jet lag l Changes t fd availability, including absence f imprtant and familiar fds. l Reliance n htels, restaurants and takeaways instead f hme cking. l Expsure t new fds and eating cultures. l Temptatins f an all yu can eat dining hall in an Athletes Village. l Risk f gastrintestinal illnesses due t expsure t fd and water with pr hygiene standards. l Excitement and distractin f a new envirnment. l Changes in digestin and/r pattern f bwel mvements due t travel. The keys t eating well while travelling are prvided belw: 1. Planning ahead Investigate fd patterns and availability at yur destinatin befre yu leave hme. Cmpetitin rganisers and athletes wh have undertaken this event n previus ccasins may be able t supply useful infrmatin n what t expect. This may help yu t plan useful fd supplies t take n yur travels that can replace missing and imprtant items. Cntact the catering rganisers at yur destinatin t let them knw f yur special dietary needs and yur needs fr meal timing and menus. Make an eating plan fr travel that incrprates the best f the available fd supplies (e.g. airline catering, restaurants en rute) as well as self-supplied snacks. 2. Eat and drink well while n the mve Recgnise that enfrced rest while travelling will reduce energy needs, but create mre pprtunities fr excessive energy intake if yu succumb t bredm eating. Be aware f eating t real need. When mving t a new time zne, adpt eating patterns that suit yur destinatin as sn as the trip starts. This will help t adapt yur bdy clck. Be aware f unseen fluid lsses in air cnditined vehicles and pressurised plane cabins. Have a drink plan that keeps yu well hydrated.

athletes medical infrmatin 3. Be wary f fd and water hygiene Find ut whether it is safe t drink the lcal water supply. If risky, stick t sealed bttles f water and ther drinks r ht drinks. Be wary f ice added t drinks it is ften made frm tap water. In high-risk envirnments stick t fd prduced in gd htels r well-knwn restaurants. Avid eating fd frm lcal stalls and markets, hwever tempting it is t have an authentic cultural experience. Stick t fd that has been well-cked, and avid salads r unpeeled fruit that has been in cntact with lcal water r sil. 4. Chse well frm lcal cuisine and supplement with nn-perishable fd supplies brught frm hme. It is ften a gd idea t bring sme snacks and favurite fds with yu, especially if yu are away frm hme fr a lng time and yur favurites are nt available at yur destinatin. Remember, thugh, that many cuntries prhibit the imprt f fresh fds: check ahead t see what is permitted s yu can avid having prhibited items cnfiscated at the airprt. D nt take the risk f trying t smuggle fd yu may be refused entry. Ideas fr prtable fds fr the travelling athlete: l Breakfast cereal l Pwdered milk l Cereal bars and granla bars l Rice cakes, crackers, pretzels l Spreads hney, jam, peanut butter l Prtin packs f canned fruit l Tinned r vacuum packed tuna, baked beans l Pwdered sprts drinks, liquid meal supplements, whey prtein pwder l Meal replacement bars and sprts bars l Dried fruit and nuts 5. Use clever tactics in restaurants and when chsing takeaways Stick t an eating plan based n what yu nrmally eaten at hme r yur new nutritinal needs, rather than being mesmerised by all the fd being ffered. Where pssible, rganise menus and meal times with restaurants ahead f time, especially when dining with a large grup. It is useful t be able t arrive at the restaurant with the meal all ready t be served. Where pssible, cnsider the advantages f buffet style meal service. It is usually mre cst-effective and ffers mre flexibility in allwing athletes t chse their individual needs and likes.

athletes medical infrmatin Be assertive in asking fr fds t be prepared t yur needs fr example, with lw fat cking methds, r with an added carbhydrate serving. Avid hanging arund in restaurants r dining halls fr entertainment it can ften lead t unplanned and unnecessary eating. Remember that yur nrmal eating patterns prbably invlve well-timed and well-chsen snacks. If yur new catering arrangements prvide nly fr main meals, ensure that the menu at meals includes sme items that can be taken away fr snack needs. Special tips fr eating in an Athlete Dining Hall are prvided in the next sectin.

