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  • Training the Nervous System after Stroke

    by Caitlin Kinser | Oct 17, 2019

    Neurotraumatic injury such as stroke is not typically symmetrical. So, it is no surprise that such damage results in a more affected side, which results in more dramatic muscle weakness and spasticity. However, evidence suggests that some human movements have conserved neural linkages even post-stroke. Thus, training the more affected side made indeed enable the re-strengthening of muscles and neural pathways. So, what kind of training can rehabilitation specialists consider prescribing to their patients?

    essr blog Training the Nervous System after StrokeCycling is one suggestion. Measures of mobility were improved following arm or arm-leg cycling. What about strength training? In the October 2019 issue of Exercise and Sport Sciences Reviews, researchers Yao Sun and E. Paul Zehr suggest that strength training can have significant impacts on neuroplasticity, even with just unilateral training. Significant strength gains have been revealed by cross-education in both the lower extremity and upper. The positive impact of cross-education in those who have experienced stroke compared with those who are neurologically intact is nearly astoundingly greater for all limbs, trained and untrained sides.

    But wait! The cross-education doesn’t stop at bodily hemispheres of left and right! Zehr showed that the upper and lower limbs share neural control elements during locomotion (i.e., walking, cycling). Other rhythmic movement training regiments can, therefore, facilitate walking. Zehr and Sun expands on this marvelous aspect of neuroplasticity in their recently published paper in Exercise and Sport Science Reviews. The capability of transferring improvements to movements and limbs not directly trained, as shown by Klarner et al.  in a 6-week moderate arm and leg cycling training in patients with chronic stroke, advocates the hypothesis that rhythmic movements are regulated by the same basic neural networks.

    Similar to our four-legged animal friends, where an injury to one limb does not prevent locomotion, injuries to one leg of the bipedal human can have symptoms ameliorated, likely by similar neural control mechanisms. Human interlimb modulation is present between legs and the upper and lower limbs, as revealed by changes in H-reflex amplitude in ipsilateral and contralateral sides of the body, even outside of locomotion.

    Certainly, Zehr and Sun make a solid argument for the superior capabilities of our plastic nervous system, especially following stroke. Engaging multiple limbs in training programs can have an impactful influence on regaining strength after stroke.

    How can you help your students better grasp the concepts of how activating interlimb neural networks can amplify strength gain and neural plasticity? Check out the online-only Journal Club questions written by the authors to help students think critically about the topic. It includes questions such as:

    Compared to training the more affected limb directly, what are the benefits of training the less affected limb after stroke?

    Diba Mani, Ph.D., is a lecturer in the Department of Applied Physiology & Kinesiology at the University of Florida. She serves as the Digital Editor for Exercise and Sport Sciences Reviews. She earned her degrees under the mentorship of Dr. Roger Enoka in the Neurophysiology of Movement Laboratory at the University of Colorado. Her doctoral dissertation focused on evaluating the effects of electrical nerve stimulation on motor unit discharge properties and mobility in young and older adults. Dr. Mani most enjoys the human component of any work she is engaging in, be it research in the field of geriatrics or teaching college students in the classroom. Dr. Mani is a nationally certified judo referee and coach and also a regular vinyasa yoga practitioner. She is passionate about diversity and cultural promotion through involvement in groups such as Iranian American Academics & Professionals and the Persian Students Organization.

  • Industry-Presented Webinar FAQ | Fueling the Extra Mile: The Science of the Endurance Athlete

    by David Barr | Oct 15, 2019

    GSSI Endurance Nutrition ACSM

    The Gatorade Sports Science Institute (GSSI) and ACSM recently hosted an industry-presented webinar with Lisa Heaton, MS, RD, CSSD, and Kelly Barnes, MS, entitled Fueling the Extra Mile: The Science of the Endurance Athlete.

    GSSI ACSM Endurance
    Watch the full webinar here

    Several questions were asked by attendees during the webinar and the answers pertaining to Exercise, Diets, and more are below.

