RECOVERY FROM EXERCISE: IMPORTANCE OF NUTRIENT TIMING AND COMPOSITION

1
RECOVERY FROM EXERCISE IMPORTANCE OF NUTRIENT
TIMING AND COMPOSITION

• John L. Ivy
• The University of Texas at Austin
• Austin, Texas

2
POST EXERCISE ENVIRONMENT

• Body is in a catabolic state
• Dehydrated
• Blood glucose and insulin are low
• Cortisol and catecholamines are elevated
• Creatine phosphate is low
• Muscle and liver glycogen depleted
• Immune system suppressed

3
NUTRIENT TIMING INTERVENTION
INSULIN SENSITIVE
NORMAL INSULIN SENSITIVITY
INSULIN RESISTANT
Exercise (ENERGY)
Post-Exercise (ANABOLIC)
Remainder of the Day (GROWTH)
4
Closing of Metabolic Window
100
80
Potential Anabolic Activity (percent)
60
40
20
0
0
15
30
45
60
75
90
120
Minutes
Without nutrient intervention, the metabolic
window begins to close within forty-five minutes
following exercise.
5
THREE MAJOR CONSIDERATIONS FOR RECOVERY FROM
EXHAUSTIVE EXERCISE

• A. Rehydration and electrolyte replacement
• B. Replenishment of muscle glycogen stores
• C. Initiation of protein synthesis and muscle
  tissue repair

6
RECOVERY OF MUSCLE GLYCOGEN STORES
7
INTRODUCTION

• Muscle glycogen is essential for prolonged
  intense aerobic exercise.

8
Muscle Glycogen Fat Blood Glucose
20
15
Energy Expenditure Calories min-1
10
5
0
25
75
50
100
Exercise Intensity VO2max
9
Timing of Carbohydrate Supplementation
10
HYPOTHESIS

• The time of consumption of a carbohydrate
  supplement post exercise will have a significant
  impact on the rate of muscle glycogen storage

Ivy et al., J. Appl. Physiol. 1988.
11
PROTOCOL

• Exercised subjects at 70 VO2max for 2 h to
  deplete glycogen stores
• Provided 2g CHO/kg body wt either immediately
  after exercise or 2 h after exercise
• Muscle biopsies performed immediately and 2 h
  post supplement

Ivy et al., J. Appl. Physiol. 1988.
12

Glycogen Storage (µmol g-1 wet wt 2h-1)
Ivy et al., J. Appl. Physiol. 1988.
13
Amount and Sequence of Carbohydrate
Supplementation
14
HYPOTHESIS

• A rapid rate of muscle glycogen storage can be
  maintained if CHO supplements are provided
  periodically.
• There is an amount of carbohydrate consumption
  that is optimal for muscle glycogen storage

15
Protocol
Treatments Oral consumption of 1.4 g CHO
immediately post exercise and 2 and 4 hours post
exercise Exercise Cycling 2h with the exercise
intensity alternating between 60 and 75 VO2max
every 15 minutes Muscle Biopsies Immediately,
2h and 4h post-exercise
16
40
1.40g/kg
Increase in Muscle Glycogen Concentration (mmol
kg-1 wet weight)
20
0
0
2
4
6
TIME (h)
Blom et al., MSSE 1987.
17
Ivy. Int. J. Sports. Med. 1998.
18
What Limits Carbohydrate Storage as Glycogen?

19
Protocol
Treatments 1) Oral consumption of 1.5g CHO
immediately post exercise and 2 hours post
exercise in liquid or solid form 2) Infusion of
glucose continuously for 3.75 hours (225 minutes)
starting immediately post-exercise Exercise Cycli
ng 2h with the exercise intensity alternating
between 60 and 75 VO2max every 15 minutes
Muscle Biopsies Immediately, 2h and 4h
post-exercise
20
180
140
BLOOD GLUCOSE mg/100 ml
100
60
20
0
40
80
120
160
200
240
280
Exercise 120 min
MINUTES OF RECOVERY
21
20
L S I
15
GLYCOGEN STORAGE µmol/g wet wt
10
5
0
0-120
120-240
MINUTES OF RECOVERY
22
150
125
100
PLASMA INSULIN µU/ml
75
50
25
0
0
40
80
120
160
200
240
280
Exercise 120 min
MINUTES OF RECOVERY
23
Carbohydrate Protein Supplementation
24
HYPOTHESIS

• The addition of protein to a carbohydrate
  supplement will enhance the blood insulin
  response and accelerate muscle glycogen synthesis.

