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] |
A\tbalanced\tmacronutrient\tintake\tis\tessential\tfor\tthe\tprovision\tof\ta\tregular\tmeal\tpattern.\tThis\nshould\tinclude\tsufficient\tcarbohydrates\tto\tprevent\tcraving\tand\tadequate\tprotein\tand\tfat\tto\tpromote\nsatiety.\n\tIn\tgeneral,\ta\tbalanced\tdiet\tproviding\t50%\tto\t60%\tof\tthe\tcalories\tfrom\tcarbohydrate,\t15%\tto
|
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] |
20%\tfrom\tprotein,\tand\tapproximately\t30%\tfrom\tfat\tis\treasonable.\nAdequacy\tof\tmicronutrient\tintake\trelative\tto\tthe\tcaloric\tprescription,\tmacronutrient\tdistribution,\nand\tdiet\tvariety\tshould\tbe\tassessed.\tA\tmultivitamin\tand\tmineral\tpreparation\tmay\tbe\tprescribed\tto\nensure\tadequacy,\tparticularly\tin\tthe\tinitial\n\tphase\tof\ttreatment.
|
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ensure\tadequacy,\tparticularly\tin\tthe\tinitial\n\tphase\tof\ttreatment.\nBingeing,\tpurging,\tand\trestrained\tintake\toften\timpair\trecognition\tof\thunger\tand\tsatiety\tcues.\tThe\ncessation\tof\tpurging\tbehavior\tcoupled\twith\ta\treasonable\tdaily\tdistribution\tof\tcalories\tat\tthree\tmeals
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] |
and\tprescribed\tsnacks\tcan\tbe\tinstrumental\tin\tstrengthening\tthese\tbiologic\tcues.\tMany\tpatients\twith\nBN\tare\tafraid\tto\teat\tearlier\tin\tthe\tday\tbecause\tthey\tare\tfearful\tthat\tthese\n\tcalories\twill\tcontribute\tto\ncaloric\texcess\tif\tthey\tbinge\tlater.\tThey\talso\tmay\tdigress\tfrom\ttheir\tmeal\tplans\tafter\ta\tbinge,
|
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] |
attempting\tto\trestrict\tintake\tto\tbalance\tout\tthe\tbinge\tcalories.\tPatience\tand\tsupport\tare\tessential\tin\nthis\tprocess\tof\tmaking\tpositive\tchanges\tin\ttheir\teating\thabits.\nWhen\tthe\tBN\tpatient\tis\treceiving\tCBT,\tthe\tRDN\tmay\tassist\tthe\tCBT\ttherapist\tin\tthe\tphase\t1\tgoal\tof\nestablishing
|
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] |
establishing\n\ta\tregular\tmeal\tpattern.\tThe\tRDN\tand\tthe\tpsychotherapist\tmust,\thowever,\tmaintain\nactive\tcommunication\tto\tavoid\toverlap\tin\tthe\tcounseling\tsessions.\tIf\tthe\tBN\tpatient\tis\tengaged\tin\ta\ntype\tof\tpsychotherapy\tother\tthan\tCBT,\tthe\tRDN\tshould\tincorporate\tmore\tCBT\tskills\tinto\tthe\tnutrition\ncounseling\tsessions\t(\nHerrin\tand\tLarkin,\t2013\n;
|
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0.07753821462392807,
0.10418414324522018,
0.061951108276844025,
-0.013261315412819386
] |
counseling\tsessions\t(\nHerrin\tand\tLarkin,\t2013\n;\t\nStellefson\tMeyers\tand\tCaperton-Kilburn,\t2017\n).\nPatients\twith\tBN\tare\ttypically\n\tmore\treceptive\tto\tnutrition\tcounseling\tthan\tAN\tpatients\tand\tless\nlikely\tto\tpresent\tin\tthe\tprecontemplation\tstage\tof\tchange.\tSuggested\tstrategies\tfor\tnutrition
|
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0.02100549452006817
] |
counseling\tat\tthe\tprecontemplation,\tcontemplation,\tpreparation,\taction,\tand\tmaintenance\tstages\tare\ngiven\tin\t\nTable\t21.4\n\t(see\t\nChapter\t13\n).\nTABLE\t21.4\nCounseling\tStrategies\tUsing\tthe\tStages\tof\tChange\tModel\tin\tEating\tDisorders\nStage\n\tof\nChange\nCounseling\tStrategies\nPrecontemplation\nEstablish\trapport.\nAssess\tnutrition\tknowledge,\tbeliefs,\tattitudes.
|
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] |
Establish\trapport.\nAssess\tnutrition\tknowledge,\tbeliefs,\tattitudes.\nConduct\tthorough\treview\tof\tfood\tlikes\tand\tdislikes,\tsafe\tand\trisky\tfoods,\tforbidden\nfoods\t(assess\treason),\tbinge\tand\tpurge\tfoods.\nAssess\tphysical,\tanthropometric,\tmetabolic\tstatus.\nAssess\tlevel\tof\tmotivation.\nUse\tmotivational\tinterviewing\ttechniques.\nDecisional\tbalance:\tweigh
|
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] |
Use\tmotivational\tinterviewing\ttechniques.\nDecisional\tbalance:\tweigh\n\tcosts\tand\tbenefits\tof\tmaintaining\tcurrent\tstatus\tversus\ncosts\tand\tbenefits\tof\tchange.\nContemplation\nIdentify\tbehaviors\tto\tchange;\tprioritize.\nIdentify\tbarriers\tto\tchange.\nIdentify\tcoping\tmechanisms.\nIdentify\tsupport\tsystems.
