K1N334 F1NAL Flashcards
1
Q
What are the 5 levels of body composition?
A
Level 1: Atomic (H2, Carbon, O2)
Level 2: Molecular (Protein, Lipid, Water)
Level 3: Cellular (Extracellular solids, fluid, cells)
Level 4: Tissue-Organ (Visceral Organs, Bone, Adipose Tissue, Skeletal muscle)
Level 5: Whole Body (Head, trunk, appendages)
2
Q
What is the Obesity Paradox?
A
- Individuals with obesity → survival advantage when only BMI is taken into account
- <10% used a direct measure of body composition
- When muscle mass is taken into account
→ a high BMI has no protective effect in the presence of low muscle mass
3
Q
When should BMI not be used??
A
Should not be used for making clinically important decisions at the individual patient level
4
Q
What are 4 techniques to measure body composition?
A
Bioelectrical Impedance Analysis
Dual-Energy X-Ray Absorptiometry
Ultrasonography
Computed Tomography
5
Q
For body composition changes, what are examples of Physiological Factors and Non-Physiological Factors (1 each)
A
Physiological Factors:
eg, Aging
Non-Physiological Factors:
eg, Illness, Injury
6
Q
What are 7 types of body composition changes?
A
Malnutrition
Acute Illness
Injury
Hospitalization
Inflammation
Sedentary Lifestyle
Chronic Diseases
7
Q
What age do body composition abnormalities typically happen at?
A
Can happen at any age!
8
Q
What are 4 body composition abnormalities that negatively impact health?
A
Osteopenia / Osteoporosis
Obesity
Sarcopenia
Sarcopenic Obesity
9
Q
What 7 things happen if someone has low muscle mass?
A
Physical Impairment/ Disability
Greater Length of Hospital Stay
Need for Rehabilitation
Post-Operative
Complications Toxicity
Shorter Time to Tumor Progression
Poorer QoL
10
Q
How is malnutrition diagnosed?
A
Having 2 or more of:
Insufficient EI
Weight Loss
Loss of Muscle Mass
Loss of Subcutaneous Fat
Fluid Accumulation
↓ Functional Status
11
Q
What does low msucle mass and malnutrition result in?
A
↑ Morbidity
↑ Mortality
↓ QoL
↓ Functionality
↑ Health Care Costs
↑ Rehospitalization Rates
12
Q
What is the Acute effect of endurance exercise?
A
- High intensity exercise (~75% VO2max; 1 hr) depletes liver glycogen 50%.
- Supramax, repetitive work also depletes
- Time to exhaustion directly related to resting glycogen stores
13
Q
What is the Effect of endurance-training?
A
- glycogen-sparing
- improved mitochondrial metabolism enhances lipid oxidation
- larger glycogen stores in skeletal muscle
14
Q
What should the Macronutrient intake (CHO) be?
A
About 12-16 g of CHO per kg of muscle
15
Q
How much can liver glycogen be depleted after an overnight fast?
A
Higher concentration than muscle but lower total amount (~100g) can be depleted to below 20g after an overnight fast
16
Q
What is important to remember about glucose?
A
Glucose is not just for muscle contractions, it’s critical for brain function
17
Q
What is the Glycemic index?
A
Pure glucose is the standard reference (100)
18
Q
What can influence the GI of a food?
A
- the biochemical structure of the carbohydrate
- the absorption process,
- the size of the food particle,
- the co-ingestion of fat, fiber, or protein
19
Q
What is GI affected by?
A
GI affected by biochemical structure of CHO, absorption, co-ingestion of fat/protein/fiber
20
Q
Glycemic load (GL) =
A
GI × g CHO/ 100
21
Q
What foods have a Low GI <55
A
Most fruit and vegetables (except potatoes), whole grains, basmati rice, pasta
22
Q
What foods have Medium GI 56 - 70
A
Sucrose, croissant, some brown rices
23
Q
What foods have High GI >70
A
Corn flakes, baked potato, some white rices (e.g. jasmine), white bread
24
Q
What are the General CHO intake guidelines – ACSM
A
Daily intake 6-10 g/kg of body weight
* Daily (mod duration, low intensity): 5-7 g/kg
* Daily (mod to heavy endurance): 7-12 g/kg
* Daily (extreme, 4-6 hrs): 10-12g+/kg
25
What is the goal of CHO days before competition?
