A nutritional intervention for moderate altitude endurance preparation: A case report

Full Te ms & Condi ions o access and use can be ound a h ps://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode= ssn20 Jou nal o he In e na ional Socie y o Spo s Nu i ion ISSN: (P in ) (Online) Jou nal homepage: h ps://www. and online.com/loi/ ssn20 A nu i ional in e en ion o mode a e al i ude endu ance p epa a ion: A case epo Juan J. Gue e o-Pinzón, Juan M.A. Alcan a a, Gus a o Ga cía-Buendia, Sol Mochón-Benguigui, Mau icio Ramí ez-Maldonado, Jona an R. Ruiz & Lucas Ju ado-Fasoli To ci e his a icle: Juan J. Gue e o-Pinzón, Juan M.A. Alcan a a, Gus a o Ga cía-Buendia, Sol Mochón-Benguigui, Mau icio Ramí ez-Maldonado, Jona an R. Ruiz & Lucas Ju ado-Fasoli (2022) A nu i ional in e en ion o mode a e al i ude endu ance p epa a ion: A case epo , Jou nal o he In e na ional Socie y o Spo s Nu i ion, 19:1, 650-663, DOI: 10.1080/15502783.2022.2140596 To link o his a icle: h ps://doi.o g/10.1080/15502783.2022.2140596 © 2022 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup. View supplemen a y ma e ial Published online: 16 No 2022. Submi you a icle o his jou nal A icle iews: 360 View ela ed a icles View C ossma k da a A nu i ional in e en ion o mode a e al i ude endu ance p epa a ion: A case epo Juan J. Gue e o-Pinzón a , Juan M.A. Alcan a a a , Gus a o Ga cía-Buendia b , Sol Mochón-Benguigui c , Mau icio Ramí ez-Maldonado a , Jona an R. Ruiz a,d and Lucas Ju ado-Fasoli a,c a PROmo ing FITness and Heal h h ough Physical Ac i i y Resea ch G oup (PROFITH), Spo and Heal h Uni e si y Resea ch Ins i u e (iMUDS), Uni e si y o G anada, Depa men o Physical Educa ion and Spo s, Facul y o Spo Sciences, G anada, Spain; b Uni e si y o G anada, Depa men Physical Educa ion and Spo s, Facul y o Spo Sciences, G anada, Spain; c Uni e si y o G anada, Depa men o Physiology. Facul y o Medicine, G anada, Spain; d Ins i u o de In es igación Biosani a ia, ibs.G anada, G anada, Spain ABSTRACT Backg ound: Mode a e al i udes ca y physiological and me abolic changes ha can dampen exe cise pe o mance. Fo una ely, hese changes can be modula ed by an op imal nu i ional in e en ion. This case s udy ep esen s he i s nu i ional in e en ion o a mode a e al i ude a hle e. These esul s may help o es ablish well-designed nu i ional guidelines o mode a e al i ude spo s a hle es. Case p esen a ion: This case s udy examined he e ec s o a 11- week nu i ional in e en ion on body composi ion, muscle s eng h, ca dio espi a o y i ness, es ing and exe cise nu ien oxida ion, and subjec i e sleep quali y, in a male high-le el mode - a e al i ude a hle e wi h a e y ligh non-exe cise ac i i y he mo- genesis. Du ing he 11-week o nu i ional in e en ion, 2800-3500 kcal/day, 6.8-8.9 g/kg/day o ca bohyd a es, 1.2-1.7 g/kg/day o p o ein, and 1-2.5 g/kg/day o a we e p esc ibed. Di e en speci ic conside a ions we e also included, such as: i on supplemen a ion, an ioxidan s inc emen in di e en phases, and e gogenic aids (i.e. c ea ine and be a-alanine). Ou esul s demons a ed a dec ease in adiposi y and an inc ease in a - ee mass. In pa allel, he a hle e imp o ed muscle s eng h, and he e o e endu ance adap a ions a e a maximal e o es (i.e. enhancemen o he hea a e eco e y). A e he in e en ion, he a hle e no only inc eased he ca bohyd a e oxida ion du ing exe cise and es ing condi ions bu also imp o ed his subjec i e sleep quali y. Conclusions: Ou esul s sugges ha a nu i ional in e en ion based on