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The placebo group receives an inactive substance that resembles the treatment in every way possible. A double-blind study is one in which neither the researchers nor the study participants know which group they are in or which treatment they are receiving. In a crossover study, subjects will be in both the treatment and placebo groups. For example, if four trials were scheduled, subjects would receive the treatment in two of the trials. Randomized double-blind, placebo-controlled study designs help to reduce bias, which can lead to inaccurate results and erroneous conclusions. Think about what might happen if researchers knew that the subjects were in the treatment group.

They might subtly influence the participants to ensure that the treatment works. If the subjects knew that they were receiving a treatment, they may try to perform better. Appropriate subject selection criteria are established and a pre-test measure of strength is determined for all subjects in the study. After consuming the supplement or placebo, a post-test of strength is determined. Before data are gathered, subjects should complete a familiarization trial. Consider a study held in an exercise physiology lab on a stationary bicycle. If subjects are not familiar with the bike or other laboratory equipment, their performance might not be as fast during the first trial. A familiarization trial gives the subjects a chance to practice on equipment and also understand what is expected of them e. When data collection begins, unfamiliarity with equipment or the study protocol should not be a factor. Most of the time, the treatment and control groups comprise different people.

In a crossover design, subjects are in both groups so they serve as their own controls. For example, a study may be designed to have subjects perform four trials. In the first and fourth trials, the subject is in the experimental group and receives a treatment e. In the second and third trials, the subject is in the control group and receives a placebo e. The results for each person can be directly compared because each subject received both the treatment and the placebo. Crossover studies are advantageous, but researchers must be careful to account for any carry-over effects. For example, the effect of creatine loading may last for a month or more while bicarbonate loading may only show effects for a day or two. When designing a crossover study, ample time must be allowed before the next phase of testing begins. An example of a research design for an experimental study is shown in Figure 1. Strong research design and methodology is fundamental to unbiased and accurate scientific information.

The recommendations made to athletes are only as strong as the research studies on which those recommendations are based. But how does a person who does not conduct research know if a research study is well designed and accurate? One safeguard is the peer review process. The peer-review Case study: An analysis of a person or a particular situation. Epidemiology: The study of health-related events in a population. Correlation: A relationship between variables. Does not imply that one causes the other. Experimental study: A research experiment that tests a specific question or hypothesis. Mortality: Death; the number of deaths in a population. Placebo: An inactive substance. Control group: The subjects in a scientific experiment that do not receive a treatment or who receive a placebo.

Also known as a nontreatment or placebo group. Subjects in the control group mirror the characteristics of the subjects in the experimental group so the groups can be compared. Experimental group: The subjects in a scientific experiment that receive a treatment or intervention; also known as a treatment group. If the study design and methodology are not scientifically sound, the peer reviewers will recommend that it not be published. If the method is sound, they will make suggestions to ensure clarity and accuracy in reporting the data and drawing conclusions, which the authors will incorporate into a revised manuscript.

The revised manuscript is reviewed by the editor and then scheduled for publication. Like the scientific studies, the peer review process should be blind—researchers should not know who reviewed the article and reviewers should not know who conducted the research and wrote the article. Readers can have confidence in the quality of an article in a peer-reviewed journal. The peer-review process should be a rigorous one. Journals that have the strongest peer-review processes have the best reputations. Examples of peer-reviewed journals that publish sports nutrition-related articles are listed in Figure 1. The results of such studies should be given greater weight than results from other study designs or those published in non-peerreviewed journals. But even the results of the bestdesigned study cannot stand alone.

Reproducible results are an important part of the scientific process. Recommendations must be based on the cumulative body of scientific literature and not on the results of one study. Just as the strength of each study must be established, the quality of the body of literature must also be determined. This process involves levels of evidence and grades of recommendations. Level of evidence refers to the relative strength or weakness of the current collective body of scientific research. The strongest evidence comes from a review of all the randomized controlled trials.

