Dan Benardot

Effects of Yoga on Inflammation and Exercise Capacity in Patients With Chronic Heart Failure

BACKGROUND Despite recent advances in pharmacologic and device therapy, morbidity and mortality from heart failure (HF) remain high. Yoga combines physical and breathing exercises that may benefit patients with HF. We hypothesized that an 8-week regimen of yoga in addition to standard medical therapy would improve exercise capacity, inflammatory markers, and quality of life (QoL) in patients with HF. METHODS AND RESULTS New York Heart Association Class I-III HF patients were randomized to yoga treatment (YT) or standard medical therapy (MT). Measurements included a graded exercise test (GXT) to V O(2Peak) and the following serum biomarkers: interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and extracellular superoxide dismutase (EC-SOD). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was administered to assess changes in QoL. A total of 19 patients were enrolled after the initial screening. Of the 19 patients, 9 were randomized to YT and 10 to MT. Patients had a mean EF of 25%. GXT time and V O(2Peak) were significantly improved in the YT versus MT groups (+18% in the YT and -7.5% in MT; P = .03 vs. control and +17 in YT and -7.1 in MT; P = .02, respectively). There were statistically significant reductions in serum levels of IL-6 and hsCRP and an increase in EC-SOD in the YT group (all P < .005 vs. MT). MLHFQ scores improved by 25.7% in the YT group and by 2.9% in the MT group. CONCLUSIONS Yoga improved exercise tolerance and positively affected levels of inflammatory markers in patients with HF, and there was also a trend toward improvements in QoL.

Relationship between energy deficits and body composition in elite female gymnasts and runners.

PURPOSE The purpose of this study was to evaluate energy balance and body composition in 42 gymnasts (mean age = 15.5 yr) and 20 runners (mean age = 26.6 yr), all of whom were on national teams or were nationally ranked. METHODS Athletes were assessed for body composition using DEXA and skinfolds, and energy balance was determined with a Computerized Time-Line Energy Analysis (CTLEA) procedure. RESULTS Results from the CTLEA were assessed as the number of within-day energy deficits (largest and frequency) and within-day energy surpluses (largest and frequency). There was a significant difference (P = 0.000) in the mean number of hourly energy deficits > 300 kcal experienced by gymnasts (9.45 +/- 6.00) and runners (3.70 +/- 5.34). There was also a significant difference (P = 0.001) in the mean number of hourly energy surpluses > 300 kcal experienced by gymnasts (1.40 +/- 3.04) and runners (6.20 +/- 5.50). The mean largest daily energy deficit was 743 (+/- 392) kcal for gymnasts and 435 (+/- 340) kcal for runners. The mean largest daily energy surplus was 239 (+/- 219) kcal for gymnasts, and 536 (+/- 340) kcal for runners. There was a significant relationship between the number of daily energy deficits > 300 kcal and DEXA-derived body fat percent for gymnasts (r = 0.508; P = 0.001) and for runners (r = 0.461; P = 0.041). There was also a negative relationship between the largest daily energy surplus and DEXA-derived body fat percentage for gymnasts (r = -0.418; P = 0.003). Using the energy balance variables, age, and athlete type (artistic gymnast, rhythmic gymnast, middle-distance runner, long-distance runner) as independent variables in a forward stepwise regression analysis, a small but significant amount of variance was explained in DEXA-derived (P = 0.000; R2 = 0.309) and skinfold-derived (P = 0.000; R2 = 0.298) body fat percent by the number of energy deficits > 300 kcal and age. CONCLUSIONS These data suggest that within-day energy deficits (measured by frequency and/or magnitude of deficit) are associated with higher body fat percentage in both anaerobic and aerobic elite athletes, possibly from an adaptive reduction in the REE. These data should discourage athletes from following restrained or delayed eating patterns to achieve a desired body composition.