he endu ance nu i ional ecommenda ions and adap ed o he al i ude physiological peculia i ies can induce body e- composi ion, imp o e physiological adap a ions o e o , and upg ade he subs a e oxida ion in a mode a e al i ude high-le el a hle es. ARTICLE HISTORY Recei ed 15 Oc obe 2021 Re ised 24 Augus 2022 Accep ed 17 Oc obe 2022 KEYWORDS Al i ude; moun ain; ski; ail unning; nu i ional in e en ion; die a y supplemen s; e gogenic aids CONTACT Lucas Ju ado-Fasoli [email p o ec ed] Depa men o Physical Educa ion and Spo s, Facul y o Spo Sciences, PROmo ing FITness and Heal h h ough Physical Ac i i y Resea ch G oup (PROFITH), Spo and Heal h Uni e si y Resea ch Ins i u e (Imuds), Uni e si y o G anada, G anada, Spain Supplemen al da a o his a icle can be accessed online a h ps://doi.o g/10.1080/15502783.2022.2140596 JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION 2022, VOL. 19, NO. 01, 650–663 h ps://doi.o g/10.1080/15502783.2022.2140596 © 2022 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup. This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/ licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. 1. Backg ound Nu i ion in al i ude spo s, speci ically in mode a e al i udes (~1500–3000 m abo e sea le el), is an eme ging opic due o he en i onmen al and physiological s esso s o hese disciplines which di ec ly in luence exe cise pe o mance [1,2]. In line wi h his, a mod- e a e al i udes, he e is an ~5% dec ease in VO 2peak [3] and appe i e sensa ions. Fu he mo e, mode a e al i udes inc ease he es ing me abolic a e (RMR), glycogen use, and oxida i e s ess [2]. The abo e-men ioned physiological and me abolic changes du ing al i ude could be po en ially modula ed by an op imal nu i ional in e en ion [2] h ough an inc ease in he ene gy in ake (EI), ca bohyd a es (CHO), an ioxidan s, and/o i on [2,4]. The e o e, he impac o nu i ion and supplemen a ion on exe cise pe o - mance a mode a e al i udes is o scien i ic in e es . Un o una ely, he cu en nu i ional ecommenda ions in al i ude condi ions a e based on s udies conduc ed a high o ex eme al i udes (>3000 m), which may no be compa able wi h spo s pe o med a mode a e al i udes [5]. Nowadays, he nu i ional ecommenda ions o mode a e al i ude spo s a e simila o hose o spo s pe o med a sea le el [6]. The e o e, he es ablishmen o well-designed nu i ional ecommenda- ions ocused on mode a e al i ude spo s is o scien i ic in e es . Al oge he , his case s udy examined he e ec s o a 11-week nu i ional in e en ion on body composi ion, muscle s eng h, ca dio espi a o y i ness, es ing and exe cise nu ien oxida ion, and subjec i e sleep quali y, in a male high-le el mode a e al i ude a hle e (≈2000-3400 m abo e sea le el; Spanish na ional le el). Case p esen a ion The s udy a hle e was a male, 23-yea -old, high-le el mode a e al i ude a hle e in he disciplines o ail unning and ski moun ainee ing (Skimo). The a hle e had an ini ial weigh o 56 kg, wi h a heigh o 166.5 cm, a body a pe cen age o 16.6%, and a ca dio espi a o y i ness o 76.5 ml/kg/min. The a hle e had mo e han 5 yea s o al i ude aining expe ience and in al i ude compe i ions ( om 1300 o 3400 m). Ini ially, he a hle e was e alua ed by a medical esea che wi h a p ecise anamnesis, a ca e ul clinical examina ion, and ou ine es s. Fu he mo e, he s udy a hle e was no on any p esc ibed medica ion, was a nonsmoke , and had no ollowed any nu i ional in e en ion o die a y ad ice p io o his inclusion in he cu en s udy. B ie ly, he