Sports Performance Coach and Licensed Massage Therapist

I just wanted to let everyone know that Keats Snideman will be hosting a Hardstyle Kettlebell Certification (HKC) course at the Reality Based Fitness/Optimum Sports Performance Facility in Tempe, Arizona on March 20th.

This is the first Dragon Door HKC certification  to be taught in the state of Arizona, and the instructor for this event is Master RKC, Mark Reifkind from Northern California.

This course can be either a pre-cursor/stepping stone for anyone interested in continuing on to the RKC (Russian Kettlebell Challenge), or is can be treated as a certification of its own for those just interested in learning the basics of proper kettebell training!

The course goes over proper execution and coaching of:

1) The Swing- this is the center of the kettebell universe!

2) The Get-Up (also known as the “Turkish Get-Up)- an absolutely essential drill to teach the mechanics of proper over head posture and a full-body mobility/stability challgenge!

3) The Goblet Squat- probably one of the best ways to teach someone how to squat properly.

For more information on the course and to register, please go to the Dragon Door Website.

Hope you see you there!

Patrick

patrick@optimumsportsperformance.com

With summer just around the corner, I thought I would run an excellent guest blog article on the topic of dehydration and athletic performance by my good friend, Yan Levitsky.

Yan is incredibly knowledgeable in both training and manual therapy.  Aside from being a registered nurse, Yan is currently studying and researching biochemistry and hopes to attend medical school in the future.

Note: The first portion of this article is a lot of technical/nerd talk, which I enjoy, and which is important to understanding dehydration and the human body. However, if you wish to skip that portion and get right down to practical application and recommendations, then scroll down to the section titled - Implications for the Athlete.

Hope you enjoy the article and get some good info out of it.

Patrick
patrick@optimumsportsperformance.com

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Dehydration and Athletic Performance
By: Yan Levitsky, RN, CPT

Proper fluid balance is a requirement for not only athletic performance, but proper functioning of the human body. Dehydration is a condition that can and does affect a great many people and may cause many undesirable effects. One study found that about 15,000 episodes of dehydration and/or heat illness occurred during a two year research period in high school athletes, which led the athlete missing from 1 day to 1 week of practice or competition (Hoffman, et al). This article will attempt to talk about some issues related to dehydration and provide some strategies to avoid and correct dehydration before, during and after athletic competition.

Relevant Physiology

A prerequisite for optimal functioning of the human organism is a state of homeostasis. In other words, your body not only prefers, but requires all of its components to fall within a certain range in order for it to function properly. Some components have a narrow range, while others have a relatively broad range. For instance, a slight change in the pH of your body can lead to some pretty nasty effects while your blood pressure can vary a great amount without killing you (immediately that is). When your body senses a component go out of range, the Central Nervous System sends signals to certain organs which then respond with some sort of chemical synthesis which results in an action to pull that component back into its optimal range, this is known as a feedback loop. A very simplified example is when blood pressure drops, pressure sensing receptors in the blood vessels tell your brain of the change, the brain activates the sympathetic nervous system, causes your blood vessels to constrict and voila, your blood pressure is back within a normal range.

The human body loses fluid through several mechanisms. Urine and fecal loss account for about 1700mL/day, respiratory losses account for another 300mL, 100mL is lost via sweat (this is at rest with an ambient temperature of 68 degrees F, when active or in a hot and humid environment this mechanism can go up to 5L/day), and about 400mL/day is lost via insensible water loss (Saladin pg 916-917). Insensible water loss is water that diffuses through the skin and evaporates into the air. This is not a glandular secretion of the body, in other words sweat, in response to a stimulus rather, it is just movement of water out of the body via the skin. Some of the mechanisms are variable, like urine and fecal losses which can be down regulated to conserve fluid however, there is a certain amount of water loss, named obligatory water loss, that will happen no matter how dehydrated a person gets. Obligatory water loss is something the body cannot down regulate, it must happen, and explains why the body cannot just keep cycling the water it has to prevent further dehydration.

The body regulates intake of water through the thirst reflex. Blood osmolarity (we will discuss this term in a moment) is the primary driver of this reflex through a series of signals between receptors, the brain, the salivary glands, the small intestine etc. There are feedback loops which both make us thirsty in response to a decreased fluid content in the blood and inhibit the thirst reflex to avoid over hydration. These mechanisms work constantly to maintain fluid and electrolyte balance in the body.

The next issue we should get a handle on before going any further is osmosis and osmolarity. Osmosis is the tendency of fluid to move across a semi-permeable membrane towards higher solute concentrations, for the purposes of this article, and the main drivers of fluid balance in the body, the solutes are electrolytes. Osmolarity is simply a measure of solute concentration within a solution. In other words, the more ‘stuff’ in the fluid the higher the osmolarity and the greater the tendency to draw in water will be. Membranes separate the extra cellular fluid (ECF), which contains the interstitial and vascular compartments, from the intracellular fluid (ICF), which consists of the cells of the body. Normally, in homeostasis, the osmolarity of these two compartments is balanced and fluid doesn’t shift. If for any reason electrolytes are lost from either compartment, the osmolarity of the other compartment is relatively higher (hypertonic or hyperosmolar) and the fluid will shift until a balance in osmolarity is once again reached, while the opposite occurs if fluid is lost from a compartment. This is a passive mechanism and is governed by the laws of Physics. Once one compartment is hyperosmolar, within seconds, the fluid will start to shift and a balance of osmolarity is once again reached. It should be noted here that when we speak of water moving, we are truly referring to the net movement of water across a membrane. Living systems are highly dynamic and there is always movement of solutes and water back and forth, but when the two systems are in equilibrium the rate of movement into the cell is equal to the rate of movement out of the cell.

