recovery - prepare acsm health & fitness summit 2013 handout · 2013-03-13 · pre-training...
Post on 15-Jul-2020
3 Views
Preview:
TRANSCRIPT
3/12/13%
1%
Sports Medicine Research Laboratory
The University of North Carolina at Chapel Hill
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Darin A. Padua, PhD, ATC @DarinPadua
Barnett S. Frank, MA, ATC @BarnettFrank
Mary Ellen Bingham, MS, RD, CSSD @WeFuelTheHeels
#PREPARE
Overview • Fatigue vs. Over-Training
– Factors & mechanisms – Performance & injury
• Evidence based solutions for combating fatigue & over-training
– 3 R’s
• Implementing an integrated and systematic recovery program
– PREPARE
Combatting the Effects of Fatigue on Performance
Muscle Performance
• Muscle strength • Muscle power • Muscle contractile
velocity
Exercise Performance
• Speed • Power output • Balance / Stability • Movement
Competition Performance
• Work rate during competition
• Decision making • Anticipation
Competitive Performance Measures References
! Work rate (1st vs 2nd half, quarters, consecutive days)
Mohr et al, J Sports Sci, 2005; Reilly et al, Sports Med, 2008; Spencer et al, J Sci Med Sport, 2005; Carling et al, Sports Med, 2008; Mohr et al, J Sports Sci, 2003
! total distance covered%! percentage of time spent sprinting (! 40% in final 15 min)%" percentage of time spent standing or walking%
" Repeated sprint / sport-related agility%
Stuart et al, Med Sci Sport Exerc, 2005; Small et al, Int J Sport Med, 2009; Perrey et al, Eur J Appl Physiol, 2010; Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005; McGregor et al, J Sports Sci, 1999; Krustup et al, Med Sci Sports Exerc, 2006; Edwards et al, Br J Sports Med, 2007
! Joint motion% Small et al, Int J Sports Med, 2009; Appiantono et al, J Sports Sci, 2006
! Technique execution Reilly et al, Sports Med, 2008; Stuart et al, Med Sci Sports Exerc, 2005; Royal et al, J Sports Sci, 2006; Gabbett et al, J Strength Cond Res, 2008; Appiantono et al, J Sports Sci, 2006; Kellis et al, Scand J Med Sci Sports, 2006
! rugby tackling skills%! water polo shooting skills%! soccer kicking motion%
! Technique outcome Stuart et al, Med Sci Sports Exerc, 2005; Appiantono et al, J Sports Sci, 2006; Kellis, Scand J Med Sci Sports, 2006; Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005; Ali et al, Med Sci Sports Exerc, 2007; Devlin et al, J Sci Med Sport, 2001
! rugby tackling skills%! rugby tackling skills%! rugby tackling skills%! rugby tackling skills%
" RPE (15-19)%Royal et al, J Sports Sci, 2006; Gabbett et al, J Strength Cond Res, 2008; McGregor et al, J Sports Sci, 1999; Edwards et al, Br J Sports Med, 2007; Ali et al, Med Sci Sports Exerc, 2007
" Sense of generalized fatigue% Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005
" Muscle soreness% Montgomery et al, J Sports Sci, 2008
Mechanisms of Fatigue
Peripheral Factors • Carbohydrate availability
– Glucose – Glycogen
• Hypoxia / Hypoxaemia • Acidosis (lactate) • Hyperkalaemia
– K+ release from working muscle fibers into interstitium / plasma
• Dehydration • Hyperthermia
Central Factors • Neural drive to muscle
– Voluntary • Psychological factors • RPE
– Involuntary • Neuro-Chemistry
– Energy supply – Neuro-transmitters – Neuro-modulators
Afferent Feedback
Main Factors Causing Fatigue
Prolonged Exercise (> 60 min)
• Decreased carbohydrate supply
• Dehydration • Central factors
High Intensity Exercise (max
effort)
• Hyperkalaemia • Systemic acidosis • Hypoxia • Central factors
Exercise in Hostile Environmental
Conditions
• Hyperthermia • Dehydration • Hypoxia • Central factors
Strong interaction between peripheral and central factors (body-mind) • Perceived exertion can greatly impact acute fatigue symptoms • Psychological mind-set can impact response to strenuous exercise
3/12/13%
2%
Central Factors
Peripheral Factors
Afferent Feedback
Muscle Performance
Exercise Performance
Competition Performance
! Stability
Altered Movement Patterns
" Injury Risk
?