|
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] |
Identify\tcoping\tmechanisms.\nIdentify\tsupport\tsystems.\nDiscuss\tself-monitoring\ttools:\tfood\tand\teating\tbehavior\trecords.\nContinue\tmotivational\tinterviewing\ttechnique.\nPreparation\nImplement\tnutrition-focused\tCBT.\nImplement\n\tself-monitoring\ttools:\tfood\tand\teating\tbehavior\trecords.\nDetermine\tlist\tof\talternative\tbehaviors\tto\tbingeing\tand\tpurging.\nAction
|
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] |
Action\nDevelop\ta\tplan\tof\thealthy\teating.\nReinforce\tpositive\tdecision\tmaking,\tself-confidence,\tand\tself-efficacy.\nPromote\tpositive\tself-rewarding\tbehaviors.\nDevelop\tstrategies\tfor\thandling\timpulsive\tbehaviors,\thigh-risk\tsituations,\tand\n“slips.”\nContinue\tCBT.\nContinue\n\tself-monitoring.\nMaintenance\tand\nrelapse
|
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] |
Continue\tCBT.\nContinue\n\tself-monitoring.\nMaintenance\tand\nrelapse\nIdentify\tstrategies;\tmanage\thigh-risk\tsituations.\nContinue\tpositive\tself-rewarding\tbehaviors.\nReinforce\tcoping\tskills\tand\timpulse-control\ttechniques.\nReinforce\trelapse\tprevention\tstrategies.\nDetermine\tand\tschedule\tfollow-up\tsessions\tneeded\tfor\tmaintenance\tand
|
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] |
Determine\tand\tschedule\tfollow-up\tsessions\tneeded\tfor\tmaintenance\tand\nreinforcement\tof\tpositive\tchanges\tin\teating\tbehavior\tand\tnutrition\tstatus.\nCBT,\n\tCognitive\n\tbehavioral\ttherapy.\nModified\tfrom\tStellefson\tMyers\tE:\t\nWinning\tthe\twar\twithin:\tnutrition\ttherapy\tfor\tclients\twith\tanorexia\tor\tbulimia\tnervosa\n,\tDallas,\t2006,\tHelm\nPublishing.
|
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0.01787622459232807
] |
,\tDallas,\t2006,\tHelm\nPublishing.\nBinge\teating\tdisorder
|
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] |
Strategies\tfor\ttreatment\tof\tBED\tinclude\tnutrition\tcounseling\tand\tdietary\tmanagement,\tindividual\nand\tgroup\tpsychotherapy,\tand\tmedication\tmanagement.\tSize-acceptance\t(HAES;\tHealth\tAt\tEvery\nSize),\n\timproved\tbody\timage,\tincreased\tphysical\tactivity,\tand\timproved\thealth\tand\tnutrition\tare
|
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] |
treatment\tgoals\tfor\tBED.\tSome\ttreatment\tprograms\tfocus\tprimarily\ton\tnutrition\tcounseling\tand\nweight\tloss.\tUnfortunately,\tbehavioral\tweight\tloss\ttherapy\tmay\tbe\teffective\tin\tattaining\tshort-term\nrather\tthan\tlong-term\tweight\tloss\tin\tthese\tindividuals\t(\nWilson,\t2011\n).\tResults\tof\ta\t6-month\tcombined\nCBT\tand\tdietary
|
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0.011034704744815826
] |
Wilson,\t2011\n).\tResults\tof\ta\t6-month\tcombined\nCBT\tand\tdietary\n\tcounseling\tintervention\t(provided\tby\tRDs)\tconducted\tin\tobese\tBED\tpatients\nindicated\timproved\tpsychological\tfunctioning\tand\ta\tsignificant\tdecrease\tin\tbinge\teating\tepisodes,\nbut\tno\tclinically\tmeaningful\tweight\tloss\t(\nMasheb\tet\tal,\t2016\n).\tMNT\tcounseling\tfor\tthe\tBED\tpatient
|
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] |
Masheb\tet\tal,\t2016\n).\tMNT\tcounseling\tfor\tthe\tBED\tpatient\nrequires\tongoing\tcommunication\twith\tthe\tpsychotherapist\tand\ta\tclear\tintervention\tgoal\t(i.e.,\nnutrition\tcounseling\tbased\ton\twellness\n\tand\tsize-acceptance\tor\tbehavioral\tweight\tloss\ttreatment).\nGuided\tself-help\tCBT\t(\nFairburn,\t1995\n)\tis\talso\ta\ttreatment\toption\t(\nStriegel-Moore\tet\tal,\t2010\n).
|
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)\tis\talso\ta\ttreatment\toption\t(\nStriegel-Moore\tet\tal,\t2010\n).\nOrthorexia\tnervosa\nNumerous\tstudies\thave\tprovided\tevidence\tfor\tthe\tcondition\tof\torthorexia\tnervosa\t(ON),\tan\teating\npattern\tcharacterized\tby\tan\tobsession\tfor\tand\tfixation\ton\thealthy\teating.\tIt\tis\tcurrently\tnot\ncategorized\tas\tan\teating\tdisorder,
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categorized\tas\tan\teating\tdisorder,\n\tand\tthe\tcurrent\tscientific\tdebate\tis\twhether\tthis\tis\ta\tbehavioral\tor\nlifestyle\tphenomenon\tor\ta\ttrue\tmental\tdisorder.\tAlthough\tbeing\taware\tof\tand\tconcerned\twith\tthe\nnutritional\tquality\tof\tthe\tfood\teaten\tis\tnot\ta\tproblem\tin\tand\tof\titself,\tpeople\tcan\tbecome\tfixated\ton
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so-called\thealthy\teating\t(often\tcharacterized\tas\tclean\teating)\tand\tactually\tdamage\ttheir\town\twell-\nbeing\tby\tadherence\tto\tstrict\tfood\n\trules.\tWhile\tON\tis\tnot\tclinically\tdefined\tand\tis\tnot\tincluded\tin\tthe\nDSM-5,\tthe\tNational\tEating\tDisorders\tAssociation\tstates\tthat\tit\tis\tcurrently\tbeing\ttreated\tby\teating
|
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0.06927033513784409,
0.07657748460769653,
0.06003829836845398,
-0.012739232741296291
] |
disorder\texperts\twho\ttreat\tON\tas\ta\tvariety\tof\tanorexia\tand/or\tobsessive-compulsive\tdisorder\n(\nEsposito\tand\tFierstein,\t2018\n).\nPreliminary\tcriteria\tfor\tthe\tdiagnosis\tof\tON\twere\tproposed\tin\t2004\t(\nDonini\tet\tal,\t2004\n).\tSince\tthat\ntime\n\tdiagnostic\tcriteria\thave\tbeen\tproposed\tfor\tthe\tcondition\t(\nDunn\tand\tBratman,\t2016\n).\tA\trecent
|
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] |
Dunn\tand\tBratman,\t2016\n).\tA\trecent\nlarge\tcross-sectional\tstudy\t(\nStrahler\tet\tal,\t2018\n)\texplored\twhether\tON\tis\tof\tepidemiologic\tand\nclinical\trelevance,\tand\twhether\tit\tcan\tbe\tdistinguished\tfrom\tother\tmental\thealth\tdisorders\tand\nhealthy\tlifestyle\tfeatures.\tThey\tconfirmed\tthe\tepidemiologic\tand\tclinical\trelevance\tof\torthorexic\nbehaviors\tbut\tfound
|
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] |
behaviors\tbut\tfound\n\tstrong\tconceptual\toverlap\twith\tother\tmental\thealth\tproblems\tand\tultimately\nchallenged\tthe\tidea\tthat\tON\tis\ta\tdistinct\tmental\thealth\tdisorder\tcategory.\nMonitoring\tnutritional\trehabilitation\nGuidelines\tfor\tpatient\tmonitoring\tare\tindicated\tin\t\nBox\t21.9\n.\tThe\thealth\tprofessional,\tpatient,\tand
|
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] |
Box\t21.9\n.\tThe\thealth\tprofessional,\tpatient,\tand\nfamily\tmust\tbe\trealistic\tabout\ttreatment,\twhich\tis\toften\ta\tlong-term\tprocess.\tAlthough\toutcomes\tmay\nbe\tfavorable,\n\tthe\tcourse\tof\ttreatment\tis\trarely\tsmooth\tand\tlinear,\tand\tclinicians\tmust\tbe\tprepared\tto\nmonitor\tprogress\twith\tpatience\tand\tcompassion.\nBOX\t21.9\nPatient\tMonitoring\n1.\t\nBody\tweight\nA.
