Universidade Lusófona de Humanidades e Tecnologias

Faculdade de Educação Física e Desporto

Análise Crítica do Artigo

Perception of Breakfast Ingestion Enhances High Intensity Cycling

Performance.

Realizado por:

João C. R. Martins (22207715)

Mestrado Exercício e Bem-estar

Unidade curricular:

Nutrição e Exercício

Dirigida por:

Prof. Doutora Inês Santos

Ano letivo:

2022-2023
Índice
Introdução........................................................................................................................3

Pertinência do tema.....................................................................................................3

Conceitos.......................................................................................................................6

Como se tem estudado o tema.....................................................................................7

Falha no conhecimento (Gap).....................................................................................7

Objetivo.........................................................................................................................8

Metodologia......................................................................................................................9

Desenho.........................................................................................................................9

Sujeitos..........................................................................................................................9

Medidas/Instrumentos...............................................................................................10

Procedimentos............................................................................................................10

Resultados......................................................................................................................12

Discussão........................................................................................................................16

Aplicações práticas........................................................................................................18

Conclusão.......................................................................................................................19
Introdução

Pertinência do tema

The benefits of carbohydrate feeding prior to prolonged bouts of endurance

exercise are well established by literature (1-6). Previous studies have shown that
performance was further improved by their ingestion, in an interval of 5 min and 4
hours, before exercise, or even during exercise (6- Wright, D. A., et al., 1991).

1- Exhaustion, 45 min before exercise. Glucose ingestion prior to exercise

resulted in a prolonged exercise duration. Feeding the placebo had no
significant effects on circulating concentrations of blood fuel substrates in
the pre-exercise period. VO2 was similar on all 3 treatments during the
exercise bout, increasing slightly as the exercise progressed. Plasma
osmolality was higher in the pre-exercise period following the glycerol and
glucose feedings compared to placebo.
2- 45 min + 15, 5 min before exercise. No significant differences were
observed between trials in O2 consumption, calculated energy expenditure,
or perceived exertion during the 45-min exercise. No significant differences
were observed in muscle glycogen concentration at 45 min of exercise or in
the total utilization between the four trials. Work output at 5,10, and 15 min
was significantly enhanced during trial M+SCHO compared with all other
trials. In addition, ingestion of CHO in the fasted state (LCHO and SCHO)
resulted in a significant improvement in performance over trial.
3- Exhaustion, 3 h before exercise. Pre- and post-exercise muscle glycogen
concentrations, respiratory exchange ratio, carbohydrate and fat oxidation,
and lactate and insulin concentrations were not significantly different
between the two trials. Insulin concentrations decreased and free fatty acid
concentrations increased. Exercise time to fatigue was significantly longer
when subjects consumed the breakfast (136+/-14 min) compared with when
they exercised in the fasted state (109+/-12 min).
 4- 95min, 4 h before exercise. These results indicate that, despite elevated
insulin at the start of and during exercise, consumption of 312 g of
carbohydrate 4 h before moderately intense prolonged exercise can improve
performance, perhaps via an enhancement of carbohydrate oxidation.
5- 90 min, 1h before exercise. Total carbohydrate oxidation was greater for the
carbohydrate trials compared with P. Time-trial performance was
significantly improved by LC and HC. Despite elevated insulin
concentrations at the start of and during exercise, and despite an initial drop
in blood glucose, consumption of between 1.1 and 2.2 g liquid
carbohydrate/kg body mass 60 mm before moderately intense prolonged
exercise can improve performance, presumably via enhanced carbohydrate
oxidation.
6- Exhaustion, 3 horas W. Time to exhaustion was 17% longer for CC, PC, and
CP than PP. Total work output was 19% greater for CC, PC, and CP, than for
PP. The greater work output when the subjects were fed. When carbohydrate
was consumed (CP, PC, CC), the resultant blood lactic acid concentrations
after the work production tests were generally higher. The association
between work production test times and the blood lactate concentrations was
significantly inversely. Additionally, the serum glucose concentrations 3 h
after ingestion of the preexercise carbohydrate feedings (CP, CC) were lower
than those for the placebo trials. Rating of perceived exertion increased
throughout exercise to a rating of 18 at exhaustion for all treatments. There
were no differences in ratings of perceived exertion for either the entire body
or legs among the treatments. There were no differences in the blood lactate
responses during exercise among the trials. Blood lactate increased before 3
hours after the preexercise carbohydrate feedings (CP, CC), the free fatty
acid concentrations were lower than for the placebo trials (PP, PC).