To replenish/maximize muscle glycogen
SUPERCOMPENSATION (CHO loading)
– ↑ time to fatigue by 20%
– ↓ time to complete task 2-3%
– Mostly for activities > 60-90 minutes
26
Any potential issues with classical supercompensation?
* -hypoglycemia when CHO is low
* -may not be not practical (meal prep)
* -GI problems
* -Mood
* -Tenseness without training
27
Why might glycogen stores be different?
* Women tend to have a greater reliance on fat oxidation.
* Carb loading may increase weight – issues?
* If carb loading is not increasing muscle glycogen, where does it go?
28
Carbohydrate loading – Muscle vs. liver glycogen?
Muscle glycogen is often super-compensated before full recovery of liver glycogen (muscle takes precedence)
29
Carbohydrate loading - Fructose (fruits/honey) vs. glucose (pasta)?
Fructose can lead to slower muscle glycogen but similar liver glycogen replenishment.
30
How does it work to take CHO hours before competition?
– Goal: to replenish/maximize liver glycogen and increase glucose delivery to muscle
– 0-4 hrs before exercise:
– Meal 3-4 hour before exercise can increase muscle glycogen.
– 1 hour before liver glycogen can be increased (but likely not muscle)
– 1.0-1.2 g/kg snack 30-60 min before exercise (more controversial but recently accepted)
* Concerns over “reactive hypoglycemia” (which may be less common if consumed closer to exercise (e.g. 15 min) or if warm up is included.
* Consequence of excessive insulin released which continues past eating.
* ~200-300g 3-4h before exercise
* Fructose (slower absorption – requires conversion in liver) may not be as effective
31
What is important while CHO loading before competition?
- Needs to be tailored to the needs of the athlete and competition.
- Always test out in advance of the competition
32
What is the goal for CHO during competition?
* ~ 30-60 g/hr (liquid or solid) benefits high intensity, long duration work (extends time to exhaustion)
– 0.7g/kg/hr
* training state does not improve ability to utilize oral CHO
* Better to provide every 15-20 min than after 2h
* Not high fructose (slower to absorb, more GI symptoms)
* Controversy for events lasting <1hr
* Adding some fructose can help
* Exercise induced elevation in epinephrine depresses the release of insulin!
33
What is the goal of CHO intake after exercise?
To replenish muscle and liver glycogen
* Create positive glycogen repletion environment (increase insulin, increase tissue sensitivity to insulin, reduce catecholamines, increase glycogen synthase)
34
Why carbohydrate load after competition?
* Replenish depleted liver and muscle glycogen stores.
* Glycogen stores is directly related to performance!
35
What affects rate of glycogen synthesis?
* Availability of glucose.
* Insulin.
* Prior exercise – increases insulin sensitivity
36
What should the timing be of CHO intake after exercise?
* Rapid phase of glycogen synthesis (1-2 hours) – glycogen synthase (exercise upregulates this rate-limiting enzyme) and glucose availability
* Slow phase of glycogen synthesis – insulin availability
* Eat immediately after you get the greatest rate of glycogen synthesis.
* Wait 2h – much slower
37
What is the optimal rate of ingestion of CHO intake after exercise?
Optimal rate is ~1.2g/min
38
How does the Type of CHO influence ingestion?
Muscle glycogen synthesis may be up to 50% slower with fructose or low GI meals (initial fructose may be preferentially store in liver as glycogen or is converted to glucose)
39
Why might adding protein help if CHO intake is lower?
AA’s can increase Insulin release!
– BUT CHO is the limiting factor
40
What is important for CHO recovery?
