Current Issues & Trends (from powerpoints)

Predictors and prevalence of post-concussion depression symptoms in collegiate athletes

Depression is common after concussion and is associated with functional outcome and quality of life after injury. However, few baseline predictors of post-concussion depressive symptoms (PCDS) have been found

Fat cell development

During periods of growth in late childhood/early puberty, the number of fat cells increase. During periods of excess intake, fat cell size increases. When fat cells have reached their maximum size, the cell number increases. Even with fat loss, the cells may shrink but not the number

The American Heart Association's Diet and Lifestyle Recommendations

Eat an overall healthy dietary pattern that emphasizes: • a variety of fruits and vegetables, • whole grains, • low-fat dairy products, • skinless poultry and fish • nuts and legumes • non-tropical vegetable oils Coconut oil, when compared with cis unsaturated plant oils, raises total cholesterol, HDL-C, and LDL-C

Smoking causes lung cancer

False From epidemiological point of view, there is a good association between smoking and lung cancer. This does not mean causation. Many people who smoke never develop lung cancer

Screening tests are available for most cancers

False Screening tests are available for some cancers, such as prostate, colorectal, and breast. There are many cancers for which we do not have screening tests yet, such as pancreatic, brain, etc.

In the past 20 years tremendous improvements in the treatment of all cancers have been achieved

False We have seen improvement in detection, monitoring, and treatment for some cancers. However, there is large number of cancers, where we have seen little improvement, such as pancreatic and ovarian

Ketogenesis

Fatty acids catabolized into acetyl groups (by beta-oxidation in mitochondrial matrix) may... Enter citric acid cycle as acetyl-CoA Undergo ketogenesis metabolized by liver to produce ketone bodies

Where does the ethanol come from?

Fermentation Yeast + sugar = ethanol + CO2 Ethanol = ethyl alcohol

Exertional and CrossFit-Induced Rhabdomyolysis

Few publications of exercise-induced rhabomyolysis currently exist in the medical literature besides case reports. However, this condition can be severe, resulting in hospitalization and IV fluid administration to prevent serious sequelae. This report describes a case of exercise-induced rhabdomyolysis caused by a CrossFit workout. A 31-year-old female presented with 2 days of bilateral upper extremity pain and soreness, which began 2 days after she completed a CrossFit workout. Workup revealed an elevated creatine phosphokinase (CPK) of 18 441 U/L, consistent with exercise-induced rhabdomyolysis, and elevated liver function tests and elevated D-dimer, although her renal function was normal. She was hospitalized for 2 days and treated with IV fluids. This case report demonstrates that CrossFit exercises can lead to rhabdomyolysis, highlighting a condition that may be underdiagnosed and underreported

Electronic questionnaires

Follow-up electronic questionnaires: Food frequency questionnaire (FFQ) that includes 127 food items, and 3 portion size pictures for 17 selected food items Life-style including PA questionnaire Medication usage and safety questionnaires

Characteristics of Type I and II Muscle Fibers

Force production: Type I Slow Twitch-low, Type IIa Fast Twitch-intermediate, Type IIb Fast Twitch-high Contraction speed: slow, fast, fast Myofibrillar ATPase Activity: low, high, high Fatigue resistant: high, moderate, low Glycolytic capacity: low, high, high Oxidative capacity: high, medium, low Capillary density: high, intermediate, low Mitochondrial density: high, intermediate, low Myoglobin content: high, intermediate, low Endurance capability: high, moderate, low Glycogen storage capability: no difference, no difference, no difference

Metabolic Syndrome Parameters 3/5

HDL Cholesterol <40 mg/dL in men <50 mg/dL in women Fasting glucose ≥100 mg/dL Blood pressure ≥130/85 mm Hg Triglycerides ≥150 mg/dL Waist circumference* ≥102 cm (40 in) in men ≥88 cm (35 in) in women if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women

Fiber Types

Improvement of muscle staining techniques Subtypes of Type I (I and Ic). Ic have less oxidative capacity than I. Subtypes for Type II (II c, II ac, II a, II ab, II b). A continuum of aerobic and anaerobic characteristics Genetics largely determines muscle fiber type distribution. Set at birth or early in life. Average individual has equal proportion of FT and ST fibers Endurance athletes primarily ST Explosive athletes primarily FT

Physical Activity and the Cancer Patient

In the past, people being treated for a chronic illness (like cancer or diabetes) were often told by their doctor to rest and reduce their physical activity. This is good advice if movement causes pain, rapid heart rate, or shortness of breath. But newer research has shown that exercise is not only safe and possible during cancer treatment, but it can improve how well you function physically and your quality of life Too much rest can lead to: • Loss of body function • Muscle weakness • Reduced range of motion • Decrease in muscle mass- sarcopenia Many cancer care teams are urging their patients to be as physically active as possible during cancer treatment

Post Exercise Protein: How much? What kind?

Investigation of effects of various slow and fast digesting proteins on protein balance following single bout of resistance training Avg. 33 g Each taken with same CHO and fats 33 grams of whey protein promoted the greatest protein balance in both young and elderly individuals

Return to play process

It is a five-step process without any set timeline for a full return from a concussion: 1. Rest and recovery: Until a player returns to the "baseline level of signs and symptoms and neurological examination," only limited stretching and balance activities are recommended. 2. Light aerobic exercise: The NFL recommends 10-20 minutes on a stationary bike or treadmill without resistance training or weight training. The cardiovascular activity is monitored by an athletic trainer to "determine if there are any recurrent concussion signs or symptoms." 3. Continued aerobic exercise and introduction of strength training: Increased duration and intensity of aerobic exercise with strength training added. An athletic trainer will supervise to watch for recurrent concussions signs or symptoms. 4. Football specific activities: The cognitive load of playing football will be added and players will participate in non-contact activities for the typical duration of a full practice. 5. Full football activity/clearance: A player returns to full participation in practice, including contact without restriction.

Muscle Force Generation

Key Points • 3 types of muscle contraction - Concentric - Isometric - Eccentric • Force production is increased by recruitment of more motor units and through increased frequency of stimulation • Force production is maximized at the muscle's optimal length • Speed of contraction also affects the amount of force produced

Cell Metabolism Improvement of Insulin Sensitivity after Lean Donor Feces in Metabolic Syndrome Is Driven by Baseline Intestinal Microbiota Composition

Kootte et al. show that fecal microbiota transplantat ion from lean donors to obese patients with metabolic syndrome improves insulin sensitivity , a transient effect associated with changes in microbiota compositio n and fasting plasma metab olites. Baseline fecal microbiota compositio n in recipients predicts the response to lean donor fecal microbiota transplantation.

Deep SAT (DSAT)

Larger, more irregular Obesity associated complications Insulin resistance

How Do I Know If My Heart is Healthy?

Life's Simple 7 1. Avoid smoking and using tobacco products 2. Be physically active every day 3. Eat a heart-healthy diet 4. Keep a healthy weight 5. Keep your blood pressure healthy 6. Keep your total cholesterol healthy 7. Keep your blood sugar healthy

Metabolic System

Many of the physiological adaptations during prolonged training relate to an improved ability to generate more energy and to use this energy more efficiently. Adaptations are specific to the mode of exercise employed.

Primate energy expenditure and life history

Measurements of daily energy expenditure indicate that primates, including humans, expend only half of the calories expected for mammals of similar body size

Hand Injuries

Most Commonly Injured Body Site Least Protected / Padded Area Growth Plate Deformities Mechanism of Injury Direct Trauma Most Common

The Influence of Nontraditional Training Modalities on Physical Performance: Review of the Literature

Most of the nontraditional forms of physical training are not supported in the scientific literature, with the exception of heavy leg strength training and agility training • Conclusions - The addition of heavy leg resistance exercises to an existing aerobic training regimen seems promising with regard to improving aerobic fitness status in those Air Force personnel who may be considered non-responders - CrossFit claim to improve physical working capacity (e.g., intensity x duration of work) and performance • There have been few documented scientific studies to support this claim, only anecdotal reports. - Future research: • Should attempt to measure changes in aerobic exercise efficiency after adding heavy leg resistance exercises to an existing aerobic routine and determine if any relationships exist between aerobic fitness and improved leg strength - Future researchers should focus on evaluating and validating agility training among active duty members as a means to enhance fitness performance, train, and select USAF personnel for rapid deployment. - Future researchers should compare the effects of these training programs to traditional forms of physical training on run performance in a group of elite battlefield airmen.

Lycopene and Its Antioxidant Role in the Prevention of Cardiovascular Diseases—A Critical Review

Most studies showed beneficial effects of lycopene to individuals who are antioxidant-deficient like elderly patients, or humans exposed to higher levels of oxidative stress like smokers, diabetics, hemodialysis patients and acute myocardial infarction patients.