Such reviews compare the results of high-quality research studies. Many of these reviews involve meta-analysis, a statistical method of comparison. Articles reviewing the collective body of scientific research give rise to the strongest recommendations. As noted previously, sports nutrition is a relatively young scientific field, so abundant, high-quality research is lacking in many areas. Practitioners must make recommendations based on the current body of literature, knowing full well the limitations of the current scientific American Journal of Clinical Nutrition European Journal of Applied Physiology International Journal of Sports Medicine International Journal of Sport Nutrition and Exercise Metabolism Journal of the American Dietetic Association Journal of the American Medical Association Journal of Applied Physiology Medicine and Science in Sports and Exercise Sports Medicine reviews Figure 1. Grading the scientific evidence is important because it indicates the relative strength and quality of the body of scientific research.

Four grades, designated either by Roman numerals or by letters, are generally accepted as described below. Grade I Level A : The conclusions are supported by good evidence, known as a rich body of data. The evidence is based on consistent results of well-designed, large randomized research studies. Confidence in the accuracy of these studies is high. Grade II Level B : The conclusions are supported by fair evidence, known as a limited body of data. The evidence is less convincing either because the results of well-designed studies are inconsistent or the results are consistent but obtained from a limited number of randomly controlled trials or studies with weaker designs. Grade III Level C : The conclusions are supported by limited evidence.

Confidence in the results of the research studies is limited by their size and design e. Grade IV Level D : The conclusions are supported by expert opinion, known as panel consensus judgment, as a result of the review of the body of experimental research. This category includes recommendations made by sports nutrition experts based on their clinical experience Myers, Pritchett, and Johnson, ; National Heart, Lung and Blood Institute evidence categories. In a perfect world, Grade I Level A evidence would be available to answer all questions regarding the nutrition and training needs of athletes. But in many cases, recommendations are supported by only fair or limited evidence. In some cases, expert opinion is relied upon until more research can be conducted. Although dietary supplements are widely Understanding and Evaluating Scientific Evidence 21 Anecdotal evidence and testimonials are often used to market dietary supplements. For example, a well-known athlete may appear in a supplement advertisement and endorse the product.

It is not illegal to include endorsements in advertisements, but it is deceptive if the consumer is led to believe that the endorsement is made voluntarily when the person is being paid to promote the product. The Federal Trade Commission FTC is responsible for regulating the advertisement of dietary supplements and more information can be found at www. The strength of any scientific recommenThe Advertising Archives dation depends on the quality of the research conducted. Many ads for dietary supplements include testimonials by elite athletes. used by athletes, the scientific evidence available may be limited or nonexistent in many cases. Lack of scientific research makes it difficult to evaluate claims regarding safety and effectiveness. When making sports nutrition, training, or dietary supplement recommendations to athletes, it is important to indicate the relative strength of the research or the absence of scientific studies.

Anecdotal Evidence. Anecdotes are personal accounts of an incident or event and are frequently used as a basis for testimonials. Anecdotal evidence is based on the experiences of one person and then stated as if it had been scientifically proven. Often anecdotal evidence is cited to show that the current recommendations are not correct. Anecdotal evidence is not necessarily false it may be proven in the future , but it should not be used as proof. As shown above, it is both the quality and quantity of scientific research that allows practitioners to make sound nutrition and training recommendations to athletes.

Critical thinking skills are needed to correctly interpret scientific research and properly communicate their results to athletes. Here are some issues that need special attention when drawing conclusions from scientific studies. Distinguish between Correlation and Causation. One of the fundamental differences between epidemiological and experimental studies is the establishment of causation. Epidemiological studies can only establish a correlation i. It takes experimental research to establish causation—that the variable studied produces a particular effect. It is very Causation: One variable causes an effect. Also known as causality. THE EXPERTS IN. Exercise Physiology and Sports Nutrition To students who are taking a first course in exercise physiology or nutrition, it might seem unfathomable that they may one day become the experts in these fields.

These men and women from all over the world have become experts because of their hard work, curiosity, and dedication to advancing knowledge in their chosen fields. They are real people who are recognized by their peers for their knowledge and experience. In time, one of those experts may be you. important in both written and oral communications that professionals do not use the word causes if in fact the study or the body of research only shows an association or correlation. For example, epidemiological studies clearly show that people with lower aerobic fitness levels have an increased risk of premature death, particularly from cardiovascular disease and cancer Blair et al.