Zawadzki et al. J. Appl. Physiol. 1992.
25
PROTOCOL
Treatments 1) 112g CHO and 40.7g protein
immediately post and 2h post exercise 2) 112g
CHO immediately post and 2h post
exercise 3) 40.7g protein immediately post and
2h post exercise Exercise Cycling 90 min with
the exercise intensity alternating between 65
and 75 VO2max, last 15 min. alternating between
50 and 85 VO2max Muscle biopsies Immediately
and 4h post exercise
Zawadzki et al. J. Appl. Physiol. 1992.
26
Zawadzki et al. J. Appl. Physiol. 1992.
27
8
CHO-PRO CHO PRO


7




6


GLUCOSE (mM)




5

4
3
120
PRE
POST
30
60
90
150
180
210
240
TIME (min)
Zawadzki et al. J. Appl. Physiol. 1992.
28
38 storage
40
30
Muscle Glycogen Storage (µmol/g)
20
10
0
CHO-PRO
CHO
PRO
TREATMENTS
Zawadzki et al. J. Appl. Physiol. 1992.
29
COMPARE ISOCALORIC CHO AND CHO-PROTEIN SUPPLEMENTS

• Treatments
• 1) 112g CHO and 40.7g protein immediately post
  and 2h post exercise
• 2) 112g CHO immediately post and 2h post
  exercise
• 3) 160g CHO immediately post and 2h post
  exercise
• Exercise
• Cycling 120 min 70 VO2max, sprints until blood
  glucose is below 68 mg.
• Glycogen measurement
• NMRS

Ivy et al. J. Appl. Physiol. 2002.
30
50
40 greater storage
55 greater storage
40
30
Glycogen Storage (mmol/l/4h)
20
10
0
CHO-PRO
HCHO
LCHO
Ivy et al. J. Appl. Physiol. 2002.
31
Recovery of Depleted Glycogen
Ivy et al. J. Appl. Physiol. 2002.
32
7
6
5
GLYCOGEN SYNTHESIS (µmol/g/h)
4
3
2
1
0
CHO SUPPLEMENT g/kg body wt
Ivy. Int. J. Sports. Med. 1998.
33
RECOMMENDATION

• A. Consume a CHO supplement immediately after
  exercise and continue at regular intervals for
  several hours.
• B. Supplement should contain 1.2-1.4 g CHO/kg
  body wt.
• C. The addition of protein (.3-.5 g/kg body wt)
  will increase the effectiveness of the supplement
  to replenish muscle glycogen.

34
STIMULATION OF PROTEIN SYNTHESIS AND MUSCLE
TISSUE REPAIR
35
Effect of Amino Acids on Protein Synthesis
36
HYPOTHESIS

• An increase in blood amino acids at rest or after
  exercise will stimulate muscle protein synthesis

Biolo et al., Am. J. Physiol. 1997.
37
AMINO ACIDS SUPPLY AND PROTEIN SYNTHESIS

• Intravenous infusion of a balanced amino acid
  mixture at rest and after a leg resistance
  exercise

Biolo et al., Am. J. Physiol. 1997.
38
400

300
200
Change from Basal
100
0
AA (Rest)
AA (Post-exercise)
Protein Synthesis
Biolo et al., Am. J. Physiol. 1997.
39
Effect of Carbohydrate on Protein Synthesis
40
Experimental Design
1. Subjects performed unilateral knee extensor
exercise 2. Received 1 g/kg carbohydrate
supplement or placebo 3. Immediately and 1 hour
post exercise protein synthesis was
determined for Exercised and Control limbs
by incremental L-1-13Cleucine enrichment
into the vastus lateralis over 10 hours
post exercise
Roy, B.D. et al., J. Appl Physiol. 1997.
41
Values are means SE for 1st 2.5h postexercise
n8. Plt0.01 between 2 conditions.
Roy, B.D. et al., J. Appl Physiol. 1997.
42
Urine results (24h). Values are means SE n8
creat, Creatinine. Plt0.01 between 2 conditions.
Roy, B.D., et al. J. Appl Physiol. 1997.
43
Values are means SE n8, MPS, Muscle Protein
Synthetic rate
Roy, B.D., et al. J. Appl Physiol. 1997.
44
Effect of Insulin on Muscle Protein Synthesis
45
AMINO ACID-CHO SUPPLEMENT AND PROTEIN ANABOLISM

