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      International society of sports nutrition position stand: nutrient timing

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          Position statement

          The International Society of Sports Nutrition (ISSN) provides an objective and critical review regarding the timing of macronutrients in reference to healthy, exercising adults and in particular highly trained individuals on exercise performance and body composition. The following points summarize the position of the ISSN:

          1. Nutrient timing incorporates the use of methodical planning and eating of whole foods, fortified foods and dietary supplements. The timing of energy intake and the ratio of certain ingested macronutrients may enhance recovery and tissue repair, augment muscle protein synthesis (MPS), and improve mood states following high-volume or intense exercise.

          2. Endogenous glycogen stores are maximized by following a high-carbohydrate diet (8–12 g of carbohydrate/kg/day [g/kg/day]); moreover, these stores are depleted most by high volume exercise.

          3. If rapid restoration of glycogen is required (< 4 h of recovery time) then the following strategies should be considered:

            1. aggressive carbohydrate refeeding (1.2 g/kg/h) with a preference towards carbohydrate sources that have a high (> 70) glycemic index

            2. the addition of caffeine (3–8 mg/kg)

            3. combining carbohydrates (0.8 g/kg/h) with protein (0.2–0.4 g/kg/h)

          4. Extended (> 60 min) bouts of high intensity (> 70% VO 2max) exercise challenge fuel supply and fluid regulation, thus carbohydrate should be consumed at a rate of ~30–60 g of carbohydrate/h in a 6–8% carbohydrate-electrolyte solution (6–12 fluid ounces) every 10–15 min throughout the entire exercise bout, particularly in those exercise bouts that span beyond 70 min. When carbohydrate delivery is inadequate, adding protein may help increase performance, ameliorate muscle damage, promote euglycemia and facilitate glycogen re-synthesis.

          5. Carbohydrate ingestion throughout resistance exercise (e.g., 3–6 sets of 8–12 repetition maximum [RM] using multiple exercises targeting all major muscle groups) has been shown to promote euglycemia and higher glycogen stores. Consuming carbohydrate solely or in combination with protein during resistance exercise increases muscle glycogen stores, ameliorates muscle damage, and facilitates greater acute and chronic training adaptations.

          6. Meeting the total daily intake of protein, preferably with evenly spaced protein feedings (approximately every 3 h during the day), should be viewed as a primary area of emphasis for exercising individuals.

          7. Ingestion of essential amino acids (EAA; approximately 10 g)either in free form or as part of a protein bolus of approximately 20–40 g has been shown to maximally stimulate muscle protein synthesis (MPS).

          8. Pre- and/or post-exercise nutritional interventions (carbohydrate + protein or protein alone) may operate as an effective strategy to support increases in strength and improvements in body composition. However, the size and timing of a pre-exercise meal may impact the extent to which post-exercise protein feeding is required.

          9. Post-exercise ingestion (immediately to 2-h post) of high-quality protein sources stimulates robust increases in MPS.

          10. In non-exercising scenarios, changing the frequency of meals has shown limited impact on weight loss and body composition, with stronger evidence to indicate meal frequency can favorably improve appetite and satiety. More research is needed to determine the influence of combining an exercise program with altered meal frequencies on weight loss and body composition with preliminary research indicating a potential benefit.

          11. Ingesting a 20–40 g protein dose (0.25–0.40 g/kg body mass/dose) of a high-quality source every three to 4 h appears to most favorably affect MPS rates when compared to other dietary patterns and is associated with improved body composition and performance outcomes.

          12. Consuming casein protein (~ 30–40 g) prior to sleep can acutely increase MPS and metabolic rate throughout the night without influencing lipolysis.

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          American College of Sports Medicine position stand. Nutrition and athletic performance.

