Nutrition for Sport and Exercise, 4th Edition PDF by Marie Dunford and J. Andrew Doyle


Nutrition for Sport and Exercise, Fourth Edition

By Marie Dunford and J. Andrew Doyle

Nutrition for Sport and Exercise, Fourth Edition


Preface xiii

About the Authors xxi

1 Introduction to Sports Nutrition 1

Learning Objectives 1

Pre-Test Assessing Current Knowledge of Sports Nutrition 2

1.1 Training, Nutrition, and the Athlete 2

Sports nutrition is a blend of exercise physiology and nutrition 2

The term athlete is very broad and inclusive 2

Physical activity, exercise, and sport differ from each other 3

Training and nutrition go hand in hand 4

Nutrition supports training, recovery, and performance 4

It is important to understand basic training principles 5

In addition to a training plan, an athlete needs a nutrition plan 6

1.2 Basic Nutrition Standards and Guidelines 8

The Dietary Reference Intakes (DRI) is a

standard used to assess nutrient intake 8

Spotlight on… The Physical Activity Guidelines for Americans 9

The Dietary Guidelines for Americans provide basic dietary and exercise advice 10

MyPlate, MyWins is a tool that can be used to help consumers implement the Dietary Guidelines 10

A food pyramid has been developed for athletes 11

Several other meal-planning tools are also available 12

The Nutrition Facts label provides specific nutrition information 14

Application exercise 15

1.3 Basic Sports Nutrition Guidelines 15

The demands of an athlete’s sport must be carefully considered 16

1.4 Dietary Supplements and Ergogenic Aids 17

Dietary Supplement Health and Education Act 17

Many products fall under the umbrella known as dietary supplements 17

Dietary supplement use among athletes is high 18

Athletes consume supplements for many reasons 18

Knowledge of a supplement’s legality, safety, purity, and effectiveness is crucial 18