s udy a hle e ained be ween 1 and 5 h/day, wi h a equency o 5-6 days/ week, and a o al olume o 10-15 h/week in Sie a Ne ada, G anada (≈2000-3400 m abo e sea le el) in ol ing bo h ail unning and skimo disciplines. Du ing he comple e nu i ional in e en ion, he a hle e pe o med his au onomous (unsupe ised) aining sessions wi hou expe iencing signi ican changes in his aining ou ine. Ne e heless, all aining sessions we e weekly egis e ed in a aining dia y du ing he 11 weeks o he in e en ion (da a no shown). Be o e he in e en ion, an exhaus i e nu i ional anamnesis was pe o med by a egis e ed die i ian o assess po en ial nu i ional alle gies, in ole ances, p e e ences, li es yle, aining schedules, e c. O no e, he s udy pa icipan had an EI o ≈4100 kcal/day, wi h a high in ake o p o ein (2 g/kg/day), and a (2 g/kg/day), and a low in ake o CHO (4 g/kg/day) and ibe (13 g/day). The main ood sou ces o his die we e ul a-p ocessed JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION 651 oods (e.g. comme cial pizza), and ied oods (e.g. F ench ies) p o iding he 15-20% o his daily ene gy in ake. The design o he cu en s udy is shown in Figu e 1. The nu i ional in e en ion had a o al du a ion o 11 weeks conside ing he a hle e’s compe i ion goals (Spanish Championship o Ve ical Kilome e and Spanish Championship o T ail). Du ing he whole in e en ion, he nu i ional in ake and e gogenic aids/supplemen a ion we e p esc ibed by a egis e ed die i ian. All dependen ou comes we e assessed be o e s a ing he nu i ional in e en ion and a e he 11 weeks o nu i ional in e en ion, in he same esea ch cen e (G anada, Spain; ≈738 m abo e he sea le el) and ollowing exac ly iden ical p ocedu es. The pa icipan p o ided w i en in o med consen p io o pa icipa ion in he cu en s udy and ead he cu en manusc ip be o e submission. The esea ch p ocedu es we e app o ed by he E hics Commi ee on Human Resea ch a he Uni e si y o G anada (1996/CEIH/2021) and we e in acco dance wi h he CARE guidelines. Assessmen s o dependen ou comes All he assessmen s we e ca ied ou ollowing s anda dized p o ocols du ing he weeks 0 and 12 (see Figu e 1). Ex ended desc ip ion and in o ma ion can be ound in he supple- men a y ma e ial. Fi s , he pa icipan a ended o he esea ch cen e (Spo and Heal h Uni e si y Resea ch Ins i u e, iMUDS) a e a es day ea ly in he mo ning a e a 10 h o e nigh as , a oiding s imulan s 12 h be o e and d ugs 24 h be o e, wi h ligh clo hing and wi hou shoes. The RMR was assessed du ing 30 min using a me abolic ca (Omnical, Maas ich Ins umen s, Maas ich , The Ne he lands) and ollowing cu en ecommenda- ions [7]. Using he measu ed gas exchange, bo h exe cise and es ing nu ien oxida ion we e es ima ed using he F ayn equa ions [8] o CHO and a oxida ions (CHOox and FATox espec i ely), and he Wei equa ion [9] was u ilized o es ima ing he RMR. Fo all equa ions, he exc e ed u ina y ni ogen was conside ed o be 0. Then, body composi ion was measu ed by dual-ene gy X- ay abso p iome y using a Disco e y Wi de ice (Hologic Inc., Bed o d, MA, USA) and analyzed wi h i s speci ic so wa e (APEX e sion 4.0.2). The Figu e 1. S udy design. Abb e ia ion: W, week. 652 J. J. GUERRERO-PINZÓN ET AL. equipmen was daily calib a ed wi h a spine phan om o co ec ion o sou ces o e o (coe icien o a ia ion o whole body composi ion o ≈0.5% [10]). Ca dio espi a o y i ness (VO 2max ) was assessed on he same day in he e ening h ough a maximal inc emen al es on a eadmill (H/P/Cosmos Spo s & Medical