* Total energy intake must match expenditure or glycogen stores deplete
* Time to replenish glycogen stores varies (2-6 days)
* Some studies have been able to show good
supercompensation (attain supranormal muscle glycogen values) following a very short bout of very intense exercise (<24 hours)
41
How does fat metabolism change with training?
* improved ability to oxidize FFA
– ↑ FFA faster
– enhanced capillarization (# and density –
access fats)
* FFA transport through plasma membrane and mitochondria
* Increased number of oxidative enzyme
* mitochondrial adaptations (↑density + size)
42
When can a high fat diet be beneficial?
Eat high fat diet then CHO.
* Same glycogen stores as high CHO but increased fat metabolism!
43
How does the high fat diet work to help athletes?
* Injecting intralipid into blood to raise FA.
* Spares glycogen reserves.
44
For endurance athlete's, is it better to have a high fat or high CHO diet?
High CHO!
45
What is the theory behind a high fat diet?
High fat diets could increase ability to oxidize fat and spare muscle glycogen (particularly if muscle glycogen is replenished before exercise)
46
Why are proteins important?
– Structural and regulatory functions.
– Fuel source.
– Can be converted to glucose (gluconeogenesis)
47
What % of muscle protein is BCAA? What does this mean?
20% for muscle synthesis
48
What 3 essential acids are BCAA?
Isoleucine
Leucine
Valine
49
What are the limiting amino acids for the following protein sources?
Wheat
Rice
Legumes
Maize
Egg, chicken
Lysine
Lysine
Tryptophan or methionine (or cysteine)
Lysine and tryptophan
None
50
Why do we do Protein breakdown?
– To replace damaged proteins
– Synthesize neurotransmitters (serotonin) or hormones (adrenaline)
– To provide energy (converted to glucose, ketones or fatty acids)
51
What are the two ways to remove the amino group?
– Transamination or deamination
(ammonia (NH3) converted to urea)
52
What's the difference between protein intake and protein turnover?
Protein turnover is several times greater than protein intake.
53
Protein intake accounts for what % of the AA that enter the AA pool every day
25%
54
Where does the remaining protein come from?
Comes from protein in the gut, kidney, liver which synthesize and resynthesize
Muscle is MUCH slower
55
How can you estimate protein metabolism?
Eat specific foods (known nitrogen content) and measure nitrogen excretion.
During exercise, nitrogen excretion is substantial and must be included in the measurements.
56
What is the Nitrogen Balance Method?
– ~16% of protein is nitrogen
– Nitrogen Intake – Nitrogen loss
* Loss: fecal, urine, sweat, ~breath(ammonia)
– Overall underestimates nitrogen excretion
(therefore overestimates retention).
– When eating high protein diet, can result in
overestimate
57
Those who believe that protein requirements are greater for athletes often state?
1. AAs may be oxidized during exercise.
2. Increased protein synthesis is necessary to repair damage and training adaptations.
58
What should protein intake usually be for the general population?
– 0.8 g/kg of body weight per day
– 10-35% of TDEI
59
What should protein intake usually be for endurance athletes?
– 1.2–1.4 g/kg of body weight per day
– Perhaps more for ultra-endurance athletes
– Usually not a problem because caloric intake is up
60
What should protein intake usually be for strength training athletes?
– 1.2–1.7 g/kg of body weight per day
– Especially early phases of training
61
What are some Strategies to favor protein synthesis?
– Co-ingestion with CHO (due to insulin response)
– Amount of protein (20-25 g?)
– Timing of protein (peri-exercise)
– Type of protein (whey vs casein vs soy)
– Ergogenic Amino acids
62
Protein supplementation is less effective in which populations?
Older populations
63
Above what amount of protein do we see no further gains in FFM?
1.6g/kg/day
64
What are some recommendations for weight gain?