Keeping it in perspective Food Is for

Fuel and Fun 20

1.5 Understanding and Evaluating Scientific

Evidence 21

There are three basic types of research studies 21

The basis of good research is strong research design

and methodology 22

Spotlight on… Evaluating Dietary Supplements 22

Peer review is an important safeguard in the

publication of scientific research 23

Focus on research Designing a Rsearch Study to Test

the Effect of a Sports Drink on Performance 24

Levels of evidence and grades of recommendations

put the scientific body of literature in

perspective 25

Spotlight on… Wikipedia 27

Conclusions from scientific studies can be

misinterpreted 27

Much of the nutrition-, exercise-, and health-related

information on the Internet is inaccurate 29

Spotlight on supplements Use of Scientific Studies as a

Marketing Tool 29

1.6 Exercise and Nutrition Credentials and

Certifications 30

There are many types of practitioners in the area of

exercise science 30

Many types of practitioners work in the area of

nutrition 31

Scope of practice helps establish professional

boundaries 32

Post-Test Reassessing Knowledge of Sports

Nutrition 33

Summary and Self-Test 33

2 Defining and Measuring Energy 35

Learning Objectives 35

Pre-Test Assessing Current Knowledge of Energy 36

2.1 Energy and Energy Concepts 36

Energy is the ability to perform work 36

High-energy phosphate compounds store and release

energy 39

Spotlight on… The Role of Enzymes 40

2.2 Measuring Energy 42

The energy content of food is measured by

calorimetry 44

The amount of energy expended can be measured

directly or indirectly 45

Focus on research Determining the Accuracy of a Wearable

Device to Measure Daily Energy Expenditure 48

2.3 Concepts of Energy Balance 50

Energy intake is estimated by analyzing daily food

and beverage consumption 50

Components of energy expenditure can be estimated

by different methods 51

Application exercise 58

Spotlight on… Fitness Tracking Websites and

Applications 59

Estimated Energy Requirement is a daily balance of

energy intake and expenditure 59

Keeping it in perspective Food  Fuel  Exercise 60

Post-Test Reassessing Knowledge of Energy 62

Summary and Self-Test 62

3 Energy Systems and Exercise 64

Learning Objectives 64

Pre-Test Assessing Current Knowledge of Energy

Systems and Exercise 65

3.1 Overview of Energy Systems 65

ATP is rephosphorylized from ADP 65

3.2 The Creatine Phosphate Energy System 67

Creatine is consumed in the diet or synthesized in the

body from amino acids 67

The creatine phosphate energy system phosphorylates

ADP to ATP rapidly 68

Rephosphorylation of creatine phosphate from

creatine depends on aerobic metabolism 69

Focus on research Determining the Use of

ATP and Creatine Phosphate in Skeletal Muscle

during Exercise 70

3.3 The Anaerobic Glycolysis Energy System 71

Spotlight on supplements Creatine Loading and

Supplementation 72

Glycolysis uses the energy contained in glucose

to rephosphorylate ATP from ADP 72

Lactate is metabolized aerobically 75

Spotlight on… Lactate Threshold 76

3.4 The Oxidative Phosphorylation

Energy System 77

Carbohydrates are oxidized in the Krebs cycle 78

Spotlight on… Free Radicals 79

The electron transport chain uses the potential

energy of electron transfer to rephosphorylate

ADP to ATP 80

Application exercise 82

3.5 Fuel Utilization 82

Fats are metabolized aerobically by the oxidation of

fatty acids 82

Proteins are metabolized aerobically by the oxidation

of amino acids 84

The respiratory exchange ratio (RER) indicates

utilization of carbohydrate and fat as fuels 84

Spotlight on… Finding Reliable Information about Energy

Systems 84

Dietary intake influences carbohydrate, fat,

and protein metabolism 87

Metabolism is influenced by the fed-fast

cycle 87

The fed state favors nutrient storage 88

Total energy intake is an important factor 89

Keeping it in perspective Understanding the

Details and the Broad Perspective of Energy

Metabolism 89

3.6 Oxygen Consumption 90

Increased use of aerobic metabolism results in an

increase in oxygen consumption 90

Each individual has a maximal ability to consume

oxygen, or V˙O2max 92

Spotlight on… Alcohol Metabolism 92

Oxygen consumption is influenced by different

skeletal muscle fiber types 94

Post-Test Reassessing Knowledge of Energy Systems and

Exercise 94

Summary and Self-Test 95

4 Carbohydrates 97

Learning Objectives 97

Pre-Test Assessing Current Knowledge of