This knowledge is based upon the strong inverse relationship between fitness levels and premature all-cause mortality. So it is correct to say that there is an association between aerobic fitness levels and premature death. However, based upon this type of research, it is not valid to suggest that low fitness levels cause premature death. Understand the Importance of Replicating Results. Recommendations should not be made based on the results of one research study. Preliminary studies, many of which are performed in very small study populations, often produce surprising results, but many of these studies are never replicated. Extrapolate Results of Scientific Research with Caution, If at All. Extrapolation takes known facts and observations about one study population and applies them to other populations. This can lead to erroneous conclusions because only the original study population was tested directly. In the area of sports nutrition there are many ways that data may be extrapolated, including animals to humans, males to females, adults to adolescents, or children and younger adults to older ones.

Sports nutritionists work with athletes of all levels, from recreational to elite, and must carefully consider the validity of extrapolating research results to these populations. For example, a dietary intervention or manipulation that shows positive results in a sedentary population with diabetes may not be applicable to well-trained runners. Other factors that are powerful influences and should be extrapolated with caution, if at all, are the presence or absence of training, the type of sport, laboratory or field conditions, and competition or practice conditions.

Interpret Results Correctly. The results of research studies are often misinterpreted or applied to an inappropriate population. Professionals must be able to evaluate the results of research studies, and be able to recognize when recommendations are being made in an inappropriate way. One important consideration is to evaluate the characteristics of the subject population studied and to determine if the results observed in this group can reasonably be expected in other groups. Many studies of specific sport or exercise performance have used physically active college students as subjects; results of these studies should be considered with great caution when making recommendations to other groups, such as highly trained athletes. Many sports nutritionists and physiologists that work with elite athletes will only use the results of studies that have used highly trained athletes that are similar to their client population.

Scientists study athletes in the laboratory so that they can carefully control as many experimental conditions as possible. While these types of protocols are useful for studying metabolic responses during these types of activities, they do not reflect the demands or strategy of a real race, and may therefore be less useful for predicting performance. Focus on Cumulative Results and Consensus. There is much excitement when a new study is published, especially when the results contradict current sports nutrition recommendations or long-held theories. But startling breakthroughs are the exception, not the rule. Cumulative data, not single studies, are the basis for sound recommendations. It is imperative that any new study be considered within the context of the current body of research. While some topics may be subject to healthy debate among experts, many topics have good scientific agreement, known as consensus.

One of the best ways to know the consensus opinion is to read review articles or position statements. Review articles help students to understand the body of literature on a particular topic. These articles also help practitioners put the results of new research studies in the proper context and remain up to date with the current body of research. For example, Burke, Kiens, and Ivy published an article on carbohydrates and fats for training and recovery in which the authors reviewed the scientific literature on postexercise glycogen storage published between and Such articles consider the cumulative body of scientific evidence over a long period of time and help students and practitioners become familiar with the consensus opinion.

Recognize the Slow Evolution of the Body of Scientific Knowledge. Occasionally, landmark research studies are published that increase knowledge in a particular field in a quantum leap e. However, for the most part, knowledge in scientific areas such as sports nutrition increases gradually as additional research studies are completed and evaluated in the context of the existing research. The process can move slowly, as it takes time for research studies to be proposed, funded, completed, published, and evaluated by the scientific community. At times it may seem to be a slow and cumbersome process. However, a deliberate, evaluative approach is an important safeguard for the integrity of the information. The scientific process is similar to building a brick wall; it takes time and must be done one brick at a time, but if done correctly, the end product has considerable strength.

Today, results of scientific studies are widely reported in the print and visual media. Athletes may hear results of a research study before the journal is received and read by professionals. Consumers like to hear about new studies, but few consumers can interpret the research or put the newest results in the proper context. Surveys suggest that the primary source of nutrition information for consumers is the media. The top two media sources are television and magazines, with newspapers a distant third. report the results of research studies. Athletes are also consumers, so these sources are likely popular with athletes too. In addition to media sources, studies of collegiate athletes suggest that nutrition information is also obtained from fellow athletes, friends, family members, coaches, strength and conditioning coordinators, and certified athletic trainers Froiland et al.