|
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BOX\t21.9\nPatient\tMonitoring\n1.\t\nBody\tweight\nA.\n\tEstablish\ttreatment\tgoal\tweight\tand\tbody\tmass\tindex\t(BMI)\nB.\n\tDetermine:\na.\n\tAcceptable\trate\tof\tweight\tgain\tin\tanorexia\tnervosa\t(AN)\nb.\n\tMaintenance\tweight\tin\tbulimia\tnervosa\t(BN)\nC.\n\tChildren\tand\tadolescents:\nc.\n\tPlot\tweight\ton\tNational\tCenter\tfor\tHealth\tStatistics\t(NCHS)\tweight-for-age
|
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] |
percentile\tgrowth\tchart\nd.\n\tDetermine\tweight\tpercentile\nD.\n\tMonitor\tweight:\n(1)\n\tInpatient\tand\tpartial\thospitalization\na.\n\tFrequency:\tInpatient:\tdaily\tor\tevery\tother\tday;\tpartial\thospitalization:\nvaries\twith\tdiagnosis,\tage\tof\tpatient,\tphase\tof\ttreatment\t(i.e.,\tdaily,\tseveral\ntimes\tper\tweek,\tonce\tper\tweek)\nb.\n\tGowned\nc.\n\tMorning\tweight\nd.
|
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] |
times\tper\tweek,\tonce\tper\tweek)\nb.\n\tGowned\nc.\n\tMorning\tweight\nd.\n\tPreprandial\ne.\n\tPostvoid\nf.\n\tSame\tscale\ng.\n\tCheck\turine\tspecific\tgravity\tif\tfluid\tloading\tis\tsuspected\nh.\n\tAdditional\trandom\tweight\tchecks\tif\tfluid\tloading\tis\tsuspected\n(2)\n\tOutpatient\ttreatment:\na.\n\tOnce\tevery\t1\tto\t2\tweeks\tin\tearly\ttreatment,\tless\tfrequently\tin\tmid-\tto\tlate
|
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treatment\nb.\n\tGowned\nc.\n\tPostvoid\nd.\n\tSame\ttime\tof\tday\ne.\n\tSame\tscale\nf.\n\tCheck\turine\tspecific\tgravity\tif\n\tfluid\tloading\tis\tsuspected\n2.\t\nHeight\nA.\n\tMeasure\tbaseline\theight\tusing\ta\tstadiometer
|
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] |
B.\n\tChildren\tand\tadolescents:\n(1)\n\tPlot\theight\ton\tNCHS\tstature-for-age\tpercentile\tgrowth\tchart\n(2)\n\tDetermine\theight\tpercentile\n(3)\n\tAssess\tfor\tgrowth\timpairment\n(4)\n\tMonitor\theight\tevery\t1\tto\t2\tmonths\tin\tpatients\twith\tgrowth\tpotential\n3.\t\nBMI:\nA.\n\tAdults:\tcalculate\tBMI\tusing\tCenters\tfor\tDisease\n\tControl\tand\tPrevention\t(CDC)\tonline
|
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] |
Control\tand\tPrevention\t(CDC)\tonline\ncalculator\tfor\tadults:\nhttps://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/b\nmi_calculator.html\nB.\n\tChildren\tand\tadolescents:\n(1)\n\tCalculate\tBMI,\tBMI\tpercentile,\tand\tBMI\tz-score\tusing\tCDC\tonline\tcalculator\nfor\tchildren\tand\tadolescents\tat
|
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] |
for\tchildren\tand\tadolescents\tat\nhttps://www.cdc.gov/healthyweight/bmi/calculator.html\n(2)\n\tPlot\tBMI\ton\tNCHS\tbody\tmass\tindex-for-age\n\tpercentile\tchart\n(3)\n\tDetermine\tmedian\tBMI\t(50th\tpercentile\tBMI\tfor\tage\tand\tsex)\tusing\tCDC\tData\nTable\tof\tBMI-for-age\tcharts\n(4)\n\tCalculate\tpercent\tmedian\tBMI\t[(current\tBMI/median\tBMI)\tx\t100]\n4.