athletes medical infrmatin Eating in an Olympic Village Dining Hall Imagine being able t eat in a self-serve restaurant that is pen 24/7, has an almst unlimited menu frm Internatinal cuisines, input frm sme f the best caterers and sprts nutritin experts in the wrld, and is free! Hw culd yu g wrng? Unfrtunately, althugh the Olympic Village Dining Hall prvides a benchmark in catering fr athletes and is a memrable experience fr many Olympians, sme f thse memries may be f lst pprtunities and pr nutritin utcmes rather than the ppsite. Sme athletes fail t achieve the ptential f the dining experience and adpt pr nutritin practices at a critical time in their sprting careers. The fault is nt the Dining Hall itself, but the failure f sme athletes t recgnise and respnd t the challenges f this new eating envirnment. A sudden switch t cmmunal cafeteria-style eating creates the fllwing issues that may be new t many athletes: Great quantities and many different chices f fd. Many athletes are nt used t unlimited access t s many wnderful fds. The temptatins and pprtunities t vereat can be s verwhelming that they becme the majr reasn fr weight gain. Different and unusual fds. Althugh the menu includes cuisine frm arund the wrld, inevitably sme athletes find themselves withut access t their favurite fds r imprtant menu items in their usual cmpetitin repertire. Athletes may be reluctant t try new things, finding themselves unable t eat enugh fd r their special nutritinal requirements fr cmpetitin preparatin and recvery. Fd bredm. Many athletes live in the Olympic Village fr 3-4 weeks. Althugh this is an exciting perid, fr the athlete wh is training thrugh t cmpetitin n the last days f the Games, the daily rutine can lse its nvelty surprisingly quickly. Even thugh mre chice is ffered than mst peple ever see in their nrmal lives, the sameness f the envirnment and f repetitive eating habits can becme bring. It desn t help if the athlete has develped the practice f piling a bit f everything n their plates at each meal s that there is n new theme r change f menu. Strangely enugh, sme athletes wh are surrunded by fantastic fd can becme disinterested in eating and find meal times a chre. Lack f knwledge f the nutritinal characteristics f Dining Hall chices. Many athletes dn t read English r have a huge knwledge f fd frm utside their regin. They may find it hard t understand what is being ffered in the Dining Hall r hw t make gd chices. Lack f understanding f hw t meet special fd needs. Athletes with fd intlerances and allergies may nt be cnfident f finding fds that meet their dietary restrictins. Lack f supervisin. Fr sme athletes, the Olympic experience may be their first experience away frm the guidance f their parents r

athletes medical infrmatin cach. It can be easy t becme distracted. Sme studies shw that ur fd intake increases as we increase the size f the cmpany sharing ur mealtimes. Surrunded by the eating habits f ther athletes, it may be difficult t cncentrate n yur wn nutritinal gals. Scial eating. An athlete may nt have much time r scpe fr leisure activities during the last busy perids f cmpetitin preparatin. Alternatively, their cmpetitin taper and time away frm their usual wrld f training, study, medical appintments and acrss twn travel may suddenly create a lt f free time in the day. In any case, the Dining Hall becmes a meeting place and entertainment hub where scial eating r eating fr enjyment rather than real needs can sabtage the athlete s eating plan. Many f these issues are faced by athletes wh live in University drms r Specialised Training facilities with cafeteria style eating. With sme insight int the new envirnment and fd challenges, sund eating practices can be achieved. Tips fr eating well in cmmunal cafeteria style Dining Halls: Be clear abut yur eating gals and hw these change during different phases f training and cmpetitin. Be fcussed n what yu need t eat rather than what ther athletes are eating. On yur first visits t the Dining Hall, learn the layut including the different fd statins and what they have t ffer. Wrk n the philsphy that there is plenty f time t gradually wrk yur way arund the menu ptins, rather than having t try it all at nce. This reduces bth the risk f vereating and f develping fd bredm. If the menu is available, yu can plan ahead t make the mst f what is n ffer. Within a single meal, survey sme ptins befre making a cnsidered chice. Learn t understand the menu cards and nutritinal labels ffered. Many fds will have symbls t let yu knw abut the nutritinal characteristics f a fd, r the presence r absence f ingredients that yu need t avid. If yu have dubts, seek advice frm Dining Hall staff, particularly the designated nutritin experts r persnnel in a Nutritin kisk. It is likely that yur special nutritinal needs are available r can be arranged, if they are nt immediately bvius. Find ways t keep yurself busy and entertained, especially during the taper befre cmpetitin when yur energy needs are reduced, r when yu are nervus and mre vulnerable t temptatin. Dn t g t the Dining Hall unless it is time fr a meal r snack, and mve t a new venue t hang ut nce yu have finished eating. Allw yurself t have sme treats r special fds, especially after yur event is finished. Hwever, keep perspective n the imprtance f eating well fr yur event.