When exercise duration is longer than 60 minutes it is generally advised that

athletes consume carbohydrate in the 1-4 hours before exercise (7-Burke, L., et al.,
2011).
 For exercise lasting less than 45 minutes there appears to be little evidence, if
any, to suggest pre-exercise carbohydrate ingestion will enhance performance. It is
generally perceived that muscle glycogen depletion is not the limiting factor for short
duration exercise and therefore prior ingestion of carbohydrate will serve little benefit
(8- Palmer, G., et al., 1998). However, for many athletes, common practice often
dictates consumption of carbohydrate prior to training sessions and competition
regardless of the duration and particularly if the training is at a high intensity.

Endurance athletes will regularly train in the morning, but for many, the logistics
of consuming carbohydrate 1 to 4 hours prior to exercise may be difficult and therefore
result in some sessions completed in a fasted state. Training in a fasted state and thereby
reducing carbohydrate availability has been shown to potentiate cellular and molecular
adaptations to endurance training (9- Van Proeyen, K., et al., 2011).

The low circulating insulin level associated with fasting exercise

stimulates rate of adipose tissue lipolysis and peripheral fat oxidation (35). We
recently also demonstrated that the breakdown of intramyocellular lipids (IMCL)
in type I fibers as well as glycogen degradation in type IIa fibers during fasting
exercise is exaggerated compared with a similar exercise in the fed state. It is
thus reasonable to speculate that regular exercise in the fasted state may
stimulate adaptations in liver to facilitate glucose production via
gluconeogenesis. Such a hypothesis is also supported by the observation that
fasted state improved maintenance of blood glucose concentration only in the
later stage of exercise when liver glycogenolysis was unlikely still to
significantly contribute to endogenous glucose production (52). In addition,
exercise in the fasted state puts a higher overload on muscle gluconeogenesis
because during exercise with carbohydrate intake high glucose delivery into the
circulation originating from intestinal absorption makes glucoregulation via
endogenous glucose production largely redundant (40). ). In conclusion, F is
more effective than CHO to increase muscular oxidative capacity and at the
same time enhances exerciseinduced net IMCL degradation. In addition, F but
not CHO prevented drop of blood glucose concentration during fasting exercise
 This may be of advantage to endurance athletes if correctly integrated into a
periodized training programme (10).

Currently, we have insufficient evidence to provide guidelines to athletes

for incorporating ‘‘train low’’ strategies into their training programs. While there
may be a sound hypothesis that training in a low carbohydrate environment can
amplify the training response, there is no clear proof that this leads to
performance enhancements. Indeed, there are potential disadvantages to the
health and performance of the athlete, including the not insignificant likelihood
that ‘‘training low’’ may interfere with the volume or intensity of training.

Despite increasing the muscle adaptive response and reducing the reliance on
carbohydrate utilization during exercise, there is no clear evidence that these strategies
enhance exercise performance.

However, other methods of reducing carbohydrate availability (i.e.‘sleep low’

and ‘train low’ paradigms) have resulted in reduced self-selected intensity, which might
attenuate the training stimulus (11-12).

From a physiological standpoint, despite small decreases in liver glycogen stores

overnight (13), fasted exercise should not impair short duration performance, and
therefore any influences on performance or self-selected intensity may be as a result of a
placebo effect.

