EFFECTS OF EXERCISE TO THE HUMAN BODY

ACUTE PHYSIOLOGICAL RESPONSES

An acute physiological response refers to an immediate response of one or more of the body systems to
exercise.

Heart Rate
 Resting heart rate averages 60 to 80 beats/min in healthy adults.
 In sedentary, middle aged individuals it may be as high as 100 beats/min.
 In elite endurance athletes heart rates may be as low as 28 to 40 beats/min

Working heat rate is the heart rate during exercise and varies depending on a person's level of fitness.

An untrained person's heart rate will rise much quicker than a trained person and continue to rise as
exercise duration and intensity increases.

For untrained person, the heart rate rapidly but for a trained person it rises slowly until they reach a
steady state, where the heart rate remains steady for the period of exercise at the level of intensity.

Also, the recovery of heart rate will be much quicker for a trained person than an untrained person.

Before exercise even begins, the heart rate increases in anticipation. This is known as the anticipatory
response. It is mediated through the releases of neurotransmitters called epinephrine and
norepinephrine also known as adrenaline and noradrenaline.

After the initial anticipatory response, heart rate increases in direct proportion to exercise intensity until a
maximum heart rate is reached.

Maximum heart rate is estimated with the formula 220-age. But this is only an estimation, and not
particularly accurate.

During prolonged steady-state exercise, particularly in a hot climate, a steady-state heart rate will
gradually increase. This phenomenon is known as cardiac drift and is thought to occur due to increasing
body temperature in an attempt to cool off.

Stroke Volume
 Stroke volume is the amount of blood pumped from the left ventricle per heartbeat.
 Stroke volume increases proportionally with exercise intensity.
 In untrained individuals stroke volume at rest averages 50-70 ml/beat increasing up to
110-130ml/beat during intense physical activity.
 In elite athletes resting stroke volume averages 90-110ml/beat increasing to as much as
150-220ml/beat.
 Stroke volume may increase only up to 40-60% of maximal capacity after which it plateaus.
 Beyond this relative exercise intensity, stroke volume remains unchanged until the point of
exhaustion.
 Different athletes experience different levels of increase in SV. Swimmers experience a smaller
increase in stroke volume compared to runners or cyclists.
 This is because the supine position of a swimmer prevents blood from pooling in the lower
extremities enhancing venous return as compared to runners and cyclists.
 Enhanced venous returns leads to increased stroke volume at the onset of exercise because the left
ventricle fills more completely, stretching it further, with the elastic recoil producing a more forceful
contraction.

Cardiac Output
1
  Cardiac output is the amount of blood pumped by the heart in 1 minute measured in L/min.
 It is a product of stroke volume and heart rate (SV x HR).
 Cardiac output increases proportionally with exercise intensity
 At rest the cardiac output is about 5L/min but during intense exercise this can increase to
20-40L/min.

Blood Flow
 The vascular system can redistribute blood to those tissues with the greatest immediate demand and
away from areas that have less demand for oxygen.
 At rest 15-20% of circulating blood supplies skeletal muscle
 During vigorous exercise this increases to 80-85% of cardiac output.
 Blood is shunted away from major organs such as the kidneys, liver, stomach and intestines.
 It is then redirected to the skin to promote heat loss.
 As a result, athletes are often advised not to eat several hours before training or competition. Food in
the stomach leads to competition for blood flow between the digestive system and muscles.

Blood Pressure
 At rest, systolic blood pressure in a healthy individual ranges from 110-140mmHg and 60-90mmHg
for diastolic blood pressure.
 During exercise systolic pressure can increase to over 200mmHg and levels as high as 250mmHg
have been reported in highly trained, healthy athletes.
 Diastolic pressure remains relatively unchanged regardless of exercise intensity.
 An increase of more than 15 mm Hg as exercise intensity increases can indicate coronary heart
disease and is used as marker for cessing an exercise tolerance test.

Blood

 During rest, the oxygen content of blood varies from about 20ml of oxygen per 100ml of arterial
blood to 14ml of oxygen per 100ml of venous blood.
 The difference in oxygen content of arterial and venous blood is known as a-vO2 difference.
 As exercise intensity increase the a-vO2 difference increase and at maximal exertion the difference
between arterial and venous blood oxygen concentration can be three times that at a resting level.
 Blood plasma volume decreases with the onset of exercise.
 The increase in blood pressure and changes in intramuscular osmotic pressures force water from the
vascular compartment to the interstitial space and to the working cells.
 During prolonged exercise, plasma volume can decrease significantly.
 A reduction in plasma, increase the concentration of hemoglobin (hematocrit).
 Although no extra red blood cells have been produced, the greater concentration of hemoglobin per
unit of blood significantly increases the bloods oxygen carrying capacity.
 Blood pH can change from a slightly alkaline 7.4 at rest to acidity of 6.5 during all-out sprinting
activity.
 This is primarily due to an increased reliance on anaerobic energy systems and the accumulation of
hydrogen ions.

CHRONIC PHYSIOLOGICAL ADAPTATIONS

A chronic adaptation refers to the long term effects on one or more of the bodies systems. They occur as a
result of continuous training as the body adjusts to level of intensity.

Adaptations in the Cardiovascular System to exercise

Heart Size
 The mass and volume of the hearts increases and cardiac muscle undergoes hypertrophy.
 The left ventricle adapts the greatest.
 The chamber size and the myocardial wall thickness increasing.

Heart Rate

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  Resting heart rate can decrease significantly following training in a previously sedentary individual.
 During a 10-week exercise program, an individual with an initial resting heart rate of 80bpm can
expect to see a reduction of about 10bpm in their resting heart rate.
 Highly conditioned athletes can have resting heart rates as low as 30bpm.
 Maximum heart rate (220-age) tends to remain unchanged by training and seems to be genetically
limited.
 However, there are some reports that maximum heart rate is reduced in elite athletes compared to
untrained individuals of the same age.
 Following an exercise bout, heart rate remains elevated before slowly recovering to a resting level.
 After a period of training, the time it takes for heart rate to recover to its resting value is shortened.

Stroke Volume
 Stroke increases at rest, during submaximal exercise and maximal exercise following training.
 Stroke volume at rest averages 50-70 ml/beat in untrained individuals, 70-90ml/beat in trained
individuals and 90-110ml/beat in world-class endurance athletes.
 This increase is attributed to greater end-diastolic filling as a results of; increase in blood plasma,
reduced heart rate which increases the diastolic filling time.
 The heart expels a greater percentage of the end-diastolic as compared to before training.

Cardiac Output
 CO=volume x heart rate
 Cardiac output remains relatively unchanged or decreases only slightly following endurance training.
 Since less heart beats allow more time for blood to fill the heart and be expelled and vice versa,
cardiac output remains the unchanged.
 During maximal exercise cardiac output increases significantly as a result of an increase in maximal
stoke volume as maximal heart rate remains unchanged with training.
 In untrained individuals, maximal cardiac output may be 14-20L/min compared to 25-35L/min in
trained subjects.

Blood Flow
Skeletal muscle receives a greater blood supply following training. This is due to:
 Increased number of capillaries
 Greater opening of existing capillaries
 More effective blood redistribution
 Increased blood volume

Blood Pressure
 Blood pressure is the force placed on the walls of the blood vessels with contractions of the heart
 It is measured in terms of two readings: systolic which is the reading affected by training and
diastolic which is not affected by training.
 The overall effect of training can lower blood pressure, while a normal blood pressure is around
120/80. Blood pressure can decrease (both systolic and diastolic pressure) at rest and during
submaximal exercise.
 However, at a maximal exercise intensity systolic blood pressure is decreased compared to pre-
training.
 Although resistance exercises can raise systolic and diastolic blood pressure significantly during the
activity, it too can lead to a long-term reduction in blood pressure.

Blood Volume
 Endurance training increase blood volume due to increased plasma volume and a greater production
of red blood cells.
 Because blood plasma increases to a greater extent than red blood cells, hematocrit reduces
following training due to the resulting increase in blood volume thus less concentration of
hemoglobin.

Lactate levels

 Lactate levels are salts that are formed from lactic acid during anaerobic exercise.
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  This relates to the pH, or the acidity of muscles. A neutral pH is seven, but during anaerobic activity
the lactate levels rise above the resting level and enter the lactic threshold, creating a chemical
imbalance and tipping the pH level below seven as the muscles acidify.

 A trained person has a higher lactate threshold; they can train harder for longer before their muscles
become acidified. While an untrained person will reach their lactate threshold quickly, which will
often cause muscular fatigue, forcing them to slow down or cease exercise.

RESPIRATORY RESPONSES TO EXERCISE

Ventilation Rate: your ventilation rate is the depth and rate of breaths per minute. Your minute
ventilation at rest should be around 12 per minute and as exercise begins this will rise to trigger your
respiratory activity needed to supply your muscles with oxygen during exercise.

As exercise commences pulmonary ventilation (breathing) increases in direct proportion to the intensity
and metabolic needs of the exercise. Ventilation increases to meet the demands of exercise through the
following;

An increase in tidal volume' which refers to the quantity of air that is inhaled and exhaled with every
breath.
An increase in the respiration or breathing rate' which refers to breaths per minute. If the exercise is
intense, breathing rates may increase from a typical resting rate of 15 breaths per minute up to 40 - 50
breaths per minute.

The most commonly used measure of respiratory function with exercise is known as VO 2 (volume of
oxygen uptake) which refers to the amount of oxygen taken up and used by the body.

With continuous exercise (≥ 1 minute in duration) VO 2 increases linearly with increases in exercise
intensity. This is due to an increasing reliance on oxygen to help provide energy as exercise continues.

As the intensity of exercise continues to increase a person reaches a maximum point above which oxygen
consumption will not increase any further. This point is known as VO2 max.

After training in high intensity and longer duration with short or no rests throughout create 'EPOC'
(Excess Post-exercise Oxygen Consumption). The body continues with high consumption of oxygen once
exercise is completed to make up for an oxygen 'debt' that is created.

Respiration rate and depth remain elevated during this recovery period in order to expel carbon dioxide
and return the acid-base balance of the muscles to neutral.

The higher the intensity of longer duration training the bigger the oxygen deficit and the longer the
respiration rate and depth will stay elevated after the workout has finished.

During intense sessions focusing on muscular endurance and/or anaerobic fitness respiration rate and
depth may remain elevated for 20-40 minutes after the workout.

High intensity short duration (≤ 30 seconds) training with long recovery intervals (≥ 2 minutes) such as
strength or power and speed training are primarily reliant on stored ATP-PC energy.

For this reason the response of the respiratory system to these training types will be minimal. Breathing
rates will rise slightly during a warm up, there may be a slight peak in breathing rate shortly after each set
and breathing rate will return to normal within a few minutes of finishing the training session.

The respiratory system response becomes greater as exercise increases in duration and the demand for
oxygen becomes more prevalent.

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RESPIRATORY SYSTEM ADAPTATIONS TO EXERCISE
Aerobic fitness, anaerobic fitness and muscular endurance training place larger demands on the lungs than
any other types of training. Over time these demands result in adaptations to the respiratory system such
as:

Physiological Adaptation
 Breathing rates increase with higher intensity training (this is more an adaptation
Ventilation / from anaerobic fitness and muscular endurance training or higher intensity
Breathing rate aerobic fitness training). This enables more air to move in and out of the lungs
enhancing gas exchange.
 Lungs increase their ability to expand enabling a greater quantity of air to move
Lung Capacity/
in and out (this is a similar adaptation to the increase in stroke volume in the
Volume
cardiovascular system).
 The strength and endurance of the diaphragm and intercostal muscles improves.
This results in an improved ability to breathe in more air, for longer with less
Respiratory
fatigue.
Muscles
 Aerobic training tends to improve the endurance of respiratory muscles
 Anaerobic training tends to increase the size and strength of respiratory muscles
 More capillaries are formed in the lungs over time allowing more blood to flow in
Capillarization in
and out of the lungs. This improves the uptake of oxygen as there is a greater
the lungs
surface area for blood to bind with haemoglobin.
 The numbers of alveoli in the lungs increase to enable more gas exchange to
Alveoli
occur.
 The exchange of oxygen and carbon dioxide improves as the gradient between
each becomes larger. This occurs because the more oxygen used in the tissues
and the more carbon dioxide produced creates a larger difference/gradient
Gas Exchange between the blood and tissues.
 Aerobic fitness training tends to improve the efficiency of the body's tissues at
absorbing O2 and removing CO2, while anaerobic fitness and muscular endurance
training tends to improve the capacity for this gas exchange.
 These are what hold oxygen and transports it around the body. This can have
Hemoglobin levels large increases in training of up to 20%, however in females this may be lower,
due to higher need for iron with menstruation and lower muscle mass.

ADAPTATIONS OF MUSCLES TO EXERCISE

Aerobic, or endurance, exercise such as swimming, jogging, fast walking, and biking, results in several
recognizable changes in skeletal muscles.

 There is an increase in the number of capillaries surrounding the muscle fibers

 The number of mitochondria increase
 Muscle fibers synthesize more myoglobin
These changes occur in all fiber types, but are most evident in slow oxidative fibers, which depend
primarily on aerobic pathways.

The changes result in more efficient muscle metabolism and in greater endurance, strength, and resistance
to fatigue.

Muscular Adaptations to Aerobic Endurance Training Programs

Aerobic training is characterized by
 increased aerobic power (VO2max) with little or no change in muscle strength or power.

Similarly, the structural and metabolic changes in muscle fibers facilitate the production of
 large quantities of ATP, primarily by aerobic means, following an aerobic training program thus
enhancing muscular endurance.
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Aerobic endurance training results in an
 increase in slow twitch fiber size in adult males and
 no change in fast twitch fiber size.