Aerobic activity

O2 consumption Long period Low-moderate intensity Fat & carbohydrate

Obesity

Obesity is increasing in an epidemic manner in most countries and constitutes a public health problem by enhancing the risk for cardiovascular disease and metabolic disorders such as type 2 diabetes Owing to the increase in obesity, life expectancy may start to decrease in developed countries for the first time in recent history

Risk Factors of Metabolic Syndrome

Obesity • Body fat distribution • Physical inactivity • Excess caloric intake • Poor diet • Medications (Exposure to antipsychotic medications) • Family history • Socioeconomic factors • Low Vitamin D 25-Hydroxy

Body Part Specific

Often used as assistance exercises • Effective in training specific joints or muscles that are susceptible to injury • Can focus training on areas established a high priority from the needs assessment

Superficial SAT (SSAT)

Organized into tightly packed negative and positive associations Improved glycemic control

Why start exercise after having a cancer?

Physical activity decreases your risk of recurrence and increases survival. Women who reported 4 hr/week of brisk walking had a 40% lower risk of recurrence and breast cancer death. Women who are overweight at breast cancer diagnosis are at a 2- fold greater risk for recurrence and death compared with lighter women. Women who gain weight (~5 lbs) are at 60% increased risk of death compared with women who do not gain weight. Obesity and weight gain lead to an increased production of certain hormones and growth factors that increases cell proliferation.

Total Energy Expenditure (TEE)

Physical activity energy expenditure: 10-30% DIT: 5-10% Resting metabolic rate (RMR): 60-75%

Bioenergetics

Primarily concerned with the source of energy for muscular contraction. Three physiological systems in the body that produce energy: Phosphagen (ATP-PC) Glycolytic Oxidative

Hormones and Exercise

Primary adaptation to exercise (resistance) involves repair and remodeling of tissue (anabolic) In instances when intensity or volume of training exceed an individual's ability to recover the result could be catabolic in nature. Hormonal response can either promote or impede tissue remodeling. Hormonal response to exercise may be different between trained and untrained individuals.

POST-EXERCISE NUTRITION 'ONLY' STRENGTH-POWER ATHLETE

Protein: Where do we start? • Recommended g/kg of body weight? • Grams of protein per meal? • Grams of protein per time of day? • What kind of protein? • How much? When? From where? Best question... • How can protein intake best stimulate protein synthesis?

Differences in How Mothers and Fathers Monitor Sugar-Sweetened Beverages for Their Young Children (7-12 Years)

Regression models also showed that the core constructs of the IBM predicted a significant amount of the variance for monitoring SSBs for both mothers and fathers (39.4% and 18.3%, respectively)

Conclusions

Regular aerobic exercise modestly increases HDL-C level. There appears to exist a minimum exercise volume for a significant increase in HDL-C level. Exercise duration per session was the most important element of an exercise prescription. Exercise was more effective in subjects with initially high total cholesterol levels or low body mass index.

Resting energy expenditure (REE/RMR)

Represents the energy required to maintain vital body functions The main component (55% to 70%) of daily energy expenditure Affects body composition (by free fat mass) Decreases with age by 1-2% per decade Higher among men (~200 kcal/day) Higher among Caucasians (~90 kcal/day) Decreases with restricted calorie diets Strength training can increase REE

Television Watching, Energy Intake, and Obesity in US Children

Results The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake. Conclusions As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.

EPOC

Resynthesis of phosphocreatine Body temperature Restoration of hemoglobin Glycogen resynthesis Reesterification of fatty acids Damage repair

Sarcopenic Obesity

Sarcopenic obesity is a medical condition which is defined as the presence of both sarcopenia and obesity

Exercise for Cancer Patients: Longer Life, Less Recurrence

Several recent studies suggest that higher levels of physical activity are associated with a reduced risk of the cancer coming back, and a longer survival after a cancer diagnosis

Cascade - wine drinking study

Slides 41-56 in lecture 11 lifestyle intervention

Muscle Fiber Types

Slow-twitch fibers, Type I (~50%), oxidative Fast-twitch fibers, Type II Type IIa (25%), fast oxidative/glycolytic (FOG) Type IIx in humans (~25%) ~ IIb in animals, fast glycolytic (FG) Type IIc (1-3%) The percentage of each fiber type is variable among muscles, among individuals, and with exercise training

Body Parts Injured May Vary By

Sport Played Some sports emphasize different body parts Lower extremity = soccer, basketball Upper extremity = tennis, baseball Equipment Used Projectiles may cause ocular injury Examples = baseball, tennis

Strength vs. Hypertrophy

Strength • Goal- Increase maximal force • capability (slow velocity strength) • Relativelyhighintensity • • Relatively low volume • • Long rest Interval • Hypertrophy Goal- Maximize muscle cross sectional area- Get bigger Lower intensity Higher volume Short rest interval • Mechanicalvs.metabolic changes ?

Benefits of exercise training on coronary blood flow in coronary artery disease patients

Systemic and cardiac benefits on slide 27 - lecture 11 lifestyle interventions Every 34 seconds anAmerican experiences a myocardial infarction or cardiac death. Approximately 80% of these coronary artery disease (CAD)- related deaths are attributable to modifiable behaviors, such as a lack of physical exercise training (ET). Regular ET decreases CAD morbidity and mortality through systemic and cardiac-specific adaptations.

TRAINING VOLUME BASED ON GOAL

Table on slide 53 - lecture 7 resistance training

Cross-sectional design

Test the association between exposure and diseases/performance/other outcome • Comparing the prevalence of the diseases between exposures and non- exposures • Odds Ratio = OR • OR>1 Risk factor • OR<1 Prevention factor • OR=1 No association Snapshot of the association of factors (e.g. back pain and swimming) Consist of assessing a population at a single point in time

Specific Anabolic and Catabolic Hormone Actions

Testosterone: stimulates protein synthesis Growth hormone (GH): stimulates tissue growth, mobilizes fatty acids for energy & inhibits carbohydrate metabolism Insulin-like-growth factor (IGF-1): increases protein synthesis in cells Insulin: promotes glucose transport into cell & protein synthesis Cortisol: promotes protein catabolism, stimulates gluconeogenesis, & promotes lipid metabolism Resistance exercise potent: stimulator of endocrine system

Western diet linked to an increased riskof type 2 diabetes in women

The "Western" diet -- one especially high in red and processed meats and refined grain -- once again appears to be a culprit in women's health -- this time linked to an increased risk of type 2 diabetes in women, according to a study released today in the .Archives of Internal Medicine

Take away message

The Metabolic Window is much longer than 15-45 minutes !

Hydration

The best way to stay well hydrated for exercise is to drink • Before • During • After Remember! Drink regardless of whether you are thirsty or not! Way Before: Drink 2-3 cups of fluid 2 to 3 hours before playing Right Before: Drink 1 cup of fluid 10 to 30 minutes before playing During: Drink 1 cup of fluid every 15 minutes After: Drink at least 2 cups for every pound of lost weight

Type 2 Diabetes prevention

The goal of treatment in type 2 diabetes mellitus (T2DM) is to achieve and maintain optimal blood glucose, lipid and blood pressure levels, and to prevent or delay the development of chronic complications of diabetes Physical exercise is central to the management of T2DM to help achieve and maintain therapeutic goals and improve quality of life

Guidelines Urge Exercise for Cancer Patients, Survivors

The panel was convened in 2009 by the American College of Sports Medicine Disclaimer (ACSM) to develop guidelines Disclaimer on exercise and physical activity in patients who are undergoing active treatment for cancer or who have completed treatment. Our hope is that there will be more conversations about the need for formalized exercise programs for patients during and right after treatment—programs that will be the cancer equivalent to cardiac rehab 4 Kinds of Exercise that Help Cancer Patients Aerobics Strength Balance Stretching

Respiratory Quotient (RQ)

The ratio between CO2 production and O2 consumption RQ =VCO2/VO2 Reflects macronutrient oxidation.

Higher folate intake decreases risk of hypertension

The researchers found that younger women who consumed at least 1,000 micrograms a day of total folate (dietary plus supplemental) had a 46 percent decreased risk of hypertension, compared with those who consumed less than 200 micrograms a day of total folate. Older women with high total folate intake also had a 18 percent reduced risk of hypertension.

Lifestyle and Cholesterol

The synthesis and utilization of cholesterol must be tightly regulated in order to prevent over-accumulation and abnormal deposition within the body. Of particular clinical importance is the abnormal deposition of cholesterol and cholesterol-rich lipoproteins in the coronary arteries. Such deposition, eventually leading to atherosclerosis, is the leading contributory factor in diseases of the coronary arteries.

