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Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study
Open accessAbstract
Retraining and resuming competition following surgery is challenging for athletes due to the prolonged period of reduced physical activity and subsequent alteration in body composition and physical performance. This is even more challenging for master athletes who endure the additional effect of aging. Within this context, the purpose of this study was to evaluate the feasibility and benefits that evidence-based nutritional and training recommendations could have on the time course of reconditioning and retraining following hip arthroplasty in an endurance master triathlete. During 38 weeks (from 6 weeks prior to surgery through to the return to competition in week 32), the athlete was provided with detailed training and nutritional recommendations. Dietary intake (via the remote food photographic method), body composition (via DXA), peak oxygen uptake (VO2peak), peak power output (PPO), cycling efficiency (GE) and energy availability (EA) were assessed 6 weeks pre- and 8, 12, 18, 21 and 25-weeks post-surgery. Training load was quantified (via TRIMP score and energy expenditure) daily during the retraining. Total body mass increased by 8.2 kg (attributable to a 3.5 and 4.6 kg increase in fat mass and lean mass, respectively) between week -6 and week 8 despite a reduction in carbohydrate (CHO) intake post-surgery (<3.0g/kg body mass/day). This was accompanied with a decrease in VO2peak, PPO, and GE due to a drop in training load. From week 7, the athlete resumed training and was advised to increase gradually CHO intake according to the demands of training. Eventually the athlete was able to return to competition in week 32 with a higher PPO, improved VO2peak and GE. Throughout retraining, EA was maintained around 30 kcal/kg Lean Body Mass/day, protein intake was high (~2g/kg/day) while CHO intake was periodized. Such dietary conditions allowed the athlete to maintain and even increase lean mass, which represents a major challenge with aging. Data reported in this study show, for the first time, the conditions required to recover and return to endurance competition following hip surgery.
Overview
CoChat Summary
TL;DR
This case study describes a 52-year-old male master triathlete who underwent hip resurfacing arthroplasty and followed individualized training and nutritional recommendations from 6 weeks pre-surgery through return to competition at week 32. The intervention was associated with maintained/increased lean mass and bone mineral content, improved cycling peak power output, and eventual return to Ironman 70.3 competition, though VO2peak remained below pre-surgery.
Key findings
- The athlete returned to competition 32 weeks after surgery; in a week-32 Ironman 70.3 he placed 1st in his age group in swimming and 3rd in cycling, but 123rd in running (82nd/155 overall, +25% of race winner time), and by week 45 another 70.3 he placed 9th/155 overall (+4% of winner time).
- Between week −6 and week 8, total body mass increased by 8.2 kg, attributable to a 3.5 kg increase in fat mass and a 4.6 kg increase in lean mass, despite carbohydrate intake <3.0 g/kg body mass/day post-surgery; total bone mineral content increased +3.4% from week −6 to 25.
- Energy availability was maintained around 30 kcal/kg lean body mass/day, protein intake was ~2 g/kg/day, and carbohydrate was periodized; the authors report this allowed maintenance and even increase in lean mass.
- VO2peak (ml/min/kg) was reduced by 31.4%, 14.3%, 9.5%, 7.7%, and 13.5% at weeks 8, 12, 18, 21, and 25, respectively; absolute VO2 (L/min) showed smaller reductions. PPO recovered by week 18 (405 W) and improved by 8.6% (440 W) at week 21 and 17.3% (475 W) at week 25.
Methods
- Single-case study of a 52-year-old male master triathlete (age 51 at surgery, body mass 83.4 kg, height 195 cm) who underwent hip resurfacing arthroplasty; the intervention ran 38 weeks, from 6 weeks pre-surgery through return to competition in week 32.
- Assessments occurred at week −6 and 8, 12, 18, 21, and 25 weeks post-surgery and included DXA for body composition and bone mineral content, submaximal and step cycling tests for VO2peak, peak power output, gross efficiency, substrate oxidation, heart rate, and blood lactate; dietary intake was recorded via the remote food photographic method for 7 consecutive days at weeks −6, 1, 4, 8, 12, 18, 21, and 25; training was recorded daily with TRIMP, energy expenditure, and energy availability estimated.
- The main analysis appears descriptive, tracking time-course changes; no formal statistical testing is stated.
