Physiology of exercise
▪ Exercise prescription depends on :
1- type & duration of exercise. 2- frequency of training. 3- intensity of work effort of training. 4- appropriate nutrition &hydration.

▪ Exercise training session should consist of:
1-warm up (5 mins). 2-training (20 to 60 mins). 3-cool down (5 mins).

▪ Responses to acute exercise:
1-increase heart rate. 2-increase SBP. 3-increase rate & depth of respiration. 4-muscle tiredness during recovery from exercise.

▪ Outcomes of regular resistive exercise:
1-increase lean body mass. 2-improve muscle strenght & endurance. 3-reduce ambulatory time to complete walking task.

▪ Exercise for aerobic fitness:
1-use large muscle groups. 2-use rhythmic exercises (15 to 60 mins). 3-including (walking,cycling,dancing,skating).

▪ Outcomes of regular aerobic training:
1-reduce resting heart rate. 2-increase myocardial efficiency. 3-increase capillary density in muscles. 4-increase physical work capacity. 5-improve serum lipid levels.

▪ Anaerobic training to improve anaerobic

- training at high intensities for intervals less than
1 min. to improve non oxidative glycolysis.

▪ Energy systems for exercise:
.these systems produce ATP for the exercising muscle At the beginning of any physical activity ATP is produced anaerobically , when the exercise continue at moderate intensity for a prolonged period ,the aerobic . pathway will become the dominant pathway for the fuel

1.ATP (2-3 sec.):
- stored in the muscle & liver. - used for quick energy. - Nerve impulses trigger breakdown of ATP into ADP.

2.ATP-CP Energy System (8-10 sec.):
- Rebuilt of ATP is a must for contractions to continue. - comes from the splitting of CP .

):Anaerobic Energy System (2-3 mins. 3
.this system provides ATP when ATP-CP is depletedthe process to produce ATP is not as fast as ATP-.CP, which makes muscle contraction slower - under anaerobic conditions,the end product of glycolysis is lactic acid,leading to muscles fatigue.

- Anaerobic Glycolysis is less efficient in producing ATP than Aerobic Glycolysis, BUT it gives large amount of energy lasting for few mins.

Aerobic Energy System (more than 3. 4 ):mins
O2 enters the system, stopping the breakdown of. glycogen to lactic acid glycogen breaks down into: ATP + CO2 + H2O.CO2 is expelled by the lungs.H2O is used in the muscle-

▪ Fueling the Energy Systems depends on :
.the intensity and duration of the exercise-1 . Nutrional status of exerciser- 2 .The exercise fitness status- 3

:the intensity and duration-1
:a - intensity ▪ Lower intensity : - Fat is a great fuel for endurance events such as marathons and ultra marathons. - Hours or days.

:Moderate to high intensity▪ - carbohydrate as the main nutrient fueling exercise such as sprints. - Limited 2 hours. b- duration : - Duration of a training session determines the substrate used - The longer the time spent exercising the greater the contribution of fat as the fuel.

▪ Factors determining Using fat for fuel:
- Fat is slow to digest. - Converting stored fat into energy takes time. - Converting stored fat into energy takes a great deal of oxygen.

2- Nutrional status of exerciser :
- Protein, fat and carbohydrates are all possible sources of fuel for muscle contraction. - Protein isn’t an ideal source of fuel for exercise. - There isn’t enough available to repair and rebuild body tissues. - Protein used for energy only if there is no adequate supplies of CHO,fats or when excess protein is ingested.

3- The exerciser fitness status :
1. improving cardiovascular systems involved in oxygen delivery. 2. Increases number of muscle mitochondria. 3. increase capacity for fatty acid metabolism. 4. enhances ability of muscle to oxidize all fuels.

Nutritional requirements for athletes
1-Carbohydrates :
- Carbohydrates are the primary fuel source. - Carbohydrates are the primary glucose source. - Complex carbohydrates should be eaten more than simple carbohydrates . - Carbohydrates should be eaten before, during and after exercise.