One of the problems with the coverage of scientific studies in the media is that preliminary research data are reported. Preliminary data often raise more questions than they answer and such data are not considered sound until replicated. Additionally, research results may not be put in the larger context of the known body of literature on the subject. Other concerns are that cause and effect are reported or inferred when an association or correlation was actually found. The results of research studies are frequently used as a marketing tool, some of them prior to being reviewed and published in peer-reviewed journals, and some from unpublished studies. Clever advertising copy can make it appear that there is a direct link between scientific research and the product being sold, as shown in Spotlight on Supplements: Use of Scientific Studies as a Marketing Tool.

Testimonials from athletes, a form of anecdotal not scientific evidence, are widely used to sell sports nutrition products. It is estimated that 40 to Consensus: General agreement among members of a group. Diet and nutrition are popular topics among people of all ages, including adolescents Skinner et al. While many consumers are accessing health information on the Internet, the impact of that information is not known. A systematic review of all Internet health information studies from to Bessel et al. It appears that people are looking for information on the Internet, but what they do with that information once they obtain it is not clear. The Internet has been described as a democracy of information since access is freely available. Consumers and professionals need excellent critical thinking skills to place health, nutrition, and exercise information found on the Internet in its proper context.

Health-care professionals are concerned about the amount of misinformation present and the degree of commercial exploitation that accompanies educational information. Some information is false and may harm consumers. Other information is biased and limited to facts that support products and services that are being sold on the same website. Some information is balanced and reliable but still may have a commercial slant since most websites are commercial enterprises Klurfeld, Morris and Avorn reported on the content of websites devoted to herbal dietary supplements. Of the websites analyzed, 76 percent websites sold or were linked to sites that sold the products.

Approximately 80 percent of the retail websites made one or more health claims and the majority 55 percent claimed that the product could treat, prevent, diagnose, or cure a specific disease, although such statements are prohibited under the Dietary Supplement Health and Education Act. Internet information about dietary supplements is widespread and easily accessible but not well regulated. Some reliable sources of diet, exercise, and health related information are listed in The Internet Café sidebar. However, the sheer amount of information can be overwhelming. Most libraries have developed research guidelines to help users understand and access electronic databases.

One of the largest is Pubmed, which contains more than 16 million scientific citations for biomedical articles from MEDLINE, the National Library of Medicine online database www. A good-looking couple were running down the beach. He was shirtless, which highlighted his impressive upper body muscle mass. She had a tight-fitting white sundress, a perfect figure, and long blond hair. The supplement was advertised as a nutritional means to control weight. The accompanying materials were also impressive. Two research studies were called into evidence. The first indicated that those who took the supplement had a much greater weight loss than those who were given a placebo. The second study was cited as evidence that taking the supplement could boost energy.

The results of these studies were reduced to a single sentence prominently displayed in the advertising—University studies show that this supplement helps people lose weight and feel less fatigued. A closer look at the studies something most consumers cannot do tells a more complete story. In the first study, the 14 obese subjects were all consuming a liquid diet of 1, Calories daily. They were living in an experimental research ward where they had no access to food other than the liquid diet. While the women receiving the supplement did lose more weight than the ones not receiving it, they were still obese at the end of the day study period.

The second study involved a different population— to year-old males. The eight subjects did not receive a calorierestricted diet. The exercise that the study subjects performed was on a stationary bike in the laboratory. Those who received the supplement experienced less fatigue than those who did not. These studies were published in peer-reviewed journals and their results are an important contribution to the body of literature about this particular compound. But small study populations and tightly controlled food and exercise conditions limit their applicability outside the laboratory setting.