|
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] |
Calculate\tpercent\tmedian\tBMI\t[(current\tBMI/median\tBMI)\tx\t100]\n4.\t\nOutpatient\tdiet\tmonitoring\nA.\n\tAN\nDaily\tfood\trecord\tto\tinclude:\n*\n(1)\n\tFood\n(2)\n\tFluid:\tcaloric,\tnoncaloric,\talcohol\n(3)\n\tArtificial\tsweeteners\n(4)\n\tEating\tbehavior:\ttime,\tplace,\thow\teaten,\twith\twhom\n(5)\n\tDietary\tenergy\tdensity\n(6)\n\tDiet\tvariety\nB.\n\tBN\nDaily\tfood\trecord\tto\tinclude:
|
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] |
(6)\n\tDiet\tvariety\nB.\n\tBN\nDaily\tfood\trecord\tto\tinclude:\n*\n(1)\n\tFood\n(2)\n\tFluid:\tcaloric,\tnoncaloric,\talcohol\n(3)\n\tArtificial\tsweeteners\n(4)\n\tEating\tbehavior:\ttime,\tplace,\thow\teaten,\twith\twhom\n(5)\n\tEmotions\tand\tfeelings\twhen\teating\n(6)\n\tFoods\teaten\tat\ta\tbinge\n(7)\n\tTime\tand\tmethod\tof\tpurge\n(8)\n\tDietary\tenergy\tdensity\n(9)\n\tDiet\tvariety\n(10)\n\tExercise
|
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] |
(8)\n\tDietary\tenergy\tdensity\n(9)\n\tDiet\tvariety\n(10)\n\tExercise\n*Consider\thaving\n\tpatient\tmonitor\tintake\twith\tan\tapp\t(see\t\nBox\t21.2\n).\nNutrition\teducation\nPatients\twith\tEDs\tmay\tappear\tknowledgeable\tabout\tfood\tand\tnutrition.\tDespite\tthis,\tnutrition\neducation\tis\tan\tessential\tcomponent\tof\ttheir\ttreatment\tplan.\tIndeed,\tsome\tpatients\tspend\tsignificant
|
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] |
amounts\tof\ttime\treading\tnutrition-related\tinformation,\tbut\ttheir\tsources\tmay\tbe\tunreliable,\tand\ttheir\ninterpretation\tpotentially\n\tdistorted\tby\ttheir\tillness.\tMalnutrition\tmay\timpair\tthe\tpatient’s\tability\tto\nassimilate\tand\tprocess\tnew\tinformation.\tEarly\tand\tmiddle\tadolescent\tdevelopment\tis\tcharacterized
|
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] |
by\tthe\ttransition\tfrom\tconcrete\tto\tabstract\toperations\tin\tproblem\tsolving\tand\tdirected\tthinking,\tand\nnormal\tdevelopmental\tissues\tmust\tbe\tconsidered\twhen\tteaching\tadolescents\twith\tEDs\t(see\t\nChapter\n17\n).\nNutrition\teducation\n\tmaterials\tmust\tbe\tassessed\tthoroughly\tto\tdetermine\twhether\tlanguage\tand
|
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] |
subject\tmatter\tare\tbias\tfree\tand\tappropriate\tfor\tAN\tand\tBN\tpatients.\tFor\texample,\tliterature\nprovided\tby\tmany\thealth\torganizations\tpromotes\ta\tlow-fat\tdiet\tand\tlow-calorie\tlifestyle\tfor\tthe\nprevention\tand\ttreatment\tof\tchronic\tdisease.\tThis\tmaterial\tis\tin\tdirect\tconflict\twith\ta\ttreatment\tplan\nthat\tencourages\tincreased\tcaloric\tand
|
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] |
that\tencourages\tincreased\tcaloric\tand\n\tfat\tintake\tfor\tthe\tpurpose\tof\tnutritional\trehabilitation\tand\nweight\trestoration.\nAlthough\tthe\tinteractive\tprocess\tof\ta\tgroup\tsetting\tmay\thave\tadvantages,\tthese\ttopics\tcan\talso\tbe\neffectively\tincorporated\tinto\tindividual\tcounseling\tsessions.\tTopics\tfor\tnutrition\teducation\tare\nsuggested\tin\t\nBox\t21.10\n.
|
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suggested\tin\t\nBox\t21.10\n.\nBOX\t21.10\nTopics\tfor\tNutrition\tEducation\nGuidelines\tfor\trecovery:\tenergy,\tmacronutrient,\n\tvitamin,\tmineral,\tand\tfluid\tintakes\nImpact\tof\tmalnutrition\ton\tadolescent\tgrowth\tand\tdevelopment\nPhysiologic\tand\tpsychological\tconsequences\tof\tmalnutrition\nSet\tpoint\ttheory\tand\tthe\tdetermination\tof\ta\thealthy\tbody\tweight
|
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Set\tpoint\ttheory\tand\tthe\tdetermination\tof\ta\thealthy\tbody\tweight\nImpact\tof\tenergy\trestriction\ton\tthe\tmetabolic\trate\nIneffectiveness\tof\tvomiting,\tlaxatives,\tand\tdiuretics\tin\tlong-term\tweight\tcontrol
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22\nNutrition\tin\texercise\tand\tsports\nperformance\nLisa\tDorfman,\tMS,\tRDN,\tCSSD,\tCCMS,\tLMHC,\tFAND\nKEY\tTERMS\nactomyosin\nadenosine\tdiphosphate\t(ADP)\nadenosine\ttriphosphate\t(ATP)\naerobic\tmetabolism\nanabolic\teffects\nanaerobic\tmetabolism\nandrogenic\teffects\nanorexia\tathletica\t(AA)\nathletic\tenergy\tdeficit\t(AED)\ncreatine\tphosphate\t(CP)\ndehydration
|
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athletic\tenergy\tdeficit\t(AED)\ncreatine\tphosphate\t(CP)\ndehydration\ndehydroepiandrosterone\t(DHEA)\neating,\texercise,\tand\tbody\timage\t(EEBI)\tdisorders\nergogenic\taid\nexercise\trelated\ttransient\tabdominal\tpain\t(ETAP)\nfat\tadaptation\tstrategy\nfemale\tathlete\ttriad\t(FAT)\nglycemic\tindex\nglycogen\nglycogen\tloading\t(glycogen\tsupercompensation)\nglycogenolysis
|
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] |
glycogen\nglycogen\tloading\t(glycogen\tsupercompensation)\nglycogenolysis\nglycolysis\nhigh-intensity\tinterval\ttraining\t(HIIT)\nhypohydration\nhuman\tgrowth\thormone\t(HGH)\nlactic\tacid\nmetabolic\tequivalents\t(METs)\nmicrobiome\nmitochondria\nmuscle\tdysmorphia\t(MD)\nmyoglobin\nnutrition\tperiodization\noxidative\tphosphorylation\npseudoanemia
|
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Vo\n2\nmax\nOptimal\tathletic\tperformance\tis\tthe\tculmination\tof\tgenetics,\tproper\ttraining,\tadequate\tnutrition,\nhydration,\tdesire,\n\tand\tadequate\trest.\tNutrition\tis\tespecially\timportant\tto\trecreational\tand\ncompetitive\tathletes\tregardless\tof\tage\tor\tgender.\tUnderstanding\tsport-specific\tphysiologic
|
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requirements\tfor\ttraining\tand\tcompetition\tis\tintegral\tto\tobtaining\tsufficient\tenergy,\toptimal\tlevels\tof\nmacronutrients\tand\tmicronutrients,\tand\tadequate\tlevels\tof\tfluids.\tA\tbalanced\tdietary\tintake\tis\tvital\nfor\tsupporting\tenergy\tneeds\tand\n\tstamina\tfor\ttraining\thard,\tachieving\ttarget\tperformance,\tbody
|
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] |
stamina\tfor\ttraining\thard,\tachieving\ttarget\tperformance,\tbody\ncomposition\tand\tweight\tgoals,\tadequate\trecovery,\tand\treducing\tthe\tincidence\tof\tillness\tand\tinjury.\tIn\nsome\tcases,\tthe\tuse\tof\tsupplements\tand\tsports\tfoods\tis\talso\thelpful\t(\nHosseinzadeh\tet\tal,\t2017\n;\nInternational\tOlympic\tCommittee\t[IOC],\t2018\n;\t\nMielgo-Ayuso\tet\tal,\t2015\n).