The human body is truly a wondrous machine but it’s not perfect and can’t always fix everything on its own. Sometimes these mechanisms land us in trouble, as we will see.

Types of Dehydration

There are three types of dehydration that can occur and they are named for the relative amount of electrolyte loss in relation to water loss. The first, and most common, is isotonic dehydration. Isotonic dehydration means simply that fluid and electrolyte losses are equal (the prefix -Iso- in Greek, means equal). The danger with this type of dehydration is that the ECF becomes depleted of fluid. This depletion then leads to a reduction of blood volume and a drop in blood pressure. The decrease in blood volume leads to poor perfusion of organs, for our purposes the organ system of importance is the musculature. With poor perfusion of the working muscles, metabolic wastes accumulate and oxygen is not being delivered efficiently which may lead to a decreased performance. Aside from the poor perfusion of the musculature, we run into problems because appropriate blood pressure is necessary in the skin to maintain adequate thermoregulation. When there is not enough blood to achieve both goals (muscle and skin perfusion), and we are in the midst of strenuous physical activity, scientific literature seems to show that the body chooses the musculature to supply with blood leading to a breakdown of thermoregulatory mechanisms (González-Alonso et al).

The body has many back up mechanisms to fix this problem, the blood vessels constrict to normalize blood pressure, the kidneys begin to reabsorb water and sodium back into the blood stream, the heart starts to beat harder and faster to get that blood moving better. All of this works well to delay problems however, we only have so much water and without proper intake these defense mechanisms will eventually fail and we will not only have poor athletic performance but illness may ensue. This type of dehydration is typically caused by bleeding (well hemorrhaging, and if you are doing that on the field you shouldn’t be worried about athletic performance), vomiting, diarrhea, profuse sweating, and inadequate intake of fluids/electrolytes (Ignatavicius et al, p. 212-222).

The second type of dehydration is hypertonic dehydration. This type is characterized by a greater loss of fluid than electrolytes. Here is where osmosis comes into play. The ECF loses water but at a greater rate than it losses electrolytes. The osmolarity of the ECF relative to the ICF increases and the osmotic pressure (just a fancy name for the pull of water into the blood vessel) causes fluid to shift from the ICF to the ECF. This shift of fluids normalizes blood volume but, unfortunately, now the cells are dehydrated. A dehydrated cell is not an optimally functioning cell and our body then uses a slew of hormones to get things going and to normalize. The kidneys now reabsorb water back into the blood stream and your body makes you thirsty to get those fluids replaced. This is one reason why it is said that waiting until you are thirsty means you are already dehydrated. Your blood pressure and organ perfusion will be adequate and there is no real threat to life, however your cells have given up precious fluids in order to accomplish this task and are now working sub-optimally. And just as before, electrolytes don’t just appear from thin air and if they are not replaced the cycle will keep going until serious problems arise. This type of dehydration is typically caused by prolonged sweating, hyperventilation, fevers and watery diarrhea (IBID).

The third and least common type is hypotonic dehydration. Obviously this is where electrolyte loss is greater than fluid loss. This type of dehydration is the rarest; it does not apply to athletes, and is typically seen in chronic illnesses. A few words should be said about it anyway to reinforce some of the principles we have already discussed. The problems that we run into with this type of dehydration are from fluid shifts. Losing electrolytes from the ECF will increase the osmolarity of the ICF and the fluid will tend to shift into the cells. The problems are 3 fold. First and foremost our cells need a certain range of fluid to work optimally (remember that homeostasis thing we were talking about?). A swollen cell is not a happy cell and a swollen brain cell is particularly cranky. Brain tissue is very sensitive to swelling and neurological symptoms are very common, and are typically first complaints, like dizziness, headache, confusion etc. The second problem is the loss of fluid from the vasculature causing your blood plasma to be depleted thus making your blood more viscous and decreasing blood volume/pressure. This can affect organ perfusion as thick blood doesn’t flow so well and doesn’t deliver oxygen and nutrients so well, either. The third is a dilution of normal electrolyte levels leading to a whole host of other issues. Each electrolyte has its own problems that it can cause when out of whack and a discussion about each of them is well out of the scope of this article, however we will touch upon sodium balance as this has some implications for athletes.

Implications for the Athlete

“So what does all this mumbo jumbo mean to me?”

Well now that we have a somewhat decent understanding of the causes, mechanisms and complications of dehydration we can talk about what it means to the athlete.

Heat Illness

Dehydration, hot, humid environments (>95 degrees F, >80% humidity) and strenuous exercise (and by extension profuse sweating) can lead to some pretty serious problems, the least of which is decreased athletic performance. But wait, this article should be about dehydration? What’s this heat exhaustion crap? These two topics pretty much go hand in hand as dehydration will potentiate heat stress and hot and humid environments will potentiate dehydration. They are undeniably linked.

Heat exhaustion is a product of dehydration coupled with hot/humid environments. Dehydration is not a pre-requisite for this condition however dehydration will severely decrease one’s ability to dissipate heat properly and in the real world heat stress is typically accompanied by dehydration. In this state the athlete may feel very ill, and may complain of flu like symptoms, which include headache, weakness, fatigue, nausea and vomiting. Although not a true medical emergency, this condition may lead to heat stroke if not adequately addressed (oral rehydration preferably with fluids containing electrolytes, cool environment, and loosening of constrictive clothing).

