Development and Presentation of Sports Nutrition Modules for the National Outdoor Leadership School (NOLS)

1. Development and Presentation of Sports Nutrition Modules for the National Outdoor Leadership School (NOLS) Focused Area of Study Defense April 16, 2013 EmaThake University of Utah

2. Outline • Introduction • Aims • Overview of Project • Subjects • Module Development • Module Topics • NOLS presentation • Conclusions • Strengths and Limitations • Future Directions

3. Introduction

4. NOLS • Offers courses ranging from 14 days to full academic year • Hot, temperate, and cold climates • Some courses at high altitudes • Backcountry poses as setting for unique, experimental education • Core curriculum • outdoor skills that include nutrition and ration planning, sanitation, equipment care, and preparing nutritious meals using a camp stove and fire • Expressed concern that unintentional weight loss and decrease in lean body mass is a growing problem among students

5. Energy Expenditure at Altitude • Upon ascent to altitude, energy expenditure increases (Meyer et al., 2011) • Unintentional weight loss • Unwanted decrease in lean body mass • Weight loss at altitude is a common occurrence (Kechijan, 2011) • Increased BMR • Increased exertion due to physical activity • Appetite suppression associated with hypoxia • Limited food availability

6. Altitude and Cold Climates • For the participants at NOLS, the exposure to higher altitudes can both increase energy needs and decrease energy intake. • Induce an energy deficit from sub-caloric intake • Result in decreased weight and a loss of lean body mass • The energy deficit is worsened when it is combined with increased energy expenditure due to exercise (Westerterp and Kayser, 2006). • The balance between catabolic processes and protein synthesis in skeletal muscle is affected by total energy balance (Pasiakos et al., 2010)

7. Extreme Climates • Prolonged physical activity in hot and cold climates can lead to a sub caloric energy intake and dehydration if adequate energy intake and fluid balance is not maintained. • Askew, 1995 • Not only does extreme environment contribute to increased energy expenditure in the participants working in hot and cold climates, but there are aspects, such as equipment and weight of clothing that could contribute to increased needs • Castellani et al., 2006 • When cold exposure is severe enough to elicit a shivering response, individual energy requirements rise, which significantly increases metabolic production in an attempt to maintain core temperature.

8. Dietary Protein Intake • AND Position Stand • Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue (Rodriguez et al., 2009). • Kreider and Campbell, 2009 • While increased energy intake is required to maintain energy balance, dietary protein is required to promote growth, repair damaged cells and tissue, and synthesize hormones, among a variety of other metabolic activities.

9. Nutrient Timing • Adequate intake and appropriate timing of protein ingestion has shown benefit in regards to anaerobic, strength, and endurance exercise (Kreider and Campbell, 2009) • Feeding studies have indicated that protein ingestion immediately after exercise training has increased the synthesis of muscle proteins (Wycherley et al., 2010). • Nutrient timing, specifically protein, may be an important factor in maintaining lean body mass and stimulating muscle adaptations that occur during prolonged exercise. • Important to consume carbohydrate + protein • Consuming both carbohydrate and protein to create a ratio of 3 - 4:1 may increase endurance performance and is shown to maximally promote glycogen re-synthesis during acute and subsequent bouts of endurance exercise (Kerksick et al., 2008).

10. Hydration • Many physiological factors contribute to dehydration • Increased body core temperature • Increased cardiovascular strain • Increased glycogen utilization • Altered central nervous system function • In a field or wilderness setting, individuals may perform activities that require anaerobic power or muscular strength (Kenefik, 2012). • Dehydration can lead to decreases in performance of strength, power, and high-intensity endurance activities • Long duration exercise in temperate or slightly warm environments can cause thermoregulatory sweating to lead to progressive dehydration and result in lower exercise output.

11. Hydration and Cold Injury • In colder climates, a common physiological response is increased urine production (Kenefik, 2012). • Fluid is shifted as a result of vasoconstriction of the extremities. • Thirst is less noticeable in colder temperature and replacing lost fluid may be neglected. • If an individual is wearing heavy clothing in colder climates, sweating may be increased, simultaneously increasing fluid loss.

