As practitioners we will both engage in exercise and prescribe it for our clients for a myriad of reasons. An elite athlete will be looking largely for improvements in performance, a recreational athlete will be considering both sporting objectives and health reasons when working out and others will be addressing medical concerns and/or successful ageing. As a Strength and Conditioning professional, I would strongly argue that exercise/activity is among the most important, but perhaps the most underused of all the modalities within the arsenal of clinical practice. Putting sporting requirements aside for a minute; strength, endurance, balance, flexibility, reaction time and power are all attributes we lose over the passage of time without taking preventative action.

Research is unequivocable about the dangers of a sedentary lifestyle and the power of exercise to combat this. It is not without reason that exercise is described as “the one true poly pill” by Pete Williams, the Functional Medicine pioneer. The link between inactivity and chronic inflammation/chronic disease was further explored in a 2011 paper by Professor Bente Klarlund Pedersen – Muscles and their Myokines - from which this graphic is taken.

The “exercise effect” was explained further in very eloquent integrative terms in 2018 by Ruegsegger & Booth in a paper – Health Benefits of Exercise – “it is clear that physical activity is complex biology invoking polygenic interactions within cells, tissues, organs and systems with remarkable cross talk occurring”. In regard to ageing recent research published in the journal Cell Metabolism and articles in the science magazine COSMOS are but a few sources which talk of exercise as being unapparelled in its success in helping slow the biological clock by way of inter alia, cellular maintenance/repair, mitochondrial biogenesis and epigenetics. If we therefore accept that exercise has a plethora of sporting and health benefits, we can start to look slightly deeper. With all of our various clients we need to be advising them on the type and intensity of exercise relevant to them. The term “Functional Training” has been much (ab)used but one definition that we may wish to use is:

“Function is the link between physical actions we call movement and the environmental context in which they take place. People use movement every day as they interact with their environment. Goal directed movement (function) is important to survive, adapt and learn within this environment. When movement is inhibited, we are less able to meet day to day needs”.

In the broadest of brush strokes exercise will affect us both physically and mentally by the adaptations we make to the exercise related stimuli imposed and how we manage these stimuli within our lives. As we are all aware, small manageable stress events are tolerated and even beneficial to any biological system, when these events grow in magnitude or become chronic however, they become damaging. The classic stress curve illustrates this.

The management of stress in an exercise context involves the informed setting of exercise programmes and targets based on the individual concerned and their personal goals, environment and requirements. Beyond the actual mechanics of the exercise process, our nutrition, lifestyle and recovery become hugely important. It is beyond the scope and space limitations of this piece to explain each of these in turn, but I do wish to highlight the recovery process which is probably the most neglected.

As part of this, basic nutrition and supplementation become vitally important as we start to “layer up” our nutritional requirements over and above basic maintenance and health. The whole area of sports supplementation, particularly concerning ergogenic aids has become a minefield with the search for the “magic bullet” spawning a multi-million-pound industry. As the majority of us will realise such a product simply doesn’t exist unless we want to travel very murky, potentially unsafe waters. There are however very well researched established ingredients that will start to help us build a robust performance/recovery programme when used together with other factors such as a constructive lifestyle, quality food and restorative sleep patterns.

In my experience it’s the serious recreational athlete who is most at risk of overtraining and needs as much support as we can provide. Many elite athletes do not work a regular job, recovery time is a built-in part of their daily structure and medical/coaching advice is readily available whereas serious amateur/recreational athletes are often all-round alpha male/female types, hold very responsible jobs and are driven to perform both professionally and in their chosen sport. I have come across many occasions where a resulting burn out has had major consequences. It is exactly these people who we are more likely to come across in practice and it is vitally important we both recognise this allostatic load and put measures in place to manage it. Don’t make the mistake of assuming that fit = well. I have come across a number of (particularly endurance) athletes who are on the point of becoming seriously broken.

Let us consider some of the supplements with years of positive research and use behind them. Again, space prevents me from providing an in depth break down but what follows is a synopsis and some personal experience.

Magnesium
Well used and established within Functional Medicine and Nutritional Therapy practices to maintain normal muscle function and as an aid to sleep and relaxation, magnesium also has a pedigree in helping recovery from exercise and Exercise Induced Muscle Damage (EIMD). I personally use and recommend magnesium products for both my athletic and non-athletic clients. I’m a huge believer in the power of restorative sleep and therefore 2 of my “go to” supplements will be MegaMag Muscleze and MegaMag Night Formula which tick many of the boxes I’m looking to address.

Creatine
Together with caffeine probably the most researched sports related supplement used. It is generally found to be safe, well-tolerated and effective. Its ability to replenish stores of ATP, the energy currency of our cells, make it a regular favourite for athletes looking for an increased level of explosive muscle contraction (bear in mind “explosive” is a relative term, we don’t need to be an Olympic level sprinter to benefit from creatine use). As research continues further benefits of creatine use, both physical and cognitive, are emerging.

Glutamine
An amino acid which may be classed as provisionally essential has been linked to benefits in post exercise recovery, immune function and GI support. Research remains equivocal but “real life” use remains strong amongst elite and recreational athletes. Again, referring back to the “alpha” personality type and allostatic load I mentioned above I will use Glutamine (as well as Creatine and Malic Acid) both separately and as part of a combination formula to help support a variety of bodily systems including gut integrity and excessive oxidation, both of which are major factors in intense exercise and potentially chronic disease conditions.

Malic Acid
An essential catalyst in the use of pyruvic acid as part of the Krebs cycle and as a buffer against the build-up of lactic acid, Malic Acid is an aid to not only exercise recovery but organ health and mitochondrial function.

My general recommendations would therefore be to carry out a full review of a clients sporting activities/recovery protocols as part of the initial client consultations, tie these in with any blood/DNA/stool/food sensitivity tests carried out so that a true picture of the clients’ requirements start to become apparent. One VERY IMPORTANT point to make here is that exercise, particularly intense exercise, will skew blood results and you need to be aware of this when assessing any tests or you run the risk of mis-diagnosing the data.

In summary, exercise/activity is vitally important in both a sporting and clinical context. For the true benefits to be realised we need to be aware of fundamental exercise prescription together with supporting nutrition and recovery within which supplementation plays an important role.

About Paul Ehren
Paul is a Master Personal Trainer & graduate of the Centre of Integrated Sports Nutrition, he has run his Exercise/Nutrition/Lifestyle Consultancy company for over 20 years, regularly lectures and contributes to a number of publications. Recently retired from competitive sport Paul has been British and regional champion as well as competing for GB abroad. In addition to providing advice to a variety of athletes Paul is passionate about the use of exercise/activity along with nutrition and lifestyle to prevent and manage both chronic disease and to help us all age well.

References
Pete Williams – Functional Medicine Associates
Bente Klarlund Pedersen – Muscle and their Myokines: Journal of Experimental Biology 214 p337 – 346: 2011
Ruegsegger & Booth – Health benefits of exercise: Ruegsegger GN, Booth FW Cold Spring Harb Perspect Med 2018 Jul 2; 8(7): a 029694
Cell Metabolism article – Exercise promotes healthy ageing of skeletal muscle Cartee GD, Hepple RT, Bamman MM, Zierath JR, Cell Metabolism Volume 23 issue 6 p1034-1047 June 14 2016
COSMOS – Cosmos magazine “The science of everything” 8th March 2017