Lack of training adaptation and progress; just a fatigued athlete, or are we missing something.?

Transcription

1 Lack of training adaptation and progress; just a fatigued athlete, or are we missing something.?

2 Best practice

3 Thorough nutritional screening Medical history Natural body weight Weight history Menstrual history Nutritional status Dietary registration Exercise registration Blood test with relevant parameters Micronutrient deficiencies (e.g., Iron, vitamin B) Macronutrient balance (% total intake, CHO, protein, fat) Food allergies and/or intolerance Energy availability (energy Intake energy expenditure = energy availability per kg fat free mass) Questions related to food, weight and body Body composition (DXA and skin folds ISAK)

4 2800 kcal 1400 kcal 2800 Kcal 1400 Kcal

5 Physiological How to and treat? psychological effects of low energy availability Athletes in weight-class sports - What should catch our attention?

6 We can manipulate training adaptation with nutrition However, this requires competence from a Increased translation science Increased transcription up-dated sports nutritionist/physiologist, Protein synthesis coach, athlete and Protein breakdown in a systematic approach If not, the athlete can get severe consequences Satellite cell activation (MGF/IGF-1) Muscular hypertrophy Mitochondria biogenesis

7 Hormones Increased cortisol Increased ghrelin Decreased thyroid hormones Decreased circulating leptin Reduced estrogen and testosterone concentration Menstrual dysfunction Decreased libido Side 7 Nattiv et al Med Sci Sports Exerc; Mountjoy et al Br J Sports Med; Roemmich & Sinning 1997; Sundgot-Borgen & Garthe 2011 J Sports Sci.; Areta et al Am J Physiol Endocrinol Metab; Melin et al Scand J Med Sci Sports; De Souza et al Br J Sports Med.;Tenforde et al Sports Med.; Trexler et al J Int Soc Sports

8 Sufficient EA Low EA «Low» fat % High BMD «Normal» fat % LowBMD High LBM Low LBM

9 Hormones Increased cortisol Increased ghrelin Decreased thyroid hormones Decreased circulating leptin Reduced estrogen and testosterone concentration Menstrual dysfunction Decreased libido Side 9

10 Changes % Changes in BMR after weight loss Weight loss and BMR 4,7 3,0-9,5-1,7-2,0-3,1 1,9 1,5 0,7-4,9 5,6-5,4 2,7 0,1-18,2-14,7-24,7-22,0 Unpublished data from Garthe et al LBM BMR

11 Hormones Increased cortisol Increased ghrelin Decreased thyroid hormones Decreased circulating leptin Reduced estrogen and testosterone concentration Menstrual dysfunction Decreased libido Side 11 José L. Areta et al. Am J Physiol Endocrinol Metab 2014;306:E989-E997 Nattiv et al Med Sci Sports Exerc; Mountjoy et al Br J Sports Med; Roemmich & Sinning 1997; Sundgot-Borgen & Garthe J Sports Sci. 2011; Areta et al. Am J Physiol Endocrinol Metab. 2014; Melin et al. Scand J Med Sci Sports. 2015; De Souza et al. Br J Sports Med. 2014;Tenforde et al. Sports Med. 2016; Trexler et al. J Int Soc Sports Nutr. 2014; Umeda et al. J Sports Med Phys

12 Restrictive energy intake + Exercise = Impaired immune function Increased risk of URI Side 12 Umeda et al J Sports Med Phys Fitness; Tsai et al Br J Sports Med.

13 Screening tool for energy availability 25-item LEAF-Q & LEAM-Q Sensitive & Specific in classifying current energy availability

14 Can we do more to get the whole picture? Use several means to get an overall impression Gather all available information Multiple test variables/approaches Monitor off- and in-season

15 Who`s at risk? Athletes who abruptly increase training load and energy expenditure without regulating energy intake Athletes during weight loss intervention Athletes with a restricted energy intake, whether inadvertent or by intent Athletes with high training loads with focus on healthy eating Athletes that have a disordered eating Thea Therese pattern or an ED Vingmark Næss World Champion kickboxing

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17 Training load Energy availability Body weight Hormonal balance Training load Energy availability Body weight Hormonal balance

18 In response to negative energy balance, muscle protein synthesis may be downregulated as a result of decreased nutrient and growth factor availability, causing reduced mtorc1 activation. P13k AMP:ATP Energy deficit Ca2+ p38mapk Action! AKT AMPK mtor CaMK FOX O Protein synthesis Protein degradation Determine a PGC-1 successful treatment approach

19 Identify underlying cause of low EA Inadvertent: early satiety, sudden increase in training load or appetite suppression. Focus: Energy intake: Aim for a surplus ~250 to 500 kcal/day Adding energy dense snacks between meals Regular meal pattern Calcium mg/day, optimal vitamin D status Optimize and monitor B-vitamin, iron and D-vitamin status Focus: Energy expenditure: Reduce training volume by including a rest & recovery day, reduce training frequency by having only one session per day (dependent on type of training) Reduce high-endurance sessions Replace with strength and power training Intended: DE/ED, weight loss intervention. Similar physiological recommendations Multidisciplinary team: Nutritionist, physician, psychiatrist, exercise physiologist, physiotherapist Nattiv et al Med Sci Sports Exerc; Mountjoy et al Br J Sports Med; Sundgot-Borgen & Garthe 2011; Lynn Cialdella-Kam et al. Sports 2016; Melin & Garthe 2015

20 How to prevent high-risk Elite athletes from chronically low energy availability?

21 Side 21

22 EXERCISE (STMULI) Increased protein metabolism Physiological stressors Reduced glycogen storage Increased loss of body water and electrolytes Increased oxidative stress RECOVERY Refuelling glycogen in muscle Rehydrate Increased protein synthesis Repairmant of tissue SUPER COMPENSATION Positiv net protein balance Increased lean mass Increased strength Physiological adaptations Side 22

23 THE ROADMAP TO SUCESS DINNER TRAINING LUNCH BREAKFAST RECOVERY MEAL PRE-TRAINING MEAL Side 23 TRAINING

24 PERIODIZATION OF TRAINING PHASE Periodization of training and nutrition Jan Feb mar Apr May Jun Jul Aug Sept Oct Nov Dec OFF- SEASON PRE- SEASON IN-SEASON ACTIVE REST OFF- SEASON DURATON INTENSITY

25 The Elite athlete - fine line between success and Stresses Training Family Friends Team mates Pressure of competition Financial failure Recovery time Sleep Diet Time «off» Sports psychology/ Mental training

26 TAKE HOME. Thorough screening with different approaches Monitor over time creating the best base for evaluation Be familiar with, and acknowledge errors related to test variables and methods used Junior-senior key word: patience Periodize training and nutrition

27 Thanks to all athletes for inviting us in to observe, learn, create and challenge for the everlasting development of best practice!