Energy expenditure

• Lavoisier and Laplace demonstrated that muscular exercise consumes

oxygen and produces carbon dioxide.
• Total daily Energy Expenditure (TDEE)
1. RMR= basal+ sleeping + arousal = 60-75%
2. Thermogenic effect of food =10%
3. Physical activity and recovery=15-30%
• BMR assessment require >> fasting the previous 12 hour and no physical activity 2
hour prior to assessment, supine position for 30 mins.
• BMR usually range: (0.8 to 1.43 kCalmin1) depending on gender, age, overall body
size (stature and body mass), and fat free mass.
• BMR establishes the important energy baseline required to develop prudent
weight control strategies through food restriction, regular exercise, or their
combination.
• Regular and resistance exercise offsets the decrease in resting metabolism that
usually accompanies aging.
• The term RMR is often substituted for and used interchangeably with BMR.
• relatively strong association between FFM and daily RMR, females exhibit an
average 5 to 10 % lower RMR than males of the same age due to changes of body
composition either dec FFM or inc body fat during adulthood.
• To estimate a person’s resting daily energy expenditure, multiply the appropriate
BMR value by the surface area computed from stature and mass. or use
nomogram to estimate BSA
• FACTORS THAT AFFECT ENERGY EXPENDITURE
1. Physical activity
2. Diet induced thermogenesis. ( Food consumption generally increases
energy metabolism.; sometimes referred to as thermic effect of food [TEF])

Obligatory thermogenesis Facultative thermogenesis

(formerly called specific dynamic action or relates to the activation of the sympathetic
SDA), results from the energy required to nervous system and its stimulating influence
digest, absorb, and assimilate food on metabolic rate.
nutrients.
 Maximum: one hour after food ingestion. Overweight individuals often have a blunted
the magnitude of DIT usually varies between thermic response to eating that contributes
10 and 30 % of the ingested food energy, to excess body fat accumulation.
depending on the quantity and type of food. DIT magnitude also may be lower in
endurance-trained individuals than in
untrained counterparts.

