Adrienne Forsyth and Tim Stewart
One of the main roles of nutrition professionals working with athletes and active people is to help them develop and implement their nutrition plans. In this chapter, we will describe the steps involved in planning diets for individual athletes and for teams, and consider a range of factors that influence an athlete’s nutrition plan. We will also consider strategies to use when working with athletes to increase engagement and participation in the diet-planning process. At the end of this chapter, you will find two case studies (see Box 8.4) to work through to help you practise your diet-planning skills.
LEARNING OUTCOMES
Upon completion of this chapter you will be able to:
• describe the steps involved in planning diets for individual athletes and teams
• understand why nutrition counselling skills are important to engage client athletes
• consider individual physiological and social factors, training and sport requirements when prioritising nutritional concerns
• develop simple nutrition plans for healthy athletes.
PLANNING DIETS FOR INDIVIDUAL ATHLETES
Developing a nutrition plan is a complex task. There are a number of factors that may influence dietary intake; these are described in more detail below. To help simplify the process, the following steps may be used as a guide to follow when developing a nutrition plan.
Step 1: Collect information
• Identify baseline physiological requirements. How much energy and nutrients are required at rest?
• Identify additional requirements related to training and competition. How much extra energy is needed to support training sessions and competition events? Should this energy be focused on any specific macronutrients?
• Determine when training, competition and recreational activity will take place. It is important to be able to time meals to effectively fuel training, competition and recovery (see Chapters 9 and 10 for more information).
• Assess current body composition and evaluate this against any required standards or goals. What information is currently available? Take additional measurements if trained to do so and relevant to the athlete’s goals.
• Identify any dietary requirements related to allergies, intolerances, religious or cultural beliefs, or personal values. Are there any foods that the athlete cannot consume?
• Identify personal preferences and food likes and dislikes. It is important to include favourite foods to develop a nutrition plan that the athlete will be willing to follow.
• Identify any factors that may influence access to food. Does the athlete have access to fresh food outlets? Can they afford to buy this food? Do they have facilities for food storage, preparation and cooking, and do they have the skills to do so?
• Identify social influences on dietary intake. Where does the athlete eat, and who do they eat with? Do they prepare their own meals? Are they cooking for other members of their household? How is their day scheduled? Do they have time to cook?
• Identify any nutrition-related health concerns. Does the athlete have any health issues that require input from a dietitian or other health professional?
• Identify any team requirements, restrictions or habits regarding food, beverages and supplements. What type of sport do they play? What is their position and what does it involve? How long do games/events run for? Will the athlete play for the entire game? Will they have access to food or fluid while they are playing or during breaks? Does the team or club eat meals together or provide food or supplements for athletes?
• Collect and assess information about the athlete’s usual diet and supplement use. What do they eat currently (what, when and how much)? Are they happy with this? What would they like to change and why?
Body composition
The proportion of muscle, fat, bone and other tissues that make up the mass of an individuals’ body weight.
Step 2: Identify priority areas
Ask the client what is important to them. Common goals include increasing lean (muscle) mass, reducing fat mass, or providing strategic fuelling suggestions to maximise performance in training or competition. There will be other important aspects to consider—for example, the athlete focused on fuelling a training session may also be interested in recovery strategies—but these do not all need to be addressed at the first appointment. Depending on the athlete’s situation, you may also ask for input from a coach or trainer to help identify nutrition goals.
Step 3: Develop a plan
Put together a specific plan with detailed recommendations for when to eat, what to eat and how much to eat. Athletes will often like the structure of a rigid plan, but it is helpful to provide some flexibility to allow for changes in circumstances, preferences and access to foods. A flexible plan that includes options will also help to teach the athlete about the components of their dietary plan and enable them to make appropriate choices on their own.
Step 4: Trial the plan
Nutrition plans must be tailored to the individual athlete. As much as we can try to develop helpful nutrition solutions for athletes based on what we know about their needs and what we know about food, the only way to determine with any certainty whether a plan will be tolerated by an athlete and help to achieve their nutrition-related goals is to trial the nutrition plan. Ask the athlete to trial the plan at least once or twice before your next consultation with them. Nutrition plans that will be used in competition should be trialled in training as much as possible, to familiarise the athlete with the plan and to help train the gut (see Chapter 23 for more information).