* Supplementing with dietary protein augments muscle mass/strength during prolonged resistance training
* More effective in younger and trained individuals (versus older and untrained)
* BUT recommends up to 1.6g/kg/day
* BUT resistance training is the more important stimulus (more of the variability in results)
65
What are some recommendations for weight loss?
* “high quality weight loss” – retention of skeletal muscle with promotion of fat loss
* Especially important for athletes as muscle loss can adversely impact performance
* Current recommendations are 1.6 to 2.4g PR/kg/day during weight loss
66
What 2 factors would influence the amount of protein (ie. The high vs. low end of the range) you recommend to your athletes?
– Rate of weight loss: faster need more PR
– Type of training: if RT then need lower because maintaining muscle
67
What does EAA stand for?
essential amino acids
68
What does BCAA stand for?
Branched-chain amino acids
69
What does PDCAAS stand for?
protein digestibility corrected amino acid score
70
What reduces AA availability for protein synthesis?
Splanchnic AA extraction
71
Micronutrients play important role in:
– Energy production (e.g. B-complex vitamin)
– Bone health (e.g. vitamin D, Calcium)
– Hemoglobin (e.g. iron)
– Others: Immune function, Antioxidants, Building and Repair
72
Northern athletes can benefit from what vitamin / supplement?
Vitamin D
73
What does vitamin E do?
Reduce oxidative stress, inflammation and muscle soreness
74
Why do athletes need more iron in their diets than sedentary people?
Because prolonged bouts of exercise increase the losses of iron in feces, urine, and sweat
75
What is foot strike hemolysis?
Results in RBCs breaking – lose iron to the blood stream, reduced RBC content
76
How is supplement use widespread in athletes?
– Prevent micronutrient deficiencies
– Convenient form of energy/macronutrients
– Directly impact performance
– Support higher intensity training
77
Why do you need to be cautious when taking Protein bars, shakes, pills, powders etc?
* Most are unregulated (watch for DIN) and can contain banned substances
* Caffeine, creatine, sodium bicarbonate (buffer pH) and nitrate generally have good evidence of benefit
* BUT effectiveness of many supplements not proven or not universally beneficial – need more high quality work
78
What are 3 Critical questions prior to taking supplements?
* Is the product available, affordable, tolerated and compatible with your performance goals?
* Does your coach, team doctor, personal physician or sports nutritionist know of and support the use of your choice of supplements?
* Is the supplement manufactured and sold by a reliable source in which the risk of cross-contamination with other substances is low?
79
What is dehydration?
Loss of >2% body weight
80
What are the water intake recommendations for before exercise?
5-7 ml of water / kg (at least 4h before exercise): e.g., 75 kg person = 375 – 525 ml
81
What are the water intake recommendations for during exercise?
Individuals should develop fluid replacement plans to prevent excessive (<2% body weight reductions from baseline body weight) dehydration.
* Sweat rates can vary from 0.3-2.4 L/h
* Maximum rate of gastric emptying ~ 1-1.5L/hr
– Concerns over hyponatremia (low sodium)
82
What are the water intake recommendations for after exercise?
If time permits, consumption of normal meals and beverages will restore dehydration.
– If needing more rapid recovery from dehydration can drink
~1.5 L of fluid per kg of weight lost.
– Fluids/foods with sodium will help expedite rapid recovery by stimulating thirst and fluid retention
83
What is sweat rate related to and impacted by?
Sweat rate is related to running time; but is impacted by ambient temperature
84
What is important for determining body weight/fat goals or standards?
* be careful with tools used to assess body composition (errors)
* be careful assigning specific weight or %fat goal for a group (don’t ignore the individual)
* provide appropriate support and expertise when suggesting weight loss or gain
* More significant weight (Fat) loss should preferably take place in the off-season
85
What is the recommended nutrition for weight loss?
* moderate energy restriction
* gradual loss (0.5-1.0 kg/week, approx 500-1000 kcal/day deficit)
* or increase expenditure with less restriction (difficult for already active athletes)
* Appropriate CHO for training needs
– lower CHO impairs performance
* Maintain/increase absolute protein intake
– especially during 1st week (amino acids used to make glucose instead of synthesis)
* Decrease absolute fat intake
* Adequate energy intake
86
What is the suggested routine for weight gain?
