Tapering: What does that mean?


Q: I am getting ready to compete in my first half marathon. In my training, I have been following the advice of friends who are runners and consulting books/websites. Race day approaches, and my resources instruct me to begin “tapering.” What does that mean?

Good luck with that race! And, may we suggest that you add the following to your library of training resources: ACSM’s Training Considerations for Novice Recreational Runners, found in the 2014 ACSM’s Certified News. To taper properly you must have trained properly; this resource will help you do that.

There is no one correct way to taper prior to a competitive sporting event, so we will try to give you some general principles to use.

First, let’s define what it means to taper as part of a precompetition training routine. Tapering is a progressive reduction in training loads designed to reduce the physiologic and psychologic stress of training prior to a competition. A successful taper will optimize sports performance. In the case of a half-marathon, it is the final part of an entire training regimen that starts several weeks prior to the race. A successful taper will help the runner avoid doing both too much and too little in the period before a race, allowing the individual to stand on the starting line feeling “fresh” and ready to run a PR, or otherwise reach their goals.

Second, let’s underscore that there is not a great deal of scientific evidence for what constitutes an ideal taper. There are different “recipes” based on a runner’s experience, pre-race training and race distance.

Typical recipes will include having an individual do their final long run (approximately race distance) two weeks prior to race day, in the case of a half marathon. These recipes also suggest a gradual diminishing of mileage and an incorporation of non running cross-training in these final two weeks. Typically, the final two days of a taper will include a marked reduction of any running and even considering avoiding running entirely on the day prior to race.

Tapering is an important part of an overall training regimen for competition. Do it, and as you gain more experience as a runner, you can figure out over time what works best for you.

Q: While training to compete in an upcoming obstacle course race, I’ve been experimenting with different techniques to reduce muscle soreness after workouts. One technique I keep reading about is “cryotherapy.” I recall Kobe Bryant, among other elite athletes, championing the idea of cold water immersion after workouts to enhance recovery. Should I do the same?

Many purported modalities and interventions exist to facilitate post-workout recovery. These include heat/cold modalities, as well as foam rolling. A recent ACSM Q&A reviewed many of these interventions: Optimal Recovery: Practical Implications for the Recreational Athlete. We encourage you to read that!

Various forms of cryotherapy (cold therapy) are used in medicine. For instance, when you go to a doctor to get a wart “burned off,” the procedure is typically done with very cold liquid nitrogen. This is cryotherapy. Special types of cryotherapy are now being considered to treat heart attacks and spinal cord injuries. You are also using a form of cryotherapy when you ice down a tendon after working out.

There is also the type of “whole-body cryotherapy” which Kobe Bryant is reported to have used. Your specific question relates to the use of immersion of parts or all of the body in cold water/cold water immersion (CWI) to facilitate recovery from strenuous workouts.

The evidence for this treatment is mixed, with most studies showing little or no objective benefit.

However, CWI has been shown to improve subjective outcomes of DOMS and RPE. Thus, based on our current understanding of CWI for recovery from exercise: you may experience a placebo effect from the therapy. But if you want to be like Kobe, you may want to give it a try.

A final note of caution: as with many newer therapies, little is known about any potential inadvertent side effects of CWI. One should always interpret case reports with a note of caution, but we would be remiss if we did not share with you a recently published case report describing an abdominal aortic dissection after whole-body cryotherapy. If you are going to do post-workout CWI, we would always encourage you to do this while being observed and with a partner.

The Role of Regenerative Medicine Therapies in Pediatric/Adolescent Sports Injuries

American College of Sports Medicine (ACSM) has just released a new call to action that outlines seven points for investigating the role of regenerative medicine therapies in pediatric and adolescent sports injuries. The collaborative study was developed from a meeting last August of sports medicine clinicians, researchers and a bioethicist to understand the current evidence risks and rewards and future directions of research and clinical practice for regenerative medicine therapies in youth sports. The meeting was supported by the National Youth Sports Health and Safety Institute (NYSHSI), a partnership between ACSM and Sanford Health, an integrated health system headquartered in the Dakotas.

“While regenerative medicine appears to have promise in many areas of medicine, little is known about the safety or effectiveness of these treatments for bone, cartilage, ligament or muscle tissue injuries in children and adolescents,” said Thomas Best, FACSM, professor of orthopedics, family medicine, biomedical engineering and kinesiology at the University of Miami’s Miller School of Medicine. “Everyone wants a young athlete to get back to sports as quickly as possible, but it is important to look first at treatments that have been shown to be effective, before considering unproven options.”