3.Climate
• resting metabolism of people in a tropical climate averages 5 to 20%
higher than for counterparts living in more temperate areas.
• Exercise performed in hot weather also imposes a small additional
metabolic load; it causes about 5% higher oxygen consumption
compared to a thermoneutral environment.
• Metabolic rate increases up to fivefold at rest during extreme cold stress
because shivering generates body heat to maintain a stable core
temperature.
4.pregnancy
o Exercise heart rate and oxygen consumption remained unchanged
during weight-supported bicycle exercise at a constant intensity.
o Weight bearing exercise: added energy cost to weight bearing loco
motions such as walking, jogging, and stair climbing during pregnancy
results.
Calorigenic Effect of Food on Exercise Metabolism
• breakfast increased resting metabolism by 10 %, performing exercise following a
meal of 1000 or 3000 kCal produced a larger energy expenditure than exercise
without prior food.
• The calorigenic effect of food on exercise metabolism nearly doubled the foods
thermic effect at rest. Apparently,exercise augments DIT.
• The DIT of carbohydrate and protein is greater than for lipid.
• As with their response during rest, some obese men and women exhibit a
depressed DIT when they exercise after eating.
• For most individuals, it seems reasonable to encourage moderate exercise after
eating to possibly augment a diet induced increase in caloric expenditure for
weight control.
• Body mass, stature, and age contribute to individual differences in basal energy
expenditure (BMR).
 • Measurement of energy expenditure
1.calorimetry >Calory the basic unit of heat measurement and the term
Calorimetry defines the measurement of heat transfer.
a-Direct >>Measures heat production in humans. A chamber where a subject
could live, eat, and sleep. And exercise on a bicycle ergometer. (airflow
calorimeter and waterflow calorimeter).
b-Indirect>>Energy expenditure from oxygen consumption and carbon dioxide
production.heat is not measured directly
1-The closed circuit method >>
• A room calorimeter can be constructed in which expired air is
analysed to estimate heat production.
• Suitable only for measuring resting or basal metabolic rate , but
absorbing the large volume of carbon dioxide produced during
prolonged, strenuous exercise becomes a problem.
2-The open circuit method> Using ambient air: O2, N2, CO2.
• Analysis of expired air to evaluate O2 consumption and CO2
generation. oxygen and carbon dioxide percentages are precisely
measured to calculate VO2 and RQ.
• For exercise metabolism
3-portable spirometry
4-bag technique
The respiratory quotient
• Evaluation of the metabolic mixture metabolized during rest and exercise from
measures of pulmonary gas exchange.
• The respiratory quotient RQ) describes this ratio of metabolic gas exchange as
follows: RQ =CO2 produced divided by O2 consumed.
• Precise determination of the body s heat production by indirect calorimetry
requires measuring both RQ and oxygen consumption.
• RQ for Carbohydrate =1 (6CO2 /6O2)
• RQ for Fat > fats contain considerably more hydrogen and carbon atoms than
oxygen atoms. RQ =16 CO2 ÷23 O2= 0.696
• RQ for Protein RQ=63 CO2 ÷77 O2=0.818
• Relative contribution of the different energy transfer systems differs markedly
depending on intensity and duration of exercise and the participant s specific
fitness status.
• Immediate energy (ATP-PCr)
High intensity exercise for short duration>> depleted within 20 to 30 seconds of
maximal exercise.
Sufficient stored phosphagen energy can power brisk walking for 1 minute,
running at marathon pace for 20 to 30 seconds, or sprint running for 5 to 8
seconds.
• Short term energy (lactic acid system)
-Resynthesis of the high energy phosphates must proceed rapidly to continue
intense, short duration exercise.
-mainly from stored muscle glycogen breakdown via (rapid) anaerobic glycolysis
with resulting lactate formation. Rapid glycolysis allows ATP to form rapidly
without oxygen.
-at the start of exercise or during the last few hundred yards of a mile run or
performs all-out from start to finish during a 440-m run or 100-m swim.
-Rapid and large accumulations of blood lactate occur during maximal exercise
that lasts between 60 and 180 seconds.
-During light and moderate exercise (50% aerobic capacity) >> no lactate
accumulation
-Aerobic training adaptations allow high rates of lactate turnover at a given
exercise intensity; thus, lactate accumulates at higher exercise levels than in the
untrained state. (Higher threshold).
-Lactate production and accumulation accelerate as exercise intensity increases.
Aerobic response most likely relates to three factors.
1. Athletes’ specific genetic endowment (e.g., muscle fiber type, muscle blood
flow responsiveness)
2. Specific local training adaptations that favor less lactate production.
3. More rapid rate of lactate removal/degradation.
Capillary density and the size and number of mitochondria increase with
endurance training, as does the concentration of enzymes and transfer agents in
aerobic metabolism.
This positive effect is not affected by aging.
 • Long term energy the aerobic system
Aerobic metabolism provides nearly all energy transfer when intense exercise
continues beyond several minutes.
Oxygen consumption rises exponentially during the first minutes of exercise to
attain a plateau between the third and fourth minutes.
steady state / steady rate: generally, describes the flat portion (plateau) of the
oxygen consumption curve. Steady rate reflects a balance between energy
required by the working muscles and ATP production in aerobic metabolism. (no
lactate accumulation.
steady rate aerobic metabolism singularly determines the capacity to sustain
submaximal exercise.
Oxygen deficit
• oxygen diffusion gradients at the tissue level, the initial increase in exercise
consumption.
• quantitatively expresses the difference between the total oxygen
consumption during exercise and the total that would be consumed had
steady rate oxygen consumption (as an indicator of aerobic energy transfer)
been achieved from the start.(diff bet ideal and real o2 uptake).
• oxygen deficit in the early stage of exercise represents the energy transition
from anerobic (IM phosphagens hydrolysis and glycolysis) until the aerobic
consumption of the steady rate matches the energy demands.
• The endurance trained person reaches steady rate more rapidly, with a
smaller oxygen deficit than sprint power athletes, cardiac patients, older
adults, or untrained individuals.
• Interestingly, lactate begins to increase in active muscle well before the high
energy phosphates (ATP) reach their lowest levels.
• The VO2 max provides a quantitative measure of a person’s capacity for aerobic ATP
resynthesis.
• VO2max is an important determinant of ability to sustain intense exercise for longer
than 4 or 5 minutes.
• 2 minutes of maximal effort requires about 50 % of the energy from combined
aerobic and anaerobic processes.
 • A 2.5-hour marathon, in contrast, generates almost all of its energy from aerobic
processes.
• Intense exercise of intermediate duration performed for 5 to 10 minutes (e.g.,
middle distance running and swimming, or basketball) places greater demand on
aerobic energy transfer.

Carbohydrates
Complex (plant polysaccharide)
Amylose Amylopectin
• long straight chain of glucose units • highly branched monosaccharide linkage.
• starches with high amylose content break • Starches with a relatively large amount of
down (hydrolyze) at a slower rate. amylopectin digest and absorb rapidly

• Fibers have no effect on HDL.

• Glycogen is polysaccharide polymer synthesized from glucose in the process of
glucogenesis (catalyzed by the enzyme glycogen synthase).
• 80 kg man stores approximately 500 g of carbohydrate.
• Carbohydrate is the major substrate for ATP resynthesis during intense exercise.
• Triacylglycerol: The alternative fuel for ATP resynthesis: is the preferred substrate
for energy production in resting muscle and can cover the energy demands of
exercise up to 50 % of maximal oxygen.
• Activation of muscle contraction by Ca 2 + and the accumulation of the products of
ATP and phosphocreatine PCr ) hydrolysis (ADP, AMP, IMP, NH 3 and Pi) act as
stimulators of glycogenolysis.
• Key Regulators of Glycogenolysis: free AMP amd Pi via Glycogen Phosphorylase a.
• muscle glycogen provides energy without oxygen, it contributes considerable
energy in the early minutes of exercise when oxygen use fails to meet oxygen
demands.
• PFK is the rate limiting step in the degradation of hexose units to pyruvate.
• Regulation of PFK: ATP is the most potent allosteric inhibitor of PFK followed by H+
and citrate accumulation.
 • the rate limiting step in carbohydrate oxidation is the decarboxylation of pyruvate to
acetyl-coenzyme A (CoA), which is controlled by the pyruvate dehydrogenase
complex (PDC) and is essentially an irreversible reaction committing pyruvate to
entry into the tricarboxylic acid (TCA)cycle and oxidation.
• Inactivation of PDC: Increased ratios of ATP/ADP, acetyl CoA/CoA and
NADH/NAD + activate the kinase.
• Activation of PDC: Ca 2 + and pyruvate availability at the onset of
contraction will result in the rapid activation of PDC.
• The last stage in pyruvate oxidation involves NADH and FADH generated in the TCA
cycle entering the electron transport chain.
• The rate of flux through the electron transport chain will be regulated by the
availability of NADH, oxygen and ADP.
• In the electron transport chain, NADH and FADH are oxidized and the energy
generated is used to dephosphorylate to ATP.
• a high rate of energy demand coupled with an inadequate oxygen supply: when
tissue oxygen supply begins to limit oxidative ATP production, resulting in the
accumulation of mitochondrial and cytosolic NADH, flux through glycolysis and a
high cytosolic NAD ++/NADH ratio are maintained by the reduction of pyruvate to
lactate.
Maximal exercise Submaximal Moderate and prolonged