Heat stroke is a medical emergency and can have a pretty high mortality rate, approaching 80%, if not treated promptly. This is what happens when our defense mechanisms fail and our body can no longer maintain a safe core body temperature. There are two types of heat stroke, exertional and classic. The former is typical of athletes who are exercising or competing in hot and humid environments. The onset is very rapid. Classic heat stroke tends to occur in the elderly with long exposures to hot and humid environments and has a more insidious, or slower, onset. The athlete’s body temperature may be very high and sweating will stop (a defense mechanism to save essential fluid), as well there will be changes in mental status such as anxiety, confusion etc. Hospitalization is a necessary step at this point to reduce further, possibly permanent, organ damage (Ignatavicius et al, p. 212-222).

Environmental factors have a very big impact on athletic performance. Heat stress combined with dehydration will significantly decrease total time to exertion during aerobic work as well as negatively affecting peak power output (Maxwell et al, Goulet et al). Most of the research in this area has been done on aerobic activity with some anaerobic work built in (think long distance cycling with intermittent sprinting) however, very little research has been done on purely high intensity activities, for example weightlifting or short distance running. These types of activities are thought to not be affected as much by dehydration and heat stress as the activities do not last long enough for the cardiovascular system to be strained and the deleterious affects to be noted (Rothenberg et al). It should be noted, as well, that cold environments attenuate the effects of heat stress, meaning that in colder climates these types of performance declines are not as significant. This last bit does not mean that dehydration is not an issue in a cold environment as cold air is drier and absorbs more water from your breath. There is also the issue that exerting yourself and increasing sweat losses, while wearing lots of gear can potentiate this effect. A study done by Palmer and Spriet looked at sweat losses from hockey players during 1 hour of practice. They found that even in a cool environment (57 degrees F and 67% humidity) the players lost between 1-2L of fluid during the hour-long practice (ranging from less than 1L while many lost more than 2L). This shows that sweat losses can be significant even in colder climates and once the athlete begins to approach a 2% loss of bodyweight, the detriments in performance are noted.

Practical Applications

Now that we have established the problems that can arise, let’s tackle the issue of adequate hydration. The unfortunate part of this, most exciting, article is that proper hydration is something that varies from person to person (what doesn’t, right?). Nevertheless we can scan through some literature and perhaps work up certain strategies to avoid dehydration.

In one study, the authors used 2 groups of athletes to compare hydration strategies. The hyperhydration group was given 26mL fluid/kg body mass coupled with 1.2g glycerol/kg body mass over an 80 minute period prior to the test while the control, or euhydrated, group was not given any fluids. Glycerol was chosen because it has been shown to aid the body in retaining water, and thus hydration, without other ergogenic properties (Goulet et al, Wingo et al, Robergs et al). Both groups were given Gatorade to drink during the exercise. Both groups cycled for 2 hours and then were given a test to measure how long they could cycle until exhaustion. The hyperhydration group had a higher peak power output, and was able to cycle for a longer period of time until exhausted. The hyperhydrated group also showed lower rectal temperatures (although the authors were not able to show this as statistically significant, a look at the data shows about a 1 degree difference between the groups at the 120min mark) and lower heart rates during the 2 hours of cycling (Goulet et al). What can we glean from this? Over hydration allows the body to cope with exercise and heat more optimally under conditions where maintaining hydration during exercise is difficult. The peak power output and time to exhaustion differences is self explanatory while the lower rectal temperatures and heart rates in the hyperhydration group show that the body was able to dissipate heat better and the cardiovascular system did not have to work as hard to keep up with the oxygen demand of the musculature. This was probably due to the maintenance of adequate blood volume and other factors having to do with the Central Nervous System (Alonzo et al). The authors concluded that beginning an exercise session hyperhydrated alleviated some of the detriments to performance seen as athletes become dehydrated during competition. For a 170 lb person the above numbers equal about 2 liters of fluid with 100g glycerol over 2 hours before exercise or competition. This method would over hydrate an individual and help to attenuate the performance detriments associated with dehydration during activity. This over hydration method should be the upper limit of fluid intake unless sufficient electrolytes accompany the water if the glycerol is not used, the reason will be discussed shortly

Another group of researchers suggest that to be appropriately hydrated before competition athletes should consume at least 6-8mL/kg of body mass of fluid containing sodium or with food about 2 hours before exercise. For a 170lb man this translates to about 450-620mL of fluid. The authors don’t deny that water needs are individual and differences and experiences are to be kept in mind when planning a hydration protocol (Shirreffs et al). The National Athletic Trainers Association recommends 500-600mL of fluid or sports drink 2-3 hours before exercise with another 200-300mL consumed 20-30 minutes before exercise/competition as a minimum for athletes across the board with individual differences to be accounted for (Casa et al, NATA Position Statement).

What can we take from all this?

Staying hydrated is best accomplished not only by drinking during the activity, but also by ensuring that you are appropriately hydrated before the exercise/competition. This is especially true if the conditions are hot and humid, as these conditions can greatly increase fluid loss through sweating.

During exercise and competition is where things get a bit dicey. Some sports are not exactly conducive to stopping for water breaks, like marathons. Other sports lend themselves to this but many athletes choose to forego or like to just take a sip of water and get back to working. This is all well and good and shows a good work ethic however, when sweat losses are in the liters and the athlete is replacing fluid with sips (we’re talking mL’s here), he/she is shooting themselves in the foot. A good practice to establish is to take a nice big drink of fluid when the opportunity arises and not just a sip or two, especially if the exercise will last over an hour or is taking place in a hot/humid environment. Using containers, which are measurable, is a great way to figure out how much one ingested and whether or not one should drink more or less. Drinking half of a 1L bottle means you ingested 500mL and if hydration was not maintained that amount can be bumped to getting ¾ or the whole bottle in.

