Maximize Your Recovery

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on how to maximize recovery.

Every athlete wants to maximize his/her recovery and this is possible by consuming the proper post-workout snack. Thirty to sixty minutes after a workout, an athlete should consume a snack that is high in carbohydrate and moderate in protein. Fluids should also be consumed to ensure adequate rehydration. These strategies have proven to be very effective for those athletes exercising more than one time per day several days per week or after intense training sessions lasting 30 minutes or longer. Knowing more about the four R’s of recovery nutrition – replace, restore, repair, and rebuild – will allow athletes to select the most appropriate post-workout fuel and fluids.

  • Replace fluids and electrolytes lost through sweat
  • Restore carbohydrate (glycogen) utilized during exercise
  • Repair and rebuild muscle tissue broken down during exercise

Replacing fluids and electrolytes lost through sweat enhances rehydration and recovery. For most this can easily be accomplished by drinking water and consuming salt in foods and snacks throughout the day. Ideally, athletes should be consuming enough fluids during a workout to prevent dehydration. The best way to ensure that you are not losing too many fluids during exercise is to weigh yourself before and after a workout (nude or in dry clothing). The goal is for your weight to be stable. If it increases then you are consuming too many fluids and if it decreases then you need to consume more fluids during exercise. For every pound lost during exercise, you must consume 24oz of fluid. The extra 8oz of fluid will offset addition respiratory and urinary losses post-workout.

Restoring the carbohydrate (glycogen) utilized during exercise is imperative for recovery. The first 30 to 60 minutes post-workout is the optimal time for the athlete to begin restoring the muscle and liver glycogen lost during exercise and commencing the process of repairing and rebuilding the muscle tissue. Glycogen stores take approximately 20-22 hours to replenish fully as long as the athlete is consuming the recommended amount of carbohydrates and eating consistently throughout the remainder of the day.

Recovery plans do differ depending upon the length and duration of activity. Athletes exercising frequently and/or intensely should consume 1-1.2g/kg/h of carbohydrate for the first 4 hours post-glycogen depleting exercise. Then regular meal and snack consumption will help further restore the glycogen. Glucose and sucrose (found in starchy foods) are twice as effective fructose (juices) in restoring glycogen. Research shows that adding protein to a recovery snack does help rebuild and repair the muscle tissue, but consuming greater than 20 grams of protein at a given time does not further benefit the recovery process.

Excellent recovery snacks include PB & J sandwich, chocolate milk, Greek yogurt parfait, fruit and yogurt smoothie, cereal, milk and fruit, fruit with peanut butter, and nut and dried fruit trail mix.

Missing post-workout snacks may result in premature muscle fatigue and prolonged soreness caused by incomplete glycogen restoration. A proper recovery plan that includes refueling and rehydrating strategies will increase training adaptations and prevent muscle fatigue.

Case Study:

Sara is training for a long distance swimming event and is practicing 1 to 2 times per day 5 days per week. She is feeling tired, sore and fatigued at the end of the week. Her nutrition plan reveals that she is consuming enough fluid throughout the day and during her workout, but is not consistently consuming post-workout fuel. Weighing 125# (57kg) Sara needs 57-68g of carbohydrate and 15-20 grams of protein in her post-workout snack. Appropriate snacks would include PB & J sandwich and 8-16oz of skim or 1% milk or Greek yogurt, banana and a granola bar.

Thank you to our readers for submitting this question. We have had many wonderful questions/comments, which have resulted in several of the articles written thus far and questions that have been submitted in the last few months will be answered in the upcoming months. information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to . Questions will be answered on a monthly basis.

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Supreme Court upholds a key part of the Affordable Care Act

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Chief Justice John G. Roberts Jr. wrote.

In a 6-3 decision, the Supreme Court passed the controversial health care law that will allow millions of Americans who got covered in health insurance marketplaces to stay covered, no matter where they live. The Supreme Court ruled the federal government’s ability to subsidize eligible people on lower and middle incomes to buy health insurance on the federal marketplace.

Roughly 10.2 million Americans have signed up for Obamacare and paid their insurance premiums through the exchanges as of March, and 6.4 million were receiving subsidies to help afford coverage in the 34 states that had not established their own marketplace.

President Obama tweeted, “Today’s decision is a victory for every hardworking American. Access to quality, affordable health care is a right, not a privilege.”

To learn more about the Affordable Care Act ruling, visit,

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Oregon passes pharmacist provider status law

After four years, Oregon State Governor, Kate Brown, passed HB 2028—permitting insurance carriers to add pharmacists to its network of providers and expand collaborative drug therapy management.

California and Washington State passed similar laws to recognize the value of pharmacists on the health care team, and efforts to pass federal legislation.

