Nutritional interventions are not commonly a standard of care in rehabilitation interventions. A nutritional approach has the potential to be a low-cost, high-volume strategy that complements the existing standard of care. In this commentary, our aim is to provide an evidence-based, practical guide for athletes with injuries treated surgically or conservatively, along with healing and rehabilitation considerations. Injuries are a normal and expected part of exercise participation. Regardless of severity, an injury typically results in the athlete's short- or long-term removal from participation. Nutritional interventions may augment the recovery process and support optimal healing; therefore, incorporating nutritional strategies is important at each stage of the healing process. Preoperative nutrition and nutritional demands during rehabilitation are key factors to consider. The physiological response to wounds, immobilization, and traumatic brain injuries may be improved by optimizing macronutrient composition, caloric consumption, and nutrient timing and using select dietary supplements. Previous research supports practical nutrition recommendations to reduce surgical complications, minimize deficits after immobilization, and maximize the chance of safe return to play. These recommendations include identifying the individual's caloric requirements to ensure that energy needs are being met. A higher protein intake, with special attention to evenly distributed consumption throughout the day, will help to minimize loss of muscle and strength during immobilization. Dietary-supplement strategies may be useful when navigating the challenges of appropriate caloric intake and timing and a reduced appetite. The rehabilitation process also requires a strong nutritional plan to enhance recovery from injury. Athletic trainers, physical therapists, and other health care professionals should provide basic nutritional recommendations during rehabilitation, discuss the timing of meals with respect to therapy, and refer the patient to a registered dietitian if warranted. Because nutrition plays an essential role in injury recovery and rehabilitation, nutritional interventions should become a component of standard-of-care practice after injury. In this article, we address best practices for implementing nutritional strategies among patients with athletic injuries.

Pre-sleep whey protein intake has been shown to improve overnight muscle protein synthesis, muscle size and strength, and muscle recovery. Despite a growing interest in alternative protein sources, such as plant-based protein, there is no evidence regarding the efficacy of plant-based proteins consumed pre-sleep. Therefore, we aimed to compare whey vs. plant-based pre-sleep protein dietary supplementation on muscle recovery in middle-aged men. Twenty-seven recreationally active, middle-aged men performed 5 sets of 15 repetitions of maximal eccentric voluntary contractions (ECC) for the knee extensors (ext) and flexors (flex), respectively, in the morning. Participants consumed 40 g of either whey hydrolysate (WH, n = 9), whey isolate (WI, n = 6), rice and pea combination (RP, n = 6), or placebo (PL, n = 6) 30 min pre-sleep on the day of ECC and the following two nights. Catered meals (15% PRO, 55% CHO, 30% Fat) were provided to participants for 5 days to standardize nutrition. Plasma creatine kinase (CK), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured at pre, immediately post (+0), +4, +6, +24, +48, and +72 h post-ECC. Isometric (ISOM) and isokinetic (ISOK) maximal voluntary contraction force were measured at pre, immediately post (+0), +24, +48, and +72 h post-ECC. Muscle soreness, thigh circumference, and HOMA-IR were measured at pre, +24, +48, and +72 h post-ECC. CK was increased at +4 h post-ECC, remained elevated at all time points compared to baseline (p < 0.001), and was significantly greater at +72 h compared to all other time points (p < 0.001). IL-6 was increased at +6 h (p = 0.002) with no other time differing from baseline. ISOMext was reduced after ECC (p = 0.001) and remained reduced until returning to baseline at +72 h. ISOMflex, ISOKext, and ISOKflex were reduced after ECC and remained reduced at +72 h (p < 0.001). Muscle soreness increased post-ECC (p < 0.001) and did not return to baseline. Thigh circumference (p = 0.456) and HOMA-IR (p = 0.396) did not change post-ECC. There were no significant differences between groups for any outcome measure. These data suggest that middle-aged men consuming 1.08 ± 0.02 g/kg/day PRO did not recover from damaging eccentric exercise at +72 h and that pre-sleep protein ingestion, regardless of protein source, did not aid in muscle recovery when damaging eccentric exercise was performed in the morning.

Body composition technology is rapidly advancing with new methods being implemented for research and clinical care. A fourcompartment (4C) model is widely accepted as the gold standard for evaluating body composition (Heymsfield & Waki, 1991). By measuring various compartments of fat-free mass (FFM), including total body water (TBW) and bone mineral content (BMC), the 4C model produces the most valid estimates of total body composition (Wang et al., 2002). However, assessment of body composition with a 4C model is costly, time intensive, and may not be widely accessible. Advancements in testing methodology have increased in the

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PURPOSE:Training above ventilatory threshold (VT), and corresponding heart rate, have resulted in improvements in aerobic capacity; the ability to oxidize fatty acids is a limiting factor in endurance performance. Additionally, little is known about the contribution of body composition on maximal fat oxidation (Fatmax). The purpose of this study was to characterize Fatmax and its relationship to VT in endurance trained young adult males. A secondary purpose was to understand the impact of body composition on Fatmax. METHODS: 25 trained males (Age: 22.2±2.4 yrs; Height:177.0±4.8 cm; Weight: 75.3±6.9 kg; VO2max: 50.5±14.6 mL/kg/min) were assessed for body composition using dual-energy X-ray absorptiometry to estimate lean mass (LM), fat mass (FM), and percent body fat (%BF). All subjects performed an incremental graded exercise test to volitional exhaustion. Fatmax was determined as the exercise intensity (%VO2max) at which the highest rate of fat oxidation was observed. VT was determined automatically from the software as the point by which respiration increased to compensate for CO2 and lactate accumulation. Paired t-tests were used to determine the differences between Fatmax and VT%VO2max, FatmaxVO2 and VTVO2, and HR at Fatmax and VT. Multiple linear regression was used to analyze the influence of body composition on Fatmax. RESULTS: There were no significant differences between Fatmax and VT%VO2 (Mean Difference ± Standard Error: -0.2±0.1%; p=0.107) or FatmaxVO2 and VTVO2 (-3.4±3.1 L/min; p=0.288). FatmaxHR was significantly lower than VTHR (-11.7±3.1 bpm; p=0.001). LM, FM, %BF did not significantly influence Fatmax (F=0.888, R 2 =0.13, p=0.464). CONCLUSIONS: The similar intensity observed between VT and Fatmax suggests training above VT could be a useful strategy for maximizing fat oxidation during exercise, thereby supporting glycogen sparing in addition to enhanced training volume and exercise adaptations. Body composition does not appear to be an important factor for Fatmax in young males.