    Read the second half of the QnA here.
    Endurance Nutrition Energy Hydration Structure ACSM GSSI


    Key Points:

    1. The sport nutrition needs for all athletes can be divided into 3 major categories: energy, hydration, and structure.


    2. The body has an abundant storage of fats that can be used for fuel, but that is what the body turns to for the slower, less intense exercise.As exercise intensity increases, the body’s need for the fuel of carbohydrate increases; however this fuel storage is limited within the body.


    3. The hydration needs of endurance athletes are unique, because as exercise intensity and duration increase, so do sweat losses — both fluid and electrolytes (specifically sodium, chloride, and potassium).To figure out sweat fluid losses, athletes should weigh themselves before and after exercise. Additional details on this testing and a calculator can be found at

      https://www.gssiweb.org/toolbox/fluidLoss/calculator.

     

    Q: I’ve heard our bodies carry 700g of carbs in the form of glucose/glycogen at any given time. Does that still hold true?

    The average athlete can store glucose as glycogen in the liver (up to ~80 grams) and muscle (up to ~300-500 grams).  But that storage volume and capacity rely on the athlete consuming carbohydrates over days and weeks to maximize the storage potential. The daily recommendation for endurance athletes to consume is 7-10 grams of carbohydrate per kilogram (pounds divided by 2.2) bodyweight per day. For ultra-endurance athletes, the total recommendation may be up to 12 g/kg depending upon their training schedule.


    Q: Regarding intensity and time, is it more common to see more of the carbs being spared for long-duration exercise? I have noticed more low CHO diets in endurance athletes as a way to utilize fat for energy. Your take?  Is there any data showing the positive or negative effects of "fasted cardio" that is so common today?

    Athlete’s ability to “spare carbohydrate” utilization is very individualistic.  The athlete can manipulate the highest exercise intensity that they can sustain where >50% of the fuel used comes from fatty acids by training at or just above that threshold or in a fasted state. However, even if they can hold onto primarily fat utilization at higher exercise intensities, they will still be utilizing carbohydrate and will need replacement to continue at that exercise intensity if the duration is long enough.  Additionally, these strategies should be used strategically to ensure that there are still enough training sessions at high enough intensity to optimize performance and that the gut is well trained to tolerate the carbohydrate plan during competition. So, while this strategy may slightly reduce the amount of exogenous carbohydrate that the athlete needs to take in per hour, it does not eliminate the need for that carbohydrate intake during prolonged endurance exercise.


    Endurance GI Distress ACSM

    Q: How does adding a third carbohydrate source (maltodextrin) affect gastric absorption?

    Maltodextrins are rapidly oxidized carbohydrates and can be absorbed at a rate of about 60g/h. If combined with glucose and fructose, the glucose and maltodextrin would be absorbed through the same transporter which can sustain a rate of about 60g/h total, so they wouldn’t want to take in much more than that. So glucose and maltodextrin can be used interchangeably or additively up to 60 g/h.


    Q: With "train low," and an athlete deciding to use more than the usual CHO from training during a race, because the gut was not trained, will the increase in CHO intake get absorbed properly?

    If an athlete chronically participates in a “train low” method, then their likelihood for stomach or GI upset is greater because the gut is not used to that volume.  It is best to use “train low” strategically throughout the training vs at all training sessions.


    Q: When we say exogenous CHO oxidation is it the same as CHO use in muscle, or it is oxidized elsewhere?

    The body oxidizes carbohydrate during exercise to supply energy primarily to the working muscles and the brain.


    Q: For clarification on the glucose + fructose studies: were the sources of glucose and fructose in the form of sucrose? Or were the fructose or glucose individual units?