High epinephrine, NE, 30-180 min (VO2 < Glycogen stored in active muscles
low insulin activates 60%) supplies almost all of the energy
glycogen phosphorylase the rate of muscle ATP in the transition from rest to
and glycogenolysis production required moderate exercise.
during prolonged During low-intensity exercise, fat
exercise is relatively serves as the main energy
low and therefore PCr, substrate throughout exercise. As
carbohydrate and fat exercise continues and muscle
can all contribute to glycogen decreases, blood
ATP resynthesis. glucose becomes the major
source of carbohydrate energy,
while fat catabolism furnishes an
increasingly greater percentage of
the total energy.

• fuel ATP resynthesis. Just 3 days of a diet with only 5% carbohydrate

considerably depresses all out-exercise capacity.
• Lactic acid accumulation during high intensity exercise is considered to
produce muscle fatigue as a result of H and Pi accumulation. An increase in
hydrogen ion concentration will negatively affect phosphorylase activity,
thereby delaying the rate of glycogenolysis, by delaying transformation of
the b form to the a form.
• The high carbohydrate diet improved endurance performance by more than
three times that of the high fat diet.
• If glucose is supplemented immediately after exercise with carbohydrates,
however, the rate of synthesis during the slow phase can be increased
several fold, and if supplementation persists, the muscle glycogen level can
be increased above normal. glycogen supercompensation.
• normal training taper in conjunction with a moderate carbohydrate 3
days/high carbohydrate 3 days diet sequence is as effective as the classic
glycogen supercompensation regimen for highly trained endurance
athletes.
• When the carbohydrate supplement is delayed for several hours after
exercise, the muscle becomes insulin resistant, reducing the rate of muscle
glucose uptake and glycogen resynthesis.
 • Protein meals and supplements also have been found to enhance the
insulin response to a carbohydrate load do not produce the unwanted side
of the amino acids.
• Ingestion of glucose or sucrose was twice as effective as fructose for
restoration of muscle glycogen.
• The increase in muscle glycogen was found to parallel the decline in muscle
lactate.
• Prolonged sustained exercise severely reduces the endogenous precursors
of muscle glycogen, thereby requiring an exogenous carbohydrate source
for rapid muscle glycogen synthesis.
• After a marathon, restoration of muscle glycogen was delayed, and this
delay was related to muscle damage caused by the run.
• muscle damage following exercise can limit glucose uptake due to a
reduced GLUT 4 protein concentration, and this limits the restoration of
muscle glycogen.

Lipids
• Mobilization of fatty acids via lipolysis predominates under four conditions:
1. Low to moderate intensity exercise.
2. Low calorie dieting or fasting
3. Cold stress
4. Prolonged exercise that depletes glycogen
• Saturated fats, hydrogenated oils also decrease the concentration of beneficial
HDL cholesterol.
• 20 % of total calories from lipid to reduce risk of cancers of the colon and rectum,
prostate, endometrium, and perhaps breast.
• Regular moderate and high intensity aerobic exercise and abstinence from
cigarette smoking increase HDL, lower LDL, and favorably alter the LDL:HDL ratio.
• VLDLs transport triacylglycerols to muscle and adipose tissue.
• LDL delivers cholesterol to arterial tissue where oxidation and plaque formation
occur.
• Cholesterol does not contain fatty acids; instead, it shares some of lipids physical
and chemical characteristics.
 • The synthesis of a triacylglycerol molecule from glycerol and three fatty acid
molecules produces three water molecules. (dehydration)
• The body’s energy reserves from carbohydrate could power high intensity
running for about 1.6 hours, whereas exercise would continue for about 120
hours using the body’s fat reserves.
• The quantity of fat used for energy in light and moderate exercise is three times
that compared to resting conditions.
• As the exercise becomes more intense (greater percentage of aerobic capacity),
adipose tissue release of FFAs fails to increase much above resting levels,
leading to a decrease in plasma FFAs.
• The energy contribution from intramuscular triacylglycerols ranges between 15
and 35 %, with endurance trained athletes catabolizing the largest quantity and
a substantial impairment in use among the obese and/or type 2 diabetics.