:Pre-exercising meal. 1
.High CHO, low fat, easily digested The meal should be eaten 3-4 hours before an . event :The aim of the pre- exercise meal is a- maintain optimum blood glucose levels for the exercising muscles. .b- improve performance c- fulfill liver glycogen stores to be ready when recalled during prolonged training & high .intensity exercise .d- Appetite control

- maintains blood glucose levels. - improves endurance and performance. - e.g. high energy fluids, of rate about 25-30% g/30min. - Fatigue is not prevented by CHO feeding it is only delayed. - should be within 30 minutes after exercise. - restore muscle glycogen. - regulate insulin-glucose response and help recovery. ▪ N.B. - one exception is athletes who are weight training for muscle & strength building effects.

:Carbohydrates during exercise. 2

:Post-exercise meals. 3

they should wait an hour after exercising before theyeat to avoid interference with the growth hormone .elevating effects of intense exercise CHO intake range from 5-7 g/kg/day for general & training . g/kg/day for heavy training 7-10

:Protein. 2
.Protein is essential for growth and recovery - branched chain amino acids are required to spare muscle break down during exercise. Glutamic acid and Glutamine are important amino . acid for growth of muscle tissue collagen-connective tissue makes up one third of total body protein content making it . one of most important proteins in the body

▪ Duration and intensity of exercise determine the

amount of protein needed:

a- Strength athletes protein requirements range is 1.4-1.8 g/kg/day e.g. Weight lifters & body builders. b- endurance athletes range is 1.2-1.4 g/kg/day e.g. Marathon runners. c- athletes need about 2 to 4 times the amount of the RDA for protein. d- they should consume high quality protein . e- consume protein with each meal but not for pre-event meals. ▪ Delayed onset muscle soreness (DOMS): - post exercise muscle soreness by Hydroxy proline. (amino acid leaks into the interstitial spaces following micro trauma to muscle cells) - as it’s highly caustic & irritating to nerve endings.

3. Fat :
- It is the most concentrated source of energy which provides 9 kcal/g. - Essential fatty acid is required for growth, recovery and over all health. - Fatty acids are important source of energy specially for endurance athletes- longer aerobic exercise- Intake of saturated fats and cholesterol must be kept low to avoid development of coronary heart diseases. - Daily intake of fat metabolizing vitamins & mineral cofactors is essential for efficient fat metabolism. calories from fat. -severe fat restriction(15 % of energy intake) limits performance and promotes fatigue.

▪ N.B : -athletes should consume 20-30 % of their daily


1- Iron : - essential for athletic performance. - One of its major functions: carry O2 to & CO2 away from all the cells in body. - the brain relies on oxygen transport,, without enough iron you will find it hard to concentrate and feel tired and irritable. - needed to maintain a healthy immune system. - vital component of the cytochrome enzymes involved in the production of ATP.

▪ Risk factors of developing iron deficiency in athletes :
1- Inadequate supply of dietary iron. 2- Female athlete with heavy menstrual losses. 3- Increased demands for iron (Hard training stimulates an increase in RBCs and blood vessel production,and increases the demand for iron). 4- High iron loss (through injury, in endurance athletes, ‘foot strike’ damage to red blood cells in the feet due to running on hard surfaces with poor quality shoes leads to iron loss). 5- Those training heavily in hot climates with heavy sweating (because iron is lost in sweat).

2- Calcium :

- In 1997 The American College of sports medicine identified (FEMALE AHLETE TRAID ) as a combination of: 1)Low energy availability (eating disorders). 2)Menstrual irregularities (amenorrhea). 3)Weak bones (increased risk of stress fractures and osteoporosis) - Osteoporosis : is a major health concern especially for women therefore, it is important that young women consume calcium throughout the peak bone mass years and throughout early adulthood because of the peak rate of bone mass accumulation is between the ages of 14-24 years.

▪ Athletic amenorrhea :
- sometimes called exercise-associated amenorrhea. - occurs when a woman doesn't have a regular period.

▪ Causes :
1- she exercises too much : - excessive exercise is an energy drain that may lead to a hypothalamic dysfunction. 2- eats too few calories : - If a woman has too little body fat the ovaries stop producing estrogen which is necessary to maintain healthy bones & the woman stops menstruating. 3- excess cortisol levels inhibit the release of gonadotropins.