• High training loads are strongly associated with increased lower extremity injury rates (r=0.86) Gabbett, J Sports Sci, 2004
– Contact (r=0.82) & non-contact (r=0.82) injuries – ! Training loads # ! Injury rates Gabbett, Br J Sports Med, 2004
• No compromise in performance improvements
Gabbett & Jenkins, J Sci Med Sport, 2011
Strenuous Exercise
Decreased Muscle
Performance Fatigue Progressive
Decline " Injury Rates
Fatigue is a part of strenuous exercise and unavoidable to
some extent
Must prevent fatigue from causing a
progressive decline in exercise performance
Over-Reaching # Over-Training • Disturbed stress-regeneration balance
– Stress: physical and/or mental
Meeusen et al, Eur J Appl Physiol, 2004; Meeusen et al, Eur J Sport Sci, 2006; Nederhof et al, Sports Med, 2006
Altered mood state
Altered sleep
Altered eating
Decreased Performance
Over-Training
Severe Months to a year
Non-Functional Over-Reaching
Mild to moderate Longer recovery
Functional Over-Reaching
Mild to moderate Days to weeks
Strenuous Exercise
!Performance & "Injury Risk
Recovery Behaviors
Over-training is a misnomer and suggests strenuous exercise is a primary cause of fatigue
Re-Fuel
Rest
Retain Movement Efficiency
"Performance & !Injury Risk
+
Under-recovery facilitates negative consequences
Optimum Recovery • Required to maximize benefits (anabolic) & eliminate
consequences (catabolic) of strenuous exercise
Strenuous Exercise
Optimum Recovery
Positive Physiologic Response
“Super-compensation” + =
Catabolic Response
Anabolic Response
3/12/13%
3%
! Performance (acute / end game)
" Injury Rates
Progressive Performance Improvement
! Injury Rates
Strenuous Exercise
Fatigue
Progressive Performance
Decline
Super-Compensation Recovery Strategies
Optimum Recovery
(3 R’s) Re-Fuel (Nutrition & Hydration)
Supplements (Nutrition & Modalities)
Rest (Sleep, Stress &
Relaxation)
Retain Movement Efficiency
(Pre/Post Training Routine)
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
• 30 min post • 2-4:1 carb:protein
ratio • Replace water
• High carbs • Moderate protein • Low fat
• Water (3-4 liters/day)
• Replace electrolytes (sodium)
• Eat Breakfast • Regular meals
during day • Well balanced
Meals Hydration
Post-Training Nutrition
Pre-Training Nutrition
Re-Fuel Strategies
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
6 to 10 g / kg of body wt / day (2.7 to 4.5 g / lb of body wt / day) • High carbohydrate diet (50-60% of
energy) • Maintain blood glucose during
exercise • Replace muscle glycogen
1.2 to 1.7 g / kg of body wt / day (0.5 to 0.8 g / lb of body wt / day)
20 to 30% of total energy intake / day
Joint Position Statement by American Dietetic Association, Dietitians of Canada, and American College of Sports Medicine: Nutrition and Athletic Performance, Med Sci Exerc Sports Sci, 2009
Meals
Carbohydrates
Proteins
Fats
• Sufficient fluid to maintain hydration • At least 3-4 hours before exercise, drink ~5-7 mL/kg body
weight (~2-3 mL/lb body weight) of water or sport beverage • Low in fat and fiber to facilitate gastric emptying • High in carbohydrates (maximize blood glucose) • Moderate in protein • During exercise:
• Replace fluid loss • Provide carbohydrates for events > 1 hour (maintain blood
glucose)
Joint Position Statement by American Dietetic Association, Dietitians of Canada, and American College of Sports Medicine: Nutrition and Athletic Performance, Med Sci Exerc Sports Sci, 2009
Pre-Training Nutrition
Post-Training Nutrition • Replace fluids, electrolytes, carbs and protein (replace muscle
glycogen & enhance protein synthesis) • 1.0 to 1.5 g / kg of body wt (0.5 to 0.7 g / lb of body wt) • High glycemic index
• Include protein (amino acid for muscle repair and promote anabolic hormone profile)
• ~10-20 g • 2 to 4 : 1 carbohydrate to protein ratio
• Moderate amount of Omega-3’s (regulate inflammatory response)
Sample Post-Exercise Recovery Snack • Option 1 (645 calories, 94 g CHO, 25 g PRO, 20 g Fat, 3.8:1 CHO:PRO)
– 1 regular bagel – 2 T. peanut butter – 8 oz 1% lowfat chocolate milk – 1 oz (30g) seedless raisins
• Option 2 (627 calories, 93 g CHO, 39 g PRO, 11 g FAT, 2.4:1 CHO:PRO) – 2 cups flavored soymilk plus 3 heaping tsp whey protein isolate – 4 graham cracker squares – 1 medium apple
• Option 3 (380-510 CAL, 72-76 g CHO, 22-44 g PRO, 3-8 g FAT, 2-3:1 CHO:PRO)
– 11-17 oz ready to drink commercial protein drink/shake – 2 medium bananas – Combine into smoothie?