Step 5: Assess the plan
Once the athlete has had some experience with the nutrition plan, it is important to meet and review how well the plan was tolerated and accepted by the athlete, and whether it is helping to achieve their nutrition-related goals. Did it cause any gastrointestinal discomfort? Did the athlete like the foods? Were the foods easy to access and prepare? Were foods planned for use during competition or training easy to consume during the activity? Were there any changes noted in performance at training, or in energy or mood through the day? Were there any barriers encountered in implementing the plan?
Based on the feedback provided by the athlete, make modifications to the plan. The new plan should also be trialled, assessed and revised as needed.
Following these steps should help you collect all of the information you require to work with an athlete to develop a nutrition plan. Take a look at Box 8.1 to see what information was collected for Janice, a recreational distance runner.
Box 8.1: Janice’s baseline physiological requirements
Age: 26
Sex: Female
Height: 168 cm
Weight: 57 kg
Resting energy expenditure
= 9.99 x (weight in kg) + 6.25 x (height in cm) – 4.92 x age – 161
= 9.99 x 57 kg + 6.25 x 168 cm – 4.92 x 26
= 569.43 + 1050 – 127.92
= 1491.51 kcal/day
1491.51 kcal/day x 4.18 kJ/kcal = 6235 kJ/day
PAL 1.5 for activities of daily living plus 30–60 minutes of light
intensity activity (e.g. walking)
6235 kJ/day x 1.5 = 9353 kJ/day
TRAINING AND COMPETITION ENERGY REQUIREMENTS
Trains 10 km/day five days per week.
• add 10 METS x 60 minutes = 2394 kJ
Trains or races 20–30 km/day one day per week.
• add 10 METS x 150 minutes (average time) = 5985 kJ
Has one rest day per week.
Races 40–50 km 2–4 times per year.
Total energy requirements on training days: 9353 kJ + 2394 kJ
= 11,747 kJ
Total requirements on long training days: 9353 kJ + 5985 kJ
= 15,338 kJ
TIMING OF TRAINING/COMPETITION/ACTIVITY
Trains after work (5 p.m.) during the week, and in the mid-morning on weekends.
BODY COMPOSITION
BMI = 57 kg/ (1.68 m)2 = 20.2 kg/m2 (considered to be within healthy range)
More detailed anthropometric measurements have not been performed. In recreational athletes of healthy BMI with no personal concerns about their body composition, there is no need to perform detailed anthropometric measurements.
DIETARY REQUIREMENTS
Nil allergies or intolerances.
PERSONAL PREFERENCES, LIKES AND DISLIKES
Prefers dairy, eggs and vegetable sources of protein to meat.
FACTORS INFLUENCING ACCESS TO FOOD
Works full time; is able to access shops on evenings and weekends. Shares a kitchen with one roommate.
SOCIAL INFLUENCES
Usually eats alone; occasionally eats dinner with her roommate. Eats lunch at her desk during the week. Works 8.30 a.m.–4.30 p.m. in an office close to home. Enjoys cooking, but not baking.
NUTRITION-RELATED HEALTH CONCERNS
Nil.
TEAM REQUIREMENTS, RESTRICTIONS OR HABITS
Long weekly training runs will require a source of carbohydrate, electrolytes and fluid while training.
Race-day nutrition strategies should be practised in training.
USUAL DIET
Breakfast (7 a.m.): 1 cup of cereal with skim milk and a glass of orange juice
Morning snack (9 a.m.): 2 slices of wholemeal toast with peanut butter and coffee with skim milk
Lunch (12 p.m.): 2 cups of salad using leftover vegetables from dinner plus 2 eggs, a small tin of tuna or crumbled feta with olive oil and vinegar to dress the salad plus an apple or pear
Afternoon snack (2.30 p.m.): chocolate bar or similar from the vending machine
Dinner (7 p.m.): pasta or rice with lentils, chickpeas or beans and vegetables, and fruit with ice cream or custard for dessert
Measures of energy expenditure typically used to describe the energy expended in physical activity. The standard resting metabolic rate is 1 MET, and is equivalent to 1.0 kcal/kg/hour, or 4.18 kJ/kg/hour (Ainsworth et al. 2000).
