Exercise, Injury & Creatine: Updates from ACSM

Each year, more than 5.000 health professionals gather at the Annual Meeting of the American College of Sports Medicine (ACSM; www.acsm.org). At this year’s meeting (Denver, June 1-4, 2011), exercise physiologists, sports medicine doctors, and sports nutritionists shared their research and offered updates. Here are three updates that might be of interest.

The Power of Exercise

“Exercise is medicine” is the slogan for ACSM’s public health campaign to teach people the importance of living an active lifestyle “Exercise is better than medicine” would also be a good slogan! According to Dr. Karim Khan of the University of British Columbia, lack of physical activity is the biggest public health problem in the 21st Century. (I know, I am “preaching to the choir” because you are undoubtedly already active. But I’m sure you have friends and loved ones who spend too much time on the couch. Please pass along this message along to them.)

We know that exercise can reduce the risk of heart disease, certain cancers, dementia, and other diseases of aging. But what most people don’t know is 16% of North Americans will die from low fitness/sedentary lifestyle. That’s more than the 14% of people who will die from “smokerdiabesity” (smoking, diabetes, and obesity combined). (1)

If exercise is so good for us, why are so many people failing to exercise regularly? And how can we get them to exercise by choice? Incentives work in the short term. That is, employees who get a discount on their health insurance premium will initiate an exercise program. But in the long term, people maintain an exercise program if it gives them pleasure, makes them feel good about themselves, improves their mood, and offers friendship.

Wanna-be exercisers should take weight loss out of the equation. That is, if they are exercising just to lose weight, what happens when they reach their goal? They’ll still need to keep exercising to maintain that fat loss, so they had better start a program they are interested in enjoying for the rest of their lives!

Just as MDs monitor blood pressure and weight, they should also monitor physical activity. Thanks to ACSM’s Exercise is Medicine campaign, doctors are now being encouraged to prescribe exercise to their overfat, underfit, (pre)diabetic clients, telling them how often, how hard, and how long to exercise. This written prescription has been shown to help improve exercise compliance.

Nutrition for injuries

Unfortunately, part of living an active lifestyle seems to entail being injured; no fun. Athletes with injuries should pay attention to their diet. If they are petrified of gaining weight (yes, petrified is a strong word, but it seems fitting to many injured athletes who seek my counsel), they may severely restrict their food intake. One runner hobbled into my office saying, “I haven’t eaten in two days because I can’t run…”

While injured athletes do require fewer calories if they are exercising less than usual, they still need to eat an appropriate amount of fuel. Injuries heal best with proper nourishment. For example, if you have had surgery (such as to repair a torn ligament), your metabolic rate might increase up to 20%. Using crutches increases energy expenditure by 5 to 8%. If a wound happens to get infected, metabolic rate can increase by 50%.

When injured, you want to eat mindfully, so that you eat enough calories—but not too many calories. Before you put food into your mouth, ask yourself: “Does my body need this fuel? … Will this food provide nutrients to help my injury heal?” Your mind may want excessive treats to comfort your sorrow, but the nutrient-poor cookies that help you feel happier for a moment can contribute to undesired fat gain that will increase your misery for the long run.

If you have ever had a broken bone, you have seen first-hand the muscle wasting that occurs when, let’s say, a leg has been in a cast for 6 to 8 weeks. The good news is, according to Dr. Stuart Phillips of McMaster University, muscle strength and power returns quicker than muscle size. You can minimize excessive muscle loss by eating adequate protein. The typical (and adequate) protein intake is 0.5 g protein per pound of body weight per day ((1.1g/kg/day). During recovery, a better target is about 0.7 g pro/lb (1.6 g/kg). For a 150-pound athlete, that’s 75 to 105 g protein for the day, an amount easily obtained through your diet. Simply choose a protein-rich food at each meal and snack throughout the day to help maximize healing and minimize muscle loss.

Creatine and health

Creatine has been shown to enhance performance in sports that require short bursts of energy (including ice hockey, sprinting, soccer, weight lifting). The question arises: Is creatine harmful? According to Eric Rawson, PhD of Bloomsburg University in PA, creatine is safe. Although critics have tried to implicate creatine in athletic events that resulted in death, other factors were involved, such as excessive exercise in extreme heat (2, 3, 4).

The NCAA and other sports organizations discourage the use of creatine in teenage athletes. Teens who take creatine while their bodies are growing will never know how well they could have performed with simply a good sports diet and hard work. The question arises: Will athletes who take creatine be enticed to try other ergogenic aids, such as harmful and illegal steroids? The answer is unknown.

On a daily basis, the brain uses creatine to help us think and process. (Thinking requires quick energy, and creatine enhances that metabolic pathway.) Taking creatine supplements can increase brain creatine by 4 to 9%.