Best was the lead author of a new collaborative study, “Not Missing the Future: A Call to Action for Investigating the Role of Regenerative Medicine Therapies in Pediatric/Adolescent Sports Injuries,” published May 15 in the American College of Sports Medicine’s Current Sports Medicine Reports.

“Unregulated clinics may sound attractive to parents and youngsters seeking aggressive regenerative therapy,” said Best, who is past president of ACSM. “But far more scientific research is necessary to determine if those treatments are helpful in overcoming sports injuries and, more importantly, without serious short- or long-term side effects.”

Seven-Point Call to Action:

1. Exercise caution in treating youth with cell-based therapies as research continues.

2. Improve regulatory oversight of these emerging therapies.

3. Expand governmental and private research funding.

4. Create a system of patient registries to gather treatment and outcomes data.

5. Develop a multi-year policy and outreach agenda to increase public awareness.

6. Build a multidisciplinary consortium to gather data and promote systematic regulation.

7. Develop and pursue a clear collective impact agenda to address the “hype” surrounding regenerative medicine.

Reflecting on the evidence, the study’s authors wrote, “Despite the media attention and perceived benefits of these therapies, there are still limited data as to efficacy and long-term safety. The involvement of clinicians, scientists and ethicists is essential in our quest for the truth.”

The Call to Action special communication is published in the May/June 2017 issue of ACSM’s Current Sports Medicine Reports (CSMR). As an official review journal of the American College of Sports Medicine, Current Sports Medicine Reports is unique in its focus entirely on the clinical aspects of sports medicine. It harnesses the tremendous scientific and clinical resources of ACSM to develop articles reviewing recent and important advances in the field that have clinical relevance. The journal’s goal is to translate the latest research and advances in the field into information physicians can use in caring for their patients.

The Athlete’s Kitchen: Taking Your Diet to the Next Level


Some athletes are still on the “see-food diet.” They see food and they eat it. Others are a bit more mindful about how they nourish their bodies; they put thought into selecting high-quality foods that invest in good health, quick healing and top performance. They commonly report they have taken their diets to the next level. For some disciplined and dedicated athletes, the next level is a perfect diet with no sugar, no processed foods, no desserts and no “fun foods.”

While aspiring to eat quality foods is certainly a step in the right direction, eating too healthfully can sometimes create problems if the food policy becomes a bit too zealous. Is birthday cake really a bad-for-you food? (I don’t think so.) Is gorging on vegetables really best for your body? (Not if your hands acquire an orange tinge from having eaten too many carrots, or if you experience recurrent diarrhea due to an excessively high-fiber diet.)

Perhaps a better goal than a perfect diet is an excellent diet. An excellent diet might be more balanced, enjoyable and sustainable. Even birthday cake with refined sugar and saturated fat can fit into an excellent diet. The 2015 Dietary Guidelines allow for the inclusion of small amounts of so-called “imperfect” foods in your food plan:

Ten percent of calories can come from refined sugar. That’s about 250 to 350 calories (60 to 90 grams) of sugar (carbohydrate) for most female and male athletes, respectively. This sugar fuels your muscles. Sports drinks and gels count as refined sugar.

Ten percent of calories can come from saturated fat that can clog arteries and is associated with heart disease. For an athlete who requires about 2,500 to 3,500 calories a day, consuming 250 to 350 calories (about 30 to 40 grams) of saturated fat per day, if desired, can fit within the saturated fat budget. This means, from time to time, you can enjoy without guilt some “bad foods” such as bacon and chips. One slice of bacon has about one gram saturated fat; a small bag of potato chips, about three grams.

Certainly there are healthier foods to eat than bacon and chips, but you want to look at your whole day’s food intake- not just a single item- to determine the overall quality of your sports diet. If 85 percent to 95 percent of your food choices are high quality, a little bacon or a few chips will not ruin your health forever.

Some athletes deal with “unhealthy” foods by setting aside one day a week to be their cheat day. This well-intentioned plan can easily backfire. Most people don’t overeat/splurge until they have first been denied or deprived of a favorite food. Hence, when the perfect diet starts on Monday, people can do a heck of a lot of “last chance” eating the days before starting their restrictive food plan.

Rather than a Sunday splurge, let’s say on bacon, you might want to enjoy just a few slices of bacon throughout the week. This can curb cravings and dissipate the urge to splurge on Sundays. There can be a “diet portion” of any food.

Going to the next level

For athletes who want to take their diets to the next level with a sustainable plan, I offer these suggestions:

-Evenly distribute your calories throughout the day. Most active women need about 2,400-2,800 calories a day; active men may need 2,800-3,600 calories a day. This number varies according to how much you weigh, how fidgety you are, and how much you exercise. That’s why meeting with a professional sports dietitian can help you determine a reliable estimate. To find a local sports dietitian, use the referral network at http://www.SCANdpg.org.