    There have been many different studies looking at different blends of glucose, sucrose, fructose, galactose, maltose and glucose polymers.  The body can use a peak of 1.75g/min when 2.4 g/min of the glucose: fructose blend.  However, a maltodextrin: fructose mix is much less sweet and can be used at a comparable quantity (1.5 g/min) when 1.8 g/min is consumed. Recommendations are based on a quantity per duration instead of per individuals body mass, since the size of the athlete doesn’t seem to affect absorption. 


    Q: What is “mouth rinse”?  What is the physiological mechanism for the benefits of mouth rinse? Is it due to the incretin effect?

    Athletes exercising for shorter durations can handle most forms of carbohydrate and could even benefit from rinsing their mouth with a carbohydrate solution.  Without even swallowing this fluid, the taste transduction pathways in the mouth can send positive signals to the brain that can possibly counteract some of the negative signals from muscles, joints, and core temperature receptors.  The specific pathway is unclear but does not seem to be related to incretins.


    Q: Are the carb ratios for adult athletes vs. youth athletes going to be different?  If so, would the carb requirements be higher or lower for youth athletes?

    The amount and the type of carbohydrate recommendation depends on the athlete’s sport performance level, their goals, the duration of exercise, and their nutrition habits around the exercise occasion. Receiving ethical approval for research with minors is difficult, thus the research-based recommendations are limited. We suggested examining practical works by practitioners who work specifically with youth athletes, such as the text “Fueling Young Athletes” by Heather Mangieri, M.S., RDN, CSSD.  


    Q: What are examples of carbs that contain glucose and fructose? Might fruit juice be an example?

    There are many sport products (like the Gatorade Endurance Formula) specifically formulated in this 2:1 glucose (or maltodextrin): fructose blend from which an athlete can choose. We recommend checking the label on any sports product to determine the types of sugars used. If choosing whole foods, fruits and fruit juices do provide a blend of glucose and fructose but the exact ratio will depend upon the specific fruit. The concentration of those sugars within the juice and fruit may be greater than can be tolerated during exercise.  As with any fueling strategy, test out the use of any products in training.


    Q: Do you have any suggestion for amateur athletes who travel abroad to compete when they will have a different sports drink than the one they're use to (because of a sponsor of the competition) and they didn't get the chance to try it before?

    Athletes should practice their fueling strategy throughout their training.  They should create and use the fuel and hydration plan for competition during some of their longer training sessions to make sure that it provides all the benefit with minimal side effects (i.e., sloshing stomach, bloating, stomach upset).  They should plan to either practice with the products on course or plan to bring their own fuel for their competition.  Their strategies should also include the timing to eat and drink the products they chose. Powdered forms of sports drinks may be easier to transport to foreign countries and can be reconstituted for use during the race.


    Q: How to advise the athlete re: hydration real-time when conditions change during a long endurance event?

    Athletes sweat profiles (or the amount of fluid and electrolytes they lose) will vary based on the temperature and humidity and the exercise intensity.  Endurance athletes should make “sweat testing” a regular part of their training.  To figure out sweat fluid losses, athletes should weigh themselves before and after exercise.  Additional details on this testing and a calculator can be found at https://www.gssiweb.org/toolbox/fluidLoss/calculator. This way an athlete will understand how his/her fluid losses change as exercise duration/intensity/climate change and can make decision on adjustments to hydration plans “on the fly.” 


    Q: Does sodium loss differ statistically more or less in either cool/warm environment versus low/high intensity settings?

    Sweat electrolyte losses vary the same as fluid losses and tend to follow the same trends with athletes losing more electrolytes as exercise intensity and climate increase.  They are also very individual but are both statistically significant.  Therefore, we recommend athletes who are exercising for more than 2 hours and those who have salt residue on their skin and clothing during even moderate-intensity exercise should plan to take additional electrolytes as part of their fueling plan.


    Q: How does the athlete know that they are "optimally" hydrated?  To know the starting body weight against which to judge that they have lost more than 2% of body weight to know that their performance can decline?