Carbohydrates 98

4.1 Carbohydrates in Food 98

Carbohydrates are classified in different ways 101

Spotlight on… Sugar Alcohols 102

4.2 Digestion, Absorption, and Transportation of

Carbohydrates 103

Glucose and fructose are absorbed by different

mechanisms 103

Carbohydrate is transported as blood glucose 104

4.3 Metabolism of Glucose in the Body 106

Blood glucose is carefully regulated 106

Glucose can be metabolized immediately for

energy 108

Spotlight on… Glycemic Index (GI) 110

Glucose can be stored as glycogen for

later use 111

Products of glucose metabolism can be used

to synthesize fatty acids 111

Glucose can be produced from lactate,

amino acids, and glycerol by a process called

gluconeogenesis 111

4.4 Carbohydrates as a Source of Energy

for Exercise 112

Exercising muscle first uses carbohydrate stored as

glycogen 112

Exercising muscle takes up and metabolizes blood

glucose 113

Exercise training increases the capacity

for carbohydrate metabolism 114

Focus on research Can Endurance Exercise Performance

Be Improved by Rinsing Your Mouth with a Carbohydrate

Drink without Swallowing It? 114

Glucose metabolism during exercise is controlled by

hormones 116

Exercise intensity affects carbohydrate

metabolism 116

4.5 Carbohydrate Recommendations

for Athletes 117

Daily carbohydrate intake is based on individual

needs to meet the long-term demands of training and

competition 118

Athletes need to plan their carbohydrate

intake before, during, and after training and

competition 120

Application exercise 125

Spotlight on… Sports Drinks, Bars, and Gels 126

Muscle glycogen stores can be maximized by diet and

exercise manipulation 129

Training and performance may be impaired

if insufficient carbohydrate is consumed 130

Carbohydrate and fiber must be consumed in

appropriate amounts for good health 131

4.6 Translating Daily Carbohydrate

Recommendations to Food Choices 132

A carbohydrate-rich diet requires planning 133

Diet planning for carbohydrate intake must consider

practical issues 136

Spotlight on a real athlete Lucas, a Cross-Country

Runner 138

Keeping it in perspective Carbohydrates Are for Fuel

and Fun 144

Spotlight on… Information about Carbohydrates for

Athletes 145

Post-Test Reassessing Knowledge of Carbohydrates 145

Summary and Self-Test 146

5 Proteins 148

Learning Objectives 148

Pre-Test Assessing Current Knowledge of

Proteins 149

5.1 Structure and Function of Protein 149

Amino acids form the basic structure of proteins 149

Some amino acids cannot be manufactured by the

body and must be provided by food 149

Proteins vary in quality due to the amount and types

of amino acids present 152

The structure of a protein determines its

function 153

Proteins perform many functions in the body 153

5.2 Digestion, Absorption, and Transportation

of Protein 155

Proteins are digested in the stomach and small

intestine 155

Proteins are absorbed in the small intestine 156

After absorption, some amino acids are transported to

the liver, whereas others circulate in the blood 156

5.3 Metabolism of Proteins and Amino Acids 158

The body uses amino acids to build proteins, a

process known as anabolism 158

The body breaks down proteins into amino acids, a

process known as catabolism 158

Protein is metabolized during endurance

exercise 160

Amino acid breakdown produces ammonia 161

The body is constantly breaking down proteins as well

as building proteins 161

Skeletal muscle protein synthesis and immune system

function are influenced by many factors 163

5.4 Protein Recommendations for Athletes 165

Recommended ranges for protein intake by athletes

are good guidelines but should be individualized for

each athlete 165

Focus on research Establishing Dietary Protein

Recommendations for Endurance and Strength

Athletes 166

Timing of protein intake is important, especially after

exercise 170

Spotlight on… Protein Intake Expressed as a Percentage

of Total Calories Can Be Deceiving 170

Application exercise 173

Most athletes consume a sufficient amount of

protein, but some consume a low or excessive

amount 173

Some practical problems are associated with

consuming an excessive amount of protein 174

5.5 Effect of Energy Intake on Protein Intake 175

Long-term, substantial energy deficits typically result

in low protein intake 175

Long-term, small energy deficits are characteristic of

a pattern of eating for some athletes 175

Intermediate-term, daily energy deficits (“dieting”)