There is also evidence that aerobic endurance training can result in the
 transformation of FG muscle fibers to FOG muscle fibers.

Muscular Adaptations to Concurrent Training

Many sports require a combination of muscular strength and aerobic endurance, and thus a combination
of resistance and aerobic endurance training is required to improve performance. This training done at
high levels at the same time, often on the same day, is called concurrent training.

The most consistent finding from studies of concurrent training is that

 increases in strength and power are lower with concurrent training than with strength training alone,
 but changes in aerobic fitness are similar to those found with aerobic training.

Neuromuscular Adaptations to Resistance Training

The hallmark adaptations to resistance training are increases in muscle strength and size (hypertrophy).
1. Muscle Function
1. Increased strength
2. Increased endurance
3. Increased power
2. Muscle Size and Structure
a. Muscle Fibers
Increased whole muscle cross sectional area
Increased muscle fiber cross sectional area
Increased myofibril protein content
Conversion of FOG to FG fibers
b. Connective Tissue
Increased collagen synthesis
Increased collagen stiffness
3. Neural Adaptations
← Increased Motor unit recruitment
← Increased synchronization
← Decreased Golgi tendon organ reflex
4. Metabolic Adaptations
← Increased glycogen
← Increased PC
← Increased creatine phosphokinase (CPK)

Muscle Function
Resistance exercise leads to increased muscular strength, endurance, and power. Increased strength is the
most obvious result of a resistance training program and the reason many individuals participate in
resistance training.

Strength gains following a resistance training program vary widely, owing largely to differences in initial
strength and the training program. Resistance training at least twice a week improves muscle strength and
endurance by approximately 25-100%.

Muscle Size and Structure

Resistance training increases muscle size and strength.

The increase in the cross-sectional area (CSA) of the whole muscle reflects an increase in the individual
muscle fiber cross-sectional area. The increased cross-sectional area of the muscle results from

6
hypertrophy of all three muscle fiber types, although the fast-glycolytic (FG) fibers appear to have the
greatest increase.

The hypertrophy that occurs is due to an increase in the total contractile protein (actin and myosin), in the
size and number of the myofibrils per fiber, and in the amount of connective tissue surrounding the
muscle fibers.

Resistance training appears to cause a conversion of FOG (Fast Oxidative Glycolytic) fibers to FG fibers
in humans.

Resistance training can theoretically lead to hyperplasia-an increase in the number of muscle fibers.
Hyperplasia could occur as a result of muscle fiber splitting or branching with subsequent hypertrophy or
myogenesis, or a combination of the two.

However, the contribution of hyperplasia to increased muscle cross-sectional area (and strength) remains
relatively unknown because of measurement difficulties. The exact role of hyperplasia in increased
muscle size is highly controversial.

Resistance training results in increased collagen synthesis and a strengthening of the connective tissue
around the muscle. However, the ratio of connective tissue to skeletal muscle appears relatively consistent
between trained and untrained individuals. There is also evidence of increased tendon stiffness with
resistance training

Neural Adaptations
Neural adaptations to resistance training include increased neural drive to the muscle, increased
synchronization of the motor units, and an inhibition of the protective mechanism of the Golgi tendon
organs.

Increased neural drive indicates that greater muscle activation can occur because more motor units can be
recruited.

Evidence suggests that resistance-trained individuals exhibit greater synchronization-a higher correlation
between timing of action potentials of concurrently active motor units that allows for greater force
production.

Indirect evidence also suggests that resistance training leads to changes in inter-muscular coordination of
agonists, antagonists, and synergists, which dampens inhibitory reflexes and allows for greater force
production.

Activation of Golgi tendon organs results in inhibition of the agonist via inhibitory motor neurons, thus
providing an important protective reflex that limits excessive force generation within the muscle

Metabolic Adaptations
Metabolic adaptations occur within muscle fibers that increase the ability of the muscle to generate ATP.

These changes are characterized by an increased ability to generate ATP from anaerobic metabolism; thus,
there is an increase in phosphocreatine (PC) and glycogen stores and an increase in the enzyme (creatine
phosphokinase) that breaks down PC.

GENERAL CHARACTERISTICS FOR VO2 MAX (AEROBIC POWER) I.E. FACTORS THAT
INFLUENCE AEROBIC CAPACITY/POWER

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While aerobic fitness is primarily a product of heredity and training, it is also influenced by the following
factors.

Heredity
Researchers estimate that aerobic fitness is 25 to 50% inherited, so maybe some sedentary individuals
with good genes may have higher fitness scores than others who train.

Training
Training can improve aerobic fitness by 20 to 25%, or more if accompanied by significant weight loss.
The major improvements in aerobic fitness (VO2 max) occur in the first 3 to 4 months, with subtle
changes afterward. But after aerobic fitness reaches a plateau, training continues to improve the
submaximal work capacity, the aerobic threshold. This measure defines the level of effort that can be
sustained for prolonged periods.

Gender
 Cross- sectional studies have shown that aerobic is approximately 25-30% higher in males than
females.
 In response to training, females improve in aerobic power at the same rates as males.
Aerobic fitness levels for untrained young women average 39 to 41 mL/kgmin, while the levels for
untrained young men average 45 to 48 mL/kg min.
 Regular activity increases the score for both sexes. Training leads to further increases.
 Elite female endurance athletes score in the high 60's and 70's, while men score in the 70's and 80's.
 At any distance, women's running records fall only 10% behind those recorded by men.
 Some part of the differences in performance may be due to differences in muscle mass, oxygen
transport (hemoglobin), or body fat.

Age
 The age of maximum aerobic power is approximately 18-22 years in both sexes.
 Studies show that fitness declines approximately 10% per decade (1% per year) in our sedentary
society.
 However, that rapid loss of fitness can be cut in half with regular activity (5% per decade), and
halved again with fitness training (2 to 3% per decade).
 Between the ages of 25 and 65, a fitness score of 50 mL/kgmin could decline to 30 mL/kg • min
with inactivity, to 40 with regular activity, or to 45 with regular training.

Lifestyle
Aerobic power is lost very fast due to sedentary life.
 As much as a 27% decrease in a 20 day rest period has been reported which would take 2-3 weeks of
training to recover.
 Aerobic power is important for performance of sports requiring sustained periods of activity such as
soccer, basketball, long distance running, swimming but not required for others such as field events -
short put, javelin etc

Body Fat
Since aerobic fitness is reported per unit (kilogram) of body weight, changes in weight or fat will
influence the score.
 If someone weighing 100 kilograms (220 pounds) with 25% body fat loses 10 kilograms (22 pounds)
of fat, fitness will improve. This is because there is resulting less mass to supply with oxygen during
activity thus higher efficiency.
 The combination of weight (fat) loss and training can improve fitness by more than 33%. The
average young female has 25% fat while the average male has 12.5 to 15%. Part of this difference is
due to sex-specific fat, so we do not recommend weight loss without a thorough analysis of body
composition and nutrition.
 Body fat values below 5% for males and 12% for females are not consistent with good health and
long-term maintenance of performance.

ENERGY BALANCE: THE ENERGY CONTINUUM

8
Anaerobic metabolism does not require oxygen to produce ATP, whereas aerobic metabolism
does.

Critical to understanding anaerobic and aerobic exercise metabolism is the fact that these
processes are not mutually exclusive. Both systems can and usually work concurrently.
When describing muscular exercise, the terms aerobic and anaerobic refer to the system
predominating at the time.

Alactic anaerobic metabolism, sometimes called the phosphagen or ATP-PC system. Once
produced, ATP is stored in the muscle.

This amount is relatively small and can provide energy for only 2-3 seconds of maximal
effort. However, another high-energy compound, phosphocreatine (PC), also known as
creatine phosphate
(CP), can be used to resynthesize ATP from ADP almost instantaneously.

The amount of PC stored in muscle is about three times that of ATP.

Muscles differ in the amount of stored PC by fiber type. Muscle fiber types, fibers that
produce energy predominantly by anaerobic glycolysis are called glycolytic; those that
produce energy predominantly aerobically are called oxidative.

In terms of contraction speed, muscle fibers are either fast twitch or slow twitch. When
contractile and metabolic characteristics are combined, three fiber types are generally
described: fast-twitch glycolytic (FG also known as Type IIX), fast-twitch oxidative glycolytic
(FOG also known as Type IIA), and slow-twitch oxidative (SO).
Fast-twitch fibers have proportionally more PC than ATP compared to slow-twitch oxidative
fibers.

Any time the energy demand is increased at least part of the immediate need for energy is
supplied by these stored forms (ATP, PC), which must ultimately be replenished. These
sources are also used preferentially in high-intensity, very short-duration activity.

Most re-synthesis of ATP from PC takes place in the first 10 seconds of maximal muscle
contraction; little, if any, occurs after 20 seconds of maximal activity. This ATP-PC system
neither uses oxygen nor produces lactic acid (LA) and is thus said to be alactic anaerobic.

Anaerobic glycolysis, also called the lactic acid (LA) system.

When the demand for ATP exceeds the capacity of the phosphagen system and the aerobic
system (at the initiation of any activity or during high- intensity, short-duration exercise),
fast (anaerobic) glycolysis is used to produce ATP.

The rate of ATP production from glycolysis reaches its maximum about 5 seconds after
initiation of contraction and is maintained at this rate for several seconds. The ability to
perform the events
with speed and power is the benefit. The cost is that the production of lactic acid often
exceeds clearance, and lactate accumulates. Because this system does not use oxygen but
does result in the production of lactic acid, it is said to be lactic anaerobic.

Aerobic oxidation, also termed the O2 system.

The generation of ATP from slow (aerobic) glycolysis, the Krebs cycle, and electron transport-
oxidative phosphorylation is constantly in operation at some level.

In resting conditions, this system provides basically all of the energy needed.

When activity begins or occurs at moderate levels of intensity, oxidation increases quickly
and proceeds at a rate that supplies the needed ATP. If the workload is continuously

9
increased, aerobic oxidation proceeds at a correspondingly higher rate until its maximal limit
is reached.

Four basic patterns can be discerned from this continuum.

Understanding these patterns is helpful when developing training programs.

1. All three energy systems (ATP-PC, LA, and O 2) are involved in providing energy for all
durations of exercise.

2. The ATP-PC system predominates in activities lasting 10 seconds or less. Since the ATP-PC
system is involved primarily at the onset of longer activities, it becomes a smaller portion of
the total energy supply as the duration gets longer.

3. Anaerobic metabolism (ATP-PC and LA) predominates in supplying energy for exercises
lasting between 1 and 2 minutes. The equal contribution point for anaerobic and aerobic
energy contribution to maximal exercise is probably close to 75 seconds.

However, even exercises lasting as long as 10 minutes use at least 15% anaerobic sources.
Within the anaerobic component the longer the duration, the greater the relative importance
of the lactic acid system is in comparison to the phosphagen system.

4. By 2 minutes of exercise, the O 2 system clearly dominates. The longer the duration, the
more important it becomes.

Overview of energy balance

This entails the following energy equation. Energy intake - energy expenditure = energy balance. When
energy intake is higher than energy output, the result is weight gain over time. Positive energy balance
(weight gain) is evidenced by increased total body weight and increased adiposity.

In children, obesity occurs when there is an increase in the number and size of fat cells whereas in adults,
fat loss or gain is as a result of decrease or increase, respectively, in the size of fat cells with no change in
the number of fat cells. Continued storage of fats in the body leads to increased adiposity which is mainly
expressed as fatness and is also seen to contribute to body weight. On the other hand, too little body fat is
also a health risk as the body also needs a certain amount of fat to support normal physiological functions.

Dietary energy
Energy for the metabolic and physiological functions of humans is derived from the chemical energy
bound in food and its macronutrient constituents, i.e. carbohydrates, fats, proteins and ethanol, which act
as substrates or fuels. After food is ingested, its chemical energy is released and converted into thermic,
mechanical and other forms of energy.

It should be noted that fats and carbohydrates are the main sources of dietary energy, although proteins
also provide important amounts of energy, especially when total dietary energy intake is limited. Ethanol
is not considered part of a food system, but its contribution to total energy intake cannot be overlooked,
particularly among populations that regularly consume alcoholic beverages.

Energy expenditure
Human beings need energy for the following:

Basal metabolism. This comprises a series of functions that are essential for life, such as cell function and
replacement; the synthesis, secretion and metabolism of enzymes and hormones to transport proteins and
other substances and molecules; the maintenance of body temperature; uninterrupted work of cardiac and
respiratory muscles; and brain function. The amount of energy used for basal metabolism in a period of
time is called the basal metabolic rate (BMR). Depending on age and lifestyle, BMR represents 45 to 70
percent of daily total energy expenditure, and it is determined mainly by the individual's age, gender,
body size and body composition.

Metabolic response to food. Eating requires energy for the ingestion and digestion of food, and for the
absorption, transport, interconversion, oxidation and deposition of nutrients. These metabolic processes
10
increase heat production and oxygen consumption, and are known by terms such as dietary-induced
thermogenesis, specific dynamic action of food and thermic effect of feeding. The metabolic response to
food increases total energy expenditure by about 10 percent of the BMR over a 24-hour period in
individuals eating a mixed diet.

Physical activity. This is the most variable and, after BMR, the second largest component of daily energy
expenditure. Humans perform mandatory (habitual) and optional physical activities. Mandatory activities
can seldom be avoided within a given setting, and they are imposed on the individual by economic,
cultural or societal demands. They also include daily activities such as going to school, tending to the
home and family and other demands made on children and adults by their economic, social and cultural
environment.