NFL Concussion Protocol

There are seven observable symptoms used to identify players with concussions. Those are: 1. Any loss of consciousness 2. Slow to get up following a hit to the head ("hit to the head" may include secondary contact with the playing surface) 3. Motor coordination/balance problems (stumbles, trips/falls, slow/labored movement) 4. Blank or vacant look 5. Disorientation (e.g., unsure of where he is on the field or location of bench) 6. Clutching of head after contact 7. Visible facial injury in combination with any of the above When spotters or other medical personnel* see those signs, that's when the protocol goes into effect. *In addition to the team medical staff and an unaffiliated neurological consultant, the league employs two medical spotters in the booth who watch the game with binoculars and video replay to identify injuries that others missed. The league added a rule in 2015 allowing for the medical spotters to stop the game with a medical timeout to remove an injured player.

Cross sectional study in an Indian population on associations between diet, physical activity and body fat distribution

There was some evidence for a small positive association between sedentary time and total fat in the IMS (an extra 10 minutes of time spent sedentary per day was associated with 26 g higher body fat (95% CI 0.1, 51))

Physical Activity and Cancer Prevention

There's a strong link between physical activity and a decrease risk of postmenopausal breast, colorectal, and endometrial cancers; between body fatness and an increased risk of gallbladder, kidney, colorectal, esophageal, postmenopausal breast, pancreatic, and endometrial cancers Physical exercise has been shown to reduce cancer incidence and inhibit tumor growth New studies provide the status of the current molecular understanding of the effect of exercise on cancer Exercise has a role in controlling cancer progression through a direct effect on tumor-intrinsic factors, interplay with whole- body exercise effects, alleviation of cancer-related adverse events, and improvement of anti-cancer treatment efficacy These findings have wide-ranging societal implications, as this understanding may lead to changes in cancer treatment strategies

Effects of low vs high load resistance training on muscle strength and hypertrophy in well-trained men

These findings indicate that both HL and LL training to failure can elicit significant increases in muscle hypertrophy among well-trained young men; however, HL training is superior for maximizing strength adaptations

Exercise has the ability

To increase RMR by reducing body fat and increasing fat free mass

Conclusions (sport nutrition)

To maximize the effect of training for the Strength and Power Athlete: • Hit leucine saturation each meal • High protein meals separated by at least 3 hours • EAA-CHO prior, during, post resistance training • Pre-Sleep Meal

Can High-Intensity Training Be Used to Enhance Fat Loss in Overweight Individuals

Traditional use of slow, prolonged endurance exercise. Greater duration the more fat is utilizied A group of Investigators from the UK (Whyte et al., 2010) examined the effect of 2-weeks of interval training (4 - 6 30-s sprints with 4.5 min recovery). Insulin sensitivity and resting fat oxidation significantly elevated. Resting carbohydrate oxidation lowered (p<0.05) Evidence for use of recreational sports High intensity sport may be an effective way of losing body fat

Large percentage of cancers are preventable

True

Preventing cancer is easier than treating cancer

True

What is the difference between "tumor" vs "cancer"

Tumor - Either benign or malignant Cancer - Usually malignant

A Photomicrograph Showing Type I, Type IIa, and Type IIx Muscle Fibers

Type I (black), type IIa (white), and type IIx (gray) muscle fibers

Obesity and Obesity Related Diseases, Sugar Consumption and Bad Oral Health: A Fatal Epidemic Mixtures: The Pediatric and Odontologist Point of View

WHO guidelines recommend reducing sugar intake to 10% of the total daily energy need, and highlight that there is evidence which suggests cutting this value down to 5% at least. The American guidelines addressing paediatric age put the limit to 25gr a day with a total ban on sugar in those aged 2 or less.

Physical exercise as therapy for type 2 diabetes

We present details of the exercise therapies used in long-term studies, describing how the parameters for exercise prescription were applied in clinical practice. These parameters are described in terms of frequency, intensity, duration, mode and rate of progression in long-term therapeutic prescriptions At present, physical exercise therapy is being considered for approval as a prescribed medication by the Food and Drug Administration in the USA Criteria for FDA on slide 30 - lecture 11 lifestyle intervention

Trajectory of RMR, RMR/kg, and RQ

Weight loss is associated with decreased total RMR BUT with increased RMR/kg Weight loss is associated with decreased RQ

Defining Adult Overweight and Obesity

Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese. Body Mass Index, or BMI, is used as a screening tool for overweight or obesity.

Post exercise protein type

Whey ≥ Milk > Casein > Soy Whey: Greater Leucine content and higher digestibility

The Benefits and Risks of CrossFit: A Systematic Review

With the increase in popularity of the CrossFit exercise program, occupational health nurses may be asked questions about the appropriateness of CrossFit training for workers. This systematic literature review was conducted to analyze the current research on CrossFit, and assess the benefits and risks of this exercise strategy. Thirteen studies (N = 2,326 participants) examined the use of CrossFit training among adults; CrossFit is comparable to other exercise programs with similar injury rates and health outcomes. Occupational health nurses should assess previous injuries prior to recommending this form of exercise. Ideal candidates for CrossFit are adults who seek high-intensity exercise with a wide variety of exercise components.

Un-aerobic activity

Without using O2 Short period Vigorous intensity Mostly from Carbohydrate

Is the EPOC greater in HIE than in MIE?

Yes Exercise intesity explains 45% of increase of EPOC Exercise duration 9%

Metabolic syndrome

a combination of disorders that multiply a person's risk for heart disease, diabetes and stroke; a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure

Increased fruit and vegetable consumption is associated with

a decreased risk of cardiovascular disease but not cancer, according to a new study issue of the Journal of the National Cancer Institute

"Western" diets consisting of red and processed meats, refined grains, sweets and desserts may be associated with

a greater risk of stroke. American Heart Association.

Insulin

a hormone made in the pancreas, an organ located behind the stomach; the pancreas contains clusters of cells called islets; beta cells within the islets make insulin and release it into the blood

Relative energy intake

absolute energy intake minus energy expenditure from exercise

The USPSTF recommends offering or referring

adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.

The incorporation of eccentric training can be recommended for

counteracting the negative effects of detraining or forced physical inactivity

Appetite

desires/needs that promote food ingestion

Decreased visceral fat is associated with

improved lipid profile, while decreased Deep-SAT is associated with improved insulin sensitivity. Superficial-SAT remains neutral except in direct association to leptin changes

Data suggest that athletes who underwent a VLCKD with adequate protein intake lost weight and improved body composition without any negative changes

in strength and power performance

Hyperplasia

increase in cell number

Hypertrophy

increase in cell size

Myoglobin

is a major protein constituent of muscle and when released from the muscle, can overwhelm the kidneys

The adoption and maintenance of physical activity are critical for

lood glucose management and overall health in individuals with diabetes and prediabetes

Lifestyle choices

may actually reduce the chance of repeating your family's history of poor health epigenetics

Rhabdomyolysis occurs when

muscle membranes become ruptured and fail to contain the cellular contents. dehydration will directly affect the ability of the body to deal with or recover from overexertion exercise, however hydration is not the sole causation of rhabdomyolysis

Gestational diabetes mellitus (GDM)

one of the common complications that occur during pregnancy. Early intervention is essential to prevent the development of the disease in the non-pregnant state but also helpful in preventing the occurrence of GDM. The aim of the study was to assess the effect of aerobic exercises on insulin sensitivity and fasting plasma glucose level in pregnant women with risk for gestational diabetes mellitus. Moderate intensity of aerobic exercises were effective in reducing fasting blood glucose level and fasting insulin level in pregnant women with risk for gestational diabetes mellitus

Homeostatic Control

physiological needs

Hedonic Control

pleasure and emotions

Alcohol is metabolized

primarily in the liver (ADH) to acetaldehyde, toxic substance • Acetaldehyde then enters the mitochondria, where it is oxidized (ALDH) to acetate ADH activity is the rate-limiting step in alcohol metabolism The "average" metabolic rate of alcohol metabolism is ~7 g/hr which translates to ~ 1 drink per hr.

Dietary Supplements

products taken orally for supplementing the diet Supplementation among athletes is becoming more popular. There are many products on the market promising "fat burn", increased muscle mass, and weight loss. What many athletes do not know is the impact of supplementation, if it is safe, if it meets its expectation, and if it is needed.

The importance of early post-exercise protein ingestion

relates to the fact that exercise-mediated increases in rates of MPS are greatest immediately after exercise (~100-150% above basal rates), and thus the synergistic effects of exercise and feeding on MPS are likely greatest during this time period

The number of fat cells in your body

remains constant throughout your adult life, a new study has found. The discovery suggests that the process of weight gain may be fundamentally different in adults and in children. Adults who gain or lose weight may do so through changes in the size of the fat cells, also called adipocytes, that constitute fatty deposits in the body. Children, on the other hand, may put on extra fat by increasing the overall number of these cells in the body.

