title: Exploring mechanisms of fatigue during repeated exercise and the dose dependent effects of carbohydrate and protein ingestion: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Muscle glycogen has been well established as the primary metabolic energy substrate during physical exercise of moderate- to high-intensity and has accordingly been implicated as a limiting factor when such activity is sustained for a prolonged duration. However, the role of this substrate during repeated exercise after limited recovery is less clear, with ongoing debate regarding how recovery processes can best be supported via nutritional intervention. The aim of this project is to examine the causes of fatigue during repeated exercise bouts via manipulation of glycogen availability through nutritional intervention, thus simultaneously informing aspects of the optimal feeding strategy for recovery from prolonged exercise.
  
  
  METHODS
  The project involves two phases with each involving two treatment arms administered in a repeated measures design. For each treatment, participants will be required to exercise to the point of volitional exhaustion on a motorised treadmill at 70% of previously determined maximal oxygen uptake, before a four hour recovery period in which participants will be prescribed solutions providing 1.2 grams of sucrose per kilogram of body mass per hour of recovery (g.kg-1.h-1) relative to either a lower rate of sucrose ingestion (that is, 0.3 g.kg-1. h-1; Phase I) or a moderate dose (that is, 0.8 g.kg-1.h-1) rendered isocaloric via the addition of 0.4 g.kg-1.h-1 whey protein hydrolysate (Phase II); the latter administered in a double blind manner as part of a randomised and counterbalanced design. Muscle biopsies will be sampled at the beginning and end of recovery for determination of muscle glycogen resynthesis rates, with further biopsies taken following a second bout of exhaustive exercise to determine differences in substrate availability relative to the initial sample taken following the first exercise bout.
  
  
  CONCLUSIONS
  Phase I will inform whether a dose-response relationship exists between carbohydrate ingestion rate and muscle glycogen availability and/or the subsequent capacity for physical exercise. Phase II will determine whether such effects are dependent on glycogen availability per se or energy intake, potentially via protein mediated mechanisms.
  
  
  BACKGROUND
  ISRCTN87937960.
authors.affiliation: Human Physiology Research Group, Department for Health, University of Bath, Bath BA2 7AY, UK. A.F.Alghannam@bath.ac.uk.
authors.forename: Abdullah F
authors.initials: AF
authors.lastname: Alghannam
authors.forename: Kostas
authors.initials: K
authors.lastname: Tsintzas
authors.forename: Dylan
authors.initials: D
authors.lastname: Thompson
authors.forename: James
authors.initials: J
authors.lastname: Bilzon
authors.forename: James A
authors.initials: JA
authors.lastname: Betts
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002985:Clinical Protocols; D018592:Cross-Over Studies; D004044:Dietary Proteins / Q000008:administration & dosage*; D019422:Dietary Sucrose / Q000008:administration & dosage*; D004311:Double-Blind Method; D004734:Energy Metabolism; D004739:England; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006003:Glycogen / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018763:Muscle Fatigue; D018482:Muscle, Skeletal / Q000378:metabolism* / Q000503:physiopathology; D009752:Nutritional Status; D010101:Oxygen Consumption; D020127:Recovery of Function; D012107:Research Design; D012420:Running; D013997:Time Factors; D055815:Young Adult
chemical_list: D004044:Dietary Proteins; D019422:Dietary Sucrose; D006003:Glycogen