may lead to loss of lean body mass 176

Short-term, substantial energy deficits are used to

“make weight,” but such diets can have detrimental

effects 176

Some athletes engage in short-term, intermittent

fasting 176

Low protein intake negatively affects the immune

system 177

5.6 Translating Protein Intake Recommendations to

Practical, Daily Food Choices 177

Well-planned vegetarian and vegan diets are healthful

and nutritionally adequate 178

Protein supplements should be considered a part of

an athlete’s overall protein intake 179

Spotlight on a real athlete Lucas, a Cross-Country

Runner 180

5.7 Supplementation with Individual Amino

Acids 182

Beta-alanine may help to buffer muscle pH in

high-intensity (sprint) exercise 182

b-Hydroxy-b-Methylbutyrate (HMB) has some

anticatabolic properties 183

Branched chain amino acids (BCAA) may help

to support immune function in endurance

athletes 183

Glutamine supplementation does not appear to be

effective as a way to enhance the functioning of the

immune system 184

Glucosamine/chondroitin sulfate is generally not

effective for reducing joint pain 184

Growth hormone releasers, particularly arginine,

may be effective for stimulating the release of growth

hormone 184

Nitric oxide (NO)/arginine alpha-ketoglutarate

(AAKG) reduces oxygen cost of exercise and improves

exercise tolerance 185

Keeping it in perspective The Role of Protein for

Athletes 185

Post-Test Reassessing Knowledge of Proteins 186

Summary and Self-Test 186

6 Fats 188

Learning Objectives 188

Pre-Test Assessing Current Knowledge of Fats 189

6.1 Fatty Acids, Sterols, and Phospholipids 189

Fatty acids vary due to their chemical

compositions 190

Most fats in food are in the form

of triglycerides 191

Spotlight on… Trans Fatty Acids 192

Two essential fatty acids cannot be manufactured by

the body 193

Omega-3 fatty acids have many beneficial

effects 194

Omega-3 fatty acids may have a role in recovery from

strenuous exercise 195

Sterols, such as cholesterol, and phospholipids are

types of fat found in foods 195

Some fats lower the risk for heart disease 196

6.2 Digestion, Absorption, and Transportation

of Fats 197

Fat is digested primarily in the small intestine 197

After being absorbed, the fatty acids are resynthesized

into triglycerides 197

The transportation of fats into the blood is a slow

process 198

6.3 Storage and Metabolism of Fats 199

Fat can be easily stored in the body 199

Fat is an important source of energy for

many athletes 199

6.4 Fats as a Source of Energy during

Exercise 203

It is important to know the relative (percentage)

and absolute amount of fat utilized as a

fuel 204

The body adapts to endurance exercise training by

improving its ability to metabolize fat 207

Focus on research Determining the Effect of High-Fat

Diets on Fat Metabolism during Exercise and Endurance

Exercise Performance 208

6.5 Fat Recommendations for Athletes 211

Total daily fat intake depends on total energy,

carbohydrate, and protein intakes 211

Reducing caloric intake by reducing dietary fat intake

over several weeks or months may help athletes

achieve a loss of body fat 212

Inadequate fat intake can negatively affect training,

performance, and health 213

Spotlight on… Must an Athlete’s Diet Be a “Low-Fat”