MODERATE EXERCISE INTENSE AEROBIC

equal amounts of carbohydrate and With adequate glycogen reserves,
fat supply energy. carbohydrates become the preferred
When exercise continues at this level fuel because of its more rapid rate of
for more than one hour, fat catabolism.
catabolism gradually supplies a Toward the end of prolonged exercise
greater percentage of energy; this (when glycogen reserves become
coincides with the progression of nearly depleted), fat, mainly as
glycogen depletion (Carbohydrate circulating FFAs, supplies up to 80% of
availability also influences fat use for the total energy requirement.
energy).

• FAs provide more adenosine triphosphate (ATP) per molecule than glucose (147 vs.
38 ATP). However, in order to produce the equivalent amount of ATP, the complete
oxidation of FA requires more oxygen than the oxidation of CHO.
• Interestingly, TG storage within the muscle cell can be increased by regular
endurance training.
• Increase in circulating catecholamines, increased lactate formation (and
accompanying hydrogen ion accumulation) from glycogen breakdown, and
glycolytic flux is increased and also suppresses lipolysis. Reduction of fat oxidation
following the elevation of blood glucose.
• elevated circulating levels of glucose and insulin is associated with elevated
concentrations of malonyl CoA. Any increase in glycolytic flux therefore may
directly inhibit long chain FA oxidation, possibly by inhibiting its transport into
the mitochondria.