BMI
Body Mass Index, an index of a person’s weight in relation to height. BMI = kg/m2.
Janice tells us that her nutrition priorities are to maintain her current body composition and to increase her energy levels at training. So, our plan will focus on providing an appropriate energy intake to maintain her current body composition, and timing her energy and macronutrient intake to increase her energy levels at training. We will also discuss non-nutritional strategies to increase energy levels, such as adequate amount and timing of sleep, and refer Janice to other health professionals where relevant.
An athlete’s nutrition plan may cover a full week or even longer, to account for varied dietary requirements on different days of training, competition and rest. Here, we will present one day of a nutrition plan for Janice that focuses on nutrition for mid-week training. Look at how the plan is laid out for Janice in Box 8.2: you will see that the instructions are very specific. There are recommendations for when to eat, what to eat and how much to eat. These recommendations have been developed based on Janice’s individual physiological and training requirements, as well as her personal preferences and social influences. This nutrition plan evolved over several iterations to include the right amount of energy and macronutrients at the right times throughout the day.
Box 8.2: Janice’s nutrition plan
| 7 a.m. | 2 poached eggs on 2 slices of sourdough bread with 1 tomato and 6 mushrooms, grilled with 1 tsp olive oil 200 mL of orange juice |
| 10 a.m. | 2 slices of wholemeal toast with 1 tbsp peanut butter 250 mL coffee with skim milk |
| 1 p.m. | 1 cup of salad vegetables plus 95 g tuna, salmon or sardines and 30 g feta or ricotta cheese and ½ cup leftover cooked starchy vegetables with 1 tsp olive oil and 2 tsp vinegar and a dinner roll One piece of fruit |
| 4 p.m. | 1 cup of cereal (not a high-fibre option) with ½ cup skim milk |
| 5 p.m. | Training |
| 6 p.m. | 1 piece of fruit with a 20 g slice of cheese |
| 7 p.m. | 1 cup cooked wholemeal pasta or brown rice with ½ cup cooked lentils, chickpeas or beans, ¾ cup tomato-based sauce, ½ cup cooked starchy vegetables (e.g. potato, sweet potato, corn) and ½ cup green vegetables (e.g. broccoli, green beans, spinach) |
| 9 p.m. | 200 mL yoghurt or custard with ¼ cup nuts and ½ cup berries |
This plan provides 11,554 kJ, 132 g protein, 89 g fat and 328 g carbohydrate per day.
Did you note that this plan contains many elements from Janice’s usual diet? We have moved the order and timing of some of the foods, but it is helpful to include as many foods as possible that are already familiar to and known to be tolerated by the athlete. You may also note that the total energy provided by the nutrition plan is not exactly what we calculated Janice’s requirements to be. Remember that estimates of energy requirements are just that—estimates. It is more important to note Janice’s usual intake and any changes in weight or body composition with dietary changes to inform fine-tuning of the nutrition plan. Estimated energy requirements are more likely to be used when an athlete requires a more substantial change to their diet, or when you have limited background information available to inform your plan.
Janice will now trial this plan on two training days and keep track of her experience in a nutrition log (Box 8.3). She will record what she eats and when, as well as her energy levels and any gastrointestinal discomfort. After these two trial days, you meet with Janice to discuss her experience. Janice reports no concerns except that she felt hungry during training. Together, you adjust her lunch and pre-training snack to include more low-GI sources of carbohydrate, and you ask her to return with feedback after her next training day.
Box 8.3: Janice’s nutrition log
| Time | Food consumed | Mood and energy levels | Gastrointestinal symptoms |
| 4 p.m. | 1 cup cornflakes ½ cup milk | Energetic | Nil |
NUTRITION COUNSELLING SKILLS
Many health professionals use a client-centred approach when working with their clients. This same approach can be applied to working with athletes. A client-centred approach means that any behavioural changes (such as changes to dietary practices) should be led by the client. The professional working with the athlete will focus on developing rapport, understanding the athlete’s interests and motivations, providing nutrition education related to the athlete’s goals, and helping the athlete identify changes that can be made to achieve these goals. In sports nutrition practice, the nutrition professional may need to provide more explicit advice than in general practice, since some foods, beverages and supplements used in sport are not commonly consumed as part of everyday diets. In some instances, there may be discrepancies between eating for health and eating for performance. Ultimately, nutrition recommendations for performance tend to support physical activity beyond normal daily levels, so foods recommended are in addition to, not instead of, a healthy diet that aligns with dietary recommendations. Athletes’ goals and priorities can change over time, so it is important to revisit their goals, and ensure that their nutrition plan aligns with these goals, on a regular basis.