-Protein: 1.2–1.7 g/kg/day or about 25% of kcals from protein
-CHO: 6.0 g/kg/day or about 55% of kcals from CHO
-FAT: about 20% of kcals from fat
* 0.1 g essential AA/kg immediately prior and/or during first few hours of recovery
* adding CHO (0.5 g/kg) may be more effective
* may be obtained from supplements or “real” food (1 cup chocolate milk or 1 cup non-fat fruit yogurt)
87
What does Ergogenic mean?
Work producing
88
What is an Ergogenic aid?
Substances or techniques used to improve athletic performance (physiological, psychological, or biomechanical function)
89
How do you determine the effectiveness of ergogenic aids?
- is it safe?
- is it banned?
- the amount
- does it make sense?
- does it match the science?
90
What are the Critical Evaluation of Nutrition
Supplement studies?
– Does the study have a clear hypothesis?
– Was the study on cells, tissues, animals or humans?
– Was the population for which the claims are made comparable to the population in the study?
– Were external variables controlled?
– Was the study placebo controlled?
– Were adequate techniques used?
– Were the trials randomized?
– Was a crossover design used?
– Do other studies confirm the findings?
– Was the study peer-reviewed?
– By who was it funded?
91
What types of ergogenic aids are used for Weight loss/ aerobic performance?
* pharmaceutical agents include thermogenic drugs (ephedrine or ephedrine/ caffeine/ asprin cocktails) or anorexiant drugs
(fenfluramine and fluoxetine – loss of appetite)
* also nicotine (appetite suppressant)
* also diuretics (rapid wt loss)
92
What types of ergogenic aids are used for Weight/strength gain (growth promoting, protein synthesis)?
- Anabolic steroids
- Prohormones (circulates in blood in inactive form ready to turn on.
- Androstenedione (Andro –precursor to testosterone)
- DHEA/S (turns to Testosterone)
- Growth hormone (GH; stimulates growth)
- β-hydroxy- β-methylbutyrate (HMB) stimulates muscle gains
- β2-adrenergic agonists -bronchodilators
(clenbuterol, salbutamol, albuterol- stimulates muscle mass in elderly)
- Creatine
93
What are 2 types of Thermogenic drugs?
Caffeine & Ephedrine
94
How to thermogenic drugs work?
– sympathetic nervous system (SNS) major regulator of thermogenesis - caffeine/ephedrine stimulate
– α receptors include α1 (heart,vascular smooth muscle) and α2 (presynaptic terminals and vascular and other smooth muscle cells)
– β receptors, including β1, β2 and β3 (heart, lungs, blood vessels) (many functions including ↑lipolysis…)
95
What are 2 types of Sympathetic stimulants?
CNS stimulants:
- Ephedrine/pseudoephedrine
96
What are the potential benefits of sympathetic stimulants?
- Weight loss
- Reaction time/acceleration/speed
- Strength/power/muscular endurance
- Possibly aerobic endurance
- Higher max HR and peak lactate at exhaustion
- Better focus
- Fine motor coordination
97
What are the risks of sympathetic stimulants?
- Death
- Cardiac arrhythmias
- Delay the sensation of fatigue
- Extreme nervousness
- Aggressive behavior
- Insommnia
98
What is Ephedrine?
(stimulant – prevent low BP)
* A sympathomimetic substance
(Stimulates SNS)
* Pseudoephedrine is a drug available over the counter
* ephedrine more effective vs. pseudoephedrine
* the herb má huáng (Ephedra sinica) contains
ephedrine and pseudoephedrine. Classified as herb (dietary supplement)
99
What are the proposed effects of sympathetic stimulants?
* Ephedrine and amphetamines are sympathomimetic (stimulate α and β receptors)
* ephedrine has both thermogenic and appetite suppressive effects
* Weight loss!