athletes medical infrmatin Envirnmental challenges Athletes train in every cuntry f the wrld, and they may face a number f different envirnmental challenges. The athlete wh trains utdrs in winter in Russia r the American mid-west is cnfrnted with wind, snw and bitter cld, while the Saudi Arabian athlete wh trains in mid-summer may face temperatures f 50 C and high humidity. In every case, hwever, athletes learn t cpe and it is ften a matter f pride never t miss a sessin because f adverse weather cnditins. Athletes are smetimes required t cmpete in envirnments that are very different frm thse they are accustmed t at hme, and this can pse special challenges. Every challenge, thugh, shuld be seen as an pprtunity, and nutritinal strategies can be adpted t help athletes cpe with envirnmental extremes. Lndn enjys a temperate climate and there are unlikely t be any extreme cnditins at the 2012 Games. Weather recrds shw that the daily temperature high in July and August is likely t be between 21 and 24 C with mderate humidity, falling t 10-12 C at night. The temperature, hwever, may reach 35 C, which is enugh t affect perfrmance and requires sme attentin frm all cmpetitrs. Weather frecasts may be unreliable, and the weather can change very quickly, s yu shuld be prepared fr all eventualities. Special issues fr exercise in ht climates Mst athletes enjy pprtunities fr warmweather training and cmpetitins, but these can be challenging fr all athletes, especially endurance and team sprts athletes. Thse wh nrmally live in cld climates will benefit frm a perid f heat acclimatin befre cmpeting in majr events held in a ht climate. It is als essential fr these athletes t gain heat experience s that they knw hw t adapt training and cmpetitin strategies, as well as drinking behaviurs and lifestyle factrs when they are suddenly expsed t ht weather. Heat acclimatin is achieved best by undertaking a series f exercise sessins in a warm envirnment. Undertaking 10-12 wrkuts f abut 60-100 minutes f mdest exercise at intervals f nt mre than 2-3 days will achieve this. Athletes nt used t ht weather must be aware f the need t make sme changes t their rutine. Sme suggestins are prvided belw: It may be necessary t mdify the warm-up and reduce the amunt f clthing wrn t prevent ver-heating and excess sweat lss befre the event begins. Extra fluids may be necessary. Since cl fluids will be mre palatable, insulated drinks bttles are valuable. There are many strategies invlving ice vests, icy twels r cl baths that can help t cl athletes befre, during r after sessins in ht envirnments. Sme athletes als drink cld and icy fluids t cntribute t these cling strategies. Since it requires mderate-large vlumes f fluid intake t make a difference t bdy temperature, these and all strategies shuld be well practised befre attempting in a cmpetitin setting.

athletes medical infrmatin The athlete shuld cnsider the side-effects r assciated utcmes f all ht weather strategies. Fr example, an increased intake f sprts drinks t meet additinal fluid needs will als increase the athlete s energy intake and affect energy balance. Special issues fr exercise at mderate altitudes Athletes ften undertake a perid f specialised training at mderate altitudes t use the physilgical adaptatins it stimulates t assist with their cmpetitin preparatin. Listed belw are a number f adjustments that may help the athlete cpe with altitude training: Altitude camps are ften a perid f intensified training. The athlete may need t alter their energy intake t allw fr the increased training lad and the additinal stresses f altitude. As well as the additinal muscle fuel csts f the increased training lad, there is an increase in carbhydrate use during exercise at altitude. The athlete shuld be mre aggressive with refuelling strategies during a wrkut, and ver the day. The cld and dry cnditins at mderate altitudes cause an increase in water lsses during breathing. This can lead t a substantial increase in fluid lsses at mderate altitude cmpared with sea level. The athlete shuld take additinal care t check fluid status ver the day and during exercise sessins when they mve t a higher altitude, since habitual drinking patterns may need t be adjusted t keep pace with these lsses. Since a mve t a higher altitude may increase xidative damage during exercise, athletes shuld ensure that their diet is rich in fruits and vegetables t prvide essential antixidants. Gd irn status is needed t maximise erythrpiesis (red bld cell prductin), which is an adaptive respnse t altitude expsure. Therefre athletes shuld cnsume adequate amunts f irn-rich fds. It may be wrth checking irn status befre undertaking altitude training. Special issues fr exercise in pr air quality Athletes ften have t train r cmpete in the plluted envirnments f big cities, and are faced with high levels f fumes, smg and dust. This can pse special challenges fr athletes with respiratry prblems such as asthma, but all athletes and supprt staff may experience minr respiratry prblems in sme envirnments. Air quality in Lndn during the Games shuld be better than in many recent majr Champinship events. It has been suggested that antixidant supplements may help reduce the severity f symptms by neutralizing free radicals prduced in respnse t airbrne pllutants, but the evidence fr this is far frm clear. Nnetheless, it seems sensible t ensure an adequate intake f fresh fruits and vegetables t ensure gd antixidant defences.