When the brain is tired, as happens with sleep-deprivation, creatine may be able to enhance brain function. For example, sleep deprived rugby players who took creatine improved their accuracy when throwing a ball (compared to those who did not take creatine). The effect was similar to if they had taken caffeine, another alertness-heightener (5).

Creatine might be helpful for athletes who suffer a concussion. Research with animals suggests taking creatine pre-concussion enhances recovery (6). Granted, few athletes know when they will get a concussion, but anecdotes tell us that hockey players who routinely take creatine (and have higher brain creatine status than athletes who do not take creatine) report enhanced recovery. In certain medical situations (such as muscular dystrophy, Parkinson’s disease), creatine can also have a health-protective role.

Copyright: Nancy Clark MS RD CSSD June 2011

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels casual and competitive athletes in her practice at Healthworks, the premier fitness center in Chestnut Hill MA (617-383-6100). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players are available at www.nancyclarkrd.com. See also sportsnutritionworkshop.com for her upcoming Western US workshops.

A cyclist’s endurance is limited by one thing: the gradual depletion of stored glycogen. Over the course of a long ride, the glycogen levels decline and the body begins to depend more on blood glucose for fuel. If you keep riding on “empty” you will become lightheaded, dizzy and fatigued and you will “bonk.” The body needs to keep up those sugar levels with some carbohydrates. Often cyclists have an energy drinks with just enough carbs to keep going for rides that last a couple hours.

BUT for the long rides of 2½ -3 hours and longer, cyclists need solid food. There are a lot of “energy bars” on the market that are convenient to buy and take along and they work very well. Yet one personal experience made me wish for more than just an energy bar. Last month after a long 4-hour strenuous ride with sprints and climbs and with another 40 minutes to go, I just couldn’t choke down my sugary energy bar; I craved “real” food.

Bananas, bagels and peanut butter sandwiches are often the go-to foods for endurance cyclists and I wondered if there were other great choices of quick energizing real food that is packable for cyclists. I asked sports dietician Kristi Spence for more ideas and these are her suggestions:

•  Baby new potatoes rolled in a salt and herb mixture
• Small white rolls filled with 100% fruit jam 
•  Fig Newtons
•  Pretzels
•  Homemade peanut butter cookies
• Zucchini or pumpkin bread (made with applesauce or extra fruit and less oil
• Squeezable applesauce pouches (they make little ones that are easy to eat for kids)

We have a few other homemade ideas as well. Check out the recipe for Pumpkin Energy Bars and Island Cruiser Mix—both are great take-along foods for the long ride.
 
For a long day in the saddle, you’ll need to pack enough food. In the years I trained for long-course triathlons, I learned to appreciate having a FuelBelt Fuelbox on my bike. For long rides they can conveniently carry food and even a cell phone.  It is often easier to access items in the fuel box than in a back jersey pocket. For a very long unsupported ride, I can cram food both in my jersey pockets and my Fuelbox and I’m set.

A Contest!

 
Fuelbelt has graciously provided 3 Fuelboxes (in black, pink & red) for a give-away for readers of Cycle & Style. We’d love your feedback on this article. What foods get you or your friends through a long ride? Tell us about your experiences (good or bad.) Your comment below (with a valid e-mail) will be your entry for the FUELBOX CONTEST.
Contest runs from today until September 17^th.  Three lucky winners will receive a large-size Fuelbelt FUELBOX (large enough to easily hold a sandwich) and Fuelbelt Water Bottle. (I can only mail within the US or Canada.)

A healthy breakfast before your long ride can give you the energy needed for the day. The alternative is low blood sugar levels and the possibility of feeling lightheaded. If you are heading out on your ride soon after breakfast, you want something that will not upset your stomach and will give you a good nutritional start on the day.

For a long day in the bike saddle, you will still want to pack some food to keep you going all day such as sandwiches, easy-to-eat fruit and energy bars or drinks. After your workout, you’ll want to eat right to help your muscles recover and replace their glycogen stores. You’ll want something with both protein and carbohydrates within 2 hours after your workout to help your body recover.

Pre-Ride Smoothie

This healthy smoothie is easy to make in the morning and it is easily digestible so I can eat it within 30 minutes of leaving for my ride!

• 1 cup fat-free milk (or soy milk)
• 1 small banana
• ½ cup frozen berries,
• 2 teaspoons greens supplement*
• 2 teaspoons ground flax seeds
• Sweetener to taste (honey, sugar or Splenda)

Blend until smooth and creamy and then serve. Makes 1 serving.

Calories (not including sweetener): 270 calories, 11 g. protein, plus lots of vitamins including antioxidants. 