Optional activities, although not socially or economically essential, are important for health, well-being
and a good quality of life in general. They include the regular practice of physical activity for fitness and
health; the performance of optional household tasks that may contribute to family comfort and well-
being; and the engagement in individually and socially desirable activities for personal enjoyment, social
interaction and community development such as recreational and sporting activities.

Growth. The energy cost of growth has two components: 1) the energy needed to synthesize growing
tissues; and 2) the energy deposited in those tissues. The energy cost of growth is about 35 percent of total
energy requirement during the first three months of age, falls rapidly to about 5 percent at 12 months and
about 3 percent in the second year, remains at 1 to 2 percent until mid-adolescence, and is negligible in
the late teens.

Pregnancy. During pregnancy, extra energy is needed for the growth of the foetus, placenta and various
maternal tissues, such as in the uterus, breasts and fat stores, as well as for changes in maternal
metabolism and the increase in maternal effort at rest and during physical activity.

Lactation. The energy cost of lactation has two components: 1) the energy content of the milk secreted;
and 2) the energy required to produce that milk. Well-nourished lactating women can derive part of this
additional requirement from body fat stores accumulated during pregnancy.

NOTE: Gender, age and body weight are the main determinants of total energy expenditure. Thus, energy
requirements are presented separately for each gender and various age groups, and are expressed both as
energy units per day and energy per kilogram of body weight. As body size and composition also
influence energy expenditure, and are closely related to basal metabolism, requirements are also
expressed as multiples of BMR.

Quantifying physical activity

A certain amount of activity must be performed regularly in order to maintain overall health and fitness to
achieve energy balance and to reduce the risk of developing obesity and associated diseases, most of
which are associated with a sedentary lifestyle. There are guidelines based on the FITT principle for
desirable physical activity levels. This is the frequency, intensity duration/time, of physical exercise as
recommended by various organizations with expertise in physical activity and health. Appropriate types
and amounts of physical activity can be carried out during the performance of either mandatory or
optional activities and those recommendations must take into account the cultural, social and
environmental characteristics of the target population.

Quantifying total physical activity energy expenditure is difficult since both mandatory and optional
activities should be considered for a 24 hour clock time. The use of METs (metabolic equivalents) for
each activity helps quantify all individual activities in a person's usual lifestyle. Another approach entails
the use of stipulated physical activity levels (sedentary, light, moderate, vigorous and very vigorous)

Children and adolescents

The following general descriptions may help to decide which level of energy requirement is more
appropriate for a specific population group.

11
Examples of populations with light physical lifestyles, or that are less active than average, are children
and adolescents who every day spend several hours at school or in sedentary occupations; do not practise
physical sports regularly; generally use motor vehicles for transportation; and spend most leisure time in
activities that require little physical effort, such as watching television, reading, using computers or
playing without much body displacement.

Examples of populations with vigorous lifestyles, or that are more active than average, are children and
adolescents who every day walk long distances or use bicycles for transportation; engage in high energy-
demanding occupations, or perform high energy-demanding chores for several hours each day; and/or
practice sports or exercise that demand a high level of physical effort for several hours, several days of
the week.

Children and adolescents with habitual physical activity that is more strenuous than the examples given
for a light lifestyle, but not as demanding as the examples for vigorous lifestyle, would qualify in the
category of average or moderate physically active lifestyles.

A certain amount of habitual physical activity is desirable for biological and social well-being. The
regular performance of physical activity by children, in conjunction with good nutrition, is associated
with health, adequate growth and well-being, and probably with lower risk of disease in adult life.
Children who are physically active explore their environment and interact socially more than their less
active counterparts. There may also be a behavioral carry-over into adulthood, whereby active children
are more likely to be active as adults, with the ensuing health benefits of exercise.

On the other hand, sedentary lifestyles are increasing in most societies around the world, mainly owing to
increased access to effort-saving technology and devices and to structural and social constraints.
Examples of these are increased use of automobiles and buses for transportation, piped water and
electrical appliances in the household, electronic equipment and computers in the workplace, elevators
and escalators in buildings, and television sets and computers for entertainment, as well as a reduction in
outdoor playing and walking caused by concerns about crime and the safety of pedestrians and cyclists.
Sedentary children often eat amounts of food that exceed their relatively lower energy requirements, go
into a positive energy balance and are at risk of becoming overweight or obese.

It is therefore important that recommendations for appropriate levels of physical activity accompany
recommendations for dietary energy intakes. Children should perform a minimum of 60 minutes per day
of moderate-intensity physical activity, which may be carried out in cumulative bouts of ten or more
minutes, and which should be supplemented by activities that promote flexibility, muscle strength and
increase in bone mass. This can be pursued by promoting walking, climbing stairs or cycling as part of
everyday activities, and encouraging participation in games and sports that involve body displacement
and a certain degree of physical effort.

Adults: Physical activity level

Examples of lifestyles with different levels of energy demands

Sedentary or light activity lifestyles. These people have occupations that do not demand much physical
effort, are not required to walk long distances, generally use motor vehicles for transportation, do not
exercise or participate in sports regularly, and spend most of their leisure time sitting or standing, with
little body displacement (e.g. talking, reading, watching television, listening to the radio, using
computers). One example is male office workers in urban areas, who only occasionally engage in
physically demanding activities during or outside working hours. Another example are rural women
living in villages that have electricity, piped water and nearby paved roads, who spend most of the time
selling produce at home or in the marketplace, or doing light household chores and caring for children in
or around their houses.

Active or moderately active lifestyles. These people have occupations that are not strenuous in terms of
energy demands, but involve more energy expenditure than that described for sedentary lifestyles.
Alternatively, they can be people with sedentary occupations who regularly spend a certain amount of
time in moderate to vigorous physical activities, during either the mandatory or the optional part of their
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daily routine. For example, the daily performance of one hour (either continuous or in several bouts
during the day) of moderate to vigorous exercise, such as jogging/running, cycling, aerobic dancing or
various sports activities, can raise a person's average PAL from 1.55 (corresponding to the sedentary
category) to 1.75 (the moderately active category). Other examples of moderately active lifestyles are
associated with occupations such as masons and construction workers, or rural women in less developed
traditional villages who participate in agricultural chores or walk long distances to fetch water and
firewood.

Vigorous or vigorously active lifestyles. These people engage regularly in strenuous work or in strenuous
leisure activities for several hours. Examples are those with non-sedentary occupations who swim or
dance an average of two hours each day, or non-mechanized agricultural labourers who work with a
machete, hoe or axe for several hours daily and walk long distances over rugged terrains, often carrying
heavy loads.

Extremes of low PALs. Extremely low levels of energy expenditure allow for survival, but they are not
compatible with long-term health, moving around freely, or earning a living.

ERGOGENIC AIDS IN EXERCISE AND SPORTS

Use of Ergogenic Aids in Exercise and Sports

Due to the importance of small improvements which are very difficult to obtain through normal training
methods, coaches and athletes have looked for alternative methods of enhancing performance through the
use of special aids. These are referred to as ergogenic aids.

 An ergogenic product is any substance or mechanical device that is used with the intention of
improving athletic performance.

 An ergogenic aid is one designed to create a competitive advantage for an athlete.

 The primary consideration regarding the usage of any ergogenic product is its benefit when weighed
against the likely athlete health risks and the desire for a level playing field among competitors

 These include

 Mechanical aids (such as ergogenic fabrics),

 Pharmacological aids,

 Physiological aids,

 Nutritional aids (sports supplements),

 Pychological aids.

Ergogenic Aids may:

 Directly influence the physiological capacity of a particular body system thereby improving
performance

 Remove psychological constraints which impact performance

13
  Delay fatigue or increase the speed of recovery from training and competition (may compromise
safety)

Ergogenic aids can be considered alright as long as:

i. The special aids used are meant to, supplement not to replace excellence in training and
conditioning.
ii. The special aids constitute no hazard to athletes.
It is important to distinguish the ergogenic aids in 2 broad categories; Non-drug aids and drugs aids.

NO DRUG APPROACHES

Use of Oxygen

 It is known that if one trains at a high altitude and competes at sea level, the athlete's performance
will be better as his/her endurance shall be improved.

 The rationale here is that at higher altitudes, there is a lower level of O 2 in the air.

 This will result in an increase in the O 2 carrying capacity of the blood. Competing at lower altitudes
with greater O2, delivery capability should raise one's endurance level.

Obviously, use of O2 during work at altitudes is not only advantageous but absolutely necessary
depending on the altitudinal level and the participants' level acclimatization. However, one use of O 2 for
athletes that rests on sound theoretical and experimental basics is when it is used for the purpose of
shortening recovery period at high altitude. In sports, that involves rest periods between endurance work
bouts, such BB and soccer. Repayment of O2 debt can be (hastened in the unacclimatized athlete by
artificial supply of O2.

 Another efficient way of increasing the O2 carrying capacity is blood doping.

 This process consists of withdrawing about 1 litre of athlete's blood about 4 weeks before the
endurance event holding it for 9-12 weeks while haemoglobin levels return to normal and then
reintroducing the withdrawn blood into athlete's body just before competition.

 This has experimentally been proved to be a very potent method in increasing an athlete's endurance
capacity- (where an average decrease of 45 seconds in running 5 miles on treadmill has been reported
though some researches refute its effects).

 Unfortunately, this approach may be counter indicative if used in women due to monthly loss of
blood in menstruation. Even in men, a diet rich in iron is a must during the holding period.

Pregame Meal
 It is a traditional practice since the time of ancient Greeks to give pregame meals to athletes.

 Unfortunately, they would feed them on steak (meat) since this contains fat and proteins. It is the
worst pregame meal one could ever have for

 It takes too long to be digested - up to 6 hours

 Its digestion places a lot of demand on the circulatory and respiratory systems during the event.
(Requires high energy and depresses the body)

 It Dehydrates the system - it require a lot of water to digest thus straining the body more during the
event

14
However, pregame meals should be light, balanced and quick in energy giving.

Carbohydrate Loading
 A carbohydrate-loading diet, also called a carb-loading diet, is a strategy to increase the amount of
fuel stored in your muscles to improve your athletic performance.

 Carbohydrate loading involves greatly increasing the amount of carbohydrates you eat several days
before a high-intensity endurance athletic event.
 You also typically reduce activity level during carbohydrate loading.

Purpose
Any physical activity you do requires carbohydrates to provide you with fuel. For most recreational
activity, your body uses its existing energy stores for fuel. But when you engage in long, intense athletic
events, your body needs extra energy to keep going. The purpose of carbohydrate loading is to give you
the energy to complete an endurance event with less fatigue, improving your athletic performance.
Carbohydrate loading is most beneficial if you're an endurance athlete - such as a marathon runner,
swimmer or cyclist - preparing for an event that will last 90 minutes or more. Other athletes generally
don't need carbohydrate loading. It's enough to eat a diet that derives half or more of its calories from
carbohydrates.

Diet details
The role of carbohydrates
Carbohydrates, also known as starches and sugars, are your body's main energy source. Complex
carbohydrates include legumes, grains and starchy vegetables, such as potatoes, peas and maize. Simple
carbohydrates are found mainly in fruits and milk, as well as in foods made with sugar, such as sweets.
During digestion, your body converts carbohydrates into sugar. The sugar enters your bloodstream, where
it's then transferred to individual cells to provide energy. Sugar is stored in your liver and muscles as
glycogen - your energy source.

Increase your energy storage

Your muscles normally store only small amounts of glycogen - enough to support you during recreational
exercise activities. If you exercise intensely for more than 90 minutes, your muscles may run out of
glycogen. At that point, you may start to become fatigued, and your performance may suffer.
But with carbohydrate loading, you may be able to store up more energy in your muscles to give you the
stamina to make it through longer endurance events without overwhelming fatigue. You still will need to
consume some energy sources during your event.

Two steps to carbohydrate loading

Traditionally, carbohydrate loading is done in two steps the week before a high-endurance activity:
iii. Step 1. About a week before the event, adjust your carbohydrate intake (by reducing it
significantly). Increase protein and fat intake to compensate for any decrease in energy intake.
Continue training at your normal level. This helps deplete your carbohydrate stores and make
room for the loading that comes next.
iv. Step 2. Three to four days before the event, increase your carbohydrate intake to about 70 percent
of your daily calories. Cut back on foods higher in fat to compensate for the extra carbohydrate-
rich foods. Also reduce your training to avoid using the energy you're trying to store up. Rest
completely the day before your big event.

The amount of carbohydrates you need depends on your total calorie goal as well as your sport. For most
athletes, 5 to 7 grams of carbohydrate per kilogram of your weight daily is right for general training.
However, endurance athletes may need 6 to 10 grams per kilogram of weight. (1 kilogram equals 2.2
pounds.)

Results
Carbohydrate loading may give you more energy during an endurance event. You may feel less fatigued
and see an improvement in your performance after carbohydrate loading. But carbohydrate loading isn't
effective for everyone.

15
Other factors can influence your athletic performance or interfere with the effectiveness of your
carbohydrate-loading strategy, including your fitness level, hydration and the intensity level of your
exercise. Even with carbohydrate loading, you still may feel muscle fatigue.
If you're a man, a carbohydrate-loading diet can increase the levels of glycogen stored in your muscles
from 25 to 100 percent of your normal amount. However, carbohydrate loading may not be as effective if
you're a woman. Fewer research studies exist about carbohydrate loading in women, and they've yielded
mixed results. A woman may need to consume more calories than usual during carbohydrate loading to
get the same benefits as a man does. A woman's menstrual cycle also may affect the effectiveness of
carbohydrate loading for reasons not yet clear.

Even if you've practiced carbohydrate loading, you still need to replenish your body's energy during
endurance events to maintain your blood sugar levels. You can do this by periodically consuming sports
drinks, fruit, hard or chewy sweets during your event at the rate of 30 to 60 grams an hour. And don't
forget to eat carbohydrate-rich foods after your endurance event, too, to replenish your glycogen stores.