* prevents loss of FFM during restriction...may be protein sparing and influencing protein synthesis
* may also prevent drop in RMR with restriction
100
What are the dose effect numbers for epinephrine? (low, medium, high)
» -0.9 kg/month for low dose (10-20 mg/d)
» -0.9 kg/month for medium dose (40-90 mg/d)
» -1.4 kg/month high dose (100-150 mg/d)
101
What are the side effects of Ephedrine?
* side effects include tremors, nervousness, increase BP and HR
* more serious side effects include MI, stroke, seizures
* ephedra-containing products account for 64% of all adverse reactions to herbs in US
- Banned in diet drugs since 2004
102
What is caffeine?
* Found mostly in coffee beans, teas leaves, cocoa beans and cola nuts
* Peak in blood about 60 minutes after consumption
* Half-life 2-10 hours
103
What does caffeine do to the body?
* ↑ mental awareness, reduce perception of fatigue,
↑central driver, ↑ fiber recruitment…
* adenosine (when binds to receptors it slows neural activity – sleepy) receptor antagonist (stimulates metabolism)
* Reduces the negative feedback that inhibits
secretion of noradrenaline (ie. The body keeps secreting noradrenaline - neurotransmitter)
* Relaxes smooth muscles (increased BF)
* Increase intestinal CHO absorption
* ~ Helps stimulate adrenal medulla -adrenaline (hormone)
* ↑ lipolysis (from adipocytes), ↑ FFA, ↑ fat oxidation?
104
What is the proposed effect of caffeine?
– Caffeine is metabolized in the liver by the
cytochrome P450 oxidase enzyme into:
* Paraxanthine (84%): Has the effect of increasing lipolysis, leading to elevated glycerol and free fatty acid levels in the blood plasma.
* Theobromine (12%): Dilates blood vessels and increases urine volume. Theobromine is the principal alkaloid in cocoa.
* Theophylline (4%): Relaxes smooth muscles of the bronchi, used to treat asthma.
105
What are caffeine's effects on weight loss?
* Short term: Caffeine 100mg was shown to increase resting oxygen consumption 3–4% in 9 lean and 9 post-obese subjects.
* Long term (fewer studies): Caffeine alone does not seem to result in much more weight loss than placebo
106
What are caffeine's effects on performance?
* No benefits on VO2max and maximal strength
* Benefits on submaximal aerobic(**) and
~anaerobic endurance
– (often time to fatigue at a certain intensity increases)
107
What are the side effects of caffeine?
* Increase HR
* Diuretic… not commonly a problem with exercise
* Reaction different in regular users vs. non-users
* Interferes with absorption of vitamin C and iron?
* Bone mineral density and osteoporosis?
* Insulin resistance and type 2 diabetes?
* Important to consider differences between coffee and caffeine
108
What are the benefits of creatine for athletes?
- increased muscle mass and strength
- increased performance of brief, high intensity exercise
- increased resistance exercise performance
- decreased muscle fatigue
109
Who else (other than athletes) can benefit from creatine?
- generally safe and potentially beneficial for children and adolescents
- can provide muscle and performance for older adults when combined with resistance training
110
What is the emerging evidence of creatine?
- increased recovery or reduced damage from mild TBI & concussion
- increased heat tolerance during exercise
- decreased muscle damage and soreness
111
What are anabolic steroids?
* Synthetic substance similar to testosterone
* Used clinically to treat delayed puberty, in osteoporosis (increase bone strength), and anaemia (increases RBC count and %Hb)
112
How / why would you use anabolic steroids?
* Intramuscular injection, orally or by using gels or creams
* Increase muscle size/strength
* can reduce recovery time between periods of strenuous activity
* No effect on endurance or stamina
* Stimulates the brain to stimulate feelings of euphoria
113
What are the side effects of anabolic steroids?