There exist a few methods to establish how dehydrated an individual gets during exercise. There are Urine Specific Gravity measuring devices, urine color charts and such but the one I will discuss is very simple and is available to most people. This method is simply weighing oneself. Weigh once pre-exercise and once again post-exercise. If the change is greater than 2%, then it is a fairly safe bet that you have become dehydrated at some point during the session. So if a 170lb person (pre-exercise) weighs in at 166-167lbs after exercise, he/she should take a closer look at what and how much was consumed before the exercise and what and how much was consumed during. A 1-liter loss of fluid amounts to about 1 kilogram (2.2 pounds) loss of weight (Ignatavicius et al, p. 212-222). Conversely, the NATA recommends ingestion of 1-1.25L of fluid for every kilogram lost during exercise as a rehydration strategy (Binkley et al, NATA position statement; Exertional Illness).

Exertional Hyponatremia or Water Intoxication

Natrium is the chemical name for sodium and is the most abundant electrolyte in the ECF. It accounts for 90-95% of the ECF osmolarity (Saladin, pg 922). As we have learned in the beginning of the article the most prevalent form of dehydration tends to be isotonic dehydration, meaning the body has lost about an equal amount of water and electrolytes. If water is replaced without any replacement of electrolytes, the situation created resembles one of hypotonic dehydration. Fluid starts to shift to maintain an osmotic equilibrium and this may potentially lead to death as cells can swell and possibly even rupture. This is a pretty easily rectified situation; don’t just drink pure water if a training session is going to last over an hour, or if the temperature and humidity are high, and especially if you haven’t had any solid food or other sources of electrolytes before the training.

Conclusion

So this long-winded article has finally come to a close. What have we learned? Dehydration can be, at worst, a very serious health concern and, at the least, can decrease performance on the field or in the gym or wherever you may choose to exert yourself. Maintaining adequate hydration is not just a matter of taking a couple of sips of water during the training session but is really more about maintaining a consistent hydration status throughout the day. Pre workout hydration may be more important than intra-workout hydration, as certain activities do not allow for breaks. Continuing with the same theme, assessing one’s own hydration status may be as simple as monitoring the weight changes pre/post workout and qualitatively analyzing urine color. Just as important is rehydrating oneself post training, and this is where the idea of hyponatremia comes into play. I say it is always better to be safe than sorry, so a whole food meal (with water of course) or some type of electrolyte rich sports drink is the preferred method to ensure safe and effective rehydration.

References

Binkley, Helen M. et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2002 Jul–Sep; 37(3): 329–343.

Casa, Douglas J et al. National Athletic Trainers’ Association Position Statement: Fluid Replacement for Athletes. J Athl Train. 2000 Apr–Jun; 35(2): 212–224.

González-Alonso, Jose et al. The cardiovascular challenge of exercising in the heat. J Physiol. 2008 January 1; 586(Pt 1): 45–53.

Goulet, Eric DB. Rousseau, Stephanie F. et al. Pre-Exercise Hyperhydration Delays Dehydration and Improves Endurance Capacity during 2 h of Cycling in a Temperate Climate. Journal of Physical Anthropology, Vol. 27 (2008) , No. 5 pp.263-271

Huffman, Elizabeth A. Yard, Ellen E. Fields, Sarah K. Collins, Christy L. Comstock, Dawn. Epidemiology of Rare Injuries and Conditions Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years. J Athl Train. 2008 Nov–Dec; 43(6): 624–630.

Ignatavicius, Donna D. Workman, Linda M. Medical-Surgical Nursing 5th Edition. Elsevier Saunders, 2006.

Maxwell NS, McKenzie RW, Bishop D. Influence of hypohydration on intermittent sprint performance in the heat. Int J Sports Physiol Perform. 2009 Mar;4(1):54-67.

Palmer , Matthew S. and Spriet, Lawrence L. Sweat rate, salt loss, and fluid intake during an intense on-ice practice in elite Canadian male junior hockey players. Appl. Physiol. Nutr. Metab. 33: 263–271 (2008)

Patel, Akshay V. Mihalik, Jason P. et al. Neuropsychological Performance, Postural Stability, and Symptoms After Dehydration. J Athl Train. 2007 Jan–Mar; 42(1): 66–75.

Robergs RA, Griffin SE. Glycerol. Biochemistry, pharmacokinetics and clinical and practical applications. Sports Med. 1998 Sep;26(3):145-67.

Rothenberg, Joseph A. Panagos, André. Musculoskeletal performance and hydration status. Curr Rev Musculoskelet Med. 2008 June; 1(2): 131–136.

Saladin, Kenneth S. Anatomy and Physiology: The Unity of Form and Function. McGraw-Hill, 2004.

Sawka MN, Latzka WA, Matott RP, Montain SJ. Hydration effects on temperature regulation. Int J Sports Med. 1998 Jun;19 Suppl 2:S108-10.

Shirreffs, S M. Maughan, R J. Leiper, J B. Factors influencing the restoration of fluid and electrolyte balance after exercise in the heat. Br J Sports Med 1997 31: 175-182

Wendt D, van Loon LJ, Lichtenbelt WD. Thermoregulation during exercise in the heat: strategies for maintaining health and performance. Sports Med. 2007;37(8):669-82.

Wingo, Jonathan E. et al. Influence of a Pre-Exercise Glycerol Hydration Beverage on Performance and Physiologic Function During Mountain-Bike Races in the Heat. J Athl Train. 2004 Apr–Jun; 39(2): 169–175.

Nutrition plays an essential role in our ability to recover from a hard workout or competition.  With so much information out there on nutritional intake, various diets, and supplements, it can get extremely confusing about what you should be eating, and when you should be eating it. 