Diet? 214

6.6 Translating Daily Fat Recommendations to Food

Choices 215

The amount and type of fat in foods varies 215

The typical American diet is usually too high in fat for

an athlete in training 216

Spotlight on a real athlete Lucas, a Cross-Country

Runner 219

There are ways to modify the typical American diet so

it is lower in fat 220

Some foods are made with fat substitutes 222

Keeping it in perspective Fat Is for Fuel and Fun 222

6.7 Fat-Related Dietary Supplements 223

Caffeine is a central nervous stimulant that helps to

delay fatigue 223

Application exercise 223

Post-Test Reassessing Knowledge of Fats 225

Summary and Self-Test 226

7 Water and Electrolytes 228

Learning Objectives 228

Pre-Test Assessing Current Knowledge of Water and

Electrolytes 229

7.1 Overview of Water and Electrolytes 229

The amount of water in the body depends on many

factors 230

Body water is distributed as intracellular or

extracellular fluid 230

7.2 Water Loss, Intake, Balance, and

Imbalance 234

Water is lost in a variety of ways 234

Water is added to the body primarily through the

intake of beverages and foods 235

There are constant changes in body

water, resulting in temporary water

imbalances 236

7.3 Effect of Exercise on Fluid Balance 239

Exercise can have dramatic effects on water loss,

particularly due to sweating 240

Focus on research How Often and How Does

Hyponatremia Occur during Ultraendurance

Events? 242

Core temperature is affected by hydration

status 244

Excessive dehydration may impair exercise

performance 245

Spotlight on… Intentional, Rapid Dehydration 245

Electrolyte loss, particularly sodium loss, during

exercise can be substantial 246

Exercise-related muscle cramping, often

associated with dehydration or electrolyte loss,

may have other causes 248

7.4 Strategies to Replenish Water and

Electrolytes 249

Hydration status should be assessed and

monitored 249

General guidelines have been developed for the

type, timing, and amount of fluids and electrolytes

consumed before, during, and after exercise 251

Each athlete should develop an individualized plan

for choosing foods and beverages that meet fluid and

electrolyte needs 256

In the process of replenishing fluids and

electrolytes, athletes may be consuming other

nutrients 259

Hyponatremia, or plasma sodium being too low, is a

serious electrolyte disturbance that can be fatal 260

Application exercise 260

Increasing fluid levels above normal is

hyperhydration 261

Spotlight on a real athlete Hyponatremia in a Boston

Marathon Runner 261

Keeping it in perspective Fluid and Electrolyte Balance Is

Critical 262

Spotlight on… Finding Reliable Information about Water

and Electrolytes 263

Post-Test Reassessing Knowledge of Water and

Electrolytes 263

Summary and Self-Test 263

8 Vitamins 265

Learning Objectives 265

Pre-Test Assessing Current Knowledge of Energy 266

8.1 Classification of Vitamins 266

A recommended daily intake has been established

for each vitamin 267

Moderate to rigorous exercise may increase the need

for some vitamins, but the increase is small 273

Poor food choices by athletes and sedentary people

often lead to low vitamin intake 274

It is important to guard against both vitamin

deficiencies and toxicities 275

8.2 The Roles of Vitamins in the Body 276

Some of the B-complex vitamins are associated

with energy metabolism 277

Spotlight on… Vitamins and “Energy” 280

Some vitamins have antioxidant properties that

help protect cells from damage 281

Vitamins with antioxidant properties are found

in both food and supplements 282

Focus on research Exploring Free Radical Production

during Exercise, Muscle Damage, and Antioxidant

Supplementation 283

Spotlight on… Antioxidant Vitamins and Health 286

Vitamin B12 and folate are two vitamins associated

with red blood cell function 287

Spotlight on supplements Vitamin C and Colds 288

Spotlight on supplements Applying Critical Thinking Skills

to Evaluating Dietary Supplements 288

Spotlight on supplements Quercetin 289

Many vitamins are associated with growth

and development, including vitamins A and D 290

8.3 Sources of Vitamins 293

Each person must decide the best ways to obtain

an adequate amount of vitamins 294

The vitamin content of a diet can vary tremendously

based on the amounts and types of food

consumed 296

Vitamins are added to many foods marketed

to athletes 298

The dose and potency of a vitamin supplement can

vary substantially from brand to brand 299

Keeping it in perspective The Need for an Adequate but

Not Excessive Amount of Vitamins 299

Application exercise 300

Post-Test Reassessing Knowledge of Vitamins 300

Summary and Self-Test 301

9 Minerals 303

Learning Objectives 303

Pre-Test Assessing Current Knowledge of

Minerals 304

9.1 Classification of Minerals 304

A recommended daily intake has been established for

many minerals 305

Moderate to rigorous exercise increases the loss of

some minerals 305

Poor food choices by athletes and sedentary people

often lead to low mineral intake 311

9.2 Mineral Deficiencies and Toxicities 312

Many factors influence mineral absorption 312

It is important to guard against mineral

deficiencies 313

Mineral toxicities are rare but possible 315

9.3 The Roles of Minerals in Bone Formation 316

Spotlight on supplements Evaluating a

High-Potency Multimineral Supplement Advertised