Conceitos

The placebo effect has been commonly observed in exercise performance

settings, arising from the belief that one is receiving a treatment or product that will
result in a favorable outcome (14). In exercise lasting approximately 1 hour, Clark and
collegues (14) observed a 4% improvement in cycling performance when a placebo
drink thought to be containing carbohydrate was consumed during exercise, yet for
longer periods of exercise (~3h), no placebo effect has been reported (15).
Como se tem estudado o tema

Although these results are based on feeding during exercise, it appears that there
is more likely to be a placebo effect when the exercise bout is short in duration and
muscle glycogen use is not the limiting factor.

Mouth rinsing with a CHO solution increased total distance covered

during a self-selected 30-min run in comparison with mouth rinsing with a color-
and taste matched placebo

Work output at 5,10, and 15 min was significantly enhanced during trial
M+SCHO compared with all other trials. In addition, ingestion of CHO in the
fasted state (LCHO and SCHO) resulted in a significant improvement in
performance over trial.

For a cycling time trial lasting ~20 minutes (i.e., comparable to a 10-mile time
trial), a placebo effect may therefore be of substantial significance, with those
consuming carbohydrate or breakfast potentially perceiving this to be advantageous and
increasing self-selected intensity.

Falha no conhecimento (Gap)

For exercise lasting less than 45 minutes there appears to be little evidence, if
any, to suggest pre-exercise carbohydrate ingestion will enhance performance.
Despite increasing the muscle adaptive response and reducing the reliance on
carbohydrate utilization during exercise, there is no clear evidence that these strategies
enhance exercise performance.
Objetivo

Therefore, the aim of this study was to examine the effect of pre-exercise
carbohydrate intake (i.e. breakfast) on cycling time trial performance compared to a
taste and flavor matched placebo and a water control.

The aim of the study was to examine the effect of a pre-exercise carbohydrate
intake in the form of maltodextrin (i.e breakfast) on a short duration high intensity
cycling time trial, compared to a placebo and water control.

A semi-solid breakfast was used to enhance the perception of energy/ nutrient

intake and facilitate blinding.

It was hypothesized that a carbohydrate breakfast would have no effect on

performance compared to the placebo, but both would be advantageous compared to
water.
Metodologia

Desenho

Estudo Observacional transversal cruzado com grupo de controlo e placebo

duplamente cego.

The time trial was completed in silence, in an enclosed area of the laboratory
with no additional feedback provided.

Sujeitos

Thirteen well-trained male cyclists, idade media de 25 anos, peso médio de 71kg
e altura media de 1,76 metros. Thirteen were recruited to provide adequate power and
account for dropouts
Medidas/Instrumentos

Subjects visited the laboratory of 5 occasions: a VO2peak test, a time trial

familiarization and three experimental trials (water (CON), placebo (PLA) and
carbohydrate (CHO); figure 1).

During the first visit, subjects performed a VO2peak test using a continuous
incremental protocol on an electronically braked cycle ergometer (Lode Excalibur; Lode
BV, Groningen, Netherlands). Commencing at 95 W, subjects completed three minutes
stages increasing by 35 W until exhaustion.

During the final minute of each stage and the final minute of the test, expired
gases were collected into a Douglas bag and analysed for oxygen and carbon dioxide
concentration (Servomex 1400 Oxygen and Carbon Dioxide Gas Analyser; Servomex,
Crowborough, UK).

During the second visit, subjects performed a familiarization of the exercise

portion of the experimental trial. This involved a 10-minute bout at 60% Wmax, 5-
minute rest, and then subjects were asked to reach a target workload, based on cycling
at 80% Wmax for 20 minutes, as quickly as possible.