|
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] |
;\t\nMielgo-Ayuso\tet\tal,\t2015\n).\nBioenergetics\tof\tphysical\tactivity\nExercise\tnutrition\trequires\n\tessential\telements\tfrom\tfood\tto\tfuel\tmuscle\tcontractions,\tbuild\tnew\ntissue,\tpreserve\tlean\tmuscle\tmass,\toptimize\tskeletal\tstructure,\trepair\texisting\tcells,\tmaximize\noxygen\ttransport,\tmaintain\tfavorable\tfluid\tand\telectrolyte\tbalance,\tand\tregulate\tmetabolic
|
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] |
processes.\nThe\thuman\tbody\tmust\tbe\tsupplied\tcontinuously\twith\tenergy\tto\tperform\tits\tmany\tcomplex\nfunctions.\tThree\tmetabolic\tsystems\tsupply\tenergy\n\tfor\tthe\tbody:\tone\tdependent\ton\toxygen\t(\noxidative\nphosphorylation\n\tor\t\naerobic\tmetabolism\n)\tand\tthe\tother\ttwo\tindependent\tof\toxygen\t(creatine\nphosphate\tand\tanaerobic\tglycolysis\tor\t\nanaerobic\tmetabolism
|
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continuous\tsupply\tof\tfuel\tthrough\t\nadenosine\ttriphosphate\t(ATP)\n,\tfound\twithin\tthe\tmitochondria\tof\nthe\tbody.\tThe\tenergy\tproduced\tfrom\tthe\tbreakdown\tof\tATP\tprovides\tthe\tfuel\tthat\tactivates\tmuscle\ncontraction.\tThe\tenergy\tfrom\tATP\tis\ttransferred\tto\tthe\tcontractile\tfilaments\t(myosin\tand\tactin)\tin\tthe
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muscle,\twhich\tform\tan\tattachment\tof\tactin\tto\tthe\tcross-bridges\n\ton\tthe\tmyosin\tmolecule,\tthus\nforming\t\nactomyosin\n.\tOnce\tactivated\tthe\tmyofibrils\tslide\tpast\teach\tother\tand\tcause\tthe\tmuscle\tto\ncontract.\nAlthough\tATP\tis\tthe\tmain\tcurrency\tfor\tenergy\tin\tthe\tbody,\tit\tis\tstored\tin\tlimited\tamounts.
|
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0.06842616200447083,
0.06101325526833534,
0.0824488177895546,
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] |
Approximately\t3\toz\tof\tATP\tis\tstored\tin\tthe\tbody\tat\tany\tone\ttime\t(\nMcArdle\tet\tal,\t2014\n).\tThis\tprovides\nonly\tenough\tenergy\tfor\tseveral\tseconds\tof\texercise,\tand\tyet\tATP\tmust\n\tbe\tresynthesized\tcontinually\nto\tprovide\ta\tconstant\tenergy\tsource.\tWhen\tATP\tloses\ta\tphosphate,\tthus\treleasing\tenergy,\tthe\nresulting\t\nadenosine\tdiphosphate\t(ADP)
|
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] |
resulting\t\nadenosine\tdiphosphate\t(ADP)\n\tis\tcombined\tenzymatically\twith\tanother\thigh-energy\nphosphate\tfrom\t\ncreatine\tphosphate\t(CP)\n\tto\tresynthesize\tATP.\tThe\tconcentration\tof\thigh-energy\tCP\nin\tthe\tmuscle\tis\tfive\ttimes\tthat\tof\tATP.\nCreatine\tkinase\tis\tthe\tenzyme\tthat\tcatalyzes\tthe\n\treaction\tof\tCP\twith\tADP\tand\tinorganic\tphosphate.
|
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] |
reaction\tof\tCP\twith\tADP\tand\tinorganic\tphosphate.\nThis\tis\tthe\tfastest\tand\tmost\timmediate\tmeans\tof\treplenishing\tATP,\tand\tit\tdoes\tso\twithout\tthe\tuse\tof\noxygen\t(anaerobic).\tAlthough\tthis\tsystem\thas\tgreat\tpower,\tit\tis\ttime\tlimited\tbecause\tof\tthe\tlimited\nconcentration\tof\tCP\tfound\tin\tthe\tmuscles\t(see\t\nCreatine\n\tlater\tin\tthe\tchapter).