3/12/13%
4%
Re-Fuel Strategies Post-Training Nutrition (cont.) • Consume within first 30 minutes post-training
– Repeat every 2 hours for 4-6 hours post-training (replace muscle glycogen stores)
�Without nutrient intervention, the
metabolic window begins to close within
forty-five minutes following exercise�
Ivy, J & Portman, R. Nutrient Timing 2004
0
20
40
60
80
100
120
0 10 20 30 40 50 60 70 80 90 100 110 120
Pote
ntia
l Ana
bolic
Effe
ct (%
)
Time Post-Exercise (minutes)
We compromise PERFORMANCE
when we don’t refuel appropriately
↓ Benefit
↓ Benefit
↓ Benefit
Sweet Spot
Refuel
Ultimately, o
ur goal is to restore
muscle function through nutrient delivery
Improper Re-Fueling
Loss of lean muscle tissue
Compromised function
Dehydration (>2% BW)
Poor nutrient uptake (micro
nutrients)
! Strength ! Endurance
Immune System
Musculoskeletal System
Endocrine System
Metabolic dysfunction
! Resting metabolic rate
! Aerobic exercise performance
Consequences of Improper Re-Fuelling
! Mental / Cognitive performance
Re-Fuel Resources
• Estimating energy requirements: http://www.health.gov/dietaryguidelines/dga2005/report/html/d3_disccalories.htm
• Consulting services for sport nutrition • Collegiate & Professional Sports Dietitians Association
www.sportsrd.org • Sports, Cardiovascular & Wellness Nutritionists
(SCAN) www.scandpg.org
Optimum Recovery
(3 R’s) Re-Fuel (Nutrition & Hydration)
Supplements (Nutrition & Modalities)
Rest (Sleep, Stress &
Relaxation)
Retain Movement Efficiency
(Pre/Post Training Routine)
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
• Rest Strategies
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Sleep • 7 to 8 hours of
sleep • Sleep extension
to 10 hours is beneficial
Relaxation • 60 minutes of
relaxation throughout the day
Stress • Minimize
psycho-social stress
Hou
rs o
f Sle
ep 8
7
6
5
4
3
2
1
9
10
Consequences of inadequate rest !Cognitive function and memory !Mood !Reaction time !Physical performance !Accuracy and consistent performance !Weight loss (% fat loss vs. % lean muscle mass)
Benefits of proper rest !Daytime sleepiness (alertness) !Reaction time (on field decisions) !Sprinting times (speed) "Performance on accuracy tasks (passing, shooting)
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Dinges et al, Sleep, 1997; Carskadon et al, Psychophysiology, 1981; Van Dongen et al, Sleep, 2003; Mougin et al, Eur J Appl Physiol Occup Physiol, 1991; Reilly et al, Ergonomics, 1994; Edwards et al, Chronobiol Int, 2009; Nedeltcheva, Ann Int Med, 2010
3/12/13%
5%
Rest and Muscle Recovery
Sleep Deprivation / Restriction
Anabolic Hormones Catabolic Hormones
Testosterone GH
IGF-1
Myostatin Glucocorticoids
Protein Synthesis Protein Degradation
Muscle Atrophy Worst Satellite Cell Proliferation, Fusion, and Signaling
Worse recovery capacity
Datillo et al, Med Hypoth, 2011 Rest and Performance
Mah et al, Sleep 34(7):943-950, 2011
!Reaction time !Sprint time
"Shooting accuracy • Free throws • 3-pointers
!Daytime sleepiness
Improved mood profile
10 hours / day over 5-7 weeks
• 6-7 hour average prior to study • Encouraged to nap if not able to
obtain 10 hours of sleep at night due to travel
Optimum Recovery
(3 R’s) Re-Fuel (Nutrition & Hydration)
Supplements (Nutrition & Modalities)
Rest (Sleep, Stress &
Relaxation)
Retain Movement Efficiency
(Pre/Post Training Routine)
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Does Movement Efficiency Matter? Increased number of
overuse injuries (football & soccer)
Increased number of ACL injuries (soccer
& basketball)
Movement Dysfunction
Decreased power output (vertical
jump)
Decreased postural control
(balance) Decreased flexibility
Decreased speed & agility
Repeated Motion / Prolong
Posture
" Activation & Tightness
Reciprocal Inhibition