Proteins
• Muscle mass does not increase simply by eating high protein foods.
• The protein RDA 0.83 holds even for overweight persons and decreased with
age. And for infants 2-4g/kg
• Pregnant women should increase total daily protein intake by 20 g, and nursing
mothers should increase their intake by 10 g.
• Tissue anabolism accounts for about one third of the protein intake during
rapid growth in infancy and childhood. As growth rate declines, so does the
percentage of protein retained for anabolic processes.
• The researchers recommended that body builders could reduce their
abnormally high protein intakes, whereas endurance athletes could possibly
benefit from increased protein intake above the RDA level.
• The remaining deaminated amino acid then either converts to a new amino
acid, converts to carbohydrate or fat, or catabolizes directly for energy.
• protein. With proper nutrition, positive nitrogen balance often occurs in
( 1 ) growing children, 2 ) during pregnancy, 3 ) in recovery from illness, and
during resistance exercise training when muscle cells promote protein
synthesis.
• Also, muscle protein can be recruited for energy metabolism. In contrast,
proteins in neural and connective tissues remain relatively fixed ” as cellular
constituents and cannot be mobilized for energy without disrupting tissue
functions.
• Ex. an individual who participates regularly in intense exercise training may
consume adequate or excess protein but inadequate energy from carbohydrate
or lipid: protein becomes a primary energy fuel, which creates a negative
protein (nitrogen) balance and a loss of lean tissue mass.
• Although protein breakdown increases only modestly with most modes and
intensities of exercise, muscle protein synthesis rises substantially following
endurance and resistance type exercise.
• because the early studies only measured nitrogen in urine. The sweat
mechanism serves an important role in excreting nitrogen from protein
breakdown during exercise.
• urea production may not reflect all aspects of protein breakdown because the
oxidation of plasma and intracellular leucine (an essential BCAA) increases
during moderate exercise independent of changes in urea production.
• This emphasizes the important role of carbohydrate as a protein sparer and
indicates that carbohydrate availability affects the demand on protein
reserves” in exercise.
• The protein sparing role of dietary carbohydrate and lipid becomes important
during tissue growth periods and the high energy output and/or tissue
synthesis requirements of intense training.
• Increases in protein catabolism during endurance exercise and intense training
often mirror the metabolic mixture in acute starvation. (glycogen depletion).
• The increased protein use for energy and depressed protein synthesis during
intense exercise may partly explain why individuals who resistance train to
build muscle size generally refrain from glycogen depleting endurance
workouts to avoid the potential for muscle m teardown.
• Based on the available science, we recommend that athletes who train
intensely consume between 1.2 and 1.8 g of protein per kg of body mass daily.
No further advantage beyond such value. No need then for protein
supplements.
• With adequate protein intake, consuming animal sources of protein does not
facilitate muscle strength or size gains with resistance training compared with
protein intake from only plant sources.
• Alanine, synthesized in muscle from glucose derived pyruvate via
transamination, enters the blood where the liver converts it to glucose and
urea.
• During exercise, increased production, and output of alanine from muscle
helps to maintain blood glucose for nervous system and active muscle needs.
Exercise training augments hepatic gluconeogenesis.
• The Tarahumara, since most of the fat in their diet (9-12%) was derived from
corn, beans and squash, their diets are rich in linoleic acid and plant sterols.
• it is now agreed that timing of the amino acid intake is less critical and that
amino acid intake must be balanced over days rather than hours.
• Vegans should be encouraged to use soybean milk fortified with vitamin B12 or
a vitamin B 12 supplement.
• prolonged exercise. The alanine glucose cycle accounts for up to 45 % of the
livers ’ release of glucose during long duration exercise.
Vitamins
• The liver stores vitamins A and D, whereas vitamin E distributes throughout the
body’s fatty tissues. Vitamin K stores only in small amounts, mainly in the liver.
• Vitamin B1 facilitates the conversion of pyruvate to acetyl coenzyme A (CoA) in
carbohydrate breakdown.
• Niacin and vitamin B2 regulate mitochondrial energy metabolism.
• Vitamins B6 and B 12 catalyze protein synthesis.
• Pantothenic acid, part of CoA, participates in the aerobic breakdown of the
carbohydrate, fat, and Protein macronutrients.
• Vitamins participate repeatedly in metabolic reactions without degradation;
thus, the vitamin needs of physically active persons do not exceed those of
sedentary counterparts.
• Dietary Reference Intakes (DRIS)>> RDAs, Estimated Average Requirements,
Adequate Intakes, and the Tolerable Upper Intake Levels.
• The DRIs also provide values for food components of nutritional importance
such as phytochemicals.
• Estimated Average Requirement EAR: Average level of daily nutrient intake to
meet the requirement of one-half of the healthy individuals in a particular life
stage and gender group. The EAR provides.
• The EAR provides a useful value to determine the prevalence of inadequate
nutrient intake by the proportion of the population with intakes below this
value.
• Recommended Dietary Allowance (RDA): The average daily nutrient intake
level sufficient to meet the requirement of about 97% of healthy in a particular
life-stage and gender group. For most nutrients, this value represents the EAR
plus two standard deviations of the requirement.
• Adequate intake: provides an assumed adequate nutritional goal when no RDA
exists.
• Tolerable Upper Intake Level (UL): The highest average daily nutrient intake
level likely to pose no risk of adverse health effects to almost all individuals in
the specified gender and life-stage group of the general population.
• Free radicals>>Can damage the electron-dense cellular components DNA and
lipid-rich cell membranes.
• Antioxidants scavenge the oxygen radicals or chemically eradicate them by
reducing oxidized compounds.
• During unchecked oxidative stress, the plasma membrane’s fatty acids
deteriorate through a chain reaction series of events termed lipid peroxidation.
• the antioxidant vitamins are thought to inhibit LDL cholesterol oxidation.
• Recent studies played down the usefulness of some vitamins and mineral
supplements for cancer prevention.
• An elevated aerobic exercise metabolism increases reactive oxygen and
nitrogen free radical production.
• Regular exercise training also protects against myocardial injury from lipid
peroxidation induced by short term tissue ischemia followed by reperfusion.
• BUT The risk of oxidative stress increases with intense exercise.
• Occurs during alterations in blood flow and oxygen supply under perfusion
during intense exercise followed by substantial reperfusion in recovery which
trigger excessive free radical generation. The reintroduction of molecular
oxygen in recovery also produces reactive oxygen species that magnify
oxidative stress.
• Exhaustive endurance exercise by untrained persons produces oxidative
damage in the active muscles.
• Intense resistance exercise also increases free radical production, indirectly
measured by malondialdehyde, the lipid peroxidation byproduct.
• Cascade of events and adaptations produced by regular aerobic exercise that