athletes medical infrmatin Cultural and reginal issues An infinite variety f different fd cmbinatins can be chsen by athletes t meet their nutritinal gals. All the essential nutrients can be btained in adequate amunts frm nrmal fds. Variety is a key t meeting nutrient needs, but many different fds can be interchanged. Preferred surces f carbhydrate may be bread, rice, pasta, ptat, cuscus, r the maize prridge favured by many Kenyan athletes. Prtein will be prvided by many different fds; the bvius prtein-rich fds are meat, fish, eggs and dairy prduce, but bread, cereals, pasta, lentils and beans als cntribute prtein t the diet. The cmmnly available fruits and vegetables will differ frm regin t regin, althugh many staples r favurites are exprted arund the glbe. Our eating habits are much mre internatinal than they were, and athletes can enjy fds frm different cuntries f the wrld. Ethnic restaurants can be fund in almst every majr city f the wrld and Lndn is especially wellserved with examples f wrld cuisine. A visit t a restaurant that serves familiar fds may be a special treat fr athletes and a chance t escape frm the Village envirnment, but these shuld be checked befrehand. The advice f lcal athletes may be useful in identifying suitable ptins. Cnsideratins fr Vegetarians Many athletes, ften endurance athletes and/r female athletes, adpt a vegetarian lifestyle. This persnal chice can be very healthy, and is in n way incmpatible with success in sprt. Hwever, it des mean, that athletes must be mre aware f the fd chices that they make in rder t maintain energy levels, meet training and recvery needs, and t supprt prper immune functin. Plant-based, high fibre diets are bulky t cnsume and may cause an inadvertent reductin in ttal energy intake. This may increase the risk f inadequate energy availability and athletes shuld mnitr bdy mass and bdy cmpsitin t ensure energy needs are being met. Sme athletes may use vegetarianism as a means t restrict energy intake in rder t achieve a desired physique: this seems t be mre cmmn in female athletes but affects men t. All athletes shuld seek help frm a trusted health prfessinal if they feel ut f cntrl with calrie restrictin and/r trying t achieve excessive leanness. Severe calrie restrictin may cmprmise perfrmance as well as reprductive health and bne health. Althugh mst vegetarians meet r exceed their prtein requirements, hwever, plant prtein quality and digestin is decreased and ften requires an intake f apprximately 10% mre prtein than if cnsuming animal prteins. Therefre, prtein recmmendatins fr vegetarian athletes are apprximately 1.3-1.8 g/kg/day frm a variety f plant prtein surces. This fact may be f mre cncern fr vegans - thse wh avid all animal prteins, including fish, eggs and milk prducts.

athletes medical infrmatin It is still imprtant t find a surce f high quality prtein t cnsume in the recvery frm key wrkuts and events. Dairy r sy milk prducts may be suitable chices fr vegetarians and vegans, respectively. If there are n animal fds in the diet, then a vitamin B12 supplement may be necessary. Sme vegan fd prducts, such as meat substitutes are B12 frtified s it is imprtant if yu adpt a vegan lifestyle t learn t read fd labels. Aviding red meat means that special attentin must be paid t ensuring that the diet cntains enugh irn, especially during perids f rapid grwth (e.g., adlescence), fr wmen because f lsses during menstruatin, and befre ging t altitude fr training r cmpetitin. Irn intake frm plant surces, shuld be cmbined with ther fds that aid irn absrptin: fr example, irn-frtified breakfast cereals, cnsumed at a meal cntaining vitamin C (a glass f range juice). Fasting fr Ramadan There may be special circumstances that cause athletes t change their nrmal training and dietary habits. Many Muslims avid fd and fluid intake during daylight hurs during the hly mnth f Ramadan. This can mean changes t training times, especially in very ht weather, t ensure that adequate hydratin is maintained. Where athletes must cmpete during Ramadan, they shuld be aware f strategies that allw their fd and fluid intake frm nightfall t dawn t maximise recvery after sessins and preparatin fr the next day. During phases f training, it may be pssible t mve the time f wrkuts t better cincide with their pprtunities t cnsume fds and drinks. Perfrmance will nt necessarily suffer if the athlete is well prepared, and it is recmmended that the athlete receive specialised advice frm training and nutritin experts befre deciding hw t apprach their sprting cmmitments during Ramadan. Dairy prduce shuld be included in the diet t ensure an adequate calcium intake, but many calcium-frtified fds are als available. Vegetarian athletes may als be at risk fr lw intakes f fat (essential fatty acids are especially imprtant), ribflavin, vitamin D, and zinc which shuld be mnitred and supplemented in the diet if necessary.