Because pre, during, and post workout nutrition are so critical to recovery, I have decided to focus this article on that topic.  However, 24-hour nutrition plays an important role in recovery and athletes should seek to establish healthy routines with regard to food consumption both in quantity and quality.  Hopefully this article will give you some general/practical recommendations regarding nutrition intake and how it can promote better recovery from training. 

Note: Consult your physician before making dietary changes or ingesting over-the-counter supplements.  The information in this article is not meant to be offered as medical advice and should not be followed instead of a proper medical consultation.  For athletes looking to optimize their nutrition program, it would be best to consult with a registered dietician that specializes in sports nutrition.  These professionals can be located through the International Society of Sports Nutrition.

Carbohydrates post exercise

It has been known for sometime now that post workout nutrition plays an important role in jump-starting recovery following intense training.  Thirty to sixty minutes following exercise is often touted as the “window of opportunity” to get nutrients in.  This is due to the fact that exercise induces an increase in insulin sensitivity, as well as greater permeability of the muscle cell membrane to glucose (blood sugar).  Therefore, carbohydrate intake during this period is extremely beneficial for increasing glycogen storage (glycogen is the storage form of carbohydrates), which has been lowered following intense bouts of exercise.  Additionally, forgoing carbohydrate intake during the 30-60 minute window has been shown to lead to lower rates of glycogen storage, which may have a negative impact on ones ability to recover from training and be prepared for the following training day.

Burke, Kiens, and Ivy offer the following recommendations for daily carbohydrate intake:

• Immediately following exercise: Within a 0-4 hour window post-exercise, consume 1-1.2g per kilogram of bodyweight per hour, at frequent intervals.
• Daily recovery from moderate duration/low-intensity training: 5-7g per kilogram of bodyweight per day
• Daily recovery from moderate to heavy endurance training: 7-12g per kilogram of bodyweight per day
• Daily recovery from an extreme exercise program (4-6+ hours of training per day): 10-12+ grams per kilogram of bodyweight per day

Carbohydrate + Protein post exercise

While the effects of carbohydrate supplementation directly following a bout of exercise are encouraging, these effects appear to be enhanced when protein is combined with the carbohydrate.

Nine male cyclists performed a 2-hour cycling program.  The first 90min. of the program consisted 3 rounds of 15min cycling at 60-65% Vo2max, 15min cycling at 70-75% Vo2max.  The last 30min. of the training program consisted of 10min. cycling at 60-65% Vo2max, 10min. cycling at 70-75% Vo2max, 5min. cycling at 50% Vo2max and 5min. cycling at 80-85% Vo2max.  This training protocol, along with a 12 hour fast prior to training, was used to deplete the athletes’ muscle glycogen.  This program was performed three times during the study, each separated by 7-days.  Following the training program, the cyclists were given a different post workout supplement on all three occasions.  The supplement was administered both post workout and repeated again 2-hours later.  Contents of the supplement during each of the three trials was as follows:

1. 112g of carbohydrate
2. 40.7g of protein
3. 112g of carbohydrate + 40.7g of protein

Zawadzki and colleagues found that the carbohydrate only supplement had a significantly greater plasma glucose response than the carbohydrate + protein supplement.  This is because the carbohydrate + protein supplement had a significantly greater plasma insulin response than the carbohydrate supplement, leading to a significantly faster rate of muscle glycogen sythesis (due to insulin’s stimulating effect on muscle glycogen synthesis and glycogen synthase) compared to the carbohydrate supplement (which was faster than the protein supplement).

Similar findings were esstablished by Berardi et al, who found that muscle glycogen resynthesis was enhanced with a carbohydrate-protein (0.8g carbohydrate per kg of BW/0.4g protein per kg of BW) supplement relative to a carbohydrate supplement (1.2g carbohydrate per kg of BW) or placebo.

General recommendations for protein intake immediately following exercise are 0.4-0.6g protein per kg of bodyweight. 

Daily protein intake recommendations have varied depending on the source.  Some resources have established daily protein requirements to be 1.2-1.4g/kg of bodyweight for endurance athletes, and 1.6-1.7g/kg of bodyweight for strength training athletes.  Others have given the broad recommendation of 1.2-2.0g/kg of bodyweight; while the U.S. registered daily allowance (RDA) recommendations are more conservatively set at 0.8g/kg of bodyweight.  However, it should be noted that the RDA recommendation is designed to prevent protein deficiency, not enhance sport or exercise performance. 

Carbohydrate + Protein pre- and during workout

While post workout nutrition has been shown to be beneficial to an athletes’ recovery, more current research has shifted towards what the athletes are consuming both pre- and during training, in an attempt to optimize their nutritional strategy.

Baty and colleagues conducted a study on 34-untrained male subjects consuming either a carbohydrate-protein supplement or placebo before, during and after resistance training.  The subjects underwent a 3-week adaptation phase where they trained 3x’s/week and were instructed and trained on the 7-exercises that were going to be used during the experimental portion of the study.  The testing day occurred in week four, and the subjects, randomly placed in either an experimental/supplement group or a placebo group, underwent the following routine:

• Following a blood draw the subjects consumed 355ml of their liquid supplement - 16 receiving the carbohydrate-protein supplement and 18 receiving a placebo - and then rest quietly for 30min.  This was a double-blind experiment, so the subjects or the individual overseeing the experiment that day had no idea who was receiving the actual supplement and who was receiving a placebo.
• After their 30min. rest, the subjects received a second blood draw and then consumed another 177ml of the supplement or placebo.
• The subjects then performed the first 4-exercises in their routine.  After those exercises were complete, a third blood draw was conducted, and the subjects again consumed 177ml of their assigned liquid.  The subjects then completed the final three exercises in their routine
• Immediately following the last exercise, the fourth blood draw was conducted, and the subjects consumed another 355ml of their liquid drink.
• The subjects rested in the weight room, until a fifth blood drawn was then taken.
• Finally subjects were allowed to leave the weight room, however they had to return five hours later for the sixth blood draw (the subjects were asked not to consume food until after the sixth blood draw, when they could then eat freely).
• The seventh and final blood draw was conducted 24-hours post exercise.