! Antagonist Activation
Force Couple Alteration
Postural Malalignment
Altered Length – Tension
Relationship
! Muscle Strength
Synergistic Dominance
Muscle Imbalance
Hip Flexion
Hip Flexor Tightness
Gluteus Maximus Inhibition
Anterior Pelvic Tilt
Gluteus Maximus Weakness
Hamstrings, Hip Adductors, Erector Spinae
Systematic, solutions-oriented & science-based approach to optimize
movement efficiency Repeated Motion / Prolong
Posture
" Activation & Tightness
Reciprocal Inhibition
! Antagonist Activation
Force Couple Alteration
Postural Malalignment
Altered Length – Tension
Relationship
! Muscle Strength
Synergistic Dominance
Movement Dysfunction
3/12/13%
6%
Retain Movement Efficiency Strategies
Monitor Movement Efficiency
Dynamic Warm Up
Active Recovery
Training Load
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Dynamic Warm-Up & Active Recovery
http://tinyurl.com/b7ztrsf
Dynamic Warm Up • Dynamic stretching • Incorporates balance and core stabilization • Sport specific agility/stability
• Progressive intensity • Focus on proper technique
Active Recovery • Promotes removal of makers associated with post-exercise soreness and muscle damage
• Lactate • Creatine kinase
• Promotes environment for “anabolic” response • Muscle glycogen re-synthesis (energy) • Protein synthesis (muscle repair/growth) • Success dependent upon compliance with re-fueling strategies
Poor Movement Efficiency
Previous Injury History
Identify High Risk Individuals Movement Efficiency Screening
Double Leg Squat
Single Leg Squat
Kinetic Chain Checkpoints: • Knee valgus / varus • Toe out / in • Low back arch / sway • Trunk flexion
• Arms fall forward • Hip shift • Pronation • Heel lift
Supporting Evidence
Control Group
Intervention Group
Subjects
Foot / Ankle Muscle Imbalance
Bell & Padua,2012
-8
-6
-4
-2
0
2
4
6
8
Cha
nge
Sco
res
(deg
rees
)
Control
Intervention
*
!0.02
!0.01
0
0.01
0.02
0.03
0.04
1 21 41 61 81 101
Knee$Center$(m)
Squat$Phase$(Percentage)
Control$Group:$Pre$/$Post$
Control0Pre0Test
Control0Post!Test
!0.04
!0.03
!0.02
!0.01
0
0.01
0.02
0.03
0.04
0.05
1 21 41 61 81 101
Knee$Center$(m)
Squat$Phase$(Percentage)
Intervention$Group:$Pre$Test$/$Post$Test
Intervention3Pre3Test
Intervention3Post3Test
Med
ial K
nee
Mot
ion
Med
ial K
nee
Mot
ion
*
Intervention Group • Improved ankle
dorsi-flexion ROM • Decrease medial
knee collapse
0
1
2
3
4
5
6
7
8
Pre-test Post-test Retention-test
LESS
Padua et al, AJSM, 2011
Improvements in movement quality are
not permanent
Return to poor movement patterns
within 3 months
Requires repeated assessment and
training for retention
Extended training duration (9 months) required for retention of improved movement quality
Improved movement quality Movement quality retained
Movement quality NOT retained
Traditional duration (3 months)
Extended duration (9 months)
Monitor Training Load • Record the following information:
(training, practices & games) – RPE within 30 minutes of
training/game • Focus on feeling of exertion (not
pain or shortness of breath)
– Total minutes of exercise
0 Rest
1 Very, very easy
2 Easy
3 Moderate
4 Somewhat hard
5 Hard
6
7 Very hard
8
9
10 Maximal
Training Load
RPE Minutes of Exercise
x =
Gabbett & Jenkins, J Sci Med Sport, 2011; Foster et al, J Str Cond Res, 2001
Training load strongly correlated to injury rates (r=0.86)
NEEDS TO BE MET w/ appropriate
RECOVERY BEHAVIORS
3/12/13%
7%
Training Load and Recovery Behaviors
Strenuous Exercise
Optimum Recovery
Positive Physiologic Response
“Super-compensation” + =
Catabolic Response
Anabolic Response
Optimum Recovery
(3 R’s) Re-Fuel (Nutrition & Hydration)
Supplements (Nutrition & Modalities)
Rest (Sleep, Stress &
Relaxation)
Retain Movement Efficiency
(Pre/Post Training Routine)
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Nutritional Supplements