* Increased aggressive behaviour, acne, body hair
* Prolonged use interferes with the ability to naturally produce testosterone
* Hypertension, atherosclerosis, blood clotting, reduced fertility
* Heart attacks and liver cancer
* IOC placed anabolic steroids on their list of banned substances in 1975
114
What is Doping in Sport?
The presence of prohibited substances or methods to unfairly improve their sporting performances and gain an advantage over their competitors
115
Why do athlete's dope?
* That competitors take drugs
* Have to use them to be competitive
* Dissatisfaction with size/ weight
* Peer/ Team Pressure
* Community attitudes and expectations
* Financial rewards and media influence
116
Which substances are prohibited at all times?
- Non-approved substances
- Anabolic Agents.
- Peptide hormones, growth factors & related substances.
- Beta-2 antagonists.
- Hormone antagonists & metabolic modulators.
- Diuretics & masking agents.
117
What methods are prohibited at all times?
- Manipulation of blood & blood components: enhancement of oxygen transfer.
- Chemical or physical manipulation.
- Gene doping.
118
What is prohibited in competition?
- Stimulants
- Cannabinoids
- Narcotics
- Glucocorticosteroids
- Alcohol (in some sports)
119
How does alcohol impair performance?
* Hangover reduces performance by ~11%
* reaction time
* hand-eye coordination
* accuracy and balance
* complex coordination
* regulation of body temperature
120
What might alcohol also reduce?
* strength
* power
* speed
* cardiovascular endurance
* healing of injuries
121
How does cannabis impair performance?
* Increased HR and decreased SV = reduced maximal performance
* Respiratory tract infection + bronchitis + lung cancer = less oxygen for performance
122
How does cannabis improve performance?
* Euphoric effect
* Anxiety reduction during performance
123
In which sports are beta blockers prohibited?
- Archery
- Automobile
- Billiards
- Darts
- Golf
- Shooting
- Skiing/snowboarding
- Underwater sports
124
What are beta-blockers?
* Clinically to reduce blood pressure
* Block the release of noradrenalin to reduce heart rate
* Used in precision sports (e.g., archery, diving, gymnastics) because of their calming effect, reduce anxiety and stabilize motor performance
125
What are the side effects of beta blockers?
* Dizziness
* Drowsiness
* Sleep problems
* Breathing problems
* Slow heart rate
* depression
126
What are 3 examples of mainstream media?
* Icarus – documentary during the Russian athlete doping scandal.
* Pumping Iron – before steroid use went out of favour.
* The Program – about Lance Armstrong
127
What is the female athlete triad?
- eating disorders
- amenorrhea
- osteoporosis
128
Why did the female athlete triad change names? What is the new name?
Relative Energy Deficiency in Sport (RED-S)
changed the name because it affects men too (more inclusive with this name)
129
How do you get REDS?
* When in negative energy balance for weeks to months, athletes will exhibit signs/ symptoms of REDS
130
What is the definition of REDS?
RED-S is the impaired physiological functioning caused by relative energy deficiency and includes (but is not limited to) impairments in metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.
131
What is the underlying factor for REDS?
Low energy availability
132
How is Disordered eating a continuum?
– Balance between appropriate eating and exercise
– Ranges from “healthy dieting” to extreme weight loss
– Can include clinical eating disorders
133
Disordered eating affects up to what % of male and females athletes?
62% of female, and 33% of male athletes
134
What % of college athletes are at risk of developping anorexia nervosa?
Females 35%
Males 10%
135
What % of college athletes are at risk of developping bulimia nervosa?
Females 58%
Males 38%
136
What is Anorexia Nervosa?
1) Refusal to maintain body weight for age & height (e.g., BMI<17.5 or <85% of expected weight); failure to gain weight during growth
2) Intense fear of gaining weight or fat
3) Disturbed body image or denial of seriousness of current low body weight
4) Amenorrhea
137
What is Bulimia Nervosa?
