Question
What if a patient has very limited strength and endurance, but is underweight? Is there any way to decrease the usually wonderful metabolic effects?
Answer
There is really not a way to decrease the metabolic effects. However, I would recommend you look at the fueling plan, making sure that they are taking in adequate calories pre, during, and post workout. That sounds kind of crazy to think about eating during a workout, but if I am taking in calories while I am exercising, I am not going to slow the metabolic effects, but I am going to take in the necessary calories as needed. If they are underweight, then that extra caloric consumption during the exercise session, something simple like fruit chews or drinking the calories like with Gatorade, you will slow or blunt the amount of calories that you have to expend.
One thing I would tell you when you are fueling pre, during and post exercise session, I would recommend that prior to a high-intensity interval training session that you take in some kind of simple carbohydrate. Even if an individual is trying to lose weight, taking in that carbohydrate, whether it is a drink like a 100 calories would of carbohydrate, that will assist greatly with performance during that interval session. Usually because high intensity intervals workouts are not very long, you do not have to worry about taking in calories during the session. However, if you are working with athletes for two or three hours doing a simulation of a football game for example, then that could be altered where we actually do need to make sure that we are stimulating caloric consumption during that time. Following a high intensity interval training session however, it is also going to be so important for individuals to replenish what they have lost. There are a lot of over the counter solutions that you can purchase at GNC, etc. In all reality, things like fat-free chocolate milk is an ideal recovery drink that an individual can take in after an exercise session. Many times, we do not think about that in a therapeutic realm. We think about it with athletes, but we do not think about it with our clients. We do not want their muscles to break down. We are trying to build them up. We are trying to get them stronger. In order to get them stronger, we need to make sure that they do not enter that state where they are going into muscle breakdown. If we introduce something like a chocolate milk immediately following or within the 20-minute window following the exercise session, then they will not experience that muscular breakdown or they will experience it to a less extent. We do not necessarily think of this with our clients, but it is so important that we change our thought process when it comes to recovery strategies. It is not just about what is happening within our therapy sessions; it is also about what is happening outside of those sessions. Nutrition has a high level of importance when it comes to building muscle, to maintaining muscle, and to giving us the ability to function. If we do not have the calories to function, then we are not going to be able to effectively perform on a regular basis. This is something that is not explored nearly enough in a therapy realm. It seems that most things are taken from the athletic world first and they eventually trickle down into our therapeutic populations. Think about recovery strategies, and not just icing down joints, but also the nutritional side of things.