:Treating Athletic Amenorrhea▪
. estrogen replacement therapy- 1 2- decreasing training volume 10-15%. .Increasing calorie intake by 10-15%- 3 diet modification to include more calcium,- 4 .vitamin D and magnesium

Antioxidant vitamins
- exercise can increase oxygen utilization from 10-20 times over the resting state. - this greatly increases the generation of free radicals prompting concern about enhanced damage to muscles & other tissues. - regular physical exercise enhances the antioxidant defense systemprotects against exercise induced free radical damage (it’s an important finding because it shows how smart the body is about adapting to the demands of exercise). - these changes occur slowly over time & appear parallel to other adaptations to exercise.


- intense exercise in untrained individuals overwhelms defensesincreased free radical damage. - Muscle contain complex endogenous cellular defense mechanism: 1- enzymatic antioxidants includes : - catalase, superoxide dismutase and glutathione peroxidase. 2- non enzymatic antioxidants includes : - vitamin A, E, C, minerals as selenium.

▪ Vitamin C :
- act as an antioxidant. - can regenerate other antioxidants. - need for vitamin C is likely increased in those who exercise regularly.

- intake of 100-500 mg seems to be sufficient to meet the needs of the exercising individual. - in some studies in which athletes were deficient in vit.C, supplementation improved physical performance, but it doesn’t increase physical capacity in subjects with normal body levels of vit.C. - vitamin C has been shown to induce a lowerfrequency fatigue (indicates less muscle damage) when compared with those deficient in the vitamin.

▪ Vitamin E :
- used widely as supplement by athletes who hope to improve performance. - recent research is showing vit E supplementation at the level of 200-450 IU/day can help to : a- protect against exercise induced oxidative injury. b- protect against acute immune response changes that exercise produces. - Vitamin E utilizes vitamin C to regenerate itself back to the original state (Studies involving exercise recovery commonly use a cocktail mixture of vitamins C and E).

Other vitamins
▪ B vitamins :
- There is no evidence that supplementing the well nourished athlete with B vitamins will increase the performance. - A deficiency of vitamin B12 could develop in vegetarian athlete after several years of strict vegan diet so vitamin B12 supplementation is needed for these individuals. - For athletes who consume low calories diet for a long period a B vitamins supplement to meet the RDA may be appropriate. - Folic acid should be supplemented to meet RDA for athletes.

Fluid needs for athletes
▪ Water is the most essential ingredient to a healthy life,it

has many important functions in the body including: a- Transportation of nutrients, elimination of waste products, facilitating digestion. b- Lubricating joints and tissues. c- Temperature regulation through sweating.

▪ Importance of Water During Exercise : a- Proper hydration is important during exercise. b-Adequate fluid intake for athletes is essential for comfort, performance and safety. c-The longer&more intensely the exercise,the more the importance to drink the right kind of fluids.

▪ Fluid balance:
-fluid lost in the form of sweatdecrease in plasma volume increase plasma osmolarity (sensed by vascular pressure receptors and hypothalamic osmoreceptors)increase in vasopressin & rennin (these hormones:angiotensin &aldosteroneincrease water & sodium retentionprovoke thrist.

▪ Fluid loss:
- Factors affecting fluid loss in athletes: 1-High altitude : - Increases fluid losses & fluid needs. 2-Temperature : - Heat increases sweating fluid losses - Coldincrease fluid losses through respiration. 3-Sweating : increase sweat risk for dehydration.

4-Exercise Duration and Intensity : - Exercising for hours (endurance sports) need to drink more and more frequently to avoid dehydration.

▪ Fluid needs :
-Daily fluid intake recommendation vary for sedentary individual from 3.7L in males to 2.7 L in female. When individual compete in warm environment the fluid needs increase up to 10 L .

▪ Fluid replacement in athletes:

specific fluid recommendations aren't possible due to individual variability, most athletes can use the following guidelines as a starting point, and modify their fluid needs accordingly.

▪ hydration for athletes :
▪ Two simple methods of estimating adequate hydration: 1- Monitoring urine volume output and color : A large amount of light colored, diluted urine probably means you are hydrated; dark colored, concentrated urine probably means you are dehydrated. 2- Weighing yourself before and after exercise : Any weight lost is likely from fluid, so try to drink enough to replenish those losses. Any weight gain could mean you are drinking more than you need.

▪ Hydration Before Exercise :
- Drink

about 500 ml, 2-3 hours before exercise . - Addition of 250 ml, in warm days.