1) Recurrent episodes of binge eating:
* Eating a larger amount of food in a discrete time
* Sense of lack of control over eating during episode
2) Recurrent, inappropriate, compensatory behavior in order to prevent weight gain
3) Binge eating and inappropriate compensatory behaviors occur twice a week for 3 months
4) Self-evaluation influenced by body image
5) May occur with/without AN
138
What are 2 types of low energy availability?
Anorexia Nervosa
Bulimia Nervosa
139
What are 6 types of menstrual dysfunction?
- Menarche
- Eumenorrhea
- Oligomenorrhea
- Amenorrhea
- Luteal suppression
- Anovulation
140
What is Menarche?
first menstrual cycle (12.5 years average)
141
What is Eumenorrhea?
menstrual cycles at intervals near the median interval for young adult women (28 days; range 21-35)
142
What is Oligomenorrhea?
menstrual cycles at intervals longer than 35 days (other definition = infrequent menstrual cycle; 3-6/yr)
143
What is Amenorrhea?
Absence of menstrual cycle lasting >3 months. (Primary Amenorrhea = delayed menarche (15 yr); Secondary Amenorrhea occurs after menarche)
144
What is Luteal suppression?
a menstrual cycle with a luteal phase shorter than 11d in length or with a low concentration of progesterone.
145
What is Anovulation?
a menstrual cycle without ovulation
146
How quickly can menstrual dysfunction occur and how long does it take to recover?
Can occur in as little as 1 month of low energy availability but more likely 2-3 months. Takes 3-6 months to recover after improvement in energy availability.
147
What % of athletes get Primary amenorrhea?
Estimated at ~7% overall, with 22% in cheerleading, diving and gymnastics
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What % of athletes get Secondary amenorrhea?
Estimated to be 2-5% in women, and as high as 69% in dancers and 65% in long distance runners
149
What important questions need to be answered when assessing menstrual dysfunction in athletes?
What is the cause…
* Low energy intake?
* High energy expenditure?
150
What is one serious misconception with menstrual dysfunction?
Some athletes coaches, athletes, trainers consider amenorrhea benign consequence of training, indicator of good training, body fat levels at optimal level for performance
- actually comes from LEA
151
What is Low Bone Mineral Density (BMD)?
(aka osteopenia)
– bone mineral density Z-score between -1.0 and -2.0.
152
What is Osteoporosis?
– bone mineral density Z-score <-2.0
– with secondary risk factors for fracture (e.g., undernutrition, hypoestrogenism, prior fractures)
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What are the 2 Causes of Low BMD in athletes?
- Low energy availability
*Low IGF-1 (promotes bone health)
*High Cortisol
*Perhaps low intake of calcium
- Menstrual dysfunction/Estrogen
*Menstrual history major determinant of BMD: late menarche, menstrual irregularities or amenorrhea lead to reduced peak BMD, premature bone loss or increased fracture risk
154
How does undernutrition affect low bone mineral density?
Decrease rate of bone formation
155
How does hypoestrogen affect low bone mineral density?
Increased bone resorption rate
156
What are the consequences of low bone mineral density?
- Increased risk of stress fractures
- Increased risk of osteoporosis
157
What is the treatment for REDS?
- Make EA > 30 kcal/ kg of FFM
(preferably 45 kcal/ kg of FFM)
- Nutrition counseling
* increase dietary Ca2+ to 1000-1300 mg/d
* increase Vit D to 400-800 IU/d
* protein 1.2.-1.6 g/kg/day
- resistance training (boost muscle/bone)
- decrease overall training by 10-20%
- aim to increase body weight by 2-3%
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What are 10 health consequences of REDS?
- Menstrual function
- Bone health
- Endocrine
- Metabolic
- Hematological
- Growth + development
- Psychological
- Cardio-vascular
- Gastro-intestinal
- Immunological
159
What are 10 performance consequences of REDS?
- Decreased training response
- Impaired judgement
- Decreased coordination
- Decreased concentration
- Irritability
- Depression
- Decreased glycogen stores
- Decreased muscle strength
- Decreased endurance performance
- Increased injury risk