The following formula was used to calculate work required:

𝑇𝑎𝑟𝑔𝑒𝑡 𝑘𝐽 = (𝑊𝑚𝑎𝑥 × 0.8 × 1200𝑠)/1000

Procedimentos

Subjects arrived overnight fasted and right on arrival, subjects provided a urine
sample, and had their body mass measured. A heart rate monitor (Polar Vantage;
Kempele, Finland) was fitted before the subject sat for 5 minutes and resting heart rate
recorded.
 At the end of the rest period a capillary fingertip blood sample (20 µl) was
collected and later analyzed for whole blood lactate and glucose concentrations.

Subjects were also asked to rate their gastrointestinal (GI) comfort (1 = neutral;
12 = painful).

Subjects were then asked to consume one of three breakfasts within 5 minutes:

-Control (CON) (7 ml·kg body mass (BM)-1 water),

- Placebo (PLA) (6 ml·kg BM-1 water, 1 ml·kg BM-1 orange squash

(Robinson’s, Britvic, Hemel Hempstead, UK), 0.67 g·kg BM-1 xanthan gum (Doves
Farm, Hungerford, UK) and 0.067 g·kg BM-1 artificial sweetener (Canderel, Merisant,
High Wycombe, UK))

-Carbohydrate (CHO) (6 ml·kg BM-1 water, 1 ml·kg BM-1 orange squash, 2

g·kg BM-1 maltodextrin (MyProtein, Northwich, UK), 0.67 g·kg BM-1 xanthan gum
and 0.067 g·kg BM1 artificial sweetener).

Xanthan gum was used to produce a semi-solid meal and increase the perception
of ‘energy intake’. When provided with either the PLA or CHO breakfast, subjects were
told, “this is one of the two breakfast drinks”. At 15-, 30-, 60- and 90-minutes post-
ingestion, heart rate and GI comfort were measured, and blood samples were collected.

The subjects were then undertaken in a randomized order to three trials.

Subjects were recruited on the premise that the investigation was examining two
breakfast drinks. Trials were performed in a randomised cross-over design. The PLA
and CHO trials were administered in a double-blind manner, although it was impossible
to blind the WAT trial from either experimenters or subjects.

Subjects completed 10 minutes at 60% Wmax. During the final minute of

exercise, heart rate and rating of perceived exertion were measured, and a sample of
expired gas was collected. On completion, a blood sample was collected, and subjects
rated GI comfort. Following a 5-minute period of rest, subjects began the time trial.

Final measurements (blood and GI comfort) were collected at the end of the
time trial. After the final trial, subjects were asked a series of questions: “Was there a
difference between the drinks?” and “Do you ever complete aspects of your training in
the morning after an overnight fast?”

Resultados

Pre-trial urine osmolality was similar between trials (WAT: 670 ± 195
mOsmol·kg-1 , PLA: 801 ± 199 mOsmol·kg-1 , CHO: 754 ± 226 mOsmol·kg-1 ; P =
0.158), suggesting subjects arrived in a similar state of hydration.

Performance measures

Time to complete the time trial was quicker in both the CHO (1120 ± 69 s; P =
0.005) and PLA (1112 ± 50 s; P = 0.030) trials compared to the WAT trial (1146 ± 74 s;
figure 2), however, there was no difference in performance between the CHO and PLA
trial (P = 0.544).

Analysis of pacing strategy showed a time effect, with the first 25% TT section
of all trials completed quicker than the 25-50% and 50-75% sections (P < 0.0001; figure
3) but similar to the final 25% (P = 0.141). The second 25% section was also completed
faster than the third section (P = 0.004). There was a significant trial effect (P < 0.0001)
but no interaction effect (P = 0.298).
 Heart rate was similar between trials at baseline, during the rest period and in the
10-minute steady state period of cycling. Mean heart rate was slightly lower during the
TT in the WAT trial (174 ± 8 bpm) compared to the PLA (175 ± 6 bpm; P = 0.006) and
CHO (177 ± 9 bpm; P = 0.003) trials.