What the researchers found was that markers of muscle damage (plasma myoglobin and creatine kinase) as well as cortisol levels were significantly elevated in the placebo group compared to the carbohydrate-protein group.  Additionally, those in the carbohydrate-protein group reported less muscular soreness 24-hours after training compared with the placebo group.  While the researchers did not find any significant differences between the two groups with regard to exercise performance, the noted results would certainly suggest that supplementation with a carbohydrate and protein beverage before, during and after training would be beneficial to the athletes recovery.  The findings of this study led the researchers to conclude; “These results suggest the use of a carbohydrate-protein supplement during resistance training to reduce muscle damage and soreness.”

Saunders et al, also sought to evaluate the potential benefits of a carbohydrate beverage on performance and muscle damage.  Fifteen male cyclists performed two rides 12-15 hours apart.  The first ride consisted of the subjects riding at a pace of 75% Vo2max to volitional exhaustion, while the second ride was performed at 85% Vo2max, again to volitional exhaustion.  The subjects consumed either 1.8ml per kilogram of bodyweight of either a carbohydrate only or a carbohydrate-protein beverage (randomly assigned) every 15min. of exercise, and 10ml per kilogram of bodyweight of the same beverage immediately following the ride.  The subjects were blinded to which beverage they consumed and were asked to then repeat the same training protocol 14-days later, when they were then given the opposite supplement that they consumed in the first trial.

Unlike the results from Baty and colleagues, the subjects in the carbohydrate-placebo group in this study saw performance improvements when compared to the carbohydrate only group.  During the first ride (75% Vo2max), those in the carbohydrate-protein group were able to ride 29% longer, while during the second ride (85% Vo2max), they were able to ride 40% longer.  Post exercise muscle damage, assessed by plasma creatine phosphokinase (CPK) levels, were 83% lower in the carbohydrate-protein group compared to the carbohydrate only group.  With these findings, it would appear that the co-ingestion of carbohydrate and protein has the potential to enhance exercise performance and decrease muscle damage.

In order to optimize training results and enhance recovery via better nutrition, athletes should seek to ingest carbohydrate-protein around the workout (before, during and after), as this is a critical time period to get nutrients into the body, and enhance the rebuilding processes following training. 

Taking a carbohydrate-protein supplement at other times of the day may lead to less than desirable results.  Cribb et al., found that when taken before and immediately after training, a supplement consisting of carbohydrate, protein and creatine monohydrate elicited greater results in lean-body mass and 1RM strength, as well as improved muscle creatine and glycogen stores, when compared to a those subjects taking the same supplement in the morning upon waking and in the evening, before bed, on each training day. 

Furthermore, because of it is of high quality, because it is rapidly digested, and because it contains a high level of amino acids, whey protein seems to be the protein of choice for post workout nutrition.  However, when ingested pre-workout, it does not appear to have the same effect on amino acid uptake, while a supplement containing essential amino acids (EAA) plus carbohydrates has been shown to improve muscle protein synthesis when take pre-workout, compared to post-workout intake.  For this reason, athletes may choose to consume an essential amino-acid and carbohydrate supplement prior to training, and a whey protein plus carbohydrate supplement post workout.

 Conclusions

Nutrition plays an important role in recovery from training and competition.  Athletes looking to maximize the results from their training should take their nutrition seriously, and establish a healthy meal plan that is tailored to their needs.  Additionally, nutrition around the work plays a critical role in helping to enhance recovery, improve glyogen resynthesis, and promote greater muscle protein synthesis.  This article contained general recommendations for the amount of protein and carbohydrate intake one should ingest around their workout and during the day.  For the best results, and for individualized recommendations, athletes should seek to consult with a registered dietician or sports nutritionist through the International Society of Sports Nutrition.

Patrick

patrick@optimumsportsperformance.com 

References

Burke LM, Kiens B, Ivy JL. Carbohydrates and Fat for Training and Recovery. J Sports Sciences 22:15-30. 2004.

Zawadzki KM, Yaspelkis BB, Ivy JL. Carbohydrate-protein complex increases the rate of muscle glycogen storage after exercise. J Appl Physiol 72(5):1854-1859. 1992.

Berardi JM, Price TB, Noreen EE, Lemon PW. Postexercise muscle glycogen recovery enhanced with a carbohydrate-protein supplement. Med Sci Sport Exerc 38(6):1106-1113. 2006.

Tipton KD, Witard OC. Protein Requirements and Recommendations for Athletes: Relevance of Ivory Tower Arguments for Practical Recommendations. Clin Sports Med 26:17-36. 2006.

Phillips SM. Moore DR, Tang JE. A critical examination of dietary protein requirements, benefits and excesses in athletes. Int J of Sports Nutr and Exerc Metabolism 17:S58-S76. 2007.

Baty JJ, Hwang H, Ding Z, Bernard JR, Wang B, Kwon B, Ivy J. The effect of a carbohydrate and protein supplement on resistance exercise performance, hormonal response and muscle damage. J Strength Cond Res 21(2):321-29. 2007.

Saunders MJ, Kane MD, Todd MK. Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Med Sci Sports Exerc 36(7):1233-1238. 2004.

