The Dietary Reference Intakes set the protein RDA for persons >19 y of age at 0.8 g protein ⋅ kg body weight-1 ⋅ d-1. A growing body of evidence suggests, however, that the protein RDA may be inadequate for older individuals. The evidence for recommending a protein intake greater than the RDA comes from a variety of metabolic approaches. Methodologies centered on skeletal muscle are of paramount importance given the age-related decline in skeletal muscle mass and function (sarcopenia) and the degree to which dietary protein could mitigate these declines. In addition to evidence from short-term experimental trials, observational data show that higher protein intakes are associated with greater muscle mass and, more importantly, better muscle function with aging. We are in dire need of more evidence from longer-term intervention trials showing the efficacy of protein intakes that are higher than the RDA in older persons to support skeletal muscle health. We propose that it should be recommended that older individuals consume ≥1.2 g protein · kg-1 · d-1 and that there should be an emphasis on the intake of the amino acid leucine, which plays a central role in stimulating skeletal muscle anabolism. Critically, the often-cited potential negative effects of consuming higher protein intakes on renal and bone health are without a scientific foundation in humans.

Estimates of critical power (CP) and anaerobic work capacity (AWC) from the power output vs. time relationship have been derived from various mathematical models. The purpose of this study was to examine estimates of CP and AWC from the multiple work bout, 2- and 3-parameter models, and those from the 3-minute all-out CP (CP3min) test. Nine college-aged subjects performed a maximal incremental test to determine the peak oxygen consumption rate and the gas exchange threshold. On separate days, each subject completed 4 randomly ordered constant power output rides to exhaustion to estimate CP and AWC from 5 regression models (2 linear, 2 nonlinear, and 1 exponential). During the final visit, CP and AWC were estimated from the CP3min test. The nonlinear 3-parameter (Nonlinear-3) model produced the lowest estimate of CP. The exponential (EXP) model and the CP3min test were not statistically different and produced the highest estimates of CP. Critical power estimated from the Nonlinear-3 model was 14% less than those from the EXP model and the CP3min test and 4-6% less than those from the linear models. Furthermore, the Nonlinear-3 and nonlinear 2-parameter (Nonlinear-2) models produced significantly greater estimates of AWC than did the linear models and CP3min. The current findings suggested that the Nonlinear-3 model may provide estimates of CP and AWC that more accurately reflect the asymptote of the power output vs. time relationship, the demarcation of the heavy and severe exercise intensity domains, and anaerobic capabilities than will the linear models and CP3min test.

These findings suggest CP and RCP demarcate the heavy from severe exercise-intensity domain and result from a different mechanism of fatigue than that of GET and VT, possibly hyperkalemia.

Insofar as atrophic loss of skeletal muscle mass is concerned, anabolic resistance is a principal determinant of age-induced losses and appears to be a contributor to critical illness-induced skeletal muscle atrophy. Older individuals should perform exercise using both heavy and light loads three times per week, ingest at least 1.2 g of protein/kg/day, evenly distribute their meals into protein boluses of 0.40 g/kg, and consume protein within 2 h of retiring for sleep. During critical care, early, frequent, and multimodal physical therapies in combination with early, enteral, hypocaloric energy (∼10-15 kcal/kg/day), and high-protein (>1.2 g/kg/day) provision is recommended.

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