Using these studies to sell supplements to the general population is stretching the scientific literature beyond its application limits. The study citations give the supplement more scientific credibility than it deserves. It is safe to say that consumers will not look like the man or woman in the picture by just taking this supplement. Scope of Practice 25 The Internet Café Where do I find reliable information about diet, exercise, and health? Healthfinder: A guide to reliable health information sponsored by the Office of Disease Prevention and Health Promotion. gov MedlinePlus®: Trusted health information sponsored by the National Library of Medicine and the National Institutes of Health.

com Nutrition. Department of Agriculture. gov American College of Sports Medicine: Professional organization whose mission is to advance health through science, education, and medicine has resources for the general public at www. org American Dietetic Association: Professional organization committed to helping people enjoy healthy lives through good nutrition. Food and nutrition information for consumers can be found at www. org Scope of Practice Who is qualified to make nutrition and training recommendations to athletes? Because health, nutrition, and exercise are interrelated, the lines between these disciplines are sometimes blurry and there is some overlap among various practitioners. Scope-of-practice definitions help establish professional boundaries by outlining the skills, responsibilities, and accepted activities of practitioners. Such definitions take into account academic training and professional knowledge and experiences.

Certifications and licenses are one way to formally define scope of practice, but not all health, exercise, and nutrition practitioners are formally licensed and some certifications are voluntary. In some states, scope of practice may be legally defined. Scope of practice protects both consumers and practitioners. Consumers can be assured that practitioners have been properly trained and are qualified to practice. Likewise, practitioners are aware of their professional boundaries and can avoid areas in which they do not have appropriate training and skills. Practitioners may be professionally and personally liable if they work outside their scope of practice and their clients are harmed. Most health-care professionals, A trainer shows an athlete how to check her pulse.

such as medical doctors MD and nurses RN , are licensed, usually by the state in which they practice. Registered dietitians RD and Registered Clinical Exercise Physiologists RCEP are certified. Other certifications are available in the exercise field. The academic preparation of each is different. Because academic training is different, scope of practice is also different. Brief explanations of these exercise certifications can be found in Figure 1. In addition to those already mentioned, other practitioners such as certified strength and conditioning specialists CSCS and certified athletic trainers ATC , may work closely with athletes. The CSCS is a certification by The National Strength and Conditioning Association, which tests and certifies individuals who can design and implement safe and effective strength and conditioning programs. Certified athletic trainers ATC are Scope of practice: Legal scope of work based on academic training, knowledge, and experience.

The ACSM Exercise Specialist® is a healthcare professional certified by the ACSM to deliver a variety of exercise assessment, training, rehabilitation, risk factor identification, and lifestyle management services to individuals with or at risk for cardiovascular, pulmonary, and metabolic disease s. The ACSM Registered Clinical Exercise Physiologist® is an allied health professional who works in the application of exercise and physical activity for those clinical and pathological situations in which exercise it has been shown to provide therapeutic or functional benefit. Patients for whom services are appropriate may include, but not be limited to, those with cardiovascular, pulmonary, metabolic, immunological, inflammatory, orthopedic, and neuromuscular diseases and conditions. To be eligible for certification, candidates must have a degree from an accredited college or university athletic training program that includes both academic and clinical requirements.

Registered dietitians RD are food and nutrition experts. In addition to the RD, which is a national certification, dietitians may also be subject to state licensure laws. Registered dietitians have clinical training, counseling experience, and a solid background in nutrition assessment. Excellent assessment and counseling skills are needed to identify and counsel clients with disordered eating issues or eating disorders Clark, In many states, anyone can legally give general nutrition advice, but only certain practitioners can give medical nutrition therapy MNT. This logo indicates the individual is a registered dietitian who is board certified in sports dietetics. disease or disorder. Nutritionist refers to someone who has studied nutrition. It is a very general term and academic training can range from marginal to rigorous. For example, one online university certifies nutritionists after they complete just six online courses and pass an exam.

Certification of sports nutritionists is in its infancy. A Board Certified Specialist in Sports Dietetics CSSD is a registered dietitian who has specialized knowledge and experiences in sports nutrition. To be eligible to take the board certification exam the individual must be a registered dietitian RD for a minimum of two years with at least 1, hours of sports nutrition experience in the past five years. More information can be found at www. The International Society of Sports Nutrition offers the CISSN Certified Sports Nutritionist from the International Society of Sports Nutrition. This certification requires the individual to possess a four-year undergraduate degree in exercise science, kinesiology, physical education, nutrition, biology, or related biological science or be a certified strength and conditioning specialist CSCS.