          It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of foods and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This updated position paper couples a rigorous, systematic, evidence-based analysis of nutrition and performance-specific literature with current scientific data related to energy needs, assessment of body composition, strategies for weight change, nutrient and fluid needs, special nutrient needs during training and competition, the use of supplements and ergogenic aids, nutrition recommendations for vegetarian athletes, and the roles and responsibilities of the sports dietitian. Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue. Fat intake should be sufficient to provide the essential fatty acids and fat-soluble vitamins and to contribute energy for weight maintenance. Although exercise performance can be affected by body weight and composition, these physical measures should not be a criterion for sports performance and daily weigh-ins are discouraged. Adequate food and fluid should be consumed before, during, and after exercise to help maintain blood glucose concentration during exercise, maximize exercise performance, and improve recovery time. Athletes should be well hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses. Sports beverages containing carbohydrates and electrolytes may be consumed before, during, and after exercise to help maintain blood glucose concentration, provide fuel for muscles, and decrease risk of dehydration and hyponatremia. Vitamin and mineral supplements are not needed if adequate energy to maintain body weight is consumed from a variety of foods. However, athletes who restrict energy intake, use severe weight-loss practices, eliminate one or more food groups from their diet, or consume unbalanced diets with low micronutrient density may require supplements. Because regulations specific to nutritional ergogenic aids are poorly enforced, they should be used with caution and only after careful product evaluation for safety, efficacy, potency, and legality. A qualified sports dietitian and, in particular, the Board Certified Specialist in Sports Dietetics in the United States, should provide individualized nutrition direction and advice after a comprehensive nutrition assessment.
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            Dose–Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis

            Background Resistance training (RT) is an intervention frequently used to improve muscle strength and morphology in old age. However, evidence-based, dose–response relationships regarding specific RT variables (e.g., training period, frequency, intensity, volume) are unclear in healthy old adults. Objectives The aims of this systematic review and meta-analysis were to determine the general effects of RT on measures of muscle strength and morphology and to provide dose–response relationships of RT variables through an analysis of randomized controlled trials (RCTs) that could improve muscle strength and morphology in healthy old adults. Data Sources A computerized, systematic literature search was performed in the electronic databases PubMed, Web of Science, and The Cochrane Library from January 1984 up to June 2015 to identify all RCTs related to RT in healthy old adults. Study Eligibility Criteria The initial search identified 506 studies, with a final yield of 25 studies. Only RCTs that examined the effects of RT in adults with a mean age of 65 and older were included. The 25 studies quantified at least one measure of muscle strength or morphology and sufficiently described training variables (e.g., training period, frequency, volume, intensity). Study Appraisal and Synthesis Methods We quantified the overall effects of RT on measures of muscle strength and morphology by computing weighted between-subject standardized mean differences (SMDbs) between intervention and control groups. We analyzed the data for the main outcomes of one-repetition maximum (1RM), maximum voluntary contraction under isometric conditions (MVC), and muscle morphology (i.e., cross-sectional area or volume or thickness of muscles) and assessed the methodological study quality by Physiotherapy Evidence Database (PEDro) scale. Heterogeneity between studies was assessed using I 2 and χ 2 statistics. A random effects meta-regression was calculated to explain the influence of key training variables on the effectiveness of RT in terms of muscle strength and morphology. For meta-regression, training variables were divided into the following subcategories: volume, intensity, and rest. In addition to meta-regression, dose–response relationships were calculated independently for single training variables (e.g., training frequency). Results RT improved muscle strength substantially (mean SMDbs = 1.57; 25 studies), but had small effects on measures of muscle morphology (mean SMDbs = 0.42; nine studies). Specifically, RT produced large effects in both 1RM of upper (mean SMDbs = 1.61; 11 studies) and lower (mean SMDbs = 1.76; 19 studies) extremities and a medium effect in MVC of lower (mean SMDbs = 0.76; four studies) extremities. Results of the meta-regression revealed that the variables “training period” (p = 0.04) and “intensity” (p < 0.01) as well as “total time under tension” (p < 0.01) had significant effects on muscle strength, with the largest effect sizes for the longest training periods (mean SMDbs = 2.34; 50–53 weeks), intensities of 70–79 % of the 1RM (mean SMDbs = 1.89), and total time under tension of 6.0 s (mean SMDbs = 3.61). A tendency towards significance was found for rest in between sets (p = 0.06), with 60 s showing the largest effect on muscle strength (mean SMDbs = 4.68; two studies). We also determined the independent effects of the remaining training variables on muscle strength. The following independently computed training variables are most effective in improving measures of muscle strength: a training frequency of two sessions per week (mean SMDbs = 2.13), a training volume of two to three sets per exercise (mean SMDbs = 2.99), seven to nine repetitions per set (mean SMDbs = 1.98), and a rest of 4.0 s between repetitions (SMDbs = 3.72). With regard to measures of muscle morphology, the small number of identified studies allowed us to calculate meta-regression for the subcategory training volume only. No single training volume variable significantly predicted RT effects on measures of muscle morphology. Additional training variables were independently computed to detect the largest effect for the single training variable. A training period of 50–53 weeks, a training frequency of three sessions per week, a training volume of two to three sets per exercise, seven to nine repetitions per set, a training intensity from 51 to 69 % of the 1RM, a total time under tension of 6.0 s, a rest of 120 s between sets, and a rest of 2.5 s between repetitions turned out to be most effective. Limitations The current results must be interpreted with caution because of the poor overall methodological study quality (mean PEDro score 4.6 points) and the considerable large heterogeneity (I 2 = 80 %, χ 2 = 163.1, df = 32, p < 0.01) for muscle strength. In terms of muscle morphology, our search identified nine studies only, which is why we consider our findings preliminary. While we were able to determine a dose–response relationship based on specific individual training variables with respect to muscle strength and morphology, it was not possible to ascertain any potential interactions between these variables. We recognize the limitation that the results may not represent one general dose–response relationship. Conclusions This systematic literature review and meta-analysis confirmed the effectiveness of RT on specific measures of upper and lower extremity muscle strength and muscle morphology in healthy old adults. In addition, we were able to extract dose–response relationships for key training variables (i.e., volume, intensity, rest), informing clinicians and practitioners to design effective RTs for muscle strength and morphology. Training period, intensity, time under tension, and rest in between sets play an important role in improving muscle strength and morphology and should be implemented in exercise training programs targeting healthy old adults. Still, further research is needed to reveal optimal dose–response relationships following RT in healthy as well as mobility limited and/or frail old adults.
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              High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women.