|
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] |
Creatine\n\tlater\tin\tthe\tchapter).\nThe\tenergy\treleased\tfrom\tthis\tATP-CP\tsystem\twill\tsupport\tan\tall-out\n\texercise\teffort\tof\tonly\ta\tfew\nseconds,\tsuch\tas\tin\ta\tpower\tlift,\ttennis\tserve,\tor\tsprint.\tIf\tthe\tall-out\teffort\tcontinues\tfor\tlonger\tthan\n8\tseconds,\tor\tif\tmoderate\texercise\tis\tto\tproceed\tfor\tlonger\tperiods,\tan\tadditional\tsource\tof\tenergy
|
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] |
must\tbe\tprovided\tfor\tthe\tresynthesis\tof\tATP.\tThe\tproduction\tof\tATP\tcarries\ton\twithin\tthe\tmuscle\tcells\nthrough\teither\tthe\tanaerobic\tor\taerobic\tpathways.\nAnaerobic\n\tor\tlactic\tacid\tpathway\nThe\tnext\tenergy\tpathway\tfor\tsupplying\tATP\tfor\tmore\tthan\t8\tseconds\tof\tphysical\tactivity\tis\tthe\nprocess\tof\t\nglycolysis
|
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] |
process\tof\t\nglycolysis\n.\tIn\tthis\tpathway\tthe\tenergy\tin\tglucose\tis\treleased\twithout\tthe\tpresence\tof\noxygen.\t\nLactic\tacid\n\tis\tthe\tend\tproduct\tof\tglycolysis.\tWithout\tthe\tproduction\tof\tlactic\tacid,\tglycolysis\nwould\tshut\tdown.\tThe\tcoenzyme\tcalled\tnicotinic\tacid\tdehydrogenase\t(NAD)\tis\tin\n\tlimited\tsupply\tin
|
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] |
limited\tsupply\tin\nthis\tpathway.\tWhen\tNAD\tis\tlimited,\tthe\tglycolytic\tpathway\tcannot\tprovide\tconstant\tenergy.\tBy\nconverting\tpyruvic\tacid\tto\tlactic\tacid,\tNAD\tis\tfreed\tto\tparticipate\tin\tfurther\tATP\tsynthesis.\tThe\namount\tof\tATP\tfurnished\tis\trelatively\tsmall;\tthe\tprocess\tis\tonly\t30%\tefficient.\tThis\tpathway
|
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] |
contributes\tenergy\tduring\tan\tall-out\teffort\tlasting\tup\tto\t60\tto\t120\tseconds.\tExamples\tare\ta\t440-yard\nsprint\tand\tmany\tsprint-swimming\tevents\t(\nPowers\tet\tal,\t2018\n).\nAlthough\tthis\tprocess\tprovides\timmediate\tprotection\tfrom\tthe\tconsequences\tof\tinsufficient\toxygen,
|
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] |
it\tcannot\tcontinue\tindefinitely.\tWhen\texercise\tcontinues\tat\tintensities\tbeyond\tthe\tbody’s\tability\tto\nsupply\toxygen\tand\tconvert\tlactic\tacid\tto\tfuel,\tlactic\tacid\taccumulates\tin\tthe\tblood\tand\tmuscle,\nlowers\tthe\tpH\tto\ta\tlevel\tthat\tinterferes\n\twith\tenzymatic\taction,\tand\tcauses\tfatigue.\tLactic\tacid\tcan\tbe
|
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] |
with\tenzymatic\taction,\tand\tcauses\tfatigue.\tLactic\tacid\tcan\tbe\nremoved\tfrom\tthe\tmuscle,\ttransported\tinto\tthe\tbloodstream,\tand\tconverted\tto\tenergy\tin\tmuscle,\nliver,\tor\tbrain.\tOtherwise,\tit\tis\tconverted\tto\tglycogen.\tConversion\tto\t\nglycogen\n\toccurs\tin\tthe\tliver\tand\nto\tsome\textent\tin\tmuscle,\tparticularly\tamong\ttrained\tathletes.
|
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] |
to\tsome\textent\tin\tmuscle,\tparticularly\tamong\ttrained\tathletes.\nThe\tamount\tof\tATP\tproduced\tthrough\tglycolysis\tis\tsmall\tcompared\twith\tthat\n\tavailable\tthrough\naerobic\tpathways.\tSubstrate\tfor\tthis\treaction\tis\tlimited\tto\tglucose\tfrom\tblood\tsugar\tor\tthe\tglycogen\nstored\tin\tthe\tmuscle.\tLiver\tglycogen\tcontributes\tbut\tis\tlimited.\nAerobic\tpathway
|
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] |
Aerobic\tpathway\nProduction\tof\tATP\tin\tamounts\tsufficient\tto\tsupport\tcontinued\tmuscle\tactivity\tfor\tlonger\tthan\t90\tto\n120\tseconds\trequires\toxygen.\tIf\tsufficient\toxygen\tis\tnot\tpresent\tto\tcombine\twith\thydrogen\tin\n\tthe\nelectron\ttransport\tchain,\tno\tfurther\tATP\tis\tmade.\tThus\tthe\toxygen\tfurnished\tthrough\trespiration\tis\tof
|
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vital\timportance.\tHere,\tglucose\tcan\tbe\tbroken\tdown\tfar\tmore\tefficiently\tfor\tenergy,\tproducing\t18\tto\n19\ttimes\tmore\tATP.\tIn\tthe\tpresence\tof\toxygen,\tpyruvate\tis\tconverted\tto\tacetyl\tcoenzyme\tA\t(CoA),\nwhich\tenters\tthe\t\nmitochondria\n.\tIn\tthe\tmitochondria\tacetyl\tCoA\tgoes\tthrough\tthe\tKrebs\tcycle,\nwhich\n\tgenerates\t36\tto\t38\tATP\tper\tmolecule\tof\tglucose\t(
|
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] |
which\n\tgenerates\t36\tto\t38\tATP\tper\tmolecule\tof\tglucose\t(\nFig.\t22.1\n).\nFIG.\t22.1\nProduction\tof\tATP\tfor\texercise.\nAerobic\tmetabolism\tis\tlimited\tby\tthe\tavailability\tof\ta\tcontinuous\tand\tadequate\tsupply\tof\toxygen,\nand\tthe\tavailability\tof\tcoenzymes.\tAt\tthe\tonset\tof\texercise\tand\twith\tthe\tincrease\tin\texercise\tintensity,
|
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] |
the\tability\tof\tthe\tcardiovascular\tsystem\tto\tsupply\tadequate\toxygen\tis\ta\tlimiting\tfactor,\tand\tthis\tis\nlargely\tdue\tto\tthe\tlevel\tof\tconditioning.\tThe\n\taerobic\tpathway\tprovides\tATP\tby\tmetabolizing\tfats\tand\nproteins.\tA\tlarge\tamount\tof\tacetyl\tCoA,\twhich\tenters\tthe\tKrebs\tcycle\tand\tprovides\tenormous
|
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] |