to Athletes 317

Bones have both structural and metabolic

functions 318

Achieving peak bone mineral density is critical to

long-term health 318

Bone loss is associated with aging 320

Calcium may be taken from bone to maintain calcium

homeostasis 320

Bone loss is associated with lack of estrogen 322

The roles of calcium and exercise in preventing or

reducing bone loss associated with aging have not

been fully established 323

Focus on research Does the Disruption of the Menstrual

Cycle That Occurs in Some Athletes Have Health

Implications? 324

It is important to meet the recommended dietary

intakes for calcium and vitamin D 325

Many people consume an inadequate amount of

calcium daily 325

There are numerous strategies for increasing dietary

calcium consumption 326

Phosphorus, fluoride, and magnesium are also

involved with bone health 328

9.4 The Roles of Minerals in Blood

Formation 328

Iron is an integral part of hemoglobin 329

Blood tests can help detect iron deficiency 330

Athletes may develop iron deficiency and iron

deficiency anemia 332

Iron deficiency and iron deficiency anemia negatively

affect performance 333

Several factors affect iron status in athletes,

particularly endurance and ultraendurance

athletes 333

Athletes should consume a variety of iron-containing

foods 334

9.5 The Roles of Minerals in the Immune

System 335

The immune system protects the body from

disease 336

9.6 The Adequate Intake of All Minerals 337

The key to obtaining all the minerals needed from

food is to consume a nutrient-dense, whole-foods

diet 337

The dose and potency of a mineral supplement can

vary substantially from brand to brand 338

Keeping it in perspective Minerals as Building

Blocks 340

Application exercise 340

Post-Test Reassessing Knowledge of Minerals 340

Spotlight on supplements How Beneficial Is Chromium

Supplementation for Athletes? 341

Summary and Self-Test 341

10 Diet Planning: Food First, Supplements Second 344

Learning Objectives 344

Pre-Test Assessing Current Knowledge of Diet Planning

for Athletes 345

10.1 Energy: The Basis of the Diet-Planning

Framework 345

A dietary prescription helps athletes

consume the proper amount of carbohydrates,

proteins, and fats within their energy

needs 347

Consuming nutrient-dense foods is the key to

eating nutritiously without consuming excess

calories 349

10.2 Translating Nutrient Recommendations into

Food Choices 351

Each athlete should have an individualized diet

plan 353

Application exercise 353

Food intake needs to be distributed appropriately

throughout the day 354

10.3 Diet Plans Popular with Athletes 359

Vegetarian or vegan diet 359

Paleolithic (“Paleo”) diet 359

Gluten-free diet 360

Low-carbohydrate diet 360

10.4 The Risks and Benefits of Caffeine and Alcohol

Consumption 360

Many athletes consume caffeine safely and effectively

as a central nervous system stimulant 360

Athletes should consider the risks and benefits of

alcohol consumption 362

10.5 Dietary Supplements and Ergogenic Aids 364

For those supplements that are known to be effective,

the ability to enhance performance is relatively

small 367

NCAA bylaws regarding banned substances and non–

muscle-building nutritional supplements 367

Practitioners should discuss dietary supplement use

with athletes 368

Vitamin and mineral supplements are frequently used

by athletes 368

Spotlight on supplements Understanding a Dietary

Supplement Label 369

Protein supplements are particularly popular with

high school and collegiate male athletes 370

Spotlight on supplements Should I Take a Vitamin or

Mineral Supplement? 370

Probiotic supplements may improve gastrointestinal

and immune functions in athletes 371

Athletes typically consume herbals and botanicals to

prevent or recover from illness or injury 371

Spotlight on supplements Should I Take a Protein

Supplement? 371

Spotlight on supplements ESPN—Every Supplement

Produces News—How Professionals Can Keep Up 372

Keeping it in perspective Where Supplements Fit into the

Athlete’s Training and Nutrition Plan 373

10.6 A Comprehensive Nutrition Plan to Support

Training and Performance 373

Spotlight on a real athlete Annika, a Collegiate Rower 374

Focus on research How Are Nutrition Recommendations

for Athletes Determined? 376

Post-Test Reassessing Knowledge of Diet Planning for

Athletes 377

Summary and Self-Test 378

11 Weight and Body Composition 380

Learning Objectives 380

Pre-Test Assessing Current Knowledge of Body Weight

and Body Composition 381

11.1 Understanding Weight and Body

Composition 382

It is important to understand the concepts of body

mass, weight, and composition 383

Spotlight on… Understanding Body Composition

Terminology 384

11.2 Assessment and Interpretation of Weight and

Body Composition 388

Body weight is measured with a scale 388

Body composition can be estimated by a variety

of methods 388

Underwater weighing and plethysmography estimate

body composition by determining body density 390

Body composition can be estimated using the thickness

of skinfolds from specific sites on the body 392

Bioelectrical impedance analysis (BIA) uses electrical

currents to estimate the proportion of fat in the

body 393

A beam of near-infrared light is used to distinguish

between fat and other tissues 394

Dual-energy X-ray absorptiometry (DEXA or DXA)