12. Mettler et al., 2010 • Examined the influence of dietary protein on lean body mass loss and performance during short-term hypoenergetic weight loss in athletes. • 20 males, 18-40 yrs, BMI >20, resistance trained • Week 1: habitual diets • Week 2: provided with 100% energy (50% CHO, 15% PRO, 35% fat) • Week 3 and 4: Allocated to control or high protein group • Both groups dropped to 60% of habitual intake • Composition of control diet remained the same • High protein diet 50% CHO, 35% PRO, 15% fat

13. Mettler et al., 2010 Both groups lost the same amount of fat mass, however the control group lost significantly more lean (p = .006) and total body mass (p = .036) than the intervention group Performance was not significantly different between groups

14. Overview of Project

15. Aims • Identify nutrition problems that may occur during NOLS courses • Develop a nutrition education curriculum consisting of four nutrition modules for NOLS • Introduce education modules to NOLS instructors in Lander, Wyoming

16. Subjects • NOLS participants • Instructors and students • Varied age, experience, and education levels

17. Module Development • Originally developed based on feedback from instructor survey • Modifications made for appropriate use in an outdoor setting • Teaching activities are provided for each module • Guidance for instructors to deliver the information to students • Teaching brochure • Short survey was developed to determine module topics • Distributed to NOLS instructors via social media • A teaching packet was developed for instructors at the meeting in Lander, WY • Included copies of the modules, brochure, NOLS rations list with nutrition information

18. Module One • An introduction to nutrition in the backcountry • Discusses each macronutrient • Purpose during exercise • Examples of NOLS rations are given • Materials • Rations list and nutrition information • Teaching activities • While preparing and consuming meals, students should identify foods that contain the different macronutrients. Discuss functions and the importance of including all at every meal. • When taking breaks, students should discuss how their snacks are contributing to the energy that can be used during activity.

19. Module Two • Energy expenditure/Increased Needs • Discusses the reason for increased energy needs during exercise at altitude and in extreme environments. • Consequences of sub-caloric intake in extreme environments • Instructions to calculate individual needs based on responsibilities around camp and throughout the day • Materials • Template for calculating energy needs based on RER and activity level • Teaching activities • Instructors will explain the reasons for increased energy needs at altitude and in extreme environments • Students will calculate their individual energy needs using the provided template

20. Module Three • Hydration • Discusses the importance of maintaining adequate hydration while on NOLS courses. • Causes of water loss, determining hydration levels, electrolyte balance and hyponatremia, hydration and cold injury, consequences of prolonged dehydration, and how to prevent dehydration. • Materials • Urine chart to assess hydration status • Teaching activities • Students will assess hydration status at least twice per day by evaluating urine samples and comparing urine color to the chart provided in the brochure. • Students will discuss the importance of maintaining adequate hydration and identify ways of doing so, including appropriate foods, beverages, and approximate amounts that are required.

22. Module Four • Nutrient timing and recovery • Discusses nutrition timing and strategies to create more calorically dense meals. • Details of nutrient timing before, during, and after exercise • Provides suggestions for increasing calorie content of meals and snacks • Materials • Table describing appropriate nutrient timing and examples of snacks and meals • List of suggestions to add more calories to meals

24. Presentation • Nutrition modules were presented in Lander, WY on March 7 • 12 instructors • Feedback and discussion was encouraged during the meeting • Overall, it appeared that modules were appropriate for implementation in the outdoor setting • Minor changes were made to some of the modules

25. Module Modifications • Module One • Macronutrient examples of NOLS rations were very helpful • Valuable feedback regarding information that was “new” to instructors • Module Two • Concern that calculating individual needs would be time consuming and unlikely • May be more appropriate for NOLS courses that are longer than two weeks in duration

26. Module Modifications • Module Three • Instructors encourage students to consume fluids throughout the day, even if it means the addition of mixes and flavorings • Hyponatremia is not a big concern in the NOLS population • Urine color most feasible way of determining hydration status • Module Four • Instructors seemed hesitant to encourage specific timing of snacks and meals • Methods of increasing calories has been discussed but is not yet being utilized

27. Conclusions

28. Conclusions • Meeting increased energy needs is essential to optimal performance, quicker recovery, and maintenance of lean body mass in individuals at altitude and in extreme environments. • In response to a brief survey taken by NOLS instructors, four modules and one educational brochure were developed to a nutrition course that can be taught to students in the backcountry setting. • It is hopeful that NOLS participants will be able to apply this valuable nutrition information to their personal lives after completing the NOLS courses.