Risks
Carbohydrate loading isn't right for every endurance athlete. It's a good idea to consult your doctor or a
registered dietitian before you start carbohydrate loading, especially if you have diabetes. You may also
need to experiment with different amounts of carbohydrates to find something that works best for your
situation.
A carbohydrate-loading diet can cause some discomfort or side effects, such as:
1. Weight gain. Much of this weight is extra water, but if it hampers your performance, you're
probably better off skipping the extra carbohydrates.
2. Digestive discomfort. You may need to avoid or limit some high-fiber foods one or two days
before your event. For example, beans can cause gassy cramps, bloating and loose stools when
you're loading up on carbohydrates.
3. Blood sugar changes. Carbohydrate loading can affect your blood sugar levels. Monitor your
blood sugar during training or practices to see what works best for you. Consult a doctor to make
sure your meal plan is a safe one for your situation and medical condition

DRUG RELATED APPROACHES

Performance Enhancing Drugs
 Performance enhancing drugs consist of a variety of substances, including medications, procedures
and even devices that are intended to improve athletic sports performance.
 Some of these substances are naturally occurring, easily available and completely legal while others
are manufactured, illegal, or banned by many sporting organizations.

In general, performance enhancing drugs and substances (ergogenic aids) can be categorized into the
following areas.

 Sports Supplements, Vitamins and Minerals

 Banned or Regulated Performance Enhancing Drugs

 Sports Supplements, Vitamins and Minerals

 All dietary supplements consumed by athletes, including those manufactured from protein, amino
acid, and vitamin complexes, are ergogenic.

 Many performance enhancing substances classified as supplements are widely marketed as "health
aids" yet have limited research on their safety or effectiveness.

Use Of Vitamins B15 (Pangamic Acid)

 One of the waste products of anaerobic respiration resulting from muscle metabolism is lactic acid

 Its accumulation leads to both fatigue and pain hence reduced endurance.

16
 Some athletes use Vitamins B15 (Pangamic acid) to increase this much needed endurance.

 The active agent vitamins is a mere food additine and not a vitamin. Some reports have cited
successful lowering of blood lactic acid as well as an increased utilization of O 2 in the muscle
following use of Vitamins B15. However, other reports disapprove these findings

 Granted these incongruency of research findings of Vitamins B15 on both its effects and safety, the
use of this chemical should be discouraged.

Creatine
 Creatine has been of particular interest as an ergogenic aid because of the role that creatine phosphate
plays in energy production.

 Creatine is important in short-term high intensity exercise, such as a 100-m sprint or weightlifting

 During the first few seconds of exercise creatine phosphate is broken down to produce ATP. This is
an extremely fast method of energy production yet the muscle only has very limited creatine stores.

 The use of creatine supplements attempts to maximize muscle stores and thereby enhance energy
production.

 The body synthesizes its store of creatine from amino acids ingested in dietary proteins. There is
now considerable scientific research that creatine supplements may create a slight advantage for an
athlete in both short-term energy as well as the ability of the athlete to recover from exercise

 . Conversely, creatine supplements will likely be of little or no benefit to endurance athletes, as the
aerobic energy system does not utilize creatine in this fashion. Consuming creatine for any purpose
other than its narrow ergogenic parameters provides no benefit to an athlete. There have also been no
studies on the long-term safety of creatine.

Caffeine
 Caffeine is used in medicine as a central system stimulant particularly in physical functions.

 Medicinal dosages range from 100-600 mgms.

 A cup of coffee usually contains 100-150.

 Caffeine is likely the most commonly consumed ergogenic substance in the world.

 It is a proven stimulant to the central nervous system and plays a role in the manner in which the
body's fat stores are metabolized in endurance activities.

 Excessive caffeine consumption negates any ergogenic effect, as the user will experience irritability,
restlessness in movement, and increased diuresis (urine production and fluid loss).

 Caffeine is a naturally occurring substance that has been used by endurance athletes for years as a
way to stay alert and improve endurance.

Effects of caffeine

 Relieve stress

 Delay in the decline of performance over time

 Decrease in the feeling of exertion during the activity

 Increased speed of gastric emptying

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 Encourages fat oxidation in the body thus sparing the muscle glycogen and increasing the capacity
for endurance.

While generally not harmful, caffeine does have side effects, and is banned (in high doses) by many
sports organizations. Unfortunately its use results in

 In impairment of motor coordination (compromising safety)

 It also gives a hangover effect, where after its administration for successful mental stimulation and
efficiency is achieved, this efficiency then falls off below normal values from 1-3 hours after taking it

 Due to fat oxidation, it adversely interferes with the body carbohydrate and protein metabolism

 May cause cardiovascular functioning to be impaired.

NOTE: The effect of caffeine closely resembles that of amphetamine (Benzedrine) in stimulation and
reduction of fatigue. Surprisingly, there is no condemnation so far on the use of coffee by athletes during
competitions or ordinary life has been done.

A caffeine level in the urine above 12mg/l is not permitted under international doping regulations (a level
achieved by taking approximately 500mg caffeine, equivalent to 6-8 cups of coffee, in a single sitting).
However, ergogenic effects are produced at lower levels than this.

Amphetamine (Benzedrine)
 Amphetamines are central nervous system stimulant drugs that increase alertness and self confidence,
improve concentration, decrease appetite and create a feeling of increased energy.

 Amphetamines such as Benzedrine, Adderall, and Dexedrine have a high potential for addiction and
are on the banned substance list of most, if not all, sports organizations.

 It is abused while being used as a fatigue remedy as well as a means to increase athletic work
capacity by improving knee extension strength.

 It is dangerous because.

 It removes warning of an impending overstrain

 It is highly addictive

 Its use may lead to collapsing- hence its use pharmacologically discouraged.

 Alkalinizers
 The magnitude of the O2 debt left after activity is related to the blood PH (of a more acidic level)
which in turn depends on the alkaline reserve (i.e. the capacity for buffering the lactic acid formed
during work).

 The idea here is to displace the blood PH upward prior to exercise by ingestion of alkaline salts so
that upon commencement of exercise, a heavy workout results only in a return to the normal PH
value instead of a displacement towards more acidic values as occurs in formation of lactic acid.

Anabolic Steroids
 Testosterone the male sex hormone has 2 primary types of action: androgenic and anabolic.

18
 The androgenic effects are those that are masculinizing, causing the growth of the accessory sex
glands and the larynx, changing the amount and distribution of body hair etc.

 The anabolic effects stimulate the growth of the muscle hence adding to strength capacity.

 Anabolic steroids then are synthetic modification of testosterone that are designed to enhance the
anabolic functions with minimal or no androgenic effects.

 The use of large doses of anabolic steroids by male athletes as well as moderate amounts by healthy
young adult males leads to suppressed secretion of gonadotropin, atrophy of tubules and interstitial
tissue of the testes, occasional prostratic hypertrophy beside other problems.

 Anabolic steroids (anabolic-androgenic steroids), are synthetic versions of the male hormone
testosterone.

 Non-medical use of anabolic steroids is illegal and banned by most major sports organizations.

 Still, some athletes continue to use them illegally in an attempt to improve sports performance,
despite evidence that using them this way can cause many serious health problems.

 Female sex hormones have been used to feminize males so that they can complete in women events.
For example, the woman's gold sprinter in 1964 Olympics was shown by chromosome testing to be a
male and he/she had to return the medal.

Cyproterone,

 an anti-androgenic agent has blood doping effects- while some investigators have found this to be a
very effective method, others found it to be of no physiological help.

 However, it is a means of getting "unfair advantage". If used by non-medically trained personnel may
result in;

Infection
Blood poisoning
Intravascular blood clotting.
 This drug has been in use to delay puberty in females particularly by gymnasts since puberty shifts
the centre of gravity lower in the body and changes body proportions in a way that adversity effects
performance

 . However, the use of anabolic steroids by females results in musculanization e.g. growth of facial
hair, deepening of voice, growth of the muscle etc.

DHEA (Dehydroepiandrosterone)

 The manufactured version of DHEA (Dehydroepiandrosterone) a designer steroids, is a precursors

to hormones, such as testosterone, and work in a similar manner to anabolic-androgenic steroids

 . Its ingestion may precipitate the greater production of testosterone within the body.

 DHEA is one of the many ergogenic substances banned in sports competition, and by the World Anti-
Doping Agency

 . Like anabolic steroids, it has a demonstrated ability to improve muscle mass, but at a significant
physical risk to the athlete.

Erythropoietin (EPO)

 Erythropoietin (EPO) is a naturally-occurring hormone, produced by the kidneys, that stimulates the
production of red blood cells.

19
 This hormone can also be manufactured and injected.

 Most recently EPO has been linked to the professional cycling world.

 Although EPO is on the banned substance list, some claim cyclists continue to use it to boost
performance.

ENVIRONMENTAL FACTORS

Exercise and Heat System

 During exercise the body produces a great deal of heat.
 In extreme circumstances this can elevate its core temperature from 37 0C to beyond 400C.
 When the surrounding air is cool, heat can be lost from the body by the process of radiation (transfer
of heat by electromagnetic waves), convection (by air movement), conduction (by contact), and
evaporation (by sweating).
 As the surrounding temperature increases it becomes more and more difficult to lose heat by
radiation, convection, and conduction.
 Hence, the predominant source of heat loss in warm to hot conditions is from the evaporation of
sweat on the skin surface.
 To retain a normal temperature heat must be transported from the core to the skin.
 The blood flow must be raised below the skin and subcutaneous tissues. This results in greater
volumes of slower-moving blood as close to the skin for better transfer of heat to the evaporative
surfaces for better cooling.
 The volume of the circulatory system is increased by a considerable amount under these conditions,
venous return to the heart is somewhat impaid and this results in a decreased stroke volume.

 To maintain a constants cardiac output for the demands of both exercising muscles and skin
circulation, the heart rate must increase.

 Because increases in heart rate depresses (reduces) cardiac efficiency, exercise at temperatures close
to or above skin temperature can impose very severe loads upon the cardiovascular system, even
when the air is relatively dry.

 Since the entire processing heat dissipation now depends on elimination of water in perspiration,
obviously dehydration sets in.

 Sweat losses exceeding 6 liters have been recorded in marathon runners.

 These deficits constitute a body weight reduction of 8-10 percent and a body water loss of 13-14
percent.

 Team-game players performing in warm to hot conditions can sweat at a rate of 2 liters per hour.

 During a game this can amount to a loss in body weight of 5 percent and a reduction in body water of
more than 10 percent.

 Losses in body weight of 2 percent have been shown to result in reductions in endurance
performance as well as increase heart rate by 5 bpm.

Activity in Hot, Dry Environment

For this case, there is no much problem in evaporation for the air is not saturated with vapor. Cooling the
skin is not the desired end result, it is the internal environment that must be cooled at all costs.

Hot Humid Environments

 When the air surrounding an individual is hot and humid, evaporative cooling is impaired for
evaporation is inhibited by the high saturation of water vapor in the air.

20
 Under these conditions, no heat dissipation can occur and consequently, the metabolic heat
accumulates and temperature rises to death (108-110F).

It may therefore be concluded that, the problems in a hot dry atmosphere are related to increased
cardiovascular loads and dehydration if water intake is insufficient. In a hot humid climate the same
problems exist and are aggravated by a lessened ability to unload water vapor into already saturated
atmosphere for cooling purposes.

Heat Acclimatization
 Partial adaptation to heat stress occurs even with training at moderate temperatures, but, full
adaptation to heat can only be achieved by actually working in hot conditions.
 The adjustment is very rapid and is achievable in about 7 to 10 days if regular daily exercise for 90
minutes is undertaken.
 This should begin by training at a reduced intensity (60-70% of the usual load), so as to avoid heat-
related disorders.
 Heat acclimatization expands the blood volume, which supports an increased capacity and precision
of sweating.
 At a given relative workload a fit, acclimatized person commences sweating sooner, sweats more
evenly over the skin surface and thereby loses less salt.
 An acclimatized person performs in a heat tolerance test with greater circulatory stability (lower
heart rate) and lower core and skin temperatures than someone who is not acclimatized.
 However, the acclimatization process is retarded by dehydration. For optimal adaptation to occur,
fluid balance should be maintained during the recovery periods between daily bouts of work in the
heat.

Adaptations that occur as a result of acclimatization to exercise in the heat:

 Sweat rate in the skin areas exposed to heat is higher, thus enhancing evaporative capacity.
 An increased production of aldosterone can strongly stimulate the sweat glands and cause them to
reabsorb more sodium and chloride.
 Earlier onset of sweating leads to a lower skin temperature, improved core-skin temperature gradient,
and less demand for blood flow to the skin.
 This later provides improved muscle blood flow and oxygen supply.
 Plasma volume increase, due to increased production of aldosterone and antidiuretic hormone
(ADH).
 Aldosterone causes sodium and chloride retention by the renal and sweat tubules, and
 ADH increases renal water retention.
 Hence, there is a decrease in sweat sodium and chloride, but not potassium.
 More sodium is retained, which promotes water retention.
 Plasma and interstitial fluid volumes can increase 10-20%.
 Body core temperature can be kept lower, as heat dissipation is more efficient.
 Heart rate is lower at any given work load, as the core temperature is lower, plasma volume is higher,
skin blood flow distribution is decreased, and there is improved stroke volume.
 The perception of heat stress is reduced.
 Onset of fatigue is delayed, as the rate of muscle glycogen utilization is decreased.
 Men and women acclimatize equally well. Training in a hot, humid environment is more stressful
than training in hot, dry conditions.