▪ Hydration During Exercise :
- Drink 8-10 fl oz every 10-15 min during exercise - If exercising longer than 90 minutes, drink 8-10 fl oz of a sports drink every 15 - 30 minutes. - Fluids should be cool and flavored, contain CHO to enhance performance (not more than 8%) and also sodium chloride to promote rehydration.

▪ Hydration after exercise : - Rapid and complete rehydration. - ingestion of adequate amount of fluid (8-16 oz) with sodium chloride (80-120 mg per 8 oz). - the replacement drink should contain 6-8% CHO (as glucose ,glucose polymers or fructose). ▪ N.B - Consume a 4:1 ratio of carbohydrate to protein within the 2 hours after exercise to replenish glycogen stores.

Ergogenic Aids
any means of enhancing energy production and .utilization

:Defined as-

:Classified into five categories1) mechanical aids: as racing shoes. 2) psychological aids: as hypnosis. 3) physiologic aids: as blood doping. 4) pharmacologic aids: as anabolic steroid supplements. 5) nutritional aids: as creatine supplementation.


▪ Eryogenic aids include: 1.Oxygen:
At higher altitude where the air contain less oxygen, the body will adapts to the shortage of oxygen by increasing the number of RBCs. When the athletes return to sea level the increased oxygen carrying capacity of the blood should enable them to push harder and faster.

- used to increase muscle mass and strength. - If over-used : a- can cause heart, liver, and immune system problems, increase blood cholesterol levels. b- Oily skin and acne.

:Anabolic Steroids-2

c- In Females athletes : wider shoulders, more body and facial hair,deeper voices, irregular Menstrual cycles. d- In adolescent athletes : growth plates in long bones to close faster than usual  reduced height.

3-Growth hormone :

- Some athletes use it as it increase muscle mass and is more difficult to detect than anabolic steroids. - Effects : 1.has an anabolic effect on the body. 2.stimulate utilization of lipids from adipose tissue as an energy source and sparing muscle glycogen. - Side effects: - gigantism in children. - acromegaly in adult - Testing: can be detected in urine, but it is difficult (short half life in blood & low concentration in urine).

4- Alcohol (depressant drug) :

- low doses : induce relaxation, reduce anxiety. - higher doses : reduce co-ordination & delay recovery from training. - banned for athletes.

:B-2 agonists- 5

- Like : Salbutamol and Ephderine. - Nowadays they are used predominantly by athletes. - Effects : 1-enhance fat loss (via their thermogenic effects). 2- strength (via their stimulant effects). - they can increase body temperature and dehydration.

6- Amphetamines (powerful stimulants) :

:Blood Doping and EPO- 7

- This practice increase red blood cell count  improve performance in sports requiring high levels of aerobic activity. - Adverse effects: - dangerous practice, risks of infection & heart trouble were high. - In the modern era blood doping has been replaced by the use of the drug Erythropoietin (EPO). - Leucine, Isoleucine and Valine. - They comprise a large part of muscle tissue and are frequently recommended to athletes to enhance recovery from training.

) :Branched chain amino acids (BCAA- 8

:Diuretics- 9

- they are abused by athletes to drop weight quickly. - natural diuretic :caffeine, vitamin C. - prescription drugs (more powerful) : as Aldactone and Furosemide, danger to the athlete's health. - number of athletes have died as a result of diuretic use.


- Carnitine is used to decrease fat and increase muscle mass.


- Increases endurance, enhances muscle recovery. - Side effects :diarrhoea, skin rashes, hypertension and sleeplessness.

:Caffeine- 12

- found naturally in coffee,tea ,chocolate. - central nervous stimulant ,mild diuretic. - used as a pre-workout stimulant & appetite suppressant. - Side effects : anxiety, restlessness, diarrhea, insomnia.

13- Creatine :
- Increases muscle energy, endurance, strength and lean muscle mass.  14- B-blockers : - decrease anxiety, have a positive effect on fine motor control, but a negative effect on aerobic capacity.

Eating Disorders
▪ Eating disorders among athletes are common with a higher prevalence in those sports where size and weight are important as: - Ballet, running, swimming, horse riding, volleyball & wrestling. ▪ Some athletes change their food intake while others just burn many more calories than they consume.

▪ Types of eating disorders :
1-anorexia nervosa (it has four specific criteria): - intense fear of gaining weight. - refusal to maintain body weight, even though they are underweight for age and height. - distorted body image, feels fat when really extremely thin. - absence of at least three consecutive menstrual cycles.