Patients will have access to the specialized care services pharmacists provide including medication management, disease prevention, wellness, and post-diagnostic disease management. Doctors and Pharmacists will now be able to collaborate to design agreement to increase access to pharmacists’ patient care services and improve patients’ health.

To learn more about HB 2028 please visit Pharmacy Today.

Helpful titles for pharmacists and healthcare professionals:







Interested in learning more about Jones & Bartlett Learning’s pharmacy titles? Visit our website.

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Author Brian Coyne Elected CEPA President

Clinical Exercise ElectrocardiographyGreat news to share– Brian Coyne, author of Clinical Exercise Electrocardiography, has just been elected President of the Clinical Exercise Physiology Association (CEPA).

An affiliate association to the American College of Sports Medicine (ACSM), CEPA is dedicated to:

  • Enhancing the communication between clinical exercise physiologists by fostering and promoting the interchange of ideas, offering mutual support and encouraging professional development
  • Improving clinical practice by promoting established standards for programs, personnel, and facilities
  • Promoting scientific inquiry and advancement of education for clinical exercise physiologists and for the public related to exercise and its application in the prevention and treatment of chronic diseases and special medical conditions
  • Cooperating with other professional organizations, health care providers, insurers, legislators, scientists and educators with the same or related concerns.
  • Supporting the development and maintenance of quality care
  • Supporting the efforts of the ACSM

Please join us in congratulating Brian Coyne on this prestigious achievement!

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June is National Aphasia Awareness Month

June is National Aphasia Awareness Month. This national campaign is to educate the public about aphasia and to recognize those who are living or caring for people with aphasia. The American Heart Association/American Stroke Association increasing aphasia awareness by sharing tips, effects, and assisting devices.

Aphasia is a language disorder that affects the ability to communicate. Aphasia affects the production of speech and the ability to read and write.  Strokes are the most common cause of aphasia, and the 5th leading cause of death in the U.S, but can also be can arise from head trauma, brain tumors, or infections. People with aphasia have difficulty communicating in daily activities, social situations, or at work.

Support the Aphasia Campaign by sharing:

Want to learn more about aphasia? Check out Aphasia and Related Neurogenic Communication Disorders by Ilias Papathanasiou and Patrick Coppens.

Aphasia and Related Neurogenic Communication Disorders covers topic in aphasia, motor speech disorders, and dementia. This text provides a foundation for understanding the disorders and learning how to apply basic theory to clinical practice in the developments of rehabilitation objectives.


  • Comprehensive review chapters with case studies
  • Global perspectives with contributions from international leaders in the field
  • Features dedicated chapter on Traumatic Brain Injury
  • Integrates neuropsychological and functional/psychosocial issues

To learn more about National Aphasia Awareness Month, visit, or more about Aphasia, visit our website.

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Identifying Overtraining Syndrome

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on identifying overtraining syndrome.

The overtraining syndrome (OTS) is one of the most challenging diagnoses in the field of sports medicine, as there is no definitive test. Many of the symptoms of overtraining can mimic the signs of certain illnesses, so it is important that both athletes and coaches consult with qualified sports professionals, (physicians, sports dietitians, exercise physiologists, and athletic trainers,) to determine whether the athlete is potentially overtraining. Additionally, to complicate matters more, rarely do athletes experience identical symptoms. Some athletes may experience physical indicators only whilst others may experience a combination of both physical and psychological symptoms.

Athletes and coaches usually describe OTS as a condition that results in a steady decrease in physical and mental performance over time. Many athletes have described feelings of constant tiredness, persistent muscle and joint soreness, inability to focus, and/or a general sense of feeling burned out or staleness.

One of the chief causes of overtraining includes the lack of sufficient recovery (rest) between intense and/or frequent training sessions. It is generally accepted in the sports science community that endurance athletes are more susceptible to the condition than strength or power athletes. However, both types of training can result in the OTS if the athlete is not careful. Athletes who find themselves engaged in repetitive high intensity or long training sessions or who train daily or twice daily without adequate recovery are likely candidates for the OTS. High intensity training (a concept know as overreaching) is necessary for athletes to develop maximum strength, speed and power. After several days of overreaching, the athlete should follow up with a few days of reduced training intensity and volume (sets and reps) to allow the body to adapt and recover. Failure of an athlete to incorporate sufficient recovery between training days can result in maladaptation, resulting in burn out and possible injury. T o help avoid the OTS many coaches employ certified strength and conditioning specialists to assist athletes in the development of periodized training programs that incorporates regular fluctuations in training intensity and volume. Additionally, endurance and ultra-endurance athletes often utilize these programs and techniques to help them prepare and peak for major events throughout the season. Typical periodized training programs carefully manipulate the scientific principles of exercise to include intensity, frequency, duration and specificity and have been very effective in helping athletes avoid the OTS.