Clothing
 During exercise in hot conditions, it is recommended that participants wear light-colored clothing
made from open-weave natural fibres (e.g., cotton, wool).

 As much of the skin as possible should be exposed to the air to maximize the evaporation of sweat.

 Clothing made from synthetic fibres, such as nylon and polyesters, offers more resistance to heat
removal and, in time, becomes uncomfortable.

21
EXERCISE AND COLD
 The body's hypothalamic set-point for temperature regulation is about 37ºC +/- 1ºC.
 A decrease in skin or core temperature signals the thermoregulatory center in the posterior
hypothalamus to set off a number of mechanisms to increase heat production.
 These include:
 Shivering-involuntary muscular contractions in response to cold. This can cause a 4-5 fold
increase in heat production. Shivering results in decreased muscular coordination and impairs
performance.
 Non-shivering thermogenesis. The sympathetic nervous system releases epinephrine and nor-
epinephrine in response to cold exposure, causing anaerobic glycolysis and a release of free fatty
acids from fat stores. This mechanism occurs in young children because of their rich brown fat.
 Increased thyroxin production. Hypothalamic thyrotropin-releasing hormone (TRH) rises,
stimulating TSH release and ultimately elevated thyroxin production to increase general
metabolic rate.
 Peripheral vaso-constriction. The sympathetic nervous system stimulates skin's smooth muscle
contraction, thus shunting blood away from the skin and into deeper tissues.
 The balance between heat loss and heat production is controlled by a number of factors.
 Generally, the greater the gradient between skin and environmental temperature, the greater the
heat loss.
 However, a great number of anatomic and environmental factors affect the rate and degree of
heat loss.
 For example, body size and body composition influence heat loss. Subcutaneous fat acts as an
insulator. Smaller athletes such as children have a higher surface area/mass ratio, and may sustain
greater heat loss. Clothing helps reduce heat loss.

Decreased Heat Loss

 Radiation is the physical action whereby heat is radiated from the body to nearby cooler objects.

 Curling the body into a tuck and reducing the exposed surface area can minimize heat lost. Such a
response is common when resting in cold conditions.

 Limiting the blood flow through the skin also can reduce heat loss by radiation. This is the first line
of defense against cold and is managed by reflex constriction of the blood vessels supplying the skin.
This mechanism is capable of improving the insulative capacity of the skin sixfold

 . Cooling the skin in this way reduces the temperature gradient between it and the environment and
effectively reduces heat loss.

 However, this means of heat conservation results in the fingers and toes, with their large surface area
to mass ratio, becoming particularly cold and losing their speed and dexterity. This is a problem in
target and touch sports such as fishing, shooting, and golf. In extreme conditions, frostbite injuries
can be sustained. Acclimatization to cold conditions promotes some improvements in local blood
flow and enhances the capabilities of the extremities to perform with skill and precision.

 The shutdown of blood flow to the skin of the head is much less than that in the hands and feet. If the
head is exposed to the cold, substantial heat loss can occur. This has resulted in strong
recommendations to wear headgear during sports played in the cold.

Thin pre-pubertal children with a high surface area:mass ratio are particularly susceptible to cooling while
swimming in cold water. Central body temperatures below 35 C have been commonly observed in
children after swimming in 20 C water temperatures. This is of some concern to swimming coaches who
rely on the child's perception of cold to provide necessary protection. A lean and ambitious young athlete
could easily become hypothermic while training enthusiastically in cool conditions (particularly when
swimming) and should be watched carefully.

Convection occurs when heat is transferred from the body to free air. As cold air comes into contact with
the body it is warmed, becomes less dense through expansion, and rises. The role of clothing is to trap
22
warmed air close to the skin and develop a microclimate that is comfortable and heat retaining.
Windproof over-garments should also be worn to avoid excessive heat loss in such conditions.

Evaporation is the means by which heat is lost through sweating. Becoming inactive immediately after
heavy sweating can invite rapid cooling and a dramatic fall in body temperature. This can occur on the
bench after an intensive period of play in a team game or perhaps as a result of an enforced rest during an
endurance event. It is important to have warm, dry clothing available to arrest the decrease in body
temperature in such situations.

Appropriate layers of clothing should be considered in vigorous sports in the cold. The appropriate
number of layers can be removed to maintain the proper level of heat loss while maintaining dry clothing.
Clothing which permits insulation to be added or subtracted in accordance with the intensity of exercise is
the most useful. Jackets that open down the front are more convenient than pullovers.

It is important not to overprotect the hands and feet against the cold as the body will perceive itself to be
very warm and not invoke the physiological temperature regulation processes that prevent a fall in core
body temperature. It is better to insulate the trunk rather than the extremities.

Should an athlete not follow these recommendations and develop hypothermia during a sporting contest it
is critical to immediately start the rewarming process. After providing shelter, wet clothes should be
removed and replaced with dry, warm ones. The individual should be warmed gradually under blankets or
in a sleeping bag, administered warm, sugared drinks and kept awake until normal body temperature has
been restored.

Exercise and Altitude (Hypobaric Environment)

Air at altitude is commonly mistaken for being lower in oxygen but this is incorrect. Air, at any level,
contains 20.93% oxygen, 0.03% carbon dioxide and 79.04% nitrogen. Instead, as elevation increases,
oxygen has a progressively lower partial pressure.

Altitude adversely affects performance in aerobic events (i.e., those lasting more than two minutes),
because the partial pressure of oxygen decreases as barometric pressure falls (as one ascends). This leads
to a decline in pulmonary diffusion of oxygen into the blood. When the body senses that it is not receiving
its accustomed level of oxygen, it determines that it must produce a greater number of erythrocytes (red
blood cells), which carry oxygen to the bloodstream. The increase of transportation capability means that
the body will be optimizing the amount of available oxygen.

High altitude training is a proven effective performance-enhancing tool, as the ability of an athlete to
utilize greater amounts of oxygen will naturally support improved capabilities. The physiological benefits
of high altitude training continue for between one to three months after the return of the athlete to sea-
level training conditions.

Effects of Chronic Altitude Exposure

1. Blood
Erythropoietin stimulates red cell production, and eventually higher hemoglobin and hematocrit.
Adequate dietary iron is essential to meet this demand for increased erythropoiesis.
2. Muscle
Muscle cross-sectional area may decrease with chronic altitude exposure, though capillary density
increases to deliver blood to the tissues. At very high altitudes (over 2500 m), levels of muscle enzymes
decline, so that muscles are less able to generate ATP aerobically or anaerobically.
3. Cardiorespiratory
Ventilation is stimulated by the hypoxia of altitude. This causes carbon dioxide removal and respiratory
alkalosis. Bicarbonate is excreted and remains low, decreasing buffering capacity.
Muscle oxygen uptake decreases at altitude, and improves little with prolonged exposure. This may be
due to the profound hypoxia that occurs during exercise at altitude and the consequent inability to train at
an adequate intensity and volume.

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Respiratory System Response to Altitude
1. Breathing rate increases at rest and during exercise..
2. Oxygen diffusion decreases.
3. The diffusion gradient at the active tissues decreases.
4. VO2 max decreases.

Preparation for Competition at Altitude

A period of adaptation to altitude is essential in preparation for competition, if one lives at sea level.
Consider the following (with examples in athletics):
1. The adaptation period at altitude should be at least 3 or 4 weeks prior to the start of competition.
2. Athletes should be in good general health, free of medical and orthopedic problems, and not iron
deficient prior to beginning altitude training. Iron supplementation should be used if are low.
3. Training volume, intensity, nutrition, and health should be carefully monitored during the training
and competition processes.
During the first week, aerobic adaptation should be stressed. Training volume should be moderate,
about 75-80% of sea-level loads (not 100%).
Intensity should increase in the second week, with mixed aerobic and anaerobic sessions.
During week three, emphasis is on maintaining speed, with aerobic work at the highest levels
possible. Intensity of runs may be maintained by increasing rest time between interval runs.
Week four is for tapering and recovery prior to the start of competition.

Altitude Illness
Rapid ascent to elevations of 1500m or more, especially above 2400m (8000ft), may result in acute
"mountain sickness" or, rarely, a severe altitude illness syndrome, such as high altitude pulmonary
oedema (HAPE), or high altitude cerebral oedema (HACE).
Symptoms of altitude illness include headache, nausea, lethargy, anorexia, vomiting, and disturbed sleep
patterns. Symptoms may begin within hours of ascent, peak in 1-2 days, and generally resolve in 3-4
days.
High altitude pulmonary oedema (HAPE) and high altitude cerebral oedema are serious medical
emergency. The following may help prevent altitude illness:
1. A gradual ascent of no more than 300 m-600 m per day over 2400 m should be made.
2. Prescribed medication for symptoms likely to appear.

Hyperbaric Environments
At any point on earth, the more air that is above that point, the greater the barometric pressure will be.
This is the same principle as being under water. The deeper a diver is the more water there is above her
and the greater the pressure.

This topic looks at the challenges of human exposure to the underwater world. The severity of these
challenges is greater than for any other human activity and are due to pressure (depth), temperature
extremes, and the unbreathable ambient medium. They affect locomotion, respiration, circulation, renal
and nervous systems, and water and thermal balance due to the physical properties of water.

Physiological adaptations to the strains caused by the underwater environment are achievable, while other
challenges require an artificially created "microenvironment" (breathing gear, diving suit, etc.), and yet,
adjustment is not always sufficient, resulting in injury and even death.

An important issue on pulmonary gas exchange in diving', deals with the effects of depth, including
immersion and pressure, on respiration. Increased pressure of the respired gas typically exposes the diver
to high partial pressures of oxygen and nitrogen during air breathing or other inert gases.

Increased nitrogen pressure in the lungs generates higher tissue nitrogen pressure, and during ascent, this
leads to an excess of nitrogen that must be eliminated via the lungs. If this elimination does not keep pace
with the reduction in depth, decompression sickness might ensue. Nitrogen is diffused into the blood
causing a risky condition called nitrogen narcosis' (read further on this).
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Hyperbaric Oxygen Therapy and the diving environments
Hyperbaric oxygen therapy employs a special airtight chamber to increase the atmospheric pressure
surrounding a person (ambient pressure). The pressure may be increased several times above normal
atmospheric pressure. The chamber is compressed with air while the patient breathes 100 percent oxygen.
With a normal cardiovascular system, this increases the total amount of oxygen delivered to the cells by
the blood stream (Henry's law).

Normally, most of the oxygen circulating in the body is carried by the red blood cells (haemoglobin).
However, hyperbaric oxygen dissolves any extra oxygen into the plasma (Henry's law). The total oxygen
carried to the tissues is about 10 times more than breathing air at sea level. The increase in the oxygen
concentration in the blood stream promotes the healing of certain medical conditions such as chronic
wounds.

Divers will not be subjected to pure hyperbaric oxygen (pure oxygen under pressure) when taking a dive.
Excessive use of pure oxygen can result in oxygen toxicity (oxygen poisoning). However, this can be
used during recovery in instances where they experienced hypoxia, or other side effects such as presence
of gas bubbles in blood and hydrogen narcosis. The application of air in high pressure preferably in
combination with oxygen, or just hyperbaric oxygen is used to eliminate the gas bubbles in blood vessels
that cause decompression sickness in divers.

Jetlag & Exercise

The following are a number of steps that can help minimize the effects of jet lag on athletes and their
performance:
Arrive at the competition site as early as possible. Allow one day for each time zone of eastward flight,
and 0.6 days for each zone of westward travel.
Before departure, adjust eating, sleeping, work, and training schedules in the direction of the new time
zone, by 1-2 hours each day over a 4-5 day period.
Arrange flights so as to arrive close to local bed-time.
Eat high protein /low carbohydrate meals for 3 days prior to flight, and during flight. Try to follow a meal
schedule that will be used at your destination. After arrival, starting with breakfast and lunch, eat high
protein/low carbohydrate meals, and use tea or coffee to enhance synchronization.
Avoid alcohol as a sleep-inducer, as it interferes with sleep and delays sleep-wake cycle adaptation. Drink
large amounts of caffeine-free drinks (juice, water) to prevent dehydration.
At departure, set watch to destination time, and adjust sleep, meals, and other activities accordingly. Upon
arrival, immediately adjust schedule (social contacts, bright sunlight, meals, training, etc.) to local time.
Maintain regular sleep-wake schedules.
Stressors, such as competition anxiety, coping with climate and food changes, and other environmental
and social factors can exacerbate the effects of "jet-lag." Dealing successfully with these elements may
minimize the effects on performance.

GENDER FACTORS IN EXERCISE

Physiological differences
Considering both male and female participants, there are many discernible physiological differences that
are of general significance however, many directly apply for athletic performances
Male and Female Anatomical +Physiological Differences
The males have lower exercise heart rate superiority than females due to their larger heart size.
They are also generally stronger and faster due to the larger muscle mass, capable of generating more
power and strength than in females.
Certainly, males' wider shoulders and longer extremities in relation to trunk length give mechanical
working musculature. Due to a great lung surface a larger heart and higher blood hemoglobin level males
have higher performance ability than females.
Female generally have greater quantities of sub-coetaneous dispose tissues than does her male
counterparts which gives an advantage in heat retention.