However, there is an alternative pathway Review Questions that does not require a four-year degree and is based on five years of experience and possession of two other certifications. The CISSN requires successful completion of the CISSN certification exam. Many professional organizations have clear statements regarding scope of practice. Practitioners must recognize the limitations of their training, skills, and knowledge. Many practitioners have basic but not advanced knowledge of nutrition and physical fitness. In such cases professional organizations often suggest using and promoting only general nutrition and exercise materials that are in the public domain.

Public domain documents can be freely copied and distributed. There are excellent public domain general nutrition and fitness materials produced by federal government agencies and large health-oriented organizations such as the American Heart Association. The use of public domain general nutrition and exercise materials is unlikely to cause harm, and consumers receive consistent health-related messages from professionals. Specific nutrition and training recommendations for athletes should be made by practitioners who are qualified to do so. To most effectively help athletes and to avoid potentially harming them, it is important to know and respect professional boundaries and to make referrals to other qualified professionals. Athletes are subject to much misinformation, especially concerning dietary supplements.

Practitioners must understand and respect the limitations of their training, skills, and knowledge. Scope of practice definitions help establish professional boundaries and protect athletes and practitioners. Many people who work with athletes are certified or licensed. Some certifications are rigorous but others are not. Post-Test Reassessing Knowledge of Sports Nutrition Now that you have more knowledge about sports nutrition, read the following statements and decide if each is true or false. The answers can be found in Appendix O. The scientific aspect of sports nutrition is developing very quickly and quantum leaps are being made in knowledge of sports nutrition. Many exercise and nutrition-related certifications do not require a four-year degree.

Review Questions Summary Sports nutrition combines the scientific disciplines of exercise physiology and nutrition. The ultimate goal is improved performance, which involves both skill development and training. Proper nutrition helps to support training and recovery as well as good health. Sports nutrition principles are based on sound general nutrition principles that have been modified to reflect the demands of training and competition. Dietary supplements are widely advertised to athletes but are not well regulated in the United States. Athletes must take into account the legality, ethics, purity, safety, and effectiveness of the dietary supplement. Sports nutrition recommendations should be evidence based.

The most conclusive evidence comes from studies that are randomized, double-blind, placebocontrolled, and published in peer-reviewed journals. The results of research studies are often misinterpreted or misapplied. The role of the professional is to provide 1. What is sports nutrition? What are the general goals of training and the short- and long-term nutrition goals that may improve performance? In what ways do basic nutrition principles parallel basic training principles? Explain the ways in which the Dietary Supplement Health and Education Act regulates dietary supplements in the United States.

In what ways are dietary supplements not well regulated? Why is the Internet both advantageous and disadvantageous for obtaining health-related and sports nutrition information? What are the advantages of experimental research? What are the limitations of epidemiological research and case studies? What are the elements of research design that give strength to a scientific study?

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Insightful, well organized, and clearly written, Nutrition for Sport and Exercise integrates nutrition and exercise physiology principles, emphasizing scientific reasoning and examining research studies to illuminate the evidence for current nutritional recommendations. You must be logged in to post a comment. Nutrition For Sport And Exercise 4th Edition Pdf. About Nutrition For Sport And Exercise Dunford Pdf Updated with the latest cutting-edge research findings, the Nutrition For Sport And Exercise 4th Edition Pdf helps readers make the bridge between nutrition and exercise concepts and their practical applications. Leave a Comment You must be logged in to post a comment.

A macrocycle may be longer e. Linda Workman PhD RN FAAN, Julia A. Training periodization involves changing the intensity, volume, and specificity of training to achieve specific goals. PDF Clinicians Guide to Research Methods in Family Therapy Foundations of Evidence Based Practice By Lee Williams, JoEllen Patterson, Todd M. Clever advertising copy can make it appear that there is a direct link between scientific research and the product being sold, as shown in Spotlight on Supplements: Use of Scientific Studies as a Marketing Tool. This is how cause-and-effect relationships are established.

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