athletes medical infrmatin Nutritin fr strength sprts Examples: Olympic weightlifting, pwerlifting, thrwing events, 100-200 m sprints, bdy building. Features and Challenges l Peridised training invlves resistance wrkuts, plus sprt-specific wrkuts such as plymetrics, lifting, thrwing. l Gals are enhance pwer and strength, and in the case f bdy builders, t increase muscle hypertrphy (size). l Main nutritin gals related t resistance training are: Fuelling training sessins Recvering frm training sessins Maximising adaptatins including an increase in muscle mass l There is a culture f interest in high prtein intakes l There is a culture f interest in supplements l In case f bdybuilders, there is a culture f extreme diets t cut up fr cmpetitin l In case f lifters, there is a culture f making weight fr cmpetitin weight divisins l Cmpetitive events ften invlve multiple thrws r lifts, r runds (e.g. heats and finals) Tp 10 eating strategies fr strength sprts: l Cnsume a diet high in energy t supprt levels f high lean mass l Cnsume adequate carbhydrate t fuel resistance training since this is glycgen-using l Cnsume adequate but nt excessive amunts f prtein since these fds are expensive and may displace carbhydrate needs l Cnsume a surce f high quality prtein (20-25 g) sn after resistance wrkuts l Spread prtein intake ver the day l Select lw fat prtein ptins t avid unnecessarily high intakes f saturated fat. l Avid extreme dieting behaviur prir t bdy building cmpetitin rather, achieve lss f bdy fat by safe and lnger-term methds l Avid extreme weight lss behaviur prir t weight lifting cmpetitin. Chse a suitable weight class and allw adequate time if weight lss is required t achieve this target. Small amunts f weight lss in the days befre cmpetitin may be safely achieved l Fr athletes participating in thrwing and sprinting events, chse a pre-event meal that keeps yu cmfrtable thrughut the cmpetitin. If there are runds in yur event r time between thrws, make sure yu have access t fluids and fds t keep yu apprpriately fuelled and hydrated. l Seek the advice f a sprts nutritin expert if yu are unable t meet yur gals easily r want specialised advice n supplement use.

Nutritin fr pwer sprts athletes medical infrmatin Examples: Middle distance running, track cycling, rwing, caneing/kayaking and swimming. Features and Challenges l Success is defined by the ability t prduce very high pwer utputs fr races ranging 1-10 minutes l The cntinuum f fuel systems need t be well develped, requiring a highly peridised training prgram l Nutritin gals change substantially with the different phases f training: General preparatin: high training vlume training, manipulatin f bdy cmpsitin Specific preparatin: high intensity training, ften with specialised perids such as altitude training Taper/cmpetitin: lwer vlume/high intensity; race fcus, avidance f weight gain Transitin: light training, small weight gain usual l Gals during training include achieving ideal physique, usually invlving lw bdy fat levels, and in sme sprts, muscularity. Cmpetitin physique may nly be maintained fr a shrt perid. Sme lss f physique during ff-perids f the year but athletes shuld try t minimise this l Perfrmance f a race may be limited by build-up f acidity as a by prduct f sustained high-intensity wrk l Cmpetitive events ften invlve multiple runds (heats, semis, finals etc) Tp 10 eating strategies fr pwer sprts: l Vary energy intake between training phases accrding t the training lad. l Cnsume mderate-high levels f carbhydrate accrding t the fuel needs f the training phase l Cnsume fluids and carbhydrate during prlnged training sessins t supprt hydratin and fuel needs l Cnsume a surce f high quality prtein (20-25 g) and carbhydrate sn after key wrkuts t prmte refuelling and adaptatin l Achieve cmpetitin physique gals gradually with majr effrt during base phase and fine tuning just prir t racing seasn l Cnsider the use f supplements carefully. Optins that pwer athletes might use include buffers that are intracellular (β-alanine) and extracellular (bicarbnate) l Chse a suitable pre-event meal that keeps yu cmfrtable during yur event. l If there are heats and finals in yur event, and especially, if yu are cmpeting in mre than ne event in a sessin, make sure yu have access t fluids and fds t recver between races l Lk after special needs fr specialised training phases such as altitude training. This may alter energy and fuel needs, fluid lsses and irn requirements l Seek the advice f a sprts nutritin expert if yu are unable t meet yur gals easily r want specialised advice n supplement use

athletes medical infrmatin Nutritin fr endurance sprts Examples: Marathn, triathln and rad cycling. Features and Challenges l Success is defined by the ability t sustain perfrmance ver prlnged perids l Nutritin gals change accrding t phase f training General preparatin: high training vlume training, manipulatin f bdy cmpsitin Specific preparatin: high intensity training, ften with specialised perids such as altitude training Taper/cmpetitin: lwer vlume/high intensity; race fcus, avidance f weight gain Transitin: light training, small weight gain usual l Gals during training include achieving ideal physique, usually invlving lw bdy fat levels, and in sme sprts, muscularity. Cmpetitin physique may nly be maintained fr a shrt perid. Sme lss f physique during ff-perids f the year but athletes shuld try t minimise this l Athletes are ften at risk f develping issues with eating and bdy image l Fatigue r decline in perfrmance during a race may be caused by dehydratin, fuel depletin, gastrintestinal discmfrt and ther factrs l Opprtunities fr fluid and fuel intake during a race vary accrding t the sprt, but usually require the athlete t eat r drink n the mve. Supplies may be prvided at feed znes r frm team supprt crews r may need t be carried by the athlete. l Cmpetitin phases differ accrding t sprts frm marathn racing where athlete may undertake 1-2 majr cmpetitins per year t rad cycling where prfessinal cyclist may cmpete n 100 days f year Tp 10 Eating strategies l Vary energy intake between training phases accrding t the training lad. Maintain adequate energy availability l Cnsume mderate-high levels f carbhydrate accrding t the fuel needs f the training phase l Cnsume fluids and carbhydrate during prlnged training sessins t supprt hydratin and fuel needs l Cnsume nutrients after training sessins t target elements f recvery this includes fluids and electrlytes fr rehydratin, carbhydrate fr refuelling and a surce f high quality prtein (20-25 g) t prmte muscle adaptatin l Set safe and achieve physique gals fr training gradually, with majr effrt during base phase and fine tuning just prir t racing seasn l Prepare fr cmpetitin with carbhydrate fuelling techniques suited t the fuel needs f the event. Fr events lasting lnger than 90 minutes, cnsider carbhydrate lading ver the 2-3 days prir t the race.