Nutrition professionals may draw upon theories and practices such as the transtheoretical model of behaviour change (Prochaska & DiClemente 1982; DiClemente & Velasquez 2002) and motivational interviewing (Rollnick & Miller 1995; Miller & Rollnick 2002) when supporting clients, including athletes, in adopting changes to their dietary practices. The transtheoretical model proposes five stages of change: (1) initial precontemplation, where clients are not currently considering change; (2) contemplation, where clients are evaluating the costs and benefits of changes to their behaviour; (3) preparation, where clients have committed to change and are making plans; (4) action, where clients are actively practising the changed behaviour; and (5) maintenance, where clients work towards sustaining the change in the long term. The approach a nutrition professional will take with an athlete may vary depending on their stage of change. An athlete in the contemplation stage may require more education and discussion about options and alternatives, while an athlete in the action stage and actively practising a changed behaviour may require encouragement and support to overcome unexpected barriers.
Transtheoretical model of behaviour change
An integrative theory that assesses an individual’s readiness to act on new, healthier behaviour. It provides strategies and defines the processes of change to guide the individual.
Reflective listening
A practice used to develop rapport with clients. It involves listening carefully to what the client is saying, then paraphrasing their ideas back to them to confirm that you have understood them correctly. This reflection of their ideas is presented rather than any judgement or advice.
Motivational interviewing is a goal-directed, client-centred approach to behaviour change that incorporates and builds upon the transtheoretical model of behaviour change. The spirit of motivational interviewing suggests that motivation to change should come from the client, so it is the client’s job to express and resolve their own uncertainty, while the nutrition professional supports them in this process rather than directly persuading them. Practitioners should build a relationship with their client by using reflective listening to understand their client’s frame of reference; expressing acceptance and affirmation; eliciting motivational statements from the client and selectively reinforcing relevant concerns, desires, intentions and abilities to change; monitoring the client’s readiness to change and working within the relevant stage of change; and reaffirming their freedom of choice. Miller and Rollnick (2002) highlight four general principles that underpin motivational interviewing.
A goal-directed, client-centred approach to behaviour change that incorporates and builds upon the transtheoretical model of behaviour change. The motivation for change should come from the client, while the nutrition professional supports them in this process.
1. Express empathy. Practice reflective listening and demonstrate acceptance of your client. Building a trusting relationship with your client is important to foster discussions that may lead to meaningful change.
2. Develop discrepancy. Clients are more likely to change when motivated by a perceived discrepancy between their personal goals and the outcomes of their current behaviour. Thoughtful conversation may help to point out these differences and allow the client to present their own arguments for change.
3. Roll with resistance. Arguing with clients is counterproductive. Avoid opposing their resistance to change, and instead try a different approach. Invite them to present their perspectives and to identify their own solutions.
4. Support self-efficacy. Clients will be responsible for identifying and implementing their own changes, so they need to believe that they are able to change. Affirming your belief in their ability to change can enhance clients’ own beliefs and become a self-fulfilling prophecy.
If we think back to Janice, we can identify that she was at the contemplation stage of change and moving towards preparation. She had identified a problem with her diet (lack of energy for training), and engaged the services of a nutrition professional. In her case, making changes was fairly straightforward and she was able to identify what changes could be made based on some basic education provided at her first consultation. Individuals at the early stages of change, with complex nutrition requirements, with emotional attachment to food and eating habits, or with disordered eating patterns, are likely to require more support in a nutrition counselling session.