Once an athlete has been diagnosed with the OTS, very little can be done other than total rest to overcome the problem. There are anecdotal treatments such as supplement use, ice therapy, massage and dietary interventions that have been touted as remedies, but to-date none of these have proven to be effective in helping with the condition. Athletes and coaches should be educated on the potential signs and symptoms of overtraining and request professional intervention if they suspect that it is occurring. The sooner the athlete or coach seeks help the less chance the athlete will succumb to the overtraining condition.

Some of the more common signs and symptoms of overtraining include the following:

  1. A decrease in performance that lasts more than a week.
  2. A loss of appetite lasting more than a few days.
  3. Unintentional weight loss or inability to gain weight.
  4. Persistent muscle soreness or joint pain.
  5. Increased susceptibility to infection or illness.
  6. Poor mental focus or “drifting” during games or practice.
  7. Constant feelings of fatigue or tiredness.
  8. An inability to fall and stay asleep despite feeling exhausted.
  9. Increase in resting heart rate by more than 6 beats per minute over consecutive days.
  10. Feeling depressed, irritable or angry on a regular basis.
  11. Regular lack of motivation or desire to train and compete.
  12. A persistent decrease in strength, power or endurance.

A multitude of physical, psychological and physiological symptoms have been associated with the OTS. If an athlete experiences three or more symptoms for more than a week, he/she should seek professional medical help immediately to rule out possible medical conditions and, if necessary, begin the management of treating overtraining. If overtraining is suspected, a multidisciplinary approach utilizing medical experts, sports dietitians, exercise physiologists, athletic trainers, and coaches is the best solution to increase the potential for successful treatment. information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to . Questions will be answered on a monthly basis.

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New Instructor Review for PUBLISH

PUBLISHWondering what your peers think about PUBLISH? We found out. According to Elaine Mormer, PhD CCC-A, from the School of Health and Rehabilitation Sciences at the University of Pittsburgh,

“Being able to customize the book gave me the ability to pare down the content to include just the chapters necessary for my course. The students appreciated this and the cost to them was reduced from the original book price. It’s great to be able to put the book chapters in the order that works best for my class. The original title of the book did not work well for the class I was teaching. The ability to change the title of the book for my class was an important selling point for me. “

PUBLISH is the easiest way for instructors and other curriculum developers to build customized course materials to fit their exact curriculum needs. Using a simple, easy-to-navigate web-based interface, instructors quickly search and select content from the Jones & Bartlett Learning content library to create fully customized print or eBook editions.

Want to learn more? Visit our website or watch this preview video now:

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Congratulations to author, Dianne V. Jewell, on her candidacy for ‪APTA‬ President

Congratulations to Jones & Bartlett Learning author, Dianne V. Jewell, on her candidacy for APTA President.

We extend our best wishes to Dianne in the upcoming election!

Jewell’s bestselling Guide to Evidence-Based Physical Therapists Practice, Third Edition provides readers with the necessary tools needed to understand what constitutes evidence, how to search for applicable evidence, evaluate the findings, and integrate the evidence with clinical judgment and individual patient preferences and values.  This reader-friendly text facilitates learning and presents the knowledge and skills essential for physical therapist students to develop a foundation in research methods and methodologies related to evidence-based medicine.

 Key Features

  • Updated research examples
  • Presents statistics coverage with accessible content to review Description and Inference
  • Expanded content related to qualitative research designs

Instructor Resources

  • Sample Syllabus
  • Slides in PowerPoint format
  • Test Bank with 150 questions
  • Image Bank
  • Sample Evidence Appraisal Worksheets

 Student Resources

  • Crossword Puzzles
  • Flashcards
  • Interactive Glossary
  • Practice Quizzes
  • Web Links
  • Screenshots of electronic databases

To learn more about Guide to Evidence-Based Physical Therapist Practice, Third Edition, visit our website.

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Massachusetts Bill HB 2041 Would Recognize Pharmacists as Health Care Providers

According to the Massachusetts Pharmacists Association, bill HB 2041 would recognize pharmacists as health care providers. On April 9, pharmacists and pharmacy students gathered in Boston to advocate for HB 2041.

If the legislation passes this proposed bill it would allow pharmacists to bill MassHealth and the plans offered by the Group Insurance Commission for “drug therapy management services” to chronic disease patients when acting under the authority of a signed collaborative drug therapy management (CDTM) agreement with a physician. This bill would eliminate the list of disease states eligible for a CDTM agreement to allow pharmacists and physicians to team up on any disease that the physician requests.

To learn more about HB 2041 please visit Pharmacy Today.

Helpful titles for patient care, evaluation, assessment, diagnosis, and medication therapy:






Interested in learning more about our pharmacy titles? Visit our website.

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Endurance Events: What to Eat for the Long Haul

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert tips on endurance events.