Saunders MJ. Coingestion of Carbohydrate-Protein During Endurance Exercise: Influences on Performance and Recovery. Int J of Sports Nutr and Exerc Metabolism 17: S87-S103. 2007

Cribb PJ, Hayes A. Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy. Med Sci Sports Exerc 38(11):1918-1925. 2006.

Tipton KD, Tabatha AE, Cree MG, Aarsland AA, Sanford AP, Wolfe RR. Stimulation of net muscle protein syntehsis by whey protein ingestion before and after exercise. Am J Physiol Endocrinol Metab 292:E71-76. 2007.

Tipton KD, Rasmussen BB, Miller SL, Wolf SE, Owens-Stovall SK, Petrini BE, Wolfe RR. Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle to resistance exercise. Am J Physiol Endocrinol Metab 281:E197-206. 2001.

This week I have a great interview with Sam Leahey.

Sam is currently working towards his degree in exercise science. As well, he is paying his dues by spending time as an intern at some of the top strength and conditioning facilities in the Boston area – Mike Boyle Strength and Conditioning and Cressey Performance.

Through the power of the internet, I got to know Sam via Mike Boyle’s website, www.strengthcoach.com, and we have since become friends/colleagues, exchanging emails and articles on strength and sports performance topics.

Recently Sam wrote a great guest blog for Eric Cressey’s site, regarding the importance of keeping things simple in the weight room. Many of the ideas Sam discusses are similar to things I have written about before regarding program design and the training theme – mainly, focusing on one or two qualities in a workout, rather than trying to do everything.

I decided to have Sam do an interview so that he could elaborate a little more on his ideas from the article, and give us a little insight into what “paying dues” is all about!

Enjoy,

Patrick
patrick@optimumsportsperformance.com

–

1. First off, great job on your article for Eric Cressey’s site. Can you tell the readers a little bit about yourself?

The short answer is I’m a college student who is trying to take over the world of Strength & Conditioning :). Alwyn Cosgrove said once you should strive to be the dumbest person in the room. In other words, surround yourself with people you know are better than you in particular areas. If you do this then you will develop much quicker in your pursuit of greatness. The catch is, since doing this I’ve realized I don’t know crap! Purposely putting yourself at the bottom of a knowledge totem pole gives you great perspective in the field and allows you to see how much farther you really have to go. If you’re willing to undergo this humbling process then it will pay huge dividends in the future.

However the longer I do this the more aggravated I find myself getting towards young people like myself who think they “know” something that no one else does. If they were truly being mentored by people way more intelligent and with numerous more years experience they would see how much they really don’t know and would stop acting like they’re the next S&C prodigy. Seriously kids, get over yourselves and find a mentor who will put you in your place. If you really want to be big time, like Patrick Ward, Eric Cressey, Mike Boyle, and Dr. Charlie Weingroff, then put yourself in those humbling situations I alluded to. There are tons of people out there to learn from and theirs no excuse for not finding a “big timer” in your area. At the very least you could join www.strengthcoach.com or www.sportsrehabexpert.com and get “mentored” by the forum they offer. The collective group of brilliance there can really offer you a lot as a young person.

Bottom line - Be humble and always look to those better than you. The moment you think you’re at the top and only have downward to look is the exact moment, which you begin to suck!!!!!!!!!!!!

2. In your article, you said some really important things regarding simplicity and keeping things simple with regard to program design. The thing I particularly enjoyed was how you listed a number of qualities that all need to be trained, and then stated that you are better off just focusing on one or two in a training session, rather than trying to cram it all in there. Which is a similar message that I have tried to convey in some of my previous blog articles on setting up training. I was wondering if you could expand on your comments a little bit. What sort of qualities do you look to train on various days, and how does this shift between different phases of training?

Well if we wanted to get into the specifics you could break it up similar to Brijesh Patel (see Total Program Design Presentation) and have a day of each week that focuses on a particular quality. For example:

Mon - Lower Body Power Day
Tue - Upper Body Strength Day
Thurs - Lower Body Strength Day
Fri - Upper Body Hypertrophy Day

Now in another sense we can talk about someone who moves like crap, has the mobility of a bowling ball and just is flat out weak as heck. A person like would be better served with a program of heavy dose corrective exercise and simple strength work - forget hypertrophy days and power days for now. Some will disagree with that last part but I’m not sure how powerful were getting someone who cant even do a pushup! I remember when Eric Cressey once said, “Many people aren’t even strong enough to worry where they fall on the static-spring continuum.” The particular person I just described is one of them. He needs to learn proper movement patterns (proper motor skills with good mobility and stability) and gain some appreciable strength first before we can start worrying about training his short and long amortization phases.

Shifting gears again, we could talk about other things besides the qualities of strength and power. When do we fit our anaerobic/aerobic conditioning in? Should it be done year round or should we have a “conditioning phase(s)”?

THERE IS NO ONE RIGHT WAY!

Take college football for instance, its very paradoxical. You’re attempting to get a peak in power and anaerobic conditioning just before camp roles around in August. I’ve been part a part of some programs that have you conditioning EVERY DAY AFTER A LIFT! Seriously! Then as the conditioning component of the program increases so does our power development? It seems to me that the football world would be better off peaking strength and power first THEN anaerobic conditioning levels before the start of summer camp. Its easier to maintain one and focus on the other then trying to peak both at the same. Many times if you do it ends up contradicting each other and lowering both qualities.

A few more random ideas are you could work on training movement skills maybe 2-3 times a week instead of doing it everyday. Heck, you can also come in and do a “corrective exercise day” if you were pressed for time previously during the week, similar to Eric’s corrective intervals idea.

All in all, you DON’T have to work on EVERYTHING every single day of your program and in every single phase of training! Take 2 or 3 qualities and milk them for all there worth then move on and maintain that or pick new qualities all together.