Increased participation in nonvigorous as well as overall and vigorous physical activity was associated with

significantly higher insulin sensitivity

Amino acids

slide 8 - lecture 12 sport nutrition

This American Heart Association (AHA) Scientific Statement for health professionals

summarizes the evidence for the benefits of physical activity in the prevention and treatment of cardiovascular disease, provides suggestions to healthcare professionals for implementing physical activity programs for their patients, and identifies areas for future investigation. This evidence supports the recommendation from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most (preferably all) days of the week

Magnetic Resonance Imaging (MRI)

the gold standard technique and the most common radiology of body structures

Add exercise to diet for

the management of lipoprotein levels associated with a high risk of coronary heart disease

A cranial computerized tomography (CT) scan is

the standard test to assess the brain right after injury. A CT scan uses a series of X-rays to obtain cross- sectional images of your skull and brain. Magnetic resonance imaging (MRI) may be used to identify changes in your brain or to diagnose complications that may occur after a concussion. An MRI uses powerful magnets and radio waves to produce detailed images of your brain.

Taken together these results suggest that a properly monitored and programmed ketogenic diet could be a useful, safe method to allow the athletes to reach their desired weight categories without

the unnecessary and harmful procedures currently in use

Clinical parameters

weight measurement Blood pressure and waist circumference (WC)

Training Status and post-exercise MPS (muscle protein synthesis)

• "Changes in MPS in the trained state are initially greater in amplitude but are reduced in duration • Similar findings from (Kim et al. 2005) and (Phillips et al. 2002)

Independent and combined effects of Amino Acids and Glucose after Resistance Exercise

• "Combined effect on net muscle protein synthesis of carbohydrate and amino acids given together after resistance exercise is roughly equivalent to the sum of the independent effects of either given alone"

An oral essential amino acid-carbohydrate supplement enhances muscle protein anabolism after resistance exercise

• 6 subjects (3 male; 3 female) -Cross-over design • recreationally active but not involved in any training program Leg Press 10 X 8 Leg Extension 8x 8 @80% 1-RM with 2 min rest intervals (~45 mins total) 1 hour post (6g EAA / 35g sucrose) 3 hours post • Significantly greater MPS compared to placebo at both time points • Similar anabolic responses at 1 and 3 hours for AA-CHO drink • Suggesting either time point is satisfactory

INJURY RISK AND DISEASE PREVENTION

• A comprehensive program of resistance exercise may be the most effective means of preventing musculoskeletal injuries and reducing the risk of degenerative diseases: Reduced risk of overuse injuries Increased bone mineral density Improved body composition A decrease in depression Improved functional ability Increased mitochondrial content and oxidative capacity of muscle tissue

Structural Exercises

• A coordinated action of many muscle groups • Multijoint exercises requiring complex motor control • Should be performed by individuals ready for more advanced lifting techniques • Because of coordinated action of many muscle groups, these may be more beneficial for sports training.

Tumor is a disorder of cells

• A neoplasm (Greek, Neo-New, plasma, thing formed) is the autonomous growth of tissue that have escaped the normal restraints on cell proliferation and exhibit varying degrees of fidelity to their precursors. • It is usually appears as a tumor (a swelling) made of mass of cells "Abnormal growth of cells", "Unlimited growth of cells".

Suicide in Athletes

• A number of high profile athletes that have committed suicide in the recent past • In a review of medical & periodical literature, investigators found 71 cases of athletes who contemplated or attempted - 66 of those cases followed- through & committed suicide • 61 of those cases were male & average age was 22 yrs old - similar to general population (males more likely to commit suicide, 15 - 24 yrs represent group with highest suicide rate) • Critical to identify the risk factors & signs

Symptoms

• Abnormal urine color (dark, red or "cola colored") • Decreased urine production • General weakness • Muscle stiffness or aching (Myalgia) • Muscle tenderness • Weakness of the affected muscles • Fatigue • Joint Pain • Seizures • Weight Gain (unintentional)

Secondary Prevention

• Aims to reduce the impact of a disease or injury that has already occurred • Regular exams and screening tests to detect disease (or injury) in its earliest stages • Before the symptoms appear

Muscle Hyperplasia

• Animal models - High intensity resistance training may cause an increase in fiber number. - Magnitude of fiber hypertrophy in animals are not similar to that seen in humans. • Study on Bodybuilders • Type II fibers

Dietary supplements include

• Any product intended to supplement dietary intake • Examples • Vitamins/Minerals • Herbs and Botanicals • Protein/Amino Acids

What is Sedentary Behavior?

• Any waking activity characterized by energy expenditure ≤ 1.5 metabolic equivalents (METs) & when individual is in a sitting or reclining position • Standing is NOT considered sedentary behavior • Sleeping is NOT considered sedentary behavior

Types Of Cardiovascular Disease

• Atherosclerosis • Coronary heart disease (CHD) • Chest pain (angina pectoris) • Irregular heartbeat (arrhythmia) • Congestive heart failure (CHF) • Congenital and rheumatic heart disease • Stroke

NUTRITION DURING EXERCISE FOR THE STRENGTH-POWER ATHLETE

• Bird et al. Supplementation During A Hypertrophy workout • Males (19 to 23 years) • Randomly put in 4 groups (600ml) • 1) Flavored water • 2) Gatorade (6% CHO) • 3) Favored water with 6 g EAA • 4) CHO + 6g EAA • 12 week resistance training program • Twice per week (only 24 workouts!) • Supplement was given during resistance training between sets only. • Came to the gym after 4 hour fast and not aloud to eat for 90min after training (only water). Conclusion • The data suggest that CHO+ EAA ingestion during strength and power training will boost the anabolic effects to a greater extent than either CHO or EAA consumed independently. • The synergistic effect of CHO + EAA maximized the anabolic training response by attenuating the post-exercise rise in protein degradation and accelerating recovery. • Maximum Training adaptation = Protein building - Protein breakdown

Athletes who struggle with mental illness

• Brandon Marshall (receiver for New York Jets)- Diagnosed with Borderline Personality Disorder in 2010 • Jonathan Martin (linesman for the Miami Dolphins) - Attempted suicide multiple times after team harassment became well-known • Junior Seau (San Diego Chargers) - Committed suicide by shooting himself in the chest in 2012 at the age of 43

Atherosclerotic Cardiovascular Disease (CVD) Prevention

• CVD is the leading cause of death in the U.S. • In 2013 CVD accounted for approximately 38 percent of all deaths • CVD has been the number one killer in the U.S. since 1900 • More than 2,500 Americans die from CVD each day

Adding an amino acid source

• Combined with exercise, AA are required to switch muscle protein balance from negative to positive Recommended Daily Allowance (RDA) • RDA has based there recommendations using this method from sedentary subjects. (0.8g/kg/bw) • 56 grams per day for the average sedentary man • 46 grams per day for the average sedentary woman

Food Sources of Protein

• Complete versus incomplete protein • Food protein is only considered complete if it contains all nine essential amino acids. • Examples: milk, eggs, meat, poultry, and fish. • Food proteins that lack one or more of the essential amino acids are termed "incomplete" and not capable of causing growth, but instead can lead to protein malnutrition if eaten in isolation. • Examples: plant proteins (corn, lentils, beans, and nuts.) • Soy is one of the few examples of a plant protein that is considered complete!

Types of Muscle Contraction

• Concentric contraction: Force is developed while the muscle is shortening • Isometric contraction: Force is generated but the length of the muscle is unchanged • Eccentric contraction: Force is generated while the muscle is lengthening

TRAINING VARIABLES

• Designing effective programs requires consideration of several factors and programming variables: A needs assessment Appropriate exercise frequency consistent with goals Training experience Current conditioning level Necessary recovery periods between sessions Appropriate exercises and exercise order consistent with program needs and goals, equipment availability, experience, technique, and conditioning level The exercise volume and load - sets, repetitions, and intensity Appropriate rest intervals between sets based on needs and goals

How do we determining Optimal Intake for athletes?

• Determine optimal protein intake at individual meals to maximize protein synthesis • Determine optimal frequency of meal intake • These variables will dictate total protein intake • Specific meal recommendations are likely more beneficial than daily recommendations • Muscle Protein Synthesis is regulated from meal to meal, NOT day to day.

EXERCISE SELECTION AND ORDER

• Determining exercise selection and order is a complex process that requires: Consideration of the individual's experience and exercise technique Movement and physiological demands of the activity or sport Consideration of equipment and time availability • Group exercises based on body area, function, or relevance to the activity: Primary exercises - multiple muscles from one or more of the larger muscle areas that span two or more joints • Grouping specific muscles into a session: Should reflect the specific needs of the client and availability for training ACSM recommends targeting each major muscle group 2 or 3 days a week, allowing a minimum of 48 hours of recovery between sessions.