GmbH, Nussdo -T auns ein, Ge many) ollowing a p e iously alida ed p o ocol in ail unne s [11]. The gas exchange (Ul ima Ca diO2, Medg aphics Co p., MN, USA) and he hea a e (HR) (Pola RS800CX, Kempele, Finland) we e con inuously egis e ed du ing he maximal inc emen al es . Fu he , om he assessed gas exchange he en ila o y equi alen s o oxygen and ca bon dioxide (VE/VO 2 and VE/VCO 2 espec i ely) we e es ima ed and he en ila o y h esholds 1 and 2 (VT 1 and VT 2 espec i ely) de e mined. We conside ed ha VT 1 was achie ed a ha momen in which an inc ease in VE/VO 2 was obse ed wi h no inc ease in VE/VCO 2 and de ia ion om linea i y o minu e en ila ion (VE) [12]. VT 2 was conside ed as ha momen in which VE/VO 2 and VE/VCO 2 concomi- an ly inc eased [12]. Bo h, VT 1 and VT 2 we e de e mined by wo independen obse e s (LJF and JMA). 48-h apa om he VO 2max assessmen s, muscle s eng h pa ame e s (one- epe i ion maximum and powe ) we e assessed wi h a DynaSys em Resea ch Func ional Dynamome e (SYMOTECH, G anada, Spain) ollowing s anda dized p o ocols o e alua e one-s ep (lowe body), ow (uppe body), and mid- high pull (lowe body) s eng h pa ame e s [13]. Las ly, subjec i e sleep quali y was e alua ed wi h he Pi sbu gh Sleep Quali y Index (PSQI; highe sco es indica e wo se sleep quali y) [14]. Nu i ional in e en ion The nu i ional in e en ion was di ided in o i e phases in acco dance wi h he nu i- ional, eco e y, and compe i ion objec i es. The nu i ional in e en ion was buil using he Die op o® so wa e, which employs he Uni ed S a es Depa men o Ag icul u e (USDA da abase). E gogenic aids and die a y supplemen s equi ed o he nu i ional in e en ion we e p o ided by HSN® (Ha ison Spo Nu i ion (HSN) S o e, G anada, Spain). Table 1 shows a summa y o he in e en ion; none heless, an ex ensi e desc ip- ion can be ound in he supplemen a y ma e ial. O no e, he nu i ional in e en ion was based on he cu en nu i ion guidelines o endu ance a hle es [15] adap ed speci ically o mode a e al i ude physiological conside a ions [2,15–19]. The speci ic conside a ions included we e: i) i on supplemen a ion; ii) CHO inc emen s du ing exe - cise; iii) an ioxidan inc emen s in di e en phases; and i ) e gogenic aids (i.e. c ea ine and be a-alanine). To al ene gy expendi u e (TEE) was es ima ed om he RMR alues ob ained in he baseline assessmen (i.e. 1829 kcal/day), plus 10% o he he mic e ec o ood (i.e. 180 kcal/day), and he ene gy expendi u e de i ed om he physical ac i i y o each phase (i.e. 550-750 kcal/h o aining), and he non-exe cise ac i i y he mogenesis ( e y ligh ; 2000- 3000 s eps/day). Addi ionally, o es uc u e he nu i ional in e en ion, a weekly body weigh eco d was pe o med wi h an elec onic weigh scale (Tani a BC-730, Tani a Co p, Japan) unde s anda dized condi ions (e.g. con olled as ing iming, hyd a ion le el). Bo h, he ene gy and mac onu ien s in ake epo ed in he di e en phases, a e ac ual in akes. JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION 653 Table 1. Summa y o he nu i ional in e en ion. Phase 1: lead-in Phase 2: p e-compe i ion Phase 3: in e media e Phase 4: compe i ion Phase 5: pos - compe i ion W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 Ene gy in ake (kcal/day) 2800-3000 2900-3100 3000-3200 3000-3200 3250-3500 3100-3500 2900-3300 2600-3000 2700-3500 2300-3000 2300 – 2800 CHO in ake (g/kg/ day) 7 7.7 8.9 7 6.4 6.8 6.8 7.3 7.3 6.8 7.3 P o ein in ake (g/ kg/day) 1.2 1.2 1.7 1.5 1.7 1.7 1.6 1.5 1.5 1.2 1.3 Fa in ake (g/kg/ day) 