l Chse a pre-race meal that prmtes additinal fuelling but leaves the gut feeling light and cmfrtable fr the race l Develp a plan f eating and drinking during the race t maintain adequate hydratin and additinal carbhydrate depending n the fuel needs f the event. Carbhydrate gals may range frm small frequent tastes during brief events (45-75 min) t aggressive intakes f up t 80-90 g/h in ultraendurance races (> 2.5 h). Practise the plan in training t perfect it. l Cnsider the use f sprts fds and supplements carefully: ptins include caffeine, sprts gels/bars/drinks. l Lk after special needs fr specialised training phases such as altitude training. This may alter energy and fuel needs, fluid lsses and irn requirements l Seek the advice f a sprts nutritin expert if yu are unable t meet yur gals easily r want specialised advice n supplement use athletes medical infrmatin

athletes medical infrmatin Nutritin fr aesthetic and weight class sprts Examples: figure skating, gymnastics, diving, cmbative sprts, lightweight rwing. Features and Challenges l Success in the aesthetic sprts may be defined at least partially by the athlete s appearance and a subjective judgement f hw it cnfrms t ideal in that sprt l Physical skills may be assisted by a small and light physique that makes it easy t mve in a small space l Athletes in sme sprts are classified in weight divisin t prmte cmpetitin between peple f similar size and strength. In these sprts, there is a culture f making weight fr cmpetitin weight divisins l Training lads vary accrding t the sprt but and may range frm high vlume/intensity (lightweight rwing) t lengthy but mderate in energy expenditure (e.g. gymnastics) l The emphasis n lw bdy mass and lw bdy fat levels creates an increased risk f issues with eating and bdy image Tp 10 Eating strategies l Maintain adequate energy availability fr yur training and cmpetitin energy expenditure. Factr in needs fr grwth l Cnsume mderate-high levels f carbhydrate accrding t the fuel needs f the training phase l Chse weight and bdy fat gals that are achievable and supprt lng-term health and perfrmance l Chse nutrient dense fds, and a gd spread f high quality prtein ver the day s that yu maximise yur ability t meet nutritinal gals l In weight categry sprts, chse a weight divisin that can be achieved safely and within minimal stress l If yu feel yu are develping issues with fd related stress, seek interventin at an early stage l Prepare fr cmpetitin by fine-tuning weight, withut the need fr extreme weight lss measures l If yu have made weight using techniques based n mild dehydratin and reductin in fd intake, use the perid after the weigh in t rehydrate and fuel up fr the event. l Cnsider the use f supplements carefully: there are n magic pills r ptins that prmte lss f bdy fat l Seek the advice f a sprts nutritin expert if yu are unable t meet yur gals easily r want specialised advice n managing yur weight and physique gals

Ntes athletes medical infrmatin

athletes medical infrmatin Nutritin fr team sprts Examples: ftball cdes, basketball, field hckey, netball. Features and Challenges l Nutritin gals change accrding t phase f highly peridised yearly calendar General preparatin: high training vlume training, manipulatin f bdy cmpsitin Pre-seasn preparatin: Increase in skills and tactical training; practice games Cmpetitin: may invlve a large number f games, with 2-7 days recvery Off-seasn: n scheduled training l Wrk patterns invlve high-intensity intermittent exercise with brief recvery intervals: patterns vary between players and between matches l Success is determined by verlay f skills n these wrk patterns, requiring cncentratin and judgement l A range f desirable physiques exists accrding t sprt and t psitin within a team: may include need fr bulk and muscularity r leanness and lw bdy fat levels l Cmpetitin may be in weekly fixture r in turnament frmat: bth require recvery after match l Fatigue r decline in perfrmance during a match may be caused by dehydratin, fuel depletin, gastrintestinal discmfrt and ther factrs l Opprtunities t cnsume fluids and carbhydrate during a match vary accrding t the rules f the sprt. There may be breaks between perids, substitutins r infrmal breaks in play that allw nutritinal supprt l In many team sprts there is a culture f alchl misuse after matches and during the ff seasn Tp 10 Eating strategies l Peridise energy and carbhydrate intake accrding t the fuel needs f the training/cmpetitin phase l Cnsume fluids and carbhydrate during prlnged training sessins t supprt hydratin and fuel needs l Cnsume nutrients after training sessins r matches t target elements f recvery this includes fluids and electrlytes fr rehydratin, carbhydrate fr refuelling and a surce f high quality prtein (20-25 g) t prmte muscle adaptatin l Set safe and achieve physique gals fr training gradually, with majr effrt during base phase and fine tuning prir t cmpetitin seasn. Avid large lss f cnditining during the ff-seasn l Prepare fr matches with carbhydrate intake suited t the fuel needs f the event. Midfield players and thers with heavy wrklads shuld cnsider mre aggressive carbhydrate intake in the 1-2 days prir t the match. l Chse a pre-match meal accrding t the time f day that prmtes additinal fuelling but leaves the gut feeling cmfrtable