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Basal Metabolic rate (BMR) _ from just before puberty and through the life span, BMR as measured
for body surface area is higher for male than for female.
However, considering the relationship to muscle mass (since some males and females may have the
same), the thin sex difference may not count as much.
Blood Constituents_ on average, men have more hemoglobin and erythrocytes than females.
Consequently they have greater O2 carrying capacity
Microcirculation_ The capillary function below the skin is more superior in men than in females. It has a
greater ability to withstand mechanical manipulation as well as being better in reacting to ultra-radiation.
Due to these differences, the higher susceptibility to bruises in females in accounted for.
Erholungs Quotient (EQ) _which is the relationship between increased O 2 consumption during exercise
to the increased O2 consumption during recovery is used as an indicative measure of physical work
capacity. It is higher in males than females although for ages12-15 years, boys and girls measure equally.
Cardiac cost- this provides a measure of withstanding stress of a given work load on the heart. Girls
reach maximum at age 12-13 without a further change in life time. The males also remain constant at this
age except a slight change at age 31-36.
Maximum O2 consumption -Girls attain a maximum O2 consumption per unit weight between 8-9 years.
This climax declines then slowly to about age 15 after which it remains constant through young
adulthood. Boys reach their peak at about15 or 16 years old and maintain this through young adulthood.
Generally (considering all other factors) both sexes are at their best in performance at ages 18 to 22.
When maximum aerobic capacity (maximal O 2 uptake) is considered in terms of total bodyweight, the
male have larger tissue which O2 must be supplied to.
Neuromuscular Function- There is no actual (real) sex differences in regard to either motor learning rate
capacity.

Physiological Factors In Female Athletism

There are so many myths, misconceptions and superstitions regarding female athletism. Sound
physiology knowledge is necessary to demystify these mistaken motions.
Women contemplating athletic participation fear loss of their femininity in appearance. Research show
that properly designed exercise programs indeed improve rather than hinder femininity. The observation
that some athletic girls are really masculine is undoubtly due to the fact that masculine girls are more apt
to be successful in such sports as track and field events which they optionally go for. Research also
reveals that there is no negative effect of strenuous exercise on female sexual and reproductive factions.
There is no evidence of incidences of dysmenorrheal or any adverse effects except for infections as
prevalence of vaginal bacterial infection among the swimmers has been observed as well as reported
together with lower abdominal pains due to contamination.
Girls and women always fear that strenuous will result in a heavily muscled unfeminine appearance.
However the truth is the degree of physical activity participation cannot change the inherent capacity
for muscle development which is genetically determined by the sex hormone level. Only the use of
male hormones or anabolic steroids has been reported to increase the muscle mass of females ( as well
as males ) when coupled with a protein diet ( to provide the amino acids ), and heavy exercises (to
provide the training stimulus). In fact, even if females engaged in weight training, no bulky genetic
potential required is present to cause this development.
Again, this does not mean that females shall not respond to resistance (strength) training by increasing
strength, rather, just like men females also do increase their strength when placed on a programme.
The fact that no muscular hypertrophy comparable to men occurs does not signify lack of strength
development (hypertrophy is a mere consequences of plasma testosterone levels presence in the male's
body).
There is considerable tendency for women to withdraw from training after childbirth due to new
responsibilities while a few make modifications to their previous participation. However, women agree
that they feel tougher after child birth and have more strength and endurance. Thus, pregnancy far from
being a health condition should be considered an intensive day and night 9-month period of intense
physical conditioning because of increased demands upon metabolism and the entire cardiovascular
system.
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One highly contested area about female participation in athletics relates to her menstrual cycle.
Despite the varied myths related to this issue, studies have conclusively shown that, no athletic activity
needs to be adjusted or modified for women during any phase of their menstrual cycle.
Accustomed activity can be continued during menstrual flow without any problem. However, because of
individual variability, the lady athlete should have freedom of choice during menstruation and coaches
should not hesitate to urge and allow willing athletes to go for full participation at any time through the
menstrual period (28 days) and probably should be encouraged to do so in order to alleviate fears
associated with such participation.
There have been fears to the effect that, active atheism may cause uterine damages. However, no
experimental or clinical evidence support this. On the contrary studies show that female athletes are more
likely to have normal menstrual function. There is advice to coaches to let their female athletes decide
freely what to do during menstruation or not to do. This owes to the fact that there is a great degree of
variability among females with regards to the role of exercise and difficulties while others experience
some discomfort regardless of whether they are physically active or sedentary. Among the later
case many of them have observed no change in discomfort with activity in terms of either helping
solve their menstrual difficulties nor aggravate them, more research is needed to get exact relationship
between menstruation and physical activity
One response that has been reported in many women athletes is a condition known as secondary
amenorrhea or abnormal cessation (a break) of monthly periods. Runners ,distance swimmers , skiers
gymnasium, balers etc where strenuous exertion over long periods of time is required have been
reported to experience this condition.
-Approximately 15-20% female athletes experience this condition. Frequently, a significant weight loss
precedes this condition especially when dieting and exercise are pursued together which is common.
Closely related to this observation, women have also experienced irregularity of periods .There are
suggestions that the low % of body fat resulting from regular vigorous exercise might be responsible
for amenorrhea /periods irregularities in women because the body does not possess sufficient stored fat
to maintain a pregnancy. Thus, according to this physiological theory it is the Mother's nature's way of
telling when she may not be able to support one through term I. i.e. the reproductive system shuts down
and conception cannot occur.
Critics of this body - fat - reduction theory point that, many females who maintain normal body fat still
experience these conditions. Consequently ,another theory comes in which suggests that any kind of
stress ,whether physical emotional etc could lead to cessation of menstruation as has been proven with
many women e.g. taking new jobs, preparation for marriage , joining a new college etc .However ,it
remains a medical mystery why some women tolerate stress with no change in their menstrual cycle
while others cease to menstruate under similar condition.
It has been noted in isolated studies that, some girls who are active in sports prior to beginning their
menstruation would have its onset delayed to commence at age 15 -16 .This is however a recent
observation and no conclusions have been arrived to.
-Both males and females have both types of sex hormones. The ratio of androgens is higher in males and
estrogens in females -hence the different responses to muscular development.
-Females have smaller hearts, hence smaller strokes volume than males for an equivalent level of effort in
compensation, though her heart rate is higher. This is why females would reach higher maximal heart
rates than males.
- Thus with a lower maximal stroke volume , lower hemoglobin level and less lung surface, the O 2
carrying and delivery capacity is less in females
- In well conditioned \trained females, injuries susceptibility is reduced and her difference with male
counterpart in injury ability is reduced where injuries become sport -related
-Over training disrupts rhythms of monthly periods with intensity as soon as this is witnessed
-Pregnancy and child birth are intensive preparation for future athleism among women.

The Female Athlete Triad

In 1992, the American College of Sports Medicine coined the term, "Female Athlete Triad." This Triad
consists of three syndromes: disordered eating, amenorrhea, and osteoporosis. Each syndrome that makes
27
up the female athlete Triad is an individual piece of the problem. However, the prevalence of this Triad is
unknown because of the relative "newness" of its diagnosis. Due to the increased number of female
participating in athletics, there is a greater risk of becoming afflicted with these conditions.
There are numerous health benefits that can be gained through participating in physical activity and
exercise, but unfortunately the Triad is a negative one. Exercise is an important factor for a healthy life.
Therefore, it is necessary to help keep the "active" safe from the dangers associated with over-training.
Women in athletics are susceptible to this combination of disorders known now as the female athlete
Triad. Athletics does not seem to be the primary cause of the Triad, but the demands from the intense
training may cause an increase in the risks of suffering from the collective condition.

Components of the Female Athlete Triad

The female athlete Triad can be explained in a triangle format. At the peak of the triangle sits the
disordered eating and heavy exercise, and these habits can lead to amenorrhea, which in turn can increase
the possibility of developing premature osteoporosis.
Individually, each component seems to be controllable, but when they are combined with one another, so
are the effects and consequences.

Disordered Eating
Eating disorders and disordered eating are significant problems among athletes. Certain subgroups such
as female athletes are especially at risk in sports that emphasize a thin body or appearance, including
gymnastics, ballet, figure skating, swimming, and distance running. Female athletes who are concerned
with controlling their body weight and body composition are at an increased risk for developing an eating
disorder. These athletes may increase their training regimes and prolong dieting routines which adds to
the risk of an eating disorder.
Several factors place an individual at risk for the development of an eating disorder. These factors include
the need to maintain strong control over body shape, the level of performance, and the level of
competition.
Some behavioural signs of disordered eating are a preoccupation with food that include weight, increased
criticism of one's body, frequent trips to the bathroom following meals and compulsive, excessive
exercise. For athletes, the eating disorder may be present in different forms. These include binge eating,
purging through compulsive exercise, fasting, food restriction, diet pills, and a preoccupation with food
and distorted body image.
The two main types of eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa
represents the extreme of restrictive eating. It is when an individual feels terrified of gaining weight.
Bulimia nervosa is characterized by binging and purging cycles, which occur two times per week for at
least three months. However, anorexia nervosa or bulimia nervosa with excessive exercise and normal
food intake with excessive exercise can also be classified as disordered eating.

Amenorrhea
Amenorrhea is defined as the absence of menstruation. The two types of amenorrhea include primary and
secondary amenorrhea. Primary amenorrhea is when a female does not have a menstrual cycle by the age
of sixteen. Secondary amenorrhea is when a female has started menstruating, but has been without
menstruation for six months. Amenorrhea can be caused by hormonal imbalances or exercise.
The hormonal causes stem from low levels of follicle-stimulating hormone (FSH) and luteinsing hormone
(LH), where as the exercise-associated amenorrhea is due to a complex relationship between weight loss,
decreased body fat and emotional or physical stresses.
According to research, amenorrhea develops in female athletes due to effects of weight loss, lowered
body fat, increased activity, and insufficient caloric intake.
Additionally, amenorrhea may retard bone growth and cause further bone loss which cannot be replaced.
At one time, amenorrhea was thought of as a normal process. Now, amenorrhea is associated with severe
results for female athletes. Physical complications from amenorrhea usually develop from decreased
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serum estrogen levels. This in turn results in cardiac risks, premature osteoporosis, inadequate bone
formation, and bone loss.

Osteoporosis
In young female athletes, osteoporosis refers to premature bone loss or inadequate bone formation. This
premature bone loss is mostly attributed to the decreased estrogen levels in the blood and the resulting
calcium imbalances.
Women build bone until a maximum age of 34 and then starts to lose bone at 0.3-0.5% a years after age
35. Premature bone loss may result in low bone mineral density, increased skeletal fragility, micro
architectural deterioration, and an increased risk of stress fractures.
In addition, the decreased levels of estrogen associated with amenorrhea coupled with decreased
calcium intake from disordered eating, leads to decreased mineralization of bone and increased stress
fractures.
Females in particular are at risk for more devastating fractures of the hip and vertebral column due to
premature osteoporosis. Additionally, bone mineral density lost secondary to amenorrhea can be
irreversible even with calcium supplementation. This becomes a problem for young female athletes who
should be forming bone at this point in their lives.
Risk Factors
Specific risk factors are associated with each component of the female athlete Triad. First, the risk factors
for disordered eating include malnutrition, fatigue, and decreased ability to fight infections, depression,
and complications from an irregular heart beat or seizures.
Females with an eating disorder consume a significantly less amount of carbohydrates, fats, proteins, and
vitamins. Long-term deprivation of energy and nutrition can lead to limited recovery from injuries, poor
athletic performance, exercise-induced-amenorrhea, and psychological stress.
Risk factors associated with amenorrhea include lack of estrogen, hormonal imbalances, and premature
osteoporosis. Finally, specific risk factors for osteoporosis include bone loss, lack of bone formation, and
susceptibility to stress fractures.
Who Is at Risk?
The first group of individuals is every female athlete or physically active women. Females participating in
sports that emphasize low body weight, or a particular body shape are at an increased risk for an eating
disorder. The individuals who participate in individual sports and who complete at an elite or highly
competitive level are also susceptible to an eating disorder.
A major problem with these athletes is that they process a "win-at-all-costs" attitude and this attitude is
ingrained in their minds.
Also susceptible to an eating disorder are those individuals who are experiencing a traumatic life event
and females who have a combination of over-training and a decreased caloric intake.
Finally, those individuals who exhibit characteristics including high self-expectations, perfectionism, and
an intense pressure to be slim and perform are also at an increased risk for an eating disorder.

Signs and symptoms of the Female Athlete Triad

Fatigue
Anemia
Depression
Stress fracture
Decreased ability to concentrate
Cold intolerance
Hypothermia
Cold and discolored hand and feet
Enlargement of the parotid glands
Sore throat
Callused knuckles from pressure against the teeth during induced vomiting
Erosion of dental from frequent vomiting
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Abdominal pain and bloating
Constipation
Dry skin
Face and extremity edema
Lightheadedness
Bradycardia
Changes in orthostatic blood pressure
Chest pain

Suggestions for Athletic Trainers

When dealing with eating disorders relating to athletes, there are several specific steps to follow. First,
arrange a private meeting with the athlete. In counselling, the health professional needs to be supportive,
express concern, and explain observations that led to the suspicions.
Next, proper nutrition, proper training techniques, and healthy mind and body should be encouraged.
Finally, the athlete should be referred to a qualified health professional trained in dealing with eating
disorders and the female athlete Triad.
If there are any questions or concerns about the athlete, contacting a family (when dealing with minors),
sport psychologist or dietician for specialized service.

NUTRITION FOR SPORT PERFORMANCE

Introduction
The type, amount, composition, and timing of food intake can dramatically affect exercise performance,
recovery from exercise, body weight and composition, and health. When exercise or physical work
increase to more than one hour per day, the importance of adequate energy and nutrient intake become
more critical. Experts maintain that any active individual "who wants to optimize health and exercise
performance needs to follow good nutrition and hydration practices, use supplements and ergogenic aids
carefully, minimize severe weight loss practices, and eat a variety of foods in adequate amounts".