Limitations
- Stated by the authors: only one master athlete was studied, so additional studies are necessary to verify whether the retraining pattern is consistent in other master athletes.
- Stated by the authors: due to logistical constraints, no body composition or physiological measurements were possible closer to training cessation, surgery time, and return to competition.
- Evident from the text: this is a single case with no control or comparison group and no formal inferential statistics; dietary and training data depend on self-report and compliance monitoring, and findings may not generalize to other athletes, surgeries, or rehabilitation contexts.
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0 Valid · 0 Not valid · 22 Not checked · 59 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our study, as expected, fat mass increased between week −6 and 8 due to high EI compared to ExEE (EA = 46.5 ± 17.8 kcal/kg LBM/day in week −6) pre surgery.”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
plainstates a causeSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The athlete recovered and even improved his cycling PPO, though VO2peak was still lower than pre-surgery.”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“He placed 1st in his age group in swimming and 3rd in cycling, but could not maintain the pace in the running part of the triathlon (123th in running and 82th/155 overall, +25% of race winner time).”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly no decrease in lean mass was recorded in week 8 despite low EA (close to 30 kcal/kg LBM/day) post operation (Table 2).”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Results
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“However, lean mass concomitantly increased thanks to the combination of increased daily PRO intake and regular S&C training as soon as in week 2 (Mettler et al., 2010).”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
plainstates a causeSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| VO2 (% VO2peak) | 37 | 66 | 100 | 58 | 93 | 100 | 48 | 76 | 100 | 41 | 65 | 100 | 41 | 57 | 100 | 43 | 71 | 100 |”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Results
Reported 57 · recomputed 63.513514
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| VO2 (% VO2peak) | 37 | 66 | 100 | 58 | 93 | 100 | 48 | 76 | 100 | 41 | 65 | 100 | 41 | 57 | 100 | 43 | 71 | 100 |”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Results
Reported 93 · recomputed 97.142857
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| VO2 (% VO2peak) | 37 | 66 | 100 | 58 | 93 | 100 | 48 | 76 | 100 | 41 | 65 | 100 | 41 | 57 | 100 | 43 | 71 | 100 |”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Results
Reported 58 · recomputed 60.779221
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
“despite the comparatively low EA (25–27 kcal/kg LBM/day) between weeks 1 and 25”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Materials and Methods > Procedures
“| EA (kcal/kg LBM) | 46.5 ± 17.8 | 36.6 ± 4.9 | 32.1 ± 9.1 | 32.1 ± 8.2 | 24.9 ± 21.6 | 26.6 ± 10.7 | 26.6 ± 12.6 | 29.9 ± 21.3 |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Discussion
“The overall pattern of retraining from week 8 to 25 showed a steady improvement in VO2peak and PPO concomitant with an improvement in GE.”
§ Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study > Results
“Compared to week −6, VO2peak (in ml/min/kg) was reduced by 31.4, 14.3, 9.5, 7.7, and 13.5% in week 8, 12, 18, 21, and 25, respectively.”
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Self-citation
Metadata
- Authors
- Louis, J., Tiollier, E., Lamb, A., Bontemps, B., Areta, J., & Bernard, T.
- Affiliations
- Liverpool John Moores University (GB)
- Institut National du Sport, de l'Expertise et de la Performance (FR)
- Université de Toulon (FR)
- Université Côte d'Azur (FR)
- Corresponding author
- Louis, Julien
- Venue
- Frontiers in Sports and Active Living
- Publisher
- Frontiers Media SA
- Published
- 2020-02-13
- Volume
- 2
- Pages
- 9-9
- ISSN
- 2624-9367 (ISSN-L)
- PMC
- PMC7739816
- OpenAlex
- W2992255322
- Cited by
- 4
- References
- 49
- Citations by year
- 2023: 2 · 2022: 1 · 2020: 1
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Sports and Active Living (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Liverpool John Moores University (acceptedVersion)
- HAL (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Keywords
- total hip arthroplasty, master athletes, return to competition, postoperative rehabilitation, nutritional strategies, carbohydrate intake, energy availability, protein intake, body composition, lean body mass, peak oxygen uptake, peak power, cycling efficiency, aging, training load
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