lessen the likelihood of tissue damage from intense physical activity.
• A single bout or even a multiple bouts of submaximal exercise increases
oxidant production, yet antioxidant defenses cope effectively in healthy
individuals.
• If antioxidant supplementation proves beneficial, vitamin E may be the most
Important antioxidant related to exercise.
• Higher amounts of vit E have produced internal bleeding by inhibiting vitamin K
metabolism, particularly in persons Taking anticoagulant medication.
• 3 weeks of a daily weeks of a daily 200 International Unit vitamin E supplement
dramatically reduced free radical production measured by pentane elimination
in men, following maximal exercise. Pentane measurement in man as an index
of lipoperoxidation.
• Vitamin mineral deficiencies appear in physically active people, they often
• occur among these three groups:
• 1. Vegetarians or groups with low energy intake such as dancers, gymnasts,
and weight class sport athletes who strive to maintain or reduce body weight.
• 2. Individuals who eliminate one or more food groups from their diet.
• 3. Individuals who consume large amounts of processed foods and simple
sugars with low micronutrient density (e.g., endurance athletes).
• A megadose of water soluble vitamin C, for example, raises serum uric acid
levels to precipitate gout in predisposed individuals. Accelerate kidney stone
formation as oxalate is breakdown product of vit c
• Excess vit b6 >> nerve damage.
• Excess vit b2 >> impair vision.
• Excess niacin>>potent vasodilator inhibits fatty acid mobilization during
exercise which deplet glycogen reserves rapidly.
• High folic acid >>allergic response >> breathing difficulties
• High vit E>> headache, blurred vision.
• Moderate exercise heightens immune function, whereas prolonged periods of
intense physical activity, as in marathon running or a strenuous training
session, transiently suppress the body s first line of defense against infectious
agents.so Additional vitamin C and E and perhaps carbohydrate ingestion
before, during, and following a workout may boost the normal immune
mechanisms for combating infection (URTI).
• Too high insulin + exercise =hypoglycemia
• Too low insulin =ketoacidosis
• IDDM
• For IDDM the insulin concentration in blood will depend on the amount of
insulin administered and the rate of release of insulin from the site of injection
• The normal decrease in insulin level during exercise will therefore not occur in
people with IDDM and, as exercise increases insulin sensitivity, glucose uptake
in skeletal muscles may be too high. To mimic the reduction in concentration of
insulin that occurs in normal subjects during exercise, insulin injections have to
be avoided immediately prior to exercise in people with IDDM.
• Elite athletes require a higher amount of carbohydrates in their diet, which
makes the regulation of blood glucose more difficult.
• For endurance exercise is suggested to eat a large meal 1– 3 h before planned
exercise and to reduce insulin injection before this meal.
• NO standard recommendation, a reduction of 30––50% in rapid acting
insulin
• For Strength training and ball games: Reduction of the insulin dose may be
smaller. However, measuring blood glucose concentration frequently is
important.
• If the blood glucose concentration is below 5mm>> not participate high risk
for hypoglycemia
• If the blood glucose concentration is above 16mmm, >> not participate Too
high a glucose concentration may be a result of a low concentration of
insulin. Exercise in under insulinated diabetics may result in a further
increase in blood glucose concentration as the normal inhibition of glucose
release from the liver is lacking.
• Low insulin concentration will also cause elevated lipolysis and the high
concentration of NEFA may increase production of ketone bodies, resulting in
ketoacidosis.
• The duration of the exercise is more than 30 min, extra glucose should be
supplied.in IDDM DURING EXERCISE
• Glucose ingestion increases performance in prolonged endurance. In IDDM,
glucose ingestion should also prevent hypoglycemia.
• Injection of insulin is therefore necessary for optimal glycogen synthesis
(REPLENSHING), even though administering insulin after exercise increases the
risk for hypoglycemia.
• NIDDM
• although a larger percentage of energy comes from fat at lower intensity
endurance training, of energy comes from fat at lower intensity endurance
 training, achieving a progressive increase in intensity is important to obtain the
largest glucose tolerance improvement.
• Progress towards Endurance training at higher intensities is probably the most
effective way to reduce body weight, increase insulin sensitivity and improves
the regulation of blood glucose concentration.
• Strength training is normally not regarded to be as effective as endurance
training in increasing insulin sensitivity.
• in older, untrained people the skeletal muscle atrophies (Reduction in the
mass of muscle available to remove glucose from the blood) . Strength training
which increases muscle mass in older, be more effective than endurance
training in such cases.
Minerals
• Seven major minerals (required in amounts of 100 mg daily).
• Biosynthesis of thyroxine requires iodine, insulin requires zinc.
• Osteopenia>>bones weaken with increased risk of fracture.
• Osteoporosis>>progressively as bone loses its calcium mass (bone mineral
content) and calcium concentration (bone mineral density). Thus, bone
progressively becomes more porous and brittle.
• Increased susceptibility to osteoporosis among older women coincides with
menopause and the marked decrease in estradiol secretion, the most potent
naturally occurring human estrogen.
• The early teens serve as the prime years to maximize bone mass.
• Excessive meat, salt, coffee, and alcohol consumption inhibits absorption of
calcium.
• Bone matrix formation also depends on vitamin K
• Mechanical loading through regular exercise slows the rate of skeletal aging.
Regardless of age or gender.
• Strength and power activities end up by as much or more bone mass than
endurance training.
• Activities with relatively high impact and strain on the skeletal mass (e.g.,
volleyball, basketball, and gymnastics) induce the greatest increases in bone
mass, particularly at weight bearing sites.
• Eccentric exercise training provides a more potent site specific osteogenic
stimulus than concentric muscle training because greater forces usually occur
with eccentric muscle loading.
• Exercise-induced increases in bone mass bone mass achieved during teenage
and young-adult years remain despite cessation of active competition.
• Magnesium>>Magnesium plays an important role in glucose metabolism by
facilitating muscle and liver glycogen formation from bloodborne glucose.
• Iron>>Plasma levels of transferrin often reflect the adequacy of the current
iron intake.
• Intense physical training theoretically creates an augmented(increased) iron
demand from three sources:
1. Small loss of iron in sweat.
2. Loss of hemoglobin in urine from red blood cell destruction with
increased temperature, spleen activity, and circulation rates and from
jarring of the kidneys and mechanical trauma from feet pounding on the
running surface (called foot strike hemolysis).
3. Gastrointestinal bleeding with distance running unrelated to age, gender,
or performance time.
• Individuals susceptible to an “iron drain” could experience reduced
exercise capacity because of iron’s crucial role in oxygen transport and use.
• suboptimal hemoglobin concentrations and hematocrits occur more
frequently among endurance athletes, occur in the early phase of training.