Energy Needs
Active individuals need more energy (calories) each day than their sedentary counterparts - assuming
individuals are the same age, body size and participate in similar non-physically active daily activities.
Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high
physical activity to maintain body weight, fuel the muscles, replenish glycogen stores, and provide
adequate protein to build and repair tissue.
Energy balance is achieved when the energy consumed (sum of energy from food, supplements and
fluids) equals energy expenditure (sum of all the energy expended by the body in movement or to
maintain body functions).
Knowing whether one is in energy balance is simple: weight is maintained. If energy intake does not
cover the costs of energy expenditure, then weight and muscle mass are lost, and the ability to perform
strenuous exercise typically declines.
Weight loss in an active individual who is currently at a healthy body weight can decrease exercise
performance and the health benefits associated with exercise training.
When energy intake is restricted, fat and muscle mass will be utilized for energy to fuel the body, and the
loss of muscle mass will result in the loss of strength and endurance.
Exactly how much energy an active individual needs each day will depend on a number of factors,
including age, gender, body size, level and intensity of physical activity and activities of daily living. The
first goal of an active individual is to maintain adequate energy intake to ensure that a healthy body
weight is maintained.

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Energy needs typically decrease with age, so even if activity levels do not change, the amount of energy
required to maintain body weight will decrease. For this reason, body weight typically increases with age,
even if activity levels remain constant.
Eating to achieve or maintain a healthy body weight and body composition
Although active individuals typically have body weights that are within normal ranges for their height
(BMI 19-25 kg/m2), many of them want to change their body weight (e.g., either increase or decrease) to
meet the demands of their sport or their own perception of an "ideal weight."Weight change should be
accomplished slowly during a period when the individual is not participating in competitive events.
If weight gain is desired, this can be accomplished by adding ~500-1000 kcal/d into the diet per day,
while participating in strength training exercises to assure that the extra energy consumed is contributing
to muscle mass and not fat gain.
Increases in muscle mass usually occur slowly and depend on a number of factors, including one's genetic
make-up, degree of positive energy balance that has occurred, amount of rest received, and the type of
exercise training program being used.
Any diet for weight loss should result in a gradual decrease in weight (~1-2 pound/wk or 0.5-1.0 kg/wk)
and maximize fat loss, while preserving lean tissues.
If energy restriction is too severe, the nutritional quality of the diet is compromised, lean tissue is lost, and
the ability to exercise decreases. In addition, severe energy restriction can lead to preoccupation with
food, loss of motivation, and the inability to stay on the diet.
The diet needs to provide adequate carbohydrate for glycogen replacement and enough protein for the
maintenance and repair of lean tissue.
For these reasons, experts do not recommend fad diets that restrict energy too severely (typically <1800
kcal/d for women; <2000 kcal/d for men) or eliminate food groups (e.g., little or no carbohydrate;
restricted to eating only certain foods) for active individuals.
Before beginning a weight loss diet, an active individual needs to identify what constitutes a realistic
healthy body weight for his/her activity level. This decision should be made based on past dieting
experiences, type of activity engaged in, the social setting around work and home, genetics (family size
and shape), health risk factors, and psychological issues.
A healthy weight is one that can be realistically maintained, allows for positive advances in exercise
performance, minimizes the risk of injury or illness, is consistent with long-term good health, and reduces
the risk factors for chronic disease. If an unrealistic weight goal is set, there is a high probability of
failure, which has a number of emotional and psychological outcomes. Unfortunately, failure to meet
weight loss goals in some sports can result in severe consequences, such as being cut from the team,
restricted participation, or elimination from competition. These situations can result in active individuals
chronically dieting to maintain a lower than healthy body weight, which can lead to disordered eating and
in severe cases a clinical eating disorder.
Dieting for weight loss in active women and girls can be especially problematic, if weight is already
within medical norms. Low energy intake combined with high energy output contributes to the
development of menstrual dysfunction in women, which is characterized by a significant decrease in
reproductive hormones and disruption of the normal menstrual cycle.
The decrease in reproductive hormones, especially estrogen, can lead to loss of (or failure to gain) bone
mass in young female athletes and active adult women. This pattern of low energy intake can put them at
risk for one or more of the disorders in the female athlete triad (amenorrhea, disordered eating, and
osteoporosis).

Macronutrient Requirements for Exercise

Athletes need to consume adequate energy during periods of high-intensity and/or long-duration training
to maintain body weight and health and maximize training effects. Low energy intakes can result in loss
of muscle mass; menstrual dysfunction; loss of or failure to gain bone density; an increased risk of
fatigue, injury, and illness; and a prolonged recovery process.

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Carbohydrate, protein and fat are important nutrients for active individuals, but the amounts of these
macronutrients will depend on an individual's exercise intensity, duration and frequency, the type of
exercise engaged in, and their health, body size, age and gender.
Carbohydrate Needs
The amount of energy required depends on the athlete's total daily energy expenditure, type of sport, sex,
and environmental conditions The mix of fuel (protein, fat, carbohydrate) burned during exercise depends
primarily on the intensity and duration of the exercise performed, one's level of fitness, and prior
nutritional status. All other conditions being equal, as exercise intensity increases the use of carbohydrate
for energy will also increase.
The duration of exercise also changes substrates use. As duration of exercise increases (e.g., from 60 to
120 min), muscle glycogen becomes depleted, causing the body to draw on circulating blood glucose as a
source of carbohydrate. If blood glucose cannot be maintained within physiological range during exercise,
the ability to perform intensity exercise will decrease.
Carbohydrate recommendations for athletes ranges from 6 to 10 gIkgj 1 per body weight (2.7-4.5 gIlbj1
body weightIdj1). Carbohydrates maintain blood glucose levels during exercise and replace muscle
glycogen.
Fat can also be used as a source of energy over a wide range of exercise intensities; however, the
proportion of energy contributed by fat decreases as exercise intensity increases. In these circumstances,
carbohydrate becomes the dominant fuel source while the contribution from fat decreases.
Protein can also be used for energy at rest and during exercise; however, in well-fed individuals it
probably provides <5% of the energy expended. As the duration of exercise increases, the energy
contribution of protein may increase to maintain blood glucose.
The amount of carbohydrate, fat and protein used for energy during exercise will also depend on when
exercise occurs relative to the last meal and the level of exercise intensity performed. For example, when
subjects are tested after an overnight fast, the contribution of fat to the energy pool is greater than when
these same individuals are tested after a meal.
Although high-carbohydrate diets (more than 60% of energy intake) have been advocated in the past,
caution is recommended in using specific proportions as a basis for meal plans for athletes. For example,
when energy intake is 4000-5000 kcalIdj1, even a diet containing 50% of the energy from carbohydrate
will provide 500-600g of carbohydrate (or approximately 7-8 gIkgj1 (3.2-3.6 gIlbj1) for a 70-kg (154 lb)
athlete, an amount sufficient to maintain muscle glycogen stores from day to day. Conversely, when
energy intake is less than 2000 kcalIdj1, a diet providing 60% of the energy from carbohydrate may not
be sufficient to maintain optimal carbohydrate stores (4-5 gIkgj1 or 1.8-2.3 gIlbj1) in a 60-kg (132 lb)
athlete.

Protein Needs
Active individuals often think that they need to consume high protein diets to cover the building and
repair of their muscle tissue. Exercise physiologists and sport nutritionists generally agree that exercise
increases the need for protein (g/kg body weight).
Exercise may increase the need for protein in three ways: 1) increased need for protein to repair exercise-
induced damage to muscle fibers; 2) support gains in muscle mass that occur with exercise; and 3)
provide energy source during exercise.
The current recommended dietary allowance (RDA) is 0.8 gIkgj1 body weight and the acceptable
macronutrient distribution range (AMDR) for protein intake for adults older than 18 yr is 10%-35% of
total calories.
There is no strong evidence documenting that additional dietary protein is needed by healthy adults who
undertake endurance or resistance exercise, and the current DRI for protein and amino acids does not
specifically recognize the unique needs of routinely active individuals and competitive athletes. However,
recommending protein intakes in excess of the RDA to maintain optimum physical performance is
commonly done in practice.

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How much additional protein is needed may depend on the type of exercise performed (endurance vs.
resistance), the intensity and duration of the activity, body composition (e.g., kg of lean tissue mass), and
whether weight loss is being attempted.
Lemon (1998, 2000) examined the research on the protein needs of athletes and recommends 1.2-1.4 g/kg
body weight/day for individuals participating in endurance sports and 1.6-1.8 g/kg body weight/day for
those involved in resistance or speed exercise. Recommended protein intakes for strength-trained athletes
ranges from approximately 1.2 to 1.7 g/kg body weight/day). These recommended protein intakes can
generally be met through diet alone, without the use of protein or amino acid supplements.
Resistance exercise may necessitate protein intake in excess of the RDA, as well as that needed for
endurance exercise, because additional protein, essential amino acids in particular, is needed along with
sufficient energy to support muscle growth. This is particularly true in the early phase of strength training
when the most significant gains in muscle size occurs. The amount of protein needed to maintain muscle
mass may be lower for individuals who routinely train for resistance because of more efficient protein
use.
Although these recommendations are higher than the current RDA for protein (0.8 g/kg body weight),
they do not typically exceed the habitual protein intakes of most active individuals
As illustrated earlier, if energy intake is 3000-5000 kcal/d for a 70 kg active male, a diet providing 10% of
energy from protein would contain 75-115 g of protein per day or 1.1-1.8 g/kg of protein for this
individual. In reality, this individual would probably consume closer to 15% of energy from protein. Thus,
there is usually little need to recommend that active individuals consume more protein.
Increasing protein intakes beyond the recommended level is unlikely to result in additional increases in
lean tissue, since there is a limit to the rate at which proteins can be assimilated. However, Protein or
amino acids consumed near strength and endurance exercise can enhance maintenance of, and net gains in
skeletal muscle.
Energy balance, or the consumption of adequate calories, particularly carbohydrates, to meet those
expended, is important to protein metabolism so that amino acids are spared for protein synthesis and not
oxidized to assist in meeting energy needs.

Fat Needs
Dietary recommendations for active individuals have typically focused on getting adequate intakes of
carbohydrate and protein, and keeping fat intake to 25-30% of energy intake. Recommendations further
state that the proportion of energy from fatty acids be 10% saturated, 10% polyunsaturated, 10%
monounsaturated, and include sources of essential fatty acids. Athletes should follow these general
recommendations.
Although fat is seen by many individuals as something to avoid, fat is a necessary component of a normal
diet. Fat provides energy and essential elements for cell membranes, and is associated with the intakes of
the fat-soluble vitamins E, A and D.
However, the type of fat consumed is important since the long-term negative effects of high saturated fat
diets on health are well known.
In addition, low fat intakes (<15-17% of energy) are generally not recommended for active individuals,
since they are reported to decrease energy and nutrient intakes and exercise performance. High-fat diets
are also not recommended for athletes.
Diets should be low in saturated and trans-fats, while providing adequate amounts of essential fatty acids
(linoleic and alinolenic acids). The essential fatty acids are required to make a number of potent
biological compounds within the body that help regulate blood clotting, blood pressure, heart rate and the
immune response. Linoleic acid is found in vegetable and nut oils (e.g., sunflower, corn, soy, peanut oil)
and it is recommended that adult men consume 14-17 g/day and adult women consume 11- 12 g/day.
A-linolenic acid is found primarily in leafy green vegetables, walnuts, soy oil and foods, and fish products
and fish oils and recommended intakes for a-linolenic is 1.6 g/day for adult men and 1.1 g/day for adult
women.
If active individuals consume very low fat diets (<15% of energy), getting adequate amounts of the
essential fatty acids can be a problem.
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Micronutrient Requirements For Exercise
Micronutrients, such as vitamins and minerals, play an important role in maintaining the health of the
active individual.
They are involved in energy production, synthesis of hemoglobin for the production of red blood cells,
maintenance of bone health, adequate immune function, building and repair of muscle tissue, and the
protection of body tissues from oxidative damage.
There are a number of ways that exercise is said to alter the need for vitamins and minerals. For example,
exercise stresses many of the metabolic pathways in which these micronutrients are required, while
exercise training may cause muscle biochemical adaptations that increase micronutrient needs. Exercise
may also increase the turnover and loss of micronutrients from the body, and thus the need for these
micronutrients to repair and maintain the higher lean tissue mass of the active individual.

Vitamins and Minerals

The most common vitamins and minerals found to be of concern in athletes' diets are calcium and vitamin
D, the B vitamins, iron, zinc, magnesium, as well as some antioxidants such as vitamins C and E, and A-
carotene.
Athletes at greatest risk for poor micronutrient status are those who restrict energy intake or have severe
weight-loss practices, who eliminate one or more of the food groups from their diet, or who consume
unbalanced and low micronutrient-dense diets. These athletes may benefit from a daily multivitamin-and-
mineral supplement.
Adequate intake of B vitamins is important to ensure optimum energy production and the building and
repair of muscle tissue. The B-complex vitamins have two major functions directly related to exercise.
Thiamin, riboflavin, niacin, pyridoxine (B6), pantothenic acid, and biotin are involved in energy
production during exercise, whereas folate and vitamin B12 are required for the production of red blood
cells, for protein synthesis, and in tissue repair and maintenance including the CNS.
Although short-term marginal deficiencies of B vitamins have not been observed to impact performance,
severe deficiency of vitamin B12, folate, or both may result in anemia and reduced endurance
performance. Therefore, it is important that athletes consume adequate amounts of these micronutrients to
support their efforts for optimal performance and health.
Vitamin D is required for adequate calcium absorption, regulation of serum calcium and phosphorus
levels, and promotion of bone health. Vitamin D also regulates the development and homeostasis of the
nervous system and skeletal muscle.
Athletes who live at northern latitudes or who train primarily indoors throughout the year, are at risk for
poor vitamin D status, especially if they do not consume foods fortified with vitamin D. These athletes
would benefit from supplementation with vitamin D.
The antioxidant nutrients, vitamins C and E, A-carotene, and selenium, play important roles in protecting
cell membranes from oxidative damage. Strenuous and prolonged exercise has been shown to increase the
need for vitamin C, thus performance can be compromised with marginal vitamin C status or deficiency.
Athletes who participate in habitual prolonged, strenuous exercise should consume 100-1000 mg of
vitamin C daily.