-Most “bad” food decisions happen at night, after your body has been underfueled during the day. If you are “starving” before dinner, add a second lunch to curb your evening (over)eating. You will easily save yourself from a lot of junk food at night. Trust me.

-If your body requires 2,400 to 2,800 calories per day, this divides into 4 food buckets with ~600-700 calories every four hours. For example: 7:00 a.m., breakfast; 11:00, early lunch; 3:00 p.m., later lunch; and 7:00, dinner. Adjust the times to suit your schedule and divide the calories, if desired, into smaller snacks within that four-hour window.

-Your breakfast food bucket should be the same size as your dinner bucket; this likely means you’ll be eating a smaller dinner and a bigger breakfast. If you train in the morning, you may want to eat part of your breakfast calories before you exercise and the rest afterwards.

-Include in each food bucket at least three of these four types of foods:
1. Grain-based foods (about 150-250 calories/bucket), to fuel your muscles. Easy whole grains: whole wheat bread, oatmeal, baked corn chips
2. Protein-based foods (about 250 calories/bucket), to build and repair your muscles. Easy ready-made options include rotisserie chicken, deli turkey, hummus, tuna pouches, tofu, hard-boiled eggs and nuts.
3. Fruits and veggies (about 100-200 calories/bucket) for vitamins and minerals. Choose a variety of colorful fruits: strawberries, cherries, oranges, peaches, bananas, and blueberries. Also choose colorful veggies: dark green broccoli, peppers, spinach; orange carrots, sweet potato; red tomato, etc.
4. Dairy/calcium-rich foods (about 100 calories/bucket) for bones and maintaining low blood pressure: Lowfat (soy) milk, (Greek) yogurt, cheeseÑbut please not rice or almond milk. They are equivalent to juice with very little protein or nutritional merit.

By filling up on quality foods at breakfast, lunch #1, and lunch #2, you will crave less “junk food” at night and may not even miss it. Your diet will easily rise to the next level, no sweat.

Recovery Modalities for Training


In the search to maximize training and improvement performance, many are now looking at what is done during recovery as a component of the entire training/performance routine. Many recovery modalities have been touted as the answer to post-exercise fatigue and reduced performance. There are three potential benefits that may be considered: immediate recovery (right after the activity), short-term (between sets) and recovery between training bouts. We will focus on training recovery, as this is the most common question from athletes and those participating in recreational competition. Some of the modalities that have been used include vibration, whole body immersion (usually cold water or contrast; cold then warm, alternating), compression garments, massage, electrical stimulation, heat or stretching or pharmacologic measures, such as nonsteroidal anti-inflammatories (NSAIDs).

In general, most of these modalities provide little, if any, benefit to recovery. Whole body cryotherapy (cooling) reduced strength loss at one hour post activity, with less pain than a passive recovery group, but by 24 hours there was no difference in strength or pain between recovery modes. Similarly, another study noted that athletes said their legs felt “lighter” at 24 hours when having used active recovery and cold immersion, but physical tests between groups showed no difference. Alternating cold and warm water immersion (contrast water therapy) showed the greatest decreases in soreness, but, as with the others, there were no differences in specific components, such as strength or range of motion.

Electrical stimulation (e-stim) is being marketed for pain reduction, and while advertisements may identify other benefits, the research suggests otherwise. E-stim does not seem to aid “restoration” of traits that are usually altered following intense activity, such as strength or fatigue. Cooling was shown to have a positive effect on aerobic activity. However, it has been noted that the results are variable and partially dependent upon the length of cooling and individual responses to the modality. While the prolonged use of NSAIDs is not recommended due to the potential for gastric issues, most of the recovery modalities do not have major negative effects when used appropriately.

Important components of recovery should include some relative rest, proper diet and rehydration. Diet and rehydration are especially necessary for longer activities and those in which the athlete is subject to high temperatures. In such cases, diet and hydration may help to restore energy resources to the muscle as well as restoration of electrolytes.

The evidence for physical benefits from recovery modalities is limited. However, many of the modalities appear to be useful for reduction of pain/muscle soreness. The noted reductions in pain/soreness may be temporary, but some have noted that this effect may allow an athlete to complete subsequent training, even if at a lower intensity. Furthermore, the psychological effect of any technique may be enough to promote improved performance or the ability to train at a desired level following previous intense bouts of training. Thus, the final decision regarding the use of a recovery modality will be based on your personal preference and the desired outcome. If pain/soreness reduction is important, then you may want to try a recovery modality. If the ability to do harder workouts in succession is the goal, a recovery modality will probably not help.