Benefits

• Different workout routine • Can provide similar benefits to traditional training • Functional Fitness • Timeefficient • Dynamic workouts • Increased joint mobility

Prevention

• Drink plenty of fluids after strenuous exercise to dilute your urine and flush any myoglobin that is released from your muscles out of your kidneys. • Also drink a lot of fluids after any condition or event that may have damaged skeletal muscle. • Don't do stupid stuff!

Sedentary Behaviors

• Driving a car • Sitting at a desk at work • Sitting & reading • Sitting & watching television • Sitting & socializing

Screen time

• Evidence suggests that screen time (watching television, playing on the computer, playing video games) is more harmful than other types of sedentary behaviors • Why do you think this could be? • What other factors may be involved? • While watching TV • 21% of kids eat or drink while watching in the afternoon • 31% of kids eat or drink while watching in the morning

Prevalence of mental illness in athletes

• Exact prevalence difficult to determine, but a study (Gulliver et al., 2015) examined 224 elite athletes and found: • 46.4% experienced symptoms of at least one mental health problem • Depression(27.2%) • Anxietydisorders • Eatingdisorders(22.8%) • Other mental illnesses found in elite & college athletes • Attention-deficithyperactivitydisorder(ADHD) • Stimulant medication banned by the NCAA - specific requirements for student-athletes with ADHD who want to compete while taking a banned stimulant • Result of injury such as concussions

Overtraining

• Excessive, intense training sometimes results in worse mental health & mood disturbances • Between 5 & 10% of competitive athletes respond adversely - exhibit severe mood disturbances and suffer from substantial performance decrements that persist for weeks or even months

Risk Factors

• For this class: - Severe exertion such as excessive exercises or marathon running • OtherCauses: - Alcoholism(withmuscletremors) - CrushInjuries - Drugs, especially cocaine, amphetamines, statins, heroin, or PCP - Geneticmusclediseases - Heatstrokeischemiaornecrosisofthemuscles - Lowphosphatelevels - Seizures - ShakingChills - Trauma

Glial Fibrillary Acidic Protein (GFAP) as a Biomarker in Severe Traumatic Brain Injury Patients: A Prospective Cohort Study

• GFAP is a protein that has been shown to escape into the bloodstream following severe TBI • Increased concentrations seem to have some association with unfavorable outcomes • Following astrocyte death (as in severe TBI), GFAP may leak into the bloodstream • Potential blood marker for severe TBI • May be beneficial for long term risk stratification • 67 patients suffering a severe TBI • Admitted within 4 hours post injury, blood samples taken up to 5 days post injury • Classified into 1 of 5 groups by Glasgow Outcome Scale (1-death; 5-full recovery) • More research needs to be done to evaluate effects of mild TBI

ORDER OF EXERCISE

• Generally proceeds from large to small muscle groups • Avoids fatigue in the core exercises (if structural exercises are the core exercises) • Muscles that are pre-exhausted may not achieve maximum intensity and may hinder exercises that require more complex motor coordination • May be specific within muscle group as well as between muscles • Legs Back Biceps • Squats leg extension leg curl calf raise • Pre-Exhaustion training • Super setting (agonist/antagonist) • Compound setting (same muscle group, different exercises) • Dependent on goals of training program

Treatment

• Getting fluids that contain bicarbonate may prevent kidney damage by quickly flushing myoglobin out of the kidneys. • Medicines that may be prescribed include diuretics and bicarbonate (if there is enough urine output). • The outcome depends on the amount of kidney damage. • Acute kidney failure occurs in many patients. • Getting treated soon after rhabdomyolysis begins will reduce the risk of permanent kidney damage.

Neuromuscular Adaptations

• Great deal of plasticity within neuromuscular system. • Neural adaptation - Maximal strength expression is not determined solely by quantity and quality of muscle mass, but also by extent that muscle mass is activated. - A better coordination in the activation of motor units allows for a greater expression of strength

PA- beneficial metabolic effects

• Improved muscle endurance • Increased insulin sensitivity • Improved HDLc • Reduce LDLc • Improved ability of the muscle cells to metabolize glucose and fat

Depression in athletes

• In general population, an estimate 8.7% of young adults (18-25) are diagnosed with depression during a 12 month period • Higher than the overall population of adults - 6.7% -why do you think this age group is at higher risk? • Reasonable to assume that young adult athletes may also be affected • Studies have mainly focused on college level athletes although results are inconsistent • As low as 15.6% & high as 21% • Approximately 1 in 5 athletes may be depressed

Mental Illness in Athletes

• In general, sports participation can be an effective way to cope with stress, & may be effective against depression and anxiety • However, at the elite level, athletes may be at risk for increased psychological distress • What types of mental illness or distress do you think may occur in athletes? • Think about characteristics of elite athletes • More studies have looked at college aged athletes - different than professional/elite athletes • Elite athletes may have additional attributes that may increase their mental toughness & aids their rise to the top of their sport • Not immune to psychopathology • Signal players vs. team players

Traumatic Brain Injury in Athletics

• In the U.S., it is estimated that 300,000 sports related concussions occur annually • This is very likely underreporting, due to: • Athletes failing to report concussive symptoms • May not be correctly identified due to variety of symptoms, individual responses • Over 3 year competitive period, 1936 high school athletes in 20 sports sustained a concussion • 47.1% occurred from football • Second place- women's soccer (8.1%)

EMG Changes

• Increase EMG activity in trained and untrained populations • Significantcorrelationsbetween EMG and strength improvements • Strengthtrainedindividualsmore capable of fully activating their primary muscles than untrained individuals

Negative effects

• Increased risk of injury, especially if unsupervised • High intensity, must be prepared • Need experience in multi-joint movements or close supervision

Acute Response of Skeletal Muscle to Resistance Exercise

• Increased skeletal muscle protein synthesis above resting values for at least 48 hours • Increased muscle protein breakdown can last 24 to 48 hours • In the absence of nutrient intake, skeletal muscle net balance can remain in a negative state for 48 hours

Physiological changes during overtraining

• Increases in resting heart rate • Increases in cortisol • Decreases in testosterone levels • Raised creatine kinase levels • Excessive sweating • Upper respiratory tract infections • Decreased VO2max • Slower than typical return to normal pulse rates post exercise

Risk Factors & Warning signs for coaches & athletic trainers - injured athletes

• Investigators examined case studies of injured athletes who committed suicide & identified the following factors that may increase the risk of suicide: • A serious injury necessitating surgery • An extended rehabilitation process • Reduced athletic skills • Perceived lack of competence when returning to sport compared with preinjury levels • Being replaced by a teammate at their given position

Ways regular exercise may help you during cancer treatment

• Keep or improve your physical abilities (how well you can use your body to do things) • Improve balance, lower risk of falls and broken bones • Keep muscles from wasting due to inactivity • Lower the risk of heart disease • Lessen the risk of osteoporosis (weak bones that are more likely to break) • Improve blood flow to your legs and lower the risk of blood clots • Make you less dependent on others for help with normal activities of daily living • Improve your self-esteem • Lower the risk of being anxious and depressed • Lessen nausea • Improve your ability to keep social contacts • Lessen symptoms of tiredness (fatigue) • Help you control your weight • Improve your quality of life

Why are levels of SB increasing?

• Less PA on the job (Brownson et al., 2005) • 1970 - 2 out of 10 workers had desk jobs • 2000 - more than 4 out of 10 workers had desk jobs • 2018? • 2030? • Use of internet (between 1989 and 2009, the number of households with a computer & internet access increased from 15% to 69%) (Owen et al., 2010) • TV watching ~ 4 - 5 hours per day (Owen et al., 2010) • Driving ~ 1 hour per day • Especially in children: 1969 - 48% of kids actively commuted to school vs. 16% in 2001

What does it mean to be Sedentary Behavior?

• Lot of disagreement over this! • What do you think? • Definitions of sedentary in 32 PA trials • <150minofMVPAperweek • <120minofMVPAperweek • <90minofMVPAperweek • <20minofMVPAperweek • <3daysofMVPAperweek • <1dayofMVPAperweek

How about in Cardiac Patients

• Low Volume HIIT (10 x 60s interval with 60s rest at 90% HRmax): - As few as 6 sessions has been shown to improve insulin and glucose in obese and diabetic patients. - Why? • Increases in cellular and peripheral vascular stress • This relative central insulation permits individuals to train at much higher intensities than they would otherwise • Result in different timelines and effective stimulus loads between the central and peripheral components of the cardiovascular system

Muscle proprioceptors

• MUSCLE SPINDLES - responsible for monitoring stretch and length of muscle and initiating contraction to reduce the stretch in the muscle. • GOLGI TENDON ORGANS - sensitive to tension in the muscle-tendon complex and form a protective mechanism to reduce potential for injury.