Calcium, Iron, Zinc, and Magnesium

The primary minerals that are low in the diets of athletes, especially female athletes, are calcium, iron,
zinc, and magnesium. Low intakes of these minerals are often due to energy restriction or avoidance of
animal products.
Calcium is especially important for growth, maintenance and repair of bone tissue, maintenance of blood
calcium levels, regulation of muscle contraction, nerve conduction, and normal blood clotting. Inadequate
dietary calcium and vitamin D increase the risk of low bone mineral density and stress fractures.
Female athletes are at greatest risk for low bone mineral density if energy intakes are low, dairy products
and other calcium-rich foods are inadequate or eliminated from the diet, and menstrual dysfunction is
present.

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Iron is required for the formation of oxygen carrying proteins, hemoglobin and myoglobin, and for
enzymes involved in energy production. Oxygen carrying capacity is essential for endurance exercise as
well as normal function of the nervous, behavioral, and immune systems.
Iron depletion (low iron stores) is one of the most prevalent nutrient deficiencies observed among
athletes, especially females. Iron deficiency, with or without anemia, can impair muscle function and limit
work capacity.
Iron requirements for endurance athletes, especially distance runners, are increased by approximately
70%. Athletes who are vegetarian or regular blood donors should aim for an iron intake greater than their
respective RDA (i.e., 18 mg and 8 mg, for men and women respectively).
Other factors that can impact iron status include vegetarian diets that have poor iron availability, periods
of rapid growth, training at high altitudes, increased iron losses in sweat, feces, urine, menstrual blood,
regular blood donation, or injury. Athletes, especially women, long-distance runners, adolescents, and
vegetarians should be screened periodically to assess and monitor iron status.
Because reversing iron deficiency anemia can require 3-6 months, it is advantageous to begin nutrition
intervention before iron deficiency anemia develops.
Improving work capacity and endurance, increasing oxygen uptake, reducing lactate concentrations, and
reducing muscle fatigue are benefits of improved iron status.
Zinc plays a role in growth, building and repair of muscle tissue, energy production, and immune status.
Zinc status has been shown to directly affect thyroid hormone levels, BMR, and protein use, which in turn
can negatively affect health and physical performance.
Magnesium plays a variety of roles in cellular metabolism (glycolysis, fat, and protein metabolism) and
regulates membrane stability and neuromuscular, cardiovascular, immune, and hormonal functions.
Magnesium deficiency impairs endurance performance by increasing oxygen requirements to complete
submaximal exercise.

Sodium, Chloride, and Potassium

Sodium is a critical electrolyte, particularly for athletes with high sweat losses. Many endurance athletes
will require much more than the fundamental requirement for sodium (2.3 gIdj1) and chloride (3.6 gIdj1).
Sports drinks containing sodium (0.5-0.7 gILj1) and potassium (0.8-2.0 gILj1), as well as carbohydrate,
are recommended for athletes especially in endurance events (92 h).
Potassium is important for fluid and electrolyte balance, nerve transmission, and active transport
mechanisms. During intense exercise, plasma potassium concentrations tend to decline to a lesser degree
than sodium.
A diet rich in a variety of fresh vegetables, fruits, nuts/seeds, dairy foods, lean meats, and whole grains is
usually considered adequate for maintaining normal potassium status among athletes.
NOTE
Athletes who restrict energy intake or use severe weight-loss practices, eliminate one or more food groups
from their diet, or consume high- or low-carbohydrate diets of low micronutrient density are at greatest
risk of micronutrient deficiencies. Athletes should consume diets that provide at least the recommended
dietary allowance (RDA) for all micronutrients.

Factors to consider when developing individualized sports nutrition plan for athletes
Each athlete is different and there is no universal type of meal plan, training diet, or competition
hydration schedule. However, the basic sports nutrition concepts and guidelines can be applied
universally and each athlete will require a unique approach of those guidelines to fit their individual
needs. For example, all athletes should consume a combination of carbohydrates and protein after
exercise to initiate the repair and rebuilding process. However, one athlete may enjoy a beef samosa with
a banana, while another athlete would love an egg, toast, and orange juice. Both of these meals meet the
carbohydrate-protein combination requirement but also take into consideration personal taste preferences.

35
This individualized approach is much more challenging and requires a greater breadth of knowledge.
Several factors must be considered when calculating nutrient needs and developing a meal plan for an
athlete.
An athlete's health history
First and foremost, an athlete must be healthy in order to train and compete to their potential. Proper
nutrition plays a vital role in preventing deficiency and degenerative diseases, while also aiding in the
treatment of existing medical conditions. An athlete's health history must be the key issue in the sports
nutrition plan.
For example, an athlete with diabetes must carefully balance his or her intake of carbohydrates with daily
doses of insulin to prevent hyper- or hypoglycemia. Whereas most athletes would not think twice about
drinking a large glass of juice in the morning before a workout, a diabetic athlete consuming only juice (a
carbohydrate source without a protein source to stabilize the digestion of food and blood sugar levels)
may experience blood sugar swings that can potentially impact performance. In addition to performance
in a single workout, long-term poor blood sugar management can lead to complications of associated
medical conditions later in life.
An athlete's health history must be considered first and then subsequently, recommendations can
intertwine with sport-specific suggestions.

A sport's bioenergetics and logistics

Energy metabolism is the foundation of sports nutrition. Consideration of the cellular machinery and
metabolic pathways responsible for making the energy needed to participate in a specific sport is critical
for the development of an individualized eating plan.
For example, the calorie, macronutrient, and micronutrient needs of a football player (intermittent
exertion over the course of several hours) will be different from the needs of a swimmer (continuous
effort for typically less than 10-20 minutes). Even within one sport, such as running, different events
(100-meter sprint versus a marathon) will highlight various energy systems (short, intense effort versus
sustained moderate effort).
In addition to the bioenergetics of a sport, nutrition plans for athletes must also consider the logistics of
training sessions and competitions. Some sports are very conducive for drinking and eating during
activity (biking), whereas other sports make fluid and energy consumption close to impossible (open
water swimming). Sports nutrition professionals must devise plans that are specific for the energy systems
utilized during training and competition as well as realistic to the nature of an athlete's sport.
An athlete's total weekly training and competition time
Athletes can range from the weekend part-time to the full-time professional. Each athlete will dedicate a
period of time each day to training and competition. Obviously, the athletes who are more active will have
greater energy and nutrient needs. However, it is not always as simple as telling highly active athletes to
"eat more." Many athletes struggle to meet their daily needs due to the time constraints of meal planning
and preparation, as well as short periods of time between workouts, work, school, and other life
commitments. Sports nutrition professionals need to be creative in helping athletes to determine how to
consume adequate amounts of energy and nutrients while making meal planning easy, convenient, and
quick.
A sports nutrition plan also includes the development of a fuelling and hydration schedule for training and
competition. The timing of meals and snacks must be strategically scheduled to provide enough time for
food to digest before training sessions, and to prevent too much time from elapsing after training. Fluid
requirements vary considerably among athletes. Therefore, the construction of a hydration schedule is
individualized for the athlete and specific to the sport.
The energy and nutrients consumed before, during, and after exercise are part of an overall daily sports
nutrition plan that can literally make or break an athlete's performance. The more time an athlete spends
training each week, the more strategic planning needs to occur to create an appropriate, individualized
regimen.
An athlete's living arrangements, access to food, and travel schedule

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A perfectly calculated nutrition plan is worthless if the athlete cannot execute the plan due to a lack of
control over the foods available to him or her on a daily basis. For example, a college athlete who lives in
a dorm is at the mercy of what is served in the school cafeterias. Therefore, the cafeteria menus should be
built into the sports nutrition plan for this athlete. Sports nutrition professionals must fully understand
each athlete's living arrangements and access to food before developing an individualized program.
Access to food can also be a factor before, during, or after competitions. Many athletes are required to eat
with the team at their training table before a game, thereby limiting their food choices to what is provided
by the team. Recreational athletes who are participating in weekend events, such as running and
especially road races, often must rely on the products supplied on the course for hydration and fuelling.
Developing an appropriate race day plan for these athletes involves investigating the foods and beverages
available on the course and then planning for the athletes to practice with these specific items throughout
training to prevent any surprises on race day.
Consuming the optimal blend of nutrients after exercise is also of great importance. Each athlete will vary
in their ability to pack a post-exercise snack or decipher the most appropriate food/beverage option from a
list of available items.
Proper nutrition while travelling is a challenge for everyone - athletes and non-athletes alike. Travel
forces individuals to change their routine, sometimes interfering on an athlete's good intentions and
typical nutrition habits. Athletes must be educated on how to make healthy choices and appropriate
substitutions while on the road. Creative planning, packing non-perishable foods for the trip, and learning
to be flexible will help athletes remain optimally fuelled while travelling.

Fluid Replacement
When fluid losses exceed 2 percent of body weight prior to exercising, significant endurance performance
deterioration occurs. It is wise to drink (hydrate) before exercising so that no dehydration occurs.
However, during some high energy sporting contests, despite experiencing sweat losses of 4-6 kg, it is
neither necessary nor advisable to attempt to entirely replace the amount of fluid lost. The body actually
produces water during exercise. Most athletes only drink enough fluid to recover between 40 and 50
percent of the sweat lost. Partial fluid replacement has been shown to reduce the risk of overheating.
During a series of 2-hour runs, marathoners who ingested 100mL of fluid every 5 minutes for the first 100
minutes maintained a lower rectal temperature than those who abstained. This occurred despite only
absorbing 1,660 ml of fluid while losing 4,000 ml of sweat during the run. The sensation of thirst lags
behind the state of negative water balance, and should not be used as the signal to drink. Drink breaks
must be regularly scheduled and made compulsory during training and competitions.

Since the body loses more water than electrolytes during exercise, the body fluids become concentrated.
Hence there is a greater need to replace water than electrolytes during periods of heavy sweating. The
answers to questions concerning the frequency, quantity, and qualities of replacement fluids depend, to
some extent, on the individual concerned, the intensity of effort, and the environmental conditions. The
major concern is to replace water. Flavored drinks, commercial preparations, and other solutions are not
necessarily the best forms of fluid replacement.

On hot days, fluid should be consumed before, during, and after training. This maintains the stability of
circulation that is so important for endurance efforts. Water is the primary requirement and, in most
circumstances, is the ideal replacement fluid. Fluids with high sugar and electrolyte concentrations empty
slowly from the stomach for absorption into the blood via the small intestine. That slow emptying will
actually delay the replacement of needed water. It is only when excessive sweat losses occur on
successive days that small amounts of salt and sugar may be necessary in a replacement fluid. On cooler
days, when fluid losses are less, a higher concentration of carbohydrate in the fluid assists in maintaining
the blood glucose level. Whether the amount of carbohydrate ingested is large or small is not a critical
factor in `feeding' during events or training. It has been shown that more frequent feeds maintain more
stable blood glucose levels. Therefore, if carbohydrate supplementation occurs during exercise, the
frequency of feeding should be considered to be of the utmost importance.

In sports such as wrestling, body-building, weight-lifting, etc, where weight limits have to be achieved to
perform in competition categories, the loss of weight at the right time is important. Such weight loss is
best achieved through gradual dietary accomplishments. Harmful procedure of trying to lose `water
37
weight' through taking diuretics or dehydrating should also be avoided. The maximum safe value to lose
(water) is 2 percent of body weight. Values that exceed that will reduce the efficiency of the body's
physiology, cause the circulatory system to work harder for a stated amount of work, and will reduce
endurance performance. More often than not, unsound weight loss programs cause performances to
decrease.

Although hydration before and during exercise is essential for good athletic performance, hydration after
exercise is equally as important. A high rate of fluid consumption during the first two hours of post-
exercise rehydration is known to increase plasma volume significantly and to result in substantial urine
production. Individuals looking to achieve rapid and complete recovery from dehydration should drink
1.5L of fluid for each kilogram of body weight loss.

The main reasons dehydration has an adverse effect on exercise performance can be summarized as
follows:
• Reduction in blood volume
• Decreased skin blood flow
• Decreased sweat rate
• Decreased heat dissipation
• Increased core temperature
• Increased rate of muscle glycogen use

The following are sensible fluid replacement guidelines for exercise:

The temperature of the fluid should be cool (8-100C) not very cold.

The fluid should be low in or lack sugar (carbohydrate) to enhance absorption of the water. The
highest concentration of sugar should be 2-5 g per 100 ml of water.

During exercise, the volume taken should be no more than 0.5 liters per hour in doses of 100-200 ml
every 15 minutes.

At least 0.5 liters of water should be consumed prior to exercise.

The loss of electrolytes in most activities is minimal in sweat and can be adequately replaced in the
diet after exercise. The need for replacement during exercise is generally non-existent.

Keeping a record of body weight after waking in the morning is an easy method of monitoring
hydration.

Forced regular fluid intakes are required. Do not rely on the feeling of thirst to determine when
ingestion of water should occur.

Hyponatremia (low sodium [salt] levels in the blood) occurs in many sports, due to loss of sodium
through sweating and replacement of fluids with excessive amounts of plain water. Symptoms include
nausea, emesis, headache, muscle weakness, lethargy, confusion, and seizures). Symptoms of heat
exhaustion and early hyponatremia are similar.

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