              Few studies examined the association between time-of-day of nutrient intake and the metabolic syndrome. Our goal was to compare a weight loss diet with high caloric intake during breakfast to an isocaloric diet with high caloric intake at dinner. Overweight and obese women (BMI 32.4 ± 1.8 kg/m(2) ) with metabolic syndrome were randomized into two isocaloric (~1400 kcal) weight loss groups, a breakfast (BF) (700 kcal breakfast, 500 kcal lunch, 200 kcal dinner) or a dinner (D) group (200 kcal breakfast, 500 kcal lunch, 700 kcal dinner) for 12 weeks. The BF group showed greater weight loss and waist circumference reduction. Although fasting glucose, insulin, and ghrelin were reduced in both groups, fasting glucose, insulin, and HOMA-IR decreased significantly to a greater extent in the BF group. Mean triglyceride levels decreased by 33.6% in the BF group, but increased by 14.6% in the D group. Oral glucose tolerance test led to a greater decrease of glucose and insulin in the BF group. In response to meal challenges, the overall daily glucose, insulin, ghrelin, and mean hunger scores were significantly lower, whereas mean satiety scores were significantly higher in the BF group. High-calorie breakfast with reduced intake at dinner is beneficial and might be a useful alternative for the management of obesity and metabolic syndrome. Copyright © 2013 The Obesity Society.
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                Author and article information