amounts\tof\tATP,\tis\tprovided\tby\tbeta-oxidation\tof\tfatty\tacids.\tProteins\tmay\tbe\tcatabolized\tinto\tacetyl\nCoA\tor\tKrebs\tcycle\tintermediates,\tor\tthey\tmay\tbe\tdirectly\toxidized\tas\tanother\tsource\tof\tATP.\nEnergy\tcontinuum\nA\tperson\twho\tis\texercising\tmay\tuse\n\tone\tor\tmore\tenergy\tpathways.\tFor\texample,\tat\tthe\tbeginning\tof
|
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one\tor\tmore\tenergy\tpathways.\tFor\texample,\tat\tthe\tbeginning\tof\nany\tphysical\tactivity,\tATP\tis\tproduced\tanaerobically.\tAs\texercise\tcontinues,\tthe\tlactic\tacid\tsystem\nproduces\tATP\tfor\texercise.\tIf\tthe\tperson\tcontinues\tto\texercise\tand\tdoes\tso\tat\ta\tmoderate\tintensity
|
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for\ta\tprolonged\tperiod,\tthe\taerobic\tpathway\twill\tbecome\tthe\tdominant\tpathway\tfor\tfuel.\tOn\tthe\tother\nhand,\tthe\tanaerobic\tpathway\tprovides\tmost\n\tof\tthe\tenergy\tfor\tshort-duration,\thigh-intensity\texercise\nsuch\tas\tsprinting;\tthe\t200-meter\tswim;\tor\thigh-power,\thigh-intensity\tmoves\tin\tbasketball,\tfootball,\tor
|
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soccer.\tHowever,\tall\tof\tthe\tATP-generating\tpathways\tare\tturned\ton\tat\tthe\tonset\tof\texercise\t(\nPowers\net\tal,\t2018\n).\nOther\tfactors\tthat\tinfluence\toxygen\tcapabilities\tand\tthus\tenergy\tpathways\tare\tthe\tcapacity\tfor\nintense\texercise\tand\tits\tduration.\n\tThese\ttwo\tfactors\tare\tinversely\trelated.\tFor\texample,\tan\tathlete
|
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] |
These\ttwo\tfactors\tare\tinversely\trelated.\tFor\texample,\tan\tathlete\ncannot\tperform\thigh-power,\thigh-intensity\tmoves\tover\ta\tprolonged\tperiod.\tTo\tdo\tthis,\tthe\tathlete\nwould\thave\tto\tdecrease\tthe\tintensity\tof\tthe\texercise\tto\tincrease\tits\tduration\t(\nFig.\t22.2\n).
|
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] |
FIG.\t22.2\nRelative\tcontribution\tof\taerobic\tand\tanaerobic\tenergy\tduring\tmaximum\tphysical\tactivity\tof\tvarious\ndurations.\tNote\tthat\t90\tto\t120\tseconds\tof\tmaximum\teffort\trequires\t50%\tof\tthe\tenergy\tfrom\teach\tof\tthe\taerobic\nand\tanaerobic\tprocesses.\tThis\tis\talso\tthe\tpoint\tat\twhich\tthe\tlactic\tacid\tpathway\tfor\tenergy\tproduction\tis\tat\tits\nmaximum.
|
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maximum.\nThe\taerobic\tpathway\tcannot\ttolerate\tthe\tsame\tlevel\tof\n\tintensity\tas\tduration\tincreases\tbecause\tof\nthe\tdecreased\tavailability\tof\toxygen\tand\taccumulation\tof\tlactic\tacid.\tAs\tthe\tduration\tof\texercise\nincreases,\tpower\toutput\tdecreases.\tThe\tcontribution\tof\tenergy-yielding\tnutrients\tmust\tbe\tconsidered
|
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] |
also.\tAs\tthe\tduration\tof\texercise\tlengthens,\tfats\tcontribute\tmore\tas\tan\tenergy\tsource.\tThe\topposite\tis\ntrue\tfor\thigh-intensity\texercise;\twhen\tintensity\tincreases,\n\tthe\tbody\trelies\tincreasingly\ton\ncarbohydrates\tas\tsubstrate\t(\nPowers\tet\tal,\t2018\n).\nFuels\tfor\tcontracting\tmuscles
|
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Powers\tet\tal,\t2018\n).\nFuels\tfor\tcontracting\tmuscles\nProtein,\tfat,\tand\tcarbohydrate\tare\tpossible\tsources\tof\tfuel\tfor\tATP\tgeneration\tand\ttherefore\tmuscle\ncontraction.\tThe\tglycolytic\tpathway\tis\trestricted\tto\tglucose,\twhich\tcan\toriginate\tin\tdietary\ncarbohydrates\tor\tstored\tglycogen,\tor\tit\tcan\tbe\tsynthesized\tfrom\tcertain\tamino\tacids\tthrough\n\tthe
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the\nprocess\tof\tgluconeogenesis.\tThe\tKrebs\tcycle\tis\tfueled\tby\tthree-carbon\tfragments\tof\tglucose;\ttwo-\ncarbon\tfragments\tof\tfatty\tacids;\tand\tcarbon\tskeletons\tof\tspecific\tamino\tacids,\tprimarily\talanine\tand\nthe\tbranched-chain\tamino\tacids.\tAll\tthese\tsubstrates\tcan\tbe\tused\tduring\texercise;\thowever,\tthe
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intensity\tand\tduration\tof\tthe\texercise\tdetermine\tthe\trelative\trates\tof\tsubstrate\tuse\t(\nPowers\tet\tal,\n2018\n).\nIntensity\nThe\tintensity\tof\tthe\texercise\tis\timportant\tin\tdetermining\twhat\tfuel\twill\tbe\tused\tby\tcontracting\nmuscles.\tHigh-intensity,\tshort-duration\texercise\thas\tto\trely\ton\tanaerobic\tproduction\tof\tATP.\tBecause
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oxygen\tis\tnot\tavailable\tfor\tanaerobic\tpathways,\tonly\tglucose\tand\tglycogen\tcan\tbe\tbroken\tdown\nanaerobically\tfor\tfuel.\tWhen\tglycogen\tis\tbroken\tdown\tanaerobically,\tit\tis\tused\t18\tto\t19\ttimes\n\tfaster\nthan\twhen\tbroken\tdown\taerobically.\tPersons\twho\tare\tperforming\thigh-intensity\tworkouts\tor
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running\tdrills.\tIn\tmoderate-intensity\tsports\tor\texercise\tsuch\tas\tjogging,\thiking,\taerobic\tdance,\ngymnastics,\tcycling,\tand\trecreational\tswimming,\n\tapproximately\thalf\tof\tthe\tenergy\tfor\tthese\tactivities\ncomes\tfrom\tthe\taerobic\tbreakdown\tof\tmuscle\tglycogen,\twhereas\tthe\tother\thalf\tcomes\tfrom\ncirculating\tblood\tglucose\tand\tfatty\tacids.