Benefits of Yoga for African American Heart Failure Patients

BACKGROUND The number of African American (AA) patients living with heart failure (HF) has been increasing, especially among the economically disadvantaged. Yoga therapy has been found to improve physical and psychological parameters among healthy individuals, but its effect in patients with HF remains unknown. The purpose of this study was to examine the effects of yoga therapy on cardiovascular endurance (VO2peak), flexibility, quality of life (QoL), and inflammatory markers on medically stable HF patients. METHODS Forty patients (38 AA, 1 Asian, and 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, n = 21) or the control group (CG, n = 19). All patients were asked to follow a home walk program. Premeasurement and postmeasurement included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ). RESULTS The statistical analyses (assessed by ANOVA and t-tests) were significant for favorable changes in the YG, compared with those in the CG, for flexibility (P = 0.012), treadmill time (P = 0.002), VO2peak (P = 0.003), and the biomarkers (IL-6, P = 0.004; CRP, P = 0.016; and EC-SOD, P = 0.012). Within the YG, pretest to posttest scores for the total (P = 0.02) and physical subscales (P < 0.001) of the MLwHFQ were improved. CONCLUSIONS Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.

Food groups and renal cell carcinoma: results from a case-control study.

BACKGROUND The role of diet in renal cell carcinoma risk has been inconclusive. This study uses an integrative approach to assess the role of food groups and food items in renal cell carcinoma risk. DESIGN A case-control study was conducted from 2003-2006. SUBJECTS/SETTING Incident cases (n=335) were identified from hospital records and the Florida cancer registry, and population controls (n=337) frequency matched by age (+/-5 years), sex, and race were identified through random-digit dialing. Eating habits were assessed through the use of the 70-item Block food frequency questionnaire. STATISTICAL ANALYSES Odds ratios (ORs), 95% confidence intervals (CIs), and tests for trends were calculated using logistic regression, controlled for age, sex, race, income, body mass index, and pack-years of smoking. RESULTS Decreased renal cell carcinoma risk was observed among the total sample and for men for vegetable consumption (all subjects: OR 0.56, 95% CI 0.35, 0.88; men: OR 0.49, 95% CI 0.25, 0.96) but not for fruit consumption. Tomato consumption decreased renal cell carcinoma risk for the total population and for men (all subjects: OR 0.50, 95% CI 0.31, 0.81; men: OR 0.47, 95% CI 0.24, 0.95). Increased risk of renal cell carcinoma was observed among all subjects and among women with increased consumption of red meat (all subjects: OR 4.43, 95% CI 2.02, 9.75; women: OR 3.04, 95% CI 1.60, 5.79). White bread consumption increased renal cell carcinoma risk among women only (OR 3.05, 95% CI 1.50, 6.20), as did total dairy consumption (OR 2.36, 95% CI 1.21, 4.60). CONCLUSIONS The protective role of vegetables and the increased risk of renal cell carcinoma with meat consumption are supported. The protective role of fruits is not. Novel findings include the increased risk of renal cell carcinoma with white bread and white potato consumption and the decreased risk of renal cell carcinoma with tomato consumption.

Comparison of creatine monohydrate and carbohydrate supplementation on repeated jump height performance.

Koenig, CA, Benardot, D, Cody, M, and Thompson, WR. Comparison of creatine monohydrate and carbohydrate supplementation on repeated jump height performance. J Strength Cond Res 22: 1081-1086, 2008-Creatine monohydrate (CrMH) supplementation aids the ability to maintain performance during repeated bouts of high-intensity exercise, including jump performance. However, carbohydrate supplementation may also provide similar benefits and is less expensive. This study compared the effects of an energy-free placebo, 2 different caloric concentrations of carbohydrate drinks, and a CrMH supplement on repeated jump heights. Sixty active males (mean age, 22 ± 3.2 years) performed 2 sets of countermovement static jump height tests (10 jumps over 60 seconds) separated by 5 days to determine the differential effects of the placebo, carbohydrate, and CrMH on jump height sustainability over 10 jumps. Subjects were randomly assigned to groups (15 subjects per group) to receive daily doses (×5 days) of carbohydrate drinks containing 100 or 250 kilocalories (kcal), a 25-g CrMH supplement, or an energy-free placebo. After 5 days, the CrMH group experienced a significant weight gain (+1.52; ±0.89 kg, p < 0.01), while the other groups did not. The 2 levels of carbohydrate and CrMH supplements were all significantly better at sustaining jump height than the energy-free placebo over the final 3-4 jumps. The 250-kcal carbohydrate-supplemented group experienced a level of benefit (p < 0.01) that was at least equal to that of the CrMH group (p < 0.05), suggesting that the higher dose of carbohydrate was as effective as CrMH in maintaining repeated bouts of high-intensity activity as measured by repeated static jumps. Given the equivalent performance improvement and the absence of weight gain, the carbohydrate supplementation could be considered the preferred option for weight-conscious power athletes involved in activities that require repeated- motion high-intensity activities.