PLANNING DIETS FOR TEAMS
It is simply not possible to plan a single diet that will meet the needs of all athletes on a team. Given all of the individual factors that are considered when planning individual diets, it is logical to expect that there would be a variety of different dietary needs within a team. So, rather than planning for an individual athlete, we may instead provide a general nutrition plan that is suitable based on the requirements of the sport and provide advice on how to tailor the diet for individual requirements. For example, a soccer team that competes on Saturdays and trains three hours per day (two hours skills, one hour personal fitness) during the week will have consistent themes in their nutrition requirements. The timing and nutrient composition of meals and snacks will be similar for all athletes. However, depending on size, age, fitness level, playing time and individual body composition goals, the amount of food and beverages required will vary. The specific foods may also vary; for example, while all athletes will require a source of protein, some may prefer lean meats while others prefer dairy or vegetable sources. Advice for the team should be general, with a range of options provided. Athletes who require more support to develop an appropriate, individually tailored nutrition plan should seek the support of a nutrition professional. Those with nutrition-related health concerns should consult an Accredited Sports Dietitian. You can read more about the requirements of team sport athletes in Chapter 16.
Planning diets for athletes is a complex activity. In addition to all the considerations presented in this chapter, there are principles of sports nutrition and sport-specific dietary recommendations to consider. As you work through the remainder of this textbook, come back periodically to apply your new learning to the case studies below.
CASE 1: JONATHAN
Jonathan is a 44-year-old elite (age group) ironman triathlete. He recently raced in Ironman WA, where the weather conditions were hotter than expected with a temperature of 36°C and he suffered badly from cramps. This is the first time this has happened and he has been racing professionally for over ten years. Jonathon works full-time running his own coaching business.
Jonathan weighs 82 kg and is 186 cm tall. He previously had low iron levels but this was resolved with iron supplements. His training program is as follows:
• Monday—Swim session (1–2 km)—recovery session
• Tuesday—Bike (2–3 hours)—a.m., Run (60–90 minutes)—p.m.
• Wednesday—Long bike session (approximately 5 hours)
• Thursday—Swim (2–3 km)—a.m., Run (30–60 minutes)—p.m.
• Friday—Bike (1–2 hours), Run (off the bike)—30 minutes
• Saturday—Swim (open water) (3–4 km), Bike (3 hrs)
• Sunday—Run (3–4 hours)
Given his high energy expenditure and multiple days with two training sessions, energy intake and energy availability will be important considerations for Jonathan. He likes chocolate and prefers sweet foods over savoury. His usual diet is as follows.
Coffee (latte, full-cream milk, no sugar), 2 slices of toast with honey
After activity (9–10 a.m.)
Muesli with dried fruit, 3 tbsp of natural Greek yoghurt and a handful of frozen berries
Lunch (12.30–1 p.m.)
Meat and salad roll with additional side salad with a light olive oil dressing OR
Leftovers from the previous dinner OR
Chicken burger (homemade with grilled chicken breast, lettuce, tomato, cheese, beetroot)
Afternoon snack (3 p.m.)/prep for afternoon session
2 pieces of fruit (prep for afternoon session) OR
1–2 x handfuls of mixed nuts (nil afternoon sessions)
Dinner (7–7.30 p.m.)
Pasta (spaghetti bolognese) OR
200–250 g meat (mainly chicken, fish and beef) with broccoli, cauliflower, carrot, potato OR
Beef stir-fry with rice noodles OR
Homemade pizzas (meat, tomato paste, cheese, olives)
Supper (8.30–9 p.m.)
Small piece of chocolate (dark)
Fluids
2–2.5 L water throughout the day
2.4–3.0 L during long ride sessions
2–3 x lattes/day
Consider the following points when working with Jonathan.
• Is he consuming enough energy, protein and carbohydrate to meet his needs?
• Is the timing and distribution of his meals appropriate to suit his training?
• Is he consuming enough iron to avoid another instance of iron deficiency?
• What are some strategies that could support Jonathan to consume more protein and carbohydrate without increasing the volume of food he is eating?
• How can Jonathan reduce the risk of cramping in the future?
• Is there any other information that you need to collect to help advise Jonathan?
CASE 2: JEREMY
Jeremy is a 23-year-old Australian football (AFL) player. He has recently commenced pre-season training and has been assigned a goal of increasing his muscle mass by 3–5 kg in the next three months. He currently weighs 83 kg and is 187 cm tall.
Jeremy tells you that he has been feeling sluggish and lacking energy. He is experiencing a low mood, is having difficulty making good food choices, and has had cold symptoms for the past three weeks. His training program is as follows.