29. Strengths and Limitations Strengths Limitations Lack of agreement among instructors regarding delivery of nutrition education Some instructors did not feel that nutrition education was necessary • Modules were developed based on feedback from instructors • Information is appropriate for target population • Modules are individualized to meet the needs of NOLS participants • Different recommendations than general population

30. Future Directions • Different methods of delivery • Learning objectives • Lecture format • Video demonstrations • Instructor survey • Feedback regarding reasonable application of the information

35. Questions? Thank You

36. References • Butterfield GE, Gates J, Fleming S, Brooks GA, Sutton JR, Reeves JT. Increased energy intake minimizes weight loss in men at high altitude. J Appl Physiol. 1992 May;72(5):1741-8. • Castellani JW, Stulz DA, DeGroot DW, Blanchard LA, Cadarette BS, Bradley C et al. Eighty-four hours of sustained operations after thermoregulation during cold exposure. Medicine and Science in Sports and Exercise, 2001, 35, 175-181. • Castellani JW, Young AHmDucharme MB, Giesbrecht GG, Glickman E, Sallis RE. American College of Sports Medicine position stand: Prevention of cold injuries during exercise. Medicine and Science in Sports and Exercise, 2006, 38, 2012-2029. • Cockburn E, Stevenson E, Hayes PR, Robson-Ansley P, Howatson G. Effect of milk-based carbohydrate-protein supplement timing on the attenuation of exercise-induced muscle damage. ApplPhysiolNutrMetab, 2010, 35: 270-277. • Howley Ryan, M. (2008). Backcountry Nutrition, Eating Beyond the Basics. Mechanicsburg, PA. Stackpole Books. • Kechijan D. Optimizing nutrition for performance at altitude: a literature review. J Spec Oper Med, 2011 Winter; 11(1):12-7. • Kerksick C, Harvey T, Stout J, Campbell B, Wilborn C, Kreider R, Kalman D, Ziegenfuss T, Lopez H, Landis J, Ivy JL, Antonio J. International Society of Sports Nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 2008;5:18. • Kreider RB, Campbell B. Protein for exercise and recovery. Phys Sportsmed, 2009 Jun;37(2):13-21. • Mettler S, Mitchell N, Tipton K. Increased protein intake reduces lean body mass loss during weight loss in athletes. Medicine in Science and Sports Exercise. 2010

37. References • Meyer NL, Manore MM, Helle C. Nutrition for Winter Sports. Journal of Sports Sciences, 2011; 29(S1): S127-S136 • Pasiakos SM, Vislocky LM, Carbone JW, Altieri N, Konopelski K, Freake HC, Anderson JM, Ferrando AA, Wolfe RR, Rodriguez NR. Acute energy deprivation affects skeletal muscle protein synthesis and associated intracellular signaling proteins in physically active adults. J Nutr. 2010;140:745-751. • Rodriguez NR, DImarco NM, Langley S; American Dietetic Association; Dietitians of Cananda; American College of Sports Medicine: Nutrition and Athletic Performance. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Am Diet Assoc, 2009 Mar; 109(3):509-27. • San Miguel JL, Spielvogel H, Berger J, Araoz M, Lujan C, Tellez W, Caceres E, Gachon P, Coudert J, Beaufrere B. Effect of high altitude on protein metabolism in Bolivian Children. High Alt Med Biol, 2002 Winter;3(4):377-86. • Westerterp KR, Kayser B. Body mass regulation at altitude. Eur J GastroenterolHepatol. 2006 Jan;18(1):1-3. • Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. Timing of protein ingestion relative to resistance exercise training does not influence body composition, energy expenditure, glycaemic control, or cardiometabolic risk factors in a hypocaloric, high protein diet in patients with type 2 diabetes. Diabetes, Obesity and Metabolism, 2010, 12: 1097-1105.