Endurance events, such as marathons, ultra marathons, adventure races, and Ironmans, pose nutritional challenges for athletes. The mode of exercise, hours of competition, weather conditions, and racecourse all factor into creating a nutrition plan that maximizes energy consumption and hydration status.

During an endurance event, it is impossible to consume enough fuel or fluids to match what is being expended. Competitors must create an individual nutrition and hydration plan to ensure the body is receiving the maximal amount of fuel and fluids. The next four steps will help you formulate the proper plan for your event.

Step One: Know the Race Details

  1. Mode of Exercise: it is always possible to carry foods and fluids during exercise, but it is not always easy to consume the foods and fluids. For example, it is often easier for cyclist to eat and drink during exercise than a runner.
  2. Hours of Competition: longer events require higher carbohydrate and fluid needs. Endurance athletes are more susceptible to running out of fuel (“bonking”), dehydration or hyponatremia.
  3. Weather Conditions: sweat rates are influenced by cold, mild and hot weather.
  4. Racecourse: the variability of the racecourse may influence consumption. For example, it may be harder to eat/drink during more challenging areas of the course such as hills.

Step Two: Understand Basics Sports Nutrition Strategies

  1. Eat a balanced and easily digestible meal 1-4 hours prior to exercise.
  2. Consume a high carbohydrate snack and 8-16 ounces of fluid 30-60 minutes prior to exercise and/or competition.
  3. Eat and drink from the start of the event. Athletes that consume foods and fluids in the early minutes of the race perform stronger.
  4. Carbohydrate consumption: 30-60 grams per hour for 1 to 2.5 hours of activity and 80-90 grams per hour for 2.5 to 3 hrs and more of activity. Use carbohydrate sources that have multiple transportable carbohydrates (glucose and fructose) to increase absorption and reduce gastrointestinal distress. Consuming fructose only could cause symptoms such as bloating and diarrhea.
  5. Hydration: consume 5-12 ounces of fluid every 15-20 minutes during exercise. Amount varies due to sweat rate differences and individual gut tolerance. Sweat rate is influenced by weather, athlete’s size, conditioning, acclimatization, gender and age.
  6. Sweat losses during exercise should not exceed 2% of body weight. Greater than 2% loss can significantly decrease performance and increases the risk of medical complications such as heat stress and heat stroke.
  7. Sodium intake is essential to prevent hyponatremia, which is a dangerous condition that occurs when blood sodium levels are too low. Sodium can be consumed via sports drinks and foods.
  8. Flavor fatigue and taste changes are common during longer events. Notice changes in palatability during training in order to minimize fueling disruptions during competition.
  9. Consume foods that contain fat and protein (in addition to carbohydrates) during the event as they increase satiety and variety.
  10. Test foods and fluids throughout training to ensure gut tolerance during competition. Train your stomach like you train your muscles, start slowly and build up. For example, marathon training does not begin with a 26-mile run nor can your gut tolerate consuming 24 ounces of fluid during an hour of exercise if you are not used to consuming fluids. Progressively add fluids – 8 ounces then 16 then 24, etc. You must let your gut gradually accept the change.
  11. Set a watch/timer as a reminder to eat and drink at regular intervals.
  12. Use hydration and fueling devices, such as camelbacks and fuel belts.
  13. Carbohydrate loading prior to competition is beneficial.
  14. Know what foods and fluids will be offered during the competition. If these are not items you trained with, then you should not try them on race day.
  15. Examples of foods/fluids include: bananas, PB & J sandwich, peanut butter crackers, cheese sandwich, turkey and cheese sandwich, mini bagels, jerky, potato chips, crackers, fig newtons, soup/broth, cookies, candy, pretzels, sports drinks, liquid meals/shakes.

Step Three: Outline Your Nutrition and Hydration Plan

Hour 1: fig newtons+ 24 ounces of sports drink

Hour 2: banana + 24 ounces of sports drink

Hour 3: PB & J sandwich + 24 ounces of sports drink

Hour 4: pretzels + 24 ounces of sports drink

Hour 5: jerky + 24 ounces of sports drink

Hour 6: cookies + 24 ounces of sports drink

Step Four: Log and Revise

Log the successes and failures of your plan during training in order to revise it as needed before competition. Keep track of tolerated foods and fluids, ability to consume and ease of consumption of the foods and fluids, sweat losses (weight changes), gastrointestinal disturbances, performance, and recovery.

A “one-size fits all” plan does not exist thus devising a sports nutrition fueling and hydration plan will often include much trial and error. Sports Dietitians (credentials: RD, CSSD) are able to provide athletes with valuable guidance during this process. If you take the time to develop the right plan, you will be one step ahead of your competitors.

Thank you to our readers for submitting this question. We have had many wonderful questions/comments, which have resulted in several of the articles written thus far and questions that have been submitted in the last few months will be answered in the upcoming months. information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to . Questions will be answered on a monthly basis.

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