Blood analysis

Following breakfast in the CHO trial, blood glucose concentrations increased

above baseline and remained elevated until 90 minutes, before dropping below baseline
concentrations following the 10-minute steady state cycling.

Blood glucose concentrations then increased above baseline following

completion of the TT. This increase following the TT also occurred in the WAT and
PLA trials. In the CHO trial, blood glucose concentrations were greater at 15, 30, 60
and 90 minutes and lower following steady state compared to the corresponding
samples in both the WAT and PLA trials (P < 0.05).

Blood lactate concentrations were not influenced by trial (P = 0.088).

Substrate utilisation

Due to problems with expired gas analysis, respiratory exchange ratio (RER)
and substrate utilization during the period of steady state cycling were only available for
10 out of 13 subjects. RER was greater in the CHO trial (0.94 ± 0.03) compared to the
PLA trial (0.89 ± 0.04). RER during the WAT trial was not different to the other trials
(0.92 ± 0.03; P = 0.112 v PLA; P = 0.117 v CHO).

Carbohydrate oxidation was greater in the CHO trial (3.10 ± 0.17 g·min-1 )
compared to the PLA trial (2.41 ± 0.53 g·min-1) however during the WAT trial (2.82 ±
0.48 g·min-1 ), carbohydrate oxidation was similar to the two other trials (P = 0.088 v
PLA; P = 0.148 v CHO).
 Fat oxidation was greater in the PLA trial (0.52 ± 0·23 g.min-1 ) compared to
the CHO trial (0.26 ± 0.17 g·min-1 ; P = 0.003), but similar in the WAT trial compared
to the two other trials (0.36 ± 0.16 g·min-1 ; P = 0.108 v PLA; P = 0.121 v CHO).

There was no difference in GI comfort between trials (time x trial interaction, P

= 0.446) and no rise from baseline values of 1 ± 1 (WAT), 1 ± 1 (PLA) and 1 ± 1 (CHO,
all P > 0.05) throughout the trials.

Questionnaire data

Out of thirteen subjects, five stated they felt there was a difference in the drinks,
with all these subjects correctly identifying the CHO trial as either containing
‘carbohydrate’ or ‘energy’. Of the remaining eight subjects, four correctly guessed the
order of the PLA and CHO trials.

Seven subjects completed little to none of their training in a fasted state, with the
remaining six subjects performing a fraction (1-2 rides per week) of their training in a
fasted state
Discussão

Performance was improved in both the CHO and PLA trials suggesting there
was a placebo effect of ingesting breakfast. This would indicate that with the length and
intensity of the exercise used in the current study, nutritional intake may be of
psychological benefit, rather than physiological.

The placebo effect has been observed in 60-minute performance trials (14),
however, when exercise is of longer duration and the metabolic benefits of carbohydrate
intake are clearer, no placebo effect was observed (15).

Pre-exercise carbohydrate studies tend to compare a carbohydrate drink with a

taste-matched placebo (5-8) but have not increased the viscosity to create the perception
of ingesting a meal. And few include a water control (15), preventing the investigation
of knowingly ingesting nothing which may dampen any placebo effect.

In the current study, it is possible the perception of nutritional intake resulted in

an anticipatory effect encouraging increased self-selected intensity as evidenced by an
increased HR in the PLA and CHO trials.

Although more commonly practiced during exercise, this effect is not too
dissimilar from the suggested mechanistic action of carbohydrate mouth rinsing, where
oral sensing of carbohydrate has enhanced endurance performance (16-17).

It has been proposed that there is an increase in central motor drive rather than
any metabolic effects (16). In the present study the increased viscosity of the drink may
have contributed to the sensing or perception of substrate and an increase in central
motor drive.

An alternative mechanism that has been mentioned by several authors is

a centrally located effect of the ingested CHO (2,11,14,20). However, to date,
this mechanism has not been discussed in any detail.
 The lack of difference between segments in trials, particularly between the PLA
and CHO trials suggests that substrate availability, or rather the increased availability
from maltodextrin ingestion did not contribute to pacing.