PROGRAM VARIABLES

• Make up the exercise stimulus • There is an almost infinite number of possible combinations that can be used within a given exercise session Exercise selection Order of Exercise Exercise Intensity Rest Period Length Training Volume Training Frequency Define what are the goals

Issues With TBI Diagnostics

• Many measures are subjective • Individual responses differ wildly • Must be compared to a baseline measure! • Symptoms may look like something else • Mostcommonsymptomisheadache • During game play, things may be missed • Players may be allowed to stay in when they shouldn't be

Anaerobic Power and Strength

• Most activities require strength at fast velocities. • Strength capability of muscle differs at different velocities of movement. • Maximal power output occurs at approximately 30% of peak force. • Recent research suggests that this may occur at higher intensities of one's maximal effort. • Typical heavy resistance training programs increase strength at the low velocity spectrum

HOW MUCH TOTAL PROTEIN PER DAY FOR ATHLETES?

• Most athletes in heavy training need 1.0-1.8 grams per kiligram body weight. Body weight for protein intake chart on slide 40 & 42 of lecture 12 sport nutrition

Protein Synthesis vs. Protein Breakdown

• Muscle Protein Synthesis • Anabolic • Amino acids are joined together to make a protein • Muscle Protein Breakdown • Catabolic • Breakdown of body proteins into amino acids

METABOLIC FUNCTION

• Muscle disuse atrophy results in a decrease in RMR. • Strength training raises RMR and results in more calories burned on a daily basis: The microtrauma-repair and muscle-remodeling processes require increased energy for at least 72 hours following a challenging strength- training session. Strength training increases muscle mass, decreases fat mass, and raises RMR The calories used during the strength-training session and in the post- exercise muscle-remodeling period contribute to fat loss and provide associated health benefits.

Skeletal Muscle Adaptation

• Muscle is quite plastic and can adapt to a wide range of functional demands. • Work above 60-70% of maximal force generating capacity appears to be required to generate improvements in strength and size of muscle. • Initial increases in strength primarily due to neural adaptations. • Increases in muscle size are not generally seen until after 6-8 weeks of resistance training. • Some evidence that growth may occur even earlier. • Increase in cross-sectional area: - Increase size of existing muscle fibers (Hypertrophy) - Increase number of muscle fibers (Hyperplasia)

FACTORS THAT INFLUENCE MUSCULAR STRENGTH AND HYPERTROPHY

• Muscle length - perhaps the most important factor for attaining large muscle size is muscle length relative to bone length: Some people have relatively short muscles with long tendon attachments. Some people have relatively long muscles with short tendon attachments. Individuals with relatively long muscles possess a greater potential for muscle development than those with relatively short muscles. • Limb length - affects strength performance, but does not influence muscle hypertrophy: Shorter limbs provide leverage advantages over longer limbs Longer limbs - longer resistance force arms require more muscle force to move a given resistance Shorter limbs - shorter resistance force arms require less muscle force to move a given resistance

Dietary supplements on the market are:

• NOT regulated • Could contain illegal substances • Could be costly • Could be harmful Current laws on dietary supplements (FDA) No requirement for efficacy (proof they do what they claim) No requirement for safety (proof they cause no harm)

Importance of Accurate TBI Assessment

• New "eye in the sky" protocol used all over the country (including NFL) as a result of this situation • Development of accurate, objective measures protects players as well as coaches/teams • Identification of blood markers shows some promise, but many proteins are not tissue-specific enough (plasma levels of a protein called 'tau')

Bridge-Enhanced ACL Repair (BEAR)

• New technique has been effective in animal models and small scale human trials • BEAR implant is placed between ends of torn ACL • Sponge soaked with patients blood (bridging scaffold) • Supposedly stimulates healing of tissue • Torn ligament ends are stitched to implant • Eventually, healed tissue replaces implant • May reduce recovery time, risk of subsequent arthritis • Still in early stages of development, clinical trials being conducted right now

MUSCULAR STRENGTH/POWER/ENDURANCE RELATIONSHIPS

• One-repetition maximum (1-RM) - the highest resistance that can be moved through the full movement range at a controlled movement speed • Muscular endurance - typically assessed by the number of repetitions that can be performed with a given submaximal resistance • Muscular power - the product of muscular strength and movement speed • An increase in muscular strength by an increase in muscular power: Training with light resistance enables fast movement speed, but results in a low power output. Training with heavy resistance enables high strength, but requires slow movement speed, and therefore results in a low power output. Training with medium resistance and moderate-to-fast movement speeds produces the highest power output and is the most effective means for increasing muscular power.

Number of sets

• Optimal number of sets depends on training goal. • Range varies from 2-8 sets. Typical programs use 4-6 sets for core exercises and 3-4 sets for assistance exercises.

Overreaching

• Overreaching is considered an accumulation of training load that leads to performance decrements requiring days to weeks for recover • Overreaching followed by appropriate rest can ultimately lead to performance increases • However, if overreaching is extreme & combined with an additional stressor, overtraining syndrome (OTS) may result Regular exercise benefits mental health, however, in some circumstances it can worsen health

PHYSICAL CAPACITY

• Physical capacity is the ability to perform work or exercise. • Resistance training results in stronger muscles that increase the physical capacity for force production: Progressive resistance exercise enables an individual to perform a single lift with a heavier weight load (muscular strength) or to perform more repetitions with a submaximal weight load (muscular endurance). Previously untrained adults may increase their muscle mass and increase their resting metabolic rate (RMR).

Sedentary behavior and physical inactivity are NOT the same thing

• Physical inactivity = absence of PA • Sedentary behavior has its own category of behaviors

PRE-EXERCISE NUTRITION FOR POWER ATHLETE

• Pre-exercise meals should consist largely of moderate to low glycemic index foods/supplements Slow, sustained release of carbohydrates and protein necessary to fuel a workout If an athlete trains or competes in the afternoon, breakfast is the most important meal to top off muscle and liver glycogen levels If the athlete trains first thing in the morning, the meal the evening before is vital Immediately Pre, During and Post Supplementation Must Contain CHO and Protein for Maximizing the benefits of Strength and Power Training!

Protein Basics

• Proteins are composed of amino acids (AA), some of which must be obtained through the diet (essential), and others which can be formed from other substrates (non-essential). • 4 kcals per gram • Contains Nitrogen (Amino = nitrogen containing) • Most body proteins are poly peptides that contain > 100 amino acids linked together

Combining Research on EAA/CHO ingestion

• Rasmussen et al. 2000 • Similar response to EAA/CHO given at 1 hr and 3 hr post exercise • Tipton et al. 2001 • MPS with EAA/CHO PRE > MPS with EAA/CHO POST • EAA/CHO PRE was greater than all three other time points: • Immediately POST • 1hrpost • 3hrpost • Tipton et al. 2007 • Amino acid uptake was not significantly different between PRE and POST ingestion of 20g whey Surprisingly few studies have compared changes in muscle mass and strength with ingestion of a protein containing supplement in close proximity to exercise with ingestion at times other than close to exercise • Questions remain: • Are we optimizing an "anabolic window" or just simply adding an additional protein meal to our day? • Is there really an elevated feeding response post exercise or "is a meal a meal"? • If these studies would have given their same supplement at any other time-point in the day, would results be different?

Conclusions (cancer)

• Regular physical activity associate with decreased risk of disease, including many types of cancer • Such benefits may translate into increased life expectancy of up to 4.5 years • Even the lowest levels of activity providing some survival advantage • Evidence from the past several years suggests that physical activity is not only safe in patients already diagnosed with cancer, but also that it may decrease the risk of recurrence and extend survival

Muscle Hypertrophy

• Related to increased synthesis of contractile proteins (actin and myosin) and increased formation of sarcomeres. • Related to repeated trauma to fibers from RT. • During recovery from cellular damage - overcompensation of protein synthesis results in anabolic effects. • Occurs in both Type I and II fibers. • Greater in Type II. • Magnitude dependent upon: - Individuals responsiveness to training - Intensity of training - Duration of training - Individuals training status. • Novice female subjects after 6 weeks: - 15.6%TypeI - 17.3%TypeIIa - 28.1%TypeIIb • After 20 weeks - 15%TypeI - 45%TypeIIa - 57%TypeIIb Similar increases seen in untrained male subjects • Experienced bodybuilders (male and female) - Nosignificantimprovements in muscle cross-sectional area were noted following 24 weeks of training. - 3.6% increase (p > 0.05) in biceps x-sectional area in elite bodybuilders. - Statistical vs practical significance • Increases in fiber size do not appear to be accompanied by increases in mitochondrial number or in the capillary to fiber ratio. • No effect on strength or power performance. • May alter oxygen kinetics by delaying transport of oxygen from vasculature to exercising muscle. • Sarcoplasmic Reticulum and T-tubule volume density will increase to maintain or improve contraction capability.