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energy.\tAlso,\tfat\tprovides\tless\tenergy\tper\tliter\tof\toxygen\tconsumed\tthan\tdoes\tglucose\t(4.65\tkcal/L\tof
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] |
O\n2\n\tversus\t5.01\tkcal/L\tof\tO\n2\n).\tTherefore\twhen\tless\toxygen\tis\tavailable\tin\thigh-intensity\tactivities,\nthere\tis\ta\tdefinite\tadvantage\tfor\tthe\tmuscles\tto\tbe\table\tto\tuse\tglycogen\tbecause\tless\toxygen\tis\nrequired.\nIn\n\tgeneral,\tglucose\tand\tfatty\tacids\tprovide\tfuel\tfor\texercise\tin\tproportions\tdepending\ton\tthe
|
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] |
intensity\tand\tduration\tof\tthe\texercise\tand\tthe\tfitness\tof\tthe\tathlete.\tExertion\tof\textremely\thigh\nintensity\tand\tshort\tduration\tdraws\tprimarily\ton\treserves\tof\tATP\tand\tCP.\tHigh-intensity\texercise\tthat\ncontinues\tfor\tmore\tthan\ta\tfew\tseconds\tdepends\ton\tanaerobic\tglycolysis\t(\nPowers\tet\tal,\t2018\n).\tDuring\nexercise
|
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Powers\tet\tal,\t2018\n).\tDuring\nexercise\n\tof\tlow-to-moderate\tintensity\t(60%\tof\tmaximum\toxygen\tuptake\t[\nVo\n2\nmax\n]),\tenergy\tis\tderived\nmainly\tfrom\tfatty\tacids.\tCarbohydrate\tbecomes\ta\tlarger\tfraction\tof\tthe\tenergy\tsource\tas\tintensity\nincreases\tuntil,\tat\tan\tintensity\tlevel\tof\t85%\tto\t90%\tVo\n2\nmax,\tcarbohydrates\tfrom\tglycogen\tare\tthe
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] |
2\nmax,\tcarbohydrates\tfrom\tglycogen\tare\tthe\nprincipal\tenergy\tsource,\tand\tthe\tduration\tof\tactivity\tis\tlimited\t(\nFig.\t22.3\n)\t(\nPowers\tet\tal,\t2018\n).\nFIG.\t22.3\nPrinciple\tEnergy\tSource\tand\tExercise\tDuration.\nDuration\nThe\tduration\tof\ta\ttraining\tsession\tdetermines\tthe\tsubstrate\tused\tduring\tthe\texercise\tbout.\tFor
|
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] |
example,\tthe\tlonger\tthe\ttime\tspent\texercising,\tthe\tgreater\tthe\tcontribution\tof\tfat\tas\tthe\tfuel.\tFat\tcan\nsupply\tup\tto\t60%\tto\t70%\tof\tthe\tenergy\tneeded\tfor\tultraendurance\tevents\tlasting\t6\tto\t10\thours.\tAs\nthe\tduration\tof\texercise\tincreases,\n\tthe\treliance\ton\taerobic\tmetabolism\tbecomes\tgreater,\tand\ta
|
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] |
the\treliance\ton\taerobic\tmetabolism\tbecomes\tgreater,\tand\ta\ngreater\tamount\tof\tATP\tcan\tbe\tproduced\tfrom\tfatty\tacids.\tHowever,\tfat\tcannot\tbe\tmetabolized\tunless\na\tcontinuous\tstream\tof\tsome\tcarbohydrates\tis\talso\tavailable\tthrough\tthe\tenergy\tpathways.\tTherefore
|
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] |
muscle\tglycogen\tand\tblood\tglucose\tare\tthe\tlimiting\tfactors\tin\thuman\tperformance\tof\tany\ttype\tof\nintensity\tor\tduration\t(\nPowers\tet\tal,\t2018\n).\nEffect\tof\ttraining\nThe\tlength\tof\ttime\tan\tathlete\tcan\toxidize\tfatty\tacids\tas\ta\tfuel\tsource\tis\trelated\tto\tthe\tathlete’s
|
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] |
acid\tmetabolism.\nIncreases\tin\tmitochondria\twith\taerobic\ttraining\tare\tseen\tmainly\tin\tthe\ttype\tIIA\t(intermediate\tfast-\ntwitch)\tmuscle\tfibers.\tHowever,\tthese\tfibers\tquickly\tlose\ttheir\taerobic\tcapacity\twith\tthe\tcessation\tof\naerobic\ttraining,\treverting\tto\tthe\tgenetic\tbaseline.\nThese\tchanges\tfrom\ttraining\tresult\tin\ta\tlower
|
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] |
These\tchanges\tfrom\ttraining\tresult\tin\ta\tlower\t\nrespiratory\texchange\tratio\t(RER)\n,\talso\tcalled\nrespiratory\tquotient,\twhich\tis\tCO\n2\n\teliminated/O\n2\n\tconsumed;\tlower\tblood\tlactate\tand\tcatecholamine\nlevels,\tand\ta\tlower\tnet\tmuscle\tglycogen\tbreakdown\tat\ta\tspecific\tpower\toutput.\tThese\tmetabolic
|
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adaptations\tenhance\tthe\tability\tof\tmuscle\tto\toxidize\tall\tfuels,\tespecially\tfat\t(\nPowers\tet\tal,\t2018\n).\nAn\tintegrative\tapproach\tto\tworking\twith\tathletes
|
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Performance\tnutrition\tis\tnot\tlimited\tto\texercise\tphysiology\tor\tdiet\talone\tbut\tintegrates\n\tsix\tcore\tareas\nof\tstudy:\tthe\trole\tof\toptimal\toverall\thealth\tand\tlongevity,\toptimal\tgrowth,\tpeak\tphysiologic\tfunction,\nenergy\tbalance\tand\tbody\tcomposition,\tnutrition\tenhancement,\tand\tsafety.
|
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] |
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