l Develp a plan f eating and drinking during the match accrding t the available pprtunities. Aim t maintain adequate hydratin and additinal carbhydrate depending n the fuel needs f the event. Carbhydrate gals may range frm small frequent tastes during brief matches (45-75 min) t intakes f 30-60 g per hur fr matches f 60-90 min. Practice the plan in training sessins and pre-seasn games t perfect it. l Develp a sensible attitude t alchl intake l Cnsider the use f sprts fds and supplements carefully: ptins include caffeine, sprts gels/bars/drinks. l Seek the advice f a sprts nutritin expert if yu are unable t meet yur gals easily r want specialised advice n managing yur weight and physique gals athletes medical infrmatin

athletes medical infrmatin References Scientific papers presented at the IOC Cnsensus Cnference n Nutritin fr Sprt held at the IOC ffices in Lausanne in Octber 2010 1. Anne B. Lucks, Bente Kiens, Hattie H Wright. Energy availability in athletes. Jurnal f Sprts Sciences, 2011, 29(S1), S7-S15 2. Luise Burke, Jhn A Hawley, Stephen H Wng, Asker E Jeukendrup. Carbhydrates fr training and cmpetitin. Jurnal f Sprts Sciences, 2011, 29(S1), S17-S27 3. Stuart M Phillips, Luc JC van Ln. Dietary prtein fr athletes: frm requirements t ptimum adaptatin. Jurnal f Sprts Sciences, 2011, 29(S1), S29-S38 4. Susan M Shirreffs, Michael N Sawka. Fluid and electrlyte needs fr training, cmpetitin and recvery. Jurnal f Sprts Sciences, 2011, 29(S1), S39-S46 5. Sctt Pwers, W Bradley Nelsn, Enette Larsn-Meyer. Antixidant and Vitamin D supplements fr athletes: sense r nnsense? Jurnal f Sprts Sciences, 2011, 29(S1), S47-S55 7. Gary Slater, Stuart M Phillips. Strength sprts: weightlifting, thrwing events, bdy building, sprints. Jurnal f Sprts Sciences, 2011, 29(S1), S67-S77 8. Trent Stellingwerff, Rnald J Maughan, Luise M Burke. Nutritin fr pwer sprts: middle-distance running, track cycling, rwing, caneing/kayaking, and swimming. Jurnal f Sprts Sciences, 2011, 29(S1), S79-S89 9. Asker E Jeukendrup. Endurance sprts: marathn, triathln, rad cycling. Jurnal f Sprts Sciences, 2011, 29(S1), S91-S99 10. Jrunn Sundgt-Brgen, Ina Garthe. Elite athletes in aesthetic and Olympic weightclass sprts and the challenge f weight and bdy cmpsitin. Jurnal f Sprts Sciences, 2011, 29(S1), S101-S114 11. Francis Hlway, Lawrence L Spriet. Practical strategies fr team sprts. Jurnal f Sprts Sciences, 2011, 29(S1), S115-S125 12. Nanna L Meyer, Melinda Manre, Christine Helle. Winter sprts. Jurnal f Sprts Sciences, 2011, 29(S1), S127-S136 6. Rnald J Maughan, Paul L Greenhaff, Peter Hespel. Dietary supplements fr athletes: emerging trends and recurring themes. Jurnal f Sprts Sciences, 2011, 29(S1), S57-S66