EXERCISE SELECTION

• Related to specific muscle action that needs to be trained • Based on biomechanical and physiological needs analysis • Structural or body part specific

Benefits of HIIT

• Repeated, short/moderate duration, intensity above anaerobic threshold • Increase in blood and plasma volume, blood flow to muscles/capillary density, oxidative enzymes • Decrease in HR, glycogen usage, glucose

REST INTERVALS

• Rest intervals - the recovery periods between successive exercises or between successive sets of the same exercise • The length of the rest interval is dependent on: The training goal The client's conditioning status The load and amount of work performed • The heavier the load, the longer the rest interval needed to replenish the muscle's energy pathways.

What is Rhabdo?

• Rhabdomyolysis: - Breakdown of muscle fibers - release muscle fiber contents (myoglobin) into the bloodstream. • Myoglobin is harmful to the kidneys and often causes kidney damage

Reasons for Depression in Athletes

• Sports injuries • Strong association between injury in the past year & depressive symptoms • Study examined depressive symptoms and injury - 51% of athletes who sustained an injury had mild to moderate depression • Concussions may be particularly problematic - retired athletes reporting 3 or more concussions were 3X more likely to be diagnosed with depression • Also association between ACL injuries & depression - may depend on the severity of the injury • Overtraining syndrome also associated with psychological disturbances • Career termination • Major life transition - change in relationships, roles, and daily routines • Sometimes it's an easy transition, and other times, it's associatedwith significantemotionaldistress

BENEFITS OF RESISTANCE TRAINING

• Strength training is the process of exercising with progressively heavier resistance to stimulate muscle development. • The outcomes and benefits of regular resistance exercise include: Increased muscle fiber size and contractile strength Increased tensile strength in tendons and ligaments Increased bone mineral density Improved power production and sports performance

What Is the ACL

• The Anterior Cruciate Ligament (ACL) is a small ligament within the knee joint • Originates on the femoral condyles, inserts on the tibial plateau • Responsible for resisting anterior tibial displacement and medial rotation of the tibia • Incidence rate of 36.9 ACL surgeries per 100,000 person- hours (Gianotti et al, 2009) • General population • Non-contact ACL surgeries • Much higher in athletic settings due to heavy contact, higher cutting/twisting movements

It remains controversial whether or not to recommend initiation of moderate alcohol consumption to patients with T2D, abstainers

• TheADA leavesmoderate alcohol consumption to personal preference. • TheAHArecommendsthat alcohol use should be a matter of discussion between the physician and the patient.

Military and ACSM Special Communication

• There is an increased risk of injury if ECP's are performed incorrectly • Personnel should approach and participate in any ECP with prudence, recognizing their limitations and challenges

After cancer treatments, patients feel

• Tired • Sore or have post-surgical pain • Increased sensitivity to an area that received radiation therapy • Bloated from chemotherapy treatments / steroids • Depressed, confused, and/or angry • What about exercising?

PHYSIOLOGICAL ADAPTATIONS TO RESISTANCE TRAINING: LONG-TERM

• Two principal long-term physiological adaptations to progressive resistance exercise: Increased muscular strength and increased muscle size (hypertrophy) • Muscular strength: Initially, strength gains are the result of neurological factors (motor learning). • Ongoing resistance exercise results in efficient activation of the motor units involved in the exercise movement • Resistance exercise causes muscle tissue microtrauma, depending on the intensity and volume of the training. • Following a challenging resistance-training session, muscle tissue remodeling results in growth of muscle fibers coupled with small increases in muscular strength.

Assessment of Traumatic Brain Injury (TBI)

• Typical evaluation protocol for concussion diagnosis includes testing of balance (BESS), memory, concentration, orientation (SAC), graded symptom checklist • Advantages • Inexpensive • Non-invasive • Quick • Disadvantages • Subjective • Rely on athlete honesty • Low intra-rater reliability • Require comparison to baseline test

Treatment of Torn ACL

• Typically, ACL repair involves a graft of tissue taken from hamstring tendons • ACL ends don't reconnect, so graft is necessary • Usually not career ending, but severe complications associated with continued participation • Up to 20% re-injury rate As many as 80% of patients may develop arthritis in knee in the long term

What are the warning signs of overtraining

• Washed out feeling/tired/lethargic • Decreased immune system • Pain in muscles & joints • Sudden drop in performance • Insomnia • Headaches • Moodiness & irritability • Depression • Decreased appetite • Decreased interest in the sport • Increased incidence of injuries • Compulsive need to exercise

Anthropometric measures are used to assess risk factor for morbidity and mortality

• Weight • Body mass index (BMI) • Waist circumference (WC) • %Fat

Why does this happen?

• When muscle is damaged, myoglobin is released into the bloodstream. - Myoglobin is a protein similar to hemoglobin • It is then filtered out of the body by the kidneys. • Myoglobin breaks down into substances that can damage kidney cells.

Is post exercise nutrition important?

• YES ....! • Protein balance remains negative post exercise without Amino Acids • There is just not enough research to support additional saturation of amino acids post exercise • The quicker you hit leucine saturation post workout, the sooner you can spike it again with your next meal!!

Is this a public health issue?

• Yes! • More & more evidence that sedentary behavior is increasing

What about Carbohydrates post workout?

• You want to spike insulin for the same reasons as the endurance athlete • Increased insulin sensitivity post exercise • ↑ glycogen re-synthesis is not just for aerobic athletes!! • But does this spiked insulin have any effect on Protein Synthesis?

Adaptations from prolonged running, cycling or swimming will cause significant improvements in exercise capacity. This is the result of adaptation to:

• capillary density • myoglobin content • mitochondrial function • oxidative enzymes • carbohydrate and fat utilization

What's Out There?

• tatted strength • P90X • American combat club • MMA Workout Programs MMA Training • Ultra marathon • Crossfit • Extreme Boot Camp Fitness Programs • Free running • parkour • American Ninja Warrior • Orange Theory

Current physical activity guidelines recommend ACSM

• ~150 min\week- health benefits • ~250 min\week- body weight management • ~420min\week-weightloss

BMI

•If your BMI is less than 18.5, it falls within the underweight range. •If your BMI is 18.5 to <25, it falls within the normal. •If your BMI is 25.0 to <30, it falls within the overweight range. •If your BMI is 30.0 or higher, it falls within the obese range. Obesity is frequently subdivided into categories: •Class 1: BMI of 30 to < 35 •Class 2: BMI of 35 to < 40 •Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as "extreme" or "severe" obesity.

Single Muscle Fiber

•Myofibrils consist of smaller units termed myofilaments •Consist of 2 proteins: Actin and Myosin. •Striated appearance: I band, A band, H zone and Z line

What does sleep and stress have to do with training and nutrition?

A lack of sleep can impair energy levels and adversely affect training and performance Sleep deprivation can even affect the body's ability to metabolize glucose and has been shown to negatively affect leptin and grehlin levels leading to weight gain Cortisol Levels are elevated (training hard and lack of sleep) The persistent drive to get ahead in today's society in combination with the classic type A personality is largely to blame for our nation's lack of sleep 25% of the adult population is sleep deprived getting an average of only 6 hours of sleep per night At least 8 to 9 hours is recommended for Athletes

Blood draw and urine samples

After 8 hours of fasting 1-2 ml each for serum, plasma, and urine Stored at -800C with a backup system Central laboratory in the University of Leipzig, in Leipzig, Germany (~10,000)

Metabolic Syndrome Criteria in Children and Adolescents

As defined by the International Diabetes Foundation Age 6 to <10 years -Obesity > 90th percentile as assessed by waist circumference -Metabolic syndrome cannot be diagnosed, but further measurements should be made if family history of metabolic syndrome, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease, hypertension, or obesity -IDF suggests that a strong message for weight reduction should be delivered for those with abdominal obesity Age 10 to <16 years -Obesity > 90th percentile (or adult cut-off if lower) as assessed by waist circumference and any two of the following conditions -Triglycerides > 150mg/dL -HDL-cholesterol <40mg/dL -Blood pressure > 130 mmHg systolic or > 85 mmHg diastolic -Fasting Glucose > 100mg/dL (5.6 mmol/L) or known type 2 diabetes mellitus

ATP-PC Adaptations to High-Intensity Training

Do not see any changes to ATP or PC concentrations. Alterations in resting enzyme concentrations (CK or MK) are unclear. Increases in CK apparent in beginning stages of training program but return to normal levels after several weeks of training. Limited ability to increase or longer time needed?

Which variables are able to affect post- exercise REI?

Exercise Intensity XXXX Hypoxia vs normoxia XXXX Time of exercise Temperature Water immersion post-exercise Caffeine Exercise duration

Changes in Oxidative Enzymes to High Intensity Exercise

Exercise programs that stimulate glycolytic enzyme adaptations may also cause elevations to oxidative enzyme concentrations when exercise duration exceeds 3 min. Implies that individuals that train anaerobically may still derive an anaerobic benefit.

