Background: Endurance events have experienced a significant increase in growth in the new millennium and are popular activities for participation globally. Sports nutrition recommendations for endurance exercise however remains a complex issue with often opposing views and advice by various health care professionals. Methods: A PubMed/Medline search on the topics of endurance, athletes, nutrition, and performance was undertaken and a review performed summarizing the current evidence concerning macronutrients, hydration, and supplements as it pertains to endurance athletes. Results: Carbohydrate and hydration recommendations have not drastically changed in years, while protein and fat intake have been traditionally underemphasized in endurance athletes. Several supplements are commercially available to athletes, of which, few may be of benefit for endurance activities, including nitrates, antioxidants, caffeine, and probiotics, and are reviewed here. The topic of “train low,” training in a low carbohydrate state is also discussed, and the post-exercise nutritional “recovery window” remains an important point to emphasize to endurance competitors. Conclusions: This review summarizes the key recommendations for macronutrients, hydration, and supplements for endurance athletes, and helps clinicians treating endurance athletes clear up misconceptions in sports nutrition research when counseling the endurance athlete.

BackgroundExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathlessness and wheeze yet frequently misdiagnosed as asthma. Insight regarding the demographic characteristics, laryngeal abnormalities and impact of EILO are currently limited, with data only available from individual centre reports. The aim of this work was to provide a broader perspective from a collaboration between multiple international expert centres.MethodsFive geographically distinct clinical paediatric and adult centres (3 Denmark, 1 UK, 1 US) with an expertise in assessing unexplained exertional breathlessness completed database entry of key characteristic features for all cases referred with suspected EILO, over a 5-year period. All included cases completed clinical asthma work-up and continuous laryngoscopy during exercise (CLE) testing for EILO.ResultsData were available for 1007 individuals (n=713 female (71%)), median (range) age of 24 (8–76) years and of these 586 (58%) were diagnosed with EILO. In all centres, EILO was frequently misdiagnosed as asthma; on average there was a 2-year delay to diagnosis of EILO and current asthma medication was discontinued in 20%. Collapse at the supraglottic level was seen in 60% whereas vocal cord dysfunction (VCD) was only detected/visualised in 18%. Nearly half (45%) of individuals with EILO were active participants in recreational level sports, suggesting that EILO is not simply confined to competitive/elite athletes.ConclusionOur findings outline key clinical characteristics and the impact of EILO/VCD similar in globally distinct regions, facilitating improved awareness of this condition to enhance recognition and avoid erroneous asthma treatment.

Triathletes need to effectively fuel during training and racing to maximize their potential for success. While most research on fueling has focused on elite male triathletes, triathlon participation encompasses a broader demographic of racers ranging from those with aspirations of winning to those whose goals are completion. Carbohydrate is the primary macronutrient for fueling endurance activities. Athletes can usually tolerate 60 to 90 mg·h in the form of multiple different carbohydrate sources. Athletes should drink as thirst dictates and consider sodium replacement of sweat loss especially in individuals with a history of exercise-associated muscle cramps. Caffeine is a known ergogenic aid that could be dosed at 3 mg·kg to maximize benefits of mental alertness while limiting potential side effects. Athletes need to balance fueling with development of exercise-induced gastrointestinal syndrome. As demographics of race participants change, understanding the special fueling needs of obese triathletes can encourage participation while minimizing bad outcomes.

Participation in ultraendurance events has been increasing. Appropriate nutrition in training and fueling while racing within the confines of gastrointestinal tolerability is essential for optimal performance. Unfortunately, there has been a paucity of studies looking at this special population of athletes. Recent field studies have helped to clarify appropriate fluid intake and dispel the myth that moderate dehydration while racing is detrimental. Additional current nutrition research has looked at the role of carbohydrate manipulation during training and its effect on macronutrient metabolism, as well as of the benefits of the coingestion of multiple types of carbohydrates for race fueling. The use of caffeine and sodium ingestion while racing is common with ultraendurance athletes, but more research is needed on their effect on performance. This article will provide the clinician and the athlete with the latest nutritional information for the ultraendurance athlete.

Activity modification, bracing, and traditional core-strengthening exercises may not be the most appropriate treatment for athletes experiencing EB LBP. Addressing cognitive-affective factors in addition to correcting maladaptive motor behavior and moving in a pain-free range reduces nociceptive input, desensitizes the nervous system, and allows athletes to gain control over their pain.