Nutritional Recommendations for Divers

Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3-8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2-1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

Nutritional Recommendations for Synchronized Swimming

The sport of synchronized swimming is unique, because it combines speed, power, and endurance with precise synchronized movements and high-risk acrobatic maneuvers. Athletes must train and compete while spending a great amount of time underwater, upside down, and without the luxury of easily available oxygen. This review assesses the scientific evidence with respect to the physiological demands, energy expenditure, and body composition in these athletes. The role of appropriate energy requirements and guidelines for carbohydrate, protein, fat, and micronutrients for elite synchronized swimmers are reviewed. Because of the aesthetic nature of the sport, which prioritizes leanness, the risks of energy and macronutrient deficiencies are of significant concern. Relative Energy Deficiency in Sport and disordered eating/eating disorders are also of concern for these female athletes. An approach to the healthy management of body composition in synchronized swimming is outlined. Synchronized swimmers should be encouraged to consume a well-balanced diet with sufficient energy to meet demands and to time the intake of carbohydrate, protein, and fat to optimize performance and body composition. Micronutrients of concern for this female athlete population include iron, calcium, and vitamin D. This article reviews the physiological demands of synchronized swimming and makes nutritional recommendations for recovery, training, and competition to help optimize athletic performance and to reduce risks for weight-related medical issues that are of particular concern for elite synchronized swimmers.

Under-Reporting of Energy Intake by Elite Female Gymnasts

Abstract The degree of under-reporting of energy intake by elite, female gymnasts was assessed using the standards established by Goldberg et al (1991). 28 female g\Tiinasts from the US national artistic gymnastics team completed the 3-day food records during their training period. The degree of under-reporting was determined using the ratio of reported energy intake (El) to predicted basal metabolic rate (BMRestd). An El/BMRestd ratio of

Comparison of Energy Expenditure at rest and during exercise in African-American and Caucasian Females

Abstract LEARNING OUTCOME: To examine differences in resting and exercise energy expenditure in moderately fit middle-aged African American and Caucasian females. The purpose of this study was to compare energy expenditure at rest and during an absolute workload in African-American females (AAF) and Caucasian (CF) females. Nineteen middle-aged females (10 African-American, age 38.7 ± 6.0 yrs, 35.3±6.8% fat; 9 Caucasian age 42.4 ± 4.2 yr, 30.6±4.4%fat) were evaluated for resting energy expenditure (REE) after a 12 hour fast and for exercise energy expenditure (EEE) during a six minute bicycle ergometer test Body composition was measured via Lunar Dual Energy X-ray Absorpoometry. Subjects maintained a 3-day diet record mat was analyzed via Nounsh-Check software to determine macro- and micronutrient intake. Correlations were performed to evaluate relationships among measured variables while one-way ANOVAs were performed to evaluate each variable by race. The two groups did not differ significantly in any of the physical characteristics measured. The correlation coefficients for REE and EEE with the body composition and measured nutrition variables ranged between r=0.00 to r=O.76 and were relatively similar for both groups. There was a significant relationship between EEE and lean body mass for the CF, while no similar relationship was seen in the AAF. No significant differences were observed between the groups for REE, EEE, body composition, predicted VO 2max energy intake or other dietary factors. These results suggest that, in middle-aged females, REE and submaximal EEE are not different between moderately fit African-Americans and Caucasians. Therefore, differences in body fat observed between middle-aged African-American and Caucasian females must be related to other factors, which may include differences in activity and energy intake patterns.