• post activity • s/s of muscle damage • mitigation of
immunosuppression • during activity
• fatigue resistance • power output maintenance
Modality Supplements
• s/s muscle damage • Whole body vibration • Cryotherapy • Compression • Massage
Supplemental Recovery Treatments & Behaviors
Recovery Supplements Recovery Supplements
• Implemented in ADDITION to best practices discussed
• The application of the following recommendations may be dependent on:
1. Training cycle (meso/micro-cycle goal) 2. Training load 3. Injury/health status 4. Practicality
Nutritional Supplements
Improved fatigue resistance during strenuous activity • Mitigation of power output decrements during strenuous exercise
Reduction in immunosuppression
post strenuous activity
Reduction of s/s associated with
exercise-induced muscle damage
Exercise-Induced Muscle Damage
• Tissue disruption & catabolism
– Circulating markers of muscle
catabolism
• Associated with body’s
inflammatory response
• Delayed onset muscle soreness
(DOMS)
• Decreased muscle force output
between bouts of activity
3/12/13%
8%
Exercise-Induced Muscle Damage
ANTIOXIDANTS
Vitamin C
Vitamin E
Coenzyme Q10 (ubiquinone)
Phytochemical – Tart Cherry Juice
RATIONALE
Limit secondary muscle cell damage
Reduction in severity of DOMS
Maintenance of force output between activity sessions
Limit muscle tissue catabolism
Supports cardiovascular health-vascular function
Decrease inflammation
May promote tissue healing
Bowtell 2011, Kreider 2010, Kon 2008, Mizuno 2008, Bloomer 2007, Hellsten 2007
• ANTIOXIDANTS – APPLICATION
– Loading periods between 10-14 days*
• Appropriate planning • Timing is less important than
loading period
– Accumulating levels in the body $ tissues
– During scheduled periods of repeated high load training and/or competition
– Injury management & rehabilitation – tissue healing
Exercise-Induced Muscle Damage
• 3 g/day Vitamin C
• 1200 IUs/day Vitamin E
• 150-350 mg/day Coenzyme Q10
• 30 mL/d (2 x day) Tart Cherry Juice
Vitamin D*
Exercise-Induced Muscle Damage
DOSAGE
A Note on Vitamin D
APPLICATION
Reduce inflammation
Calcium absorption • Endurance athletes • High training volumes
Mood • Sunlight exposure
DOSAGE* Deficiency? • “optimal” – 100-250 nmol/L (25(OH)D) • Environment • Individual
Calcium absorption • Endurance athletes • High training volumes
Mood • Sunlight exposure
4000 – 10,000 IUs 3-5 mos
*Lots of debate regarding the optimal dosing, use, effectiveness Powers et al. 2011
Exercise-Induced Muscle Damage
AMINO ACIDS
L-Carnitine
Leucine • HMB (β-hydroxy-β-
methylbutyrate)
RATIONALE
Limits muscle catabolism
Limits the severity of DOMS
Reduction in tissue disruption
Thomas 2011, Kreider 2010, Sharp 2010, Jacobs 2009, Bloomer 2007
Exercise-Induced Muscle Damage • AMINO ACIDS –
APPLICATION – During scheduled periods of
repeated high load training and competition
– May be significant benefits to L-Carnitine supplementation during periods of high-intensity resistance training
• 2g/d L-carnitine
• 0.1g/kgbw/hractivity Leucine
• 1.5 – 3 g/d* • Loading period* HMB
3/12/13%
9%
Exercise-Induced Muscle Damage
• RATIONALE – Limits inflammation – May reduce severity of
DOMS
Kreider 2010, Bloomer 2009, Bloomer 2007
• FATTY ACIDS – Omega-3 Fatty Acids
(EPA & DHA) • Fish Oil, Krill Oil, Algae-
source, Plant-source (flax
seed)
ALA
EPA
DHA
Exercise-Induced Muscle Damage
• FATTY ACIDS – Omega-3 Fatty Acids
(EPA & DHA) • Eicosapentaenoic acid
(EPA)$Docosahexaenoic
acid (DHA)
• Fish Oil, Krill Oil, Algae-source, Plant-source (flax
seed)
• RATIONALE – Limits inflammation – May reduce severity of
DOMS
Kreider 2010, Bloomer 2009, Bloomer 2007
*Overall, EPA may have stronger effect in limiting inflammation. Thus as a inflammatory reducing agent may be more important than DHA.