• Supplement containing 6 g essential amino acids
  and 35 g sucrose
• Given 1 h after exercise

Rasmussen et al., Am. J. Physiol. 2000.
46
60
EAA 1 hr No Supplement
50
40
Insulin (uU/ml)
30
20
10
0
-200
-150
-100
-50
0
50
100
150
200
250
Minutes Post Exercise
Rasmussen et al., Am. J. Physiol. 2000.
47
Supplement 1 h after exercise
Protein Breakdown (nmolmin-1100 ml leg volume-1)
No Supplement
Protein Breakdown (nmolmin-1100 ml leg volume-1)
0-1
1-2
2-3
(Hours Post Exercise)
Rasmussen et al., Am. J. Physiol. 2000.
48

Supplement 1 h after exercise
Protein Synthesis (nmolmin-1100 ml leg volume-1)
No Supplement
Protein Synthesis (nmolmin-1100 ml leg volume-1)
0-1
1-2
2-3
(Hours Post Exercise)
Rasmussen et al., Am. J. Physiol. 2000.
49

125
Supplement 1 h after exercise
100
75
Net Balance (nmolmin-1100 ml leg volume-1)
50
25
75
50
25
0
125
No Supplement
100
75
Net Balance (nmolmin-1100 ml leg volume-1)
50
25
0
-25
-50
0-1
1-2
2-3
Hours Post Exercise
Rasmussen et al., Am. J. Physiol. 2000.
50
Interaction of Amino Acids and Insulin on Muscle
Protein Synthesis
51
HYPOTHESIS

• The combination of an amino acid and
  carbohydrate supplement post exercise will
  stimulate protein synthesis more effectively than
  either a carbohydrate or amino acid supplement
  alone.

Miller, S.L. et al., Med. Sci. Sports Exerc.
2003.
52
EXPERIMENTAL PROTOCOL

• Exercise was performed by weightlifting
• Immediately after exercise and 1 hour after
  exercise 6 g of an essential amino acid mix and
  30 g CHO were provided
• Protein synthesis and degradation were determined
  for the first 3 hours post exercise

Miller, S.L. et al., Med. Sci. Sports Exerc.
2003.
53
180
160
140
120
Net Phenylalanine Uptake (mg / 3h / leg)
100
80
60
40
20
0
MIX
CHO
AA
Miller, S.L. et al., Med. Sci. Sports Exerc.
2003.
54
Timing of CHO/Protein Supplementation
55
EXPERIMENTAL PROTOCOL

• Exercise - 60 VO2max for 60 min
• Supplement - 10g protein, 8g CHO and 3g fat
• Times of supplement administration - immediately
  after exercise or 3 hours after exercise
• Protein synthesis and proteolysis were measured 3
  hours after supplementation

Levenhagen D.K., et al. Am. J. Physiol.
Endocrinol. Metab. 2001.
56
Basal Early Late
300

250
200
150

Leg Protein Dynamics (µg min-1 100cc-1)
100
50
0
-50
-100
Protein Breakdown
Protein Synthesis
Net Balance
Levenhagen D.K. et al., Am. J. Physiol.
Endocrinol. Metab. 2001.
57
RECOMMENDATIONS

• A. To stimulate muscle protein synthesis post
  exercise consume a protein or amino acid
  supplementation.
• B. The addition of CHO to the protein supplement
  will enhance the effectiveness of the supplement
  to promote protein accretion,tissue repair and
  growth.
• C. The supplement should be consumed within the
  first hour post exercise.

58
HOW DOES A CARBOHYRATE-PROTEIN SUPPLEMENT WORK
ADDITIVELY?
59
Interactions of Insulin Amino Acids
Insulin
Amino Acids
PI-3 Kinase
mTOR
elF4F
PP2A
Akt
P70 s6k
GLUT4 Translocation
GSK3
S6
GS
Glycogen Storage
Glucose Transport
Protein Translation
60
Experimental Protocol

• Subjects cycled for 50 minutes at 70 VO2max and
  10 minutes of sprint work
• Received a placebo or CHO/PRO supplement
  immediately post-exercise and 15 minutes post
  exercise
• Muscle biopsies performed immediately before
  exercise and 45 minutes post exercise

61
Akt

140
120
100
80
Relative Units
60
40
20
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
62
mTOR