Glycolytic System Adaptations to High- Intensity Training

Glycolytic enzymes (LDH, PFK) have been shown to increase following exercise routine utilizing protocols employing bouts of exercise of at least 30-sec in duration. Mode of training important. See changes following sprinting, cycling, swimming but not resistance training. Importance of sprint training for football or basketball players.

HIIT: Cardiovascular Effects

Hickson, Bromze, and Holloszy (1977) N=8 men, 10 weeks of HIIT training 6 days a week, 3 on cycle ergometer six 5 min @ VO2max and 3 days run for distance in 40 min HIIT increased VO2max of these sedentary individuals 44% Burgomaster et al. (2005) N=16 (14 men, 2 women), 6 sessions @ 30 sec "All-out" effort Significant increase in citrate synthase, muscle glycogen content, and cycle endurance time to fatigue increased 100% Talanian et al. (2007) N=8 women, 2 weeks, 10 x 4 min bouts @ 90% VO2max Significant increase in plasma FFA, and citrate synthase, decrease in RER and HR

Size Principle Concepts!

Motor Units range from low number of fibers, small to larger cross-sectional area size fibers, type I slow or Type II fast twitch fibers....... Range of functional abilities to produce force and power.....in a given muscle Typically always recruited from small to large Motor Units recruited by a "size factor" to meet the demands of force or power production • Muscle fiber type - two categories of contractile proteins: Type I muscle fibers (slow-twitch) o Typically smaller with more aerobic capacity o Activated at lower force levels Type II muscle fibers (fast-twitch)-type IIa and type IIx o Typically larger with more anaerobic capacity o Activated at higher force levels • New studies show that training can create small shifts in fiber composition from type IIx fibers to type IIa fibers. • Anaerobic training - type IIa fibers change to function more like type IIx fibers.

Ethanol Metabolism

Rapidly absorbed, predominantly from duodenum (1st section of the small intestine) Rate of absorption is variable 85-90% metabolized primarily in liver 5-10% metabolized in stomach 5% metabolized in lungs

Energetic balance is much complex

Resting energy expenditure Energy expenditure of the leisure time Stress and emotional factors Social and family environment Energy intake Epigenetic and genetic factors High individual variability in above responses

Fat Free Mass- Use It or Lose It

Sedentary people lose large amounts of muscle mass (20-40%) 6% per decade loss of Lean Body Mass Aerobic activity only not sufficient to stop this loss Combination of resistance training can overcome this loss of mass

Abdominal obesity is associated with insulin resistance, dyslipidemia, cardiovascular disease and the metabolic syndrome

Visceral adipose tissue (VAT) Subcutaneous adipose tissue (SAT)

Estimate of Number of Repetitions Performed at a Percentage of 1RM

% of 1RM = 100 - # of reps = 1 95 - 2 90 - 3 85 - 5 80 - 8 75 - 10 70 - 12 65 - 15

High-Intensity Interval Training (HIIT)

- ''HIIT involves repeated short-to-long bouts of rather high-intensity exercise interspersed with recovery periods" - Shorter Interval = Higher Speed/Wattage • >100% VO2max speed/wattage - Longer Interval = Lower Speed/Wattage • ~100% VO2max speed/wattage - The sport someone is involved with should dictate the interval • A marathoner would benefit more from speeds around VO2max • An 800 meter runner would benefit more from higher speeds

Crossfit-based high intensity power training improves maximal aerobic fitness and body composition

- 54 started Crossfit Program/43 completed • 2 cited time constraints/9 cited injury (16%) - 10-week training program • Wide variety of fitness level • Aerobic Fitness Ranked as: Well Below Average, Below Average, Average, Above Average, Well Above Average Results: - Significant increases in VO2max in: • Well Below Average, Below Average, and Above Average groups - Significant decreases in body fat in all groups - Didn't address any strength changes - No strength results? - No comparison to traditional training?

Periodization

- Can you do HIIT Training for an extended period of time (months)? - You really need to analyze who you are working with and their goals - Manipulate various factors

Classification of Tumors

-Based on histological origin (epithelial, mesenchyme, etc..) -Based on biological behavior (benign vs malignant)

Measurement of Resting metabolic rate

1) Direct calorimeter 2) Indirect calorimeter Equations (age, weight and height) Indirect calorimeter - based on measurement of gas exchange, CO2 production and O2 consumption, which reflect nutrient metabolism. Based on: O2= 20.95% CO2= 0.04%

What is "Moderate" alcohol consumption?

10-30 g of alcohol per day ~0.5-2 drinks per day women up to 1 drink a day men up to 2 drinks a day 240-330 ml. of regular beer = ~11-13 g alcohol (~150kCal) 100-150 ml. of wine = 12-14 g alcohol (~100kCal) 30-45 ml. of 80-proof spirit = ~14-15 g alcohol (~100kCal)

How much calorie we "burning"?

400Kcal = (7.5k/h) 5km, 40min 60% VO2 max= 50% fat and 50% Carb 5km, 25min (12k/h) = 400Kcal 85 VO2 max= 20% fat and 80% Carb

Subcutaneous fat (SAT)

Abdominal SAT is further separable into two distinct sub-compartments by the fascia superficialis Superficial SAT (SSAT) and Deep SAT (DSAT)

Muscle Structure

Ability of muscle to provide force and maintain physical activity is the basis for athletic performance. Goal of all training programs is to improve the functional ability of exercising muscles.

What do you think is the average daily intake of sugar?

According to the American Heart Association (AHA), the maximum amount of added sugars you should eat in a day are: Men: 150 calories per day (37.5 grams or 9 teaspoons). Women: 100 calories per day (25 grams or 6 teaspoons)

Why does HIIT cause muscular changes?

Activation of peroxisome- proliferator activated (PGC-1α) coactivator, which is regarded as the 'master regulator' of mitochondrial biogenesis in muscle (Wu et al. 1999). • Evidence suggests that exercise intensity is the key factor influencing PGC-1α activation in human skeletal muscle (Egan et al. 2010). • Key regulator of energy metabolism • It appears that protocols at VO2max or a high percentage of VO2max: - Will maximally stress the oxygen transport and utilization systems - Will provide most effective training stimulus • Acutelow-volumeWingate-basedHITincreasesPGC- 1α mRNA by several-fold when measured 3 hr post- exercise (Gibala et al. 2009; Little et al. 2011). •ThisiscomparablewiththeacuteincreaseinPGC-1α mRNA expression observed after a bout of continuous endurance-type exercise (Norrbom et al. 2004; Egan et al. 2010).

Types of Injuries Acute vs. Chronic

Both types usually involve muscle & bone Acute Result from a collision or sudden twist Examples = Sprains/Strains, Contusions, Fractures Chronic / Overuse Repetitive, small injuries due to repeat motions Increased today as children strive for excellence at younger ages Examples = Pitching a baseball, Running cross country

Muscular fatigue in response to different modalities of CrossFit sessions

CONCLUSIONS: Muscular fatigue, reflected by reduced CMJ variables, was produced following the gymnastics and weightlifting sessions, while recovery of this fatigue was observed at the end of metabolic conditioning, likely attributable to rest intervals allowing for the recovery of phosphocreatine stores. Our findings also suggest that the high intensity and volume of exercise in gymnastics and weightlifting WODs could lead to reduced muscular-tendon stiffness causing a loss of jump ability, related here to a longer isometric phase during the CMJ.

Epidemiology of Cancer

Cancer has a major impact on society in the United States and across the world In 2016, an estimated 1,685,210 new cases of cancer was diagnosed in the United States and 595,690 people died from the disease The number of new cases of cancer (cancer incidence) is 454 per 100,000 men and women per year (based on 2008-2012 cases). The number of cancer deaths (cancer mortality) is 171 per 100,000 men and women per year (based on 2008-2012 deaths) The number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million by 2024. Approximately 39.6% of men and women will be diagnosed with cancer at some point during their lifetimes

Ketogenic Diets

Characterized by a reduction in carbohydrates (usually to less than 50 g/day) and a relative increase in the proportions of protein and fat (Paoli et al., 2013)" The reduction in carbs puts your body into a metabolic state called ketosis Ketosis - the result of long term low carb diets (burning ketones for fuel) A result of breaking down and burning fat stores instead of carbs Strong evidence supports weight loss (Paoli et al., 2013) Massive reductions in blood sugar Not appropriate for people with any stage of kidney disease.

Sleep

Charts on slides 45-47 on lecture 12 sport nutrition

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction

Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes

Resting metabolic rate (RMR)

Cosmed Quark system with canopy to assess O2 and CO2 during 16 minutes lying on a bed Gas and breath volume calibration, and fixed room temperature of 23-250C Four hours fasting and 10 minutes of rest Weight, WC, and height TV relaxing channels during the test