1.2 1 1.2 1.4 2 2.5 1.5 1.4 1 1.3 1.4 An ioxidan s in ake → → → → ↓ ↓ ↓ ↑ ↑ ↑ ↑ I on in ake → → → + + → → + + → → Supplemen a ion and e gogenic aids - Ca eine, gels E oca bs, gels, ca eine, c ea ine, be a-alanine E oca bs, gels, ca eine, c ea ine, be a- alanine, E oly es E oca bs, gels, ca eine, c ea ine, be a- alanine, E oly es E oca bs, gels, ca eine, c ea ine, be a- alanine, E oly es E oca bs, gels, ca eine, c ea ine, be a- alanine, E oly es E oca bs, gels, ca eine, c ea ine, be a- alanine, E oly es E oca bs, gels, ca eine, be a-alanine, E oly es E oca bs, gels, c ea ine, be a- alanine E oca bs, gels, c ea ine Peculia i ies Nu i ional educa ion Nu i ional educa ion + In a- nu i ion Nu i ion o compe i ion Nu i ion o compe i ion Gu aining, ↑CHO Ene gy and CHO pe iodiza ion, ↑calo ies Ene gy and mac onu ien eadjus men s Compe i ion p epa a ion Ta ge compe i ion Ene gy and liquid eposi ion Ene gy and liquid eposi ion Compe i ion No Yes Yes Yes No No No No Yes No No Abb e ia ions: →, no modi y; ↓, dec ease; ↑, inc ease; +, i on supplemen a ion; CHO, ca bohyd a es; W, week. All die a y supplemen s and e gogenic aids we e p o ided by Ha ison Spo Nu i ion (HSN®) S o e, G anada, Spain. See supplemen a y able S1 o he speci ic nu i ional in o ma ion o he die a y supplemen s. 654 J. J. GUERRERO-PINZÓN ET AL. Phase 1, lead-in (Weeks 1-2): The ini ial in e en ion was ocused on ‘nu i ional educa ion’ o inc ease he in ake o heal hy ood, and dec ease he in ake o ul a- p ocessed ood and ied p epa a ions. In pa allel, he ene gy and mac onu ien equi e- men s we e p esc ibed acco dingly o he nu i ional ecommenda ions in endu ance a hle es’ (2800-3100 kcal; CHO: 7-7.7 g/kg/day; P o ein: 1.2 g/kg/day o high biological alue; Fa : 1-1.2 g/kg/day) [15,16,18,19]. A 3.6 mg o ca eine/kg body weigh (o 4.3 mg o ca eine/kg o a - ee mass; FFM) was p esc ibed du ing he second week o he Phase 1 (30-45 min p io o he aining session, 1-2 imes pe week; Anhyd ous Ca eine Table s, HSN®, G anada, Spain) [20,21]. Fu he mo e, a p og essi e in oduc ion o spo s gels dilu ed in wa e was ini ia ed o ain he gu wi h he p oduc s o be used in he upcoming compe i i e e en s (E oene gy spo gel wi h gua ana and ca eine and E oene gy spo gel wi hou ca eine, HSN® G anada, Spain) [22]. Du ing his phase, 30-45 g/h o CHO and 200-250 mg/h o Na + we e p esc ibed du ing he exe cise aining sessions which had a mean du a ion o 1:45- 2 h [23]. Las ly, i was obse ed ha he nu i ion was p esc ibed acco dingly as he las weekend o his phase he a hle e had a compe i ion e en . Phase 2, p e-compe i ion (Weeks 3-4): The main objec i e o his phase was o op imize he physical pe o mance o he compe i ion e en s du ing bo h weekends. The e o e, due o he aining accumula ion o his phase and he dec ease in he a hle e’s body weigh (1 kg) a e phase 1, an inc ease in he EI (200-400 kcal/day) was ca ied ou . The CHO and P o ein (high biological alue) in ake p esc ip ions we e g adually inc eased un il an amoun o 7-8.9 g/kg/day and 1.5-1.7 g/kg/day espec i ely, whe eas he a in ake was main ained a 1.2-1.4 g/kg/day [15,16,18,19]. On he o he hand, he day be o e he compe i ion e en , a 10 g/kg/day CHO in ake was p esc ibed [15,16,18,19]. Fu he mo e, pos - aining in ake o whey p o ein (15-30 g o E owhey 2.0 [whey p o ein concen a e, WPC] HSN® G anada, Spain), 4 g/day o be a-alanine spli in wo sepa a e in akes (Be a-alanine powde 100% RAW, HSN® G anada, Spain), and 5 g/day o c ea ine (C ea ine monohyd a e powde [100% C eapu e®], HSN®, G anada, Spain) we e p esc ibed o suppo he high-in ensi y and olume o he upcoming phases (Phase 3 and 4) and he a hle e compe i ion goals (week 9) [24–26]. Mo eo e , he die du ing his phase had an i on con en o 20-25 mg/day and was supplemen ed wi h a mode a e dose o 50 mg o i on (Chela ed I on, HSN®, G anada, Spain) in he mo nings accompanied wi h oods ich in i amin C and a oiding oods ich in calcium, ibe , and ca eine [27,28]. The aim o he i on supplemen a ion was o main ain an op imal i on balance o suppo bo h he hema ological and non-hema ological adap a ions o al i ude aining and/o com- pe i ions and also o suppo aining-induced i on losses [29]. Al hough no i on de i- ciency was epo ed, he pa icipan had a low in ake o i on ood sou ces and epo ed a p e ious his o y o i on de iciency in he pas yea . Finally, oods ich in an ioxidan s we e included in he daily die o he a hle e o heigh en he eco e y be ween compe i- ions (i.e. be ies shake, an ioxidan s in usions, and da k chocola e) [30], whe eas ca eine was only included du ing compe i ions o pe iodize i s supplemen a ion and o a oid possible adap a ions [31]. Phase 3, in e media e (Weeks 5-7): Du ing his phase, he e was no compe i ion, and he a hle e inc eased he in ensi y and olume o ail and Skimo aining, and included esis ance- aining sessions. Consequen ly, an inc ease in he EI was p e- sc ibed (~250-500 kcal/day, +7-16%), un il 3250-3500 kcal/day, main aining he same JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION 655 p opo ion o CHO (6.4-6.8 g/kg/day) and p o ein (1.6-1.7 g/kg/day o high biological alue p o ein), and sligh ly inc easing he a in ake (2 g/kg/day) o easily achie e he ene gy equi emen s. The main objec i es o his phase we e o ain he gu , and he pe iodiza ion o EI and CHO acco ding o he ype o aining sessions. In his sense, he EI and CHO in ake p esc ip ions we e augmen ed (~10%) hose days when he a hle e pe o med endu ance aining sessions ( ail o Skimo; 3100-3500 kcal/day and 7.1-7.5 g/kg/day), and we e diminished (~20-25%) when he a hle e pe o med esis- ance aining sessions o es ed (2500-2700 kcal/day and 5-5.5 g/kg/day) [15,16,18,19]. To ain he gu , mode a e quan i ies o CHO (30-70 g/h) wi h high liquid olumes we e p esc ibed du ing aining sessions o inc ease he adap a ions o he diges i e sys em [22]. The aining sessions had a du a ion be ween 2 h and 3.5 h. The supplemen a ion wi h be a-alanine and c ea ine was equi ed ollowing he abo e-men ioned ecommen- da ions, whe eas ca eine was only aken du ing high- olume/high-in ensi y aining sessions only one o wo imes pe week o maximize i s e gogenic e ec s [31]. I on supplemen a ion s opped in he middle o his phase o s a a es pe iod and a oid he possible sa u a ion and adap a ions [2,29,32]. Ul ima ely, oods ich in an ioxidan s we e es ic ed du ing his phase wi h he aim o a oiding possible in e e ence wi h he physiological adap a ions o he aining [33]. Phase 4, compe i ion (Weeks 8-9): The objec i e o his phase was he double compe i ion (Spanish Championship o Ve ical Kilome e and Spanish Championship o T ail) p epa a ion which we e he main compe i ion goals o he a hle e. Du ing his phase, he EI was sligh ly lowe han he p e ious phase (2900-3500 kcal/day). Howe e , an inc ease in CHO in ake was p esc ibed (5.4-8.5 g/kg/day) o enhance he eco e y a e he aining sessions. P o ein and a in akes we e sligh ly dec eased (1.5 g/kg/day o high biological alue and 1.4 g/kg/day). Ene gy