Ingestion of maltodextrin increased carbohydrate oxidation during the steady

state exercise in CHO compared to PLA and likely during the time trial. Maltodextrin
ingestion would have stimulated insulin release and in combination with high blood
glucose would decrease fatty acid oxidation (18), as well as increasing glucose uptake
into the muscle (19).

In the current study, this did not appear to influence performance, either because
the time trial was too short in duration for substrate utilization to have a meaningful
influence or the placebo effect of breakfast was greater than any metabolic effects and
had greater regulation over pacing.

One of the main aims of a carbohydrate meal after an overnight fast is to

replenish liver glycogen (13). In the current study this did not appear to enhance
performance as there was no difference between the PLA and CHO performance times.
The absence of a difference is likely explained by the short duration of the time trial,
where less glycogen availability is required compared to longer performance tests in
which differences have been observed (5).

The pre-exercise feeding recommendation for exercise greater than 60 minutes is

to ingest carbohydrate in the 1-4 hours before exercise (7).

The 90 minutes pre-exercise breakfast ingestion in the current study found

similar results to Galloway and colleagues (20) when ingestion occurred 2 hours before
a shorter exercise capacity test (~7.5-9.0 minutes). The amount of carbohydrate
provided by Galloway et al. (20) used was 32 g (the present study used approximately
142 g) and there was no water control to determine if there was a placebo effect.

In an interesting caveat, in the same study, a performance difference was

observed when the 32 g of carbohydrate was ingested 30 minutes before exercise
compared to a placebo. This was attributed to an increase in glucose uptake and
oxidation in the early stages of exercise as well as possible non-metabolic effects such
as positive alterations in mood and arousal.

When carbohydrate is ingested close to exercise there is the possibility of

rebound hypoglycaemia during the initial stages of exercise. Although the general
results are mixed, the effect on performance has been largely refuted (21). Whilst
hypoglycaemia did not occur in the present study there was a small decrease in blood
glucose concentrations following the 10-minute steady state.

It therefore seems that for short duration exercise carbohydrate ingestion close to
exercise may improve performance through a partial metabolic effect, however, when
ingested around 90 minutes before exercise the improvement in performance is likely
psychological hence the similar performance observed between the PLA and CHO
trials.

Aplicações práticas

Many athletes will complete some training sessions in a fasted state; however,
these are often limited to recovery and low intensity sessions. Typically, athletes will
ingest a pre-exercise meal or source of carbohydrate prior to engaging in high quality
and intense bouts of exercise, even if guidelines do not necessarily suggest consumption
when exercise duration is less than 60 minutes (7). The results of this study suggest that
from a physiological perspective this is not necessary; however, the act of ingesting a
perceived breakfast improved performance regardless of energy content. Studies
examining alternative methods of low carbohydrate availability (i.e. training after an
overnight fast or in a depleted state – in both situations the athlete is not blinded to the
condition) have repeatedly demonstrated a reduction in self-selected intensity (11-12),
yet also beneficial cell signalling responses and the increasing of mitochondrial
biogenesis (9-12-22).

This study poses the question of the possibility that the benefits of both high
(maintained self-selected intensity) and low (increased cellular adaptations)
carbohydrate availability can be achieved through a placebo breakfast.
 The placebo effect is unlikely to last chronically so a carefully planned approach
by the coaching team is required to maximise adaptations by selecting key sessions for
acute implementation.

Conclusão

In conclusion, subjects in this study were able to complete a short duration

(approximately 20 minutes) cycling time trial quicker when they consumed a PLA or
CHO breakfast 90 minutes prior to the start of exercise compared to a water control.

The improvement in performance was due to a psychological rather than

physiological cause, with the subjects perceiving the ingestion of breakfast and nutrients
as beneficial, resulting in an increased self-selected intensity