• Monday—Running/skills session—a.m. (2–3 hours, likely to cover between 11 and 15 km), weight session (30–40 minutes, circuit-based session with individual programs)
• Tuesday—Weights (40 minutes, strength-based)—a.m., skills work (1 hour)
• Wednesday—Recovery day
• Thursday—Running/skills session—a.m. (2–3 hours, likely to cover between 11 and 15 km), weight session (30–40 minutes, circuit-based session with individual programs)
• Friday—Skills session (1–2 hours)
• Saturday—Weights (strength-based, 40 minutes)
• Sunday—Recovery day
Jeremy has modified his diet in an attempt to stay healthy and meet the goals set for him, and has attempted to reduce his carbohydrate intake to stay lean. Jeremy has limited cooking skills and does not enjoy cooking. His current diet is as follows.
Breakfast
2 poached eggs with ½ avocado and ½ slice of toast OR
½ cup muesli with 1 cup of natural Greek yoghurt
Morning snack
Handful nuts OR
Muesli bar OR
1–2 pieces of fruit (apple/banana/stone fruit/mango)
Lunch
Salad with grains (mainly quinoa or brown rice), tuna and vegetables including lettuce, tomato and carrot OR Leftovers from dinner
Protein shake (post-weights), protein bar OR
Nil (on days off)
Dinner
Spaghetti bolognese OR
Beef stir-fry with black bean sauce (jar of sauce) OR
400 g steak/200 g salmon and vegetables (mainly ½ sweet potato, handful of beans, ½ carrot, ¼ cauliflower)
Supper/Dessert
Nil
Fluids
2–3 lattes with full-cream milk
Approximately 0.5–1 L during training sessions (mix of water and sports drink)
2–3 L water
Consider the following points when working with Jeremy.
• Is he consuming enough energy, protein, carbohydrate and fluids to meet his needs?
• Is the timing and distribution of his meals appropriate to suit his training?
• Are you concerned about Jeremy’s energy levels? What nutrition-related strategies could you recommend to improve Jeremy’s energy levels?
• What are some strategies that could support Jeremy to increase his muscle mass?
• Do you have any meal or snack suggestions for Jeremy that will require little or no cooking?
• Is there any other information that you need to collect to help advise Jeremy?
SUMMARY AND KEY MESSAGES
The development of a nutrition plan is a complex activity that requires consideration of a number of factors related to the athlete and the requirements of the sport. Adopting a client-centred approach can help to engage athletes and involve them to develop an individually tailored nutrition plan. Team nutrition plans can be developed based on the requirements of the sport, and athletes should be provided with advice on how to tailor the team plan to suit their individual requirements.
• Nutrition plans for athletes should be individually tailored and take into consideration a number of factors related to the sport and the athlete’s personal circumstances.
• Nutrition plans for teams can be sport-specific, and should provide options for individuals to be able to develop their own personalised nutrition plans.
• A client-centred approach will help nutrition professionals to effectively collaborate with athletes to develop realistic and successful nutrition plans.
REFERENCES
Ainsworth, B.A., Haskell, W.L., Whitt, M.C., et al., 2000, ‘Compendium of physical activities: An update of activity codes and MET intensities’, Medicine & Science in Sports and Exercise, vol. 32, no. 9, pp. S498–516.
DiClemente, C.C. & Velasquez, M.M., 2002, ‘Motivational interviewing and the stages of change’, in Miller, W.R. & Rollnick, S. (eds), Motivational Interviewing: Preparing People for Change, 2nd edn, New York, NY: The Guilford Press.
Miller, W.R. & Rollnick, S. (eds), 2002, Motivational Interviewing: Preparing People for Change, 2nd edn, New York, NY: The Guilford Press.
Prochaska, J.O. & DiClemente, C.C., 1982, ‘Transtheoretical therapy: Toward a more integrative model of change’, Psychotherapy: Theory, Research and Practice, vol. 9. no. 3, pp. 276–87.
Rollnick, S. & Miller, W.R., 1995, ‘What is motivational interviewing?’, Behavioural and Cognitive Psychotherapy, vol. 23, no. 4, pp. 325–34.