80
70
60
50
Relative Units
40
30
20
10
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
63
p70s6k
120

100
80
Relative Units
60
40
20
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
64
GSK3a/b
120

100
80
Relative Units
60
40
20
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
65
GS
180
160
140
120

100
Relative Units
80

60
40
20
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
66
rs6

45
40
35

30
25
Relative Units
20
15
10
5
0
PRE
POST
PRE
POST
Placebo
CHO/PRO
67
EFFECT OF A CHO/PROTEIN SUPPLEMENT ON RECOVERY
AND PERFORMANCE
68
STUDY 1

• Williams, M.B., P.B. Raven, D.L. Fogt and J.L.
  Ivy. Effects of recovery beverages on glucose
  restoration and endurance exercise performance.
  Journal of Strength and Conditioning Research 17
  12-19, 2003.

69
HYPOTHESIS

• A CHO/protein supplement compared with a
  traditional sports drink will speed recovery and
  enhance subsequent physical performance

Williams, M.B., et al. J. Strength Cond. Res.
2003.
70
PROTOCOL

• A. Muscle glycogen was depleted with 2h of
  cycling at 70 VO2max plus sprints
• B. Subjects received 12 oz of a CHO/protein
  supplement or a traditional sports drink
  immediately post and 2h post exercise
• C. Muscle biopsies were performed immediately
  post and 4h post exercise
• D. 4h post exercise subjects cycled to
  exhaustion at 80 VO2max

Williams, M.B., et al. J. Strength Cond. Res.
2003.
71
Williams, M.B., et al. J. Strength Cond. Res.
2003.
72
110
CHO-PRO Sports Drink

100

90
GLUCOSE (mg/dl)
80
70
60
50
120
PRE
POST
30
60
90
150
180
210
240
TIME (min)
Williams, M.B., et al. J. Strength Cond. Res.
2003.
73
Williams, M.B. et al., J. Strength Cond. Res.
2003.
74
55 greater performance with no difference in
hydration
40

Minutes of Exercise Following Recovery
30
20
10
Sports Drink
CHO-PRO
Williams, M.B., et al. J. Strength Cond. Res.
2003.
75
STUDY 2

• Saunders, M.J., et al. Effects of a
  cabohydrate-protein beverage on cycling endurance
  and muscle damage. MSSE (In Press)

76
Time Course of Study Protocol
Treatment 1 (CHO)
Treatment 2 (CHO-PRO)
Ride to fatigue at 75 VO2peak
Ride to fatigue at 85 VO2peak
Ride to fatigue at 75 VO2peak
Ride to fatigue at 85 VO2peak
12-15 hours
7-14 days
12-15 hours
Supplements 1.8 ml/kg every 15 min during
exercise and 10 ml/kg within 30 minutes post
exercise
Saunders, M.J., et al., MSSE, In Press.
77
Supplement Composition Carbohydrate/Protein
supplement contained 7.3 carbohydrate and
1.8 protein Carbohydrate supplement
contained 7.3 carbohydrate Both supplements
containedelectrolytes
Saunders, M.J., et al., MSSE, In Press.
78
Significantly greater (plt0.05) than CHO Ride.
Saunders, M.J., et al., MSSE, In Press.
79
Significantly lower (plt0.05) than CHO Ride.
Saunders, M.J., et al., MSSE, In Press.
80
CONCLUSION

• A CHO/PRO drink following glycogen depleting
  exercise will facilitate a greater rate of muscle
  glycogen synthesis than a CHO only beverage,
  hasten the recovery process and improve exercise
  endurance during a second bout of exercise
  performed on the same day. The addition of
  protein to a carbohydrate supplement also may be
  beneficial during exercise.

81
FINAL REMARKS

• A. CHO/protein supplements maximize muscle
  glycogen storage and protein synthesis post
  exercise
• B. The rapid replacement of carbohydrate and
  protein will limit tissue damage, speed recovery
  and improved subsequent physical performance
• C. For optimal results the CHO/protein
  supplements should provide 1.2-1.4g CHO and
  .3-.5g protein per kg body weight at 2 hour
  intervals

82
Impact of Exercise Type on Gene Expression
Aerobic Exercise
Resistance Exercise
Aerobic Load, Hormones, Nutrient Levels
Muscle Energy Load, Hormones, Nutrient Levels
DNA
Transcription
Messenger RNA
Translation
Contractile Protein
Mitochondrial Protein