Relatively high prevalence of nonanemic iron

depletion exists among athletes in diverse
sports as well as in recreationally active women
and men.
Women with low serum ferritin levels but
hemoglobin concentrations above 12 g·,
although not clinically anemic, might still be
functionally anemic and thus benefit from iron
supplementation to augment exercise
performance.
 • Despite this hemoglobin dilution, aerobic capacity and exercise
performance improve with training.
• Electrolytes
• Na &Cl >> extracellular …. K >> intracellular
• Salt supplements may be beneficial in prolonged exercise in the heat when
the fluid loss exceeds 4 or 5kg.this can be achieved by drinking a 0.1 to
0.2% salt solution.
• Strenuous exercise may increase excretion of the following trace elements
• Chromium: required for carbohydrate and lipid catabolism and proper
insulin function and protein Synthesis.
• Copper: required for red blood cell formation; influences gene expression
and serves as a cofactor or prosthetic group for several enzymes
• Manganese: component of superoxide dismutase in the body s antioxidant
defense system
• Zinc: component of lactate dehydrogenase, carbonic anhydrase, superoxide
dismutase, and enzymes related to energy metabolism, cell growth and
differentiation, and tissue repair.
• The female athlete
• Disordered eating behaviors eventually lead to the female athlete triad
energy drain, amenorrhea, band osteoporosis.
• most prominently those involved in leanness related sports (distance
running, gymnastics, ballet, cheerleading, figure skating, and body
building).
• Premature cessation of menstruation removes estrogen protective effect on bone,
making these young women more vulnerable to calcium loss with concomitant
decrease in bone mass.
• Persistent amenorrhea that begins at an early age diminishes the benefits of
exercise on bone mass.
• Bone mass often remains permanently at suboptimal levels throughout adult life
leaving the woman at increased risk for osteoporosis and stress fractures, even
years following competitive athletic participation.
• prolonged oligomenorrhea/ amenorrhea may irreversibly decrease vertebral bone
density; the condition becomes exacerbated in women with persistently low body
weight.
 • Nonpharmacologic treatment of athletic amenorrhea uses a four phase
behavioral approach plus diet and training interventions
• . Reduce training level by 10 to 20%
• . Gradually increase total energy intake
• . Increase body weight by 2 to 3%
• . Maintain calcium intake at 1500 mg daily.
• Aerobic capacity in female athletes with mild anemia can be improved with iron
supplementation.
• Energy intakes of normally ovulating women are higher during the luteal phase of
their menstrual.
• Females demonstrated greater lipid utilization based on RER values, less muscle
glycogen use and less urea nitrogen excretion than males during moderate
intensity, long duration exercise. Females would have an advantage in endurance
and ultra--endurance events in which fat oxidation becomes metabolically more
important.
• It is advisable for those working with athletes who typically report low energy
intakes,i.e. gymnasts, figure skaters, and runners, to assess adequate vitamin B 6
intake.

On the run
• Intense aerobic exercise for 1 hour decreases liver glycogen by about 55 %,
whereas a 2-hour strenuous workout almost depletes the glycogen content of the liver
and active muscle fibers.
• Prior to exercise: consuming rapidly absorbed high-glycemic carbohydrates within
glycemic carbohydrates within 1 hour before exercising accelerates glycogen
depletion and fatigue This negatively affects endurance performance by increasing
insulin inhibit lipolysis. And cause rebound hypoglycemia.
• Consume a meal rich in complex carbohydrates (low glycemic index)
• During exercise, Physical and mental performance improves with carbohydrate
supplementation during exercise.
• The addition of protein to carbohydrate containing beverages (4:1 ratio of
carbohydrate to protein) may delay fatigue and reduce muscle damage compared
with supplementation during exercise with carbohydrates only.
 • Consuming about 60 g of liquid or solid carbohydrates each hour during
exercise benefits high-intensity, long-duration (1 h) aerobic exercise and
repetitive short bouts of near-maximal effort.
• Carbohydrate feedings during exercise at 60 to 80 % of aerobic capacity
postpones fatigue threshold by 15 to 30 minutes.
• Fat provides the primary energy fuel in light to moderate exercise below 50%
of maximum; at this intensity, glycogen reserves do not decrease to a level
that limits endurance.
• A food with a moderate to high glycemic index rating offers more benefit for
rapid replenishment of carbohydrates following prolonged exercise than one
rated low, even if the replenishment meal contains a small amount of lipid and
protein.
• Consuming food after exercising facilitates glucose transport into muscle cells
for three reasons:
1. Higher insulin low catecholamine
2. Increased tissue sensitivity to insulin (high GLUT 4)
3. Inc activity of glycogen synthase
• One strategy is to consume about 50 to 75 g of high to moderate glycemic
carbohydrates every 2 hours until reaching 500 to 700 g per kg of body mass)
or until eating a large, high-carbohydrate meal. Following exercise
• Legumes, fructose, and milk products have a slow rate of digestion and/or
intestinal absorption and should be avoided. (for replenishing)
• Glycogen resynthesis occurs more rapidly if the person remains inactive during
the recovery period.
• Postexercise consumption of high—glycemic carbohydrates also may speed
recovery by facilitating the removal of free ammonia that forms at an increased
rate during strenuous exercise. Consuming glucose enhances glutamine and
alanine synthesis in skeletal muscle; these compounds provide the primary
vehicle to transport ammonia out of muscle tissue.
• Glucose enters red blood cells, brain cells, and kidney and liver cells depend on
maintaining a positive concentration gradient of glucose across the cell
membrane. (Unregulated glucose transport).
• In contrast, skeletal and heart muscle and adipose tissue require glucose
transport via regulated uptake with insulin and GLUT 4.
• Active skeletal muscle can increase the uptake of glucose from the blood,
independent of the effect of insulin. This effect persists into the early
postexercise period and helps to replenish glycogen stores.
• Consuming low--glycemic, carbohydrate--rich foods (starch with high amylose
content or moderate glycemic carbohydrate with high dietary fiber content) in
the immediate 45 to 60-minute pre-exercise period allows a slower rate of
glucose absorption (less insulinemic response).
• Concern centers on the dual observations that (1) a large fluid volume intake
impairs carbohydrate uptake, whereas (2) a concentrated sugar solution
impairs fluid replenishment.
• Little negative effect of exercise on gastric emptying occurs up to an intensity
of about 75 % of maximum, after which the emptying rate slows.
• A major factor to speed gastric emptying (and compensate for any inhibitory
effects of the beverage s carbohydrate content) involves maintaining a
relatively high fluid volume in the stomach.