*A greens supplement is a good idea if you aren’t one of those who eats enough vegetables—just put a little in your smoothie! (If you don’t have any on hand, consider it optional, but you may want to get some in the near future.) Many types and brands are available at stores like Trader Joe’s, Whole Foods and health food sections of large grocery stores. 

Long Ride Recovery Smoothie

This smoothie is filled with protein, heart-healthy fats, and some iron to help your muscles recover after a hard-workout. This was my main recovery drink when I trained for my Half-Iron triathlon—and I didn’t have the usual muscle soreness.

• 1 small banana
• 1 tbsp natural peanut butter or almond butter
• 2 tbsp unsweetened cocoa
• ¾ cup fat-free milk (or soy milk)
• ½ cup ice
• 1 tbsp flaxseed, ground
• 1 tbsp wheat germ, ground
• Sweetener to taste (honey, sugar or Splenda)

Blend until smooth and creamy and then serve. Makes 1 serving.

Calories (determined w/ Splenda): 350 calories, 16 g. protein, 9 g. fiber, 40 g. carbs

Love chocolate? These brownie-like bars have protein, nutrition and a great chocolate-y taste! They are perfect to pack for your next adventure.

Chocolate Energy Bars

• 6 oz. semi-sweet chocolate chips or dark chocolate
• 3 tablespoons butter
• ½ cup rolled oats
• ½ cup dry non-fat milk
• ¼ cup ground flax
• ¼ cup toasted wheat germ
• ¼ cup soy flour
• ½ teaspoon baking powder
• 1 cup chopped walnuts
• ½ cup Egg beaters or egg whites (4)
• ½ cup brown sugar, packed
• 1 teaspoon vanilla
• 1/3 cup chopped dried cherries (add more if you love them)

Preheat the oven to 350 degrees. Melt the chocolate chips and butter together in a microwavable dish, in a microwave oven. It may take 45 seconds or more. Blend well and set aside. Combine dry ingredients together in a medium-sized bowl: oats through walnuts and mix well. In a large bowl, lightly beat the egg whites and add the sugar and vanilla and beat. Stir in the flour mixture and chocolate mixture and fold in the chopped dried cherries. Pour chocolate mixture into an 8 x 8-inch pan that has been lightly sprayed with baking spray. Bake at 350 degrees for about 30 minutes. Cool completely before cutting. This recipe makes an even dozen. (They can be deliciously fudgy, but you may wish to cut them and chill in the refrigerator to make a little more neat & pack-able.)

“100 calories can power a cyclist for three miles; 100 calories can power a car for 280 feet.”

Pumpkin Energy Bars

Fall has the perfect weather for cycling: temperate weather that is neither too hot, nor too cold. These are the perfect weeks to go out for a long weekend ride on your bicycle. Should you bring along a little food to sustain your energy? A general rule of thumb is that for a ride of at least 2 hours, you’ll need to bring some food: perhaps a banana, PB & J sandwich or an “energy bar” to avoiding “bonking” (i.e. totally running out of energy.) Don’t forget to bring a full water bottle to stay hydrated!  Yes, you can make your own energy bars for your next long ride! Here is one made just for a golden autumn afternoon bicycle ride!  

Pumpkin Energy Bars

• ½ cup canned pumpkin
• ½ cup packed brown sugar
• 1 tablespoon canola oil
• ½ teaspoon vanilla extract
• 1 egg
• ½ cup flour
• ¾ teaspoon pumpkin pie spice*
• ½ teaspoon salt
• 1 cup rolled oats or quick-cooking oatmeal
•  ¼ cup ground milled flaxseed**
• ¼ cup chopped nuts

Preheat the oven to 350 degrees. In a medium bowl, beat together pumpkin, sugar, oil, vanilla and egg. Gradually add flour, spice, salt, oatmeal, flaxseed, and nuts and stir until well blended. Spoon into an 8 x 8-inch square pan that has been sprayed with cooking spray. Bake at 350 for 22-25 minutes.Cool completely on wire rack Cut into bars. If you cut them into 9 bars, each bar will be less than 200 calories and have nearly 4 grams of protein. They keep for several days if well wrapped and actually taste better the next day.*A substitute for the pumpkin pie spice: ½ teaspoon cinnamon, ¼ teaspoon nutmeg, 1/8 teaspoon ginger.**If you don’t have ground flax seed you can substitute oatmeal. The protein count won’t be as high. Remember, pumpkin adds some great nutriton as well!

For more on ideas for homemade food for long bike rides check out “Real Food for the Long Ride.” 

For another great pumpkin recipe for cyclists, see our recipe for a Pumpkin Protein Smoothie!

Homemade Pumpkin Energy Bars