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Exercise physiology and diet recommendations to optimize exercise recovery for LC-FAOD patients

Overview of exercise physiology

  • About 50% of our body is composed of muscles
  • There are 3 types of muscle fibers
    • Type 1: Slow-twitch
      • Slow-twitch fibers generate less strength, but can be used to sustain an activity for longer. They are used during low-intensity activities, such as walking, tai-chi or pedalling on a bike.
      • They use an aerobic energy system, meaning that energy is fuelled by the aerobic pathway, and energy comes mostly from the oxidation of fat. The longer the duration of the exercise, the more fat is utilized as glucose and glycogen (stored glucose in the muscles) gets depleted.
      • They have a high content in mitochondria, which are the organelles that turn fats into energy through fatty acid oxidation.
    • Type 2: Fast-twitch
      • Fast-twitch fibers generate more power and strength, but get fatigued faster than slow-twitch fibers and require a longer recovery time. They are used during high-intensity physical activities, such as powerlifting, sprinting or HIIT.
      • Fast-twitch muscle fibers use anaerobic energy, as during high-intensity exercise, oxygen can’t be delivered that quickly. Instead of relying on oxygen, the energy comes from glucose or glycogen.
      • They have a low content in mitochondria.
    • Type 2a: Hybrid between slow-twitch and fast-twitch
  • Most muscle types are a mix of slow and fast muscle fibers.

Strength training or cardio?

Both are beneficial!

Strength training increases glycolytic enzymes, which increase the capacity to burn glycogen and transform it into glucose. It also increases the capacity of the muscle to store glycogen.

Cardiovascular training increases the mitochondria count up to 5 times, which increases the limited, but still present, fatty acid oxidation in LC-FAOD. It also decreases lactate production. In untrained muscles, lactate production can be increased relative to trained muscles, which can lead to muscle weakness and hyperventilation. Cardio has also been shown to increase the ability to burn fat.

Diet recommendations – adults/teens

Pre-exercise

  • Consume carbohydrates and protein 20min – 1h before exercise
    • Carbohydrate: 0.5g-1g/kg of body weight
    • Protein: 5-10g
    • Low fiber, easy to digest
    • The lowest the fiber content in the carbohydrate snack, the closer to exercise it should be.
  • For LC-FAODs: include a small amount of MCT

During exercise

  • If exercise lasts for 1h or less: It is not necessary to consume calories during exercise.
  • If it lasts longer than 1h, stop and hydrate, and consume carbohydrates.

Post-exercise

  • Within 45 minutes after exercise, consume a carbohydrate:protein ratio of 4:1. This increases glycogen stores and promotes protein synthesis, reducing the recovery time.

References

  • https://www.youtube.com/watch?v=vbU3Ss6YGSk&ab_channel=MitoAction
  • Book ‘Nutrition management of Inherited Metabolic Diseases’ Lessons from Metabolic University