uses low-intensity, focused X-rays to determine bone

density and estimate body composition 395

Advanced imaging techniques include CT scans, MRI,

and ultrasound 396

Body composition results must be interpreted

appropriately 396

Body weight results must be interpreted appropriately

and used consistently 396

11.3 Body Composition and Weight Related to

Performance 397

Certain physical characteristics are associated with

sports performance 397

Spotlight on… Athletes and Appearance—Meeting Body

Composition Expectations 400

Many athletes establish weight and body composition

goals in an effort to improve performance or

health 401

11.4 Changing Body Composition to Enhance

Performance 402

Desired body composition can be used to determine a

target weight 402

Body composition can be changed by increasing

muscle mass 403

Application exercise 403

Body composition can be changed by decreasing

body fat 404

Increasing muscle mass while decreasing body fat is

difficult 406

Body composition changes may be seasonal 406

Athletes who compete in lightweight sports push the

biological envelope 407

Spotlight on a real athlete Sondra, a Superlightweight

Kickboxer 409

Underweight athletes may need to increase muscle

mass and body fat 410

Focus on research Can Boxers Effectively “Make Weight”

While Following a Nutritious Diet? 411

11.5 Supplements Used to Change Body Composition 412

Supplements are often used to help increase muscle

mass 412

Spotlight on a real athlete One Wrestler’s True Story 413

Supplements are often used to assist weight loss 414

Citrus aurantium (bitter orange) may be used in supplements advertised as ephedra-free 417

Conjugated linoleic acid (CLA) is marketed to athletes

as a way to change body composition and improve

performance 417

Athletes should be cautious about using weight-loss

and muscle-building supplements 417

Spotlight on… Finding Reliable Information about Body

Composition and Body Weight 417

Keeping it in perspective Body Composition, Body

Weight, Performance, Appearance, and Health 418

Post-Test Reassessing Knowledge of Body Weight and

Body Composition 419

Summary and Self-Test 419

12 Disordered Eating and Exercise Patterns in Athletes 421

Learning Objectives 421

Pre-Test Assessing Current Knowledge of Disordered

Eating and Exercise Dependence 422

12.1 Case Study: Disordered Eating and Eating

Disorders 422

Case Study: Karen, a cross-country runner 422

12.2 Overview of Eating and Exercise

Patterns 424

“Normal” eating is flexible 424

Disordered eating is not the same as an eating

disorder 425

Eating disorders are psychiatric diseases 426

Anorexia athletica describes an eating disorder

unique to athletes 429

Obsessive-compulsive disorder and disordered eating

may be intertwined 430

Some people suffer from exercise dependence and

voluntarily engage in excessive exercise 430

Spotlight on… Do Combat Athletes Have Eating Disorders? 431

Application exercise 432

Focus on research To What Degree Is Exercise

Dependence Associated with Diagnosed Eating Disorders,

and Does Exercise Dependence Change with Treatment for

Eating Disorders? 433

12.3 Disordered Eating and Eating Disorders in Athletes 434

The prevalence of disordered eating and eating

disorders is difficult to determine 435

Some sports have a higher prevalence of disordered eating and eating disorders 435

More information is emerging about eating disorders

in males 436

Disordered eating behaviors may progress to an eating disorder 437

It is important to distinguish “normal” and dysfunctional eating and exercise behaviors in athletes 438

Ultimately, eating disorders have a negative effect on performance and health 439

If disordered eating or an eating disorder is suspected, then the athlete should be approached with care and concern 440