Exercise-Induced Muscle Damage
• FATTY ACIDS – APPLICATION
– During scheduled periods of repeated high load training and competition
– Injury management & rehabilitation
• 2-4 g/day Fish Oil
• Most evidence is provided surrounding fish-oil supplementation
• reaction time Mental fatigue
• combination of cardiovascular, muscle-level and mental fatigue – commonly measured via “time to exhaustion”
Systemic
• Local muscle environment Isolated muscle power output
Fatigue Resistance
Fatigue Resistance
SUPPLEMENTS
β-Alanine
Fatty Acids (DHA)
Coenzyme Q10
L-Arginine
RATIONALE
Improved “buffering” of blood acidosis – increased tolerance to low blood pH (β-Alanine) • Improved muscular endurance, power output, time to exhaustion
Support for reduced mental fatigue • Reaction time (fatty acids – DHA) • Mood-state/perceived fatigue (Coenzyme Q10)
Increased time to exhaustion & decreased metabolic cost(L-Arginine)
Guzman 2011, Kreider 2010, Bailey 2010, Bloomer 2009, Kon 2008, Mizuno, 2008, Bloomer 2007
Fatigue Resistance • APPLICATION
– During scheduled periods of repeated high load training and competition
– Reconditioning $ returning to exercise/play
• post-injury/illness
– Periods for high susceptibility for for sleep deprivation
• Travel concerns (Coenzyme Q10 timing*)
• 4-6 g/day β-Alanine
• 2-4 g/day Fatty Acids
• 150-350 mg/day Coenzyme Q10
• 6g prior to exercise • Acute Response L-Arginine
3/12/13%
10%
Reduction of Immunosuppression
• After bouts of high levels of physical exertion there is a transient period of reduction in the body’s immune system function
• There is a significant body of evidence suggesting that L-glutamine supplementation reduces the severity of immunosuppression
Hoffman 2012, Kreider 2010, Smith 2008, Bloomer 2007, Castell 2003, Petibois 2002
Reduction of Immunosuppression
• DOSEAGE
– L-glutamine – 6g/ day • Loading/adaptation phase – 6g / 1-serving / day
• Maintenance phase – 3g / 2x / day – higher concentrations may lead to parathesia side-effect
– dividing dose up over course of the day will limit the potential for parathesia
Nutritional Supplement Summary
Use • Exercise-Induced Muscle Damage • Fatigue Resistance • Combat Immunosupression
Loading Concerns • Appropriate length • Planning
Supplements not to be used as replacements • To work in conjunction with macronutrient best practices
Nutritional Supplements Resources
– NSF International www.nsfsport.com* – Informed Choice www.informed-choice.org – Consumer Labs www.consumerlabs.com – Natural Medicines Database
http://naturaldatabase.therapeuticresearch.com/home.aspx – US Pharmacopeia www.usp.org – The National Center for Drug-Free Sport www.drugfreesport.com – NCAA www.ncaa.org
Modality Supplements
• Whole body vibration
• Massage
• Compression garments
• Cryotherapy
– Cold-water immersion
Limit DOMS
Limit Catabolism
Limit Strength
Loss Limit ROM
Loss
Whole Body Vibration
PARAMETERS
1-2 sets of ~60s
static stretch or contact massage
30-50 Hz(frequency is proportional to conditioning level)
APPLICATION
If available, can be applied after each
training or competition session
Travel may be a concern with athletes* • Do not want to establish
“mental dependence”
Kosar 2011, Lau 2011, Aminian-Far 2011. Rhea 2009
3/12/13%
11%
Massage
PARAMETERS
Applied as soon as possible post activity
Types include (petrissage, effleurage, muscle “shaking”)
Time applied is variable range 10 mins to >1 hr
Some reported evidence of non-isolated application
APPLICATION
Need to determine if realistic for player/org
Repeated high-intensity play
Applied within 2 hrs of activity cessation
Conjunction with active w/u & c/d
Mancinelli 2006, Brooks 2005, Lane 2004, Hilbert 2003, Smith 1994
*Limited evidence regarding best practices
Compression Garments
PARAMETERS
Worn as soon as possible post-activity
Worn for 24 hours post-activity* • Best not to remove
APPLICATION
Benefits in all post-activity scenarios
Individually applied (low clinician maintenance)
Research supports UE & LE benefits
Air travel
de Glanville 2012, Duffield 2010, Jakeman 2010 Kraemer 2010, Davies 2009
Cold Water Immersion
PARAMETERS
Within 1 hr post-activity
1-4 applications with 72 hour period
10-15 minute immersion period
10-15ºC (50-59ºF)
Proposed benefit to water agitation • Reduction of thermopanes
APPLICATION
After bouts of high-intensity activity
Heavy resistance training*
Eccentric & plyometric training
Bleakley 2012, Leeder 2012 *Presence of limiter of anabolic effect has been disputed.