                Contributors
                ckerksick@lindenwood.edu
                shawn.arent@rutgers.edu
                brad.schoenfeld@lehman.cuny.edu
                jeffrey.stout@ucf.edu
                bcampbell@usf.edu
                cwilborn@umhb.edu
                ltaylor@umb.edu
                douglas.kalman@qps.com
                abbiesmith@unc.edu
                rbkreider@tamu.edu
                darryn_willoughby@baylor.edu
                parciero@skidmore.edu
                tvanduss@kennesaw.edu
                mormsbee@fsu.edu
                rwildman@dymatize.com
                mgreenwood26@tamu.edu
                tz@appliedhealthsciences.org
                alaneats@gmail.com
                ja839@nova.edu
                Journal
                J Int Soc Sports Nutr
                J Int Soc Sports Nutr
                Journal of the International Society of Sports Nutrition
                BioMed Central (London )
                1550-2783
                29 August 2017
                29 August 2017
                2017
                : 14
                : 33
                Affiliations
                [1 ]ISNI 0000 0000 8539 0749, GRID grid.431378.a, Exercise and Performance Nutrition Laboratory, School of Health Sciences, , Lindenwood University, ; St. Charles, MO USA
                [2 ]ISNI 0000 0004 1936 8796, GRID grid.430387.b, IFNH Center for Health & Human Performance, Department of Kinesiology & Health, , Rutgers University, ; New Brunswick, NJ USA
                [3 ]ISNI 0000 0001 2238 1260, GRID grid.259030.d, Health Science Department, Program of Exercise Science, , CUNY Lehman College, ; Bronx, NY USA
                [4 ]ISNI 0000 0001 2159 2859, GRID grid.170430.1, Institute of Exercise Physiology and Wellness, , University of Central Florida, ; Orlando, FL USA
                [5 ]ISNI 0000 0001 2353 285X, GRID grid.170693.a, Performance & Physique Enhancement Laboratory, Exercise Science Program, , University of South Florida, ; Tampa, FL USA
                [6 ]GRID grid.441596.b, Human Performance Lab, Department of Exercise Sport Science, , University of Mary Hardin-Baylor, ; Belton, TX USA
                [7 ]ISNI 0000 0001 2110 1845, GRID grid.65456.34, Department of Athletics, , Florida International University, ; Miami, FL USA
                [8 ]ISNI 0000000122483208, GRID grid.10698.36, Applied Physiology Laboratory, Department of Exercise and Sport Science, , University of North Carolina-Chapel Hill, ; Chapel Hill, NC USA
                [9 ]ISNI 0000 0004 4687 2082, GRID grid.264756.4, Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Department of Health & Kinesiology, , Texas A&M University, ; College Station, TX USA
                [10 ]ISNI 0000 0001 2111 2894, GRID grid.252890.4, Exercise and Biochemical Nutrition Laboratory, Department of Health, Human Performance, and Recreation, , Baylor University, ; Waco, TX USA
                [11 ]ISNI 0000 0001 2270 6467, GRID grid.60094.3b, Human Nutrition and Metabolism Laboratory, Health and Exercise Sciences Department, , Skidmore College, ; Saratoga Springs, NY 12866 USA
                [12 ]ISNI 0000 0000 9620 8332, GRID grid.258509.3, Department of Exercise Science and Sport Management, , Kennesaw State University, ; Kennesaw, GA USA
                [13 ]ISNI 0000 0004 0472 0419, GRID grid.255986.5, Department of Nutrition, Food and Exercise Sciences, Institute of Sport Sciences and Medicine, , Florida State University, ; Tallahassee, FL USA
                [14 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, University of KwaZulu-Natal, Biokinetics, Exercise and Leisure Studies, ; Durban, 4000 South Africa
                [15 ]Post Active Nutrition, 111 Leslie St, Dallas, TX USA
                [16 ]The Center for Applied Health Sciences, Stow, OH USA
                [17 ]ISNI 0000 0001 0657 9381, GRID grid.253563.4, Department of Family Environmental Sciences, , California State University, ; Northridge, CA USA
                [18 ]ISNI 0000 0001 2168 8324, GRID grid.261241.2, Department of Health and Human Performance, , Nova Southeastern University, ; Davie, FL USA
                Author information
                http://orcid.org/0000-0002-8930-1058
                Article
                189
                10.1186/s12970-017-0189-4
                5596471
                28919842
                a7f8ee5c-8dcb-4c07-85c1-fe4dbb34e886
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 July 2017
                : 14 August 2017
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Sports medicine
                position stand,exercise,nutrition,timing,macronutrients,performance,micronutrients,nutrients
                Sports medicine
                position stand, exercise, nutrition, timing, macronutrients, performance, micronutrients, nutrients

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