Nutrition for Sport and Exercise, Fourth Edition
By Marie Dunford and J. Andrew Doyle
Contents:
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