    This would necessitate an athlete doing a “sweat test” and measuring their body mass before and after exercise. If the athlete replaces what they have lost through sweat, based upon body mass loss from the sweat test, and then attempt to keep urine color light like lemonade throughout the remainder of the day, they generally can assume that they are hydrated going into the next training session.


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  • Nutrition Spotlight | CEC Bundle

    by David Barr | Oct 14, 2019

    ACSM's Health & Fitness Journal®: The Nutritionist's View CEC Course Bundle 

    Available ACSM CECs: 9.0

    Nutrition Quiz ACSM 

    Stay on top of the hot nutrition topics in the industry by taking advantage of this continuing education opportunity.

    Description:

    The Nutritionist's View column is written by a nutrition expert and covers an important nutrition topic in each column with the intent to provide practical information the health and fitness professional can put into immediate practice.

    This course includes online articles from ACSM's Health & Fitness Journal® and corresponding online quizzes.


    This continuing education course combines various Nutritionist's View columns on essential topics such as:

    • fruit and vegetable intake
    • intermittent fasting
    • food insecurity
    • gluten-free diets
    • nutrition and brain health
    • turmeric and osteoarthritis
    • gut microbiota
    • carbohydrate and caffeine mouth rinsing and exercise performance
    • dairy protein in the management of type 2 diabetes mellitus
     

    Purchase the bundle and earn CECs

    ACSM Members save 50% - Join Today


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  • Russian Twist Technique Video | ACSM’s Foundations of Strength Training and Conditioning

    by David Barr | Oct 11, 2019

    Foundations of Strength Training and Conditioning

    Exercise technique videos, like the Russian Twist below, are one key feature of ACSM’s Foundations of Strength Training and Conditioning

    As an exercise professional, you need to know how to translate the scientific information of physiology and kinesiology into practical application so that you can help your clients put your knowledge into practice. ACSM’s Foundations of Strength Training and Conditioning offers a comprehensive look at the essentials of strength training and conditioning based on solid research findings. It also provides practical applications in a clear writing style so that you can easily grasp new concepts.

    Features to bridge the gap between scientific study and professional practice include:

    • Interpreting Research boxes explore research findings and application to the field
    • Myths and Misconceptions boxes debunk myths and clarify misconceptions
    • Exercise boxes provide step-by-step instructions and photos to guide you through proper positioning and movement

    Did you know that many ACSM books include access to online-only features, including video clips?
    For ACSM’s Foundations of Strength Training and Conditioning, you don’t want to miss demonstrations of proper technique for the stiff leg deadlift, sit-up with barbell press or the stability ball trunk rotation. Check out this sample video. 

    To take advantage of this online-only content included with your book, use the access code and link on the inside cover. To see other ACSM publications, go to the Books page or ACSM Resource Library and filter by the Publication format

    Updates to book content can be found at the Updates to ACSM Books page.

    Learn more or purchase on our publisher's page


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  • Understanding the Physical Inactivity Epidemic | CEC Quiz

    by David Barr | Oct 09, 2019

    ACSM's Health & Fitness Journal®: September - October 2019 CEC Course #1: Houston, We Have a (Physical Activity) Problem

    Available ACSM CECs: 2.0

    Physical Activity Quiz ACSM 

    Action Message: Innovative strategies from health and fitness professionals are needed to promote physical activity throughout the day.

    Description:

    This course includes an online article from ACSM's Health & Fitness Journal® and a corresponding online quiz.


    3 Learning Objectives for Houston, We Have a (Physical Activity) Problem:

    • Physical activity is associated with several health and well-being benefits, but current levels of daily physical activity are at an all-time low.
    • Daily physical activity has decreased over the years due to declining lifestyle physical activity levels.
    • Innovative strategies from health and fitness professionals are needed to promote physical activity throughout the day.

    Read the free article

    Purchase the course and earn CECs

    Bundle quizzes and save 50%


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