.
Whole Body Vibration • 1-2 sets of ~60s • static stretch or contact
massage • 30-50 Hz
Massage • Applied as soon as
possible post activity • 10 mins - >1 hr
Compression Garments • Applied as soon as
possible post-activity • 24 hours post-activity
Cold Water Immersion • 1 hr post-activity • 1-4 in 72 hrs • 10-15 minutes 10-15ºC
(50-59ºF) • Water agitation
DOMS Strength loss Catabolism ROM loss
• Putting it all together • Requires an integrated and systematic approach
1. Educate 2. Access 3. Monitor
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Educate # Empowerment
• Provide consistent messaging – Meals & hydration – Post-training nutrition**
• 30-minute window of opportunity
– Sport nutrition consultant • Individual assessments and plans • Supplement advice
– Impact of rest & movement efficiency on recovery
3/12/13%
12%
Access • Fueling stations
– Pre & Post training – Regulate pre & post training re-
fuel strategies • 2-4 : 1 Carb to Protein ratio • Difficult to regulate meals, but pre
& post training may be easier
• Recovery modalities – Foam roller – Cryotherapy – Compression garments – Whole body vibration
Monitor • Movement efficiency
– Continual re-assessment – Guide corrective exercise
• Training load – Minutes x RPE
• Within 30 minutes – Age and injury history likely
impact the relative training load • Recovery Behaviors (PREPARE
Score) – Behavior modification and
educational tool
How PREPARE’d are you? http://bit.ly/Yib0aG
3/12/13%
13%
0 10 20 30 40 50 60 70 80 90
100 Re-Fuel
Rest Retain
Movement Efficiency
PREPARE Score • Range 0 to 100
• Optimum recovery = 100 • Score for each recovery
domain • Re-Fuel (0-100) • Rest (0-100) • Retain Movement
Efficiency (0-100)
PREPARE%Score%Interpreta0on%<%50% Not%PREPAREd%
51%6%70% Under%PREPAREd%71%6%90% Moderately%PREPAREd%>%90% Well%PREPAREd%
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Catabolic Response
Anabolic Response
Training Load Movement Efficiency
Injury History 0 10 20 30 40 50 60 70 80 90
100 Re-Fuel
Rest Retain
Movement Efficiency
PREPARE Score
PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate
Implement Preventive & Recovery
Training
Monitor Recovery
Behaviors & Training
Load
Poor movement # CEx
Injury History # CEx
4 steps to prevent over-training and reduce non-contact lower extremity injury rates by 50% in 18 months
Sadoghi et al, J Bone Jt Surg, 2012; Longo et al, Am J Sports Med, 2012
Key Points
• Fatigue is a physiologic stimulus for anabolic response, if recovery is optimized
– Under-recovery leads to catabolic response
• 3 R’s of optimum recovery – Re-fuel, Rest, Retain Movement
Efficiency, Supplemental Modalities
• 4 steps for preventing over-training & injury
Implement Preventive &
Recovery Training
Monitor Recovery
Behaviors & Training Load
Poor movement # CEx
Injury History # CEx
3/12/13%
14%
Darin A. Padua, PhD, ATC dpadua@email.unc.edu
@DarinPadua
Barnett Frank, MA, ATC bsfrank@email.unc.edu
@BarnettFrank
Copy of presentation slides:
peakcontrol.wordpress.com
top related