▪ Physical symptoms: 1. Amenorrhea, menstrual dysfunction.
2.Impaired immune response. 3.Anemia, dehydration, bradycardia,hypothermiaa. 4.GIT problems (decreased peristalsis, diarrhea, atrophy). 5. PEM ,BMR slows.

▪ Pyschological symptoms:
- anxiety, restlessness, insomnia, depression, social withdrawal.

2-Bulimia :
▪ A cycle of binging on food and then purging the food from the system.

▪ Diagnostic criteria:
1. Recurrent episodes of binging at least twice/week for three months. 2. a lack of control during binges. 3. Uses one or more of the following methods to purge: selfinduced vomiting, laxatives, diuretics, excessive exercise. 4. Overly concerned with body weight.

▪ Physical symptoms:
1.electrolytes abnormalities, muscle cramps. 2. edema, GIT problems. & gum problems. 4. loss of weight despite eating large amounts. 5. menstrual irregularities.

▪ pyschological symptoms:
- binge eating, depression, excessive exercise.

3- anorexia athletica :
- Diagnostic criteria: 1.Weight loss is more than 5% of expected body weight. 2.Excessive fear of becoming obese, distorted body image. 2.Restriction of food (<1,200 kcal/day). 3.Menstrual dysfunction(1ry ,2ry amenorrhea, oligomenorrhea). 4.Compulsive exercise.

▪ Risk factors for development of eating disorders:
1.pressure from influential ppl (coaches or parents) to lose weight to improve performance. 2-over involvement in sports, with limited other social activities. 3.poor performance. 4. training even in sick or injured. 5. personality factors as; perfectionism, high self expectation.

▪ Treatment :
- The most critical thing about treating eating disorders is to recognize & address the problem as soon as possible. - It can do a lot of damage to body & mind if left untreated as they don’t go better by themselves. ▪ Lines of treatment : 1.Psychological counseling (family, individual). 2.medical (weight stabilization, re-feeding, health status). 3.Nutrition intervention - improve, well-balanced diet. - Increase food calories gradually. - Small, frequent feedings. - Multivitamins.

Nutrition for travelling athletes

▪ Overview : - In the modern world of sports many athletes, both recreational and elite, travel frequently to training camps or competitions. - Regardless of whether travelling by car, bus, or plane (domestically or internationally), travel has a tendency to disrupt normal eating patterns. - This can easily result in suboptimal nutrition, which in turn can affect training or competition performance.

▪ Travel related challenges :
-Depending on the mode and distance of travel, the challenges that may interfere with healthy eating include: 1-Altered and irregular meal times. 2-Encountering unfamiliar food. 3-Unavailability of some favorite foods and fluids. 4-Limited availability of healthy foods and beverages. 5-Food and water safety issues. 6-Altered environmental conditions (e.g. heat, cold, altitude). 7-Jetlag resulting from long-haul travel.

▪ Potential effects on diet may include :
1- reduced carbohydrate and increased fat intake. 2- inadequate intake of fibers, essential vitamins &minerals. 3- dehydration.

▪ How to overcome these problems :
a- Before travelling overseas we have to : -research the destination country with regard to climate. -food availability, food & water safety. b- While travelling : -be wise to stick to their usual training diet. -bring along suitable foods and fluids. -perishable travel foods as: sandwiches, cheese, meat, and milk should be stored at their safe temperature.

- to avoid food poisoning, keep cold foods cold and hot foods hot. - Portable travel food and fluid ideas: -fresh fruit, raw veggies,, trail mix with dried fruit and dry cereal, cheese and crackers. -yogurt, milk, chocolate milk, unsweetened juices.

▪ Nutritional tips to prevent dehydration, digestive problems and to counter jet lag:
a- Athletes should carry a water bottle and sip fluids frequently. b- Airline travel is especially dehydrating. c- Well-hydrated athletes reach for at least 1 cup (250 mL) of fluid for every hour of air travel.

▪ Overcoming jet lag:
a- consume a high carbohydrate diet prior to departure to build extra glycogen (energy) and fluid stores. b- Limit pop, coffee, tea, and alcohol. c- Pack extra calories with nutritious portable snacks. d- Set your watch to the destination time upon take off. e- Allow 1–3 days to adjust for every time zone crossed.


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