It is important to promote a culture that supports

“normal” eating for all athletes 440

12.4 Energy Availability, Female Athlete Triad,

and Relative Energy Deficiency in Sport (RED-S) 441

Low energy availability is a major factor in performance and health 442

The Female Athlete Triad raised awareness of potential problems in athletes 443

Amenorrhea is the absence or suppression of menstruation 443

Low bone mineral density is a factor involved in the

Female Athlete Triad 444

Both elite and recreational athletes can develop the Female Athlete Triad 446

Spotlight on… Normal Bone Density in a Former Amenorrheic, Osteoporotic Distance Runner 446

The Relative Energy Deficiency in Sport (RED-S) is a

proposed extension to the Female Athlete Triad 447

Prevention, intervention, and treatment of low energy availability are critical 448

Spotlight on… Finding Reliable Information about Low Energy Availability 449

Keeping it in perspective Eating, Exercising, Weight, and Performance 450

Post-Test Reassessing Knowledge of Disordered Eating and Exercise Dependence 450

Summary and Self-Test 450

13 Diet and Exercise for Lifelong Fitness and Health 453

Learning Objectives 453

Pre-Test Assessing Current Knowledge of Health, Fitness, and Chronic Diseases 454

13.1 The Lifelong Athlete 454

Most collegiate athletes do not become professional

athletes and must adjust to reduced exercise training 455

Various nutrition and exercise guidelines are remarkably similar, although there are some differences 456

Spotlight on… Finding Reliable Information about Diet, Exercise, and Health 459

13.2 The Impact of Overweight and Obesity on Chronic Diseases 460

The majority of Americans are overweight or obese 461

Spotlight on… Childhood and Adolescent Obesity 463

Spotlight on a real athlete Susan, 26-Year-Old,

Former Collegiate Basketball Player, No Longer Playing Competitively 464

Regulation of body weight is a complex process that

is not completely understood 465

The treatment of overweight and obesity involves

long-term changes to established food and exercise patterns 468

Focus on research How Does Exercise Affect the

Processes That Regulate Energy Balance? Are the Effects

Different in Men and Women? 470

Spotlight on… Overweight and Obesity 473

13.3 Diet, Exercise, and Chronic Disease 474

Diet and exercise are associated with the prevention and treatment of hypertension 474

Diabetes is a group of diseases characterized by a high blood glucose level 475

Spotlight on… Hypertension 475

Diet and physical activity play critical roles in the management of type 2 diabetes 476

Spotlight on… Type 2 Diabetes 476

Spotlight on… Glycemic Index and Glycemic Load 477

Spotlight on a real athlete Lucas, 23-Year-Old, Collegiate

Cross-Country Runner 478

Cardiovascular disease is the major cause of death in the United States 480

Spotlight on a real athlete Vijay, 38-Year-Old, Occasional Triathlete 481

Application exercise 482

Spotlight on a real athlete Freddie, 48-Year-Old, Former

Star High School Athlete, Physically Active until His

Mid-20s, Sedentary for 20 Years 484

Metabolic syndrome is a cluster of metabolic disorders strongly associated with abdominal obesity and insulin resistance 486

Spotlight on… Heart Disease (Atherosclerosis) 486

Osteoporosis is characterized by low bone mineral density 487

Spotlight on… Metabolic Syndrome 488

Spotlight on a real athlete Lena, 67-Year-Old,

Formerly Lightly Active, Now Has Physical

Limitations 489

Many cancers are related to lifestyle 490

Spotlight on… Osteoporosis 490

Chronic disease risk can be assessed with a number of

screening tools 491

Spotlight on… Lifestyle-Related Cancers 491

Spotlight on… Finding Reliable Information about Chronic Diseases 492

Physical activity and fitness may reduce the adverse

impact of overfatness on health 493

The Health at Every Size movement emphasizes

improved metabolic health over weight and fat

loss 494

Behavior change is needed to prevent and treat

lifestyle-related chronic diseases 494

Keeping it in perspective Everyone Is an

Athlete 495

Post-Test Reassessing Knowledge of Health, Fitness, and

Chronic Diseases 496

Summary and Self-Test 497

Appendices 499

Glossary 543

Index 551

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