Consuming 400 to 600 mL of fluid immediately

before exercise optimizes the beneficial effect of
increased stomach fluid and nutrient passage into
the intestine.

Then, regularly drinking 150to250 mL of fluid at 15-

minute intervals throughout exercise continually
replenishes fluid.

The negative effect of concentrated sugar solutions

on gastric emptying diminishes (and plasma volume
remains unaltered) when the drink contains a short-
chain glucose polymer (maltodextrin) rather than
simple sugars.

In hot weather>dilute carbohydrate-electrolyte

solution 5%

In cold weather>more- concentrated 15 %

carbohydrate beverage would suffice.
 Optimal nutrition for performance
• Those who exercise regularly to keep fit do not require additional nutrients
beyond those in a regular intake of a nutritionally well-balanced diet.
• The high fat diet produced suboptimal adaptations in endurance performance.
Low training capacity, inc fatigue
• A diet of 20% lipid produced poorer endurance performance scores than a
diet containing recommended fat.
• A low-fat diet also blunts the normal rise in plasma testosterone following an
acute bout of Resistance exercise. (loss of weight and muscular mass).
• Excluding sufficient carbohydrate energy from the diet causes an individual to
train in a state of relative glycogen depletion; this may eventually produce
“staleness” that can hinder exercise performance.
• For intense training/ competitive athletes,
even consuming a relatively large percentage of carbohydrate calories will not
adequately replenish glycogen stores. Thus, carbohydrates intake must exceed
the minimum recommendation of 55 to 60 % to represent 65 % of total energy.
• A negative energy balance in the transition from moderate to intense training
can ultimately compromise an athlete s full potential to train and compete.
• By combining liquid nutrition with normal meals, this cyclist nearly matched
daily energy expenditure with energy intake.
• carbohydrates represented 95.3% in ultra endurance running competition
(korous).
• The Tarahumara Indians (low cholesterol intake-95% of lipid from corn and
beans-sat fat 2%-simple sugar 5%).
• Nutrition to Prevent Chronic Athletic Fatigue
• It requires at least requires at least 1 to 2 days of rest or lighter exercise
combined with a high carbohydrate intake to reestablish pre-exercise muscle
glycogen levels after exhaustive training or competition.
• High-Risk Sports for Marginal Nutrition
• Gymnasts, ballet dancers, ice dancers, and weight-class athletes in boxing,
wrestling, rowing, and judo engage in arduous training.
• Precompetition meal>The meal should provide adequate carbohydrate
energy and ensures optimal hydration Fasting before competition or training
makes no sense physiologically because it rapidly depletes liver liver andmuscle
glycogen and impairs exercise performance
•

• If a person trains or competes in the afternoon, breakfast becomes the

important meal to optimize glycogen reserves. For late afternoon training
or competition, lunch becomes the important source for topping off
glycogen stores.
• exclude foods high in lipid and protein because they digest slowly and
remain in the digestive tract longer than foods containing similar energy
content as carbohydrate.
• A high protein meal elevates resting metabolism more than a high
carbohydrate meal because of protein s greater energy requirements for
digestion, absorption, and assimilation. i.e., additional thermic effect.
• Protein catabolism for energy facilitates dehydration. because the
byproducts of amino acid breakdown require water for urinary excretion.
(50 mL of water “accompanies” one gram of urea excretion.)
• The meal should accomplish the following three goals:
1. Contain 150 to 300 g of carbohydrate (3 to 5 g per kg body mass in
either solid or liquid form)
2. Be consumed 3 to 4 hours before exercising
 3. Contain relatively little fat and fiber to facilitate gastric emptying and
minimize gastrointestinal distress.
• Supplements and meal replacements
Liquid meals Nutrition bars
High CHO content High CHO
Rapidly digested Contains vitamins and minerals.
Practical during high energy Contains hydroxy methyl butyrate
output phase of training (HMB).
For athletes facing difficulty should not totally substitute
maintaining body weight, and as normal food intake.
a ready source of calories to gain Lack fibers and phytochemicals
weight. and high in sat fats
Sold as dietary supplement so do
not receive assessment to validate
labelling.

Nutrition powder and liquids

High protein content

marketed as meal replacements,
dieting aids, energy boosters, or
concentrated protein sources.
Exceed recommended protein
intake and fall below lipid and CHO
levels.
Lack fibers and phytochemicals.
Should not substitute regular food
Not assessed for labeling.

‘’ when you have mountains to climb, you can complain about the
walk or appreciate the view.”