and mac o- nu ien equi emen s we e achie ed including oods and ecipes p e iously used by he a hle e wi h he aim o inc ease he adhe ence and a oid po en ial gas oin es inal p oblems. I on supplemen a ion was e-in oduced du ing his phase o a oid he anemia appea ance due o he physiological s ess, as well as ood ich in an ioxidan s was e- included in he die o he a hle e o enhance he p e-compe i ion eco e y [30]. In addi ion, du ing he aining sessions o his phase (1:45-2:45 h o du a ion), simila in a- aining nu i ion s a egies (i.e. CHO and Na + ) we e used as men ioned abo e. In he end, be a-alanine supplemen a ion was p esc ibed o hese weeks, whe eas c ea ine supple- men a ion was emo ed he las week p io o he compe i ion e en o dec ease he po en ial wa e e en ion and o e-adjus he body weigh [34]. Phase 5, pos -compe i ion (Weeks 10-11): The objec i e o he las phase was o enhance he eco e y a e he aining and compe i ion pe iods. The EI and mac onu- ien p esc ip ion in ake ebbed acco ding o he lowe aining olume and in ensi ies (i.e. o 2300-3000 kcal/day, 6.8 g/kg/day o CHO, 1.2 g/kg/day o p o ein, and 1.3 g/kg/day o a ). The in ake o high-an ioxidan oods and c ea ine supplemen a ion we e e- in oduced o imp o e he eco e y p ocesses [30,35]. E en ually, he ca eine in ake dwindled along he aining sessions o his phase whe eas he CHO in akes we e main- ained du ing he sessions (30-60 g/h o CHO in aining session o 2 h-3 h o du a ion), and ehyd a ion s a egies we e implemen ed [23]. 656 J. J. GUERRERO-PINZÓN ET AL. Resul s The s udy a hle e's body weigh escala ed p og essi ely du ing he nu i ional in e en- ion (week 0: 56.0 kg; week 4: 56.8 kg; week 8: 56.9 kg; and week 12: 57.3 kg). In line wi h his, a body e-composi ion was achie ed once he nu i ional in e en ion concluded (Figu e 2A). The a hle e amelio a ed his bone pa ame e s (bone mine al con en : +2.4%; bone mine al densi y: +2.5%), inc eased his FFM con en (+5.2%) and dec eased his adiposi y con en ( a mass: −12.5%; isce al adipose issue: −14.8%) (Figu e 2A). Addi ionally, he esul s showed ha all he muscle s eng h pa ame e s we e imp o ed a e he nu i ional in e en ion (Figu e 2B, 2C, and Table 2). The s udy a hle e no only inc eased his one- epe i ion maximum bu also his powe mean s eng h, peak s eng h o he one-s ep, ow, and mid- high pull exe cises (Figu e 2B, 2C, and Table 2). The du a ion o he maximal e o es (i.e. he ime un il exhaus ion) a e he 11-week nu i ional in e en ion had he same du a ion as he baseline es (Table 2). Fu he mo e, VO 2peak in bo h absolu e alues (ml/min) and ela i e o FFM (ml/kg/min) alues we e lowe in compa ison o he a hle e baseline alues (Table 2). Simila ly, o e he es ime, a lowe VO 2 dynamics ela i e o FFM was obse ed a e he in e en ion pe iod Figu e 2. Changes in body composi ion (Panel A), one-s ep muscle s eng h (Panels B-C), he dynamics o he ou comes de i ed om he maximal e o eadmill es (Panels D-F) and he RER and hea a e eco e y a e he maximal e o eadmill es (Panels G and H). Δ1 min was calcula ed as: Reco e y alue minu e 2- alue eco e y minu e 1; whe eas Δ2 min was calcula ed as: alue eco e y minu e 3- alue eco e y minu e 1. Abb e ia ions: BMC, bone mine al con en ; BMD, bone mine al densi y; FFM, a ee mass; FM, a mass; HR, hea a e; RER, espi a o y exchange a io; RM, one- epe i ion maximum; VAT, isce al adipose issue; VO 2 , olume o oxygen consump ion. Bpm: bea s pe minu e; W, wa s. JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION 657