3. Being a former athlete, what does your own training look like now? What are your goals, and how does your training differ now, compared to when you played football and had a strength coach writing the program for you?

I didn’t come from a very “updated” strength and conditioning program while playing college football. It was your typical old school mentality. So suffice it to say that it is night and day difference with the only constant being I try to lift heavy stuff frequently. Currently I’m doing Eric Cressey’s Maximum Strength program all while in the midst of coming off of a strained bicep. Its been fun having to learn first hand how to train around injury but admittedly I am embarrassed when I do upper body lifts because I feel so limited :).

4. Thanks for taking the time to answer these questions, Sam. Keep up the great work! Can you let the readers know where they can get in touch with you?

No problem Patrick, anytime. People can reach me at Sam.Leahey@gmail.com. I don’t have a blog but if enough people keep asking me maybe I’ll start one (LOL). My biggest fear in that is I’d be spending time trying to make quality blog posts and no one would read them, HA!

Contrast therapy has been used as a method of recovery in athletics for a significant period of time.

This type of therapy alternates between the application of hot and cold in a repetitive fashion, with the theoretical goal being to enhance recovery, decrease delayed-onset of muscle soreness (DOMS), enhance blood lactate removal, and improve various other markers of inflammation.

Application of Hot and Cold

When using contrast therapy, several factors must be taken into consideration:

• The temperature of the hot and cold plunges
• The duration of time that one spends in the hot and cold plunge
• The number of times one should alternate between hot and cold
• Which intervention - hot or cold - should begin and end the therapy
• Method - some may choose to just place one body part into the hot/cold plunge (IE, lower leg or forearm), while others may choose to do a full body plunge or just a plunge up to their waist.  Additionally, some studies didn’t use a plunge, but rather alternated between hydrocollator (hot packs) and ice packs.

Many coaches and athletes probably have their favorite way of applying contrast therapy; however, the research seems to be up in the air as far as the best way to go about managing hot and cold.

In studies, the duration of time in the hot and cold tended to vary from 1min hot:1min cold all the way up to 10min. hot:1min cold.  The common trend seems to be to have the cold interval shorter than the hot interval, with a majority of the studies using 1min. for the cold plunge. 

One study used 5min hot:5min cold.  The cold intervention, however, was with an ice pack (rather than a cold pool) and the temperature was not noted in the study - this is important to note, as 5min. in an extremely low temperature cold plunge may not be well tolerated by the athletes.

The total duration of time that the athletes spent performing contrast therapy in studies varied.  This would alter the number of times athletes alternate between hot to cold, depending on the duration of time spent in the hot and cold.  Overall, total duration varied from as low as 6-minutes, all the way up to 31-minutes of contrast therapy.

The temperature of hot and cold was different amongst studies as well. 

The temperature during the hot intervention varied from 38° C up to 75° C (100.4° F up to 167° F).  It should be noted that the 75° C was applied via hydrocollator pack with a terry cloth and two layers of towels used to protect the subjects from excessive heat.  The highest temperature used in a study where subjects were submerged up to their waist was 42° C (107.6° F). 

For cold interventions, temperatures ranged from 8° C to 15° C (46.4° F to 59° F).

Starting with hot or cold differed amongst studies, with the majority of the studies electing to begin with heat and end with cold.

Enhancements in Recovery

Studies on contrast therapy have found that this intervention has been shown to change subcutaneous tissue temperature - possibly suggesting enhancements in peripheral circulation and cuteaneous sensation.  However, no studies to date have shown actual changes in intermuscular temperature.

One study showed significant fluctuations in blood flow during a 20min contrast therapy session, where changing from hot to cold showed decreases in blood flow and vice versa when going from cold to heat.  Additionally, when looking at blood marker changes, contrast therapy was shown to reduce creatine kinase (a marker of inflammation) and blood lactate concentration at a similar rate as active recovery, when compared to passive recovery following training.  These findings may suggest that contrast therapy has a potential benefit to athletic recovery.

Finally, following exercise, contrast therapy was shown to decrease girth measurements, increase joint range of motion, and improve perceptions of soreness.

Conclusions

Anecdotally, athletes and coaches have used contrast therapy as a means to enhance recovery following training and competition.

While studies on contrast therapy are limited and their quality has been questioned, the take home points for me are:

• Athletes perceive less soreness following contrast therapy.  The mind is incredibly important, and if this method makes athletes feel less sore and more relaxed/recovered, then its use can be validated in my book.
• Both contrast therapy and active recovery have been shown to improve markers of inflammation following exercise when compared to passive recovery.  This information is potentially beneficial, as active recovery - while helping to get athletes moving and improve recovery - is still dependant on the athletes performing exercise (even if it is low-intensity), which may add more joint stress to an athlete who is slightly overtrained.  Further, for athletes who are in the middle of a long season, the use of contrast therapy may be more appealing (psychologically) than trying to go out and get in another workout/training session (again, even if it is low-intensity).

Hopefully future research will look more closely at this method of recovery to help athletes and coaches come to conclusions about the best ratio, total duration, and application of contrast therapy.

Patrick
patrick@optimumsportsperformance.com

References

Hing WA, White SG, Bouaaphone A, Lee P. Contrast therapy - a systematic review. Physical Thearpy in Sport 2008;9:148-161.

Myrer JW, Measom G, Durrant E, Fellingham GW. Cold and Hot-pack contrast therapy: Subcutaneous and intramuscular change. J Athletic Training 1997;32(3):238-241.

Myrer JW, Draper DO, Durrant E. Contrast therapy and intramuscular temperature in the human leg. J Athletic Training 1994;29(4):318-322.