Ntes athletes medical infrmatin

athletes medical infrmatin IOC Cnsensus Statement n Sprts Nutritin 2010 Diet significantly influences athletic perfrmance. All athletes shuld adpt specific nutritinal strategies befre, during and after training and cmpetitin t maximise their mental and physical perfrmance. Evidencebased guidelines n the amunt, cmpsitin, and timing f fd intake have been defined t help athletes perfrm and train mre effectively, with less risk f illness and injury. Athletes will benefit frm the guidance f qualified sprts nutritin prfessinals wh can advise n their individual energy, nutrient and fluid needs and help develp sprt-specific nutritinal strategies fr training, cmpetitin and recvery. Energy demands depend n the peridised training lad and cmpetitin prgram, and will vary frm day t day and acrss the seasn. A diet that prvides adequate energy frm a wide range f cmmnly available fds can meet the carbhydrate, prtein, fat and micrnutrient requirements f training and cmpetitin. An apprpriate diet will help athletes reach an ptimum bdy size and bdy cmpsitin t achieve greater success in their sprt. Careful selectin f nutrient-rich fds t reduce the risk f develping nutrient deficiencies that impair bth health and perfrmance is especially imprtant when energy intake is restricted t reduce bdy and/r fat mass. During high-intensity training, particularly f lng duratin, athletes shuld aim t achieve carbhydrate intakes that meet the needs f their training prgrams and als adequately replace carbhydrate stres during recvery between training sessins and cmpetitins. Dietary prtein shuld be cnsumed in daily amunts greater than thse recmmended fr the general ppulatin, but a varied diet that meets energy needs will generally prvide prtein in excess f requirements. Fds r snacks that cntain high-quality prteins shuld be cnsumed regularly thrughut the day as part f the day s ttal prtein intake, and in particular sn after exercise, in quantities sufficient t maximise the synthesis f prteins, t aid in lng-term maintenance r gain f muscle and bne and in the repair f damaged tissues. Ingestin f fds r drinks prviding 15-25 g f such prtein after each training sessin will maximise the synthesis f prteins that underpins these gals. Fr events lasting an hur r mre, the athlete shuld aim t begin cmpetitin with bdy carbhydrate stres sufficient t meet their needs by cnsuming carbhydrate-rich fds in the hurs and days befrehand. Ingestin f even small amunts f carbhydrate during exercise can enhance cgnitive and physical perfrmance in cmpetitin lasting ne hur. As the duratin f the event increases, s des the amunt f carbhydrate needed t ptimise perfrmance. T achieve the relatively high rates f intake (up t 90 g/h) needed t ptimise perfrmance in events lasting mre than abut 3 hurs, athletes shuld practise cnsuming carbhydrate during training t develp an individual strategy, and shuld make use f sprts fds and drinks cntaining carbhydrate cmbinatins that will maximise

athletes medical infrmatin absrptin frm the gut and minimise gastrintestinal disturbances. Dehydratin, if sufficiently severe, can impair perfrmance in mst events, particularly in warm and highaltitude envirnments. Athletes shuld be well hydrated befre exercise and drink sufficient fluid during exercise t limit dehydratin t less than abut 2% f bdy mass. Chilled fluids may benefit perfrmance in ht cnditins. Athletes shuld nt drink s much that they gain weight during exercise. Sdium shuld be included when sweat lsses are high, especially when exercise lasts mre than abut 2 hurs. During recvery frm exercise, rehydratin shuld include replacement f bth water and salts lst in sweat. When athletes must cmpete in several events in a shrt time-perid, strategies t enhance recvery f fluid and fuel are imprtant. Lw energy availability shuld be avided, as it can impair perfrmance and adaptatin t training and may be harmful t brain, reprductive, metablic and immune functin, and t bne health. Dieting in yung athletes shuld be discuraged. Rbust immunity and reduced risk f infectin can be achieved by cnsuming a varied diet adequate in energy and micrnutrients, ensuring adequate sleep and limiting ther life stress. Athletes shuld be particularly aware f their needs fr calcium, irn and Vitamin D, but the use f large amunts f sme micrnutrients may be harmful. Athletes at risk f disrdered eating patterns and reprductive disrders shuld be prmptly referred t a qualified health prfessinal fr evaluatin and treatment. The use f supplements des nt cmpensate fr pr fd chices and an inadequate diet, but supplements that prvide essential nutrients may be a shrt-term ptin when fd intake r fd chices are restricted due t travel r ther factrs. Vitamin D may be needed in supplemental frm when sun expsure is inadequate. Of the many different dietary erggenic aids available t athletes, a very small number may enhance perfrmance fr sme athletes when used in accrdance with current evidence under the guidance f a well-infrmed prfessinal. Athletes cntemplating the use f supplements and sprts fds shuld cnsider their efficacy, their cst, the risk t health and perfrmance, and the ptential fr a psitive dping test. Supplement use in yung athletes shuld be discuraged, and the fcus shuld be n cnsuming a nutrient-rich, well-chsen diet t allw fr grwth while maintaining a healthy bdy cmpsitin. T enjy all the benefits f sprt, athletes, whether they cmpete at the elite level r exercise n a recreatinal basis, shuld adpt specific nutritin strategies that can ptimise mental and physical perfrmance and supprt gd health. Lausanne, 27 Octber 2010

athletes medical infrmatin Ntes

athletes medical infrmatin